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Sample records for daily patient setup

  1. Interfractional Variations in Patient Setup and Anatomic Change Assessed by Daily Computed Tomography

    International Nuclear Information System (INIS)

    Li, X. Allen; Qi, X. Sharon; Pitterle, Marissa; Kalakota, Kapila; Mueller, Kevin; Erickson, Beth A.; Wang Dian; Schultz, Christopher J.; Firat, Selim Y.; Wilson, J. Frank

    2007-01-01

    Purpose: To analyze the interfractional variations in patient setup and anatomic changes at seven anatomic sites observed in image-guided radiotherapy. Methods and Materials: A total of 152 patients treated at seven anatomic sites using a Hi-Art helical tomotherapy system were analyzed. Daily tomotherapy megavoltage computed tomography images acquired before each treatment were fused to the planning kilovoltage computed tomography images to determine the daily setup errors and organ motions and deformations. The setup errors were corrected before treatment and were used, along with the organ motions, to determine the clinical target volume/planning target volume margins. The organ motions and deformations for 3 representative patient cases (pancreas, uterus, and soft-tissue sarcoma) and for 14 kidneys of 7 patients are presented. Results: Interfractional setup errors in the skull, brain, and head and neck are significantly smaller than those in the chest, abdomen, pelvis, and extremities. These site-specific relationships are statistically significant. The margins required to account for these setup errors range from 3 to 8 mm for the seven sites. The margin to account for both setup errors and organ motions for kidney is 16 mm. Substantial interfractional anatomic changes were observed. For example, the pancreas moved up to ±20 mm and volumes of the uterus and sarcoma varied ≤30% and 100%, respectively. Conclusion: The interfractional variations in patient setup and in shapes, sizes, and positions of both targets and normal structures are site specific and may be used to determine the site-specific margins. The data presented in this work dealing with seven anatomic sites may be useful in developing adaptive radiotherapy

  2. Influence of Daily Set-Up Errors on Dose Distribution During Pelvis Radiotherapy

    International Nuclear Information System (INIS)

    Kasabasic, M.; Ivkovic, A.; Faj, D.; Rajevac, V.; Sobat, H.; Jurkovic, S.

    2011-01-01

    An external beam radiotherapy (EBRT) using megavoltage beam of linear accelerator is usually the treatment of choice for the cancer patients. The goal of EBRT is to deliver the prescribed dose to the target volume, with as low as possible dose to the surrounding healthy tissue. A large number of procedures and different professions involved in radiotherapy process, uncertainty of equipment and daily patient set-up errors can cause a difference between the planned and delivered dose. We investigated a part of this difference caused by daily patient set-up errors. Daily set-up errors for 35 patients were measured. These set-up errors were simulated on 5 patients, using 3D treatment planning software XiO (CMS Inc., St. Louis, MO). The differences in dose distributions between the planned and shifted ''geometry'' were investigated. Additionally, an influence of the error on treatment plan selection was checked by analyzing the change in dose volume histograms, planning target volume conformity index (CI P TV) and homogeneity index (HI). Simulations showed that patient daily set-up errors can cause significant differences between the planned and actual dose distributions. Moreover, for some patients those errors could influence the choice of treatment plan since CI P TV fell under 97 %. Surprisingly, HI was not as sensitive as CI P TV on set-up errors. The results showed the need for minimizing daily set-up errors by quality assurance programme. (author)

  3. Influence of daily setup measurements and corrections on the estimated delivered dose during IMRT treatment of prostate cancer patients

    International Nuclear Information System (INIS)

    Haaren, Paul M.A. van; Bel, Arjan; Hofman, Pieter; Vulpen, Marco van; Kotte, Alexis N.T.J.; Heide, Uulke A. van der

    2009-01-01

    Purpose: To evaluate the impact of marker-based position verification, using daily imaging and an off-line correction protocol, by calculating the delivered dose to prostate, rectum and bladder. Methods: Prostate cancer patients (n = 217) were treated with IMRT, receiving 35 daily fractions. Plans with five beams were optimized taking target coverage (CTV, boost) and organs-at-risk (rectum and bladder) into account. PTV margins were 8 mm. Prostate position was verified daily using implanted fiducial gold markers by imaging the first segment of all the five beams on an EPID. Setup deviations were corrected off-line using an adapted shrinking-action-level protocol. The estimated delivered dose, including daily organ movements, was calculated using a version of PLATO's dose engine, enabling batch processing of large numbers of patients. The dose was calculated ± inclusion of setup corrections, and was evaluated relative to the original static plan. The marker-based measurements were considered representative for all organs. Results: Daily organ movements would result in an underdosage of 2-3 Gy to CTV and boost volume relative to the original plan, which was prevented by daily setup corrections. The dose to rectum and bladder was on average unchanged, but a large spread was introduced by organ movements, which was reduced by including setup corrections. Conclusions: Without position verification and setup corrections, margins of 8mm would be insufficient to account for position uncertainties during IMRT of prostate cancer. With the daily off-line correction protocol, the remaining variations are accommodated adequately

  4. Infrared-Guided Patient Setup for Lung Cancer Patients

    International Nuclear Information System (INIS)

    Lyatskaya, Yulia; James, Steven; Killoran, Joseph H.; Soto, Ricardo; Mamon, Harvey J.; Chin, Lee; Allen, Aaron M.

    2008-01-01

    Purpose: To evaluate the utility of an infrared-guided patient setup (iGPS) system to reduce the uncertainties in the setup of lung cancer patients. Methods and Materials: A total of 15 patients were setup for lung irradiation using skin tattoos and lateral leveling marks. Daily electronic portal device images and iGPS marker locations were acquired and retrospectively reviewed. The iGPS-based shifts were compared with the daily electronic portal device image shifts using both the central axis iGPS marker and all five iGPS markers. For shift calculation using the five markers, rotational misalignment was included. The level of agreement between the iGPS and portal imaging to evaluate the setup was evaluated as the frequency of the shift difference in the range of 0-5 mm, 5-10 mm, and >10 mm. Results: Data were obtained for 450 treatment sessions for 15 patients. The difference in the isocenter shifts between the weekly vs. daily images was 0-5 mm in 42%, 5-10 mm in 30%, and >10 mm in 10% of the images. The shifts seen using the iGPS data were 0-5 mm in 81%, 5-10 mm in 14%, and >10 mm in 5%. Using only the central axis iGPS marker, the difference between the iGPS and portal images was 10 mm in 7% in the left-right direction and 73%, 18%, and 9% in the superoinferior direction, respectively. When all five iGPS markers were used, the disagreements between the iGPS and portal image shifts >10 mm were reduced from 7% to 2% in the left-right direction and 9% to 3% in the superoinferior direction. Larger reductions were also seen (e.g., a reduction from 50% to 0% in 1 patient). Conclusion: The daily iGPS-based shifts correlated well with the daily electronic portal device-based shifts. When patient movement has nonlinear rotational components, a combination of surface markers and portal images might be particularly beneficial to improve the setup for lung cancer patients

  5. Effect of Body Mass Index on Magnitude of Setup Errors in Patients Treated With Adjuvant Radiotherapy for Endometrial Cancer With Daily Image Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Lilie L., E-mail: lin@uphs.upenn.edu [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States); Hertan, Lauren; Rengan, Ramesh; Teo, Boon-Keng Kevin [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States)

    2012-06-01

    Purpose: To determine the impact of body mass index (BMI) on daily setup variations and frequency of imaging necessary for patients with endometrial cancer treated with adjuvant intensity-modulated radiotherapy (IMRT) with daily image guidance. Methods and Materials: The daily shifts from a total of 782 orthogonal kilovoltage images from 30 patients who received pelvic IMRT between July 2008 and August 2010 were analyzed. The BMI, mean daily shifts, and random and systematic errors in each translational and rotational direction were calculated for each patient. Margin recipes were generated based on BMI. Linear regression and spearman rank correlation analysis were performed. To simulate a less-than-daily IGRT protocol, the average shift of the first five fractions was applied to subsequent setups without IGRT for assessing the impact on setup error and margin requirements. Results: Median BMI was 32.9 (range, 23-62). Of the 30 patients, 16.7% (n = 5) were normal weight (BMI <25); 23.3% (n = 7) were overweight (BMI {>=}25 to <30); 26.7% (n = 8) were mildly obese (BMI {>=}30 to <35); and 33.3% (n = 10) were moderately to severely obese (BMI {>=} 35). On linear regression, mean absolute vertical, longitudinal, and lateral shifts positively correlated with BMI (p = 0.0127, p = 0.0037, and p < 0.0001, respectively). Systematic errors in the longitudinal and vertical direction were found to be positively correlated with BMI category (p < 0.0001 for both). IGRT for the first five fractions, followed by correction of the mean error for all subsequent fractions, led to a substantial reduction in setup error and resultant margin requirement overall compared with no IGRT. Conclusions: Daily shifts, systematic errors, and margin requirements were greatest in obese patients. For women who are normal or overweight, a planning target margin margin of 7 to 10 mm may be sufficient without IGRT, but for patients who are moderately or severely obese, this is insufficient.

  6. Effect of Body Mass Index on Magnitude of Setup Errors in Patients Treated With Adjuvant Radiotherapy for Endometrial Cancer With Daily Image Guidance

    International Nuclear Information System (INIS)

    Lin, Lilie L.; Hertan, Lauren; Rengan, Ramesh; Teo, Boon-Keng Kevin

    2012-01-01

    Purpose: To determine the impact of body mass index (BMI) on daily setup variations and frequency of imaging necessary for patients with endometrial cancer treated with adjuvant intensity-modulated radiotherapy (IMRT) with daily image guidance. Methods and Materials: The daily shifts from a total of 782 orthogonal kilovoltage images from 30 patients who received pelvic IMRT between July 2008 and August 2010 were analyzed. The BMI, mean daily shifts, and random and systematic errors in each translational and rotational direction were calculated for each patient. Margin recipes were generated based on BMI. Linear regression and spearman rank correlation analysis were performed. To simulate a less-than-daily IGRT protocol, the average shift of the first five fractions was applied to subsequent setups without IGRT for assessing the impact on setup error and margin requirements. Results: Median BMI was 32.9 (range, 23–62). Of the 30 patients, 16.7% (n = 5) were normal weight (BMI <25); 23.3% (n = 7) were overweight (BMI ≥25 to <30); 26.7% (n = 8) were mildly obese (BMI ≥30 to <35); and 33.3% (n = 10) were moderately to severely obese (BMI ≥ 35). On linear regression, mean absolute vertical, longitudinal, and lateral shifts positively correlated with BMI (p = 0.0127, p = 0.0037, and p < 0.0001, respectively). Systematic errors in the longitudinal and vertical direction were found to be positively correlated with BMI category (p < 0.0001 for both). IGRT for the first five fractions, followed by correction of the mean error for all subsequent fractions, led to a substantial reduction in setup error and resultant margin requirement overall compared with no IGRT. Conclusions: Daily shifts, systematic errors, and margin requirements were greatest in obese patients. For women who are normal or overweight, a planning target margin margin of 7 to 10 mm may be sufficient without IGRT, but for patients who are moderately or severely obese, this is insufficient.

  7. The effectiveness of an immobilization device in conformal radiotherapy for lung tumor: reduction of respiratory tumor movement and evaluation of the daily setup accuracy

    International Nuclear Information System (INIS)

    Negoro, Yoshiharu; Nagata, Yasushi; Aoki, Tetsuya; Mizowaki, Takashi; Araki, Norio; Takayama, Kenji; Kokubo, Masaki; Yano, Shinsuke; Koga, Sachiko; Sasai, Keisuke; Shibamoto, Yuta; Hiraoka, Masahiro

    2001-01-01

    Purpose: To evaluate the daily setup accuracy and the reduction of respiratory tumor movement using a body frame in conformal therapy for solitary lung tumor. Methods and Materials: Eighteen patients with a solitary lung tumor underwent conformal therapy using a body frame. The body shell of the frame was shaped to the patient's body contour. The respiratory tumor movement was estimated using fluoroscopy, and if it was greater than 5 mm, pressure was applied to the patient's abdomen with the goal of minimizing tumor movement. CT images were then obtained, and a treatment planning was made. A total dose of 40 or 48 Gy was delivered in 4 fractions. Portal films were obtained at each treatment, and the field displacements between them and the simulation films were measured for daily setup errors. The patients were repositioned if the setup error was greater than 3 mm. Correlations were analyzed between patient characteristics and the tumor movement, or the tumor movement reduction and the daily setup errors. Results: Respiratory tumor movement ranged from 0 to 20 mm (mean 7.7 mm). The abdominal press reduced the tumor movement significantly from a range of 8 to 20 mm to a range of 2 to 11 mm (p=0.0002). Daily setup errors were within 5 mm in 90%, 100%, and 93% of all verifications in left-right, anterior-posterior, and cranio-caudal directions, respectively. Patient repositioning was performed in 25% of all treatments. No significant correlation was detected between patient characteristics and tumor movement, tumor movement reduction, and the daily setup errors. Conclusions: The abdominal press was successful in reducing the respiratory tumor movement. Daily setup accuracy using the body frame was acceptable. Verification should be performed at each treatment in hypofractionated conformal therapy

  8. Impact of the frequency of online verifications on the patient set-up accuracy and set-up margins

    International Nuclear Information System (INIS)

    Rudat, Volker; Hammoud, Mohamed; Pillay, Yogin; Alaradi, Abdul Aziz; Mohamed, Adel; Altuwaijri, Saleh

    2011-01-01

    The purpose of the study was to evaluate the patient set-up error of different anatomical sites, to estimate the effect of different frequencies of online verifications on the patient set-up accuracy, and to calculate margins to accommodate for the patient set-up error (ICRU set-up margin, SM). Alignment data of 148 patients treated with inversed planned intensity modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT) of the head and neck (n = 31), chest (n = 72), abdomen (n = 15), and pelvis (n = 30) were evaluated. The patient set-up accuracy was assessed using orthogonal megavoltage electronic portal images of 2328 fractions of 173 planning target volumes (PTV). In 25 patients, two PTVs were analyzed where the PTVs were located in different anatomical sites and treated in two different radiotherapy courses. The patient set-up error and the corresponding SM were retrospectively determined assuming no online verification, online verification once a week and online verification every other day. The SM could be effectively reduced with increasing frequency of online verifications. However, a significant frequency of relevant set-up errors remained even after online verification every other day. For example, residual set-up errors larger than 5 mm were observed on average in 18% to 27% of all fractions of patients treated in the chest, abdomen and pelvis, and in 10% of fractions of patients treated in the head and neck after online verification every other day. In patients where high set-up accuracy is desired, daily online verification is highly recommended

  9. Setup Variations in Radiotherapy of Esophageal Cancer: Evaluation by Daily Megavoltage Computed Tomographic Localization

    International Nuclear Information System (INIS)

    Chen, Y.-J.; Han Chunhui; Liu An; Schultheiss, Timothy E.; Kernstine, Kemp H.; Shibata, Stephen; Vora, Nayana L.; Pezner, Richard D.; Wong, Jeffrey Y.C.

    2007-01-01

    Purpose: To use pretreatment megavoltage computed tomography (MVCT) scans to evaluate setup variations in anterior-posterior (AP), lateral, and superior-inferior (SI) directions and rotational variations, including pitch, roll, and yaw, for esophageal cancer patients treated with helical tomotherapy. Methods and Materials: Ten patients with locally advanced esophageal cancer treated by combined chemoradiation using helical tomotherapy were selected. After patients were positioned using their skin tattoos/marks, MVCT scans were performed before every treatment and automatically registered to planning kilovoltage CT scans according to bony landmarks. Image registration data were used to adjust patient setups before treatment. A total of 250 MVCT scans were analyzed. Correlations between setup variations and body habitus, including height, weight, relative weight change, body surface area, and patient age, were evaluated. Results: The standard deviations for systematic setup corrections in AP, lateral, and SI directions and pitch, roll, and yaw rotations were 1.5, 3.7, and 4.8 mm and 0.5 deg., 1.2 deg., and 0.8 deg., respectively. The appropriate averages of random setup variations in AP, lateral, and SI directions and pitch, roll, and yaw rotations were 2.9, 5.2, and 4.4 mm, and 1.0 deg., 1.2 deg., and 1.1 deg., respectively. Setup variations were stable throughout the entire course of radiotherapy in all three translational and three rotational displacements, with little change in magnitude. No significant correlations were found between setup variations and body habitus variables. Conclusions: Daily MVCT scans before each treatment can effectively detect setup errors and thereby reduce planning target volume (PTV) margins. This will reduce radiation dose to critical organs and may translate into lower treatment-related toxicities

  10. Impact of the frequency of online verifications on the patient set-up accuracy and set-up margins

    Directory of Open Access Journals (Sweden)

    Mohamed Adel

    2011-08-01

    Full Text Available Abstract Purpose The purpose of the study was to evaluate the patient set-up error of different anatomical sites, to estimate the effect of different frequencies of online verifications on the patient set-up accuracy, and to calculate margins to accommodate for the patient set-up error (ICRU set-up margin, SM. Methods and materials Alignment data of 148 patients treated with inversed planned intensity modulated radiotherapy (IMRT or three-dimensional conformal radiotherapy (3D-CRT of the head and neck (n = 31, chest (n = 72, abdomen (n = 15, and pelvis (n = 30 were evaluated. The patient set-up accuracy was assessed using orthogonal megavoltage electronic portal images of 2328 fractions of 173 planning target volumes (PTV. In 25 patients, two PTVs were analyzed where the PTVs were located in different anatomical sites and treated in two different radiotherapy courses. The patient set-up error and the corresponding SM were retrospectively determined assuming no online verification, online verification once a week and online verification every other day. Results The SM could be effectively reduced with increasing frequency of online verifications. However, a significant frequency of relevant set-up errors remained even after online verification every other day. For example, residual set-up errors larger than 5 mm were observed on average in 18% to 27% of all fractions of patients treated in the chest, abdomen and pelvis, and in 10% of fractions of patients treated in the head and neck after online verification every other day. Conclusion In patients where high set-up accuracy is desired, daily online verification is highly recommended.

  11. Residual rotational set-up errors after daily cone-beam CT image guided radiotherapy of locally advanced cervical cancer

    International Nuclear Information System (INIS)

    Laursen, Louise Vagner; Elstrøm, Ulrik Vindelev; Vestergaard, Anne; Muren, Ludvig P.; Petersen, Jørgen Baltzer; Lindegaard, Jacob Christian; Grau, Cai; Tanderup, Kari

    2012-01-01

    Purpose: Due to the often quite extended treatment fields in cervical cancer radiotherapy, uncorrected rotational set-up errors result in a potential risk of target miss. This study reports on the residual rotational set-up error after using daily cone beam computed tomography (CBCT) to position cervical cancer patients for radiotherapy treatment. Methods and materials: Twenty-five patients with locally advanced cervical cancer had daily CBCT scans (650 CBCTs in total) prior to treatment delivery. We retrospectively analyzed the translational shifts made in the clinic prior to each treatment fraction as well as the residual rotational errors remaining after translational correction. Results: The CBCT-guided couch movement resulted in a mean translational 3D vector correction of 7.4 mm. Residual rotational error resulted in a target shift exceeding 5 mm in 57 of the 650 treatment fractions. Three patients alone accounted for 30 of these fractions. Nine patients had no shifts exceeding 5 mm and 13 patients had 5 or less treatment fractions with such shifts. Conclusion: Twenty-two of the 25 patients have none or few treatment fractions with target shifts larger than 5 mm due to residual rotational error. However, three patients display a significant number of shifts suggesting a more systematic set-up error.

  12. Poster - 33: Dosimetry Comparison of Prone Breast Forward and Inverse Treatment planning considering daily setup variations

    Energy Technology Data Exchange (ETDEWEB)

    Jiang, Runqing; Zhan, Lixin; Osei, Ernest [Grand River Regional Cancer Centre (Canada)

    2016-08-15

    Introduction: The purpose of this study is to investigate the effects of daily setup variations on prone breast forward field-in-field (FinF) and inverse IMRT treatment planning. Methods: Rando Phantom (Left breast) and Pixy phantom (Right breast) were built and CT scanned in prone position. The treatment planning (TP) is performed in Eclipse TP system. Forward FinF plan and inverse IMRT plan were created to satisfy the CTV coverage and OARs criteria. The daily setup variations were assumed to be 5 mm at left-right, superior-inferior, and anterior-posterior directions. The DVHs of CTV coverage and OARs were compared for both forward FinF plan and inverse IMRT plans due to 5mm setup variation. Results and Discussions: DVHs of CTV coverage had fewer variations for 5m setup variation for forward FinF and inverse IMRT plan for both phantoms. However, for the setup variations in the left-right direction, the DVH of CTV coverage of IMRT plan showed the worst variation due to lateral setup variation for both phantoms. For anterior-posterior variation, the CTV could not get full coverage when the breast chest wall is shallow; however, with the guidance of MV imaging, breast chest wall will be checked during the MV imaging setup. So the setup variations have more effects on inverse IMRT plan, compared to forward FinF plan, especially in the left-right direction. Conclusions: The Forward FinF plan was recommended clinically considering daily setup variation.

  13. Evaluation of overall setup accuracy and adequate setup margins in pelvic image-guided radiotherapy: Comparison of the male and female patients

    International Nuclear Information System (INIS)

    Laaksomaa, Marko; Kapanen, Mika; Tulijoki, Tapio; Peltola, Seppo; Hyödynmaa, Simo; Kellokumpu-Lehtinen, Pirkko-Liisa

    2014-01-01

    We evaluated adequate setup margins for the radiotherapy (RT) of pelvic tumors based on overall position errors of bony landmarks. We also estimated the difference in setup accuracy between the male and female patients. Finally, we compared the patient rotation for 2 immobilization devices. The study cohort included consecutive 64 male and 64 female patients. Altogether, 1794 orthogonal setup images were analyzed. Observer-related deviation in image matching and the effect of patient rotation were explicitly determined. Overall systematic and random errors were calculated in 3 orthogonal directions. Anisotropic setup margins were evaluated based on residual errors after weekly image guidance. The van Herk formula was used to calculate the margins. Overall, 100 patients were immobilized with a house-made device. The patient rotation was compared against 28 patients immobilized with CIVCO's Kneefix and Feetfix. We found that the usually applied isotropic setup margin of 8 mm covered all the uncertainties related to patient setup for most RT treatments of the pelvis. However, margins of even 10.3 mm were needed for the female patients with very large pelvic target volumes centered either in the symphysis or in the sacrum containing both of these structures. This was because the effect of rotation (p ≤ 0.02) and the observer variation in image matching (p ≤ 0.04) were significantly larger for the female patients than for the male patients. Even with daily image guidance, the required margins remained larger for the women. Patient rotations were largest about the lateral axes. The difference between the required margins was only 1 mm for the 2 immobilization devices. The largest component of overall systematic position error came from patient rotation. This emphasizes the need for rotation correction. Overall, larger position errors and setup margins were observed for the female patients with pelvic cancer than for the male patients

  14. Patient setup aid with wireless CCTV system in radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Park, Yang Kyun; Cho, Woong; Park, Jong Min [Seoul National University Graduate School, Seoul (Korea, Republic of); Ha, Sung Whan; Ye, Sung Joon [Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Suk Won [Chung-Ang University Cellege of Medicine, Seoul (Korea, Republic of); Huh, Soon Nyung [Seoul National University Hospital, Seoul (Korea, Republic of)

    2006-12-15

    To develop a wireless CCTV system in semi-beam's eye view (BEV) to monitor daily patient setup in radiation therapy. In order to get patient images in semi-BEV, CCTV cameras are installed in a custom-made acrylic applicator below the treatment head of a linear accelerator. The images from the cameras are transmitted via radio frequency signal ( {approx} 2.4 GHz and 10 mW RF output). An expected problem with this system is radio frequency interference, which is solved utilizing RF shielding with Cu foils and median filtering software. The images are analyzed by our custom-made software. In the software, three anatomical landmarks in the patient surface are indicated by a user, then automatically the 3 dimensional structures are obtained and registered by utilizing a localization procedure consisting mainly of stereo matching algorithm and Gauss-Newton optimization. This algorithm is applied to phantom images in investigate the setup accuracy. Respiratory gating system is also researched with real-time image processing. A line-laser marker projected on a patient's surface is extracted by binary image processing and the breath pattern is calculated and displayed in real-time. More than 80% of the camera noises from the linear accelerator are eliminated by wrapping the camera with copper foils. The accuracy of the localization procedure is found to be on the order of 1.5 {+-} 0.7 mm with a point phantom and sub-millimeters and degrees with a custom-made head/neck phantom. With line-laser marker, real-time respiratory monitoring is possible in the delay time of {approx} 0.7 sec. The wireless CCTV camera system is the novel tool which can monitor daily patient setups. The feasibility of respiratory gating system with the wireless CCTV is hopeful.

  15. Patient setup aid with wireless CCTV system in radiation therapy

    International Nuclear Information System (INIS)

    Park, Yang Kyun; Cho, Woong; Park, Jong Min; Ha, Sung Whan; Ye, Sung Joon; Park, Suk Won; Huh, Soon Nyung

    2006-01-01

    To develop a wireless CCTV system in semi-beam's eye view (BEV) to monitor daily patient setup in radiation therapy. In order to get patient images in semi-BEV, CCTV cameras are installed in a custom-made acrylic applicator below the treatment head of a linear accelerator. The images from the cameras are transmitted via radio frequency signal ( ∼ 2.4 GHz and 10 mW RF output). An expected problem with this system is radio frequency interference, which is solved utilizing RF shielding with Cu foils and median filtering software. The images are analyzed by our custom-made software. In the software, three anatomical landmarks in the patient surface are indicated by a user, then automatically the 3 dimensional structures are obtained and registered by utilizing a localization procedure consisting mainly of stereo matching algorithm and Gauss-Newton optimization. This algorithm is applied to phantom images in investigate the setup accuracy. Respiratory gating system is also researched with real-time image processing. A line-laser marker projected on a patient's surface is extracted by binary image processing and the breath pattern is calculated and displayed in real-time. More than 80% of the camera noises from the linear accelerator are eliminated by wrapping the camera with copper foils. The accuracy of the localization procedure is found to be on the order of 1.5 ± 0.7 mm with a point phantom and sub-millimeters and degrees with a custom-made head/neck phantom. With line-laser marker, real-time respiratory monitoring is possible in the delay time of ∼ 0.7 sec. The wireless CCTV camera system is the novel tool which can monitor daily patient setups. The feasibility of respiratory gating system with the wireless CCTV is hopeful

  16. Three-dimensional patient setup errors at different treatment sites measured by the Tomotherapy megavoltage CT

    Energy Technology Data Exchange (ETDEWEB)

    Hui, S.K.; Lusczek, E.; Dusenbery, K. [Univ. of Minnesota Medical School, Minneapolis, MN (United States). Dept. of Therapeutic Radiology - Radiation Oncology; DeFor, T. [Univ. of Minnesota Medical School, Minneapolis, MN (United States). Biostatistics and Informatics Core; Levitt, S. [Univ. of Minnesota Medical School, Minneapolis, MN (United States). Dept. of Therapeutic Radiology - Radiation Oncology; Karolinska Institutet, Stockholm (Sweden). Dept. of Onkol-Patol

    2012-04-15

    Reduction of interfraction setup uncertainty is vital for assuring the accuracy of conformal radiotherapy. We report a systematic study of setup error to assess patients' three-dimensional (3D) localization at various treatment sites. Tomotherapy megavoltage CT (MVCT) images were scanned daily in 259 patients from 2005-2008. We analyzed 6,465 MVCT images to measure setup error for head and neck (H and N), chest/thorax, abdomen, prostate, legs, and total marrow irradiation (TMI). Statistical comparisons of the absolute displacements across sites and time were performed in rotation (R), lateral (x), craniocaudal (y), and vertical (z) directions. The global systematic errors were measured to be less than 3 mm in each direction with increasing order of errors for different sites: H and N, prostate, chest, pelvis, spine, legs, and TMI. The differences in displacements in the x, y, and z directions, and 3D average displacement between treatment sites were significant (p < 0.01). Overall improvement in patient localization with time (after 3-4 treatment fractions) was observed. Large displacement (> 5 mm) was observed in the 75{sup th} percentile of the patient groups for chest, pelvis, legs, and spine in the x and y direction in the second week of the treatment. MVCT imaging is essential for determining 3D setup error and to reduce uncertainty in localization at all anatomical locations. Setup error evaluation should be performed daily for all treatment regions, preferably for all treatment fractions. (orig.)

  17. Preliminary Results on Setup Precision of Prone-Lateral Patient Positioning for Whole Breast Irradiation

    International Nuclear Information System (INIS)

    Veldeman, Liv; Speleers, Bruno; Bakker, Marlies; Jacobs, Filip; Coghe, Marc; De Gersem, Werner; Impens, Aline; Nechelput, Sarah; De Wagter, Carlos

    2010-01-01

    Purpose: The aim of this study was to develop a rapid and reproducible technique for prone positioning and to compare dose-volume indices in prone and supine positions. Methods and Materials: Eighteen patients underwent computed tomography imaging for radiotherapy planning in prone and supine position. Experience was gained in the first eight patients, which lead to modifications of the Horizon prone breast board (Civco Medical Solutions, Orange City, Iowa, USA) and the patient setup technique. A unilateral breast holder (U-BH) was developed (Van de Velde, Schellebelle, Belgium) to retract the contralateral breast away from the treated breast. The technique was then applied to an additional 10 patients. The setup precision was evaluated using daily cone-beam CT. Results: Modifications to the breast board were made to secure a prone-lateral rather then a pure prone position. We evolved from a classical setup using laser marks on the patients' body to a direct breast setup using marks on the breast only. The setup precision of the direct positioning procedure with the modified breast board and the U-BH is comparable to supine setup data in the literature. Dose-volume indices for heart and lung show significantly better results for prone than for supine position, and dose homogeneity within the treated breast did not differ according to the treatment position. Conclusions: The setup precision of our prone-lateral positioning technique is comparable to supine data in literature. Our data show the advantage of prone radiotherapy to spare the lung and heart. Further research is necessary to reduce the duration of prone setup.

  18. SU-F-J-191: Dosimetric Evaluation of a Left Chestwall Patient Treated with a Compact Proton Pencil Beam Gantry Utilizing Daily Setup CBCT

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    Maynard, M; Chen, K; Rosen, L; Wu, H [Willis-Knighton Medical Center, Shreveport, LA (United States)

    2016-06-15

    Purpose: To evaluate the robustness of the gradient technique for treating a multi-isocenter left chest wall patient with a compact proton pencil beam gantry. Both CBCT and stereoscopic imaging are used to facilitate daily treatment setup. Methods: To treat the elongated chest wall planning target volume (PTV) with the compact PBS system, a 28 fraction (5040 CcGE) treatment plan was created using two fields with gradient matching technique. Daily table shifts between treatment field isocenters were obtained from the record and verify system for each treatment fraction. Copies of the initial treatment plan were made for each fraction and the field isocenter coordinates for each plan copy were adjusted to reflect daily table shifts. Doses were re-calculated for each fraction, summed, and compared against the initial plan. Results: The table shifts (average and range) were 2.2 (−5.1–+3.9), 3.0 (−6.0–+4.0) and 3.0 (−10.1–+1.9) millimeters in the anterior-posterior, superior-inferior and right-left directions, respectively. Dose difference to the PTV, heart and ipsilateral lung were evaluated. The percentage of the PTV receiving the prescription dose decreased from 94.6% to 89.1%. The D95 of the PTV increased from 99.6% to 99.9%. The maximum dose in PTV increased from 106.6% to 109.2% and V105 increased from 1.0% to 16.5%. The V20 of the ipsilateral lung increased from 18.5% to 21.0%. The mean heart dose difference was negligible. Conclusion: Observed dose differences to lung and heart tissues due to daily setup variations remained acceptably low while maintaining sufficient dose coverage to the PTV. This initial case study demonstrates the robustness of the gradient technique to treat a large target, multi-isocenter plan with a compact proton pencil beam gantry equipped with CBCT and stereoscopic imaging modalities.

  19. Daily Setup Uncertainties and Organ Motion Based on the Tomoimages in Prostatic Radiotherapy

    International Nuclear Information System (INIS)

    Cho, Jeong Hee; Lee, Sang Kyu; Kim, Sei Joon; Na, Soo Kyung

    2007-01-01

    The patient's position and anatomy during the treatment course little bit varies to some extend due to setup uncertainties and organ motions. These factors could affected to not only the dose coverage of the gross tumor but over dosage of normal tissue. Setup uncertainties and organ motions can be minimized by precise patient positioning and rigid immobilization device but some anatomical site such as prostate, the internal organ motion due to physiological processes are challenge. In planning procedure, the clinical target volume is a little bit enlarged to create a planning target volume that accounts for setup uncertainties and organ motion as well. These uncertainties lead to differences between the calculated dose by treatment planning system and the actually delivered dose. The purpose of this study was to evaluate the differences of interfractional displacement of organ and GTV based on the tomoimages. Over the course of 3 months, 3 patients, those who has applied rectal balloon, treated for prostatic cancer patient's tomoimage were studied. During the treatment sessions 26 tomoimages per patient, Total 76 tomoimages were collected. Tomoimage had been taken everyday after initial setup with lead marker attached on the patient's skin center to comparing with C-T simulation images. Tomoimage was taken after rectal balloon inflated with 60 cc of air for prostate gland immobilization for daily treatment just before treatment and it was used routinely in each case. The intrarectal balloon was inserted to a depth of 6 cm from the anal verge. MVCT image was taken with 5 mm slice thickness after the intrarectal balloon in place and inflated. For this study, lead balls are used to guide the registration between the MVCT and CT simulation images. There are three image fusion methods in the tomotherapy, bone technique, bone/tissue technique, and full image technique. We used all this 3 methods to analysis the setup errors. Initially, image fusions were based on the

  20. Daily Setup Uncertainties and Organ Motion Based on the Tomoimages in Prostatic Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Jeong Hee; Lee, Sang Kyu [Dept. of Radiation Oncology, Yensei Univesity Health System, Seoul (Korea, Republic of); Kim, Sei Joon [Dept. of Radiation Oncology,Yongdong Severance Hospital , Seoul (Korea, Republic of); Na, Soo Kyung [Dept. of Radiological Science, Gimcheon College, Gimcheon (Korea, Republic of)

    2007-09-15

    The patient's position and anatomy during the treatment course little bit varies to some extend due to setup uncertainties and organ motions. These factors could affected to not only the dose coverage of the gross tumor but over dosage of normal tissue. Setup uncertainties and organ motions can be minimized by precise patient positioning and rigid immobilization device but some anatomical site such as prostate, the internal organ motion due to physiological processes are challenge. In planning procedure, the clinical target volume is a little bit enlarged to create a planning target volume that accounts for setup uncertainties and organ motion as well. These uncertainties lead to differences between the calculated dose by treatment planning system and the actually delivered dose. The purpose of this study was to evaluate the differences of interfractional displacement of organ and GTV based on the tomoimages. Over the course of 3 months, 3 patients, those who has applied rectal balloon, treated for prostatic cancer patient's tomoimage were studied. During the treatment sessions 26 tomoimages per patient, Total 76 tomoimages were collected. Tomoimage had been taken everyday after initial setup with lead marker attached on the patient's skin center to comparing with C-T simulation images. Tomoimage was taken after rectal balloon inflated with 60 cc of air for prostate gland immobilization for daily treatment just before treatment and it was used routinely in each case. The intrarectal balloon was inserted to a depth of 6 cm from the anal verge. MVCT image was taken with 5 mm slice thickness after the intrarectal balloon in place and inflated. For this study, lead balls are used to guide the registration between the MVCT and CT simulation images. There are three image fusion methods in the tomotherapy, bone technique, bone/tissue technique, and full image technique. We used all this 3 methods to analysis the setup errors. Initially, image fusions were

  1. An evaluation of setup uncertainties for patients treated to pelvic sites

    International Nuclear Information System (INIS)

    Hunt, Margie A.; Schultheiss, Timothy E.; Desobry, Gregory E.; Hakki, Morgan; Hanks, Gerald E.

    1995-01-01

    Purpose: Successful delivery of conformal fields requires stringent immobilization and treatment verification, as well as knowledge of the setup reproducibility. The purpose of this study was to compare the three-dimensional distribution of setup variations for patients treated to pelvic sites with electronic portal imaging devices (EPID) and portal film. Methods and Materials: Nine patients with genitourinary and gynecological cancers immobilized with custom casts and treated with a four-field whole-pelvis technique were imaged daily using an EPID and filmed once every five to seven treatments. The three-dimensional translational and rotational setup errors were determined using a technique that relies on anatomical landmarks identified on simulation and treatment images. The distributions of the translational and rotational variations in each dimension as well as the total displacement of the treatment isocenter from the simulation isocenter were determined. Results: Grouped analysis of all patients revealed average unidirectional translational deviations of less than 2 mm and a standard deviation of 5.3 mm. The average total undirected distance between the treatment and simulated isocenters was 8.3 mm with a standard deviation of 5 mm. Individual patient analysis revealed eight of nine patients had statistically significant nonzero mean translational variations (p < 0.05). Translational variations measured with film were an average of 1.4 mm less than those measured with EPID, but this difference was not statistically significant. Conclusion: Translational variations measured in this study are in general agreement with previous studies. The use of the EPID in this study was less intrusive and may have resulted in less additional attention being given each imaging setup. This may explain the slightly larger average translational variations observed with EPID vs. film, and suggests that the use of EPIDs is a superior method for assessing the true extent of setup

  2. A novel method to correct for pitch and yaw patient setup errors in helical tomotherapy

    International Nuclear Information System (INIS)

    Boswell, Sarah A.; Jeraj, Robert; Ruchala, Kenneth J.; Olivera, Gustavo H.; Jaradat, Hazim A.; James, Joshua A.; Gutierrez, Alonso; Pearson, Dave; Frank, Gary; Mackie, T. Rock

    2005-01-01

    An accurate means of determining and correcting for daily patient setup errors is important to the cancer outcome in radiotherapy. While many tools have been developed to detect setup errors, difficulty may arise in accurately adjusting the patient to account for the rotational error components. A novel, automated method to correct for rotational patient setup errors in helical tomotherapy is proposed for a treatment couch that is restricted to motion along translational axes. In tomotherapy, only a narrow superior/inferior section of the target receives a dose at any instant, thus rotations in the sagittal and coronal planes may be approximately corrected for by very slow continuous couch motion in a direction perpendicular to the scanning direction. Results from proof-of-principle tests indicate that the method improves the accuracy of treatment delivery, especially for long and narrow targets. Rotational corrections about an axis perpendicular to the transverse plane continue to be implemented easily in tomotherapy by adjustment of the initial gantry angle

  3. Analysis of Daily Setup Variation With Tomotherapy Megavoltage Computed Tomography

    International Nuclear Information System (INIS)

    Zhou Jining; Uhl, Barry; Dewit, Kelly; Young, Mark; Taylor, Brian; Fei Dingyu; Lo, Y-C

    2010-01-01

    The purpose of this study was to evaluate different setup uncertainties for various anatomic sites with TomoTherapy (registered) pretreatment megavoltage computed tomography (MVCT) and to provide optimal margin guidelines for these anatomic sites. Ninety-two patients with tumors in head and neck (HN), brain, lung, abdominal, or prostate regions were included in the study. MVCT was used to verify patient position and tumor target localization before each treatment. With the anatomy registration tool, MVCT provided real-time tumor shift coordinates relative to the positions where the simulation CT was performed. Thermoplastic facemasks were used for HN and brain treatments. Vac-Lok TM cushions were used to immobilize the lower extremities up to the thighs for prostate patients. No respiration suppression was administered for lung and abdomen patients. The interfractional setup variations were recorded and corrected before treatment. The mean interfractional setup error was the smallest for HN among the 5 sites analyzed. The average 3D displacement in lateral, longitudinal, and vertical directions for the 5 sites ranged from 2.2-7.7 mm for HN and lung, respectively. The largest movement in the lung was 2.0 cm in the longitudinal direction, with a mean error of 6.0 mm and standard deviation of 4.8 mm. The mean interfractional rotation variation was small and ranged from 0.2-0.5 deg., with the standard deviation ranging from 0.7-0.9 deg. Internal organ displacement was also investigated with a posttreatment MVCT scan for HN, lung, abdomen, and prostate patients. The maximum 3D intrafractional displacement across all sites was less than 4.5 mm. The interfractional systematic errors and random errors were analyzed and the suggested margins for HN, brain, prostate, abdomen, and lung in the lateral, longitudinal, and vertical directions were between 4.2 and 8.2 mm, 5.0 mm and 12.0 mm, and 1.5 mm and 6.8 mm, respectively. We suggest that TomoTherapy (registered) pretreatment

  4. Analysis of daily setup variation with tomotherapy megavoltage computed tomography.

    Science.gov (United States)

    Zhou, Jining; Uhl, Barry; Dewit, Kelly; Young, Mark; Taylor, Brian; Fei, Ding-Yu; Lo, Yeh-Chi

    2010-01-01

    The purpose of this study was to evaluate different setup uncertainties for various anatomic sites with TomoTherapy pretreatment megavoltage computed tomography (MVCT) and to provide optimal margin guidelines for these anatomic sites. Ninety-two patients with tumors in head and neck (HN), brain, lung, abdominal, or prostate regions were included in the study. MVCT was used to verify patient position and tumor target localization before each treatment. With the anatomy registration tool, MVCT provided real-time tumor shift coordinates relative to the positions where the simulation CT was performed. Thermoplastic facemasks were used for HN and brain treatments. Vac-Lok cushions were used to immobilize the lower extremities up to the thighs for prostate patients. No respiration suppression was administered for lung and abdomen patients. The interfractional setup variations were recorded and corrected before treatment. The mean interfractional setup error was the smallest for HN among the 5 sites analyzed. The average 3D displacement in lateral, longitudinal, and vertical directions for the 5 sites ranged from 2.2-7.7 mm for HN and lung, respectively. The largest movement in the lung was 2.0 cm in the longitudinal direction, with a mean error of 6.0 mm and standard deviation of 4.8 mm. The mean interfractional rotation variation was small and ranged from 0.2-0.5 degrees, with the standard deviation ranging from 0.7-0.9 degrees. Internal organ displacement was also investigated with a posttreatment MVCT scan for HN, lung, abdomen, and prostate patients. The maximum 3D intrafractional displacement across all sites was less than 4.5 mm. The interfractional systematic errors and random errors were analyzed and the suggested margins for HN, brain, prostate, abdomen, and lung in the lateral, longitudinal, and vertical directions were between 4.2 and 8.2 mm, 5.0 mm and 12.0 mm, and 1.5 mm and 6.8 mm, respectively. We suggest that TomoTherapy pretreatment MVCT can be used to

  5. Inter-treatment compensation of treatment setup variation to enhance the radiotherapeutic ratio

    International Nuclear Information System (INIS)

    Di, Yan; John, Wong; Michalski, Jeff; Pan, Cheng; Frazier, Arthur; Bosch, Walter; Martinez, Alvaro

    1995-01-01

    Purpose: In radiotherapy, treatment setup error has been one of the major causes of dose variation in the treated volume. With the data acquired from on-line electronic portal imaging, it is now possible not only to adjust the patient setup, but also to modify the treatment plan during the course of clinical treatment based on the setup error measured for each individual patient. In this work, daily clinical portal images were retrospectively analyzed to study (1) the number of initial daily portal images required to give adequate prediction of the systematic and random deviations of treatment setup, and (2) the potential therapeutic gain when the inter-treatment planning modification was established using the setup error of each individual patient. Methods and Materials: Only those patients whose treatment positions had not been adjusted during the course of treatment were selected for the retrospective study. Daily portal images of 27 lung, 25 pelvis, and 12 head and neck (h and n) cancer patients were obtained from two independent clinics with similar setup procedures. The anterior-to-posterior field was analyzed for the pelvis and lung treatments, and the right lateral field for the h and n treatments. Between 13 to 30 daily portal images were acquired for each patient and were analyzed using a 2D alignment tool. Systematic and random deviations of the treatment setup were calculated for each individual patient. The statistical confidence on the convergence of both systematic and random deviations with time were tested to determine the number of initial daily portal images needed to predict these deviations. In addition, a mean deviation for each site was also calculated using the setup errors from all patients. Two treatment planning schemes were simulated to evaluate margin design and prescription dose adjustment. Therapeutic scores were quantified in terms of tumor control probability (TCP) and normal tissue complication probability (NTCP). In the first

  6. The value of setup portal films as an estimate of a patient's position throughout fractionated tangential breast irradiation: an on-line study

    International Nuclear Information System (INIS)

    McGee, Kiaran P.; Fein, Douglas A.; Hanlon, Alex L.; Schultheiss, Timothy E.; Fowble, Barbara L.

    1997-01-01

    Purpose: To determine if portal setup films are an accurate representation of a patient's position throughout the course of fractionated tangential breast irradiation. Methods and Materials: Thirteen patients undergoing external beam irradiation for T1-T2 infiltrating ductal carcinoma of the breast following excisional biopsy and axillary dissection were imaged using an on-line portal imaging device attached to a 6 MV linear accelerator. Medial and lateral tangential fields were imaged and a total of 139 fractions, 225 portal fields, and 4450 images were obtained. Interfractional and intrafractional variations for anatomical parameters including the central lung distance (CLD), central flash distance (CFD), and inferior central margin (ICM) were calculated from these images. A pooled estimate of the random error associated with a given treatment was determined by adding the interfractional and intrafractional standard deviations in quadrature. A 95% confidence level assigned a value of two standard deviations of the random error estimate. Central lung distance, CFD, and ICM distances were then measured for all portal setup films. Significant differences were defined as occurring when the simulation-setup difference was greater than the 95% confidence value. Results: Differences between setup portal and simulation films were less than their 95% confidence values in 70 instances indicating that in 90% of the time these differences are a result of random differences in daily treatment positioning. Conclusions: In 90% of cases tested, initial portal setup films are an accurate representation of a patients daily treatment setup

  7. Daily online bony correction is required for prostate patients without fiducial markers or soft-tissue imaging.

    Science.gov (United States)

    Johnston, M L; Vial, P; Wiltshire, K L; Bell, L J; Blome, S; Kerestes, Z; Morgan, G W; O'Driscoll, D; Shakespeare, T P; Eade, T N

    2011-09-01

    To compare online position verification strategies with offline correction protocols for patients undergoing definitive prostate radiotherapy. We analysed 50 patients with implanted fiducial markers undergoing curative prostate radiation treatment, all of whom underwent daily kilovoltage imaging using an on-board imager. For each treatment, patients were set-up initially with skin tattoos and in-room lasers. Orthogonal on-board imager images were acquired and the couch shift to match both bony anatomy and the fiducial markers recorded. The set-up error using skin tattoos and offline bone correction was compared with online bone correction. The fiducial markers were used as the reference. Data from 1923 fractions were analysed. The systematic error was ≤1 mm for all protocols. The average random error was 2-3mm for online bony correction and 3-5mm for skin tattoos or offline-bone. Online-bone showed a significant improvement compared with offline-bone in the number of patients with >5mm set-up errors for >10% (P20% (Pmarkers or daily soft-tissue imaging. Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  8. Cone-Beam Computed Tomography–Guided Positioning of Laryngeal Cancer Patients with Large Interfraction Time Trends in Setup and Nonrigid Anatomy Variations

    International Nuclear Information System (INIS)

    Gangsaas, Anne; Astreinidou, Eleftheria; Quint, Sandra; Levendag, Peter C.; Heijmen, Ben

    2013-01-01

    Purpose: To investigate interfraction setup variations of the primary tumor, elective nodes, and vertebrae in laryngeal cancer patients and to validate protocols for cone beam computed tomography (CBCT)-guided correction. Methods and Materials: For 30 patients, CBCT-measured displacements in fractionated treatments were used to investigate population setup errors and to simulate residual setup errors for the no action level (NAL) offline protocol, the extended NAL (eNAL) protocol, and daily CBCT acquisition with online analysis and repositioning. Results: Without corrections, 12 of 26 patients treated with radical radiation therapy would have experienced a gradual change (time trend) in primary tumor setup ≥4 mm in the craniocaudal (CC) direction during the fractionated treatment (11/12 in caudal direction, maximum 11 mm). Due to these trends, correction of primary tumor displacements with NAL resulted in large residual CC errors (required margin 6.7 mm). With the weekly correction vector adjustments in eNAL, the trends could be largely compensated (CC margin 3.5 mm). Correlation between movements of the primary and nodal clinical target volumes (CTVs) in the CC direction was poor (r 2 =0.15). Therefore, even with online setup corrections of the primary CTV, the required CC margin for the nodal CTV was as large as 6.8 mm. Also for the vertebrae, large time trends were observed for some patients. Because of poor CC correlation (r 2 =0.19) between displacements of the primary CTV and the vertebrae, even with daily online repositioning of the vertebrae, the required CC margin around the primary CTV was 6.9 mm. Conclusions: Laryngeal cancer patients showed substantial interfraction setup variations, including large time trends, and poor CC correlation between primary tumor displacements and motion of the nodes and vertebrae (internal tumor motion). These trends and nonrigid anatomy variations have to be considered in the choice of setup verification protocol and

  9. Application of video imaging for improvement of patient set-up

    International Nuclear Information System (INIS)

    Ploeger, Lennert S.; Frenay, Michel; Betgen, Anja; Bois, Josien A. de; Gilhuijs, Kenneth G.A.; Herk, Marcel van

    2003-01-01

    Background and purpose: For radiotherapy of prostate cancer, the patient is usually positioned in the left-right (LR) direction by aligning a single marker on the skin with the projection of a room laser. The aim of this study is to investigate the feasibility of a room-mounted video camera in combination with previously acquired CT data to improve patient set-up along the LR axis. Material and methods: The camera was mounted in the treatment room at the caudal side of the patient. For 22 patients with prostate cancer 127 video and portal images were acquired. The set-up error determined by video imaging was found by matching video images with rendered CT images using various techniques. This set-up error was retrospectively compared with the set-up error derived from portal images. It was investigated whether the number of corrections based on portal imaging would decrease if the information obtained from the video images had been used prior to irradiation. Movement of the skin with respect to bone was quantified using an analysis of variance method. Results: The measurement of the set-up error was most accurate for a technique where outlines and groins on the left and right side of the patient were delineated and aligned individually to the corresponding features extracted from the rendered CT image. The standard deviations (SD) of the systematic and random components of the set-up errors derived from the portal images in the LR direction were 1.5 and 2.1 mm, respectively. When the set-up of the patients was retrospectively adjusted based on the video images, the SD of the systematic and random errors decreased to 1.1 and 1.3 mm, respectively. From retrospective analysis, a reduction of the number of set-up corrections (from nine to six corrections) is expected when the set-up would have been adjusted using the video images. The SD of the magnitude of motion of the skin of the patient with respect to the bony anatomy was estimated to be 1.1 mm. Conclusion: Video

  10. Couch height–based patient setup for abdominal radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Ohira, Shingo [Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita (Japan); Ueda, Yoshihiro [Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita (Japan); Nishiyama, Kinji [Department of Radiation Oncology, Yao Municipal Hospital, Yao (Japan); Miyazaki, Masayoshi; Isono, Masaru; Tsujii, Katsutomo [Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Takashina, Masaaki; Koizumi, Masahiko [Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita (Japan); Kawanabe, Kiyoto [Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Teshima, Teruki, E-mail: teshima-te@mc.pref.osaka.jp [Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan)

    2016-04-01

    There are 2 methods commonly used for patient positioning in the anterior-posterior (A-P) direction: one is the skin mark patient setup method (SMPS) and the other is the couch height–based patient setup method (CHPS). This study compared the setup accuracy of these 2 methods for abdominal radiation therapy. The enrollment for this study comprised 23 patients with pancreatic cancer. For treatments (539 sessions), patients were set up by using isocenter skin marks and thereafter treatment couch was shifted so that the distance between the isocenter and the upper side of the treatment couch was equal to that indicated on the computed tomographic (CT) image. Setup deviation in the A-P direction for CHPS was measured by matching the spine of the digitally reconstructed radiograph (DRR) of a lateral beam at simulation with that of the corresponding time-integrated electronic portal image. For SMPS with no correction (SMPS/NC), setup deviation was calculated based on the couch-level difference between SMPS and CHPS. SMPS/NC was corrected using 2 off-line correction protocols: no action level (SMPS/NAL) and extended NAL (SMPS/eNAL) protocols. Margins to compensate for deviations were calculated using the Stroom formula. A-P deviation > 5 mm was observed in 17% of SMPS/NC, 4% of SMPS/NAL, and 4% of SMPS/eNAL sessions but only in one CHPS session. For SMPS/NC, 7 patients (30%) showed deviations at an increasing rate of > 0.1 mm/fraction, but for CHPS, no such trend was observed. The standard deviations (SDs) of systematic error (Σ) were 2.6, 1.4, 0.6, and 0.8 mm and the root mean squares of random error (σ) were 2.1, 2.6, 2.7, and 0.9 mm for SMPS/NC, SMPS/NAL, SMPS/eNAL, and CHPS, respectively. Margins to compensate for the deviations were wide for SMPS/NC (6.7 mm), smaller for SMPS/NAL (4.6 mm) and SMPS/eNAL (3.1 mm), and smallest for CHPS (2.2 mm). Achieving better setup with smaller margins, CHPS appears to be a reproducible method for abdominal patient setup.

  11. Evaluation of rotational set-up errors in patients with thoracic neoplasms

    International Nuclear Information System (INIS)

    Wang Yanyang; Fu Xiaolong; Xia Bing; Fan Min; Yang Huanjun; Ren Jun; Xu Zhiyong; Jiang Guoliang

    2010-01-01

    Objective: To assess the rotational set-up errors in patients with thoracic neoplasms. Methods: 224 kilovoltage cone-beam computed tomography (KVCBCT) scans from 20 thoracic tumor patients were evaluated retrospectively. All these patients were involved in the research of 'Evaluation of the residual set-up error for online kilovoltage cone-beam CT guided thoracic tumor radiation'. Rotational set-up errors, including pitch, roll and yaw, were calculated by 'aligning the KVCBCT with the planning CT, using the semi-automatic alignment method. Results: The average rotational set-up errors were -0.28 degree ±1.52 degree, 0.21 degree ± 0.91 degree and 0.27 degree ± 0.78 degree in the left-fight, superior-inferior and anterior-posterior axis, respectively. The maximal rotational errors of pitch, roll and yaw were 3.5 degree, 2.7 degree and 2.2 degree, respectively. After correction for translational set-up errors, no statistically significant changes in rotational error were observed. Conclusions: The rotational set-up errors in patients with thoracic neoplasms were all small in magnitude. Rotational errors may not change after the correction for translational set-up errors alone, which should be evaluated in a larger sample future. (authors)

  12. Impact of different setup approaches in image-guided radiotherapy as primary treatment for prostate cancer. A study of 2940 setup deviations in 980 MVCTs

    International Nuclear Information System (INIS)

    Schiller, Kilian; Specht, Hanno; Kampfer, Severin; Duma, Marciana Nona; Petrucci, Alessia; Geinitz, Hans; Schuster, Tibor

    2014-01-01

    The goal of this study was to assess the impact of different setup approaches in image-guided radiotherapy (IMRT) of the prostatic gland. In all, 28 patients with prostate cancer were enrolled in this study. After the placement of an endorectal balloon, the planning target volume (PTV) was treated to a dose of 70 Gy in 35 fractions. A simultaneously integrated boost (SIB) of 76 Gy (2.17 Gy per fraction and per day) was delivered to a smaller target volume. All patients underwent daily prostate-aligned IGRT by megavoltage CT (MVCT). Retrospectively, three different setup approaches were evaluated by comparison to the prostate alignment: setup by skin alignment, endorectal balloon alignment, and automatic registration by bones. A total of 2,940 setup deviations were analyzed in 980 fractions. Compared to prostate alignment, skin mark alignment was associated with substantial displacements, which were ≥ 8 mm in 13 %, 5 %, and 44 % of all fractions in the lateral, longitudinal, and vertical directions, respectively. Endorectal balloon alignment yielded displacements ≥ 8 mm in 3 %, 19 %, and 1 % of all setups; and ≥ 3 mm in 27 %, 58 %, and 18 % of all fractions, respectively. For bone matching, the values were 1 %, 1 %, and 2 % and 3 %, 11 %, and 34 %, respectively. For prostate radiotherapy, setup by skin marks alone is inappropriate for patient positioning due to the fact that, during almost half of the fractions, parts of the prostate would not be targeted successfully with an 8-mm safety margin. Bone matching performs better but not sufficiently for safety margins ≤ 3 mm. Endorectal balloon matching can be combined with bone alignment to increase accuracy in the vertical direction when prostate-based setup is not available. Daily prostate alignment remains the gold standard for high-precision radiotherapy with small safety margins. (orig.) [de

  13. Daily targeting of intrahepatic tumors for radiotherapy

    International Nuclear Information System (INIS)

    Balter, James M.; Brock, Kristy K.; Litzenberg, Dale W.; McShan, Daniel L.; Lawrence, Theodore S.; Haken, Randall Ten; McGinn, Cornelius J.; Lam, Kwok L.; Dawson, Laura A.

    2002-01-01

    Introduction: A system has been developed for daily targeting of intrahepatic tumors using a combination of ventilatory immobilization, in-room diagnostic imaging, and on-line setup adjustment. By reducing geometric position uncertainty, as well as organ movement, this system permits reduction of margins and thus potentially higher treatment doses. This paper reports our initial experience treating 8 patients with focal liver tumors using this system. Methods and Materials: The system includes diagnostic X-ray tubes mounted on the wall and ceiling of a treatment room, an active matrix flat panel imager, in-room control for image acquisition and setup adjustment, and a ventilatory immobilization system via active breathing control (ABC). Eight patients participated in the study, two using an early prototype ABC unit, and the remaining six with a commercial ABC system and improved setup measurement tools. Treatment margins were reduced, and dose consequently increased because of increased confidence in target position under this protocol. After daily setup via skin marks, orthogonal radiographs were acquired at suspended ventilation. The images were aligned to the CT model using the diaphragm for inferior-superior (IS) alignment, and the skeleton for left-right (LR) and anterior-posterior (AP) alignment. Adjustments were made for positioning errors greater than a threshold (3 or 5 mm). After treatment, retrospective analysis determined the final setup accuracy, as well as the error in initial setup measurement performed before setup adjustment. Results: Two hundred sixty-two treatment fractions were delivered on eight patients, with 171 treatments requiring repositioning. Typical treatment times were 25-30 min. Patients were able to tolerate ABC throughout the course of treatment. Breath holds up to 35 s long were used for treatment. The use of on-line imaging and setup adjustment reduced setup errors (σ) from 4.0 mm (LR), 6.7 mm (IS), and 3.8 mm (AP) to 2.1 mm (LR

  14. Residual setup errors caused by rotation and non-rigid motion in prone-treated cervical cancer patients after online CBCT image-guidance

    International Nuclear Information System (INIS)

    Ahmad, Rozilawati; Hoogeman, Mischa S.; Quint, Sandra; Mens, Jan Willem; Osorio, Eliana M. Vásquez; Heijmen, Ben J.M.

    2012-01-01

    Purpose: To quantify the impact of uncorrected or partially corrected pelvis rotation and spine bending on region-specific residual setup errors in prone-treated cervical cancer patients. Methods and materials: Fifteen patients received an in-room CBCT scan twice a week. CBCT scans were registered to the planning CT-scan using a pelvic clip box and considering both translations and rotations. For daily correction of the detected translational pelvis setup errors by couch shifts, residual setup errors were determined for L5, L4 and seven other points of interest (POIs). The same was done for a procedure with translational corrections and limited rotational correction (±3°) by a 6D positioning device. Results: With translational correction only, residual setup errors were large especially for L5/L4 in AP direction (Σ = 5.1/5.5 mm). For the 7 POIs the residual setup errors ranged from 1.8 to 5.6 mm (AP). Using the 6D positioning device, the errors were substantially smaller (for L5/L4 in AP direction Σ = 2.7/2.2 mm). Using this device, the percentage of fractions with a residual AP displacement for L4 > 5 mm reduced from 47% to 9%. Conclusions: Setup variations caused by pelvis rotations are large and cannot be ignored in prone treatment of cervical cancer patients. Corrections with a 6D positioning device may considerably reduce resulting setup errors, but the residual setup errors should still be accounted for by appropriate CTV-to-PTV margins.

  15. TU-F-CAMPUS-J-04: Setup Uncertainties in the Mediastinum Area for IMRT Treatment of Lymphoma Patients

    Energy Technology Data Exchange (ETDEWEB)

    Aristophanous, M; Court, L [UT MD Anderson Cancer Center, Houston, TX (United States)

    2015-06-15

    Purpose: Despite daily image guidance setup uncertainties can be high when treating large areas of the body. The aim of this study was to measure local uncertainties inside the PTV for patients receiving IMRT to the mediastinum region. Methods: Eleven lymphoma patients that received radiotherapy (breath-hold) to the mediastinum were included in this study. The treated region could range all the way from the neck to the diaphragm. Each patient had a CT scan with a CT-on-rails system prior to every treatment. The entire PTV region was matched to the planning CT using automatic rigid registration. The PTV was then split into 5 regions: neck, supraclavicular, superior mediastinum, upper heart, lower heart. Additional auto-registrations for each of the 5 local PTV regions were performed. The residual local setup errors were calculated as the difference between the final global PTV position and the individual final local PTV positions for the AP, SI and RL directions. For each patient 4 CT scans were analyzed (1 per week of treatment). Results: The residual mean group error (M) and standard deviation of the inter-patient (or systematic) error (Σ) were lowest in the RL direction of the superior mediastinum (0.0mm and 0.5mm) and highest in the RL direction of the lower heart (3.5mm and 2.9mm). The standard deviation of the inter-fraction (or random) error (σ) was lowest in the RL direction of the superior mediastinum (0.5mm) and highest in the SI direction of the lower heart (3.9mm) The directionality of local uncertainties is important; a superior residual error in the lower heart for example keeps it in the global PTV. Conclusion: There is a complex relationship between breath-holding and positioning uncertainties that needs further investigation. Residual setup uncertainties can be significant even under daily CT image guidance when treating large regions of the body.

  16. Measurement and analysis of the thoracic patient setup deviations in routine radiotherapy

    International Nuclear Information System (INIS)

    Jia Mingxuan; Zou Huawei; Wu Rong; Sun Jian; Dong Xiaoqi

    2003-01-01

    Objective: To determine the magnitude of the setup deviations of the thoracic patients in routine radiotherapy. Methods: Altogether 408 films for 21 thoracic patients were recorded using the electronic portal imaging device (EPID), and comparison with reference CT simulator digitally-reconstructed radiograph (DRR) for anterior-posterior fields was performed. The deviation of setup for 21 patients in the left-right (RL), superior-inferior (SI) directions and rotation about the anterior-posterior (AP) axis were measured and analyzed. Results: Without immobilization device, the mean translational and rotational setup deviations were (0.7±3.1) mm and (1.5±4.1) mm in the RL and SI directions, respectively, and (0.3±2.4) degree about AP axis. With immobilization device, the mean translational and rotational setup deviations were (0.5±2.4) mm and (0.8±2.7) mm in the RL and SI directions respectively, and (0.2±1.6) degree about AP axis. Conclusion: The setup deviations in thoracic patients irradiation may be reduced with the use of the immobilization device. The setup deviation in the SI direction is greater than that in the RL direction. The setup deviations are mainly random errors

  17. SU-F-J-24: Setup Uncertainty and Margin of the ExacTrac 6D Image Guide System for Patients with Brain Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Kim, S; Oh, S; Yea, J; Park, J [Yeungnam University Medical Center, Daegu, Daegu (Korea, Republic of)

    2016-06-15

    Purpose: This study evaluated the setup uncertainties for brain sites when using BrainLAB’s ExacTrac X-ray 6D system for daily pretreatment to determine the optimal planning target volume (PTV) margin. Methods: Between August 2012 and April 2015, 28 patients with brain tumors were treated by daily image-guided radiotherapy using the BrainLAB ExacTrac 6D image guidance system of the Novalis-Tx linear accelerator. DUONTM (Orfit Industries, Wijnegem, Belgium) masks were used to fix the head. The radiotherapy was fractionated into 27–33 treatments. In total, 844 image verifications were performed for 28 patients and used for the analysis. The setup corrections along with the systematic and random errors were analyzed for six degrees of freedom in the translational (lateral, longitudinal, and vertical) and rotational (pitch, roll, and yaw) dimensions. Results: Optimal PTV margins were calculated based on van Herk et al.’s [margin recipe = 2.5∑ + 0.7σ − 3 mm] and Stroom et al.’s [margin recipe = 2∑ + 0.7σ] formulas. The systematic errors (∑) were 0.72, 1.57, and 0.97 mm in the lateral, longitudinal, and vertical translational dimensions, respectively, and 0.72°, 0.87°, and 0.83° in the pitch, roll, and yaw rotational dimensions, respectively. The random errors (σ) were 0.31, 0.46, and 0.54 mm in the lateral, longitudinal, and vertical rotational dimensions, respectively, and 0.28°, 0.24°, and 0.31° in the pitch, roll, and yaw rotational dimensions, respectively. According to van Herk et al.’s and Stroom et al.’s recipes, the recommended lateral PTV margins were 0.97 and 1.66 mm, respectively; the longitudinal margins were 1.26 and 3.47 mm, respectively; and the vertical margins were 0.21 and 2.31 mm, respectively. Conclusion: Therefore, daily setup verifications using the BrainLAB ExacTrac 6D image guide system are very useful for evaluating the setup uncertainties and determining the setup margin.∑σ.

  18. Analysis of patient setup accuracy using electronic portal imaging device

    International Nuclear Information System (INIS)

    Onogi, Yuzo; Aoki, Yukimasa; Nakagawa, Keiichi

    1996-01-01

    Radiation therapy is performed in many fractions, and accurate patient setup is very important. This is more significant nowadays because treatment planning and radiation therapy are more precisely performed. Electronic portal imaging devices and automatic image comparison algorithms let us analyze setup deviations quantitatively. With such in mind we developed a simple image comparison algorithm. Using 2459 electronic verification images (335 ports, 123 treatment sites) generated during the past three years at our institute, we evaluated the results of the algorithm, and analyzed setup deviations according to the area irradiated, use of a fixing device (shell), and arm position. Calculated setup deviation was verified visually and their fitness was classified into good, fair, bad, and incomplete. The result was 40%, 14%, 22%, 24% respectively. Using calculated deviations classified as good (994 images), we analyzed setup deviations. Overall setup deviations described in 1 SD along axes x, y, z, was 1.9 mm, 2.5 mm, 1.7 mm respectively. We classified these deviations into systematic and random components, and found that random error was predominant in our institute. The setup deviations along axis y (cranio-caudal direction) showed larger distribution when treatment was performed with the shell. Deviations along y (cranio-caudal) and z (anterior-posterior) had larger distribution when treatment occurred with the patient's arm elevated. There was a significant time-trend error, whose deviations become greater with time. Within all evaluated ports, 30% showed a time-trend error. Using an electronic portal imaging device and automatic image comparison algorithm, we are able to analyze setup deviations more precisely and improve setup method based on objective criteria. (author)

  19. Analysis of Prostate Patient Setup and Tracking Data: Potential Intervention Strategies

    International Nuclear Information System (INIS)

    Su Zhong; Zhang Lisha; Murphy, Martin; Williamson, Jeffrey

    2011-01-01

    Purpose: To evaluate the setup, interfraction, and intrafraction organ motion error distributions and simulate intrafraction intervention strategies for prostate radiotherapy. Methods and Materials: A total of 17 patients underwent treatment setup and were monitored using the Calypso system during radiotherapy. On average, the prostate tracking measurements were performed for 8 min/fraction for 28 fractions for each patient. For both patient couch shift data and intrafraction organ motion data, the systematic and random errors were obtained from the patient population. The planning target volume margins were calculated using the van Herk formula. Two intervention strategies were simulated using the tracking data: the deviation threshold and period. The related planning target volume margins, time costs, and prostate position 'fluctuation' were presented. Results: The required treatment margin for the left-right, superoinferior, and anteroposterior axes was 8.4, 10.8, and 14.7 mm for skin mark-only setup and 1.3, 2.3, and 2.8 mm using the on-line setup correction, respectively. Prostate motion significantly correlated among the superoinferior and anteroposterior directions. Of the 17 patients, 14 had prostate motion within 5 mm of the initial setup position for ≥91.6% of the total tracking time. The treatment margin decreased to 1.1, 1.8, and 2.3 mm with a 3-mm threshold correction and to 0.5, 1.0, and 1.5 mm with an every-2-min correction in the left-right, superoinferior, and anteroposterior directions, respectively. The periodic corrections significantly increase the treatment time and increased the number of instances when the setup correction was made during transient excursions. Conclusions: The residual systematic and random error due to intrafraction prostate motion is small after on-line setup correction. Threshold-based and time-based intervention strategies both reduced the planning target volume margins. The time-based strategies increased the

  20. Patients setup verification tool for RT (PSVTs): DRR, simulation, portal and digital images

    International Nuclear Information System (INIS)

    Lee, Suk; Seong, Jin Sil; Chu, Sung Sil; Lee, Chang Geol; Suh, Chang Ok; Kwon, Soo Il

    2003-01-01

    To develop a patients' setup verification tool (PSVT) to verify the alignment of the machine and the target isocenters, and the reproducibility of patients' setup for three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (MRT). The utilization of this system is evaluated through phantom and patient case studies. We developed and clinically tested a new method for patients' setup verification, using digitally reconstructed radiography (DRR), simulation, portal and digital images. The PSVT system was networked to a Pentium PC for the transmission of the acquired images to the PC for analysis. To verify the alignment of the machine and target isocenters, orthogonal pairs of simulation images were used as verification images. Errors in the isocenter alignment were measured by comparing the verification images with DRR of CT images. Orthogonal films were taken of all the patients once a week. These verification films were compared with the DRR were used for the treatment setup. By performing this procedure every treatment, using humanoid phantom and patient cases, the errors of localization can be analyzed, with adjustments made from the translation. The reproducibility of the patients' setup was verified using portal and digital images. The PSVT system was developed to verify the alignment of the machine and the target isocenters, and the reproducibility of the patients' setup for 3DCRT and IMRT The results show that the localization errors are 0.8±0.2 mm (AP) and 1.0±0.3 mm (Lateral) in the cases relating to the brain and 1.1± 0.5 mm (AP) and 1.0±0.6 mm (Lateral) in the cases relating to the pelvis. The reproducibility of the patients' setup was verified by visualization, using real-time image acquisition, leading to the practical utilization of our software. A PSVT system was developed for the verification of the alignment between machine and the target isocenters, and the reproducibility of the patients' setup in 3DCRT and IMRT

  1. Local Setup Reproducibility of the Spinal Column When Using Intensity-Modulated Radiation Therapy for Craniospinal Irradiation With Patient in Supine Position

    International Nuclear Information System (INIS)

    Stoiber, Eva Maria; Giske, Kristina; Schubert, Kai; Sterzing, Florian; Habl, Gregor; Uhl, Matthias; Herfarth, Klaus; Bendl, Rolf; Debus, Jürgen

    2011-01-01

    Purpose: To evaluate local positioning errors of the lumbar spine during fractionated intensity-modulated radiotherapy of patients treated with craniospinal irradiation and to assess the impact of rotational error correction on these uncertainties for one patient setup correction strategy. Methods and Materials: 8 patients (6 adults, 2 children) treated with helical tomotherapy for craniospinal irradiation were retrospectively chosen for this analysis. Patients were immobilized with a deep-drawn Aquaplast head mask. Additionally to daily megavoltage control computed tomography scans of the skull, once-a-week positioning of the lumbar spine was assessed. Therefore, patient setup was corrected by a target point correction, derived from a registration of the patient's skull. The residual positioning variations of the lumbar spine were evaluated applying a rigid-registration algorithm. The impact of different rotational error corrections was simulated. Results: After target point correction, residual local positioning errors of the lumbar spine varied considerably. Craniocaudal axis rotational error correction did not improve or deteriorate these translational errors, whereas simulation of a rotational error correction of the right–left and anterior–posterior axis increased these errors by a factor of 2 to 3. Conclusion: The patient fixation used allows for deformations between the patient's skull and spine. Therefore, for the setup correction strategy evaluated in this study, generous margins for the lumbar spinal target volume are needed to prevent a local geographic miss. With any applied correction strategy, it needs to be evaluated whether or not a rotational error correction is beneficial.

  2. Feasibility of geometrical verification of patient set-up using body contours and computed tomography data

    International Nuclear Information System (INIS)

    Ploeger, Lennert S.; Betgen, Anja; Gilhuijs, Kenneth G.A.; Herk, Marcel van

    2003-01-01

    Background and purpose: Body contours can potentially be used for patient set-up verification in external-beam radiotherapy and might enable more accurate set-up of patients prior to irradiation. The aim of this study is to test the feasibility of patient set-up verification using a body contour scanner. Material and methods: Body contour scans of 33 lung cancer and 21 head-and-neck cancer patients were acquired on a simulator. We assume that this dataset is representative for the patient set-up on an accelerator. Shortly before acquisition of the body contour scan, a pair of orthogonal simulator images was taken as a reference. Both the body contour scan and the simulator images were matched in 3D to the planning computed tomography scan. Movement of skin with respect to bone was quantified based on an analysis of variance method. Results: Set-up errors determined with body-contours agreed reasonably well with those determined with simulator images. For the lung cancer patients, the average set-up errors (mm)±1 standard deviation (SD) for the left-right, cranio-caudal and anterior-posterior directions were 1.2±2.9, -0.8±5.0 and -2.3±3.1 using body contours, compared to -0.8±3.2, -1.0±4.1 and -1.2±2.4 using simulator images. For the head-and-neck cancer patients, the set-up errors were 0.5±1.8, 0.5±2.7 and -2.2±1.8 using body contours compared to -0.4±1.2, 0.1±2.1, -0.1±1.8 using simulator images. The SD of the set-up errors obtained from analysis of the body contours were not significantly different from those obtained from analysis of the simulator images. Movement of the skin with respect to bone (1 SD) was estimated at 2.3 mm for lung cancer patients and 1.7 mm for head-and-neck cancer patients. Conclusion: Measurement of patient set-up using a body-contouring device is possible. The accuracy, however, is limited by the movement of the skin with respect to the bone. In situations where the error in the patient set-up is relatively large, it is

  3. Daily cone-beam computed tomography used to determine tumour shrinkage and localisation in lung cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Marquard Knap, Marianne; Nordsmark, Marianne (Aarhus Univ. Hospital, Dept. of Oncology, Aarhus (Denmark)), E-mail: mariknap@rm.dk; Hoffmann, Lone; Vestergaard, Anne (Aarhus Univ. Hospital, Dept. of Medical Physics, Aarhus (Denmark))

    2010-10-15

    Purpose/Objective. Daily Cone-beam computed tomography (CBCT) in room imaging is used to determine tumour shrinkage during a full radiotherapy (RT) course. In addition, relative interfractional tumour and lymph node motion is determined for each RT fraction. Material and methods. From November 2009 to March 2010, 20 consecutive lung cancer patients (14 NSCLC, 6 SCLC) were followed with daily CBCT during RT. The gross tumour volume for lung tumour (GTV-t) was visible in all daily CBCT scans and was delineated at the beginning, at the tenth and the 20th fraction, and at the end of treatment. Whenever visible, the gross tumour volume for lymph nodes (GTV-n) was also delineated. The GTV-t and GTV-n volumes were determined. All patients were setup according to an online bony anatomy match. Retrospectively, matching based on the internal target volume (ITV), the GTV-t or the GTV-n was performed. Results. In eight patients, we observed a significant GTV-t shrinkage (15-40%) from the planning CT until the last CBCT. Only five patients presented a significant shrinkage (21-37%) in the GTV-n. Using the daily CBCT imaging, it was found that the mean value of the difference between a setup using the skin tattoo and an online matching using the ITV was 7.3+-2.9 mm (3D vector in the direction of ITV). The mean difference between the ITV and bony anatomy matching was 3.0+-1.3 mm. Finally, the mean distance between the GTV-t and the GTV-N was 2.9+-1.6 mm. Conclusion. One third of all patients with lung cancer undergoing chemo-RT achieved significant tumour shrinkage from planning CT until the end of the radiotherapy. Differences in GTV-t and GTV-n motion was observed and matching using the ITV including both GTV-t and GTV-n is therefore preferable.

  4. Daily cone-beam computed tomography used to determine tumour shrinkage and localisation in lung cancer patients

    International Nuclear Information System (INIS)

    Marquard Knap, Marianne; Nordsmark, Marianne; Hoffmann, Lone; Vestergaard, Anne

    2010-01-01

    Purpose/Objective. Daily Cone-beam computed tomography (CBCT) in room imaging is used to determine tumour shrinkage during a full radiotherapy (RT) course. In addition, relative interfractional tumour and lymph node motion is determined for each RT fraction. Material and methods. From November 2009 to March 2010, 20 consecutive lung cancer patients (14 NSCLC, 6 SCLC) were followed with daily CBCT during RT. The gross tumour volume for lung tumour (GTV-t) was visible in all daily CBCT scans and was delineated at the beginning, at the tenth and the 20th fraction, and at the end of treatment. Whenever visible, the gross tumour volume for lymph nodes (GTV-n) was also delineated. The GTV-t and GTV-n volumes were determined. All patients were setup according to an online bony anatomy match. Retrospectively, matching based on the internal target volume (ITV), the GTV-t or the GTV-n was performed. Results. In eight patients, we observed a significant GTV-t shrinkage (15-40%) from the planning CT until the last CBCT. Only five patients presented a significant shrinkage (21-37%) in the GTV-n. Using the daily CBCT imaging, it was found that the mean value of the difference between a setup using the skin tattoo and an online matching using the ITV was 7.3±2.9 mm (3D vector in the direction of ITV). The mean difference between the ITV and bony anatomy matching was 3.0±1.3 mm. Finally, the mean distance between the GTV-t and the GTV-N was 2.9±1.6 mm. Conclusion. One third of all patients with lung cancer undergoing chemo-RT achieved significant tumour shrinkage from planning CT until the end of the radiotherapy. Differences in GTV-t and GTV-n motion was observed and matching using the ITV including both GTV-t and GTV-n is therefore preferable.

  5. SU-E-CAMPUS-T-01: Analysis of the Precision of Patient Set-Up, and Fidelity of the Delivered Dose Distribution in Proton Therapy of Ocular Tumors

    International Nuclear Information System (INIS)

    Trofimov, A; Carpenter, K; Shih, HA

    2014-01-01

    Purpose: To quantify daily set-up variations in fractionated proton therapy of ocular melanomas, and to assess the effect on the fidelity of delivered distribution to the plan. Methods: In a typical five-fraction course, daily set-up is achieved by matching the position of fiducial markers in orthogonal radiographs to the images generated by treatment planning program. A patient maintains the required gaze direction voluntarily, without the aid of fixation devices. Confirmation radiographs are acquired to assess intrafractional changes. For this study, daily radiographs were analyzed to determine the daily iso-center position and apparent gaze direction, which were then transferred to the planning system to calculate the dose delivered in individual fractions, and accumulated dose for the entire course. Dose-volume metrics were compared between the planned and accumulated distributions for the tumor and organs at risk, for representative cases that varied by location within the ocular globe. Results: The analysis of the first set of cases (3 posterior, 3 transequatorial and 4 anterior tumors) revealed varying dose deviation patterns, depending on the tumor location. For anterior and posterior tumors, the largest dose increases were observed in the lens and ciliary body, while for the equatorial tumors, macula, optic nerve and disk, were most often affected. The iso-center position error was below 1.3 mm (95%-confidence interval), and the standard deviation of daily polar and azimuthal gaze set-up were 1.5 and 3 degrees, respectively. Conclusion: We quantified interfractional and intrafractional set-up variation, and estimated their effect on the delivered dose for representative cases. Current safety margins are sufficient to maintain the target coverage, however, the dose delivered to critical structures often deviates from the plan. The ongoing analysis will further explore the patterns of dose deviation, and may help to identify particular treatment scenarios

  6. SU-E-CAMPUS-T-01: Analysis of the Precision of Patient Set-Up, and Fidelity of the Delivered Dose Distribution in Proton Therapy of Ocular Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Trofimov, A; Carpenter, K; Shih, HA [Massachusetts General Hospital, Boston, MA (United States)

    2014-06-15

    Purpose: To quantify daily set-up variations in fractionated proton therapy of ocular melanomas, and to assess the effect on the fidelity of delivered distribution to the plan. Methods: In a typical five-fraction course, daily set-up is achieved by matching the position of fiducial markers in orthogonal radiographs to the images generated by treatment planning program. A patient maintains the required gaze direction voluntarily, without the aid of fixation devices. Confirmation radiographs are acquired to assess intrafractional changes. For this study, daily radiographs were analyzed to determine the daily iso-center position and apparent gaze direction, which were then transferred to the planning system to calculate the dose delivered in individual fractions, and accumulated dose for the entire course. Dose-volume metrics were compared between the planned and accumulated distributions for the tumor and organs at risk, for representative cases that varied by location within the ocular globe. Results: The analysis of the first set of cases (3 posterior, 3 transequatorial and 4 anterior tumors) revealed varying dose deviation patterns, depending on the tumor location. For anterior and posterior tumors, the largest dose increases were observed in the lens and ciliary body, while for the equatorial tumors, macula, optic nerve and disk, were most often affected. The iso-center position error was below 1.3 mm (95%-confidence interval), and the standard deviation of daily polar and azimuthal gaze set-up were 1.5 and 3 degrees, respectively. Conclusion: We quantified interfractional and intrafractional set-up variation, and estimated their effect on the delivered dose for representative cases. Current safety margins are sufficient to maintain the target coverage, however, the dose delivered to critical structures often deviates from the plan. The ongoing analysis will further explore the patterns of dose deviation, and may help to identify particular treatment scenarios

  7. Evaluation of Setup Error Correction for Patients Using On Board Imager in Image Guided Radiation Therapy

    International Nuclear Information System (INIS)

    Kang, Soo Man

    2008-01-01

    To reduce side effects in image guided radiation therapy (IGRT) and to improve the quality of life of patients, also to meet accurate SETUP condition for patients, the various SETUP correction conditions were compared and evaluated by using on board imager (OBI) during the SETUP. Each 30 cases of the head, the neck, the chest, the belly, and the pelvis in 150 cases of IGRT patients was corrected after confirmation by using OBI at every 2-3 day. Also, the difference of the SETUP through the skin-marker and the anatomic SETUP through the OBI was evaluated. General SETUP errors (Transverse, Coronal, Sagittal) through the OBI at original SETUP position were Head and Neck: 1.3 mm, Brain: 2 mm, Chest: 3 mm, Abdoman: 3.7 mm, Pelvis: 4 mm. The patients with more that 3 mm in the error range were observed in the correction devices and the patient motions by confirming in treatment room. Moreover, in the case of female patients, the result came from the position of hairs during the Head and Neck, Brain tumor. Therefore, after another SETUP in each cases of over 3 mm in the error range, the treatment was carried out. Mean error values of each parts estimated after the correction were 1 mm for the head, 1.2 mm for the neck, 2.5 mm for the chest, 2.5 mm for the belly, and 2.6 mm for the pelvis. The result showed the correction of SETUP for each treatment through OBI is extremely difficult because of the importance of SETUP in radiation treatment. However, by establishing the average standard of the patients from this research result, the better patient satisfaction and treatment results could be obtained.

  8. Evaluation of Setup Error Correction for Patients Using On Board Imager in Image Guided Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Soo Man [Dept. of Radiation Oncology, Kosin University Gospel Hospital, Busan (Korea, Republic of)

    2008-09-15

    To reduce side effects in image guided radiation therapy (IGRT) and to improve the quality of life of patients, also to meet accurate SETUP condition for patients, the various SETUP correction conditions were compared and evaluated by using on board imager (OBI) during the SETUP. Each 30 cases of the head, the neck, the chest, the belly, and the pelvis in 150 cases of IGRT patients was corrected after confirmation by using OBI at every 2-3 day. Also, the difference of the SETUP through the skin-marker and the anatomic SETUP through the OBI was evaluated. General SETUP errors (Transverse, Coronal, Sagittal) through the OBI at original SETUP position were Head and Neck: 1.3 mm, Brain: 2 mm, Chest: 3 mm, Abdoman: 3.7 mm, Pelvis: 4 mm. The patients with more that 3 mm in the error range were observed in the correction devices and the patient motions by confirming in treatment room. Moreover, in the case of female patients, the result came from the position of hairs during the Head and Neck, Brain tumor. Therefore, after another SETUP in each cases of over 3 mm in the error range, the treatment was carried out. Mean error values of each parts estimated after the correction were 1 mm for the head, 1.2 mm for the neck, 2.5 mm for the chest, 2.5 mm for the belly, and 2.6 mm for the pelvis. The result showed the correction of SETUP for each treatment through OBI is extremely difficult because of the importance of SETUP in radiation treatment. However, by establishing the average standard of the patients from this research result, the better patient satisfaction and treatment results could be obtained.

  9. The use of adaptive radiation therapy to reduce setup error: a prospective clinical study

    International Nuclear Information System (INIS)

    Yan Di; Wong, John; Vicini, Frank; Robertson, John; Horwitz, Eric; Brabbins, Donald; Cook, Carla; Gustafson, Gary; Stromberg, Jannifer; Martinez, Alvaro

    1996-01-01

    Purpose: Adaptive Radiation Therapy (ART) is a closed-loop feedback process where each patients treatment is adaptively optimized according to the individual variation information measured during the course of treatment. The process aims to maximize the benefits of treatment for the individual patient. A prospective study is currently being conducted to test the feasibility and effectiveness of ART for clinical use. The present study is limited to compensating the effects of systematic setup error. Methods and Materials: The study includes 20 patients treated on a linear accelerator equipped with a computer controlled multileaf collimator (MLC) and a electronic portal imaging device (EPID). Alpha cradles are used to immobilize those patients treated for disease in the thoracic and abdominal regions, and thermal plastic masks for the head and neck. Portal images are acquired daily. Setup error of each treatment field is quantified off-line every day. As determined from an earlier retrospective study of different clinical sites, the measured setup variation from the first 4 to 9 days, are used to estimate systematic setup error and the standard deviation of random setup error for each field. Setup adjustment is made if estimated systematic setup error of the treatment field was larger than or equal to 2 mm. Instead of the conventional approach of repositioning the patient, setup correction is implemented by reshaping MLC to compensate for the estimated systematic error. The entire process from analysis of portal images to the implementation of the modified MLC field is performed via computer network. Systematic and random setup errors of the treatment after adjustment are compared with those prior to adjustment. Finally, the frequency distributions of block overlap cumulated throughout the treatment course are evaluated. Results: Sixty-seven percent of all treatment fields were reshaped to compensate for the estimated systematic errors. At the time of this writing

  10. Tumor Localization Using Cone-Beam CT Reduces Setup Margins in Conventionally Fractionated Radiotherapy for Lung Tumors

    International Nuclear Information System (INIS)

    Yeung, Anamaria R.; Li, Jonathan G.; Shi Wenyin; Newlin, Heather E.; Chvetsov, Alexei; Liu, Chihray; Palta, Jatinder R.; Olivier, Kenneth

    2009-01-01

    Purpose: To determine whether setup margins can be reduced using cone-beam computed tomography (CBCT) to localize tumor in conventionally fractionated radiotherapy for lung tumors. Methods and Materials: A total of 22 lung cancer patients were treated with curative intent with conventionally fractionated radiotherapy using daily image guidance with CBCT. Of these, 13 lung cancer patients had sufficient CBCT scans for analysis (389 CBCT scans). The patients underwent treatment simulation in the BodyFix immobilization system using four-dimensional CT to account for respiratory motion. Daily alignment was first done according to skin tattoos, followed by CBCT. All 389 CBCT scans were retrospectively registered to the planning CT scans using automated soft-tissue and bony registration; the resulting couch shifts in three dimensions were recorded. Results: The daily alignment to skin tattoos with no image guidance resulted in systematic (Σ) and random (σ) errors of 3.2-5.6 mm and 2.0-3.5 mm, respectively. The margin required to account for the setup error introduced by aligning to skin tattoos with no image guidance was approximately 1-1.6 cm. The difference in the couch shifts obtained from the bone and soft-tissue registration resulted in systematic (Σ) and random (σ) errors of 1.5-4.1 mm and 1.8-5.3 mm, respectively. The margin required to account for the setup error introduced using bony anatomy as a surrogate for the target, instead of localizing the target itself, was 0.5-1.4 cm. Conclusion: Using daily CBCT soft-tissue registration to localize the tumor in conventionally fractionated radiotherapy reduced the required setup margin by up to approximately 1.5 cm compared with both no image guidance and image guidance using bony anatomy as a surrogate for the target.

  11. SU-E-J-44: A Novel Approach to Quantify Patient Setup and Target Motion for Real-Time Image-Guided Radiotherapy (IGRT)

    Energy Technology Data Exchange (ETDEWEB)

    Li, S; Charpentier, P; Sayler, E; Micaily, B; Miyamoto, C [Temple University Hospital, Phila., PA (United States); Geng, J [Xigen LLC, Gaithersburg, MD (United States)

    2015-06-15

    Purpose Isocenter shifts and rotations to correct patient setup errors and organ motion cannot remedy some shape changes of large targets. We are investigating new methods in quantification of target deformation for realtime IGRT of breast and chest wall cancer. Methods Ninety-five patients of breast or chest wall cancer were accrued in an IRB-approved clinical trial of IGRT using 3D surface images acquired at daily setup and beam-on time via an in-room camera. Shifts and rotations relating to the planned reference surface were determined using iterative-closest-point alignment. Local surface displacements and target deformation are measured via a ray-surface intersection and principal component analysis (PCA) of external surface, respectively. Isocenter shift, upper-abdominal displacement, and vectors of the surface projected onto the two principal components, PC1 and PC2, were evaluated for sensitivity and accuracy in detection of target deformation. Setup errors for some deformed targets were estimated by superlatively registering target volume, inner surface, or external surface in weekly CBCT or these outlines on weekly EPI. Results Setup difference according to the inner-surface, external surface, or target volume could be 1.5 cm. Video surface-guided setup agreed with EPI results to within < 0.5 cm while CBCT results were sometimes (∼20%) different from that of EPI (>0.5 cm) due to target deformation for some large breasts and some chest walls undergoing deep-breath-hold irradiation. Square root of PC1 and PC2 is very sensitive to external surface deformation and irregular breathing. Conclusion PCA of external surfaces is quick and simple way to detect target deformation in IGRT of breast and chest wall cancer. Setup corrections based on the target volume, inner surface, and external surface could be significant different. Thus, checking of target shape changes is essential for accurate image-guided patient setup and motion tracking of large deformable

  12. SU-F-T-519: Is Geometry Based Setup Sufficient for All of the Head and Neck Treatment Cases?: A Feasibility Study Towards the Dose Based Setup

    International Nuclear Information System (INIS)

    Lee, S; Chen, S; Zhang, B; Xu, H; Prado, K; D’Souza, W; Yi, B

    2016-01-01

    Purpose: This study compares the geometric-based setup (GBS) which is currently used in the clinic to a novel concept of dose-based setup (DBS) of head and neck (H&N) patients using cone beam CT (CBCT) of the day; and evaluates the clinical advantages. Methods: Ten H&N patients who underwent re-simulation and re-plan due to noticeable anatomic changes during the course of the treatments were retrospectively reviewed on dosimetric changes in the assumption of no plan modification was performed. RayStation planning system (RaySearch Laboratories AB, Sweden) was used to match (ROI fusion module) between prescribed isodoseline (IDL) in the CBCT imported along with ROIs from re-planned CT and the IDL of original plan (Dose-based setup: DBS). Then, the CBCT plan based on daily setup using the GBS (previously used for a patient) and the DBS CBCT plan recalculated in RayStation compared against the original CT-sim plan. Results: Most of patients’ tumor coverage and OAR doses got generally worsen when the CBCT plans were compared with original CT-sim plan with GBS. However, when DBS intervened, the OAR dose and tumor coverage was better than the GBS. For example, one of patients’ daily average doses of right parotid and oral cavity increased to 26% and 36%, respectively from the original plan to the GBS planning. However, it only increased by 13% and 24%, respectively with DBS. GTV D95 coverage also decreased by 16% with GBS, but only 2% decreased with DBS. Conclusion: DBS method is superior to GBS to prevent any abrupt dose changes to OARs as well as PTV/CTV or GTV at least for some H&N cases. Since it is not known when the DBS is beneficial to the GBS, a system which enables the on-line DBS may be helpful for better treatment of H&N.

  13. SU-F-T-519: Is Geometry Based Setup Sufficient for All of the Head and Neck Treatment Cases?: A Feasibility Study Towards the Dose Based Setup

    Energy Technology Data Exchange (ETDEWEB)

    Lee, S; Chen, S; Zhang, B; Xu, H; Prado, K; D’Souza, W; Yi, B [University of Maryland School of Medicine, Baltimore, MD (United States)

    2016-06-15

    Purpose: This study compares the geometric-based setup (GBS) which is currently used in the clinic to a novel concept of dose-based setup (DBS) of head and neck (H&N) patients using cone beam CT (CBCT) of the day; and evaluates the clinical advantages. Methods: Ten H&N patients who underwent re-simulation and re-plan due to noticeable anatomic changes during the course of the treatments were retrospectively reviewed on dosimetric changes in the assumption of no plan modification was performed. RayStation planning system (RaySearch Laboratories AB, Sweden) was used to match (ROI fusion module) between prescribed isodoseline (IDL) in the CBCT imported along with ROIs from re-planned CT and the IDL of original plan (Dose-based setup: DBS). Then, the CBCT plan based on daily setup using the GBS (previously used for a patient) and the DBS CBCT plan recalculated in RayStation compared against the original CT-sim plan. Results: Most of patients’ tumor coverage and OAR doses got generally worsen when the CBCT plans were compared with original CT-sim plan with GBS. However, when DBS intervened, the OAR dose and tumor coverage was better than the GBS. For example, one of patients’ daily average doses of right parotid and oral cavity increased to 26% and 36%, respectively from the original plan to the GBS planning. However, it only increased by 13% and 24%, respectively with DBS. GTV D95 coverage also decreased by 16% with GBS, but only 2% decreased with DBS. Conclusion: DBS method is superior to GBS to prevent any abrupt dose changes to OARs as well as PTV/CTV or GTV at least for some H&N cases. Since it is not known when the DBS is beneficial to the GBS, a system which enables the on-line DBS may be helpful for better treatment of H&N.

  14. Local Setup Reproducibility of the Spinal Column When Using Intensity-Modulated Radiation Therapy for Craniospinal Irradiation With Patient in Supine Position

    Energy Technology Data Exchange (ETDEWEB)

    Stoiber, Eva Maria, E-mail: eva.stoiber@med.uni-heidelberg.de [Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg (Germany); Department of Medical Physics, German Cancer Research Center, Heidelberg (Germany); Giske, Kristina [Department of Medical Physics, German Cancer Research Center, Heidelberg (Germany); Schubert, Kai; Sterzing, Florian; Habl, Gregor; Uhl, Matthias; Herfarth, Klaus [Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg (Germany); Bendl, Rolf [Department of Medical Physics, German Cancer Research Center, Heidelberg (Germany); Medical Informatics, Heilbronn University, Heilbronn (Germany); Debus, Juergen [Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg (Germany)

    2011-12-01

    Purpose: To evaluate local positioning errors of the lumbar spine during fractionated intensity-modulated radiotherapy of patients treated with craniospinal irradiation and to assess the impact of rotational error correction on these uncertainties for one patient setup correction strategy. Methods and Materials: 8 patients (6 adults, 2 children) treated with helical tomotherapy for craniospinal irradiation were retrospectively chosen for this analysis. Patients were immobilized with a deep-drawn Aquaplast head mask. Additionally to daily megavoltage control computed tomography scans of the skull, once-a-week positioning of the lumbar spine was assessed. Therefore, patient setup was corrected by a target point correction, derived from a registration of the patient's skull. The residual positioning variations of the lumbar spine were evaluated applying a rigid-registration algorithm. The impact of different rotational error corrections was simulated. Results: After target point correction, residual local positioning errors of the lumbar spine varied considerably. Craniocaudal axis rotational error correction did not improve or deteriorate these translational errors, whereas simulation of a rotational error correction of the right-left and anterior-posterior axis increased these errors by a factor of 2 to 3. Conclusion: The patient fixation used allows for deformations between the patient's skull and spine. Therefore, for the setup correction strategy evaluated in this study, generous margins for the lumbar spinal target volume are needed to prevent a local geographic miss. With any applied correction strategy, it needs to be evaluated whether or not a rotational error correction is beneficial.

  15. A method for patient set-up guidance in radiotherapy using augmented reality

    International Nuclear Information System (INIS)

    Talbot, J.; Meyer, J.; Watts, R.; Grasset, R.

    2009-01-01

    Full text: A system for patient set-up in external beam radiotherapy was developed using Augmented Reality (AR). Live images of the linac treatment couch and patient were obtained with video cameras and displayed on a nearby monitor. A 3D model of the patient's external contour was obtained from planning CT data, and AR tracking software was used to superimpose the model onto the video images in the correct position for treatment. Throughout set-up and treatment, the user can view the monitor and visually confirm that the patient is positioned correctly. To ensure that the virtual contour was displayed in the correct position, a process was devised to register the coordinates of the linac with the camera images. A cube with AR tracking markers attached to its faces was constructed for alignment with the isocentre using room lasers or cone-beam CT. The performance of the system was investigated in a clinical environment by using it to position an anthropomorphic phantom without the aid of additional set-up methods. The positioning errors were determined by means of CBCT and image registration. The translational set-up errors were found to be less than 2.4 mm and the rotational errors less than 0.3 0 . This proof-of-principle study has demonstrated the feasibility of using AR for patient position and pose guidance.

  16. Developing and implementing a high precision setup system

    Science.gov (United States)

    Peng, Lee-Cheng

    The demand for high-precision radiotherapy (HPRT) was first implemented in stereotactic radiosurgery using a rigid, invasive stereotactic head frame. Fractionated stereotactic radiotherapy (SRT) with a frameless device was developed along a growing interest in sophisticated treatment with a tight margin and high-dose gradient. This dissertation establishes the complete management for HPRT in the process of frameless SRT, including image-guided localization, immobilization, and dose evaluation. The most ideal and precise positioning system can allow for ease of relocation, real-time patient movement assessment, high accuracy, and no additional dose in daily use. A new image-guided stereotactic positioning system (IGSPS), the Align RT3C 3D surface camera system (ART, VisionRT), which combines 3D surface images and uses a real-time tracking technique, was developed to ensure accurate positioning at the first place. The uncertainties of current optical tracking system, which causes patient discomfort due to additional bite plates using the dental impression technique and external markers, are found. The accuracy and feasibility of ART is validated by comparisons with the optical tracking and cone-beam computed tomography (CBCT) systems. Additionally, an effective daily quality assurance (QA) program for the linear accelerator and multiple IGSPSs is the most important factor to ensure system performance in daily use. Currently, systematic errors from the phantom variety and long measurement time caused by switching phantoms were discovered. We investigated the use of a commercially available daily QA device to improve the efficiency and thoroughness. Reasonable action level has been established by considering dosimetric relevance and clinic flow. As for intricate treatments, the effect of dose deviation caused by setup errors remains uncertain on tumor coverage and toxicity on OARs. The lack of adequate dosimetric simulations based on the true treatment coordinates from

  17. A Simulation Study on Patient Setup Errors in External Beam Radiotherapy Using an Anthropomorphic 4D Phantom

    Directory of Open Access Journals (Sweden)

    Payam Samadi Miandoab

    2016-12-01

    Full Text Available Introduction Patient set-up optimization is required in radiotherapy to fill the accuracy gap between personalized treatment planning and uncertainties in the irradiation set-up. In this study, we aimed to develop a new method based on neural network to estimate patient geometrical setup using 4-dimensional (4D XCAT anthropomorphic phantom. Materials and Methods To access 4D modeling of motion of dynamic organs, a phantom employs non-uniform rational B-splines (NURBS-based Cardiac-Torso method with spline-based model to generate 4D computed tomography (CT images. First, to generate all the possible roto-translation positions, the 4D CT images were imported to Medical Image Data Examiner (AMIDE. Then, for automatic, real time verification of geometrical setup, an artificial neural network (ANN was proposed to estimate patient displacement, using training sets. Moreover, three external motion markers were synchronized with a patient couch position as reference points. In addition, the technique was validated through simulated activities by using reference 4D CT data acquired from five patients. Results The results indicated that patient geometrical set-up is highly depended on the comprehensiveness of training set. By using ANN model, the average patient setup error in XCAT phantom was reduced from 17.26 mm to 0.50 mm. In addition, in the five real patients, these average errors were decreased from 18.26 mm to 1.48 mm various breathing phases ranging from inhalation to exhalation were taken into account for patient setup. Uncertainty error assessment and different setup errors were obtained from each respiration phase. Conclusion This study proposed a new method for alignment of patient setup error using ANN model. Additionally, our correlation model (ANN could estimate true patient position with less error.

  18. Effectiveness of couch height-based patient set-up and an off-line correction protocol in prostate cancer radiotherapy

    International Nuclear Information System (INIS)

    Lin, Emile N.J.Th. van; Nijenhuis, Edwin; Huizenga, Henk; Vight, Lisette van der; Visser, Andries

    2001-01-01

    Purpose: To investigate set-up improvement caused by applying a couch height-based patient set-up method in combination with a technologist-driven off-line correction protocol in nonimmobilized radiotherapy of prostate patients. Methods and Materials: A three-dimensional shrinking action level correction protocol is applied in two consecutive patient cohorts with different set-up methods: the traditional 'laser set-up' group (n=43) and the 'couch height set-up' group (n=112). For all directions, left-right, ventro-dorsal, and cranio-caudal, random and systematic set-up deviations were measured. Results: The couch height set-up method improves the patient positioning compared to the laser set-up method. Without application of the correction protocol, both systematic and random errors reduced to 2.2-2.4 mm (1 SD) and 1.7-2.2 mm (1 SD), respectively. By using the correction protocol, systematic errors reduced further to 1.3-1.6 mm (1 SD). One-dimensional deviations were within 5 mm for >90% of the measured fractions. The required number of corrections per patient in the off-line correction protocol was reduced significantly during the course of treatment from 1.1 to 0.6 by the couch height set-up method. The treatment time was not prolonged by application of the correction protocol. Conclusions: The couch height set-up method improves the set-up significantly, especially in the ventro-dorsal direction. Combination of this set-up method with an off-line correction strategy, executed by technologists, reduces the number of set-up corrections required

  19. Setup uncertainties in linear accelerator based stereotactic radiosurgery and a derivation of the corresponding setup margin for treatment planning.

    Science.gov (United States)

    Zhang, Mutian; Zhang, Qinghui; Gan, Hua; Li, Sicong; Zhou, Su-min

    2016-02-01

    In the present study, clinical stereotactic radiosurgery (SRS) setup uncertainties from image-guidance data are analyzed, and the corresponding setup margin is estimated for treatment planning purposes. Patients undergoing single-fraction SRS at our institution were localized using invasive head ring or non-invasive thermoplastic masks. Setup discrepancies were obtained from an in-room x-ray patient position monitoring system. Post treatment re-planning using the measured setup errors was performed in order to estimate the individual target margins sufficient to compensate for the actual setup errors. The formula of setup margin for a general SRS patient population was derived by proposing a correlation between the three-dimensional setup error and the required minimal margin. Setup errors of 104 brain lesions were analyzed, in which 81 lesions were treated using an invasive head ring, and 23 were treated using non-invasive masks. In the mask cases with image guidance, the translational setup uncertainties achieved the same level as those in the head ring cases. Re-planning results showed that the margins for individual patients could be smaller than the clinical three-dimensional setup errors. The derivation of setup margin adequate to address the patient setup errors was demonstrated by using the arbitrary planning goal of treating 95% of the lesions with sufficient doses. With image guidance, the patient setup accuracy of mask cases can be comparable to that of invasive head rings. The SRS setup margin can be derived for a patient population with the proposed margin formula to compensate for the institution-specific setup errors. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  20. SU-D-BRF-04: Digital Tomosynthesis for Improved Daily Setup in Treatment of Liver Lesions

    International Nuclear Information System (INIS)

    Armstrong, H; Jones, B; Miften, M

    2014-01-01

    Purpose: Daily localization of liver lesions with cone-beam CT (CBCT) is difficult due to poor image quality caused by scatter, respiratory motion, and the lack of radiographic contrast between the liver parenchyma and the lesion(s). Digital tomosynthesis (DTS) is investigated as a modality to improve liver visualization and lesion/parenchyma contrast for daily setup. Methods: An in-house tool was developed to generate DTS images using a point-by-point filtered back-projection method from on-board CBCT projection data. DTS image planes are generated in a user defined orientation to visualize the anatomy at various depths. Reference DTS images are obtained from forward projection of the planning CT dataset at each projection angle. The CBCT DTS image set can then be registered to the reference DTS image set as a means for localization. Contour data from the planning CT's associate RT Structure file and forward projected similarly to the planning CT data. DTS images are created for each contoured structure, which can then be overlaid onto the DTS images for organ volume visualization. Results: High resolution DTS images generated from CBCT projections show fine anatomical detail, including small blood vessels, within the patient. However, the reference DTS images generated from forward projection of the planning CT lacks this level of detail due to the low resolution of the CT voxels as compared to the pixel size in the projection images; typically 1mm-by-1mm-by-3mm (lat, vrt, lng) for the planning CT vs. 0.4mm-by-0.4mm for CBCT projections. Overlaying of the contours onto the DTS image allows for visualization of structures of interest. Conclusion: The ability to generate DTS images over a limited range of projection angles allows for reduction in the amount of respiratory motion within each acquisition. DTS may provide improved visualization of structures and lesions as compared to CBCT for highly mobile tumors

  1. A dual centre study of setup accuracy for thoracic patients based on Cone-Beam CT data

    DEFF Research Database (Denmark)

    Nielsen, Tine B; Hansen, Vibeke N; Westberg, Jonas

    2011-01-01

    BACKGROUND AND PURPOSE: To compare setup uncertainties at two different institutions by using identical imaging and analysis techniques for thoracic patients with different fixation equipments. METHODS AND MATERIALS: Patient registration results from Cone-Beam CT (CBCT) scans of 174 patients were...... increase of the systematic setup uncertainties in between imaging fractions. A margin reduction of ⩾0.2cm can be achieved for patients with peak-to-peak respiration amplitudes of ⩾1.2cm when changing from 4D-CT to Active Breathing Coordinator™ (ABC). CONCLUSIONS: The setup uncertainties at the two...

  2. Patient set-up verification by infrared optical localization and body surface sensing in breast radiation therapy

    International Nuclear Information System (INIS)

    Spadea, Maria Francesca; Baroni, Guido; Riboldi, Marco; Orecchia, Roberto; Pedotti, Antonio; Tagaste, Barbara; Garibaldi, Cristina

    2006-01-01

    Background and purpose: The aim of the study was to investigate the clinical application of a technique for patient set-up verification in breast cancer radiotherapy, based on the 3D localization of a hybrid configuration of surface control points. Materials and methods: An infrared optical tracker provided the 3D position of two passive markers and 10 laser spots placed around and within the irradiation field on nine patients. A fast iterative constrained minimization procedure was applied to detect and compensate patient set-up errors, through the control points registration with reference data coming from treatment plan (markers reference position, CT-based surface model). Results: The application of the corrective spatial transformation estimated by the registration procedure led to significant improvement of patient set-up. Median value of 3D errors affecting three additional verification markers within the irradiation field decreased from 5.7 to 3.5 mm. Errors variability (25-75%) decreased from 3.2 to 2.1 mm. Laser spots registration on the reference surface model was documented to contribute substantially to set-up errors compensation. Conclusions: Patient set-up verification through a hybrid set of control points and constrained surface minimization algorithm was confirmed to be feasible in clinical practice and to provide valuable information for the improvement of the quality of patient set-up, with minimal requirement of operator-dependant procedures. The technique combines conveniently the advantages of passive markers based methods and surface registration techniques, by featuring immediate and robust estimation of the set-up accuracy from a redundant dataset

  3. Effect of patient setup errors on simultaneously integrated boost head and neck IMRT treatment plans

    International Nuclear Information System (INIS)

    Siebers, Jeffrey V.; Keall, Paul J.; Wu Qiuwen; Williamson, Jeffrey F.; Schmidt-Ullrich, Rupert K.

    2005-01-01

    Purpose: The purpose of this study is to determine dose delivery errors that could result from random and systematic setup errors for head-and-neck patients treated using the simultaneous integrated boost (SIB)-intensity-modulated radiation therapy (IMRT) technique. Methods and Materials: Twenty-four patients who participated in an intramural Phase I/II parotid-sparing IMRT dose-escalation protocol using the SIB treatment technique had their dose distributions reevaluated to assess the impact of random and systematic setup errors. The dosimetric effect of random setup error was simulated by convolving the two-dimensional fluence distribution of each beam with the random setup error probability density distribution. Random setup errors of σ = 1, 3, and 5 mm were simulated. Systematic setup errors were simulated by randomly shifting the patient isocenter along each of the three Cartesian axes, with each shift selected from a normal distribution. Systematic setup error distributions with Σ = 1.5 and 3.0 mm along each axis were simulated. Combined systematic and random setup errors were simulated for σ = Σ = 1.5 and 3.0 mm along each axis. For each dose calculation, the gross tumor volume (GTV) received by 98% of the volume (D 98 ), clinical target volume (CTV) D 90 , nodes D 90 , cord D 2 , and parotid D 50 and parotid mean dose were evaluated with respect to the plan used for treatment for the structure dose and for an effective planning target volume (PTV) with a 3-mm margin. Results: Simultaneous integrated boost-IMRT head-and-neck treatment plans were found to be less sensitive to random setup errors than to systematic setup errors. For random-only errors, errors exceeded 3% only when the random setup error σ exceeded 3 mm. Simulated systematic setup errors with Σ = 1.5 mm resulted in approximately 10% of plan having more than a 3% dose error, whereas a Σ = 3.0 mm resulted in half of the plans having more than a 3% dose error and 28% with a 5% dose error

  4. Primary headache diagnosis among chronic daily headache patients

    Directory of Open Access Journals (Sweden)

    Krymchantowski Abouch Valenty

    2003-01-01

    Full Text Available Chronic daily headache (CDH refers to a group of non-paroxysmal daily or near-daily headaches with peculiar characteristics that are highly prevalent in populations of neurological clinics and not uncommon among non-patient populations. Most of the patients with CDH had, as primary diagnosis, episodic migraine, which, with the time, presented a progressive frequency, pattern modification and loss of specific migraine characteristics. Other CDH patients had chronic tension-type headache, new daily persistent headache and hemicrania continua, which evolved thru the time to the daily or near-daily presentation. The objective of this study was to determine the primary headache diagnosis among a population of chronic daily headache patients attending a tertiary center for headache treatment. During a 5-year period 651 consecutive chronic daily headache patients attending a private subspecialty center were studied prospectively. The criteria adopted were those proposed by Silberstein et al (1994, revised 1996. Five hundred seventy four patients (88.1% had episodic migraine as primary headache before turning into daily presentation, 52 (8% had chronic tension-type headache, 14 (2.2% had hemicrania continua and 11 patients (1.7% had new daily persistent headache. CDH is quite frequent in patients from clinic-based studies suggesting a high degree of disability. Emphasis on education of patients suffering from frequent primary headaches with regard to measures that are able to decrease suffering and disability as well as better medical education directed to more efficient ways to handle these patients are necessary to improve outcome of such a prevalent condition.

  5. Cone Beam Computed Tomography Guidance for Setup of Patients Receiving Accelerated Partial Breast Irradiation

    International Nuclear Information System (INIS)

    White, Elizabeth A.; Cho, John; Vallis, Katherine A.; Sharpe, Michael B.; Lee, Grace B.Sc.; Blackburn, Helen; Nageeti, Tahani; McGibney, Carol; Jaffray, David A.

    2007-01-01

    Purpose: To evaluate the role of cone-beam CT (CBCT) guidance for setup error reduction and soft tissue visualization in accelerated partial breast irradiation (APBI). Methods and Materials: Twenty patients were recruited for the delivery of radiotherapy to the postoperative cavity (3850 cGy in 10 fractions over 5 days) using an APBI technique. Cone-beam CT data sets were acquired after an initial skin-mark setup and before treatment delivery. These were registered online using the ipsilateral lung and external contours. Corrections were executed for translations exceeding 3 mm. The random and systematic errors associated with setup using skin-marks and setup using CBCT guidance were calculated and compared. Results: A total of 315 CBCT data sets were analyzed. The systematic errors for the skin-mark setup were 2.7, 1.7, and 2.4 mm in the right-left, anterior-posterior, and superior-inferior directions, respectively. These were reduced to 0.8, 0.7, and 0.8 mm when CBCT guidance was used. The random errors were reduced from 2.4, 2.2, and 2.9 mm for skin-marks to 1.5, 1.5, and 1.6 mm for CBCT guidance in the right-left, anterior-posterior, and superior-inferior directions, respectively. Conclusion: A skin-mark setup for APBI patients is sufficient for current planning target volume margins for the population of patients studied here. Online CBCT guidance minimizes the occurrence of large random deviations, which may have a greater impact for the accelerated fractionation schedule used in APBI. It is also likely to permit a reduction in planning target volume margins and provide skin-line visualization and dosimetric evaluation of cardiac and lung volumes

  6. The dose distribution and DVH change analysis wing to effect of the patient setup error

    International Nuclear Information System (INIS)

    Kim, Kyung Tae; Ju, Sang Gyu; Ahn, Jae Hong; Park, Young Hwan

    2004-01-01

    The setup error due to the patient and the staff from radiation treatment as the reason which is important the treatment record could be decided is a possibility of effect. The SET-UP ERROR of the patient analyzes the effect of dose distribution and DVH from radiation treatment of the patient. This test uses human phantom and when C-T scan doing, It rotated the Left direction of the human phantom and it made SET-UP ERROR, Standard plan and 3 mm, 5 mm, 7 mm, 10 mm, 15 mm, 20 mm with to distinguish, it made the C-T scan error. With the result, The SET-UP ERROR got each C-T image Using RTP equipment It used the plan which is used generally from clinical - Box plan, 3 Dimension plan( identical angle 5beam plan) Also, ( CTV+1cm margin, CTV+0.5cm margin, CTV+0.3,cm margin = PTV) it distinguished the standard plan and each set-up error plan and the plan used a dose distribution and the DVH and it analyzed. The Box 4 the plan and 3 Dimension plan which it bites it got similar an dose distribution and DVH in 3 mm, 5 mm From rotation error and Rectilinear movement (0%-2%). Rotation error and rectilinear error 7 mm, 10 mm, 15 mm, 20 mm appeared effect it will go mad to a enough change in treatment (2%-11%) The diminishes the effect of the SET-UP ERROR must reduce move with tension of the patient Also, we are important accessory development and the supply that it reducing of reproducibility and the move.

  7. Calculation errors of Set-up in patients with tumor location of prostate. Exploratory study; Calculo de errores de Set-up en pacientes con localizacion tumoral de prostata. Estudio exploratorio

    Energy Technology Data Exchange (ETDEWEB)

    Donis Gil, S.; Robayna Duque, B. E.; Jimenez Sosa, A.; Hernandez Armas, O.; Gonzalez Martin, A. E.; Hernandez Armas, J.

    2013-07-01

    The calculation of SM is done from errors in positioning (set-up). These errors are calculated from movements in 3D of the patient. This paper is an exploratory study of 20 patients with tumor location of prostate in which errors of set-up for two protocols of work are evaluated. (Author)

  8. Daily variations in delivered doses in patients treated with radiotherapy for localized prostate cancer

    International Nuclear Information System (INIS)

    Kupelian, Patrick A.; Langen, Katja M.; Zeidan, Omar A.; Meeks, Sanford L.; Willoughby, Twyla R.; Wagner, Thomas H.; Jeswani, Sam; Ruchala, Kenneth J.; Haimerl, Jason; Olivera, Gustavo H.

    2006-01-01

    Purpose: The aim of this work was to study the variations in delivered doses to the prostate, rectum, and bladder during a full course of image-guided external beam radiotherapy. Methods and Materials: Ten patients with localized prostate cancer were treated with helical tomotherapy to 78 Gy at 2 Gy per fraction in 39 fractions. Daily target localization was performed using intraprostatic fiducials and daily megavoltage pelvic computed tomography (CT) scans, resulting in a total of 390 CT scans. The prostate, rectum, and bladder were manually contoured on each CT by a single physician. Daily dosimetric analysis was performed with dose recalculation. The study endpoints were D95 (dose to 95% of the prostate), rV2 (absolute rectal volume receiving 2 Gy), and bV2 (absolute bladder volume receiving 2 Gy). Results: For the entire cohort, the average D95 (±SD) was 2.02 ± 0.04 Gy (range, 1.79-2.20 Gy). The average rV2 (±SD) was 7.0 ± 8.1 cc (range, 0.1-67.3 cc). The average bV2 (±SD) was 8.7 ± 6.8 cc (range, 0.3-36.8 cc). Unlike doses for the prostate, there was significant daily variation in rectal and bladder doses, mostly because of variations in volume and shape of these organs. Conclusion: Large variations in delivered doses to the rectum and bladder can be documented with daily megavoltage CT scans. Image guidance for the targeting of the prostate, even with intraprostatic fiducials, does not take into account the variation in actual rectal and bladder doses. The clinical impact of techniques that take into account such dosimetric parameters in daily patient set-ups should be investigated

  9. Comparison of prostate set-up accuracy and margins with off-line bony anatomy corrections and online implanted fiducial-based corrections.

    Science.gov (United States)

    Greer, P B; Dahl, K; Ebert, M A; Wratten, C; White, M; Denham, J W

    2008-10-01

    The aim of the study was to determine prostate set-up accuracy and set-up margins with off-line bony anatomy-based imaging protocols, compared with online implanted fiducial marker-based imaging with daily corrections. Eleven patients were treated with implanted prostate fiducial markers and online set-up corrections. Pretreatment orthogonal electronic portal images were acquired to determine couch shifts and verification images were acquired during treatment to measure residual set-up error. The prostate set-up errors that would result from skin marker set-up, off-line bony anatomy-based protocols and online fiducial marker-based corrections were determined. Set-up margins were calculated for each set-up technique using the percentage of encompassed isocentres and a margin recipe. The prostate systematic set-up errors in the medial-lateral, superior-inferior and anterior-posterior directions for skin marker set-up were 2.2, 3.6 and 4.5 mm (1 standard deviation). For our bony anatomy-based off-line protocol the prostate systematic set-up errors were 1.6, 2.5 and 4.4 mm. For the online fiducial based set-up the results were 0.5, 1.4 and 1.4 mm. A prostate systematic error of 10.2 mm was uncorrected by the off-line bone protocol in one patient. Set-up margins calculated to encompass 98% of prostate set-up shifts were 11-14 mm with bone off-line set-up and 4-7 mm with online fiducial markers. Margins from the van Herk margin recipe were generally 1-2 mm smaller. Bony anatomy-based set-up protocols improve the group prostate set-up error compared with skin marks; however, large prostate systematic errors can remain undetected or systematic errors increased for individual patients. The margin required for set-up errors was found to be 10-15 mm unless implanted fiducial markers are available for treatment guidance.

  10. Speed and amplitude of lung tumor motion precisely detected in four-dimensional setup and in real-time tumor-tracking radiotherapy

    International Nuclear Information System (INIS)

    Shirato, Hiroki; Suzuki, Keishiro; Sharp, Gregory C.; Fujita, Katsuhisa R.T.; Onimaru, Rikiya; Fujino, Masaharu; Kato, Norio; Osaka, Yasuhiro; Kinoshita, Rumiko; Taguchi, Hiroshi; Onodera, Shunsuke; Miyasaka, Kazuo

    2006-01-01

    Background: To reduce the uncertainty of registration for lung tumors, we have developed a four-dimensional (4D) setup system using a real-time tumor-tracking radiotherapy system. Methods and Materials: During treatment planning and daily setup in the treatment room, the trajectory of the internal fiducial marker was recorded for 1 to 2 min at the rate of 30 times per second by the real-time tumor-tracking radiotherapy system. To maximize gating efficiency, the patient's position on the treatment couch was adjusted using the 4D setup system with fine on-line remote control of the treatment couch. Results: The trajectory of the marker detected in the 4D setup system was well visualized and used for daily setup. Various degrees of interfractional and intrafractional changes in the absolute amplitude and speed of the internal marker were detected. Readjustments were necessary during each treatment session, prompted by baseline shifting of the tumor position. Conclusion: The 4D setup system was shown to be useful for reducing the uncertainty of tumor motion and for increasing the efficiency of gated irradiation. Considering the interfractional and intrafractional changes in speed and amplitude detected in this study, intercepting radiotherapy is the safe and cost-effective method for 4D radiotherapy using real-time tracking technology

  11. Alternated prone and supine whole-breast irradiation using IMRT: setup precision, respiratory movement and treatment time.

    Science.gov (United States)

    Veldeman, Liv; De Gersem, Werner; Speleers, Bruno; Truyens, Bart; Van Greveling, Annick; Van den Broecke, Rudy; De Neve, Wilfried

    2012-04-01

    The objective of this study was to compare setup precision, respiration-related breast movement and treatment time between prone and supine positions for whole-breast irradiation. Ten patients with early-stage breast carcinoma after breast-conserving surgery were treated with prone and supine whole breast-irradiation in a daily alternating schedule. Setup precision was monitored using cone-beam computed tomography (CBCT) imaging. Respiration-related breast movement in the vertical direction was assessed by magnetic sensors. The time needed for patient setup and for the CBCT procedure, the beam time, and the length of the whole treatment slot were also recorded. Random and systematic errors were not significantly different between positions in individual patients for each of the three axes (left-right, longitudinal, and vertical). Respiration-related movement was smaller in prone position, but about 80% of observations showed amplitudes movement was smaller in prone position. The longer treatment slots in prone position can probably be attributed to the higher repositioning need. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Extracranial stereotactic radiation therapy: set-up accuracy of patients treated for liver metastases

    International Nuclear Information System (INIS)

    Herfarth, K.K.; Debus, J.; Lohr, F.; Bahner, M.L.; Fritz, P.; Hoess, A.; Schlegel, W. Ph.D.; Wannenmacher, M.F.

    2000-01-01

    Purpose: Patients with liver metastases might benefit from high-dose conformal radiation therapy. A high accuracy of repositioning and a reduction of target movement are necessary for such an approach. The set-up accuracy of patients with liver metastases treated with stereotactic single dose radiation was evaluated. Methods and Materials: Twenty-four patients with liver metastases were treated with single dose radiation therapy on 26 occasions using a self-developed stereotactic frame. Liver movement was reduced by abdominal pressure. The effectiveness was evaluated under fluoroscopy. CT scans were performed on the planning day and directly before treatment. Representative reference marks were chosen and the coordinates were calculated. In addition, the target displacement was quantitatively evaluated after treatment. Results: Diaphragmal movement was reduced to median 7 mm (range: 3-13 mm). The final set-up accuracy of the body was limited to all of median 1.8 mm in latero-lateral direction (range: 0.3-5.0 mm) and 2.0 mm in anterior-posterior direction (0.8-3.8 mm). Deviations of the body in cranio-caudal direction were always less than the thickness of one CT slice (<5 mm). However, a repositioning was necessary in 16 occasions. The final target shift was median 1.6 mm (0.2-7.0 mm) in latero-lateral and 2.3 mm in anterior-posterior direction (0.0-6.3 mm). The median shift in cranio-caudal direction was 4.4 mm (0.0-10.0 mm). Conclusions: In patients with liver metastases, a high set-up accuracy of the body and the target can be achieved. This allows a high-dose focal radiotherapy of these lesions. However, a control CT scan should be performed directly before therapy to confirm set-up accuracy and possibly prompt necessary corrections

  13. Estimation of Setup Uncertainty Using Planar and MVCT Imaging for Gynecologic Malignancies

    International Nuclear Information System (INIS)

    Santanam, Lakshmi; Esthappan, Jacqueline; Mutic, Sasa; Klein, Eric E.; Goddu, S. Murty; Chaudhari, Summer; Wahab, Sasha; El Naqa, Issam M.; Low, Daniel A.; Grigsby, Perry W.

    2008-01-01

    Purpose: This prospective study investigates gynecologic malignancy online treatment setup error corrections using planar kilovoltage/megavoltage (KV/MV) imaging and helical MV computed tomography (MVCT) imaging. Methods and Materials: Twenty patients were divided into two groups. The first group (10 patients) was imaged and treated using a conventional linear accelerator (LINAC) with image-guidance capabilities, whereas the second group (10 patients) was treated using tomotherapy with MVCT capabilities. Patients treated on the LINAC underwent planar KV and portal MV imaging and a two-dimensional image registration algorithm was used to match these images to digitally reconstructed radiographs (DRRs). Patients that were treated using tomotherapy underwent MVCT imaging, and a three-dimensional image registration algorithm was used to match planning CT to MVCT images. Subsequent repositioning shifts were applied before each treatment and recorded for further analysis. To assess intrafraction motion, 5 of the 10 patients treated on the LINAC underwent posttreatment planar imaging and DRR matching. Based on these data, patient position uncertainties along with estimated margins based on well-known recipes were determined. Results: The errors associated with patient positioning ranged from 0.13 cm to 0.38 cm, for patients imaged on LINAC and 0.13 cm to 0.48 cm for patients imaged on tomotherapy. Our institutional clinical target volume-PTV margin value of 0.7 cm lies inside the confidence interval of the margins established using both planar and MVCT imaging. Conclusion: Use of high-quality daily planar imaging, volumetric MVCT imaging, and setup corrections yields excellent setup accuracy and can help reduce margins for the external beam treatment of gynecologic malignancies

  14. Accuracy in tangential breast treatment set-up

    International Nuclear Information System (INIS)

    Tienhoven, G. van; Lanson, J.H.; Crabeels, D.; Heukelom, S.; Mijnheer, B.J.

    1991-01-01

    To test accuracy and reproducibility of tangential breast treatment set-up used in The Netherlands Cancer Institute, a portal imaging study was performed in 12 patients treated for early stage breast cancer. With an on-line electronic portal imaging device (EPID) images were obtained of each patient in several fractions and compared with simulator films and with each other. In 5 patients multiple images (on the average 7) per fraction were obtained to evaluate set-up variations due to respiratory movement. The central lung distance (CLD) and other set-up parameters varied within 1 fraction about 1mm (1SD). The average variation of these parameters between various fractions was about 2 mm (1SD). The differences between simulator and treatment set-up over all patients and all fractions was on the average 2-3mm for the central beam edge to skin distance and CLD. It can be concluded that the tangential breast treatment set-up is very stable and reproducible and that respiration does not have a significant influence on treatment volume. EPID appears to be an adequate tool for studies of treatment set-up accuracy like this. (author). 35 refs.; 2 figs.; 3 tabs

  15. Alternated Prone and Supine Whole-Breast Irradiation Using IMRT: Setup Precision, Respiratory Movement and Treatment Time

    International Nuclear Information System (INIS)

    Veldeman, Liv; De Gersem, Werner; Speleers, Bruno; Truyens, Bart; Van Greveling, Annick; Van den Broecke, Rudy; De Neve, Wilfried

    2012-01-01

    Purpose: The objective of this study was to compare setup precision, respiration-related breast movement and treatment time between prone and supine positions for whole-breast irradiation. Methods and Materials: Ten patients with early-stage breast carcinoma after breast-conserving surgery were treated with prone and supine whole breast-irradiation in a daily alternating schedule. Setup precision was monitored using cone-beam computed tomography (CBCT) imaging. Respiration-related breast movement in the vertical direction was assessed by magnetic sensors. The time needed for patient setup and for the CBCT procedure, the beam time, and the length of the whole treatment slot were also recorded. Results: Random and systematic errors were not significantly different between positions in individual patients for each of the three axes (left-right, longitudinal, and vertical). Respiration-related movement was smaller in prone position, but about 80% of observations showed amplitudes <1 mm in both positions. Treatment slots were longer in prone position (21.2 ± 2.5 min) than in supine position (19.4 ± 0.8 min; p = 0.044). Conclusion: Comparison of setup precision between prone and supine position in the same patient showed no significant differences in random and systematic errors. Respiratory movement was smaller in prone position. The longer treatment slots in prone position can probably be attributed to the higher repositioning need.

  16. Efficient on-line setup correction strategies using plan-intent functions

    International Nuclear Information System (INIS)

    Keller, Harry; Jaffray, David A.; Rosewall, Tara; White, Elizabeth

    2006-01-01

    With the introduction of image-guided radiation therapy (IGRT) delivery systems on-line set-up correction strategies have gained in popularity. Usually, the correction workload of these strategies is high compared to off-line strategies as daily setup corrections have to be performed based on a predefined action level. In this work, it is proposed that on-line strategies must not only be judged in terms of workload but also in terms of efficacy. While workload can be easily predicted for such strategies, the efficacy must ultimately reflect the efficiency with which the original treatment plan intent is met. The purpose of this work is to investigate the tradeoff between workload and efficacy of three different on-line set-up correction strategies: The common fixed action level strategy and two novel on-line setup correction strategies, i.e., a dose-volume histogram (DVH) constraint and an equivalent uniform dose (EUD) score strategy that aim directly for better compliance with original treatment plan intent. All strategies were reformulated in terms of a score function that reflected treatment plan intent. A retrospective study was conducted on 5 prostate patients (7-field conformal, 79.8 Gy, 42 fractions). PTV margins were 10 mm except in the posterior direction (7 mm). The original treatment plan intent for these patients was defined using a set of DVH constraints. The results show that the on-line setup correction strategy based on a fixed action level of 3 mm resulted in a considerable correction workload. For larger action levels, a dose benefit (in terms of EUD) in the rectum and bladder was observed for all patients which is clinically ''fortuitous'' but difficult to take advantage of. In contrast, the application of the two novel strategies generally resulted in a controlled decrease of the dose to the rectum and the bladder with a smaller workload. It is concluded that using information about target anatomy and the planned dose distribution allows the

  17. Quantifying Appropriate PTV Setup Margins: Analysis of Patient Setup Fidelity and Intrafraction Motion Using Post-Treatment Megavoltage Computed Tomography Scans

    International Nuclear Information System (INIS)

    Drabik, Donata M.; MacKenzie, Marc A.; Fallone, Gino B.

    2007-01-01

    Purpose: To present a technique that can be implemented in-house to evaluate the efficacy of immobilization and image-guided setup of patients with different treatment sites on helical tomotherapy. This technique uses an analysis of alignment shifts between kilovoltage computed tomography and post-treatment megavoltage computed tomography images. The determination of the shifts calculated by the helical tomotherapy software for a given site can then be used to define appropriate planning target volume internal margins. Methods and Materials: Twelve patients underwent post-treatment megavoltage computed tomography scans on a helical tomotherapy machine to assess patient setup fidelity and net intrafraction motion. Shifts were studied for the prostate, head and neck, and glioblastoma multiforme. Analysis of these data was performed using automatic and manual registration of the kilovoltage computed tomography and post-megavoltage computed tomography images. Results: The shifts were largest for the prostate, followed by the head and neck, with glioblastoma multiforme having the smallest shifts in general. It appears that it might be more appropriate to use asymmetric planning target volume margins. Each margin value reported is equal to two standard deviations of the average shift in the given direction. Conclusion: This method could be applied using individual patient post-image scanning and combined with adaptive planning to reduce or increase the margins as appropriate

  18. Comparison of prostate set-up accuracy and margins with off-line bony anatomy corrections and online implanted fiducial-based corrections

    International Nuclear Information System (INIS)

    Greer, P. B.; Dahl, K.; Ebert, M. A.; Wratten, C.; White, M.; Denham, K. W.

    2008-01-01

    Full text: The aim of the study was to determine prostate set-up accuracy and set-up margins with off-line bony anatomy-based imaging protocols, compared with online implanted fiducial marker-based imaging with daily corrections. Eleven patients were treated with implanted prostate fiducial markers and online set-up corrections. Pretreatment orthogonal electronic portal images were acquired to determine couch shifts and verification images were acquired during treatment to measure residual set-up error. The prostate set-up errors that would result from skin marker set-up, off-line bony anatomy-based protocols and online fiducial marker-based corrections were determined. Set-up margins were calculated for each set-up technique using the percentage of encompassed isocentres land a margin recipe. The prostate systematic set-up errors in the medial-lateral, superior-inferior and anterior-I posterior directions for skin marker set-up were 2.2, 3.6 and 4.5 mm (1 standard deviation). For our bony anatomy-I based off-line protocol the prostate systematic set-up errors were 1.6, 2.5 and 4.4 mm. For the online fiducial based set-up the results were 0.5, 1.4 and 1.4 mm. A prostate systematic error of 10.2 mm was uncorrected by the off-line bone protocol in one patient. Set-up margins calculated to encompass 98% of prostate set-up shifts were 111-14 mm with bone off-line set-up and 4-7 mm with online fiducial markers. Margins from the van Herk margin I recipe were generally 1-2 mm smaller. Bony anatomy-based set-up protocols improve the group prostate set-up error compared with skin marks; however, large prostate systematic errors can remain undetected or systematic (errors increased for individual patients. The margin required for set-up errors was found to be 10-15 mm unless I implanted fiducial markers are available for treatment guidance.

  19. Automated Patient Identification and Localization Error Detection Using 2-Dimensional to 3-Dimensional Registration of Kilovoltage X-Ray Setup Images

    International Nuclear Information System (INIS)

    Lamb, James M.; Agazaryan, Nzhde; Low, Daniel A.

    2013-01-01

    Purpose: To determine whether kilovoltage x-ray projection radiation therapy setup images could be used to perform patient identification and detect gross errors in patient setup using a computer algorithm. Methods and Materials: Three patient cohorts treated using a commercially available image guided radiation therapy (IGRT) system that uses 2-dimensional to 3-dimensional (2D-3D) image registration were retrospectively analyzed: a group of 100 cranial radiation therapy patients, a group of 100 prostate cancer patients, and a group of 83 patients treated for spinal lesions. The setup images were acquired using fixed in-room kilovoltage imaging systems. In the prostate and cranial patient groups, localizations using image registration were performed between computed tomography (CT) simulation images from radiation therapy planning and setup x-ray images corresponding both to the same patient and to different patients. For the spinal patients, localizations were performed to the correct vertebral body, and to an adjacent vertebral body, using planning CTs and setup x-ray images from the same patient. An image similarity measure used by the IGRT system image registration algorithm was extracted from the IGRT system log files and evaluated as a discriminant for error detection. Results: A threshold value of the similarity measure could be chosen to separate correct and incorrect patient matches and correct and incorrect vertebral body localizations with excellent accuracy for these patient cohorts. A 10-fold cross-validation using linear discriminant analysis yielded misclassification probabilities of 0.000, 0.0045, and 0.014 for the cranial, prostate, and spinal cases, respectively. Conclusions: An automated measure of the image similarity between x-ray setup images and corresponding planning CT images could be used to perform automated patient identification and detection of localization errors in radiation therapy treatments

  20. Automated Patient Identification and Localization Error Detection Using 2-Dimensional to 3-Dimensional Registration of Kilovoltage X-Ray Setup Images

    Energy Technology Data Exchange (ETDEWEB)

    Lamb, James M., E-mail: jlamb@mednet.ucla.edu; Agazaryan, Nzhde; Low, Daniel A.

    2013-10-01

    Purpose: To determine whether kilovoltage x-ray projection radiation therapy setup images could be used to perform patient identification and detect gross errors in patient setup using a computer algorithm. Methods and Materials: Three patient cohorts treated using a commercially available image guided radiation therapy (IGRT) system that uses 2-dimensional to 3-dimensional (2D-3D) image registration were retrospectively analyzed: a group of 100 cranial radiation therapy patients, a group of 100 prostate cancer patients, and a group of 83 patients treated for spinal lesions. The setup images were acquired using fixed in-room kilovoltage imaging systems. In the prostate and cranial patient groups, localizations using image registration were performed between computed tomography (CT) simulation images from radiation therapy planning and setup x-ray images corresponding both to the same patient and to different patients. For the spinal patients, localizations were performed to the correct vertebral body, and to an adjacent vertebral body, using planning CTs and setup x-ray images from the same patient. An image similarity measure used by the IGRT system image registration algorithm was extracted from the IGRT system log files and evaluated as a discriminant for error detection. Results: A threshold value of the similarity measure could be chosen to separate correct and incorrect patient matches and correct and incorrect vertebral body localizations with excellent accuracy for these patient cohorts. A 10-fold cross-validation using linear discriminant analysis yielded misclassification probabilities of 0.000, 0.0045, and 0.014 for the cranial, prostate, and spinal cases, respectively. Conclusions: An automated measure of the image similarity between x-ray setup images and corresponding planning CT images could be used to perform automated patient identification and detection of localization errors in radiation therapy treatments.

  1. Automated patient identification and localization error detection using 2-dimensional to 3-dimensional registration of kilovoltage x-ray setup images.

    Science.gov (United States)

    Lamb, James M; Agazaryan, Nzhde; Low, Daniel A

    2013-10-01

    To determine whether kilovoltage x-ray projection radiation therapy setup images could be used to perform patient identification and detect gross errors in patient setup using a computer algorithm. Three patient cohorts treated using a commercially available image guided radiation therapy (IGRT) system that uses 2-dimensional to 3-dimensional (2D-3D) image registration were retrospectively analyzed: a group of 100 cranial radiation therapy patients, a group of 100 prostate cancer patients, and a group of 83 patients treated for spinal lesions. The setup images were acquired using fixed in-room kilovoltage imaging systems. In the prostate and cranial patient groups, localizations using image registration were performed between computed tomography (CT) simulation images from radiation therapy planning and setup x-ray images corresponding both to the same patient and to different patients. For the spinal patients, localizations were performed to the correct vertebral body, and to an adjacent vertebral body, using planning CTs and setup x-ray images from the same patient. An image similarity measure used by the IGRT system image registration algorithm was extracted from the IGRT system log files and evaluated as a discriminant for error detection. A threshold value of the similarity measure could be chosen to separate correct and incorrect patient matches and correct and incorrect vertebral body localizations with excellent accuracy for these patient cohorts. A 10-fold cross-validation using linear discriminant analysis yielded misclassification probabilities of 0.000, 0.0045, and 0.014 for the cranial, prostate, and spinal cases, respectively. An automated measure of the image similarity between x-ray setup images and corresponding planning CT images could be used to perform automated patient identification and detection of localization errors in radiation therapy treatments. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. SU-E-J-90: MRI-Based Treatment Simulation and Patient Setup for Radiation Therapy of Brain Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Y [UCLA School of Medicine, Los Angeles, AA (United States); Cao, M; Han, F; Santhanam, A; Neylon, J; Gomez, C; Kaprealian, T; Sheng, K; Agazaryan, N; Low, D; Hu, P

    2014-06-01

    Purpose: Traditional radiation therapy of cancer is heavily dependent on CT. CT provides excellent depiction of the bones but lacks good soft tissue contrast, which makes contouring difficult. Often, MRIs are fused with CT to take advantage of its superior soft tissue contrast. Such an approach has drawbacks. It is desirable to perform treatment simulation entirely based on MRI. To achieve MR-based simulation for radiation therapy, bone imaging is an important challenge because of the low MR signal intensity from bone due to its ultra-short T2 and T1, which presents difficulty for both dose calculation and patient setup in terms of digitally reconstructed radiograph (DRR) generation. Current solutions will either require manual bone contouring or multiple MR scans. We present a technique to generate DRR using MRI with an Ultra Short Echo Time (UTE) sequence which is applicable to both OBI and ExacTrac 2D patient setup. Methods: Seven brain cancer patients were scanned at 1.5 Tesla using a radial UTE sequence. The sequence acquires two images at two different echo times. The two images were processed using in-house software. The resultant bone images were subsequently loaded into commercial systems to generate DRRs. Simulation and patient clinical on-board images were used to evaluate 2D patient setup with MRI-DRRs. Results: The majority bones are well visualized in all patients. The fused image of patient CT with the MR bone image demonstrates the accuracy of automatic bone identification using our technique. The generated DRR is of good quality. Accuracy of 2D patient setup by using MRI-DRR is comparable to CT-based 2D patient setup. Conclusion: This study shows the potential of DRR generation with single MR sequence. Further work will be needed on MR sequence development and post-processing procedure to achieve robust MR bone imaging for other human sites in addition to brain.

  3. Registration quality evaluator: application to automated patient setup verification in radiotherapy

    Science.gov (United States)

    Wu, Jian; Samant, Sanjiv S.

    2004-05-01

    An image registration quality evaluator (RQE) is proposed to automatically quantify the accuracy of registrations. The RQE, based on an adaptive pattern classifier, is generated from a pair of reference and target images. It is unique to each patient, anatomical site and imaging modality. RQE is applied to patient positioning in cranial radiotherapy using portal/portal and portal/DRR registrations. We adopted 1mm translation and 1° rotation as the maximal acceptable registration errors, reflecting typical clinical setup tolerances. RQE is used to determine the acceptability of a registration. The performance of RQE was evaluated using phantom images containing radio-opaque fiducial markers. Using receiver operating characteristic (ROC) analysis, we estimated the sensitivity and the specificity of the RQE are 0.95 (with 0.89-0.98 confidence interval (CI) at 95% significance level) and 0.95 (with 0.88-0.98 CI at 95% significance level) respectively for intramodal RQE. For intermodal RQE, the sensitivity and the specificity are 0.92 (with 0.81-0.98 CI at 95% significance level) and 0.98 (with 0.89-0.99 CI at 95% significance level) respectively. Clinical use of RQE could significantly reduce the involvement of the oncologist for routine pre-treatment patient positioning verification, while increasing setup accuracy.

  4. Objected constrained registration and manifold learning: A new patient setup approach in image guided radiation therapy of thoracic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chen Ting; Jabbour, Salma K.; Haffty, Bruce G.; Yue, Ning [Radiation Oncology Department, Cancer Institute of New Jersey, University of Medicine and Dentistry of New Jersey, 195 Little Albany Street, New Brunswick, New Jersey 08901 (United States); Qin Songbing [Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006 (China)

    2013-04-15

    Purpose: The management of thoracic malignancies with radiation therapy is complicated by continuous target motion. In this study, a real time motion analysis approach is proposed to improve the accuracy of patient setup. Methods: For 11 lung cancer patients a long training fluoroscopy was acquired before the first treatment, and multiple short testing fluoroscopies were acquired weekly at the pretreatment patient setup of image guided radiotherapy (IGRT). The data analysis consisted of three steps: first a 4D target motion model was constructed from 4DCT and projected to the training fluoroscopy through deformable registration. Then the manifold learning method was used to construct a 2D subspace based on the target motion (kinetic) and location (static) information in the training fluoroscopy. Thereafter the respiratory phase in the testing fluoroscopy was determined by finding its location in the subspace. Finally, the phase determined testing fluoroscopy was registered to the corresponding 4DCT to derive the pretreatment patient position adjustment for the IGRT. The method was tested on clinical image sets and numerical phantoms. Results: The registration successfully reconstructed the 4D motion model with over 98% volume similarity in 4DCT, and over 95% area similarity in the training fluoroscopy. The machine learning method derived the phase values in over 98% and 93% test images of the phantom and patient images, respectively, with less than 3% phase error. The setup approach achieved an average accumulated setup error less than 1.7 mm in the cranial-caudal direction and less than 1 mm in the transverse plane. All results were validated against the ground truth of manual delineations by an experienced radiation oncologist. The expected total time for the pretreatment setup analysis was less than 10 s. Conclusions: By combining the registration and machine learning, the proposed approach has the potential to improve the accuracy of pretreatment setup for

  5. Objected constrained registration and manifold learning: A new patient setup approach in image guided radiation therapy of thoracic cancer

    International Nuclear Information System (INIS)

    Chen Ting; Jabbour, Salma K.; Haffty, Bruce G.; Yue, Ning; Qin Songbing

    2013-01-01

    Purpose: The management of thoracic malignancies with radiation therapy is complicated by continuous target motion. In this study, a real time motion analysis approach is proposed to improve the accuracy of patient setup. Methods: For 11 lung cancer patients a long training fluoroscopy was acquired before the first treatment, and multiple short testing fluoroscopies were acquired weekly at the pretreatment patient setup of image guided radiotherapy (IGRT). The data analysis consisted of three steps: first a 4D target motion model was constructed from 4DCT and projected to the training fluoroscopy through deformable registration. Then the manifold learning method was used to construct a 2D subspace based on the target motion (kinetic) and location (static) information in the training fluoroscopy. Thereafter the respiratory phase in the testing fluoroscopy was determined by finding its location in the subspace. Finally, the phase determined testing fluoroscopy was registered to the corresponding 4DCT to derive the pretreatment patient position adjustment for the IGRT. The method was tested on clinical image sets and numerical phantoms. Results: The registration successfully reconstructed the 4D motion model with over 98% volume similarity in 4DCT, and over 95% area similarity in the training fluoroscopy. The machine learning method derived the phase values in over 98% and 93% test images of the phantom and patient images, respectively, with less than 3% phase error. The setup approach achieved an average accumulated setup error less than 1.7 mm in the cranial-caudal direction and less than 1 mm in the transverse plane. All results were validated against the ground truth of manual delineations by an experienced radiation oncologist. The expected total time for the pretreatment setup analysis was less than 10 s. Conclusions: By combining the registration and machine learning, the proposed approach has the potential to improve the accuracy of pretreatment setup for

  6. Impact of different setup approaches in image-guided radiotherapy as primary treatment for prostate cancer. A study of 2940 setup deviations in 980 MVCTs

    Energy Technology Data Exchange (ETDEWEB)

    Schiller, Kilian; Specht, Hanno; Kampfer, Severin; Duma, Marciana Nona [Technische Universitaet Muenchen Klinikum rechts der Isar, Department of Radiation Oncology, Muenchen (Germany); Petrucci, Alessia [University of Florence, Department of Radiation Oncology, Florence (Italy); Geinitz, Hans [Krankenhaus der Barmherzigen Schwestern Linz, Department of Radiation Oncology, Linz (Austria); Schuster, Tibor [Klinikum Rechts der Isar, Technische Universitaet Muenchen, Institute for Medical Statistics and Epidemiology, Muenchen (Germany)

    2014-08-15

    The goal of this study was to assess the impact of different setup approaches in image-guided radiotherapy (IMRT) of the prostatic gland. In all, 28 patients with prostate cancer were enrolled in this study. After the placement of an endorectal balloon, the planning target volume (PTV) was treated to a dose of 70 Gy in 35 fractions. A simultaneously integrated boost (SIB) of 76 Gy (2.17 Gy per fraction and per day) was delivered to a smaller target volume. All patients underwent daily prostate-aligned IGRT by megavoltage CT (MVCT). Retrospectively, three different setup approaches were evaluated by comparison to the prostate alignment: setup by skin alignment, endorectal balloon alignment, and automatic registration by bones. A total of 2,940 setup deviations were analyzed in 980 fractions. Compared to prostate alignment, skin mark alignment was associated with substantial displacements, which were ≥ 8 mm in 13 %, 5 %, and 44 % of all fractions in the lateral, longitudinal, and vertical directions, respectively. Endorectal balloon alignment yielded displacements ≥ 8 mm in 3 %, 19 %, and 1 % of all setups; and ≥ 3 mm in 27 %, 58 %, and 18 % of all fractions, respectively. For bone matching, the values were 1 %, 1 %, and 2 % and 3 %, 11 %, and 34 %, respectively. For prostate radiotherapy, setup by skin marks alone is inappropriate for patient positioning due to the fact that, during almost half of the fractions, parts of the prostate would not be targeted successfully with an 8-mm safety margin. Bone matching performs better but not sufficiently for safety margins ≤ 3 mm. Endorectal balloon matching can be combined with bone alignment to increase accuracy in the vertical direction when prostate-based setup is not available. Daily prostate alignment remains the gold standard for high-precision radiotherapy with small safety margins. (orig.) [German] Das Ziel dieser Studie bestand darin, den Einfluss verschiedener Herangehensweisen bei der Einstellung einer

  7. Comparison of health care resource utilization and costs among patients with GERD on once-daily or twice-daily proton pump inhibitor therapy

    Directory of Open Access Journals (Sweden)

    Mody R

    2013-04-01

    Full Text Available Reema Mody,1 Debra Eisenberg,2 Likun Hou,2 Siddhesh Kamat,2 Joseph Singer,2 Lauren B Gerson3 1Takeda Pharmaceuticals International Inc, Deerfield, IL, 2HealthCore Inc, Wilmington, DE, 3Stanford University School of Medicine, Stanford, CA, USA Background: The purpose of this study was to assess differences in health care resource utilization and costs associated with once-daily and twice-daily proton pump inhibitor (PPI therapy. Most patients with gastroesophageal reflux disease (GERD achieve symptom control on once-daily PPI therapy, but approximately 20%–30% require twice-daily dosing. Methods: Patients were ≥18 years of age with at least one medical claim for GERD and at least two PPI claims from HealthCore's Integrated Research Database (HIRDSM during 2004–2009. Patients were continuously eligible for 12 months before and after the index date (date of first PPI claim. Based on PPI dosing throughout the post-index period (quantity of medication dispensed/number of days supply, patients were classified as once-daily (dose ≤ 1.5 pills per day or twice-daily (≥1.5 PPI users. Results: The study cohort included 248,386 patients with GERD (mean age 52.8 ± 13.93 years, 56% females of whom 90% were once-daily and 10% were twice-daily PPI users. The Deyo-Charlson Comorbidity Index for once-daily and twice-daily PPI users was 0.70 ± 1.37 and 0.89 ± 1.54, respectively (P < 0.05. More once-daily patients had claims for Barrett's esophagus (5% versus 2%, P < 0.0001 than twice-daily patients. Post-index, higher proportions of twice-daily patients had at least one GERD-related inpatient visit (7% versus 5%, outpatient visit (60% versus 49%, and office visit (48% versus 38% versus once-daily patients (P < 0.0001. Mean total GERD-related health care costs were $2065 ± $6636 versus $3749 ± $11,081 for once-daily and twice-daily PPI users, respectively (P < 0.0001. Conclusion: Patients receiving twice-daily PPI therapy were likely to have more

  8. High-precision prostate cancer irradiation by clinical application of an offline patient setup verification procedure, using portal imaging

    International Nuclear Information System (INIS)

    Bel, Arjan; Vos, Pieter H.; Rodrigus, Patrick T. R.; Creutzberg, Carien L.; Visser, Andries G.; Stroom, Joep C.; Lebesque, Joos V.

    1996-01-01

    Purpose: To investigate in three institutions, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Huis [AvL]), Dr. Daniel den Hoed Cancer Center (DDHC), and Dr, Bernard Verbeeten Institute (BVI), how much the patient setup accuracy for irradiation of prostate cancer can be improved by an offline setup verification and correction procedure, using portal imaging. Methods and Materials: The verification procedure consisted of two stages. During the first stage, setup deviations were measured during a number (N max ) of consecutive initial treatment sessions. The length of the average three dimensional (3D) setup deviation vector was compared with an action level for corrections, which shrunk with the number of setup measurements. After a correction was applied, N max measurements had to be performed again. Each institution chose different values for the initial action level (6, 9, and 10 mm) and N max (2 and 4). The choice of these parameters was based on a simulation of the procedure, using as input preestimated values of random and systematic deviations in each institution. During the second stage of the procedure, with weekly setup measurements, the AvL used a different criterion ('outlier detection') for corrective actions than the DDHC and the BVI ('sliding average'). After each correction the first stage of the procedure was restarted. The procedure was tested for 151 patients (62 in AvL, 47 in DDHC, and 42 in BVI) treated for prostate carcinoma. Treatment techniques and portal image acquisition and analysis were different in each institution. Results: The actual distributions of random and systematic deviations without corrections were estimated by eliminating the effect of the corrections. The percentage of mean (systematic) 3D deviations larger than 5 mm was 26% for the AvL and the DDHC, and 36% for the BVI. The setup accuracy after application of the procedure was considerably improved (percentage of mean 3D deviations larger than 5 mm was 1.6% in the

  9. Daily dialysis reduces pulse wave velocity in chronic hemodialysis patients.

    Science.gov (United States)

    Di Micco, Lucia; Torraca, Serena; Sirico, Maria Luisa; Tartaglia, Domenico; Di Iorio, Biagio

    2012-05-01

    Pulse wave velocity (PWV) is a predictor of morbidity and mortality in patients with end-stage renal disease (ESRD). Dialysis patients show cyclic changes in PWV related to their hydration status and blood pressure. Our aim is to assess the impact of daily dialysis on PWV. We performed a randomized crossover study of 60 patients who underwent standard hemodialysis (HD) three times per week for at least 6 months. Patients were classified into three groups according to their PWV values before (pre-) and after (post-) HD, with a cutoff value of 12 m s(-1), as follows: the low-low (LL) group had normal pre-HD and post-HD PWV; the high-low (HL) group had high pre-HD PWV and normal post-HD PWV; and the high-high (HH) group had high pre- and post-HD PWV. All patients continued standard HD for 2 weeks. A total of 10 patients from each group were randomly assigned to continue standard HD for 1 week and then underwent daily dialysis for 1 week. The remaining 10 patients underwent daily dialysis for 1 week and then underwent standard HD for 1 week. PWV values were measured before and 1 h after each dialysis session. With daily dialysis treatment, 2 of 20 patients (10%) moved from the PWV-HH group to the PWV-HL group, whereas 18 of 20 patients (90%) moved from the PWV-HL group to the PWV-LL group (P = 0.030). Daily dialysis reduces PWV in the ESRD patients. As PWV is a strong predictor of mortality in ESRD and has cyclic variations in patients who are on standard HD, we believe that daily dialysis may be used in patients with high PWV levels to reduce their mortality risk.

  10. Intrafractional setup errors in patients undergoing non-invasive fixation using an immobilization system during hypofractionated stereotactic radiotherapy for lung tumors

    International Nuclear Information System (INIS)

    Watanabe, Meguru; Onishi, Hiroshi; Kuriyama, Kengo

    2013-01-01

    Intrafractional setup errors during hypofractionated stereotactic radiotherapy (SRT) were investigated on the patient under voluntary breath-holding conditions with non-invasive immobilization on the CT-linac treatment table. A total of 30 patients with primary and metastatic lung tumors were treated with the hypofractionated SRT with a total dose of 48-60 Gy with four treatment fractions. The patient was placed supine and stabilized on the table with non-invasive patient fixation. Intrafractional setup errors in Right/Left (R.L.), Posterior/Anterior (P.A.), and Inferior/Superior (I.S.) dimensions were analyzed with pre- and post-irradiation CT images. The means and one standard deviation of the intrafractional errors were 0.9±0.7 mm (R.L.), 0.9±0.7 mm (P.A.) and 0.5±1.0 mm (I.S.). Setup errors in each session of the treatment demonstrated no statistically significant difference in the mean value between any two sessions. The frequency within 3 mm displacement was 98% in R.L., 98% in P.A. and 97% in I.S. directions. SRT under the non-invasive patient fixation immobilization system with a comparatively loose vacuum pillow demonstrated satisfactory reproducibility of minimal setup errors with voluntary breath-holding conditions that required a small internal margin. (author)

  11. Once- versus twice-daily aspirin treatment in patients with essential thrombocytosis

    DEFF Research Database (Denmark)

    Larsen, Mads Lamm; Pedersen, Oliver Heidmann; Hvas, Anne-Mette

    2018-01-01

    Insufficient platelet inhibition has been reported in up to 40% of aspirin-treated patients, including patients with essential thrombocytosis. To maintain sufficient platelet inhibition, a shorter dosing interval with aspirin has been suggested. We aimed to investigate the antiplatelet effect...... of low-dose aspirin given twice-daily compared to standard once-daily dosing in patients with essential thrombocytosis. We included 22 patients, who were treated for 7 days with standard once-daily aspirin (75 mg once-daily) followed by 7 days treatment of twice-daily aspirin (37.5 mg twice......-daily). The two regimens were separated by 14 days aspirin washout. Blood samples were obtained 1h and 24h/12h after the last pill intake in each regimen. The effect of aspirin was evaluated by: (1) platelet aggregation measured by whole blood impedance aggregometry (Multiplate® Analyser) using arachidonic acid...

  12. Forecasting daily patient volumes in the emergency department.

    Science.gov (United States)

    Jones, Spencer S; Thomas, Alun; Evans, R Scott; Welch, Shari J; Haug, Peter J; Snow, Gregory L

    2008-02-01

    Shifts in the supply of and demand for emergency department (ED) resources make the efficient allocation of ED resources increasingly important. Forecasting is a vital activity that guides decision-making in many areas of economic, industrial, and scientific planning, but has gained little traction in the health care industry. There are few studies that explore the use of forecasting methods to predict patient volumes in the ED. The goals of this study are to explore and evaluate the use of several statistical forecasting methods to predict daily ED patient volumes at three diverse hospital EDs and to compare the accuracy of these methods to the accuracy of a previously proposed forecasting method. Daily patient arrivals at three hospital EDs were collected for the period January 1, 2005, through March 31, 2007. The authors evaluated the use of seasonal autoregressive integrated moving average, time series regression, exponential smoothing, and artificial neural network models to forecast daily patient volumes at each facility. Forecasts were made for horizons ranging from 1 to 30 days in advance. The forecast accuracy achieved by the various forecasting methods was compared to the forecast accuracy achieved when using a benchmark forecasting method already available in the emergency medicine literature. All time series methods considered in this analysis provided improved in-sample model goodness of fit. However, post-sample analysis revealed that time series regression models that augment linear regression models by accounting for serial autocorrelation offered only small improvements in terms of post-sample forecast accuracy, relative to multiple linear regression models, while seasonal autoregressive integrated moving average, exponential smoothing, and artificial neural network forecasting models did not provide consistently accurate forecasts of daily ED volumes. This study confirms the widely held belief that daily demand for ED services is characterized by

  13. Dosimetric Changes Resulting From Patient Rotational Setup Errors in Proton Therapy Prostate Plans

    International Nuclear Information System (INIS)

    Sejpal, Samir V.; Amos, Richard A.; Bluett, Jaques B.; Levy, Lawrence B.; Kudchadker, Rajat J.; Johnson, Jennifer; Choi, Seungtaek; Lee, Andrew K.

    2009-01-01

    Purpose: To evaluate the dose changes to the target and critical structures from rotational setup errors in prostate cancer patients treated with proton therapy. Methods and Materials: A total of 70 plans were analyzed for 10 patients treated with parallel-opposed proton beams to a dose of 7,600 60 Co-cGy-equivalent (CcGE) in 200 CcGE fractions to the clinical target volume (i.e., prostate and proximal seminal vesicles). Rotational setup errors of +3 o , -3 deg., +5 deg., and -5 deg. (to simulate pelvic tilt) were generated by adjusting the gantry. Horizontal couch shifts of +3 deg. and -3 deg. (to simulate longitudinal setup variability) were also generated. Verification plans were recomputed, keeping the same treatment parameters as the control. Results: All changes shown are for 38 fractions. The mean clinical target volume dose was 7,780 CcGE. The mean change in the clinical target volume dose in the worse case scenario for all shifts was 2 CcGE (absolute range in worst case scenario, 7,729-7,848 CcGE). The mean changes in the critical organ dose in the worst case scenario was 6 CcGE (bladder), 18 CcGE (rectum), 36 CcGE (anterior rectal wall), and 141 CcGE (femoral heads) for all plans. In general, the percentage of change in the worse case scenario for all shifts to the critical structures was <5%. Deviations in the absolute percentage of volume of organ receiving 45 and 70 Gy for the bladder and rectum were <2% for all plans. Conclusion: Patient rotational movements of 3 deg. and 5 deg. and horizontal couch shifts of 3 deg. in prostate proton planning did not confer clinically significant dose changes to the target volumes or critical structures.

  14. Detection of treatment setup errors between two CT scans for patients with head and neck cancer

    International Nuclear Information System (INIS)

    Ezzell, Leah C.; Hansen, Eric K.; Quivey, Jeanne M.; Xia Ping

    2007-01-01

    Accuracy of treatment setup for head and neck patients undergoing intensity-modulated radiation therapy is of paramount importance. The conventional method using orthogonal portal images can only detect translational setup errors while the most frequent setup errors for head and neck patients could be rotational errors. With the rapid development of image-guided radiotherapy, three-dimensional images are readily acquired and can be used to detect both translational and rotational setup errors. The purpose of this study is to determine the significance of rotational variations between two planning CT scans acquired for each of eight head and neck patients, who experienced substantial weight loss or tumor shrinkage. To this end, using a rigid body assumption, we developed an in-house computer program that utilizes matrix transformations to align point bony landmarks with an incremental best-fit routine. The program returns the quantified translational and rotational shifts needed to align the scans of each patient. The program was tested using a phantom for a set of known translational and rotational shifts. For comparison, a commercial treatment planning system was used to register the two CT scans and estimate the translational errors for these patients. For the eight patients, we found that the average magnitudes and standard deviations of the rotational shifts about the transverse, anterior-posterior, and longitudinal axes were 1.7±2.3 deg., 0.8±0.7 deg., and 1.8±1.1 deg., respectively. The average magnitudes and standard deviations of the translational shifts were 2.5±2.6 mm, 2.9±2.8 mm, 2.7±1.7 mm while the differences detected between our program and the CT-CT fusion method were 1.8±1.3 mm, 3.3±5.4 mm, and 3.0±3.4 mm in the left-right, anterior-posterior, and superior-inferior directions, respectively. A trend of larger rotational errors resulting in larger translational differences between the two methods was observed. In conclusion, conventional

  15. SU-F-T-224: Importance of Timely Review of Daily Cone-Beam CTs: Dosimetric Evaluation of Rejected CBCTs for Head and Neck Patients

    Energy Technology Data Exchange (ETDEWEB)

    Andrews, M; Yu, N; Joshi, N; Koyfman, S; Xia, P [Cleveland Clinic, Cleveland, OH (United States); Lin, S [Cleveland State University, Cleveland, OH (United States)

    2016-06-15

    Purpose: To dosimetrically evaluate the importance of timely reviewing daily CBCTs for patients with head and neck cancer. Methods: After each fraction daily cone-beam CT (CBCT) for head and neck patients are reviewed by physicians prior to next treatment. Physician rejected image registrations of CBCT were identified and analyzed for 17 patients. These CBCT images were rigidly fused with planning CT images and the contours from the planning CT were transferred to CBCTs. Because of limited extension in the superior-inferior dimension contours with partial volumes in CBCTs were discarded. The treatment isocenter was placed by applying the clinically recorded shifts to the volume isocenter of the CBCT. Dose was recalculated at the shifted isocenter using a homogeneous dose calculation algorithm. Dosimetrically relevant changes defined as greater than 5% deviation from the clinically accepted plans but with homogeneous dose calculation were evaluated for the high dose (HD), intermediate dose (ID), and low dose (LD) CTVs, spinal cord, larynx, oropharynx, parotids, and submandibular glands. Results: Among seventeen rejected CBCTS, HD-CTVs, ID-CTVs, and LD-CTVs were completely included in the CBCTs for 17, 1, and 15 patients, respectively. The prescription doses to the HD-CTV, ID-CTV, and LD-CTV were received by < 95% of the CTV volumes in 5/17, 1/1, and 5/15 patients respectively. For the spinal cord, the maximum doses (D0.03cc) were increased > 5% in 13 of 17 patients. For the oropharynx, larynx, parotid, and submandibular glands, the mean dose of these organs at risk was increased > 5% in 7/17, 8/12, 11/16 and 6/16 patients, respectively. Conclusion: Timely review daily CBCTs for head and neck patients under daily CBCT guidance is important, and uncorrected setup errors can translate to dosimetrically relevant dose increases in organsat- risk and dose decreases in the clinical target volumes.

  16. Setup uncertainties: consequences for multi-isocentre stereotactic radiotherapy

    International Nuclear Information System (INIS)

    Ebert, M.A.; Harper, C.S.

    2000-01-01

    Full text: Beam data for use in dose calculations by planning systems is generally measured under static and controlled conditions. Yet, patient motion and setup uncertainties will effectively blur the resulting dose distributions leading to a discrepancy between planned and delivered dose distributions. This is particularly so for stereotactic radiotherapy where small well-defined fields are used. When multiple isocentres are used (possibly for larger irregular lesions), relative motion of isocentres due to setup variations may have deleterious effects on the intended radiation delivery. The influence of setup uncertainties was examined by performing a three-dimensional convolution of measured off-axis ratio (OAR) data with a Maxwellian distribution, with standard deviations representing several feasible levels of inaccuracy in patient setup. A sample of patient plans (predominantly multi-isocentre plans) were then considered using original (measured) OAR data, and then modified data in order to observe the resulting effect. The effect of systematic localisation error was also considered by examining resulting DVHs as isocentres were shifted by fixed amounts. In all cases considered, the maximum dose varied quite minimally with increase in setup error with the variation decreasing with increasing high-dose volume. The minimum dose however varied more significantly, and this has serious consequences for dose prescription as the minimum dose can be the controlling factor in treatment efficacy. For multi-isocentre plans, the degree of non-uniformity generated by setup error was not as significant as originally expected. This is in part due to the non-uniformity already present in such plans to begin with. Through incorporation of the effect of setup error into planning data, the influence of setup variations on dose distributions for multi-isocentre treatments has been determined. This influence should be considered when creating plans based on the level of spatial

  17. Intrafractional Target Motions and Uncertainties of Treatment Setup Reference Systems in Accelerated Partial Breast Irradiation

    International Nuclear Information System (INIS)

    Yue, Ning J.; Goyal, Sharad; Zhou Jinghao; Khan, Atif J.; Haffty, Bruce G.

    2011-01-01

    Purpose: This study investigated the magnitude of intrafractional motion and level of accuracy of various setup strategies in accelerated partial breast irradiation (APBI) using three-dimensional conformal external beam radiotherapy. Methods and Materials: At lumpectomy, gold fiducial markers were strategically sutured to the surrounding walls of the cavity. Weekly fluoroscopy imaging was conducted at treatment to investigate the respiration-induced target motions. Daily pre- and post-RT kV imaging was performed, and images were matched to digitally reconstructed radiographs based on bony anatomy and fiducial markers, respectively, to determine the intrafractional motion magnitudes over the course of treatment. The positioning differences of the laser tattoo- and the bony anatomy-based setups compared with those of the marker-based setup (benchmark) were also determined. The study included 21 patients. Results: Although lung exhibited significant motion, the average marker motion amplitude on the fluoroscopic image was about 1 mm. Over a typical treatment time period, average intrafractional motion magnitude was 4.2 mm and 2.6 mm based on the marker and bony anatomy matching, respectively. The bony anatomy- and laser tattoo-based interfractional setup errors, with respect to the fiducial marker-based setup, were 7.1 and 9.0 mm, respectively. Conclusions: Respiration has limited effects on the target motion during APBI. Bony anatomy-based treatment setup improves the accuracy relative to that of the laser tattoo-based setup approach. Since fiducial markers are sutured directly to the surgical cavity, the marker-based approach can further improve the interfractional setup accuracy. On average, a seroma cavity exhibits intrafractional motion of more than 4 mm, a magnitude that is larger than that which is otherwise derived based on bony anatomy matching. A seroma-specific marker-based approach has the potential to improve treatment accuracy by taking the true inter

  18. Daily organ tracking in intensity-modulated radiotherapy of prostate cancer using an electronic portal imaging device with a dose saving acquisition mode

    International Nuclear Information System (INIS)

    Vetterli, Daniel; Thalmann, Sandrine; Behrensmeier, Frank; Kemmerling, Ludger; Born, Ernst J.; Mini, Roberto; Greiner, Richard H.; Aebersold, Daniel M.

    2006-01-01

    Background and purpose: Daily use of conventional electronic portal imaging devices (EPID) for organ tracking is limited due to the relatively high dose required for high quality image acquisition. We studied the use of a novel dose saving acquisition mode (RadMode) allowing to take images with one monitor unit per image in prostate cancer patients undergoing intensity-modulated radiotherapy (IMRT) and tracking of implanted fiducial gold markers. Patients and methods: Twenty five patients underwent implantation of three fiducial gold markers prior to the planning CT. Before each treatment of a course of 37 fractions, orthogonal localization images from the antero-posterior and from the lateral direction were acquired. Portal images of both the setup procedure and the five IMRT treatment beams were analyzed. Results: On average, four localization images were needed for a correct patient setup, resulting in four monitor units extra dose per fraction. The mean extra dose delivered to the patient was thereby increased by 1.2%. The procedure was precise enough to reduce the mean displacements prior to treatment to ≤0.3 mm. Conclusions: The use of a new dose saving acquisition mode enables to perform daily EPID-based prostate tracking with a cumulative extra dose of below 1 Gy. This concept is efficiently used in IMRT-treated patients, where separation of setup beams from treatment beams is mandatory

  19. SU-E-J-21: Setup Variability of Colorectal Cancer Patients Treated in the Prone Position and Dosimetric Comparison with the Supine Position

    Energy Technology Data Exchange (ETDEWEB)

    Kim, A; Foster, J; Chu, W; Karotki, A [Sunnybrook Health Sciences Centre/Odette Cancer Centre, Toronto, Ontario (Canada)

    2015-06-15

    Purpose: Many cancer centers treat colorectal patients in the prone position on a belly board to minimize dose to the small bowel. That may potentially Result in patient setup instability with corresponding impact on dose delivery accuracy for highly conformal techniques such as IMRT/VMAT. Two aims of this work are 1) to investigate setup accuracy of rectum patients treated in the prone position on a belly board using CBCT and 2) to evaluate dosimetric impact on bladder and small bowel of treating rectum patients in supine vs. prone position. Methods: For the setup accuracy study, 10 patients were selected. Weekly CBCTs were acquired and matched to bone. The CBCT-determined shifts were recorded. For the dosimetric study, 7 prone-setup patients and 7 supine-setup patients were randomly selected from our clinical database. Various clinically relevant dose volume histogram values were recorded for the small bowel and bladder. Results: The CBCT-determined rotational shifts had a wide variation. For the dataset acquired at the time of this writing, the ranges of rotational setup errors for pitch, roll, and yaw were [−3.6° 4.7°], [−4.3° 3.2°], and [−1.4° 1.4°]. For the dosimetric study: the small bowel V(45Gy) and mean dose for the prone position was 5.6±12.1% and 18.4±6.2Gy (ranges indicate standard deviations); for the supine position the corresponding dose values were 12.9±15.8% and 24.7±8.8Gy. For the bladder, the V(30Gy) and mean dose for prone position were 68.7±12.7% and 38.4±3.3Gy; for supine position these dose values were 77.1±13.7% and 40.7±3.1Gy. Conclusion: There is evidence of significant rotational instability in the prone position. The OAR dosimetry study indicates that there are some patients that may still benefit from the prone position, though many patients can be safely treated supine.

  20. Automatic detection of patient identification and positioning errors in radiation therapy treatment using 3-dimensional setup images.

    Science.gov (United States)

    Jani, Shyam S; Low, Daniel A; Lamb, James M

    2015-01-01

    To develop an automated system that detects patient identification and positioning errors between 3-dimensional computed tomography (CT) and kilovoltage CT planning images. Planning kilovoltage CT images were collected for head and neck (H&N), pelvis, and spine treatments with corresponding 3-dimensional cone beam CT and megavoltage CT setup images from TrueBeam and TomoTherapy units, respectively. Patient identification errors were simulated by registering setup and planning images from different patients. For positioning errors, setup and planning images were misaligned by 1 to 5 cm in the 6 anatomical directions for H&N and pelvis patients. Spinal misalignments were simulated by misaligning to adjacent vertebral bodies. Image pairs were assessed using commonly used image similarity metrics as well as custom-designed metrics. Linear discriminant analysis classification models were trained and tested on the imaging datasets, and misclassification error (MCE), sensitivity, and specificity parameters were estimated using 10-fold cross-validation. For patient identification, our workflow produced MCE estimates of 0.66%, 1.67%, and 0% for H&N, pelvis, and spine TomoTherapy images, respectively. Sensitivity and specificity ranged from 97.5% to 100%. MCEs of 3.5%, 2.3%, and 2.1% were obtained for TrueBeam images of the above sites, respectively, with sensitivity and specificity estimates between 95.4% and 97.7%. MCEs for 1-cm H&N/pelvis misalignments were 1.3%/5.1% and 9.1%/8.6% for TomoTherapy and TrueBeam images, respectively. Two-centimeter MCE estimates were 0.4%/1.6% and 3.1/3.2%, respectively. MCEs for vertebral body misalignments were 4.8% and 3.6% for TomoTherapy and TrueBeam images, respectively. Patient identification and gross misalignment errors can be robustly and automatically detected using 3-dimensional setup images of different energies across 3 commonly treated anatomical sites. Copyright © 2015 American Society for Radiation Oncology. Published by

  1. Performance of activities of daily living among hospitalized cancer patients

    DEFF Research Database (Denmark)

    Lindahl-Jacobsen, Line; Hansen, Dorte Gilså; Wæhrens, Eva Ejlersen

    2015-01-01

    and characterize ADL task performance problems among a group of adult disabled hospitalized cancer patients using interview and questionnaire data. METHODS: Cross-sectional study on prevalence of ADL task performance problems experienced by disabled hospitalized cancer patients using the Activities of Daily Living...... Questionnaire (ADL-Q) (n = 118) and the Canadian Occupational Performance Measure (COPM) (n = 55). RESULTS: All 118 patients reported problems with ADL task performance. Based on the ADL-Q patients reported more problems within instrumental (I-)ADL than personal (P-)ADL. In both I-ADL and P-ADL the results......BACKGROUND: Many cancer patients report unmet rehabilitation needs. Rehabilitation may include activities of daily living (ADL) tasks, but little is known about how cancer patients perform these tasks and how they prioritize their daily activities. Hence, this study aims to identify...

  2. Implementation and utility of a daily ultrasound-based localization system with intensity-modulated radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Morr, Jody; DiPetrillo, Thomas; Tsai, J.-S.; Engler, Mark; Wazer, David E. MD.

    2002-01-01

    Purpose: To evaluate the clinical feasibility of daily computer-assisted transabdominal ultrasonography for target position verification in the setting of intensity-modulated radiotherapy (IMRT) for prostate cancer. Methods and Materials: Twenty-three patients with clinically localized prostate cancer were treated using a sequential tomotherapy IMRT technique (Peacock) and daily computer-assisted transabdominal ultrasonography (BAT) for target localization. Patients were instructed to maintain a full bladder and were placed in the supine position using triangulation tattoos and a leg immobilizer to minimize pelvic rotation. The BAT ultrasound system is docked to the treatment collimator and electronically imports the CT simulation target contours and isocenter. The system is able to use the machine isocenter as a reference point to overlay the corresponding CT contours onto the ultrasound images captured in the transverse and sagittal planes. A touch screen menu is used to maneuver the CT contours in three dimensions such that they match the ultrasound images. The system then displays the three-dimensional couch shifts required to produce field alignment. Data were prospectively collected to measure the frequency by which useful ultrasound images were obtained, the amount of time required for localization/setup, and the direction/magnitude of the positional adjustments. Results: Of the 23 patients, the BAT ultrasound system produced images of sufficient quality to perform the overlay of the CT contours in 19 patients such that positional verification could be reliably performed. Poor image quality was associated with patient inability to maintain a full bladder, large body habitus, or other anatomic constraints. Of the 19 assessable patients, a total of 185 treatment alignments were performed (mean 8.8/patient). For all cases, the average time required for the daily ultrasound imaging and positional adjustments was 11.9 min. After the initial 5 cases, the user

  3. MO-G-BRE-03: Automated Continuous Monitoring of Patient Setup with Second-Check Independent Image Registration

    Energy Technology Data Exchange (ETDEWEB)

    Jiang, X; Fox, T; Schreibmann, E [Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA (United States)

    2014-06-15

    Purpose: To create a non-supervised quality assurance program to monitor image-based patient setup. The system acts a secondary check by independently computing shifts and rotations and interfaces with Varian's database to verify therapist's work and warn against sub-optimal setups. Methods: Temporary digitally-reconstructed radiographs (DRRs) and OBI radiographic image files created by Varian's treatment console during patient setup are intercepted and used as input in an independent registration module customized for accuracy that determines the optimal rotations and shifts. To deal with the poor quality of OBI images, a histogram equalization of the live images to the DDR counterparts is performed as a pre-processing step. A search for the most sensitive metric was performed by plotting search spaces subject to various translations and convergence analysis was applied to ensure the optimizer finds the global minima. Final system configuration uses the NCC metric with 150 histogram bins and a one plus one optimizer running for 2000 iterations with customized scales for translations and rotations in a multi-stage optimization setup that first corrects and translations and subsequently rotations. Results: The system was installed clinically to monitor and provide almost real-time feedback on patient positioning. On a 2 month-basis uncorrected pitch values were of a mean 0.016° with standard deviation of 1.692°, and couch rotations of − 0.090°± 1.547°. The couch shifts were −0.157°±0.466° cm for the vertical, 0.045°±0.286 laterally and 0.084°± 0.501° longitudinally. Uncorrected pitch angles were the most common source of discrepancies. Large variations in the pitch angles were correlated with patient motion inside the mask. Conclusion: A system for automated quality assurance of therapist's registration was designed and tested in clinical practice. The approach complements the clinical software's automated registration in

  4. MO-G-BRE-03: Automated Continuous Monitoring of Patient Setup with Second-Check Independent Image Registration

    International Nuclear Information System (INIS)

    Jiang, X; Fox, T; Schreibmann, E

    2014-01-01

    Purpose: To create a non-supervised quality assurance program to monitor image-based patient setup. The system acts a secondary check by independently computing shifts and rotations and interfaces with Varian's database to verify therapist's work and warn against sub-optimal setups. Methods: Temporary digitally-reconstructed radiographs (DRRs) and OBI radiographic image files created by Varian's treatment console during patient setup are intercepted and used as input in an independent registration module customized for accuracy that determines the optimal rotations and shifts. To deal with the poor quality of OBI images, a histogram equalization of the live images to the DDR counterparts is performed as a pre-processing step. A search for the most sensitive metric was performed by plotting search spaces subject to various translations and convergence analysis was applied to ensure the optimizer finds the global minima. Final system configuration uses the NCC metric with 150 histogram bins and a one plus one optimizer running for 2000 iterations with customized scales for translations and rotations in a multi-stage optimization setup that first corrects and translations and subsequently rotations. Results: The system was installed clinically to monitor and provide almost real-time feedback on patient positioning. On a 2 month-basis uncorrected pitch values were of a mean 0.016° with standard deviation of 1.692°, and couch rotations of − 0.090°± 1.547°. The couch shifts were −0.157°±0.466° cm for the vertical, 0.045°±0.286 laterally and 0.084°± 0.501° longitudinally. Uncorrected pitch angles were the most common source of discrepancies. Large variations in the pitch angles were correlated with patient motion inside the mask. Conclusion: A system for automated quality assurance of therapist's registration was designed and tested in clinical practice. The approach complements the clinical software's automated registration in

  5. SU-F-I-03: Correction of Intra-Fractional Set-Up Errors and Target Coverage Based On Cone-Beam Computed Tomography for Cervical Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, JY [Cancer Hospital of Shantou University Medical College, Shantou, Guangdong (China); Hong, DL [The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong (China)

    2016-06-15

    Purpose: The purpose of this study is to investigate the patient set-up error and interfraction target coverage in cervical cancer using image-guided adaptive radiotherapy (IGART) with cone-beam computed tomography (CBCT). Methods: Twenty cervical cancer patients undergoing intensity modulated radiotherapy (IMRT) were randomly selected. All patients were matched to the isocenter using laser with the skin markers. Three dimensional CBCT projections were acquired by the Varian Truebeam treatment system. Set-up errors were evaluated by radiation oncologists, after CBCT correction. The clinical target volume (CTV) was delineated on each CBCT, and the planning target volume (PTV) coverage of each CBCT-CTVs was analyzed. Results: A total of 152 CBCT scans were acquired from twenty cervical cancer patients, the mean set-up errors in the longitudinal, vertical, and lateral direction were 3.57, 2.74 and 2.5mm respectively, without CBCT corrections. After corrections, these were decreased to 1.83, 1.44 and 0.97mm. For the target coverage, CBCT-CTV coverage without CBCT correction was 94% (143/152), and 98% (149/152) with correction. Conclusion: Use of CBCT verfication to measure patient setup errors could be applied to improve the treatment accuracy. In addition, the set-up error corrections significantly improve the CTV coverage for cervical cancer patients.

  6. Actual Dose Variation of Parotid Glands and Spinal Cord for Nasopharyngeal Cancer Patients During Radiotherapy

    International Nuclear Information System (INIS)

    Han Chunhui; Chen Yijen; Liu An; Schultheiss, Timothy E.; Wong, Jeffrey Y.C.

    2008-01-01

    Purpose: For intensity-modulated radiotherapy of nasopharyngeal cancer, accurate dose delivery is crucial to the success of treatment. This study aimed to evaluate the significance of daily image-guided patient setup corrections and to quantify the parotid gland volume and dose variations for nasopharyngeal cancer patients using helical tomotherapy megavoltage computed tomography (CT). Methods and Materials: Five nasopharyngeal cancer patients who underwent helical tomotherapy were selected retrospectively. Each patient had received 70 Gy in 35 fractions. Daily megavoltage CT scans were registered with the planning CT images to correct the patient setup errors. Contours of the spinal cord and parotid glands were drawn on the megavoltage CT images at fixed treatment intervals. The actual doses delivered to the critical structures were calculated using the helical tomotherapy Planned Adaptive application. Results: The maximal dose to the spinal cord showed a significant increase and greater variation without daily setup corrections. The significant decrease in the parotid gland volume led to a greater median dose in the later phase of treatment. The average parotid gland volume had decreased from 20.5 to 13.2 cm 3 by the end of treatment. On average, the median dose to the parotid glands was 83 cGy and 145 cGy for the first and the last treatment fractions, respectively. Conclusions: Daily image-guided setup corrections can eliminate significant dose variations to critical structures. Constant monitoring of patient anatomic changes and selective replanning should be used during radiotherapy to avoid critical structure complications

  7. An experimental set-up to test heatmoisture exchangers

    NARCIS (Netherlands)

    N. Ünal (N.); J.C. Pompe (Jan); W.P. Holland (Wim); I. Gultuna; P.E.M. Huygen; K. Jabaaij (K.); C. Ince (Can); B. Saygin (B.); H.A. Bruining (Hajo)

    1995-01-01

    textabstractObjectives: The purpose of this study was to build an experimental set-up to assess continuously the humidification, heating and resistance properties of heat-moisture exchangers (HMEs) under clinical conditions. Design: The experimental set-up consists of a patient model, measurement

  8. [Comparison of set-up control for head and neck patients between radiation oncologist and therapists with the aim of partial delegation].

    Science.gov (United States)

    Garcia-Ramirez, M; Maugey, S; Burgaud, L; Carpentey, F; Parezys, E; Carricaburu, M

    2014-11-01

    The aim of this prospective study was to evaluate daily set-up by a radiation oncologist and by radiation therapists using on-board imaging of patients with head and neck cancer in order to calculate margin to PTV (planning target volume) and intent partial delegation of positioning images control. The files of 11 patients with head and neck cancer treated on a Synergy™ (Elekta™) accelerator with on-board imaging system were evaluated. Daily kV-kV images were double-blind reviewed by radiation therapists (7 participants) and by one radiation oncologist. The radiation oncologist's measures were used for margin calculation from CTV to PTV. The difference of measures and the concordance of decisions between radiation therapists and the radiation oncologist were calculated. The 325 measures made by the radiation oncologist resulted in a margin of 5mm to be applied to the CTV in each direction. Nine hundred seventy-seven measures were made by the radiation oncologist and radiation therapists with a difference of 3mm or less in 98.46%. The concordance of decision for a 4mm difference or less to the isocenter was 96.7%. This study confirms the 5mm PTV margin mostly used in ORL. The small gap between the radiation oncologist's and therapists' measures allows a partial delegation of positioning images control. Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  9. SU-E-J-24: Can Fiducial Marker-Based Setup Using ExacTrac Be An Alternative to Soft Tissue-Based Setup Using Cone-Beam CT for Prostate IMRT?

    Energy Technology Data Exchange (ETDEWEB)

    Tanabe, S [Department of Radiation Oncology, Niigata University Medical and Dental Hospital (Japan); Utsunomiya, S; Abe, E; Aoyama, H [Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences (Japan); Satou, H [Department of Radiation Oncology, Niigata Cancer Center Hospital (Japan); Sakai, H; Yamada, T [Section of Radiology, Department of Clinical Support, Niigata University Medical and Dental Hospital (Japan)

    2015-06-15

    Purpose: To assess an accuracy of fiducial maker-based setup using ExacTrac (ExT-based setup) as compared with soft tissue-based setup using Cone-beam CT (CBCT-based setup) for patients with prostate cancer receiving intensity-modulated radiation therapy (IMRT) for the purpose of investigating whether ExT-based setup can be an alternative to CBCT-based setup. Methods: The setup accuracy was analyzed prospectively for 7 prostate cancer patients with implanted three fiducial markers received IMRT. All patients were treated after CBCT-based setup was performed and corresponding shifts were recorded. ExacTrac images were obtained before and after CBCT-based setup. The fiducial marker-based shifts were calculated based on those two images and recorded on the assumption that the setup correction was carried out by fiducial marker-based auto correction. Mean and standard deviation of absolute differences and the correlation between CBCT and ExT shifts were estimated. Results: A total of 178 image dataset were analyzed. On the differences between CBCT and ExT shifts, 133 (75%) of 178 image dataset resulted in smaller differences than 3 mm in all dimensions. Mean differences in the anterior-posterior (AP), superior-inferior (SI), and left-right (LR) dimensions were 1.8 ± 1.9 mm, 0.7 ± 1.9 mm, and 0.6 ± 0.8 mm, respectively. The percentages of shift agreements within ±3 mm were 76% for AP, 90% for SI, and 100% for LR. The Pearson coefficient of correlation for CBCT and ExT shifts were 0.80 for AP, 0.80 for SI, and 0.65 for LR. Conclusion: This work showed that the accuracy of ExT-based setup was correlated with that of CBCT-based setup, implying that ExT-based setup has a potential ability to be an alternative to CBCT-based setup. The further work is to specify the conditions that ExT-based setup can provide the accuracy comparable to CBCT-based setup.

  10. Manufacture of Daily Check Device and Efficiency Evaluation for Daily Q.A

    International Nuclear Information System (INIS)

    Kim, Chan Yong; Jae, Young Wan; Park, Heung Deuk; Lee, Jae Hee

    2005-01-01

    Daily Q.A is the important step which must be preceded in a radiation treatment. Specially, radiation output measurement and laser alignment, SSD indicator related to a patient set-up recurrence must be confirmed for a reasonable radiation treatment. Daily Q.A proceeds correctness and a prompt way, and needs an objective measurement basis. Manufacture of the device which can facilitate confirmation of output measurement and appliances check at one time was requested. Produced the phantom formal daily check device which can confirm a lot of appliances check (output measurement and laser alignment. field size, SSD indicator) with one time of set up at a time, and measurement observed a linear accelerator (4 machine) for four months and evaluated efficiency. We were able to confirm an laser alignment, field size, SSD indicator check at the same time, and out put measurement was possible with the same set up, so daily Q.A time was reduced, and we were able to confirm an objective basis about each item measurement. As a result of having measured for four months, output measurement within ±2%, and measured laser alignment, field size, SSD indicator in range within ±1 mm. We can enforce output measurement and appliances check conveniently, and time was reduced and was able to raise efficiency of business. We were able to bring a cost reduction by substitution expensive commercialized equipment. Further It is necessary to makes a product as strong and slight materials, and improve convenience of use.

  11. Daily Tracking of Glioblastoma Resection Cavity, Cerebral Edema, and Tumor Volume with MRI-Guided Radiation Therapy.

    Science.gov (United States)

    Mehta, Shahil; Gajjar, Shefali R; Padgett, Kyle R; Asher, David; Stoyanova, Radka; Ford, John C; Mellon, Eric A

    2018-03-19

    Radiation therapy (RT) plays a critical role in the treatment of glioblastoma. Studies of brain imaging during RT for glioblastoma have demonstrated changes in the brain during RT. However, frequent or daily utilization of standalone magnetic resonance imaging (MRI) scans during RT have limited feasibility. The recent release of the tri-cobalt-60 MRI-guided RT (MR-IGRT) device (ViewRay MRIdian, Cleveland, OH) allows for daily brain MRI for the RT setup. Daily MRI of three postoperative patients undergoing RT and temozolomide for glioblastoma over a six-week course allowed for the identification of changes to the cavity, edema, and visible tumor on a daily basis. The volumes and dimensions of the resection cavities, edema, and T2-hyperintense tumor were measured. A general trend of daily decreases in cavity measurements was observed in all patients. For the one patient with edema, a trend of daily increases followed by a trend of daily decreases were observed. These results suggest that daily MRI could be used for onboard resimulation and adaptive RT for future fluctuations in the sizes of brain tumors, cavities, or cystic components. This could improve tumor targeting and reduce RT of healthy brain tissue.

  12. Cerebrospinal fluid abacavir concentrations in HIV-positive patients following once-daily administration.

    Science.gov (United States)

    Calcagno, A; Pinnetti, C; De Nicolò, A; Scarvaglieri, E; Gisslen, M; Tempestilli, M; D'Avolio, A; Fedele, V; Di Perri, G; Antinori, A; Bonora, S

    2018-06-01

    Abacavir is a widely used nucleotide reverse transcriptase inhibitor, for which cerebrospinal fluid (CSF) exposure has been previously assessed in twice-daily recipients. We studied abacavir CSF concentrations in 61 and nine HIV-positive patients taking abacavir once daily and twice daily, respectively. Patients on once-daily abacavir had higher plasma and CSF concentrations (96 vs. 22 ng ml -1 , P = 0.038 and 123 vs. 49 ng ml -1 , P = 0.038) but similar CSF-to-plasma ratios (0.8 vs. 0.5, P = 0.500). CSF abacavir concentrations were adequate in patients receiving once-daily treatment. © 2018 The British Pharmacological Society.

  13. Fast evaluation of patient set-up during radiotherapy by aligning features in portal and simulator images

    International Nuclear Information System (INIS)

    Bijhold, J.; Herk, M. van; Vijlbrief, R.; Lebesque, J.V.

    1991-01-01

    A new fast method is presented for the quantification of patient set-up errors during radiotherapy with external photon beams. The set-up errors are described as deviations in relative position and orientation of specified anatomical structures relative to specified field shaping devices. These deviations are determined from parameters of the image transformations that make their features in a portal image align with the corresponding features in a simulator image. Knowledge of some set-up parameters during treatment simulation is required. The method does not require accurate knowledge about the position of the portal imaging device as long as the positions of some of the field shaping devices are verified independently during treatment. By applying this method, deviations in a pelvic phantom set-up can be measured with a precision of 2 mm within 1 minute. Theoretical considerations and experiments have shown that the method is not applicable when there are out-of-plane rotations larger than 2 degrees or translations larger than 1 cm. Inter-observer variability proved to be a source of large systematic errors, which could be reduced by offering a precise protocol for the feature alignment. (author)

  14. Quality assurance in daily treatment procedure

    International Nuclear Information System (INIS)

    Westbrook, Catherine; Gildersleve, James; Yarnold, John

    1991-01-01

    Fifteen women undergoing breast radiotherapy following wide local excision of an early stage breast cancer were submitted to repeated measurements of surface landmarks to check the reproducibility of patient positioning, and to portal imaging using a megavoltage imaging device. When the patient is being set-up the mean rise and fall of a lateral skin mark (tattoo) was within 4 mm in 95 observations of 15 patients. At the end of the lateral field exposure, mean displacement of the lateral tattoo was close to zero, with only 15/95 (16%) observations falling outside the range ±2mm. The daily measurements of lung thickness fell above and below the stimulated lung thickness, consistent with random fluctuations. Eighty-eight percent of lung thickness measurements were within ±5mm of the stimulator position. A tentative conclusion is made that more sophisticated immobilisation and imaging devices may be unnecessary for breast irradiation with a high degree of reproducibility. (author). 3 refs.; 5 figs

  15. Balancing dose and image registration accuracy for cone beam tomosynthesis (CBTS) for breast patient setup

    International Nuclear Information System (INIS)

    Winey, B. A.; Zygmanski, P.; Cormack, R. A.; Lyatskaya, Y.

    2010-01-01

    Purpose: To balance dose reduction and image registration accuracy in breast setup imaging. In particular, the authors demonstrate the relationship between scan angle and dose delivery for cone beam tomosynthesis (CBTS) when employed for setup verification of breast cancer patients with surgical clips. Methods: The dose measurements were performed in a female torso phantom for varying scan angles of CBTS. Setup accuracy was measured using three registration methods: Clip centroid localization accuracy and the accuracy of two semiautomatic registration algorithms. The dose to the organs outside of the ipsilateral breast and registration accuracy information were compared to determine the optimal scan angle for CBTS for breast patient setup verification. Isocenter positions at the center of the patient and at the breast-chest wall interface were considered. Results: Image registration accuracy was within 1 mm for the CBTS scan angles θ above 20 deg. for some scenarios and as large as 80 deg. for the worst case, depending on the imaged breast and registration algorithm. Registration accuracy was highest based on clip centroid localization. For left and right breast imaging with the isocenter at the chest wall, the dose to the contralateral side of the patient was very low (<0.5 cGy) for all scan angles considered. For central isocenter location, the optimal scan angles were 30 deg. - 50 deg. for the left breast imaging and 40 deg. - 50 deg. for the right breast imaging, with the difference due to the geometric asymmetry of the current clinical imaging system. Conclusions: The optimal scan angles for CBTS imaging were found to be between 10 deg. and 50 deg., depending on the isocenter location and ipsilateral breast. Use of the isocenter at the breast-chest wall locations always resulted in greater accuracy of image registration (<1 mm) at smaller angles (10 deg. - 20 deg.) and at lower doses (<0.1 cGy) to the contralateral organs. For chest wall isocenters, doses

  16. Cone-Beam CT Assessment of Interfraction and Intrafraction Setup Error of Two Head-and-Neck Cancer Thermoplastic Masks

    International Nuclear Information System (INIS)

    Velec, Michael; Waldron, John N.; O'Sullivan, Brian; Bayley, Andrew; Cummings, Bernard; Kim, John J.; Ringash, Jolie; Breen, Stephen L.; Lockwood, Gina A.; Dawson, Laura A.

    2010-01-01

    Purpose: To prospectively compare setup error in standard thermoplastic masks and skin-sparing masks (SSMs) modified with low neck cutouts for head-and-neck intensity-modulated radiation therapy (IMRT) patients. Methods and Materials: Twenty head-and-neck IMRT patients were randomized to be treated in a standard mask (SM) or SSM. Cone-beam computed tomography (CBCT) scans, acquired daily after both initial setup and any repositioning, were used for initial and residual interfraction evaluation, respectively. Weekly, post-IMRT CBCT scans were acquired for intrafraction setup evaluation. The population random (σ) and systematic (Σ) errors were compared for SMs and SSMs. Skin toxicity was recorded weekly by use of Radiation Therapy Oncology Group criteria. Results: We evaluated 762 CBCT scans in 11 patients randomized to the SM and 9 to the SSM. Initial interfraction σ was 1.6 mm or less or 1.1 deg. or less for SM and 2.0 mm or less and 0.8 deg. for SSM. Initial interfraction Σ was 1.0 mm or less or 1.4 deg. or less for SM and 1.1 mm or less or 0.9 deg. or less for SSM. These errors were reduced before IMRT with CBCT image guidance with no significant differences in residual interfraction or intrafraction uncertainties between SMs and SSMs. Intrafraction σ and Σ were less than 1 mm and less than 1 deg. for both masks. Less severe skin reactions were observed in the cutout regions of the SSM compared with non-cutout regions. Conclusions: Interfraction and intrafraction setup error is not significantly different for SSMs and conventional masks in head-and-neck radiation therapy. Mask cutouts should be considered for these patients in an effort to reduce skin toxicity.

  17. Analysis and reduction of 3D systematic and random setup errors during the simulation and treatment of lung cancer patients with CT-based external beam radiotherapy dose planning.

    NARCIS (Netherlands)

    Boer, H.D. de; Sornsen de Koste, J.R. van; Senan, S.; Visser, A.G.; Heijmen, B.J.M.

    2001-01-01

    PURPOSE: To determine the magnitude of the errors made in (a) the setup of patients with lung cancer on the simulator relative to their intended setup with respect to the planned treatment beams and (b) in the setup of these patients on the treatment unit. To investigate how the systematic component

  18. Measuring uncertainty in dose delivered to the cochlea due to setup error during external beam treatment of patients with cancer of the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Yan, M.; Lovelock, D.; Hunt, M.; Mechalakos, J.; Hu, Y.; Pham, H.; Jackson, A., E-mail: jacksona@mskcc.org [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065 (United States)

    2013-12-15

    Purpose: To use Cone Beam CT scans obtained just prior to treatments of head and neck cancer patients to measure the setup error and cumulative dose uncertainty of the cochlea. Methods: Data from 10 head and neck patients with 10 planning CTs and 52 Cone Beam CTs taken at time of treatment were used in this study. Patients were treated with conventional fractionation using an IMRT dose painting technique, most with 33 fractions. Weekly radiographic imaging was used to correct the patient setup. The authors used rigid registration of the planning CT and Cone Beam CT scans to find the translational and rotational setup errors, and the spatial setup errors of the cochlea. The planning CT was rotated and translated such that the cochlea positions match those seen in the cone beam scans, cochlea doses were recalculated and fractional doses accumulated. Uncertainties in the positions and cumulative doses of the cochlea were calculated with and without setup adjustments from radiographic imaging. Results: The mean setup error of the cochlea was 0.04 ± 0.33 or 0.06 ± 0.43 cm for RL, 0.09 ± 0.27 or 0.07 ± 0.48 cm for AP, and 0.00 ± 0.21 or −0.24 ± 0.45 cm for SI with and without radiographic imaging, respectively. Setup with radiographic imaging reduced the standard deviation of the setup error by roughly 1–2 mm. The uncertainty of the cochlea dose depends on the treatment plan and the relative positions of the cochlea and target volumes. Combining results for the left and right cochlea, the authors found the accumulated uncertainty of the cochlea dose per fraction was 4.82 (0.39–16.8) cGy, or 10.1 (0.8–32.4) cGy, with and without radiographic imaging, respectively; the percentage uncertainties relative to the planned doses were 4.32% (0.28%–9.06%) and 10.2% (0.7%–63.6%), respectively. Conclusions: Patient setup error introduces uncertainty in the position of the cochlea during radiation treatment. With the assistance of radiographic imaging during setup

  19. An experimental set-up to test heat-moisture exchangers

    NARCIS (Netherlands)

    Unal, N.; Pompe, J. C.; Holland, W. P.; Gültuna, I.; Huygen, P. E.; Jabaaij, K.; Ince, C.; Saygin, B.; Bruining, H. A.

    1995-01-01

    The purpose of this study was to build an experimental set-up to assess continuously the humidification, heating and resistance properties of heat-moisture exchangers (HMEs) under clinical conditions. The experimental set-up consists of a patient model, measurement systems and a ventilator. Surgical

  20. Developing models for patient flow and daily surge capacity research.

    Science.gov (United States)

    Asplin, Brent R; Flottemesch, Thomas J; Gordon, Bradley D

    2006-11-01

    Between 1993 and 2003, visits to U.S. emergency departments (EDs) increased by 26%, to a total of 114 million visits annually. At the same time, the number of U.S. EDs decreased by more than 400, and almost 200,000 inpatient hospital beds were taken out of service. In this context, the adequacy of daily surge capacity within the system is clearly an important issue. However, the research agenda on surge capacity thus far has focused primarily on large-scale disasters, such as pandemic influenza or a serious bioterrorism event. The concept of daily surge capacity and its relationship to the broader research agenda on patient flow is a relatively new area of investigation. In this article, the authors begin by describing the overlap between the research agendas on daily surge capacity and patient flow. Next, they propose two models that have potential applications for both daily surge capacity and hospitalwide patient-flow research. Finally, they identify potential research questions that are based on applications of the proposed research models.

  1. 'When measurements mean action' decision models for portal image review to eliminate systematic set-up errors

    International Nuclear Information System (INIS)

    Wratten, C.R.; Denham, J.W.; O; Brien, P.; Hamilton, C.S.; Kron, T.; London Regional Cancer Centre, London, Ontario

    2004-01-01

    The aim of the present paper is to evaluate how the use of decision models in the review of portal images can eliminate systematic set-up errors during conformal therapy. Sixteen patients undergoing four-field irradiation of prostate cancer have had daily portal images obtained during the first two treatment weeks and weekly thereafter. The magnitude of random and systematic variations has been calculated by comparison of the portal image with the reference simulator images using the two-dimensional decision model embodied in the Hotelling's evaluation process (HEP). Random day-to-day set-up variation was small in this group of patients. Systematic errors were, however, common. In 15 of 16 patients, one or more errors of >2 mm were diagnosed at some stage during treatment. Sixteen of the 23 errors were between 2 and 4 mm. Although there were examples of oversensitivity of the HEP in three cases, and one instance of undersensitivity, the HEP proved highly sensitive to the small (2-4 mm) systematic errors that must be eliminated during high precision radiotherapy. The HEP has proven valuable in diagnosing very small ( 4 mm) systematic errors using one-dimensional decision models, HEP can eliminate the majority of systematic errors during the first 2 treatment weeks. Copyright (2004) Blackwell Science Pty Ltd

  2. Twice-daily versus once-daily applications of pimecrolimus cream 1% for the prevention of disease relapse in pediatric patients with atopic dermatitis.

    Science.gov (United States)

    Ruer-Mulard, Mireille; Aberer, Werner; Gunstone, Anthony; Kekki, Outi-Maria; López Estebaranz, Jose Luis; Vertruyen, André; Guettner, Achim; Hultsch, Thomas

    2009-01-01

    The aim of this study is to compare twice-daily and once-daily applications of pimecrolimus cream 1% for prevention of atopic dermatitis relapses in pediatric patients. This multicenter trial enrolled 300 outpatients aged 2 to 17 years, with mild-to-severe atopic dermatitis. The patients were initially treated with twice-daily topical pimecrolimus until complete clearance or for up to 6 weeks (open-label period). Those who achieved a decrease of at least 1 point in the Investigator's Global Assessment score were then randomized to double-blind treatment with pimecrolimus cream 1% either twice daily or once daily for up to 16 weeks. Study medication was discontinued during periods of disease remission (Investigator's Global Assessment = 0). The primary efficacy end point of the double-blind phase was disease relapse (worsening requiring topical corticosteroids or additional/alternative therapy and confirmed by Investigator's Global Assessment score > or = 3 and pruritus score > or = 2). Of the 300 patients enrolled in the study, 268 were randomized to treatment with pimecrolimus cream 1% either twice daily or once daily (n = 134 in each group). The relapse rate was lower in the twice-daily dose group (9.9%) than that in the once-daily dose group (14.7%), but analysis of the time to disease relapse, using a Cox proportional model to adjust for confounding variables, did not show a statistically significant difference between treatment arms (hazard ratio: 0.64; 95% CI: 0.31-1.30). Treatment of active atopic dermatitis lesions with pimecrolimus cream 1% twice daily, followed by the once-daily dosing regimen, was sufficient to prevent subsequent atopic dermatitis relapses over 16 weeks in pediatric patients.

  3. MO-G-BRE-04: Automatic Verification of Daily Treatment Deliveries and Generation of Daily Treatment Reports for a MR Image-Guided Treatment Machine

    International Nuclear Information System (INIS)

    Yang, D; Li, X; Li, H; Wooten, H; Green, O; Rodriguez, V; Mutic, S

    2014-01-01

    Purpose: Two aims of this work were to develop a method to automatically verify treatment delivery accuracy immediately after patient treatment and to develop a comprehensive daily treatment report to provide all required information for daily MR-IGRT review. Methods: After systematically analyzing the requirements for treatment delivery verification and understanding the available information from a novel MR-IGRT treatment machine, we designed a method to use 1) treatment plan files, 2) delivery log files, and 3) dosimetric calibration information to verify the accuracy and completeness of daily treatment deliveries. The method verifies the correctness of delivered treatment plans and beams, beam segments, and for each segment, the beam-on time and MLC leaf positions. Composite primary fluence maps are calculated from the MLC leaf positions and the beam-on time. Error statistics are calculated on the fluence difference maps between the plan and the delivery. We also designed the daily treatment delivery report by including all required information for MR-IGRT and physics weekly review - the plan and treatment fraction information, dose verification information, daily patient setup screen captures, and the treatment delivery verification results. Results: The parameters in the log files (e.g. MLC positions) were independently verified and deemed accurate and trustable. A computer program was developed to implement the automatic delivery verification and daily report generation. The program was tested and clinically commissioned with sufficient IMRT and 3D treatment delivery data. The final version has been integrated into a commercial MR-IGRT treatment delivery system. Conclusion: A method was developed to automatically verify MR-IGRT treatment deliveries and generate daily treatment reports. Already in clinical use since December 2013, the system is able to facilitate delivery error detection, and expedite physician daily IGRT review and physicist weekly chart

  4. A two-shift optimisation of the 'no action level' setup correction protocol

    International Nuclear Information System (INIS)

    Fox, C.; Fisher, R.

    2004-01-01

    Full text: As electronic portal imaging equipment becomes more common, many radiotherapy centres now have the ability to collect patient treatment position deviation values. One commonly used off-line set-up correction protocol for calculating patient setup corrections is the 'no action level' (NAL) protocol. This paper proposes a two-shift approach and calculates the number of images required for minimum systematic error. Patient data is used in a simulation to confirm this approach. Patient treatment position deviations were available for all treatment sessions for a large group of patients undergoing radiation therapy for prostate. Thirty of these patients were selected. The patient position at treatment and all isocentre shifts made were recorded in the treatment notes. These were used to simulate the effect of the NAL protocol using a range of image numbers as the basis of the set-up correction. As Bortfeld et al noted, there is an error minimum that can be observed beyond which the mean radial systematic set-up error increases slowly with an increase in the number of images used. An enhancement to the NAL was proposed in which the patient's position is corrected on two occasions; once early in the treatment schedule, and again after more images have been collected. The expectation value of the set-up error for this two-shift NAL was found and minimised. The optimum staging for the two-shift NAL for the prostate patients was to image for a total of 9 sessions and to shift the patient after 3 sessions and 9 sessions. The thirty patients showed an uncorrected mean radial setup error of 0.65cm. In this simulation this was corrected to 0.26cm by application of the NAL using 5 images and to 0.17 cm using the two shift NAL with shifts after three and nine images. In situations where staff can manage the workload of collecting and analysing portal images for nine sessions for each patient, the two-shift NAL will result in a high level of set-up accuracy. Copyright

  5. A managed clinical network for cardiac services: set-up, operation and impact on patient care.

    Science.gov (United States)

    Stc Hamilton, Karen E; Sullivan, Frank M; Donnan, Peter T; Taylor, Rex; Ikenwilo, Divine; Scott, Anthony; Baker, Chris; Wyke, Sally

    2005-01-01

    To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and 'bed down'. Its primary "modus operand" was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were not statistically significant. There was no difference

  6. Accuracy of daily image guidance for hypofractionated liver radiotherapy with active breathing control

    International Nuclear Information System (INIS)

    Dawson, Laura A.; Eccles, Cynthia; Bissonnette, Jean-Pierre; Brock, Kristy K.

    2005-01-01

    Purpose: A six-fraction, high-precision radiotherapy protocol for unresectable liver cancer has been developed in which active breathing control (ABC) is used to immobilize the liver and daily megavoltage (MV) imaging and repositioning is used to decrease geometric uncertainties. We report the accuracy of setup in the first 20 patients consecutively treated using this approach. Methods and materials: After setup using conventional skin marks and lasers, orthogonal MV images were acquired with the liver immobilized using ABC. The images were aligned to reference digitally reconstructed radiographs using the diaphragm for craniocaudal (CC) alignment and the vertebral bodies for anterior-posterior (AP) and mediolateral (ML) alignment. Adjustments were made for positioning errors >3 mm. Verification imaging was repeated after repositioning to assess for residual positioning error. Offline image matching was conducted to determine the setup accuracy using this approach compared with the initial setup error before repositioning. Real-time beam's-eye-view MV movies containing an air-diaphragm interface were also evaluated. Results: A total of 405 images were evaluated from 20 patients. Repositioning occurred in 109 of 120 fractions because of offsets >3 mm. Three to eight beam angles, with up to four segments per field, were used for each isocenter. Breath holds of up to 27 s were used for imaging and treatment. The average time from the initial verification image to the last treatment beam was 21 min. Image guidance and repositioning reduced the population random setup errors (σ) from 6.5 mm (CC), 4.2 mm (ML), and 4.7 mm (AP) to 2.5 mm (CC), 2.8 mm (ML), and 2.9 mm (AP). The average individual random setup errors (σ) were reduced from 4.5 mm (CC), 3.2 mm (AP), and 2.5 mm (ML) to 2.2 mm (CC), 2.0 mm (AP), and 2.0 mm (ML). The standard deviation of the distribution of systematic deviations (Σ) was also reduced from 5.1 mm (CC), 3.4 mm (ML), and 3.1 mm (AP) to 1.4 mm (CC

  7. Raltegravir once daily or twice daily in previously untreated patients with HIV-1: a randomised, active-controlled, phase 3 non-inferiority trial

    NARCIS (Netherlands)

    Eron, Joseph J.; Rockstroh, Jürgen K.; Reynes, Jacques; Andrade-Villanueva, Jaime; Ramalho-Madruga, Jose Valdez; Bekker, Linda-Gail; Young, Benjamin; Katlama, Christine; Gatell-Artigas, Jose Maria; Arribas, Jose R.; Nelson, Mark; Campbell, Havilland; Zhao, Jing; Rodgers, Anthony J.; Rizk, Matthew L.; Wenning, Larissa; Miller, Michael D.; Hazuda, Daria; DiNubile, Mark J.; Leavitt, Randi; Isaacs, Robin; Robertson, Michael N.; Sklar, Peter; Nguyen, Bach-Yen; Bloch, M. T.; Hoy, J.; Workman, C.; Madruga, J. V.; Souza, T.; Telles, F. Q.; Zajdenverg, R.; Angel, J.; Montaner, J. S.; Smith, G. H. R.; Trottier, B.; Tamara, J. R.; Velez, J. D.; Gerstoft, J.; Laursen, A. L.; Mathiesen, L.; Katlama, C.; Molina, J. M.; Raffi, F.; Reynes, J.; Yazdanpanah, Y.; Bogner, J. R.; Fatkenheuer, G.; Hartl, H.; Jaeger, H.; Geerlings, S. E.

    2011-01-01

    Twice-daily raltegravir with once-daily tenofovir-emtricitabine is an effective initial antiretroviral regimen for patients with HIV-1. On the basis of pharmacokinetic data suggesting efficacy of once-daily raltegravir and because adherence is often improved with once-daily dosing, we aimed to

  8. Electronic portal image assisted reduction of systematic set-up errors in head and neck irradiation

    International Nuclear Information System (INIS)

    Boer, Hans C.J. de; Soernsen de Koste, John R. van; Creutzberg, Carien L.; Visser, Andries G.; Levendag, Peter C.; Heijmen, Ben J.M.

    2001-01-01

    Purpose: To quantify systematic and random patient set-up errors in head and neck irradiation and to investigate the impact of an off-line correction protocol on the systematic errors. Material and methods: Electronic portal images were obtained for 31 patients treated for primary supra-glottic larynx carcinoma who were immobilised using a polyvinyl chloride cast. The observed patient set-up errors were input to the shrinking action level (SAL) off-line decision protocol and appropriate set-up corrections were applied. To assess the impact of the protocol, the positioning accuracy without application of set-up corrections was reconstructed. Results: The set-up errors obtained without set-up corrections (1 standard deviation (SD)=1.5-2 mm for random and systematic errors) were comparable to those reported in other studies on similar fixation devices. On an average, six fractions per patient were imaged and the set-up of half the patients was changed due to the decision protocol. Most changes were detected during weekly check measurements, not during the first days of treatment. The application of the SAL protocol reduced the width of the distribution of systematic errors to 1 mm (1 SD), as expected from simulations. A retrospective analysis showed that this accuracy should be attainable with only two measurements per patient using a different off-line correction protocol, which does not apply action levels. Conclusions: Off-line verification protocols can be particularly effective in head and neck patients due to the smallness of the random set-up errors. The excellent set-up reproducibility that can be achieved with such protocols enables accurate dose delivery in conformal treatments

  9. Telemonitoring of Daily Activity and Symptom Behavior in Patients with COPD

    Directory of Open Access Journals (Sweden)

    Monique Tabak

    2012-01-01

    Full Text Available Objectives. This study investigated the activity behavior of patients with COPD in detail compared to asymptomatic controls, and the relationship between subjective and objective activities (awareness, and readiness to change activity behavior. Methods. Thirty-nine patients with COPD (66.0 years; FEV1% predicted: 44.9% and 21 healthy controls (57.0 years participated. Objective daily activity was assessed by accelerometry and expressed as amount of activity in counts per minute (cpm. Patients' baseline subjective activity and stage of change were assessed prior to measurements. Results. Mean daily activity in COPD patients was significantly lower compared to the healthy controls ( cpm versus  cpm, . COPD patients showed a temporary decrease in objective activities in the early afternoon. Objective and subjective activities were significantly moderately related and most patients (55.3% were in the maintenance phase of the stages of change. Conclusions. COPD patients show a distinctive activity decrease in the early afternoon. COPD patients are moderately aware of their daily activity but regard themselves as physically active. Therefore, future telemedicine interventions might consider creating awareness of an active lifestyle and provide feedback that aims to increase and balance activity levels.

  10. Automation and robotization of the set-up and treatment for patients treated for a brain and base of the skull tumor

    International Nuclear Information System (INIS)

    Noel, G.; Ferrand, R.; Feuvret, L.; Meyroneinc, S.; Mazeron, J.J.; Boisserie, G.; Mazeron, J.J.

    2003-01-01

    Progresses of the three-dimensional imageries and of the software of planning systems makes that the radiotherapy of the tumours of brain and the base of skull is increasingly precise. The set-up of the patients and the positioning of the beams are key acts whose realization can become extremely tiresome if the requirement of precision increases. This precision very often rests still on the visual comparison of digital images. In the near future, the development of the automated systems controlled by robots should allow a noticeable improvement of the precision, safety and speed of the patient set-up. (author)

  11. Special set-up and treatment techniques for the radiotherapy of pediatric malignancies

    International Nuclear Information System (INIS)

    Martinez, A.; Donaldson, S.S.; Bagshaw, M.A.

    1977-01-01

    The prevention of serious and long term complications of treatment have become as important a consideration in the therapy of children with malignant disease as the goal of tumor control. This balance requires meticulous treatment planning and attention to the treatment preparation and immobilization techniques when radiotherapy is administered to children. Accurate localization of tumor volume and daily reproducibility is essential for delivering precise irradiation. Four special set-up and treatment techniques which have a specific usefulness in radiotherapy for pediatric malignancies are defined and illustrated with the aid of clinical cases. They include the three point set-up, the split beam technique, the isocentric technique, and the strinking field technique

  12. Image-Guided Radiotherapy via Daily Online Cone-Beam CT Substantially Reduces Margin Requirements for Stereotactic Lung Radiotherapy

    International Nuclear Information System (INIS)

    Grills, Inga S.; Hugo, Geoffrey; Kestin, Larry L.; Galerani, Ana Paula; Chao, K. Kenneth; Wloch, Jennifer; Yan Di

    2008-01-01

    Purpose: To determine treatment accuracy and margins for stereotactic lung radiotherapy with and without cone-beam CT (CBCT) image guidance. Methods and Materials: Acquired for the study were 308 CBCT of 24 patients with solitary peripheral lung tumors treated with stereotactic radiotherapy. Patients were immobilized in a stereotactic body frame (SBF) or alpha-cradle and treated with image guidance using daily CBCT. Four (T1) or five (T2/metastatic) 12-Gy fractions were prescribed to the planning target volume (PTV) edge. The PTV margin was ≥5 mm depending on a pretreatment estimate of tumor excursion. Initial daily setup was according to SBF coordinates or tattoos for alpha-cradle cases. A CBCT was performed and registered to the planning CT using soft tissue registration of the target. The initial setup error/precorrection position, was recorded for the superior-inferior, anterior-posterior, and medial-lateral directions. The couch was adjusted to correct the tumor positional error. A second CBCT verified tumor position after correction. Patients were treated in the corrected position after the residual errors were ≤2 mm. A final CBCT after treatment assessed intrafraction tumor displacement. Results: The precorrection systematic (Σ) and random errors (σ) for the population ranged from 2-3 mm for SBF and 2-6 mm for alpha-cradle patients; postcorrection errors ranged from 0.4-1.0 mm. Calculated population margins were 9 to 13 mm (SBF) and 10-14 mm (cradle) precorrection, 1-2 mm (SBF), and 2-3 mm (cradle) postcorrection, and 2-4 mm (SBF) and 2-5 mm (cradle) posttreatment. Conclusions: Setup for stereotactic lung radiotherapy using a SBF or alpha-cradle alone is suboptimal. CBCT image guidance significantly improves target positioning and substantially reduces required target margins and normal tissue irradiation

  13. Setup planning for machining

    CERN Document Server

    Hazarika, Manjuri

    2015-01-01

    Professionals as well as researchers can benefit from this comprehensive introduction into the topic of setup planning, which reflects the latest state of research and gives hands-on examples. Starting with a brief but thorough introduction, this book explains the significance of setup planning in process planning and includes a reflection on its external constraints. Step-by-step the different phases of setup planning are outlined and traditional as well as modern approaches, such as fuzzy logic based setup planning, on the solution of setup planning problems are presented. Three detailed examples of applications provide a clear and accessible insight into the up-to-date techniques and various approaches in setup planning.

  14. High dose three-dimensional conformal boost (3DCB) using an orthogonal diagnostic X-ray set-up for patients with gynecological malignancy: a new application of real-time tumor-tracking system

    International Nuclear Information System (INIS)

    Yamamoto, Ritsu; Yonesaka, Akio; Nishioka, Seiko; Watari, Hidemichi; Hashimoto, Takayuki; Uchida, Daichi; Taguchi, Hiroshi; Nishioka, Takeshi; Miyasaka, Kazuo; Sakuragi, Noriaki; Shirato, Hiroki

    2004-01-01

    The feasibility and accuracy of high dose three-dimensional conformal boost (3DCB) using three internal fiducial markers and a two-orthogonal X-ray set-up of the real-time tumor-tracking system on patients with gynecological malignancy were investigated in 10 patients. The standard deviation of the distribution of systematic deviations (Σ) was reduced from 3.8, 4.6, and 4.9 mm in the manual set-up to 2.3, 2.3 and 2.7 mm in the set-up using the internal markers. The average standard deviation of the distribution of random deviations (σ) was reduced from 3.7, 5.0, and 4.5 mm in the manual set-up to 3.3, 3.0, and 4.2 mm in the marker set-up. The appropriate PTV margin was estimated to be 10.2, 12.8, and 12.9 mm in the manual set-up and 6.9, 6.7, and 8.3 mm in the gold marker set-up, respectively, using the formula 2Σ+0.7σ. Set-up of the patients with three markers and two fluoroscopy is useful to reduce PTV margin and perform 3DCB

  15. Hospitalization in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients.

    Science.gov (United States)

    Weinhandl, Eric D; Nieman, Kimberly M; Gilbertson, David T; Collins, Allan J

    2015-01-01

    Cardiovascular disease is a common cause of hospitalization in dialysis patients. Daily hemodialysis improves some parameters of cardiovascular function, but whether it associates with lower hospitalization risk is unclear. Observational cohort study using US Renal Data System data. Medicare-enrolled daily (5 or 6 sessions weekly) home hemodialysis (HHD) patients initiating NxStage System One use from January 1, 2006, through December 31, 2009, and contemporary thrice-weekly in-center hemodialysis patients, matched 5 to 1. Daily HHD or thrice-weekly in-center hemodialysis. All-cause and cause-specific hospital admissions, hospital readmissions, and hospital days assessed from Medicare Part A claims. For 3,480 daily HHD and 17,400 thrice-weekly in-center hemodialysis patients in intention-to-treat analysis, the HR of all-cause admission for daily HHD versus in-center hemodialysis was 1.01 (95%CI, 0.98-1.03). Cause-specific admission HRs were 0.89 (95%CI, 0.86-0.93) for cardiovascular disease, 1.18 (95%CI, 1.13-1.23) for infection, 1.01 (95%CI, 0.93-1.09) for vascular access dysfunction, and 1.02 (95%CI, 0.99-1.06) for other morbidity. Regarding cardiovascular disease, first admission and readmission HRs for daily HHD versus in-center hemodialysis were 0.91 and 0.87, respectively. Regarding infection, first admission and readmission HRs were 1.35 and 1.03, respectively. Protective associations of daily HHD with heart failure and hypertensive disease were most pronounced, as were adverse associations of daily HHD with bacteremia/sepsis, cardiac infection, osteomyelitis, and vascular access infection. Results may be confounded by unmeasured factors, including vascular access type; information about dialysis frequency, duration, and dose was lacking; causes of admission may be misclassified; results may not apply to patients without Medicare coverage. All-cause hospitalization risk was similar in daily HHD and thrice-weekly in-center hemodialysis patients. However

  16. Assessment of three-dimensional setup errors in image-guided pelvic radiotherapy for uterine and cervical cancer using kilovoltage cone-beam computed tomography and its effect on planning target volume margins.

    Science.gov (United States)

    Patni, Nidhi; Burela, Nagarjuna; Pasricha, Rajesh; Goyal, Jaishree; Soni, Tej Prakash; Kumar, T Senthil; Natarajan, T

    2017-01-01

    To achieve the best possible therapeutic ratio using high-precision techniques (image-guided radiation therapy/volumetric modulated arc therapy [IGRT/VMAT]) of external beam radiation therapy in cases of carcinoma cervix using kilovoltage cone-beam computed tomography (kV-CBCT). One hundred and five patients of gynecological malignancies who were treated with IGRT (IGRT/VMAT) were included in the study. CBCT was done once a week for intensity-modulated radiation therapy and daily in IGRT/VMAT. These images were registered with the planning CT scan images and translational errors were applied and recorded. In all, 2078 CBCT images were studied. The margins of planning target volume were calculated from the variations in the setup. The setup variation was 5.8, 10.3, and 5.6 mm in anteroposterior, superoinferior, and mediolateral direction. This allowed adequate dose delivery to the clinical target volume and the sparing of organ at risks. Daily kV-CBCT is a satisfactory method of accurate patient positioning in treating gynecological cancers with high-precision techniques. This resulted in avoiding geographic miss.

  17. Initial Australian experience with daily ultrasound localisation for prostate radiotherapy

    International Nuclear Information System (INIS)

    Kneebone, A.; Fuller, M.W.; Williams, M.J.

    2003-01-01

    Variability in prostate position is a major problem in the delivery of external beam radiotherapy (EBRT). Daily ultrasound localisation prior to radiotherapy has become popular in the United States but to date has not been used clinically in Australia or New Zealand. Daily transabdominal ultrasound images through the prostate were acquired using the BAT ultrasound system. Contour data from the planning system is reconstructed at the same locations/angles as the BAT images. By overlaying the planned contours with the newly acquired images, the isocentre is adjusted to ensure that the prostate will be within the irradiated volume. After commissioning by Medical Physics, an initial pre-clinical trial period was adopted. This involved performing BAT alignments daily but treating to the planned isocentre in 30 patients. Eighty three percent of patients (25/30) had images judged to be of good or excellent quality by the reviewing radiation oncologist. It was noted that for each operator there was a period needed to build confidence/competence in both imaging and interpreting the images for the moves. The median scan time in addition to the normal patient set-up was 3.2 minutes (range=1.5-12.0 mins) with the second 15 patients scanned quicker than the first 15 (2.9 minutes versus 3.8 minutes). A summary of the movements recommended by the BAT system is contained in the table. We feel that daily prostate ultrasound localization offers a significant advance in delivering EBRT for prostate cancer. The incorporation of the system into clinical use, however, was not without difficulty and requires significant time and effort from therapists, physicists and medical staff. Further clinical evaluation of the unit is ongoing

  18. SU-E-J-217: Accuracy Comparison Between Surface and Volumetric Registrations for Patient Setup of Head and Neck Radiation Therapy

    International Nuclear Information System (INIS)

    Kim, Y; Li, R; Na, Y; Jenkins, C; Xing, L; Lee, R

    2014-01-01

    Purpose: Optical surface imaging has been applied to radiation therapy patient setup. This study aims to investigate the accuracy of the surface registration of the optical surface imaging compared with that of the conventional method of volumetric registration for patient setup in head and neck radiation therapy. Methods: Clinical datasets of planning CT and treatment Cone Beam CT (CBCT) were used to compare the surface and volumetric registrations in radiation therapy patient setup. The Iterative Closest Points based on point-plane closest method was implemented for surface registration. We employed 3D Slicer for rigid volumetric registration of planning CT and treatment CBCT. 6 parameters of registration results (3 rotations and 3 translations) were obtained by the two registration methods, and the results were compared. Digital simulation tests in ideal cases were also performed to validate each registration method. Results: Digital simulation tests showed that both of the registration methods were accurate and robust enough to compare the registration results. In experiments with the actual clinical data, the results showed considerable deviation between the surface and volumetric registrations. The average root mean squared translational error was 2.7 mm and the maximum translational error was 5.2 mm. Conclusion: The deviation between the surface and volumetric registrations was considerable. Special caution should be taken in using an optical surface imaging. To ensure the accuracy of optical surface imaging in radiation therapy patient setup, additional measures are required. This research was supported in part by the KIST institutional program (2E24551), the Industrial Strategic technology development program (10035495) funded by the Ministry of Trade, Industry and Energy (MOTIE, KOREA), and the Radiation Safety Research Programs (1305033) through the Nuclear Safety and Security Commission, and the NIH (R01EB016777)

  19. SU-E-J-217: Accuracy Comparison Between Surface and Volumetric Registrations for Patient Setup of Head and Neck Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Y [Stanford University School of Medicine, Stanford, CA (United States); Korea Institute of Science and Technology, Seoul (Korea, Republic of); Li, R; Na, Y; Jenkins, C; Xing, L [Stanford University School of Medicine, Stanford, CA (United States); Lee, R [Ewha Womans University, Seoul (Korea, Republic of)

    2014-06-01

    Purpose: Optical surface imaging has been applied to radiation therapy patient setup. This study aims to investigate the accuracy of the surface registration of the optical surface imaging compared with that of the conventional method of volumetric registration for patient setup in head and neck radiation therapy. Methods: Clinical datasets of planning CT and treatment Cone Beam CT (CBCT) were used to compare the surface and volumetric registrations in radiation therapy patient setup. The Iterative Closest Points based on point-plane closest method was implemented for surface registration. We employed 3D Slicer for rigid volumetric registration of planning CT and treatment CBCT. 6 parameters of registration results (3 rotations and 3 translations) were obtained by the two registration methods, and the results were compared. Digital simulation tests in ideal cases were also performed to validate each registration method. Results: Digital simulation tests showed that both of the registration methods were accurate and robust enough to compare the registration results. In experiments with the actual clinical data, the results showed considerable deviation between the surface and volumetric registrations. The average root mean squared translational error was 2.7 mm and the maximum translational error was 5.2 mm. Conclusion: The deviation between the surface and volumetric registrations was considerable. Special caution should be taken in using an optical surface imaging. To ensure the accuracy of optical surface imaging in radiation therapy patient setup, additional measures are required. This research was supported in part by the KIST institutional program (2E24551), the Industrial Strategic technology development program (10035495) funded by the Ministry of Trade, Industry and Energy (MOTIE, KOREA), and the Radiation Safety Research Programs (1305033) through the Nuclear Safety and Security Commission, and the NIH (R01EB016777)

  20. Evaluating the influence of setup uncertainties on treatment planning for focal liver tumors

    International Nuclear Information System (INIS)

    Balter, J.M.; Brock, K.K.; Lam, K.L.; Dawson, L.A.; McShan, D.L.; Ten Haken, R.K.

    2001-01-01

    Purpose: A mechanism has been developed to evaluate the influence of systematic and random setup variations on dose during treatment planning. The information available for studying these factors shifts from population-based models towards patient-specific data as treatment progresses and setup measurements for an individual patient become available. This study evaluates the influence of population as well as patient-specific setup distributions on treatment plans for focal liver tumors. Materials and Methods: 8 patients with focal liver tumors were treated on a protocol that involved online setup measurement and adjustment, as well as ventilatory immobilization. Summary statistics from these treatments yielded individual and population distributions of position at initial setup for each fraction as well as after setup adjustment. A convolution model for evaluation of the influence of random setup variation on calculated dose distributions has been previously described and investigated for application to focal liver radiotherapy by our department. Individual patient doses based on initial setup positions were calculated by applying the measured systematic offset to the initial treatment plan, and then convolving the calculated dose distribution with an anisotropic probability distribution function representing the individual patient's random variations. A separate calculation with no offset and convolution using population averaged random variations was performed. Individual beam apertures were then adjusted to provide plans that ensured proper dose to the clinical target volume (CTV) following convolution with population distributions prior to and following setup adjustment. Results: Input distributions comprised 262 position measurements. Individual patient setup distributions for the course of treatment had systematic offsets ranging from (σ) 1.1 to 4.1 mm (LR), -2.0 to 1.4 mm (AP), and 5.6 to 1.7 mm (IS). Individual random setup variations ranged from 2.5 to 5

  1. Automatic detection of patient identification and positioning errors in radiotherapy treatment using 3D setup images

    OpenAIRE

    Jani, Shyam

    2015-01-01

    The success of modern radiotherapy treatment depends on the correct alignment of the radiation beams with the target region in the patient. In the conventional paradigm of image-guided radiation therapy, 2D or 3D setup images are taken immediately prior to treatment and are used by radiation therapy technologists to localize the patient to the same position as defined from the reference planning CT dataset. However, numerous reports in the literature have described errors during this step, wh...

  2. Variations of target volume definition and daily target volume localization in stereotactic body radiotherapy for early-stage non–small cell lung cancer patients under abdominal compression

    Energy Technology Data Exchange (ETDEWEB)

    Han, Chunhui, E-mail: chan@coh.org; Sampath, Sagus; Schultheisss, Timothy E.; Wong, Jeffrey Y.C.

    2017-07-01

    We aimed to compare gross tumor volumes (GTV) in 3-dimensional computed tomography (3DCT) simulation and daily cone beam CT (CBCT) with the internal target volume (ITV) in 4-dimensional CT (4DCT) simulation in stereotactic body radiotherapy (SBRT) treatment of patients with early-stage non–small cell lung cancer (NSCLC) under abdominal compression. We retrospectively selected 10 patients with NSCLC who received image-guided SBRT treatments under abdominal compression with daily CBCT imaging. GTVs were contoured as visible gross tumor on the planning 3DCT and daily CBCT, and ITVs were contoured using maximum intensity projection (MIP) images of the planning 4DCT. Daily CBCTs were registered with 3DCT and MIP images by matching of bony landmarks in the thoracic region to evaluate interfractional GTV position variations. Relative to MIP-based ITVs, the average 3DCT-based GTV volume was 66.3 ± 17.1% (range: 37.5% to 92.0%) (p < 0.01 in paired t-test), and the average CBCT-based GTV volume was 90.0 ± 6.7% (daily range: 75.7% to 107.1%) (p = 0.02). Based on bony anatomy matching, the center-of-mass coordinates for CBCT-based GTVs had maximum absolute shift of 2.4 mm (left-right), 7.0 mm (anterior-posterior [AP]), and 5.2 mm (superior-inferior [SI]) relative to the MIP-based ITV. CBCT-based GTVs had average overlapping ratio of 81.3 ± 11.2% (range: 45.1% to 98.9%) with the MIP-based ITV, and 57.7 ± 13.7% (range: 35.1% to 83.2%) with the 3DCT-based GTV. Even with abdominal compression, both 3DCT simulations and daily CBCT scans significantly underestimated the full range of tumor motion. In daily image-guided patient setup corrections, automatic bony anatomy-based image registration could lead to target misalignment. Soft tissue-based image registration should be performed for accurate treatment delivery.

  3. SU-E-T-139: Automated Daily EPID Exit Dose Analysis Uncovers Treatment Variations

    Energy Technology Data Exchange (ETDEWEB)

    Olch, A [University of Southern California, Los Angeles, CA (United States)

    2015-06-15

    Purpose: To evaluate a fully automated EPID exit dose system for its ability to detect daily treatment deviations including patient setup, delivery, and anatomy changes. Methods: PerFRACTION (Sun Nuclear Corporation) software is a system that uses integrated EPID images taken during patient treatment and automatically pulled from the Aria database and analyzed based on user-defined comparisons. This was used to monitor 20 plans consisting of a total of 859 fields for 18 patients, for a total of 251 fractions. Nine VMAT, 5 IMRT, and 6 3D plans were monitored. The Gamma analysis was performed for each field within a plan, comparing the first fraction against each of the other fractions in each treatment course. A 2% dose difference, 1 mm distance-to-agreement, and 10% dose threshold was used. These tight tolerances were chosen to achieve a high sensitivity to treatment variations. The field passed if 93% of the pixels had a Gamma of 1 or less. Results: Twenty-nine percent of the fields failed. The average plan passing rate was 92.5%.The average 3D plan passing rate was less than for VMAT or IMRT, 84%, vs. an average of 96.2%. When fields failed, an investigation revealed changes in patient anatomy or setup variations, often also leading to variations of transmission through immobilization devices. Conclusion: PerFRACTION is a fully automated system for determining daily changes in dose transmission through the patient that requires no effort other than for the imager panel to be deployed during treatment. A surprising number of fields failed the analysis and can be attributed to important treatment variations that would otherwise not be appreciated. Further study of inter-fraction treatment variations is possible and warranted. Sun Nuclear Corporation provided a license to the software described.

  4. SU-E-J-53: A Phantom Design to Assist Patient Position Verification System in Daily Image-Guided RT and Comprehensive QA Measurements

    International Nuclear Information System (INIS)

    Syh, J; Wu, H

    2015-01-01

    Purpose This study is to implement a homemade novel device with surface locking couch index to check daily radiograph (DR) function of adaPTInsight™, stereoscopic image guided system (SIGS), for proton therapy. The comprehensive daily QA checks of proton pencil beam output, field size, flatness and symmetry of spots and energy layers will be followed by using MatriXX dosimetry device. Methods The iBa MatriXX device was used to perform daily dosimetry which is also used to perform SIGS checks. A set of markers were attached to surface of MatriXX device in alignment of DRR of reconstructed CT images and daily DR. The novel device allows MatriXX to be fit into the cradle which was locked by couch index bars on couch surface. This will keep the MatriXX at same XY plane daily with exact coordinates. Couch height Z will be adjusted according to imaging to check isocenter-laser coincidence accuracy. Results adaPTInsight™ provides robotic couch to move in 6-degree coordinate system to align the dosimetry device to be within 1.0 mm / 1.0°. The daily constancy was tightened to be ± 0.5 mm / 0.3° compared to 1.0 mm / 1.0° before. For gantry at 0° and couch all 0° angles (@ Rt ARM 0 setting), offsets measured of the couch systems were ≤ 0.5° in roll, yaw and pitch dimensions. Conclusion Simplicity of novel device made daily image guided QA consistent with accuracy. The offset of the MatriXX isocenter-laser coincident was reproducible. Such easy task not only speeds up the setup, but it increases confidence level in detailed daily comprehensive measurements. The total SIGS alignment time has been shortened with less setup error. This device will enhance our experiences for the future QA when cone beam CT imaging modality becomes available at proton therapy center

  5. SU-F-P-18: Development of the Technical Training System for Patient Set-Up Considering Rotational Correction in the Virtual Environment Using Three-Dimensional Computer Graphic Engine

    Energy Technology Data Exchange (ETDEWEB)

    Imura, K [Division of Quantum Radiation Science, Department of Health Science, Graduate School of Medical Science, Kyushu University, Fukuoka (Japan); Fujibuchi, T; Hirata, H [Department of Health Science, Graduate School of Medical Science, Kyushu University, Fukuoka (Japan); Kaneko, K [Innovation Center for Educational Resource, Kyushu University, Fukuoka (Japan); Hamada, E [Cancer Treatment Center, Tobata Kyoritsu Hospital, Kitakyushu (Japan)

    2016-06-15

    Purpose: Patient set-up skills in radiotherapy treatment room have a great influence on treatment effect for image guided radiotherapy. In this study, we have developed the training system for improving practical set-up skills considering rotational correction in the virtual environment away from the pressure of actual treatment room by using three-dimensional computer graphic (3DCG) engine. Methods: The treatment room for external beam radiotherapy was reproduced in the virtual environment by using 3DCG engine (Unity). The viewpoints to perform patient set-up in the virtual treatment room were arranged in both sides of the virtual operable treatment couch to assume actual performance by two clinical staffs. The position errors to mechanical isocenter considering alignment between skin marker and laser on the virtual patient model were displayed by utilizing numerical values expressed in SI units and the directions of arrow marks. The rotational errors calculated with a point on the virtual body axis as the center of each rotation axis for the virtual environment were corrected by adjusting rotational position of the body phantom wound the belt with gyroscope preparing on table in a real space. These rotational errors were evaluated by describing vector outer product operations and trigonometric functions in the script for patient set-up technique. Results: The viewpoints in the virtual environment allowed individual user to visually recognize the position discrepancy to mechanical isocenter until eliminating the positional errors of several millimeters. The rotational errors between the two points calculated with the center point could be efficiently corrected to display the minimum technique mathematically by utilizing the script. Conclusion: By utilizing the script to correct the rotational errors as well as accurate positional recognition for patient set-up technique, the training system developed for improving patient set-up skills enabled individual user to

  6. SU-F-P-18: Development of the Technical Training System for Patient Set-Up Considering Rotational Correction in the Virtual Environment Using Three-Dimensional Computer Graphic Engine

    International Nuclear Information System (INIS)

    Imura, K; Fujibuchi, T; Hirata, H; Kaneko, K; Hamada, E

    2016-01-01

    Purpose: Patient set-up skills in radiotherapy treatment room have a great influence on treatment effect for image guided radiotherapy. In this study, we have developed the training system for improving practical set-up skills considering rotational correction in the virtual environment away from the pressure of actual treatment room by using three-dimensional computer graphic (3DCG) engine. Methods: The treatment room for external beam radiotherapy was reproduced in the virtual environment by using 3DCG engine (Unity). The viewpoints to perform patient set-up in the virtual treatment room were arranged in both sides of the virtual operable treatment couch to assume actual performance by two clinical staffs. The position errors to mechanical isocenter considering alignment between skin marker and laser on the virtual patient model were displayed by utilizing numerical values expressed in SI units and the directions of arrow marks. The rotational errors calculated with a point on the virtual body axis as the center of each rotation axis for the virtual environment were corrected by adjusting rotational position of the body phantom wound the belt with gyroscope preparing on table in a real space. These rotational errors were evaluated by describing vector outer product operations and trigonometric functions in the script for patient set-up technique. Results: The viewpoints in the virtual environment allowed individual user to visually recognize the position discrepancy to mechanical isocenter until eliminating the positional errors of several millimeters. The rotational errors between the two points calculated with the center point could be efficiently corrected to display the minimum technique mathematically by utilizing the script. Conclusion: By utilizing the script to correct the rotational errors as well as accurate positional recognition for patient set-up technique, the training system developed for improving patient set-up skills enabled individual user to

  7. High-precision prostate cancer irradiation by clinical application of an offline patient setup verification procedure, using portal imaging

    NARCIS (Netherlands)

    Bel, A.; Vos, P. H.; Rodrigus, P. T.; Creutzberg, C. L.; Visser, A. G.; Stroom, J. C.; Lebesque, J. V.

    1996-01-01

    PURPOSE: To investigate in three institutions, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Huis [AvL]), Dr. Daniel den Hoed Cancer Center (DDHC), and Dr, Bernard Verbeeten Institute (BVI), how much the patient setup accuracy for irradiation of prostate cancer can be improved by an

  8. High-precision prostate cancer irradiation by clinical application of an offline patient setup verification procedure, using portal imaging

    NARCIS (Netherlands)

    A. Bel (Arjan); P.H. Vos (Pieter); P. Rodrigus (Patrick); C.L. Creutzberg (Carien); A.G. Visser (Andries); J.Ch. Stroom (Joep); J.V. Lebesque (Joos)

    1996-01-01

    textabstractPurpose: To investigate in three institutions, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Huis [AvL]), Dr. Daniel den Hoed Cancer Center (DDHC), and Dr. Bernard Verbeeten Institute (BVI), how much the patient setup accuracy for irradiation of prostate cancer can be improved

  9. Improving Communication During Cardiac ICU Multidisciplinary Rounds Through Visual Display of Patient Daily Goals.

    Science.gov (United States)

    Justice, Lindsey B; Cooper, David S; Henderson, Carla; Brown, James; Simon, Katherine; Clark, Lindsey; Fleckenstein, Elizabeth; Benscoter, Alexis; Nelson, David P

    2016-07-01

    To improve communication during daily cardiac ICU multidisciplinary rounds. Quality improvement methodology. Twenty-five-bed cardiac ICUs in an academic free-standing pediatric hospital. All patients admitted to the cardiac ICU. Implementation of visual display of patient daily goals through a write-down and read-back process. The Rounds Effectiveness Assessment and Communication Tool was developed based on the previously validated Patient Knowledge Assessment Tool to evaluate comprehension of patient daily goals. Rounds were assessed for each patient by the bedside nurse, nurse practitioner or fellow, and attending physician, and answers were compared to determine percent agreement per day. At baseline, percent agreement for patient goals was only 62%. After initial implementation of the daily goal write-down/read-back process, which was written on paper by the bedside nurse, the Rounds Effectiveness Assessment and Communication Tool survey revealed no improvement. With adaptation of the intervention so goals were written on whiteboards for visual display during rounds, the percent agreement improved to 85%. Families were also asked to complete a survey (1-6 Likert scale) of their satisfaction with rounds and understanding of daily goals before and after the intervention. Family survey results improved from a mean of 4.6-5.7. Parent selection of the best possible score for each question was 19% at baseline and 75% after the intervention. Visual display of patient daily goals via a write-down/read-back process improves comprehension of goals by all team members and improves parent satisfaction. The daily goal whiteboard facilitates consistent development of a comprehensive plan of care for each patient, fosters goal-directed care, and provides a checklist for providers and parents to review throughout the day.

  10. Setup error in radiotherapy: on-line correction using electronic kilovoltage and megavoltage radiographs

    International Nuclear Information System (INIS)

    Pisani, Laura; Lockman, David; Jaffray, David; Yan Di; Martinez, Alvaro; Wong, John

    2000-01-01

    Purpose: We hypothesize that the difference in image quality between the traditional kilovoltage (kV) prescription radiographs and megavoltage (MV) treatment radiographs is a major factor hindering our ability to accurately measure, thus correct, setup error in radiation therapy. The objective of this work is to study the accuracy of on-line correction of setup errors achievable using either kV- or MV-localization (i.e., open-field) radiographs. Methods and Materials: Using a gantry mounted kV and MV dual-beam imaging system, the accuracy of on-line measurement and correction of setup error using electronic kV- and MV-localization images was examined based on anthropomorphic phantom and patient imaging studies. For the phantom study, the user's ability to accurately detect known translational shifts was analyzed. The clinical study included 14 patients with disease in the head and neck, thoracic, and pelvic regions. For each patient, 4 orthogonal kV radiographs acquired during treatment simulation from the right lateral, anterior-to-posterior, left lateral, and posterior-to-anterior directions were employed as reference prescription images. Two-dimensional (2D) anatomic templates were defined on each of the 4 reference images. On each treatment day, after positioning the patient for treatment, 4 orthogonal electronic localization images were acquired with both kV and 6-MV photon beams. On alternate weeks, setup errors were determined from either the kV- or MV-localization images but not both. Setup error was determined by aligning each 2D template with the anatomic information on the corresponding localization image, ignoring rotational and nonrigid variations. For each set of 4 orthogonal images, the results from template alignments were averaged. Based on the results from the phantom study and a parallel study of the inter- and intraobserver template alignment variability, a threshold for minimum correction was set at 2 mm in any direction. Setup correction was

  11. Retrospective analysis of prostate cancer patients with implanted gold markers using off-line and adaptive therapy protocols

    International Nuclear Information System (INIS)

    Litzenberg, Dale W.; Balter, James M.; Lam, Kwok L.; Sandler, Howard M.; Ten Haken, Randall K.

    2005-01-01

    Purpose: To determine the efficacy of applying adaptive and off-line setup correction models to bony anatomy and gold fiducial markers implanted in the prostate, relative to daily alignment to skin tattoos and daily on-line corrections of the implanted gold markers. Methods and Materials: Ten prostate cancer patients with implanted gold fiducial markers were treated using a daily on-line setup correction protocol. The patients' positions were aligned to skin tattoos and two orthogonal diagnostic digital radiographs were obtained before treatment each day. These radiographs were compared with digitally reconstructed radiographs to obtain the translational setup errors of the bony anatomy and gold markers. The adaptive, no-action-level and shrinking-action-level off-line protocols were retrospectively applied to the bony anatomy to determine the change in the setup errors of the gold markers. The protocols were also applied to the gold markers directly to determine the residual setup errors. Results: The percentage of remaining fractions that the gold markers fell within the adaptive margins constructed with 1.5σ' (estimated random variation) after 5, 10, and 15 measurement fractions was 74%, 88%, and 93% for the prone patients and 55%, 77%, and 93% for the supine patients, respectively. Using 2σ', the percentage after 5, 10, and 15 measurements was 85%, 95%, and 97% for the prone patients and 68%, 87%, and 99% for the supine patients, respectively. The average initial three-dimensional (3D) setup error of the gold markers was 0.92 cm for the prone patients and 0.70 cm for the supine patients. Application of the no-action-level protocol to bony anatomy with N m = 3 days resulted in significant benefit to 4 of 10 patients, but 3 were significantly worse. The residual average 3D setup error of the gold markers was 1.14 cm and 0.51 cm for the prone and supine patients, respectively. When applied directly to the gold markers with N m = 3 days, 5 patients benefited and

  12. Leadership set-up

    DEFF Research Database (Denmark)

    Thude, Bettina Ravnborg; Stenager, Egon; von Plessen, Christian

    2018-01-01

    . Findings: The study found that the leadership set-up did not have any clear influence on interdisciplinary cooperation, as all wards had a high degree of interdisciplinary cooperation independent of which leadership set-up they had. Instead, the authors found a relation between leadership set-up and leader...... could influence legitimacy. Originality/value: The study shows that leadership set-up is not the predominant factor that creates interdisciplinary cooperation; but rather, leader legitimacy also should be considered. Additionally, the study shows that leader legitimacy can be difficult to establish...... and that it cannot be taken for granted. This is something chief executive officers should bear in mind when they plan and implement new leadership structures. Therefore, it would also be useful to look more closely at how to achieve legitimacy in cases where the leader is from a different profession to the staff....

  13. Disability, Activities of Daily Living and Self Efficacy in Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Mukadder Mollaoglu

    2011-04-01

    Full Text Available Purpose: The purpose of this study is to assess patients’ disability, activities of daily living and self-efficacy patients undergoing hemodialysis (HD and continuos ambulatory peritoneal dialysis (CAPD, to examine the relationship between them. Material and Methods: This study was carried with 152 patients as sample group. In this study, three instruments were used: Personal Information Form, Brief Disability Questionnaire, Katz\\'s Activity\\'s of Daily Living Index and Lawton and Brody\\'s Instrumental Activities of Daily Living Index and Self-efficacy Assessment Form. Data collected from the study was analyzed using percent, mean, Tukey test, significance test of two means, One-way variant analysis and Kruskal-Wallis test. Results: The study results demonstrate that while there is a correlation between self-care ability and age, education level, marital status and additional health problems, factors such as age, gender, education level, work status, income level, social insurance status and frequency of hemodialysis application determine self-efficacy. Furthermore, a negative correlation was found between patients’ disability and activities of daily living , self-efficacy. It was determined that as the level of disability increases self-efficiacy level decreases. Conclusions: Dialysis application affects patients’ disability, activities of daily living and self-efficacy levels. In view of this study’s results, it is recommended to organize education programs to increase self-efficacy levels of dialysis patients and prepare comprehensive plans including patients’ families. [TAF Prev Med Bull 2011; 10(2.000: 181-186

  14. An edge over diagnostic setup

    Directory of Open Access Journals (Sweden)

    Sridhar Kannan

    2017-01-01

    Full Text Available Diagnostic setup proposed by H.D. Kingsley serves as a practical aid in treatment planning and diagnosis. These setups have some inherent shortcomings. A simple technique of duplication of the setups in dental stone can solve problems encountered before as well as provide many other advantages over the conventional procedure. The diagnostic setup is prepared by the conventional method [Figure 1]. An alginate impression is then taken of the setups and poured in dental stone to obtain the derived treatment model [Figure 2]. The same setup can now be further modified for alternate lines of treatment. Subsequently models could then be obtained as required [Figure 3].

  15. Relationship between daily physical activity and exercise capacity in patients with COPD

    NARCIS (Netherlands)

    Zwerink, Marlies; van der Palen, Jacobus Adrianus Maria; van der Valk, P.; Brusse-Keizer, M.G.J.; Effing, T.W.

    2013-01-01

    BACKGROUND: Exercise training programmes for patients with COPD are effective in improving exercise capacity. The few trials that have investigated the effects of exercise programmes on daily physical activity show contradictory results. AIM: To investigate the relation between daily physical

  16. Impact of setup variability on incidental lung irradiation during tangential breast treatment

    International Nuclear Information System (INIS)

    Carter, Dennis L.; Marks, Lawrence B.; Bentel, Gunilla C.

    1997-01-01

    Purpose: This study aimed to determine the variability in treatment setup during a 5-week course of tangential breast treatment for patients immobilized in a customized hemibody cradle, to assess the relationship between the height of the lung shadow on the tangential port film and the percentage of lung volume irradiated, and to estimate the impact of setup variabilities on irradiated lung volume. Methods: One hundred seventy-two port films were reviewed from 20 patients who received tangential beam treatment for breast cancer. The height of the lung shadow at the central axis (CLD) on each port film was compared to the corresponding simulator film as an assessment of setup variability. A three-dimensional dose calculation was performed, and the percentage of total lung volume within the field was correlated with the CLD. The three-dimensional dose calculation was repeated for selected patients with the location of the treatment beams modified to reflect typical setup variations. Results: The CLD measured on the port films was within 3 mm of that prescribed on the simulator film in 43% (74 of 172) of the port films. The variation was 3-5 mm in 26%, 5-10 mm in 25%, and >10 mm in 6%. The height of the lung shadow correlated with the percentage of lung volume included in the radiation field (r 2 = 0.6). Typical variations in treatment setup resulted in ≤5% fluctuation in the absolute volume of ipsilateral lung irradiated. Conclusion: The current immobilization system used in our clinic provides a clinically acceptable reproducibility of patient setup. The height of the lung shadow is reasonably well correlated with the percentage of irradiated lung volume. During a typical 5-week course of radiotherapy, the ipsilateral irradiated lung volume fluctuates <5%

  17. Daily CT localization for correcting portal errors in the treatment of prostate cancer

    International Nuclear Information System (INIS)

    Lattanzi, Joseph; McNeely, Shawn; Hanlon, Alexandra; Das, Indra; Schultheiss, Timothy E.; Hanks, Gerald E.

    1998-01-01

    Introduction: Improved prostate localization techniques should allow the reduction of margins around the target to facilitate dose escalation in high-risk patients while minimizing the risk of normal tissue morbidity. A daily CT simulation technique is presented to assess setup variations in portal placement and organ motion for the treatment of localized prostate cancer. Methods and Materials: Six patients who consented to this study underwent supine position CT simulation with an alpha cradle cast, intravenous contrast, and urethrogram. Patients received 46 Gy to the initial Planning Treatment Volume (PTV 1 ) in a four-field conformal technique that included the prostate, seminal vesicles, and lymph nodes as the Gross Tumor Volume (GTV 1 ). The prostate or prostate and seminal vesicles (GTV 2 ) then received 56 Gy to PTV 2 . All doses were delivered in 2-Gy fractions. After 5 weeks of treatment (50 Gy), a second CT simulation was performed. The alpha cradle was secured to a specially designed rigid sliding board. The prostate was contoured and a new isocenter was generated with appropriate surface markers. Prostate-only treatment portals for the final conedown (GTV 3 ) were created with a 0.25-cm margin from the GTV to PTV. On each subsequent treatment day, the patient was placed in his cast on the sliding board for a repeat CT simulation. The daily isocenter was recalculated in the anterior/posterior (A/P) and lateral dimension and compared to the 50-Gy CT simulation isocenter. Couch and surface marker shifts were calculated to produce portal alignment. To maintain proper positioning, the patients were transferred to a stretcher while on the sliding board in the cast and transported to the treatment room where they were then transferred to the treatment couch. The patients were then treated to the corrected isocenter. Portal films and electronic portal images were obtained for each field. Results: Utilizing CT-CT image registration (fusion) of the daily and 50

  18. Initial Results of Using Daily CT Localization to Correct Portal Error in Prostate Cancer

    International Nuclear Information System (INIS)

    Lattanzi, Joseph; McNeely, Shawn; Barnes, Scott; Das, Indra; Schultheiss, Timothy E; Hanks, Gerald E.

    1997-01-01

    (surface marker shifts) error and absolute prostate motion relative to the bony pelvis. Prostate organ motion for the group is summarized in Table I. The maximum daily A/P shift was 7 mm observed in patient no. 4. Motion was less than 5 mm in the remaining patients and the overall mean change only 2.9 mm. The overall variability is quantified by a pooled standard deviation of only 1.5 mm. The maximum lateral shifts were less than 3 mm for all patients. With careful attention to proper patient positioning technique set-up error can be reduced to 2 mm or less. Conclusion: In our experience prostate motion after 50 Gy was significantly less than has been previously reported and may reflect early physiologic changes due to radiation which restrict prostate motion. This observation is being tested in a separate study. Intrapatient and overall population variance was minimal. With daily isocenter correction we can nearly eliminate set-up and organ motion error and therefore reduce the prostate PTV margins to 0 cm posteriorly and 0.25 cm anteriorly/laterally. We believe this will facilitate dose escalation beyond 75 Gy in high risk patients with minimal risk of increased morbidity. This technique may also be beneficial in low risk patients by sparing more normal surrounding tissue

  19. Lower limb immobilization device induced small setup errors in the radiotherapy.

    Science.gov (United States)

    Lu, Yuting; Ni, Xinye; Yu, Jingping; Ni, Xinchu; Sun, Zhiqiang; Wang, Jianlin; Sun, Suping; Wang, Jian

    2018-04-01

    The aim of this study was to design a lower limb immobilization device and investigate its clinical application in the radiotherapy of the lower limbs.Around 38 patients who underwent lower limb radiotherapy using the designed immobilization device were included in this study. The setup errors were calculated by comparison of the portal images and the simulator films or digital reconstructed radiographs (DRRs).From all 38 patients accomplished the radiotherapy using this device, 178 anteroposterior portal images and 178 lateral portal images were used for the analysis of the positional accuracy. Significant differences were observed in the setup error of the head-foot direction compared with the left-right direction (t = 3.404, P = .002) and the anterior-posterior directions (t = 3.188, P = .003). No statistical differences were identified in the setup error in the left-right direction and anterior-posterior direction (t = 0.497, P = .622).The use of the in-house designed lower limb immobilization device allowed for relatively small setup errors. Furthermore, it showed satisfactory accuracy and repeatability.

  20. Impact of patient-specific factors, irradiated left ventricular volume, and treatment set-up errors on the development of myocardial perfusion defects after radiation therapy for left-sided breast cancer

    International Nuclear Information System (INIS)

    Evans, Elizabeth S.; Prosnitz, Robert G.; Yu Xiaoli; Zhou Sumin; Hollis, Donna R.; Wong, Terence Z.; Light, Kim L.; Hardenbergh, Patricia H.; Blazing, Michael A.; Marks, Lawrence B.

    2006-01-01

    Purpose: The aim of this study was to assess the impact of patient-specific factors, left ventricle (LV) volume, and treatment set-up errors on the rate of perfusion defects 6 to 60 months post-radiation therapy (RT) in patients receiving tangential RT for left-sided breast cancer. Methods and Materials: Between 1998 and 2005, a total of 153 patients were enrolled onto an institutional review board-approved prospective study and had pre- and serial post-RT (6-60 months) cardiac perfusion scans to assess for perfusion defects. Of the patients, 108 had normal pre-RT perfusion scans and available follow-up data. The impact of patient-specific factors on the rate of perfusion defects was assessed at various time points using univariate and multivariate analysis. The impact of set-up errors on the rate of perfusion defects was also analyzed using a one-tailed Fisher's Exact test. Results: Consistent with our prior results, the volume of LV in the RT field was the most significant predictor of perfusion defects on both univariate (p = 0.0005 to 0.0058) and multivariate analysis (p = 0.0026 to 0.0029). Body mass index (BMI) was the only significant patient-specific factor on both univariate (p = 0.0005 to 0.022) and multivariate analysis (p = 0.0091 to 0.05). In patients with very small volumes of LV in the planned RT fields, the rate of perfusion defects was significantly higher when the fields set-up 'too deep' (83% vs. 30%, p = 0.059). The frequency of deep set-up errors was significantly higher among patients with BMI ≥25 kg/m 2 compared with patients of normal weight (47% vs. 28%, p = 0.068). Conclusions: BMI ≥25 kg/m 2 may be a significant risk factor for cardiac toxicity after RT for left-sided breast cancer, possibly because of more frequent deep set-up errors resulting in the inclusion of additional heart in the RT fields. Further study is necessary to better understand the impact of patient-specific factors and set-up errors on the development of RT

  1. Interfractional and intrafractional errors assessed by daily cone-beam computed tomography in nasopharyngeal carcinoma treated with intensity-modulated radiation therapy. A prospective study

    International Nuclear Information System (INIS)

    Lu Heming; Lin Hui; Feng Guosheng

    2012-01-01

    This prospective study was to assess interfractional and intrafractional errors and to estimate appropriate margins for planning target volume (PTV) by using daily cone-beam computed tomography (CBCT) guidance in nasopharyngeal carcinoma (NPC). Daily pretreatment and post-treatment CBCT scans were acquired separately after initial patient setup and after the completion of each treatment fraction in 10 patients treated with intensity-modulated radiation therapy (IMRT). Online corrections were made before treatment if any translational setup error was found. Interfractional and intrafractional errors were recorded in the right-left (RL), superior-inferior (SI) and anterior-posterior (AP) directions. For the translational shifts, interfractional errors >2 mm occurred in 21.7% of measurements in the RL direction, 12.7% in the SI direction and 34.1% in the AP direction, respectively. Online correction resulted in 100% of residual errors ≤2 mm in the RL and SI directions, and 95.5% of residual errors ≤2 mm in the AP direction. No residual errors >3 mm occurred in the three directions. For the rotational shifts, a significant reduction was found in the magnitudes of residual errors compared with those of interfractional errors. A margin of 4.9 mm, 4.0 mm and 6.3 mm was required in the RL, SI and AP directions, respectively, when daily CBCT scans were not performed. With daily CBCT, the margins were reduced to 1.2 mm in all directions. In conclusion, daily CBCT guidance is an effective modality to improve the accuracy of IMRT for NPC. The online correction could result in a 70-81% reduction in margin size. (author)

  2. A randomized controlled trial comparing customized versus standard headrests for head and neck radiotherapy immobilization in terms of set-up errors, patient comfort and staff satisfaction (ICORG 08-09)

    International Nuclear Information System (INIS)

    Howlin, C.; O'Shea, E.; Dunne, M.; Mullaney, L.; McGarry, M.; Clayton-Lea, A.; Finn, M.; Carter, P.; Garret, B.; Thirion, P.

    2015-01-01

    Purpose: To recommend a specific headrest, customized or standard, for head and neck radiotherapy patients in our institution based primarily on an evaluation of set-up accuracy, taking into account a comparison of patient comfort, staff and patient satisfaction, and resource implications. Methods and materials: Between 2008 and 2009, 40 head and neck patients were randomized to either a standard (Arm A, n = 21) or customized (Arm B, n = 19) headrest, and immobilized with a customized thermoplastic mask. Set-up accuracy was assessed using electronic portal images (EPI). Random and systematic set-up errors for each arm were determined from 668 EPIs, which were analyzed by one Radiation Therapist. Patient comfort was assessed using a visual analogue scale (VAS) and staff satisfaction was measured using an in-house questionnaire. Resource implications were also evaluated. Results: The difference in set-up errors between arms was not significant in any direction. However, in this study the standard headrest (SH) arm performed well, with set-up errors comparative to customized headrests (CHs) in previous studies. CHs require regular monitoring and 47% were re-vacuumed making them more resource intensive. Patient comfort and staff satisfaction were comparable in both arms. Conclusion: The SH provided similar treatment accuracy and patient comfort compared with the CH. The large number of CHs that needed to be re-vacuumed undermines their reliability for radiotherapy schedules that extend beyond 34 days from the initial CT scan. Accordingly the CH was more resource intensive without improving the accuracy of positioning, thus the standard headrest is recommended for continued use at our institution

  3. Setup errors and effectiveness of Optical Laser 3D Surface imaging system (Sentinel) in postoperative radiotherapy of breast cancer.

    Science.gov (United States)

    Wei, Xiaobo; Liu, Mengjiao; Ding, Yun; Li, Qilin; Cheng, Changhai; Zong, Xian; Yin, Wenming; Chen, Jie; Gu, Wendong

    2018-05-08

    Breast-conserving surgery (BCS) plus postoperative radiotherapy has become the standard treatment for early-stage breast cancer. The aim of this study was to compare the setup accuracy of optical surface imaging by the Sentinel system with cone-beam computerized tomography (CBCT) imaging currently used in our clinic for patients received BCS. Two optical surface scans were acquired before and immediately after couch movement correction. The correlation between the setup errors as determined by the initial optical surface scan and CBCT was analyzed. The deviation of the second optical surface scan from the reference planning CT was considered an estimate for the residual errors for the new method for patient setup correction. The consequences in terms for necessary planning target volume (PTV) margins for treatment sessions without setup correction applied. We analyzed 145 scans in 27 patients treated for early stage breast cancer. The setup errors of skin marker based patient alignment by optical surface scan and CBCT were correlated, and the residual setup errors as determined by the optical surface scan after couch movement correction were reduced. Optical surface imaging provides a convenient method for improving the setup accuracy for breast cancer patient without unnecessary imaging dose.

  4. Local setup errors in image-guided radiotherapy for head and neck cancer patients immobilized with a custom-made device.

    Science.gov (United States)

    Giske, Kristina; Stoiber, Eva M; Schwarz, Michael; Stoll, Armin; Muenter, Marc W; Timke, Carmen; Roeder, Falk; Debus, Juergen; Huber, Peter E; Thieke, Christian; Bendl, Rolf

    2011-06-01

    To evaluate the local positioning uncertainties during fractionated radiotherapy of head-and-neck cancer patients immobilized using a custom-made fixation device and discuss the effect of possible patient correction strategies for these uncertainties. A total of 45 head-and-neck patients underwent regular control computed tomography scanning using an in-room computed tomography scanner. The local and global positioning variations of all patients were evaluated by applying a rigid registration algorithm. One bounding box around the complete target volume and nine local registration boxes containing relevant anatomic structures were introduced. The resulting uncertainties for a stereotactic setup and the deformations referenced to one anatomic local registration box were determined. Local deformations of the patients immobilized using our custom-made device were compared with previously published results. Several patient positioning correction strategies were simulated, and the residual local uncertainties were calculated. The patient anatomy in the stereotactic setup showed local systematic positioning deviations of 1-4 mm. The deformations referenced to a particular anatomic local registration box were similar to the reported deformations assessed from patients immobilized with commercially available Aquaplast masks. A global correction, including the rotational error compensation, decreased the remaining local translational errors. Depending on the chosen patient positioning strategy, the remaining local uncertainties varied considerably. Local deformations in head-and-neck patients occur even if an elaborate, custom-made patient fixation method is used. A rotational error correction decreased the required margins considerably. None of the considered correction strategies achieved perfect alignment. Therefore, weighting of anatomic subregions to obtain the optimal correction vector should be investigated in the future. Copyright © 2011 Elsevier Inc. All rights

  5. Evidence of Limited Motion of the Prostate by Carefully Emptying the Rectum as Assessed by Daily MVCT Image Guidance with Helical Tomotherapy

    International Nuclear Information System (INIS)

    Fiorino, Claudio Ph.D.; Di Muzio, Nadia; Broggi, Sara; Cozzarini, Cesare; Maggiulli, Eleonora M.Sc.; Alongi, Filippo; Valdagni, Riccardo; Fazio, Ferruccio; Calandrino, Riccardo

    2008-01-01

    Purpose: To assess setup and organ motion error by means of analysis of daily megavoltage computed tomography (MVCT) of patients treated with hypofractionated helical tomotherapy (71.4-74.2 Gy in 28 fractions). Methods and Materials: Data from 21 patients were analyzed. Patients were instructed to empty the rectum carefully before planning CT and every morning before therapy by means of a self-applied rectal enema. The position of the prostate was assessed by means of automatic bone matching (BM) with the planning kilovoltage CT (BM, setup error) followed by a direct visualization (DV) match on the prostate. Deviations between planning and therapy positions referred to BM and BM + DV were registered for the three main axes. In case of a full rectum at MVCT with evident shift of the prostate, treatment was postponed until after additional rectal emptying procedures; in this case, additional MVCT was performed before delivering the treatment. Data for 522 fractions were available; the impact of post-MVCT procedure was investigated for 17 of 21 patients (410 fractions). Results: Prostate motion relative to bony anatomy was limited. Concerning posterior-anterior shifts, only 4.9% and 2.7% of fractions showed deviation of 3 mm or greater of the prostate relative to BM without and with consideration of post-MVCT procedures, respectively. Interobserver variability for BM + DV match was within 0.8 mm (1 SD). Conclusions: Daily MVCT-based correction is feasible. The BM + DV matching was found to be consistent between operators. Rectal emptying using a daily enema is an efficient tool to minimize prostate motion, even for centers that have not yet implemented image-guided radiotherapy

  6. Genetic evolutionary taboo search for optimal marker placement in infrared patient setup

    International Nuclear Information System (INIS)

    Riboldi, M; Baroni, G; Spadea, M F; Tagaste, B; Garibaldi, C; Cambria, R; Orecchia, R; Pedotti, A

    2007-01-01

    In infrared patient setup adequate selection of the external fiducial configuration is required for compensating inner target displacements (target registration error, TRE). Genetic algorithms (GA) and taboo search (TS) were applied in a newly designed approach to optimal marker placement: the genetic evolutionary taboo search (GETS) algorithm. In the GETS paradigm, multiple solutions are simultaneously tested in a stochastic evolutionary scheme, where taboo-based decision making and adaptive memory guide the optimization process. The GETS algorithm was tested on a group of ten prostate patients, to be compared to standard optimization and to randomly selected configurations. The changes in the optimal marker configuration, when TRE is minimized for OARs, were specifically examined. Optimal GETS configurations ensured a 26.5% mean decrease in the TRE value, versus 19.4% for conventional quasi-Newton optimization. Common features in GETS marker configurations were highlighted in the dataset of ten patients, even when multiple runs of the stochastic algorithm were performed. Including OARs in TRE minimization did not considerably affect the spatial distribution of GETS marker configurations. In conclusion, the GETS algorithm proved to be highly effective in solving the optimal marker placement problem. Further work is needed to embed site-specific deformation models in the optimization process

  7. Correlation between Cognitive Functions and Activity of Daily Living among Post-Stroke Patients

    Directory of Open Access Journals (Sweden)

    Kurniawan Prakoso

    2016-09-01

    Full Text Available Background: Cognitive impairment is one of the most common post-stroke complications; however, neither patients nor health professionals are often aware of this complication. The impact of cognitive impairment on quality of life is reflected through basic activity daily living (bADL and instrumental activity daily living (IADL. Prior studies concerning the correlation between cognitive impairment and activity daily living has shown contradictive results. This study was conducted in order to analyze the correlation between the cognitive functions and activity daily living in post stroke patients at Dr. Hasan Sadikin General Hospital. Methods: This cross-sectional study was carried out to 23 post-stroke patients from September–November 2015. Samples were collected through consecutive sampling at Dr. Hasan Sadikin General Hospital. Mini Mental State Examination (MMSE was used to assess the cognitive functions and Lawton and Brody Scale to assess both bADL and IADL. Spearman correlation was selected to analyze the existing correlation between each cognitive domain and activity daily living. Results: Spearman statistical correlation showed an insignificant correlation between the cognitive functions and bADL (r2=0.181, p=0.408 and a significant correlation with IADL was obtained (r2=0.517, p=0.03. The only cognitive domain positively correlated with IADL was orientation to time and verbal recall. Conclusions: There is a correlation between cognitive functions and IADL among post-stroke patients at Dr. Hasan Sadikin General Hospital.

  8. Assessment of the Correlation between Appointment Scheduling and Patient Satisfaction in a Pediatric Dental Setup

    Directory of Open Access Journals (Sweden)

    Amar N. Katre

    2014-01-01

    Full Text Available Introduction. The practice of modern pediatric dentistry requires delivery of quality care in combination with adherence to excellent business as well as time management principles. A definite appointment schedule should be presented to the parents on the first or second appointment. More importantly, the prescribed schedule should be followed to the best of the professional abilities of the pediatric dentist. Aims. The aim of the study was to assess the co-relation between appointment scheduling and patient satisfaction in a pediatric dental setup with the objective of understanding the parameters related to appointment scheduling to increase patient satisfaction. Method. A total of 40 patients, who visited the Department of Pediatric and Preventive Dentistry, YMT Dental College & Hospital, for dental treatment were selected on a random basis. A questionnaire with a set of 6 questions with a rating scale of 1–5 to assess the patient satisfaction related to appointment scheduling was prepared. Results. A significant number of the patients were happy with the existing appointment scheduling system barring a few exceptions.

  9. SU-E-T-258: Development of a New Patient Set-Up Monitoring System Using Force Sensing Resistor (FSR) Sensor for the Radiation Therapy

    International Nuclear Information System (INIS)

    Cho, M; Kim, T; Kang, S; Kim, D; Kim, K; Shin, D; Suh, T

    2015-01-01

    Purpose: The purpose of this work is to develop a new patient set-up monitoring system using force sensing resistor (FSR) sensors that can confirm pressure of contact surface and evaluate its feasibility. Methods: In this study, we focused on develop the patient set-up monitoring system to compensate for the limitation of existing optical based monitoring system, so the developed system can inform motion in the radiation therapy. The set-up monitoring system was designed consisting of sensor units (FSR sensor), signal conditioning devices (USB cable/interface electronics), a control PC, and a developed analysis software. The sensor unit was made by attaching FSR sensor and dispersing pressure sponge to prevent error which is caused by concentrating specific point. Measured signal from the FSR sensor was sampled to arduino mega 2560 microcontroller, transferred to control PC by using serial communication. The measured data went through normalization process. The normalized data was displayed through the developed graphic user interface (GUI) software. The software was designed to display a single sensor unit intensity (maximum 16 sensors) and display 2D pressure distribution (using 16 sensors) according to the purpose. Results: Changes of pressure value according to motion was confirmed by the developed set-up monitoring system. Very small movement such as little physical change in appearance can be confirmed using a single unit and using 2D pressure distribution. Also, the set-up monitoring system can observe in real time. Conclusion: In this study, we developed the new set-up monitoring system using FSR sensor. Especially, we expect that the new set-up monitoring system is suitable for motion monitoring of blind area that is hard to confirm existing optical system and compensate existing optical based monitoring system. As a further study, an integrated system will be constructed through correlation of existing optical monitoring system. This work was supported by

  10. SU-E-T-258: Development of a New Patient Set-Up Monitoring System Using Force Sensing Resistor (FSR) Sensor for the Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Cho, M; Kim, T; Kang, S; Kim, D; Kim, K; Shin, D; Suh, T [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    Purpose: The purpose of this work is to develop a new patient set-up monitoring system using force sensing resistor (FSR) sensors that can confirm pressure of contact surface and evaluate its feasibility. Methods: In this study, we focused on develop the patient set-up monitoring system to compensate for the limitation of existing optical based monitoring system, so the developed system can inform motion in the radiation therapy. The set-up monitoring system was designed consisting of sensor units (FSR sensor), signal conditioning devices (USB cable/interface electronics), a control PC, and a developed analysis software. The sensor unit was made by attaching FSR sensor and dispersing pressure sponge to prevent error which is caused by concentrating specific point. Measured signal from the FSR sensor was sampled to arduino mega 2560 microcontroller, transferred to control PC by using serial communication. The measured data went through normalization process. The normalized data was displayed through the developed graphic user interface (GUI) software. The software was designed to display a single sensor unit intensity (maximum 16 sensors) and display 2D pressure distribution (using 16 sensors) according to the purpose. Results: Changes of pressure value according to motion was confirmed by the developed set-up monitoring system. Very small movement such as little physical change in appearance can be confirmed using a single unit and using 2D pressure distribution. Also, the set-up monitoring system can observe in real time. Conclusion: In this study, we developed the new set-up monitoring system using FSR sensor. Especially, we expect that the new set-up monitoring system is suitable for motion monitoring of blind area that is hard to confirm existing optical system and compensate existing optical based monitoring system. As a further study, an integrated system will be constructed through correlation of existing optical monitoring system. This work was supported by

  11. Visuo-acoustic stimulation that helps you to relax: A virtual reality setup for patients in the intensive care unit.

    Science.gov (United States)

    Gerber, Stephan M; Jeitziner, Marie-Madlen; Wyss, Patric; Chesham, Alvin; Urwyler, Prabitha; Müri, René M; Jakob, Stephan M; Nef, Tobias

    2017-10-16

    After prolonged stay in an intensive care unit (ICU) patients often complain about cognitive impairments that affect health-related quality of life after discharge. The aim of this proof-of-concept study was to test the feasibility and effects of controlled visual and acoustic stimulation in a virtual reality (VR) setup in the ICU. The VR setup consisted of a head-mounted display in combination with an eye tracker and sensors to assess vital signs. The stimulation consisted of videos featuring natural scenes and was tested in 37 healthy participants in the ICU. The VR stimulation led to a reduction of heart rate (p = 0. 049) and blood pressure (p = 0.044). Fixation/saccade ratio (p < 0.001) was increased when a visual target was presented superimposed on the videos (reduced search activity), reflecting enhanced visual processing. Overall, the VR stimulation had a relaxing effect as shown in vital markers of physical stress and participants explored less when attending the target. Our study indicates that VR stimulation in ICU settings is feasible and beneficial for critically ill patients.

  12. Compliance, clinical outcome, and quality of life of patients with stable angina pectoris receiving once-daily betaxolol versus twice daily metoprolol: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Przemyslaw Kardas

    2007-05-01

    Full Text Available Przemyslaw KardasThe First Department of Family Medicine, Medical University of LodzBackground: A randomized, controlled trial was conducted in an outpatient setting to examine the effect of beta-blocker dosing frequency on patient compliance, clinical outcome, and health-related quality of life in patients with stable angina pectoris.Methods: One hundred and twelve beta-blockers-naive outpatients with stable angina pectoris were randomized to receive betaxolol, 20 mg once daily or metoprolol tartrate, 50 mg twice daily for 8 weeks. The principal outcome measure was overall compliance measured electronically, whereas secondary outcome measures were drug effectiveness and health-related quality of life.Results: The overall compliance was 86.5 ± 21.3% in the betaxolol group versus 76.1 ± 26.3% in the metoprolol group (p < 0.01, and the correct number of doses was taken on 84.4 ± 21.6% and 64.0 ± 31.7% of treatment days, respectively (p < 0.0001. The percentage of missed doses was 14.5 ± 21.5% in the once-daily group and 24.8 ± 26.4% in the twice-daily group (p < 0.01. The percentage of doses taken in the correct time window (58.6% vs 42.0%, p = 0.01, correct interdose intervals (77.4% v 53.1%, p < 0.0001, and therapeutic coverage (85.6% vs 73.7%, p < 0.001 were significantly higher in the once-daily group. Both studied drugs had similar antianginal effectiveness. Health-related quality of life improved in both groups, but this increase was more pronounced in the betaxolol arm in some dimensions.Conclusions: The study demonstrates that patient compliance with once-daily betaxolol is significantly better than with twice daily metoprolol. Similarly, this treatment provides better quality of life. These results demonstrate possible therapeutic advantages of once-daily over twice-daily beta-blockers in the treatment of stable angina pectoris.Keywords: patient compliance, quality of life, stable angina pectoris, randomized controlled trial

  13. Patterns of intrafractional motion and uncertainties of treatment setup reference systems in accelerated partial breast irradiation for right- and left-sided breast cancer.

    Science.gov (United States)

    Yue, Ning J; Goyal, Sharad; Kim, Leonard H; Khan, Atif; Haffty, Bruce G

    2014-01-01

    This study investigated the patterns of intrafractional motion and accuracy of treatment setup strategies in 3-dimensional conformal radiation therapy of accelerated partial breast irradiation (APBI) for right- and left-sided breast cancers. Sixteen right-sided and 17 left-sided breast cancer patients were enrolled in an institutional APBI trial in which gold fiducial markers were strategically sutured to the surgical cavity walls. Daily pre- and postradiation therapy kV imaging were performed and were matched to digitally reconstructed radiographs based on bony anatomy and fiducial markers, respectively, to determine the intrafractional motion. The positioning differences of the laser-tattoo and the bony anatomy-based setups with respect to the marker-based setup (benchmark) were determined to evaluate their accuracy. Statistical differences were found between the right- and left-sided APBI treatments in vector directions of intrafractional motion and treatment setup errors in the reference systems, but less in their overall magnitudes. The directional difference was more pronounced in the lateral direction. It was found that the intrafractional motion and setup reference systems tended to deviate in the right direction for the right-sided breast treatments and in the left direction for the left-sided breast treatments. It appears that the fiducial markers placed in the seroma cavity exhibit side dependent directional intrafractional motion, although additional data may be needed to further validate the conclusion. The bony anatomy-based treatment setup improves the accuracy over laser-tattoo. But it is inadequate to rely on bony anatomy to assess intrafractional target motion in both magnitude and direction. Copyright © 2014 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  14. Contrast-Enhanced Proton Radiography for Patient Set-up by Using X-Ray CT Prior Knowledge

    Energy Technology Data Exchange (ETDEWEB)

    Spadea, Maria Francesca, E-mail: mfspadea@unicz.it [Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro (Italy); Fassi, Aurora [Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano (Italy); Zaffino, Paolo [Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro (Italy); Riboldi, Marco; Baroni, Guido [Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano (Italy); Bioengineering Unit—CNAO Foundation, Pavia (Italy); Depauw, Nicolas [Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts (United States); Centre for Medical Radiation Physics, University of Wollongong, Wollongong (Australia); Seco, Joao [Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts (United States)

    2014-11-01

    Purpose: To obtain a contrasted image of the tumor region during the setup for proton therapy in lung patients, by using proton radiography and x-ray computed tomography (CT) prior knowledge. Methods and Materials: Six lung cancer patients' CT scans were preprocessed by masking out the gross tumor volume (GTV), and digitally reconstructed radiographs along the planned beam's eye view (BEV) were generated, for a total of 27 projections. Proton radiographies (PR) were also computed for the same BEV through Monte Carlo simulations. The digitally reconstructed radiograph was subtracted from the corresponding proton image, resulting in a contrast-enhanced proton radiography (CEPR). Michelson contrast analysis was performed both on PR and CEPR. The tumor region was then automatically segmented on CEPR and compared to the ground truth (GT) provided by physicians in terms of Dice coefficient, accuracy, precision, sensitivity, and specificity. Results: Contrast on CEPR was, on average, 4 times better than on PR. For 10 lateral projections (±45° off of 90° or 270°), although it was not possible to distinguish the tumor region in the PR, CEPR offers excellent GTV visibility. The median ± quartile values of Dice, precision, and accuracy indexes were 0.86 ± 0.03, 0.86 ± 0.06, and 0.88 ± 0.02, respectively, thus confirming the reliability of the method in highlighting tumor boundaries. Sensitivity and specificity analysis demonstrated that there is no systematic over- or underestimation of the tumor region. Identification of the tumor boundaries using CEPR resulted in a more accurate and precise definition of GTV compared to that obtained from pretreatment CT. Conclusions: In most proton centers, the current clinical protocol is to align the patient using kV imaging with bony anatomy as a reference. We demonstrated that CEPR can significantly improve tumor visualization, allowing better patient set-up and permitting image guided proton therapy (IGPT)

  15. Procedures for high precision setup verification and correction of lung cancer patients using CT-simulation and digitally reconstructed radiographs (DRR).

    NARCIS (Netherlands)

    Sornsen de Koste, van J.R.; Boer, de HC; Schuchhard-Schipper, RH; Senan, S.; Heijmen, BJ

    2003-01-01

    PURPOSE: In a recent study, large systematic setup errors were detected in patients with lung cancer when a conventional simulation procedure was used to define and mark the treatment isocenter. In the present study, we describe a procedure to omit the session at a conventional simulator to remove

  16. Association between body mass index and activities of daily living in homecare patients.

    Science.gov (United States)

    Ozturk, Guzin Zeren; Egici, Memet Taskın; Bukhari, Mulazim Hussain; Toprak, Dilek

    2017-01-01

    Overweight or obesity may cause many chronic illnesses. Furthermore, several studies have shown that high body mass index is associated with mortality and morbidity among the elderly. Therefore, obesity or being overweight could adversely affect the performance of activities of daily living. In this study our aim was to investigate the association between Body Mass Index and Activity of Daily Living in Homecare Patients. The records of 2016 from the homecare unit of Sisli Hamidiye Etfal Training and Research Hospital were retrospectively reviewed. During this period, 1105 patients visited this facility. Unconscious or bedridden patients (hemiplegia, hemiparesia, and tetraparesis) and patients with incomplete data were excluded from the study. Therefore, the survey was completed with 250 files, which included all the data needed for our research. Age, gender, Body Mass Index and Barthel Index scores were recorded to the statistical program; p≤0.05 was considered as statistically significant. One hundred fifty one (60.4%) were women, and 99 (39.6%) were men. The relations between gender and age, weight, and Barthel index scores were not statistically significant. There was a significant positive correlation between weight and Barthel index scores as well as between Body Mass Index and Barthel index scores (r = 0.190; p = 0.003). The patients were divided into two groups: Group-I (underweight and normal weight) and Group-II (overweight and obese). Group-II exhibited a much higher ability to perform Activity of Daily Living than Group-I (p = 0.002). Some studies report that obesity is protective against Activity of Daily Living, but the opposite is reported in some others. Our study showed increased values of Body Mass Index and Activity of Daily Living ability, which are indicative of protective effects. The relationship between Body Mass Index and physical disability is not yet proven to be linear.

  17. ASSESSMENT OF RILMENIDINE EFFICIENCY IN PATIENTS WITH ARTERIAL HYPERTENSION WITH DETERIORATION OF DAILY PROFILE OF BLOOD PRESSURE

    Directory of Open Access Journals (Sweden)

    P. P. Tikhonov

    2005-01-01

    Full Text Available Aim. To estimate an efficiency and tolerability of rilmenidine in hypertensive patients with different types of blood pressure (BP daily profile – dipper and non-dipper.Methods. 23 patients with essential hypertension (EH, I-II stages, were included into the study. They were treated with rilmeneidine 1 mg daily during one month. Ambulatory BP monitoring (ABPM and office BP measurements were made before and after the treatment. Based on ABPM results all patients were divided into two groups: with adequate decrease of BP at nighttime (dipper, D, and with insufficient decrease of BP at nighttime (non-dipper, ND.Results. One month rilmenidine monotherapy resulted in BP normalization in 52% of patients. Decrease in 24-hour BP, daytime and nighttime BP, burden with BP and BP variability during daytime was observed in both groups. A distinction in rilmenidine influence on BP daily index was revealed: initially normal BP daily index didn’t change in D group, while initially decreased BP daily index increased in ND group. Rilmenidine reduced the speed of morning BP rise in patients of ND group.Conclusion. Results of the study testify efficiency and satisfactory tolerability of monotherapy with rilmenidine 1 mg daily in patients with EH of I-II stages. For patients with insufficient decrease in BP during nighttime rilmenidine provides normalization of BP daily profile intensifying BP night decrease and reducing the speed of morning BP rise.

  18. Improved mortar setup technique

    CSIR Research Space (South Africa)

    De Villiers, D

    2008-10-01

    Full Text Available bearing sensor. This concept focuses directly on one of the most cumbersome aspects of a mortar set-up, namely the use of aiming posts. The prismatic mirror and bearing dials is described as well as the required setup procedures. The measurement...

  19. The virtual slice setup.

    Science.gov (United States)

    Lytton, William W; Neymotin, Samuel A; Hines, Michael L

    2008-06-30

    In an effort to design a simulation environment that is more similar to that of neurophysiology, we introduce a virtual slice setup in the NEURON simulator. The virtual slice setup runs continuously and permits parameter changes, including changes to synaptic weights and time course and to intrinsic cell properties. The virtual slice setup permits shocks to be applied at chosen locations and activity to be sampled intra- or extracellularly from chosen locations. By default, a summed population display is shown during a run to indicate the level of activity and no states are saved. Simulations can run for hours of model time, therefore it is not practical to save all of the state variables. These, in any case, are primarily of interest at discrete times when experiments are being run: the simulation can be stopped momentarily at such times to save activity patterns. The virtual slice setup maintains an automated notebook showing shocks and parameter changes as well as user comments. We demonstrate how interaction with a continuously running simulation encourages experimental prototyping and can suggest additional dynamical features such as ligand wash-in and wash-out-alternatives to typical instantaneous parameter change. The virtual slice setup currently uses event-driven cells and runs at approximately 2 min/h on a laptop.

  20. A Device and Procedure for Immobilization of Patients Receiving Limb-Preserving Radiotherapy for Soft Tissue Sarcoma

    International Nuclear Information System (INIS)

    Dickie, Colleen I.; Parent, Amy; Griffin, Anthony; Craig, Tim; Catton, Charles; Chung, Peter; Panzarella, Tony; O'Sullivan, Brian; Sharpe, Michael

    2009-01-01

    The purpose of this study was to determine the accuracy and efficiency of a custom-designed immobilization device for patients with extremity soft-tissue sarcoma. The custom device consisted of a thermoplastic shell, vacuum pillow, and adaptable baseplate. The study included patients treated from January 2005 to March 2007, with 92 patients immobilized with the custom device and 98 with an established standard. Setup times for these cohorts were analyzed retrospectively for conformal and intensity modulated radiotherapy techniques (IMRT). Thigh tumor setup times were analyzed independently. A subset of patients treated with IMRT was analyzed for setup error using the radiographically verified isocenter position measured daily with electronic portal imaging and cone-beam computed tomography. Mean setup time was reduced by 2.2 minutes when using the custom device for conformal treatment (p = 0.03) and by 5.8 min for IMRT of thigh tumors (p = 0.009). All other setup time comparisons were not significant. A significant systematic error reduction was seen in all directions using the custom device. Random error standard deviations favored the custom device. The custom device offers immobilization advantages. Patient setup time was reduced for conformal techniques and IMRT of thigh tumors. Positioning uncertainty was improved, permitting a reduction of the planning target volume margin by 2 to 4 mm.

  1. Setup Analysis: Combining SMED with Other Tools

    Directory of Open Access Journals (Sweden)

    Stadnicka Dorota

    2015-02-01

    Full Text Available The purpose of this paper is to propose the methodology for the setup analysis, which can be implemented mainly in small and medium enterprises which are not convinced to implement the setups development. The methodology was developed after the research which determined the problem. Companies still have difficulties with a long setup time. Many of them do nothing to decrease this time. A long setup is not a sufficient reason for companies to undertake any actions towards the setup time reduction. To encourage companies to implement SMED it is essential to make some analyses of changeovers in order to discover problems. The methodology proposed can really encourage the management to take a decision about the SMED implementation, and that was verified in a production company. The setup analysis methodology is made up of seven steps. Four of them concern a setups analysis in a chosen area of a company, such as a work stand which is a bottleneck with many setups. The goal is to convince the management to begin actions concerning the setups improvement. The last three steps are related to a certain setup and, there, the goal is to reduce a setup time and the risk of problems which can appear during the setup. In this paper, the tools such as SMED, Pareto analysis, statistical analysis, FMEA and other were used.

  2. Set-up for differential manometers testing

    International Nuclear Information System (INIS)

    Ratushnyj, M.I.; Galkin, Yu.V.; Nechaj, A.G.

    1985-01-01

    Set-up characteristic for controlling and testing metrological characteristics of TPP and NPP differential manometers with extreme pressure drop upto 250 kPa is briefly described. The set-up provides with automatic and manual assignment of values of gauge air pressure with errors of 0.1 and 0.25% correspondingly. The set-up is supplied with standard equipment to measure output signals. Set-up supply is carried out by a one-phase alternating current circuit with 220 V. Air supply is carried out by O.4-0.6 MPa. pressure of a pneumatic system. Application of the set-up increases operating efficiency 5 times while checking and turning differential manometers

  3. [Development of an activity of daily living scale for patients with COPD: the Activity of Daily Living Dyspnea scale].

    Science.gov (United States)

    Yoza, Yoshiyasu; Ariyoshi, Koya; Honda, Sumihisa; Taniguchi, Hiroyuki; Senjyu, Hideaki

    2009-10-01

    Patients with COPD often experience restriction in their activities of daily living (ADL) due to dyspnea. This type of restriction is unique to patients with COPD and cannot be adequately evaluated by the generic ADL scales. This study developed an ADL scale (the Activity of Daily Living Dyspnea scale [ADL-D scale]) for patients with COPD and investigated its validity and internal consistency. Patients with stable COPD were recruited and completed a pilot 26-item questionnaire. Patients also performed the Incremental Shuttle Walk Test (ISWT), and completed the St George's Respiratory Questionnaire (SGRQ), and Medical Research Council (MRC) dyspnea grade. There were 83 male participants who completed the pilot questionnaire. Following the pilot, 8 items that were not undertaken by the majority of subjects, and 3 items judged to be of low clinical importance by physical therapists were removed from the pilot questionnaire. The final ADL-D scale contained 15 items. Scores obtained with the ADL-D scale were significantly correlated with the MRC dyspnea grades, distance walked on the ISWT and SGRQ scores. The ADL-D scores were significantly different across the five grades of the MRC dyspnea grade. The ADL-D scale showed high consistency (Chronbach's alpha coefficient of 0.96). The ADL-D scale is a useful scale for assessing impairments in ADL in Japanese male patients with COPD.

  4. The application of a low-cost 3D depth camera for patient set-up and respiratory motion management in radiotherapy

    Science.gov (United States)

    Tahavori, Fatemeh

    Respiratory motion induces uncertainty in External Beam Radiotherapy (EBRT), which can result in sub-optimal dose delivery to the target tissue and unwanted dose to normal tissue. The conventional approach to managing patient respiratory motion for EBRT within the area of abdominal-thoracic cancer is through the use of internal radiological imaging methods (e.g. Megavoltage imaging or Cone-Beam Computed Tomography) or via surrogate estimates of tumour position using external markers placed on the patient chest. This latter method uses tracking with video-based techniques, and relies on an assumed correlation or mathematical model, between the external surrogate signal and the internal target position. The marker's trajectory can be used in both respiratory gating techniques and real-time tracking methods. Internal radiological imaging methods bring with them limited temporal resolution, and additional radiation burden, which can be addressed by external marker-based methods that carry no such issues. Moreover, by including multiple external markers and placing them closer to the internal target organs, the effciency of correlation algorithms can be increased. However, the quality of such external monitoring methods is underpinned by the performance of the associated correlation model. Therefore, several new approaches to correlation modelling have been developed as part of this thesis and compared using publicly-available datasets. Highly competitive results have been obtained when compared against state-of-the-art methods. Marker-based methods also have the disadvantages of requiring manual set-up time for marker placement and patient positioning and potential issues with reproducibility of marker placement. This motivates the investigation of non-contact marker-free methods for use in EBRT, which is the main topic of this thesis. The Microsoft Kinect is used as an example of a low-cost consumer grade 3D depth camera for capturing and analysing external

  5. SU-E-J-15: Automatically Detect Patient Treatment Position and Orientation in KV Portal Images

    International Nuclear Information System (INIS)

    Qiu, J; Yang, D

    2015-01-01

    Purpose: In the course of radiation therapy, the complex information processing workflow will Result in potential errors, such as incorrect or inaccurate patient setups. With automatic image check and patient identification, such errors could be effectively reduced. For this purpose, we developed a simple and rapid image processing method, to automatically detect the patient position and orientation in 2D portal images, so to allow automatic check of positions and orientations for patient daily RT treatments. Methods: Based on the principle of portal image formation, a set of whole body DRR images were reconstructed from multiple whole body CT volume datasets, and fused together to be used as the matching template. To identify the patient setup position and orientation shown in a 2D portal image, the 2D portal image was preprocessed (contrast enhancement, down-sampling and couch table detection), then matched to the template image so to identify the laterality (left or right), position, orientation and treatment site. Results: Five day’s clinical qualified portal images were gathered randomly, then were processed by the automatic detection and matching method without any additional information. The detection results were visually checked by physicists. 182 images were correct detection in a total of 200kV portal images. The correct rate was 91%. Conclusion: The proposed method can detect patient setup and orientation quickly and automatically. It only requires the image intensity information in KV portal images. This method can be useful in the framework of Electronic Chart Check (ECCK) to reduce the potential errors in workflow of radiation therapy and so to improve patient safety. In addition, the auto-detection results, as the patient treatment site position and patient orientation, could be useful to guide the sequential image processing procedures, e.g. verification of patient daily setup accuracy. This work was partially supported by research grant from

  6. SU-E-J-15: Automatically Detect Patient Treatment Position and Orientation in KV Portal Images

    Energy Technology Data Exchange (ETDEWEB)

    Qiu, J [Washington University in St Louis, Taian, Shandong (China); Yang, D [Washington University School of Medicine, St Louis, MO (United States)

    2015-06-15

    Purpose: In the course of radiation therapy, the complex information processing workflow will Result in potential errors, such as incorrect or inaccurate patient setups. With automatic image check and patient identification, such errors could be effectively reduced. For this purpose, we developed a simple and rapid image processing method, to automatically detect the patient position and orientation in 2D portal images, so to allow automatic check of positions and orientations for patient daily RT treatments. Methods: Based on the principle of portal image formation, a set of whole body DRR images were reconstructed from multiple whole body CT volume datasets, and fused together to be used as the matching template. To identify the patient setup position and orientation shown in a 2D portal image, the 2D portal image was preprocessed (contrast enhancement, down-sampling and couch table detection), then matched to the template image so to identify the laterality (left or right), position, orientation and treatment site. Results: Five day’s clinical qualified portal images were gathered randomly, then were processed by the automatic detection and matching method without any additional information. The detection results were visually checked by physicists. 182 images were correct detection in a total of 200kV portal images. The correct rate was 91%. Conclusion: The proposed method can detect patient setup and orientation quickly and automatically. It only requires the image intensity information in KV portal images. This method can be useful in the framework of Electronic Chart Check (ECCK) to reduce the potential errors in workflow of radiation therapy and so to improve patient safety. In addition, the auto-detection results, as the patient treatment site position and patient orientation, could be useful to guide the sequential image processing procedures, e.g. verification of patient daily setup accuracy. This work was partially supported by research grant from

  7. [Impact of an Aspherical Aberration Correcting Monofocal Intraocular Lens on Patient Satisfaction for Daily Life Activities: The Heidelberg Daily Task Evaluation (DATE) Questionnaire].

    Science.gov (United States)

    Kretz, F T A; Son, H; Liebing, S; Tandogan, T; Auffarth, G U

    2015-08-01

    A clinical evaluation of the functional results and its impact on daily activities of an aspherical, aberration correcting intraocular lens (IOL) was undertaken. Twenty-one patients aged from 50 to 83 years underwent cataract surgery with implantation of the aspheric IOL (Tecnis ZCB00, Abbott Medical Optics). They were evaluated 2 to 4 months after surgery for their subjective satisfaction of vision quality and its impact on performance of daily activities as well as functional results and refractive outcome. Patients were asked to fill out a questionnaire - the Heidelberg DATE (DAily Tasks Evaluation) questionnaire. Significant changes from pre- to postoperative results were found in refraction (p ≤ 0.03), with a mean prediction error of + 0.21 ± 0.43 D. UDVA and CDVA improved significantly (p < 0.01), with a postoperative CDVA of 0.0 logMAR or better in 97.1 % of eyes. All patients would recommend the procedure to a relative or a friend and 93.8 % of patients reported to be satisfied with the outcome. The implantation of the aspheric IOL Tecnis ZCB00 after cataract surgery allows the restoration of visual function, providing an optimised optical quality and a high level of patient satisfaction. Georg Thieme Verlag KG Stuttgart · New York.

  8. Efficacy and safety of rosuvastatin every other day compared with once daily in patients with hypercholesterolemia.

    Science.gov (United States)

    Wongwiwatthananukit, Supakit; Sansanayudh, Nakarin; Dhummauppakorn, Rawadee; Kitiyadisai, Chutiporn

    2006-11-01

    Although most patients with hypercholesterolemia require life-long therapy with statins, these drugs are underused due to high costs. Every-other-day therapy could be one strategy to resolve this problem. To compare the efficacy and safety of rosuvastatin 10 mg administered every other day versus once daily. An 8 week, randomized, open-label, parallel trial was conducted at the outpatient department of Phramongkutklao Hospital in Bangkok, Thailand. Eighty patients with primary hypercholesterolemia were equally randomized to receive rosuvastatin 10 mg once daily or every other day; 76 patients completed the study. Laboratory data were assessed at baseline and at the end of the study. Low-density lipoprotein cholesterol (LDL-C) levels were reduced by 48% and 39% in the once-daily and every-other-day groups, respectively (p = 0.011). The percentage of patients who achieved LDL-C goals according to National Cholesterol Education Program-Adult Treatment Panel III guidelines was not significantly different between the once-daily (85%) and every-other-day (70%) groups (p = 0.180). In addition, both regimens were well tolerated, with no patient developing an elevation of more than 3 times baseline levels of aspartate aminotransferase or alanine aminotransferase or 10 times that of creatine kinase. As expected, the monthly cost per percent LDL-C reduction of the once-daily (0.72 dollars) regimen was about 38% higher than that of the every-other-day (0.44 dollars) regimen. Every-other-day dosing of rosuvastatin may be an alternative regimen for cost savings, without a major decrease in therapeutic benefit or increase in adverse events, in patients with hypercholesterolemia. The number of patients achieving their LDL-C goal using the every-other-day regimen is comparable with the number using the once-daily regimen, especially in the low-risk patient category.

  9. Quantifying daily physical activity and determinants in sedentary patients with Parkinson's disease

    NARCIS (Netherlands)

    Dontje, M. L.; de Greef, M. H. G.; Speelman, A. D.; van Nimwegen, M.; Krijnen, W. P.; Stolk, R. P.; Kamsma, Y. P. T.; Munneke, M.; van der Schans, C. P.; Bloem, Bastiaan R.

    2013-01-01

    Background: Although physical activity is beneficial for Parkinson's disease (PD) patients, many do not meet the recommended levels. The range of physical activity among sedentary PD patients is unknown, as are factors that determine this variability. Hence, we aimed to (1) assess daily physical

  10. Data Of Daily Blood Pressure Monitoring In Patients With Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    A.P. Rebrov

    2009-06-01

    Full Text Available The aim of present work is to study the frequency of hypertension and the peculiarity of 24-hour blood pressure monitoring in patients with rheumatoid arthritis. We studied 584 patients with rheumatoid arthritis. Daily blood pressure monitoring was carried out in 46 patients with arthritis and 18 patients with essential hypertension. Frequency of hypertension was higher in patients with arthritis then in general population. Elevation of systolic blood pressure, heart rate and arterial blood pressure adequate decrease at night were developed to associate with advance of the disease.

  11. Accuracy and Consistency of Respiratory Gating in Abdominal Cancer Patients

    International Nuclear Information System (INIS)

    Ge, Jiajia; Santanam, Lakshmi; Yang, Deshan; Parikh, Parag J.

    2013-01-01

    Purpose: To evaluate respiratory gating accuracy and intrafractional consistency for abdominal cancer patients treated with respiratory gated treatment on a regular linear accelerator system. Methods and Materials: Twelve abdominal patients implanted with fiducials were treated with amplitude-based respiratory-gated radiation therapy. On the basis of daily orthogonal fluoroscopy, the operator readjusted the couch position and gating window such that the fiducial was within a setup margin (fiducial-planning target volume [f-PTV]) when RPM indicated “beam-ON.” Fifty-five pre- and post-treatment fluoroscopic movie pairs with synchronized respiratory gating signal were recorded. Fiducial motion traces were extracted from the fluoroscopic movies using a template matching algorithm and correlated with f-PTV by registering the digitally reconstructed radiographs with the fluoroscopic movies. Treatment was determined to be “accurate” if 50% of the fiducial area stayed within f-PTV while beam-ON. For movie pairs that lost gating accuracy, a MATLAB program was used to assess whether the gating window was optimized, the external-internal correlation (EIC) changed, or the patient moved between movies. A series of safety margins from 0.5 mm to 3 mm was added to f-PTV for reassessing gating accuracy. Results: A decrease in gating accuracy was observed in 44% of movie pairs from daily fluoroscopic movies of 12 abdominal patients. Three main causes for inaccurate gating were identified as change of global EIC over time (∼43%), suboptimal gating setup (∼37%), and imperfect EIC within movie (∼13%). Conclusions: Inconsistent respiratory gating accuracy may occur within 1 treatment session even with a daily adjusted gating window. To improve or maintain gating accuracy during treatment, we suggest using at least a 2.5-mm safety margin to account for gating and setup uncertainties

  12. Detection of patient setup errors with a portal image - DRR registration software application.

    Science.gov (United States)

    Sutherland, Kenneth; Ishikawa, Masayori; Bengua, Gerard; Ito, Yoichi M; Miyamoto, Yoshiko; Shirato, Hiroki

    2011-02-18

    The purpose of this study was to evaluate a custom portal image - digitally reconstructed radiograph (DRR) registration software application. The software works by transforming the portal image into the coordinate space of the DRR image using three control points placed on each image by the user, and displaying the fused image. In order to test statistically that the software actually improves setup error estimation, an intra- and interobserver phantom study was performed. Portal images of anthropomorphic thoracic and pelvis phantoms with virtually placed irradiation fields at known setup errors were prepared. A group of five doctors was first asked to estimate the setup errors by examining the portal and DRR image side-by-side, not using the software. A second group of four technicians then estimated the same set of images using the registration software. These two groups of human subjects were then compared with an auto-registration feature of the software, which is based on the mutual information between the portal and DRR images. For the thoracic case, the average distance between the actual setup error and the estimated error was 4.3 ± 3.0 mm for doctors using the side-by-side method, 2.1 ± 2.4 mm for technicians using the registration method, and 0.8 ± 0.4mm for the automatic algorithm. For the pelvis case, the average distance between the actual setup error and estimated error was 2.0 ± 0.5 mm for the doctors using the side-by-side method, 2.5 ± 0.4 mm for technicians using the registration method, and 2.0 ± 1.0 mm for the automatic algorithm. The ability of humans to estimate offset values improved statistically using our software for the chest phantom that we tested. Setup error estimation was further improved using our automatic error estimation algorithm. Estimations were not statistically different for the pelvis case. Consistency improved using the software for both the chest and pelvis phantoms. We also tested the automatic algorithm with a

  13. Evaluation of Robustness to Setup and Range Uncertainties for Head and Neck Patients Treated With Pencil Beam Scanning Proton Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Malyapa, Robert [Centre for Proton Radiotherapy, PSI (Switzerland); Lowe, Matthew [Manchester Academic Health Science Centre, Faculty of Medical and Human Sciences, University of Manchester (United Kingdom); Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester (United Kingdom); Bolsi, Alessandra; Lomax, Antony J. [Centre for Proton Radiotherapy, PSI (Switzerland); Weber, Damien C. [University of Zürich, Zürich (Switzerland); Albertini, Francesca, E-mail: francesca.albertini@psi.ch [Centre for Proton Radiotherapy, PSI (Switzerland)

    2016-05-01

    Purpose: To evaluate the robustness of head and neck plans for treatment with intensity modulated proton therapy to range and setup errors, and to establish robustness parameters for the planning of future head and neck treatments. Methods and Materials: Ten patients previously treated were evaluated in terms of robustness to range and setup errors. Error bar dose distributions were generated for each plan, from which several metrics were extracted and used to define a robustness database of acceptable parameters over all analyzed plans. The patients were treated in sequentially delivered series, and plans were evaluated for both the first series and for the combined error over the whole treatment. To demonstrate the application of such a database in the head and neck, for 1 patient, an alternative treatment plan was generated using a simultaneous integrated boost (SIB) approach and plans of differing numbers of fields. Results: The robustness database for the treatment of head and neck patients is presented. In an example case, comparison of single and multiple field plans against the database show clear improvements in robustness by using multiple fields. A comparison of sequentially delivered series and an SIB approach for this patient show both to be of comparable robustness, although the SIB approach shows a slightly greater sensitivity to uncertainties. Conclusions: A robustness database was created for the treatment of head and neck patients with intensity modulated proton therapy based on previous clinical experience. This will allow the identification of future plans that may benefit from alternative planning approaches to improve robustness.

  14. Evaluation of Robustness to Setup and Range Uncertainties for Head and Neck Patients Treated With Pencil Beam Scanning Proton Therapy

    International Nuclear Information System (INIS)

    Malyapa, Robert; Lowe, Matthew; Bolsi, Alessandra; Lomax, Antony J.; Weber, Damien C.; Albertini, Francesca

    2016-01-01

    Purpose: To evaluate the robustness of head and neck plans for treatment with intensity modulated proton therapy to range and setup errors, and to establish robustness parameters for the planning of future head and neck treatments. Methods and Materials: Ten patients previously treated were evaluated in terms of robustness to range and setup errors. Error bar dose distributions were generated for each plan, from which several metrics were extracted and used to define a robustness database of acceptable parameters over all analyzed plans. The patients were treated in sequentially delivered series, and plans were evaluated for both the first series and for the combined error over the whole treatment. To demonstrate the application of such a database in the head and neck, for 1 patient, an alternative treatment plan was generated using a simultaneous integrated boost (SIB) approach and plans of differing numbers of fields. Results: The robustness database for the treatment of head and neck patients is presented. In an example case, comparison of single and multiple field plans against the database show clear improvements in robustness by using multiple fields. A comparison of sequentially delivered series and an SIB approach for this patient show both to be of comparable robustness, although the SIB approach shows a slightly greater sensitivity to uncertainties. Conclusions: A robustness database was created for the treatment of head and neck patients with intensity modulated proton therapy based on previous clinical experience. This will allow the identification of future plans that may benefit from alternative planning approaches to improve robustness.

  15. Evaluation of set-up deviations during the irradiation of patients suffering from breast cancer treated with two different techniques

    International Nuclear Information System (INIS)

    KukoIowicz, Pawel Franciszek; Debrowski, Andrzej; Gut, Piotr; Chmielewski, Leszek; Wieczorek, Andrzej; Kedzierawski, Piotr

    2005-01-01

    Purpose: To compare reproducibility of set-up for two different treatment techniques for external irradiation of the breast. Methods and materials: In total, the analysis comprised 56 pairs of portal and simulator films for 14 consecutive patients treated following breast conserving therapy and 98 pairs of portal and simulator films for 20 consecutive patients treated after mastectomy. For the first group the tangential field technique (TF technique) was used, for the second the inverse hockey stick technique (IHS technique). Evaluation of the treatment reproducibility was performed in terms of systematic and random error calculated for the whole groups, comparison of set-up accuracy by means of comparison of cumulative distribution of the length of the displacement vector. Results: In the IHS and TF techniques for medial and lateral fields, displacement larger than 5 mm occurred in 28.3, 15.8 and 25.4%, respectively. For the IHS technique, the systematic errors for lateral and cranial-caudal direction were 1.9 and 1.7 mm, respectively (1 SD), the random errors for lateral and cranial-caudal direction were 2.0 and 2.5 mm. For the TF technique, the systematic errors for ventral-dorsal and cranial-caudal direction were 2.6 and 1.3 mm for medial field and 3.7 and 0.7 mm for lateral fields, respectively, the random errors for lateral and cranial-caudal direction were 2.2 and 1.0 mm for medial field and 2.9 and 1.1 for lateral field, respectively. Rotations were negligible in the IHS technique. For the TF technique the systematic and random components amounted to about 2.0 degrees (1 SD). Conclusions: Both the inverse hockey stick and standard tangential techniques showed good reproducibility of patients' set-up with respect to cranial-caudal direction. For the TF technique, the accuracy should be improved for the medial field with respect to the ventral-dorsal direction

  16. Factors that influence physical activity in the daily life of male patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Barriga, S; Rodrigues, F; Bárbara, C

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) is a disease with great impact on the ability to carry out physical activity. To identify the main factors that affect physical activity in the daily life of patients with COPD. Physical activity in daily routine has been evaluated according to the London Chest Activity of Daily Living scale (LCADL) and the pedometer counting the number of steps per day, for a period of three days. Fifty-five male patients with a diagnosis of moderate to very severe COPD were included (aged 67±9.6 years; FEV1 50.8±14.7% predicted). Patients walked on average 4972 steps per day. Very severe COPD patients (n=12) walked much less than severe (n=21) and moderate (n=22) patients (respectively 3079.8 versus 4853.5 and 6118.1 steps per day, ppositive correlation with the distance covered in the six-minute walk test (6MWT), forced expiratory volume in the first second (FEV1), carbon monoxide diffusion capacity (DLCO), arterial oxygen saturation (SpO2) and body mass index (BMI). The main factors that correlated with limited physical activity in daily life routine of this group of COPD patients were dyspnea and 6 min walking distance. These patients form a sedentary group, with a low rate of daily physical activity, which is more evident in patients with GOLD spirometry stage IV. Although pedometer is simpler and less accurate than other devices, it can be used to detect significant restraints daily life physical activity of COPD patients. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  17. Correlations between patient satisfaction and ability to perform daily activities after total knee arthroplasty: why aren't patients satisfied?

    Science.gov (United States)

    Nakahara, Hiroyuki; Okazaki, Ken; Mizu-Uchi, Hideki; Hamai, Satoshi; Tashiro, Yasutaka; Matsuda, Shuichi; Iwamoto, Yukihide

    2015-01-01

    Patient satisfaction has become an important parameter for assessing overall outcomes after total knee arthroplasty (TKA). The level of difficulty in performing activities of daily life that affects overall patient satisfaction is unknown. We therefore evaluated the influence of difficulty in performing activities of daily life on patient satisfaction and expectations. The 2011 Knee Society Knee Scoring System Questionnaire was mailed to patients who had undergone TKA with 375 patients completing and returning it. We evaluated the relationship between the ability to perform daily activities, as assessed via the questionnaire, and patient satisfaction and expectations of the same score in each patient using linear regression analysis. We also determined which activities affected patient satisfaction and expectations using multivariate linear regression analyses. All patient-derived functional activities correlated significantly with the patient satisfaction score. In particular, "climbing up or down a flight of stairs" followed by "getting into or out of a car," "moving laterally (stepping to the side)" and "walking and standing" correlated strongly with patient satisfaction by linear regression analysis and were revealed to have significant contributions to patient satisfaction by multivariate linear regression analysis. Regarding expectations, all patient-derived functional activities correlated significantly with the patient expectation score, although none of the correlation coefficients was very high. "Squatting," followed by "walking and standing," contributed to the patient expectation score by multivariate linear regression analysis. Activities related to walking and standing are some of the most basic movements and basic demands for patients. In addition, "climbing up or down a flight of stairs," "getting into and out of a car" and "squatting" are very important and distressing activities that significantly correlate with patient satisfaction after TKA.

  18. Implementation and Setup of a System Dedicated Logbook based on ELisA

    CERN Document Server

    Van Tonder, Raynette

    2016-01-01

    ELisA is a web tool used by the ATLAS community as a daily logbook facility in order to record and share information concerning the experiment's operation and deployment. A few subsystems, notably the FTK subsystem, of the ATLAS experiment would like to setup a logbook based on the ELisA logbook for their own private usage. This new logbook would be completely separated from the main ATLAS logbook and will only be accessed from the general public network. In this project the implementation and setup of the ELisA based logbook will be discussed as well as various modifications that were made to the new logbook. These modifications were specified by the FTK users in order to make the logbook relevant to the FTK subsystem. Once the logbook was functioning as expected and the users were satisfied with the modifications, the FTK logbook was installed on a FTK dedicated machine where it is currently being used by members of the FTK group.

  19. Impact of cradle immobilization on setup reproducibility during external beam radiation therapy for lung cancer

    International Nuclear Information System (INIS)

    Bentel, Gunilla C.; Marks, Lawrence B.; Krishnamurthy, Rupa

    1997-01-01

    Purpose: To compare the setup accuracy during fractionated radiation therapy for two patient groups with lung cancer treated with and without an immobilization cradle. Methods: Three hundred ninety-seven port films from 30 patients immobilized in the Alpha Cradle TM1 were compared with 329 port films from 30 patients who were not immobilized with the cradle. All patients were treated with curative intent for nonmetastatic lung cancer. The frequency of physician-requested isocenter shifts were compared in the two groups using a two-tailed chi-square test. Initial port films taken on the first day of treatment, routine films taken usually weekly during radiation therapy, and requested films taken after a requested shift were considered separately. The immobilization device consisted of a custom-made foam cradle that extended from above the head to the knees. Patients were generally treated with their arms above their heads, and treatment setup marks in the immobilized patients were placed on both the patients' skin and the immobilization cradle. For the noncradle patients, setup marks were placed only on the patients' skin. Results: For the routine films, the frequency of physician-requested isocenter shifts was lower in immobilized patients than in the nonimmobilized group (p = 0.139). Most of this reduction was seen on oblique fields (p = 0.038). No benefits were seen among initial or requested films. The two groups were well balanced with regard to stage, age, field size, and total dose. Conclusions: The use of aggressive immobilization improves the setup reproducibility in patients receiving external beam radiation therapy for lung cancer, especially during treatment with oblique fields. This improvement in treatment accuracy might improve the therapeutic ratio

  20. Rehabilitation of limb apraxia improves daily life activities in patients with stroke.

    Science.gov (United States)

    Smania, N; Aglioti, S M; Girardi, F; Tinazzi, M; Fiaschi, A; Cosentino, A; Corato, E

    2006-12-12

    We randomly assigned 33 patients with left hemisphere stroke, limb apraxia, and aphasia to an apraxia or a control (aphasia) treatment group. Before and after each treatment, patients underwent a comprehensive neuropsychological testing battery and a caregiver evaluation of patient's activities of daily life (ADL) independence. Apraxia severity was related with ADL independence. Control (aphasia) treatment improved patients' language and intelligence performance. Apraxia treatment specifically improved praxic function and ADL.

  1. The daily cost of ICU patients: A micro-costing study in 23 French Intensive Care Units.

    Science.gov (United States)

    Lefrant, Jean-Yves; Garrigues, Bernard; Pribil, Céline; Bardoulat, Isabelle; Courtial, Frédéric; Maurel, Frédérique; Bazin, Jean-Étienne

    2015-06-01

    To estimate the daily cost of intensive care unit (ICU) stays via micro-costing. A multicentre, prospective, observational, cost analysis study was carried out among 21 out of 23 French ICUs randomly selected from French National Hospitals. Each ICU randomly enrolled 5 admitted adult patients with a simplified acute physiology II score ≥ 15 and with at least one major intensive care medical procedure. All health-care human resources used by each patient over a 24-hour period were recorded, as well as all medications, laboratory analyses, investigations, tests, consumables and administrative expenses. All resource costs were estimated from the hospital's perspective (reference year 2009) based on unitary cost data. One hundred and four patients were included (mean age: 62.3 ± 14.9 years, mean SAPS II: 51.5 ± 16.1, mean SOFA on the study day: 6.9 ± 4.3). Over 24 hours, 29 to 186 interventions per patient were performed by different caregivers, leading to a mean total time spent for patient care of 13:32 ± 05:00 h. The total daily cost per patient was € 1425 ± € 520 (95% CI = € 1323 to € 1526). ICU human resources represented 43% of total daily cost. Patient-dependent expenses (€ 842 ± € 521) represented 59% of the total daily cost. The total daily cost was correlated with the daily SOFA score (r = 0.271, P = 0.006) and the bedside-time given by caregivers (r = 0.716, P average cost of one day of ICU care in French National Hospitals is strongly correlated with the duration of bedside-care carried out by human resources. Copyright © 2015. Published by Elsevier Masson SAS.

  2. The role of patients' explanatory models and daily-lived experience in hypertension self-management.

    Science.gov (United States)

    Bokhour, Barbara G; Cohn, Ellen S; Cortés, Dharma E; Solomon, Jeffrey L; Fix, Gemmae M; Elwy, A Rani; Mueller, Nora; Katz, Lois A; Haidet, Paul; Green, Alexander R; Borzecki, Ann M; Kressin, Nancy R

    2012-12-01

    Uncontrolled hypertension remains a significant problem for many patients. Few interventions to improve patients' hypertension self-management have had lasting effects. Previous work has focused largely on patients' beliefs as predictors of behavior, but little is understood about beliefs as they are embedded in patients' social contexts. This study aims to explore how patients' "explanatory models" of hypertension (understandings of the causes, mechanisms or pathophysiology, course of illness, symptoms and effects of treatment) and social context relate to their reported daily hypertension self-management behaviors. Semi-structured qualitative interviews with a diverse group of patients at two large urban Veterans Administration Medical centers. PARTICIPANTS (OR PATIENTS OR SUBJECTS): African-American, white and Latino Veterans Affairs (VA) primary care patients with uncontrolled blood pressure. We conducted thematic analysis using tools of grounded theory to identify key themes surrounding patients' explanatory models, social context and hypertension management behaviors. Patients' perceptions of the cause and course of hypertension, experiences of hypertension symptoms, and beliefs about the effectiveness of treatment were related to different hypertension self-management behaviors. Moreover, patients' daily-lived experiences, such as an isolated lifestyle, serious competing health problems, a lack of habits and routines, barriers to exercise and prioritizing lifestyle choices, also interfered with optimal hypertension self-management. Designing interventions to improve patients' hypertension self-management requires consideration of patients' explanatory models and their daily-lived experience. We propose a new conceptual model - the dynamic model of hypertension self-management behavior - which incorporates these key elements of patients' experiences.

  3. Is a home based video teleconcltation setup cost effective for lowering HBA1C for patients with type-2 diabetes over a six-month period?

    DEFF Research Database (Denmark)

    Sall Jensen, Morten; Rasmussen, Ole Winther

    OBJECTIVES: A RCT assessed the effectiveness and costs of a home based video teleconsultation (HVT) setup to lower HbA1c in patients with type-2 diabetes against usual out-patient treatment on the hospital. The HVT equipment was delivered to the patients by the hospital. This analysis shows...... the potential incremental cost-effectiveness ratio (ICER) of using a HVT setup on six-months health care effects and costs. METHODS: The study effectiveness outcome was HbA1c level in mmol/l. The economic analysis was performed with a spreadsheet decision tree model with a Danish hospital payer’s direct cost...... perspective. Cost data were based on study measured time consumption pr. HVT, consultations at out-patient clinic, HVT-equipment, -subscription, -support costs, and hospital operating cost. Medicine costs weren’t included in the model. Model output included the cost of a 1 mmol/l point reduction of HbA1c...

  4. Intercultural doctor-patient communication in daily outpatient care: relevant communication skills

    NARCIS (Netherlands)

    Paternotte, E.; Scheele, F.; Seeleman, C.M.; Bank, L.; Scherpbier, A.J.; Dulmen, S. van

    2016-01-01

    INTRODUCTION: Intercultural communication (ICC) between doctors and patients is often associated with misunderstandings and dissatisfaction. To develop ICC-specific medical education, it is important to find out which ICC skills medical specialists currently apply in daily clinical consultations.

  5. A managed clinical network for cardiac services: set-up, operation and impact on patient care

    Directory of Open Access Journals (Sweden)

    Karen E. Hamilton

    2005-09-01

    Full Text Available Purpose: To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. Methods: This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Results: Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and ‘bed down’. Its primary “modus operand” was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were

  6. Intercultural doctor-patient communication in daily outpatient care: relevant communication skills.

    NARCIS (Netherlands)

    Paternotte, E.; Scheele, F.; Seeleman, C.M.; Bank, L.; Scherpbier, A.J.J.A.; Dulmen, A.M. van

    2016-01-01

    Introduction Intercultural communication (ICC) between doctors and patients is often associated with misunderstandings and dissatisfaction. To develop ICC-specific medical education, it is important to find out which ICC skills medical specialists currently apply in daily clinical

  7. Surgical robot setup simulation with consistent kinematics and haptics for abdominal surgery.

    Science.gov (United States)

    Hayashibe, Mitsuhiro; Suzuki, Naoki; Hattori, Asaki; Suzuki, Shigeyuki; Konishi, Kozo; Kakeji, Yoshihiro; Hashizume, Makoto

    2005-01-01

    Preoperative simulation and planning of surgical robot setup should accompany advanced robotic surgery if their advantages are to be further pursued. Feedback from the planning system will plays an essential role in computer-aided robotic surgery in addition to preoperative detailed geometric information from patient CT/MRI images. Surgical robot setup simulation systems for appropriate trocar site placement have been developed especially for abdominal surgery. The motion of the surgical robot can be simulated and rehearsed with kinematic constraints at the trocar site, and the inverse-kinematics of the robot. Results from simulation using clinical patient data verify the effectiveness of the proposed system.

  8. Adherence and Patients' Experiences with the Use of Capecitabine in Daily Practice

    OpenAIRE

    Timmers, Lonneke; Boons, Christel C. L. M.; Mangnus, Dirk; Van de Ven, Peter M.; Van den Berg, Pieter H.; Beeker, Aart; Swart, Eleonora L.; Honeywell, Richard J.; Peters, Godefridus J.; Boven, Epie; Hugtenburg, Jacqueline G.

    2016-01-01

    Introduction: Capecitabine is a widely prescribed oral anticancer agent. We studied medication adherence and explored its use in daily practice from a patients' perspective. Patients and Methods: Patients (n = 92) starting capecitabine were followed up to five 3-week cycles. Adherence was assessed using a pill count, pharmacy data and dosing information from the patients' medical file. Self-reported adherence was measured using the Medication Adherence Report Scale (MARS). At baseline and ...

  9. ASD FieldSpec Calibration Setup and Techniques

    Science.gov (United States)

    Olive, Dan

    2001-01-01

    This paper describes the Analytical Spectral Devices (ASD) Fieldspec Calibration Setup and Techniques. The topics include: 1) ASD Fieldspec FR Spectroradiometer; 2) Components of Calibration; 3) Equipment list; 4) Spectral Setup; 5) Spectral Calibration; 6) Radiometric and Linearity Setup; 7) Radiometric setup; 8) Datadets Required; 9) Data files; and 10) Field of View Measurement. This paper is in viewgraph form.

  10. Cone beam CT-based set-up strategies with and without rotational correction for stereotactic body radiation therapy in the liver.

    Science.gov (United States)

    Bertholet, Jenny; Worm, Esben; Høyer, Morten; Poulsen, Per

    2017-06-01

    Accurate patient positioning is crucial in stereotactic body radiation therapy (SBRT) due to a high dose regimen. Cone-beam computed tomography (CBCT) is often used for patient positioning based on radio-opaque markers. We compared six CBCT-based set-up strategies with or without rotational correction. Twenty-nine patients with three implanted markers received 3-6 fraction liver SBRT. The markers were delineated on the mid-ventilation phase of a 4D-planning-CT. One pretreatment CBCT was acquired per fraction. Set-up strategy 1 used only translational correction based on manual marker match between the CBCT and planning CT. Set-up strategy 2 used automatic 6 degrees-of-freedom registration of the vertebrae closest to the target. The 3D marker trajectories were also extracted from the projections and the mean position of each marker was calculated and used for set-up strategies 3-6. Translational correction only was used for strategy 3. Translational and rotational corrections were used for strategies 4-6 with the rotation being either vertebrae based (strategy 4), or marker based and constrained to ±3° (strategy 5) or unconstrained (strategy 6). The resulting set-up error was calculated as the 3D root-mean-square set-up error of the three markers. The set-up error of the spinal cord was calculated for all strategies. The bony anatomy set-up (2) had the largest set-up error (5.8 mm). The marker-based set-up with unconstrained rotations (6) had the smallest set-up error (0.8 mm) but the largest spinal cord set-up error (12.1 mm). The marker-based set-up with translational correction only (3) or with bony anatomy rotational correction (4) had equivalent set-up error (1.3 mm) but rotational correction reduced the spinal cord set-up error from 4.1 mm to 3.5 mm. Marker-based set-up was substantially better than bony-anatomy set-up. Rotational correction may improve the set-up, but further investigations are required to determine the optimal correction

  11. Assessment of Set-up Accuracy in Tangential Breast Treatment Using Electronic Portal Imaging Device

    International Nuclear Information System (INIS)

    Lee, Byung Koo; Kang, Soo Man

    2012-01-01

    The aim of this study was to investigate the setup accuracy for tangential breast treatment patients using electronic portal image and 2-D reconstruction image Twenty two patients undergoing tangential breast treatment. To explore the setup accuracy, distances between chosen landmarks were taken as reference parameters. The difference between measured reference parameters on simulation films and electronic portal images (EPIs) was calculated as the setup error. A total of 22 simulation films and 110 EPIs were evaluated. In the tangential fields, the calculated reference parameters were the central lung distance (CLD), central soft-tissue distance (CSTD), and above lung distance (ALD), below lung distance (BLD). In the medial tangential field, the average difference values for these parameters were 1.0, -6.4, -2.1 and 2.0, respectively; and the values were 1.5, 2.3, 4.1 and 1.1, respectively. In the lateral tangential field, the average difference values for these parameters were -1.5, -4.3, -2.7 and -1.3, respectively; and the values were 3.3, 2.1, 2.9 and 2.5, respectively. CLD, CSTD, ALD and BLD in the tangential fields are easily identifiable and are helpful for detecting setup errors using EPIs in patients undergoing tangential breast radiotherapy treatment.

  12. Assessment of Set-up Accuracy in Tangential Breast Treatment Using Electronic Portal Imaging Device

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Koo [Dept. of Radiation Oncology, Korea University Anam Hospital, Seoul (Korea, Republic of); Kang, Soo Man [Dept. of Radiation Oncology, Korea University Gospel Hospital, Seoul (Korea, Republic of)

    2012-09-15

    The aim of this study was to investigate the setup accuracy for tangential breast treatment patients using electronic portal image and 2-D reconstruction image Twenty two patients undergoing tangential breast treatment. To explore the setup accuracy, distances between chosen landmarks were taken as reference parameters. The difference between measured reference parameters on simulation films and electronic portal images (EPIs) was calculated as the setup error. A total of 22 simulation films and 110 EPIs were evaluated. In the tangential fields, the calculated reference parameters were the central lung distance (CLD), central soft-tissue distance (CSTD), and above lung distance (ALD), below lung distance (BLD). In the medial tangential field, the average difference values for these parameters were 1.0, -6.4, -2.1 and 2.0, respectively; and the values were 1.5, 2.3, 4.1 and 1.1, respectively. In the lateral tangential field, the average difference values for these parameters were -1.5, -4.3, -2.7 and -1.3, respectively; and the values were 3.3, 2.1, 2.9 and 2.5, respectively. CLD, CSTD, ALD and BLD in the tangential fields are easily identifiable and are helpful for detecting setup errors using EPIs in patients undergoing tangential breast radiotherapy treatment.

  13. Setup reproducibility in radiation therapy for lung cancer: a comparison between T-bar and expanded foam immobilization devices

    International Nuclear Information System (INIS)

    Halperin, Ross; Roa, Wilson; Field, Melissa; Hanson, John; Murray, Brad

    1999-01-01

    Purpose: Physiologic and non-physiologic tumor motion complicates the use of tight margins in three-dimensional (3D) conformal radiotherapy. Setup reproducibility is an important non-physiologic cause of tumor motion. The objective of this study is to evaluate and compare patient setup reproducibility using the reusable T-bar and the disposable expanded foam immobilization device (EFID) in radiation therapy for lung cancer. Methods and Materials: Two hundred forty-four portal films were taken from 16 prospectively accrued patients treated for lung cancer. Patients were treated with either a pair of anterior and posterior parallel opposing fields (POF), or a combination of POF and a three-field isocentric technique. Each patient was treated in a supine position using either the T-bar setup or EFID. Six patients were treated in both devices over their treatment courses. Field placement analysis was used to evaluate 3D setup reproducibility, by comparing positions of bony landmarks relative to the radiation field edges in digitized simulator and portal images. Anterior-posterior, lateral, and longitudinal displacements, as well as field rotations along coronal and sagittal planes were measured. Statistical analyses of variance were applied to the deviations among portal films of all patients and the subgroup treated with both immobilization methods. Results: For the T-bar immobilization device, standard deviations of the setup reproducibility were 5.1, 3.7, and 5.1 mm in the anterior-posterior, lateral, and longitudinal dimensions, respectively. Rotations in the coronal plane and the sagittal plane were 0.9 deg. and 1.0 deg. , respectively. For the EFID, corresponding standard deviations of set up reproducibility were 3.6 mm, 5.3 mm, 5.4 mm, 0.7 deg. and 1.4 deg. , respectively. There was no statistically significant difference (p = 0.22) in the 3D setup reproducibility between T-bar and EFID. Subgroup analysis for the patients who were treated with both

  14. Development and content validation of a patient-reported endometriosis pain daily diary.

    Science.gov (United States)

    van Nooten, Floortje E; Cline, Jennifer; Elash, Celeste A; Paty, Jean; Reaney, Matthew

    2018-01-04

    Endometriosis is a common gynecological disorder that causes inflammation and pelvic pain. Endometriosis-related pain is best captured with patient-reported outcome (PRO) measures, however, assessment of endometriosis-related pain in clinical trials has been difficult in the absence of a reliable and valid PRO instrument. We describe the development of the Endometriosis Pain Daily Diary (EPDD), an electronic PRO developed as a survey instrument to assess endometriosis-related pain and its impact on patients' lives. The EPDD was initially developed on the basis of an existing Endometriosis Pain and Bleeding Diary, a targeted review of relevant literature, clinical expert interviews, and open-ended (concept elicitation) patient interviews in the United States (US) and Japan which captured patients' experience with endometriosis. Cognitive interviews of patients with endometriosis were conducted to evaluate patient comprehension of the EPDD items. A conceptual model of endometriosis was developed, and meetings with US and European regulatory authorities provided feedback for validating the EPDD in the context of clinical trials. Translatability assessments of the EPDD were conducted to confirm its appropriate interpretation and ease of completion across 17 languages. The iterative development progressed through three versions of the instrument. The EPDDv1 included 18 items relating to dysmenorrhea/pelvic pain, dyspareunia and sexual activity, bleeding, hot flashes, daily activities, and use of rescue medication. The EPDDv2 was a larger 43-item survey tested in cognitive interviews and subsequently revised to yield the current 11-item EPDDv3, consisting of five core items relating to dysmenorrhea, non-menstrual pelvic pain, and dyspareunia, and six extension items relating to sexual activity, daily activities, and use of rescue medication. The EPDD is a PRO for the evaluation of endometriosis-related pain and its associated impacts on patients' lives. The EPDD

  15. Surface imaging, portal imaging, and skin marker set-up vs. CBCT for radiotherapy of the thorax and pelvis

    International Nuclear Information System (INIS)

    Pallotta, Stefania; Bucciolini, Marta; Vanzi, Eleonora; Marrazzo, Livia; Simontacchi, Gabriele; Paiar, Fabiola; Ceroti, Marco; Livi, Lorenzo

    2015-01-01

    The aim of this study was to compare surface imaging, portal imaging, and skin marker set-up in radiotherapy of thoracic and pelvic regions, using cone beam computed tomography (CBCT) data as the gold standard. Twenty patients were included in this study. CBCT, surface acquisition (SA), and two orthogonal portal images (PI) were acquired during the first four treatment sessions. Patient set-up corrections, obtained by registering the planning CT with CBCT, were used as the gold standard. Registration results of the PI and SA were evaluated and compared with those obtained with CBCT. The advantage derived from using SA or PI verification systems over a skin marker set-up was also quantified. A statistically significant difference between PI and SA (in favour of PI) was observed in seven patients undergoing treatment of the pelvic region and in two patients undergoing treatment of the thoracic region. The use of SA or PI, compared with a skin marker set-up, improved patient positioning in 50% and 57 % of the thoracic fractions, respectively. For pelvic fractions, the use of PI was beneficial in 73 % of the cases, while the use of SA was beneficial in only 45 %. Patient positioning worsened with SA, particularly along longitudinal and vertical directions. PI yielded more accurate registration results than SA for both pelvic and thoracic fractions. Compared with the skin marker set-up, PI performances were superior to SA for pelvic fractions while comparable results were obtained for thoracic fractions. (orig.) [de

  16. ESTERR-PRO: A Setup Verification Software System Using Electronic Portal Imaging

    Directory of Open Access Journals (Sweden)

    Pantelis A. Asvestas

    2007-01-01

    Full Text Available The purpose of the paper is to present and evaluate the performance of a new software-based registration system for patient setup verification, during radiotherapy, using electronic portal images. The estimation of setup errors, using the proposed system, can be accomplished by means of two alternate registration methods. (a The portal image of the current fraction of the treatment is registered directly with the reference image (digitally reconstructed radiograph (DRR or simulator image using a modified manual technique. (b The portal image of the current fraction of the treatment is registered with the portal image of the first fraction of the treatment (reference portal image by applying a nearly automated technique based on self-organizing maps, whereas the reference portal has already been registered with a DRR or a simulator image. The proposed system was tested on phantom data and on data from six patients. The root mean square error (RMSE of the setup estimates was 0.8±0.3 (mean value ± standard deviation for the phantom data and 0.3±0.3 for the patient data, respectively, by applying the two methodologies. Furthermore, statistical analysis by means of the Wilcoxon nonparametric signed test showed that the results that were obtained by the two methods did not differ significantly (P value >0.05.

  17. Setup error in three-dimensional conformal radiotherapy for thoracic esophageal carcinoma

    International Nuclear Information System (INIS)

    Hong Jinsheng; Zhang Weijian; Chen Jinmei; Cai Chuanshu; Ke Chunlin; Chen Xiuying; Wu Bing; Guo Feibao

    2009-01-01

    Objective: To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods: Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs (DRR). Then the setup margins from CTV to PTV were calculated. By using self paired design, 22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes; Group B: the margins were aquired in this study. The difference were compared by Paired t-test or Wilcoxon signed-rank test. Results: The margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy ± 1449.6 cGy vs. 4310.2 cGy ± 1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82% ± 5.99% vs. 3.64% ± 4.70%; Z=-2.70, P=0.007). Conclusions: For patients with thoracic esophageal carcinoma who receive 3DCRT in author's department, the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis. (authors)

  18. Verification of the Patient Positioning in the Bellyboard Pelvic Radiotherapy

    International Nuclear Information System (INIS)

    Kasabasic, M.; Faj, D.; Smilovic Radojcic, D.; Svabic, M.; Ivkovic, A.; Jurkovic, S.

    2008-01-01

    The size and shape of the treatment fields applied in radiotherapy account for uncertainties in the daily set-up of the patients during the treatment. We investigated the accuracy of daily patient positioning in the bellyboard pelvic radiotherapy in order to find out the magnitude of the patients movement during the treatment. Translational as well as rotational movements of the patients are explored. Film portal imaging is used in order to find patient positioning error during the treatment of the pelvic region. Patients are treated in the prone position using the bellyboard positioning device. Thirty six patients are included in the study; 15 patients were followed during the whole treatment and 21 during the first 5 consecutive treatment days. The image acquisition was completed in 85 percent and systematic and random positioning errors in 453 images are analyzed. (author)

  19. Refinement of Treatment Setup and Target Localization Accuracy Using Three-Dimensional Cone-Beam Computed Tomography for Stereotactic Body Radiotherapy

    International Nuclear Information System (INIS)

    Wang Zhiheng; Nelson, John W.; Yoo, Sua; Wu, Q. Jackie; Kirkpatrick, John P.; Marks, Lawrence B.; Yin Fangfang

    2009-01-01

    Purposes: To quantitatively compare two-dimensional (2D) orthogonal kV with three-dimensional (3D) cone-beam CT (CBCT) for target localization; and to assess intrafraction motion with kV images in patients undergoing stereotactic body radiotherapy (SBRT). Methods and Materials: A total of 50 patients with 58 lesions received 178 fractions of SBRT. After clinical setup using in-room lasers and skin/cradle marks placed at simulation, patients were imaged and repositioned according to orthogonal kV/MV registration of bony landmarks to digitally reconstructed radiographs from the planning CT. A subsequent CBCT was registered to the planning CT using soft tissue information, and the resultant 'residual error' was measured and corrected before treatment. Posttreatment 2D kV and/or 3D CBCT images were compared with pretreatment images to determine any intrafractional position changes. Absolute averages, statistical means, standard deviations, and root mean square (RMS) values of observed setup error were calculated. Results: After initial setup to external marks with laser guidance, 2D kV images revealed vector mean setup deviations of 0.67 cm (RMS). Cone-beam CT detected residual setup deviations of 0.41 cm (RMS). Posttreatment imaging demonstrated intrafractional variations of 0.15 cm (RMS). The individual shifts in three standard orthogonal planes showed no obvious directional biases. Conclusions: After localization based on superficial markings in patients undergoing SBRT, orthogonal kV imaging detects setup variations of approximately 3 to 4 mm in each direction. Cone-beam CT detects residual setup variations of approximately 2 to 3 mm

  20. Clinical Experiences With Onboard Imager KV Images for Linear Accelerator-Based Stereotactic Radiosurgery and Radiotherapy Setup

    International Nuclear Information System (INIS)

    Hong, Linda X.; Chen, Chin C.; Garg, Madhur; Yaparpalvi, Ravindra; Mah, Dennis

    2009-01-01

    Purpose: To report our clinical experiences with on-board imager (OBI) kV image verification for cranial stereotactic radiosurgery (SRS) and radiotherapy (SRT) treatments. Methods and Materials: Between January 2007 and May 2008, 42 patients (57 lesions) were treated with SRS with head frame immobilization and 13 patients (14 lesions) were treated with SRT with face mask immobilization at our institution. No margin was added to the gross tumor for SRS patients, and a 3-mm three-dimensional margin was added to the gross tumor to create the planning target volume for SRT patients. After localizing the patient with stereotactic target positioner (TaPo), orthogonal kV images using OBI were taken and fused to planning digital reconstructed radiographs. Suggested couch shifts in vertical, longitudinal, and lateral directions were recorded. kV images were also taken immediately after treatment for 21 SRS patients and on a weekly basis for 6 SRT patients to assess any intrafraction changes. Results: For SRS patients, 57 pretreatment kV images were evaluated and the suggested shifts were all within 1 mm in any direction (i.e., within the accuracy of image fusion). For SRT patients, the suggested shifts were out of the 3-mm tolerance for 31 of 309 setups. Intrafraction motions were detected in 3 SRT patients. Conclusions: kV imaging provided a useful tool for SRS or SRT setups. For SRS setup with head frame, it provides radiographic confirmation of localization using the stereotactic target positioner. For SRT with mask, a 3-mm margin is adequate and feasible for routine setup when TaPo is combined with kV imaging

  1. Motivational counselling and SMS-reminders for reduction of daily sitting time in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Thomsen, T; Aadahl, Mette; Beyer, Nina Ann-Marie

    2016-01-01

    for daily leisure time sitting > 4 h. The 16-week intervention included 1) three individual motivational counselling sessions and 2) individual text message reminders aimed at reducing daily sitting time. The control group was encouraged to maintain their usual lifestyles. Outcomes were assessed at baseline...... and screened before 20 met eligibility criteria and consented; reasons for declining study participation were mostly flares, lack of time and co-morbidities. One patient from the control group dropped out before end of intervention (due to a RA flare). Intervention participants completed all counselling...... tailored, theory-based behavioural intervention targeting reduction in daily sitting time in patients with RA. METHODS: A randomised, controlled trial with two parallel groups. RA patients >18 years of age and Health Assessment Questionnaire (HAQ) score 

  2. Patterns of Daily Costs Differ for Medical and Surgical Intensive Care Unit Patients.

    Science.gov (United States)

    Gershengorn, Hayley B; Garland, Allan; Gong, Michelle N

    2015-12-01

    Published studies suggest hospital costs on Day 1 in the intensive care unit (ICU) far exceed those of subsequent days, when costs are relatively stable. Yet, no study stratified patients by ICU type. To determine whether daily cost patterns differ by ICU type. We performed a retrospective study of adults admitted to five ICUs (two surgical: quaternary surgical ICU [SICU quat] and quaternary cardiac surgical ICU [CSICU quat]; two medical: tertiary medical ICU [MICU tertiary] and quaternary medical ICU [MICU quat]; one general: community medical surgical ICU [MSICU comm]) at Montefiore Medical Center in the Bronx, New York during 2013. After excluding costs clearly accrued outside the ICU, daily hospital costs were merged with clinical data. Patterns of daily unadjusted costs were evaluated in each ICU using median regression. Generalized estimating equations with first-order autocorrelation were used to identify factors independently associated with daily costs. Unadjusted daily costs were higher on Day 1 than on subsequent days only for surgical ICUs-SICU quat (median [interquartile range], $2,636 [$1,834-$4,282] on Day 1 vs. $1,840 [$1,501-$2,332] on Day 2; P cost from Days 1 to 2. After multivariate adjustment, there remained a significant decrease in cost from ICU Day 1 to 2 in surgical units with statistically similar Day 1 and 2 costs for other ICUs. Higher Day 1 costs are not seen in patients admitted to medical/nonsurgical ICUs.

  3. Normal tissue sparing in a phase II trial on daily adaptive plan selection in radiotherapy for urinary bladder cancer.

    Science.gov (United States)

    Vestergaard, Anne; Muren, Ludvig P; Lindberg, Henriette; Jakobsen, Kirsten L; Petersen, Jørgen B B; Elstrøm, Ulrik V; Agerbæk, Mads; Høyer, Morten

    2014-08-01

    Background: Patients with urinary bladder cancer often display large changes in the shape and size of their bladder target during a course of radiotherapy (RT), making adaptive RT (ART) appealing for this tumour site. We are conducting a clinical phase II trial of daily plan selection-based ART for bladder cancer and here report dose-volume data from the first 20 patients treated in the trial. All patients received 60 Gy in 30 fractions to the bladder; in 13 of the patients the pelvic lymph nodes were simultaneously treated to 48 Gy. Daily patient set-up was by use of cone beam computed tomography (CBCT) guidance. The first 5 fractions were delivered with large, population-based (non-adaptive) margins. The bladder contours from the CBCTs acquired in the first 4 fractions were used to create a patient-specific library of three plans, corresponding to a small, medium and large size bladder. From fraction 6, daily online plan selection was performed, where the smallest plan covering the bladder was selected prior to each treatment delivery. A total of 600 treatment fractions in the 20 patients were evaluated. Small, medium and large size plans were used almost equally often, with an average of 10, 9 and 11 fractions, respectively. The median volume ratio of the course-averaged PTV (PTV-ART) relative to the non-adaptive PTV was 0.70 (range: 0.46-0.89). A linear regression analysis showed a 183 cm(3) (CI 143-223 cm(3)) reduction in PTV-ART compared to the non-adaptive PTV (R(2) = 0.94). Daily adaptive plan selection in RT of bladder cancer results in a considerable normal tissue sparing, of a magnitude that we expect will translate into a clinically significant reduction of the treatment-related morbidity.

  4. Environmental Influences on Daily Emergency Admissions in Sickle-Cell Disease Patients

    Science.gov (United States)

    Mekontso Dessap, Armand; Contou, Damien; Dandine-Roulland, Claire; Hemery, François; Habibi, Anoosha; Charles-Nelson, Anaïs; Galacteros, Frederic; Brun-Buisson, Christian; Maitre, Bernard; Katsahian, Sandrine

    2014-01-01

    Abstract Previous reports have suggested a role for weather conditions and air pollution on the variability of sickle cell disease (SCD) severity, but large-scale comprehensive epidemiological studies are lacking. In order to evaluate the influence of air pollution and climatic factors on emergency hospital admissions (EHA) in SCD patients, we conducted an 8-year observational retrospective study in 22 French university hospitals in Paris conurbation, using distributed lag non-linear models, a methodology able to flexibly describe simultaneously non-linear and delayed associations, with a multivariable approach. During the 2922 days of the study, there were 17,710 EHA, with a mean daily number of 6.1 ± 2.8. Most environmental factors were significantly correlated to each other. The risk of EHA was significantly associated with higher values of nitrogen dioxide, atmospheric particulate matters, and daily mean wind speed; and with lower values of carbon monoxide, ozone, sulfur dioxide, daily temperature (minimal, maximal, mean, and range), day-to-day mean temperature change, daily bright sunshine, and occurrence of storm. There was a lag effect for 12 of 15 environmental factors influencing hospitalization rate. Multivariate analysis identified carbon monoxide, day-to-day temperature change, and mean wind speed, along with calendar factors (weekend, summer season, and year) as independent factors associated with EHA. In conclusion, most weather conditions and air pollutants assessed were correlated to each other and influenced the rate of EHA in SCD patients. In multivariate analysis, lower carbon monoxide concentrations, day-to-day mean temperature drop and higher wind speed were associated with increased risk of EHA. PMID:25546672

  5. The impact of hyperhidrosis on patients' daily life and quality of life: a qualitative investigation.

    Science.gov (United States)

    Kamudoni, P; Mueller, B; Halford, J; Schouveller, A; Stacey, B; Salek, M S

    2017-06-08

    An understanding of the daily life impacts of hyperhidrosis and how patients deal with them, based on qualitative research, is lacking. This study investigated the impact of hyperhidrosis on the daily life of patients using a mix of qualitative research methods. Participants were recruited through hyperhidrosis patient support groups such as the Hyperhidrosis Support Group UK. Data were collected using focus groups, interviews and online surveys. A grounded theory approach was used in the analysis of data transcripts. Data were collected from 71 participants, out of an initial 100 individuals recruited. Seventeen major themes capturing the impacts of hyperhidrosis were identified; these covered all areas of life including daily life, psychological well-being, social life, professional /school life, dealing with hyperhidrosis, unmet health care needs and physical impact. Psychosocial impacts are central to the overall impacts of hyperhidrosis, cutting across and underlying the limitations experienced in other areas of life.

  6. Daily intake and serum concentration of menaquinone-4 (MK-4) in haemodialysis patients with chronic kidney disease.

    Science.gov (United States)

    Wyskida, Katarzyna; Żak-Gołąb, Agnieszka; Łabuzek, Krzysztof; Suchy, Dariusz; Ficek, Rafał; Pośpiech, Kornel; Olszanecka-Glinianowicz, Magdalena; Okopień, Bogusław; Więcek, Andrzej; Chudek, Jerzy

    2015-12-01

    Decreased concentration of menaquinone-4 (MK-4) seems to be an important risk factor of vascular calcification in haemodialysis (HD) patients. Optimal dietary intake, as well as serum MK-4 reference range, in HD has not been determined, yet. The aim of the present study was to assess daily vitamin K1 and MK-4 intakes and their relation to serum MK-4 concentration in HD patients. Daily vitamin K1 and MK-4, micro- and macronutrients and energy intakes were assessed using 3-day food diary completed by patients and serum MK-4 concentration was measured by HPLC [limit of quantification (LOQ): 0.055 ng/mL] in 85 HD patients (51 males) and 22 apparently healthy subjects. Daily MK-4 intake was significantly lower (by 29%) among HD, while K1 consumption was similar in both groups. Daily MK-4 intake was associated with fat and protein consumption in HD (r=0.43, pintakes were weaker in HD (r=0.38 and r=0.30 respectively) than in the control group (r=0.47 and r=0.45, respectively). In multiple regression analysis the variability of serum MK-4 concentrations in HD patients was explained by its daily intake. Decreased serum MK-4 concentration in HD patients is caused by lower dietary MK-4 intake, mainly due to diminished meat consumption, and in addition, probably reduced K1 conversion. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  7. Proteasome activity related with the daily physical activity of COPD patients

    Directory of Open Access Journals (Sweden)

    Lee KY

    2017-05-01

    Full Text Available Kang-Yun Lee,1,2,* Tzu-Tao Chen,1,* Ling-Ling Chiang,1,3 Hsiao-Chi Chuang,1,3 Po-Hao Feng,1,2 Wen-Te Liu,1–3 Kuan-Yuan Chen,1 Shu-Chuan Ho1,3 1Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 2Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 3School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan *These authors contributed equally to this work Background: COPD is a debilitating disease that affects patients’ daily lives. One’s daily physical activity (DPA decreases due to multifactorial causes, and this decrease is correlated with a poor prognosis in COPD patients. Muscle wasting may at least be partly due to increased activity of the ubiquitin proteasome pathway and apoptosis.Methods: This study investigated the relationships among DPA, circulating proteasome activity, and protein carbonyl in COPD patients and healthy subjects (HSs. This study included 57 participants (42 patients and 15 healthy subjects. Ambulatory DPA was measured using actigraphy, and oxygen saturation was measured with a pulse oximeter.Results: COPD patients had lower DPA, lower 6 min walking distance (6MWD, lower delta saturation pulse oxygenation (SpO2 during the 6MWT, and lower delta SpO2 during DPA than HSs. COPD patients had higher proteasome activity and protein carbonyl than HSs. Circulating proteasome activity was significantly negatively correlated with DPA (r=−0.568, P<0.05 in COPD patients, whereas delta SpO2 during the 6MWT was significantly positively correlated with proteasome activity (r=0.685, P<0.05 in HSs. Protein carbonyl was significantly negatively correlated with the body mass index (r=−0.318, P<0.05, mid-arm circumference (r=0.350, P<0.05, calf circumference (r=0.322, P<0.05, forced expiratory volume in the first second (r=−0.441, P<0

  8. SU-E-T-659: Quantitative Evaluation of Patient Setup Accuracy of Stereotactic Radiotherapy with the Frameless 6D-ExacTrac System Using Statistical Modeling

    Energy Technology Data Exchange (ETDEWEB)

    Keeling, V; Jin, H; Hossain, S; Algan, O; Ahmad, S; Ali, I [University of Oklahoma Health Science Center, Oklahoma City, OK (United States)

    2015-06-15

    Purpose: To evaluate patient setup accuracy and quantify individual and cumulative positioning uncertainties associated with different hardware and software components of the stereotactic radiotherapy (SRS/SRT) with the frameless-6D-ExacTrac system. Methods: A statistical model was used to evaluate positioning uncertainties of the different components of SRS/SRT treatment with the BrainLAB 6D-ExacTrac system using the positioning shifts of 35 patients having cranial lesions (49 total lesions treated in 1, 3, 5 fractions). All these patients were immobilized with rigid head-and-neck masks, simulated with BrainLAB-localizer and planned with iPlan treatment planning system. Infrared imaging (IR) was used initially to setup patients. Then, stereoscopic x-ray images (XC) were acquired and registered to corresponding digitally-reconstructed-radiographs using bony-anatomy matching to calculate 6D-translational and rotational shifts. When the shifts were within tolerance (0.7mm and 1°), treatment was initiated. Otherwise corrections were applied and additional x-rays were acquired (XV) to verify that patient position was within tolerance. Results: The uncertainties from the mask, localizer, IR-frame, x-ray imaging, MV and kV isocentricity were quantified individually. Mask uncertainty (Translational: Lateral, Longitudinal, Vertical; Rotational: Pitch, Roll, Yaw) was the largest and varied with patients in the range (−1.05−1.50mm, −5.06–3.57mm, −5.51−3.49mm; −1.40−2.40°, −1.24−1.74°, and −2.43−1.90°) obtained from mean of XC shifts for each patient. Setup uncertainty in IR positioning (0.88,2.12,1.40mm, and 0.64,0.83,0.96°) was extracted from standard-deviation of XC. Systematic uncertainties of the localizer (−0.03,−0.01,0.03mm, and −0.03,0.00,−0.01°) and frame (0.18,0.25,−1.27mm,−0.32,0.18, and 0.47°) were extracted from means of all XV setups and mean of all XC distributions, respectively. Uncertainties in isocentricity of the

  9. Maintenance of heartburn relief after step-down from twice-daily proton pump inhibitor to once-daily dexlansoprazole modified release.

    Science.gov (United States)

    Fass, Ronnie; Inadomi, John; Han, Cong; Mody, Reema; O'Neil, Janet; Perez, M Claudia

    2012-03-01

    Many patients with gastroesophageal reflux disease (GERD) take a proton pump inhibitor (PPI) twice daily to control symptoms. Once-daily dexlansoprazole modified release (MR) has a dual-delayed release formulation, making it attractive for step-down management of patients whose symptoms are well controlled on twice-daily PPIs. We investigated whether step-down to once-daily dexlansoprazole controls heartburn in patients with GERD who were receiving twice-daily PPI therapy. Patients 18 years and older taking a twice-daily PPI for symptom control were enrolled (n = 178) in a single-blind, multicenter study; 163 patients completed the study and 142 patients met criteria for the efficacy analysis. During the 6-week screening and treatment periods, patients recorded the presence of heartburn symptoms twice daily in electronic diaries. Patients' heartburn was considered well controlled if they had an average of 1 symptom or fewer per week during the last 4 weeks of screening and treatment. After screening, qualified patients were switched to masked dexlansoprazole MR 30 mg and placebo for 6 weeks. The primary efficacy end point was the proportion of patients whose heartburn remained well controlled after step-down. GERD-related symptoms and quality of life (QOL) also were evaluated using the Patient Assessment of Upper Gastrointestinal Disorders Symptom Severity Index (PAGI-SYM) and the PAGI-QOL questionnaires, respectively. After step-down to once-daily dexlansoprazole MR 30 mg, heartburn remained well controlled in 88% of patients (125 of 142). These patients were able to maintain their GERD-related symptom severity and QOL, indicated by marginal changes in the PAGI-SYM and PAGI-QOL total and subscale scores, respectively. Most patients with GERD who take twice-daily PPI to control heartburn are able to successfully step down to once-daily dexlansoprazole 30 mg. Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

  10. Relief of depression and pain improves daily functioning and quality of life in patients with major depressive disorder.

    Science.gov (United States)

    Lin, Ching-Hua; Yen, Yung-Chieh; Chen, Ming-Chao; Chen, Cheng-Chung

    2013-12-02

    The objective of this study was to investigate the effects of depression relief and pain relief on the improvement in daily functioning and quality of life (QOL) for depressed patients receiving a 6-week treatment of fluoxetine. A total of 131 acutely ill inpatients with major depressive disorder (MDD) were enrolled to receive 20mg of fluoxetine daily for 6 weeks. Depression severity, pain severity, daily functioning, and health-related QOL were assessed at baseline and again at week 6. Depression severity, pain severity, and daily functioning were assessed using the 17-item Hamilton Depression Rating Scale, the Short-Form 36 (SF-36) Body Pain Index, and the Work and Social Adjustment Scale. Health-related QOL was assessed by three primary domains of the SF-36, including social functioning, vitality, and general health perceptions. Pearson's correlation and structural equation modeling were used to examine relationships among the study variables. Five models were proposed. In model 1, depression relief alone improved daily functioning and QOL. In model 2, pain relief alone improved daily functioning and QOL. In model 3, depression relief, mediated by pain relief, improved daily functioning and QOL. In model 4, pain relief, mediated by depression relief, improved daily functioning and QOL. In model 5, both depression relief and pain relief improved daily functioning and QOL. One hundred and six patients completed all the measures at baseline and at week 6. Model 5 was the most fitted structural equation model (χ(2) = 8.62, df = 8, p = 0.376, GFI = 0.975, AGFI = 0.935, TLI = 0.992, CFI = 0.996, RMSEA = 0.027). Interventions which relieve depression and pain improve daily functioning and QOL among patients with MDD. The proposed model can provide quantitative estimates of improvement in treating patients with MDD. © 2013 Elsevier Inc. All rights reserved.

  11. SU-F-P-23: Setup Uncertainties for the Lung Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Q; Vigneri, P; Madu, C; Potters, L [Northwell Health, New Hyde Park, NY (United States); Cao, Y; Jamshidi, A [Northwell Health, Lake Success, NY (United States); Klein, E [Long Island Jewish Medical Center, Lake Success, NY (United States)

    2016-06-15

    Purpose: The Exactrack X-ray system with six degree-of-freedom (6DoF) adjustment ability can be used for setup of lung stereotactic body radiation therapy. The setup uncertainties from ExacTrack 6D system were analyzed. Methods: The Exactrack X-ray 6D image guided radiotherapy system is used in our clinic. The system is an integration of 2 subsystems: (1): an infrared based optical position system and (2) a radiography kV x-ray imaging system. The infrared system monitors reflective body markers on the patient’s skin to assistant in the initial setup. The radiographic kV devices were used for patient positions verification and adjustment. The position verification was made by fusing the radiographs with the digitally reconstructed radiograph (DRR) images generated by simulation CT images using 6DoF fusion algorithms. Those results were recorded in our system. Gaussian functions were used to fit the data. Results: For 37 lung SBRT patients, the image registration results for the initial setup by using surface markers and for the verifications, were measured. The results were analyzed for 143 treatments. The mean values for the lateral, longitudinal, vertical directions were 0.1, 0.3 and 0.3mm, respectively. The standard deviations for the lateral, longitudinal and vertical directions were 0.62, 0.78 and 0.75mm respectively. The mean values for the rotations around lateral, longitudinal and vertical directions were 0.1, 0.2 and 0.4 degrees respectively, with standard deviations of 0.36, 0.34, and 0.42 degrees. Conclusion: The setup uncertainties for the lung SBRT cases by using Exactrack 6D system were analyzed. The standard deviations of the setup errors were within 1mm for all three directions, and the standard deviations for rotations were within 0.5 degree.

  12. SU-F-P-23: Setup Uncertainties for the Lung Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Zhang, Q; Vigneri, P; Madu, C; Potters, L; Cao, Y; Jamshidi, A; Klein, E

    2016-01-01

    Purpose: The Exactrack X-ray system with six degree-of-freedom (6DoF) adjustment ability can be used for setup of lung stereotactic body radiation therapy. The setup uncertainties from ExacTrack 6D system were analyzed. Methods: The Exactrack X-ray 6D image guided radiotherapy system is used in our clinic. The system is an integration of 2 subsystems: (1): an infrared based optical position system and (2) a radiography kV x-ray imaging system. The infrared system monitors reflective body markers on the patient’s skin to assistant in the initial setup. The radiographic kV devices were used for patient positions verification and adjustment. The position verification was made by fusing the radiographs with the digitally reconstructed radiograph (DRR) images generated by simulation CT images using 6DoF fusion algorithms. Those results were recorded in our system. Gaussian functions were used to fit the data. Results: For 37 lung SBRT patients, the image registration results for the initial setup by using surface markers and for the verifications, were measured. The results were analyzed for 143 treatments. The mean values for the lateral, longitudinal, vertical directions were 0.1, 0.3 and 0.3mm, respectively. The standard deviations for the lateral, longitudinal and vertical directions were 0.62, 0.78 and 0.75mm respectively. The mean values for the rotations around lateral, longitudinal and vertical directions were 0.1, 0.2 and 0.4 degrees respectively, with standard deviations of 0.36, 0.34, and 0.42 degrees. Conclusion: The setup uncertainties for the lung SBRT cases by using Exactrack 6D system were analyzed. The standard deviations of the setup errors were within 1mm for all three directions, and the standard deviations for rotations were within 0.5 degree.

  13. Impact of setup variability on incidental lung irradiation during tangential breast treatment

    International Nuclear Information System (INIS)

    Carter, D.C.; Marks, L.B.; Bentel, G.B.

    1995-01-01

    Purpose: 1) To determine the variability in treatment setup during a 5 week course of tangential breast treatment. 2) To assess the relationship between the height of the lung shadow at the central axis (Central Lung Distance: CLD) on the tangential port film and the percent of total lung volume included within the tangential fields (to verify the previously reported result from Bornstein, et al, IJROBP 18:181, 90). 3) To determine the impact of the variabilities in treatment setup on the volume of lung that is incidentally included within the radiation fields. Methods: 1) 172 port films of tangential breast/chest wall fields were reviewed from 20 patients who received tangential beam treatment for breast cancer. All patients were immobilized in customized hemibody foam cradles during simulation and treatment. The CLD (height of the lung shadow at the central axis) seen on each of the port films was compared to the corresponding simulator film (correcting for differences in magnification) as an assessment of setup variability. Both inter and intrapatient differences were considered. 2) A three-dimensional dose calculation (reflecting lung density) was performed, and the percent of total lung volume within the field was compared to the CLD. 3) The three-dimensional dose calculation was repeated for selected patients with the location of the treatment beams modified to reflect typical setup variations, in order to assess the impact of this variability on the volume of lung irradiated. Results: 1) The CLD measured on the port films was within 3 mm of that prescribed on the simulator film in 43% ((74(172))) of the port films. The variation was 3-5 mm in 26 %, 5-10 mm in 25 % and > 10 mm in 6 %. The data are shown in Figure 1. 2) There was an excellent correlation found between the height of the lung shadow and the percent of total lung volume seen within the radiation field, (Figure 2), thus verifying the concept previously reported by Bornstein. 3) A 1 cm setup

  14. Influence on intraocular pressure of the postural change and daily activities in the early morning in suspected glaucoma patients

    Directory of Open Access Journals (Sweden)

    Ting Chen

    2014-05-01

    Full Text Available AIM:To evaluate the influence on intraocular pressure(IOPof the postural change and daily activities in the early morning in suspected glaucoma patients.METHODS:The supine and sitting IOP were measured and analyzed on 51 suspected glaucoma patients(100 eyeswith Icare rebound tonometer before and after getting up and daily activities in the early morning. RESULTS: The mean of sitting IOP of 51 patients was 17.12±4.53mmHg, which was significantly lower than the mean of supine IOP(19.14±5.51mmHg. The mean of IOP before and after daily activity of 51 patients were 17.12±4.53mmHg and 14.44±3.90mmHg respectively, which showed significantly difference. CONCLUSION:Postural change and daily activities can result in significant changes of IOP in suspected glaucoma patients.

  15. Server farms with setup costs

    NARCIS (Netherlands)

    Gandhi, A.; Harchol-Balter, M.; Adan, I.J.B.F.

    2010-01-01

    In this paper we consider server farms with a setup cost. This model is common in manufacturing systems and data centers, where there is a cost to turn servers on. Setup costs always take the form of a time delay, and sometimes there is additionally a power penalty, as in the case of data centers.

  16. Approaches to daily body condition management in patients with stable chronic obstructive pulmonary disease.

    Science.gov (United States)

    Kawada, Terue

    2016-11-01

    To clarify the characteristics of sub-groups of patients with stable chronic obstructive pulmonary disease having similar approaches to daily body condition management. Prior literature has shed light on the experience of patients with chronic obstructive pulmonary disease and revealed that these patients engage in many activities and try different things in their daily lives to regulate and manage their body condition. The research so far has all been qualitative, comprising mostly interviews, and no quantitative studies have been performed. In this study, cluster analysis was used to show that subgroups of patients with similar characteristics undertake similar approaches to body condition management. Descriptive, correlational study. Invitations to participate in the survey were extended to patients with stable chronic obstructive pulmonary disease. Cluster analysis was performed on the basis of questionnaire scores relating to nine different categories of daily body condition management actions. The characteristics of the body condition management approaches, in each subgroup, were investigated using analysis of variance and multiple comparisons. The cluster analysis produced six subgroups, each defined by the effort expended as part of their body condition management. The subgroups also differed depending on patient age and disease severity. Body condition management approaches taken by patients with stable chronic obstructive pulmonary disease are overall, comprehensive approaches. Patients with chronic obstructive pulmonary disease were subgrouped based on their engagement in body conditioning. Relationships between the subgroups and the engagement in body conditioning, age and shortness of breath severity were observed. The care of patient support should be comprehensive and depend on their age and the duration of the disease. In addition, it should be long term and recognise that the patients are living their own respective lives. Such considerations and

  17. Setup verification in stereotactic radiotherapy using digitally reconstructed radiograph (DRR)

    International Nuclear Information System (INIS)

    Cho, Byung Chul; Oh, Do Hoon; Bae, Hoon Sik

    1999-01-01

    To develop a method for verifying a treatment setup in stereotactic radiotherapy by matching portal images to DRRs. Four pairs of orthogonal portal images of one patient immobilized by a thermoplastic mast frame for fractionated stereotactic radiotherapy were compared with DRRs. Portal images are obtained in AP (anterior/posterior) and lateral directions with a target localizer box containing fiducial markers attached to a stereotactic frame. DRRs superimposed over a planned isocenter and fiducial markers are printed out on transparent films. And then, they were overlaid over orthogonal portal images by matching anatomical structures. From three different kind of objects (isocenter, fiducial markers, anatomical structure) on DRRs and portal images, the displacement error between anatomical structure and isocenters (overall setup error), and the displacement error between fiducial markers and isocenters (localization error)were measured. Localization errors were 1.5±0.3 mm (lateral), and immobilization errors were 1.9±0.5 mm (AP), 1.9±0.4 mm (lateral). In addition, overall setup errors were 1.6±0.9 mm (AP), 1.3±0.4 mm(lateral). From these orthogonal displacement errors, maximum 3D displacement errors(√(ΔAP) 2 +(ΔLat) 2 ) were found to be 1.7±0.4 mm for localization, 2.6±0.6 mm for immobilization, and 2.3±0.7 mm for overall treatment setup. By comparing orthogonal portal images with DRRs, we find out that it is possible to verify treatment setup directly in stereotactic radiotherapy

  18. Evaluation of new drugs in daily clinical practice: anti-TNF alpha in rheumatoid arthritis patients.

    OpenAIRE

    Kievit, W.

    2008-01-01

    The objective of this thesis was to explore the value and the validity of data collected in daily clinical practice for drug evaluation and cost-effectiveness studies, using data collected on TNFa blocking agents in rheumatoid arthritis. First, the need for and value of information from daily clinical practice was researched. Together, the results of Chapters 3, 4 and 5 illustrated that treatment of RA patients with anti-TNFa blocking agents in daily clinical practice was different from what ...

  19. Daily energy expenditure, physical activity, and weight loss in Parkinson's disease patients

    Science.gov (United States)

    Patients with Parkinson's disease (PD) commonly exhibit weight loss (WL) which investigators attribute to various factors, including elevated energy expenditure. We tested the hypothesis that daily energy expenditure (DEE) and its components, resting energy expenditure (REE) and physical activity (P...

  20. Assessment of postoperative changes in antihypertensive drug consumption in patients with primary aldosteronism using the defined daily dose

    Directory of Open Access Journals (Sweden)

    Takanobu Utsumi

    2014-10-01

    Conclusion: The defined daily dose is a useful tool for assessing total changes in the consumption of antihypertensive drugs in patients with primary aldosteronism. Using the defined daily dose, clinicians could explain in detail to patients with primary aldosteronism the predicted postoperative change in antihypertensive drug consumption.

  1. Comparison of setup deviations for two thermoplastic immobilization masks in glottis cancer

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jae Hong [Dept. of Biomedical Engineering, College of Medicine, The Catholic University, Seoul (Korea, Republic of)

    2017-03-15

    The purpose of this study was compare to the patient setup deviation of two different type thermoplastic immobilization masks for glottis cancer in the intensity-modulated radiation therapy (IMRT). A total of 16 glottis cancer cases were divided into two groups based on applied mask type: standard or alternative group. The mean error (M), three-dimensional setup displacement error (3D-error), systematic error (Σ), random error (σ) were calculated for each group, and also analyzed setup margin (mm). The 3D-errors were 5.2 ± 1.3 mm and 5.9 ± 0.7 mm for the standard and alternative groups, respectively; the alternative group was 13.6% higher than the standard group. The systematic errors in the roll angle and the x, y, z directions were 0.8°, 1.7 mm, 1.0 mm, and 1.5 mm in the alternative group and 0.8°, 1.1 mm, 1.8 mm, and 2.0 mm in the alternative group. The random errors in the x, y, z directions were 10.9%, 1.7%, and 23.1% lower in the alternative group than in the standard group. However, absolute rotational angle (i.e., roll) in the alternative group was 12.4% higher than in the standard group. For calculated setup margin, the alternative group in x direction was 31.8% lower than in standard group. In contrast, the y and z direction were 52.6% and 21.6% higher than in the standard group. Although using a modified thermoplastic immobilization mask could be affect patient setup deviation in terms of numerical results, various point of view for an immobilization masks has need to research in terms of clinic issue.

  2. Prospective Trial of High-Dose Reirradiation Using Daily Image Guidance With Intensity-Modulated Radiotherapy for Recurrent and Second Primary Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Chen, Allen M.; Farwell, D. Gregory; Luu, Quang; Cheng, Suzan; Donald, Paul J.; Purdy, James A.

    2011-01-01

    Purpose: To report a single-institutional experience using intensity-modulated radiotherapy with daily image-guided radiotherapy for the reirradiation of recurrent and second cancers of the head and neck. Methods and Materials: Twenty-one consecutive patients were prospectively treated with intensity-modulated radiotherapy from February 2006 to March 2009 to a median dose of 66 Gy (range, 60-70 Gy). None of these patients received concurrent chemotherapy. Daily helical megavoltage CT scans were obtained before each fraction as part of an image-guided radiotherapy registration protocol for patient alignment. Results: The 1- and 2-year estimates of in-field control were 72% and 65%, respectively. A total of 651 daily megavoltage CT scans were obtained. The mean systematic shift to account for interfraction motion was 1.38 ± 1.25 mm, 1.79 ± 1.45 mm, and 1.98 ± 1.75 mm for the medial-lateral, superior-inferior, and anterior-posterior directions, respectively. Pretreatment shifts of >3 mm occurred in 19% of setups in the medial-lateral, 27% in the superior-inferior, and 33% in the anterior-posterior directions, respectively. There were no treatment-related fatalities or hospitalizations. Complications included skin desquamation, odynophagia, otitis externa, keratitis, naso-lacrimal duct stenosis, and brachial plexopathy. Conclusions: Intensity-modulated radiotherapy with daily image guidance results in effective disease control with relatively low morbidity and should be considered for selected patients with recurrent and second primary cancers of the head and neck.

  3. SU-F-T-642: Sub Millimeter Accurate Setup of More Than Three Vertebrae in Spinal SBRT with 6D Couch

    International Nuclear Information System (INIS)

    Wang, X; Zhao, Z; Yang, J; Yang, J; McAleer, M; Brown, P; Li, J; Ghia, A

    2016-01-01

    Purpose: To assess the initial setup accuracy in treating more than 3 vertebral body levels in spinal SBRT using a 6D couch. Methods: We retrospectively analyzed last 20 spinal SBRT patients (4 cervical, 9 thoracic, 7 lumbar/sacrum) treated in our clinic. These patients in customized immobilization device were treated in 1 or 3 fractions. Initial setup used ExacTrac and Brainlab 6D couch to align target within 1 mm and 1 degree, following by a cone beam CT (CBCT) for verification. Our current standard practice allows treating a maximum of three continuous vertebrae. Here we assess the possibility to achieve sub millimeter setup accuracy for more than three vertebrae by examining the residual error in every slice of CBCT. The CBCT had a range of 17.5 cm, which covered 5 to 9 continuous vertebrae depending on the patient and target location. In the study, CBCT from the 1st fraction treatment was rigidly registered with the planning CT in Pinnacle. The residual setup error of a vertebra was determined by expanding the vertebra contour on the planning CT to be large enough to enclose the corresponding vertebra on CBCT. The margin of the expansion was considered as setup error. Results: Out of the 20 patients analyzed, initial setup accuracy can be achieved within 1 mm for a span of 5 or more vertebrae starting from T2 vertebra to inferior vertebra levels. 2 cervical and 2 upper thoracic patients showed the cervical spine was difficult to achieve sub millimeter accuracy for multi levels without a customized immobilization headrest. Conclusion: If the curvature of spinal columns can be reproduced in customized immobilization device during treatment as simulation, multiple continuous vertebrae can be setup within 1 mm with the use of a 6D couch.

  4. SU-F-T-642: Sub Millimeter Accurate Setup of More Than Three Vertebrae in Spinal SBRT with 6D Couch

    Energy Technology Data Exchange (ETDEWEB)

    Wang, X; Zhao, Z; Yang, J; Yang, J; McAleer, M; Brown, P; Li, J; Ghia, A [MD Anderson Cancer Center, Houston, TX (United States)

    2016-06-15

    Purpose: To assess the initial setup accuracy in treating more than 3 vertebral body levels in spinal SBRT using a 6D couch. Methods: We retrospectively analyzed last 20 spinal SBRT patients (4 cervical, 9 thoracic, 7 lumbar/sacrum) treated in our clinic. These patients in customized immobilization device were treated in 1 or 3 fractions. Initial setup used ExacTrac and Brainlab 6D couch to align target within 1 mm and 1 degree, following by a cone beam CT (CBCT) for verification. Our current standard practice allows treating a maximum of three continuous vertebrae. Here we assess the possibility to achieve sub millimeter setup accuracy for more than three vertebrae by examining the residual error in every slice of CBCT. The CBCT had a range of 17.5 cm, which covered 5 to 9 continuous vertebrae depending on the patient and target location. In the study, CBCT from the 1st fraction treatment was rigidly registered with the planning CT in Pinnacle. The residual setup error of a vertebra was determined by expanding the vertebra contour on the planning CT to be large enough to enclose the corresponding vertebra on CBCT. The margin of the expansion was considered as setup error. Results: Out of the 20 patients analyzed, initial setup accuracy can be achieved within 1 mm for a span of 5 or more vertebrae starting from T2 vertebra to inferior vertebra levels. 2 cervical and 2 upper thoracic patients showed the cervical spine was difficult to achieve sub millimeter accuracy for multi levels without a customized immobilization headrest. Conclusion: If the curvature of spinal columns can be reproduced in customized immobilization device during treatment as simulation, multiple continuous vertebrae can be setup within 1 mm with the use of a 6D couch.

  5. Causes of decreased activity of daily life in elderly patients who need daily living care.

    Science.gov (United States)

    Yoshino, Hiroshi; Sakurai, Takashi; Hasegawa, Kazuo; Yokono, Koichi

    2011-07-01

    The causes of decreased activity of daily life (ADL) in elderly patients include cerebrovascular diseases, bone fracture by falls, and dementia. The present study was conducted among elderly patients with decreased ADL who were hospitalized in nursing wards in order to investigate the causes of becoming early bedridden and to determine precautionary measures against decreased ADL. The study subjects were 224 elderly patients with decreased ADL (mean age: 83.3 ± 8.0 years) and 49 outpatients without decreased ADL (mean age: 76.8 ± 5.3 years). Current age, age at the start of ADL decrease, medical history and history of smoking were investigated. In the groups with decreased ADL, current age and the age of becoming bedridden in non-diabetic versus diabetic groups were 84.7 ± 7.9 versus 80.3 ± 7.5 and 82.7 ± 8.3 versus 77.6 ± 8.0 years, respectively, both showing significantly lower values in the diabetic group (P bedridden. Diabetic patients with smoking habit were significantly younger than diabetic and non-diabetic patients without smoking habit. Sex difference, smoking habit and presence of diabetes mellitus are independent risk factors of becoming early bedridden. Therefore, the major targets of medical care among elderly should be diabetic men with a smoking habit to lower the risks of decreased ADL. © 2011 Japan Geriatrics Society.

  6. High-temperature metallography setup

    International Nuclear Information System (INIS)

    Blumenfeld, M.; Shmarjahu, D.; Elfassy, S.

    1979-06-01

    A high-temperature metallography setup is presented. In this setup the observation of processes such as that of copper recrystallization was made possible, and the structure of metals such as uranium could be revealed. A brief historical review of part of the research works that have been done with the help of high temperature metallographical observation technique since the beginning of this century is included. Detailed description of metallographical specimen preparation technique and theoretical criteria based on the rate of evaporation of materials present on the polished surface of the specimens are given

  7. Efficacy and Safety of Terbinafine 500 mg Once Daily in Patients with Dermatophytosis.

    Science.gov (United States)

    Babu, P Ravindra; Pravin, A J S; Deshmukh, Gaurav; Dhoot, Dhiraj; Samant, Aniket; Kotak, Bhavesh

    2017-01-01

    Dermatophytosis are the most common fungal infections globally. Terbinafine is considered to have good potency against dermatophytes, but resistance to terbinafine is on the rise. The objective of this study was to evaluate the efficacy and safety of terbinafine 500 mg given once daily in treatment of patients with superficial dermatophytosis. It was a retrospective questionnaire-based survey. Each doctor was given survey questionnaire booklet containing survey forms. Clinical response was graded according to the improvement in the affected lesion. Mycological cure was defined as negative microscopy under potassium hydroxide examination and a negative culture in Sabouraud's dextrose agar. Patients were divided into three groups depending on the duration of therapy, Group A - terbinafine 500 mg for 2 weeks, Group B - terbinafine 500 mg for 4 weeks, and Group C - terbinafine 500 mg for 6 weeks. Total 50 doctors completed the survey involving 440 patients. In Group A, out of 194 patients, 87% ( n = 169) patients showed very good response. In Group B, out of 211 patients, 92% ( n = 194) of the patients showed very good response with >75% improvement in their lesion. In Group C, out of 35 patients, 80% ( n = 30) patients showed very good response. Adverse drug reactions of mild to moderate intensity related to terbinafine were seen in 57 patients. Our survey indicates that terbinafine in a dose of 500 mg given once daily was efficacious and safe in the treatment of patients with dermatophytosis.

  8. Pulse versus daily oral Alfacalcidol treatment of secondary hyperparathyroidism in hemodialysis patients: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Sawalmeh O

    2018-01-01

    Full Text Available Osama Sawalmeh,1 Shaheed Moala,1 Zakaria Hamdan,2 Huda Masri,3 Khubaib Ayoub,4 Emad Khazneh,2 Mujahed Shraim5 1Medicine Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; 2Nephrology Department, 3Pharmacy Department, 4Internal Medicine Department, An-Najah National University Hospital, Nablus, Palestine; 5Public Health Department, College of Health Sciences, Qatar University, Doha, Qatar Background: Secondary hyperparathyroidism is a common complication of chronic kidney disease and is managed using vitamin D replacement therapy. Very few studies have examined the effectiveness of pulse alfacalcidol therapy in comparison to daily oral alfacalcidol therapy in suppressing serum parathyroid hormone (PTH levels in hemodialysis patients. The aim of this randomized controlled trial was to replicate the findings of prior studies comparing effectiveness of pulse oral alfacalcidol therapy versus daily oral alfacalcidol therapy in suppressing PTH after 13 weeks of therapy using a Palestinian sample of hemodialysis patients, and to identify demographic and biomedical characteristics of patients that are independently associated with PTH levels.Methods: One hundred and sixty-seven patients completed the study, 88 in the daily group and 79 in the pulse group. The pulse group had more clinically significant reduction in mean PTH level by 75 pg/dL at 13 weeks than the daily group, but this was not statistically significant.Results: The effect of alfacalcidol therapy on metabolism of phosphate and corrected calcium levels was comparable in both groups, and pulse therapy was not associated with increased risk of hypercalcemia and hyperphosphatemia. Serum PTH levels were independently and inversely associated with older age and diabetes.Conclusion: Switching daily alfacalcidol therapy to thrice-weekly alfacalcidol pulse therapy seems safe and convenient, especially for hemodialysis patients with poor compliance

  9. Comparison of setup accuracy between exactrac X-ray 6 dimensions and cone-beam computed tomography for intracranial and pelvic image-guided radiotherapy

    International Nuclear Information System (INIS)

    Kudo, Tsuyoshi; Ono, Kaoru; Furukawa, Kengo; Fujimoto, Sachie; Akagi, Yukio; Koyama, Tadashi; Hirokawa, Yutaka

    2012-01-01

    The aim of this study was to compare the setup difference measured with ExacTrac X-ray 6D (ETX6D) and cone-beam computed tomography (CBCT) for non-invasive fractionated radiotherapy. Setup data were collected on a Novalis Tx treatment unit for both a head phantom and patients with intracranial tumors and a pelvic phantom and patients with prostate cancer. Initially, setup was done for a phantom using ETX6D. Secondly, a treatment couch was shifted or rotated by each already known value. Thirdly, ETX6D and CBCT scans were obtained. Finally, setup difference was determined: the registrations of ETX6D images with the corresponding digitally reconstructed radiographs using ETX6D fusion, and registrations of CBCT images with the planning CT using online 6D fusion. The setup difference between ETX6D and CBCT was compared. The impact of shifts and rotations on the difference was evaluated. Patients' setup data was similarly analyzed. In phantom experiments, the root mean square (RMS) of difference of the shift and rotation was less than 0.45 mm for translations, and 0.17 degrees for rotations. In intracranial patients' data, the RMS of that was 0.55 mm and 0.44 degree, respectively. In prostate cancer patients' data, the RMS of that was 0.77 mm and 0.79 degree, respectively. In this study, we observed modest setup differences between ETX6D and CBCT. These differences were generally less than 1.00 mm for translations, and 1.00 degrees for rotations, respectively. (author)

  10. SU-E-J-16: Automatic Image Contrast Enhancement Based On Automatic Parameter Optimization for Radiation Therapy Setup Verification

    International Nuclear Information System (INIS)

    Qiu, J; Li, H. Harlod; Zhang, T; Yang, D; Ma, F

    2015-01-01

    Purpose: In RT patient setup 2D images, tissues often cannot be seen well due to the lack of image contrast. Contrast enhancement features provided by image reviewing software, e.g. Mosaiq and ARIA, require manual selection of the image processing filters and parameters thus inefficient and cannot be automated. In this work, we developed a novel method to automatically enhance the 2D RT image contrast to allow automatic verification of patient daily setups as a prerequisite step of automatic patient safety assurance. Methods: The new method is based on contrast limited adaptive histogram equalization (CLAHE) and high-pass filtering algorithms. The most important innovation is to automatically select the optimal parameters by optimizing the image contrast. The image processing procedure includes the following steps: 1) background and noise removal, 2) hi-pass filtering by subtracting the Gaussian smoothed Result, and 3) histogram equalization using CLAHE algorithm. Three parameters were determined through an iterative optimization which was based on the interior-point constrained optimization algorithm: the Gaussian smoothing weighting factor, the CLAHE algorithm block size and clip limiting parameters. The goal of the optimization is to maximize the entropy of the processed Result. Results: A total 42 RT images were processed. The results were visually evaluated by RT physicians and physicists. About 48% of the images processed by the new method were ranked as excellent. In comparison, only 29% and 18% of the images processed by the basic CLAHE algorithm and by the basic window level adjustment process, were ranked as excellent. Conclusion: This new image contrast enhancement method is robust and automatic, and is able to significantly outperform the basic CLAHE algorithm and the manual window-level adjustment process that are currently used in clinical 2D image review software tools

  11. SU-E-J-16: Automatic Image Contrast Enhancement Based On Automatic Parameter Optimization for Radiation Therapy Setup Verification

    Energy Technology Data Exchange (ETDEWEB)

    Qiu, J [Taishan Medical University, Taian, Shandong (China); Washington University in St Louis, St Louis, MO (United States); Li, H. Harlod; Zhang, T; Yang, D [Washington University in St Louis, St Louis, MO (United States); Ma, F [Taishan Medical University, Taian, Shandong (China)

    2015-06-15

    Purpose: In RT patient setup 2D images, tissues often cannot be seen well due to the lack of image contrast. Contrast enhancement features provided by image reviewing software, e.g. Mosaiq and ARIA, require manual selection of the image processing filters and parameters thus inefficient and cannot be automated. In this work, we developed a novel method to automatically enhance the 2D RT image contrast to allow automatic verification of patient daily setups as a prerequisite step of automatic patient safety assurance. Methods: The new method is based on contrast limited adaptive histogram equalization (CLAHE) and high-pass filtering algorithms. The most important innovation is to automatically select the optimal parameters by optimizing the image contrast. The image processing procedure includes the following steps: 1) background and noise removal, 2) hi-pass filtering by subtracting the Gaussian smoothed Result, and 3) histogram equalization using CLAHE algorithm. Three parameters were determined through an iterative optimization which was based on the interior-point constrained optimization algorithm: the Gaussian smoothing weighting factor, the CLAHE algorithm block size and clip limiting parameters. The goal of the optimization is to maximize the entropy of the processed Result. Results: A total 42 RT images were processed. The results were visually evaluated by RT physicians and physicists. About 48% of the images processed by the new method were ranked as excellent. In comparison, only 29% and 18% of the images processed by the basic CLAHE algorithm and by the basic window level adjustment process, were ranked as excellent. Conclusion: This new image contrast enhancement method is robust and automatic, and is able to significantly outperform the basic CLAHE algorithm and the manual window-level adjustment process that are currently used in clinical 2D image review software tools.

  12. The role of a prone setup in breast radiation therapy.

    Science.gov (United States)

    Huppert, Nelly; Jozsef, Gabor; Dewyngaert, Keith; Formenti, Silvia Chiara

    2011-01-01

    Most patients undergoing breast conservation therapy receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy and image-guided radiation therapy have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of patient setup. This review describes some of the available techniques for prone breast radiotherapy and the available experience in their application. The NYU prone breast radiotherapy approach is discussed, including a summary of the results from several prospective trials.

  13. The role of a prone setup in breast radiation therapy

    Directory of Open Access Journals (Sweden)

    Nelly eHuppert

    2011-10-01

    Full Text Available Most patients undergoing breast conservation therapy (BCT receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy (IMRT and image-guided radiation therapy (IGRT have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of patient setup. This review describes some of the available techniques for prone breast radiotherapy and the available experience in their application. The NYU prone breast radiotherapy approach is discussed, including a summary of the results from several prospective trials.

  14. The Role of a Prone Setup in Breast Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Huppert, Nelly; Jozsef, Gabor; DeWyngaert, Keith; Formenti, Silvia Chiara, E-mail: silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University School of Medicine, New York University Langone Medical Center, New York, NY (United States)

    2011-10-11

    Most patients undergoing breast conservation therapy receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy and image-guided radiation therapy have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of patient setup. This review describes some of the available techniques for prone breast radiotherapy and the available experience in their application. The NYU prone breast radiotherapy approach is discussed, including a summary of the results from several prospective trials.

  15. Adaptive Liver Stereotactic Body Radiation Therapy: Automated Daily Plan Reoptimization Prevents Dose Delivery Degradation Caused by Anatomy Deformations

    Energy Technology Data Exchange (ETDEWEB)

    Leinders, Suzanne M. [Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Delft University of Technology, Delft (Netherlands); Breedveld, Sebastiaan; Méndez Romero, Alejandra [Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Schaart, Dennis [Delft University of Technology, Delft (Netherlands); Seppenwoolde, Yvette, E-mail: y.seppenwoolde@erasmusmc.nl [Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Heijmen, Ben J.M. [Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

    2013-12-01

    Purpose: To investigate how dose distributions for liver stereotactic body radiation therapy (SBRT) can be improved by using automated, daily plan reoptimization to account for anatomy deformations, compared with setup corrections only. Methods and Materials: For 12 tumors, 3 strategies for dose delivery were simulated. In the first strategy, computed tomography scans made before each treatment fraction were used only for patient repositioning before dose delivery for correction of detected tumor setup errors. In adaptive second and third strategies, in addition to the isocenter shift, intensity modulated radiation therapy beam profiles were reoptimized or both intensity profiles and beam orientations were reoptimized, respectively. All optimizations were performed with a recently published algorithm for automated, multicriteria optimization of both beam profiles and beam angles. Results: In 6 of 12 cases, violations of organs at risk (ie, heart, stomach, kidney) constraints of 1 to 6 Gy in single fractions occurred in cases of tumor repositioning only. By using the adaptive strategies, these could be avoided (<1 Gy). For 1 case, this needed adaptation by slightly underdosing the planning target volume. For 2 cases with restricted tumor dose in the planning phase to avoid organ-at-risk constraint violations, fraction doses could be increased by 1 and 2 Gy because of more favorable anatomy. Daily reoptimization of both beam profiles and beam angles (third strategy) performed slightly better than reoptimization of profiles only, but the latter required only a few minutes of computation time, whereas full reoptimization took several hours. Conclusions: This simulation study demonstrated that replanning based on daily acquired computed tomography scans can improve liver stereotactic body radiation therapy dose delivery.

  16. A setup for active fault diagnosis

    DEFF Research Database (Denmark)

    Niemann, Hans Henrik

    2006-01-01

    A setup for active fault diagnosis (AFD) of parametric faults in dynamic systems is formulated in this paper. It is shown that it is possible to use the same setup for both open loop systems, closed loop systems based on a nominal feedback controller as well as for closed loop systems based...... on a reconfigured feedback controller. This will make the proposed AFD approach very useful in connection with fault tolerant control (FTC). The setup will make it possible to let the fault diagnosis part of the fault tolerant controller remain unchanged after a change in the feedback controller. The setup for AFD...... is based on the YJBK (after Youla, Jabr, Bongiorno and Kucera) parameterization of all stabilizing feedback controllers and the dual YJBK parameterization. It is shown that the AFD is based directly on the dual YJBK transfer function matrix. This matrix will be named the fault signature matrix when...

  17. High precision neutron interferometer setup S18b

    International Nuclear Information System (INIS)

    Hasegawa, Y.; Lemmel, H.

    2011-01-01

    The present setup at S18 is a multi purpose instrument. It is used for both interferometry and a Bonse-Hart camera for USANS (Ultra Small Angle Neutron Scattering) spectroscopy with wide range tunability of wavelength. Some recent measurements demand higher stability of the instrument, which made us to propose a new setup dedicated particularly for neutron interferometer experiments requiring high phase stability. To keep both options available, we suggest building the new setup in addition to the old one. By extending the space of the present setup by 1.5 m to the upstream, both setups can be accommodated side by side. (authors)

  18. Difficulties in daily life reported by patients with homonymous visual field defects

    NARCIS (Netherlands)

    Heutink, Jochem; de Haan, Gera; Melis-Dankers, Bart; Brouwer, Wiebo; Tucha, Oliver

    2015-01-01

    Background: Homonymous visual field defects (HVFDs) are a common consequence of posterior brain injury and may have a substantial influence on ADL and participation in society. In this study we analysed self-reported visionrelated difficulties in daily life in a group of patients with HVFDs.

  19. Digital setup for Doppler broadening spectroscopy

    International Nuclear Information System (INIS)

    Cizek, J; Vlcek, M; Prochazka, I

    2011-01-01

    New digital spectrometer for measurement of the Doppler shift of annihilation photons was developed and tested in this work. Digital spectrometer uses a fast 12-bit digitizer for direct sampling of signals from HPGe detectors. Analysis of sampled waveforms is performed off-line in software. Performance of the new digital setup was compared with its traditional analogue counterpart. Superior energy resolution was achieved in the digital setup. Moreover, the digital setup allows for a better control of the shape of detector signals. This enables to eliminate undesired signals damaged by pile-up effects or by ballistic deficit.

  20. Bright Light Delights: Effects of Daily Light Exposure on Emotions, Restactivity Cycles, Sleep and Melatonin Secretion in Severely Demented Patients.

    Science.gov (United States)

    Münch, Mirjam; Schmieder, Michael; Bieler, Katharina; Goldbach, Rolf; Fuhrmann, Timo; Zumstein, Naomi; Vonmoos, Petra; Scartezzini, Jean-Louis; Wirz-Justice, Anna; Cajochen, Christian

    2017-01-01

    We tested whether the effects of a dynamic lighting system are superior to conventional lighting on emotions, agitation behaviour, quality of life, melatonin secretion and circadian restactivity cycles in severely demented patients. As a comparison, an age matched control patient group was exposed to conventional lighting. For none of the output measures were significant differences between the two lighting conditions found during the 8 study weeks in fall/winter. Thus, we divided the patient cohort (n = 89) into two groups, solely based on the median of their daily individual light exposure. Patients with higher average daily light exposure (>417 lx) showed significantly longer emotional expressions of pleasure and alertness per daily observations than patients with lower daily light exposure. Moreover, they had a higher quality of life, spent less time in bed, went to bed later and initiated their sleep episodes later, even though the two groups did not differ with respect to age, severity of cognitive impairment and mobility. In general, men were more agitated, had shorter sleep with more wake episodes, had a lower circadian amplitude of relative rest-wake activity and interdaily circadian stability than women. In particular, lower daily light exposures significantly predicted lower circadian amplitudes of rest-activity cycles in men but not in women. This may indicate sex specific susceptibility to daily light exposures for rest-activity regulation in older demented patients. Our results provide evidence that a higher daily light exposure has beneficial effects on emotions and thus improved quality of life in a severely demented patient group. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  1. Efficacy and tolerability of rasagiline in daily clinical use--a post-marketing observational study in patients with Parkinson's disease.

    Science.gov (United States)

    Reichmann, H; Jost, W H

    2010-09-01

    The MAO-B inhibitor rasagiline is indicated for the treatment of idiopathic Parkinson's disease (PD), and its use is supported by evidence from large-scale, controlled clinical studies. The post-marketing observational study presented here investigated the efficacy and tolerability of rasagiline treatment (monotherapy or combination therapy) in daily clinical practice. The study included patients with idiopathic PD who received rasagiline (recommended dose 1 mg, once daily) as monotherapy or combination therapy. The treatment and observation period was approximately 4 months. Outcome measures included the change from baseline in the Columbia University Rating Scale (CURS), the Unified PD Rating Scale fluctuation subscale, daily OFF time (patient home diaries) and the PD Questionnaire-39. Adverse drug reactions/adverse events (ADRs/AEs) and the physician's global judgement of tolerability and efficacy were also examined. Overall, 754 patients received rasagiline during the study. Patients treated with rasagiline (monotherapy or combination therapy) showed significant improvements from baseline in symptom severity (including classical motor and non-classical motor/non-motor symptoms) and quality of life (QoL). Patients receiving combination therapy also experienced significant reductions in daily OFF time. Tolerability was rated as good/very good in over 90% of patients. In daily clinical practice, monotherapy or combination therapy with rasagiline is able to improve PD symptoms, reduce OFF time, and improve QoL, whilst demonstrating favourable tolerability. In addition, rasagiline has a simple dosing schedule of one tablet, once daily, with no titration. These results are consistent with the pivotal rasagiline clinical studies (TEMPO, LARGO and PRESTO).

  2. Efficacy and safety of terbinafine 500 mg once daily in patients with dermatophytosis

    Directory of Open Access Journals (Sweden)

    P Ravindra Babu

    2017-01-01

    Full Text Available Introduction: Dermatophytosis are the most common fungal infections globally. Terbinafine is considered to have good potency against dermatophytes, but resistance to terbinafine is on the rise. Objective: The objective of this study was to evaluate the efficacy and safety of terbinafine 500 mg given once daily in treatment of patients with superficial dermatophytosis. Materials and Methods: It was a retrospective questionnaire-based survey. Each doctor was given survey questionnaire booklet containing survey forms. Clinical response was graded according to the improvement in the affected lesion. Mycological cure was defined as negative microscopy under potassium hydroxide examination and a negative culture in Sabouraud's dextrose agar. Patients were divided into three groups depending on the duration of therapy, Group A – terbinafine 500 mg for 2 weeks, Group B – terbinafine 500 mg for 4 weeks, and Group C – terbinafine 500 mg for 6 weeks. Results: Total 50 doctors completed the survey involving 440 patients. In Group A, out of 194 patients, 87% (n = 169 patients showed very good response. In Group B, out of 211 patients, 92% (n = 194 of the patients showed very good response with >75% improvement in their lesion. In Group C, out of 35 patients, 80% (n = 30 patients showed very good response. Adverse drug reactions of mild to moderate intensity related to terbinafine were seen in 57 patients. Conclusion: Our survey indicates that terbinafine in a dose of 500 mg given once daily was efficacious and safe in the treatment of patients with dermatophytosis.

  3. Criteria of medical care evaluation in daily in-patient department in pediatrics

    Directory of Open Access Journals (Sweden)

    Grozdova T.U.

    2011-06-01

    Full Text Available The research goal is to work out criteria for the evaluation of medical care quality. Materials included 386 medical cards of daily in-patients, 216 medical cards of in-patients; 602 cards of analysis of case histories; 4 computer data bases. Methods of mathematical statistics were successfully used in the study. The comparative method of data analysis was applied to the research work. Intensity of medical care in values from 0,1 to 0,5 conditional units corresponded to requirements of criterion of estimation of medical care quality. Parameters of medicinal treatment were close to the standards of treatment in interval from 44,4 to 100%, as criterion of quality of medical care. Specific weight of apparatus and instrumental researches constituted an interval from 7, 4% to 22, 6%, forming corresponding criterion. Interval of effectiveness according to standards of consultations is from 0, 26 to 1, 04 conditional units. In conclusion the article stated that the characteristics for criteria to evaluate medical care in daily in-patient departments were worked out on the basis of indices obtained during the research work

  4. Comparison of once-daily versus twice-daily dosing of valsartan in patients with chronic stable heart failure

    Directory of Open Access Journals (Sweden)

    Inder S Anand

    2010-06-01

    Full Text Available Inder S Anand1, Anita Deswal2, Dean J Kereiakes3, Das Purkayastha4, Dion H Zappe41Veterans Administration Medical Center, Minneapolis, MN, USA; 2Michael E DeBakey VA Medical Center, Houston, TX, USA; 3The Christ Hospital Heart and Vascular Center, Cincinnati, OH, USA; 4Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; Clinical trial registration information: www.clinicaltrials.gov/ct2/show/NC T00294086 Unique identification number: NC T00294086Background: The safety of once-daily (qd dosing of valsartan in heart failure (HF patients is not known. Hypothesis: This 10-week, double-blind trial examined the relative safety and efficacy of valsartan administered qd versus twice-daily (bid.Methods: HF patients (NYHA class II–III receiving diuretics (87%, angiotensin-converting enzyme inhibitors (98%, beta-blockers (92%, aldosterone antagonists (25%, or digoxin (32% were randomized to valsartan 40 mg bid (n = 60 or 80 mg qd (n = 55 and titrated to a maximum dose of 320 mg/day; doubling the dose every 2 weeks. Clinical and biochemical parameters were measured at Weeks 2, 4, 6, and 10.Results: The average dose of valsartan at the end of study was 245 mg in the bid group vs 256 mg in the qd group (P = NS. Similar proportions of patients tolerated qd vs bid dosing (bid 67% vs qd 68%. Outcome measures including reduction in blood pressure, incidence of hypotension, renal impairment, orthostatic dizziness or fatigue, changes in serum K+, creatinine, cystatin-C, and estimated glomerular filtration rate were similar between the 2 groups at all time-points. Brain natriuretic peptide levels decreased and plasma renin activity increased from baseline by the same amount in both groups at all time-points.Conclusion: Valsartan administered qd has a similar safety and tolerability profile with comparable 24-hour RAAS blockade, as assessed by increases in PRA, as bid dosing in patients with moderate to severe (NYHA class II–III heart failure

  5. Influence of random setup error on dose distribution

    International Nuclear Information System (INIS)

    Zhai Zhenyu

    2008-01-01

    Objective: To investigate the influence of random setup error on dose distribution in radiotherapy and determine the margin from ITV to PTV. Methods: A random sample approach was used to simulate the fields position in target coordinate system. Cumulative effect of random setup error was the sum of dose distributions of all individual treatment fractions. Study of 100 cumulative effects might get shift sizes of 90% dose point position. Margins from ITV to PTV caused by random setup error were chosen by 95% probability. Spearman's correlation was used to analyze the influence of each factor. Results: The average shift sizes of 90% dose point position was 0.62, 1.84, 3.13, 4.78, 6.34 and 8.03 mm if random setup error was 1,2,3,4,5 and 6 mm,respectively. Univariate analysis showed the size of margin was associated only by the size of random setup error. Conclusions: Margin of ITV to PTV is 1.2 times random setup error for head-and-neck cancer and 1.5 times for thoracic and abdominal cancer. Field size, energy and target depth, unlike random setup error, have no relation with the size of the margin. (authors)

  6. Inventory control with multiple setup costs

    NARCIS (Netherlands)

    Alp, O.; Huh, W.T.; Tan, T.

    2014-01-01

    We consider an infinite-horizon, periodic-review, single-item production/inventory system with random demand and backordering, where multiple setups are allowed in any period and a separate fixed cost is associated for each setup. Contrary to the majority of the literature on this topic, we do not

  7. An analysis of anatomic landmark mobility and setup errors in radiotherapy for lung cancer

    International Nuclear Information System (INIS)

    Samson, M.J.; Soernsen de Koste, J.R. van; Boer, J.C.J. de; Tankink, J.J.; Verstraate, M.B.J.; Essers, M.; Visser, A.G.; Senan, S.

    1997-01-01

    Purpose: To identify visible structures in the thorax which exhibit little internal motion during irradiation and, to determine random and systematic setup deviations in lung cancer patients with the use of these structures. Methods: Ten patients with lung cancer were set up in the supine position, and aligned using lasers. No immobilization devices were used. With an electronic portal imaging device (Siemens Beam View PLUS ), 12 sequential images (exposure 0.54 sec.; processing time 1.5 sec.) were obtained during a single fraction of radiotherapy. These 'movie loops' were generated for the A-P fields during each of 3-5 fractions. In order to determine the mobility of internal structures during each fraction, visible structures such as the trachea, carina, the upper chest wall, aortic arch, clavicle and paraspinal line were contoured manually in each image and matched with the first image of the corresponding movie loop by means of a cross-correlation algorithm. Translations in the cranial and lateral directions and in-plane rotations were determined for each structure separately. As the reference image represents a random position, relative movements were determined by comparing the translations and rotation for every image to the calculated means per movie-loop. Standard deviations of the relative movements were determined for each structure and each patient. Patient setup was evaluated for 15 patients with lung cancer. Setup was not corrected at any time during the treatment. The electronic portal images of each fraction were matched with the digitized simulator films by using a combination of the structures which had been determined to be relatively stable in the infra-fractional analysis. Results: In the infra-fractional analysis 120 to 380 matches were made per structure (a total of 1400). The standard deviation (SD) of translations in the lateral direction was small (≤1 mm) for the trachea, thoracic wall, paraspinal line and aortic arch. This was also the

  8. Design and development of multiple sample counting setup

    International Nuclear Information System (INIS)

    Rath, D.P.; Murali, S.; Babu, D.A.R.

    2010-01-01

    Full text: The analysis of active samples on regular basis for ambient air activity and floor contamination from radio chemical lab accounts for major chunk of the operational activity in Health Physicist's responsibility. The requirement for daily air sample analysis on immediate counting and delayed counting from various labs in addition to samples of smear swipe check of lab led to the urge for development of system that could cater multiple sample analysis in a time programmed manner on a single sample loading. A multiple alpha/beta counting system for counting was designed and fabricated. It has arrangements for loading 10 samples in slots in order, get counted in a time programmed manner with results displayed and records maintained in PC. The paper describes the design and development of multiple sample counting setup presently in use at the facility has resulted in reduction of man-hour consumption in counting and recording of the results

  9. Split scheduling with uniform setup times.

    NARCIS (Netherlands)

    F. Schalekamp; R.A. Sitters (René); S.L. van der Ster; L. Stougie (Leen); V. Verdugo; A. van Zuylen

    2015-01-01

    htmlabstractWe study a scheduling problem in which jobs may be split into parts, where the parts of a split job may be processed simultaneously on more than one machine. Each part of a job requires a setup time, however, on the machine where the job part is processed. During setup, a

  10. Split Scheduling with Uniform Setup Times

    NARCIS (Netherlands)

    Schalekamp, F.; Sitters, R.A.; van der Ster, S.L.; Stougie, L.; Verdugo, V.; van Zuylen, A.

    2015-01-01

    We study a scheduling problem in which jobs may be split into parts, where the parts of a split job may be processed simultaneously on more than one machine. Each part of a job requires a setup time, however, on the machine where the job part is processed. During setup, a machine cannot process or

  11. SU-F-J-218: Predicting Radiation-Induced Xerostomia by Dosimetrically Accounting for Daily Setup Uncertainty During Head and Neck IMRT

    International Nuclear Information System (INIS)

    Park, S; Quon, H; McNutt, T; Lee, J; Plishker, W; Shekhar, R

    2016-01-01

    Purpose: To determine if the accumulated parotid dosimetry using planning CT to daily CBCT deformation and dose re-calculation can predict for radiation-induced xerostomia. Methods: To track and dosimetrically account for the effects of anatomical changes on the parotid glands, we propagated physicians’ contours from planning CT to daily CBCT using a deformable registration with iterative CBCT intensity correction. A surface mesh for each OAR was created with the deformation applied to the mesh to obtain the deformed parotid volumes. Daily dose was computed on the deformed CT and accumulated to the last fraction. For both the accumulated and the planned parotid dosimetry, we tested the prediction power of different dosimetric parameters including D90, D50, D10, mean, standard deviation, min/max dose to the combined parotids and patient age to severe xerostomia (NCI-CTCAE grade≥2 at 6 mo follow-up). We also tested the dosimetry to parotid sub-volumes. Three classification algorithms, random tree, support vector machine, and logistic regression were tested to predict severe xerostomia using a leave-one-out validation approach. Results: We tested our prediction model on 35 HN IMRT cases. Parameters from the accumulated dosimetry model demonstrated an 89% accuracy for predicting severe xerostomia. Compared to the planning dosimetry, the accumulated dose consistently demonstrated higher prediction power with all three classification algorithms, including 11%, 5% and 30% higher accuracy, sensitivity and specificity, respectively. Geometric division of the combined parotid glands into superior-inferior regions demonstrated ∼5% increased accuracy than the whole volume. The most influential ranked features include age, mean accumulated dose of the submandibular glands and the accumulated D90 of the superior parotid glands. Conclusion: We demonstrated that the accumulated parotid dosimetry using CT-CBCT registration and dose re-calculation more accurately predicts for

  12. SU-F-J-218: Predicting Radiation-Induced Xerostomia by Dosimetrically Accounting for Daily Setup Uncertainty During Head and Neck IMRT

    Energy Technology Data Exchange (ETDEWEB)

    Park, S; Quon, H; McNutt, T; Lee, J [Johns Hopkins University, Baltimor, MD (United States); Plishker, W [IGI Technologies, Inc., College Park, MD (United States); Shekhar, R [IGI Technologies, Inc., College Park, MD (United States); Children’s National Medical Center, Washington, DC (United States)

    2016-06-15

    Purpose: To determine if the accumulated parotid dosimetry using planning CT to daily CBCT deformation and dose re-calculation can predict for radiation-induced xerostomia. Methods: To track and dosimetrically account for the effects of anatomical changes on the parotid glands, we propagated physicians’ contours from planning CT to daily CBCT using a deformable registration with iterative CBCT intensity correction. A surface mesh for each OAR was created with the deformation applied to the mesh to obtain the deformed parotid volumes. Daily dose was computed on the deformed CT and accumulated to the last fraction. For both the accumulated and the planned parotid dosimetry, we tested the prediction power of different dosimetric parameters including D90, D50, D10, mean, standard deviation, min/max dose to the combined parotids and patient age to severe xerostomia (NCI-CTCAE grade≥2 at 6 mo follow-up). We also tested the dosimetry to parotid sub-volumes. Three classification algorithms, random tree, support vector machine, and logistic regression were tested to predict severe xerostomia using a leave-one-out validation approach. Results: We tested our prediction model on 35 HN IMRT cases. Parameters from the accumulated dosimetry model demonstrated an 89% accuracy for predicting severe xerostomia. Compared to the planning dosimetry, the accumulated dose consistently demonstrated higher prediction power with all three classification algorithms, including 11%, 5% and 30% higher accuracy, sensitivity and specificity, respectively. Geometric division of the combined parotid glands into superior-inferior regions demonstrated ∼5% increased accuracy than the whole volume. The most influential ranked features include age, mean accumulated dose of the submandibular glands and the accumulated D90 of the superior parotid glands. Conclusion: We demonstrated that the accumulated parotid dosimetry using CT-CBCT registration and dose re-calculation more accurately predicts for

  13. An adaptive control algorithm for optimization of intensity modulated radiotherapy considering uncertainties in beam profiles, patient set-up and internal organ motion

    International Nuclear Information System (INIS)

    Loef, Johan; Lind, Bengt K.; Brahme, Anders

    1998-01-01

    A new general beam optimization algorithm for inverse treatment planning is presented. It utilizes a new formulation of the probability to achieve complication-free tumour control. The new formulation explicitly describes the dependence of the treatment outcome on the incident fluence distribution, the patient geometry, the radiobiological properties of the patient and the fractionation schedule. In order to account for both measured and non-measured positioning uncertainties, the algorithm is based on a combination of dynamic and stochastic optimization techniques. Because of the difficulty in measuring all aspects of the intra- and interfractional variations in the patient geometry, such as internal organ displacements and deformations, these uncertainties are primarily accounted for in the treatment planning process by intensity modulation using stochastic optimization. The information about the deviations from the nominal fluence profiles and the nominal position of the patient relative to the beam that is obtained by portal imaging during treatment delivery, is used in a feedback loop to automatically adjust the profiles and the location of the patient for all subsequent treatments. Based on the treatment delivered in previous fractions, the algorithm furnishes optimal corrections for the remaining dose delivery both with regard to the fluence profile and its position relative to the patient. By dynamically refining the beam configuration from fraction to fraction, the algorithm generates an optimal sequence of treatments that very effectively reduces the influence of systematic and random set-up uncertainties to minimize and almost eliminate their overall effect on the treatment. Computer simulations have shown that the present algorithm leads to a significant increase in the probability of uncomplicated tumour control compared with the simple classical approach of adding fixed set-up margins to the internal target volume. (author)

  14. The daily life of informal caregivers of patients undergoing chemotherapy

    Directory of Open Access Journals (Sweden)

    Mariana Ortelani de Toledo

    2013-04-01

    Full Text Available This paper aims to discuss the daily life of Informal Caregivers (ICG of cancer patients assisted in an outpatient chemotherapy unit of a university hospital in Campinas, São Paulo state. This study is part of a broader investigation. It was approved by a Research Ethics Committee under protocol n. 0288/10, and all ethical principles were adopted in accordance with the recommendations of Resolution 196/96. It is a descriptive, quantitative and qualitative study with literature and field research. Semi-structured interviews were conducted with 14 ICGs for data collection. The data were analyzed based on the goals of the study and the theory and practice pertaining to the Theory of Social Representation. The results showed that (92.8% of the ICGs are female (57.1%, married, between 41 and 60 years old (78.5%, living in the same household of the sickened family members at the following degrees of relatedness: (35.7% mother-daughter, followed by (21.4% husband-wife. In the Informal Caregivers’ perception, their role interfered with their daily activities, bringing restrictions to leisure activities, self-care and work. The study expanded the understanding of the impacts that the function of caring brings to their everyday activities, helping to foster discussions about the need to implement actions and interventions of occupational therapy strategies that facilitate the daily lives of ICGs.

  15. V-Go Insulin Delivery System Versus Multiple Daily Insulin Injections for Patients With Uncontrolled Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Winter, Abigail; Lintner, Michaela; Knezevich, Emily

    2015-04-21

    Type 2 diabetes mellitus affects over 29.1 million Americans, diagnosed and undiagnosed. Achieving and maintaining glycemic control for these patients is of extreme importance when working to prevent complications and improve quality of life for patients. The V-Go is a newly developed insulin delivery system. The push of a button inserts a needle into the patient once daily and remains attached for 24 hours. The V-Go is designed to release a set basal rate throughout the day, while allowing patients to provide up to 36 units of on-demand bolus insulin with the manual click of 2 buttons. It is a spring-loaded device filled daily with rapid-acting insulin that runs without the use of batteries or computer software. The main objective of this prospective active comparator study was to observe the A1C lowering effects of multiple daily insulin injections (MDII) versus the use of the V-Go insulin delivery system for patients with uncontrolled type 2 diabetes mellitus over a 3-month period. In addition, the effect on insulin requirement for these patients was assessed with secondary comparisons of weight, blood pressure, prevalence of hypoglycemic events, and quality of life before and after 3 months of intensified insulin therapy with regular monitoring by a clinical pharmacist at an internal medicine clinic. The average A1C lowering experienced by the 3 patients in the V-Go group was 1.5%, while the average A1C change in the 3 patients in the MDII group was an increase of 0.2%. All patients in the V-Go group experienced a decrease in insulin total daily dose (TDD), with an average decrease of 26.3 units. All patients in the MDII group experienced an increase in insulin TDD with an average of 15 units daily to achieve therapeutic goals individualized for each patient. All patients who underwent intensification of insulin therapy experienced an increase in subjective quality of life (QOL) as determined using the Diabetes-39 (D-39) questionnaire, though QOL results lacked

  16. Assessment of a daily online implanted fiducial marker-guided prostate radiotherapy process.

    Science.gov (United States)

    Greer, P B; Dahl, K; Ebert, M A; White, M; Wratten, C; Ostwald, P; Pichler, P; Denham, J W

    2008-10-01

    The aims of this study were to investigate whether intrafraction prostate motion can affect the accuracy of online prostate positioning using implanted fiducial markers and to determine the effect of prostate rotations on the accuracy of the software-predicted set-up correction shifts. Eleven patients were treated with implanted prostate fiducial markers and online set-up corrections. Orthogonal electronic portal images were acquired to determine couch shifts before treatment. Verification images were also acquired during treatment to assess whether intrafraction motion had occurred. A limitation of the online image registration software is that it does not allow for in-plane prostate rotations (evident on lateral portal images) when aligning marker positions. The accuracy of couch shifts was assessed by repeating the registration measurements with separate software that incorporates full in-plane prostate rotations. Additional treatment time required for online positioning was also measured. For the patient group, the overall postalignment systematic prostate errors were less than 1.5 mm (1 standard deviation) in all directions (range 0.2-3.9 mm). The random prostate errors ranged from 0.8 to 3.3 mm (1 standard deviation). One patient exhibited intrafraction prostate motion, resulting in a postalignment prostate set-up error of more than 10 mm for one fraction. In 14 of 35 fractions, the postalignment prostate set-up error was greater than 5 mm in the anterior-posterior direction for this patient. Maximum prostate rotations measured from the lateral images varied from 2 degrees to 20 degrees for the patients. The differences between set-up shifts determined by the online software without in-plane rotations to align markers, and with rotations applied, was less than 1 mm (root mean square), with a maximum difference of 4.1 mm. Intrafraction prostate motion was found to reduce the effectiveness of the online set-up for one of the patients. A larger study is required

  17. A simple experimental setup for magneto-dielectric measurements

    Energy Technology Data Exchange (ETDEWEB)

    Manimuthu, P.; Shanker, N. Praveen; Kumar, K. Saravana; Venkateswaran, C., E-mail: cvunom@hotmail.com

    2014-09-01

    The increasing demand for the multiferroic materials calls for the need of an experimental setup that will facilitate magneto-dielectric coupling measurements. A connector setup designed makes it possible to measure and analyze the dielectric properties of the material under the influence of a magnetic field. The salient feature of this setup is in its incorporation with the already existing experimental facilities.

  18. A simple experimental setup for magneto-dielectric measurements

    International Nuclear Information System (INIS)

    Manimuthu, P.; Shanker, N. Praveen; Kumar, K. Saravana; Venkateswaran, C.

    2014-01-01

    The increasing demand for the multiferroic materials calls for the need of an experimental setup that will facilitate magneto-dielectric coupling measurements. A connector setup designed makes it possible to measure and analyze the dielectric properties of the material under the influence of a magnetic field. The salient feature of this setup is in its incorporation with the already existing experimental facilities

  19. Continuous infusion versus daily injections of growth hormone (GH) for 4 weeks in GH-deficient patients

    DEFF Research Database (Denmark)

    Laursen, Torben; Jørgensen, Jens Otto Lunde; Jakobsen, Grethe

    1995-01-01

    effects with constant and pulsatile GH delivery. This study was carried out to compare the metabolic effects of longer term continuous infusion vs. daily injections of GH. Thirteen GH-deficient patients were studied in a cross-over design. The patients were randomized to receive GH as a continuous sc...... infusion by means of a portable pump for 1 month and as daily sc injections (at 1900 h) for another month. An average daily GH dosage (+/- SEM) of 3.15 +/- 0.27 IU was administered during both periods. Steady state 24-h profiles of GH, IGF-I, IGF-binding proteins (IGFBPs), insulin, glucose, lipid.......35 (infusion); P infusion induced higher nighttime than daytime GH levels (P = 0.01), indicating a diurnal variation in the absorption or clearance of GH. Serum IGF-I levels (micrograms per L) were slightly higher (P infusion [312...

  20. On-Line Use of Three-Dimensional Marker Trajectory Estimation From Cone-Beam Computed Tomography Projections for Precise Setup in Radiotherapy for Targets With Respiratory Motion

    International Nuclear Information System (INIS)

    Worm, Esben S.; Høyer, Morten; Fledelius, Walther; Nielsen, Jens E.; Larsen, Lars P.; Poulsen, Per R.

    2012-01-01

    Purpose: To develop and evaluate accurate and objective on-line patient setup based on a novel semiautomatic technique in which three-dimensional marker trajectories were estimated from two-dimensional cone-beam computed tomography (CBCT) projections. Methods and Materials: Seven treatment courses of stereotactic body radiotherapy for liver tumors were delivered in 21 fractions in total to 6 patients by a linear accelerator. Each patient had two to three gold markers implanted close to the tumors. Before treatment, a CBCT scan with approximately 675 two-dimensional projections was acquired during a full gantry rotation. The marker positions were segmented in each projection. From this, the three-dimensional marker trajectories were estimated using a probability based method. The required couch shifts for patient setup were calculated from the mean marker positions along the trajectories. A motion phantom moving with known tumor trajectories was used to examine the accuracy of the method. Trajectory-based setup was retrospectively used off-line for the first five treatment courses (15 fractions) and on-line for the last two treatment courses (6 fractions). Automatic marker segmentation was compared with manual segmentation. The trajectory-based setup was compared with setup based on conventional CBCT guidance on the markers (first 15 fractions). Results: Phantom measurements showed that trajectory-based estimation of the mean marker position was accurate within 0.3 mm. The on-line trajectory-based patient setup was performed within approximately 5 minutes. The automatic marker segmentation agreed with manual segmentation within 0.36 ± 0.50 pixels (mean ± SD; pixel size, 0.26 mm in isocenter). The accuracy of conventional volumetric CBCT guidance was compromised by motion smearing (≤21 mm) that induced an absolute three-dimensional setup error of 1.6 ± 0.9 mm (maximum, 3.2) relative to trajectory-based setup. Conclusions: The first on-line clinical use of

  1. Prediction of motor outcomes and activities of daily living function using diffusion tensor tractography in acute hemiparetic stroke patients.

    Science.gov (United States)

    Imura, Takeshi; Nagasawa, Yuki; Inagawa, Tetsuji; Imada, Naoki; Izumi, Hiroaki; Emoto, Katsuya; Tani, Itaru; Yamasaki, Hiroyuki; Ota, Yuichiro; Oki, Shuichi; Maeda, Tadanori; Araki, Osamu

    2015-05-01

    [Purpose] The efficacy of diffusion tensor imaging in the prediction of motor outcomes and activities of daily living function remains unclear. We evaluated the most appropriate diffusion tensor parameters and methodology to determine whether the region of interest- or tractography-based method was more useful for predicting motor outcomes and activities of daily living function in stroke patients. [Subjects and Methods] Diffusion tensor imaging data within 10 days after stroke onset were collected and analyzed for 25 patients. The corticospinal tract was analyzed. Fractional anisotropy, number of fibers, and apparent diffusion coefficient were used as diffusion tensor parameters. Motor outcomes and activities of daily living function were evaluated on the same day as diffusion tensor imaging and at 1 month post-onset. [Results] The fractional anisotropy value of the affected corticospinal tract significantly correlated with the motor outcome and activities of daily living function within 10 days post-onset and at 1 month post-onset. Tthere were no significant correlations between other diffusion tensor parameters and motor outcomes or activities of daily living function. [Conclusion] The fractional anisotropy value of the affected corticospinal tract obtained using the tractography-based method was useful for predicting motor outcomes and activities of daily living function in stroke patients.

  2. Treatment of streptococcal pharyngitis with once-daily compared with twice-daily amoxicillin: a noninferiority trial.

    Science.gov (United States)

    Clegg, Herbert W; Ryan, Amy G; Dallas, Steven D; Kaplan, Edward L; Johnson, Dwight R; Norton, H James; Roddey, Oliver F; Martin, Edward S; Swetenburg, Raymond L; Koonce, Elizabeth W; Felkner, Mary M; Giftos, P Michael

    2006-09-01

    Two relatively small previous studies comparing once-daily amoxicillin with conventional therapy for group A streptococcal (GAS) pharyngitis reported similar rates of bacteriologic success for each treatment group. The purpose of this study was to further evaluate once-daily amoxicillin for GAS pharyngitis in a larger study. In a single pediatric practice, from October through May for 2 consecutive years (2001-2003), we recruited children 3 to 18 years of age who had symptoms and signs suggestive of GAS pharyngitis. Patients with a positive rapid test for GAS were stratified by weight (or=40 kg) and then randomly assigned to receive once-daily (750 mg or 1000 mg) or twice-daily (2 doses of 375 mg or 500 mg) amoxicillin for 10 days. We determined bacteriologic failure rates for GAS in the pharynx from subsequent swabs taken at 14 to 21 (visit 2) and 28 to 35 (visit 3) days after treatment initiation. We conducted a randomized, controlled, investigator-blinded, noninferiority trial to evaluate whether amoxicillin given once daily would have a bacteriologic failure rate no worse than that of amoxicillin given twice daily within a prespecified margin of 10%. GAS isolates were characterized to distinguish bacteriologic failures from new acquisitions. Adverse events were described and adherence was evaluated by review of returned daily logs and dosage bottles. Of 2139 potential study patients during the 2-year period, we enrolled 652 patients, 326 into each treatment group. Children in the 2 groups were comparable with respect to all demographic and clinical characteristics except that children <40 kg more often presented with rash in each treatment group. At visit 2, failure rates were 20.1% (59 of 294) for the once-daily group and 15.5% (46 of 296) for the twice-daily group (difference, 4.53%; 90% confidence interval [CI], -0.6 to 9.7). At visit 3, failure rates were 2.8% (6 of 216) for the once-daily group and 7.1% (16 of 225) for the twice-daily group (difference, -4

  3. Setup accuracy of stereoscopic X-ray positioning with automated correction for rotational errors in patients treated with conformal arc radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Soete, Guy; Verellen, Dirk; Tournel, Koen; Storme, Guy

    2006-01-01

    We evaluated setup accuracy of NovalisBody stereoscopic X-ray positioning with automated correction for rotational errors with the Robotics Tilt Module in patients treated with conformal arc radiotherapy for prostate cancer. The correction of rotational errors was shown to reduce random and systematic errors in all directions. (NovalisBody TM and Robotics Tilt Module TM are products of BrainLAB A.G., Heimstetten, Germany)

  4. Set-up errors in patients undergoing image guided radiation treatment. Relationship to body mass index and weight loss

    DEFF Research Database (Denmark)

    Johansen, Jørgen; Bertelsen, Anders; Hansen, Christian Rønn

    2008-01-01

    by the relative weight change over time. Results: The SD of the translational and rotational random set-up errors during the first three sessions for H&N were 0.9 mm (Left-Right), 1.1mm (Anterior-Posterior), 0.7 mm (Cranio-Caudal) and 0.7 degrees (LR-axis), 0.5 degrees (AP-axis), and 0.7 degrees (CC......-axis). The equivalent data for lung cancer patients were 1.1 mm (LR), 1.1mm (AP), 1.5 mm (CC) and 0.5 degrees (LR-axis), 0.6 degrees (AP-axis), and 0.4 degrees (CC-axis). The median BMI for H&N and lung was 25.8 (17.6-39.7) and 23.7 (17.4-38.8), respectively. The median weekly weight change for H&N was -0.3% (-2.0 to 1...... (H&N) and 20 lung cancer patients were investigated. Patients were positioned using customized immobilization devices consisting of vacuum cushions and thermoplastic shells. Treatment was given on an Elekta Synergy accelerator. Cone-beam acquisitions were obtained according to a standardized Action...

  5. Evaluation of image-guidance protocols in the treatment of head and neck cancers

    International Nuclear Information System (INIS)

    Zeidan, Omar A.; Langen, Katja M.; Meeks, Sanford L.; Manon, Rafael R.; Wagner, Thomas H.; Willoughby, Twyla R.; Jenkins, D. Wayne; Kupelian, Patrick A.

    2007-01-01

    Purpose: The aim of this study was to assess the residual setup error of different image-guidance (IG) protocols in the alignment of patients with head and neck cancer. The protocols differ in the percentage of treatment fractions that are associated with image guidance. Using data from patients who were treated with daily IG, the residual setup errors for several different protocols are retrospectively calculated. Methods and Materials: Alignment data from 24 patients (802 fractions) treated with daily IG on a helical tomotherapy unit were analyzed. The difference between the daily setup correction and the setup correction that would have been made according to a specific protocol was used to calculate the residual setup errors for each protocol. Results: The different protocols are generally effective in reducing systematic setup errors. Random setup errors are generally not reduced for fractions that are not image guided. As a consequence, if every other treatment is image guided, still about 11% of all treatments (IG and not IG) are subject to three-dimensional setup errors of at least 5 mm. This frequency increases to about 29% if setup errors >3 mm are scored. For various protocols that require 15% to 31% of the treatments to be image guided, from 50% to 60% and from 26% to 31% of all fractions are subject to setup errors >3 mm and >5 mm, respectively. Conclusion: Residual setup errors reduce with increasing frequency of IG during the course of external-beam radiotherapy for head-and-neck cancer patients. The inability to reduce random setup errors for fractions that are not image guided results in notable residual setup errors

  6. Deviations in daily physical activity patterns in patients with the chronic fatigue syndrome: A case control study

    NARCIS (Netherlands)

    Evering, R.M.H.; Tönis, Thijs; Vollenbroek-Hutten, Miriam Marie Rosé

    2011-01-01

    Deviations in daily physical activity patterns may play an important role in the development and maintenance of fatigue in the chronic fatigue syndrome (CFS). The aim of this study is to gain insight into the objective daily physical activity pattern of patients with CFS in comparison with healthy

  7. Positioning accuracy during VMAT of gynecologic malignancies and the resulting dosimetric impact by a 6-degree-of-freedom couch in combination with daily kilovoltage cone beam computed tomography.

    Science.gov (United States)

    Yao, Lihong; Zhu, Lihong; Wang, Junjie; Liu, Lu; Zhou, Shun; Jiang, ShuKun; Cao, Qianqian; Qu, Ang; Tian, Suqing

    2015-04-26

    To improve the delivery of radiotherapy in gynecologic malignancies and to minimize the irradiation of unaffected tissues by using daily kilovoltage cone beam computed tomography (kV-CBCT) to reduce setup errors. Thirteen patients with gynecologic cancers were treated with postoperative volumetric-modulated arc therapy (VMAT). All patients had a planning CT scan and daily CBCT during treatment. Automatic bone anatomy matching was used to determine initial inter-fraction positioning error. Positional correction on a six-degrees-of-freedom (6DoF) couch was followed by a second scan to calculate the residual inter-fraction error, and a post-treatment scan assessed intra-fraction motion. The margins of the planning target volume (MPTV) were calculated from these setup variations and the effect of margin size on normal tissue sparing was evaluated. In total, 573 CBCT scans were acquired. Mean absolute pre-/post-correction errors were obtained in all six planes. With 6DoF couch correction, the MPTV accounting for intra-fraction errors was reduced by 3.8-5.6 mm. This permitted a reduction in the maximum dose to the small intestine, bladder and femoral head (P=0.001, 0.035 and 0.032, respectively), the average dose to the rectum, small intestine, bladder and pelvic marrow (P=0.003, 0.000, 0.001 and 0.000, respectively) and markedly reduced irradiated normal tissue volumes. A 6DoF couch in combination with daily kV-CBCT can considerably improve positioning accuracy during VMAT treatment in gynecologic malignancies, reducing the MPTV. The reduced margin size permits improved normal tissue sparing and a smaller total irradiated volume.

  8. The efficacy of motivational counselling and SMS reminders on daily sitting time in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Thomsen, Tanja; Aadahl, Mette; Beyer, Nina

    2017-01-01

    biomarkers in patients with rheumatoid arthritis (RA). METHODS: In this randomised controlled trial 150 patients with RA were randomised to an intervention or a no-intervention control group. The intervention group received three individual motivational counselling sessions and short message service or text...... lipids, haemoglobin A1c, body weight, body mass index, waist circumference and waist-hip ratio. RESULTS: 75 patients were allocated to each group. Mean reduction in daily sitting time was -1.61 hours/day in the intervention versus 0.59 hours/day increase in the control group between-group difference -2.......20 (95% CI -2.72 to -1.69; pgroup. Most of the secondary outcomes were also in favour of the intervention. CONCLUSION: An individually tailored, behavioural intervention reduced daily sitting time in patients with RA and improved patient-reported outcomes...

  9. Treatment adherence in concurrent chemoradiation in patients with locally advanced non-small cell lung carcinoma: Results of daily intravenous prehydration

    International Nuclear Information System (INIS)

    Uyterlinde, Wilma; Chen, Chun; Nijkamp, Jasper; Obbink, Marieke Groot; Sonke, Jan-Jakob; Belderbos, Jose; Heuvel, Michel van den

    2014-01-01

    Purpose: To test the hypothesis that daily intravenous pre-hydration decreases renal toxicity and improves chemotherapy adherence in patients receiving daily cisplatin to concurrent radiotherapy for locally advanced non-small cell lung cancer (NSCLC). Patients and methods: Patients with locally advanced NSCLC were treated between 2008 and August 2012 with daily 6 mg/m 2 cisplatin as a bolus injection in 10 ml; of saline and 66 Gy/24 fr radiotherapy in 32 days. Since January 2011, the administration of cisplatin was routinely preceded by intravenous pre-hydration with 1 L of natriumchloride 0.9%. Patients were divided in a pre-hydrated (PH) and non-pre-hydrated (NPH) cohort. Serum-creatinine and glomerular filtration rate (GFR) were assessed twice weekly during treatment. Retrospectively, baseline data, toxicity, treatment adherence and efficacy data were compared. Results: Of the 356 patients 232 NPH patients and 100 PH patients were eligible. Patient-and treatment characteristics compared equally. The median of the maximum decrease in GFR was 24% and 8% for NPH and PH (p < 0.01), respectively. Sixty-nine percent of the patients in the NPH group completed the 24 administrations of cisplatin, as compared to 83% of the PH group (p < 0.01). Nineteen percent vs. 2% of the patients in the NPH and PH group discontinued cisplatin treatment because of renal toxicity. Surprisingly, the incidence of acute esophageal toxicity grade ⩾2 decreased following prehydration: 62% vs. 34% (p < 0.001) for the NPH and PH groups, respectively. The one-year survival was comparable between groups (75% for NPH and 71% for PH). Conclusion: Daily pre-hydration was associated with a reduced rate of both renal and acute esophageal toxicity and an increased chemotherapy adherence in patients receiving daily dose of cisplatin and concurrent radiotherapy for locally advanced NSCLC

  10. Evaluation of initial setup errors of two immobilization devices for lung stereotactic body radiation therapy (SBRT).

    Science.gov (United States)

    Ueda, Yoshihiro; Teshima, Teruki; Cárdenes, Higinia; Das, Indra J

    2017-07-01

    The aim of this study was to investigate the accuracy and efficacy of two commonly used commercial immobilization systems for stereotactic body radiation therapy (SBRT) in lung cancer. This retrospective study assessed the efficacy and setup accuracy of two immobilization systems: the Elekta Body Frame (EBF) and the Civco Body Pro-Lok (CBP) in 80 patients evenly divided for each system. A cone beam CT (CBCT) was used before each treatment fraction for setup correction in both devices. Analyzed shifts were applied for setup correction and CBCT was repeated. If a large shift (>5 mm) occurred in any direction, an additional CBCT was employed for verification after localization. The efficacy of patient setup was analyzed for 105 sessions (48 with the EBF, 57 with the CBP). Result indicates that the CBCT was repeated at the 1 st treatment session in 22.5% and 47.5% of the EBF and CBP cases, respectively. The systematic errors {left-right (LR), anterior-posterior (AP), cranio-caudal (CC), and 3D vector shift: (LR 2 + AP 2 + CC 2 ) 1/2 (mm)}, were {0.5 ± 3.7, 2.3 ± 2.5, 0.7 ± 3.5, 7.1 ± 3.1} mm and {0.4 ± 3.6, 0.7 ± 4.0, 0.0 ± 5.5, 9.2 ± 4.2} mm, and the random setup errors were {5.1, 3.0, 3.5, 3.9} mm and {4.6, 4.8, 5.4, 5.3} mm for the EBF and the CBP, respectively. The 3D vector shift was significantly larger for the CBP (P patient comfort could dictate the use of CBP system with slightly reduced accuracy. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

  11. Evaluation of setup accuracy for NSCLC patients; studying the impact of different types of cone-beam CT matches based on whole thorax, columna vertebralis, and GTV

    DEFF Research Database (Denmark)

    Ottosson, W.; Baker, M.; Hedman, Mattias

    2010-01-01

    Purpose. The aim of this study is to evaluate the patient setup accuracy by investigating the impact of different types of CBCT matches, performed with 3 (translations only) or 6 (including rotations) degrees-of-freedom (DOF). The purpose is also to calculate and compare CTV to PTV margins based...

  12. Minimization of number of setups for mounting machines

    Energy Technology Data Exchange (ETDEWEB)

    Kolman, Pavel; Nchor, Dennis; Hampel, David [Department of Statistics and Operation Analysis, Faculty of Business and Economics, Mendel University in Brno, Zemědělská 1, 603 00 Brno (Czech Republic); Žák, Jaroslav [Institute of Technology and Business, Okružní 517/10, 370 01 České Budejovice (Czech Republic)

    2015-03-10

    The article deals with the problem of minimizing the number of setups for mounting SMT machines. SMT is a device used to assemble components on printed circuit boards (PCB) during the manufacturing of electronics. Each type of PCB has a different set of components, which are obligatory. Components are placed in the SMT tray. The problem consists in the fact that the total number of components used for all products is greater than the size of the tray. Therefore, every change of manufactured product requires a complete change of components in the tray (i.e., a setup change). Currently, the number of setups corresponds to the number of printed circuit board type. Any production change affects the change of setup and stops production on one shift. Many components occur in more products therefore the question arose as to how to deploy the products into groups so as to minimize the number of setups. This would result in a huge increase in efficiency of production.

  13. Target volume delineation and field setup. A practical guide for conformal and intensity-modulated radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Nancy Y. [Memorial Sloan-Kettering Cancer Center, New York, NY (United States). Radiation Oncology; Lu, Jiade J. (eds.) [National Univ. Health System, Singapore (Singapore). Dept. of Radiation Oncology; National Univ. of Singapore (Singapore). Dept. of Medicine

    2013-03-01

    Practical handbook on selection and delineation of tumor volumes and fields for conformal radiation therapy, including IMRT. Helpful format facilitating use on a step-by-step basis in daily practice. Designed to ensure accurate coverage of commonly encountered tumors along their routes of spread. This handbook is designed to enable radiation oncologists to appropriately and confidently delineate tumor volumes/fields for conformal radiation therapy, including intensity-modulated radiation therapy (IMRT), in patients with commonly encountered cancers. The orientation of this handbook is entirely practical, in that the focus is on the illustration of clinical target volume (CTV) delineation for each major malignancy. Each chapter provides guidelines and concise knowledge on CTV selection for a particular disease, explains how the anatomy of lymphatic drainage shapes the selection of the target volume, and presents detailed illustrations of volumes, slice by slice, on planning CT images. While the emphasis is on target volume delineation for three-dimensional conformal therapy and IMRT, information is also provided on conventional radiation therapy field setup and planning for certain malignancies for which IMRT is not currently suitable.

  14. Field Observation of Setup

    National Research Council Canada - National Science Library

    Yemm, Sean

    2004-01-01

    Setup is defined as the superelevation of mean water surface within the surfzone and is caused by the reduction in wave momentum shoreward of the breaking point and compensating positive pressure gradient...

  15. [Patient reported outcome of tyrosine kinase inhibitor related side effects and their impact on daily life in Chinese patients with chronic myeloid leukemia in the chronic phase].

    Science.gov (United States)

    Yu, L; Wang, H B; Jiang, Q

    2016-11-14

    Objective: To explore the impact of patient reported outcome of tyrosine kinase inhibitor (TKI) related side effects on daily life in Chinese patients with chronic myeloid leukemia (CML) in the chronic phase (CP). Methods: From May to November in 2014, anonymous questionnaires were distributed to adult CML patients who were receiving TKI treatment in China. The impact of TKI-related side effects on daily life were assessed by the score of 1 (no impact) to 5 (high impact) from patient self-report. Results: Data from 731 respondents in the CP who reported the score of the impact of TKI-related side effects on daily life were collected. 407 (56%) were male. The median age was 41 years (range, 18 to 88 years). 560 (77%) started TKI treatment within 1 year after diagnosis. With a median treatment duration of 3 years (range, effects were edema ( n =323, 44% ), fatigue ( n =277, 38% ), gastrointestinal disorders ( n =235, 32% ), skin color changes ( n =142, 19% ), muscle cramps ( n =137, 19% ), rash ( n =105, 14% ), hepatic function abnormalities ( n =91, 12%), weight gain ( n =86, 12%), and cytopenia ( n =59, 8%). Multivariate analyses showed that TKI treatment duration effects on daily life in 218 (30%)respondents (1 score). 375 (51%)respondents reported their daily life were slightly or moderately decreased (2 or 3 score), while 138 (19%) significantly decreased (4 or 5 score). Multivariate analyses showed that female, ≥40 years old, use of generic TKI, TKI treatment duration negative effect on their daily life. When taking TKI related side-effects into considderation, secondary school and below, use of generic TKI, TKI treatment duration negative effect on their daily life. Conclusion: Edema, fatigue, gastrointestinal disorders, rash, skin color changes and hepatic function abnormalities were common TKI-related side effects and influenced CML patients' daily life in China. In addition, female, older age, lower education level, use of generic TKI and shorter TKI

  16. CPD: The patient with daily headaches. | Maizels | South African ...

    African Journals Online (AJOL)

    The term "chronic daily headache" (CDH) describes a variety of headache types, of which chronic migraine is the most common. Daily headaches often are disabling and may be challenging to diagnose and treat. Medication overuse, or drug rebound headache, is the most treatable cause of refractory daily headache.

  17. Reducing dosing frequency of carbidopa/levodopa: double-blind crossover study comparing twice-daily bilayer formulation of carbidopa/levodopa (IPX054) versus 4 daily doses of standard carbidopa/levodopa in stable Parkinson disease patients.

    Science.gov (United States)

    Hinson, Vanessa K; Goetz, Christopher G; Leurgans, Sue; Fan, Wenqing; Nguyen, Tiffany; Hsu, Ann

    2009-01-01

    We compared IPX054, a bilayer tablet of immediate- and extended-release carbidopa/levodopa (CD/LD) given twice daily to standard CD/LD given 4 times daily in patients with stable Parkinson disease (PD). Twelve PD patients with no or mild fluctuations on CD/LD 25/100 mg 4 times daily were randomized to a double-blind crossover comparison with IPX054 (50/200 mg) twice daily. At the end of each 2-week treatment, patients were video recorded while performing a modified Unified Parkinson's Disease Rating Scale motor examination and Rush Dyskinesia Rating Scale at 30-minute intervals over 8.5 hours. The primary outcome measure was the number of videotape epochs rated as "ON" without troublesome dyskinesia by a blinded observer (Wilcoxon signed rank tests). The 9 men and 3 women had a mean age of 69 years and mean PD duration of 6 years. IPX054 and CD/LD showed no significant differences in the primary outcome measure (mean number of video epochs rated as ON without troublesome dyskinesia; P = 0.14). The mean time to ON was improved with IPX054 (P = 0.014), and the mean modified Unified Parkinson's Disease Rating Scale scores slightly favored IPX054 (14.4 vs 16.9; P = 0.052). Mean Rush Dyskinesia Rating Scale scores were not significantly different between IPX054 and CD/LD (0.45 vs 0.69; P = 0.25). No patient developed troublesome dyskinesias. In stable PD patients, no difference was detected between twice-daily treatment with IPX054 and CD/LD given 4 times daily. In this group, substitution with IPX054 reduced dosing frequency while maintaining CD/LD efficacy. In clinical practice, this ease of administration may offer improved treatment compliance.

  18. [The impact of Glivec related side effects on daily life in Chinese patients with chronic myeloid leukemia in the chronic phase].

    Science.gov (United States)

    Yu, L; Wang, H B; Huang, X J; Jiang, Q

    2016-07-01

    To explore the impact of Glivec related side effects on daily life in Chinese patients with chronic myeloid leukemia (CML) in the chronic phase (CP). From May to November in 2014, anonymous questionnaires were distributed to adult CML patients who were receiving tyrosine kinase inhibitors (TKI) treatment in China. The impact of TKI related side effects on daily life were assessed by the score of 1 (no impact) to 5 (high impact) from patient self- report. Data from 548 respondents in the CP on Glivec were collected. 303(55%) cases were male with the median age of 40 years (range, 18 to 88 years). 437 (80% ) cases started Glivec treatment within one year after diagnosis with a median treatment duration of 3 years (range, effects were edema (n=278, 51% ), fatigue (n=218, 40% ), gastrointestinal disorders (n=190, 35%), muscle cramps (n=118, 22%), skin color changes (n=118, 22%), weight gain (n=71, 13%), rash (n=60, 11%), hepatic function abnormality (n=55, 10%), and cytopenia (n=38, 7%). Among the 548 respondents, the mean score of Glivec-related side effects on daily life was 2.4±1.2. There was no negative impact of Glivec related side effects on daily life in 161(29%) respondents. 295 (54% ) and 92 (17% ) respondents reported slightly or moderately (2- 3 score) and significantly decreased (4-5 score) daily life, respectively. Multivariate analysis showed that Glivec treatment duration effects including fatigue (OR=2.9, 95% CI 2.1-4.1;Pnegative effect on daily life. Daily life was impaired seriously in a minority of Chinese CML patients who received Glivec, especially in the first 4 years of treatment. Fatigue, edema, gastrointestinal disorders, rash and hepatic function abnormality were side effects associated with negative impact on patients' daily life.

  19. Depression and pain impair daily functioning and quality of life in patients with major depressive disorder.

    Science.gov (United States)

    Lin, Ching-Hua; Yen, Yung-Chieh; Chen, Ming-Chao; Chen, Cheng-Chung

    2014-09-01

    Depression and pain frequently occur together. The objective of this study was to investigate the effects of depression and pain on the impairment of daily functioning and quality of life (QOL) of depressed patients. We enrolled 131 acutely ill inpatients with major depressive disorder. Depression, pain, and daily functioning were assessed using the 17-item Hamilton Depression Rating Scale, the Short-Form 36 (SF-36) Body Pain Index, and the Work and Social Adjustment Scale. Health-related QOL was assessed using three primary domains of the SF-36: social functioning, vitality, and general health perceptions. Pearson׳s correlation and structural equation modeling were used to examine relationships among the study variables. Five models were proposed. In all, 129 patients completed all the measures. Model 5, both depression and pain impaired daily functioning and QOL, was the most fitted structural equation model (χ(2)=9.2, df=8, p=0.33, GFI=0.98, AGFI=0.94, TLI=0.99, CFI=0.99, RMSEA=0.03). The correlation between pain and depression was weak (r=-0.27, z=-2.95, p=0.003). This was a cross-sectional study with a small sample size. Depression and pain exert a direct influence on the impairment of daily functioning and QOL of depressed patients; this impairment could be expected regardless of increased pain, depression, or both pain and depression. Pain had a somewhat separate entity from depression. Copyright © 2014. Published by Elsevier B.V.

  20. Set-up error in supine-positioned patients immobilized with two different modalities during conformal radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Fiorino, C.; Cattaneo, G.M.; Calandrino, R.; Reni, M.; Bolognesi, A.; Bonini, A.

    1998-01-01

    Background: Conformal radiotherapy requires reduced margins around the clinical target volume (CTV) with respect to traditional radiotherapy techniques. Therefore, high set-up accuracy and reproducibility are mandatory. Purpose: To investigate the effectiveness of two different immobilization techniques during conformal radiotherapy of prostate cancer with small fields. Materials and methods: 52 patients with prostate cancer were treated by conformal three- or four-field techniques with radical or adjuvant intent between November 1996 and March 1998. In total, 539 portal images were collected on a weekly basis for at least the first 4 weeks of the treatment on lateral and anterior 18 MV X-ray fields. The average number of sessions monitored per patient was 5.7 (range 4-10). All patients were immobilized with an alpha-cradle system; 25 of them were immobilized at the pelvis level (group A) and the remaining 27 patients were immobilized in the legs (group B). The shifts with respect to the simulation condition were assessed by measuring the distances between the same bony landmarks and the field edges. The global distributions of cranio-caudal (CC), posterior-anterior (PA) and left-right (LR) shifts were considered; for each patient random and systematic error components were assessed by following the procedure suggested by Bijhold et al. (Bijhold J, Lebesque JV, Hart AAM, Vijlbrief RE. Maximising set-up accuracy using portal images as applied to a conformal boost technique for prostatic cancer. Radiother. Oncol. 1992;24:261-271). For each patient the average isocentre (3D) shift was assessed as the quadratic sum of the average shifts in the three directions. Results 5 mm equal to 4.4% with respect to the 21.6% of group A (P<0.0001). This value was also better than the corresponding value found in a previously investigated group of 21 non-immobilized patients (Italia C, Fiorino C, Ciocca M, et al. Quality control by portal film analysis of the conformal radiotherapy

  1. TU-H-CAMPUS-TeP1-02: Seated Treatment: Setup Uncertainty Comparable to Supine

    Energy Technology Data Exchange (ETDEWEB)

    McCarroll, R [UT MD Anderson Cancer Center, Houston, TX (United States); UT Health Science Center, Graduate School of Biomedical Sciences, Houston, TX (United States); Beadle, B; Fullen, D; Balter, P; Followill, D; Stingo, F; Yang, J; Court, L [UT MD Anderson Cancer Center, Houston, TX (United States)

    2016-06-15

    Purpose: For some head and neck patients, positioning in the supine position is not well tolerated. For these patients, treatment in a seated position would be preferred. We have evaluated inter- and intra- fraction uncertainty of patient set-up in a novel treatment chair which is compatible with modern linac designs. Methods: Five head-and-neck cancer patients were positioned in the chair, fitted with immobilization devices, and imaged with orthogonal X-rays. The couch (with chair attached) was rotated to simulate delivery (without actual treatment), another set of images were acquired, providing a measure of intra-fraction displacement. The patient then got off of and back onto the chair and the process was repeated, thus providing a measure of inter-fraction set-up uncertainty. Six sub-regions in the head-and-neck were rigidly registered to evaluate local intra- and interfraction displacement. Image guidance was simulated by first registering one sub-region; the residual displacement of other sub-regions was then measured. Additionally, a patient questionnaire was administered to evaluate tolerance of the seated position. Results: The chair design is such that all advantages of couch motions may be utilized. Average inter- and intrafraction displacements of all sub-regions in the seated position were less than 2 and 3 mm, respectively. When image guidance was simulated, interfraction displacements were reduced by an average of 4 mm, providing comparable setup to the supine position. The enrolled patients, who had no indication for a seated treatment position, reported no preference for the seated or the supine position. Conclusion: The novel chair design provides acceptable inter- and intra-fraction displacement, with reproducibility similar to that observed for patients in the supine position. Such a chair will be utilized for patients who cannot tolerate the supine position and use with CBCT images for planning, in a fixed-beam linac system, and for other

  2. Factors associated with daily consumption of sugar-sweetened beverages among adult patients at four federally qualified health centers, Bronx, New York, 2013.

    Science.gov (United States)

    Kristal, Ross B; Blank, Arthur E; Wylie-Rosett, Judith; Selwyn, Peter A

    2015-01-08

    Consumption of sugar-sweetened beverages (SSBs) is associated with cardiovascular disease risk factors. This study examined the relationships between SSB consumption and demographic, health behavior, health service, and health condition characteristics of adult patients of a network of federally qualified health centers (FQHCs) in a low-income, urban setting. Validated, standardized self-reported health behavior questions were incorporated into the electronic health record (EHR) and asked of patients yearly, at 4 FQHCs. We conducted cross-sectional analysis of EHR data collected in 2013 from 12,214 adult patients by using logistic regression. Forty percent of adult patients consumed 1 or more SSBs daily. The adjusted odds ratios indicated that patients who consumed more than 1 SSB daily were more likely to be aged 18 to 29 years versus age 70 or older, current smokers versus never smoking, eating no servings of fruits and/or vegetables daily or 1 to 4 servings daily versus 5 or more servings daily, and not walking or biking more than 10 blocks in the past 30 days. Patients consuming 1 or more servings of SSBs daily were less likely to speak Spanish than English, be women than men, be diagnosed with type 2 diabetes versus no diabetes, and be diagnosed with hypertension versus no hypertension. SSB consumption differed by certain demographic characteristics, health behaviors, and health conditions. Recording SSB intake and other health behaviors data in the EHR could help clinicians in identifying and counseling patients to promote health behavior changes. Future studies should investigate how EHR data on patient health behavior can be used to improve the health of patients and communities.

  3. Exercise training raises daily activity stronger than predicted from exercise capacity in patients with COPD.

    Science.gov (United States)

    Behnke, Michaela; Wewel, Alexandra R; Kirsten, Detlef; Jörres, Rudolf A; Magnussen, Helgo

    2005-06-01

    The 6-min walking (6MWD) and 6-min treadmill distance (6MTD) are often used as measures of exercise performance in patients with COPD. The aim of our study was to assess their relationship to daily activity in the course of an exercise training program. Eighty-eight patients with stable COPD (71m/17f; mean +/- SD age, 60 +/-8 year; FEV1, 43+/-14% pred) were recruited, 66 of whom performed a hospital-based 10-day walking training, whereas 22 were treated as control. On day 16MTD, and on days 8 and 10, 6MTD and 6MWD were determined. In addition, patients used an accelerometer (TriTrac-R3D) to record 24 h-activity, whereby training sessions were excluded. In both groups there was a linear relationship (r > or = 0.84 and P daily activity did not markedly vary with exercise capacity under baseline conditions. Participation in a training program increased activity significantly stronger than predicted from the gain in exercise capacity. This underlines the importance of non-physiological, patient-centered factors associated with training in COPD.

  4. Profiles of recreational activities of daily living (RADL) in patients with mental disorders.

    Science.gov (United States)

    Linden, Michael; Gehrke, G; Geiselmann, B

    2009-12-01

    Activities of daily living, play a key role in the measurement of functional health as defined by the International Classification of Functioning, Disability and Health (ICF) and in prevention and treatment of mental or somatic illnesses. From a clinical context it is important to discriminate between basic "activities of daily living, ADL", "intentional activities of daily living, IADL", and "recreational activities of daily living, RADL". While ADL and IADL have gained much attention in dementia, the elderly, or severe somatic illnesses, there is a lack of research on RADL, which are important in depression, anxiety, or other neurotic disorders. 154 unselected inpatients of a department of behavioral and psychosomatic medicine filled in the "Check List of Recreational Activities" to assess the rates and profiles of RADL. Patients reported on average 19.3 (s.d. 7.0) activities (range 4 - 40), i.e. males 21.3 (s.d. 6.5, 9 - 34) and females 18.9 (s.d. 7.1, 4 - 40). Most frequent RADL were passive and unspecific activities like "watching tv" (93.4%). Least frequent were activities which need special skills or preparation like "horse back riding" (0.7%). Low rates were also found for activities which are in the centre of inpatient occupational therapy like "ceramics" (4.7%) or "silk-painting" (2.6%). There are differences between sexes but not in respect to age (18 to 60), sick leave and unemployment, or diagnostic status. When patients were asked what they would like to do in the future, the same activity profile emerged as when looking at what they had done in the last month The data give a reference profile for recreational activities, help to define what can be considered a normal frequency and spectrum of RADL, and, by this, can guide therapeutic interventions.

  5. Collider shot setup for Run 2 observations and suggestions

    International Nuclear Information System (INIS)

    Annala, J.; Joshel, B.

    1996-01-01

    This note is intended to provoke discussion on Collider Run II shot setup. We hope this is a start of activities that will converge on a functional description of what is needed for shot setups in Collider Run II. We will draw on observations of the present shot setup to raise questions and make suggestions for the next Collider run. It is assumed that the reader has some familiarity with the Collider operational issues. Shot setup is defined to be the time between the end of a store and the time the Main Control Room declares colliding beams. This is the time between Tevatron clock events SCE and SCB. This definition does not consider the time experiments use to turn on their detectors. This analysis was suggested by David Finley. The operational scenarios for Run II will require higher levels of reliability and speed for shot setup. See Appendix I and II. For example, we estimate that a loss of 3 pb -1 /week (with 8 hour stores) will occur if shot setups take 90 minutes instead of 30 minutes. In other words: If you do 12 shots for one week and accept an added delay of one minute in each shot, you will loose more than 60 nb -1 for that week alone (based on a normal shot setup of 30 minutes). These demands should lead us to be much more pedantic about all the factors that affect shot setups. Shot setup will be viewed as a distinct process that is composed of several inter- dependent 'components': procedures, hardware, controls, and sociology. These components don't directly align with the different Accelerator Division departments, but are topical groupings of the needed accelerator functions. Defining these components, and categorizing our suggestions within them, are part of the goal of this document. Of course, some suggestions span several of these components

  6. Radiation therapy in cancer patients with psoriasis. The fractionated daily dose and the Koebner phenomenon

    International Nuclear Information System (INIS)

    Ben-Yosef, Rami; Soyfer, Vyacheslav; Vexler, Akiva

    2005-01-01

    Skin side effects following XRT take place more often in patients with skin disorders. In this study six patients with psoriatic lesions were evaluated. The total/daily XRT dose to the tumor site was 50-70/1.8-2.0 Gy. No debilitating effect of XRT was observed in both the psoriatic lesions and in the surrounding normal skin

  7. SU-F-T-92: Clinical Benefit for Breast and Chest Wall Setup in Using a Breast Board

    Energy Technology Data Exchange (ETDEWEB)

    Li, S; Miyamoto, C; Serratore, D; Liang, Q; Dziemianowicz, E [Temple University Hospital, Philadelphia, PA (United States)

    2016-06-15

    Purpose: To validate benefit of using a breast board (BB) by analyzing the geometry and dosimetry changes of the regions of interest (ROIs) between CT scans with and without BB. Methods: Seven patients, two chest walls (CW) and five breasts, use BB at CT simulation and no BB at diagnostic CT were included. By using deformable image registration software (Velocity AI), diagnostic CT and planning CT were rigidly co-registered according to the thoracic cage at the target. The heart and the target were then deformedly matched and the contours of the planned ROIs were transferred to the diagnostic CT. Which were brought back to the planning CT data set though the initial rigid co-registration in order to keep the deformed ROIs redefined in the diagnostic CT. Anatomic shifts and volume changes of a ROI beyond the rigid translation were recorded and dosimetry changes to ROIs were compared with recalculated DVHs. Results: Patient setup without the BB had small but systematic heart shifts superiorly by ∼5 mm. Torso rotations in two cases moved the heart in opposite directions by ∼10 mm. The breast target volume, shape, and locations were significantly changed with arm extension over the head but not in cases with the arm extended laterally. Breast setup without BB could increase the mean dose to the heart and the maximal dose to the anterior ventricle wall by 1.1 and 6.7 Gy, respectively. Conclusion: A method for evaluation of breast setup technique is introduced and applied for patients. Results of systematic heart displacement without using the BB and the potential increase of heart doses encourage us to further investigate the current trend of not using a BB for easy setup and CT scans. Using a BB would likely increase patient sag during prolonged IMRT and real-time patient position monitoring is clinically desired.

  8. Development and daily use of an electronic oncological patient record for the total management of cancer patients: 7 years' experience.

    Science.gov (United States)

    Galligioni, E; Berloffa, F; Caffo, O; Tonazzolli, G; Ambrosini, G; Valduga, F; Eccher, C; Ferro, A; Forti, S

    2009-02-01

    We describe our experience with an electronic oncological patient record (EOPR) for the total management of cancer patients. The web-based EOPR was developed on the basis of a user-centred design including user education and training, followed by continuous assistance; user acceptance was monitored by means of three questionnaires administered after 2 weeks, 6 months and 6 years. The EOPR has been used daily for all in-ward, day hospital and ambulatory clinical activities since July 2000. The most widely appreciated functions are its rapid multipoint access, the self-updated summary of the patients' clinical course, the management of the entire therapeutic programme synchronised with working agendas and oncological teleconsultation. Security and privacy are assured by means of the separate storage of clinical and demographic data, with access protected by login and a password. The questionnaires highlighted appreciation of rapid data retrieval and exchange and the perception of improved quality of care, but also revealed a sense of additional work and a negative impact on doctor-patient relationships. Our EOPR has proved to be effective in the total management of cancer patients. Its user-centred design and flexible web technology have been key factors in its successful implementation and daily use.

  9. Recreating Daily life in Pompeii

    Directory of Open Access Journals (Sweden)

    Nadia Magnenat-Thalmann

    2010-05-01

    Full Text Available We propose an integrated Mixed Reality methodology for recreating ancient daily life that features realistic simulations of animated virtual human actors (clothes, body, skin, face who augment real environments and re-enact staged storytelling dramas. We aim to go further from traditional concepts of static cultural artifacts or rigid geometrical and 2D textual augmentations and allow for 3D, interactive, augmented historical character-based event representations in a mobile and wearable setup. This is the main contribution of the described work as well as the proposed extensions to AR Enabling technologies: a VR/AR character simulation kernel framework with real-time, clothed virtual humans that are dynamically superimposed on live camera input, animated and acting based on a predefined, historically correct scenario. We demonstrate such a real-time case study on the actual site of ancient Pompeii.

  10. Development of chronic daily headache : A clinical study

    NARCIS (Netherlands)

    Spierings, E.L.H.; Schroevers, M.; Honkoop, P.C.; Sorbi, M.

    1998-01-01

    We studied the development of chronic daily headache in 258 headache practice patients, 50 men and 208 women. Chronic daily headache was defined as headaches occurring at least 5 days per week for at least 1 year. Twenty-two percent of the patients had daily headaches from the onset, and 78%

  11. Coping with side effects from cancer treatment in daily life from the perspective of cancer patients: A qualitative empirical study

    DEFF Research Database (Denmark)

    Pedersen, Birgith; Koktved, Dorte Pallesen; Nielsen, Lene Lyngø

    Aim The aim of this paper is to deepen our understanding of how patients cope with side effects from cancer treatment in daily life. Background Patients receiving cancer treatment experience acute side effects and need individualized information and guidance in order to manage treatment......-related adverse events in everyday life. However development in cancer treatment and the societal demands for efficiency may limit the possibility for individualized support. Methods Nine patients were interviewed from March to July 2009 to explore the patients’ experience of coping with side effects in daily...... their identity but the side effects can control the daily life. Patients do not always possess the knowledge of how to handle the side effects and adaptation to the institutional efficiency can lead to lack of confidence and feelings of responsibility and guilt concerning coping with these side effects...

  12. Depression Screening Using Daily Mental-Health Ratings from a Smartphone Application for Breast Cancer Patients.

    Science.gov (United States)

    Kim, Junetae; Lim, Sanghee; Min, Yul Ha; Shin, Yong-Wook; Lee, Byungtae; Sohn, Guiyun; Jung, Kyung Hae; Lee, Jae-Ho; Son, Byung Ho; Ahn, Sei Hyun; Shin, Soo-Yong; Lee, Jong Won

    2016-08-04

    Mobile mental-health trackers are mobile phone apps that gather self-reported mental-health ratings from users. They have received great attention from clinicians as tools to screen for depression in individual patients. While several apps that ask simple questions using face emoticons have been developed, there has been no study examining the validity of their screening performance. In this study, we (1) evaluate the potential of a mobile mental-health tracker that uses three daily mental-health ratings (sleep satisfaction, mood, and anxiety) as indicators for depression, (2) discuss three approaches to data processing (ratio, average, and frequency) for generating indicator variables, and (3) examine the impact of adherence on reporting using a mobile mental-health tracker and accuracy in depression screening. We analyzed 5792 sets of daily mental-health ratings collected from 78 breast cancer patients over a 48-week period. Using the Patient Health Questionnaire-9 (PHQ-9) as the measure of true depression status, we conducted a random-effect logistic panel regression and receiver operating characteristic (ROC) analysis to evaluate the screening performance of the mobile mental-health tracker. In addition, we classified patients into two subgroups based on their adherence level (higher adherence and lower adherence) using a k-means clustering algorithm and compared the screening accuracy between the two groups. With the ratio approach, the area under the ROC curve (AUC) is 0.8012, indicating that the performance of depression screening using daily mental-health ratings gathered via mobile mental-health trackers is comparable to the results of PHQ-9 tests. Also, the AUC is significantly higher (P=.002) for the higher adherence group (AUC=0.8524) than for the lower adherence group (AUC=0.7234). This result shows that adherence to self-reporting is associated with a higher accuracy of depression screening. Our results support the potential of a mobile mental

  13. Cost-effectiveness of exenatide twice daily vs insulin glargine as add-on therapy to oral antidiabetic agents in patients with type 2 diabetes in China.

    Science.gov (United States)

    Gu, Shuyan; Wang, Xiaoyong; Qiao, Qing; Gao, Weiguo; Wang, Jian; Dong, Hengjin

    2017-12-01

    To estimate the long-term cost-effectiveness of exenatide twice daily vs insulin glargine once daily as add-on therapy to oral antidiabetic agents (OADs) for Chinese patients with type 2 diabetes (T2DM). The Cardiff Diabetes Model was used to simulate disease progression and estimate the long-term effects of exenatide twice daily vs insulin glargine once daily. Patient profiles and treatment effects required for the model were obtained from literature reviews (English and Chinese databases) and from a meta-analysis of 8 randomized controlled trials comparing exenatide twice daily with insulin glargine once daily add-on to OADs for T2DM in China. Medical expenditure data were collected from 639 patients with T2DM (aged ≥18 years) with and without complications incurred between January 1, 2014 and December 31, 2015 from claims databases in Shandong, China. Costs (2014 Chinese Yuan [¥]) and benefits were estimated, from the payers' perspective, over 40 years at a discount rate of 3%. A series of sensitivity analyses were performed. Patients on exenatide twice daily + OAD had a lower predicted incidence of most cardiovascular and hypoglycaemic events and lower total costs compared with those on insulin glargine once daily + OAD. A greater number of quality-adjusted life years (QALYs; 1.94) at a cost saving of ¥117 706 gained was associated with exenatide twice daily vs insulin glargine once daily. (i.e. cost saving of ¥60 764/QALY) per patient. In Chinese patients with T2DM inadequately controlled by OADs, exenatide twice daily is a cost-effective add-on therapy alternative to insulin glargine once daily, and may address the problem of an excess of medical needs resulting from weight gain and hypoglycaemia in T2DM treatment. © 2017 John Wiley & Sons Ltd.

  14. Intercultural doctor-patient communication in daily outpatient care: relevant communication skills.

    Science.gov (United States)

    Paternotte, Emma; Scheele, Fedde; Seeleman, Conny M; Bank, Lindsay; Scherpbier, Albert J J A; van Dulmen, Sandra

    2016-10-01

    Intercultural communication (ICC) between doctors and patients is often associated with misunderstandings and dissatisfaction. To develop ICC-specific medical education, it is important to find out which ICC skills medical specialists currently apply in daily clinical consultations. Doctor-patient consultations of Dutch doctors with non-Dutch patients were videotaped in a multi-ethnic hospital in the Netherlands. The consultations were analyzed using the validated MAAS-Global assessment list in combination with factors influencing ICC, as described in the literature. In total, 39 videotaped consultations were analyzed. The doctors proved to be capable of practising many communication skills, such as listening and empathic communication behaviour. Other skills were not practised, such as being culturally aware and checking the patient's language ability. We showed that doctors did practice some but not all the relevant ICC skills and that the ICC style of the doctors was mainly biomedically centred. Furthermore, we discussed the possible overlap between intercultural and patient-centred communication. Implications for practice could be to implement the relevant ICC skills in the existing communication training or develop a communication training with a patient-centred approach including ICC skills.

  15. A user-friendly technical set-up for infrared photography of forensic findings.

    Science.gov (United States)

    Rost, Thomas; Kalberer, Nicole; Scheurer, Eva

    2017-09-01

    Infrared photography is interesting for a use in forensic science and forensic medicine since it reveals findings that normally are almost invisible to the human eye. Originally, infrared photography has been made possible by the placement of an infrared light transmission filter screwed in front of the camera objective lens. However, this set-up is associated with many drawbacks such as the loss of the autofocus function, the need of an external infrared source, and long exposure times which make the use of a tripod necessary. These limitations prevented up to now the routine application of infrared photography in forensics. In this study the use of a professional modification inside the digital camera body was evaluated regarding camera handling and image quality. This permanent modification consisted of the replacement of the in-built infrared blocking filter by an infrared transmission filter of 700nm and 830nm, respectively. The application of this camera set-up for the photo-documentation of forensically relevant post-mortem findings was investigated in examples of trace evidence such as gunshot residues on the skin, in external findings, e.g. hematomas, as well as in an exemplary internal finding, i.e., Wischnewski spots in a putrefied stomach. The application of scattered light created by indirect flashlight yielded a more uniform illumination of the object, and the use of the 700nm filter resulted in better pictures than the 830nm filter. Compared to pictures taken under visible light, infrared photographs generally yielded better contrast. This allowed for discerning more details and revealed findings which were not visible otherwise, such as imprints on a fabric and tattoos in mummified skin. The permanent modification of a digital camera by building in a 700nm infrared transmission filter resulted in a user-friendly and efficient set-up which qualified for the use in daily forensic routine. Main advantages were a clear picture in the viewfinder, an auto

  16. In-bore setup and software for 3T MRI-guided transperineal prostate biopsy

    International Nuclear Information System (INIS)

    Tokuda, Junichi; Tuncali, Kemal; Song, Sang-Eun; Fedorov, Andriy; Oguro, Sota; Fennessy, Fiona M; Tempany, Clare M; Hata, Nobuhiko; Iordachita, Iulian; Lasso, Andras

    2012-01-01

    MRI-guided prostate biopsy in conventional closed-bore scanners requires transferring the patient outside the bore during needle insertion due to the constrained in-bore space, causing a safety hazard and limiting image feedback. To address this issue, we present our custom-made in-bore setup and software to support MRI-guided transperineal prostate biopsy in a wide-bore 3 T MRI scanner. The setup consists of a specially designed tabletop and a needle-guiding template with a Z-frame that gives a physician access to the perineum of the patient at the imaging position and allows the physician to perform MRI-guided transperineal biopsy without moving the patient out of the scanner. The software and Z-frame allow registration of the template, target planning and biopsy guidance. Initially, we performed phantom experiments to assess the accuracy of template registration and needle placement in a controlled environment. Subsequently, we embarked on our clinical trial (N = 10). The phantom experiments showed that the translational errors of the template registration along the right–left (RP) and anterior–posterior (AP) axes were 1.1 ± 0.8 and 1.4 ± 1.1 mm, respectively, while the rotational errors around the RL, AP and superior–inferior axes were (0.8 ± 1.0)°, (1.7 ± 1.6)° and (0.0 ± 0.0)°, respectively. The 2D root-mean-square (RMS) needle-placement error was 3 mm. The clinical biopsy procedures were safely carried out in all ten clinical cases with a needle-placement error of 5.4 mm (2D RMS). In conclusion, transperineal prostate biopsy in a wide-bore 3T scanner is feasible using our custom-made tabletop setup and software, which supports manual needle placement without moving the patient out of the magnet. (paper)

  17. X-ray-assisted positioning of patients treated by conformal arc radiotherapy for prostate cancer: Comparison of setup accuracy using implanted markers versus bony structures

    International Nuclear Information System (INIS)

    Soete, Guy; Cock, Mieke de; Verellen, Dirk; Michielsen, Dirk; Keuppens, Frans; Storme, Guy

    2007-01-01

    Purpose: The aim of this study was to compare setup accuracy of NovalisBody stereoscopic X-ray positioning using implanted markers in the prostate vs. bony structures in patients treated with dynamic conformal arc radiotherapy for prostate cancer. Methods and Materials: Random and systematic setup errors (RE and SE) of the isocenter with regard to the center of gravity of three fiducial markers were measured by means of orthogonal verification films in 120 treatment sessions in 12 patients. Positioning was performed using NovalisBody semiautomated marker fusion. The results were compared with a control group of 261 measurements in 15 patients who were positioned with NovalisBody automated bone fusion. In addition, interfraction and intrafraction prostate motion was registered in the patients with implanted markers. Results: Marker-based X-ray positioning resulted in a reduction of RE as well as SE in the anteroposterior, craniocaudal, and left-right directions compared with those in the control group. The interfraction prostate displacements with regard to the bony pelvis that could be avoided by marker positioning ranged between 1.6 and 2.8 mm for RE and between 1.3 and 4.3 mm for SE. Intrafraction random and systematic prostate movements ranged between 1.4 and 2.4 mm and between 0.8 and 1.3 mm, respectively. Conclusion: The problem of interfraction prostate motion can be solved by using implanted markers. In addition, the NovalisBody X-ray system performs more accurately with markers compared with bone fusion. Intrafraction organ motion has become the limiting factor for margin reduction around the clinical target volume

  18. Discrepancy between functional exercise capacity and daily physical activity: a cross-sectional study in patients with mild to moderate COPD.

    Science.gov (United States)

    Fastenau, Annemieke; van Schayck, Onno C P; Gosselink, Rik; Aretz, Karin C P M; Muris, Jean W M

    2013-12-01

    In patients with moderate to severe chronic obstructive pulmonary disease (COPD) the six-minute walk distance reflects the functional exercise level for daily physical activity. It is unknown if this also applies to patients with mild to moderate COPD in primary care. To assess the relationship between functional exercise capacity and physical activity in patients with mild to moderate COPD. A cross-sectional study was performed in 51 patients with mild to moderate COPD in primary care. Functional exercise capacity was assessed by the six-minute walk test and physical activity was measured with an accelerometer-based activity monitor. Functional exercise capacity was close to normal values. However, the daily physical activity of the patients could be classified as 'sedentary' and 'low active'. No significant correlations were observed between six-minute walk distance (% predicted) and any of the physical activity variables (steps per day, movement intensity during walking, total active time, total walking time, physical activity level, and time spent in moderate physical activity). A discrepancy was found between functional exercise capacity and daily physical activity in patients with mild to moderate COPD recruited and assessed in primary care. We conclude that these variables represent two different concepts. Our results reinforce the importance of measuring daily physical activity in order to fine-tune treatment (i.e. focusing on enhancement of exercise capacity or behavioural change, or both).

  19. Daily life activity routine discovery in hemiparetic rehabilitation patients using topic models.

    Science.gov (United States)

    Seiter, J; Derungs, A; Schuster-Amft, C; Amft, O; Tröster, G

    2015-01-01

    Monitoring natural behavior and activity routines of hemiparetic rehabilitation patients across the day can provide valuable progress information for therapists and patients and contribute to an optimized rehabilitation process. In particular, continuous patient monitoring could add type, frequency and duration of daily life activity routines and hence complement standard clinical scores that are assessed for particular tasks only. Machine learning methods have been applied to infer activity routines from sensor data. However, supervised methods require activity annotations to build recognition models and thus require extensive patient supervision. Discovery methods, including topic models could provide patient routine information and deal with variability in activity and movement performance across patients. Topic models have been used to discover characteristic activity routine patterns of healthy individuals using activity primitives recognized from supervised sensor data. Yet, the applicability of topic models for hemiparetic rehabilitation patients and techniques to derive activity primitives without supervision needs to be addressed. We investigate, 1) whether a topic model-based activity routine discovery framework can infer activity routines of rehabilitation patients from wearable motion sensor data. 2) We compare the performance of our topic model-based activity routine discovery using rule-based and clustering-based activity vocabulary. We analyze the activity routine discovery in a dataset recorded with 11 hemiparetic rehabilitation patients during up to ten full recording days per individual in an ambulatory daycare rehabilitation center using wearable motion sensors attached to both wrists and the non-affected thigh. We introduce and compare rule-based and clustering-based activity vocabulary to process statistical and frequency acceleration features to activity words. Activity words were used for activity routine pattern discovery using topic models

  20. CT image-guided intensity-modulated therapy for paraspinal tumors using stereotactic immobilization

    International Nuclear Information System (INIS)

    Yenice, Kamil M.; Lovelock, D. Michael; Hunt, Margie A.; Lutz, Wendell R.; Fournier-Bidoz, Nathalie; Hua, C.-H.; Yamada, Josh; Bilsky, Mark; Lee, Henry; Pfaff, Karl; Spirou, Spiridon V.; Amols, Howard I.

    2003-01-01

    Purpose: To design and implement a noninvasive stereotactic immobilization technique with daily CT image-guided positioning to treat patients with paraspinal lesions accurately and to quantify the systematic and random patient setup errors occurring with this method. Methods and Materials: A stereotactic body frame (SBF) was developed for 'rigid' immobilization of paraspinal patients. The inherent accuracy of this system for stereotactic CT-guided treatment was evaluated with phantom studies. Seven patients with thoracic and lumbar spine lesions were immobilized with the SBF and positioned for 33 treatment fractions using daily CT scans. For all 7 patients, the daily setup errors, as assessed from the daily CT scans, were corrected at each treatment fraction. A retrospective analysis was also performed to assess what the impact on patient treatment would have been without the CT-based corrections (i.e., if patient setup had been performed only with the SBF). Results: The average magnitude of systematic and random errors from uncorrected patient setups using the SBF was approximately 2 mm and 1.5 mm (1 SD), respectively. For fixed phantom targets, the system accuracy for the SBF localization and treatment was shown to be within 1 mm (1 SD) in any direction. Dose-volume histograms incorporating these uncertainties for an intensity-modulated radiotherapy plan for lumbar spine lesions were generated, and the effects on the dose-volume histograms were studied. Conclusion: We demonstrated a very accurate and precise method of patient immobilization and treatment delivery based on a noninvasive SBF and daily image guidance for paraspinal lesions. The SBF provides excellent immobilization for paraspinal targets, with setup accuracy better than 2 mm (1 SD). However, for highly conformal paraspinal treatments, uncorrected systematic and random errors of 2 mm in magnitude can result in a significantly greater (>100%) dose to the spinal cord than planned, even though the

  1. Chronic Daily Headache in a Patient With Nasopharyngeal Carcinoma

    Directory of Open Access Journals (Sweden)

    Jiann-Jy Chen

    2010-12-01

    Full Text Available Chronic daily headache (CDH among nasopharyngeal carcinoma (NPC patients is a multidisciplinary challenge. Although imaging studies are recommended to identify skull-base invasion, intracranial metastasis or skull-base osteoradionecrosis, a headache diary is also a practical approach. A 42-year-old woman had been bothered with CDH since she was diagnosed with T3N1M0 stage III NPC 2 years earlier. Although the imaging studies did not show any abnormality, the attending doctor informed her that there remained the possibility of an intracranial or skull-base lesion. She was regularly taking painkillers. Eventually, when her headache diary was examined, the diagnosis of chronic migraine superimposed on medication overuse headache was made according to the ICHD-IIR. The CDH abated after 1 week of outpatient detoxification. The following half year was uneventful. In reporting this case, we suggest that it would be of interest to a number of disciplines including otorhinolaryngologists, oncologists and radio-oncologists. By avoiding medication overuse in similar patients, we hope to improve the quality of life of these individuals.

  2. The compact and inexpensive arrowhead setup for holographic interferometry

    Energy Technology Data Exchange (ETDEWEB)

    Ladera, Celso L; Donoso, Guillermo, E-mail: clladera@usb.v [Departamento de Fisica, Universidad Simon BolIvar, Apdo. 89000, Caracas 1086 (Venezuela, Bolivarian Republic of)

    2011-07-15

    Hologram recording and holographic interferometry are intrinsically sensitive to phase changes, and therefore both are easily perturbed by minuscule optical path perturbations. It is therefore very convenient to bank on holographic setups with a reduced number of optical components. Here we present a compact off-axis holographic setup that requires neither a collimator nor a beam-splitter, and whose layout is reminiscent of an arrowhead. We show that this inexpensive setup is a good alternative for the study and applications of scientific holography by measuring small displacements and deformations of a body. The arrowhead setup will be found particularly useful for holography and holographic interferometry experiments and projects in teaching laboratories.

  3. Evaluation of the Positional Uncertainty of a Liver Tumor using 4-Dimensional Computed Tomography and Gated Orthogonal Kilovolt Setup Images

    International Nuclear Information System (INIS)

    Ju, Sang Gyu; Hong, Chae Seon; Park, Hee Chul; Ahn, Jong Ho; Shin, Eun Hyuk; Shin, Jung Suk; Kim, Jin Sung; Han, Young Yih; Lim, Do Hoon; Choi, Doo Ho

    2010-01-01

    In order to evaluate the positional uncertainty of internal organs during radiation therapy for treatment of liver cancer, we measured differences in inter- and intra-fractional variation of the tumor position and tidal amplitude using 4-dimensional computed radiograph (DCT) images and gated orthogonal setup kilovolt (KV) images taken on every treatment using the on board imaging (OBI) and real time position management (RPM) system. Twenty consecutive patients who underwent 3-dimensional (3D) conformal radiation therapy for treatment of liver cancer participated in this study. All patients received a 4DCT simulation with an RT16 scanner and an RPM system. Lipiodol, which was updated near the target volume after transarterial chemoembolization or diaphragm was chosen as a surrogate for the evaluation of the position difference of internal organs. Two reference orthogonal (anterior and lateral) digital reconstructed radiograph (DRR) images were generated using CT image sets of 0% and 50% into the respiratory phases. The maximum tidal amplitude of the surrogate was measured from 3D conformal treatment planning. After setting the patient up with laser markings on the skin, orthogonal gated setup images at 50% into the respiratory phase were acquired at each treatment session with OBI and registered on reference DRR images by setting each beam center. Online inter-fractional variation was determined with the surrogate. After adjusting the patient setup error, orthogonal setup images at 0% and 50% into the respiratory phases were obtained and tidal amplitude of the surrogate was measured. Measured tidal amplitude was compared with data from 4DCT. For evaluation of intra-fractional variation, an orthogonal gated setup image at 50% into the respiratory phase was promptly acquired after treatment and compared with the same image taken just before treatment. In addition, a statistical analysis for the quantitative evaluation was performed. Medians of inter

  4. Motor function and activities of daily living capacity of patients with fractures sustained during the Wenchuan earthquake.

    Science.gov (United States)

    Zhang, Jin-Long; He, Hong-Chen; Lin, Hai-Dan; Luo, Qing-Lu; Xia, Lu; Li, Sha-Sha; He, Cheng-Qi

    2011-05-01

    On the afternoon of May 12, 2008, a 8.0-magnitude earthquake hit Sichuan Province, a mountainous region in Western China, killing about 70 000 people and leaving over 18 000 missing. What about the survivors motor functions and activities of daily living (ADL) capacity, especially for fractures? We need the data to guide the rehabilitation for the seismic wounded and it's important to collect the data for the future. We study the survivors to understand the motor functions and ADL capacity of patients with fractures sustained in the Wenchuan earthquake, to provide a basis for rehabilitation and treatment. We used the Manual Muscle Testing method to evaluate muscle strength, the joint angle scale to measure joint range of motion (ROM), and the Barthel index to evaluate the activities of daily living status. SPSS 13.0 software was used to analyze the data and the results were tested using one-way analysis of variance (ANOVA). The number of seismic wounded amounted to 487; 81.1% of patients had fractures. Most of the injured had fractures in multiple regions (53.9% of all fracture patients), followed by fractures of the upper limb (34.0% of patients); cranial fractures were rare (2.3%). Totally 82.0% had restricted range of motion, 23.5% had decreased muscle force, and 72.2% of the patients had restricted activities of daily living capacities. With time the activities of daily living capacity of female increased (P 0.05). The difference between the patients' ages and ADL capacities did not reach statistical significance (P > 0.05), nor was there a significant difference between their ages and the numbers of days in hospital (P > 0.05). Fractures were the main issue in the seismic wounded, many of them had reductions in the ROM, muscle force and ADL capacities. The physicians involved in rehabilitation should pay greater attention to muscle force exercises, joint mobilization, and occupational therapy during the early phases post disaster.

  5. A new setup for the underground study of capture reactions

    CERN Document Server

    Casella, C; Lemut, A; Limata, B; Bemmerer, D; Bonetti, R; Broggini, C; Campajola, L; Cocconi, P; Corvisiero, P; Cruz, J; D'Onofrio, A; Formicola, A; Fülöp, Z; Gervino, G; Gialanella, L; Guglielmetti, A; Gustavino, C; Gyürky, G; Loiano, A; Imbriani, G; Jesus, A P; Junker, M; Musico, P; Ordine, A; Parodi, F; Parolin, M; Pinto, J V; Prati, P; Ribeiro, J P; Roca, V; Rogalla, D; Rolfs, C; Romano, M; Rossi-Alvarez, C; Rottura, A; Schuemann, F; Somorjai, E; Strieder, F; Terrasi, F; Trautvetter, H P; Vomiero, A; Zavatarelli, S

    2002-01-01

    For the study of astrophysically relevant capture reactions in the underground laboratory LUNA a new setup of high sensitivity has been implemented. The setup includes a windowless gas target, a 4 pi BGO summing crystal, and beam calorimeters. The setup has been recently used to measure the d(p,gamma) sup 3 He cross-section for the first time within its solar Gamow peak, i.e. down to 2.5 keV c.m. energy. The features of the optimized setup are described.

  6. Simple optical setup implementation for digital Fourier transform holography

    Energy Technology Data Exchange (ETDEWEB)

    De Oliveira, G N [Pos-graduacao em Engenharia Mecanica, TEM/PGMEC, Universidade Federal Fluminense, Rua Passo da Patria, 156, Niteroi, R.J., Cep.: 24.210-240 (Brazil); Rodrigues, D M C; Dos Santos, P A M, E-mail: pams@if.uff.br [Instituto de Fisica, Laboratorio de Optica Nao-linear e Aplicada, Universidade Federal Fluminense, Av. Gal. Nilton Tavares de Souza, s/n, Gragoata, Niteroi, R.J., Cep.:24.210-346 (Brazil)

    2011-01-01

    In the present work a simple implementation of Digital Fourier Transform Holography (DFTH) setup is discussed. This is obtained making a very simple modification in the classical setup arquiteture of the Fourier Transform holography. It is also demonstrated the easy and practical viability of the setup in an interferometric application for mechanical parameters determination. The work is also proposed as an interesting advanced introductory training for graduated students in digital holography.

  7. Estimation of daily protein intake based on spot urine urea nitrogen concentration in chronic kidney disease patients.

    Science.gov (United States)

    Kanno, Hiroko; Kanda, Eiichiro; Sato, Asako; Sakamoto, Kaori; Kanno, Yoshihiko

    2016-04-01

    Determination of daily protein intake in the management of chronic kidney disease (CKD) requires precision. Inaccuracies in recording dietary intake occur, and estimation from total urea excretion presents hurdles owing to the difficulty of collecting whole urine for 24 h. Spot urine has been used for measuring daily sodium intake and urinary protein excretion. In this cross-sectional study, we investigated whether urea nitrogen (UN) concentration in spot urine can be used to predict daily protein intake instead of the 24-h urine collection in 193 Japanese CKD patients (Stages G1-G5). After patient randomization into 2 datasets for the development and validation of models, bootstrapping was used to develop protein intake estimation models. The parameters for the candidate multivariate regression models were male gender, age, body mass index (BMI), diabetes mellitus, dyslipidemia, proteinuria, estimated glomerular filtration rate, serum albumin level, spot urinary UN and creatinine level, and spot urinary UN/creatinine levels. The final model contained BMI and spot urinary UN level. The final model was selected because of the higher correlation between the predicted and measured protein intakes r = 0.558 (95 % confidence interval 0.400, 0.683), and the smaller distribution of the difference between the measured and predicted protein intakes than those of the other models. The results suggest that UN concentration in spot urine may be used to estimate daily protein intake and that a prediction formula would be useful for nutritional control in CKD patients.

  8. Open-Label Single-Sequence Crossover Study Evaluating Pharmacokinetics, Efficacy, and Safety of Once-Daily Dosing of Nitisinone in Patients with Hereditary Tyrosinemia Type 1.

    Science.gov (United States)

    Guffon, Nathalie; Bröijersén, Anders; Palmgren, Ingrid; Rudebeck, Mattias; Olsson, Birgitta

    2018-01-01

    Although nitisinone is successfully used to treat hereditary tyrosinemia type 1 (HT-1) with the recommended twice-daily dosing, data describing a long half-life motivate less frequent dosing. Therefore, in agreement with the Pharmacovigilance Risk Assessment Committee at the European Medicines Agency, this study was performed to investigate the switch to once-daily dosing. This open-label, non-randomized, single-sequence crossover study evaluated the pharmacokinetics, efficacy, and safety of once-daily compared to twice-daily dosing of nitisinone in patients with HT-1 (NCT02323529). Well-controlled patients of dry blood spots by tandem mass spectrometry. The primary endpoint was C min of nitisinone after ≥4 weeks of treatment on each dosing regimen. Secondary objectives were evaluation of efficacy and safety during each dosing regimen. In total, 19 patients were enrolled and 17 included in the per-protocol analysis set. The mean (SD) nitisinone C min decreased by 23%, from 26.4 (10.2) to 21.2 (9.9) μmol/L in dry blood spot samples (not equivalent to plasma concentrations), when patients switched from twice- to once-daily dosing. There was no apparent age- or bodyweight-related trend in the degree of C min decrease. No patient had quantifiable succinylacetone levels during the once-daily treatment period, indicating efficacious treatment. All adverse events were mild or moderate and judged unrelated to nitisinone. The switch to once-daily treatment with nitisinone appeared efficacious and safe in the treatment of patients with HT-1.

  9. Weight control in schizophrenic patients through Sakata's Charting of Daily Weight Pattern and its associations with temperament and character.

    Science.gov (United States)

    Miyoshi, Ryoei; Matsuo, Hisae; Naono-Nagatomo, Keiko; Ozono, Kazuhiko; Araki, Ryuji; Ishikawa, Michiko; Abe, Hiroshi; Taniguchi, Hiroshi; Ishida, Yasushi

    2014-02-01

    This study examined whether daily self-monitoring of weight and monthly interviews with a doctor improved eating habits and led to weight loss, and whether temperament and character traits affect weight change in persons with schizophrenia. Participants used Sakata's Charting of Daily Weight Pattern to monitor their weight daily. In addition, Sakata's Eating Behavior Questionnaire was administered to evaluate eating-behavior awareness. The Temperament and Character Inventory (TCI) was used to assess participants' temperament and character. Fifty patients were divided into two groups: the intervention group (n = 25) filled in Sakata's Charting of Daily Weight Pattern every day; was interviewed monthly by a doctor about weight management; was weighed monthly. The non-intervention group (n = 25) was only weighed monthly. The body mass index (mean ± standard error: 0.59 ± 0.10 kg/m(2), p Weight change and TCI scores were not correlated for the intervention group, but scores for "self-directedness" and weight gain in the non-intervention group had a marginally significant negative correlation (r = -0.33, p weight daily on Sakata's Charting of Daily Weight Pattern led to improvements in eating behavior and a decrease in BMI of patients with schizophrenia. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. The Impact of use of Double Set-up on Infection Rates in Revision Total Knee Replacement and Limb Salvage Procedures

    Directory of Open Access Journals (Sweden)

    Jennifer Waterman

    2015-03-01

    Full Text Available A retrospective analysis was performed to determine the impact of utilizing a double set-up procedure on reducing infection rates revision total knee and limb salvage procedures in patients with known joint infection.  Eighteen cases fit selection criteria.  The recurrence rate of infection was 5.5% which is less than reported recent literature review.   This suggests the use of a double set-up in combination with other infection reducing protocols may help further reduce recurrent infection.  Keywords: double set-up, infection, revision total knee arthroplasty, limb-salvage

  11. Comparison of the effectiveness of different immobilization systems in different body regions using daily megavoltage CT in helical tomotherapy

    Science.gov (United States)

    Cheng, K-F

    2014-01-01

    Objective: Effective immobilization is crucial for the accurate delivery of radiotherapy. This study aimed to compare the effectiveness of the commonly used immobilization systems for different body regions using megavoltage CT (MVCT). Methods: Daily treatment set-up data from 212 patients treated by helical tomotherapy (Accuray, Sunnyvale, CA) in 6 body regions (52 head and neck, 41 chest, 38 abdomen, 36 pelvis, 18 breast and 27 cranium) were obtained. Based on a verification tool using the pre-treatment MVCT, set-up corrections for each patient were recorded. Mean systematic and random errors of lateral, longitudinal, vertical and roll directions and three-dimensional vectors were compared between immobilization systems of each region. Results: Smaller set-up deviations were observed in the Orfit system (Orfit Industries NV, Wijnegem, Belgium) of the head and neck region, while the performance of immobilization systems for the chest, abdomen and pelvis regions was similar. Larger differences were noted in the breast group, where the prone BodyFIX® system (Medical Intelligence, Medizintechnik GmbH, Schwabmünchen, Germany) was less stable than the supine VacLok® system (CIVCO Medical Solutions, Orange City, IA). Conclusion: Differences were found between the immobilization systems in the head and neck region, in which the Orfit system was relatively more effective, whereas the VacLok and BodyFIX systems performed similarly in the chest, abdomen and pelvis regions. For the breast case, the supine position with VacLok was much more stable than the prone breast technique. The results provided references for the estimation of clinical target volume–planning target volume margins. Advances in knowledge: This is the first article on comprehensive comparisons performed in immobilization systems for main body regions that provides some practical recommendations. PMID:24398111

  12. Predictors for half-year outcome of impairment in daily life for back pain patients referred for physiotherapy: a prospective observational study.

    Science.gov (United States)

    Karstens, Sven; Hermann, Katja; Froböse, Ingo; Weiler, Stephan W

    2013-01-01

    From observational studies, there is only sparse information available on the predictors of development of impairment in daily life for patients receiving physiotherapy. Therefore, our aim was to identify factors which predict impairment in daily life for patients with back pain 6 months after receiving physiotherapy. We conducted a prospective cohort study with 6-month follow-up. Patients were enrolled for treatment in private physiotherapy practices. Patients with a first physiotherapy referral because of thoracic or low back pain, aged 18 to 65 years were included. Primary outcome impairment was measured utilising the 16-item version of the Musculoskeletal Function Assessment Questionnaire. Therapy was documented on a standardized form. Baseline scores for impairment in daily life, symptom characteristics, sociodemographic and psychosocial factors, physical activity, nicotine consumption, intake of analgesics, comorbidity and delivered primary therapy approach were investigated as possible predictors. Univariate and multiple linear regression analyses were performed. A total of 792 patients participated in the study (59% female, mean age 44.4 (SD 11.4), with 6-month follow-up results available from 391 patients. In univariate analysis 17 variables reached significance. In multiple linear regression identified predictors were: impairment in daily life before therapy, mental disorders, duration of the complaints, self-prognosis on work ability, rheumatoid arthritis, age, form of stress at work and physical activity. The variables explain 34% of variance (adjusted R(2), pphysiotherapy patients, this study adds new knowledge for forming appropriate referral guidelines. Impairment in daily life before therapy, mental disorder as comorbidity and the duration of the complaints can be named as outstanding factors. The results of this study can be used to facilitate comparison of patient therapy goals with the prognosis in everyday practice.

  13. Predictors for half-year outcome of impairment in daily life for back pain patients referred for physiotherapy: a prospective observational study.

    Directory of Open Access Journals (Sweden)

    Sven Karstens

    Full Text Available BACKGROUND AND OBJECTIVE: From observational studies, there is only sparse information available on the predictors of development of impairment in daily life for patients receiving physiotherapy. Therefore, our aim was to identify factors which predict impairment in daily life for patients with back pain 6 months after receiving physiotherapy. METHODS: We conducted a prospective cohort study with 6-month follow-up. Patients were enrolled for treatment in private physiotherapy practices. Patients with a first physiotherapy referral because of thoracic or low back pain, aged 18 to 65 years were included. Primary outcome impairment was measured utilising the 16-item version of the Musculoskeletal Function Assessment Questionnaire. Therapy was documented on a standardized form. Baseline scores for impairment in daily life, symptom characteristics, sociodemographic and psychosocial factors, physical activity, nicotine consumption, intake of analgesics, comorbidity and delivered primary therapy approach were investigated as possible predictors. Univariate and multiple linear regression analyses were performed. RESULTS: A total of 792 patients participated in the study (59% female, mean age 44.4 (SD 11.4, with 6-month follow-up results available from 391 patients. In univariate analysis 17 variables reached significance. In multiple linear regression identified predictors were: impairment in daily life before therapy, mental disorders, duration of the complaints, self-prognosis on work ability, rheumatoid arthritis, age, form of stress at work and physical activity. The variables explain 34% of variance (adjusted R(2, p<0.001. CONCLUSIONS: With minimal information available from observational studies on the predictors of development of back problems for physiotherapy patients, this study adds new knowledge for forming appropriate referral guidelines. Impairment in daily life before therapy, mental disorder as comorbidity and the duration of the

  14. Personal meaning in relation to daily functioning of a patient in physical therapy practice: narratives of a patient, a family member, and physical therapist.

    Science.gov (United States)

    Oosting, Ellen; Dronkers, Jaap; Hoogeboom, Thomas; van Meeteren, Nico; Speelman, Willem Marie

    2018-05-01

    To get insight into personal meaning of a person involved in a physical therapy intervention. Mrs. A, a 76-year-old woman is referred to a physical therapist (PT) for assessment of functioning and training before total hip arthroplasty (THA). The patient, her daughter, and PT were asked to write a story about their daily life. Stories were analyzed according to the narrative scheme based on a method to find meaning in daily life, which consists of four phases: 1. Motivation; 2. Competences; 3. Performance; and 4. Mrs. A was mainly motivated by her will to do enjoyable social activities and stay independent. Although she tried her best to undertake activities (performance) that made her proud (evaluation), her pain and physical limitations were anti-competences that motivated her to attend healthcare. Although the PT seemed to be aware of personal participation goals, her main motivation was to improve and evaluate functions and activities. The daughter was motivated by good relationships and did not see herself as informal caregiver. The narrative method was a valuable tool to clarify motivations, competences, and values in the process of creating personal meaning related to functioning. This knowledge could help caregivers in applying patient-centered goal-setting and treatment on a participation level. Implications for rehabilitation Personal meaning of people's functioning within their daily context can be clarified from daily life stories. This case report demonstrates that motivations and goals may differ between patient and therapist; the PT seems to focus on improving and evaluating functions and activities, while the patient seems to focus her motivations and personal meaning on participation. This approach may help in patient-centered goal-setting at the level of activities and participation.

  15. Tamsulosin 0.4 mg once daily: effect on sexual function in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction

    NARCIS (Netherlands)

    Höfner, K.; Claes, H.; de Reijke, T. M.; Folkestad, B.; Speakman, M. J.

    1999-01-01

    To evaluate the effect of tamsulosin, 0.4 mg once daily, on sexual function in comparison with placebo and alfuzosin, 2.5 mg three times daily, in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO). Data from 830 patients randomized into three European

  16. Setup accuracy for prone and supine whole breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Mulliez, Thomas; Vercauteren, Tom; Greveling, Annick van; Speleers, Bruno; Neve, Wilfried de; Veldeman, Liv [University Hospital Ghent, Department of Radiotherapy, Ghent (Belgium); Gulyban, Akos [University Hospital Ghent, Department of Radiotherapy, Ghent (Belgium); University Hospital Liege, Department of Radiotherapy, Liege (Belgium)

    2016-04-15

    To evaluate cone-beam computed tomography (CBCT) based setup accuracy and margins for prone and supine whole breast irradiation (WBI). Setup accuracy was evaluated on 3559 CBCT scans of 242 patients treated with WBI and uncertainty margins were calculated using the van Herk formula. Uni- and multivariate analysis on individual margins was performed for age, body mass index (BMI) and cup size. The population-based margin in vertical (VE), lateral (LA) and longitudinal (LO) directions was 10.4/9.4/9.4 mm for the 103 supine and 10.5/22.4/13.7 mm for the 139 prone treated patients, being significantly (p < 0.01) different for the LA and LO directions. Multivariate analysis identified a significant (p < 0.05) correlation between BMI and the LO margin in supine position and the VE/LA margin in prone position. In this series, setup accuracy is significantly worse in prone compared to supine position for the LA and LO directions. However, without proper image-guidance, uncertainty margins of about 1 cm are also necessary for supine WBI. For patients with a higher BMI, larger margins are required. (orig.) [German] Ziel der Arbeit war es, die interfraktionelle Repositionierungsgenauigkeit in Bauchlage (BL) versus Rueckenlage (RL) bei Ganzbrustbestrahlung (GBB) mittels Cone-Beam-CT (CBCT) zu bestimmen, um die notwendigen PTV-Sicherheitsabstaende zu definieren. Die Repositionierungsgenauigkeit wurde basierend an 3559 CBCT-Scans von 242 mit GBB behandelten Patienten ausgewertet. Die PTV-Sicherheitsabstaende wurden unter Verwendung der ''van-Herk''-Formel berechnet. Uni- und multivariable Analysen wurden fuer Sicherheitsabstaende in jede Richtung auf Basis von Alter, Body-Mass-Index (BMI) und Koerbchengroesse durchgefuehrt. Die basierend auf den taeglichen CBCT-Verschiebungen berechneten PTV-Sicherheitsabstaende betrugen in anteroposteriorer (AP), lateraler (LT oder links-rechts) und kraniokaudaler (CC) Richtung 10,4/9,4/9,4 mm fuer die RL (103 Patienten) und

  17. The COMPASS Setup for Physics with Hadron Beams

    CERN Document Server

    Abbon, Ph.; Akhunzyanov, R.; Alexandrov, Yu.; Alexeev, M.G.; Alexeev, G.D.; Amoroso, A.; Andrieux, V.; Anosov, V.; Austregesilo, A.; Badelek, B.; Balestra, F.; Barth, J.; Baum, G.; Beck, R.; Bedfer, Y.; Berlin, A.; Bernhard, J.; Bicker, K.; Bielert, E.R.; Bieling, J.; Birsa, R.; Bisplinghoff, J.; Bodlak, M.; Boer, M.; Bordalo, P.; Bradamante, F.; Braun, C.; Bressan, A.; Buchele, M.; Burtin, E.; Capozza, L.; Ciliberti, P.; Chiosso, M.; Chung, S.U.; Cicuttin, A.; Colantoni, M.; Cotte, D.; Crespo, M.L.; Curiel, Q.; Dafni, T.; Dalla Torre, S.; Dasgupta, S.S.; Dasgupta, S.; Denisov, O.Yu.; Desforge, D.; Dinkelbach, A.M.; Donskov, S.V.; Doshita, N.; Duic, V.; Dunnweber, W.; Durand, D.; Dziewiecki, M.; Efremov, A.; Elia, C.; Eversheim, P.D.; Eyrich, W.; Faessler, M.; Ferrero, A.; Finger, M.; M. Finger jr; Fischer, H.; Franco, C.; von Hohenesche, N. du Fresne; Friedrich, J.M.; Frolov, V.; Gatignon, L.; Gautheron, F.; Gavrichtchouk, O.P.; Gerassimov, S.; Geyer, R.; Giganon, A.; Gnesi, I.; Gobbo, B.; Goertz, S.; Gorzellik, M.; Grabmuller, S.; Grasso, A.; Gregori, M.; Grube, B.; Grussenmeyer, T.; Guskov, A.; Haas, F.; von Harrach, D.; Hahne, D.; Hashimoto, R.; Heinsius, F.H.; Herrmann, F.; Hinterberger, F.; Hoppner, Ch.; Horikawa, N.; d'Hose, N.; Huber, S.; Ishimoto, S.; Ivanov, A.; Ivanshin, Yu.; Iwata, T.; Jahn, R.; Jary, V.; Jasinski, P.; Jorg, P.; Joosten, R.; Kabuss, E.; Ketzer, B.; Khaustov, G.V.; Khokhlov, Yu. A.; Kisselev, Yu.; Klein, F.; Klimaszewski, K.; Koivuniemi, J.H.; Kolosov, V.N.; Kondo, K.; Konigsmann, K.; Konorov, I.; Konstantinov, V.F.; Kotzinian, A.M.; Kouznetsov, O.; Kramer, M.; Kroumchtein, Z.V.; Kuchinski, N.; Kuhn, R.; Kunne, F.; Kurek, K.; Kurjata, R.P.; Lednev, A.A.; Lehmann, A.; Levillain, M.; Levorato, S.; Lichtenstadt, J.; Maggiora, A.; Magnon, A.; Makke, N.; Mallot, G.K.; Marchand, C.; Marroncle, J.; Martin, A.; Marzec, J.; Matousek, J.; Matsuda, H.; Matsuda, T.; Menon, G.; Meshcheryakov, G.; Meyer, W.; Michigami, T.; Mikhailov, Yu. V.; Miyachi, Y.; Moinester, M.A.; Nagaytsev, A.; Nagel, T.; Nerling, F.; Neubert, S.; Neyret, D.; Nikolaenko, V.I.; Novy, J.; Nowak, W.D.; Nunes, Ana Sofia; Olshevsky, A.G.; Orlov, I.; Ostrick, M.; Panknin, R.; Panzieri, D.; Parsamyan, B.; Paul, S.; Pesaro, G.; Pesaro, V.; Peshekhonov, D.V.; Pires, C.; Platchkov, S.; Pochodzalla, J.; Polyakov, V.A.; Pretz, J.; Quaresma, M.; Quintans, C.; Ramos, S.; Regali, C.; Reicherz, G.; Reymond, J-M.; Rocco, E.; Rossiyskaya, N.S.; Rousse, J.Y.; Ryabchikov, D.I.; Rychter, A.; Samartsev, A.; Samoylenko, V.D.; Sandacz, A.; Sarkar, S.; Savin, I.A.; Sbrizzai, G.; Schiavon, P.; Schill, C.; Schluter, T.; Schmidt, K.; Schmieden, H.; Schonning, K.; Schopferer, S.; Schott, M.; Shevchenko, O.Yu.; Silva, L.; Sinha, L.; Sirtl, S.; Slunecka, M.; Sosio, S.; Sozzi, F.; Srnka, A.; Steiger, L.; Stolarski, M.; Sulc, M.; Sulej, R.; Suzuki, H.; Szabelski, A.; Szameitat, T.; Sznajder, P.; Takekawa, S.; Wolbeek, J. ter; Tessaro, S.; Tessarotto, F.; Thibaud, F.; Tskhay, V.; Uhl, S.; Uman, I.; Virius, M.; Wang, L.; Weisrock, T.; Weitzel, Q.; Wilfert, M.; Windmolders, R.; Wollny, H.; Zaremba, K.; Zavertyaev, M.; Zemlyanichkina, E.; Ziembicki, M.; Zink, A.

    2015-01-01

    The main characteristics of the COMPASS experimental setup for physics with hadron beams are described. This setup was designed to perform exclusive measurements of processes with several charged and/or neutral particles in the final state. Making use of a large part of the apparatus that was previously built for spin structure studies with a muon beam, it also features a new target system as well as new or upgraded detectors. The hadron setup is able to operate at the high incident hadron flux available at CERN. It is characterised by large angular and momentum coverages, large and nearly flat acceptances, and good two and three-particle mass resolutions. In 2008 and 2009 it was successfully used with positive and negative hadron beams and with liquid hydrogen and solid nuclear targets. This article describes the new and upgraded detectors and auxiliary equipment, outlines the reconstruction procedures used, and summarises the general performance of the setup.

  18. Cannabis and alcohol use, affect and impulsivity in psychiatric out-patients' daily lives.

    Science.gov (United States)

    Trull, Timothy J; Wycoff, Andrea M; Lane, Sean P; Carpenter, Ryan W; Brown, Whitney C

    2016-11-01

    Cannabis and alcohol are the most commonly used (il)licit drugs world-wide. We compared the effects of cannabis and alcohol use on within-person changes in impulsivity, hostility and positive affect at the momentary and daily levels, as they occurred in daily life. Observational study involving ecological momentary assessments collected via electronic diaries six random times a day for 28 consecutive days. Out-patients' everyday life contexts in Columbia, MO, USA. Ninety-three adult psychiatric out-patients (85% female; mean = 30.9 years old) with borderline personality or depressive disorders, who reported using only cannabis (n = 3), only alcohol (n = 58) or both (n = 32) at least once during the study period. Real-time, standard self-report measures of impulsivity, hostility and positive affect, as impacted by momentary reports of cannabis and alcohol use. Cannabis use was associated with elevated feelings of impulsivity at the day level [b = 0.83, 95% confidence interval (CI) = 0.17-1.49] and increased hostility at the momentary (b = 0.07, 95% CI = 0.01-0.12) and person (b = 0.81, 95% CI = 0.15-1.47) level. Alcohol use was associated with elevated feelings of impulsivity at the momentary (b = 0.42, 95% CI = 0.13-0.71) and day levels (b = 0.82, 95% CI = 0.22-1.41) and increased positive affect at the momentary (b = 0.12, 95% CI = 0.06-0.18) and day (b = 0.33, 95% CI = 0.16-0.49) levels. Cannabis and alcohol use are associated with increases in impulsivity (both), hostility (cannabis) and positive affect (alcohol) in daily life, and these effects are part of separate processes that operate on different time-scales (i.e. momentary versus daily). © 2016 Society for the Study of Addiction.

  19. Coping with side effects from cancer treatment in daily life from the perspective of cancer patients: A qualitative empirical study

    DEFF Research Database (Denmark)

    Pedersen, Birgith; Koktved, Dorte Pallesen; Nielsen, Lene Lyngø

    Aim The aim of this paper is to deepen our understanding of how patients cope with side effects from cancer treatment in daily life. Background Patients receiving cancer treatment experience acute side effects and need individualized information and guidance in order to manage treatment......-related adverse events in everyday life. However development in cancer treatment and the societal demands for efficiency may limit the possibility for individualized support. Methods Nine patients were interviewed from March to July 2009 to explore the patients’ experience of coping with side effects in daily...

  20. Evaluation of Image-Guidance Strategies in the Treatment of Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Kupelian, Patrick A.; Lee, Choonik; Langen, Katja M.; Zeidan, Omar A.; Manon, Rafael R.; Willoughby, Twyla R.; Meeks, Sanford L.

    2008-01-01

    Purpose: To compare different image-guidance strategies in the alignment of prostate cancer patients. Using data from patients treated using daily image guidance, the remaining setup errors for several different strategies were retrospectively calculated. Methods and Materials: The alignment data from 74 patients treated with helical tomotherapy were analyzed, resulting in a data set of 2,252 fractions during which a megavoltage computed tomography image was used for image guidance with intraprostatic metallic fiducials. Given the daily positional adjustments, a variety of protocols, differing in imaging frequency and method, were retrospectively studied. The residual setup errors were determined for each protocol. Results: As expected, the systematic errors were effectively reduced with imaging. However, the random errors were unaffected. Even when image guidance was performed every other day with a running mean of the previous displacements, residual setup errors >5 mm occurred in 24% of all fractions. This frequency increased to about 40% if setup errors >3 mm were scored. Conclusion: Setup errors increased with decreasing frequency of image guidance. However, residual errors were still significant at the 5-mm level, even with imaging was performed every other day. This suggests that localizations must be performed daily in the set up of prostate cancer patients during a course of external beam radiotherapy

  1. Automated evaluation of setup errors in carbon ion therapy using PET: Feasibility study

    International Nuclear Information System (INIS)

    Kuess, Peter; Hopfgartner, Johannes; Georg, Dietmar; Helmbrecht, Stephan; Fiedler, Fine; Birkfellner, Wolfgang; Enghardt, Wolfgang

    2013-01-01

    Purpose: To investigate the possibility of detecting patient mispositioning in carbon-ion therapy with particle therapy positron emission tomography (PET) in an automated image registration based manner. Methods: Tumors in the head and neck (H and N), pelvic, lung, and brain region were investigated. Biologically optimized carbon ion treatment plans were created with TRiP98. From these treatment plans, the reference β + -activity distributions were calculated using a Monte Carlo simulation. Setup errors were simulated by shifting or rotating the computed tomography (CT). The expected β + activity was calculated for each plan with shifts. Finally, the reference particle therapy PET images were compared to the “shifted” β + -activity distribution simulations using the Pearson's correlation coefficient (PCC). To account for different PET monitoring options the inbeam PET was compared to three different inroom scenarios. Additionally, the dosimetric effects of the CT misalignments were investigated. Results: The automated PCC detection of patient mispositioning was possible in the investigated indications for cranio-caudal shifts of 4 mm and more, except for prostate tumors. In the rather homogeneous pelvic region, the generated β + -activity distribution of the reference and compared PET image were too much alike. Thus, setup errors in this region could not be detected. Regarding lung lesions the detection strongly depended on the exact tumor location: in the center of the lung tumor misalignments could be detected down to 2 mm shifts while resolving shifts of tumors close to the thoracic wall was more challenging. Rotational shifts in the H and N and lung region of +6° and more could be detected using inroom PET and partly using inbeam PET. Comparing inroom PET to inbeam PET no obvious trend was found. However, among the inroom scenarios a longer measurement time was found to be advantageous. Conclusions: This study scopes the use of various particle therapy

  2. Daily online localization using implanted fiducial markers and its impact on planning target volume for carcinoma prostate.

    Science.gov (United States)

    Khosa, Robin; Nangia, Sapna; Chufal, Kundan S; Ghosh, D; Kaul, Rakesh; Sharma, Lalit

    2010-01-01

    Aim of the study was to assess prostate motion on daily basis with respect to setup and to compare the shifts based on bony anatomy and gold fiducial markers. Gold fiducial markers were inserted in prostate under U/S guidance and daily portal images were taken and compared with digitally reconstructed images, both using bony landmarks and fiducial markers as reference. A dose of 2 MU was given for two orthogonal images daily. The mean and standard deviation of displacement using gold seeds and bone were calculated. Systematic and random errors were generated. The planning target volume (PTV) was calculated using the Van Herk formula. A total of 180 portal images from 10 patients were studied. The mean displacement along x, y and z axes was 1.67 mm, 3.58 mm, and 1.76 mm using fiducial markers and 2.12 mm, 3.47 mm, and 2.09 mm using bony landmarks, respectively. The mean internal organ motion was 1.23 mm (+1.45), 3.11 mm (+2.69 mm); and 1.87 mm (+1.67 mm) along x, y and z axes, respectively. The PTV to account for prostate motion if daily matching was not done was 4.64 mm, 10.41 mm and 4.40 mm along lateral, superoinferior, and anteroposterior directions, respectively. If bony landmarks were used for daily matching, margins of 3.61 mm, 7.31 mm, and 4.72 mm in lateral, superoinferior, and anteroposterior directions should be added to the clinical target volume. Daily alignment using gold fiducial markers is an effective method of localizing prostate displacement. It provides the option of reducing margins, thus limiting normal tissue toxicity and allowing the possibility of dose escalation for better long-term control.

  3. Effect of Gait Retraining on Balance, Activities of Daily Living, Quality of Life and Depression in Stroke Patients

    Directory of Open Access Journals (Sweden)

    Majid Farhadian

    2015-12-01

    Full Text Available Objectives: Stroke is one of the most common neurological disease and it is the main cause of physical and mental disability and staying in house. Gait difficulties have high incidence in patients with stroke. So the aim of this study was to investigate the effect of gait retraining on balance, activities of daily living, quality of life and depressionin stroke patients. Methods: This study was a clinical trial without control group. Sampling was performed by convenience sampling method and 18 patients participated. After recording demographic data, Berg Balance Scale, Barthel Index, SF36 questionnaire and Beck Depression Inventory-II used in pre-test and post-test to assess balance, activities of daily living, quality of life and depression, respectively .Data were analyzed using Pearson correlation coefficient and paired T-test. Results: The results showed statistically significant correlation in pre-test and difference between mean score of the all instruments before and after the intervention. Discussion: According to high prevalence of gait difficulties in stroke patients, it seems interventions in this area is necessary. Statistical results showed that the gait retraining intervention may have a positive effect on improving balance, activities of daily living, quality of life and depression of these patients. According to lack of information in this area, further research is needed.

  4. A Daily Diary Approach to the Examination of Chronic Stress, Daily Hassles and Safety Perceptions in Hospital Nursing.

    Science.gov (United States)

    Louch, Gemma; O'Hara, Jane; Gardner, Peter; O'Connor, Daryl B

    2017-12-01

    Stress is a significant concern for individuals and organisations. Few studies have explored stress, burnout and patient safety in hospital nursing on a daily basis at the individual level. This study aimed to examine the effects of chronic stress and daily hassles on safety perceptions, the effect of chronic stress on daily hassles experienced and chronic stress as a potential moderator. Utilising a daily diary design, 83 UK hospital nurses completed three end-of-shift diaries, yielding 324 person days. Hassles, safety perceptions and workplace cognitive failure were measured daily, and a baseline questionnaire included a measure of chronic stress. Hierarchical multivariate linear modelling was used to analyse the data. Higher chronic stress was associated with more daily hassles, poorer perceptions of safety and being less able to practise safely, but not more workplace cognitive failure. Reporting more daily hassles was associated with poorer perceptions of safety, being less able to practise safely and more workplace cognitive failure. Chronic stress did not moderate daily associations. The hassles reported illustrate the wide-ranging hassles nurses experienced. The findings demonstrate, in addition to chronic stress, the importance of daily hassles for nurses' perceptions of safety and the hassles experienced by hospital nurses on a daily basis. Nurses perceive chronic stress and daily hassles to contribute to their perceptions of safety. Measuring the number of daily hassles experienced could proactively highlight when patient safety threats may arise, and as a result, interventions could usefully focus on the management of daily hassles.

  5. Impact of fixed orthodontic appliance or clear-aligner on daily performance, in adult patients with moderate need for treatment.

    Science.gov (United States)

    Lin, Feiou; Yao, Linjie; Bhikoo, Chandradev; Guo, Jing

    2016-01-01

    To assess the impact of wearing fixed orthodontic appliance (FOA) or clear-aligner, on daily performance in adult patients. The Oral Impacts on Daily Performance (OIDP) index was assessed in 152 adults aged 25-35 years at baseline (T0), 6 months after bonding (T1), and 12 months after bonding (T2). Participants were randomly divided into two groups: CA group (participants treated with clear-aligner) and a control group (FOA group; participants treated with FOA). Baseline malocclusion severity was assessed using the Index of Orthodontic Treatment Need. There were no significant differences in sociodemographic variables and OIDP scores at baseline between the two groups. Significant changes in OIDP total and subscale scores were observed while wearing FOA: OIDP total score and subscale scores of eating, cleaning teeth, smiling, and social relation at T1 and T2 were significantly higher than at baseline (P<0.05 or P<0.01). However, only OIDP total score was significantly increased at T1 compared to the baseline in the CA group. OIDP total score and subscale scores of eating, cleaning teeth, smiling, and social relation were significantly higher in patients wearing FOA than in patients wearing clear-aligner at T1 and T2 (P<0.05 or P<0.01). Patients wearing clear-aligner have fewer impacts on daily life than those wearing FOA during treatment, and have no significant changes in OIPD subscale scores at 12 months. FOA therapy significantly impacts daily performance in adult patients during treatment.

  6. Strategies of Daily Living Rehabilitative Activities for Post Stroke Patients at Minia University Hospital

    Science.gov (United States)

    Zaky, Hend Elham Mohamed; EL-Lateef Mohammad, Zienab Abd; EL-Labban, Abdou Saad Taha; Ahmed, Gahen

    2015-01-01

    Background: Stroke is a leading cause of disability. Rehabilitation aims to hasten and maximize recovery from stroke by treating the disabilities caused by the stroke. Therefore, the aim of this study determine the post stroke patients' knowledge and practices in relation to disease and activities of daily living before the implementation of…

  7. Multiple regions-of-interest analysis of setup uncertainties for head-and-neck cancer radiotherapy

    International Nuclear Information System (INIS)

    Zhang Lifei; Garden, Adam S.; Lo, Justin; Ang, K. Kian; Ahamad, Anesa; Morrison, William H.; Rosenthal, David I.; Chambers, Mark S.; Zhu, X. Ronald; Mohan, Radhe; Dong Lei

    2006-01-01

    Purpose: To analyze three-dimensional setup uncertainties for multiple regions of interest (ROIs) in head-and-neck region. Methods and Materials: In-room computed tomography (CT) scans were acquired using a CT-on-rails system for 14 patients. Three separate bony ROIs were defined: C2 and C6 vertebral bodies and the palatine process of the maxilla. Translational shifts of 3 ROIs were calculated relative to the marked isocenter on the immobilization mask. Results: The shifts for all 3 ROIs were highly correlated. However, noticeable differences on the order of 2-6 mm existed between any 2 ROIs, indicating the flexibility and/or rotational effect in the head-and-neck region. The palatine process of the maxilla had the smallest right-left shifts because of the tight lateral fit in the face mask, but the largest superior-inferior movement because of in-plane rotation and variations in jaw positions. The neck region (C6) had the largest right-left shifts. The positioning mouthpiece was found effective in reducing variations in the superior-inferior direction. There was no statistically significant improvement for using the S-board (8 out of 14 patients) vs. the short face mask. Conclusions: We found variability in setup corrections for different regions of head-and-neck anatomy. These relative positional variations should be considered when making setup corrections or designing treatment margins

  8. Peripheral Lymph Node Excisional Biopsy: Yield, Relevance, and Outcomes in a Remote Surgical Setup

    Directory of Open Access Journals (Sweden)

    Ashish Lal Shrestha

    2018-01-01

    Full Text Available Objective. To study the patient profile for symptomatic peripheral lymphadenopathy in terms of histopathological findings and demography and evaluate the yield, relevance, and outcomes of peripheral lymph node biopsy (PLNB as a diagnostic step in a remote setup in the absence of less invasive options like fine-needle aspiration cytology (FNAC or ultrasonogram- (USG- guided FNAC. Methods. A retrospective review of patients undergoing PLNB between 1 May 2011 and 30 April 2013 was done. Demographics, histopathological reports, and outcomes were studied. Results. Of 132 patients, 51 (38.63% were male and 81 (61.36% were female. There were 48 (36.3% patients in the age group less than 16 years, and 84 (63.6% were beyond 16 years. The commonest site of biopsy was the neck in 114 (86.36% patients. The histopathological diagnosis was tuberculosis (TB in 60 (45.45% patients, reactive lymphadenitis in 29 (21.9%, nonspecific granuloma in 18 (13.6%, lymphoma in 7 (5.3%, acute lymphadenitis in 7 (5.3%, metastatic secondary in 3 (2.2%, and other benign causes in 8 (6.06%. Conclusions. PLNB is a procedure with good diagnostic yield in evaluation of peripheral lymphadenopathy. Its relevance is appreciable in a remote setup where less invasive options are unavailable. Its simplicity and lack of mortality/significant morbidity make it a valid option in rural surgical practice.

  9. Six dimensional analysis with daily stereoscopic x-ray imaging of intrafraction patient motion in head and neck treatments using five points fixation masks

    International Nuclear Information System (INIS)

    Linthout, Nadine; Verellen, Dirk; Tournel, Koen; Storme, Guy

    2006-01-01

    The safety margins used to define the Planning Target Volume (PTV) should reflect the accuracy of the target localization during treatment that comprises both the reproducibility of the patient positioning and the positional uncertainty of the target, so both the inter- and intrafraction motion of the target. Our first aim in this study was to determine the intrafraction motion of patients immobilized with a five-point thermoplastic mask for head and neck treatments. The five-point masks have the advantage that the patient's shoulders as well as the cranial part of the patient's head is covered with the thermoplastic material that improves the overall immobilization of the head and neck region of the patient. Thirteen patients were consecutively assigned to use a five-point thermoplastic mask. The patients were positioned by tracking of infrared markers (IR) fixed to the immobilization device and stereoscopic x-ray images were used for daily on-line setup verification. Repositioning was carried out prior to treatment as needed; rotations were not corrected. Movements during treatment were monitored by real-time IR tracking. Intrafraction motion and rotation was supplementary assessed by a six-degree-of-freedom (6-D) fusion of x-ray images, taken before and after all 385 treatments, with DRR images generated from the planning CT data. The latter evaluates the movement of the patient within the thermoplastic mask independent from the mask movement, where IR tracking evaluates the movement of the mask caused by patient movement in the mask. These two movements are not necessarily equal to each other. The maximum intrafraction movement detected by IR tracking showed a shift [mean (SD; range)] of -0.1(0.7; 6.0), 0.1(0.6; 3.6), -0.2(0.8;5.5) mm in the vertical, longitudinal, and lateral direction, respectively, and rotations of 0.0(0.2; 1.6), 0.0(0.2; 1.7) and 0.2(0.2; 2.4) degrees about the vertical, longitudinal, and lateral axis, respectively. The standard deviations

  10. Clinical validation of a body-fixed 3D accelerometer and algorithm for activity monitoring in orthopaedic patients

    Directory of Open Access Journals (Sweden)

    Matthijs Lipperts

    2017-10-01

    Conclusion: Activity monitoring of orthopaedic patients by counting and timing a large set of relevant daily life events is feasible in a user- and patient-friendly way and at high clinical validity using a generic three-dimensional accelerometer and algorithms based on empirical and physical methods. The algorithms performed well for healthy individuals as well as patients recovering after total joint replacement in a challenging validation set-up. With such a simple and transparent method real-life activity parameters can be collected in orthopaedic practice for diagnostics, treatments, outcome assessment, or biofeedback.

  11. Set-Up and Punchline as Figure and Ground

    DEFF Research Database (Denmark)

    Keisalo, Marianna Päivikki

    the two that cannot be resolved by appeal to either set-up or punchline, but traps thought between them in an ‘epistemological problem’ as comedian Louis CK put it. For comedians, set-ups and punchlines are basic tools, practical and concrete ways to create and organize material. They are also familiar...

  12. A Simple and Effective Daily Pain Management Method for Patients Receiving Radiation Therapy for Painful Bone Metastases

    International Nuclear Information System (INIS)

    Andrade, Regiane S.; Proctor, Julian W.; Slack, Robert; Marlowe, Ursula; Ashby, Karlotta R.; Schenken, Larry L.

    2010-01-01

    Purpose: The incidence of painful bone metastases increases with longer survival times. Although external beam radiation therapy (EBRT) is an effective palliative treatment, it often requires several days from the start of treatment to produce a measurable reduction in pain scores and a qualitative amelioration of patient pain levels. Meanwhile, the use of analgesics remains the best approach early on in the treatment course. We investigated the role of radiation therapists as key personnel for collecting daily pain scores to supplement assessments by physician and oncology nursing staff and manage pain more effectively during radiation treatment. Methods and Materials: Daily pain scores were obtained by the radiation therapists for 89 patients undertaking a total of 124 courses of EBRT for bone metastases and compared with pretreatment pain scores. The majority of patients (71%) were treated to 30 Gy (range, 20-37.5) in 10 fractions (range, 8-15 fractions). Results: One hundred nineteen treatment courses (96%) were completed. Pain scores declined rapidly to 37.5%, 50%, and 75% of the pretreatment levels by Days 2, 4, and 10, respectively. Pain was improved in 91% of patients with only 4% of worse pain at the end of treatment. Improved pain scores were maintained in 83% of patients at 1-month follow-up, but in 35% of them, the pain was worse than at the end of treatment. Conclusions: Collection of daily pain scores by radiation therapists was associated with an effective reduction in pain scores early on during EBRT of painful osseous metastases.

  13. Dose delivered from Varian's CBCT to patients receiving IMRT for prostate cancer

    International Nuclear Information System (INIS)

    Wen Ning; Guan Huaiqun; Hammoud, Rabih; Pradhan, Deepak; Nurushev, T; Li Shidong; Movsas, Benjamin

    2007-01-01

    With the increased use of cone beam CT (CBCT) for daily patient setup, the accumulated dose from CBCT may be significantly higher than that from simulation CT or portal imaging. The objective of this work is to measure the dose from daily pelvic scans with fixed technical settings and collimations. CBCT scans were acquired in half-fan mode using a half bowtie and x-rays were delivered in pulsed-fluoro mode. The skin doses for seven prostate patients were measured on an IRB-approved protocol. TLD capsules were placed on the patient's skin at the central axis of three beams: AP, left lateral (Lt Lat) and right lateral (Rt Lat). To avoid the ring artefacts centred in the prostate, the treatment couch was dropped 3 cm from the patient's tattoo (central axis). The measured AP skin doses ranged 3-6 cGy for 20-33 cm separation. The larger the patient size the less the AP skin dose. Lateral doses did not change much with patient size. The Lt Lat dose was ∼4.0 cGy, which was ∼40% higher than the Rt Lat dose of ∼2.6 cGy. To verify this dose asymmetry, surface doses on an IMRT QA phantom (oval shaped, 30 cm x 20 cm) were measured at the same three sites using TLD capsules with 3 cm table-drop. The dose asymmetry was due to: (1) kV source rotation which always starts from the patient's Lt Lat and ends at Lt Lat. Gantry rotation gets much slower near the end of rotation but dose rate stays constant and (2) 370 0 scan rotation (10 0 scan overlap on the Lt Lat side). In vivo doses were measured inside a Rando pelvic heterogeneous phantom using TLDs. The left hip (femoral head and neck) received the highest doses of ∼10-11 cGy while the right hip received ∼6-7 cGy. The surface and in vivo doses were also measured for phantoms at the central-axis setup. The difference was less than ∼12% to the table-drop setup

  14. Experimental Setups for Single Event Effect Studies

    OpenAIRE

    N. H. Medina; V. A. P. Aguiar; N. Added; F. Aguirre; E. L. A. Macchione; S. G. Alberton; M. A. G. Silveira; J. Benfica; F. Vargas; B. Porcher

    2016-01-01

    Experimental setups are being prepared to test and to qualify electronic devices regarding their tolerance to Single Event Effect (SEE). A multiple test setup and a new beam line developed especially for SEE studies at the São Paulo 8 UD Pelletron accelerator were prepared. This accelerator produces proton beams and heavy ion beams up to 107Ag. A Super conducting Linear accelerator, which is under construction, may fulfill all of the European Space Agency requirements to qualify electronic...

  15. Portal imaging to assess set-up errors, tumor motion and tumor shrinkage during conformal radiotherapy of non-small cell lung cancer

    International Nuclear Information System (INIS)

    Erridge, Sara C.; Seppenwoolde, Yvette; Muller, Sara H.; Herk, Marcel van; Jaeger, Katrien de; Belderbos, Jose S.A.; Boersma, Liesbeth J.; Lebesque, Joos V.

    2003-01-01

    Purpose: To investigate patient set-up, tumor movement and shrinkage during 3D conformal radiotherapy for non-small cell lung cancer. Materials and methods: In 97 patients, electronic portal images (EPIs) were acquired and corrected for set-up using an off-line correction protocol based on a shrinking action level. For 25 selected patients, the orthogonal EPIs (taken at random points in the breathing cycle) throughout the 6-7 week course of treatment were assessed to establish the tumor position in each image using both an overlay and a delineation technique. The range of movement in each direction was calculated. The position of the tumor in the digitally reconstructed radiograph (DRR) was compared to the average position of the lesion in the EPIs. In addition, tumor shrinkage was assessed. Results: The mean overall set-up errors after correction were 0, 0.6 and 0.2 mm in the x (left-right), y (cranial-caudal) and z (anterior-posterior) directions, respectively. After correction, the standard deviations (SDs) of systematic errors were 1.4, 1.5 and 1.3 mm and the SDs of random errors were 2.9, 3.1 and 2.0 mm in the x-, y- and z-directions, respectively. Without correction, 41% of patients had a set-up error of more than 5 mm vector length, but with the set-up correction protocol this percentage was reduced to 1%. The mean amplitude of tumor motion was 7.3 (SD 2.7), 12.5 (SD 7.3) and 9.4 mm (SD 5.2) in the x-, y- and z-directions, respectively. Tumor motion was greatest in the y-direction and in particular for lower lobe tumors. In 40% of the patients, the projected area of the tumor regressed by more than 20% during treatment in at least one projection. In 16 patients it was possible to define the position of the center of the tumor in the DRR. There was a mean difference of 6 mm vector length between the tumor position in the DRR and the average position in the portal images. Conclusions: The application of the correction protocol resulted in a significant

  16. Using a Systems Engineering Initiative for Patient Safety to Evaluate a Hospital-wide Daily Chlorhexidine Bathing Intervention.

    Science.gov (United States)

    Caya, Teresa; Musuuza, Jackson; Yanke, Eric; Schmitz, Michelle; Anderson, Brooke; Carayon, Pascale; Safdar, Nasia

    2015-01-01

    We undertook a systems engineering approach to evaluate housewide implementation of daily chlorhexidine bathing. We performed direct observations of the bathing process and conducted provider and patient surveys. The main outcome was compliance with bathing using a checklist. Fifty-seven percent of baths had full compliance with the chlorhexidine bathing protocol. Additional time was the main barrier. Institutions undertaking daily chlorhexidine bathing should perform a rigorous assessment of implementation to optimize the benefits of this intervention.

  17. The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital

    DEFF Research Database (Denmark)

    Andreasen, Jane; Lund, Hans; Aadahl, Mette

    2015-01-01

    INTRODUCTION: Frail elderly are at higher risk of negative outcomes such as disability, low quality of life, and hospital admissions. Furthermore, a peak in readmission of acutely admitted elderly patients is seen shortly after discharge. An investigation into the daily life experiences...... of the frail elderly shortly after discharge seems important to address these issues. The aim of this study was to explore how frail elderly patients experience daily life 1 week after discharge from an acute admission. METHODS: The qualitative methodological approach was interpretive description. Data were...... gathered using individual interviews. The participants were frail elderly patients over 65 years of age, who were interviewed at their home 1 week after discharge from an acute admission to a medical ward. RESULTS: Four main categories were identified: "The system," "Keeping a social life," "Being...

  18. Plasma levels and symptom complaints in patients maintained on daily dosage of methadone hydrochloride.

    Science.gov (United States)

    Horns, W H; Rado, M; Goldstein, A

    1975-06-01

    Plasma methadone levels, symptom complaints, and urine tests for illicit opiate use were followed weekly in 17 patients on a methadone maintenance program. There were very large differences between patients in the plasma level established at a given dosage, implying large differences in the rate of methadone metabolism. Despite virtually constant daily dosage, the plasma methadone levels fluctuated greatly from week to week and from day to day in individual patients. With rate exceptions there was no relationship between plasma methadone level and symptom complaints or between weekly chamges in plasma methadone level and changes in symptom complaints. Except possible to identify the ocassional patient with unusually low plasam methadone levels, the determination of methadone levels is not likely to be or practical value in methadone programs.

  19. Clinical efficacy of levofloxacin 500 mg once daily for 7 days for patients with non-gonococcal urethritis.

    Science.gov (United States)

    Takahashi, Satoshi; Ichihara, Kohji; Hashimoto, Jiro; Kurimura, Yuichiro; Iwasawa, Akihiko; Hayashi, Kenji; Sunaoshi, Kenichi; Takeda, Koichi; Suzuki, Nobukazu; Satoh, Takashi; Tsukamoto, Taiji

    2011-06-01

    To confirm the efficacy of the treatment regimen with oral levofloxacin (LVFX) 500 mg once daily for 7 days for patients with non-gonococcal urethritis (NGU), we evaluated the microbiological and clinical outcomes of the regimen in those patients. We finally evaluated 53 patients with symptomatic NGU and 5 patients with asymptomatic NGU. As a result of microbiological examinations, 19 of the symptomatic patients were diagnosed as having non-gonococcal chlamydial urethritis (NGCU); 13 had non-gonococcal non-chlamydial urethritis (NGNCU), and 21 had urethritis without any microbial detection. Five of the asymptomatic patients were diagnosed as having NGCU. Microbiological cure was achieved in 91% of the 32 patients with symptomatic NGU and in 80% of the 5 patients with asymptomatic NGCU. Clinical cure was obtained in 92% of the 53 patients with symptomatic NGU. The microbiological eradication rate for Chlamydia trachomatis was 92% in 24 patients. As for other organisms, the microbiological eradication rate for Mycoplasma genitalium was 60% in 5 patients and that for Ureaplasma urealyticum was 100% in 10. The microbiological and clinical efficacy of oral LVFX 500 mg once daily for 7 days for the patients with NGU was the same for the azithromycin (AZM) 1,000 mg single dose that we previously reported. The eradication rates of C. trachomatis and U. urealyticum in the treatment regimen with LVFX 500 mg were high enough in the clinical setting; however, for M. genitalium, the rate was relatively inferior to that with AZM.

  20. Predictive value of daily living score in acute respiratory failure of COPD patients requiring invasive mechanical ventilation pilot study.

    Science.gov (United States)

    Langlet, Ketty; Van Der Linden, Thierry; Launois, Claire; Fourdin, Caroline; Cabaret, Philippe; Kerkeni, Nadia; Barbe, Coralie; Lebargy, François; Deslée, Gaetan

    2012-10-18

    Mechanical ventilation (MV) is imperative in many forms of acute respiratory failure (ARF) in COPD patients. Previous studies have shown the difficulty to identify parameters predicting the outcome of COPD patients treated by invasive MV. Our hypothesis was that a non specialized score as the activities daily living (ADL) score may help to predict the outcome of these patients. We studied the outcome of 25 COPD patients admitted to the intensive care unit for ARF requiring invasive MV. The patients were divided into those weaning success (group A n = 17, 68%) or failure (group B n = 8, 32%). We investigated the correlation between the ADL score and the outcome and mortality. The ADL score was higher in group A (5.1 ±1.1 vs 3.7 ± 0.7 in group B, p success and mortality at 6 months, suggesting that the assessment of daily activities should be an important component of ARF management in COPD patients.

  1. Daily energy expenditure and physical activity measured in Parkinson's disease patients with and without weight loss

    Science.gov (United States)

    Patients with Parkinson's disease (PD) commonly exhibit weight loss, which investigators attribute to various factors, including elevated resting energy expenditure. We tested the hypothesis that daily energy expenditure (DEE) and its components, resting energy expenditure (REF) and physical activit...

  2. Patient perceptions of risky drinking: Knowledge of daily and weekly low-risk guidelines and standard drink sizes.

    Science.gov (United States)

    Sprague, Debra J; Vinson, Daniel C

    2017-01-01

    Effective intervention for risky drinking requires that clinicians and patients know low-risk daily and weekly guidelines and what constitutes a "standard drink." The authors hypothesized that most patients lack this knowledge, and that education is required. Following primary care visits, patients completed anonymous exit questionnaires that included the 3 Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions, "How many drinks (containing alcohol) can you safely have in one day?" and questions about size, in ounces, of a standard drink of wine, beer, and liquor. Descriptive analyses were done in Stata. Of 1,331 respondents (60% female, mean age: 49.6, SD = 17.5), 21% screened positive on the AUDIT-C for risky drinking. Only 10% of those accurately estimated daily low-risk limits, with 9% accurate on weekly limits, and half estimated low-risk limits at or below guidelines. Fewer than half who checked "Yes" to "Do you know what a 'standard drink' is?" provided accurate answers for beer, wine, or liquor. Patients with a positive screen were twice as likely to say they knew what a standard drink is, but only a third gave accurate estimates. When asked about plans in the next month regarding change in drinking behavior, 23% with a positive AUDIT-C indicated they were at least considering a change. Most patients in primary care don't know specifics of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for low-risk drinking. Exploring patient perceptions of low-risk guidelines and current drinking behavior may reveal discrepancies worth discussing. For risky drinkers, most of whom don't know daily and weekly low-risk guidelines or standard drink sizes, education can be vital in intervening. Findings suggest the need for detailed and explicit social marketing and communication on exactly what low-risk drinking entails.

  3. Detemir as a once-daily basal insulin in type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Nelson SE

    2011-08-01

    Full Text Available Scott E NelsonCleveland Family Medicine, Cleveland, Mississippi, USABackground: Insulin detemir, a long-acting basal insulin analog, is labeled for once-daily or twice-daily dosing in patients with type 1 (T1DM or type 2 (T2DM diabetes mellitus. Protocols for some earlier clinical studies of detemir evaluated twice-daily dosing, which may have generated the misperception that detemir should be prescribed twice daily for most patients. This review examines pharmacokinetic and pharmacodynamic (PK/PD, observational, and controlled studies that have evaluated once-daily and twice-daily detemir in patients with T2DM to determine the efficacy and safety of once-daily dosing.Methods: PubMed was searched using the keywords “detemir,” “once daily,” “twice daily,” and “type 2 diabetes” with the limits of clinical trial, human, and English.Results: Detemir has a relatively flat time–action profile and duration of action of up to 24 hours for patients with T2DM. Once-daily dosing is the most commonly used detemir regimen reported in observational studies, and controlled clinical studies indicate that once-daily dosing controls glycosylated hemoglobin when detemir is administered alone or in combination with a prandial insulin or oral antidiabetes drugs. In comparative clinical trials, detemir had a similar time–action profile and duration of action to another long-acting insulin analog, glargine, with less within-subject variability. Once-daily detemir was associated with no weight gain or less weight gain than comparator regimens. For patients who had not achieved glycemic control with a basal dose of once-daily detemir, adding a prandial insulin provided better glycemic control, less postprandial hypoglycemia, and a lower total daily dose of detemir than twice-daily detemir. Involvement of a multidisciplinary team and the use of a holistic approach for the treatment of T2DM patients are recommended to achieve and maintain the best

  4. Single Machine Multi-product Capacitated Lotsizing with Sequence-dependent Setups

    OpenAIRE

    Almada-Lobo , Bernardo; Klabjan , Diego; Carravilla , Maria Antónia; Oliveira , Jose Fernando

    2007-01-01

    Abstract In production planning in the glass container industry, machine dependent setup times and costs are incurred for switchovers from one product to another. The resulting multi-item capacitated lot sizing problem has sequence-dependent setup times and costs. We present two novel linear mixed integer programming formulations for this problem, incorporating all the necessary features of setup carryovers. The compact formulation has polynomially many constraints, while, on the o...

  5. The current status of the MASHA setup

    Science.gov (United States)

    Vedeneev, V. Yu.; Rodin, A. M.; Krupa, L.; Belozerov, A. V.; Chernysheva, E. V.; Dmitriev, S. N.; Gulyaev, A. V.; Gulyaeva, A. V.; Kamas, D.; Kliman, J.; Komarov, A. B.; Motycak, S.; Novoselov, A. S.; Salamatin, V. S.; Stepantsov, S. V.; Podshibyakin, A. V.; Yukhimchuk, S. A.; Granja, C.; Pospisil, S.

    2017-11-01

    The MASHA setup designed as the mass-separator with the resolving power of about 1700, which allows mass identification of superheavy nuclides is described. The setup uses solid ISOL (Isotope Separation On-Line) method. In the present article the upgrade of some parts of MASHA are described: target box (rotating target + hot catcher), ion source based on electron cyclotron resonance, data acquisition, beam diagnostics and control systems. The upgrade is undertaken in order to increase the total separation efficiency, reduce the separation time, of the installation and working stability and make possible continuous measurements at high beam currents. Ion source efficiency was measured in autonomous regime with using calibrated gas leaks of Kr and Xe injected directly to ion source. Some results of the first experiments for production of radon isotopes using the multi-nucleon transfer reaction 48Ca+242Pu are described in the present article. The using of TIMEPIX detector with MASHA setup for neutron-rich Rn isotopes identification is also described.

  6. The current status of the MASHA setup

    International Nuclear Information System (INIS)

    Vedeneev, V. Yu.; Rodin, A. M.; Krupa, L.; Belozerov, A. V.; Chernysheva, E. V.; Dmitriev, S. N.; Gulyaev, A. V.; Gulyaeva, A. V.; Kamas, D.; Kliman, J.; Komarov, A. B.; Motycak, S.; Novoselov, A. S.; Salamatin, V. S.; Stepantsov, S. V.; Podshibyakin, A. V.; Yukhimchuk, S. A.; Granja, C.; Pospisil, S.

    2017-01-01

    The MASHA setup designed as the mass-separator with the resolving power of about 1700, which allows mass identification of superheavy nuclides is described. The setup uses solid ISOL (Isotope Separation On-Line) method. In the present article the upgrade of some parts of MASHA are described: target box (rotating target + hot catcher), ion source based on electron cyclotron resonance, data acquisition, beam diagnostics and control systems. The upgrade is undertaken in order to increase the total separation efficiency, reduce the separation time, of the installation and working stability and make possible continuous measurements at high beam currents. Ion source efficiency was measured in autonomous regime with using calibrated gas leaks of Kr and Xe injected directly to ion source. Some results of the first experiments for production of radon isotopes using the multi-nucleon transfer reaction "4"8Ca+"2"4"2Pu are described in the present article. The using of TIMEPIX detector with MASHA setup for neutron-rich Rn isotopes identification is also described.

  7. The current status of the MASHA setup

    Energy Technology Data Exchange (ETDEWEB)

    Vedeneev, V. Yu., E-mail: vvedeneyev@gmail.com; Rodin, A. M.; Krupa, L.; Belozerov, A. V.; Chernysheva, E. V.; Dmitriev, S. N.; Gulyaev, A. V.; Gulyaeva, A. V.; Kamas, D. [Joint Institute for Nuclear Research, Flerov Laboratory of Nuclear Reactions (Russian Federation); Kliman, J. [Slovak Academy of Sciences, Institute of Physics (Slovakia); Komarov, A. B.; Motycak, S.; Novoselov, A. S.; Salamatin, V. S.; Stepantsov, S. V.; Podshibyakin, A. V.; Yukhimchuk, S. A. [Joint Institute for Nuclear Research, Flerov Laboratory of Nuclear Reactions (Russian Federation); Granja, C.; Pospisil, S. [Czech Technical University in Prague, Institute of Experimental and Applied Physics (Czech Republic)

    2017-11-15

    The MASHA setup designed as the mass-separator with the resolving power of about 1700, which allows mass identification of superheavy nuclides is described. The setup uses solid ISOL (Isotope Separation On-Line) method. In the present article the upgrade of some parts of MASHA are described: target box (rotating target + hot catcher), ion source based on electron cyclotron resonance, data acquisition, beam diagnostics and control systems. The upgrade is undertaken in order to increase the total separation efficiency, reduce the separation time, of the installation and working stability and make possible continuous measurements at high beam currents. Ion source efficiency was measured in autonomous regime with using calibrated gas leaks of Kr and Xe injected directly to ion source. Some results of the first experiments for production of radon isotopes using the multi-nucleon transfer reaction {sup 48}Ca+{sup 242}Pu are described in the present article. The using of TIMEPIX detector with MASHA setup for neutron-rich Rn isotopes identification is also described.

  8. SU-E-J-258: Inter- and Intra-Fraction Setup Stability and Couch Change Tolerance for Image Guided Radiation Therapy

    International Nuclear Information System (INIS)

    Teboh, Forbang R; Agee, M; Rowe, L; Creasy, T; Schultz, J; Bell, R; Wong, J; Armour, E

    2014-01-01

    Purpose: Immobilization devices combine rigid patient fixation as well as comfort and play a key role providing the stability required for accurate radiation delivery. In the setup step, couch re-positioning needed to align the patient is derived via registration of acquired versus reference image. For subsequent fractions, replicating the initial setup should yield identical alignment errors when compared to the reference. This is not always the case and further couch re-positioning can be needed. An important quality assurance measure is to set couch tolerances beyond which additional investigations are needed. The purpose of this work was to study the inter-fraction couch changes needed to re-align the patient and the intra-fraction stability of the alignment as a guide to establish the couch tolerances. Methods: Data from twelve patients treated on the Accuray CyberKnife (CK) system for fractionated intracranial radiotherapy and immobilized with Aquaplast RT, U-frame, F-Head-Support (Qfix, PA, USA) was used. Each fraction involved image acquisitions and registration with the reference to re-align the patient. The absolute couch position corresponding to the approved setup alignment was recorded per fraction. Intra-fraction set-up corrections were recorded throughout the treatment. Results: The average approved setup alignment was 0.03±0.28mm, 0.15±0.22mm, 0.06±0.31mm in the L/R, A/P, S/I directions respectively and 0.00±0.35degrees, 0.03±0.32degrees, 0.08±0.45degrees for roll, pitch and yaw respectively. The inter-fraction reproducibility of the couch position was 6.65mm, 10.55mm, and 4.77mm in the L/R, A/P and S/I directions respectively and 0.82degrees, 0.71degrees for roll and pitch respectively. Intra-fraction monitoring showed small average errors of 0.21±0.21mm, 0.00±0.08mm, 0.23±0.22mm in the L/R, A/P, S/I directions respectively and 0.03±0.12degrees, 0.04±0.25degrees, and 0.13±0.15degrees in the roll, pitch and yaw respectively. Conclusion

  9. SU-E-J-258: Inter- and Intra-Fraction Setup Stability and Couch Change Tolerance for Image Guided Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Teboh, Forbang R; Agee, M; Rowe, L; Creasy, T; Schultz, J; Bell, R; Wong, J; Armour, E [Johns Hopkins University, Baltimore, MD (United States)

    2014-06-01

    Purpose: Immobilization devices combine rigid patient fixation as well as comfort and play a key role providing the stability required for accurate radiation delivery. In the setup step, couch re-positioning needed to align the patient is derived via registration of acquired versus reference image. For subsequent fractions, replicating the initial setup should yield identical alignment errors when compared to the reference. This is not always the case and further couch re-positioning can be needed. An important quality assurance measure is to set couch tolerances beyond which additional investigations are needed. The purpose of this work was to study the inter-fraction couch changes needed to re-align the patient and the intra-fraction stability of the alignment as a guide to establish the couch tolerances. Methods: Data from twelve patients treated on the Accuray CyberKnife (CK) system for fractionated intracranial radiotherapy and immobilized with Aquaplast RT, U-frame, F-Head-Support (Qfix, PA, USA) was used. Each fraction involved image acquisitions and registration with the reference to re-align the patient. The absolute couch position corresponding to the approved setup alignment was recorded per fraction. Intra-fraction set-up corrections were recorded throughout the treatment. Results: The average approved setup alignment was 0.03±0.28mm, 0.15±0.22mm, 0.06±0.31mm in the L/R, A/P, S/I directions respectively and 0.00±0.35degrees, 0.03±0.32degrees, 0.08±0.45degrees for roll, pitch and yaw respectively. The inter-fraction reproducibility of the couch position was 6.65mm, 10.55mm, and 4.77mm in the L/R, A/P and S/I directions respectively and 0.82degrees, 0.71degrees for roll and pitch respectively. Intra-fraction monitoring showed small average errors of 0.21±0.21mm, 0.00±0.08mm, 0.23±0.22mm in the L/R, A/P, S/I directions respectively and 0.03±0.12degrees, 0.04±0.25degrees, and 0.13±0.15degrees in the roll, pitch and yaw respectively. Conclusion

  10. DAILY CHANGES OF CENTRAL HEMODYNAMICS IN PATIENTS WITH CHRONIC HEART FAILURE WITH NIGHT-TIME DYSPNOEA ATTACK

    Directory of Open Access Journals (Sweden)

    S. A. Dovgolis

    2006-01-01

    Full Text Available Aim. To study daily changes of central hemodynamics (CHD in patients with chronic heart failure (CHF and the effects of therapy. Materials and methods. 22 patients with ischemic heart disease and CHF of III-IV functional class (FC by NYHA, age 60,5±10,5 were observed. Patients were suffering from night-time dyspnoea attacks and had pulmonary artery occlusion pressure (PAOP 15-20 mm Hg. CHD was monitored invasively before the treatment and after 4 weeks of CHF treatment. Results. According to the cardiac index (CI at admission patients were split into two groups. 9 patients of group-I had CI ≤2,15 l\\min\\m2, and 13 patients of group-II had CI >2,15 l\\min\\m2. In patients of group-I CI increased in 4 weeks of treatment. The treatment caused considerable clinical improvement in all patients. The CHD indexes also improved. Initially evening-night-time peaks of PAOP (р≤0,002, systolic (SBP (р≤0,003, diastolic (DBP (р=0,002 and average (BPa (р=0,0007 blood pressure (BP as well as double multiplication (DM (р≤0,008 were registered in patients of group-I. At the end of treatment only evening-night increase in DBP (р=0,002 and BPa (р≤0,006 were noted. In patients of group-II after 4 weeks of treatment CI decreased or didn’t change. Towards 28-th day of treatment 10 patients had clinical improvements. Only one patient’s FC NYHA increased. At the end of treatment the normalization of CHD was registered totally in group. Initially evening-night-time peaks of PAOP (р≤0,002, SBP (р≤0, 0001, CI (р=0,057 and DM (р=0,084 were registered in patients of group-II. At the end of treatment evening-night-time peaks of PAOP (р≤0,015, SBP (р≤0,044, CI (р≤0,005 and DM (р≤0,044 still remained. Besides, evening-night-time peaks of cardiac output (р≤0,01 and systolic index (р≤0, 06 have added. Conclusion. In patients with CHF with initial CI ≤2,15 l\\min\\m2 treatment results in the normalization of CHD and its daily

  11. Accelerated partial breast irradiation using once-daily fractionation: analysis of 312 cases with four years median follow-up

    Directory of Open Access Journals (Sweden)

    Shaikh Arif Y

    2012-02-01

    Full Text Available Abstract Background There are limited data on accelerated partial breast irradiation (APBI using external beam techniques. Moreover, there are recent reports of increased fibrosis and unacceptable cosmesis with APBI using external beam with BID fractionation. We adopted a once daily regimen of APBI with fractionation similar to that shown to be effective in a Canadian randomized trial of whole breast irradiation. It is unclear whether patients with DCIS or invasive lobular carcinoma (ILC are suitable for APBI. Methods The retrospective cohort included 310 patients with 312 tumors of T1-T2N0-N1micM0 invasive ductal carcinoma (IDC, ILC, or Tis (DCIS treated with APBI via external beam. Most patients were treated using IMRT with 16 daily fractions of 270 cGy to a dose of 4320 cGy. The target volume included the lumpectomy cavity plus 1.0 cm to account for microscopic disease and an additional 0.5 to 1.0 cm for setup uncertainty and breathing motion. Ipsilateral breast failure (IBF was pathologically confirmed as a local failure (LF or an elsewhere failure (EF. Results Median follow-up was 49 months. Among the 312 cases, 213 were IDC, 31 ILC, and 68 DCIS. Median tumor size was 1.0 cm. There were 9 IBFs (2.9% including 5 LFs and 4 EFs. The IBF rates among patients with IDC, ILC, and DCIS were 2.4%, 3.2%, and 4.4%, respectively, with no significant difference between histologies. When patients were analyzed by the ASTRO APBI consensus statement risk groups, 32% of treated cases were considered suitable, 50% cautionary, and 18% unsuitable. The IBF rates among suitable, cautionary, and unsuitable patients were 4.0%, 2.6%, and 1.8%, respectively, with no significant difference between risk groups. Acute skin reactions were rare and long-term cosmetic outcome was very good to excellent. Conclusions External beam APBI with once daily fractionation has a low rate of IBF consistent with other published APBI studies. The ASTRO risk stratification did not

  12. Maxillary molar derotation and distalization by using a nickel-titanium wire fabricated on a setup model.

    Science.gov (United States)

    Jung, Jong Moon; Wi, Young Joo; Koo, Hyun Mo; Kim, Min Ji; Chun, Youn Sic

    2017-07-01

    The purpose of this article is to introduce a simple appliance that uses a setup model and a nickel-titanium (Ni-Ti) wire for correcting the mesial rotation and drift of the permanent maxillary first molar. The technique involves bonding a Ni-Ti wire to the proper position of the target tooth on a setup model, followed by the fabrication of the transfer cap for indirect bonding and its transfer to the patient's teeth. This appliance causes less discomfort and provides better oral hygiene for the patients than do conventional appliances such as the bracket, pendulum, and distal jet. The treatment time is also shorter with the new appliance than with full-fixed appliances. Moreover, the applicability of the new appliance can be expanded to many cases by using screws or splinting with adjacent teeth to improve anchorage.

  13. Effect of body mass index on shifts in ultrasound-based image-guided intensity-modulated radiation therapy for abdominal malignancies

    International Nuclear Information System (INIS)

    Choi, Mehee; Fuller, Clifton D.; Wang, Samuel J.; Siddiqi, Ather; Wong, Adrian; Thomas, Charles R.; Fuss, Martin

    2009-01-01

    Background and purpose: We investigated whether corrective shifts determined by daily ultrasound-based image-guidance correlate with body mass index (BMI) of patients treated with image-guided intensity-modulated radiation therapy (IG-IMRT) for abdominal malignancies. The utility of daily image-guidance, particularly for patients with BMI > 25.0, is examined. Materials and methods: Total 3162 ultrasound-directed shifts were performed in 86 patients. Direction and magnitude of shifts were correlated with pretreatment BMI. Bivariate statistical analysis and analysis of set-up correction data were performed using systematic and random error calculations. Results: Total 2040 daily alignments were performed. Average 3D vector of set-up correction for all patients was 12.1 mm/fraction. Directional and absolute shifts and 3D vector length were significantly different between BMI cohorts. 3D displacement averaged 4.9 mm/fraction and 6.8mm/fraction for BMI ≤ 25.0 and BMI > 25.0, respectively. Systematic error in all axes and 3D vector was significantly greater for BMI > 25.0. Differences in random error were not statistically significant. Conclusions: Set-up corrections derived from daily ultrasound-based IG-IMRT of abdominal tumors correlated with BMI. Daily image-guidance may improve precision of IMRT delivery with benefits assessed for the entire population, particularly patients with increased habitus. Requisite PTV margins suggested in the absence of daily image-guidance are significantly greater in patients with BMI > 25.0.

  14. New attacks on Wi-Fi Protected Setup

    OpenAIRE

    Hamed Mohtadi; Alireza Rahimi

    2015-01-01

    Wi-Fi Protected Setup (WPS) is a network security standard that is used to secure networks in home and office, introduced in 2006 by the Wi-Fi Alliance. It provides easier configuration setup and is used in almost all recent Wi-Fi devices. In this paper we propose two attacks on this standard. The first attack is an offline brute force attack that uses imbalance on registration protocol. This attack needs user action, but it is more efficient than previous attacks. The second attack uses weak...

  15. Effects by daily long term provision of ghrelin to unselected weight-losing cancer patients: a randomized double-blind study.

    Science.gov (United States)

    Lundholm, Kent; Gunnebo, Lena; Körner, Ulla; Iresjö, Britt-Marie; Engström, Cecilia; Hyltander, Anders; Smedh, Ulrika; Bosaeus, Ingvar

    2010-04-15

    The short-term provision of ghrelin to patients with cancer indicates that there may be benefits from long-term provision of ghrelin for the palliative treatment of weight-losing cancer patients. This hypothesis was evaluated in a randomized, double-blind, phase 2 study. Weight-losing cancer patients with solid gastrointestinal tumors were randomized to receive either high-dose ghrelin treatment (13 microg/kg daily; n = 17 patients) or low-dose ghrelin treatment (0.7 microg/kg daily; n = 14 patients) for 8 weeks as a once-daily, subcutaneous injections. Appetite was scored on a visual analog scale; and food intake, resting energy expenditure, and body composition (dual x-ray absorpitometry) were measured before the start of treatment and during follow-up. Serum levels of ghrelin, insulin, insulin-like growth factor 1, growth hormone (GH), triglycerides, free fatty acids, and glucose were measured. Health-related quality of life, anxiety, and depression were assessed by using standardized methods (the 36-item Short Form Health Survey and the Hospital Anxiety and Depression Scale). Physical activity, rest, and sleep were measured by using a multisensor body monitor. Treatment groups were comparable at inclusion. Appetite scores were increased significantly by high-dose ghrelin analyzed both on an intent-to-treat basis and according to the protocol. High-dose ghrelin reduced the loss of whole body fat (P losing cancer patients with solid tumors supports host metabolism, improves appetite, and attenuates catabolism. (c) 2010 American Cancer Society.

  16. Relationship of daily arterial blood pressure monitoring readings and arterial stiffness profile in male patients with chronic obstructive pulmonary disease combined with arterial hypertension

    Directory of Open Access Journals (Sweden)

    Karoli N.A.

    2013-06-01

    Full Text Available The aim of the study was to determine correlation between arterial blood pressure daily rhythm and daily profile of arterial stiffness in male patients with chronic obstructive pulmonary disease (COPD and arterial hypertension. Materials et methods: Prospective investigation comprised 45 male patients with COPD and arterial hypertension. Individuals of 40 years younger and 80 years elder, patients with diabetes, stroke, angina pectoris, or heart infarction, vascular diseases, and exacerbation of chronic disease, bronchial and pulmonary diseases of other etiology were excluded from the analyses. Comparison group included 47 patients with essential arterial hypertension and without chronic respiratory diseases closely similar on general parameters with patients from main clinical series. Twenty-four-hour arterial blood pressure monitoring (ABPM and daily arterial stiffness monitoring were performed using BPLab® MnSDP-2 apparatus (Petr Telegin, Russian Federation. Results: Patients with COPD combined with arterial hypertension with raised arterial stiffness measures prevail over individuals in essential hypertension group. There is pathological alteration of the ABPM circadian rhythm and raised «Pressure load» values in raised arterial stiffness group. Conclusion: We found ABPM raised parameters in patients with COPD and arterial hypertension. It confirms necessity of ABPM in daily arterial stiffness assessment in patients with COPD.

  17. Target volume shape variation during irradiation of rectal cancer patients in supine position: Comparison with prone position

    International Nuclear Information System (INIS)

    Nijkamp, Jasper; Jong, Rianne de; Sonke, Jan-Jakob; Vliet, Corine van; Marijnen, Corrie

    2009-01-01

    Purpose: To quantify the inter-fraction shape variation of the mesorectum for rectal cancer patients treated with 5 x 5 Gy in supine position and compare it to variation in prone position. Methods and materials: For 28 patients a planning CT (pCT) and five daily cone-beam-CT (CBCT) scans were acquired in supine position. The mesorectal part of the CTV (MesoRect) was delineated on all scans. The shape variation was quantified by the distance between the pCT- and the CBCT delineations and stored in surface maps after online setup correction. Data were analyzed for male and female patients separately and compared to prone data. Results: A large range of systematic, 1-8 mm (1SD), and random, 1-5 mm, shape variation was found, comparable to prone patients. Random-shape variation was comparable for male and female patients, while systematic variation was 3 mm larger for female patients. Conclusions: Shape variation of the MesoRect is substantial, heterogeneous and different between male and female patients. Differences between supine and prone orientation, however, are small. Clinical margins should be differentiated in position along the cranio-caudal axis, in anterior-posterior direction and for gender. Margins should also be increased, even when online setup correction is used. Due to the small margin differences between prone and supine treatments, the setup choice should be determined on dose to the organs at risk.

  18. Influences of patient informed cognitive complaints on activities of daily living in patients with bipolar disorder

    DEFF Research Database (Denmark)

    Träger, Conny; Decker, Lone; Wæhrens, Eva Elisabet Ejlersen

    2017-01-01

    Many patients with bipolar disorder (BD) experience debilitating cognitive deficits, with risk of impaired occupational and psychosocial functioning. However, knowledge of how these deficits impact the patients’ ability to perform Activities of Daily Living (ADL), tasks related to self...... Complaints in Bipolar Disorder Rating Assessment questionnaire (COBRA)) were included. Objective neurocognitive function was evaluated with a short comprehensive cognitive test battery and ADL ability was evaluated with the performance-based Assessment of Motor and Process Skills (AMPS) in the homes......-care and domestic life is limited. We explored the relation between impaired cognitive function and the ability to perform ADL in patients with BD. A total of 42 outpatients (mean age 36 years (range 19.0–58.0 years), 69% women) with BD in remission and with subjective cognitive complaints (≥ 13 on the Cognitive...

  19. Comparison of orthogonal kilovolt X-ray images and cone-beam CT matching results in setup error assessment and correction for EB-PBI during free breathing

    International Nuclear Information System (INIS)

    Wang Wei; Li Jianbin; Hu Hongguang; Ma Zhifang; Xu Min; Fan Tingyong; Shao Qian; Ding Yun

    2014-01-01

    Objective: To compare the differences in setup error (SE) assessment and correction between the orthogonal kilovolt X-ray images and CBCT in EB-PBI patients during free breathing. Methods: Nineteen patients after breast conserving surgery EB-PBI were recruited. Interfraction SE was acquired using orthogonal kilovolt X-ray setup images and CBCT, after on-line setup correction,calculate the residual error and compare the SE, residual error and setup margin (SM) quantified for orthogonal kilovolt X-ray images and CBCT. Wilcoxon sign-rank test was used to evaluate the differences. Results: The CBCT based SE (systematic error, ∑) was smaller than the orthogonal kilovolt X-ray images based ∑ in AP direction (-1.2 mm vs 2.00 mm; P=0.005), and there was no statistically significant differences for three dimensional directions in random error (σ) (P=0.948, 0.376, 0.314). After on-line setup correction,CBCT decreases setup residual error than the orthogonal kilovolt X-ray images in AP direction (Σ: -0.20 mm vs 0.50 mm, P=0.008; σ: 0.45 mm vs 1.34 mm, P=0.002). And also the CBCT based SM was smaller than orthogonal kilovolt X-ray images based SM in AP direction (Σ: -1.39 mm vs 5.57 mm, P=0.003; σ: 0.00 mm vs 3.2 mm, P=0.003). Conclusions: Compared with kilovolt X-ray images, CBCT underestimate the setup error in the AP direction, but decreases setup residual error significantly.An image-guided radiotherapy and setup error assessment using kilovolt X-ray images for EB-PBI plans was feasible. (authors)

  20. Barriers and Facilitators to eHealth Use in Daily Practice: Perspectives of Patients and Professionals in Dermatology.

    Science.gov (United States)

    Ariens, Lieneke Fm; Schussler-Raymakers, Florine Ml; Frima, Cynthia; Flinterman, Annebeth; Hamminga, Eefje; Arents, Bernd Wm; Bruijnzeel-Koomen, Carla Afm; de Bruin-Weller, Marjolein S; van Os-Medendorp, Harmieke

    2017-09-05

    The number of eHealth interventions in the management of chronic diseases such as atopic dermatitis (AD) is growing. Despite promising results, the implementation and use of these interventions is limited. This study aimed to assess opinions of the most important stakeholders influencing the implementation and use of eHealth services in daily dermatology practice. The perspectives of health care professionals and patients towards the implementation and use of eHealth services in daily practice were assessed by using a mixed method design. A cross-sectional survey based on the eHealth implementation toolkit (eHit) was conducted to explore factors influencing the adoption of eHealth interventions offering the possibility of e-consultations, Web-based monitoring, and Web-based self-management training among dermatologists and dermatology nurses. The perspectives of patients with atopic dermatitis (AD) regarding the use of eHealth services were discussed in an online focus group. Health care professionals (n=99) and patients (n=9) acknowledged the value of eHealth services and were willing to use these digital tools in daily dermatology practice. Key identified barriers (statements with eHealth interventions included concerns about the availability (12/99, 12%) and allocation (14/99, 14%) of resources, financial aspects (26/99, 26%), reliability, security, and confidentially of the intervention itself (29/99, 29%), and the lack of education and training (6/99, 6%). Health care professionals and patients acknowledge the benefits arising from the implementation and use of eHealth services in daily dermatology practice. However, some important barriers were identified that might be useful in addressing the implementation strategy in order to enhance the implementation success of eHealth interventions in dermatology. ©Lieneke FM Ariens, Florine ML Schussler-Raymakers, Cynthia Frima, Annebeth Flinterman, Eefje Hamminga, Bernd WM Arents, Carla AFM Bruijnzeel

  1. Evaluation of errors set-up and setting margins calculation in treatments 3-D conformal radiotherapy; Evaluacion de errores de set-up y calculo de margenes de configuracion en tratamientos de radioterapia CONFORMADA 3-D

    Energy Technology Data Exchange (ETDEWEB)

    Donis, S.; Robayna, B.; Gonzalez, A.; Hernandez Armas, J.

    2011-07-01

    The use of IGRT techniques provide knowledge of the mistakes made in the positioning of a patient, to population studies and estimate the margins for each population.In this paper we evaluate the errors of set-up in 3 different locations and from these margins are calculated configuration (SM).

  2. Presentation of chronic daily headache : A clinical study

    NARCIS (Netherlands)

    Spierings, E L H; Schroevers, M.; Honkoop, P.C.; Sorbi, M.

    We studied the presentation of chronic daily headache in 258 patients from a private headache practice, 50 men and 208 women. Chronic daily headache was defined as headaches, occurring at least 5 days per week for at least 1 year. Seventy-seven percent of the patients experienced the onset of

  3. Control of hypertension with single daily doses of sotalol hydrochloride.

    Science.gov (United States)

    Gabriel, R

    A study was carried out in 12 previously untreated hypertensive patients to assess the efficacy of sotalol given in a once-daily dosage regimen. After an initial dosage titration period (mean 3 weeks) during which diastolic pressure was stabilized at less than 100 mmHg, all patients were satisfactorily maintained on a constant once-daily dose of sotalol for 3 months. Eight of the 12 patients required 320 mg or less daily (mean dose 190 mg). Whilst blood pressure remained controlled for at least 26 hours after daily doses the pulse rate, counted at the same time, showed escape from beta-blockade. Side-effects (vivid dreams) were reported in only 1 patient.

  4. Neuropsychological rehabilitation of memory deficits and activities of daily living in patients with Alzheimer's disease: a pilot study

    Directory of Open Access Journals (Sweden)

    Ávila R.

    2004-01-01

    Full Text Available Patients with Alzheimer's disease (AD gradually lose their cognitive competence, particularly memory, and the ability to perform daily life tasks. Neuropsychological rehabilitation is used to improve cognitive functions by facilitating memory performance through the use of external aids and internal strategies. The effect of neuropsychological rehabilitation through memory training - motor movements, verbal association, and categorization - and activities of daily living (ADL training was tested in a sample of 5 elderly out-patients (mean age: 77.4 ± 2.88 years, with mild AD (Mini-Mental State Examination score: 22.20 ± 2.17 and their caregivers. All patients had been taking rivastigmine (6-12 mg/day for at least 3 months before being assigned to the rehabilitation sessions, and they continued to take the medication during the whole program. Just before and after the 14-week neuropsychological rehabilitation program all patients were assessed by interviewers that did not participate in the cognitive training, using the Mini-Mental State Examination, Montgomery-Alsberg Depression Rating Scale, Hamilton Anxiety Scale, Interview to Determine Deterioration in Functioning in Dementia, Functional Test, Memory Questionnaire of Daily Living for patient and caregiver, Quality of Life Questionnaire for patient and caregiver, and a neuropsychological battery. The results showed a statistically significant improvement in ADL measured by Functional Test (P = 0.04, and only a small improvement in memory and psychiatric symptoms. Our results support the view that weekly stimulation of memory and training of ADL is believed to be of great value in AD treatment, not only delaying the progress of the disease, but also improving some cognitive functions and ADL, even though AD is a progressively degenerative disease.

  5. The spectral imaging facility: Setup characterization

    Energy Technology Data Exchange (ETDEWEB)

    De Angelis, Simone, E-mail: simone.deangelis@iaps.inaf.it; De Sanctis, Maria Cristina; Manzari, Paola Olga [Institute for Space Astrophysics and Planetology, INAF-IAPS, Via Fosso del Cavaliere, 100, 00133 Rome (Italy); Ammannito, Eleonora [Institute for Space Astrophysics and Planetology, INAF-IAPS, Via Fosso del Cavaliere, 100, 00133 Rome (Italy); Department of Earth, Planetary and Space Sciences, University of California, Los Angeles, Los Angeles, California 90095-1567 (United States); Di Iorio, Tatiana [ENEA, UTMEA-TER, Rome (Italy); Liberati, Fabrizio [Opto Service SrL, Campagnano di Roma (RM) (Italy); Tarchi, Fabio; Dami, Michele; Olivieri, Monica; Pompei, Carlo [Selex ES, Campi Bisenzio (Italy); Mugnuolo, Raffaele [Italian Space Agency, ASI, Spatial Geodesy Center, Matera (Italy)

    2015-09-15

    The SPectral IMager (SPIM) facility is a laboratory visible infrared spectrometer developed to support space borne observations of rocky bodies of the solar system. Currently, this laboratory setup is used to support the DAWN mission, which is in its journey towards the asteroid 1-Ceres, and to support the 2018 Exo-Mars mission in the spectral investigation of the Martian subsurface. The main part of this setup is an imaging spectrometer that is a spare of the DAWN visible infrared spectrometer. The spectrometer has been assembled and calibrated at Selex ES and then installed in the facility developed at the INAF-IAPS laboratory in Rome. The goal of SPIM is to collect data to build spectral libraries for the interpretation of the space borne and in situ hyperspectral measurements of planetary materials. Given its very high spatial resolution combined with the imaging capability, this instrument can also help in the detailed study of minerals and rocks. In this paper, the instrument setup is first described, and then a series of test measurements, aimed to the characterization of the main subsystems, are reported. In particular, laboratory tests have been performed concerning (i) the radiation sources, (ii) the reference targets, and (iii) linearity of detector response; the instrumental imaging artifacts have also been investigated.

  6. Dose delivered from Varian's CBCT to patients receiving IMRT for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wen Ning; Guan Huaiqun; Hammoud, Rabih; Pradhan, Deepak; Nurushev, T; Li Shidong; Movsas, Benjamin [Henry Ford Health System, Detroit, MI (United States)

    2007-04-21

    With the increased use of cone beam CT (CBCT) for daily patient setup, the accumulated dose from CBCT may be significantly higher than that from simulation CT or portal imaging. The objective of this work is to measure the dose from daily pelvic scans with fixed technical settings and collimations. CBCT scans were acquired in half-fan mode using a half bowtie and x-rays were delivered in pulsed-fluoro mode. The skin doses for seven prostate patients were measured on an IRB-approved protocol. TLD capsules were placed on the patient's skin at the central axis of three beams: AP, left lateral (Lt Lat) and right lateral (Rt Lat). To avoid the ring artefacts centred in the prostate, the treatment couch was dropped 3 cm from the patient's tattoo (central axis). The measured AP skin doses ranged 3-6 cGy for 20-33 cm separation. The larger the patient size the less the AP skin dose. Lateral doses did not change much with patient size. The Lt Lat dose was {approx}4.0 cGy, which was {approx}40% higher than the Rt Lat dose of {approx}2.6 cGy. To verify this dose asymmetry, surface doses on an IMRT QA phantom (oval shaped, 30 cm x 20 cm) were measured at the same three sites using TLD capsules with 3 cm table-drop. The dose asymmetry was due to: (1) kV source rotation which always starts from the patient's Lt Lat and ends at Lt Lat. Gantry rotation gets much slower near the end of rotation but dose rate stays constant and (2) 370{sup 0} scan rotation (10{sup 0} scan overlap on the Lt Lat side). In vivo doses were measured inside a Rando pelvic heterogeneous phantom using TLDs. The left hip (femoral head and neck) received the highest doses of {approx}10-11 cGy while the right hip received {approx}6-7 cGy. The surface and in vivo doses were also measured for phantoms at the central-axis setup. The difference was less than {approx}12% to the table-drop setup.

  7. Cervix Motion in 50 Cervical Cancer Patients Assessed by Daily Cone Beam Computed Tomographic Imaging of a New Type of Marker

    Energy Technology Data Exchange (ETDEWEB)

    Langerak, Thomas, E-mail: t.langerak@erasmusmc.nl; Mens, Jan Willem; Quint, Sandra; Bondar, Luiza; Heijkoop, Sabrina; Heijmen, Ben; Hoogeman, Mischa

    2015-11-01

    Purpose: To evaluate a new type of marker and a new method of marker implantation and to assess interfraction cervix motion for a large population of patients with locally advanced cervical cancer by daily cone beam computed tomographic (CBCT) imaging. Methods and Materials: We investigated the position of markers in 50 patients treated in prone position during at least 23 fractions. To reduce streaking artifacts in the planning CT scan, a new type of polymeric marker was used and compared with conventional gold markers. In addition, a new method of implantation was used in an attempt to reduce marker loss. In each fraction, a CT scan was acquired before dose delivery and aligned to the bony anatomy of the planning CT scan, simulating the clinical setup protocol. First, sufficient visibility of the markers was verified. Then, systematic and random displacement of the marker centroids was recorded and analyzed in 3 directions with regard to the planning CT and the first CBCT (to evaluate the presence of a vaginal catheter in the planning CT). Streaking artifacts were quantified with the standard deviation of the mean squared intensity difference in a radius around the marker. Results: Marker loss was minimal during treatment: in only 3 of the 50 patients 1 marker was lost. Streaking artifacts for the new markers were reduced compared with conventional gold markers. For the planning CT, M/Σ/σ were 0.4/3.4/2.2 mm, 1.0/5.5/4.5 mm, and −3.9/5.1/3.6 mm for the left-right, anterior-posterior, and cranial-caudal directions, respectively. With regard to the first CBCT scan, M/Σ/σ were 0.8/2.8/2.1, 0.6/4.4/4.4, and −1.3/4.5/3.6 mm. Conclusions: A new type of marker and implantation method was shown to have significantly reduced marker loss and streaking artifacts compared with gold fiducial markers. The recorded marker displacement confirms results reported in the existing literature but for a larger dataset.

  8. Impact of daily cooling treatment on skin inflammation in patients with chronic venous disease.

    Science.gov (United States)

    Kelechi, Teresa J; Mueller, Martina; King, Dana E; Madisetti, Mohan; Prentice, Margie

    2015-05-01

    People with chronic venous disease are at high risk for developing venous leg ulcers. Inflammation is posited as a pathological factor for this chronic condition as evidenced by persistently elevated skin temperature. As part of a larger trial to test the effects of a cooling regimen on leg ulcer prevention, the objective of this preliminary study was to evaluate the first 30 days of intense daily cooling. Compared to a placebo control cuff, a gel cuff applied to the most severely affected lower leg skin for 30 min daily showed no statistically significant differences between temperatures taken in the home at baseline compared to those measured at the 1 month follow up visit. There were also no differences in temperatures noted between the two groups, although the temperatures in the treatment group were lower 30 min after treatment, an indication of adherence. There was no discernable decrease or increase in temperature at a given time point during the 30 day treatment period compared to the control group. It may be better to have patients monitor skin temperature on a daily basis and then apply the cuff as necessary, rather than requiring daily cooling based on baseline measurement. This "prn" approach may provide a sufficient cooling milieu to prevent escalation of inflammation and thwart ulcer occurrence or recurrence. Clinical trials registration #NCT01509599. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  9. Predictive value of daily living score in acute respiratory failure of COPD patients requiring invasive mechanical ventilation pilot study

    Directory of Open Access Journals (Sweden)

    Langlet Ketty

    2012-10-01

    Full Text Available Abstract Background Mechanical ventilation (MV is imperative in many forms of acute respiratory failure (ARF in COPD patients. Previous studies have shown the difficulty to identify parameters predicting the outcome of COPD patients treated by invasive MV. Our hypothesis was that a non specialized score as the activities daily living (ADL score may help to predict the outcome of these patients. Methods We studied the outcome of 25 COPD patients admitted to the intensive care unit for ARF requiring invasive MV. The patients were divided into those weaning success (group A n = 17, 68% or failure (group B n = 8, 32%. We investigated the correlation between the ADL score and the outcome and mortality. Results The ADL score was higher in group A (5.1 ±1.1 vs 3.7 ± 0.7 in group B, p  Conclusion Our pilot study demonstrates that the ADL score is predictive of weaning success and mortality at 6 months, suggesting that the assessment of daily activities should be an important component of ARF management in COPD patients.

  10. Recall of ICU Stay in Patients Managed With a Sedation Protocol or a Sedation Protocol With Daily Interruption.

    Science.gov (United States)

    Burry, Lisa; Cook, Deborah; Herridge, Margaret; Devlin, John W; Fergusson, Dean; Meade, Maureen; Steinberg, Marilyn; Skrobik, Yoanna; Olafson, Kendiss; Burns, Karen; Dodek, Peter; Granton, John; Ferguson, Niall; Jacka, Michael; Tanios, Maged; Fowler, Robert; Reynolds, Steven; Keenan, Sean; Mallick, Ranjeeta; Mehta, Sangeeta

    2015-10-01

    To 1) describe factual, emotional, and delusional memories of ICU stay for patients enrolled in the SLEAP (Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol) trial; 2) compare characteristics of patients with and without ICU recall, and patients with and without delusional memories; and 3) determine factors associated with delusional memories 28 days after ICU discharge. Prospective cohort. Sixteen North American medical and surgical ICUs. Critically ill, mechanically ventilated adults randomized in the SLEAP trial. Post-ICU interviews on days 3, 28, and 90 using the validated ICU Memory Tool. Overall, 289 of 297 ICU survivors (97%) (146 protocolized sedation and 143 protocolized sedation plus daily interruption patients) were interviewed at least once. Because there were no differences in recall status or types of memories between the two sedation groups, we present the findings for all patients rather than by study group. On days 3, 28, and 90, 28%, 26%, and 36% of patients, respectively, reported no recall of being in the ICU (overall perception, self-reported) (p = 0.75). Mean daily doses of benzodiazepines and opioids were lower in patients with no ICU recall than those with recall (p patients reporting no recall of ICU stay on day 3, 97% and 90% reported at least one factual and one emotional memory from ICU, respectively. Emotional memories declined with time after ICU discharge, particularly panic and confusion. Delusional memories 28 days after discharge were common (70%) yet unrelated to delirium (p = 0.84), recall status (p = 0.15), total dose of benzodiazepine (p = 0.78), or opioid (p = 0.21). Delusional memories were less likely with longer duration of mechanical ventilation (odds ratio, 0.955; 95% CI, 0.91-1.00; p = 0.04). Recall of ICU stay and types of memories reported were not influenced by the trial sedation strategy. Lack of ICU recall and delusional memories were common after ICU

  11. HEART RATE VARIABILITY PARAMETERS IN PATIENTS WITH ARTERIAL HYPERTENSION IN DEPENDENCE ON THE TYPE OF DAILY BLOOD PRESSURE PROFILE

    Directory of Open Access Journals (Sweden)

    S. G. B. K. Gorantla

    2017-06-01

    Full Text Available Violation of functioning of the autonomic nervous system is an important factor in the formation and progression of arterial hypertension (AH. Abnormal nocturnal blood pressure (BP reduction is regarded as an independent prognostic factor for cardiovascular complications in patients with AH. One of the possible factors that determine the violation of BP circadian rhythm can be imbalance of different parts of autonomic nervous system. The aim of our study was to study heart rate variability (HRV in patients with AH, dependently of BP profile. 72 patients with AH were examined. Average age was 57 ± 11 years. All patients underwent ambulatory BP (ABPM and ECG monitoring. To define the daily profile the nocturnal BP dip was quantified and for HRV evaluation the frequency analysis method was used. HRV changes in patients with AH present with reduced total power and with a violation in the ratio of the powers of very low, low and high frequencies, enhanced sympathycotension and influence of humoral factors. Violations of systolic BP (SBP daily profile was mainly characterized by an increase in the power of low frequency waves, which indicates an intensification of sympathetic and decreased parasympathetic influences. Violations of diastolic BP (DBP daily profile were mainly characterized by a relative increase in the power of very low frequency waves. The obtained results showed that in the management of patients with AH it is important not only to control the circadian SBP and DBP profiles, but the evaluation of HRV also.

  12. Benchmark test cases for evaluation of computer-based methods for detection of setup errors: realistic digitally reconstructed electronic portal images with known setup errors

    International Nuclear Information System (INIS)

    Fritsch, Daniel S.; Raghavan, Suraj; Boxwala, Aziz; Earnhart, Jon; Tracton, Gregg; Cullip, Timothy; Chaney, Edward L.

    1997-01-01

    Purpose: The purpose of this investigation was to develop methods and software for computing realistic digitally reconstructed electronic portal images with known setup errors for use as benchmark test cases for evaluation and intercomparison of computer-based methods for image matching and detecting setup errors in electronic portal images. Methods and Materials: An existing software tool for computing digitally reconstructed radiographs was modified to compute simulated megavoltage images. An interface was added to allow the user to specify which setup parameter(s) will contain computer-induced random and systematic errors in a reference beam created during virtual simulation. Other software features include options for adding random and structured noise, Gaussian blurring to simulate geometric unsharpness, histogram matching with a 'typical' electronic portal image, specifying individual preferences for the appearance of the 'gold standard' image, and specifying the number of images generated. The visible male computed tomography data set from the National Library of Medicine was used as the planning image. Results: Digitally reconstructed electronic portal images with known setup errors have been generated and used to evaluate our methods for automatic image matching and error detection. Any number of different sets of test cases can be generated to investigate setup errors involving selected setup parameters and anatomic volumes. This approach has proved to be invaluable for determination of error detection sensitivity under ideal (rigid body) conditions and for guiding further development of image matching and error detection methods. Example images have been successfully exported for similar use at other sites. Conclusions: Because absolute truth is known, digitally reconstructed electronic portal images with known setup errors are well suited for evaluation of computer-aided image matching and error detection methods. High-quality planning images, such as

  13. A simple Lissajous curves experimental setup

    Science.gov (United States)

    Şahin Kızılcık, Hasan; Damlı, Volkan

    2018-05-01

    The aim of this study is to develop an experimental setup to produce Lissajous curves. The setup was made using a smartphone, a powered speaker (computer speaker), a balloon, a laser pointer and a piece of mirror. Lissajous curves are formed as follows: a piece of mirror is attached to a balloon. The balloon is vibrated with the sound signal provided by the speaker that is connected to a smartphone. The laser beam is reflected off the mirror and the reflection is shaped as a Lissajous curve. Because of the intersection of two frequencies (frequency of the sound signal and natural vibration frequency of the balloon), these curves are formed. They can be used to measure the ratio of frequencies.

  14. Conversion From Twice-Daily Tacrolimus Capsules to Once-Daily Extended-Release Tacrolimus (LCPT): A Phase 2 Trial of Stable Renal Transplant Recipients

    Science.gov (United States)

    Gaber, A. Osama; Alloway, Rita R.; Bodziak, Kenneth; Kaplan, Bruce; Bunnapradist, Suphamai

    2013-01-01

    Background LCP-Tacro is an extended-release formulation of tacrolimus designed for once-daily dosing. Phase 1 studies demonstrated greater bioavailability to twice-daily tacrolimus capsules and no new safety concerns. Methods In this phase 2 study, adult stable kidney transplant patients on tacrolimus capsules (Prograf) twice-daily were converted to tacrolimus tablets (LCP-Tacro) once-daily; patients continued on LCP-Tacro once-daily for days 8 to 21; trough levels were to be maintained between 5 and 15 ng/mL; 24-hr pharmacokinetic assessments were done on days 7 (baseline pre-switch), 14, and 21. Results Forty-seven patients completed LCP-Tacro dosing per protocol. The mean conversion ratio was 0.71. Pharmacokinetic data demonstrated consistent exposure (AUC) at the lower conversion dose. Cmax (P=0.0001), Cmax/Cmin ratio (P<0.001), percent fluctuation (P<0.0001), and swing (P=0.0004) were significantly lower and Tmax significantly (P<0.001) longer for LCP-Tacro versus Prograf. AUC24 and Cmin correlation coefficients after 7 and 14 days of therapy were 0.86 or more, demonstrating a robust correlation between LCP-Tacro tacrolimus exposure and trough levels. There were three serious adverse events; none were related to study drug and all were resolved. Conclusions Stable kidney transplant patients can be safely converted from Prograf twice-daily to LCP-Tacro. The greater bioavailability of LCP-Tacro allows for once-daily dosing and similar (AUC) exposure at a dose approximately 30% less than the total daily dose of Prograf. LCP-Tacro displays flatter kinetics characterized by significantly lower peak-trough fluctuations. PMID:23715050

  15. Setup Time Reduction On Solder Paste Printing Machine – A Case Study

    Directory of Open Access Journals (Sweden)

    Rajesh Dhake

    2013-06-01

    Full Text Available Lean manufacturing envisages the reduction of the seven deadly wastes referred to as MUDA. Setup time forms a major component of the equipment downtime. It leads to lower machine utilization and restricts the output and product variety. This necessitates the requirement for quick setups. Single Minute Exchange of Die philosophy (a lean manufacturing tool here after referred as “SMED” is one of the important tool which aims at quick setups driving smaller lot sizes, lower production costs, improve productivity in terms of increased output, increased utilization of machine and labor hours, make additional capacity available (often at bottleneck resources, reduce scrap and rework, and increase flexibility[3]. This paper focuses on the application of Single Minute Exchange of Die[1] and Quick Changeover Philosophy[2] for reducing setup time on Solder Past Printing Machine (bottleneck machine in a electronic speedo-cluster manufacturing company. The four step SMED philosophy was adopted to effect reduction in setup time. The initial step was gathering information about the present setup times and its proportion to the total productive time. A detailed video based time study of setup activities was done to classify them into external and internal setup activities in terms of their need (i.e. preparation, replacement or adjustment, time taken and the way these could be reduced, simplified or eliminated. The improvements effected were of three categories viz., mechanical, procedural and organizational. The paper concludes by comparing the present and proposed (implemented methods of setup procedures.

  16. Evaluation of Flexible Tacrolimus Drug Concentration Monitoring Approach in Patients Receiving Extended-Release Once-Daily Tacrolimus Tablets.

    Science.gov (United States)

    Philosophe, Benjamin; Leca, Nicolae; West-Thielke, Patricia M; Horwedel, Timothy; Culkin-Gemmell, Christine; Kistler, Kristin; Stevens, Daniel R

    2018-02-20

    The majority of United States kidney transplant patients are treated with tacrolimus, a drug effective in preventing graft rejection, but with a narrow therapeutic range, necessitating close monitoring to avoid increased risks of transplant rejection or toxicity if the tacrolimus concentration is too low or too high, respectively. The trough drug concentration tests are time sensitive; patients treated on a twice-daily basis have blood draws exactly 12 hours after their previous dose. The schedule's rigidity causes problems for both patients and health care providers. Novel once-daily tacrolimus formulations such as LCPT (an extended-release tablet by Veloxis Pharmaceuticals, Inc., Cary, North Carolina) have allowed for blood draws on a once-daily basis; however, even that schedule can be restrictive. Results from tests taken either before or after that 24-hour target time may be discarded, or worse, may lead to inappropriate dose changes. Data from ASTCOFF, a phase 3B pharmacokinetic clinical trial (NCT02339246), demonstrated that the unique pharmacokinetic curve of LCPT may allow for a therapeutic monitoring window that extends for 3 hours before or after the 24-hour monitoring target. Furthermore, important tools to help clinicians interpret these levels, such as formulas to estimate the 24-hour trough level if an alternative monitoring time is used, were constructed from these data. These study results give treating clinicians access to data that allow them to safely use and monitor LCPT in their patients and expand the body of evidence surrounding differentiation and practical application of the novel LCPT tacrolimus formulation. © 2018, The Authors. The Journal of Clinical Pharmacology published by Wiley Periodicals, Inc. on behalf of American College of Clinical Pharmacology.

  17. Range resolution and reproducibility of a dedicated phantom for proton PBS daily quality assurance.

    Science.gov (United States)

    Placidi, Lorenzo; Togno, Michele; Weber, Damien C; Lomax, Antony J; Hrbacek, Jan

    2018-03-13

    Wedge phantoms coupled with a CCD camera are suggested as a simple means to improve the efficiency of quality assurance for pencil beam scanning (PBS) proton therapy, in particular to verify energy/range consistency on a daily basis. The method is based on the analysis of an integral image created by a pencil beam (PB) pattern delivered through a wedge. We have investigated the reproducibility of this method and its dependence on setup and positional beam errors for a commercially available phantom (Sphinx ® , IBA Dosimetry) and CCD camera (Lynx ® , IBA Dosimetry) system. The phantom includes 4 wedges of different thickness, allowing verification of the range for 4 energies within one integral image. Each wedge was irradiated with a line pattern of clinical energies (120, 150, 180 and 230MeV). The equipment was aligned to the isocenter using lasers, and the delivery was repeated for 5 consecutive days, 4 times each day. Range was computed using the myQA software (IBA Dosimetry) and inter- and intra-setup uncertainty were calculated. Dependence of range on energy was investigated delivering the same pencil beam pattern but with energy variations in steps of ±0.2MeV for all the nominal energies, up to ±1.0MeV. Possible range uncertainties, caused by setup and positional errors, were then simulated including inclination of the phantom, pencil beam and couch shifts. Intra position setup (based on in-room laser system) shows a maximum in plane difference within 1.5mm. Range reproducibility (standard deviation) was less than 0.14mm. Setup and beam errors did not affect significantly the results, except for a vertical shift of 10mm which leads to an error in the range computation. Taking into account different day-to-day setup and beam errors, day-to-day determination of range has been shown to be reproducible using the proposed system. Copyright © 2018. Published by Elsevier GmbH.

  18. The efficacy of motivational counseling and SMS-reminders on daily sitting time in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Esbensen, Bente Appel; Thomsen, Tanja; Hetland, Merete L

    2015-01-01

    group receiving usual care. The intervention includes: 1) individual motivational counseling (in total 3 sessions) on reduction of daily sitting time in combination with 2) individual Short Text Message Service (SMS) reminders over a 16-week intervention period. Primary outcome is change in daily...... that SB can be reduced by behavioural interventions in healthy populations. However, it remains unexplored whether it is valid for patients with RA also. Therefore, the aim of this trial is to investigate the efficacy of an individually tailored, theory-based motivational counseling intervention......, and finally to assess the cost-effectiveness of the intervention. METHODS/DESIGN: For this parallel group randomized trial, 150 patients with RA and at least 5 hours of sitting time per day, will be recruited from a rheumatology outpatient clinic, and block-randomized to the intervention group or the control...

  19. Impact of residual setup error on parotid gland dose in intensity-modulated radiation therapy with or without planning organ-at-risk margin

    International Nuclear Information System (INIS)

    Delana, Anna; Menegotti, Loris; Valentini, Aldo; Bolner, Andrea; Tomio, Luigi; Vanoni, Valentina; Lohr, Frank

    2009-01-01

    Purpose: To estimate the dosimetric impact of residual setup errors on parotid sparing in head-and-neck (H and N) intensity-modulated treatments and to evaluate the effect of employing an PRV (planning organ-at-risk volume) margin for the parotid gland. Patients and methods: Ten patients treated for H and N cancer were considered. A nine-beam intensity-modulated radiotherapy (IMRT) was planned for each patient. A second optimization was performed prescribing dose constraint to the PRV of the parotid gland. Systematic setup errors of 2 mm, 3 mm, and 5 mm were simulated. The dose-volume histograms of the shifted and reference plans were compared with regard to mean parotid gland dose (MPD), normal-tissue complication probability (NTCP), and coverage of the clinical target volume (V 95% and equivalent uniform dose [EUD]); the sensitivity of parotid sparing on setup error was evaluated with a probability-based approach. Results: MPD increased by 3.4%/mm and 3.0%/mm for displacements in the craniocaudal and lateral direction and by 0.7%/mm for displacements in the anterior-posterior direction. The probability to irradiate the parotid with a mean dose > 30 Gy was > 50%, for setup errors in cranial and lateral direction and 95% and EUD variations < 1% and < 1 Gy). Conclusion: The parotid gland is more sensitive to craniocaudal and lateral displacements. A setup error of 2 mm guarantees an MPD ≤ 30 Gy in most cases, without adding a PRV margin. If greater displacements are expected/accepted, an adequate PRV margin could be used to meet the clinical parotid gland constraint of 30 Gy, without affecting target volume coverage. (orig.)

  20. The efficacy of motivational counselling and SMS reminders on daily sitting time in patients with rheumatoid arthritis: a randomised controlled trial.

    Science.gov (United States)

    Thomsen, Tanja; Aadahl, Mette; Beyer, Nina; Hetland, Merete Lund; Løppenthin, Katrine; Midtgaard, Julie; Christensen, Robin; Østergaard, Mikkel; Jennum, Poul Jørgen; Esbensen, Bente Appel

    2017-09-01

    The aim of this report is to investigate the efficacy of an individually tailored, theory-based behavioural intervention for reducing daily sitting time, pain and fatigue, as well as improving health-related quality of life, general self-efficacy, physical function and cardiometabolic biomarkers in patients with rheumatoid arthritis (RA). In this randomised controlled trial 150 patients with RA were randomised to an intervention or a no-intervention control group. The intervention group received three individual motivational counselling sessions and short message service or text messages aimed at reduction of sedentary behaviour during the 16-week intervention period. Primary outcome was change in daily sitting time measured objectively by ActivPAL. Secondary outcomes included change in pain, fatigue, physical function, general self-efficacy, quality of life, blood pressure, blood lipids, haemoglobin A1c, body weight, body mass index, waist circumference and waist-hip ratio. 75 patients were allocated to each group. Mean reduction in daily sitting time was -1.61 hours/day in the intervention versus 0.59 hours/day increase in the control group between-group difference -2.20 (95% CI -2.72 to -1.69; pgroup. Most of the secondary outcomes were also in favour of the intervention. An individually tailored, behavioural intervention reduced daily sitting time in patients with RA and improved patient-reported outcomes and cholesterol levels. NCT01969604; Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Image guidance during head-and-neck cancer radiation therapy: analysis of alignment trends with in-room cone-beam computed tomography scans.

    Science.gov (United States)

    Zumsteg, Zachary; DeMarco, John; Lee, Steve P; Steinberg, Michael L; Lin, Chun Shu; McBride, William; Lin, Kevin; Wang, Pin-Chieh; Kupelian, Patrick; Lee, Percy

    2012-06-01

    On-board cone-beam computed tomography (CBCT) is currently available for alignment of patients with head-and-neck cancer before radiotherapy. However, daily CBCT is time intensive and increases the overall radiation dose. We assessed the feasibility of using the average couch shifts from the first several CBCTs to estimate and correct for the presumed systematic setup error. 56 patients with head-and-neck cancer who received daily CBCT before intensity-modulated radiation therapy had recorded shift values in the medial-lateral, superior-inferior, and anterior-posterior dimensions. The average displacements in each direction were calculated for each patient based on the first five or 10 CBCT shifts and were presumed to represent the systematic setup error. The residual error after this correction was determined by subtracting the calculated shifts from the shifts obtained using daily CBCT. The magnitude of the average daily residual three-dimensional (3D) error was 4.8 ± 1.4 mm, 3.9 ± 1.3 mm, and 3.7 ± 1.1 mm for uncorrected, five CBCT corrected, and 10 CBCT corrected protocols, respectively. With no image guidance, 40.8% of fractions would have been >5 mm off target. Using the first five CBCT shifts to correct subsequent fractions, this percentage decreased to 19.0% of all fractions delivered and decreased the percentage of patients with average daily 3D errors >5 mm from 35.7% to 14.3% vs. no image guidance. Using an average of the first 10 CBCT shifts did not significantly improve this outcome. Using the first five CBCT shift measurements as an estimation of the systematic setup error improves daily setup accuracy for a subset of patients with head-and-neck cancer receiving intensity-modulated radiation therapy and primarily benefited those with large 3D correction vectors (>5 mm). Daily CBCT is still necessary until methods are developed that more accurately determine which patients may benefit from alternative imaging strategies. Copyright © 2012 Elsevier

  2. Stereotactic ablative body radiotherapy for non-small-cell lung cancer: setup reproducibility with novel arms-down immobilization.

    Science.gov (United States)

    Moore, Karen; Paterson, Claire; Hicks, Jonathan; Harrow, Stephen; McJury, Mark

    2016-12-01

    A clinical evaluation of the intrafraction and interfraction setup accuracy of a novel thermoplastic mould immobilization device and patient position in early-stage lung cancer being treated with stereotactic radiotherapy at the Beatson West of Scotland Cancer Centre, Glasgow, UK. 35 patients were immobilized in a novel, arms-down position, with a four-point Klarity ™ (Klarity Medical Products, Ohio, US) clear thermoplastic mould fixed to a SinMed (CIVCO Medical solutions, lowa, US) head and neck board. A knee support was also used for patient comfort and support. Pre- and post-treatment kilovoltage cone beam CT (CBCT) images were fused with the planning CT scan to determine intra- and interfraction motion. A total of 175 CBCT scans were analysed in the longitudinal, vertical and lateral directions. The mean intrafraction errors were 0.05 ± 0.77 mm (lateral), 0.44 ± 1.2 mm (superior-inferior) and -1.44 ± 1.35 mm (anteroposterior), respectively. Mean composite three-dimensional displacement vector was 2.14 ± 1.2 mm. Interfraction errors were -0.66 ± 2.35 mm (lateral), -0.13 ± 3.11 mm (superior-inferior) and 0.00 ± 2.94 mm (anteroposterior), with three-dimensional vector 4.08 ± 2.73 mm. Setup accuracy for lung image-guided stereotactic ablative radiotherapy using a unique immobilization device, where patients have arms by their sides, has been shown to be safe and favourably comparable to other published setup data where more complex and cumbersome devices were utilised. There was no arm toxicity reported and low arm doses. Advances in knowledge: We report on the accuracy of a novel patient immobilization device.

  3. Effect of modified constraint-induced movement therapy on the activities of daily living of patients with acute stroke

    Directory of Open Access Journals (Sweden)

    Wei-ming ZHANG

    2015-04-01

    Full Text Available Objective To observe the rehabilitation effect of modified constraint-induced movement therapy (mCIMT on activities of daily living (ADL in patients with acute ischemic stroke.  Methods A total of 60 patients in acute stage of cerebral stroke with limb dysfunction admitted in Ruijin Hospital from December 2012 to May 2013, were randomly divided into routine rehabilitation treatment group (control group, N = 30 and mCIMT group (N = 30. Control group was given routine rehabilitation training, 60 min each time, twice per day, 5 d per week; mCIMT group received mCIMT treatment with the similar frequency. After 2-week training, all patients were transferred to rehabilitation center for 4-week continous training. The total treatment period was 6 weeks. All of those patients received assessment before treatment and 2 weeks, 6 weeks, 12 weeks after treatment on the ability of daily living and motor function, including the modified Barthel Index (mBI, Fugl-Meyer Assessment (FMA and Berg Balance Scale (BBS.  Results Patients in both groups got increased mBI (P = 0.004, 0.000, 0.000, FMA (upper limb: P = 0.000, for all and BBS scores (P = 0.005, 0.000, 0.000 2, 6, 12 weeks after treatment. FMA (lower limb score was increased 6 and 12 weeks after treatment (P = 0.000, for all. Compared to the control group, patients in mCIMT group got increased mBI (P = 0.000, for all, FMA (upper limb: P = 0.000, for all; lower limb: P = 0.000, for all and BBS scores (P = 0.000, for all 2, 6, 12 weeks after treatment.  Conclusions mCIMT has positive therapeutic effects on the motor function of limbs in hemiplegic patients with stroke in acute stage, which can improve the balance ability and the ability of daily life, so as to raise the quality of life of patients. The efficacy of mCIMT is superior to general routine rehabilitation treatment. DOI: 10.3969/j.issn.1672-6731.2015.04.006

  4. Impact of inter- and intrafraction deviations and residual set-up errors on PTV margins. Different alignment techniques in 3D conformal prostate cancer radiotherapy

    International Nuclear Information System (INIS)

    Langsenlehner, T.; Doeller, C.; Winkler, P.; Kapp, K.S.; Galle, G.

    2013-01-01

    The aim of this work was to analyze interfraction and intrafraction deviations and residual set-up errors (RSE) after online repositioning to determine PTV margins for 3 different alignment techniques in prostate cancer radiotherapy. The present prospective study included 44 prostate cancer patients with implanted fiducials treated with three-dimensional (3D) conformal radiotherapy. Daily localization was based on skin marks followed by marker detection using kilovoltage (kV) imaging and subsequent patient repositioning. Additionally, in-treatment megavoltage (MV) images were obtained for each treatment field. In an off-line analysis of 7,273 images, interfraction prostate motion, RSE after marker-based prostate localization, prostate position during each treatment session, and the effect of treatment time on intrafraction deviations were analyzed to evaluate PTV margins. Margins accounting for interfraction deviation, RSE and intrafraction motion were 14.1, 12.9, and 15.1 mm in anterior-posterior (AP), superior-inferior (SI), and left-right (LR) direction for skin mark alignment and 9.6, 8.7, and 2.6 mm for bony structure alignment, respectively. Alignment to implanted markers required margins of 4.6, 2.8, and 2.5 mm. As margins to account for intrafraction motion increased with treatment prolongation PTV margins could be reduced to 3.9, 2.6, and 2.4 mm if treatment time was ≤ 4 min. With daily online correction and repositioning based on implanted fiducials, a significant reduction of PTV margins can be achieved. The use of an optimized workflow with faster treatment techniques such as volumetric modulated arc techniques (VMAT) could allow for a further decrease. (orig.)

  5. Ability to perform Actvities of Daily Living among patients with bipolar disorder in remission

    DEFF Research Database (Denmark)

    Decker, Lone; Träger, Conny; Miskowiak, Kamilla

    2017-01-01

    in the community. While participants reported decreased ADL ability, especially within instrumental ADL, they had a tendency towards evaluating themselves as more competent than what was observed. No relationships between measures of observed and self-reported ADL ability were found. Conclusion: Overall, patients......ABSTRACT Aims: Patients with bipolar disorder often experience disability in terms of cognitive impairments and activity limitations even in remission. However, knowledge is sparse concerning the ability to perform Activities of Daily Living (ADL) during remission. The aim of this study was to (1......) investigate the observed and self-reported ability to perform ADL tasks and (2) examine the association between observed and self-reported ability to perform ADL in patients with bipolar disorder in remission. Methods: The observed ADL ability was assessed with the Assessment of Motor and Process Skills...

  6. Dosimetric impact of image-guided 3D conformal radiation therapy of prostate cancer

    International Nuclear Information System (INIS)

    Schaly, B; Song, W; Bauman, G S; Battista, J J; Van Dyk, J

    2005-01-01

    The goal of this work is to quantify the impact of image-guided conformal radiation therapy (CRT) on the dose distribution by correcting patient setup uncertainty and inter-fraction tumour motion. This was a retrospective analysis that used five randomly selected prostate cancer patients that underwent approximately 15 computed tomography (CT) scans during their radiation treatment course. The beam arrangement from the treatment plan was imported into each repeat CT study and the dose distribution was recalculated for the new beam setups. Various setup scenarios were then compared to assess the impact of image guidance on radiation treatment precision. These included (1) daily alignment to skin markers, thus representing a conventional beam setup without image guidance (2) alignment to bony anatomy for correction of daily patient setup error, thus representing on-line portal image guidance, and (3) alignment to the 'CTV of the day' for correction of inter-fraction tumour motion, thus representing on-line CT or ultrasound image guidance. Treatment scenarios (1) and (3) were repeated with a reduced CTV to PTV margin, where the former represents a treatment using small margins without daily image guidance. Daily realignment of the treatment beams to the prostate showed an average increase in minimum tumour dose of 1.5 Gy, in all cases where tumour 'geographic miss' without image guidance was apparent. However, normal tissue sparing did not improve unless the PTV margin was reduced. Daily realignment to the tumour combined with reducing the margin size by a factor of 2 resulted in an average escalation in tumour dose of 9.0 Gy for all five static plans. However, the prescription dose could be escalated by 13.8 Gy when accounting for changes in anatomy by accumulating daily doses using nonlinear image registration techniques. These results provide quantitative information on the effectiveness of image-guided radiation treatment of prostate cancer and demonstrate that

  7. Evaluation of different set-up error corrections on dose-volume metrics in prostate IMRT using CBCT images

    International Nuclear Information System (INIS)

    Hirose, Yoshinori; Tomita, Tsuneyuki; Kitsuda, Kenji; Notogawa, Takuya; Miki, Katsuhito; Nakamura, Mitsuhiro; Nakamura, Kiyonao; Ishigaki, Takashi

    2014-01-01

    We investigated the effect of different set-up error corrections on dose-volume metrics in intensity-modulated radiotherapy (IMRT) for prostate cancer under different planning target volume (PTV) margin settings using cone-beam computed tomography (CBCT) images. A total of 30 consecutive patients who underwent IMRT for prostate cancer were retrospectively analysed, and 7-14 CBCT datasets were acquired per patient. Interfractional variations in dose-volume metrics were evaluated under six different set-up error corrections, including tattoo, bony anatomy, and four different target matching groups. Set-up errors were incorporated into planning the isocenter position, and dose distributions were recalculated on CBCT images. These processes were repeated under two different PTV margin settings. In the on-line bony anatomy matching groups, systematic error (Σ) was 0.3 mm, 1.4 mm, and 0.3 mm in the left-right, anterior-posterior (AP), and superior-inferior directions, respectively. Σ in three successive off-line target matchings was finally comparable with that in the on-line bony anatomy matching in the AP direction. Although doses to the rectum and bladder wall were reduced for a small PTV margin, averaged reductions in the volume receiving 100% of the prescription dose from planning were within 2.5% under all PTV margin settings for all correction groups, with the exception of the tattoo set-up error correction only (≥ 5.0%). Analysis of variance showed no significant difference between on-line bony anatomy matching and target matching. While variations between the planned and delivered doses were smallest when target matching was applied, the use of bony anatomy matching still ensured the planned doses. (author)

  8. The Residual Setup Errors of Different IGRT Alignment Procedures for Head and Neck IMRT and the Resulting Dosimetric Impact

    International Nuclear Information System (INIS)

    Graff, Pierre; Kirby, Neil; Weinberg, Vivian; Chen, Josephine; Yom, Sue S.; Lambert, Louise; Pouliot, Jean

    2013-01-01

    Purpose: To assess residual setup errors during head and neck radiation therapy and the resulting consequences for the delivered dose for various patient alignment procedures. Methods and Materials: Megavoltage cone beam computed tomography (MVCBCT) scans from 11 head and neck patients who underwent intensity modulated radiation therapy were used to assess setup errors. Each MVCBCT scan was registered to its reference planning kVCT, with seven different alignment procedures: automatic alignment and manual registration to 6 separate bony landmarks (sphenoid, left/right maxillary sinuses, mandible, cervical 1 [C1]-C2, and C7-thoracic 1 [T1] vertebrae). Shifts in the different alignments were compared with each other to determine whether there were any statistically significant differences. Then, the dose distribution was recalculated on 3 MVCBCT images per patient for every alignment procedure. The resulting dose-volume histograms for targets and organs at risk (OARs) were compared to those from the planning kVCTs. Results: The registration procedures produced statistically significant global differences in patient alignment and actual dose distribution, calling for a need for standardization of patient positioning. Vertically, the automatic, sphenoid, and maxillary sinuses alignments mainly generated posterior shifts and resulted in mean increases in maximal dose to OARs of >3% of the planned dose. The suggested choice of C1-C2 as a reference landmark appears valid, combining both OAR sparing and target coverage. Assuming this choice, relevant margins to apply around volumes of interest at the time of planning to take into account for the relative mobility of other regions are discussed. Conclusions: Use of different alignment procedures for treating head and neck patients produced variations in patient setup and dose distribution. With concern for standardizing practice, C1-C2 reference alignment with relevant margins around planning volumes seems to be a valid

  9. The antianginal efficacy and tolerability of controlled-release metoprolol once daily

    DEFF Research Database (Denmark)

    Egstrup, K; Gundersen, T; Härkönen, R

    1988-01-01

    In a randomized, double-blind, cross-over study treatment with a new controlled-release (CR) preparation of metoprolol, given once daily, was compared with treatment with conventional metoprolol tablets, given twice daily, in 115 patients with stable effort angina pectoris. The patients were...... questionnaire. When all patients were analysed together there were no differences in antianginal efficacy between the two treatment regimens. However, when the group taking 200 mg daily was analysed separately better exercise tolerance was found during metoprolol CR therapy, as measured by onset of chest pain...... and ST-segment change, compared with conventional metoprolol therapy. The two formulations were well tolerated. When given once daily in a total daily dose of 100 mg, the CR preparation induced less adverse effects than the conventional tablets, 50 mg twice daily. It was concluded that the new metoprolol...

  10. Local control and functional results after twice-daily radiotherapy for Ewing's sarcoma of the extremities

    International Nuclear Information System (INIS)

    Bolek, Timothy W.; Marcus, Robert B.; Mendenhall, Nancy Price; Scarborough, Mark T.; Graham-Pole, John

    1996-01-01

    Purpose: Radiotherapy (RT) has been the predominant local treatment for Ewing's sarcoma of bone at the University of Florida. Twice-daily hyperfractionated RT was initiated in 1982 to improve local control and functional outcome. This retrospective review compares the results of once-daily vs. twice-daily RT in patients with primary Ewing's sarcoma of an extremity, with emphasis on functional outcome. Methods and Materials: Between June 1971 and January 1990, 37 patients were treated at the University of Florida for nonmetastatic Ewing's sarcoma of bone with a primary lesion in an extremity. Three patients underwent amputation. Of 34 patients treated with RT, 31 had RT alone and 3 had a combination of RT and local excision. Before 1982, 14 patients received once-daily RT; since 1982, 17 patients have received twice-daily RT. Doses of once-daily RT varied from 47 to 61 Gy at 1.8-2 Gy per fraction. Doses of twice-daily RT varied, depending on the response of the soft-tissue component of the tumor to chemotherapy, and ranged from 50.4 to 60 Gy at 1.2 Gy per fraction. Some patients in the twice-daily RT group also received total body irradiation 1-3 months after local RT as part of a conditioning regimen before marrow-ablative therapy with stem cell rescue. They received either 8 Gy in two once-daily fractions or 12 Gy in six twice-daily fractions. The six patients who received surgery were excluded from local control analysis. Local control rates were calculated using the Kaplan-Meier (actuarial) method. Fifteen patients had a formal functional evaluation. Results: In the 31 patients treated with RT alone, the actuarial local control rate at 5 years was 81% for patients treated twice daily and 77% for those treated once daily (p = NS). No posttreatment pathologic fractures occurred in patients treated twice daily, whereas five fractures occurred in those treated once daily (p = 0.01). On functional evaluation, less loss in range of motion (15 deg. vs. 28 deg. of loss

  11. GPU-accelerated automatic identification of robust beam setups for proton and carbon-ion radiotherapy

    International Nuclear Information System (INIS)

    Ammazzalorso, F; Jelen, U; Bednarz, T

    2014-01-01

    We demonstrate acceleration on graphic processing units (GPU) of automatic identification of robust particle therapy beam setups, minimizing negative dosimetric effects of Bragg peak displacement caused by treatment-time patient positioning errors. Our particle therapy research toolkit, RobuR, was extended with OpenCL support and used to implement calculation on GPU of the Port Homogeneity Index, a metric scoring irradiation port robustness through analysis of tissue density patterns prior to dose optimization and computation. Results were benchmarked against an independent native CPU implementation. Numerical results were in agreement between the GPU implementation and native CPU implementation. For 10 skull base cases, the GPU-accelerated implementation was employed to select beam setups for proton and carbon ion treatment plans, which proved to be dosimetrically robust, when recomputed in presence of various simulated positioning errors. From the point of view of performance, average running time on the GPU decreased by at least one order of magnitude compared to the CPU, rendering the GPU-accelerated analysis a feasible step in a clinical treatment planning interactive session. In conclusion, selection of robust particle therapy beam setups can be effectively accelerated on a GPU and become an unintrusive part of the particle therapy treatment planning workflow. Additionally, the speed gain opens new usage scenarios, like interactive analysis manipulation (e.g. constraining of some setup) and re-execution. Finally, through OpenCL portable parallelism, the new implementation is suitable also for CPU-only use, taking advantage of multiple cores, and can potentially exploit types of accelerators other than GPUs.

  12. GPU-accelerated automatic identification of robust beam setups for proton and carbon-ion radiotherapy

    Science.gov (United States)

    Ammazzalorso, F.; Bednarz, T.; Jelen, U.

    2014-03-01

    We demonstrate acceleration on graphic processing units (GPU) of automatic identification of robust particle therapy beam setups, minimizing negative dosimetric effects of Bragg peak displacement caused by treatment-time patient positioning errors. Our particle therapy research toolkit, RobuR, was extended with OpenCL support and used to implement calculation on GPU of the Port Homogeneity Index, a metric scoring irradiation port robustness through analysis of tissue density patterns prior to dose optimization and computation. Results were benchmarked against an independent native CPU implementation. Numerical results were in agreement between the GPU implementation and native CPU implementation. For 10 skull base cases, the GPU-accelerated implementation was employed to select beam setups for proton and carbon ion treatment plans, which proved to be dosimetrically robust, when recomputed in presence of various simulated positioning errors. From the point of view of performance, average running time on the GPU decreased by at least one order of magnitude compared to the CPU, rendering the GPU-accelerated analysis a feasible step in a clinical treatment planning interactive session. In conclusion, selection of robust particle therapy beam setups can be effectively accelerated on a GPU and become an unintrusive part of the particle therapy treatment planning workflow. Additionally, the speed gain opens new usage scenarios, like interactive analysis manipulation (e.g. constraining of some setup) and re-execution. Finally, through OpenCL portable parallelism, the new implementation is suitable also for CPU-only use, taking advantage of multiple cores, and can potentially exploit types of accelerators other than GPUs.

  13. Factors that influence physical activity in the daily life of male patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    S. Barriga

    2014-05-01

    Full Text Available Introduction: Chronic obstructive pulmonary disease (COPD is a disease with great impact on the ability to carry out physical activity. Objective: To identify the main factors that affect physical activity in the daily life of patients with COPD. Methods: Physical activity in daily routine has been evaluated according to the London Chest Activity of Daily Living scale (LCADL and the pedometer counting the number of steps per day, for a period of three days. Fifty-five male patients with a diagnosis of moderate to very severe COPD were included (aged 67 ± 9.6 years; FEV1 50.8 ± 14.7% predicted. Results: Patients walked on average 4972 steps per day. Very severe COPD patients (n = 12 walked much less than severe (n = 21 and moderate (n = 22 patients (respectively 3079.8 versus 4853.5 and 6118.1 steps per day, p < 0.001. The number of steps per day had a negative correlation with age, dyspnea (mMRC, depression, BODE index and pulmonary hyperinflation; and a positive correlation with the distance covered in the six-minute walk test (6MWT, forced expiratory volume in the first second (FEV1, carbon monoxide diffusion capacity (DLCO, arterial oxygen saturation (SpO2 and body mass index (BMI. Conclusions: The main factors that correlated with limited physical activity in daily life routine of this group of COPD patients were dyspnea and 6 min walking distance. These patients form a sedentary group, with a low rate of daily physical activity, which is more evident in patients with GOLD spirometry stage IV. Although pedometer is simpler and less accurate than other devices, it can be used to detect significant restraints daily life physical activity of COPD patients. Resumo: Introdução: A Doença Pulmonar Obstrutiva Crónica (DPOC é uma doença com grande impacto na capacidade de realizar atividade física. Objetivo: Identificar os principais fatores que influenciam a atividade física na

  14. A comparison of center-based vs. home-based daily hemodialysis for patients with end-stage renal disease.

    Science.gov (United States)

    Kraus, Michael; Burkart, John; Hegeman, Rebecca; Solomon, Richard; Coplon, Norman; Moran, John

    2007-10-01

    Home hemodialysis has been a therapeutic option for almost 4 decades. The complexity of dialysis equipment has been a factor-limiting adoption of this modality. We performed a feasibility study to demonstrate the safety of center-based vs. home-based daily hemodialysis with the NxStage System One portable hemodialysis device. We also performed a retrospective analysis to determine if clinical effects previously associated with short-daily dialysis were also seen using this novel device. We conducted a prospective, 2-treatment, 2-period, open-label, crossover study of in-center hemodialysis vs. home hemodialysis in 32 patients treated at 6 U.S. centers. The 8-week In-Center Phase (6 days/week) was followed by a 2-week transition period and then followed by the 8-week Home Phase (6 days/week). We retrospectively collected data on hemodialysis treatment parameters immediately preceding the study in a subset of patients. Twenty-six out of 32 patients (81%) successfully completed the study. Successful delivery of at least 90% of prescribed fluid volume (primary endpoint) was achieved in 98.5% of treatments in-center and 97.3% at home. Total effluent volume as a percentage of prescribed volume was between 94% and 100% for all study weeks. The composite rate of intradialytic and interdialytic adverse events per 100 treatments was significantly higher for the In-Center Phase (5.30) compared with the Home Phase (2.10; p=0.007). Compared with the period immediately preceding the study, there were reductions in blood pressure, antihypertensive medications, and interdialytic weight gain. Daily home hemodialysis with a small, easy-to-use hemodialysis device is a viable dialysis option for end-stage renal disease patients capable of self/partner-administered dialysis.

  15. Set-up for steam generator tube bundle washing after explosion expanding the tubes

    International Nuclear Information System (INIS)

    Osipov, S.I.; Kal'nin, A.Ya.; Mazanenko, M.F.

    1985-01-01

    Set-up for steam generator tube bundle washing after the explosion expanding of tubes is described. Washing is accomplished by distillate. Steam is added to distillate for heating, and compersed air for preventing hydraulic shock. The set-up is equiped by control equipment. Set-up performances are presented. Time for one steam generator washing constitutes 8-12 h. High economic efficiency is realized due to the set-up introduction

  16. Water level effects on breaking wave setup for Pacific Island fringing reefs

    Science.gov (United States)

    Becker, J. M.; Merrifield, M. A.; Ford, M.

    2014-02-01

    The effects of water level variations on breaking wave setup over fringing reefs are assessed using field measurements obtained at three study sites in the Republic of the Marshall Islands and the Mariana Islands in the western tropical Pacific Ocean. At each site, reef flat setup varies over the tidal range with weaker setup at high tide and stronger setup at low tide for a given incident wave height. The observed water level dependence is interpreted in the context of radiation stress gradients specified by an idealized point break model generalized for nonnormally incident waves. The tidally varying setup is due in part to depth-limited wave heights on the reef flat, as anticipated from previous reef studies, but also to tidally dependent breaking on the reef face. The tidal dependence of the breaking is interpreted in the context of the point break model in terms of a tidally varying wave height to water depth ratio at breaking. Implications for predictions of wave-driven setup at reef-fringed island shorelines are discussed.

  17. Once-daily dose regimen of ribavirin is interchangeable with a twice-daily dose regimen: randomized open clinical trial

    Directory of Open Access Journals (Sweden)

    Balk JM

    2015-08-01

    Full Text Available Jiska M Balk,1 Guido RMM Haenen,1 Özgür M Koc,2 Ron Peters,3 Aalt Bast,1 Wim JF van der Vijgh,1 Ger H Koek,4 1Department of Toxicology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, 2Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 3DSM Resolve, Geleen, 4Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands Background: The combination of ribavirin (RBV and pegylated interferon (PEG-IFN is effective in the treatment of chronic hepatitis C infection. Reducing the frequency of RBV intake from twice to once a day will improve compliance and opens up the opportunity to combine RBV with new and more specific direct-acting agents in one pill. Therefore, the purpose of this study was to evaluate the pharmacokinetic profile of RBV in a once-daily to twice-daily regimen. The secondary aim was to determine tolerability as well as the severity and differences in side effects of both treatment regimens. Methods: In this randomized open-label crossover study, twelve patients with chronic type 1 hepatitis C infection and weighing more than 75 kg were treated with 180 µg of PEG-IFN weekly and 1,200 mg RBV daily for 24 weeks. The patients received RBV dosed as 1,200 mg once-daily for 12 weeks followed by RBV dosed as 600 mg twice-daily for 12 weeks, or vice versa. In addition to the pharmacokinetic profile, the hematological profile and side effects were recorded. The RBV concentrations in plasma were determined using liquid chromatography-tandem mass spectrometry. Results: Eight of twelve patients completed the study. Neither the time taken for RBV to reach peak plasma concentration nor the AUC0-last (adjusted for difference in dose was significantly different between the two groups (P>0.05. Furthermore, the once-daily regimen did not give more side effects than the twice-daily regimen (P>0

  18. VITEX 2016 : Evaluation of learning objectives and exercise set-up

    NARCIS (Netherlands)

    Rijk, R. van; Stubbé-Alberts, H.E.

    2016-01-01

    To strengthen awareness of the need for cooperation, between public and private partners, and between countries, a new exercise set-up was developed. The VITEX exercise set-up is a table top exercise that aims to bring relevant networks together, and supports cooperation and collaboration between

  19. Why IV Setup for Stream Ciphers is Difficult

    DEFF Research Database (Denmark)

    Zenner, Erik

    2007-01-01

    In recent years, the initialization vector (IV) setup has proven to be the most vulnerable point when designing secure stream ciphers. In this paper, we take a look at possible reasons why this is the case, identifying numerous open research problems in cryptography.......In recent years, the initialization vector (IV) setup has proven to be the most vulnerable point when designing secure stream ciphers. In this paper, we take a look at possible reasons why this is the case, identifying numerous open research problems in cryptography....

  20. On SIP Session setup delay for VoIP services over correlated fading channels

    DEFF Research Database (Denmark)

    Fathi, Hanane; Chakraborty, Shyam S.; Prasad, Ramjee

    2006-01-01

    In this paper, the session setup delay of the session initiation protocol (SIP) is studied. The transmissions on both the forward and reverse channel are assumed to experience Markovian errors. The session setup delay is evaluated for different transport protocols, and with the use of the radio...... link protocol (RLP). An adaptive retransmission timer is used to optimize SIP performances. Using numerical results, we find that SIP over user datagram protocol (UDP) instead of transport control protocol (TCP) can make the session setup up to 30% shorter. Also, RLP drastically reduces the session...... setup delay down to 4 to 5 s, even in environments with high frame error rates (10%) and significant correlation in the fading process (fDT=0.02). SIP is compared with its competitor H.323. SIP session setup delay with compressed messages outperforms H.323 session setup delay....

  1. Characterization of Cochlear, Vestibular and Cochlear-Vestibular Electrically Evoked Compound Action Potentials in Patients with a Vestibulo-Cochlear Implant

    Directory of Open Access Journals (Sweden)

    T. A. K. Nguyen

    2017-11-01

    Full Text Available The peripheral vestibular system is critical for the execution of activities of daily life as it provides movement and orientation information to motor and sensory systems. Patients with bilateral vestibular hypofunction experience a significant decrease in quality of life and have currently no viable treatment option. Vestibular implants could eventually restore vestibular function. Most vestibular implant prototypes to date are modified cochlear implants to fast-track development. These use various objective measurements, such as the electrically evoked compound action potential (eCAP, to supplement behavioral information. We investigated whether eCAPs could be recorded in patients with a vestibulo-cochlear implant. Specifically, eCAPs were successfully recorded for cochlear and vestibular setups, as well as for mixed cochlear-vestibular setups. Similarities and slight differences were found for the recordings of the three setups. These findings demonstrated the feasibility of eCAP recording with a vestibulo-cochlear implant. They could be used in the short term to reduce current spread and avoid activation of non-targeted neurons. More research is warranted to better understand the neural origin of vestibular eCAPs and to utilize them for clinical applications.

  2. Improvement in toxicity in high risk prostate cancer patients treated with image-guided intensity-modulated radiotherapy compared to 3D conformal radiotherapy without daily image guidance.

    Science.gov (United States)

    Sveistrup, Joen; af Rosenschöld, Per Munck; Deasy, Joseph O; Oh, Jung Hun; Pommer, Tobias; Petersen, Peter Meidahl; Engelholm, Svend Aage

    2014-02-04

    Image-guided radiotherapy (IGRT) facilitates the delivery of a very precise radiation dose. In this study we compare the toxicity and biochemical progression-free survival between patients treated with daily image-guided intensity-modulated radiotherapy (IG-IMRT) and 3D conformal radiotherapy (3DCRT) without daily image guidance for high risk prostate cancer (PCa). A total of 503 high risk PCa patients treated with radiotherapy (RT) and endocrine treatment between 2000 and 2010 were retrospectively reviewed. 115 patients were treated with 3DCRT, and 388 patients were treated with IG-IMRT. 3DCRT patients were treated to 76 Gy and without daily image guidance and with 1-2 cm PTV margins. IG-IMRT patients were treated to 78 Gy based on daily image guidance of fiducial markers, and the PTV margins were 5-7 mm. Furthermore, the dose-volume constraints to both the rectum and bladder were changed with the introduction of IG-IMRT. The 2-year actuarial likelihood of developing grade > = 2 GI toxicity following RT was 57.3% in 3DCRT patients and 5.8% in IG-IMRT patients (p analysis, 3DCRT was associated with a significantly increased risk of developing grade > = 2 GI toxicity compared to IG-IMRT (p analysis there was no difference in biochemical progression-free survival between 3DCRT and IG-IMRT. The difference in toxicity can be attributed to the combination of the IMRT technique with reduced dose to organs-at-risk, daily image guidance and margin reduction.

  3. Verification of setup errors in external beam radiation therapy using electronic portal imaging

    International Nuclear Information System (INIS)

    Krishna Murthy, K.; Al-Rahbi, Zakiya; Sivakumar, S.S.; Davis, C.A.; Ravichandran, R.

    2008-01-01

    The objective of this study was to conduct an audit on QA aspects of treatment delivery by the verification of the treatment fields position on different days to document the efficiency of immobilization methods and reproducibility of treatment. A retrospective study was carried out on 60 patients, each 20 treated for head and neck, breast, and pelvic sites; and a total of 506 images obtained by electronic portal imaging device (EPID) were analyzed. The portal images acquired using the EPID systems attached to the Varian linear accelerators were superimposed on the reference images. The anatomy matching software (Varian portal Vision. 6.0) was used, and the displacements in two dimensions and rotation were noted for each treated field to study the patient setup errors. The percentages of mean deviations more than 3 mm in lateral (X) and longitudinal (Y) directions were 17.5%, 11.25%, and 7.5% for breast, pelvis, and head and neck cases respectively. In all cases, the percentage of mean deviation with more than 5 mm error was 0.83%. The maximum average mean deviation in all the cases was 1.87. The average mean SD along X and Y directions in all the cases was less than 2.65. The results revealed that the ranges of setup errors are site specific and immobilization methods improve reproducibility. The observed variations were well within the limits. The study confirmed the accuracy and quality of treatments delivered to the patients. (author)

  4. SU-D-201-05: On the Automatic Recognition of Patient Safety Hazards in a Radiotherapy Setup Using a Novel 3D Camera System and a Deep Learning Framework

    Energy Technology Data Exchange (ETDEWEB)

    Santhanam, A; Min, Y; Beron, P; Agazaryan, N; Kupelian, P; Low, D [UCLA, Los Angeles, CA (United States)

    2016-06-15

    Purpose: Patient safety hazards such as a wrong patient/site getting treated can lead to catastrophic results. The purpose of this project is to automatically detect potential patient safety hazards during the radiotherapy setup and alert the therapist before the treatment is initiated. Methods: We employed a set of co-located and co-registered 3D cameras placed inside the treatment room. Each camera provided a point-cloud of fraxels (fragment pixels with 3D depth information). Each of the cameras were calibrated using a custom-built calibration target to provide 3D information with less than 2 mm error in the 500 mm neighborhood around the isocenter. To identify potential patient safety hazards, the treatment room components and the patient’s body needed to be identified and tracked in real-time. For feature recognition purposes, we used a graph-cut based feature recognition with principal component analysis (PCA) based feature-to-object correlation to segment the objects in real-time. Changes in the object’s position were tracked using the CamShift algorithm. The 3D object information was then stored for each classified object (e.g. gantry, couch). A deep learning framework was then used to analyze all the classified objects in both 2D and 3D and was then used to fine-tune a convolutional network for object recognition. The number of network layers were optimized to identify the tracked objects with >95% accuracy. Results: Our systematic analyses showed that, the system was effectively able to recognize wrong patient setups and wrong patient accessories. The combined usage of 2D camera information (color + depth) enabled a topology-preserving approach to verify patient safety hazards in an automatic manner and even in scenarios where the depth information is partially available. Conclusion: By utilizing the 3D cameras inside the treatment room and a deep learning based image classification, potential patient safety hazards can be effectively avoided.

  5. SU-D-201-05: On the Automatic Recognition of Patient Safety Hazards in a Radiotherapy Setup Using a Novel 3D Camera System and a Deep Learning Framework

    International Nuclear Information System (INIS)

    Santhanam, A; Min, Y; Beron, P; Agazaryan, N; Kupelian, P; Low, D

    2016-01-01

    Purpose: Patient safety hazards such as a wrong patient/site getting treated can lead to catastrophic results. The purpose of this project is to automatically detect potential patient safety hazards during the radiotherapy setup and alert the therapist before the treatment is initiated. Methods: We employed a set of co-located and co-registered 3D cameras placed inside the treatment room. Each camera provided a point-cloud of fraxels (fragment pixels with 3D depth information). Each of the cameras were calibrated using a custom-built calibration target to provide 3D information with less than 2 mm error in the 500 mm neighborhood around the isocenter. To identify potential patient safety hazards, the treatment room components and the patient’s body needed to be identified and tracked in real-time. For feature recognition purposes, we used a graph-cut based feature recognition with principal component analysis (PCA) based feature-to-object correlation to segment the objects in real-time. Changes in the object’s position were tracked using the CamShift algorithm. The 3D object information was then stored for each classified object (e.g. gantry, couch). A deep learning framework was then used to analyze all the classified objects in both 2D and 3D and was then used to fine-tune a convolutional network for object recognition. The number of network layers were optimized to identify the tracked objects with >95% accuracy. Results: Our systematic analyses showed that, the system was effectively able to recognize wrong patient setups and wrong patient accessories. The combined usage of 2D camera information (color + depth) enabled a topology-preserving approach to verify patient safety hazards in an automatic manner and even in scenarios where the depth information is partially available. Conclusion: By utilizing the 3D cameras inside the treatment room and a deep learning based image classification, potential patient safety hazards can be effectively avoided.

  6. High daily doses of benzodiazepines among Quebec seniors: prevalence and correlates

    Directory of Open Access Journals (Sweden)

    Moride Yola

    2001-11-01

    Full Text Available Abstract Background Use of high daily doses of benzodiazepines is generally contraindicated for seniors. While both patient and physician factors may influence the use of high daily doses, previous research on the effect of patient factors has been extremely limited. The objectives of this study were to determine the one year prevalence of use of high daily doses of benzodiazepines, and examine physician and patient correlates of such use among Quebec community-dwelling seniors. Methods Patient information for 1423 community-dwelling Quebec seniors who participated in the Canadian Study of Health and Aging was linked to provincial health insurance administrative data bases containing detailed information on prescriptions received and prescribers. Results The standardized one year period prevalence of use of high daily doses of benzodiazepines was 7.9%. Use of high daily doses was more frequent among younger seniors and those who had reported anxiety during the previous year. Patients without cognitive impairment were more likely to receive high dose prescriptions from general practitioners, while those with cognitive impairment were more likely to receive high dose prescriptions from specialists. Conclusion High dose prescribing appears to be related to both patient and physician factors.

  7. A new tribological experimental setup to study confined and sheared monolayers.

    Science.gov (United States)

    Fu, L; Favier, D; Charitat, T; Gauthier, C; Rubin, A

    2016-03-01

    We have developed an original experimental setup, coupling tribology, and velocimetry experiments together with a direct visualization of the contact. The significant interest of the setup is to measure simultaneously the apparent friction coefficient and the velocity of confined layers down to molecular scale. The major challenge of this experimental coupling is to catch information on a nanometer-thick sheared zone confined between a rigid spherical indenter of millimetric radius sliding on a flat surface at constant speed. In order to demonstrate the accuracy of this setup to investigate nanometer-scale sliding layers, we studied a model lipid monolayer deposited on glass slides. It shows that our experimental setup will, therefore, help to highlight the hydrodynamic of such sheared confined layers in lubrication, biolubrication, or friction on solid polymer.

  8. Precision assessment of model-based RSA for a total knee prosthesis in a biplanar set-up.

    Science.gov (United States)

    Trozzi, C; Kaptein, B L; Garling, E H; Shelyakova, T; Russo, A; Bragonzoni, L; Martelli, S

    2008-10-01

    Model-based Roentgen Stereophotogrammetric Analysis (RSA) was recently developed for the measurement of prosthesis micromotion. Its main advantage is that markers do not need to be attached to the implants as traditional marker-based RSA requires. Model-based RSA has only been tested in uniplanar radiographic set-ups. A biplanar set-up would theoretically facilitate the pose estimation algorithm, since radiographic projections would show more different shape features of the implants than in uniplanar images. We tested the precision of model-based RSA and compared it with that of the traditional marker-based method in a biplanar set-up. Micromotions of both tibial and femoral components were measured with both the techniques from double examinations of patients participating in a clinical study. The results showed that in the biplanar set-up model-based RSA presents a homogeneous distribution of precision for all the translation directions, but an inhomogeneous error for rotations, especially internal-external rotation presented higher errors than rotations about the transverse and sagittal axes. Model-based RSA was less precise than the marker-based method, although the differences were not significant for the translations and rotations of the tibial component, with the exception of the internal-external rotations. For both prosthesis components the precisions of model-based RSA were below 0.2 mm for all the translations, and below 0.3 degrees for rotations about transverse and sagittal axes. These values are still acceptable for clinical studies aimed at evaluating total knee prosthesis micromotion. In a biplanar set-up model-based RSA is a valid alternative to traditional marker-based RSA where marking of the prosthesis is an enormous disadvantage.

  9. Importance of daily electronic portal imaging in radiotherapy

    International Nuclear Information System (INIS)

    Bell, L. J.; Shakespeare, T. P.; Willis, A.

    2008-01-01

    Full text: An audit was conducted on 20 randomly selected patients who had daily electronic portal imaging during the course of their radiotherapy treatment. The daily images were reviewed to determine whether they were within tolerance according to departmental protocol. If they were not, the actions that were taken were documented. Four treatment areas (spine, chest, breast and prostate) were compared among five patients belonging to each of these categories. The patients were also categorized according to their treatment intent (radical or palliative). A total of 889 electronic portal images of 475 fractions were audited and 33.5% of all fractions were outside tolerance. It was found that 95% of patients needed an action during their treatment and 80% of the patients needed a treatment centre move during the course of their treatment. We found that errors occurred throughout the treatment and it was not possible to predict patients who could have daily imaging omitted. Concordance between radiation therapists and radiation oncologists for identification of error was also investigated. Despite the use of familiar electronic portal imaging protocols, image reviewers (radiation therapists and radiation oncologists) disagreed in interpretation 10% of the time. Our results support the hypothesis that daily imaging may be a useful tool for patients undergoing radiotherapy and that imaging may be ideally carried out before each fraction. Image assessments would be ideally carried out by a team approach, with all images reviewed by both radiation therapists and radiation oncologists. This approach has significant resource implications and may require review of current Medicare and Health Program Grant reimbursements.

  10. CHEMOTHERAPY-INDUCED NEUTROPENIA IN HIV POSITIVE PATIENTS WITH LYMPHOMA: COMPARISON OF PEGFILGRASTIM WITH DAILY FILGRASTIM ADMINISTRATION.

    Directory of Open Access Journals (Sweden)

    Luciana Teofili

    2012-01-01

    Full Text Available

    We retrospectively compared the incidence of neutropenia  in two groups of  HIV patients with lymphoma,  who underwent chemotherapy supported by once-per-cycle administration of pegfilgrastim or by daily subcutaneous injection of filgrastim, respectively. Our findings indicate that pegfilgrastim and filgastrim produce similar results in preventing both neutropenia and febrile neutropenia.

  11. CHEMOTHERAPY-INDUCED NEUTROPENIA IN HIV POSITIVE PATIENTS WITH LYMPHOMA: COMPARISON OF PEGFILGRASTIM WITH DAILY FILGRASTIM ADMINISTRATION.

    Directory of Open Access Journals (Sweden)

    Luciana Teofili

    2012-10-01

    Full Text Available We retrospectively compared the incidence of neutropenia  in two groups of  HIV patients with lymphoma,  who underwent chemotherapy supported by once-per-cycle administration of pegfilgrastim or by daily subcutaneous injection of filgrastim, respectively. Our findings indicate that pegfilgrastim and filgastrim produce similar results in preventing both neutropenia and febrile neutropenia.

  12. Estimation of Daily Proteinuria in Patients with Amyloidosis by Using the Protein-To-Creatinine ratio in Random Urine Samples.

    Science.gov (United States)

    Talamo, Giampaolo; Mir Muhammad, A; Pandey, Manoj K; Zhu, Junjia; Creer, Michael H; Malysz, Jozef

    2015-02-11

    Measurement of daily proteinuria in patients with amyloidosis is recommended at the time of diagnosis for assessing renal involvement, and for monitoring disease activity. Renal involvement is usually defined by proteinuria >500 mg/day. We evaluated the accuracy of the random urine protein-to-creatinine ratio (Pr/Cr) in predicting 24 hour proteinuria in patient with amyloidosis. We compared results of random urine Pr/Cr ratio and concomitant 24-hour urine collections in 44 patients with amyloidosis. We found a strong correlation (Spearman's ρ=0.874) between the Pr/Cr ratio and the 24 hour urine protein excretion. For predicting renal involvement, the optimal cut-off point of the Pr/Cr ratio was 715 mg/g. The sensitivity and specificity for this point were 91.8% and 95.5%, respectively, and the area under the curve value was 97.4%. We conclude that the random urine Pr/Cr ratio could be useful in the screening of renal involvement in patients with amyloidosis. If validated in a prospective study, the random urine Pr/Cr ratio could replace the 24 hour urine collection for the assessment of daily proteinuria and presence of nephrotic syndrome in patients with amyloidosis.

  13. Vitamin D supplementation in nursing home patients: randomized controlled trial of standard daily dose versus individualized loading dose regimen.

    Science.gov (United States)

    Wijnen, Hugo; Salemink, Dayenne; Roovers, Lian; Taekema, Diana; de Boer, Hans

    2015-05-01

    Supplementation of cholecalciferol 800 IU daily appears to be insufficient to raise vitamin D levels to >75 nmol/l in nursing home (NH) patients. Our objective was to compare the efficacy of an individualized cholecalciferol loading dose (LD) regimen and a daily dose (DD) regimen of cholecalciferol 800 IU in reaching 25-OH vitamin D (25OHD) levels >75 nmol/l. A total of 30 NH patients with 25OHD levels 50 nmol/l were included. Patients were randomized using the minimization method in the LD or DD group. The cholecalciferol LD, calculated with an algorithm based on serum 25OHD level and body weight, was administered in divided doses of 50,000 IU twice a week, followed by a monthly maintenance dose of either 50,000 or 25,000 IU. The DD regimen consisted of cholecalciferol 800 IU daily for 26 weeks. Serum 25OHD, calcium, creatinine, phosphate, and parathyroid hormone were measured, and 2-minute walking test, handgrip strength, and timed get up and go test were assessed at baseline (T 0), after 5 weeks (T 5), 12 weeks (T 12), and 26 weeks (T 26). The primary endpoint was the percentage of patients with 25OHD levels >75 nmol/l at T 5. Secondary endpoints were the proportion of patients with 25OHD levels >75 nmol/l at T 26, safety of LD regimen, and improvement of performance tests with normalization of vitamin D levels. Median baseline 25OHD levels (interquartile range) were comparable between the 14 DD and 16 LD patients: 20.9 (15.9-29.6) and 21.7 (16.4-32.8) nmol/l, respectively. Levels of 25OHD >75 nmol/l at T 5 were reached in 79 % of the 14 LD patients, but in none of the 13 DD patients (p 75 nmol/l were reached in 83 % of the 12 LD patients and in 30 % of the ten DD patients (p tests was observed. In NH patients with severe 25OHD deficiency, an individualized calculated cholecalciferol LD is likely to be superior to a DD of cholecalciferol 800 IU in terms of the ability to rapidly normalize vitamin D levels.

  14. False sense of safety by daily QTc interval monitoring during methadone IVPCA titration in a patient with chronic pain

    Directory of Open Access Journals (Sweden)

    Miranda-Grajales H

    2013-05-01

    Full Text Available Hector Miranda-Grajales, Joy Hao, Ricardo A CrucianiDepartment of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, USAAbstract: It has been proposed that some deaths attributed to methadone are related to prolongation of the QTc interval; however, there are no clear recommendations on electrocardiogram (ECG monitoring in patients undergoing intravenous methadone infusion. This is a report on a patient receiving methadone intravenous patient-controlled analgesia titration for the treatment of chronic pain. Initially, her daily ECGs showed QTc intervals within normal limits; however, she experienced a rapid increase in QTc interval from 317 ms to 784 ms within a 24-hour period after methadone had been discontinued for excessive sedation. QTc interval greater than 500 ms is considered to be high risk for the fatal arrhythmia Torsades de Pointes. Daily ECGs did not detect a gradual increase in the QTc interval that would have alerted the medical staff of the need to decrease or stop the methadone before reaching a prolonged QTc interval associated with cardiotoxicity. In selected cases where aggressive methadone titration is required, more intensive monitoring, such as telemetry or ECG determinations every 12 hours, might help detect changes in QTc interval duration that might otherwise be missed by daily ECG determinations.Keywords: methadone, QTc prolongation, opioids, opioid side effects, IVPCA methadone

  15. Intensive group training protocol versus guideline physiotherapy for patients with chronic low back pain: a randomised controlled trial

    OpenAIRE

    van der Roer, Nicole; van Tulder, Maurits; Barendse, Johanna; Knol, Dirk; van Mechelen, Willem; de Vet, Henrica

    2008-01-01

    Intensive group training using principles of graded activity has been proven to be effective in occupational care for workers with chronic low back pain. Objective of the study was to compare the effects of an intensive group training protocol aimed at returning to normal daily activities and guideline physiotherapy for primary care patients with non-specific chronic low back pain. The study was designed as pragmatic randomised controlled trial with a setup of 105 primary care physiotherapist...

  16. Peak and end effects in patients' daily recall of pain and fatigue: a within-subjects analysis.

    Science.gov (United States)

    Schneider, Stefan; Stone, Arthur A; Schwartz, Joseph E; Broderick, Joan E

    2011-02-01

    Clinical research often relies on retrospective recall of symptom levels, but the information contained in these ratings is not well understood. The "peak-and-end rule" suggests that the most intense (peak) and final (end) moments of an experience disproportionately influence retrospective judgments, which may bias self-reports of somatic symptoms. This study examined the extent to which peak and end symptom levels systematically affect patients' day-to-day recall of pain and fatigue. Rheumatology patients (N = 97) completed 5 to 6 momentary ratings of pain and fatigue per day as well as a daily recall rating of these symptoms for 28 consecutive days. For pain, peak and end momentary ratings predicted daily recall of average pain beyond the actual average of momentary ratings. This effect was small, yet was confirmed in both between-person and within-person (repeated measures) analyses. For fatigue, neither peak nor end momentary symptoms significantly contributed to daily recall. Of note, the evidence for peak- and end-effects in recall of pain and fatigue varied significantly between individual patients. These findings suggest that peak- and end-effects create a small bias in recall reports of pain, but not fatigue. However, there are considerable individual differences in susceptibility to peak and end heuristics. The peak-end cognitive heuristic could bias end-of-day recall of pain and fatigue. An effect was shown for pain, but not for fatigue. The effects were small and were unlikely to substantially bias end-of-day assessments. Individuals were shown to differ in the degree that the heuristic was associated with recall. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

  17. Cone beam CT with zonal filters for simultaneous dose reduction, improved target contrast and automated set-up in radiotherapy

    International Nuclear Information System (INIS)

    Moore, C J; Marchant, T E; Amer, A M

    2006-01-01

    Cone beam CT (CBCT) using a zonal filter is introduced. The aims are reduced concomitant imaging dose to the patient, simultaneous control of body scatter for improved image quality in the tumour target zone and preserved set-up detail for radiotherapy. Aluminium transmission diaphragms added to the CBCT x-ray tube of the Elekta Synergy TM linear accelerator produced an unattenuated beam for a central 'target zone' and a partially attenuated beam for an outer 'set-up zone'. Imaging doses and contrast noise ratios (CNR) were measured in a test phantom for transmission diaphragms 12 and 24 mm thick, for 5 and 10 cm long target zones. The effect on automatic registration of zonal CBCT to conventional CT was assessed relative to full-field and lead-collimated images of an anthropomorphic phantom. Doses along the axis of rotation were reduced by up to 50% in both target and set-up zones, and weighted dose (two thirds surface dose plus one third central dose) was reduced by 10-20% for a 10 cm long target zone. CNR increased by up to 15% in zonally filtered CBCT images compared to full-field images. Automatic image registration remained as robust as that with full-field images and was superior to CBCT coned down using lead-collimation. Zonal CBCT significantly reduces imaging dose and is expected to benefit radiotherapy through improved target contrast, required to assess target coverage, and wide-field edge detail, needed for robust automatic measurement of patient set-up error

  18. Surface imaging, portal imaging, and skin marker set-up vs. CBCT for radiotherapy of the thorax and pelvis

    Energy Technology Data Exchange (ETDEWEB)

    Pallotta, Stefania; Bucciolini, Marta [Universita degli Studi di Firenze, Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Florence (Italy); AOU Careggi, Sezione di Fisica Medica, Florence (Italy); Vanzi, Eleonora; Marrazzo, Livia [AOU Careggi, Sezione di Fisica Medica, Florence (Italy); Simontacchi, Gabriele; Paiar, Fabiola [AOU Careggi, Sezione di Radioterapia, Florence (Italy); Ceroti, Marco [ISPO, U.O. Epidemiologia Molecolare e Nutrizionale, Florence (Italy); Livi, Lorenzo [Universita degli Studi di Firenze, Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Florence (Italy); AOU Careggi, Sezione di Radioterapia, Florence (Italy)

    2015-09-15

    The aim of this study was to compare surface imaging, portal imaging, and skin marker set-up in radiotherapy of thoracic and pelvic regions, using cone beam computed tomography (CBCT) data as the gold standard. Twenty patients were included in this study. CBCT, surface acquisition (SA), and two orthogonal portal images (PI) were acquired during the first four treatment sessions. Patient set-up corrections, obtained by registering the planning CT with CBCT, were used as the gold standard. Registration results of the PI and SA were evaluated and compared with those obtained with CBCT. The advantage derived from using SA or PI verification systems over a skin marker set-up was also quantified. A statistically significant difference between PI and SA (in favour of PI) was observed in seven patients undergoing treatment of the pelvic region and in two patients undergoing treatment of the thoracic region. The use of SA or PI, compared with a skin marker set-up, improved patient positioning in 50% and 57 % of the thoracic fractions, respectively. For pelvic fractions, the use of PI was beneficial in 73 % of the cases, while the use of SA was beneficial in only 45 %. Patient positioning worsened with SA, particularly along longitudinal and vertical directions. PI yielded more accurate registration results than SA for both pelvic and thoracic fractions. Compared with the skin marker set-up, PI performances were superior to SA for pelvic fractions while comparable results were obtained for thoracic fractions. (orig.) [German] Ziel dieser Studie ist der Vergleich der Patientenpositionierung mittels der 3-D/4-D-Erfassung der Patientenoberflaeche durch ein Abtastsystem, kV/MV-Verifikationsaufnahmen mit Hochenergiebildsystemen und Markierungen auf der Haut bei Bestrahlungen im Thorax- bzw. Beckenbereich. Als Goldstandard zum Vergleich dienten CBCT(''cone beam computed tomography'')-Aufnahmen. Die Studie basiert auf Untersuchungen an 20 Patienten. Es wurden

  19. Recreating Riser Slugging Flow Based on an Economic Lab-sized Setup

    DEFF Research Database (Denmark)

    Hansen, Lasse; Pedersen, Simon; Yang, Zhenyu

    2013-01-01

    As a kind of periodic phenomenon, the slugging flow in the offshore oil & gas production addresses a lot of attentions, due to its limitation of production rate, periodic overload processing facilities, and even direct cause of emergent shutdown. This work studies the emulation of the riser...... slugging flow in the offshore oil & gas production, by constructing an economical lab-sized setup in the university campus. Firstly, the construction and used components for the lab setup are illustrated; then, the constructed setup is validated by checking the consistency with some existing typical riser...

  20. Robotic-based carbon ion therapy and patient positioning in 6 degrees of freedom: setup accuracy of two standard immobilization devices used in carbon ion therapy and IMRT.

    Science.gov (United States)

    Jensen, Alexandra D; Winter, Marcus; Kuhn, Sabine P; Debus, Jürgen; Nairz, Olaf; Münter, Marc W

    2012-03-29

    To investigate repositioning accuracy in particle radiotherapy in 6 degrees of freedom (DOF) and intensity-modulated radiotherapy (IMRT, 3 DOF) for two immobilization devices (Scotchcast masks vs thermoplastic head masks) currently in use at our institution for fractionated radiation therapy in head and neck cancer patients. Position verifications in patients treated with carbon ion therapy and IMRT for head and neck malignancies were evaluated. Most patients received combined treatment regimen (IMRT plus carbon ion boost), immobilization was achieved with either Scotchcast or thermoplastic head masks. Position corrections in robotic-based carbon ion therapy allowing 6 DOF were compared to IMRT allowing corrections in 3 DOF for two standard immobilization devices. In total, 838 set-up controls of 38 patients were analyzed. Robotic-based position correction including correction of rotations was well tolerated and without discomfort. Standard deviations of translational components were between 0.5 and 0.8 mm for Scotchcast and 0.7 and 1.3 mm for thermoplastic masks in 6 DOF and 1.2-1.4 mm and 1.0-1.1 mm in 3 DOF respectively. Mean overall displacement vectors were between 2.1 mm (Scotchcast) and 2.9 mm (thermoplastic masks) in 6 DOF and 3.9-3.0 mm in 3 DOF respectively. Displacement vectors were lower when correction in 6 DOF was allowed as opposed to 3 DOF only, which was maintained at the traditional action level of >3 mm for position correction in the pre-on-board imaging era. Setup accuracy for both systems was within the expected range. Smaller shifts were required when 6 DOF were available for correction as opposed to 3 DOF. Where highest possible positioning accuracy is required, frequent image guidance is mandatory to achieve best possible plan delivery and maintenance of sharp gradients and optimal normal tissue sparing inherent in carbon ion therapy.

  1. Insertion and fixation of fiducial markers for setup and tracking of lung tumors in radiotherapy

    International Nuclear Information System (INIS)

    Imura, Mikado; Yamazaki, Koichi; Shirato, Hiroki; Onimaru, Rikiya; Fujino, Masaharu; Shimizu, Shinichi; Harada, Toshiyuki; Ogura, Shigeaki; Dosaka-Akita, Hirotoshi; Miyasaka, Kazuo; Nishimura, Masaharu

    2005-01-01

    Purpose: Internal 1.5-mm fiducial markers were used in real-time tumor-tracking radiotherapy (RT) for lung cancer. The fixation rate of the markers using the bronchial insertion technique, reliability of the setup using markers around the target volume, dislocation of the markers after real-time tumor-tracking RT, and long-term toxicity of marker insertion were investigated. Methods and Materials: Between July 2000 and April 2004, 154 gold markers were inserted into 57 patients with peripheral lung cancer. The distances between the implanted markers in 198 measurements in 71 setups in 11 patients were measured using two sets of orthogonal diagnostic X-ray images of the real-time tumor-tracking RT system. The distance between the markers and the chest wall was also measured in a transaxial CT image on 186 occasions in 48 patients during treatment planning and during follow-up. The median treatment time was 6 days (range, 4-14 days). Results: In 115 (75%) of the 154 inserted markers, the gold marker was detected throughout the treatment period. In 122 markers detected at CT planning, 115 (94%) were detected until the end of treatment. The variation in the distances between the implanted markers was within ±2 mm in 95% and ±1 mm in 80% during treatment. The variation in the distances between the implanted markers was >2 mm in at least one direction in 9% of the setups for which reexamination with a CT scan was indicated. The fixation rate in the left upper lobe was lower than in the other lobes. A statistically significant relationship was found between a shorter distance between the markers and the chest wall and the fixation rate, suggesting that the markers in the smaller bronchial lumens fixed better than those in the larger lumens. A learning curve among the endoscopists was suggested in the fixation rate. The distance between the markers and the chest wall changed significantly within a median of 44 days (range, 16-181 days) after treatment. Conclusion: The

  2. The ATLAS Level-1 Trigger Timing Setup

    CERN Document Server

    Spiwoks, R; Ellis, Nick; Farthouat, P; Gällnö, P; Haller, J; Krasznahorkay, A; Maeno, T; Pauly, T; Pessoa-Lima, H; Resurreccion-Arcas, I; Schuler, G; De Seixas, J M; Torga-Teixeira, R; Wengler, T

    2005-01-01

    The ATLAS detector at CERN's LHC will be exposed to proton-proton collisions at a bunch-crossing rate of 40 MHz. In order to reduce the data rate, a three-level trigger system selects potentially interesting physics. The first trigger level is implemented in electronics and firmware. It aims at reducing the output rate to less than 100 kHz. The Central Trigger Processor combines information from the calorimeter and muon trigger processors and makes the final Level-1-Accept decision. It is a central element in the timing setup of the experiment. Three aspects are considered in this article: the timing setup with respect to the Level-1 trigger, with respect to the expriment, and with respect to the world.

  3. Enhancement of daily physical activity increases physical fitness of outclinic COPD patients : Results of an exercise counseling program

    NARCIS (Netherlands)

    Hospes, Gieneke; Bossenbroek, Linda; ten Hacken, Nick H. T.; van Hengel, Peter; de Greef, Mathieu H. G.

    Objective: To investigate whether a 12-week pedometer-based exercise counseling strategy is feasible and effectively enhances daily physical activity in outclinic Chronic Obstructive Pulmonary Disease (COPD) patients who do not participate in a rehabilitation program in a controlled way. Methods: 35

  4. Whole-abdomen radiotherapy for non-Hodgkin's lymphoma using twice-daily fractionation

    International Nuclear Information System (INIS)

    Liauw, Stanley L.; Yeh, Alexander M.; Morris, Christopher G.; Olivier, Kenneth R.; Mendenhall, Nancy Price

    2006-01-01

    Purpose: To report the tolerability and efficacy of twice-daily whole-abdomen irradiation (WAI) for non-Hodgkin's lymphoma (NHL). Methods and Materials: Of 123 patients treated for NHL with WAI, 37% received previous chemotherapy, 28% received WAI as part of comprehensive lymphatic irradiation (CLI), and 32% received WAI for palliation. The median dose to the whole abdomen was 25.0 Gy, followed by a median tumor boost of 9.8 Gy in 58 patients. Fractionation was 1.0 Gy once daily (54%) or 0.8 Gy twice daily (46%). Blood counts were measured weekly. Results: At a median follow-up of 4.3 years, local control was 72% and overall survival was 55% at 5 years. Median time of WAI was 42 days for once-daily treatment and 32 days for twice-daily treatment. Patients receiving twice-daily WAI did not have a significantly higher rate of acute side effects (e.g., nausea, diarrhea, platelet or red blood cell toxicity). Overall, acute thrombocytopenia was the most frequent side effect of treatment; 24 of 96 patients (25%) with available hematologic data had Grade 3+ toxicity. There was no acute Grade 3 gastrointestinal toxicity and no late small bowel obstruction. Multiple regression indicated that patients with four or less involved sites and disease size ≤6 cm had improved local control and overall survival. Conclusions: Twice-daily WAI using 0.8 Gy/fraction does not appear to have any greater toxicity compared with once-daily treatment using 1 Gy/fraction. Small doses per fraction (0.8-1 Gy/fx) are effective, tolerated well in the acute setting, and associated with a low rate of late toxicity

  5. Physical, Digital, and Hybrid Setups Supporting Card-Based Collaborative Design Ideation

    DEFF Research Database (Denmark)

    Lundqvist, Caroline Emilie; Klinkhammer, Daniel; Dalsgaard, Peter

    2018-01-01

    to supporting collaborative ideation? To answer this question, we present a study and analysis of three different implementations of a well-established collaborative ideation technique called Inspiration Card Workshop, with physical, digital, and hybrid setups. Each setup is evaluated in a controlled experiment...

  6. [The daily experience of the patient with an implantable cardioverter defibrillator].

    Science.gov (United States)

    Palacios-Ceña, Domingo; Alonso-Blanco, Cristina; Cachón-Pérez, José Miguel; Alvarez-López, Cristina

    2010-01-01

    To describe the daily experience of patients with an automatic defibrillator (AD) implant and the adaptive changes of the patient. Qualitative and phenomenological research. Collection of data through; initially unstructured interview with half of the informants, semi-structured interviews through an open questions guide after the initial unstructured interviews and use of personal narratives of the informants. Analysis of the data using the Van Manen proposal. We analysed the interviews of 10 participants. We collected socio-demographic variables and identified the following themes, which respond to the question "How is life with an AD": It is life "with the two sides of the coin," living in constant wait and uncertainty, accepting change, developing adaptation strategies, renegotiating relationships and sexuality and it is to live transformed. The results of this study can be integrated into nurse clinical practice in areas such as valuation after discharge, changes in habits, control of treatment, notification of shocks, masking detection of symptoms and strategies that can jeopardise the bearer. Research needs to be developed that looks closer into the influence of other technological devices in people. Copyright 2009 Elsevier España, S.L. All rights reserved.

  7. Radiotherapy for breast cancer: respiratory and set-up uncertainties

    International Nuclear Information System (INIS)

    Saliou, M.G.; Giraud, P.; Simon, L.; Fournier-Bidoz, N.; Fourquet, A.; Dendale, R.; Rosenwald, J.C.; Cosset, J.M.

    2005-01-01

    Adjuvant Radiotherapy has been shown to significantly reduce locoregional recurrence but this advantage is associated with increased cardiovascular and pulmonary morbidities. All uncertainties inherent to conformal radiation therapy must be identified in order to increase the precision of treatment; misestimation of these uncertainties increases the potential risk of geometrical misses with, as a consequence, under-dosage of the tumor and/or overdosage of healthy tissues. Geometric uncertainties due to respiratory movements or set-up errors are well known. Two strategies have been proposed to limit their effect: quantification of these uncertainties, which are then taken into account in the final calculation of safety margins and/or reduction of respiratory and set-up uncertainties by an efficient immobilization or gating systems. Measured on portal films with two tangential fields. CLD (central lung distance), defined as the distance between the deep field edge and the interior chest wall at the central axis, seems to be the best predictor of set-up uncertainties. Using CLD, estimated mean set-up errors from the literature are 3.8 and 3.2 mm for the systematic and random errors respectively. These depend partly on the type of immobilization device and could be reduced by the use of portal imaging systems. Furthermore, breast is mobile during respiration with motion amplitude as high as 0.8 to 10 mm in the anteroposterior direction. Respiratory gating techniques, currently on evaluation, have the potential to reduce effect of these movements. Each radiotherapy department should perform its own assessments and determine the geometric uncertainties with respect of the equipment used and its particular treatment practices. This paper is a review of the main geometric uncertainties in breast treatment, due to respiration and set-up, and solutions proposed to limit their impact. (author)

  8. Reducing the sensitivity of IMPT treatment plans to setup errors and range uncertainties via probabilistic treatment planning

    International Nuclear Information System (INIS)

    Unkelbach, Jan; Bortfeld, Thomas; Martin, Benjamin C.; Soukup, Martin

    2009-01-01

    Treatment plans optimized for intensity modulated proton therapy (IMPT) may be very sensitive to setup errors and range uncertainties. If these errors are not accounted for during treatment planning, the dose distribution realized in the patient may by strongly degraded compared to the planned dose distribution. The authors implemented the probabilistic approach to incorporate uncertainties directly into the optimization of an intensity modulated treatment plan. Following this approach, the dose distribution depends on a set of random variables which parameterize the uncertainty, as does the objective function used to optimize the treatment plan. The authors optimize the expected value of the objective function. They investigate IMPT treatment planning regarding range uncertainties and setup errors. They demonstrate that incorporating these uncertainties into the optimization yields qualitatively different treatment plans compared to conventional plans which do not account for uncertainty. The sensitivity of an IMPT plan depends on the dose contributions of individual beam directions. Roughly speaking, steep dose gradients in beam direction make treatment plans sensitive to range errors. Steep lateral dose gradients make plans sensitive to setup errors. More robust treatment plans are obtained by redistributing dose among different beam directions. This can be achieved by the probabilistic approach. In contrast, the safety margin approach as widely applied in photon therapy fails in IMPT and is neither suitable for handling range variations nor setup errors.

  9. Slaw extracted proton beam formation and monitoring for the ''QUARTZ'' setup

    International Nuclear Information System (INIS)

    Bushnin, Yu.B.; Gres', V.N.; Davydenko, Yu.P.

    1982-01-01

    The version of optical mode of the beam channel providing with simultaneous operating the experimental setups FODS and ''QUARTZ'' at consecutive usage of the slow extracted proton beam is reported. The ''QUARTZ'' setup beam diagnostics system comprises two subsystems: for measuring beam profile beam timing structure and beam intensity and operates in the beam extraction duration from 20 ns to few seconds at beam intensity from 10 10 to 5x10 12 protons/pulse. The ''QUARTZ'' setup represents a focusing crystal-diffraction spectrometer with 5-meter focal distance and Ge(Li) special construction detector. High efficiency target is applied in the setup. The ''QUARTZ'' setup is designed for studying exotic atoms produced by negative charged heavy particles (π, K, μ, P tilde) and atomic nuclei. Precise energy measurement of X ray transitions in such atoms is performed. For measuring beam geometric parameters 32-channel secondary emission chambers are used. As detector of beam intensity and timing structure of slow extracted beam the secondary emission chamber is employed. The principle circuit of current integrator is given. As data transmission line a 50-pair telephone cable is used. Information conversion into digital form and its subsequent processing is performed in the CAMAC system and the SM-3 computer. The proton beam full intensity measuring system provides with accuracy not worse than +-4.5% in the 10 10 -10 12 proton/sec range. The implemented optical mode of the beam channel and proton beam monitoring system permitted to begin fulfillment of the experimental program on the ''QUARTZ'' setup

  10. Does weather affect daily pain intensity levels in patients with acute low back pain? A prospective cohort study.

    Science.gov (United States)

    Duong, Vicky; Maher, Chris G; Steffens, Daniel; Li, Qiang; Hancock, Mark J

    2016-05-01

    The aim of this study was to investigate the influence of various weather parameters on pain intensity levels in patients with acute low back pain (LBP). We performed a secondary analysis using data from the PACE trial that evaluated paracetamol (acetaminophen) in the treatment of acute LBP. Data on 1604 patients with LBP were included in the analysis. Weather parameters (precipitation, temperature, relative humidity, and air pressure) were obtained from the Australian Bureau of Meteorology. Pain intensity was assessed daily on a 0-10 numerical pain rating scale over a 2-week period. A generalised estimating equation analysis was used to examine the relationship between daily pain intensity levels and weather in three different time epochs (current day, previous day, and change between previous and current days). A second model was adjusted for important back pain prognostic factors. The analysis did not show any association between weather and pain intensity levels in patients with acute LBP in each of the time epochs. There was no change in strength of association after the model was adjusted for prognostic factors. Contrary to common belief, the results demonstrated that the weather parameters of precipitation, temperature, relative humidity, and air pressure did not influence the intensity of pain reported by patients during an episode of acute LBP.

  11. Measurement setup at light source operational: Milestone M4.3

    CERN Document Server

    Perez, Francis

    2016-01-01

    The design of the experimental setup for the measurements of the FCC-hh beam screen prototype to be installed at the ANKA lightsource has been completed and the alignment strategy and procedure has been validated by the CERN and KIT teams. In this report, a complete description of the setup and the program of measurements under different operation conditions is presented.

  12. Immobilisation precision in VMAT for oral cancer patients

    Science.gov (United States)

    Norfadilah, M. N.; Ahmad, R.; Heng, S. P.; Lam, K. S.; Radzi, A. B. Ahmad; John, L. S. H.

    2017-05-01

    A study was conducted to evaluate and quantify a precision of the interfraction setup with different immobilisation devices throughout the treatment time. Local setup accuracy was analysed for 8 oral cancer patients receiving radiotherapy; 4 with HeadFIX® mouthpiece moulded with wax (HFW) and 4 with 10 ml/cc syringe barrel (SYR). Each patients underwent Image Guided Radiotherapy (IGRT) with total of 209 cone-beam computed tomography (CBCT) data sets for position set up errors measurement. The setup variations in the mediolateral (ML), craniocaudal (CC), and anteroposterior (AP) dimensions were measured. Overall mean displacement (M), the population systematic (Σ) and random (σ) errors and the 3D vector length were calculated. Clinical target volume to planning target volume (CTV-PTV) margins were calculated according to the van Herk formula (2.5Σ+0.7σ). The M values for both group were < 1 mm and < 1° in all translational and rotational directions. This indicate there is no significant imprecision in the equipment (lasers) and during procedure. The interfraction translational 3 dimension vector for HFW and SYR were 1.93±0.66mm and 3.84±1.34mm, respectively. The interfraction average rotational error were 0.00°±0.65° and 0.34°±0.59°, respectively. CTV-PTV margins along the 3 translational axis (Right-Left, Superior-Inferior, Anterior-Posterior) calculated were 3.08, 2.22 and 0.81 mm for HFW and 3.76, 6.24 and 5.06 mm for SYR. The results of this study have demonstrated that HFW more precise in reproducing patient position compared to conventionally used SYR (p<0.001). All margin calculated did not exceed hospital protocol (5mm) except S-I and A-P axes using syringe. For this reason, a daily IGRT is highly recommended to improve the immobilisation precision.

  13. Pragmatic setup for bioparticle responses by dielectrophoresis for resource limited environment application

    Science.gov (United States)

    Ali, Mohd Anuar Md; Yeop Majlis, Burhanuddin; Kayani, Aminuddin Ahmad

    2017-12-01

    Various dielectrophoretic responses of bioparticles, including cell-chain, spinning, rotation and clustering, are of high interest in the field due to their benefit into application for biomedical and clinical implementation potential. Numerous attempts using sophisticated equipment setup have been studied to perform those dielectrophoretic responses, however, for development into resource limited environment application, such as portable, sustainable and environmental friendly diagnostic tools, establishment of pragmatic setup using standard, non-sophisticated and low-cost equipment is of important task. Here we show the advantages in the judicious design optimization of tip microelectrode, also with selection of suspending medium and optimization of electric signal configuration in establishing setup that can promote the aforementioned dielectrophoretic responses within standard equipments, i.e. pragmatic setup.

  14. Experiment Setup for Focused Learning of Advanced Servo Control of DC-motors

    Directory of Open Access Journals (Sweden)

    Dag A. H. Samuelsen

    2012-02-01

    Full Text Available Remote laboratories are normally developed for giving students and others remote access to physical laboratory facilities. In contradiction to this, the main objective of the setup presented in this paper is to create a controlled environment where unwanted side activities like hardware setup, driver problems, troubleshooting faulty components, and struggles with special software for configuring DSP systems, are removed as much as possible, in order for the students to have their full focus on the tasks that is considered relevant for the module: modeling of non-linear systems, synthetisation of controllers, and stability and performance analysis. A secondary objective is to significantly reduce the setup and maintenance cost associated with complex laboratory setups involving DSPs and expensive hardware.

  15. Is ExacTrac x-ray system an alternative to CBCT for positioning patients with head and neck cancers?

    International Nuclear Information System (INIS)

    Clemente, Stefania; Chiumento, Costanza; Fiorentino, Alba; Cozzolino, Mariella; Oliviero, Caterina; Califano, Giorgia; Caivano, Rocchina; Fusco, Vincenzo; Simeon, Vittorio

    2013-01-01

    Purpose: To evaluate the usefulness of a six-degrees-of freedom (6D) correction using ExacTrac robotics system in patients with head-and-neck (HN) cancer receiving radiation therapy.Methods: Local setup accuracy was analyzed for 12 patients undergoing intensity-modulated radiation therapy (IMRT). Patient position was imaged daily upon two different protocols, cone-beam computed tomography (CBCT), and ExacTrac (ET) images correction. Setup data from either approach were compared in terms of both residual errors after correction and punctual displacement of selected regions of interest (Mandible, C2, and C6 vertebral bodies).Results: On average, both protocols achieved reasonably low residual errors after initial correction. The observed differences in shift vectors between the two protocols showed that CBCT tends to weight more C2 and C6 at the expense of the mandible, while ET tends to average more differences among the different ROIs.Conclusions: CBCT, even without 6D correction capabilities, seems preferable to ET for better consistent alignment and the capability to see soft tissues. Therefore, in our experience, CBCT represents a benchmark for positioning head and neck cancer patients

  16. Estimation of daily proteinuria in patients with amyloidosis by using the protein-to-creatinine ratio in random urine sample

    Directory of Open Access Journals (Sweden)

    Giampaolo Talamo

    2015-02-01

    Full Text Available Measurement of daily proteinuria in patients with amyloidosis is recommended at the time of diagnosis for assessing renal involvement, and for monitoring disease activity. Renal involvement is usually defined by proteinuria >500 mg/day. We evaluated the accuracy of the random urine protein-to-creatinine ratio (Pr/Cr in predicting 24 hour proteinuria in patient with amyloidosis. We com- pared results of random urine Pr/Cr ratio and concomitant 24-hour urine collections in 44 patients with amyloidosis. We found a strong correlation (Spearman’s ρ=0.874 between the Pr/Cr ratio and the 24 hour urine protein excretion. For predicting renal involvement, the optimal cut-off point of the Pr/Cr ratio was 715 mg/g. The sensitivity and specificity for this point were 91.8% and 95.5%, respectively, and the area under the curve value was 97.4%. We conclude that the random urine Pr/Cr ratio could be useful in the screening of renal involvement in patients with amyloidosis. If validated in a prospective study, the random urine Pr/Cr ratio could replace the 24 hour urine collection for the assessment of daily proteinuria and presence of nephrotic syndrome in patients with amyloidosis.

  17. Oxygen therapy devices and portable ventilators for improved physical activity in daily life in patients with chronic respiratory disease.

    Science.gov (United States)

    Furlanetto, Karina Couto; Pitta, Fabio

    2017-02-01

    Patients with hypoxemia and chronic respiratory failure may need to use oxygen therapy to correct hypoxemia and to use ventilatory support to augment alveolar ventilation, reverse abnormalities in blood gases (in particular hypercapnia) and reduce the work of breathing. Areas covered: This narrative review provides an overview on the use of oxygen therapy devices or portable ventilators for improved physical activity in daily life (PADL) as well as discusses the issue of lower mobility in daily life among stable patients with chronic respiratory disease who present indication for long-term oxygen therapy (LTOT) or home-based noninvasive ventilation (NIV). A literature review of these concepts was performed by using all related search terms. Expert commentary: Technological advances led to the development of light and small oxygen therapy devices and portable ventilators which aim to facilitate patients' mobility and ambulation. However, the day-by-day dependence of a device may reduce mobility and partially impair patients' PADL. Nocturnal NIV implementation in hypercapnic patients seems promising to improve PADL. The magnitude of their equipment-related physical inactivity is underexplored up to this moment and more long-term randomized clinical trials and meta-analysis examining the effects of ambulatory oxygen and NIV on PADL are required.

  18. An optimised set-up for total reflection particle induced X-ray emission

    International Nuclear Information System (INIS)

    Kan, J.A. van; Vis, R.D.

    1997-01-01

    MeV proton beams at small angles of incidence (0-35 mrad) are used to analyse trace elements on flat surfaces such as Si wafers or quartz substrates. In these experiments, the particle induced X-ray emission (PIXE) signal is used in a new optimized set-up. This set-up is constructed in such a way that the X-ray detector can reach very large solid angles, larger than 1 sr. Use of these large detector solid angles, combined with the reduction of bremsstrahlung background, affords limits of detection (LOD) of the order of 10 10 at cm -2 using total reflection particle induced X-ray emission (TPIXE). The LODs from earlier TPIXE measurements in a non-optimized set-up are used to estimate LODs in the new TPIXE set-up. Si wafers with low surface concentrations of V, Ni, Cu and Ag are used as standards to calibrate the LODs found with this set-up. The metal concentrations are determined by total reflection X-ray fluorescence (TXRF). The TPIXE measurements are compared with TXRF measurements on the same wafers. (Author)

  19. Low-Density Lipoprotein and Intracerebral Hematoma Expansion in Daily Alcohol Users

    Directory of Open Access Journals (Sweden)

    Gayle R. Pletsch

    2014-01-01

    Full Text Available Background: Epidemiological studies suggest that the intracerebral hemorrhage (ICH rate correlates with alcohol consumption. Alcohol leads to elevated blood pressure (BP and inhibition of platelet aggregation. These factors could promote excessive bleeding. To our knowledge, in the setting of normal liver function tests, there are no studies that have systematically evaluated the relationship between daily alcohol use and hematoma expansion. The aim of this study is to compare the baseline ICH characteristics, frequency of hematoma expansion, and outcomes in patients with ICH who are daily alcohol users with those who are not daily alcohol users. Methods: A retrospective chart review was performed on consecutive patients who presented from July 2008 to July 2013 to the Tulane University Hospital in New Orleans, La., USA, with a spontaneous ICH. Ninety-nine patients who met these criteria were admitted. Patients who underwent hematoma evacuation were excluded. Hemorrhage volumes were calculated based on the ABC/2 method. Low-density lipoprotein (LDL was dichotomized into low (2 and nonparametric equivalents where appropriate. ICH growth in 24 h and LDL were evaluated using linear regression. Results: Of the 226 patients who met inclusion criteria, 20.4% had a history of daily alcohol use. The average age was 61 years (range 19-94, 55.6% of the patients were males, and 67.1% were of African American origin. Daily alcohol use was associated with male gender, lower rate of home antihypertensive, higher presenting BP, and lower platelet counts, but there was no difference in ICH characteristics, ICH growth, or clinical outcome. Daily alcohol use in patients with a low LDL level was associated with supratentorial location and trends for lower baseline Glasgow Coma Scale score, higher ICH score, and follow-up ICH volume, but no significant difference in significant hematoma expansion or clinical outcome except for a trend for higher mortality was found

  20. Demonstration of a setup for chronic optogenetic stimulation and recording across cortical areas in non-human primates

    Science.gov (United States)

    Yazdan-Shahmorad, Azadeh; Diaz-Botia, Camilo; Hanson, Tim; Ledochowitsch, Peter; Maharabiz, Michel M.; Sabes, Philip N.

    2015-03-01

    Although several studies have shown the feasibility of using optogenetics in non-human primates (NHP), reliable largescale chronic interfaces have not yet been reported for such studies in NHP. Here we introduce a chronic setup that permits repeated, daily optogenetic stimulation and large-scale recording from the same sites in NHP cortex. The setup combines optogenetics with a transparent artificial dura (AD) and high-density micro-electrocorticography (μECoG). To obtain expression across large areas of cortex, we infused AAV5-CamKIIa-C1V1-EYFP viral vector using an infusion technique based on convection-enhanced delivery (CED) in primary somatosensory (S1) and motor (M1) cortices. By epifluorescent imaging through AD we were able to confirm high levels of expression covering about 110 mm2 of S1 and M1. We then incorporated a 192-channel μECoG array spanning 192 mm2 into the AD for simultaneous electrophysiological recording during optical stimulation. The array consists of patterned Pt-Au-Pt metal traces embedded in ~10 μm Parylene-C insulator. The parylene is sufficiently transparent to allow minimally attenuated optical access for optogenetic stimulation. The array was chronically implanted over the opsin-expressing areas in M1 and S1 for over two weeks. Optical stimulation was delivered via a fiber optic placed on the surface of the AD. With this setup, we recorded reliable evoked activity following light stimulation at several locations. Similar responses were recorded across tens of days, however a decline in the light-evoked signal amplitude was observed during this period due to the growth of dural tissue over the array. These results show the feasibility of a chronic interface for combined largescale optogenetic stimulation and cortical recordings across days.

  1. Eye-in-Hand Manipulation for Remote Handling: Experimental Setup

    Science.gov (United States)

    Niu, Longchuan; Suominen, Olli; Aref, Mohammad M.; Mattila, Jouni; Ruiz, Emilio; Esque, Salvador

    2018-03-01

    A prototype for eye-in-hand manipulation in the context of remote handling in the International Thermonuclear Experimental Reactor (ITER)1 is presented in this paper. The setup consists of an industrial robot manipulator with a modified open control architecture and equipped with a pair of stereoscopic cameras, a force/torque sensor, and pneumatic tools. It is controlled through a haptic device in a mock-up environment. The industrial robot controller has been replaced by a single industrial PC running Xenomai that has a real-time connection to both the robot controller and another Linux PC running as the controller for the haptic device. The new remote handling control environment enables further development of advanced control schemes for autonomous and semi-autonomous manipulation tasks. This setup benefits from a stereovision system for accurate tracking of the target objects with irregular shapes. The overall environmental setup successfully demonstrates the required robustness and precision that remote handling tasks need.

  2. Validity test of design calculations of a PGNAA setup

    International Nuclear Information System (INIS)

    Naqvi, A.A.; Garwan, M.A.

    2004-01-01

    A rectangular moderator has been designed for the prompt gamma ray neutron activation analysis (PGNAA) setup at King Fahd University of Petroleum and Minerals (KFUPM) to analyze Portland cement samples. The design of the moderator assembly was obtained using Monte Carlo calculations. The design calculations of the new rectangular moderator of the KFUPM PGNAA setup have been verified experimentally through prompt gamma ray yield measurement as a function of the front moderator thickness. In this study the yield of the 3.54 and 4.94 MeV prompt gamma rays from silicon in a soil sample was measured as a function of thickness of the front moderator of the rectangular moderator. The experimental results were compared with the results of the Monte Carlo simulations. A good agreement has been achieved between the experimental results and the results of the calculations. The experimental results have provided useful information about the PGNAA setup performance, neutron moderation, and gamma ray attenuation in the PGNAA sample

  3. User requirements for assistance of the supporting hand in bimanual daily activities via a robotic glove for severely affected stroke patients

    NARCIS (Netherlands)

    Prange, Grada Berendina; Smulders, Laura Cornelia; Smulders, L.C.; van Wijngaarden, J.; Lijbers, G.J.; Nijenhuis, Sharon Maria; Veltink, Petrus H.; Buurke, Jaap; Stienen, Arno; Braun, D.; Yu, H.; Campolo, D.

    2015-01-01

    For independent functioning in activities of daily life (ADL), proper hand function is paramount. Many stroke patients have a reduced ability to grasp and handle objects, while they don't fully recover functional use of the arm and hand, even after extensive (robotic) training. These patients may

  4. SU-C-204-06: Surface Imaging for the Set-Up of Proton Post-Mastectomy Chestwall Irradiation: Gated Images Vs Non Gated Images

    Energy Technology Data Exchange (ETDEWEB)

    Batin, E; Depauw, N; MacDonald, S; Lu, H [Massachusetts General Hospital, Boston, MA (United States)

    2015-06-15

    Purpose: Historically, the set-up for proton post-mastectomy chestwall irradiation at our institution started with positioning the patient using tattoos and lasers. One or more rounds of orthogonal X-rays at gantry 0° and beamline X-ray at treatment gantry angle were then taken to finalize the set-up position. As chestwall targets are shallow and superficial, surface imaging is a promising tool for set-up and needs to be investigated Methods: The orthogonal imaging was entirely replaced by AlignRT™ (ART) images. The beamline X-Ray image is kept as a confirmation, based primarily on three opaque markers placed on skin surface instead of bony anatomy. In the first phase of the process, ART gated images were used to set-up the patient and the same specific point of the breathing curve was used every day. The moves (translations and rotations) computed for each point of the breathing curve during the first five fractions were analyzed for ten patients. During a second phase of the study, ART gated images were replaced by ART non-gated images combined with real-time monitoring. In both cases, ART images were acquired just before treatment to access the patient position compare to the non-gated CT. Results: The average difference between the maximum move and the minimum move depending on the chosen breathing curve point was less than 1.7 mm for all translations and less than 0.7° for all rotations. The average position discrepancy over the course of treatment obtained by ART non gated images combined to real-time monitoring taken before treatment to the planning CT were smaller than the average position discrepancy obtained using ART gated images. The X-Ray validation images show similar results with both ART imaging process. Conclusion: The use of ART non gated images combined with real time imaging allows positioning post-mastectomy chestwall patients in less than 3 mm / 1°.

  5. SU-C-204-06: Surface Imaging for the Set-Up of Proton Post-Mastectomy Chestwall Irradiation: Gated Images Vs Non Gated Images

    International Nuclear Information System (INIS)

    Batin, E; Depauw, N; MacDonald, S; Lu, H

    2015-01-01

    Purpose: Historically, the set-up for proton post-mastectomy chestwall irradiation at our institution started with positioning the patient using tattoos and lasers. One or more rounds of orthogonal X-rays at gantry 0° and beamline X-ray at treatment gantry angle were then taken to finalize the set-up position. As chestwall targets are shallow and superficial, surface imaging is a promising tool for set-up and needs to be investigated Methods: The orthogonal imaging was entirely replaced by AlignRT™ (ART) images. The beamline X-Ray image is kept as a confirmation, based primarily on three opaque markers placed on skin surface instead of bony anatomy. In the first phase of the process, ART gated images were used to set-up the patient and the same specific point of the breathing curve was used every day. The moves (translations and rotations) computed for each point of the breathing curve during the first five fractions were analyzed for ten patients. During a second phase of the study, ART gated images were replaced by ART non-gated images combined with real-time monitoring. In both cases, ART images were acquired just before treatment to access the patient position compare to the non-gated CT. Results: The average difference between the maximum move and the minimum move depending on the chosen breathing curve point was less than 1.7 mm for all translations and less than 0.7° for all rotations. The average position discrepancy over the course of treatment obtained by ART non gated images combined to real-time monitoring taken before treatment to the planning CT were smaller than the average position discrepancy obtained using ART gated images. The X-Ray validation images show similar results with both ART imaging process. Conclusion: The use of ART non gated images combined with real time imaging allows positioning post-mastectomy chestwall patients in less than 3 mm / 1°

  6. Thresholds for human detection of patient setup errors in digitally reconstructed portal images of prostate fields

    International Nuclear Information System (INIS)

    Phillips, Brooke L.; Jiroutek, Michael R.; Tracton, Gregg; Elfervig, Michelle; Muller, Keith E.; Chaney, Edward L.

    2002-01-01

    Purpose: Computer-assisted methods to analyze electronic portal images for the presence of treatment setup errors should be studied in controlled experiments before use in the clinical setting. Validation experiments using images that contain known errors usually report the smallest errors that can be detected by the image analysis algorithm. This paper offers human error-detection thresholds as one benchmark for evaluating the smallest errors detected by algorithms. Unfortunately, reliable data are lacking describing human performance. The most rigorous benchmarks for human performance are obtained under conditions that favor error detection. To establish such benchmarks, controlled observer studies were carried out to determine the thresholds of detectability for in-plane and out-of-plane translation and rotation setup errors introduced into digitally reconstructed portal radiographs (DRPRs) of prostate fields. Methods and Materials: Seventeen observers comprising radiation oncologists, radiation oncology residents, physicists, and therapy students participated in a two-alternative forced choice experiment involving 378 DRPRs computed using the National Library of Medicine Visible Human data sets. An observer viewed three images at a time displayed on adjacent computer monitors. Each image triplet included a reference digitally reconstructed radiograph displayed on the central monitor and two DRPRs displayed on the flanking monitors. One DRPR was error free. The other DRPR contained a known in-plane or out-of-plane error in the placement of the treatment field over a target region in the pelvis. The range for each type of error was determined from pilot observer studies based on a Probit model for error detection. The smallest errors approached the limit of human visual capability. The observer was told what kind of error was introduced, and was asked to choose the DRPR that contained the error. Observer decisions were recorded and analyzed using repeated

  7. The effect of setup uncertainty on normal tissue sparing with IMRT for head-and-neck cancer

    International Nuclear Information System (INIS)

    Manning, Matthew A.; Wu Quiwen; Cardinale, Robert M.; Mohan, Radhe; Lauve, Andrew D.; Kavanagh, Brian D.; Morris, Monica M.; Schmidt-Ullrich, Rupert K.

    2001-01-01

    Purpose: Intensity-modulated radiotherapy (IMRT) is being evaluated in the management of head-and-neck cancers at several institutions, and a Radiation Therapy Oncology Group study of its utility in parotid sparing is under development. There is an inherent risk that the sharper dose gradients generated by IMRT amplify the potentially detrimental impact of setup uncertainty. The International Commission on Radiation Units and Measurements Report 62 (ICRU-62) defined planning organ-at-risk volume (PRV) to account for positional uncertainties for normal tissues. The purpose of this study is to quantify the dosimetric effect of employing PRV for the parotid gland and to evaluate the use of PRV on normal-tissue sparing in the setting of small clinical setup errors. Methods and Materials: The optimized nine-beam IMRT plans for three head-and-neck cancer patients participating in an institutional review board approved parotid-sparing protocol were used as reference plans. A second optimized plan was generated for each patient by adding a PRV of 5 mm for the contralateral parotid gland. The effect of these additions on the quality of the plans was quantified, in terms of both target coverage and normal-tissue sparing. To test the value of PRV in a worst-case scenario, systematic translational setup uncertainties were simulated by shifting the treatment isocenter 5 mm superiorly, inferiorly, left, right, anteriorly, and posteriorly, without altering optimized beam profiles. At each shifted isocenter, dose distributions were recalculated, producing a total of six shifted plans without PRV and six shifted plans with PRV for each patient. The effect of setup uncertainty on parotid sparing and the value of PRV in compensating for the uncertainty were evaluated. Results: The addition of the PRV and reoptimization did not significantly affect the dose to gross tumor volume, spinal cord, or brainstem. In contrast, without any shift, the PRV did increase parotid sparing and reduce

  8. Feasibility study of image guided radiotherapy for lung tumor using online and offline cone-beam CT setup verification

    International Nuclear Information System (INIS)

    Li Hongsheng; Li Baosheng; Lu Jie; Yin Yong; Yu Ningsha; Chen Yiru

    2009-01-01

    Objective: To investigate the feasibility of online and offline cone-beam CT(CBCT) guided radiotherapy for lung cancer. Methods: Fourteen patients with lung tumor treated by three-dimensional conformal radiotherapy were investigated. Online kV CBCT scan, image registration and setup correction were performed before and immediately after radiotherapy. CBCT online-guided correction data were used to calculate the population-based CTV-PTV margins under the condition of non-correction and correction in every fraction respectively. The numbers of initial images and the population-based CTV-PTV margins after the offline compensation of the system setup error were evaluated with the permission of 0.5 mm and 1.5 mm maximal residue error, respectively. Results: Under the condition of non-correction, the required margins for total error were 5.7 mm, 8.0 mm and 7.8 mm in the left-right (x axis), cranio-caudal (y axis) and anterior-posterior(z axis) directions, respectively. When the tumor was corrected in every fraction, the required margins for intra-fraction error were 2.4 mm, 2.4 mm and 2.3 mm in x,y and z axes, respectively. To correct the systematic setup error, 9 sets of CBCT images for 3.3 mm, 3.7 mm and 3.6 mm PTV margins, and 7 sets of CBCT images for 3.9 mm, 4.3 mm and 4.3 mm PTV margins in x,y and z axes were necessary when 0.5 mm and 1.5 mm maximal residue error were permitted respectively. Conclusions: Both of the online CBCT correction and the offline adaptive correction can markedly reduce the impact of setup error and reduce the required PTV margins accordingly. It is feasible to deliver the online and offline image guided radiation for patients with lung tumor. (authors)

  9. The effects of health education given by nurses to COPD patients on the daily oxygen concentrator usage time.

    Science.gov (United States)

    Doğan, Uğur; Ovayolu, Nimet

    2017-01-01

    Long-term oxygen therapy is the most effective method which has been shown to prolong the lifespan in people with COPD. The aim of the study was to investigate the effects of health education given by nurses to patients with COPD on the daily oxygen concentrator (OC) usage time. The study was carried out in a State Hospital, Turkey, between July and November 2015. After given consent to the study, participants were divided into intervention and control groups by simple random sampling method. Then data forms were filled during face-to-face interview. Firstly, the data describing patients' arrival times were collected retrospectively. Afterwards, the patients from the intervention group were educated through educational booklets prepared by the researchers. They were phoned in the weeks 4, 8 and 12th for problems they might have encountered during the use of OC. After the 14th week, data forms of patients from the both groups were filled again; the results were compared with previous clinical findings. Data were analysed using SPSS 15.0 for Windows. It was determined that 95.5% of patients did not get information about the use of OC. Daily OC usage time (hour) by patients in the intervention group firstly amounted to 5.69 ± 3.90, later on to 11.94 ± 4.73 (p < 0.05). Whereas when clinical findings concerning pre- and post educational periods were compared; a significant improvement in PaO₂, PaCO2, FEV₁ and SaO₂ of patients in the intervention group (p<0.05) was shown, contrary to the control group. It may be recommended that patients receive continuous education and close monitoring of their results.

  10. The preliminary study of setup errors' impact on dose distribution of image guide radiation therapy for head and neck cancer

    International Nuclear Information System (INIS)

    Xu Luying; Pan Jianji; Wang Xiaoliang; Bai Penggang; Li Qixin; Fei Zhaodong; Chen Chuanben; Ma Liqin; Tang Tianlan

    2011-01-01

    Objective: To measure the set-up errors of patients with head and neck (H and N) cancer during the image guided intensity-modulated radiotherapy (IMRT) treatment and analyze the impact of setup errors on dose distribution; then to further investigate the necessity of adjustment online for H and N cancer during IMRT treatment. Methods: Cone-beam CT (CBCT) scanning of thirty patients with H and N cancer were acquired by once weekly with a total of 6 times during IMRT treatment. The CBCT images and the original planning CT images were matched by the bony structure and worked out the translational errors of the x, y, z axis, as well as rotational errors. The dose distributions were recalculated based on the data of each setup error. The dose of planning target volume (PTV) and organs at risk were calculated in the re-planning, and than compared with the original plan by paired t-test. Results: The mean value of x, y, z axis translational set-up errors were (1.06 ± 0.95)mm, (0.95 ± 0.77)mm and (1.31 ± 1.07)mm, respectively. The rotational error of x, y, z axis were (1.04 ±0.791), (1.06 ±0.89) and (0.81 ±0.61 ), respectively. PTV 95% volume dose (D 95 ) and PTV minimal dose of re-planning for 6 times set-up were lower than original plan (6526.6 cGy : 6630.3 cGy, t =3.98, P =0.000 and 5632.6 cGy : 5792.5 cGy, t =- 2.89, P =0.007). Brain stem received 45 Gydose volume (V 45 ) and 1% brain stem volume dose (D 01 )were higher than original plan (3.54% : 2.75%, t =3.84, P =0.001 and 5129.7 cGy : 4919.3 cGy, t =4.36, P =0.000). Conclusions: The set-up errors led to the dose of PTV D 95 obviously insufficient and significantly increased V 45 , D 01 of the brainstem. So, adjustment online is necessary for H and N cancer during IMRT treatment. (authors)

  11. Daily pilates exercise or inactivity for patients with low back pain: a clinical prospective observational study.

    Science.gov (United States)

    Notarnicola, A; Fischetti, F; Maccagnano, G; Comes, R; Tafuri, S; Moretti, B

    2014-02-01

    Studies have shown the effectiveness of a few weekly pilates sessions as helping to reduce lower back pain (LBP). However many patients fear that physical activity can actually make the pain and disability worse. We carried out this observational prospective clinical study to look at the effects that taking part in daily pilates has one on side and on the other the effects of LBP management without physical exercise. The volunteers who participated in this study were recruited from among some local cultural associations. Patients affected by LBP were evaluated. The subjects were 60 volunteers (27 males and 33 females) with a mean age of 51.2 years who had chronic low back pain (CLBP). They were allocated to pilates group (N.=30) or inactivity control group (N.=30). The pilates group performed one-hour lesson of pilates exercise, 5 lessons per week during the following 6 months. The inactivity group continued with their normal daily activities. The Roland-Morris Disability, the Oswestry, the SF-36 and the Spinal Functional Sort Questionaries of all subjects were measured at the baseline (T1) and at 6 months (T2). At T2 improvements were observed in the pilates group with increases in physical and social functioning, general health and vitality (Ppilates. Some authors underlined the possible risk of a lack of adherence to an exercise program at home. This study suggests that a daily pilates program is effective for the management of CLBP. On the other hand, the inactivity contributes to further worsening, inducing a vicious cycle in which pain and physical activity intolerance follow each other.

  12. Influence of weather on daily symptoms of pain and fatigue in female patients with fibromyalgia: a multilevel regression analysis

    NARCIS (Netherlands)

    Bossema, E.R.; Middendorp, H. van; Jacobs, J.W.G.; Bijlsma, J.W.J.; Geenen, R.

    2013-01-01

    OBJECTIVE: Although patients with fibromyalgia often report that specific weather conditions aggravate their symptoms, empirical studies have not conclusively demonstrated such a relationship. Our aim was to examine the association between weather conditions and daily symptoms of pain and fatigue in

  13. A long arm for ultrasound: a combined robotic focused ultrasound setup for magnetic resonance-guided focused ultrasound surgery.

    Science.gov (United States)

    Krafft, Axel J; Jenne, Jürgen W; Maier, Florian; Stafford, R Jason; Huber, Peter E; Semmler, Wolfhard; Bock, Michael

    2010-05-01

    Focused ultrasound surgery (FUS) is a highly precise noninvasive procedure to ablate pathogenic tissue. FUS therapy is often combined with magnetic resonance (MR) imaging as MR imaging offers excellent target identification and allows for continuous monitoring of FUS induced temperature changes. As the dimensions of the ultrasound (US) focus are typically much smaller than the targeted volume, multiple sonications and focus repositioning are interleaved to scan the focus over the target volume. Focal scanning can be achieved electronically by using phased-array US transducers or mechanically by using dedicated mechanical actuators. In this study, the authors propose and evaluate the precision of a combined robotic FUS setup to overcome some of the limitations of the existing MRgFUS systems. Such systems are typically integrated into the patient table of the MR scanner and thus only provide an application of the US wave within a limited spatial range from below the patient. The fully MR-compatible robotic assistance system InnoMotion (InnoMedic GmbH, Herxheim, Germany) was originally designed for MR-guided interventions with needles. It offers five pneumatically driven degrees of freedom and can be moved over a wide range within the bore of the magnet. In this work, the robotic system was combined with a fixed-focus US transducer (frequency: 1.7 MHz; focal length: 68 mm, and numerical aperture: 0.44) that was integrated into a dedicated, in-house developed treatment unit for FUS application. A series of MR-guided focal scanning procedures was performed in a polyacrylamide-egg white gel phantom to assess the positioning accuracy of the combined FUS setup. In animal experiments with a 3-month-old domestic pig, the system's potential and suitability for MRgFUS was tested. In phantom experiments, a total targeting precision of about 3 mm was found, which is comparable to that of the existing MRgFUS systems. Focus positioning could be performed within a few seconds

  14. The Concomitant Consumption of Cod Liver Oil Causes a Reduction in the Daily Diclofenac Sodium Usage in Rheumatoid Arthritis Patients: A Pilot Study

    Science.gov (United States)

    Gupta, Vinay Kumar; Khan, Z. Y. Zafer; Ahmad, Mushtaq

    2013-01-01

    Objective: To evaluate whether the concomitant consumption of Cod liver oil can reduce the daily dose of Diclofenac Sodium and probably the risk of the side effects which are associated with it in Rheumatoid Arthritis patients. Material and Methods: This longitudinal, prospective, open label study was conducted from April to September 2012 at Mahatma Gandhi Medical College and Hospital, Jaipur, India. 30 Rheumatoid Arthritis patients who were aged between 19 to 60 years, who fulfilled the inclusion criteria, were enrolled. Each patient was given five Cod liver oil capsules twice a day, for a period of 24 weeks. Each capsule which contained 300 mg of Cod liver oil had Eicosapentaenoic acid-20 mg and Docosahexaenoic acid-30 mg. The patients who took different Nonsteroidal anti-inflammatory drugs daily were switched over to Diclofenac Sodium 50 mg as a single dose, up to a maximum dose of 200 mg per day. The dose of Diclofenac Sodium which was consumed per day and the average daily requirement at different visits were recorded in each patient and they were compared. The patients were assessed for their pain scores by using the Visual Analogue Scale (VAS) at different weeks. In addition, the ‘Subjective Response’ to the pain was evaluated in each patient at the respective visits. The Student’s “t”-test was applied for the analysis of the VAS pain score and for the evaluation of the reduction in the mean daily dose of the Diclofenac Sodium consumption. A probability value of less than 0.05 (p< 0.05) was considered to be statistically significant. Moreover, the results of the ‘Subjective Response’ to the pain were expressed as percentage. Results: A significant decrease (p< 0.05) in the mean VAS pain score from 80.38 ± 6.4 at week 0 to 67.30 ± 5.3 at week 24 was noted in the patients. There was a significant reduction (p<0.05) in mean dose of Diclofenac Sodium consumed from 115.04 ± 24.56 at week 4 to 98.83 ± 22.32 at week 24. Moreover, the percentage

  15. Quality assurance of a system for improved target localization and patient set-up that combines real-time infrared tracking and stereoscopic X-ray imaging.

    Science.gov (United States)

    Verellen, Dirk; Soete, Guy; Linthout, Nadine; Van Acker, Swana; De Roover, Patsy; Vinh-Hung, Vincent; Van de Steene, Jan; Storme, Guy

    2003-04-01

    The aim of this study is to investigate the positional accuracy of a prototype X-ray imaging tool in combination with a real-time infrared tracking device allowing automated patient set-up in three dimensions. A prototype X-ray imaging tool has been integrated with a commercially released real-time infrared tracking device. The system, consisting of two X-ray tubes mounted to the ceiling and a centrally located amorphous silicon detector has been developed for automated patient positioning from outside the treatment room prior to treatment. Two major functions are supported: (a) automated fusion of the actual treatment images with digitally reconstructed radiographs (DRRs) representing the desired position; (b) matching of implanted radio opaque markers. Measurements of known translational (up to 30.0mm) and rotational (up to 4.0 degrees ) set-up errors in three dimensions as well as hidden target tests have been performed on anthropomorphic phantoms. The system's accuracy can be represented with the mean three-dimensional displacement vector, which yielded 0.6mm (with an overall SD of 0.9mm) for the fusion of DRRs and X-ray images. Average deviations between known translational errors and calculations varied from -0.3 to 0.6mm with a standard deviation in the range of 0.6-1.2mm. The marker matching algorithm yielded a three-dimensional uncertainty of 0.3mm (overall SD: 0.4mm), with averages ranging from 0.0 to 0.3mm and a standard deviation in the range between 0.3 and 0.4mm. The stereoscopic X-ray imaging device integrated with the real-time infrared tracking device represents a positioning tool allowing for the geometrical accuracy that is required for conformal radiation therapy of abdominal and pelvic lesions, within an acceptable time-frame.

  16. The use of gold markers and electronic portal imaging for radiotherapy verification in prostate cancer patients: Sweden Ghana Medical Centre experience

    Directory of Open Access Journals (Sweden)

    George Felix Acquah

    2014-02-01

    Full Text Available The success of radiotherapy cancer treatment delivery depends on the accuracy of patient setup for each fraction. A significant problem arises from reproducing the same patient position and prostate location during treatment planning for every fraction of the treatment process. To analyze the daily movements of the prostate, gold markers are implanted in the prostate and portal images taken and manually matched with reference images to locate the prostate. Geometrical and fiducial markers are annotated onto a highly quality generated digitally reconstructed radiographs, that are compared with portal images acquired right before treatment dose delivery. A 0 and 270 degree treatment fields are used to calculate prostate shifts for all prostate cancer patients undergoing treatment at the Sweden Ghana Medical Centre, using an iViewGT portal imaging device. After aligning of the marker positions onto the reference images, the set-up deviations corrections are displayed and an on-line correction procedure applied. The measured migrations of the prostate markers are below the threshold of 3 mm for the main plans and 2 mm for the boost plans. With daily electronic portal imaging combined with gold markers, provides an objective method for verifying and correcting the position of the prostate immediately prior to radiation delivery.--------------------------------------------Cite this article as: Acquah GF. The use of gold markers and electronic portal imaging for radiotherapy verification in prostate cancer patients: Sweden Ghana Medical Centre experience. Int J Cancer Ther Oncol 2014; 2(1:020112.DOI: http://dx.doi.org/10.14319/ijcto.0201.12

  17. Measurements of operator performance - an experimental setup

    International Nuclear Information System (INIS)

    Netland, K.

    1980-01-01

    The human has to be considered as an important element in a process control system, even if the degree of automation is extremely high. Other elements, e.g. computer, displays, etc., can to a large extent be described and quantified. The human (operator), is difficult to describe in a precise way, and it is just as difficult to predict his thinking and acting in a control room environment. Many factors influence his performance, such as: experience, motivation, level of knowledge, training, control environment, job organization, etc. These factors have to a certain degree to be described before guidelines for design of the man-process interfaces and the control room layout can be developed. For decades, the psychological science has obtained knowledge of the human mind and behaviour. This knowledge should have the potential of a positive input on our effort to describe the factors influencing the operator performance. Even if the human is complex, a better understanding of his thinking and acting, and a more precise description of the factors influencing his performance can be obtained. At OECD Halden Reactor Project an experimental set-up for such studies has been developed and implemented in the computer laboratory. The present set-up includes elements as a computer- and display-based control room, a simulator representing a nuclear power plant, training programme for the subjects, and methods for the experiments. Set-up modules allow reconfiguration of experiments. (orig./HP)

  18. A Modernized UDM-600 Dynamometer-Based Setup for the Cutting Force Measurement

    Directory of Open Access Journals (Sweden)

    Ya. I. Shuliak

    2016-01-01

    Full Text Available The article considers development of a modernized UDM-600 dynamometer-based setup for measuring the cutting force components. Modernization of existing equipment to improve the method of recording the cutting force components in the automated mode is of relevance. The measuring setup allows recording the cutting force components in turning and milling, as well as the axial force and the torque in the drilling and milling operations.The article presents a block diagram and a schematic diagram of the setup to measure the cutting force components, and describes a basic principle of measuring units within the modernized setup. The developed setup uses a half-bridge strain gauge measuring circuit to record the cutting forces. To enhance the measuring circuit output voltage is used a 16-channel amplifier of LA-UN16 model with a discretely adjustable gain. To record and process electrical signals is used a data acquisition device of NI USB-6009 model, which enables transmitting the received data to a PC via USB-interface. The data acquisition device has a built-in stabilized DC power supply that is used to power the strain gauge bridges. A developed schematic diagram of the measuring setup allows us to realize this measuring device and implement its modernization.Final processing of recorded data is provided through the software developed in visual programming environment LabVIEW 9.0. The program allows us to show the real-time measuring values of the cutting force components graphically and to record the taken data to a text file.The measuring setup modernization enabled increasing measurement accuracy and reducing time for processing and analysis of experimental data obtained when measuring the cutting force components. The MT2 Department of BMSTU uses it in education and research activities and in experimental efforts and laboratory classes.

  19. Production Planning of a Failure-Prone Manufacturing System under Different Setup Scenarios

    Directory of Open Access Journals (Sweden)

    Guy-Richard Kibouka

    2016-01-01

    Full Text Available This paper presents a control problem for the optimization of the production and setup activities of an industrial system operating in an uncertain environment. This system is subject to random disturbances (breakdowns and repairs. These disturbances can engender stock shortages. The considered industrial system represents a well-known production context in industry and consists of a machine producing two types of products. In order to switch production from one product type to another, a time factor and a reconfiguration cost for the machine are associated with the setup activities. The parts production rates and the setup strategies are the decision variables which influence the inventory and the capacity of the system. The objective of the study is to find the production and setup policies which minimize the setup and inventory costs, as well as those associated with shortages. A modeling approach based on stochastic optimal control theory and a numerical algorithm used to solve the obtained optimality conditions are presented. The contribution of the paper, for industrial systems not studied in the literature, is illustrated through a numerical example and a comparative study.

  20. Scintillation forward spectrometer of the SPHERE setup

    International Nuclear Information System (INIS)

    Anisimov, Yu.S.; Afanas'ev, S.V.; Bondarev, V.K.

    1991-01-01

    The construction of the forward spectrometer for the 4π SPHERE setup to study multiple production of particles in nucleus-nucleus interactions is described. The measured parameters of the spectrometer detectors are presented. 7 refs.; 14 figs.; 1 tab

  1. The effect of daily sedation interruption protocol on early incidence of ventilator-associated pneumonia among patients hospitalized in critical care units receiving mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Mehdi Shahabi

    2016-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP is a common side effect in patients who receive intravenous sedation infusion. In routine care, after starting sedation infusion for patients who receive mechanical ventilation, interruption of sedation starts without protocol. This study aimed to evaluate the effect of daily sedation vacation protocol on the incidence of VAP in mechanically ventilated patients. Materials and Methods: In this clinical trial study, 80 patients with intravenous sedation infusion were selected and randomly allocated to intervention and control groups. In the intervention group, daily sedation vacation protocol and in the control group, routine sedation vacation was followed. Modified clinical pulmonary infection score questionnaire was completed before intervention and on the third, fourth, and fifth days after intervention. Data were analyzed by using repeated measures analysis of variance (ANOVA, Chi-square, and independent t-test. Results: The results of this study showed that the incidence rate of VAP in the intervention and control groups was 0% versus 15% on the third day of intervention, 12.5% versus 50% on the fourth day, and 27.5% versus 55.3% on the fifth day of intervention in the intervention and control groups, respectively. The incidence of VAP in the intervention group was significantly lower than in the control group (P < 0.05. Conclusions: The results of this study showed that in patients with intravenous sedation, infusion of a daily sedation vacation protocol may reduce the incidence of VAP. Therefore, in order to prevent VAP, nurses are recommended to use this daily sedation vacation protocol.

  2. A new instrumental set-up for polarized neutron scattering experiments

    International Nuclear Information System (INIS)

    Schmidt, Wolfgang; Ohl, Michael

    2005-01-01

    Neutron scattering with polarization analysis is a powerful tool to determine magnetic structures and excitations. A common setup is to mount the sample at the center of a Helmholtz-type coil which can provide a magnetic field of any direction at the sample position and also a guide field along the neutron flight paths around the sample. Recent experiments showed quite a high demand for measurements at low momentum transfers. For the corresponding low scattering angles air scattering gives rise to a very large background. For this reason we have extended the standard setup to a combination of a large vacuum tank surrounded by electrical coils. The vacuum tank eliminates the air scattering and we can use the polarization analysis down to the lowest accessible momentum transfers. The coils themselves also show some new features: In contrary to the classic (symmetric) coil distribution we use an asymmetric setup which gives the advantage of a larger scattering window. Due to a more sophisticated current distribution this modified coil arrangement needs not to be rotated for different scattering conditions. The whole set-up will soon be available at IN12, a cold neutrons three-axis spectrometer operated by FZ Juelich in collaboration with CEA Grenoble as a CRG-B instrument at the Institut Laue Langevin in Grenoble

  3. Characterization of a neutron imaging setup at the INES facility

    Energy Technology Data Exchange (ETDEWEB)

    Durisi, E.A., E-mail: elisabettaalessandra.durisi@unito.it [Università di Torino, Dipartimento di Fisica, Via Pietro Giuria 1, 10125 Torino (Italy); Istituto Nazionale di Fisica Nucleare—Sezione di Torino, Via Pietro Giuria 1, 10125 Torino (Italy); Visca, L. [Università di Torino, Dipartimento di Fisica, Via Pietro Giuria 1, 10125 Torino (Italy); Istituto Nazionale di Fisica Nucleare—Sezione di Torino, Via Pietro Giuria 1, 10125 Torino (Italy); Albertin, F.; Brancaccio, R. [Istituto Nazionale di Fisica Nucleare—Sezione di Torino, Via Pietro Giuria 1, 10125 Torino (Italy); Corsi, J. [Università di Torino, Dipartimento di Fisica, Via Pietro Giuria 1, 10125 Torino (Italy); Istituto Nazionale di Fisica Nucleare—Sezione di Torino, Via Pietro Giuria 1, 10125 Torino (Italy); Dughera, G. [Istituto Nazionale di Fisica Nucleare—Sezione di Torino, Via Pietro Giuria 1, 10125 Torino (Italy); Ferrarese, W. [Università di Torino, Dipartimento di Fisica, Via Pietro Giuria 1, 10125 Torino (Italy); Istituto Nazionale di Fisica Nucleare—Sezione di Torino, Via Pietro Giuria 1, 10125 Torino (Italy); Giovagnoli, A.; Grassi, N. [Fondazione Centro per la Conservazione ed il Restauro dei Beni Culturali “La Venaria Reale”, Piazza della Repubblica, 10078 Venaria Reale, Torino (Italy); Grazzi, F. [Consiglio Nazionale delle Ricerche, Istituto dei Sistemi Complessi, Via Madonna del Piano 10, 50019 Sesto Fiorentino, Firenze (Italy); Lo Giudice, A.; Mila, G. [Università di Torino, Dipartimento di Fisica, Via Pietro Giuria 1, 10125 Torino (Italy); Istituto Nazionale di Fisica Nucleare—Sezione di Torino, Via Pietro Giuria 1, 10125 Torino (Italy); and others

    2013-10-21

    The Italian Neutron Experimental Station (INES) located at the ISIS pulsed neutron source (Didcot, United Kingdom) provides a thermal neutron beam mainly used for diffraction analysis. A neutron transmission imaging system was also developed for beam monitoring and for aligning the sample under investigation. Although the time-of-flight neutron diffraction is a consolidated technique, the neutron imaging setup is not yet completely characterized and optimized. In this paper the performance for neutron radiography and tomography at INES of two scintillator screens read out by two different commercial CCD cameras is compared in terms of linearity, signal-to-noise ratio, effective dynamic range and spatial resolution. In addition, the results of neutron radiographies and a tomography of metal alloy test structures are presented to better characterize the INES imaging capabilities of metal artifacts in the cultural heritage field. -- Highlights: A full characterization of the present INES imaging set-up was carried out. Two CCD cameras and two scintillators (ZnS/{sup 6}LiF) of different thicknesses were tested. Linearity, effective dynamic range and spatial resolution were determined. Radiographies of steep wedges were performed using the highest dynamic range setup. Tomography of a bronze cube was performed using the best spatial resolution setup.

  4. Characterization of a neutron imaging setup at the INES facility

    International Nuclear Information System (INIS)

    Durisi, E.A.; Visca, L.; Albertin, F.; Brancaccio, R.; Corsi, J.; Dughera, G.; Ferrarese, W.; Giovagnoli, A.; Grassi, N.; Grazzi, F.; Lo Giudice, A.; Mila, G.

    2013-01-01

    The Italian Neutron Experimental Station (INES) located at the ISIS pulsed neutron source (Didcot, United Kingdom) provides a thermal neutron beam mainly used for diffraction analysis. A neutron transmission imaging system was also developed for beam monitoring and for aligning the sample under investigation. Although the time-of-flight neutron diffraction is a consolidated technique, the neutron imaging setup is not yet completely characterized and optimized. In this paper the performance for neutron radiography and tomography at INES of two scintillator screens read out by two different commercial CCD cameras is compared in terms of linearity, signal-to-noise ratio, effective dynamic range and spatial resolution. In addition, the results of neutron radiographies and a tomography of metal alloy test structures are presented to better characterize the INES imaging capabilities of metal artifacts in the cultural heritage field. -- Highlights: A full characterization of the present INES imaging set-up was carried out. Two CCD cameras and two scintillators (ZnS/ 6 LiF) of different thicknesses were tested. Linearity, effective dynamic range and spatial resolution were determined. Radiographies of steep wedges were performed using the highest dynamic range setup. Tomography of a bronze cube was performed using the best spatial resolution setup

  5. Evaluation of the precision of portal-image-guided head-and-neck localization: An intra- and interobserver study

    International Nuclear Information System (INIS)

    Court, Laurence E.; Allen, Aaron; Tishler, Roy

    2007-01-01

    There is increasing evidence that, for some patients, image-guided intensity-modulated radiation therapy (IMRT) for head-and-neck cancer patients may maintain target dose coverage and critical organ (e.g., parotids) dose closer to the planned doses than setup using lasers alone. We investigated inter- and intraobserver uncertainties in patient setup in head-and-neck cancer patients. Twenty-two sets of orthogonal digital portal images (from five patients) were selected from images used for daily localization of head-and-neck patients treated with IMRT. To evaluate interobserver variations, five radiation therapists compared the portal images with the plan digitally reconstructed radiographs and reported shifts for the isocenter (∼C2) and for a supraclavicular reference point. One therapist repeated the procedure a month later to evaluate intraobserver variations. The procedure was then repeated with teams of two therapists. The frequencies for which agreement between the shift reported by the observer and the daily mean shift (average of all observers for a given image set) were less than 1.5 and 2.5 mm were calculated. Standard errors of measurement for the intra- and interobserver uncertainty (SEM intra and SEM inter ) for the individual and teams were calculated. The data showed that there was very little difference between individual therapists and teams. At isocenter, 80%-90% of all reported shifts agreed with the daily average within 1.5 mm, showing consistency in the ways both individuals and teams interpret the images (SEM inter ∼1 mm). This dropped to 65% for the supraclavicular point (SEM inter ∼1.5 mm). Uncertainties increased for larger setup errors. In conclusion, image-guided patient positioning allows head-and-neck patients to be controlled within 3-4 mm. This is similar to the setup uncertainties found for most head-and-neck patients, but may provide some improvement for the subset of patients with larger setup uncertainties

  6. Set-up errors in radiotherapy for oesophageal cancers - Is electronic portal imaging or conebeam more accurate?

    International Nuclear Information System (INIS)

    Hawkins, Maria A.; Aitken, Alexandra; Hansen, Vibeke N.; McNair, Helen A.; Tait, Diana M.

    2011-01-01

    Purpose: To compare kV computed tomography (CBCT) with electronic portal imaging (EPI) and evaluate set-up variations in the anterior-posterior (AP), right-left (LR) and cranio-caudal (CC) directions and rotational variations: pitch, roll, and yaw, for oesophageal cancer patients treated with radical radiotherapy. Methods and materials: Twenty patients with locally advanced oesophageal cancer treated with chemoradiation were consented for this prospective ethics approved protocol. Patients were positioned using skin marks/tattoos, kV-CBCT scans (XVI) and EPI's were performed prior to treatment and registered to the planning CT scans and digitally reconstructed radiographs, respectively. XVI data was used to adjust patient setups before treatment delivery. A total of 122 EPI pairs and 207 CBCT scans were analysed. The systematic and random errors were calculated. Results: The systematic and random errors (mm) for XVI were 1.3, 1.7, 1.4 and 2.6, 3.9, 2.0 in RL, CC and AP direction, respectively, with EPI of similar magnitude. There was no correlation between the 2 modalities of imaging as 31.7% of all image pairs were discordant >3 mm and 12.5% >5 mm. XVI identified rotations >3 o in 44 images. Conclusions: EPI results in different position correction for verification of radiotherapy in oesophageal malignancies when compared with CBCT. CBCT verification offers adequate 3D volumetric image quality to improve the accuracy of treatment delivery for oesophageal malignancies in radiotherapy and should be used for image guidance.

  7. Level of daily physical activity in chronic obstructive pulmonary disease (COPD) patients according to GOLD classification.

    Science.gov (United States)

    Rodó-Pin, Anna; Balañá, Ana; Molina, Lluís; Gea, Joaquim; Rodríguez, Diego A

    2017-02-09

    The Global Initiative for Chronic Obstructive Lung Disease (GOLD guideline) for patients with chronic obstructive pulmonary disease does not adequately reflect the impact of the disease because does not take into account daily physical activity (DPA). Forty eight patients (12 in each GOLD group) were prospectively recruited. DPA was evaluated by accelerometer. Patients were classified into 3 levels of activity (very inactive, sedentary, active). No significant differences in levels of physical activity among GOLD groups (P=.361) were observed. The percentages of very inactive patients were 33% in group A, 42% in group B, 42% in group C and 59% in group D. In addition, high percentage of sedentary patients were observed through 4 groups, in group A (50%), B and C (42%, each), and group D (41%). COPD patients has very low levels of physical activity at all stages of GOLD classification even those defined as low impact (such as GOLD A). Is necessary to detect patients at risk who might benefit from specific interventions. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  8. Non-sedation versus sedation with a daily wake-up trial in critically ill patients receiving mechanical ventilation (NONSEDA Trial)

    DEFF Research Database (Denmark)

    Toft, Palle; Olsen, Hanne Tanghus; Jørgensen, Helene Korvenius

    2014-01-01

    comparing sedation with no sedation, a priori powered to have all-cause mortality as primary outcome.The objective is to assess the benefits and harms of non-sedation versus sedation with a daily wake-up trial in critically ill patients. METHODS: The non-sedation (NONSEDA) trial is an investigator......-sedation supplemented with pain management during mechanical ventilation.Control intervention is sedation with a daily wake-up trial.The primary outcome will be all cause mortality at 90 days after randomization. Secondary outcomes will be: days until death throughout the total observation period; coma- and delirium...... in mortality with a type I error risk of 5% and a type II error risk of 20% (power at 80%). DISCUSSION: The trial investigates potential benefits of non-sedation. This might have large impact on the future treatment of mechanically ventilated critically ill patients.Trial register: ClinicalTrials.gov NCT...

  9. Fast and thermal neutron intensity measurements at the KFUPM PGNAA setup

    CERN Document Server

    Al-Jarallah, M I; Fazal-Ur-Rehman; Abu-Jarad, F A

    2002-01-01

    Fast and thermal neutron intensity distributions have been measured at an accelerator based prompt gamma ray neutron activation analysis (PGNAA) setup. The setup is built at the 350 keV accelerator laboratory of King Fahd University of Petroleum and Minerals (KFUPM). The setup is mainly designed to carry out PGNAA elemental analysis via thermal neutron capture. In this study relative intensity of fast and thermal neutrons was measured as a function of the PGNAA moderator assembly parameters using nuclear track detectors (NTDs). The relative intensity of the neutrons was measured inside the sample region as a function of front moderator thickness as well as sample length. Measurements were carried out at the KFUPM 350 keV accelerator using 2.8 MeV pulsed neutron beam from D(d,n) reaction. The pulsed deuteron beam with 5 ns pulse width and 30 kHz frequency was used to produce neutrons. Experimental results were compared with results of Monte Carlo design calculations of the PGNAA setup. A good agreement has bee...

  10. Fast and thermal neutron intensity measurements at the KFUPM PGNAA setup

    Energy Technology Data Exchange (ETDEWEB)

    Al-Jarallah, M.I.; Naqvi, A.A. E-mail: aanaqvi@kfupm.edu.sa; Fazal-ur-Rehman; Abu-jarad, F

    2002-10-01

    Fast and thermal neutron intensity distributions have been measured at an accelerator based prompt gamma ray neutron activation analysis (PGNAA) setup. The setup is built at the 350 keV accelerator laboratory of King Fahd University of Petroleum and Minerals (KFUPM). The setup is mainly designed to carry out PGNAA elemental analysis via thermal neutron capture. In this study relative intensity of fast and thermal neutrons was measured as a function of the PGNAA moderator assembly parameters using nuclear track detectors (NTDs). The relative intensity of the neutrons was measured inside the sample region as a function of front moderator thickness as well as sample length. Measurements were carried out at the KFUPM 350 keV accelerator using 2.8 MeV pulsed neutron beam from D(d,n) reaction. The pulsed deuteron beam with 5 ns pulse width and 30 kHz frequency was used to produce neutrons. Experimental results were compared with results of Monte Carlo design calculations of the PGNAA setup. A good agreement has been found between the experimental results and the calculations.

  11. Once-Daily Radiation Therapy for Inflammatory Breast Cancer

    International Nuclear Information System (INIS)

    Brown, Lindsay; Harmsen, William; Blanchard, Miran; Goetz, Matthew; Jakub, James; Mutter, Robert; Petersen, Ivy; Rooney, Jessica; Stauder, Michael; Yan, Elizabeth; Laack, Nadia

    2014-01-01

    Purpose: Inflammatory breast cancer (IBC) is a rare and aggressive breast cancer variant treated with multimodality therapy. A variety of approaches intended to escalate the intensity and efficacy of radiation therapy have been reported, including twice-daily radiation therapy, dose escalation, and aggressive use of bolus. Herein, we examine our outcomes for patients treated with once-daily radiation therapy with aggressive bolus utilization, focusing on treatment technique. Methods and Materials: A retrospective review of patients with nonmetastatic IBC treated from January 1, 2000, through December 31, 2010, was performed. Locoregional control (LRC), disease-free survival (DFS), overall survival (OS) and predictors thereof were assessed. Results: Fifty-two women with IBC were identified, 49 (94%) of whom were treated with neoadjuvant chemotherapy. All underwent mastectomy followed by adjuvant radiation therapy. Radiation was delivered in once-daily fractions of 1.8 to 2.25 Gy (median, 2 Gy). Patients were typically treated with daily 1-cm bolus throughout treatment, and 33 (63%) received a subsequent boost to the mastectomy scar. Five-year Kaplan Meier survival estimates for LRC, DFS, and OS were 81%, 56%, and 64%, respectively. Locoregional recurrence was associated with poorer OS (P<.001; hazard ratio [HR], 4.1). Extracapsular extension was associated with worse LRC (P=.02), DFS (P=.007), and OS (P=.002). Age greater than 50 years was associated with better DFS (P=.03). Pathologic complete response was associated with a trend toward improved LRC (P=.06). Conclusions: Once-daily radiation therapy with aggressive use of bolus for IBC results in outcomes consistent with previous reports using various intensified radiation therapy regimens. LRC remains a challenge despite modern systemic therapy. Extracapsular extension, age ≤50 years, and lack of complete response to chemotherapy appear to be associated with worse outcomes. Novel strategies are needed in IBC

  12. A decision-making tool to prescribe knee orthoses in daily practice for patients with osteoarthritis.

    Science.gov (United States)

    Coudeyre, Emmanuel; Nguyen, Christelle; Chabaud, Aurore; Pereira, Bruno; Beaudreuil, Johann; Coudreuse, Jean-Marie; Deat, Philippe; Sailhan, Frédéric; Lorenzo, Alain; Rannou, François

    2018-03-01

    To develop a decision-making tool (DMT) to facilitate the prescription of knee orthoses for patients with osteoarthritis (OA) in daily practice. A steering committee gathered a multidisciplinary task force experienced in OA management/clinical research. Two members performed a literature review with qualitative analysis of the highest-quality randomized controlled trials and practice guidelines to confirm evidence concerning knee orthosis for OA. A first DMT draft was presented to the task force in a 1-day meeting in January 2016. The first version of the DMT was criticized and discussed regarding everyday practice issues. Every step was discussed and amended until consensus agreement was achieved within the task force. Then 4 successive consultation rounds occurred by electronic communication, first with primary- and secondary-care physicians, then with international experts. All corrections and suggestions by each member were shared with the rest of the task force and included to reach final consensus. The final version was validated by the steering committee. The definition and indication of several types of knee orthoses (sleeve, patello-femoral, hinged or unicompartmental offloading braces) were detailed. Orthoses may be proposed in addition to first-line non-pharmacological treatment if patient acceptance is considered good. At every step, a specific clinical assessment is needed. Based on the latest high-level evidence, practice guidelines, and an expert panel, a DMT to facilitate daily practice prescription of knee orthoses for OA patients was designed. An evaluation of DMT implementation in a wide range of health professionals is still needed. Copyright © 2018 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.

  13. Daily antibiotic cost of nosocomial infections in a Turkish university hospital

    Directory of Open Access Journals (Sweden)

    Yalcin Ata

    2005-01-01

    Full Text Available Abstract Background Many studies associated nosocomial infections with increased hospital costs due to extra days in hospital, staff time, extra investigations and drug treatment. The cost of antibiotic treatment for these infections represents a significant part of hospital expenditure. This prospective observational study was designed to determine the daily antibiotic cost of nosocomial infections per infected adult patient in Akdeniz University Hospital. Methods All adult patients admitted to the ICUs between January 1, 2000, and June 30, 2003 who had only one nosocomial infection during their stay were included in the study. Infection sites and pathogens, antimicrobial treatment of patient and it's cost were recorded. Daily antibiotic costs were calculated per infected patient. Results Among the 8460 study patients, 817 (16.6% developed 1407 episodes of nosocomial infection. Two hundred thirty three (2.7% presented with only one nosocomial infection. Mean daily antibiotic cost was $89.64. Daily antibiotic cost was $99.02 for pneumonia, $94.32 for bloodstream infection, $94.31 for surgical site infection, $52.37 for urinary tract infection, and $162.35 for the other infections per patient. The treatment of Pseudomonas aeruginosa infections was the most expensive infection treated. Piperacillin-tazobactam and amikacin were the most prescribed antibiotics, and meropenem was the most expensive drug for treatment of the nosocomial infections in the ICU. Conclusions Daily antibiotic cost of nosocomial infections is an important part of extra costs that should be reduced providing rational antibiotic usage in hospitals.

  14. Translational and rotational intra- and inter-fractional errors in patient and target position during a short course of frameless stereotactic body radiotherapy

    DEFF Research Database (Denmark)

    Josipovic, Mirjana; Persson, Gitte Fredberg; Logadottir, Ashildur

    2012-01-01

    Implementation of cone beam computed tomography (CBCT) in frameless stereotactic body radiotherapy (SBRT) of lung tumours enables setup correction based on tumour position. The aim of this study was to compare setup accuracy with daily soft tissue matching to bony anatomy matching and evaluate...

  15. Quick setup of test unit for accelerator control system

    International Nuclear Information System (INIS)

    Fu, W.; D'Ottavio, T.; Gassner, D.; Nemesure, S.; Morris, J.

    2011-01-01

    Testing a single hardware unit of an accelerator control system often requires the setup of a program with graphical user interface. Developing a dedicated application for a specific hardware unit test could be time consuming and the application may become obsolete after the unit tests. This paper documents a methodology for quick design and setup of an interface focused on performing unit tests of accelerator equipment with minimum programming work. The method has three components. The first is a generic accelerator device object (ADO) manager which can be used to setup, store, and log testing controls parameters for any unit testing system. The second involves the design of a TAPE (Tool for Automated Procedure Execution) sequence file that specifies and implements all te testing and control logic. The sting third is the design of a PET (parameter editing tool) page that provides the unit tester with all the necessary control parameters required for testing. This approach has been used for testing the horizontal plane of the Stochastic Cooling Motion Control System at RHIC.

  16. Changes in Rectal Dose Due to Alterations in Beam Angles for Setup Uncertainty and Range Uncertainty in Carbon-Ion Radiotherapy for Prostate Cancer.

    Directory of Open Access Journals (Sweden)

    Yoshiki Kubota

    Full Text Available Carbon-ion radiotherapy of prostate cancer is challenging in patients with metal implants in one or both hips. Problems can be circumvented by using fields at oblique angles. To evaluate the influence of setup and range uncertainties accompanying oblique field angles, we calculated rectal dose changes with oblique orthogonal field angles, using a device with fixed fields at 0° and 90° and a rotating patient couch.Dose distributions were calculated at the standard angles of 0° and 90°, and then at 30° and 60°. Setup uncertainty was simulated with changes from -2 mm to +2 mm for fields in the anterior-posterior, left-right, and cranial-caudal directions, and dose changes from range uncertainty were calculated with a 1 mm water-equivalent path length added to the target isocenter in each angle. The dose distributions regarding the passive irradiation method were calculated using the K2 dose algorithm.The rectal volumes with 0°, 30°, 60°, and 90° field angles at 95% of the prescription dose were 3.4±0.9 cm3, 2.8±1.1 cm3, 2.2±0.8 cm3, and 3.8±1.1 cm3, respectively. As compared with 90° fields, 30° and 60° fields had significant advantages regarding setup uncertainty and significant disadvantages regarding range uncertainty, but were not significantly different from the 90° field setup and range uncertainties.The setup and range uncertainties calculated at 30° and 60° field angles were not associated with a significant change in rectal dose relative to those at 90°.

  17. Setup error and motion during deep inspiration breath-hold breast radiotherapy measured with continuous portal imaging

    DEFF Research Database (Denmark)

    Lutz, Christina Maria; Poulsen, Per Rugaard; Fledelius, Walther

    2016-01-01

    BACKGROUND: The position and residual motion of the chest wall of breast cancer patients during treatment in deep inspiration breath-hold (DIBH) were investigated. MATERIAL AND METHODS: The study included 58 left-sided breast cancer patients treated with DIBH three-dimensional (3D) conformal......). At every third treatment fraction, continuous portal images were acquired. The time-resolved chest wall position during treatment was compared with the planned position to determine the inter-fraction setup errors and the intra-fraction motion of the chest wall. RESULTS: The DIBH compliance was 95% during...

  18. Improvement in toxicity in high risk prostate cancer patients treated with image-guided intensity-modulated radiotherapy compared to 3D conformal radiotherapy without daily image guidance

    International Nuclear Information System (INIS)

    Sveistrup, Joen; Rosenschöld, Per Munck af; Deasy, Joseph O; Oh, Jung Hun; Pommer, Tobias; Petersen, Peter Meidahl; Engelholm, Svend Aage

    2014-01-01

    Image-guided radiotherapy (IGRT) facilitates the delivery of a very precise radiation dose. In this study we compare the toxicity and biochemical progression-free survival between patients treated with daily image-guided intensity-modulated radiotherapy (IG-IMRT) and 3D conformal radiotherapy (3DCRT) without daily image guidance for high risk prostate cancer (PCa). A total of 503 high risk PCa patients treated with radiotherapy (RT) and endocrine treatment between 2000 and 2010 were retrospectively reviewed. 115 patients were treated with 3DCRT, and 388 patients were treated with IG-IMRT. 3DCRT patients were treated to 76 Gy and without daily image guidance and with 1–2 cm PTV margins. IG-IMRT patients were treated to 78 Gy based on daily image guidance of fiducial markers, and the PTV margins were 5–7 mm. Furthermore, the dose-volume constraints to both the rectum and bladder were changed with the introduction of IG-IMRT. The 2-year actuarial likelihood of developing grade > = 2 GI toxicity following RT was 57.3% in 3DCRT patients and 5.8% in IG-IMRT patients (p < 0.001). For GU toxicity the numbers were 41.8% and 29.7%, respectively (p = 0.011). On multivariate analysis, 3DCRT was associated with a significantly increased risk of developing grade > = 2 GI toxicity compared to IG-IMRT (p < 0.001, HR = 11.59 [CI: 6.67-20.14]). 3DCRT was also associated with an increased risk of developing GU toxicity compared to IG-IMRT. The 3-year actuarial biochemical progression-free survival probability was 86.0% for 3DCRT and 90.3% for IG-IMRT (p = 0.386). On multivariate analysis there was no difference in biochemical progression-free survival between 3DCRT and IG-IMRT. The difference in toxicity can be attributed to the combination of the IMRT technique with reduced dose to organs-at-risk, daily image guidance and margin reduction

  19. High-resolution continuous-flow analysis setup for water isotopic measurement from ice cores using laser spectroscopy

    Science.gov (United States)

    Emanuelsson, B. D.; Baisden, W. T.; Bertler, N. A. N.; Keller, E. D.; Gkinis, V.

    2015-07-01

    Here we present an experimental setup for water stable isotope (δ18O and δD) continuous-flow measurements and provide metrics defining the performance of the setup during a major ice core measurement campaign (Roosevelt Island Climate Evolution; RICE). We also use the metrics to compare alternate systems. Our setup is the first continuous-flow laser spectroscopy system that is using off-axis integrated cavity output spectroscopy (OA-ICOS; analyzer manufactured by Los Gatos Research, LGR) in combination with an evaporation unit to continuously analyze water samples from an ice core. A Water Vapor Isotope Standard Source (WVISS) calibration unit, manufactured by LGR, was modified to (1) enable measurements on several water standards, (2) increase the temporal resolution by reducing the response time and (3) reduce the influence from memory effects. While this setup was designed for the continuous-flow analysis (CFA) of ice cores, it can also continuously analyze other liquid or vapor sources. The custom setups provide a shorter response time (~ 54 and 18 s for 2013 and 2014 setup, respectively) compared to the original WVISS unit (~ 62 s), which is an improvement in measurement resolution. Another improvement compared to the original WVISS is that the custom setups have a reduced memory effect. Stability tests comparing the custom and WVISS setups were performed and Allan deviations (σAllan) were calculated to determine precision at different averaging times. For the custom 2013 setup the precision after integration times of 103 s is 0.060 and 0.070 ‰ for δ18O and δD, respectively. The corresponding σAllan values for the custom 2014 setup are 0.030, 0.060 and 0.043 ‰ for δ18O, δD and δ17O, respectively. For the WVISS setup the precision is 0.035, 0.070 and 0.042 ‰ after 103 s for δ18O, δD and δ17O, respectively. Both the custom setups and WVISS setup are influenced by instrumental drift with δ18O being more drift sensitive than δD. The

  20. Assessment of efficacy and tolerability of once-daily extended release metformin in patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    S Yu Vorotnikova

    2012-09-01

    Full Text Available Реферат по статье: Assessment of efficacy and tolerability of once-daily extended release metformin in patients with type 2 diabetes mellitus Juliana Levy, Roberta A Cobas, Marilia B Gomes. Diabetol Metab Syndr. 2010 Mar 18; 2:16.