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Sample records for glimepiride doses improve

  1. Glimepiride

    Science.gov (United States)

    Glimepiride comes as a tablet to take by mouth. It is usually taken once a day with breakfast or the first main meal of the ... medications to treat high blood sugar or diabetes; isoniazid (INH); MAO inhibitors such as isocarboxazid (Marplan), phenelzine ( ...

  2. Improved oral bioavailability of poorly water-soluble glimepiride by utilizing microemulsion technique

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    Li HY

    2016-08-01

    Full Text Available Haiying Li,1 Tingting Pan,1 Ying Cui,1 Xiaxia Li,1 Jiefang Gao,1 Wenzhi Yang,1 Shigang Shen2 1Key Laboratory of Pharmaceutical Quality Control of Hebei Province, College of Pharmacy, 2Key Laboratory of Analytical Science and Technology of Hebei Province, College of Chemistry and Environmental Science, Hebei University, Baoding, People’s Republic of China Abstract: The objective of this work was to prepare an oil/water glimepiride (GM microemulsion (ME for oral administration to improve its solubility and enhance its bioavailability. Based on a solubility study, pseudoternary phase diagrams, and Box–Behnken design, the oil/water GMME formulation was optimized and prepared. GMME was characterized by dynamic laser light scattering, zeta potential, transmission electron microscopy, and viscosity. The in vitro drug release, storage stability, pharmacodynamics, and pharmacokinetics of GMME were investigated. The optimized GMME was composed of Capryol 90 (oil, ­Cremophor RH40 (surfactant, and Transcutol (cosurfactant, and increased GM solubility up to 544.6±4.91 µg/mL. The GMME was spherical in shape. The particle size and its polydispersity index were 38.9±17.46 nm and 0.266±0.057, respectively. Meanwhile, the GMME was physicochemically stable at 4°C for at least 3 months. The short-term efficacy in diabetic mice provided the proof that blood glucose had a consistent and significant reduction at a dose of 375 µg/kg whether via IP injection or IG administration of GMME. Compared with the glimepiride suspensions or glimepiride-meglumine complex solution, the pharmacokinetics of GMME in Wistar rats via IG administration exhibited higher plasma drug concentration, larger area under the curve, and more enhanced oral bioavailability. There was a good correlation of GMME between the in vitro release values and the in vivo oral absorption. ME could be an effective oral drug delivery system to improve bioavailability of GM. Keywords: glimepiride

  3. Evaluation of fixed dose combination of glimepiride and metformin in patients with type 2 diabetes. Results of Russian observational study

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    Natalya Vladislavovna Zaytseva

    2015-04-01

    Full Text Available Aim. To investigate the efficacy and safety of combined glimepiride and metformin therapy in patients with type 2 diabetes mellitus (T2DM. Materials and methods. A multi-centre, open-label, prospective, observational study was conducted. A total of 1200 patients with T2DM inadequately controlled with metformin, glimepiride or combination of metformin + glimepiride were enrolled. Change in serum glycated haemoglobin (HbA1c, fasting plasma glucose (FPG, and postprandial blood glucose (PPG levels; weight; waist circumference and hypoglycemic episodes were evaluated. Results. Baseline HbA1c levels (8.24% ? 0.42% were significantly reduced after 12 weeks of treatment (7.48% ? 0.48% and at the end of the study. (6.88% ? 0.56%. Target HbA1c levels (?7% were achieved in 65.1% of patients at the final visit at 24 weeks. FPG and PPG levels decreased by 1.45 ? 1.14 mmol/l and 2.17 ? 1.27 mmol/l respectively (p < 0.001. No severe hypoglycemic events were reported. Body mass index reduced by 0.85 ? 1.28 kg/m2 (p < 0.001. Conclusion. . Combined glimepiride and metformin therapy significantly improved long-term glycemic control in patients with T2DM during the period of 24 weeks. without additional risk of hypoglycemic events or weight gain.

  4. Evaluation of fixed dose combination of glimepiride and metformin in patients with type 2 diabetes. Results of Russian observational study

    Directory of Open Access Journals (Sweden)

    Natalya Vladislavovna Zaytseva

    2015-04-01

    Full Text Available Aim.To investigate the efficacy and safety of combined glimepiride and metformin therapy in patients with type 2 diabetes mellitus (T2DM.Materials and methods.A multi-centre, open-label, prospective, observational study was conducted. A total of 1200 patients with T2DM inadequately controlled with metformin, glimepiride or combination of metformin + glimepiride were enrolled. Change in serum glycated haemoglobin (HbA1c, fasting plasma glucose (FPG, and postprandial blood glucose (PPG levels; weight; waist circumference and hypoglycemic episodes were evaluated.Results.Baseline HbA1c levels (8.24% ± 0.42% were significantly reduced after 12 weeks of treatment (7.48% ± 0.48% and at the end of the study(6.88% ± 0.56%. Target HbA1c levels (≤7% were achieved in 65.1% of patients at the final visit at 24 weeks. FPG and PPG levels decreased by 1.45 ± 1.14 mmol/l and 2.17 ± 1.27 mmol/l respectively (p < 0.001. No severe hypoglycemic events were reported. Body mass index reduced by 0.85 ± 1.28 kg/m2 (p < 0.001.Conclusion. Combined glimepiride and metformin therapy significantly improved long-term glycemic control in patients with T2DM during the period of 24 weeks without additional risk of hypoglycemic events or weight gain.

  5. Improvement of dissolution and hypoglycemic efficacy of glimepiride by different carriers.

    Science.gov (United States)

    Mohamed, Elham A; Meshali, Mahasen M; Foda, Abdel Monem M; Borg, Thanaa M

    2012-09-01

    Effects of tromethamine (Tris), polyvinylpyrrolidone (PVP-K25), and low molecular weight chitosan (LM-CH) on dissolution and therapeutic efficacy of glimepiride (Gmp) were investigated using physical mixtures (PMs), coground mixtures, coprecipitates (Coppts) or kneaded mixtures (KMs), and compared with drug alone. Fourier transform infrared spectroscopy, differential scanning colorimetry, and X-ray diffractometry were performed to identify any physicochemical interaction with Gmp. Surface morphology was examined via scanning electron microscopy. The results of Gmp in vitro dissolution revealed that it was greatly enhanced by Coppt with Tris or PVP-K25 and KM with LM-CH at a drug to carrier ratio of 1:8. Gmp amorphization by PVP-K25 and LM-CH was a major factor in increasing Gmp dissolution. Being basic, Tris might increase the pH of the microdiffusion layer around Gmp particles improving its dissolution. Formation of water-soluble complexes suggested by solubility study may also explain the enhanced dissolution. Capsules were prepared from Coppts and KM 1:8 drug to carrier binary systems and also with Tris PMs. In vivo, the hypoglycemic efficacy of Gmp capsules in rabbits increased by 1.63-, 1.50-, and 1.46-fold for 1:8 Coppts with Tris or PVP-K25 and KM with LM-CH respectively, compared with Gmp alone. Surprisingly, the response to Tris PM 1:20 capsules was 1.52-fold revealing statistically insignificant difference to that of Tris Coppt 1:8 (1.63 fold). As a conclusion, dissolution enhancement and hypoglycemic potentiation by 1:20 PM of Gmp/Tris, being simple and easy to prepare, may enable development of a reduced-dose and fast-release oral dosage form of Gmp.

  6. Metformin, but not glimepiride, improves carotid artery diameter and blood flow in patients with type 2 diabetes mellitus

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    Helena Atroch Machado

    2012-07-01

    Full Text Available OBJECTIVE: To compare the effects of glimepiride and metformin on vascular reactivity, hemostatic factors and glucose and lipid profiles in patients with type 2 diabetes. METHODS: A prospective study was performed in 16 uncontrolled patients with diabetes previously treated with dietary intervention. The participants were randomized into metformin or glimepiride therapy groups. After four months, the patients were crossed over with no washout period to the alternative treatment for an additional four-month period on similar dosage schedules. The following variables were assessed before and after four months of each treatment: 1 fasting glycemia, insulin, catecholamines, lipid profiles and HbA1 levels; 2 t-PA and PAI-1 (antigen and activity, platelet aggregation and fibrinogen and plasminogen levels; and 3 the flow indices of the carotid and brachial arteries. In addition, at the end of each period, a 12-hour metabolic profile was obtained after fasting and every 2 hours thereafter. RESULTS: Both therapies resulted in similar decreases in fasting glucose, triglyceride and norepinephrine levels, and they increased the fibrinolytic factor plasminogen but decreased t-PA activity. Metformin caused lower insulin and pro-insulin levels and higher glucagon levels and increased systolic carotid diameter and blood flow. Neither metformin nor glimepiride affected endothelial-dependent or endothelial-independent vasodilation of the brachial artery. CONCLUSIONS: Glimepiride and metformin were effective in improving glucose and lipid profiles and norepinephrine levels. Metformin afforded more protection against macrovascular diabetes complications, increased systolic carotid artery diameter and total and systolic blood flow, and decreased insulin levels. As both therapies increased plasminogen levels but reduced t-PA activity, a coagulation process was likely still ongoing.

  7. Glimepiride versus pioglitazone combination therapy in subjects with type 2 diabetes inadequately controlled on metformin monotherapy: results of a randomized clinical trial.

    Science.gov (United States)

    Umpierrez, Guillermo; Issa, Maher; Vlajnic, Aleksandra

    2006-04-01

    To compare the effect of add-on glimepiride or pioglitazone in subjects with type 2 diabetes inadequately controlled on metformin monotherapy. Multicenter, randomized, parallel-group, open-label, forcedtitration study involving 203 adults with poorly controlled type 2 diabetes (A1C 7.5-10%) on metformin monotherapy. Subjects were randomized to receive glimepiride or pioglitazone, titrated to the maximum dose for 26 weeks. Subjects were evaluated for A1C changes, fasting plasma glucose (FPG), insulin, C-peptide, and lipid levels. Safety outcomes and diabetes-related healthcare resource utilization were also evaluated. Both treatment groups achieved similar and significant mean decreases from baseline to endpoint (week 26) in A1C (p = 0.0001) and FPG (p use of fasting C-peptide concentration > or = 0.27 nmol/L in the inclusion criteria was a potential limitation as it may have included those patients with an improved probability for glimepiride or pioglitazone response. In addition, a larger patient population would have provided a greater degree of data applicability. In patients with type 2 diabetes inadequately controlled on metformin monotherapy, add-on glimepiride or pioglitazone results in similar overall improvements in glycemic control. Compared with pioglitazone, glimepiride is associated with faster glycemic control, lower total and LDL cholesterol levels and reduced short-term healthcare costs.

  8. The Impact of Amorphisation and Spheronization Techniques on the Improved in Vitro & in Vivo Performance of Glimepiride Tablets

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    Rana Refaat Makar

    2017-12-01

    Full Text Available Purpose: Triple solid dispersion adsorbates (TSDads and spherical agglomerates (SA present new techniques that extensively enhance dissolution of poorly soluble drugs. The aim of the present study is to hasten the onset of hypoglycemic effect of glimepiride through enhancing its rate of release from tablet formulation prepared from either technique. Methods: Drug release from TSDads or SA tablets with different added excipients was explored. Scanning electron microscopy (SEM and effect of compression on dissolution were illustrated. Pharmacodynamic evaluation was performed on optimized tablets. Results: TSDads & SA tablets with Cross Povidone showed least disintegration times of 1.48 and 0.5 min. respectively. Kinetics of drug release recorded least half-lives (54.13 and 59.83min for both techniques respectively. Cross section in tablets displayed an organized interconnected matrix under SEM, accounting for the rapid access of dissolution media to the tablet core. Components of tablets filled into capsules showed a similar release profile to that of tablets after compression as indicated by similarity factor. The onset time of maximum reduction in blood glucose in male albino rabbits was hastened to 2h instead of 3h for commercial tablets. Conclusion: After optimization of tablet excipients that interacted differently with respect to their effect on drug release, we could conclude that both amorphisation and spheronization were equally successful in promoting in vitro dissolution enhancement as well as providing a more rapid onset time for drug action in vivo.

  9. Optimization of therapy of type 2 diabetes mellitus with the oral hypoglycemic agent glimepiride

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    Tatiana Ivanovna Romantsova

    2010-03-01

    Full Text Available Type 2 diabetes is believed to develop as a result of lowered insulin secretion and insulin resistance leading to hyperglycemia. Sulfonylureas stimulateinsulin secretion and thereby decrease blood glucose level which accounts for their wide application in the treatment of diabetes. However, manyagents of this class produce side effects (increased body mass, hypoglycemia, resistance to therapy, etc. attributable to excess stimulation of insulinsecretion. Glimepiride is as efficient as traditionally used sulfonylureas but causes a smaller rise in insulin secretion. Sulfonylurea receptors showlower affinity for glimepiride than for glibenclamide. Formation and dissociation of glimepiride-receptor complexes occur faster than those of glibenclamide-receptor complexes. In addition, therapeutic effect of glimepiride was shown to be associated with improved insulin sensitivity. It is concludedthat glimepiride is an efficacious agent for the treatment of type 2 diabetes.

  10. Pharmacokinetic interactions between glimepiride and rosuvastatin in healthy Korean subjects: does the SLCO1B1 or CYP2C9 genetic polymorphism affect these drug interactions?

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    Kim CO

    2017-02-01

    Full Text Available Choon Ok Kim,1 Eun Sil Oh,2 Hohyun Kim,3 Min Soo Park1,4 1Department of Clinical Pharmacology, Severance Hospital, Yonsei University College of Medicine, Seoul, 2Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, Incheon, 3Korea Medicine Research Institute, Inc., Seongnam, 4Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea Abstract: To improve cardiovascular outcomes, dyslipidemia in patients with diabetes needs to be treated. Thus, these patients are likely to take glimepiride and rosuvastatin concomitantly. Therefore, this study aimed to evaluate the pharmacokinetic (PK interactions between these two drugs in healthy males and to explore the effect of SLCO1B1 and CYP2C9 polymorphisms on their interactions in two randomized, open-label crossover studies. Glimepiride was studied in part 1 and rosuvastatin in part 2. Twenty-four participants were randomly assigned to each part. All subjects (n=24 completed part 1, and 22 subjects completed part 2. A total of 38 subjects among the participants of the PK interaction studies were enrolled in the genotype study to analyze their SLCO1B1 and CYP2C9 polymorphisms retrospectively (n=22 in part 1, n=16 in part 2. Comparison of the PK and safety of each drug alone with those of the drugs in combination showed that both glimepiride and rosuvastatin did not interact with each other and had tolerable safety profiles in all subjects. However, with regard to glimepiride PK, the SLCO1B1 521TC group had a significantly higher maximum plasma concentration (Cmax,ss and area under the plasma concentration–time curve during the dose interval at steady state (AUCt,ss for glimepiride in combination with rosuvastatin than those for glimepiride alone. However, other significant effects of the SLCO1B1 or CYP2C9 polymorphism on the interaction between the two drugs were not observed. In conclusion, there were no significant PK

  11. Comparison between the therapeutic effect of metformin, glimepiride and their combination as an add-on treatment to insulin glargine in uncontrolled patients with type 2 diabetes.

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    Cheol-Young Park

    Full Text Available To compare the commonly prescribed oral anti-diabetic drug (OAD combinations to use as an add-on therapy with insulin glargine in patients with uncontrolled type 2 diabetes despite submaximal doses of OADs.People with inadequately controlled type 2 diabetes (n = 99 were randomly assigned on a 1∶1∶1 basis to receive insulin glargin, with fixed doses of glimepiride, metformin, and glimepiride plus metformin. Outcomes assessed included HbA1c, the changes in fasting glucose levels, body weight, serum lipids values, insulin dose and symptomatic hypoglycemia.After 24 weeks, HbA1C levels improved from (mean ± SD 8.5±0.9% to 7.7±0.8% (69.0±10.0 mmol/mol to 60.8±8.6 mmol/mol with insulin glargine plus metformin, from 8.4±1.0% to 7.7±1.3% (68.8±10.6 mmol/mol to 61.1±14.4 mmol/mol with insulin glargine plus glimepiride and from 8.7±0.9% to 7.3±0.6% (71.7±9.8 mmol/mol to 56.2±6.7 mmol/mol with insulin glargine plus glimepirde plus metformin. The decrease in HbA1c was more pronounced with insulin glargine plus glimepiride plus metformin than with insulin glargine plus metformin (0.49% [CI, 0.16% to 0.82%]; P = 0.005 (5.10 mmol/mol [CI, 1.64 to 8.61]; P = 0.005 and insulin glargine plus glimepiride (0.59% [CI, 0.13% to 1.05%]; P = 0.012 (5.87 mmol/mol [CI, 1.10 to 10.64]; P = 0.012 (overall P = 0.02. Weight gain and the risk of hypoglycemia of any type did not significantly differ among the treatment groups.The combination therapy of metformin and glimepiride plus glargine insulin resulted in a significant improvement in overall glycemic control as compared with the other combinations.ClinicalTrials.gov, NCT00708578. The approval number of Kangbuk Samsung hospital's institutional review board (IRB: C0825.

  12. Comparison of vildagliptin and glimepiride: effects on glycaemic control, fat tolerance and inflammatory markers in people with type 2 diabetes.

    Science.gov (United States)

    Derosa, G; Bonaventura, A; Bianchi, L; Romano, D; Fogari, E; D'Angelo, A; Maffioli, P

    2014-12-01

    To compare the effects of vildagliptin with those of glimepiride on glycaemic control, fat tolerance and inflammatory markers in people with Type 2 diabetes mellitus receiving metformin treatment. A total of 167 participants were randomized to vildagliptin 50 mg twice a day or glimepiride 2 mg three times a day, for 6 months. We evaluated the following variables: BMI; glycaemic control; fasting plasma insulin; homeostatic model assessment of insulin resistance index; fasting plasma proinsulin; glucagon; lipid profile; adiponectin; high-sensitivity C-reactive protein; interleukin-6; and tumour necrosis factor-α. A euglycaemic-hyperinsulinaemic clamp procedure and an oral fat load test were also performed. Despite a similar decrease in HbA1c levels (P = 0.009, and P = 0.008, respectively), body weight increased with glimepiride (P = 0.048 vs baseline) and decreased with vildagliptin (P = 0.041 vs baseline and vs glimepiride). Fasting plasma insulin and homeostatic model assessment of insulin resistance index were significantly lower with vildagliptin compared with glimepiride (P = 0.035 and 0.047). M value, an index of insulin sensitivity, increased with vildagliptin, both compared with baseline and with glimepiride (P = 0.028 and 0.039, respectively). Vildagliptin improved all post-oral fat load peaks of lipid profile compared with glimepiride. Adiponectin levels were higher (P = 0.035) and high-sensitivity C-reactive protein levels were lower (P = 0.038) with vildagliptin vs glimepiride. During the oral fat load test, interleukin-6, high-sensitivity C-reactive protein and tumour necrosis factor-α peaks were lower and adiponectin peak was higher in the vildagliptin group than in the glimepiride group. There was a higher dropout rate as a result of hypoglycaemia in the glimepiride group than in the vildagliptin group. Vildagliptin was more effective than glimepiride in reducing post-oral fat load peaks of lipid-trafficking adipocytokines and

  13. Vildagliptin compared to glimepiride on post-prandial lipemia and on insulin resistance in type 2 diabetic patients.

    Science.gov (United States)

    Derosa, Giuseppe; Bonaventura, Aldo; Bianchi, Lucio; Romano, Davide; Fogari, Elena; D'Angelo, Angela; Maffioli, Pamela

    2014-07-01

    To evaluate the effects of vildagliptin compared to glimepiride on glycemic control, insulin resistance and post-prandial lipemia. 167 type 2 diabetic patients, not adequately controlled by metformin, were randomized to vildagliptin 50 mg twice a day or glimepiride 2 mg three times a day for 6 months, in a double blind, randomized clinical trial. We evaluated: body mass index (BMI), glycemic control, fasting plasma insulin (FPI), homeostasis model assessment insulin resistance index (HOMA-IR), fasting plasma proinsulin (FPPr), glucagon, lipid profile, resistin, retinol binding protein-4 (RBP-4), visfatin and vaspin. Furthermore, at the randomization and at the end of the study all patients underwent an euglycemic hyperinsulinemic clamp to evaluate M value and an oral fat load. Despite a similar decrease of glycated hemoglobin, there were an increase of body weight with glimepiride + metformin and a decrease with vildagliptin + metformin. Fasting plasma insulin increased with glimepiride + metformin, while it did not change with vildagliptin + metformin. Vildagliptin + metformin improved lipid profile. Regarding insulin sensitivity, vildagliptin + metformin increased M value. Resistin, RBP-4, vaspin and visfatin were decreased by vildagliptin + metformin, but in group to group comparison, only vaspin reduction resulted statistically significant. Vildagliptin + metformin reduced post-prandial lipemia and insulinemia compared to glimepiride + metformin. Vildagliptin, in addition to metformin, was more effective than glimepiride + metformin in reducing insulin resistance and post-prandial lipemia. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Mechanistic analysis of Zein nanoparticles/PLGA triblock in situ forming implants for glimepiride

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    Ahmed OAA

    2016-02-01

    Full Text Available Osama Abdelhakim Aly Ahmed,1,2 Ahmed Samir Zidan,1,3 Maan Khayat4 1Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Minia University, Minia, Egypt; 3Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt; 4Department of Pharmaceutical Chemistry, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia Objectives: The study aims at applying pharmaceutical nanotechnology and D-optimal fractional factorial design to screen and optimize the high-risk variables affecting the performance of a complex drug delivery system consisting of glimepiride–Zein nanoparticles and inclusion of the optimized formula with thermoresponsive triblock copolymers in in situ gel. Methods: Sixteen nanoparticle formulations were prepared by liquid–liquid phase separation method according to the D-optimal fractional factorial design encompassing five variables at two levels. The responses investigated were glimepiride entrapment capacity (EC, particle size and size distribution, zeta potential, and in vitro drug release from the prepared nanoparticles. Furthermore, the feasibility of embedding the optimized Zein-based glimepiride nanoparticles within thermoresponsive triblock copolymers poly(lactide-co-glycolide-block-poly(ethylene glycol-block-poly(lactide-co-glycolide in in situ gel was evaluated for controlling glimepiride release rate. Results: Through the systematic optimization phase, improvement of glimepiride EC of 33.6%, nanoparticle size of 120.9 nm with a skewness value of 0.2, zeta potential of 11.1 mV, and sustained release features of 3.3% and 17.3% drug released after 2 and 24 hours, respectively, were obtained. These desirability functions were obtained at Zein and glimepiride loadings of 50 and 75 mg, respectively, utilizing

  15. Appropriate timing of glimepiride administration in patients with type 2 diabetes millitus: a study in Mediterranean countries.

    Science.gov (United States)

    Gomis, R; Raptis, S A; Ravella, R

    2000-08-01

    Sulfonylureas are used to treat patients with type 2 diabetes mellitus when diet and exercise fail. Glimepiride, a new sulfonylurea, can be administered in one daily dose, thanks to its pharmacokinetic properties. We attempted to establish the optimal time of day for the administration of Glimepiride in a group of patients from the Mediterranean area by clinical trial. No relationship was found between the time of administration and fasting blood glucose values, or HbA1c, or the frequency or severity of hypoglycemic episodes.

  16. Neuro, cardio, and reno protective activities of rosuvastatin in streptozotocin-induced type 2 diabetic rats undergoing treatment with metformin and glimepiride

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    Shailaja Rondi

    2014-01-01

    Full Text Available Diabetes is associated with complications like neuropathy, nephropathy, cardiomyopathy, and retinopathy due to increased oxidative stress and serum lipids. In the present study, rosuvastatin, a HMG-CoA inhibitor, was investigated for its protective effect in neuropathy, nephropathy, and cardiomyopathy based on the lipid-lowering property along with its pleiotropic effects such as improved blood flow to the organ and antioxidant defense. Type 2 diabetes was induced in Wistar rats by single i.p. administration of streptozotocin (50 mg/kg. These diabetic rats were treated with daily doses of rosuvastatin (10 mg/kg alone, metformin (120 mg/kg and glimepiride (1 mg/kg and rosuvastatin in combination with metformin (120 mg/kg and glimepiride (1 mg/kg for a period of 6 weeks. The biochemical parameters involved in neuropathy, renopathy, and cardiopathy were estimated. Treatment resulted in significant (P < 0.05 decrease in thiobarbituric acid reactive substances (TBARS and increase in levels of glutathione peroxidise and catalase in brain and kidney homogenates. Significant (P < 0.05 increase in high-density lipoproteins and decrease in creatinine kinase, triglycerides, total serum cholesterol represents the cardioprotective action, whereas significant (P < 0.05 increase in the latency in the hotplate model shows the neuroprotective activity, and significant (P < 0.05 decrease in blood urea nitrogen, creatinine levels and increase in serum total protein levels suggested the renoprotective actions. The unique properties of rosuvastatin such as antioxidant defense and lipid-lowering nature might have resulted in cardio, neuro, and renoprotective activity in type 2 diabetic rats treated with metformin and glimepiride.

  17. The efficacy and safety of adding either vildagliptin or glimepiride to ongoing metformin therapy in patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Kim, Gyuri; Oh, Sewon; Jin, Sang-Man; Hur, Kyu Yeon; Kim, Jae Hyeon; Lee, Moon-Kyu

    2017-08-01

    To compare the effects of either vildagliptin or glimepiride on glycemic variability, oxidative stress, and endothelial parameters in patients with type 2 diabetes mellitus (T2DM) inadequately controlled with metformin alone. In this randomized, open-label, parallel study, 34 patients with T2DM being treated with metformin having an HbA1c of 7.0-10.0% were allocated into either the vildagliptin or glimepiride group. A mixed-meal tolerance test and 72-hour continuous glucose monitoring were conducted, and urinary 8-iso-prostaglandinF 2α (PGF 2α ) and endothelial-dependent flow-mediated dilatation (FMD) were evaluated at baseline and after 12 weeks of treatment. Similar significant improvements in HbA1c level were shown in both vildagliptin (-0.8%) and glimepiride (-0.9%) groups after treatment (Psvildagliptin (P = 0.044 and P = 0.031, respectively) but not by glimepiride. Glimepiride was significantly associated with a higher incidence of hypoglycemia than vildagliptin (P = 0.005). There were no significant differences in urinary 8-iso-PGF 2α or FMD between the two groups. Vildagliptin effectively improved glucose level with a significantly greater reduction in glycemic variability and hypoglycemia than glimepiride in patients with T2DM ongoing metformin therapy. The two drugs showed no significant differences in urinary 8-iso-PGF 2α and FMD. NCT01404676.

  18. Vildagliptin reduces plasma stromal cell-derived factor-1α in patients with type 2 diabetes compared with glimepiride.

    Science.gov (United States)

    Park, Kyeong Seon; Kwak, SooHeon; Cho, Young Min; Park, Kyong Soo; Jang, Hak C; Kim, Seong Yeon; Jung, Hye Seung

    2017-03-01

    Dipeptidyl peptidase-4 inhibitors might have pleiotropic protective effects on cardiovascular disease (CVD), in contrast to sulfonylureas. Therefore, we compared various CVD risk factors between vildagliptin and glimepiride. We carried out a randomized, prospective and crossover trial. A total of 16 patients with type 2 diabetes whose glycated hemoglobin was >7% were randomized to add vildagliptin or glimepiride. After 12-week treatment, each drug was replaced with the other for another 12 weeks. Before and after each treatment, glucose homeostasis and CVD risk factors were assessed, and the continuous glucose monitoring system was applied to calculate glycemic variability. The mean age of the participants was 60 years, 31% were men, body mass index 25.5 kg/m 2 and HbA1c 8.41%. Both vildagliptin and glimepiride significantly decreased glycated hemoglobin and glycemic variability indices. Despite the improved glucose homeostasis, favorable change of CVD markers was not prominent in both the arms, along with significant weight gain. Only plasma stromal cell-derived factor (SDF)-1α decreased by 30% in the vildagliptin arm. According to regression analyses, the reduction of SDF-1α was independently associated with vildagliptin usage and serum interleukin-6 changes, but white blood cells were not related with the SDF-1α changes. Compared with glimepiride, vildagliptin arrestingly decreased plasma SDF-1α, and its clinical implications should be further investigated. © 2016 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

  19. Clinical Trial Of Glimepiride Compared With Glibenclamide For ...

    African Journals Online (AJOL)

    Objective: The study was undertaken to compare the efficacy and safety of Glimepiride against Glibenclamide in the management of patients with type 2 DM in Jos, Nigeria. Study design: An open, randomised controlled trial. Setting: Diabetes Clinic of the Jos University Teaching Hospital, Jos, Nigeria. Subjects: Seventy four ...

  20. Improved dose estimates for nuclear criticality accidents

    International Nuclear Information System (INIS)

    Wilkinson, A.D.; Basoglu, B.; Bentley, C.L.; Dunn, M.E.; Plaster, M.J.; Dodds, H.L.; Yamamoto, T.

    1995-01-01

    Slide rules are improved for estimating doses and dose rates resulting from nuclear criticality accidents. The original slide rules were created for highly enriched uranium solutions and metals using hand calculations along with the decades old Way-Wigner radioactive decay relationship and the inverse square law. This work uses state-of-the-art methods and better data to improve the original slide rules and also to extend the slide rule concept to three additional systems; i.e., highly enriched (93.2 wt%) uranium damp (H/ 235 U = 10) powder (U 3 O 8 ) and low-enriched (5 wt%) uranium mixtures (UO 2 F 2 ) with a H/ 235 U ratio of 200 and 500. Although the improved slide rules differ only slightly from the original slide rules, the improved slide rules and also the new slide rules can be used with greater confidence since they are based on more rigorous methods and better nuclear data

  1. Glimepiride attenuates Aβ production via suppressing BACE1 activity in cortical neurons.

    Science.gov (United States)

    Liu, Feiyang; Wang, Yijin; Yan, Ming; Zhang, Luyong; Pang, Tao; Liao, Hong

    2013-12-17

    Numerous lines of evidence suggest a strong link between diabetes mellitus and Alzheimer's disease (AD). Impaired insulin signaling and insulin resistance occur not only in diabetes but also in the brain of AD. Recent evidence has indicated that peroxisome proliferator-activated receptor γ (PPARγ) agonists thiazolidinediones (TZDs) can decrease β-amyloid peptide (Aβ) deposition, which is the core component of senile plaques in AD, but the underlying mechanisms still remain unclear. In this study, we investigated whether glimepiride with PPARγ-stimulating activity, an oral anti-diabetic drug, has similar effects on Aβ production in primary cortical neurons. We demonstrated that glimepiride decreased extracellular Aβ40 and Aβ42 levels. The effect of glimepiride on reduction of Aβ40 generation was mediated by downregulation of β-site APP-cleaving enzyme 1 (BACE1) mRNA and protein expression, and by suppression of BACE1 activity. In addition, we found that high glucose condition enhanced Aβ40 production and glimepiride significantly decreased high glucose-induced Aβ40 production. Finally, a specific PPARγ antagonist GW9662 reversed glimepiride inhibitory effect on Aβ40 generation, suggesting a PPARγ-dependent mechanism may be involved. Our data indicated that glimepiride may serve as a promising drug for the treatment of AD associated with diabetes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  2. Formulation and Evaluation of New Glimepiride Sublingual Tablets

    Directory of Open Access Journals (Sweden)

    Wafa Al-Madhagi

    2017-01-01

    Full Text Available Oral mucosal delivery of drugs promotes rapid absorption and high bioavailability, with a subsequent immediate onset of pharmacological effect. However, many oral mucosal deliveries are compromised by the possibility of the patient swallowing the active substance before it has been released and absorbed locally into the systemic circulation. The aim of this research was to introduce a new glimepiride formula for sublingual administration and rapid drug absorption that can be used in an emergency. The new sublingual formulation was prepared after five trials to prepare the suitable formulation. Two accepted formulations of the new sublingual product were prepared, but one of them with disintegration time of 1.45 min and searching for preferred formulation, the binder, is changed with Flulac and starch slurry to prepare formula with disintegration time of 21 seconds that supports the aim of research to be used in an emergency. The five formulations were done, after adjusting to the binder as Flulac and aerosil with disintegration time of 21 seconds and accepted hardness as well as the weight variation. The assay of a new product (subglimepiride is 103% which is a promising result, confirming that the formula succeeded. The new product (subglimepiride is accepted in most quality control tests and it is ready for marketing.

  3. A simple and convenient method for the simultaneous in vitro study of metformin and glimepiride tablets.

    Science.gov (United States)

    Ahmed, Rehan

    2014-11-01

    A simple and convenient method was developed for the simultaneous determination of metformin HCl and glimepiride in tablet dosage form of different pharmaceuticals companies. This method was validated and proved to be applicable for assay determination in intermediate and finished staged. More over a single medium dissolution of metformin HCl and glimepiride was established and the media was evaluated for comparative studies for different formulations. Reverse phase HPLC equipped with UV detector was used for the determination of metformin HCl and glimepiride. A mixture of acetonitrile and ammonium acetate buffer 0.05M pH 3.0 was used as mobile phase at flow rate of 1.0ml/min. Promocil C18 5µ 100Aº 4.6 x 100mm C18 silica column was used and detection was carried out at 270nm. Method was found to be linear over the range of 4ppm to 16ppm for glimepiride and 170ppm to 680ppm for metformin HCl. Regression co-efficient were found to be 0.9949 and 0.9864 for glimepiride and metformin HCl respectively. Dissolution was performed in 500ml 0.2% sodium lauryl sulfate at 37°C for 45min using paddle apparatus. Dissolution of glimepiride was found to be 98.60% and 101.08% in Orinase Met1 tablet and Amaryl M tablet respectively whereas metformin was found 99.41% and 98.59% in Orinase Met 1 tablet and Amaryl M tablet. RSD for all the dissolutions was less than 2.0% after completion.

  4. A rapid hydrophilic interaction liquid chromatographic determination of glimepiride in pharmaceutical formulations

    Directory of Open Access Journals (Sweden)

    Si Zhou

    2017-09-01

    Full Text Available Glimepiride is one of the most widely prescribed antidiabetic drugs and contains both hydrophobic and hydrophilic functional groups in its molecules, and thus could be analyzed by either reversed-phase high performance liquid chromatography (HPLC or hydrophilic interaction liquid chromatography (HILIC. In the literature, however, only reversed-phase HPLC has been reported. In this study, a simple, rapid and accurate hydrophilic interaction liquid chromatographic method was developed for the determination of glimepiride in pharmaceutical formulations. The analytical method comprised a fast ultrasound-assisted extraction with acetonitrile as a solvent followed by HILIC separation and quantification using a Waters Spherisorb S5NH2 hydrophilic column with a mobile phase consisting of acetonitrile and aqueous acetate buffer (5.0 mM. The retention time of glimepiride increased slightly with decrease of mobile phase pH value from 6.8 to 5.8 and of acetonitrile content from 60% to 40%, indicating that both hydrophilic, ionic, and hydrophobic interactions were involved in the HILIC retention and elution mechanisms. Quantitation was carried out with a mobile phase of 40% acetonitrile and 60% aqueous acetate buffer (5.0 mM at pH 6.3, by relating the peak area of glimepiride to that of the internal standard, with a detection limit of 15.0 μg/L. UV light absorption responses at 228 nm were linear over a wide concentration range from 50.0 μg/L to 6.00 mg/L. The recoveries of the standard added to pharmaceutical tablet samples were 99.4–103.0% for glimepiride, and the relative standard deviation for the analyte was less than 1.0%. This method has been successfully applied to determine the glimepiride contents in pharmaceutical formulations.

  5. Comparison of Vildagliptin-Metformin and Glimepiride-Metformin Treatments in Type 2 Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Hyun Jeong Jeon

    2011-10-01

    Full Text Available BackgroundThe present study investigated the efficacy and safety of vildagliptin-metformin treatment compared to those of glimepiride-metformin treatment for type 2 diabetes.MethodsIn a randomized, open-label, comparative study, 106 patients with type 2 diabetes were enrolled. The primary endpoint was a reduction in HbA1c from baseline and secondary endpoints included fasting plasma glucose (FPG or 2-hour postprandial glucose (2h-PPG reduction from baseline, as well as HbA1c responder rate and HbA1c reduction according to baseline HbA1c category.ResultsComparable HbA1c reduction was observed with a mean±standard deviation change from baseline to the 32-week endpoint of -0.94±1.15% in the vildagliptin group and -1.00±1.32% in the glimepiride group. A similar reduction in 2h-PPG (vildagliptin group 3.53±4.11 mmol/L vs. the glimepiride group 3.72±4.17 mmol/L was demonstrated, and the decrements in FPG (vildagliptin group 1.54±2.41 mmol/L vs. glimepiride group 2.16±2.51 mmol/L were not different between groups. The proportion of patients who achieved an HbA1c less than 7% at week 32 was 50.1% in the vildagliptin group and 56.0% in the glimepiride group. An average body weight gain of 2.53±1.21 kg in the glimepiride group was observed in contrast with the 0.23±0.69 kg weight gain noted in the vildagliptin group. A 10-fold lower incidence of hypoglycemia was demonstrated in the vildagliptin group, in addition to an absence of severe hypoglycemia.ConclusionVildagliptin-metformin treatment provided blood glucose control efficacy comparable to that of glimepiride-metformin treatment and resulted in better adverse event profiles with lower risks of hypoglycemia and weight gain.

  6. Treatment satisfaction in type 2 diabetes patients taking empagliflozin compared with patients taking glimepiride.

    Science.gov (United States)

    Chirila, Costel; Zheng, Qingyao; Davenport, Eric; Kaschinski, Dagmar; Pfarr, Egon; Hach, Thomas; Palencia, Roberto

    2016-05-01

    This exploratory analysis assessed and compared patients' treatment satisfaction with empagliflozin plus metformin versus glimepiride plus metformin, using data obtained from the Diabetes Treatment Satisfaction Questionnaire, status version (DTSQs) collected in a randomized, double-blind, double-dummy clinical trial. Observed values for DTSQs scale score and each of its eight items were summarized by visit and treatment arm. Changes from baseline in these scores were analyzed using linear mixed models for repeated measures. The baseline scale score and item scores were comparable between empagliflozin plus metformin (n = 765) and glimepiride plus metformin (n = 780). Compared with baseline, patients reported significant treatment satisfaction increases and significant decreases in perceived hyperglycemia with both treatments at all visits. Also, compared with baseline, a significant increase in perceived frequency of hypoglycemia was observed in the glimepiride treatment group at all visits. No statistically significant treatment difference was observed in DTSQs scale score and its items at week 104. The difference between the treatment groups was significant and in favor of empagliflozin from week 28 onward for perceived frequency of hyperglycemia (P ≤ 0.006) and perceived frequency of hypoglycemia (P ≤ 0.011). Despite positive trends in favor of empagliflozin, there was no significant difference in DTSQs scale score between empagliflozin and glimepiride at 104 weeks. However, when compared with glimepiride, empagliflozin demonstrated significantly lower perceived frequency of hyperglycemia and hypoglycemia at all visits from week 28 onward. This finding is consistent with the clinical results reported for the EMPA-REG H2H-SU trial.

  7. Clinical pharmacokinetic study for the effect of glimepiride matrix tablets developed by quality by design concept.

    Science.gov (United States)

    Ahmed, Tarek A; Suhail, Mohammad A A; Hosny, Khaled M; Abd-Allah, Fathy I

    2018-01-01

    Implementation of a new pharmaceutical technique to improve aqueous solubility and thus dissolution, enhancement of drug permeation, and finally formulation of a controlled release tablet loaded with glimepiride (GLMP). Improve GLMP bioavailability and pharmacokinetics in type II diabetic patients. Different polymers were used to enhance aqueous GLMP solubility of which a saturated polymeric drug solution was prepared and physically adsorbed onto silica. An experimental design was employed to optimize the formulation parameters affecting the preparation of GLMP matrix tablets. A compatibility study was conducted to study components interactions. Scanning electron microscope (SEM) was performed before and after the tablets were placed in the dissolution medium. An in vivo study in human volunteers was performed with the optimized GLMP tablets, which were compared to pure and marketed drug products. Enhancement of GLMP aqueous solubility, using the polymeric drug solution technique, by more than 6-7 times when compared with the binary system. All the studied formulation factors significantly affected the studied variables. No significant interaction was detected among components. SEM illustrated the surface and inner tablet structure, and confirmed the drug release which was attributed to diffusion mechanism. The volunteer group administered the optimized GLMP tablet exhibited higher drug plasma concentration (147.4 ng/mL), longer time to reach maximum plasma concentration (4 h) and longer t 1/2 (7.236 h) compared to other groups. Matrix tablet loaded with a physically modified drug form could represent a key solution for drugs with inconsistent dissolution and absorption profiles.

  8. An evaluation of high-dose jobs for ALARA improvement

    International Nuclear Information System (INIS)

    Mun, J. H.; Kim, H. S.

    1997-01-01

    It is well known that about 70 percent of occupational dose have incurred from maintenance jobs at outage period. To reduce occupational dose, first, the high-dose jobs at the outage period should be identified and evaluated. For this, the database program is used, which contains the ORE data of reference plants, Kori Units 3 and 4. As a result, it is found that the jobs related to steam generator are the highest dose jobs in terms of collective ORE dose. From the analysis of the job procedures of those jobs, the ALARA improvements are also derived

  9. Improvements to the Hunter Dose tracking system

    Energy Technology Data Exchange (ETDEWEB)

    Whiteside, T. S. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Aucott, T. J. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Brand, A. D. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Diprete, D. P. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2017-07-01

    Since 1965, the Savannah River Site (SRS) has conducted deer hunts which are open to the general public. SRS performs field monitoring for cesium-137 (Cs-137) of each harvested animal to determine whether the animal may be released to the hunter. A new field system for measuring Cs-137 in the harvested animals has been developed. The system incorporates numerous enhancements compared to the original system. The original system was composed of two Ludlum Measurements scalar-driven 2 inch x 2 inch sodium iodide counters, while the new system is based on a single Ametek Ortec Digibase-driven 2 inch x 4 inch x 16 inch sodium iodide gamma spectrometer. The new system includes a series of easy-to-assemble stainless steel encapsulated lead shields. The combination of the larger detector size and lead shielding improved the detection limit of the new system by a factor of approximately three compared to the original system. This lower detection limit allows for a larger number of measurements to be directly compared to the laboratory results, in cases where animal portions have been sampled. The results from developing and using this system are presented as well as recommendations on improvements to the overall field monitoring of the SRS hunts.

  10. Work management practices that reduce dose and improve efficiency

    International Nuclear Information System (INIS)

    Miller, D.W.; Hulin, M.

    1998-01-01

    Work management practices at nuclear power plants can dramatically affect the outcome of annual site dose goals and outage costs. This presentation discusses global work management practices that contribute to dose reduction including work philosophy, work selection, work planning, work scheduling, worker training, work implementation and worker feedback. The presentation is based on a two-year international effort (sponsored by NEA/IAEA ISOE) to study effective work practices that reduce dose. Experts in this area believe that effective work selection and planning practices can substantially reduce occupational dose during refueling outages. For example, some plants represented in the expert group complete refueling outages in 12-18 days (Finland) with doses below 0,90 person-Sv. Other plants typically have 50-75 day outages with substantially higher site doses. The fundamental reasons for longer outages and higher occupational doses are examined. Good work management principles that have a proven track record of reducing occupational dose are summarized. Practical methods to reduce work duration and dose are explained. For example, scheduling at nuclear power plants can be improved by not only sequencing jobs on a time line but also including zone and resource-based considerations to avoid zone congestion and manpower delays. An ongoing, global, benchmarking effort is described which provides current duration and dose information for repetitive jobs to participating utilities world-wide. (author)

  11. Improvement of dose evaluation method for employees at severe accident

    International Nuclear Information System (INIS)

    Onda, Takashi; Yoshida, Yoshitaka; Kudo, Seiichi; Nishimura, Kazuya

    2003-01-01

    It is expected that the selection of access routes for employees who engage in emergency work at a severe accident in a nuclear power plant makes a difference in their radiation dose values. In order to examine how much difference arises in the dose by the selection of the access routes, in the case of a severe accident in a pressurized water reactor plant, we improved the method to obtain the dose for employees and expanded the analyzing system. By the expansion of the system and the improvement of the method, we have realized the followings: (1) in the whole plant area, the dose evaluation is possible, (2) the efficiency of calculation is increased by the reduction of the number of radiation sources, etc, and (3) the function is improved by introduction of the sky shine calculation into the highest floor, etc. The improved system clarifies the followings: (1) the doses change by selected access routes, and this system can give the difference in the doses quantitatively, and (2) in order to suppress the dose, it is effective to choose the most adequate access route for the employees. (author)

  12. Dose escalation using conformal high-dose-rate brachytherapy improves outcome in unfavorable prostate cancer

    International Nuclear Information System (INIS)

    Martinez, Alvaro A.; Gustafson, Gary; Gonzalez, Jose; Armour, Elwood; Mitchell, Chris; Edmundson, Gregory; Spencer, William; Stromberg, Jannifer; Huang, Raywin; Vicini, Frank

    2002-01-01

    Purpose: To overcome radioresistance for patients with unfavorable prostate cancer, a prospective trial of pelvic external beam irradiation (EBRT) interdigitated with dose-escalating conformal high-dose-rate (HDR) prostate brachytherapy was performed. Methods and Materials: Between November 1991 and August 2000, 207 patients were treated with 46 Gy pelvic EBRT and increasing HDR brachytherapy boost doses (5.50-11.5 Gy/fraction) during 5 weeks. The eligibility criteria were pretreatment prostate-specific antigen level ≥10.0 ng/mL, Gleason score ≥7, or clinical Stage T2b or higher. Patients were divided into 2 dose levels, low-dose biologically effective dose 93 Gy (149 patients). No patient received hormones. We used the American Society for Therapeutic Radiology and Oncology definition for biochemical failure. Results: The median age was 69 years. The mean follow-up for the group was 4.4 years, and for the low and high-dose levels, it was 7.0 and 3.4 years, respectively. The actuarial 5-year biochemical control rate was 74%, and the overall, cause-specific, and disease-free survival rate was 92%, 98%, and 68%, respectively. The 5-year biochemical control rate for the low-dose group was 52%; the rate for the high-dose group was 87% (p<0.001). Improvement occurred in the cause-specific survival in favor of the brachytherapy high-dose level (p=0.014). On multivariate analysis, a low-dose level, higher Gleason score, and higher nadir value were associated with increased biochemical failure. The Radiation Therapy Oncology Group Grade 3 gastrointestinal/genitourinary complications ranged from 0.5% to 9%. The actuarial 5-year impotency rate was 51%. Conclusion: Pelvic EBRT interdigitated with transrectal ultrasound-guided real-time conformal HDR prostate brachytherapy boost is both a precise dose delivery system and a very effective treatment for unfavorable prostate cancer. We demonstrated an incremental beneficial effect on biochemical control and cause

  13. Clean focus, dose and CD metrology for CD uniformity improvement

    Science.gov (United States)

    Lee, Honggoo; Han, Sangjun; Hong, Minhyung; Kim, Seungyoung; Lee, Jieun; Lee, DongYoung; Oh, Eungryong; Choi, Ahlin; Kim, Nakyoon; Robinson, John C.; Mengel, Markus; Pablo, Rovira; Yoo, Sungchul; Getin, Raphael; Choi, Dongsub; Jeon, Sanghuck

    2018-03-01

    Lithography process control solutions require more exacting capabilities as the semiconductor industry goes forward to the 1x nm node DRAM device manufacturing. In order to continue scaling down the device feature sizes, critical dimension (CD) uniformity requires continuous improvement to meet the required CD error budget. In this study we investigate using optical measurement technology to improve over CD-SEM methods in focus, dose, and CD. One of the key challenges is measuring scanner focus of device patterns. There are focus measurement methods based on specially designed marks on scribe-line, however, one issue of this approach is that it will report focus of scribe line which is potentially different from that of the real device pattern. In addition, scribe-line marks require additional design and troubleshooting steps that add complexity. In this study, we investigated focus measurement directly on the device pattern. Dose control is typically based on using the linear correlation behavior between dose and CD. The noise of CD measurement, based on CD-SEM for example, will not only impact the accuracy, but also will make it difficult to monitor dose signature on product wafers. In this study we will report the direct dose metrology result using an optical metrology system which especially enhances the DUV spectral coverage to improve the signal to noise ratio. CD-SEM is often used to measure CD after the lithography step. This measurement approach has the advantage of easy recipe setup as well as the flexibility to measure critical feature dimensions, however, we observe that CD-SEM metrology has limitations. In this study, we demonstrate within-field CD uniformity improvement through the extraction of clean scanner slit and scan CD behavior by using optical metrology.

  14. Design and baseline characteristics of the CARdiovascular Outcome Trial of LINAgliptin Versus Glimepiride in Type 2 Diabetes (CAROLINA (R))

    NARCIS (Netherlands)

    Marx, Nikolaus; Rosenstock, Julio; Kahn, Steven E.; Zinman, Bernard; Kastelein, John J.; Lachin, John M.; Espeland, Mark A.; Bluhmki, Erich; Mattheus, Michaela; Ryckaert, Bart; Patel, Sanjay; Johansen, Odd Erik; Woerle, Hans-Juergen

    2015-01-01

    CARdiovascular Outcome Trial of LINAgliptin Versus Glimepiride in Type 2 Diabetes (NCT01243424) is an ongoing, randomized trial in subjects with early type 2 diabetes and increased cardiovascular risk or established complications that will determine the long-term cardiovascular impact of linagliptin

  15. A review of pioglitazone HCL and glimepiride in the treatment of type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Mozhgan Dorkhan

    2007-11-01

    Full Text Available Mozhgan Dorkhan, Anders FridDepartment of Clinical Sciences, Division of Diabetes and Endocrinology, Lund University, Malmö University Hospital, SwedenAbstract: Type 2 diabetes (T2D is a progressive disorder with a consistent and steady increase in glycosylated hemoglobin (HbA1c over time associated with enhanced risk of micro- and macrovascular complications and a substantial reduction in life expectancy. There are three major pathophysiologic abnormalities associated with T2D: impaired insulin secretion, excessive hepatic glucose output, and insulin resistance in skeletal muscle, liver, and adipose tissue. These defects have been treated in clinical praxis by use of oral insulin secretagogues (sulfonylureas/glinides or insulin, biguanides, and thiazolidinediones (TZDs respectively. Pioglitazone HCL is an insulin sensitizer in the TZD family and glimepiride is an insulin secretagogue in the SU family. This article reviews mechanisms of action and clinical data behind the use of these two commonly used oral hypoglycemic agents with documented efficacy and good safety profile of once-daily administration, alone or in combination with insulin or metformin, in the management of T2D in terms of glycemic and non-glycemic effects, tolerability and side effects, and impact on vascular health.Keywords: pioglitazone, glimepiride, type 2 diabetes, thiazolidinediones, sulfonylureas

  16. Improvement of quantification of somatic radiation risks at low doses

    International Nuclear Information System (INIS)

    Jacobi, W.; Paretzke, H.G.; Henrichs, K.; Hettig, H.; Jacob, P.; Merkle, W.; Messerer, P.; Schindel, F.

    1985-10-01

    In this research contract several selected topics of basic relevancy for assessment models of radiological consequences of hypothetical reactor accidents have been considered. The investigations focussed on the following areas: 1) Age dependent dose conversion factors for members of the public and their variability for radioisotopes of iodine, strontium, and caesium, - improvement of the accuracy of dose calculations for external gamma irradiation from cloud- and ground-shine; 2) analysis of data and models relevant for the assessment of exposure-time-effect relationships for lethal somatic late effects of lung and breast cancer and of leukemia; 3) analysis of various health status indices (e.g. ''loss of healthy life span'') with respect to their usefulness in addition to incidence, mortality, etc. for the evaluation of the magnitude of a health detriment due to a previous radiation exposure. (orig./HP) [de

  17. Comparative evaluation of safety and efficacy of glimepiride and sitagliptin in combination with metformin in patients with type 2 diabetes mellitus: Indian multicentric randomized trial - START Study

    Directory of Open Access Journals (Sweden)

    T V Devarajan

    2017-01-01

    Full Text Available Background and Objective: Modern sulfonylureas like glimepiride offer effective glycemic control with extrapancreatic benefits and good tolerability. The objective of the present study was to evaluate and compare safety and efficacy of glimepiride and sitagliptin in combination with metformin in patients with type 2 diabetes mellitus (T2DM. Methods: In this open-label, randomized, comparative, multicenter study, a total of 305 T2DM patients who were either drug naïve or uncontrolled on metformin were randomized to glimepiride 1 or 2 mg/sustained-release metformin 1000 mg once daily (glimepiride group, n = 202 or sitagliptin 50 mg/metformin 500 mg twice daily (sitagliptin group, n = 103 for 12 weeks. Primary endpoint was change in glycosylated hemoglobin (HbA1c. Secondary endpoints were change in fasting plasma glucose (FPG, postprandial plasma glucose (PPG, body mass index (BMI and to assess overall safety profile. Results: At 12 weeks, there was a statistically significant difference in the mean HbA1c reduction in glimepiride group (0.42% as compared to sitagliptin group (0.30% (P = 0.001. Mean reduction in FPG and PPG was also statistically significant in the glimepiride group as compared to the sitagliptin group (P = 0.008. There was no significant difference in terms of change in BMI (0.07 ± 0.39 kg/m2 vs. 0.08 ± 0.31 kg/m2 in glimepiride and sitagliptin groups, respectively, (P = 0.644 between both the groups. The incidences of hypoglycemic events were also comparable among both the groups. Conclusion: In T2DM patients, glimepiride/metformin combination exhibited significant reduction in glycemic parameters as compared to sitagliptin/metformin combination. Moreover, there was no significant difference between both the groups in terms of change in BMI and incidence of hypoglycemia.

  18. Theoretical and experimental studies on the internal mobility of two sulfonylurea agents: glibenclamide and glimepiride

    Energy Technology Data Exchange (ETDEWEB)

    Wlodarczyk, P; Paluch, M; Wojnarowska, Z; Hawelek, L; Kaminski, K [Institute of Physics, University of Silesia, ulica Uniwersytecka 4, 40-007 Katowice (Poland); Pilch, J, E-mail: pwlodarc@us.edu.pl [Department of Biological Sciences, Academy of Physical Education, ulica Raciborska 1, 40-074 Katowice (Poland)

    2011-10-26

    Molecular dynamics of glibenclamide and glimepiride in their glassy state were studied by means of broadband dielectric spectroscopy. In both compounds we found a {gamma}-relaxation process, with nearly the same value of activation energy. Further, we were able to identify the origin of {gamma} relaxation by performing calculations within the framework of density functional theory. It was found that rotation of the chain end included cyclohexyl and neighboring carbonyl group is related to the observed mode in dielectric spectra. The calculated activation energy was only a few kJ per mole lower than the energies obtained from experiment. It is demonstrated that this fast {gamma} process is insensitive to pressure. Finally, another secondary mode in glibenclamide, predicted by computations, was confirmed from dielectric measurements at elevated pressure. Our calculations indicate that this mode should be pressure-sensitive. (paper)

  19. Effects on Subclinical Heart Failure in Type 2 Diabetic Subjects on Liraglutide Treatment vs. Glimepiride Both in Combination with Metformin: A Randomized Open Parallel-Group Study.

    Science.gov (United States)

    Nyström, Thomas; Padro Santos, Irene; Hedberg, Fredric; Wardell, Johan; Witt, Nils; Cao, Yang; Bojö, Leif; Nilsson, Bo; Jendle, Johan

    2017-01-01

    We aimed to investigate the effect of liraglutide treatment on heart function in type 2 diabetes (T2D) patients with subclinical heart failure. Randomized open parallel-group trial. 62 T2D patients (45 male) with subclinical heart failure were randomized to either once daily liraglutide 1.8 mg, or glimepiride 4 mg, both add on to metformin 1 g twice a day. Mitral annular systolic (s') and early diastolic (e') velocities were measured at rest and during bicycle ergometer exercise, using tissue Doppler echocardiography. The primary endpoint was 18-week treatment changes in longitudinal functional reserve index (LFRI diastolic/systolic ). Clinical characteristics between groups (liraglutide = 33 vs. glimepiride = 29) were well matched. At baseline left ventricle ejection fraction (53.7 vs. 53.6%) and global longitudinal strain (-15.3 vs. -16.5%) did not differ between groups. There were no significant differences in mitral flow velocities between groups. For the primary endpoint, there was no treatment change [95% confidence interval] for: LFRI diastolic (-0.18 vs. -0.53 [-0.28, 2.59; p  = 0.19]), or LFRI systolic (-0.10 vs. -0.18 [-1.0, 1.7; p  = 0.54]); for the secondary endpoints, there was a significant treatment change in respect of body weight (-3.7 vs. -0.2 kg [-5.5, -1.4; p  = 0.001]), waist circumference (-3.1 vs. -0.8 cm [-4.2, -0.4; p  = 0.019]), and heart rate (HR) (6.3 vs. -2.3 bpm [-3.0, 14.2; p  = 0.003]), with no such treatment change in hemoglobin A1c levels (-11.0 vs. -9.2 mmol/mol [-7.0, 2.6; p  = 0.37]), between groups. 18-week treatment of liraglutide compared with glimepiride did not improve LFRI diastolic/systolic , but however increased HR. There was a significant treatment change in body weight reduction in favor for liraglutide treatment.

  20. Low Dose Vaporized Cannabis Significantly Improves Neuropathic Pain

    Science.gov (United States)

    Wilsey, Barth; Marcotte, Thomas D.; Deutsch, Reena; Gouaux, Ben; Sakai, Staci; Donaghe, Haylee

    2013-01-01

    We conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Thirty-nine patients with central and peripheral neuropathic pain underwent a standardized procedure for inhaling either medium dose (3.53%), low dose (1.29%), or placebo cannabis with the primary outcome being VAS pain intensity. Psychoactive side-effects, and neuropsychological performance were also evaluated. Mixed effects regression models demonstrated an analgesic response to vaporized cannabis. There was no significant difference between the two active dose groups’ results (p>0.7). The number needed to treat (NNT) to achieve 30% pain reduction was 3.2 for placebo vs. low dose, 2.9 for placebo vs. medium dose, and 25 for medium vs. low dose. As these NNT are comparable to those of traditional neuropathic pain medications, cannabis has analgesic efficacy with the low dose being, for all intents and purposes, as effective a pain reliever as the medium dose. Psychoactive effects were minimal and well-tolerated, and neuropsychological effects were of limited duration and readily reversible within 1–2 hours. Vaporized cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain. PMID:23237736

  1. Low-dose vaporized cannabis significantly improves neuropathic pain.

    Science.gov (United States)

    Wilsey, Barth; Marcotte, Thomas; Deutsch, Reena; Gouaux, Ben; Sakai, Staci; Donaghe, Haylee

    2013-02-01

    We conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Thirty-nine patients with central and peripheral neuropathic pain underwent a standardized procedure for inhaling medium-dose (3.53%), low-dose (1.29%), or placebo cannabis with the primary outcome being visual analog scale pain intensity. Psychoactive side effects and neuropsychological performance were also evaluated. Mixed-effects regression models demonstrated an analgesic response to vaporized cannabis. There was no significant difference between the 2 active dose groups' results (P > .7). The number needed to treat (NNT) to achieve 30% pain reduction was 3.2 for placebo versus low-dose, 2.9 for placebo versus medium-dose, and 25 for medium- versus low-dose. As these NNTs are comparable to those of traditional neuropathic pain medications, cannabis has analgesic efficacy with the low dose being as effective a pain reliever as the medium dose. Psychoactive effects were minimal and well tolerated, and neuropsychological effects were of limited duration and readily reversible within 1 to 2 hours. Vaporized cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain. The analgesia obtained from a low dose of delta-9-tetrahydrocannabinol (1.29%) in patients, most of whom were experiencing neuropathic pain despite conventional treatments, is a clinically significant outcome. In general, the effect sizes on cognitive testing were consistent with this minimal dose. As a result, one might not anticipate a significant impact on daily functioning. Published by Elsevier Inc.

  2. Determination of crossed gamma doses for garlic improvement (Allium Sativum)

    International Nuclear Information System (INIS)

    Perez Talavera, S.; Labrada, A.; Savin, V.

    1991-01-01

    The determination of four Cuban varieties of garlic was made so as to optimized the use of ionizing radiations in Cuba to breed vegetatively propagated crops such as garlic. The dose-effect regresion equation characterizing the radioinhibition zone of each crop was presented. We used a criteria to select the irradiation dose to be used in mutation breeding techniques based on obtaining height variability in the productive indicators, a survival and a number of garlic cloves high enough to allow and adequate reproduction of M1 plants. It was verified that this small inhibitor doses of radiations produced a higher percentage of good variability than the medium and high doses. With the use of small inhibitor doses (GR10-GR20) on the Guadalupe-15 garlic variety, 65 variety plants were obtained., 93.7% out of this number is higher than the control in the indicators considered

  3. Dose escalation using conformal high-dose-rate brachytherapy improves outcome in unfavorable prostate cancer.

    Science.gov (United States)

    Martinez, Alvaro A; Gustafson, Gary; Gonzalez, José; Armour, Elwood; Mitchell, Chris; Edmundson, Gregory; Spencer, William; Stromberg, Jannifer; Huang, Raywin; Vicini, Frank

    2002-06-01

    To overcome radioresistance for patients with unfavorable prostate cancer, a prospective trial of pelvic external beam irradiation (EBRT) interdigitated with dose-escalating conformal high-dose-rate (HDR) prostate brachytherapy was performed. Between November 1991 and August 2000, 207 patients were treated with 46 Gy pelvic EBRT and increasing HDR brachytherapy boost doses (5.50-11.5 Gy/fraction) during 5 weeks. The eligibility criteria were pretreatment prostate-specific antigen level >or=10.0 ng/mL, Gleason score >or=7, or clinical Stage T2b or higher. Patients were divided into 2 dose levels, low-dose biologically effective dose 93 Gy (149 patients). No patient received hormones. We used the American Society for Therapeutic Radiology and Oncology definition for biochemical failure. The median age was 69 years. The mean follow-up for the group was 4.4 years, and for the low and high-dose levels, it was 7.0 and 3.4 years, respectively. The actuarial 5-year biochemical control rate was 74%, and the overall, cause-specific, and disease-free survival rate was 92%, 98%, and 68%, respectively. The 5-year biochemical control rate for the low-dose group was 52%; the rate for the high-dose group was 87% (p failure. The Radiation Therapy Oncology Group Grade 3 gastrointestinal/genitourinary complications ranged from 0.5% to 9%. The actuarial 5-year impotency rate was 51%. Pelvic EBRT interdigitated with transrectal ultrasound-guided real-time conformal HDR prostate brachytherapy boost is both a precise dose delivery system and a very effective treatment for unfavorable prostate cancer. We demonstrated an incremental beneficial effect on biochemical control and cause-specific survival with higher doses. These results, coupled with the low risk of complications, the advantage of not being radioactive after implantation, and the real-time interactive planning, define a new standard for treatment.

  4. A review of pioglitazone HCL and glimepiride in the treatment of type 2 diabetes.

    Science.gov (United States)

    Dorkhan, Mozhgan; Frid, Anders

    2007-01-01

    Type 2 diabetes (T2D) is a progressive disorder with a consistent and steady increase in glycosylated hemoglobin (HbA1c) over time associated with enhanced risk of micro- and macrovascular complications and a substantial reduction in life expectancy. There are three major pathophysiologic abnormalities associated with T2D: impaired insulin secretion, excessive hepatic glucose output, and insulin resistance in skeletal muscle, liver, and adipose tissue. These defects have been treated in clinical praxis by use of oral insulin secretagogues (sulfonylureas/ glinides) or insulin, biguanides, and thiazolidinediones (TZDs) respectively. Pioglitazone HCL is an insulin sensitizer in the TZD family and glimepiride is an insulin secretagogue in the SU family. This article reviews mechanisms of action and clinical data behind the use of these two commonly used oral hypoglycemic agents with documented efficacy and good safety profile of once-daily administration, alone or in combination with insulin or metformin, in the management of T2D in terms of glycemic and non-glycemic effects, tolerability and side effects, and impact on vascular health.

  5. Time improvement of photoelectric effect calculation for absorbed dose estimation

    International Nuclear Information System (INIS)

    Massa, J M; Wainschenker, R S; Doorn, J H; Caselli, E E

    2007-01-01

    Ionizing radiation therapy is a very useful tool in cancer treatment. It is very important to determine absorbed dose in human tissue to accomplish an effective treatment. A mathematical model based on affected areas is the most suitable tool to estimate the absorbed dose. Lately, Monte Carlo based techniques have become the most reliable, but they are time expensive. Absorbed dose calculating programs using different strategies have to choose between estimation quality and calculating time. This paper describes an optimized method for the photoelectron polar angle calculation in photoelectric effect, which is significant to estimate deposited energy in human tissue. In the case studies, time cost reduction nearly reached 86%, meaning that the time needed to do the calculation is approximately 1/7 th of the non optimized approach. This has been done keeping precision invariant

  6. Improvement of the following accident dose assessment system

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Enn Han; Han, Moon Hee; Suh, Kyung Suk; Hwang, Won Tae; Choi, Young Gil [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    1999-12-15

    The FADAS has been updates for calculating the real-time wind fields continuously at the nuclear sites in Korea. The system has been constructed to compute the wind fields using its own process for the dummy meteorological data, and dose not effect on the overall wind field module. If the radioactive materials are released into the atmosphere in real situation, the calculations of wind fields and exposure dose in the previous FADAS are performed in the case of the recognition of the above situation in the source term evaluation module. The current version of FADAS includes the program for evaluating the effect of the predicted accident and the assumed scenario together. The dose assessment module is separated into the real-time and the supposed accident respectively.

  7. Novel high dose rate lip brachytherapy technique to improve dose homogeneity and reduce toxicity by customized mold

    International Nuclear Information System (INIS)

    Feldman, Jon; Appelbaum, Limor; Sela, Mordechay; Voskoboinik, Ninel; Kadouri, Sarit; Weinberger, Jeffrey; Orion, Itzhak; Meirovitz, Amichay

    2014-01-01

    The purpose of this study is to describe a novel brachytherapy technique for lip Squamous Cell Carcinoma, utilizing a customized mold with embedded brachytherapy sleeves, which separates the lip from the mandible, and improves dose homogeneity. Seven patients with T2 lip cancer treated with a “sandwich” technique of High Dose Rate (HDR) brachytherapy to the lip, consisting of interstitial catheters and a customized mold with embedded catheters, were reviewed for dosimetry and outcome using 3D planning. Dosimetric comparison was made between the “sandwich” technique to “classic” – interstitial catheters only plan. We compared dose volume histograms for Clinical Tumor Volume (CTV), normal tissue “hot spots” and mandible dose. We are reporting according to the ICRU 58 and calculated the Conformal Index (COIN) to show the advantage of our technique. The seven patients (ages 36–81 years, male) had median follow-up of 47 months. Four patients received Brachytherapy and External Beam Radiation Therapy, 3 patients received brachytherapy alone. All achieved local control, with excellent esthetic and functional results. All patients are disease free. The Customized Mold Sandwich technique (CMS) reduced the high dose region receiving 150% (V150) by an average of 20% (range 1–47%), The low dose region (les then 90% of the prescribed dose) improved by 73% in average by using the CMS technique. The COIN value for the CMS was in average 0.92 as opposed to 0.88 for the interstitial catheter only. All differences (excluding the low dose region) were statistically significant. The CMS technique significantly reduces the high dose volume and increases treatment homogeneity. This may reduce the potential toxicity to the lip and adjacent mandible, and results in excellent tumor control, cosmetic and functionality

  8. ACDOS2: an improved neutron-induced dose rate code

    International Nuclear Information System (INIS)

    Lagache, J.C.

    1981-06-01

    To calculate the expected dose rate from fusion reactors as a function of geometry, composition, and time after shutdown a computer code, ACDOS2, was written, which utilizes up-to-date libraries of cross-sections and radioisotope decay data. ACDOS2 is in ANSI FORTRAN IV, in order to make it readily adaptable elsewhere

  9. ACDOS2: an improved neutron-induced dose rate code

    Energy Technology Data Exchange (ETDEWEB)

    Lagache, J.C.

    1981-06-01

    To calculate the expected dose rate from fusion reactors as a function of geometry, composition, and time after shutdown a computer code, ACDOS2, was written, which utilizes up-to-date libraries of cross-sections and radioisotope decay data. ACDOS2 is in ANSI FORTRAN IV, in order to make it readily adaptable elsewhere.

  10. An improved standard total dose test for CMOS space electronics

    International Nuclear Information System (INIS)

    Fleetwood, D.M.; Winokur, P.S.; Riewe, L.C.; Pease, R.L.

    1989-01-01

    The postirradiation response of hardened and commercial CMOS devices is investigated as a function of total dose, dose rate, and annealing time and temperature. Cobalt-60 irradiation at ≅ 200 rad(SiO 2 )/s followed by a 1-week 100 degrees C biased anneal and testing is shown to be an effective screen of hardened devices for space use. However, a similar screen and single-point test performed after Co-60 irradiation and elevated temperature anneal cannot be generally defined for commercial devices. In the absence of detailed knowledge about device and circuit radiation response, a two-point standard test is proposed to ensure space surviability of CMOS circuits: a Co-60 irradiation and test to screen against oxide-trapped charge related failures, and an additional rebound test to screen against interface-trap related failures. Testing implications for bipolar technologies are also discussed

  11. Differential effects of vildagliptin and glimepiride on glucose fluctuations in patients with type 2 diabetes mellitus assessed using continuous glucose monitoring.

    Science.gov (United States)

    He, Y L; Foteinos, G; Neelakantham, S; Mattapalli, D; Kulmatycki, K; Forst, T; Taylor, A

    2013-12-01

    To assess whether there is a difference in the effects of vildagliptin and glimepiride on glucose fluctuation in patients with type 2 diabetes mellitus (T2DM) using continuous glucose monitoring (CGM). This was an open-label, randomized cross-over study conducted in T2DM patients. A total of 24 patients (age: 58.3 ± 5.56 years, baseline HbA1c: 7.6 ± 0.50%) who were on stable metformin monotherapy (500-3000 mg) were enrolled, and all completed the study. Each patient received two 5-day treatments (vildagliptin 50 mg b.i.d. or glimepiride 2 mg q.d.) in a cross-over manner. Various biomarkers and blood glucose concentrations were measured following breakfast. The 24-h glucose profiles were also measured using the CGM device at baseline and after 5 days of treatment, and fluctuations in glucose levels were estimated from CGM data. Both vildagliptin and glimepiride reduced postprandial glucose levels, based on both CGM data (15% vs. 16%) and measured plasma glucose (13% vs.17%). Vildagliptin showed lower glucose fluctuations than glimepiride as measured by mean amplitude of glycaemic excursions (MAGE, p = 0.1076), standard deviation (s.d., p = 0.1346) of blood glucose rate of change, but did not reach statistical significance attributed to the small sample size. MAGE was reduced by ∼20% with vildagliptin versus glimepiride. Vildagliptin led to statistically significant lowering of the rate of change in the median curve (RCMC) and interquartile range (IQR) of glucose. Treatment with vildagliptin significantly increased the levels of active glucagon-like peptide-1 by 2.36-fold (p ≤ 0.0001) and suppressed glucagon by 8% (p = 0.01), whereas glimepiride significantly increased the levels of insulin and C-peptide by 21% (p = 0.012) and 12% (p = 0.003), respectively. Vildagliptin treatment was associated with less fluctuation of glucose levels than glimepiride treatment as assessed by 24-h CGM device, suggesting vildagliptin may

  12. Cosolvent-free polymer gel dosimeters with improved dose sensitivity and resolution for x-ray CT dose response

    Energy Technology Data Exchange (ETDEWEB)

    Chain, J N M; McAuley, K B [Department of Chemical Engineering, Queen' s University, Kingston, K7L 3N6 (Canada); Jirasek, A [Department of Physics and Astronomy, University of Victoria, Victoria, V8W 3P6 (Canada); Schreiner, L J, E-mail: kim.mcauley@chee.queensu.ca [Cancer Centre of Southeastern Ontario, Kingston, K7L 5P9 (Canada)

    2011-04-07

    This study reports new N-isopropylacrylamide (NIPAM) polymer gel recipes with increased dose sensitivity and improved dose resolution for x-ray CT readout. NIPAM can be used to increase the solubility of N, N'-methylenebisacrylamide (Bis) in aqueous solutions from approximately 3% to 5.5% by weight, enabling the manufacture of dosimeters containing up to 19.5%T, which is the total concentration of NIPAM and Bis by weight. Gelatin is shown to have a mild influence on dose sensitivity when gels are imaged using x-ray CT, and a stronger influence when gels are imaged optically. Phantoms that contain only 3% gelatin and 5 mM tetrakis hydroxymethyl phosphonium chloride are sufficiently stiff for dosimetry applications. The best cosolvent-free gel formulation has a dose sensitivity in the linear range ({approx}0.88 H Gy{sup -1}) that is a small improvement compared to the best NIPAM-based gels that incorporate isopropanol as a cosolvent ({approx}0.80 H Gy{sup -1}). This new gel formulation results in enhanced dose resolution ({approx}0.052 Gy) for x-ray CT readout, making clinical applications of this imaging modality more feasible.

  13. Cosolvent-free polymer gel dosimeters with improved dose sensitivity and resolution for x-ray CT dose response

    International Nuclear Information System (INIS)

    Chain, J N M; McAuley, K B; Jirasek, A; Schreiner, L J

    2011-01-01

    This study reports new N-isopropylacrylamide (NIPAM) polymer gel recipes with increased dose sensitivity and improved dose resolution for x-ray CT readout. NIPAM can be used to increase the solubility of N, N'-methylenebisacrylamide (Bis) in aqueous solutions from approximately 3% to 5.5% by weight, enabling the manufacture of dosimeters containing up to 19.5%T, which is the total concentration of NIPAM and Bis by weight. Gelatin is shown to have a mild influence on dose sensitivity when gels are imaged using x-ray CT, and a stronger influence when gels are imaged optically. Phantoms that contain only 3% gelatin and 5 mM tetrakis hydroxymethyl phosphonium chloride are sufficiently stiff for dosimetry applications. The best cosolvent-free gel formulation has a dose sensitivity in the linear range (∼0.88 H Gy -1 ) that is a small improvement compared to the best NIPAM-based gels that incorporate isopropanol as a cosolvent (∼0.80 H Gy -1 ). This new gel formulation results in enhanced dose resolution (∼0.052 Gy) for x-ray CT readout, making clinical applications of this imaging modality more feasible.

  14. Comparison of the Efficacy of Glimepiride, Metformin, and Rosiglitazone Monotherapy in Korean Drug-Naïve Type 2 Diabetic Patients: The Practical Evidence of Antidiabetic Monotherapy Study

    Directory of Open Access Journals (Sweden)

    Kun Ho Yoon

    2011-02-01

    Full Text Available BackgroundAlthough many anti-diabetic drugs have been used to control hyperglycemia for decades, the efficacy of commonly-used oral glucose-lowering agents in Korean type 2 diabetic patients has yet to be clearly demonstrated.MethodsWe evaluated the efficacy of glimepiride, metformin, and rosiglitazone as initial treatment for drug-naïve type 2 diabetes mellitus patients in a 48-week, double-blind, randomized controlled study that included 349 Korean patients. Our primary goal was to determine the change in HbA1c levels from baseline to end point. Our secondary goal was to evaluate changes in fasting plasma glucose (FPG levels, body weight, frequency of adverse events, and the proportion of participants achieving target HbA1c levels.ResultsHbA1c levels decreased from 7.8% to 6.9% in the glimepiride group (P<0.001, from 7.9% to 7.0% in the metformin group (P<0.001, and from 7.8% to 7.0% (P<0.001 in the rosiglitazone group. Glimepiride and rosiglitazone significantly increased body weight and metformin reduced body weight during the study period. Symptomatic hypoglycemia was more frequent in the glimepiride group and diarrhea was more frequent in the metformin group.ConclusionThe efficacy of glimepiride, metformin, and rosiglitazone as antidiabetic monotherapies in drug-naïve Korean type 2 diabetic patients was similar in the three groups, with no statistical difference. This study is the first randomized controlled trial to evaluate the efficacy of commonly-used oral hypoglycemic agents in Korean type 2 diabetic patients. An additional subgroup analysis is recommended to obtain more detailed information.

  15. An improved analytical model for CT dose simulation with a new look at the theory of CT dose

    International Nuclear Information System (INIS)

    Dixon, Robert L.; Munley, Michael T.; Bayram, Ersin

    2005-01-01

    Gagne [Med. Phys. 16, 29-37 (1989)] has previously described a model for predicting the sensitivity and dose profiles in the slice-width (z) direction for CT scanners. The model, developed prior to the advent of multidetector CT scanners, is still widely used; however, it does not account for the effect of anode tilt on the penumbra or include the heel effect, both of which are increasingly important for the wider beams (up to 40 mm) of contemporary, multidetector scanners. Additionally, it applied only on (or near) the axis of rotation, and did not incorporate the photon energy spectrum. The improved model described herein transcends all of the aforementioned limitations of the Gagne model, including extension to the peripheral phantom axes. Comparison of simulated and measured dose data provides experimental validation of the model, including verification of the superior match to the penumbra provided by the tilted-anode model, as well as the observable effects on the cumulative dose distribution. The initial motivation for the model was to simulate the quasiperiodic dose distribution on the peripheral, phantom axes resulting from a helical scan series in order to facilitate the implementation of an improved method of CT dose measurement utilizing a short ion chamber, as proposed by Dixon [Med. Phys. 30, 1272-1280 (2003)]. A more detailed set of guidelines for implementing such measurements is also presented in this paper. In addition, some fundamental principles governing CT dose which have not previously been clearly enunciated follow from the model, and a fundamental (energy-based) quantity dubbed 'CTDI-aperture' is introduced

  16. Using Six Sigma to improve once daily gentamicin dosing and therapeutic drug monitoring performance.

    LENUS (Irish Health Repository)

    Egan, Sean

    2012-08-07

    BACKGROUND: Safe, effective therapy with the antimicrobial gentamicin requires good practice in dose selection and monitoring of serum levels. Suboptimal therapy occurs with breakdown in the process of drug dosing, serum blood sampling, laboratory processing and level interpretation. Unintentional underdosing may result. This improvement effort aimed to optimise this process in an academic teaching hospital using Six Sigma process improvement methodology. METHODS: A multidisciplinary project team was formed. Process measures considered critical to quality were defined, and baseline practice was examined through process mapping and audit. Root cause analysis informed improvement measures. These included a new dosing and monitoring schedule, and standardised assay sampling and drug administration timing which maximised local capabilities. Three iterations of the improvement cycle were conducted over a 24-month period. RESULTS: The attainment of serum level sampling in the required time window improved by 85% (p≤0.0001). A 66% improvement in accuracy of dosing was observed (p≤0.0001). Unnecessary dose omission while awaiting level results and inadvertent disruption to therapy due to dosing and monitoring process breakdown were eliminated. Average daily dose administered increased from 3.39 mg\\/kg to 4.78 mg\\/kg\\/day. CONCLUSIONS: Using Six Sigma methodology enhanced gentamicin usage process performance. Local process related factors may adversely affect adherence to practice guidelines for gentamicin, a drug which is complex to use. It is vital to adapt dosing guidance and monitoring requirements so that they are capable of being implemented in the clinical environment as a matter of routine. Improvement may be achieved through a structured localised approach with multidisciplinary stakeholder involvement.

  17. Transdermal glimepiride delivery system based on optimized ethosomal nano-vesicles: Preparation, characterization, in vitro, ex vivo and clinical evaluation.

    Science.gov (United States)

    Ahmed, Tarek A; El-Say, Khalid M; Aljaeid, Bader M; Fahmy, Usama A; Abd-Allah, Fathy I

    2016-03-16

    This work aimed to develop an optimized ethosomal formulation of glimepiride then loading into transdermal films to offer lower drug side effect, extended release behavior and avoid first pass effect. Four formulation factors were optimized for their effects on vesicle size (Y1), entrapment efficiency (Y2) and vesicle flexibility (Y3). Optimum desirability was identified and, an optimized formulation was prepared, characterized and loaded into transdermal films. Ex-vivo permeation study for the prepared films was conducted and, the permeation parameters and drug permeation mechanism were identified. Penetration through rat skin was studied using confocal laser microscope. In-vivo study was performed following transdermal application on human volunteers. The percent of alcohol was significantly affecting all the studied responses while the other factors and their interaction effects were varied on their effects on each response. The optimized ethosomal formulation showed observed values for Y1, Y2 and Y3 of 61 nm, 97.12% and 54.03, respectively. Ex-vivo permeation of films loaded with optimized ethosomal formulation was superior to that of the corresponding pure drug transdermal films and this finding was also confirmed after confocal laser microscope study. Permeation of glimepiride from the prepared films was in favor of Higushi-diffusion model and exhibited non-Fickian or anomalous release mechanism. In-vivo study revealed extended drug release behavior and lower maximum drug plasma level from transdermal films loaded with drug ethosomal formulation. So, the ethosomal formulation could be considered a suitable drug delivery system especially when loaded into transdermal vehicle with possible reduction in side effects and controlling the drug release. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Improvement in C-reactive protein and advanced glycosylation end-products in poorly controlled diabetics is independent of glucose control.

    Science.gov (United States)

    Md Isa, S H; Najihah, I; Nazaimoon, W M Wan; Kamarudin, N A; Umar, N A; Mat, N H; Khalid, B A K

    2006-04-01

    We studied the efficacy of four different treatment regimens (sulphonylurea and metformin+/-acarbose versus glimepiride and rosiglitazone versus glimepiride and bedtime NPH insulin versus multiple actrapid and NPH insulin injections) in poorly controlled type 2 diabetes subjects on hs-CRP, VCAM-1 and AGE at 4, 8 and 12 weeks of treatment. Multiple insulin injections rapidly improved HbA(1c) by 0.6+/-0.9% (pimprovement in blood glucose. AGE improved in all groups irrespective of type of treatment, glycaemic control and CRP levels. Our data indicate rapid glycaemic control alone does not necessarily result in improvement in markers of inflammation in type 2 diabetes patients.

  19. Improvement of Off-site Dose Assessment Code for Operating Nuclear Power Plant

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Juyub; Kim, Juyoul; Shin, Kwangyoung [FNC Technology Co. Ltd., Yongin (Korea, Republic of); You, Songjae; Moon, Jongyi [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2014-05-15

    XOQDOQ code which calculates atmospheric Dispersion factor was included into INDAC also. A research on the improvement of off-site dose assessment system for an operating nuclear power plant was performed by KINS in 2011. As a result, following improvements were derived: - Separation of dose assessment for new and existing facilities - Update of food ingestion data - Consideration of multi-unit operation and so on In order to reflect the results, INDAC is under modification. INDAC is an integrated dose assessment code for an operating nuclear power plant and consists of three main modules: XOQDOQ, GASDOS and LIQDOS. The modules are under modification in order to improve the accuracy of assessment and usability. Assessment points for multi-unit release can be calculated through the improved code and the method on dose assessment for multi-unit release has been modified, so that the dose assessment result of multi-unit site becomes more realistic by relieving excessive conservatism. Finally, as the accuracy of calculation modules has been improved, the reliability of dose assessment result has been strengthened.

  20. Monte Carlo dose calculation improvements for low energy electron beams using eMC

    International Nuclear Information System (INIS)

    Fix, Michael K; Frei, Daniel; Volken, Werner; Born, Ernst J; Manser, Peter; Neuenschwander, Hans

    2010-01-01

    The electron Monte Carlo (eMC) dose calculation algorithm in Eclipse (Varian Medical Systems) is based on the macro MC method and is able to predict dose distributions for high energy electron beams with high accuracy. However, there are limitations for low energy electron beams. This work aims to improve the accuracy of the dose calculation using eMC for 4 and 6 MeV electron beams of Varian linear accelerators. Improvements implemented into the eMC include (1) improved determination of the initial electron energy spectrum by increased resolution of mono-energetic depth dose curves used during beam configuration; (2) inclusion of all the scrapers of the applicator in the beam model; (3) reduction of the maximum size of the sphere to be selected within the macro MC transport when the energy of the incident electron is below certain thresholds. The impact of these changes in eMC is investigated by comparing calculated dose distributions for 4 and 6 MeV electron beams at source to surface distance (SSD) of 100 and 110 cm with applicators ranging from 6 x 6 to 25 x 25 cm 2 of a Varian Clinac 2300C/D with the corresponding measurements. Dose differences between calculated and measured absolute depth dose curves are reduced from 6% to less than 1.5% for both energies and all applicators considered at SSD of 100 cm. Using the original eMC implementation, absolute dose profiles at depths of 1 cm, d max and R50 in water lead to dose differences of up to 8% for applicators larger than 15 x 15 cm 2 at SSD 100 cm. Those differences are now reduced to less than 2% for all dose profiles investigated when the improved version of eMC is used. At SSD of 110 cm the dose difference for the original eMC version is even more pronounced and can be larger than 10%. Those differences are reduced to within 2% or 2 mm with the improved version of eMC. In this work several enhancements were made in the eMC algorithm leading to significant improvements in the accuracy of the dose calculation

  1. Monte Carlo dose calculation improvements for low energy electron beams using eMC.

    Science.gov (United States)

    Fix, Michael K; Frei, Daniel; Volken, Werner; Neuenschwander, Hans; Born, Ernst J; Manser, Peter

    2010-08-21

    The electron Monte Carlo (eMC) dose calculation algorithm in Eclipse (Varian Medical Systems) is based on the macro MC method and is able to predict dose distributions for high energy electron beams with high accuracy. However, there are limitations for low energy electron beams. This work aims to improve the accuracy of the dose calculation using eMC for 4 and 6 MeV electron beams of Varian linear accelerators. Improvements implemented into the eMC include (1) improved determination of the initial electron energy spectrum by increased resolution of mono-energetic depth dose curves used during beam configuration; (2) inclusion of all the scrapers of the applicator in the beam model; (3) reduction of the maximum size of the sphere to be selected within the macro MC transport when the energy of the incident electron is below certain thresholds. The impact of these changes in eMC is investigated by comparing calculated dose distributions for 4 and 6 MeV electron beams at source to surface distance (SSD) of 100 and 110 cm with applicators ranging from 6 x 6 to 25 x 25 cm(2) of a Varian Clinac 2300C/D with the corresponding measurements. Dose differences between calculated and measured absolute depth dose curves are reduced from 6% to less than 1.5% for both energies and all applicators considered at SSD of 100 cm. Using the original eMC implementation, absolute dose profiles at depths of 1 cm, d(max) and R50 in water lead to dose differences of up to 8% for applicators larger than 15 x 15 cm(2) at SSD 100 cm. Those differences are now reduced to less than 2% for all dose profiles investigated when the improved version of eMC is used. At SSD of 110 cm the dose difference for the original eMC version is even more pronounced and can be larger than 10%. Those differences are reduced to within 2% or 2 mm with the improved version of eMC. In this work several enhancements were made in the eMC algorithm leading to significant improvements in the accuracy of the dose

  2. Improvement of dose distribution of esophageal irradiation using the field-within-a-field technique

    International Nuclear Information System (INIS)

    Iwai, Tsugunori; Okabe, Keigo; Yamato, Hidetada; Murakami, Jyunji; Nakazawa, Yasuo; Kato, Mitsuyoshi

    2002-01-01

    The wide radiation field for mediastinal dose distribution should be inhomogeneous with the usual simple opposed beam irradiation. The purpose of this study was to improve the dose distribution of the mediastinum using a conventional planning system with a dose-volume histogram (DVH) and the field-in-field technique. Three-dimensional (3D) dose distribution is obtained in bilateral opposed-field irradiation. An overdose area obtained from the 3D dose distribution is defined and reprojected into the irradiation field. A new reduced field is created by removing the reprojected overdose area. A 3D dose distribution is again obtained and compared with the results from first one. Procedures were repeated until each of the target volumes was within ±5% of the prescribed dose and the irradiation volume within 107% or less of the prescribed dose. From the DVH analysis, our field-within-a-field technique resulted in a more uniform dose distribution within the conventional planning. The field-within-a-field technique involves many parameters, and an inverse planning algorithm is suitable for computation. However, with our method, the forward planning system is adequate for planning, at least in a relatively straightforward planning system such as bilateral opposed fields therapy. (author)

  3. Improving dose homogeneity in head and neck radiotherapy with custom 3-D compensation

    International Nuclear Information System (INIS)

    Brock, Linda K.; Harari, Paul M.; Sharda, Navneet N.; Paliwal, Bhudatt R.; Kinsella, Timothy J.

    1996-01-01

    Purpose/Objective: Anatomic contour irregularities and tissue inhomogeneities can lead to significant radiation dose variation across complex treatment volumes. Such dose non-uniformity occurs routinely in radiation of the head and neck (H and N) despite beam shaping with blocks or beam modification with wedges. Small dose variations are amplified by the high total doses delivered (often >70 Gy) which can thereby influence late normal tissue complications as well as tumor control. We have therefore implemented the routine use of 3-D custom tissue compensators for our H and N cancer patients fabricated directly from CT scan contour data obtained in the treatment position. The capacity of such compensators to improve dose uniformity in patients with tumors of the H and N is herein reported. Materials and Methods: Between July 1992 and March 1995, 80 patients receiving H and N radiotherapy had 3-D custom compensators fabricated for their treatment course. Detailed dosimetric records have been reviewed for thirty cases to date (60 custom compensators). Dose uniformity across the treatment volume, peak dose delivery and maximum doses to selected, clinically relevant, anatomic subsites were analyzed and compared with uncompensated and wedged plans. Dose-volume histograms were generated and volumes receiving greater than 5% and 10% of the prescribed dose noted. Phantom dose measurements were performed for compensated fields using a water chamber and were compared to calculated doses in order to evaluate the accuracy of isodoses generated by the Theraplan treatment planning system. Accuracy of the fabrication and positioning of the custom compensators was verified by direct measurement. Results: Custom compensators resulted in an average reduction of dose variance across the treatment volume from 13.8% (7-20%) for the uncompensated plans to 4.5% (2-7%) with the compensators. Wedged plans were variable but on average an 8% (3-15%) dose variance was noted. Maximum doses

  4. Keeping an eye on the ring: COMS plaque loading optimization for improved dose conformity and homogeneity.

    Science.gov (United States)

    Gagne, Nolan L; Cutright, Daniel R; Rivard, Mark J

    2012-09-01

    To improve tumor dose conformity and homogeneity for COMS plaque brachytherapy by investigating the dosimetric effects of varying component source ring radionuclides and source strengths. The MCNP5 Monte Carlo (MC) radiation transport code was used to simulate plaque heterogeneity-corrected dose distributions for individually-activated source rings of 14, 16 and 18 mm diameter COMS plaques, populated with (103)Pd, (125)I and (131)Cs sources. Ellipsoidal tumors were contoured for each plaque size and MATLAB programming was developed to generate tumor dose distributions for all possible ring weighting and radionuclide permutations for a given plaque size and source strength resolution, assuming a 75 Gy apical prescription dose. These dose distributions were analyzed for conformity and homogeneity and compared to reference dose distributions from uniformly-loaded (125)I plaques. The most conformal and homogeneous dose distributions were reproduced within a reference eye environment to assess organ-at-risk (OAR) doses in the Pinnacle(3) treatment planning system (TPS). The gamma-index analysis method was used to quantitatively compare MC and TPS-generated dose distributions. Concentrating > 97% of the total source strength in a single or pair of central (103)Pd seeds produced the most conformal dose distributions, with tumor basal doses a factor of 2-3 higher and OAR doses a factor of 2-3 lower than those of corresponding uniformly-loaded (125)I plaques. Concentrating 82-86% of the total source strength in peripherally-loaded (131)Cs seeds produced the most homogeneous dose distributions, with tumor basal doses 17-25% lower and OAR doses typically 20% higher than those of corresponding uniformly-loaded (125)I plaques. Gamma-index analysis found > 99% agreement between MC and TPS dose distributions. A method was developed to select intra-plaque ring radionuclide compositions and source strengths to deliver more conformal and homogeneous tumor dose distributions than

  5. Hypertonic Saline in Conjunction with High-Dose Furosemide Improves Dose-Response Curves in Worsening Refractory Congestive Heart Failure.

    Science.gov (United States)

    Paterna, Salvatore; Di Gaudio, Francesca; La Rocca, Vincenzo; Balistreri, Fabio; Greco, Massimiliano; Torres, Daniele; Lupo, Umberto; Rizzo, Giuseppina; di Pasquale, Pietro; Indelicato, Sergio; Cuttitta, Francesco; Butler, Javed; Parrinello, Gaspare

    2015-10-01

    14% for urine output; 29, 24, and 16% for total sodium excretion; 45, 34, and 20% for urinary osmolarity; and 27, 36, and 32% for total furosemide excretion in groups 1, 2, and 3, respectively. These findings were translated in an improvement in the furosemide dose-response curves in these patients. These results may serve as new pathophysiological basis for HSS use in the treatment of refractory CHF.

  6. Asymmetric fan beams (AFB) for improvement of the craniocaudal dose distribution in helical tomotherapy delivery

    International Nuclear Information System (INIS)

    Gladwish, Adam; Kron, Tomas; McNiven, Andrea; Bauman, Glenn; Van Dyk, Jake

    2004-01-01

    Helical tomotherapy (HT) is a novel radiotherapy technique that utilizes intensity modulated fan beams that deliver highly conformal dose distributions in a helical beam trajectory. The most significant limitation in dose delivery with a constant fan beam thickness (FBT) is the penumbra width of the dose distribution in the craniocaudal direction, which is equivalent to the FBT. We propose to employ a half-blocked fan beam at start and stop location to reduce the penumbra width by half. By opening the jaw slowly during the helical delivery until the desired FBT is achieved it is possible to create a sharper edge in the superior and inferior direction from the target. The technique was studied using a tomotherapy beam model implemented on a commercial treatment planning system (Theraplan Plus V3.0). It was demonstrated that the dose distribution delivered using a 25 mm fan beam can be improved significantly, to reduce the dose to normal structures located superiorly and inferiorly of the target. Dosimetry for this technique is straightforward down to a FBT of 15 mm and implementation should be simple as no changes in couch movement are required compared to a standard HT delivery. We conclude that the use of asymmetric collimated fan beams for the start and stop of the helical tomotherapeutic dose delivery has the potential of significantly improving the dose distribution in helical tomotherapy

  7. Improving dose homogeneity in routine head and neck radiotherapy with custom 3-D compensation

    International Nuclear Information System (INIS)

    Harari, P.M.; Sharda, N.N.; Brock, L.K.; Paliwal, B.R.

    1998-01-01

    Background and purpose: Anatomic contour irregularity and tissue inhomogeneity can lead to significant radiation dose variation across the complex treatment volumes found in the head and neck (HandN) region. This dose inhomogeneity can routinely create focal hot or cold spots of 10-20% despite beam shaping with blocks or beam modification with wedges. Since 1992, we have implemented the routine use of 3-D custom tissue compensators fabricated directly from CT scan contour data obtained in the treatment position in order to improve dose uniformity in patients with tumors of the HandN. Materials and methods: Between July 1992 and January 1997, 160 patients receiving comprehensive HandN radiotherapy had 3-D custom compensators fabricated for their treatment course. Detailed dosimetric records have been analyzed for 30 cases. Dose uniformity across the treatment volume and clinically relevant maximum doses to selected anatomic sub-sites were examined with custom-compensated, uncompensated and optimally-wedged plans. Results: The use of 3-D custom compensators resulted in an average reduction of dose variance across the treatment volume from 19±4% for the uncompensated plans to 5±2% with the use of 3-D compensators. Optimally-wedged plans were variable, but on average a 10±3% dose variance was noted. For comprehensive HandN treatment which encompassed the larynx within the primary field design, the peak doses delivered were reduced by 5-15% with 3-D custom compensation as compared to optimal wedging. Conclusions: The use of 3-D custom tissue compensation can improve dose homogeneity within the treatment volume for HandN cancer patients. Maximum doses to clinically important structures which often receive greater than 105-110% of the prescribed dose are routinely reduced with the use of 3-D custom compensators. Improved dose uniformity across the treatment volume can reduce normal tissue complication profiles and potentially allow for delivery of higher total doses in

  8. On the impact of improved dosimetric accuracy on head and neck high dose rate brachytherapy.

    Science.gov (United States)

    Peppa, Vasiliki; Pappas, Eleftherios; Major, Tibor; Takácsi-Nagy, Zoltán; Pantelis, Evaggelos; Papagiannis, Panagiotis

    2016-07-01

    To study the effect of finite patient dimensions and tissue heterogeneities in head and neck high dose rate brachytherapy. The current practice of TG-43 dosimetry was compared to patient specific dosimetry obtained using Monte Carlo simulation for a sample of 22 patient plans. The dose distributions were compared in terms of percentage dose differences as well as differences in dose volume histogram and radiobiological indices for the target and organs at risk (mandible, parotids, skin, and spinal cord). Noticeable percentage differences exist between TG-43 and patient specific dosimetry, mainly at low dose points. Expressed as fractions of the planning aim dose, percentage differences are within 2% with a general TG-43 overestimation except for the spine. These differences are consistent resulting in statistically significant differences of dose volume histogram and radiobiology indices. Absolute differences of these indices are however small to warrant clinical importance in terms of tumor control or complication probabilities. The introduction of dosimetry methods characterized by improved accuracy is a valuable advancement. It does not appear however to influence dose prescription or call for amendment of clinical recommendations for the mobile tongue, base of tongue, and floor of mouth patient cohort of this study. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Improvement of Dose Homogeneity in a 3-Dimensional Conformal Radiotherapy for Head and Neck Cancer

    International Nuclear Information System (INIS)

    Kim, Yong Nam; Lee, Chang Geol; Chung, Kyeong Keun; Kim, Joo Young; Seong, Jin Sil

    2007-01-01

    When an electron field is abutted at the surface with a photon field for head-and-neck cancer (HNC) treatment, the traditional method using bilateral field gives rise to an extreme inhomogeneity of dose distribution with both very hot and very cold regions. When we consider clinically only tumor doses of primary concern regardless of dose to normal tissues, the hot spots can be accepted, depending on their magnitude, extent, and location. However, an extreme inhomogeneity inside the radiation field is generally undesirable. An overdose to normal tissues around a target region or an underdosage in the tumor may be problematic. This study intends to develop a novel approach to improve the dose distribution inside the photon-electron abutting fields for HNC treatment

  10. Cohort-specific imputation of gene expression improves prediction of warfarin dose for African Americans.

    Science.gov (United States)

    Gottlieb, Assaf; Daneshjou, Roxana; DeGorter, Marianne; Bourgeois, Stephane; Svensson, Peter J; Wadelius, Mia; Deloukas, Panos; Montgomery, Stephen B; Altman, Russ B

    2017-11-24

    Genome-wide association studies are useful for discovering genotype-phenotype associations but are limited because they require large cohorts to identify a signal, which can be population-specific. Mapping genetic variation to genes improves power and allows the effects of both protein-coding variation as well as variation in expression to be combined into "gene level" effects. Previous work has shown that warfarin dose can be predicted using information from genetic variation that affects protein-coding regions. Here, we introduce a method that improves dose prediction by integrating tissue-specific gene expression. In particular, we use drug pathways and expression quantitative trait loci knowledge to impute gene expression-on the assumption that differential expression of key pathway genes may impact dose requirement. We focus on 116 genes from the pharmacokinetic and pharmacodynamic pathways of warfarin within training and validation sets comprising both European and African-descent individuals. We build gene-tissue signatures associated with warfarin dose in a cohort-specific manner and identify a signature of 11 gene-tissue pairs that significantly augments the International Warfarin Pharmacogenetics Consortium dosage-prediction algorithm in both populations. Our results demonstrate that imputed expression can improve dose prediction and bridge population-specific compositions. MATLAB code is available at https://github.com/assafgo/warfarin-cohort.

  11. Cohort-specific imputation of gene expression improves prediction of warfarin dose for African Americans

    Directory of Open Access Journals (Sweden)

    Assaf Gottlieb

    2017-11-01

    Full Text Available Abstract Background Genome-wide association studies are useful for discovering genotype–phenotype associations but are limited because they require large cohorts to identify a signal, which can be population-specific. Mapping genetic variation to genes improves power and allows the effects of both protein-coding variation as well as variation in expression to be combined into “gene level” effects. Methods Previous work has shown that warfarin dose can be predicted using information from genetic variation that affects protein-coding regions. Here, we introduce a method that improves dose prediction by integrating tissue-specific gene expression. In particular, we use drug pathways and expression quantitative trait loci knowledge to impute gene expression—on the assumption that differential expression of key pathway genes may impact dose requirement. We focus on 116 genes from the pharmacokinetic and pharmacodynamic pathways of warfarin within training and validation sets comprising both European and African-descent individuals. Results We build gene-tissue signatures associated with warfarin dose in a cohort-specific manner and identify a signature of 11 gene-tissue pairs that significantly augments the International Warfarin Pharmacogenetics Consortium dosage-prediction algorithm in both populations. Conclusions Our results demonstrate that imputed expression can improve dose prediction and bridge population-specific compositions. MATLAB code is available at https://github.com/assafgo/warfarin-cohort

  12. Improving abdomen tumor low-dose CT images using a fast dictionary learning based processing

    International Nuclear Information System (INIS)

    Chen Yang; Shi Luyao; Shu Huazhong; Luo Limin; Coatrieux, Jean-Louis; Yin Xindao; Toumoulin, Christine

    2013-01-01

    In abdomen computed tomography (CT), repeated radiation exposures are often inevitable for cancer patients who receive surgery or radiotherapy guided by CT images. Low-dose scans should thus be considered in order to avoid the harm of accumulative x-ray radiation. This work is aimed at improving abdomen tumor CT images from low-dose scans by using a fast dictionary learning (DL) based processing. Stemming from sparse representation theory, the proposed patch-based DL approach allows effective suppression of both mottled noise and streak artifacts. The experiments carried out on clinical data show that the proposed method brings encouraging improvements in abdomen low-dose CT images with tumors. (paper)

  13. Implementation of the systems approach to improve a pharmacist-managed vancomycin dosing service.

    Science.gov (United States)

    Gagnon, David J; Roberts, Russel; Sylvia, Lynne

    2014-12-01

    Quality improvements achieved by applying the systems approach to assess the clinical effectiveness, operational efficiency, and financial feasibility of a pharmacist-managed vancomycin dosing service are described. Faced with increased patient volumes and resource demands, the pharmacy department at Tufts Medical Center conducted an evaluation of its adult inpatient vancomycin dosing service using the systems approach, which emphasizes multidisciplinary assessment of system inputs, processes, and outcomes and consensus-building methods to identify needed changes and recommended action steps. A multidisciplinary committee composed of representatives of the medical center's pharmacy, internal medicine, infectious diseases, nursing, phlebotomy, and clinical laboratory services was assembled; in a series of three moderated monthly sessions, committee members deliberated and ultimately reached consensus on a list of action items. Relative to a concurrent intradepartmental assessment of the vancomycin dosing service based solely on pharmacist feedback, the systems approach identified a greater number and wider array of needed improvements in key program areas. Quality improvements implemented as a direct result of the systems-based analysis included a policy change authorizing pharmacists to order serum vancomycin determinations without physician cosignature and inclusion of a vancomycin dosing algorithm in the institutional antibiotic dosing guide. Future changes based on deliverable action items will result in a structured process to help direct program resources toward the patients most in need of pharmacist-managed vancomycin dosing services. The systems approach allowed for a comprehensive multidisciplinary evaluation of the service, as indicated by the identification of process improvements not identified by the department of pharmacy alone. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  14. Daily high doses of fluoxetine for weight loss and improvement in lifestyle before bariatric surgery

    NARCIS (Netherlands)

    Dolfing, JG; Wolffenbuttel, BHR; Oei, HI; ten Hoor-Aukerna, NM; Schweitzer, DH

    Background: The number of gastric restrictive bariatric operations is increasing each year, but about one-fifth of patients will become disappointed due to unsatisfactory weight reduction or annoying complications. We questioned whether weight reduction by taking high doses of fluoxetine improves

  15. Toward an organ based dose prescription method for the improved accuracy of murine dose in orthovoltage x-ray irradiators

    International Nuclear Information System (INIS)

    Belley, Matthew D.; Wang, Chu; Nguyen, Giao; Gunasingha, Rathnayaka; Chao, Nelson J.; Chen, Benny J.; Dewhirst, Mark W.; Yoshizumi, Terry T.

    2014-01-01

    Purpose: Accurate dosimetry is essential when irradiating mice to ensure that functional and molecular endpoints are well understood for the radiation dose delivered. Conventional methods of prescribing dose in mice involve the use of a single dose rate measurement and assume a uniform average dose throughout all organs of the entire mouse. Here, the authors report the individual average organ dose values for the irradiation of a 12, 23, and 33 g mouse on a 320 kVp x-ray irradiator and calculate the resulting error from using conventional dose prescription methods. Methods: Organ doses were simulated in the Geant4 application for tomographic emission toolkit using the MOBY mouse whole-body phantom. Dosimetry was performed for three beams utilizing filters A (1.65 mm Al), B (2.0 mm Al), and C (0.1 mm Cu + 2.5 mm Al), respectively. In addition, simulated x-ray spectra were validated with physical half-value layer measurements. Results: Average doses in soft-tissue organs were found to vary by as much as 23%–32% depending on the filter. Compared to filters A and B, filter C provided the hardest beam and had the lowest variation in soft-tissue average organ doses across all mouse sizes, with a difference of 23% for the median mouse size of 23 g. Conclusions: This work suggests a new dose prescription method in small animal dosimetry: it presents a departure from the conventional approach of assigninga single dose value for irradiation of mice to a more comprehensive approach of characterizing individual organ doses to minimize the error and uncertainty. In human radiation therapy, clinical treatment planning establishes the target dose as well as the dose distribution, however, this has generally not been done in small animal research. These results suggest that organ dose errors will be minimized by calibrating the dose rates for all filters, and using different dose rates for different organs

  16. Optimal treatment scheduling of ionizing radiation and sunitinib improves the antitumor activity and allows dose reduction

    International Nuclear Information System (INIS)

    Kleibeuker, Esther A; Hooven, Matthijs A ten; Castricum, Kitty C; Honeywell, Richard; Griffioen, Arjan W; Verheul, Henk M; Slotman, Ben J; Thijssen, Victor L

    2015-01-01

    The combination of radiotherapy with sunitinib is clinically hampered by rare but severe side effects and varying results with respect to clinical benefit. We studied different scheduling regimes and dose reduction in sunitinib and radiotherapy in preclinical tumor models to improve potential outcome of this combination treatment strategy. The chicken chorioallantoic membrane (CAM) was used as an angiogenesis in vivo model and as a xenograft model with human tumor cells (HT29 colorectal adenocarcinoma, OE19 esophageal adenocarcinoma). Treatment consisted of ionizing radiation (IR) and sunitinib as single therapy or in combination, using different dose-scheduling regimes. Sunitinib potentiated the inhibitory effect of IR (4 Gy) on angiogenesis. In addition, IR (4 Gy) and sunitinib (4 days of 32.5 mg/kg per day) inhibited tumor growth. Ionizing radiation induced tumor cell apoptosis and reduced proliferation, whereas sunitinib decreased tumor angiogenesis and reduced tumor cell proliferation. When IR was applied before sunitinib, this almost completely inhibited tumor growth, whereas concurrent IR was less effective and IR after sunitinib had no additional effect on tumor growth. Moreover, optimal scheduling allowed a 50% dose reduction in sunitinib while maintaining comparable antitumor effects. This study shows that the therapeutic efficacy of combination therapy improves when proper dose-scheduling is applied. More importantly, optimal treatment regimes permit dose reductions in the angiogenesis inhibitor, which will likely reduce the side effects of combination therapy in the clinical setting. Our study provides important leads to optimize combination treatment in the clinical setting

  17. Improved estimates of external gamma dose rates in the environs of Hinkley Point Power Station

    International Nuclear Information System (INIS)

    Macdonald, H.F.; Thompson, I.M.G.

    1988-07-01

    The dominant source of external gamma dose rates at centres of population within a few kilometres of Hinkley Point Power Station is the routine discharge of 41-Ar from the 'A' station magnox reactors. Earlier estimates of the 41-Ar radiation dose rates were based upon measured discharge rates, combined with calculations using standard plume dispersion and cloud-gamma integration models. This report presents improved dose estimates derived from environmental gamma dose rate measurements made at distances up to about 1 km from the site, thus minimising the degree of extrapolation introduced in estimating dose rates at locations up to a few kilometres from the site. In addition, results from associated chemical tracer measurements and wind tunnel simulations covering distances up to about 4 km from the station are outlined. These provide information on the spatial distribution of the 41-Ar plume during the initial stages of its dispersion, including effects due to plume buoyancy and momentum and behaviour under light wind conditions. In addition to supporting the methodology used for the 41-Ar dose calculations, this information is also of generic interest in the treatment of a range of operational and accidental releases from nuclear power station sites and will assist in the development and validation of existing environmental models. (author)

  18. Improvement of dose determination using glass display of mobile phones for accident dosimetry

    International Nuclear Information System (INIS)

    Discher, M.; Woda, C.; Fiedler, I.

    2013-01-01

    Previous studies have demonstrated that mobile phones can be used as suitable emergency dosimeters in case of an accidental radiation overexposure. Glass samples extracted from displays of mobile phones are sensitive to ionizing radiation and can be measured using the thermoluminescence (TL) method. A non-radiation induced background signal (so-called zero dose signal) was observed which overlaps with the radiation induced signal and consequently limits the minimum detectable dose. Investigations of several glasses from different displays showed that it is possible to reduce the zero dose signal up to 90% by etching the glass surface with concentrated hydrofluoric acid. With this approach a reduction of the detection limit of a factor of four, corresponding to approximately 80 mGy, was achieved. Dosimetric properties of etched samples are presented and developed protocols validated by dose recovery tests under realistic conditions. With the improvements in sample preparation the proposed method of dose determination is a competitive alternative to OSL/TL measurements of electronic components and chip cards and provides a useful option for retrospective accident dosimetry. -- Highlights: ► Glass displays from mobile phones have good potential for emergency dosimetry. ► The background signal can be reduced by etching glass samples with hydrofluoric acid. ► The minimum detectable dose can be lowered to approximately 80 mGy

  19. Improved Dose Targeting for a Clinical Epithermal Neutron Capture Beam Using Optional 6Li Filtration

    International Nuclear Information System (INIS)

    Binns, Peter J.; Riley, Kent J.; Ostrovsky, Yakov; Gao Wei; Albritton, J. Raymond; Kiger, W.S.; Harling, Otto K.

    2007-01-01

    Purpose: The aim of this study was to construct a 6 Li filter and to improve penetration of thermal neutrons produced by the fission converter-based epithermal neutron beam (FCB) for brain irradiation during boron neutron capture therapy (BNCT). Methods and Materials: Design of the 6 Li filter was evaluated using Monte Carlo simulations of the existing beam line and radiation transport through an ellipsoidal water phantom. Changes in beam performance were determined using three figures of merit: (1) advantage depth (AD), the depth at which the total biologically weighted dose to tumor equals the maximum weighted dose to normal tissue; (2) advantage ratio (AR), the ratio of the integral tumor dose to that of normal tissue averaged from the surface to the AD; and (3) advantage depth dose rate (ADDR), the therapeutic dose rate at the AD. Dosimetry performed with the new filter installed provided calibration data for treatment planning. Past treatment plans were recalculated to illustrate the clinical potential of the filter. Results: The 8-mm-thick Li filter is more effective for smaller field sizes, increasing the AD from 9.3 to 9.9 cm, leaving the AR unchanged at 5.7 but decreasing the ADDR from 114 to 55 cGy min -1 for the 12 cm diameter aperture. Using the filter increases the minimum deliverable dose to deep seated tumors by up to 9% for the same maximum dose to normal tissue. Conclusions: Optional 6 Li filtration provides an incremental improvement in clinical beam performance of the FCB that could help to establish a therapeutic window in the future treatment of deep-seated tumors

  20. Two-dimensional pencil beam scaling: an improved proton dose algorithm for heterogeneous media

    International Nuclear Information System (INIS)

    Szymanowski, Hanitra; Oelfke, Uwe

    2002-01-01

    New dose delivery techniques with proton beams, such as beam spot scanning or raster scanning, require fast and accurate dose algorithms which can be applied for treatment plan optimization in clinically acceptable timescales. The clinically required accuracy is particularly difficult to achieve for the irradiation of complex, heterogeneous regions of the patient's anatomy. Currently applied fast pencil beam dose calculations based on the standard inhomogeneity correction of pathlength scaling often cannot provide the accuracy required for clinically acceptable dose distributions. This could be achieved with sophisticated Monte Carlo simulations which are still unacceptably time consuming for use as dose engines in optimization calculations. We therefore present a new algorithm for proton dose calculations which aims to resolve the inherent problem between calculation speed and required clinical accuracy. First, a detailed derivation of the new concept, which is based on an additional scaling of the lateral proton fluence is provided. Then, the newly devised two-dimensional (2D) scaling method is tested for various geometries of different phantom materials. These include standard biological tissues such as bone, muscle and fat as well as air. A detailed comparison of the new 2D pencil beam scaling with the current standard pencil beam approach and Monte Carlo simulations, performed with GEANT, is presented. It was found that the new concept proposed allows calculation of absorbed dose with an accuracy almost equal to that achievable with Monte Carlo simulations while requiring only modestly increased calculation times in comparison to the standard pencil beam approach. It is believed that this new proton dose algorithm has the potential to significantly improve the treatment planning outcome for many clinical cases encountered in highly conformal proton therapy. (author)

  1. Enhanced oral bioavailability and sustained delivery of glimepiride via niosomal encapsulation: in-vitro characterization and in-vivo evaluation.

    Science.gov (United States)

    Mohsen, Amira Mohamed; AbouSamra, Mona Mahmoud; ElShebiney, Shaimaa Ahmed

    2017-08-01

    This study was designed to investigate the potency of niosomes, for glimepiride (GLM) encapsulation, aiming at enhancing its oral bioavailability and hypoglycemic efficacy. Niosomes containing nonionic surfactants (NIS) were prepared by thin film hydration technique and characterized. In-vitro release study was performed using a dialysis technique. In-vivo pharmacodynamic studies, as well as pharmacokinetic evaluation were performed on alloxan-induced diabetic rats. GLM niosomes exhibited high-entrapment efficiency percentages (E.E. %) up to 98.70% and a particle size diameter ranging from 186.8 ± 18.69 to 797.7 ± 12.45 nm, with negatively charged zeta potential (ZP). Different GLM niosomal formulation showed retarded in vitro release, compared to free drug. In-vivo studies revealed the superiority of GLM niosomes in lowering blood glucose level (BGL) and in maintaining a therapeutic level of GLM for a longer period of time, as compared to free drug and market product. There was no significant difference between mean plasma AUC 0-48 hr of GLM-loaded niosomes and that of market product. GLM-loaded niosomes exhibited seven-fold enhancement in relative bioavailability in comparison with free drug. These findings reinforce the potential use of niosomes for enhancing the oral bioavailability and prolonged delivery of GLM via oral administration.

  2. Improvement of dose distributions in abutment regions of intensity modulated radiation therapy and electron fields

    International Nuclear Information System (INIS)

    Dogan, Nesrin; Leybovich, Leonid B.; Sethi, Anil; Emami, Bahman

    2002-01-01

    In recent years, intensity modulated radiation therapy (IMRT) is used to radiate tumors that are in close proximity to vital organs. Targets consisting of a deep-seated region followed by a superficial one may be treated with abutting photon and electron fields. However, no systematic study regarding matching of IMRT and electron beams was reported. In this work, a study of dose distributions in the abutment region between tomographic and step-and-shoot IMRT and electron fields was carried out. A method that significantly improves dose homogeneity between abutting tomographic IMRT and electron fields was developed and tested. In this method, a target region that is covered by IMRT was extended into the superficial target area by ∼2.0 cm. The length and shape of IMRT target extension was chosen such that high isodose lines bent away from the region treated by the electrons. This reduced the magnitude of hot spots caused by the 'bulging effect' of electron field penumbra. To account for the uncertainties in positioning of the IMRT and electron fields, electron field penumbra was modified using conventional (photon) multileaf collimator (MLC). The electron beam was delivered in two steps: half of the dose delivered with MLCs in retracted position and another half with MLCs extended to the edge of electron field that abuts tomographic IMRT field. The experimental testing of this method using film dosimetry has demonstrated that the magnitude of the hot spots was reduced from ∼45% to ∼5% of the prescription dose. When an error of ±1.5 mm in field positioning was introduced, the dose inhomogeneity in the abutment region did not exceed ±15% of the prescription dose. With step-and-shoot IMRT, the most homogeneous dose distribution was achieved when there was a 3 mm gap between the IMRT and electron fields

  3. 3D in radiotherapy - pushing the dose envelope to improve cure

    International Nuclear Information System (INIS)

    Leibel, Steven A.

    1996-01-01

    Approximately one in four newly diagnosed cancer patients receive radiation in the initial attempt to cure the tumor. In terms of the 1996 cancer incidence data, this comprises more than 350,000 patients. Inasmuch as 25% of these patients initially relapse at primary tumor sites, the issue of improving local control remains a major challenge to the profession. Recent improvements in treatment planning and delivery have enhanced the precision of radiotherapy, but radiation resistance remains a critical issue that confounds the potential for cure in many tumors. Chemical and biological modifiers of the radiation response have provided an approach with clinical promise, but their therapeutic impact remains to be established. Hence, tumor dose escalation continues to represent the most viable approach to improve local control. Recent experience with new conformal radiotherapy techniques has demonstrated that significant tumor dose escalation is feasible with concomitant reduction in normal tissue toxicity. This experience provides the best hope for immediate improvement in the rates of local tumor control. It remains, nonetheless, unclear how far the dose envelope can be pushed and whether this would be sufficient to overcome the problem of local failure. It may turn out that biological modification of the radiation response may still be necessary to provide a maximal control in certain types of tumors

  4. An improved Monte Carlo (MC) dose simulation for charged particle cancer therapy

    Energy Technology Data Exchange (ETDEWEB)

    Ying, C. K. [Advanced Medical and Dental Institute, AMDI, Universiti Sains Malaysia, Penang, Malaysia and School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu (Malaysia); Kamil, W. A. [Advanced Medical and Dental Institute, AMDI, Universiti Sains Malaysia, Penang, Malaysia and Radiology Department, Hospital USM, Kota Bharu (Malaysia); Shuaib, I. L. [Advanced Medical and Dental Institute, AMDI, Universiti Sains Malaysia, Penang (Malaysia); Matsufuji, Naruhiro [Research Centre of Charged Particle Therapy, National Institute of Radiological Sciences, NIRS, Chiba (Japan)

    2014-02-12

    Heavy-particle therapy such as carbon ion therapy are more popular nowadays because of the nature characteristics of charged particle and almost no side effect to patients. An effective treatment is achieved with high precision of dose calculation, in this research work, Geant4 based Monte Carlo simulation method has been used to calculate the radiation transport and dose distribution. The simulation have the same setting with the treatment room in Heavy Ion Medical Accelerator, HIMAC. The carbon ion beam at the isocentric gantry nozzle for the therapeutic energy of 290 MeV/u was simulated, experimental work was carried out in National Institute of Radiological Sciences, NIRS, Chiba, Japan by using the HIMAC to confirm the accuracy and qualities dose distribution by MC methods. The Geant4 based simulated dose distribution were verified with measurements for Bragg peak and spread out Bragg peak (SOBP) respectively. The verification of results shows that the Bragg peak depth-dose and SOBP distributions in simulation has good agreement with measurements. In overall, the study showed that Geant4 based can be fully applied in the heavy-ion therapy field for simulation, further works need to be carry on to refine and improve the Geant4 MC simulations.

  5. An improved Monte Carlo (MC) dose simulation for charged particle cancer therapy

    International Nuclear Information System (INIS)

    Ying, C. K.; Kamil, W. A.; Shuaib, I. L.; Matsufuji, Naruhiro

    2014-01-01

    Heavy-particle therapy such as carbon ion therapy are more popular nowadays because of the nature characteristics of charged particle and almost no side effect to patients. An effective treatment is achieved with high precision of dose calculation, in this research work, Geant4 based Monte Carlo simulation method has been used to calculate the radiation transport and dose distribution. The simulation have the same setting with the treatment room in Heavy Ion Medical Accelerator, HIMAC. The carbon ion beam at the isocentric gantry nozzle for the therapeutic energy of 290 MeV/u was simulated, experimental work was carried out in National Institute of Radiological Sciences, NIRS, Chiba, Japan by using the HIMAC to confirm the accuracy and qualities dose distribution by MC methods. The Geant4 based simulated dose distribution were verified with measurements for Bragg peak and spread out Bragg peak (SOBP) respectively. The verification of results shows that the Bragg peak depth-dose and SOBP distributions in simulation has good agreement with measurements. In overall, the study showed that Geant4 based can be fully applied in the heavy-ion therapy field for simulation, further works need to be carry on to refine and improve the Geant4 MC simulations

  6. An improved Monte Carlo (MC) dose simulation for charged particle cancer therapy

    International Nuclear Information System (INIS)

    Ying, C.K.; Kamil, W.A.; Shuaib, I.L.; Ying, C.K.; Kamil, W.A.

    2013-01-01

    Full-text: Heavy-particle therapy such as carbon ion therapy are more popular nowadays because of the nature characteristics of charged particle and almost no side effect to patients. An effective treatment is achieved with high precision of dose calculation, in this research work, Geant4 based Monte Carlo simulation method has been used to calculate the radiation transport and dose distribution. The simulation have the same setting with the treatment room in Heavy Ion Medical Accelerator, HIMAC. The carbon ion beam at the isocentric gantry nozzle for the therapeutic energy of 290 MeV/u was simulated, experimental work was carried out in National Institute of Radiological Sciences, NIRS, Chiba, Japan by using the HIMAC to confirm the accuracy and qualities dose distribution by MC methods. The Geant4 based simulated dose distribution were verified with measurements for Bragg peak and spread out Bragg peak (SOBP) respectively. The verification of results shows that the Bragg peak depth-dose and SOBP distributions in simulation has good agreement with measurements. In overall, the study showed that Geant4 based can be fully applied in the heavy ion therapy field for simulation, further works need to be carry on to refine and improve the Geant4 MC simulations. (author)

  7. 3D representation of radioisotopic dose rates within nuclear plants for improved radioprotection and plant safety

    International Nuclear Information System (INIS)

    Vabo, Rune; Rindahl, Grete; Piotrowski, Leon

    2010-01-01

    A better awareness of the origin and nature of gamma doses in nuclear environments is demonstrated by visualizing the dose maps created by individual radionucleides that are present in radioactive contaminations. This isotopic representation of doses is much more informative than showing a map of the measured total doses. Two practical examples are given : (a) the placing of protections, and (b) using radiation decay to help plan dismantling operations. The necessary radionucleide information can be easily obtained by the new EDF CZT gamma spectrometer that is now used by all its NPPs. Defining radioactive sources based on such information enables the reconstruction of the radiation situation in a virtual 3-D environment. In such a virtual environment, dose rates can be calculated in any position in space and information about how much each radionucleide contributes can be extracted. Such 3D visualisations increase the awareness and knowledge of the distribution of radiation in a nuclear facility and can be considered as an educational tool for training and improved ALARA procedures. (author)

  8. Low and moderate doses of caffeine late in exercise improve performance in trained cyclists.

    Science.gov (United States)

    Talanian, Jason L; Spriet, Lawrence L

    2016-08-01

    The aim of the present study was to assess if low and moderate doses of caffeine delivered in a carbohydrate-electrolyte solution (CES) late in exercise improved time-trial (TT) performance. Fifteen (11 male, 4 female) cyclists (age, 22.5 ± 0.9 years; body mass, 69.3 ± 2.6 kg; peak oxygen consumption, 64.6 ± 1.9 mL·min(-1)·kg(-1)) completed 4 double-blinded randomized trials. Subjects completed 120 min of cycling at ∼60% peak oxygen consumption with 5 interspersed 120-s intervals at ∼82% peak oxygen consumption, immediately followed by 40-s intervals at 50 W. Following 80 min of cycling, subjects either ingested a 6% CES (PL), a CES with 100 mg (low dose, 1.5 ± 0.1 mg·kg body mass(-1)) of caffeine (CAF1), or a CES with 200 mg (moderate dose, 2.9 ± 0.1 mg·kg body mass(-1)) of caffeine (CAF2). Following the 120-min cycling challenge, cyclists completed a 6-kJ·kg body mass(-1) TT. There was no difference between respiratory, heart rate, glucose, free fatty acid, body mass, hematocrit, or urine specific gravity measurements between treatments. The CAF2 (26:36 ± 0:22 min:s) TT was completed faster than CAF1 (27:36 ± 0:32 min:s, p caffeine delivered late in exercise improved TT performance over the PL trial and the moderate dose (CAF2) improved performance to a greater extent than the low dose (CAF1).

  9. Improvements in dose calculation accuracy for small off-axis targets in high dose per fraction tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Hardcastle, Nicholas; Bayliss, Adam; Wong, Jeannie Hsiu Ding; Rosenfeld, Anatoly B.; Tome, Wolfgang A. [Department of Human Oncology, University of Wisconsin-Madison, WI, 53792 (United States); Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC 3002 (Australia) and Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia); Department of Human Oncology, University of Wisconsin-Madison, WI 53792 (United States); Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia) and Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur (Malaysia); Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia); Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53792 (United States); Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53792 (United States); Einstein Institute of Oncophysics, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York 10461 (United States) and Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia)

    2012-08-15

    Purpose: A recent field safety notice from TomoTherapy detailed the underdosing of small, off-axis targets when receiving high doses per fraction. This is due to angular undersampling in the dose calculation gantry angles. This study evaluates a correction method to reduce the underdosing, to be implemented in the current version (v4.1) of the TomoTherapy treatment planning software. Methods: The correction method, termed 'Super Sampling' involved the tripling of the number of gantry angles from which the dose is calculated during optimization and dose calculation. Radiochromic film was used to measure the dose to small targets at various off-axis distances receiving a minimum of 21 Gy in one fraction. Measurements were also performed for single small targets at the center of the Lucy phantom, using radiochromic film and the dose magnifying glass (DMG). Results: Without super sampling, the peak dose deficit increased from 0% to 18% for a 10 mm target and 0% to 30% for a 5 mm target as off-axis target distances increased from 0 to 16.5 cm. When super sampling was turned on, the dose deficit trend was removed and all peak doses were within 5% of the planned dose. For measurements in the Lucy phantom at 9.7 cm off-axis, the positional and dose magnitude accuracy using super sampling was verified using radiochromic film and the DMG. Conclusions: A correction method implemented in the TomoTherapy treatment planning system which triples the angular sampling of the gantry angles used during optimization and dose calculation removes the underdosing for targets as small as 5 mm diameter, up to 16.5 cm off-axis receiving up to 21 Gy.

  10. Improvements in dose calculation accuracy for small off-axis targets in high dose per fraction tomotherapy

    International Nuclear Information System (INIS)

    Hardcastle, Nicholas; Bayliss, Adam; Wong, Jeannie Hsiu Ding; Rosenfeld, Anatoly B.; Tomé, Wolfgang A.

    2012-01-01

    Purpose: A recent field safety notice from TomoTherapy detailed the underdosing of small, off-axis targets when receiving high doses per fraction. This is due to angular undersampling in the dose calculation gantry angles. This study evaluates a correction method to reduce the underdosing, to be implemented in the current version (v4.1) of the TomoTherapy treatment planning software. Methods: The correction method, termed “Super Sampling” involved the tripling of the number of gantry angles from which the dose is calculated during optimization and dose calculation. Radiochromic film was used to measure the dose to small targets at various off-axis distances receiving a minimum of 21 Gy in one fraction. Measurements were also performed for single small targets at the center of the Lucy phantom, using radiochromic film and the dose magnifying glass (DMG). Results: Without super sampling, the peak dose deficit increased from 0% to 18% for a 10 mm target and 0% to 30% for a 5 mm target as off-axis target distances increased from 0 to 16.5 cm. When super sampling was turned on, the dose deficit trend was removed and all peak doses were within 5% of the planned dose. For measurements in the Lucy phantom at 9.7 cm off-axis, the positional and dose magnitude accuracy using super sampling was verified using radiochromic film and the DMG. Conclusions: A correction method implemented in the TomoTherapy treatment planning system which triples the angular sampling of the gantry angles used during optimization and dose calculation removes the underdosing for targets as small as 5 mm diameter, up to 16.5 cm off-axis receiving up to 21 Gy.

  11. Dose-dependent response of Trichoderma harzianum in improving drought tolerance in rice genotypes.

    Science.gov (United States)

    Pandey, Veena; Ansari, Mohammad W; Tula, Suresh; Yadav, Sandep; Sahoo, Ranjan K; Shukla, Nandini; Bains, Gurdeep; Badal, Shail; Chandra, Subhash; Gaur, A K; Kumar, Atul; Shukla, Alok; Kumar, J; Tuteja, Narendra

    2016-05-01

    This study demonstrates a dose-dependent response of Trichoderma harzianum Th-56 in improving drought tolerance in rice by modulating proline, SOD, lipid peroxidation product and DHN / AQU transcript level, and the growth attributes. In the present study, the effect of colonization of different doses of T. harzianum Th-56 strain in rice genotypes were evaluated under drought stress. The rice genotypes treated with increasing dose of T. harzianum strain Th-56 showed better drought tolerance as compared with untreated control plant. There was significant change in malondialdehyde, proline, higher superoxide dismutase level, plant height, total dry matter, relative chlorophyll content, leaf rolling, leaf tip burn, and the number of scorched/senesced leaves in T. harzianum Th-56 treated rice genotypes under drought stress. This was corroborated with altered expression of aquaporin and dehydrin genes in T. harzianum Th-56 treated rice genotypes. The present findings suggest that a dose of 30 g/L was the most effective in improving drought tolerance in rice, and its potential exploitation will contribute to the advancement of rice genotypes to sustain crop productivity under drought stress. Interaction studies of T. harzianum with three aromatic rice genotypes suggested that PSD-17 was highly benefitted from T. harzianum colonization under drought stress.

  12. Low-dose budesonide treatment improves lung function in patients with infrequent asthma symptoms at baseline

    DEFF Research Database (Denmark)

    Reddel, H. K.; Busse, W. W.; Pedersen, Søren

    2015-01-01

    symptom frequency groups (Figure). CONCLUSIONS: Long-term, once-daily, low-dose budesonide treatment plus usual asthma medication improves lung function in patients with mild, recent-onset asthma. These beneficial effects were seen even in patients with the lowest baseline asthma symptom frequency (0......RATIONALE: Inhaled corticosteroids (ICS) are highly effective in low doses for improving asthma outcomes, including lung function. In the past, ICS treatment was recommended for patients with 'persistent' asthma, defined by symptoms >2 days/week.1 However, evidence is lacking for the benefit of ICS...... in patients with less frequent symptoms at presentation. This was investigated in a post-hoc analysis of the multinational inhaled Steroid Treatment As Regular Therapy in early asthma (START) study.2 METHODS: Patients aged 4-66 years (median 21 years) with a history of recent-onset mild asthma (11 years...

  13. Simultaneous determination of atorvastatin, metformin and glimepiride in human plasma by LC–MS/MS and its application to a human pharmacokinetic study

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao Polagani

    2013-02-01

    Full Text Available A simple, rapid and sensitive liquid chromatography-tandem mass spectrometric (LC–MS/MS assay method has been developed and fully validated for the simultaneous quantification of atorvastatin, metformin and glimepiride in human plasma. Carbamazepine was used as internal standard (IS. The analytes were extracted from 200 μL aliquots of human plasma via protein precipitation using acetonitrile. The reconstituted samples were chromatographed on a Alltima HP C18 column by using a 60:40 (v/v mixture of acetonitrile and 10 mM ammonium acetate (pH 3.0 as the mobile phase at a flow rate of 1.1 mL/min. The calibration curves obtained were linear (r2≥0.99 over the concentration range of 0.50–150.03 ng/mL for atorvastatin, 12.14–1207.50 ng/mL for metformin and 4.98–494.29 ng/mL for glimepiride. The API-4000 LC–MS/MS in multiple reaction monitoring (MRM mode was used for detection. The results of the intra- and inter-day precision and accuracy studies were well within the acceptable limits. All the analytes were found to be stable in a battery of stability studies. The method is precise and sensitive enough for its intended purpose. A run time of 2.5 min for each sample made it possible to analyze more than 300 plasma samples per day. The developed assay method was successfully applied to a pharmacokinetic study in human male volunteers. Keywords: Atorvastatin, Metformin, Glimepiride, LC–MS/MS, Human plasma, Pharmacokinetics

  14. Improvement in erection hardness and intercourse success with first dose of sildenafil citrate 100 mg

    Directory of Open Access Journals (Sweden)

    Mulhall JP

    2013-11-01

    Full Text Available John P Mulhall,1 Dana L Creanga,2 Vera J Stecher31Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 2Consultant to Pfizer Inc., New York, NY, USA; 3Medical Affairs, Primary Care Business Unit, Pfizer Inc., New York, NY, USAPurpose: To determine, in men with erectile dysfunction (ED, the extent of improvement in erection hardness and in the rate of successful sexual intercourse (SSI during the final intercourse attempt using sildenafil 50 mg compared with the subsequent initial attempt after a dose increase to 100 mg.Patients and methods: This post hoc analysis used data from two randomized, double-blind, placebo-controlled studies of flexible-dose sildenafil for the treatment of men with ED, who were given sildenafil 50 mg or matching placebo, to be taken as needed before sexual intercourse. After 2 weeks, those with no tolerability concerns were titrated up to 100 mg, forming the subgroup of this analysis. The main outcome measures were event log data, including an Erection Hardness Score (EHS and a question on SSI (“Did your erection last long enough for you to have successful sexual intercourse?”, for each attempt at sexual intercourse, analyzed by study and treatment group (sildenafil or placebo. Statistical comparisons were conducted by using the Fisher's exact test.Results: In both studies, the sildenafil group had a larger proportion of EHS4 (completely hard and fully rigid erections (P < 0.001 and SSI (P < 0.005 compared with the placebo group, both before and after the dose increase. Between the final 50 mg sildenafil dose and the initial 100 mg sildenafil dose, the outcomes improved and significantly so in the larger study.Conclusion: The improved efficacy with sildenafil 100 mg versus 50 mg, which occurs rapidly, suggests that patients should be encouraged to use 100 mg if they are unable to achieve completely hard and fully rigid erections or SSI with the 50 mg dose

  15. Improving the Accuracy of a Heliocentric Potential (HCP Prediction Model for the Aviation Radiation Dose

    Directory of Open Access Journals (Sweden)

    Junga Hwang

    2016-12-01

    Full Text Available The space radiation dose over air routes including polar routes should be carefully considered, especially when space weather shows sudden disturbances such as coronal mass ejections (CMEs, flares, and accompanying solar energetic particle events. We recently established a heliocentric potential (HCP prediction model for real-time operation of the CARI-6 and CARI-6M programs. Specifically, the HCP value is used as a critical input value in the CARI-6/6M programs, which estimate the aviation route dose based on the effective dose rate. The CARI-6/6M approach is the most widely used technique, and the programs can be obtained from the U.S. Federal Aviation Administration (FAA. However, HCP values are given at a one month delay on the FAA official webpage, which makes it difficult to obtain real-time information on the aviation route dose. In order to overcome this critical limitation regarding the time delay for space weather customers, we developed a HCP prediction model based on sunspot number variations (Hwang et al. 2015. In this paper, we focus on improvements to our HCP prediction model and update it with neutron monitoring data. We found that the most accurate method to derive the HCP value involves (1 real-time daily sunspot assessments, (2 predictions of the daily HCP by our prediction algorithm, and (3 calculations of the resultant daily effective dose rate. Additionally, we also derived the HCP prediction algorithm in this paper by using ground neutron counts. With the compensation stemming from the use of ground neutron count data, the newly developed HCP prediction model was improved.

  16. Improvement of radiation dose estimation due to nuclear accidents using deep neural network and GPU

    Energy Technology Data Exchange (ETDEWEB)

    Desterro, Filipe S.M.; Almeida, Adino A.H.; Pereira, Claudio M.N.A., E-mail: filipesantana18@gmail.com, E-mail: adino@ien.gov.br, E-mail: cmcoelho@ien.gov.br [Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil)

    2017-07-01

    Recently, the use of mobile devices has been proposed for dose assessment during nuclear accidents. The idea is to support field teams, providing an approximated estimation of the dose distribution map in the vicinity of the nuclear power plant (NPP), without needing to be connected to the NPP systems. In order to provide such stand-alone execution, the use of artificial neural networks (ANN) has been proposed in substitution of the complex and time consuming physical models executed by the atmospheric dispersion radionuclide (ADR) system. One limitation observed on such approach is the very time-consuming training of the ANNs. Moreover, if the number of input parameters increases the performance of standard ANNs, like Multilayer-Perceptron (MLP) with backpropagation training, is affected leading to unreasonable training time. To improve learning, allowing better dose estimations, more complex ANN architectures are required. ANNs with many layers (much more than a typical number of layers), referred to as Deep Neural Networks (DNN), for example, have demonstrating to achieve better results. On the other hand, the training of such ANNs is very much slow. In order to allow the use of such DNNs in a reasonable training time, a parallel programming solution, using Graphic Processing Units (GPU) and Computing Unified Device Architecture (CUDA) is proposed. This work focuses on the study of computational technologies for improvement of the ANNs to be used in the mobile application, as well as their training algorithms. (author)

  17. Improvement of radiation dose estimation due to nuclear accidents using deep neural network and GPU

    International Nuclear Information System (INIS)

    Desterro, Filipe S.M.; Almeida, Adino A.H.; Pereira, Claudio M.N.A.

    2017-01-01

    Recently, the use of mobile devices has been proposed for dose assessment during nuclear accidents. The idea is to support field teams, providing an approximated estimation of the dose distribution map in the vicinity of the nuclear power plant (NPP), without needing to be connected to the NPP systems. In order to provide such stand-alone execution, the use of artificial neural networks (ANN) has been proposed in substitution of the complex and time consuming physical models executed by the atmospheric dispersion radionuclide (ADR) system. One limitation observed on such approach is the very time-consuming training of the ANNs. Moreover, if the number of input parameters increases the performance of standard ANNs, like Multilayer-Perceptron (MLP) with backpropagation training, is affected leading to unreasonable training time. To improve learning, allowing better dose estimations, more complex ANN architectures are required. ANNs with many layers (much more than a typical number of layers), referred to as Deep Neural Networks (DNN), for example, have demonstrating to achieve better results. On the other hand, the training of such ANNs is very much slow. In order to allow the use of such DNNs in a reasonable training time, a parallel programming solution, using Graphic Processing Units (GPU) and Computing Unified Device Architecture (CUDA) is proposed. This work focuses on the study of computational technologies for improvement of the ANNs to be used in the mobile application, as well as their training algorithms. (author)

  18. Radioactivity of flour, wheat, bread improvers and dose estimates in Sudan

    International Nuclear Information System (INIS)

    Hamdan, Adam Mahana

    2015-10-01

    The steady rise in the use of isotopes and nuclear technology in various purposes in human life, both agro-industrial military, medical, may increase the chances of radioactive contamination that increases the exposure of ionizing radiation which raise awareness in increasing the need to know how to assess that exposure. Control of imported foodstuffs to ensure that not contaminated with radioactive materials is very important at this stage. The present study aims to investigating radioactivity in foodstuff consumed in Sudan to measure radionuclide in wheat flour, bread improvers specific objectives to measure radioactive contaminants and to estimate radiation dose from this consumption. The health impact of radionuclide ingestion from foodstuffs was evaluated by the committed effective doses determined in 30 samples of foodstuff. collected in the Port Sudan on the red sea, the radioactivity tracer of K-40, U-238 and Th-232 were measured by gamma ray spectrometry employing an using Nal (Ti) calibration process carried out for gamma spectrometry using MW652 as a reference source which recommended by International Atomic Energy Agency (IAEA) including source Cs-137 and Co-60 with two energy levels. The K-40 activity concentration in the flour samples, rang (303.07-40.48) (Bq/kg), 238U (4.81-1.95) (Bq/kg), Th-232 (7.60-1.61) Bq/kg) wheat samples range k-40 (250.62-27.22) (Bq/kg), U-238 (4.92-190) (Bq/kg), Th-232 (5.74-1.61) (Bq/kg) and bread improvers samples k-40 (68.60-13.61 (Bq/kg) U-238 (5.73-194) (Bq/kg). The total average effective dose for age (>17 years) was found in to flour be 2.35±7.12 mSv/y, 1.15±0.95 mSv/y, 1.65±2.02 mSv/y, the maximum dose values obtained were 6.01 mSv/y, 1.95 mSv/y, 1.57 mSv/y. The total average effective dose for age (>17 years) was found in to wheat 1.58±6.85 mSv/y 1.16±1.33 mSv/y, 0.48±1.14 mSv/y, the maximum dose values obtained were 4.14 mSv/y, 1.66 mSv/y, 0.99 mSv/y. The total average effective dose for age (>17 years) was

  19. High-dose therapy improved the bone remodelling compartment canopy and bone formation in multiple myeloma

    DEFF Research Database (Denmark)

    Hinge, Maja; Delaissé, Jean-Marie; Plesner, Torben

    2015-01-01

    transplantation, and from 20 control patients with monoclonal gammopathy of undetermined significance were histomorphometrically investigated. This investigation confirmed that MM patients exhibited uncoupled bone formation to resorption and reduced canopy coverage. More importantly, this study revealed......Bone loss in multiple myeloma (MM) is caused by an uncoupling of bone formation to resorption trigged by malignant plasma cells. Increasing evidence indicates that the bone remodelling compartment (BRC) canopy, which normally covers the remodelling sites, is important for coupled bone remodelling....... Loss of this canopy has been associated with bone loss. This study addresses whether the bone remodelling in MM is improved by high-dose therapy. Bone marrow biopsies obtained from 20 MM patients, before and after first-line treatment with high-dose melphalan followed by autologous stem cell...

  20. Improving the quality control program for patient dose calibrator according to IEC 60580

    International Nuclear Information System (INIS)

    Costa, Nathalia Almeida; Potiens, Maria da Penha Albuquerque

    2013-01-01

    The objective of this work was to improve the program quality control of this equipment based on the International Standard IEC 60580 - Medical electrical equipment - Dose area product meters . The initial program was established following the recommendations of IEC 61674 quoting dosimeters with ionization chambers and / or semiconductor detectors used in diagnostic X-ray image, however, the IEC 60580 is referred specifically to gauges and KAP (kerma-area product) presents additional tests. Tests included: intrinsic relative error, repeatability, scanning resolution, settling time, restarting, float values, response time and spatial uniformity of response. As a rule, all measurements are within the range characteristic of equipment performance. Thus, the PDC (Patient Dose Calibrator) again shows a device with excellent functionality and reliability in characterization tests carried out to quality control as( for the test in clinical PKA meters

  1. IMRT: Improvement in treatment planning efficiency using NTCP calculation independent of the dose-volume-histogram

    International Nuclear Information System (INIS)

    Grigorov, Grigor N.; Chow, James C.L.; Grigorov, Lenko; Jiang, Runqing; Barnett, Rob B.

    2006-01-01

    The normal tissue complication probability (NTCP) is a predictor of radiobiological effect for organs at risk (OAR). The calculation of the NTCP is based on the dose-volume-histogram (DVH) which is generated by the treatment planning system after calculation of the 3D dose distribution. Including the NTCP in the objective function for intensity modulated radiation therapy (IMRT) plan optimization would make the planning more effective in reducing the postradiation effects. However, doing so would lengthen the total planning time. The purpose of this work is to establish a method for NTCP determination, independent of a DVH calculation, as a quality assurance check and also as a mean of improving the treatment planning efficiency. In the study, the CTs of ten randomly selected prostate patients were used. IMRT optimization was performed with a PINNACLE3 V 6.2b planning system, using planning target volume (PTV) with margins in the range of 2 to 10 mm. The DVH control points of the PTV and OAR were adapted from the prescriptions of Radiation Therapy Oncology Group protocol P-0126 for an escalated prescribed dose of 82 Gy. This paper presents a new model for the determination of the rectal NTCP ( R NTCP). The method uses a special function, named GVN (from Gy, Volume, NTCP), which describes the R NTCP if 1 cm 3 of the volume of intersection of the PTV and rectum (R int ) is irradiated uniformly by a dose of 1 Gy. The function was 'geometrically' normalized using a prostate-prostate ratio (PPR) of the patients' prostates. A correction of the R NTCP for different prescribed doses, ranging from 70 to 82 Gy, was employed in our model. The argument of the normalized function is the R int , and parameters are the prescribed dose, prostate volume, PTV margin, and PPR. The R NTCPs of another group of patients were calculated by the new method and the resulting difference was <±5% in comparison to the NTCP calculated by the PINNACLE3 software where Kutcher's dose

  2. Emergency preparedness in Finland: improvement of the measurement equipment used in the assessment of internal doses

    Energy Technology Data Exchange (ETDEWEB)

    Muikku, M.; Rahola, T. [STUK - Radiation and nuclear safety authority, Helsinki (Finland)

    2006-07-01

    The need for assessing internal radiation doses in emergency situations is evident. Internal exposure can be assessed using direct measurement results or by using information on activity concentrations in inhaled air and in foodstuffs combined with inhalation and consumption data. As a part of the continuous improving of emergency preparedness in Finland, S.T.U.K. - Radiation and Nuclear Safety Authority has obtained 35 monitors for thyroid measurements in field conditions and initiated a project to revise the radiation measurement equipment in local food and environmental laboratories. (authors)

  3. Global NDE Best Practice for Technology Improvement, Outage Management, Foreign Material Exclusion and Dose Control

    International Nuclear Information System (INIS)

    Glass, S. W.; Mohr, F.

    2010-01-01

    Non Destructive Examination (NDE) is a critical element of both Boiling Water and Pressurized Water Reactor outages. Frequently this includes critical path activity so both the utility and the inspection vendor are under intense pressure to perform the work quickly. Concurrent with AREVA's new global organization of NDE resources, AREVA NDE SOLUTIONS, efforts have intensified for global application of lessons learned and best practices. These best practices include new developments as well as continuous improvements to well established tools and NDE techniques. Advancements range from steam generator robots, advanced steam generator deposit characterization sensors and method, new phased array approaches for PWR and BWR reactor vessel examination, new sensors and approaches for RPV head examinations, plus advanced internals examination robots and methods. In addition to specialized tools and techniques, best practice includes numerous management innovations. AREVA's multi-disciplined integrated nuclear worker strategy helps to minimize the total number of personnel deployed to multi-task outages. Specific design and on-site practice has been implemented to minimize or eliminate foreign material from the reactor system and vigorous pursuit of dose management practices keeps our nuclear worker dose as low as reasonably achievable. The industry is moving to much more conservative nuclear worker dose limits. While this is proving to be an issue with many vendors, AREVA has had an internal policy of <2R since 2006. Globalizing the organization also helps AREVA manage peaks and unplanned emergency inspections from an enlarged pool of globally qualified inspection personnel and tools. (Author)

  4. Improved consistency in dosing anti-tuberculosis drugs in Taipei, Taiwan.

    Science.gov (United States)

    Chiang, Chen-Yuan; Yu, Ming-Chih; Shih, Hsiu-Chen; Yen, Muh-Yong; Hsu, Yu-Ling; Yang, Shiang-Lin; Lin, Tao-Ping; Bai, Kuan-Jen

    2012-01-01

    It was reported that 35.5% of tuberculosis (TB) cases reported in 2003 in Taipei City had no recorded pre-treatment body weight and that among those who had, inconsistent dosing of anti-TB drugs was frequent. Taiwan Centers for Disease Control (CDC) have taken actions to strengthen dosing of anti-TB drugs among general practitioners. Prescribing practices of anti-TB drugs in Taipei City in 2007-2010 were investigated to assess whether interventions on dosing were effective. Lists of all notified culture positive TB cases in 2007-2010 were obtained from National TB Registry at Taiwan CDC. A medical audit of TB case management files was performed to collect pretreatment body weight and regimens prescribed at commencement of treatment. Dosages prescribed were compared with dosages recommended. The proportion of patients with recorded pre-treatment body weight was 64.5% in 2003, which increased to 96.5% in 2007-2010 (pTaipei City has remarkably improved after health authorities implemented a series of interventions.

  5. Improved dose localization with dual energy photon irradiation in treatment of lateralized intracranial malignancies

    International Nuclear Information System (INIS)

    Cooley, G.; Gillin, M.T.; Murray, K.J.; Wilson, J.F.; Janjan, N.A.

    1991-01-01

    Dual energy photon irradiation (6 MV and 20 MV) was compared to conventional treatment planning with 6 MV photons in a lateralized intracranial malignancy. Dose volume analysis was performed of both the tumor plus a 2 cm margin (target volume, TV) and normal tissues (NT). Parallel opposed treatment using weightings of 1:1, 1.5:1, and 2:1 were compared for 6 MV photons alone or in combination with 20 MV photons. Uniform treatment of the TV was accomplished within the 60 Gy isodose. Significant differences were observed, however, in NT volumes receiving greater than or equal to 60 Gy and 45-59 Gy. Dual photon energy reduced treatment of NT volumes to greater than or equal to 60 Gy by 13% (177 cm3 vs 204 cm3 in 2:1 weighting) to 70% (147 cm3 vs 498 cm3 in 1:1 weighting) for comparable plans. Dose optimization was also performed for both 6 MV alone or in combination with 20 MV photons. Usual approaches to achieve dose lateralization with conventional isocentric techniques were applied including parallel opposed 6 MV photons ipsilaterally weighted 3.4:1 (POP), and a 110 degrees arc rotational field used to limit treatment to the eye (ARC). Dual energy photon optimized plans included a three beam parallel opposed plan (TOP) and a mixed photon ipsilateral (IPSI) approach. The technique using parallel opposed 20 MV photons and ipsilateral 6 MV photons (TOP) used beam weightings of 1.1 (contralateral 20 MVX): 1.6 (ipsilateral 6 MVX): 1 (ipsilateral 20 MVX) to achieve dose optimization. The ipsilateral approach with 6 MVX and 20 MVX (IPSI) used beam weightings of 1:1.4, respectively. All optimized plans demonstrated a 41% (120 cm3; POP) to 53% (95 cm3; TOP) improvement over parallel opposed 6 MV photons weighted 2:1 (204 cm3) in NT volume receiving greater than or equal to 60 Gy

  6. Optimizing hyaluronidase dose and plasmid DNA delivery greatly improves gene electrotransfer efficiency in rat skeletal muscle

    DEFF Research Database (Denmark)

    Åkerström, Thorbjörn; Vedel, Kenneth; Needham Andersen, Josefine

    2015-01-01

    Transfection of rat skeletal muscle in vivo is a widely used research model. However, gene electrotransfer protocols have been developed for mice and yield variable results in rats. We investigated whether changes in hyaluronidase pre-treatment and plasmid DNA delivery can improve transfection...... with a homogenous distribution. We also show that transfection was stable over five weeks of regular exercise or inactivity. Our findings show that species-specific plasmid DNA delivery and hyaluronidase pre-treatment greatly improves transfection efficiency in rat skeletal muscle....... efficiency in rat skeletal muscle. We found that pre-treating the muscle with a hyaluronidase dose suitable for rats (0.56. U/g b.w.) prior to plasmid DNA injection increased transfection efficiency by >200% whereas timing of the pre-treatment did not affect efficiency. Uniformly distributing plasmid DNA...

  7. The role of intercomparisons and intercalibrations in the improvement of internal dose assessment

    International Nuclear Information System (INIS)

    Griffith, R.V.

    2000-01-01

    In vivo monitoring and dose assessment is a highly technical field. Moreover, it is carried out by a relatively small number of specialists. A number of technical steps can be taken to improve internal dosimetry programmes. However, one of the most valuable activities for overall improvement of measurement programmes is active participation in national and international intercomparisons and intercalibrations. These bring a number of benefits to the internal dosimetry programme, including validation of measurement practices, harmonisation of techniques, information exchange, and training. The number of intercalibration and intercomparison activities conducted on the national and international level has grown in recent years. These activities may involve actual measurement programmes or calculation exercises to compare approaches used for assessment of internal dose from measurement results. When conducted effectively such programmes are a highly cost effective use of limited resources. They also contribute to the credibility of the overall dosimetry process. Intercomparisons should be an important component of the in vivo measurement programme. Cooperation between the organisers of various intercomparison activities is essential to avoid unnecessary duplication and ensure the most effective use of the participants' time and energy. Future activities should address the use of simplified phantoms and source arrays to expedite shipping, reduce cost, and contribute to more timely conduct of intercomparisons. It is also important that managers and regulatory authorities be prepared to support intercomparison and intercalibration programmes. (author)

  8. Isocentric integration of intensity-modulated radiotherapy with electron fields improves field junction dose uniformity in postmastectomy radiotherapy.

    Science.gov (United States)

    Wright, Pauliina; Suilamo, Sami; Lindholm, Paula; Kulmala, Jarmo

    2014-08-01

    In postmastectomy radiotherapy (PMRT), the dose coverage of the planning target volume (PTV) with additional margins, including the chest wall, supraclavicular, interpectoral, internal mammary and axillar level I-III lymph nodes, is often compromised. Electron fields may improve the medial dose coverage while maintaining organ at risk (OAR) doses at an acceptable level, but at the cost of hot and cold spots at the electron and photon field junction. To improve PMRT dose coverage and uniformity, an isocentric technique combining tangential intensity-modulated (IM)RT fields with one medial electron field was implemented. For 10 postmastectomy patients isocentric IMRT with electron plans were created and compared with a standard electron/photon mix and a standard tangent technique. PTV dose uniformity was evaluated based on the tolerance range (TR), i.e. the ratio of the standard deviation to the mean dose, a dice similarity coefficient (DSC) and the 90% isodose coverage and the hot spot volumes. OAR and contralateral breast doses were also recorded. IMRT with electrons significantly improved the PTV dose homogeneity and conformity based on the TR and DSC values when compared with the standard electron/photon and tangent technique (p < 0.02). The 90% isodose coverage improved to 86% compared with 82% and 80% for the standard techniques (p < 0.02). Compared with the standard electron/photon mix, IMRT smoothed the dose gradient in the electron and photon field junction and the volumes receiving a dose of 110% or more were reduced by a third. For all three strategies, the OAR and contralateral breast doses were within clinically tolerable limits. Based on these results two-field IMRT combined with an electron field is a suitable strategy for PMRT.

  9. Postimplantation Analysis Enables Improvement of Dose-Volume Histograms and Reduction of Toxicity for Permanent Seed Implantation

    International Nuclear Information System (INIS)

    Wust, Peter; Postrach, Johanna; Kahmann, Frank; Henkel, Thomas; Graf, Reinhold; Cho, Chie Hee; Budach, Volker; Boehmer, Dirk

    2008-01-01

    Purpose: To demonstrate how postimplantation analysis is useful for improving permanent seed implantation and reducing toxicity. Patients and Methods: We evaluated 197 questionnaires completed by patients after permanent seed implantation (monotherapy between 1999 and 2003). For 70% of these patients, a computed tomography was available to perform postimplantation analysis. The index doses and volumes of the dose-volume histograms (DVHs) were determined and categorized with respect to the date of implantation. Differences in symptom scores relative to pretherapeutic status were analyzed with regard to follow-up times and DVH descriptors. Acute and subacute toxicities in a control group of 117 patients from an earlier study (June 1999 to September 2001) by Wust et al. (2004) were compared with a matched subgroup from this study equaling 110 patients treated between October 2001 and August 2003. Results: Improved performance, identifying a characteristic time dependency of DVH parameters (after implantation) and toxicity scores, was demonstrated. Although coverage (volume covered by 100% of the prescription dose of the prostate) increased slightly, high-dose regions decreased with the growing experience of the users. Improvement in the DVH and a reduction of toxicities were found in the patient group implanted in the later period. A decline in symptoms with follow-up time counteracts this gain of experience and must be considered. Urinary and sexual discomfort was enhanced by dose heterogeneities (e.g., dose covering 10% of the prostate volume, volume covered by 200% of prescription dose). In contrast, rectal toxicities correlated with exposed rectal volumes, especially the rectal volume covered by 100% of the prescription dose. Conclusion: The typical side effects occurring after permanent seed implantation can be reduced by improving the dose distributions. An improvement in dose distributions and a reduction of toxicities were identified with elapsed time between

  10. Improved metabolic control in tetrahydrobiopterin (BH4), responsive phenylketonuria with sapropterin administered in two divided doses vs. a single daily dose.

    Science.gov (United States)

    Kör, Deniz; Yılmaz, Berna Şeker; Bulut, Fatma Derya; Ceylaner, Serdar; Mungan, Neslihan Önenli

    2017-07-26

    Phenylketonuria (PKU) often requires a lifelong phenylalanine (Phe)-restricted diet. Introduction of 6R-tetrahydrobiopterin (BH4) has made a huge difference in the diets of patients with PKU. BH4 is the co-factor of the enzyme phenylalanine hydroxylase (PAH) and improves PAH activity and, thus, Phe tolerance in the diet. A limited number of published studies suggest a pharmacodynamic profile of BH4 more suitable to be administered in divided daily doses. After a 72-h BH4 loading test, sapropterin was initiated in 50 responsive patients. This case-control study was conducted by administering the same daily dose of sapropterin in group 1 (n=24) as a customary single dose or in two divided doses in group 2 (n=26) over 1 year. Mean daily consumption of Phe increased significantly after the first year of BH4 treatment in group 2 compared to group 1 (p<0.05). At the end of the first year of treatment with BH4, another dramatic difference observed between the two groups was the ability to transition to a Phe-free diet. Eight patients from group 2 and two from group 1 could quit dietary restriction. When given in two divided daily doses, BH4 was more efficacious than a single daily dose in increasing daily Phe consumption, Phe tolerance and the ability to transition to a Phe-unrestricted diet at the end of the first year of treatment.

  11. A single dose of oxytocin nasal spray improves higher-order social cognition in schizophrenia.

    Science.gov (United States)

    Guastella, Adam J; Ward, Philip B; Hickie, Ian B; Shahrestani, Sara; Hodge, Marie Antoinette Redoblado; Scott, Elizabeth M; Langdon, Robyn

    2015-11-01

    Schizophrenia is associated with significant impairments in both higher and lower order social cognitive performance and these impairments contribute to poor social functioning. People with schizophrenia report poor social functioning to be one of their greatest unmet treatment needs. Recent studies have suggested the potential of oxytocin as such a treatment, but mixed results render it uncertain what aspects of social cognition are improved by oxytocin and, subsequently, how oxytocin might best be applied as a therapeutic. The aim of this study was to determine whether a single dose of oxytocin improved higher-order and lower-order social cognition performance for patients with schizophrenia across a well-established battery of social cognition tests. Twenty-one male patients received both a single dose of oxytocin nasal spray (24IU) and a placebo, two weeks apart in a randomized within-subjects placebo controlled design. Following each administration, participants completed the social cognition tasks, as well as a test of general neurocognition. Results revealed that oxytocin particularly enhanced performance on higher order social cognition tasks, with no effects on general neurocognition. Results for individual tasks showed most improvement on tests measuring appreciation of indirect hints and recognition of social faux pas. These results suggest that oxytocin, if combined to enhance social cognition learning, may be beneficial when targeted at higher order social cognition domains. This study also suggests that these higher order tasks, which assess social cognitive processing in a social communication context, may provide useful markers of response to oxytocin in schizophrenia. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. An Automated Inpatient Split-dose Bowel Preparation System Improves Colonoscopy Quality and Reduces Repeat Procedures.

    Science.gov (United States)

    Yadlapati, Rena; Johnston, Elyse R; Gluskin, Adam B; Gregory, Dyanna L; Cyrus, Rachel; Werth, Lindsay; Ciolino, Jody D; Grande, David P; Keswani, Rajesh N

    2017-07-19

    Inpatient colonoscopy preparations are often inadequate, compromising patient safety and procedure quality, while resulting in greater hospital costs. The aims of this study were to: (1) design and implement an electronic inpatient split-dose bowel preparation order set; (2) assess the intervention's impact upon preparation adequacy, repeated colonoscopies, hospital days, and costs. We conducted a single center prospective pragmatic quasiexperimental study of hospitalized adults undergoing colonoscopy. The experimental intervention was designed using DMAIC (define, measure, analyze, improve, and control) methodology. Prospective data collected over 12 months were compared with data from a historical preintervention cohort. The primary outcome was bowel preparation quality and secondary outcomes included number of repeated procedures, hospital days, and costs. On the basis of a Delphi method and DMAIC process, we created an electronic inpatient bowel preparation order set inclusive of a split-dose bowel preparation algorithm, automated orders for rescue medications, and nursing bowel preparation checks. The analysis data set included 969 patients, 445 (46%) in the postintervention group. The adequacy of bowel preparation significantly increased following intervention (86% vs. 43%; P<0.01) and proportion of repeated procedures decreased (2.0% vs. 4.6%; P=0.03). Mean hospital days from bowel preparation initiation to discharge decreased from 8.0 to 6.9 days (P=0.02). The intervention resulted in an estimated 1-year cost-savings of $46,076 based on a reduction in excess hospital days associated with repeated and delayed procedures. Our interdisciplinary initiative targeting inpatient colonoscopy preparations significantly improved quality and reduced repeat procedures, and hospital days. Other institutions should consider utilizing this framework to improve inpatient colonoscopy value.

  13. Conformal technique dose escalation in prostate cancer: improved cancer control with higher doses in patients with pretreatment PSA {>=} 10 ngm/ml

    Energy Technology Data Exchange (ETDEWEB)

    Hanks, G E; Lee, W R; Hanlon, A L; Kaplan, E; Epstein, B; Schultheiss, T

    1995-07-01

    Purpose: Single institutions and an NCI supported group of institutions have been investigating the value of dose escalation in patients with prostate cancer treated by conformal treatment techniques. Improvement in morbidity has been previously established, while this report identifies the pretreatment PSA level subgroups of patients who benefitted in cancer control from higher dose. Materials and Methods: We report actuarial bNED survival rates for 375 consecutive patients with known pretreatment PSA levels treated with conformal technique between 5/89 and 12/93. The whole pelvis was treated to 45 Gy in 25 fractions in all T2C,3, all Gleason 8, 9, 10 and all patients with pretreatment PSA {>=}20. The prostate {+-} seminal vesicles was boosted at 2.1 Gy/day to the center of the prostate to 65-79 Gy (65-69 N=50), 70-72.49 N=94, 72.5-74.9 N=82, 75-77.49 N=129 and {>=}77.5 N=20). The median followup is 21 mos with a range of 3 to 67 mos. The highest dose patients have the least followup, reducing the impact of the highest dose levels at this time. Patients are analyzed for the entire group divided at 71 Gy and at 73 Gy calculated at the center of the prostate. Each dose group is then subdivided by pretreatment PSA levels <10, 10-19.9, and {>=}20 ngm/ml and dose levels are compared within pretreatment PSA level group. bNED failure is defined as PSA {>=}1.5 ngm/ml and rising on two consecutive values. Results: Table 1 shows the bNED survival rates at 24 and 36 mos for all patients and the three pretreatment PSA level groups. For all patients pooled, there is an overall advantage to using doses {>=}71 Gy (64% vs 85% at 36 mo, p=.006) and {>=}73 Gy (71% vs 86% at 36 mo, p=.07). The subgroup of PSA <10 ngm/ml, however, shows no benefit in bNED survival when using doses over 71 Gy (90% vs 93% at 36 mo) or 73 Gy (91 vs 94% at 36 mo). The subgroup PSA 10 ngm/ml to 19.9 ngm/ml shows improved cancer control when using doses over 71 Gy (61% vs 88% at 36 mo, p=.03) and over 73

  14. Influence of Exercise Intensity for Improving Depressed Mood in Depression: A Dose-Response Study.

    Science.gov (United States)

    Meyer, Jacob D; Koltyn, Kelli F; Stegner, Aaron J; Kim, Jee-Seon; Cook, Dane B

    2016-07-01

    Exercise effectively improves mood in major depressive disorder (MDD), but the optimal exercise stimulus to improve depressed mood is unknown. To determine the dose-response relationship of acute exercise intensity with depressed mood responses to exercise in MDD. We hypothesized that the acute response to exercise would differ between light, moderate, and hard intensity exercise with higher intensities yielding more beneficial responses. Once weekly, 24 women (age: 38.6±14.0) diagnosed with MDD underwent a 30-minute session at one of three steady-state exercise intensities (light, moderate, hard; rating of perceived exertion 11, 13 or 15) or quiet rest on a stationary bicycle. Depressed mood was evaluated with the Profile of Mood States before, 10 and 30 minutes post-exercise. Exercise reduced depressed mood 10 and 30 minutes following exercise, but this effect was not influenced by exercise intensity. Participants not currently taking antidepressants (n=10) had higher baseline depression scores, but did not demonstrate a different antidepressant response to exercise compared to those taking antidepressants. To acutely improve depressed mood, exercise of any intensity significantly improved feelings of depression with no differential effect following light, moderate, or hard exercise. Pharmacological antidepressant usage did not limit the mood-enhancing effect of acute exercise. Acute exercise should be used as a symptom management tool to improve mood in depression, with even light exercise an effective recommendation. These results need to be replicated and extended to other components of exercise prescription (e.g., duration, frequency, mode) to optimize exercise guidelines for improving depression. Copyright © 2016. Published by Elsevier Ltd.

  15. SU-E-T-622: Identification and Improvement of Patients Eligible for Dose Escalation with Matched Plans

    International Nuclear Information System (INIS)

    Bush, K; Holcombe, C; Kapp, D; Buyyounouski, M; Hancock, S; Xing, L; Atwood, T; King, M

    2014-01-01

    Purpose: Radiation-therapy dose-escalation beyond 80Gy may improve tumor control rates for patients with localized prostate cancer. Since toxicity remains a concern, treatment planners must achieve dose-escalation while still adhering to dose-constraints for surrounding structures. Patientmatching is a machine-learning technique that identifies prior patients that dosimetrically match DVH parameters of target volumes and critical structures prior to actual treatment planning. We evaluated the feasibility of patient-matching in (1)identifying candidates for safe dose-escalation; and (2)improving DVH parameters for critical structures in actual dose-escalated plans. Methods: We analyzed DVH parameters from 319 historical treatment plans to determine which plans could achieve dose-escalation (8640cGy) without exceeding Zelefsky dose-constraints (rectal and bladder V47Gy<53%, and V75.6Gy<30%, max-point dose to rectum of 8550cGy, max dose to PTV< 9504cGy). We then estimated the percentage of cases that could achieve safe dose-escalation using software that enables patient matching (QuickMatch, Siris Medical, Mountain View, CA). We then replanned a case that had violated DVH constraints with DVH parameters from patient matching, in order to determine whether this previously unacceptable plan could be made eligible with this automated technique. Results: Patient-matching improved the percentage of patients eligible for dose-escalation from 40% to 63% (p=4.7e-4, t-test). Using a commercial optimizer augmented with patient-matching, we demonstrated a case where patient-matching improved the toxicity-profile such that dose-escalation would have been possible; this plan was rapidly achieved using patientmatching software. In this patient, all lower-dose constraints were met with both the denovo and patient-matching plan. In the patient-matching plan, maximum dose to the rectum was 8385cGy, while the denovo plan failed to meet the maximum rectal constraint at 8571c

  16. 75 FR 25279 - Device Improvements to Reduce the Number of Under-Doses, Over-Doses, and Misaligned Exposures...

    Science.gov (United States)

    2010-05-07

    ... with new equipment? C. Quality Assurance Measures 1. Is there a model QA program that exists which is... software (afternoon session). Day 2 will focus on steps manufacturers should take to improve training of individuals who use these devices (morning session) and steps to improve quality assurance (QA) at medical...

  17. Improved Behavior and Neuropsychological Function in Children With ROHHAD After High-Dose Cyclophosphamide.

    Science.gov (United States)

    Jacobson, Lisa A; Rane, Shruti; McReynolds, Lisa J; Steppan, Diana A; Chen, Allen R; Paz-Priel, Ido

    2016-07-01

    Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare, generally progressive, and potentially fatal syndrome of unclear etiology. The syndrome is characterized by normal development followed by a sudden, rapid hyperphagic weight gain beginning during the preschool period, hypothalamic dysfunction, and central hypoventilation, and is often accompanied by personality changes and developmental regression, leading to substantial morbidity and mortality. We describe 2 children who had symptomatic and neuropsychological improvement after high-dose cyclophosphamide treatment. Our experience supports an autoimmune pathogenesis and provides the first neuropsychological profile of patients with rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation. Copyright © 2016 by the American Academy of Pediatrics.

  18. Homeopathic Doses of Gelsemium sempervirens Improve the Behavior of Mice in Response to Novel Environments

    Directory of Open Access Journals (Sweden)

    Paolo Bellavite

    2011-01-01

    Full Text Available Gelsemium sempervirens is used in homeopathy for treating patients with anxiety related symptoms, however there have been few experimental studies evaluating its pharmacological activity. We have investigated the effects of homeopathic doses of G. sempervirens on mice, using validated behavioral models. Centesimal (CH dilutions/dynamizations of G. sempervirens, the reference drug diazepam (1 mg/kg body weight or a placebo (solvent vehicle were intraperitoneally delivered to groups of mice of CD1 strain during 8 days, then the effects were assessed by the Light-Dark (LD choice test and by the Open-Field (OF exploration test, in a fully blind manner. In the LD test, the mean time spent in the illuminated area by control and placebo-treated animals was 15.98%, for mice treated with diazepam it increased to 19.91% (P = .047, while with G. sempervirens 5 CH it was 18.11% (P = .341, non-significant. The number of transitions between the two compartments increased with diazepam from 6.19 to 9.64 (P < .001 but not with G. Sempervirens. In the OF test, G. sempervirens 5 CH significantly increased the time spent and the distance traveled in the central zone (P = .009 and P = .003, resp., while diazepam had no effect on these OF test parameters. In a subsequent series of experiments, G. sempervirens 7 and 30 CH also significantly improved the behavioral responses of mice in the OF test (P < .01 for all tested variables. Neither dilutions of G. sempervirens affected the total distance traveled, indicating that the behavioral effect was not due to unspecific changes in locomotor activity. In conclusion, homeopathic doses of G. sempervirens influence the emotional responses of mice to novel environments, suggesting an improvement in exploratory behavior and a diminution of thigmotaxis or neophobia.

  19. Combination With Low-dose Dextromethorphan Improves the Effect of Amlodipine Monotherapy in Clinical Hypertension

    Science.gov (United States)

    Yin, Wei-Hsian; Chen, Pei; Yeh, Hung-I; Wang, Kuo-Yang; Hung, Yi-Jen; Tseng, Wei-Kung; Wen, Ming-Shien; Wu, Tao-Cheng; Wu, Chau-Chung; Cheng, Shu-Meng; Chen, Jaw-Wen

    2016-01-01

    Abstract The combination of low rather than high dose of dextromethorphan (DXM) with amlodipine (AM) could improve blood pressure (BP) reduction in hypertensive animals. The study aimed to evaluate the feasibility of different doses of DXM combined with standard AM treatment in clinical hypertension. This was a prospective, 14-week, dose-escalation, multicenter study. After 2-week run-in period with AM 5 mg/day, hypertensive patients who got the BP goal of 140/90 mmHg kept receiving AM monotherapy for another 12 weeks. The nonresponders, while kept on AM 5 mg/day, received additional DXM treatment for 3 sequential dose-titrated periods with initially 2.5 mg/day, followed by 7.5 mg/day, and finally 30 mg/day. Each period was for 4 weeks. The patients at BP goal after each treatment period were defined as the responders and kept on the same combination till the end of the study. The responder rate of each treatment period was recorded. The changes of BP and serum antioxidant/endothelial markers between week 14 and week 2 were evaluated. Of the 103 patients initially enrolled, 89 entered the treatment period. In the 78 patients completing the study, 31 (40%) at BP goal after 2-week AM run-in kept on AM monotherapy (DXM0). The addition of 2.5 (DXM2.5) and 7.5 mg/day (DXM7.5) of DXM enabled BP goal achievement in 22 (47%) nonresponders to AM monotherapy including 16 (29%) with DXM2.5 and 6 (18%) with DXM7.5. Only 4 patients (16%) reached BP goal with the combination of DXM 30 mg/day (DXM30). Overall, 73% of the 78 patients reached BP goal at the end of the 14-week study. Mean systolic BP was reduced by 7.9% ± 7.0% with DXM2.5 (P < 0.001) and by 5.4% ± 2.4% with DXM7.5 (P = 0.003) respectively at week 14 from that at week 2, which was unchanged in either DXM0 or DXM30 group. Besides, the effects of combination treatment were particularly significant in the patients with impaired endothelial function suggested by reduced serum NOx level

  20. Iterative metal artifact reduction improves dose calculation accuracy. Phantom study with dental implants

    Energy Technology Data Exchange (ETDEWEB)

    Maerz, Manuel; Mittermair, Pia; Koelbl, Oliver; Dobler, Barbara [Regensburg University Medical Center, Department of Radiotherapy, Regensburg (Germany); Krauss, Andreas [Siemens Healthcare GmbH, Forchheim (Germany)

    2016-06-15

    Metallic dental implants cause severe streaking artifacts in computed tomography (CT) data, which affect the accuracy of dose calculations in radiation therapy. The aim of this study was to investigate the benefit of the metal artifact reduction algorithm iterative metal artifact reduction (iMAR) in terms of correct representation of Hounsfield units (HU) and dose calculation accuracy. Heterogeneous phantoms consisting of different types of tissue equivalent material surrounding metallic dental implants were designed. Artifact-containing CT data of the phantoms were corrected using iMAR. Corrected and uncorrected CT data were compared to synthetic CT data to evaluate accuracy of HU reproduction. Intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans were calculated in Oncentra v4.3 on corrected and uncorrected CT data and compared to Gafchromic trademark EBT3 films to assess accuracy of dose calculation. The use of iMAR increased the accuracy of HU reproduction. The average deviation of HU decreased from 1006 HU to 408 HU in areas including metal and from 283 HU to 33 HU in tissue areas excluding metal. Dose calculation accuracy could be significantly improved for all phantoms and plans: The mean passing rate for gamma evaluation with 3 % dose tolerance and 3 mm distance to agreement increased from 90.6 % to 96.2 % if artifacts were corrected by iMAR. The application of iMAR allows metal artifacts to be removed to a great extent which leads to a significant increase in dose calculation accuracy. (orig.) [German] Metallische Implantate verursachen streifenfoermige Artefakte in CT-Bildern, welche die Dosisberechnung beeinflussen. In dieser Studie soll der Nutzen des iterativen Metall-Artefakt-Reduktions-Algorithmus iMAR hinsichtlich der Wiedergabetreue von Hounsfield-Werten (HU) und der Genauigkeit von Dosisberechnungen untersucht werden. Es wurden heterogene Phantome aus verschiedenen Arten gewebeaequivalenten Materials mit

  1. EcoDoses improving radiological assessment of doses to man from terrestrial ecosystems. A status report for the NKS-B project 2003

    Energy Technology Data Exchange (ETDEWEB)

    Bergan, T. [Lavrans Skuterud, Haevard Thoerring (Norway); Liland, A. [Norwegian Radiation Protection Authority (NRPA) (Denmark)] (eds.)

    2004-05-01

    The NKS B-programme EcoDoses project started in 2003 as a collaboration between all the Nordic countries. The aim of the project is to improve the radiological assessments of doses to man from terrestrial ecosystems. The first part, conducted in 2003, has focussed on an extensive collation and review of both published and unpublished data from all the Nordic countries for the nuclear weapons fallout period and the post-Chemobyl period. This included data on radionuclides in air filters, precipitation, soil samples, milk and reindeer. Based on this, an improved model for estimating radioactive fallout based on precipitation data during the nuclear weapons fallout period has been developed. Effective ecological half- lives for 137Cs and 90Sr in milk have been calculated for the nuclear weapons fallout period. For reindeer the ecological half- lives for 137Cs have been calculated for both the nuclear weapons fallout period and the post-Chemobyl period. The data were also used to compare modelling results with observed concentrations. This was done at a workshop where the radioecological food-and-dose module in the ARGOS decision support system was used to predict transfer of deposited radionuclides to foodstuffs and subsequent radiation doses to man. The work conducted the first year is presented in this report and gives interesting, new results relevant for terrestrial radioecology. (au)

  2. An improved distance-to-dose correlation for predicting bladder and rectum dose-volumes in knowledge-based VMAT planning for prostate cancer

    Science.gov (United States)

    Wall, Phillip D. H.; Carver, Robert L.; Fontenot, Jonas D.

    2018-01-01

    The overlap volume histogram (OVH) is an anatomical metric commonly used to quantify the geometric relationship between an organ at risk (OAR) and target volume when predicting expected dose-volumes in knowledge-based planning (KBP). This work investigated the influence of additional variables contributing to variations in the assumed linear DVH-OVH correlation for the bladder and rectum in VMAT plans of prostate patients, with the goal of increasing prediction accuracy and achievability of knowledge-based planning methods. VMAT plans were retrospectively generated for 124 prostate patients using multi-criteria optimization. DVHs quantified patient dosimetric data while OVHs quantified patient anatomical information. The DVH-OVH correlations were calculated for fractional bladder and rectum volumes of 30, 50, 65, and 80%. Correlations between potential influencing factors and dose were quantified using the Pearson product-moment correlation coefficient (R). Factors analyzed included the derivative of the OVH, prescribed dose, PTV volume, bladder volume, rectum volume, and in-field OAR volume. Out of the selected factors, only the in-field bladder volume (mean R  =  0.86) showed a strong correlation with bladder doses. Similarly, only the in-field rectal volume (mean R  =  0.76) showed a strong correlation with rectal doses. Therefore, an OVH formalism accounting for in-field OAR volumes was developed to determine the extent to which it improved the DVH-OVH correlation. Including the in-field factor improved the DVH-OVH correlation, with the mean R values over the fractional volumes studied improving from  -0.79 to  -0.85 and  -0.82 to  -0.86 for the bladder and rectum, respectively. A re-planning study was performed on 31 randomly selected database patients to verify the increased accuracy of KBP dose predictions by accounting for bladder and rectum volume within treatment fields. The in-field OVH led to significantly more precise

  3. Dose metric considerations in in vitro assays to improve quantitative in vitro–in vivo dose extrapolations

    NARCIS (Netherlands)

    Groothuis, Floris|info:eu-repo/dai/nl/37343586X; Heringa, M.B.; Nicol, B; Hermens, Joop|info:eu-repo/dai/nl/069681384; Blaauboer, B|info:eu-repo/dai/nl/068359802; Kramer, Nynke|info:eu-repo/dai/nl/304836125

    2015-01-01

    Challenges to improve toxicological risk assessment to meet the demands of the EU chemical’s legisla- tion, REACH, and the EU 7th Amendment of the Cosmetics Directive have accelerated the development of non-animal based methods. Unfortunately, uncertainties remain surrounding the power of alterna-

  4. EcoDoses. Improving radiological assessment of doses to man from terrestrial ecosystems: A status report for the NKS-B activity 2006

    Energy Technology Data Exchange (ETDEWEB)

    Nielsen, S.; Andersson, K.G. (Technical Univ. of Denmark, Risoe National Lab. for Sustainable Energy, Roskilde (Denmark)); Thoerring, H.; Liland, A. (Norwegian Radiation Protection Authority (Norway)); Joensen, H.P. (Frooskaparsetur Foeroya, Faroe Islands, Torshavn (Denmark)); Isaksson, M. (Goeteborg Univ. (Sweden)); Saxen, R.; Kostiainen, E. (Radiation and Nuclear Safety Authority (STUK) (Finland)); Suolanen, V. (VTT Technical Research Centre of Finland, Espoo (Finland)); Palsson, S.E. (Geislavarnir rikisins (Iceland))

    2009-03-15

    The overall aim of the NKS-B EcoDoses activity is to improve the prediction of doses to humans from consumption of radioactively contaminated food. For this purpose, various published and unpublished datasets have been compiled and applied in developing refined parameterisation for existing food dose models. The ECOSYS model developed in Germany after the Chernobyl accident has been applied as the basis for the investigations. This model can be operated both with discrete releases adequately representing a nuclear power plant accident, and with continuous or multiple releases, as observed in the nuclear weapons testing period. The modelling has revealed that it is essential to ensure that case-specific values are applied for a range of parameters, adequately reflecting the actual conditions with respect to geology, season, climate and demography. In connection with this year's work on the activity, sensitivity studies have been conducted with the ECOSYS model, in which the influence on ingestion dose estimates of a number of parameters has been evaluated in relation to Faroese conditions. The importance of applying location specific data to estimate dose is pinpointed, and it is also concluded that dose predictions for a small and distinct area like the Faroese, where not all of the many parameters required to run ECOSYS optimally have been adequately assessed in recent years, can be associated with considerable uncertainty. A Finnish study has been made in relation to modelling of radiocaesium behaviour in lakes. This study was carried out using a compartmental model that is included as a module in the DETRA dose assessment tool. A total of nine different input parameters (distribution coefficients, run-off from the catchment, erosion from the catchment, sedimentation rate in the lakes, lake water exchange rate, and biological half-lives in four fish species) were varied, and particularly distribution coefficients and lake water exchange rates were

  5. EcoDoses. Improving radiological assessment of doses to man from terrestrial ecosystems: A status report for the NKS-B activity 2006

    International Nuclear Information System (INIS)

    Nielsen, S.; Andersson, K.G.; Thoerring, H.; Liland, A.; Joensen, H.P.; Isaksson, M.; Saxen, R.; Kostiainen, E.; Suolanen, V.; Palsson, S.E.

    2009-03-01

    The overall aim of the NKS-B EcoDoses activity is to improve the prediction of doses to humans from consumption of radioactively contaminated food. For this purpose, various published and unpublished datasets have been compiled and applied in developing refined parameterisation for existing food dose models. The ECOSYS model developed in Germany after the Chernobyl accident has been applied as the basis for the investigations. This model can be operated both with discrete releases adequately representing a nuclear power plant accident, and with continuous or multiple releases, as observed in the nuclear weapons testing period. The modelling has revealed that it is essential to ensure that case-specific values are applied for a range of parameters, adequately reflecting the actual conditions with respect to geology, season, climate and demography. In connection with this year's work on the activity, sensitivity studies have been conducted with the ECOSYS model, in which the influence on ingestion dose estimates of a number of parameters has been evaluated in relation to Faroese conditions. The importance of applying location specific data to estimate dose is pinpointed, and it is also concluded that dose predictions for a small and distinct area like the Faroese, where not all of the many parameters required to run ECOSYS optimally have been adequately assessed in recent years, can be associated with considerable uncertainty. A Finnish study has been made in relation to modelling of radiocaesium behaviour in lakes. This study was carried out using a compartmental model that is included as a module in the DETRA dose assessment tool. A total of nine different input parameters (distribution coefficients, run-off from the catchment, erosion from the catchment, sedimentation rate in the lakes, lake water exchange rate, and biological half-lives in four fish species) were varied, and particularly distribution coefficients and lake water exchange rates were demonstrated to

  6. Does inverse planning applied to Iridium192 high dose rate prostate brachytherapy improve the optimization of the dose afforded by the Paris system?

    International Nuclear Information System (INIS)

    Nickers, Philippe; Lenaerts, Eric; Thissen, Benedicte; Deneufbourg, Jean-Marie

    2005-01-01

    Background and purpose: The purpose of the work is to analyse for 192 Ir prostate brachytherapy (BT) some of the different steps in optimizing the dose delivered to the CTV, urethra and rectum. Materials and methods: Between 07/1998 and 12/2001, 166 patients were treated with 192 Ir wires providing a low dose rate, according to the Paris system philosophy and with the 2D version of the treatment planning Isis R . 40-45 Gy were delivered after an external beam radiotherapy of 40 Gy. The maximum tolerable doses for BT were 25 Gy to the anterior third of the rectum on the whole length of the implant (R dose) and 52 Gy to the urethra on a 1 cm length (U max ). A U max /CTV dose ratio >1.3 represented a pejorative value as the planned dose of 40-45 Gy could not be achieved. On the other side a ratio ≤1.25 was considered optimal and the intermediate values satisfactory. A R/CTV dose ratio 192 Ir sources. Results: At the end of a learning curve reaching a plateau after the first 71 patients, 90% of the implants with 192 Ir wires were stated at least satisfactory for a total rate of 82% for the whole population. When the 3D dosimetry for SST was used, the initial values >1.25 decreased significantly with optimization required on CTV contours and additional constraints on urethra while the R/CTV ratio was maintained under 0.55. For initial U max /CTV >1.3 or >1.25 but ≤1.3 indeed, the mean respective values of 1.41±0.16 and 1.28±0.01 decreased to 1.28±0.24 and 1.17±0.09 (P<0.001), allowing to increase the total dose to the CTV by 4 Gy. Conclusions: The Paris system which assumes a homogeneous distribution of a minimum number of catheters inside the CTV allowed to anticipate a satisfactory dosimetry in 82% of cases. However, this precision rate could be improved until 95% with an optimization approach based on an inverse planning philosophy. These new 3D optimization methods, ideally based on good quality implants at first allow to deliver the highest doses with

  7. Mathematical modeling improves EC50 estimations from classical dose-response curves.

    Science.gov (United States)

    Nyman, Elin; Lindgren, Isa; Lövfors, William; Lundengård, Karin; Cervin, Ida; Sjöström, Theresia Arbring; Altimiras, Jordi; Cedersund, Gunnar

    2015-03-01

    The β-adrenergic response is impaired in failing hearts. When studying β-adrenergic function in vitro, the half-maximal effective concentration (EC50 ) is an important measure of ligand response. We previously measured the in vitro contraction force response of chicken heart tissue to increasing concentrations of adrenaline, and observed a decreasing response at high concentrations. The classical interpretation of such data is to assume a maximal response before the decrease, and to fit a sigmoid curve to the remaining data to determine EC50 . Instead, we have applied a mathematical modeling approach to interpret the full dose-response curve in a new way. The developed model predicts a non-steady-state caused by a short resting time between increased concentrations of agonist, which affect the dose-response characterization. Therefore, an improved estimate of EC50 may be calculated using steady-state simulations of the model. The model-based estimation of EC50 is further refined using additional time-resolved data to decrease the uncertainty of the prediction. The resulting model-based EC50 (180-525 nm) is higher than the classically interpreted EC50 (46-191 nm). Mathematical modeling thus makes it possible to re-interpret previously obtained datasets, and to make accurate estimates of EC50 even when steady-state measurements are not experimentally feasible. The mathematical models described here have been submitted to the JWS Online Cellular Systems Modelling Database, and may be accessed at http://jjj.bio.vu.nl/database/nyman. © 2015 FEBS.

  8. Accuracy of intermediate dose of furosemide injection to improve multidetector row CT urography

    International Nuclear Information System (INIS)

    Roy, Catherine; Jeantroux, Jeremy; Irani, Farah G.; Sauer, Benoit; Lang, Herve; Saussine, Christian

    2008-01-01

    Objective: Evaluate the usefulness of intermediate dose furosemide to improve visualization of the intrarenal collecting system and ureter using MDCTU. Materials and methods: Two groups of 100 patients without urinary tract disease or major abdominal pathology underwent MDCTU. Group I (various abdominal indications) was performed without any additional preparation and Group II (suspicion of urinary tract disease) 10 min after injection of furosemide (20 mg). MIP images of the excretory phase were post-processed. Maximal short-axis diameter of the pelvis and ureter were measured on axial images for all phases. Visualization of the collecting system wall and the identification of the whole ureter were assessed. Results: Mean pelvic diameter before contrast was (7.4 mm, S.D. ± 2.7; 13.4 mm, S.D. ± 4.1), on cortico-medullary phase (8.4 mm, S.D. ± 4.2; 14.3 mm, S.D. ± 4), on nephrographic phase (8.1 mm, S.D. ± 2.5; 14.8 mm, S.D. ± 4) and on excretory phase (9.7 mm, S.D. ± 3.4; 14.9 mm, S.D. ± 4.5), respectively, for Groups I and II. Intrarenal collecting system wall was clearly identified on both corticomedullary and nephrographic phases in 91% of Group II against 20% of Group I. Opacification of the entire ureter was excellent on excretory phase in 96% of Group II against 13% of Group I. The difference between the mean values for the two groups was statistically significant for all phases (p -9 ). Conclusion: Intermediate-dose furosemide (20 mg) before MDCTU is a very simple add-on for accurate depiction of pelvicalyceal details and collecting system wall without artefacts. The procedure is associated with a constant and complete visualisation of the entire urete

  9. High-dose estradiol improves cognition for women with AD: results of a randomized study.

    Science.gov (United States)

    Asthana, S; Baker, L D; Craft, S; Stanczyk, F Z; Veith, R C; Raskind, M A; Plymate, S R

    2001-08-28

    To characterize the cognitive and neuroendocrine response to treatment with a high dose of estrogen for postmenopausal women with AD. Twenty postmenopausal women with AD were randomized to receive either 0.10 mg/day of 17 beta-estradiol by skin patch or a placebo patch for 8 weeks. Subjects were evaluated at baseline, at weeks 3, 5, and 8 during treatment, and again 8 weeks after treatment termination. During each visit, cognition was assessed with a battery of neuropsychological tests, and blood samples were collected to measure plasma estradiol as well as several other neuroendocrine markers of interest. Significant effects of estrogen treatment were observed on attention (Stroop Color Word Interference Test), verbal memory (Buschke Selective Reminding Test), and visual memory (Figure Copy/Memory). In addition, women treated with estrogen demonstrated improved performance on a test of semantic memory (Boston Naming Test) compared with subjects who received a placebo. Estrogen appeared to have a suppressive effect on the insulin-like growth factor (IGF) system such that plasma concentration of IGF binding protein-3 was significantly reduced and plasma levels of estradiol and IGF-I were negatively correlated during estrogen treatment. Administration of a higher dose of estrogen may enhance attention and memory for postmenopausal women with AD. Although these findings provide further clinical evidence to support a cognitive benefit of estrogen for women with AD, studies evaluating the effect of estradiol administration, in particular, using larger sample sizes and for longer treatment durations are warranted before the therapeutic potential of estrogen replacement for women with AD can be firmly established.

  10. Accuracy of intermediate dose of furosemide injection to improve multidetector row CT urography

    Energy Technology Data Exchange (ETDEWEB)

    Roy, Catherine [Department of Radiology B, Universitary Hospital of Strasbourg-Civil Hospital, 1, Place de l' hopital BP 426, 67091 Strasbourg Cedex (France)], E-mail: catherine.roy@chru-strasbourg.fr; Jeantroux, Jeremy; Irani, Farah G.; Sauer, Benoit [Department of Radiology B, Universitary Hospital of Strasbourg-Civil Hospital, 1, Place de l' hopital BP 426, 67091 Strasbourg Cedex (France); Lang, Herve; Saussine, Christian [Department of Urology, Universitary Hospital of Strasbourg-Civil Hospital, 1, Place de l' hopital BP 426, 67091 Strasbourg Cedex (France)

    2008-05-15

    Objective: Evaluate the usefulness of intermediate dose furosemide to improve visualization of the intrarenal collecting system and ureter using MDCTU. Materials and methods: Two groups of 100 patients without urinary tract disease or major abdominal pathology underwent MDCTU. Group I (various abdominal indications) was performed without any additional preparation and Group II (suspicion of urinary tract disease) 10 min after injection of furosemide (20 mg). MIP images of the excretory phase were post-processed. Maximal short-axis diameter of the pelvis and ureter were measured on axial images for all phases. Visualization of the collecting system wall and the identification of the whole ureter were assessed. Results: Mean pelvic diameter before contrast was (7.4 mm, S.D. {+-} 2.7; 13.4 mm, S.D. {+-} 4.1), on cortico-medullary phase (8.4 mm, S.D. {+-} 4.2; 14.3 mm, S.D. {+-} 4), on nephrographic phase (8.1 mm, S.D. {+-} 2.5; 14.8 mm, S.D. {+-} 4) and on excretory phase (9.7 mm, S.D. {+-} 3.4; 14.9 mm, S.D. {+-} 4.5), respectively, for Groups I and II. Intrarenal collecting system wall was clearly identified on both corticomedullary and nephrographic phases in 91% of Group II against 20% of Group I. Opacification of the entire ureter was excellent on excretory phase in 96% of Group II against 13% of Group I. The difference between the mean values for the two groups was statistically significant for all phases (p < 10{sup -9}). Conclusion: Intermediate-dose furosemide (20 mg) before MDCTU is a very simple add-on for accurate depiction of pelvicalyceal details and collecting system wall without artefacts. The procedure is associated with a constant and complete visualisation of the entire urete.

  11. Prescription dose and fractionation predict improved survival after stereotactic radiotherapy for brainstem metastases

    Directory of Open Access Journals (Sweden)

    Leeman Jonathan E

    2012-07-01

    nausea (n = 1 and headaches (n = 2 that resolved with a short-course of dexamethasone. Conclusion SRT/SRS for brainstem metastases is safe and achieves a high rate of local control. We found higher GPA as well as greater number of treatment fractions and higher prescription dose to be correlated with improved overall survival. Despite this approach, prognosis remains poor and distant intracranial control remains an issue, even in patients previously treated with WBRT.

  12. Low-dose hydrocortisone (HC) replacement therapy is associated with improved bone remodeling balance in hypopituitary subjects

    LENUS (Irish Health Repository)

    Behan, L A

    2011-06-01

    The effect of commonly used glucocorticoid replacement regimens on bone health in hypopituitary subjects is not well known. We aimed to assess the effect of 3 hydrocortisone (HC) replacement dose regimens on bone turnover in this group.10 hypopituitary men with severe ACTH deficiency were randomised in a crossover design to 3 HC dose regimens, Dose A (20mg mane, 10mg tarde), Dose B (10mg twice daily) and Dose C (10mg mane, 5mg tarde). Following 6 weeks of each regimen participants underwent fasting sampling of bone turnover markers.Data from matched controls were used to produce a Z score for subject bone formation and resorption markers and to calculate the bone remodeling balance (formation Z score-resorption Z score) and turnover index ((formation Z + resorption Z)\\/2). A positive bone remodeling balance with increased turnover is consistent with a favourable bone cycle. Data are expressed as median (range).The Pro Collagen Type 1 Peptide (PINP) bone formation Z-score was significantly increased in Dose C, (1.805 (-0.6-10.24)) compared to Dose A (0.035 (-1.0-8.1)) p<0.05 while there was no difference in the C-terminal crosslinking telopeptide (CTx) resorption Z score. The bone remodeling balance was significantly lower for dose A -0.02 (-1.05-4.12) compared to dose C 1.13 (0.13-6.4) (p<0.05). Although there was a trend to an increased bone turnover index with the lower dose regimen, this was not statistically significant.Low dose HC replacement (10mg mane\\/5 mg tarde) was associated with increased bone formation and improved bone remodeling balance which is associated with a more favourable bone cycle. This may have a long term beneficial effect on bone health.

  13. EcoDoses. Improving radiological assessment of doses to man from terrestrial ecosystems. A status report for the NKS-B project 2004

    Energy Technology Data Exchange (ETDEWEB)

    Nielsen, Sven P.; Isaksson, M.; Nilsson, Elisabeth (and others)

    2005-07-01

    The NKS B-programme EcoDoses project started in 2003 as a collaboration between all the Nordic countries. The aim of the project is to improve the radiological assessments of doses to man from terrestrial ecosystems. The present report sums up the work performed in the second phase of the project. The main topics in 2004 have been: (i) A continuation of previous work with a better approach for estimating global fallout on a regional or national scale, based on a correlation between precipitation and deposition rates. (ii) Fur-ther extension of the EcoDoses milk database. Estimation of effective ecological half lives of {sup 137}Cs in cows milk focussing on suitable post-Chernobyl time-series. Modelling integrated transfer of {sup 13}7{sup C}s to cow's milk from Nordic countries. (iii) Determination of effective ecological half lives for fresh water fish from Nordic lakes. (iv) Investigate ra-dioecological sensitivity for Nordic populations. (v) Food-chain modelling using the Eco-sys-model, which is the underlying food- and dose-module in several computerised deci-sion-making systems. (au)

  14. EcoDoses. Improving radiological assessment of doses to man from terrestrial ecosystems. A status report for the NKS-B project 2004

    International Nuclear Information System (INIS)

    Nielsen, Sven P.; Isaksson, M.; Nilsson, Elisabeth

    2005-07-01

    The NKS B-programme EcoDoses project started in 2003 as a collaboration between all the Nordic countries. The aim of the project is to improve the radiological assessments of doses to man from terrestrial ecosystems. The present report sums up the work performed in the second phase of the project. The main topics in 2004 have been: (i) A continuation of previous work with a better approach for estimating global fallout on a regional or national scale, based on a correlation between precipitation and deposition rates. (ii) Fur-ther extension of the EcoDoses milk database. Estimation of effective ecological half lives of 137 Cs in cows milk focussing on suitable post-Chernobyl time-series. Modelling integrated transfer of 13 7 C s to cow's milk from Nordic countries. (iii) Determination of effective ecological half lives for fresh water fish from Nordic lakes. (iv) Investigate ra-dioecological sensitivity for Nordic populations. (v) Food-chain modelling using the Eco-sys-model, which is the underlying food- and dose-module in several computerised deci-sion-making systems. (au)

  15. Cranial CT with adaptive statistical iterative reconstruction: improved image quality with concomitant radiation dose reduction.

    Science.gov (United States)

    Rapalino, O; Kamalian, Shervin; Kamalian, Shahmir; Payabvash, S; Souza, L C S; Zhang, D; Mukta, J; Sahani, D V; Lev, M H; Pomerantz, S R

    2012-04-01

    To safeguard patient health, there is great interest in CT radiation-dose reduction. The purpose of this study was to evaluate the impact of an iterative-reconstruction algorithm, ASIR, on image-quality measures in reduced-dose head CT scans for adult patients. Using a 64-section scanner, we analyzed 100 reduced-dose adult head CT scans at 6 predefined levels of ASIR blended with FBP reconstruction. These scans were compared with 50 CT scans previously obtained at a higher routine dose without ASIR reconstruction. SNR and CNR were computed from Hounsfield unit measurements of normal GM and WM of brain parenchyma. A blinded qualitative analysis was performed in 10 lower-dose CT datasets compared with higher-dose ones without ASIR. Phantom data analysis was also performed. Lower-dose scans without ASIR had significantly lower mean GM and WM SNR (P = .003) and similar GM-WM CNR values compared with higher routine-dose scans. However, at ASIR levels of 20%-40%, there was no statistically significant difference in SNR, and at ASIR levels of ≥60%, the SNR values of the reduced-dose scans were significantly higher (P ASIR levels of ≥40% (P ASIR levels ≥60% (P ASIR in adult head CT scans reduces image noise and increases low-contrast resolution, while allowing lower radiation doses without affecting spatial resolution.

  16. Use of an electron reflector to improve dose uniformity at the vertex during total skin electron therapy

    International Nuclear Information System (INIS)

    Peters, V.G.

    2000-01-01

    Purpose: The vertex of the scalp is always tangentially irradiated during total skin electron therapy (TSET). This study was conducted to determine the dose distribution at the vertex for a commonly used irradiation technique and to evaluate the use of an electron reflector, positioned above the head, as a means of improving the dose uniformity. Methods and Materials: Phantoms, simulating the head of a patient, were irradiated using our standard procedure for TSET. The technique is a six-field irradiation using dual angled electron beams at a treatment distance of 3.6 meters. Vertex dosimetry was performed using ionization methods and film. Measurements were made for an unmodified 6 MeV electron beam and for a 4 MeV beam obtained by placing an acrylic scattering plate in the beam line. Studies were performed to examine the effect of electron scattering on vertex dose when a lead reflector, 50 x 50 cm in area, was positioned above the phantom. Results: The surface dose at the vertex, in the absence of the reflector, was found to be less than 40% of the prescribed skin dose. Use of the lead reflector increased this value to 73% for the 6 MeV beam and 99% for the degraded 4 MeV beam. Significant improvements in depth dose were also observed. The dose enhancement is not strongly dependent on reflector distance or angulation since the reflector acts as a large source of broadly scattered electrons. Conclusion: The vertex may be significantly underdosed using standard techniques for total skin electron therapy. Use of an electron reflector improves the dose uniformity at the vertex and may reduce or eliminate the need for supplemental irradiation

  17. Focal Radiation Therapy Dose Escalation Improves Overall Survival in Locally Advanced Pancreatic Cancer Patients Receiving Induction Chemotherapy and Consolidative Chemoradiation

    Energy Technology Data Exchange (ETDEWEB)

    Krishnan, Sunil, E-mail: skrishnan@mdanderson.org [Department of Radiation Oncology, The University of Texas, Houston, Texas (United States); Chadha, Awalpreet S. [Department of Radiation Oncology, The University of Texas, Houston, Texas (United States); Suh, Yelin [Department of Radiation Physics, The University of Texas, Houston, Texas (United States); Chen, Hsiang-Chun [Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas (United States); Rao, Arvind [Department of Bioinformatics and Computational Biology, MD Anderson Cancer Center, Houston, Texas (United States); Das, Prajnan; Minsky, Bruce D.; Mahmood, Usama; Delclos, Marc E. [Department of Radiation Oncology, The University of Texas, Houston, Texas (United States); Sawakuchi, Gabriel O. [Department of Radiation Physics, The University of Texas, Houston, Texas (United States); Graduate School of Biomedical Sciences, The University of Texas, Houston, Texas (United States); Beddar, Sam [Department of Radiation Physics, The University of Texas, Houston, Texas (United States); Katz, Matthew H.; Fleming, Jason B. [Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Javle, Milind M.; Varadhachary, Gauri R.; Wolff, Robert A. [Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Crane, Christopher H. [Department of Radiation Oncology, The University of Texas, Houston, Texas (United States)

    2016-03-15

    Purpose: To review outcomes of locally advanced pancreatic cancer (LAPC) patients treated with dose-escalated intensity modulated radiation therapy (IMRT) with curative intent. Methods and Materials: A total of 200 patients with LAPC were treated with induction chemotherapy followed by chemoradiation between 2006 and 2014. Of these, 47 (24%) having tumors >1 cm from the luminal organs were selected for dose-escalated IMRT (biologically effective dose [BED] >70 Gy) using a simultaneous integrated boost technique, inspiration breath hold, and computed tomographic image guidance. Fractionation was optimized for coverage of gross tumor and luminal organ sparing. A 2- to 5-mm margin around the gross tumor volume was treated using a simultaneous integrated boost with a microscopic dose. Overall survival (OS), recurrence-free survival (RFS), local-regional and distant RFS, and time to local-regional and distant recurrence, calculated from start of chemoradiation, were the outcomes of interest. Results: Median radiation dose was 50.4 Gy (BED = 59.47 Gy) with a concurrent capecitabine-based (86%) regimen. Patients who received BED >70 Gy had a superior OS (17.8 vs 15.0 months, P=.03), which was preserved throughout the follow-up period, with estimated OS rates at 2 years of 36% versus 19% and at 3 years of 31% versus 9% along with improved local-regional RFS (10.2 vs 6.2 months, P=.05) as compared with those receiving BED ≤70 Gy. Degree of gross tumor volume coverage did not seem to affect outcomes. No additional toxicity was observed in the high-dose group. Higher dose (BED) was the only predictor of improved OS on multivariate analysis. Conclusion: Radiation dose escalation during consolidative chemoradiation therapy after induction chemotherapy for LAPC patients improves OS and local-regional RFS.

  18. Single dose oral ranitidine improves MRCP image quality: a double-blind study

    International Nuclear Information System (INIS)

    Bowes, M.T.; Martin, D.F.; Melling, A.; Roberts, D.; Laasch, H.-U.; Sukumar, S.; Morris, J.

    2007-01-01

    Aim: To investigate the possibility of whether a single 300 mg dose of ranitidine given orally 2-3 h before magnetic resonance cholangiopancreatography (MRCP) could reduce the signal from the stomach and duodenum, and thus increase the conspicuousness of the biliary tree. Materials and methods: Thirty-five volunteers (22 female, 13 male), (age range 21-50) were underwent MRCP in a double-blind, placebo-controlled, randomized, crossover trial on a Philips Intera 1.5 T machine using a phased array surface coil. Imaging was carried out in the coronal oblique plane. Six 40 mm sections were acquired at varying angles to delineate the biliary tree and pancreatic duct. The 70 examinations were blindly scored by three consultants experienced in cholangiography. Results: After ranitidine administration there was a significant decrease in signal from the stomach (mean = 17.7, p = 0.0005, CI 10, 25.3) and duodenum (mean = 18.4, p = 0.0005, 95%CI 9.6, 27.1) with a significant increase in conspicuousness of the distal common duct (mean = 7.7, p = 0.033, 95%CI 0.7, 14.7) and proximal common duct (mean = 8.7, p = 0.010 CI 2.2, 15.2). There were no adverse effects. Conclusion: Oral ranitidine is a cheap and effective agent to decrease signal from the upper gastrointestinal tract and to improve visibility of the biliary tree

  19. Improvement of single detector proton radiography by incorporating intensity of time-resolved dose rate functions

    Science.gov (United States)

    Zhang, Rongxiao; Jee, Kyung-Wook; Cascio, Ethan; Sharp, Gregory C.; Flanz, Jacob B.; Lu, Hsiao-Ming

    2018-01-01

    Proton radiography, which images patients with the same type of particles as those with which they are to be treated, is a promising approach to image guidance and water equivalent path length (WEPL) verification in proton radiation therapy. We have shown recently that proton radiographs could be obtained by measuring time-resolved dose rate functions (DRFs) using an x-ray amorphous silicon flat panel. The WEPL values were derived solely from the root-mean-square (RMS) of DRFs, while the intensity information in the DRFs was filtered out. In this work, we explored the use of such intensity information for potential improvement in WEPL accuracy and imaging quality. Three WEPL derivation methods based on, respectively, the RMS only, the intensity only, and the intensity-weighted RMS were tested and compared in terms of the quality of obtained radiograph images and the accuracy of WEPL values. A Gammex CT calibration phantom containing inserts made of various tissue substitute materials with independently measured relative stopping powers (RSP) was used to assess the imaging performances. Improved image quality with enhanced interfaces was achieved while preserving the accuracy by using intensity information in the calibration. Other objects, including an anthropomorphic head phantom, a proton therapy range compensator, a frozen lamb’s head and an ‘image quality phantom’ were also imaged. Both the RMS only and the intensity-weighted RMS methods derived RSPs within  ±  1% for most of the Gammex phantom inserts, with a mean absolute percentage error of 0.66% for all inserts. In the case of the insert with a titanium rod, the method based on RMS completely failed, whereas that based on the intensity-weighted RMS was qualitatively valid. The use of intensity greatly enhanced the interfaces between different materials in the obtained WEPL images, suggesting the potential for image guidance in areas such as patient positioning and tumor tracking by proton

  20. Fixed-dose combinations in type 2 diabetes – role of the canagliflozin metformin combination

    Directory of Open Access Journals (Sweden)

    Fleming JW

    2015-06-01

    Full Text Available Joshua W Fleming, Laurie W Fleming, Courtney S Davis Department of Pharmacy Practice, The University of Mississippi School of Pharmacy, Jackson, MS, USA Abstract: Canagliflozin–metformin is one of the newest combination therapies available for the treatment of type 2 diabetes mellitus (T2DM. Canagliflozin is an inhibitor of the sodium–glucose co-transporter 2 which causes an increase in the urinary excretion of glucose. In the present article, we review the safety and efficacy of canagliflozin and metformin from data obtained from Phase III metformin add-on therapy clinical trials as there are no studies to date that specifically evaluate the combination of metformin and canagliflozin. Trials included in this review were dual-therapy trials of subjects who were already taking background metformin and were assigned to receive canagliflozin, glimepiride, or sitagliptin. The addition of canagliflozin to metformin resulted in a decrease in HbA1c of 0.73%–0.93%. Canagliflozin 100 mg was considered to be non-inferior to glimepiride and sitagliptin 100 mg with the canagliflozin 300 mg dose being statistically superior to sitagliptin and glimepiride. Other advantages of the use of canagliflozin are reduction in weight (3.3–4.0 kg and systolic blood pressure (3.3–4.7 mmHg. The primary disadvantages are potential genital mycotic infections, hypotension, and gastrointestinal side effects from metformin. All things considered, this combination appears to be safe and effective in clinical trials and represents a promising option for the treatment of T2DM. Keywords: type 2 diabetes, fixed-dose combination (FDC, canagliflozin metformin 

  1. High dose vitamin D may improve lower urinary tract symptoms in postmenopausal women.

    Science.gov (United States)

    Oberg, Johanna; Verelst, Margareta; Jorde, Rolf; Cashman, Kevin; Grimnes, Guri

    2017-10-01

    Lower urinary tract symptoms (LUTS) are common in postmenopausal women, and have been reported inversely associated with vitamin D intake and serum 25-hydroxyvitamin D (25(OH)D) levels. The aim of this study was to investigate if high dose vitamin D supplementation would affect LUTS in comparison to standard dose. In a randomized controlled study including 297 postmenopausal women with low bone mineral density, the participants were allocated to receive capsules of 20 000IU of vitamin D 3 twice a week (high dose group) or similar looking placebo (standard dose group). In addition, all the participants received 1g of calcium and 800IU of vitamin D daily. A validated questionnaire regarding LUTS was filled in at baseline and after 12 months. At baseline, 76 women in the high dose group and 82 in the standard dose group reported any LUTS. Levels of serum 25(OH)D increased significantly more in the high dose group (from 64.7 to 164.1nmol/l compared to from 64.1 to 81.8nmol/l, p<0.01). No differences between the groups were seen regarding change in LUTS except for a statistically significant reduction in the reported severity of urine incontinence in the high dose group as compared to the standard dose group after one year (p<0.05). The results need confirmation in a study specifically designed for this purpose. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Xylitol improves pancreatic islets morphology to ameliorate type 2 diabetes in rats: a dose response study.

    Science.gov (United States)

    Rahman, Md Atiar; Islam, Md Shahdiul

    2014-07-01

    Xylitol has been reported as a potential antidiabetic sweetener in a number of recent studies; however, the most effective dietary dose and organ-specific effects are still unclear. Six-week-old male Sprague-Dawley rats were randomly divided into 5 groups: normal control (NC), diabetic control (DBC), diabetic xylitol 2.5% (DXL2.5), diabetic xylitol 5.0% (DXL5), and diabetic xylitol 10.0% (DXL10). Diabetes was induced only in the animals in DBC and DXL groups and considered diabetic when their nonfasting blood glucose level was >300 mg/dL. The DXL groups were fed with 2.5%, 5.0%, and 10% xylitol solution, whereas the NC and DBC groups were supplied with normal drinking water. After 4-wk intervention, body weight, food and fluid intake, blood glucose, serum fructosamine, liver glycogen, serum alanine transaminase, aspartate transaminase, lactate dehydrogenase, creatine kinase, uric acid, creatinine, and most serum lipids were significantly decreased, and serum insulin concentration, glucose tolerance ability, and pancreatic islets morphology were significantly improved in the DXL10 group compared to the DBC group. The data of this study suggest that 10% xylitol has the better antidiabetic effects compared to 2.5% and 5.0% and it can be used as an excellent antidiabetic sweetener and food supplement in antidiabetic foods. Xylitol is widely used as a potential anticariogenic and sweetening agent in a number of oral care and food products when many of its health benefits are still unknown. Due to its similar sweetening power but lower calorific value (2.5 compared with 4 kcal) and lower glycemic index (13 compared with 65) compared to sucrose, recently it has been widely used as a sugar substitute particularly by overweight, obese, and diabetic patients in order to reduce their calorie intake from sucrose. However, the potential antidiabetic effects of xylitol have been discovered recently. The results of this study confirmed the effective dietary dose of xylitol for

  3. Chloroquine Improves Survival and Hematopoietic Recovery After Lethal Low-Dose-Rate Radiation

    International Nuclear Information System (INIS)

    Lim Yiting; Hedayati, Mohammad; Merchant, Akil A.; Zhang Yonggang; Yu, Hsiang-Hsuan M.; Kastan, Michael B.; Matsui, William; DeWeese, Theodore L.

    2012-01-01

    Purpose: We have previously shown that the antimalarial agent chloroquine can abrogate the lethal cellular effects of low-dose-rate (LDR) radiation in vitro, most likely by activating the ataxia-telangiectasia mutated (ATM) protein. Here, we demonstrate that chloroquine treatment also protects against lethal doses of LDR radiation in vivo. Methods and Materials: C57BL/6 mice were irradiated with a total of 12.8 Gy delivered at 9.4 cGy/hour. ATM null mice from the same background were used to determine the influence of ATM. Chloroquine was administered by two intraperitoneal injections of 59.4 μg per 17 g of body weight, 24 hours and 4 hours before irradiation. Bone marrow cells isolated from tibia, fibula, and vertebral bones were transplanted into lethally irradiated CD45 congenic recipient mice by retroorbital injection. Chimerism was assessed by flow cytometry. In vitro methylcellulose colony-forming assay of whole bone marrow cells and fluorescence activated cell sorting analysis of lineage depleted cells were used to assess the effect of chloroquine on progenitor cells. Results: Mice pretreated with chloroquine before radiation exhibited a significantly higher survival rate than did mice treated with radiation alone (80% vs. 31%, p = 0.0026). Chloroquine administration before radiation did not affect the survival of ATM null mice (p = 0.86). Chloroquine also had a significant effect on the early engraftment of bone marrow cells from the irradiated donor mice 6 weeks after transplantation (4.2% vs. 0.4%, p = 0.015). Conclusion: Chloroquine administration before radiation had a significant effect on the survival of normal but not ATM null mice, strongly suggesting that the in vivo effect, like the in vitro effect, is also ATM dependent. Chloroquine improved the early engraftment of bone marrow cells from LDR-irradiated mice, presumably by protecting the progenitor cells from radiation injury. Chloroquine thus could serve as a very useful drug for protection

  4. A matter of timing: identifying significant multi-dose radiotherapy improvements by numerical simulation and genetic algorithm search.

    Directory of Open Access Journals (Sweden)

    Simon D Angus

    Full Text Available Multi-dose radiotherapy protocols (fraction dose and timing currently used in the clinic are the product of human selection based on habit, received wisdom, physician experience and intra-day patient timetabling. However, due to combinatorial considerations, the potential treatment protocol space for a given total dose or treatment length is enormous, even for relatively coarse search; well beyond the capacity of traditional in-vitro methods. In constrast, high fidelity numerical simulation of tumor development is well suited to the challenge. Building on our previous single-dose numerical simulation model of EMT6/Ro spheroids, a multi-dose irradiation response module is added and calibrated to the effective dose arising from 18 independent multi-dose treatment programs available in the experimental literature. With the developed model a constrained, non-linear, search for better performing cadidate protocols is conducted within the vicinity of two benchmarks by genetic algorithm (GA techniques. After evaluating less than 0.01% of the potential benchmark protocol space, candidate protocols were identified by the GA which conferred an average of 9.4% (max benefit 16.5% and 7.1% (13.3% improvement (reduction on tumour cell count compared to the two benchmarks, respectively. Noticing that a convergent phenomenon of the top performing protocols was their temporal synchronicity, a further series of numerical experiments was conducted with periodic time-gap protocols (10 h to 23 h, leading to the discovery that the performance of the GA search candidates could be replicated by 17-18 h periodic candidates. Further dynamic irradiation-response cell-phase analysis revealed that such periodicity cohered with latent EMT6/Ro cell-phase temporal patterning. Taken together, this study provides powerful evidence towards the hypothesis that even simple inter-fraction timing variations for a given fractional dose program may present a facile, and highly cost

  5. A matter of timing: identifying significant multi-dose radiotherapy improvements by numerical simulation and genetic algorithm search.

    Science.gov (United States)

    Angus, Simon D; Piotrowska, Monika Joanna

    2014-01-01

    Multi-dose radiotherapy protocols (fraction dose and timing) currently used in the clinic are the product of human selection based on habit, received wisdom, physician experience and intra-day patient timetabling. However, due to combinatorial considerations, the potential treatment protocol space for a given total dose or treatment length is enormous, even for relatively coarse search; well beyond the capacity of traditional in-vitro methods. In constrast, high fidelity numerical simulation of tumor development is well suited to the challenge. Building on our previous single-dose numerical simulation model of EMT6/Ro spheroids, a multi-dose irradiation response module is added and calibrated to the effective dose arising from 18 independent multi-dose treatment programs available in the experimental literature. With the developed model a constrained, non-linear, search for better performing cadidate protocols is conducted within the vicinity of two benchmarks by genetic algorithm (GA) techniques. After evaluating less than 0.01% of the potential benchmark protocol space, candidate protocols were identified by the GA which conferred an average of 9.4% (max benefit 16.5%) and 7.1% (13.3%) improvement (reduction) on tumour cell count compared to the two benchmarks, respectively. Noticing that a convergent phenomenon of the top performing protocols was their temporal synchronicity, a further series of numerical experiments was conducted with periodic time-gap protocols (10 h to 23 h), leading to the discovery that the performance of the GA search candidates could be replicated by 17-18 h periodic candidates. Further dynamic irradiation-response cell-phase analysis revealed that such periodicity cohered with latent EMT6/Ro cell-phase temporal patterning. Taken together, this study provides powerful evidence towards the hypothesis that even simple inter-fraction timing variations for a given fractional dose program may present a facile, and highly cost-effecitive means

  6. Improvements on a patient-specific dose estimation system in nuclear medicine examination

    International Nuclear Information System (INIS)

    Chuang, K. S.; Lu, J. C.; Lin, H. H.; Dong, S. L.; Yang, H. J.; Shih, C. T.; Lin, C. H.; Yao, W. J.; Ni, Y. C.; Jan, M. L.; Chang, S. J.

    2014-01-01

    The purpose of this paper is to develop a patient-specific dose estimation system in nuclear medicine examination. A dose deposition routine to store the deposited energy of the photons during their flights was embedded in the widely used SimSET Monte Carlo code and a user-friendly interface for reading PET and CT images was developed. Dose calculated on ORNL phantom was used to validate the accuracy of this system. The ratios of S value for 99m Tc, 18 F and 131 I computed by this system to those obtained with OLINDA for various organs were ranged from 0.93 to 1.18, which were comparable to that obtained from MCNPX2.6 code (0.88-1.22). Our system developed provides opportunity for tumor dose estimation which cannot be known from the MIRD. The radiation dose can provide useful information in the amount of radioisotopes to be administered in radioimmunotherapy. (authors)

  7. Improving early diagnosis of pulmonary infections in patients with febrile neutropenia using low-dose chest computed tomography.

    Directory of Open Access Journals (Sweden)

    M G Gerritsen

    Full Text Available We performed a prospective study in patients with chemotherapy induced febrile neutropenia to investigate the diagnostic value of low-dose computed tomography compared to standard chest radiography. The aim was to compare both modalities for detection of pulmonary infections and to explore performance of low-dose computed tomography for early detection of invasive fungal disease. The low-dose computed tomography remained blinded during the study. A consensus diagnosis of the fever episode made by an expert panel was used as reference standard. We included 67 consecutive patients on the first day of febrile neutropenia. According to the consensus diagnosis 11 patients (16.4% had pulmonary infections. Sensitivity, specificity, positive predictive value and negative predictive value were 36%, 93%, 50% and 88% for radiography, and 73%, 91%, 62% and 94% for low-dose computed tomography, respectively. An uncorrected McNemar showed no statistical difference (p = 0.197. Mean radiation dose for low-dose computed tomography was 0.24 mSv. Four out of 5 included patients diagnosed with invasive fungal disease had radiographic abnormalities suspect for invasive fungal disease on the low-dose computed tomography scan made on day 1 of fever, compared to none of the chest radiographs. We conclude that chest radiography has little value in the initial assessment of febrile neutropenia on day 1 for detection of pulmonary abnormalities. Low-dose computed tomography improves detection of pulmonary infiltrates and seems capable of detecting invasive fungal disease at a very early stage with a low radiation dose.

  8. Improving early diagnosis of pulmonary infections in patients with febrile neutropenia using low-dose chest computed tomography.

    Science.gov (United States)

    Gerritsen, M G; Willemink, M J; Pompe, E; van der Bruggen, T; van Rhenen, A; Lammers, J W J; Wessels, F; Sprengers, R W; de Jong, P A; Minnema, M C

    2017-01-01

    We performed a prospective study in patients with chemotherapy induced febrile neutropenia to investigate the diagnostic value of low-dose computed tomography compared to standard chest radiography. The aim was to compare both modalities for detection of pulmonary infections and to explore performance of low-dose computed tomography for early detection of invasive fungal disease. The low-dose computed tomography remained blinded during the study. A consensus diagnosis of the fever episode made by an expert panel was used as reference standard. We included 67 consecutive patients on the first day of febrile neutropenia. According to the consensus diagnosis 11 patients (16.4%) had pulmonary infections. Sensitivity, specificity, positive predictive value and negative predictive value were 36%, 93%, 50% and 88% for radiography, and 73%, 91%, 62% and 94% for low-dose computed tomography, respectively. An uncorrected McNemar showed no statistical difference (p = 0.197). Mean radiation dose for low-dose computed tomography was 0.24 mSv. Four out of 5 included patients diagnosed with invasive fungal disease had radiographic abnormalities suspect for invasive fungal disease on the low-dose computed tomography scan made on day 1 of fever, compared to none of the chest radiographs. We conclude that chest radiography has little value in the initial assessment of febrile neutropenia on day 1 for detection of pulmonary abnormalities. Low-dose computed tomography improves detection of pulmonary infiltrates and seems capable of detecting invasive fungal disease at a very early stage with a low radiation dose.

  9. Head CT: Image quality improvement with ASIR-V using a reduced radiation dose protocol for children.

    Science.gov (United States)

    Kim, Hyun Gi; Lee, Ho-Joon; Lee, Seung-Koo; Kim, Hyun Ji; Kim, Myung-Joon

    2017-09-01

    To investigate the quality of images reconstructed with adaptive statistical iterative reconstruction V (ASIR-V), using pediatric head CT protocols. A phantom was scanned at decreasing 20% mA intervals using our standard pediatric head CT protocols. Each study was then reconstructed at 10% ASIR-V intervals. After the phantom study, we reduced mA by 10% in the protocol for ASIR-V and by 30% in the protocol for 3- to 15-year-old patients and applied 40% ASIR-V. Increasing the percentage of ASIR-V resulted in lower noise and higher contrast-to-noise ratio (CNR) and preserved spatial resolution in the phantom study. Compared to a conventional-protocol, reduced-dose protocol with ASIR-V achieved 12.8% to 34.0% of dose reduction and showed images of lower noise (9.22 vs. 10.73, P = 0.043) and higher CNR in different levels (centrum semiovale, 2.14 vs. 1.52, P = 0.003; basal ganglia, 1.46 vs. 1.07, P = 0.001; and cerebellum, 2.18 vs. 1.33, P ASIR-V. Use of ASIR-V allowed a 12.8% to 34.0% dose reduction in each age group with potential to improve image quality. • It is possible to reduce radiation dose and improve image quality with ASIR-V. • We improved noise and CNR and decreased radiation dose. • Sharpness improved with ASIR-V. • Total radiation dose was decreased by 12.8% to 34.0%.

  10. High dose sapropterin dihydrochloride therapy improves monoamine neurotransmitter turnover in murine phenylketonuria (PKU).

    Science.gov (United States)

    Winn, Shelley R; Scherer, Tanja; Thöny, Beat; Harding, Cary O

    2016-01-01

    Central nervous system (CNS) deficiencies of the monoamine neurotransmitters, dopamine and serotonin, have been implicated in the pathophysiology of neuropsychiatric dysfunction in phenylketonuria (PKU). Increased brain phenylalanine concentration likely competitively inhibits the activities of tyrosine hydroxylase (TH) and tryptophan hydroxylase (TPH), the rate limiting steps in dopamine and serotonin synthesis respectively. Tetrahydrobiopterin (BH4) is a required cofactor for TH and TPH activity. Our hypothesis was that treatment of hyperphenylalaninemic Pah(enu2/enu2) mice, a model of human PKU, with sapropterin dihydrochloride, a synthetic form of BH4, would stimulate TH and TPH activities leading to improved dopamine and serotonin synthesis despite persistently elevated brain phenylalanine. Sapropterin (20, 40, or 100mg/kg body weight in 1% ascorbic acid) was administered daily for 4 days by oral gavage to Pah(enu2/enu2) mice followed by measurement of brain biopterin, phenylalanine, tyrosine, tryptophan and monoamine neurotransmitter content. A significant increase in brain biopterin content was detected only in mice that had received the highest sapropterin dose, 100mg/kg. Blood and brain phenylalanine concentrations were unchanged by sapropterin therapy. Sapropterin therapy also did not alter the absolute amounts of dopamine and serotonin in brain but was associated with increased homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA), dopamine and serotonin metabolites respectively, in both wild type and Pah(enu2/enu2) mice. Oral sapropterin therapy likely does not directly affect central nervous system monoamine synthesis in either wild type or hyperphenylalaninemic mice but may stimulate synaptic neurotransmitter release and subsequent metabolism. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Acute personalized habitual caffeine doses improve attention and have selective effects when considering the fractionation of executive functions.

    Science.gov (United States)

    Lanini, Juliana; Galduróz, José Carlos Fernandes; Pompéia, Sabine

    2016-01-01

    Caffeine is widely used, often consumed with food, and improves simple and complex/executive attention under fasting conditions. We investigated whether these cognitive effects are observed when personalized habitual doses of caffeine are ingested by caffeine consumers, whether they are influenced by nutriments and if various executive domains are susceptible to improvement. This was a double-blind, placebo-controlled study including 60 young, healthy, rested males randomly assigned to one of four treatments: placebo fasting, caffeine fasting, placebo meal and caffeine meal. Caffeine doses were individualized for each participant based on their self-reported caffeine consumption at the time of testing (morning). The test battery included measures of simple and sustained attention, executive domains (inhibiting, updating, shifting, dual tasking, planning and accessing long-term memory), control measures of subjective alterations, glucose and insulin levels, skin conductance, heart rate and pupil dilation. Regardless of meal intake, acute habitual doses of caffeine decreased fatigue, and improved simple and sustained attention and executive updating. This executive effect was not secondary to the habitual weekly dose consumed, changes in simple and sustained attention, mood, meal ingestion and increases in cognitive effort. We conclude that the morning caffeine "fix" has positive attentional effects and selectively improved executive updating whether or not caffeine is consumed with food. Copyright © 2015 John Wiley & Sons, Ltd.

  12. Improved Patient Size Estimates for Accurate Dose Calculations in Abdomen Computed Tomography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chang-Lae [Yonsei University, Wonju (Korea, Republic of)

    2017-07-15

    The radiation dose of CT (computed tomography) is generally represented by the CTDI (CT dose index). CTDI, however, does not accurately predict the actual patient doses for different human body sizes because it relies on a cylinder-shaped head (diameter : 16 cm) and body (diameter : 32 cm) phantom. The purpose of this study was to eliminate the drawbacks of the conventional CTDI and to provide more accurate radiation dose information. Projection radiographs were obtained from water cylinder phantoms of various sizes, and the sizes of the water cylinder phantoms were calculated and verified using attenuation profiles. The effective diameter was also calculated using the attenuation of the abdominal projection radiographs of 10 patients. When the results of the attenuation-based method and the geometry-based method shown were compared with the results of the reconstructed-axial-CT-image-based method, the effective diameter of the attenuation-based method was found to be similar to the effective diameter of the reconstructed-axial-CT-image-based method, with a difference of less than 3.8%, but the geometry-based method showed a difference of less than 11.4%. This paper proposes a new method of accurately computing the radiation dose of CT based on the patient sizes. This method computes and provides the exact patient dose before the CT scan, and can therefore be effectively used for imaging and dose control.

  13. Improved tissue assignment using dual-energy computed tomography in low-dose rate prostate brachytherapy for Monte Carlo dose calculation

    Energy Technology Data Exchange (ETDEWEB)

    Côté, Nicolas [Département de Physique, Université de Montréal, Pavillon Roger-Gaudry (D-428), 2900 Boulevard Édouard-Montpetit, Montréal, Québec H3T 1J4 (Canada); Bedwani, Stéphane [Département de Radio-Oncologie, Centre Hospitalier de l’Université de Montréal (CHUM), 1560 Rue Sherbrooke Est, Montréal, Québec H2L 4M1 (Canada); Carrier, Jean-François, E-mail: jean-francois.carrier.chum@ssss.gouv.qc.ca [Département de Physique, Université de Montréal, Pavillon Roger-Gaudry (D-428), 2900 Boulevard Édouard-Montpetit, Montréal, Québec H3T 1J4, Canada and Département de Radio-Oncologie, Centre Hospitalier de l’Université de Montréal (CHUM), 1560 Rue Sherbrooke Est, Montréal, Québec H2L 4M1 (Canada)

    2016-05-15

    Purpose: An improvement in tissue assignment for low-dose rate brachytherapy (LDRB) patients using more accurate Monte Carlo (MC) dose calculation was accomplished with a metallic artifact reduction (MAR) method specific to dual-energy computed tomography (DECT). Methods: The proposed MAR algorithm followed a four-step procedure. The first step involved applying a weighted blend of both DECT scans (I {sub H/L}) to generate a new image (I {sub Mix}). This action minimized Hounsfield unit (HU) variations surrounding the brachytherapy seeds. In the second step, the mean HU of the prostate in I {sub Mix} was calculated and shifted toward the mean HU of the two original DECT images (I {sub H/L}). The third step involved smoothing the newly shifted I {sub Mix} and the two original I {sub H/L}, followed by a subtraction of both, generating an image that represented the metallic artifact (I {sub A,(H/L)}) of reduced noise levels. The final step consisted of subtracting the original I {sub H/L} from the newly generated I {sub A,(H/L)} and obtaining a final image corrected for metallic artifacts. Following the completion of the algorithm, a DECT stoichiometric method was used to extract the relative electronic density (ρ{sub e}) and effective atomic number (Z {sub eff}) at each voxel of the corrected scans. Tissue assignment could then be determined with these two newly acquired physical parameters. Each voxel was assigned the tissue bearing the closest resemblance in terms of ρ{sub e} and Z {sub eff}, comparing with values from the ICRU 42 database. A MC study was then performed to compare the dosimetric impacts of alternative MAR algorithms. Results: An improvement in tissue assignment was observed with the DECT MAR algorithm, compared to the single-energy computed tomography (SECT) approach. In a phantom study, tissue misassignment was found to reach 0.05% of voxels using the DECT approach, compared with 0.40% using the SECT method. Comparison of the DECT and SECT D

  14. Poster - 53: Improving inter-linac DMLC IMRT dose precision by fine tuning of MLC leaf calibration

    International Nuclear Information System (INIS)

    Nakonechny, Keith; Tran, Muoi; Sasaki, David; Beck, James; Poirier, Yannick; Malkoske, Kyle

    2016-01-01

    Purpose: To develop a method to improve the inter-linac precision of DMLC IMRT dosimetry. Methods: The distance between opposing MLC leaf banks (“gap size”) can be finely tuned on Varian linacs. The dosimetric effect due to small deviations from the nominal gap size (“gap error”) was studied by introducing known errors for several DMLC sliding gap sizes, and for clinical plans based on the TG119 test cases. The plans were delivered on a single Varian linac and the relationship between gap error and the corresponding change in dose was measured. The plans were also delivered on eight Varian 2100 series linacs (at two institutions) in order to quantify the inter-linac variation in dose before and after fine tuning the MLC calibration. Results: The measured dose differences for each field agreed well with the predictions of LoSasso et al. Using the default MLC calibration, the variation in the physical MLC gap size was determined to be less than 0.4 mm between all linacs studied. The dose difference between the linacs with the largest and smallest physical gap was up to 5.4% (spinal cord region of the head and neck TG119 test case). This difference was reduced to 2.5% after fine tuning the MLC gap calibration. Conclusions: The inter-linac dose precision for DMLC IMRT on Varian linacs can be improved using a simple modification of the MLC calibration procedure that involves fine adjustment of the nominal gap size.

  15. Improvement of the equivalent sphere model for better estimates of skin or eye dose in space radiation environments

    International Nuclear Information System (INIS)

    Lin, Z.W.

    2011-01-01

    It is often useful to get a quick estimate of the dose or dose equivalent of an organ, such as blood-forming organs, the eye or the skin, in a radiation field. Sometimes an equivalent sphere is used to represent the organ for this purpose. For space radiation environments, recently it has been shown that the equivalent sphere model does not work for the eye or the skin in solar particle event environments. In this study, we improve the representation of the eye and the skin using a two-component equivalent sphere model. Motivated by the two-peak structure of the body organ shielding distribution for the eye and the skin, we use an equivalent sphere with two radius parameters, for example a partial spherical shell of a smaller thickness over a proper fraction of the full solid angle combined with a concentric partial spherical shell of a larger thickness over the rest of the full solid angle, to represent the eye or the skin. We find that using an equivalent sphere with two radius parameters instead of one drastically improves the accuracy of the estimates of dose and dose equivalent in space radiation environments. For example, in solar particle event environments the average error in the estimate of the skin dose equivalent using an equivalent sphere with two radius parameters is about 8%, while the average error of the conventional equivalent sphere model using one radius parameter is around 100%.

  16. Poster - 53: Improving inter-linac DMLC IMRT dose precision by fine tuning of MLC leaf calibration

    Energy Technology Data Exchange (ETDEWEB)

    Nakonechny, Keith; Tran, Muoi; Sasaki, David; Beck, James; Poirier, Yannick; Malkoske, Kyle [Simcoe-Muskoka Regional Cancer Centre (Canada)

    2016-08-15

    Purpose: To develop a method to improve the inter-linac precision of DMLC IMRT dosimetry. Methods: The distance between opposing MLC leaf banks (“gap size”) can be finely tuned on Varian linacs. The dosimetric effect due to small deviations from the nominal gap size (“gap error”) was studied by introducing known errors for several DMLC sliding gap sizes, and for clinical plans based on the TG119 test cases. The plans were delivered on a single Varian linac and the relationship between gap error and the corresponding change in dose was measured. The plans were also delivered on eight Varian 2100 series linacs (at two institutions) in order to quantify the inter-linac variation in dose before and after fine tuning the MLC calibration. Results: The measured dose differences for each field agreed well with the predictions of LoSasso et al. Using the default MLC calibration, the variation in the physical MLC gap size was determined to be less than 0.4 mm between all linacs studied. The dose difference between the linacs with the largest and smallest physical gap was up to 5.4% (spinal cord region of the head and neck TG119 test case). This difference was reduced to 2.5% after fine tuning the MLC gap calibration. Conclusions: The inter-linac dose precision for DMLC IMRT on Varian linacs can be improved using a simple modification of the MLC calibration procedure that involves fine adjustment of the nominal gap size.

  17. Design and dosimetry of an eye plaque containing I-125 seeds: An improved dose distribution

    International Nuclear Information System (INIS)

    Detorie, N.A.; Tkacik, M.F.; Neglia, W.J.; Jenkins, D.; Shadday, J.

    1986-01-01

    To treat intraocular tumors, a temporarily implanted eye plaque, containing 24 I-125 seeds (3M model 6711), was fabricated from 0.6-mm-thick lead disk with a 1.5-cm diameter. The I-125 seeds were distributed in a particular geometric pattern to average the dose anisotropy of each individual seed. Water phantom measurements made with TLD chips (LiF) and film over the approximate depth range of 1-25 mm were compared with treatment planning computer calculations (Capintec RT-108). Data indicate that the specified geometry produces a dose distribution delivering a tumor dose of 10,000 rad to the tumor apex (7 mm) without exceeding a sclera dose (1 mm) of 40,000 rad. Information regarding fabrication, dosimetry, and radiation safety is presented

  18. 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

  19. SU-D-BRB-02: Combining a Commercial Autoplanning Engine with Database Dose Predictions to Further Improve Plan Quality

    Energy Technology Data Exchange (ETDEWEB)

    Robertson, SP; Moore, JA; Hui, X; Cheng, Z; McNutt, TR [Johns Hopkins University, Baltimore, MD (United States); DeWeese, TL; Tran, P; Quon, H [John Hopkins Hospital, Baltimore, MD (United States); Bzdusek, K [Philips, Fitchburg, WI (United States); Kumar, P [Philips India Limited, Bangalore, Karnataka (India)

    2016-06-15

    Purpose: Database dose predictions and a commercial autoplanning engine both improve treatment plan quality in different but complimentary ways. The combination of these planning techniques is hypothesized to further improve plan quality. Methods: Four treatment plans were generated for each of 10 head and neck (HN) and 10 prostate cancer patients, including Plan-A: traditional IMRT optimization using clinically relevant default objectives; Plan-B: traditional IMRT optimization using database dose predictions; Plan-C: autoplanning using default objectives; and Plan-D: autoplanning using database dose predictions. One optimization was used for each planning method. Dose distributions were normalized to 95% of the planning target volume (prostate: 8000 cGy; HN: 7000 cGy). Objectives used in plan optimization and analysis were the larynx (25%, 50%, 90%), left and right parotid glands (50%, 85%), spinal cord (0%, 50%), rectum and bladder (0%, 20%, 50%, 80%), and left and right femoral heads (0%, 70%). Results: All objectives except larynx 25% and 50% resulted in statistically significant differences between plans (Friedman’s χ{sup 2} ≥ 11.2; p ≤ 0.011). Maximum dose to the rectum (Plans A-D: 8328, 8395, 8489, 8537 cGy) and bladder (Plans A-D: 8403, 8448, 8527, 8569 cGy) were significantly increased. All other significant differences reflected a decrease in dose. Plans B-D were significantly different from Plan-A for 3, 17, and 19 objectives, respectively. Plans C-D were also significantly different from Plan-B for 8 and 13 objectives, respectively. In one case (cord 50%), Plan-D provided significantly lower dose than plan C (p = 0.003). Conclusion: Combining database dose predictions with a commercial autoplanning engine resulted in significant plan quality differences for the greatest number of objectives. This translated to plan quality improvements in most cases, although special care may be needed for maximum dose constraints. Further evaluation is warranted

  20. What is the best dose of nature and green exercise for improving mental health? A multi-study analysis.

    Science.gov (United States)

    Barton, Jo; Pretty, Jules

    2010-05-15

    Green exercise is activity in the presence of nature. Evidence shows it leads to positive short and long-term health outcomes. This multistudy analysis assessed the best regime of dose(s) of acute exposure to green exercise required to improve self-esteem and mood (indicators of mental health). The research used meta-analysis methodology to analyze 10 UK studies involving 1252 participants. Outcomes were identified through a priori subgroup analyses, and dose-responses were assessed for exercise intensity and exposure duration. Other subgroup analyses included gender, age group, starting health status, and type of habitat. The overall effect size for improved self-esteem was d = 0.46 (CI 0.34-0.59, p exercise, and then diminishing but still positive returns. Every green environment improved both self-esteem and mood; the presence of water generated greater effects. Both men and women had similar improvements in self-esteem after green exercise, though men showed a difference for mood. Age groups: for self-esteem, the greatest change was in the youngest, with diminishing effects with age; for mood, the least change was in the young and old. The mentally ill had one of the greatest self-esteem improvements. This study confirms that the environment provides an important health service.

  1. Cost reduction from resolution/improvement of carcinoid syndrome symptoms following treatment with above-standard dose of octreotide LAR.

    Science.gov (United States)

    Huynh, Lynn; Totev, Todor; Vekeman, Francis; Neary, Maureen P; Duh, Mei S; Benson, Al B

    2017-09-01

    To calculate the cost reduction associated with diarrhea/flushing symptom resolution/improvement following treatment with above-standard dose octreotide-LAR from the commercial payor's perspective. Diarrhea and flushing are two major carcinoid syndrome symptoms of neuroendocrine tumor (NET). Previously, a study of NET patients from three US tertiary oncology centers (NET 3-Center Study) demonstrated that dose escalation of octreotide LAR to above-standard dose resolved/improved diarrhea/flushing in 79% of the patients within 1 year. Time course of diarrhea/flushing symptom data were collected from the NET 3-Center Study. Daily healthcare costs were calculated from a commercial claims database analysis. For the patient cohort experiencing any diarrhea/flushing symptom resolution/improvement, their observation period was divided into days of symptom resolution/improvement or no improvement, which were then multiplied by the respective daily healthcare cost and summed over 1 year to yield the blended mean annual cost per patient. For patients who experienced no diarrhea/flushing symptom improvement, mean annual daily healthcare cost of diarrhea/flushing over a 1-year period was calculated. The economic model found that 108 NET patients who experienced diarrhea/flushing symptom resolution/improvement within 1 year had statistically significantly lower mean annual healthcare cost/patient than patients with no symptom improvement, by $14,766 (p = .03). For the sub-set of 85 patients experiencing resolution/improvement of diarrhea, their cost reduction was more pronounced, at $18,740 (p = .01), statistically significantly lower than those with no improvement; outpatient costs accounted for 56% of the cost reduction (p = .02); inpatient costs, emergency department costs, and pharmacy costs accounted for the remaining 44%. The economic model relied on two different sources of data, with some heterogeneity in the prior treatment and disease status of patients

  2. Improved method for calculation of population doses from nuclear complexes over large geographical areas

    International Nuclear Information System (INIS)

    Corley, J.P.; Baker, D.A.; Hill, E.R.; Wendell, L.L.

    1977-09-01

    To simplify the calculation of potential long-distance environmental impacts, an overall average population exposure coefficient (P.E.C.) for the entire contiguous United States was calculated for releases to the atmosphere from Hanford facilities. The method, requiring machine computation, combines Bureau of Census population data by census enumeration district and an annual average atmospheric dilution factor (anti chi/Q') derived from 12-hourly gridded wind analyses provided by the NOAA's National Meteorological Center. A variable-trajectory puff-advection model was used to calculate an hourly anti chi/Q' for each grid square, assuming uniform hourly releases; seasonal and annual averages were then calculated. For Hanford, using 1970 census data, a P.E.C. of 2 x 10 -3 man-seconds per cubic meter was calculated. The P.E.C. is useful for both radioactive and nonradioactive releases. To calculate population doses for the entire contiguous United States, the P.E.C. is multiplied by the annual average release rate and then by the dose factor (rem/yr per Ci/m 3 ) for each radionuclide, and the dose contribution in man-rem is summed for all radionuclides. For multiple pathways, the P.E.C. is still useful, provided that doses from a unit release can be obtained from a set of atmospheric dose factors. The methodology is applicable to any point source, any set of population data by map grid coordinates, and any geographical area covered by equivalent meteorological data

  3. Improvement of image quality and dose management in CT fluoroscopy by iterative 3D image reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Grosser, Oliver S.; Kupitz, Dennis; Powerski, Maciej; Mohnike, Konrad; Ricke, Jens [University Hospital Magdeburg, Department of Radiology and Nuclear Medicine, Magdeburg (Germany); Wybranski, Christian [University Hospital Magdeburg, Department of Radiology and Nuclear Medicine, Magdeburg (Germany); University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne (Germany); Pech, Maciej [University Hospital Magdeburg, Department of Radiology and Nuclear Medicine, Magdeburg (Germany); Medical University of Gdansk, Second Department of Radiology, Gdansk (Poland); Amthauer, Holger [University Hospital Magdeburg, Department of Radiology and Nuclear Medicine, Magdeburg (Germany); Charite, Department of Nuclear Medicine, Berlin (Germany)

    2017-09-15

    The objective of this study was to assess the influence of an iterative CT reconstruction algorithm (IA), newly available for CT-fluoroscopy (CTF), on image noise, readers' confidence and effective dose compared to filtered back projection (FBP). Data from 165 patients (FBP/IA = 82/74) with CTF in the thorax, abdomen and pelvis were included. Noise was analysed in a large-diameter vessel. The impact of reconstruction and variables (e.g. X-ray tube current I) influencing noise and effective dose were analysed by ANOVA and a pairwise t-test with Bonferroni-Holm correction. Noise and readers' confidence were evaluated by three readers. Noise was significantly influenced by reconstruction, I, body region and circumference (all p ≤ 0.0002). IA reduced the noise significantly compared to FBP (p = 0.02). The effect varied for body regions and circumferences (p ≤ 0.001). The effective dose was influenced by the reconstruction, body region, interventional procedure and I (all p ≤ 0.02). The inter-rater reliability for noise and readers' confidence was good (W ≥ 0.75, p < 0.0001). Noise and readers' confidence were significantly better in AIDR-3D compared to FBP (p ≤ 0.03). Generally, IA yielded a significant reduction of the median effective dose. The CTF reconstruction by IA showed a significant reduction in noise and effective dose while readers' confidence increased. (orig.)

  4. Improving the performance of membrane bioreactors by powdered activated carbon dosing with cost considerations.

    Science.gov (United States)

    Yang, W; Paetkau, M; Cicek, N

    2010-01-01

    Effects of powdered activated carbon (PAC) dosing on the overall performance of membrane bioreactors (MBR) were investigated in two bench-scale submerged MBRs. Positive impacts of PAC dosing on membrane fouling and the removal of 17beta-estradiol (E2) and 17alpha-ethyinylestradiol (EE2) were demonstrated over a six-month stable operational period. PAC dosing in the MBR increased the removal rates of E2 and EE2 by 3.4% and 15.8%, respectively. The average soluble extracellular polymeric substances (EPS) and colloidal total organic carbon (TOC) concentrations in the PAC-MBR sludge was 60.1% and 61.8% lower than the control MBR sludge, respectively. Lower soluble EPS and colloidal TOC concentrations in the PAC-MBR sludge resulted in a slower rate of trans-membrane pressure (TMP) increase during MBRs operation, which could prolong the lifespan of membranes. Cost assessment showed that PAC dosing could reduce the operating cost for membrane cleaning and/or membrane replacement by about 25%. The operating cost for PAC dosing could be offset by the benefit from its reducing the cost for membrane maintenance.

  5. Improvement of dose evaluation system for employees at severe accident in a nuclear power plant. Introduction of the dose rate conversion coefficient and addition of the access route edit function

    International Nuclear Information System (INIS)

    Sasaki, Yasuhiro; Minami, Noritoshi; Yoshida, Yoshitaka

    2006-01-01

    Institute of Nuclear Safety System, Inc. had developed the dose evaluation system to evaluate the radiation dose of employees at severe accident in a nuclear power plant. This system has features, which are (1) the dose rate of any evaluation point can be evaluated, (2) the dose rate at any time can be evaluated in consideration of the change in the radioactive source, (3) the dose rate map in the plant can be displayed (4) the dose along the access route when moving can be evaluated, and it is possible to use it for examination of the accident management guideline on the dose side etc.. To upgrade the dose evaluation function of this system, the improvements had been done which were introduction of the dose rate conversion coefficient and addition of the access route edit function. By introducing the dose rate conversion coefficient, the calculation time of the dose rate map in the plant was shortened at about 20 seconds, and a new function to evaluate time-dependent dose rate of any evaluation point was added. By adding the access route edit function, it became possible to re-calculate the dose easily at the route change. (author)

  6. Hydroxychloroquine Blood Levels in Systemic Lupus Erythematosus: Clarifying Dosing Controversies and Improving Adherence.

    Science.gov (United States)

    Durcan, Laura; Clarke, William A; Magder, Laurence S; Petri, Michelle

    2015-11-01

    Hydroxychloroquine (HCQ) is used for its effect on systemic lupus erythematosus (SLE) disease activity and longterm benefits. This can be limited by adherence. One way to assess adherence is to measure blood levels. Conflicting data exist regarding blood levels and disease activity. There is disagreement about dosing; rheumatologists recommend weight-based dosing while some other specialists advocate height-based "ideal body weight" dosing. Patients were prescribed HCQ not exceeding 6.5 mg/kg (max 400 mg/day). In hemodialysis, the dose was 200 mg after each session, and in renal insufficiency it was 200 mg/day. Levels were measured at each visit with a therapeutic range of 500-2000 ng/ml. Patients were divided according to baseline blood level. To assess the effect of measurement and counseling on adherence, we compared the proportion of patients with a level of 500 ng/ml or higher based on the number of prior assessments. The proportion of patients with HCQ levels in the therapeutic range differed significantly by age, sex, and Vitamin D level. There was a trend toward lower levels with renal failure. Blood levels were similar regardless of height and ideal body weight. Comparing those with undetectable, subtherapeutic, and therapeutic levels, disease activity decreased (SLE Disease Activity Index 2.92, 2.36, and 2.20, p = 0.04 for trend). At first, 56% were therapeutic, and by the third measurement this increased to 80% (p ≤ 0.0001). There was a trend toward higher disease activity with lower HCQ levels. Renal failure dosing led to suboptimum levels. We show that weight-based dosing (max 400 mg daily) is appropriate and that height does not appear to influence levels. Measurement, counseling, and repeated testing can increase adherence rates.

  7. CORK Study in Cystic Fibrosis: Sustained Improvements in Ultra-Low-Dose Chest CT Scores After CFTR Modulation With Ivacaftor.

    Science.gov (United States)

    Ronan, Nicola J; Einarsson, Gisli G; Twomey, Maria; Mooney, Denver; Mullane, David; NiChroinin, Muireann; O'Callaghan, Grace; Shanahan, Fergus; Murphy, Desmond M; O'Connor, Owen J; Shortt, Cathy A; Tunney, Michael M; Eustace, Joseph A; Maher, Michael M; Elborn, J Stuart; Plant, Barry J

    2018-02-01

    Ivacaftor produces significant clinical benefit in patients with cystic fibrosis (CF) with the G551D mutation. Prevalence of this mutation at the Cork CF Centre is 23%. This study assessed the impact of cystic fibrosis transmembrane conductance regulator modulation on multiple modalities of patient assessment. Thirty-three patients with the G551D mutation were assessed at baseline and prospectively every 3 months for 1 year after initiation of ivacaftor. Change in ultra-low-dose chest CT scans, blood inflammatory mediators, and the sputum microbiome were assessed. Significant improvements in FEV 1 , BMI, and sweat chloride levels were observed post-ivacaftor treatment. Improvement in ultra-low-dose CT imaging scores were observed after treatment, with significant mean reductions in total Bhalla score (P < .01), peribronchial thickening (P = .035), and extent of mucous plugging (P < .001). Reductions in circulating inflammatory markers, including interleukin (IL)-1β, IL-6, and IL-8 were demonstrated. There was a 30% reduction in the relative abundance of Pseudomonas species and an increase in the relative abundance of bacteria associated with more stable community structures. Posttreatment community richness increased significantly (P = .03). Early and sustained improvements on ultra-low-dose CT scores suggest it may be a useful method of evaluating treatment response. It paralleled improvement in symptoms, circulating inflammatory markers, and changes in the lung microbiota. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  8. Improving ingestion dose modelling for the ARGOS and RODOS decision support systems: A Nordic Initiative

    DEFF Research Database (Denmark)

    Andersson, Kasper Grann; Nielsen, Sven Poul; Thørring, Håvard

    2011-01-01

    A Nordic work group under the NKS-B activity PARDNOR has revised the input parameters in the ECOSYS model that is incorporated for ingestion dose modelling in the ARGOS and RODOS decision support systems. The new parameterisation takes into account recent measurement data, and targets the model f...

  9. Efficiency improvement in proton dose calculations with an equivalent restricted stopping power formalism

    Science.gov (United States)

    Maneval, Daniel; Bouchard, Hugo; Ozell, Benoît; Després, Philippe

    2018-01-01

    The equivalent restricted stopping power formalism is introduced for proton mean energy loss calculations under the continuous slowing down approximation. The objective is the acceleration of Monte Carlo dose calculations by allowing larger steps while preserving accuracy. The fractional energy loss per step length ɛ was obtained with a secant method and a Gauss-Kronrod quadrature estimation of the integral equation relating the mean energy loss to the step length. The midpoint rule of the Newton-Cotes formulae was then used to solve this equation, allowing the creation of a lookup table linking ɛ to the equivalent restricted stopping power L eq, used here as a key physical quantity. The mean energy loss for any step length was simply defined as the product of the step length with L eq. Proton inelastic collisions with electrons were added to GPUMCD, a GPU-based Monte Carlo dose calculation code. The proton continuous slowing-down was modelled with the L eq formalism. GPUMCD was compared to Geant4 in a validation study where ionization processes alone were activated and a voxelized geometry was used. The energy straggling was first switched off to validate the L eq formalism alone. Dose differences between Geant4 and GPUMCD were smaller than 0.31% for the L eq formalism. The mean error and the standard deviation were below 0.035% and 0.038% respectively. 99.4 to 100% of GPUMCD dose points were consistent with a 0.3% dose tolerance. GPUMCD 80% falloff positions (R80 ) matched Geant’s R80 within 1 μm. With the energy straggling, dose differences were below 2.7% in the Bragg peak falloff and smaller than 0.83% elsewhere. The R80 positions matched within 100 μm. The overall computation times to transport one million protons with GPUMCD were 31-173 ms. Under similar conditions, Geant4 computation times were 1.4-20 h. The L eq formalism led to an intrinsic efficiency gain factor ranging between 30-630, increasing with the prescribed accuracy of simulations. The

  10. Improved image quality and radiation dose reduction in liver dynamic CT scan with the protocol change

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Yu Jin; Cho, Pyong Kon [Radiological Science, Catholic University of Daegu, Daegu (Korea, Republic of)

    2015-06-15

    The purpose is reducing radiation dose while maintaining of image quality in liver dynamic CT(LDCT) scan, by protocols generally used and the tube voltage set at a low level protocol compared to the radiation dose and image quality. The target is body mass index, 18.5-24 patients out of 40 patients who underwent the ACT(abdominal CT). Group A(tube voltage : 120 kVp, SAFIRE strength 1) of 20 people among 40 people, to apply the general abdominal CT scan protocol, group B(tube voltage : 100 kVp, apply SAFIRE strength 0-5) was 20 people, set a lower tube voltage. Image quality evaluation was setting a region of interest(ROI) in the liver parenchyma, aorta, superior mesenteric artery (SMA), celiac trunk, visceral fat of arterial phase. In the ROI were compared by measuring the noise, signal to noise ratio(SNR), contrast to noise ratio(CNR), CT number. In addition, qualitative assessments to evaluate two people in the rich professional experience in Radiology by 0-3 points. We compared the total radiation dose, dose length product(DLP) and effective dose, volume computed tomography dose index(CTDIvol). The higher SAFIRE in the tube voltage 100 kVp, noise is reduced, CT number was increased. Thus, SNR and CNR was increased higher the SAFIRE step. Compared with the tube voltage 120 kVp, noise, SNR, CNR was most similar in SAFIRE strength 2 and 3. Qualitative assessment SAFIRE strength 2 is the most common SAFIRE strength 2 the most common qualitative assessment, if the tube voltage of 100 kVp when the quality of the images better evaluated was SAFIRE strength 1. Dose was reduced from 21.69%, in 100 kVp than 120 kVp. In the case of a relatively high BMI is not LDCT scan, When it is shipped from the factory tube voltage is set higher, unnecessary radiation exposure when considering the reality that is concerned, when according to the results of this study, set a lower tube voltage and adjust the SAFIRE strength to 1 or 2, the radiation without compromising image quality

  11. Hydroxychloroquine Blood Levels in SLE: Clarifying dosing controversies and improving adherence

    Science.gov (United States)

    Durcan, Laura; Clarke, William A; Magder, Laurence S.; Petri, Michelle

    2015-01-01

    OBJECTIVES Hydroxychloroquine is used for its effect on systemic lupus erythematosus (SLE) disease activity and long-term benefits. This can be limited by adherence. One way to assess adherence is to measure blood levels. Conflicting data exist regarding blood levels and disease activity. There is dosing controversy; rheumatologists recommend weight-based, while ophthalmologists advocate height-based ‘ideal body weight’ dosing. METHODS Patients were prescribed hydroxychloroquine not to exceed 6.5mg/kg (max400mg/day). In hemodialysis, the dose was 200mg after each session, in renal insufficiency it was 200mg/day. Levels were measured at each visit with a therapeutic range of 500-2000 ng/ml. Patients were divided according to baseline blood level. To assess the impact of measurement and counseling on adherence, we compared the proportion of patients with a level of 500ng/ml or higher based on how many prior assessments the patient had. RESULTS The proportion of patients with hydroxychloroquine levels in the therapeutic range differed significantly by age, gender and vitamin D level. There was a trend toward lower levels with renal failure. Blood levels were similar regardless of height and ideal body weight. Comparing those with undetectable, sub-therapeutic and therapeutic levels, disease activity decreased (SLEDAI 2.92, 2.36 and 2.20)(P=0.04, for trend). At first, 56% were therapeutic and by the third measurement this increased to 80% (p =hydroxychloroquine levels. Renal failure dosing led to sub-optimum levels. We show that weight-based dosing (max 400mg daily) is appropriate and that height does not appear to influence levels. Measurement, counseling and repeated testing can increase adherences rates. PMID:26428205

  12. Cocoa consumption dose-dependently improves flow-mediated dilation and arterial stiffness decreasing blood pressure in healthy individuals.

    Science.gov (United States)

    Grassi, Davide; Desideri, Giovambattista; Necozione, Stefano; di Giosia, Paolo; Barnabei, Remo; Allegaert, Leen; Bernaert, Herwig; Ferri, Claudio

    2015-02-01

    Cocoa flavonoids exert beneficial vascular effects and reduce the risk of cardiovascular morbidity and mortality. Nevertheless, the involved mechanisms have not been clarified and no study has yet focused on the dose-response effects. We aimed to investigate the effects of different doses of cocoa flavonoids on flow-mediated dilation (FMD), endothelin-1 (ET-1), pulse wave velocity (PWV), and SBP and DBP. According to a randomized, double-blind, controlled, cross-over design, 20 healthy volunteers (1.5% improvement in FMD in 20 individuals: 0.99 at alpha = 0.05) were assigned to receive either five treatments with daily intake of 10 g cocoa (0, 80, 200, 500 and 800 mg cocoa flavonoids/day) in five periods lasting 1 week each. Cocoa dose-dependently increased FMD from 6.2% (control) to 7.3, 7.6, 8.1 and 8.2% after the different flavonoid doses, respectively (P cocoa flavonoids per day increased FMD (P Cocoa dose-dependently decreased PWV (P Cocoa intake decreased office blood pressure (BP) (SBP: -4.8 ± 1.03  mmHg, P cocoa ingestion decreased 24-h (P = 0.05) and daytime (P = 0.038) SBP, and 24-h (P = 0.0064), daytime (P = 0.0088) and night-time (P = 0.0352) pulse pressure. Compared with the control, cocoa dose-dependently decreased ET-1 levels [from 17.1 (control) to 15.2, 14.5, 14.2 and 14.1 pg/ml, after the different flavonoid doses, respectively (P for treatment cocoa dose-dependently improved FMD and decreased PWV and ET-1 also by ameliorating office and monitored BP. Our findings are clinically relevant, suggesting cocoa, with very low calorie intake, might be reasonably incorporated into a dietary approach, representing a consistent tool in cardiovascular prevention.

  13. Biological dose estimation for charged-particle therapy using an improved PHITS code coupled with a microdosimetric kinetic model

    International Nuclear Information System (INIS)

    Sato, Tatsuhiko; Watanabe, Ritsuko; Kase, Yuki; Niita, Koji; Sihver, Lembit

    2009-01-01

    High-energy heavy ions (HZE particles) have become widely used for radiotherapy of tumors owing to their high biological effectiveness. In the treatment planning of such charged-particle therapy, it is necessary to estimate not only physical but also biological dose, which is the product of physical dose and relative biological effectiveness (RBE). In the Heavy-ion Medical Accelerator in Chiba (HIMAC), the biological dose is estimated by a method proposed by Kanai et al., which is based on the linear-quadratic (LQ) model with its parameters α and β determined by the dose distribution in terms of the unrestricted linear energy transfer (LET). Thus, RBE is simply expressed as a function of LET in their model. However, RBE of HZE particles cannot be uniquely determined from their LET because of their large cross sections for high-energy δ-ray production. Hence, development of a biological dose estimation model that can explicitly consider the track structure of δ-rays around the trajectory of HZE particles is urgently needed. Microdosimetric quantities such as lineal energy y are better indexes for representing RBE of HZE particles in comparison to LET, since they can express the decrease of ionization densities around their trajectories due to the production of δ-rays. The difference of the concept between LET and y is illustrated in Figure 1. However, the use of microdosimetric quantities in computational dosimetry was severely limited because of the difficulty in calculating their probability densities (PDs) in macroscopic matter. We therefore improved the 3-dimensional particle transport simulation code PHITS, providing it with the capability of estimating the microdosimetric PDs in a macroscopic framework by incorporating a mathematical function that can instantaneously calculate the PDs around the trajectory of HZE particles with precision equivalent to a microscopic track-structure simulation. A new method for estimating biological dose from charged

  14. Improvement of the clinical use of computed radiography for mobile chest imaging: Image quality and patient dose

    Science.gov (United States)

    Rill, Lynn Neitzey

    Chest radiography is technically difficult because of the wide variation of tissue attenuations in the chest and limitations of screen-film systems. Mobile chest radiography, performed bedside on hospital inpatients, presents additional difficulties due to geometrical and equipment limitations inherent to mobile x-ray procedures and the severity of illness in patients. Computed radiography (CR) offers a new approach for mobile chest radiography by utilizing a photostimulable phosphor. Photostimulable phosphors are more efficient in absorbing lower-energy x-rays than standard intensifying screens and overcome some image quality limitations of mobile chest imaging, particularly because of the inherent latitude. This study evaluated changes in imaging parameters for CR to take advantage of differences between CR and screen-film radiography. Two chest phantoms, made of acrylic and aluminum, simulated x-ray attenuation for average-sized and large- sized adult chests. The phantoms contained regions representing the lungs, heart and subdiaphragm. Acrylic and aluminum disks (1.9 cm diameter) were positioned in the chest regions to make signal-to-noise ratio (SNR) measurements for different combinations of imaging parameters. Disk thicknesses (contrast) were determined from disk visibility. Effective dose to the phantom was also measured for technique combinations. The results indicated that using an anti-scatter grid and lowering x- ray tube potential improved the SNR significantly; however, the dose to the phantom also increased. An evaluation was performed to examine the clinical applicability of the observed improvements in SNR. Parameter adjustments that improved phantom SNRs by more than 50% resulted in perceived image quality improvements in the lung region of clinical mobile chest radiographs. Parameters that produced smaller improvements in SNR had no apparent effect on clinical image quality. Based on this study, it is recommended that a 3:1 grid be used for

  15. Ultra-low-dose continuous combined estradiol and norethisterone acetate: improved bleeding profile in postmenopausal women

    DEFF Research Database (Denmark)

    Sturdee, D.W.; Archer, D.F.; Rakov, V.

    2008-01-01

    OBJECTIVE: To evaluate the effect of two ultra-low-dose hormone treatments containing estradiol (E2) 0.5 mg and norethisterone acetate (NETA) 0.1 or 0.25 mg on the endometrium and bleeding. METHODS: A prospective, randomized, placebo-controlled trial of 6 months. Local Ethics Committee approval...... and informed consent were obtained prior to initiation and enrollment. Out of 577 postmenopausal women randomized, 575 took E2/NETA 0.1 (n = 194), or E2/NETA 0.25 (n = 181) or placebo (n = 200). Endometrial bleeding was monitored by daily diary cards and endometrial thickness by transvaginal ultrasound......: The ultra-low-dose combination of E2/NETA 0.1 or E2/NETA 0.25 resulted in a high incidence of amenorrhea and no bleeding in postmenopausal women, and a corresponding high level of compliance. Overall, there was no significant change in mean endometrial thickness during 6 months of active treatment...

  16. A METHOD TO IMPROVE DOSE ASSESSMENT BY RECONSTRUCTION OF THE COMPLETE ISOTOPES INVENTORY.

    Science.gov (United States)

    Bonin, Alice; Tsilanizara, Aimé

    2017-06-01

    Radiation shielding assessments may underestimate the expected dose if some isotopes at trace level are not considered in the isotopes inventory of the shielded radioactive materials. Indeed, information about traces is not often available. Nevertheless, the activation of some minor isotopic traces may significantly contribute to the dose build-up. This paper presents a new method (Isotopes Inventory Reconstruction-IIR) estimating the concentration of the minor isotopes in the irradiated material at the beginning of the cooling period. The method requires the solution of the inverse problem describing the irradiated material's decay. In a mixture of an irradiated uranium-plutonium oxide shielded by a set-up made of stainless-steel, porous polyethylene plaster and lead methyl methacrylate, the comparison between different methods proves that the IIR-method allows better assessment of the dose than other approximate methods. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Improvements in the methods for optimising dose rate CTOR NPPs in the Russian Federation

    International Nuclear Information System (INIS)

    Noskov, A.A.

    1995-01-01

    The paper describes the results of a model investigation and an occupational radiation exposure analysis for reducing the collective doses on LWGMR nuclear power plants. The first RBMK NPP had been commissioned more than twenty years ago. It was the new generation unit of the Light Water Graphite Moderated Reactor (LWGMR). The RBMK-1000 occupational exposures were the same as or smaller than BWR doses. For example in 1980-1983 US BWR collective doses were 12.30-10.17 man-Sv per unit-year and the equivalent RBMK-1000 were 5.00-9.05 man-Sv per unit-year. A new generation of LWGMR, the MKER-800, is currently at the design stage and the design target for the plant is 1.0 man-Sv per GW(e)-year. There were three principal trends in the investigation of the occupational radiation exposure mechanism on LWMGR units. They were: (1) ionizing radiation sources; (2) radiation field distribution in the NPP compartments; (3) occupational radiation exposure profile. (author)

  18. Addition of low-dose ketamine to midazolam and low-dose bupivacaine improves hemodynamics and postoperative analgesia during spinal anesthesia for cesarean section

    Directory of Open Access Journals (Sweden)

    Ahmed Sobhy Basuni

    2016-01-01

    Conclusion: Intrathecal low-dose ketamine combined with midazolam and low-dose bupivacaine stabilizes hemodynamics and prolongs postoperative analgesia without significant side-effects in parturients undergoing CS.

  19. Improved dose-volume histogram estimates for radiopharmaceutical therapy by optimizing quantitative SPECT reconstruction parameters

    Science.gov (United States)

    Cheng, Lishui; Hobbs, Robert F.; Segars, Paul W.; Sgouros, George; Frey, Eric C.

    2013-06-01

    In radiopharmaceutical therapy, an understanding of the dose distribution in normal and target tissues is important for optimizing treatment. Three-dimensional (3D) dosimetry takes into account patient anatomy and the nonuniform uptake of radiopharmaceuticals in tissues. Dose-volume histograms (DVHs) provide a useful summary representation of the 3D dose distribution and have been widely used for external beam treatment planning. Reliable 3D dosimetry requires an accurate 3D radioactivity distribution as the input. However, activity distribution estimates from SPECT are corrupted by noise and partial volume effects (PVEs). In this work, we systematically investigated OS-EM based quantitative SPECT (QSPECT) image reconstruction in terms of its effect on DVHs estimates. A modified 3D NURBS-based Cardiac-Torso (NCAT) phantom that incorporated a non-uniform kidney model and clinically realistic organ activities and biokinetics was used. Projections were generated using a Monte Carlo (MC) simulation; noise effects were studied using 50 noise realizations with clinical count levels. Activity images were reconstructed using QSPECT with compensation for attenuation, scatter and collimator-detector response (CDR). Dose rate distributions were estimated by convolution of the activity image with a voxel S kernel. Cumulative DVHs were calculated from the phantom and QSPECT images and compared both qualitatively and quantitatively. We found that noise, PVEs, and ringing artifacts due to CDR compensation all degraded histogram estimates. Low-pass filtering and early termination of the iterative process were needed to reduce the effects of noise and ringing artifacts on DVHs, but resulted in increased degradations due to PVEs. Large objects with few features, such as the liver, had more accurate histogram estimates and required fewer iterations and more smoothing for optimal results. Smaller objects with fine details, such as the kidneys, required more iterations and less

  20. Improvement of quality of radiation indicators used for food irradiation in dose range of 3-10 kGy

    International Nuclear Information System (INIS)

    Hoang Hoa Mai; Pham Duy Duong; Nguyen Dinh Duong

    2007-01-01

    A sensitive indicators based on the polyvinyl butyral dyed with leuco-malachite green and methyl orange were made for use as devices for discriminating and monitoring radiation treatment in food irradiation. The sensitivity and stability of the indicator have been improved by using several additives such as CCl 4 in combination with di(nonylphenyl) isophthalate [dinonyl phthalate -C 6 H 4 (COOC 9 H 19 ) 2 ]. The dosimeters change their color from orange to greenish when irradiated with gamma rays or electrons to dose just about 2 kGy. The greenish continue to develop to deep-green upon the increase of dose to 7 kGy. This makes the indicators useful for the dose range of food irradiation application, especially in treatment of frozen meat and sea products for elimination of micro-organism. The quality of indicators are also improved by adjusting of factors and procedures during preparation of film and dosimeters. The indicators were produced in a stick-on label type showing attractive characteristics in use. The orange color before irradiation keep well stable for as long as 20 months under normal conditions in laboratory. The green after irradiation was maintained up to 12 months in piratical conditions of products. The indicator can be produced in big amount to supply to the irradiation facilities in Vietnam instead of imported devices. (author)

  1. CT image quality improvement using adaptive iterative dose reduction with wide-volume acquisition on 320-detector CT

    International Nuclear Information System (INIS)

    Gervaise, Alban; Osemont, Benoit; Lecocq, Sophie; Blum, Alain; Noel, Alain; Micard, Emilien; Felblinger, Jacques

    2012-01-01

    To evaluate the impact of Adaptive Iterative Dose Reduction (AIDR) on image quality and radiation dose in phantom and patient studies. A phantom was examined in volumetric mode on a 320-detector CT at different tube currents from 25 to 550 mAs. CT images were reconstructed with AIDR and with Filtered Back Projection (FBP) reconstruction algorithm. Image noise, Contrast-to-Noise Ratio (CNR), Signal-to-Noise Ratio (SNR) and spatial resolution were compared between FBP and AIDR images. AIDR was then tested on 15 CT examinations of the lumbar spine in a prospective study. Again, FBP and AIDR images were compared. Image noise and SNR were analysed using a Wilcoxon signed-rank test. In the phantom, spatial resolution assessment showed no significant difference between FBP and AIDR reconstructions. Image noise was lower with AIDR than with FBP images with a mean reduction of 40%. CNR and SNR were also improved with AIDR. In patients, quantitative and subjective evaluation showed that image noise was significantly lower with AIDR than with FBP. SNR was also greater with AIDR than with FBP. Compared to traditional FBP reconstruction techniques, AIDR significantly improves image quality and has the potential to decrease radiation dose. (orig.)

  2. Calculations on the dose decreasing and image quality improving effects of an abdomen dodger

    International Nuclear Information System (INIS)

    Koblinger, L.

    1974-07-01

    A Monte Carlo computer program is performed to study the effects of an abdomen dodger. For this study the inhomogeneous Snyder phantom is assumed to be irradiated by an X-ray tube operated at 80 kV. By the use of a dodger which compensates the varying thickness of the body the exposure distribution on the photoreceptor can be made more uniform and the absorbed dose decreases. As different patients have different dimensions, the results presented here cannot be applied for any given abdomen examination, but can be used as average values, characteristic for an average examination, thus applicable in the estimations for the total population. (K.A.)

  3. Single doses of Panax ginseng (G115) reduce blood glucose levels and improve cognitive performance during sustained mental activity.

    Science.gov (United States)

    Reay, Jonathon L; Kennedy, David O; Scholey, Andrew B

    2005-07-01

    Single doses of the traditional herbal treatment Panax ginseng have recently been shown to elicit cognitive improvements in healthy young volunteers. The mechanisms by which ginseng improves cognitive performance are not known. However, they may be related to the glycaemic properties of some Panax species. Using a double-blind, placebo-controlled, balanced crossover design, 30 healthy young adults completed a 10 min test battery at baseline, and then six times in immediate succession commencing 60 min after the day's treatment (placebo, 200mg G115 or 400mg G115). The 10 min battery comprised a Serial Threes subtraction task (2 min); a Serial Sevens task (2 min); a Rapid Visual Information Processing task (5 min); then a 'mental fatigue' visual analogue scale. Blood glucose was measured prior to each day's treatment, and before, during and after the post-dose completions of the battery. Both the 200mg and 400mg treatments led to significant reductions in blood glucose levels at all three post-treatment measurements (p 0.005 in all cases). The most notable behavioural effects were associated with 200mg of ginseng and included significantly improved Serial Sevens subtraction task performance and significantly reduced subjective mental fatigue throughout all (with the exception of one time point in each case) of the post-dose completions of the 10 min battery (p 0.05). Overall these data suggest that Panax ginseng can improve performance and subjective feelings of mental fatigue during sustained mental activity. This effect may be related to the acute gluco-regulatory properties of the extract.

  4. The Radiobiological Basis for Improvements in Radiotherapy and Low Dose Risk Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Hei, Tom K. [Columbia Univ., New York, NY (United States)

    2009-12-09

    This conference grant was proposed to organize and host an international conference at Columbia University in New York to critically assess the cellular and molecular signaling events and tissue response following radiation damage. The conference would also serve as a venue to play tribute to the more than forty years contributions made by Professor Eric J. Hall to the radiation biology field. The goals of the meeting were to examine tumor hypoxia and sensitizer development; recent advances made in clinical radiotherapy; addressed several low dose phenomena, including genomic instability and bystander effects that are important in radiation risk assessment. Study and Results: The symposium was held on October 13th and 14th, 2008 at the Alfred Lerner Hall in the Morningside campus of Columbia University. The symposium, entitled “From Beans to Genes: A Forty Year Odyssey in Radiation Biology” was attended by more than 120 faculty, scientists, clinicians, fellows and students. The symposium, spanned over a day and a half, covered four scientific themes. These included tumor hypoxia and radiosensitizers; low dose radiation response; radiation biology in the practice of radiotherapy, and radiation hazard in space and genetic predisposition to cancer. The program of the symposium is as follow:

  5. A programme to reduce down-time and site radiation dose through improvements in control rod design

    International Nuclear Information System (INIS)

    Izatt, J.A.; Scobie, J.

    1985-01-01

    On the UTR-300 reactor at SURRC, it has been found necessary to carry out preventive or remedial maintenance at least once per year on the in-core elements of the control rod assemblies. This has led to reduced availability of the reactor and to significant overall radiation doses to the few long-serving staff members who carry out this work. In an attempt to reduce down-time and radiation dose to staff a radical re-design of the control assemblies was undertaken in-house, and a conversion programme has been underway over the last four years. Details of the design improvements are presented together with a discussion of the operating experience to date. (author)

  6. Incidence of intracranial bleeds in new users of low-dose aspirin: a cohort study using The Health Improvement Network.

    Science.gov (United States)

    Cea Soriano, L; Gaist, D; Soriano-Gabarró, M; García Rodríguez, L A

    2017-06-01

    Essentials Intracranial bleeds (ICB) are serious clinical events that have been associated with aspirin use. Incidence rates of ICB were calculated among new-users of low-dose aspirin in the UK (2000-2012). Over a median follow-up of 5.58 years, the incidence of ICB was 0.08 per 100 person-years. Our estimates are valuable for inclusion in risk-benefit assessments of low-dose aspirin use. Background Low-dose aspirin protects against both ischemic cardiovascular (CV) events and colorectal cancer (CRC). However, low-dose aspirin may be associated with a slightly increased risk of intracranial bleeds (ICBs). Objectives To obtain the incidence rates of ICBs overall and by patient subgroups among new users of low-dose aspirin. Patients/Methods Using The Health Improvement Network (THIN) UK primary-care database (2000-2012), we identified a cohort of new users of low-dose aspirin aged 40-84 years (N = 199 079; mean age at start of follow-up, 63.9 years) and followed them for up to 14 years (median 5.58 years). Incident ICB cases were identified and validated through linkage to hospitalization data and/or review of THIN records with free-text comments. Incidence rates with 95% confidence intervals (CIs) were calculated. Results Eight hundred and eighty-one incident ICBs cases were identified: 407 cases of intracerebral hemorrhage (ICH), 283 cases of subdural hematoma (SDH), and 191 cases of subarachnoid hemorrhage (SAH). Incidence rates per 100 person-years were 0.08 (95% CI 0.07-0.08) for all ICBs, 0.04 (95% CI 0.03-0.04) for ICH, 0.03 (95% CI 0.02-0.03) for SDH, and 0.02 (95% CI 0.01-0.02) for SAH. The ICB incidence rates per 100 person-years for individuals with an indication of primary CV disease prevention were 0.07 (95% CI 0.06-0.07) and 0.09 (95% CI 0.08-0.10) for secondary CV disease prevention. Incidence rates were higher in men for SDH, and higher in women for ICH and SAH. Conclusions Our results provide valuable estimates of the absolute ICB risk for

  7. Sterile insect technique: A model for dose optimisation for improved sterile insect quality

    International Nuclear Information System (INIS)

    Parker, A.; Mehta, K.

    2007-01-01

    The sterile insect technique (SIT) is an environment-friendly pest control technique with application in the area-wide integrated control of key pests, including the suppression or elimination of introduced populations and the exclusion of new introductions. Reproductive sterility is normally induced by ionizing radiation, a convenient and consistent method that maintains a reasonable degree of competitiveness in the released insects. The cost and effectiveness of a control program integrating the SIT depend on the balance between sterility and competitiveness, but it appears that current operational programs with an SIT component are not achieving an appropriate balance. In this paper we discuss optimization of the sterilization process and present a simple model and procedure for determining the optimum dose. (author) [es

  8. Improving the dose-myelotoxicity correlation in radiometabolic therapy of bone metastases with {sup 153}Sm-EDTMP

    Energy Technology Data Exchange (ETDEWEB)

    Pacilio, Massimiliano; Basile, Chiara [Azienda Ospedaliera San Camillo Forlanini, Rome (Italy). Dept. of Medical Physics; Ventroni, Guido; Mango, Lucio [Azienda Ospedaliera San Camillo Forlanini, Rome (Italy). Dept. of Nuclear Medicine; Ialongo, Pasquale [Azienda Ospedaliera San Camillo Forlanini, Rome (Italy). Dept. of Radiology; Becci, Domenico [University of Rome, Health Physics Postgraduate School, Rome (Italy)

    2014-02-15

    {sup 153}Sm-ethylene diamine tetramethylene phosphonic acid ({sup 153}Sm-EDTMP) is widely used to palliate pain from bone metastases, and is being studied for combination therapy beyond palliation. Conceptually, red marrow (RM) dosimetry allows myelotoxicity to be predicted, but the correlation is poor due to dosimetric uncertainty, individual sensitivity and biological effects from previous treatments. According to EANM guidelines, basic dosimetric procedures have been studied to improve the correlation between dosimetry and myelotoxicity in {sup 153}Sm-EDTMP therapy. RM dosimetry for 33 treatments of bone metastases from breast, prostate and lung tumours was performed prospectively (with {sup 99m}Tc-MDP) and retrospectively, acquiring whole-body scans early and late after injection. The {sup 153}Sm-EDTMP activity was calculated by prospective dosimetry based on measured skeletal uptake and full physical retention, with the RM absorbed dose not exceeding 3.8 Gy. Patient-specific RM mass was evaluated by scaling in terms of body weight (BW), lean body mass (LBM) and trabecular volume (TV) estimated from CT scans of the L2-L4 vertebrae. Correlations with toxicity were determined in a selected subgroup of 27 patients, in which a better correlation between dosimetry and myelotoxicity was expected. Skeletal uptakes of {sup 99m}Tc and {sup 153}Sm (Tc{sub %} and Sm{sub %}) were well correlated. The median Sm{sub %} was higher in prostate cancer (75.3 %) than in lung (60.5 %, p = 0.005) or breast (60.8 %, p = 0.008). PLT and WBC nadirs were not correlated with administered activity, but were weakly correlated with uncorrected RM absorbed doses, and the correlation improved after rescaling in terms of BW, LBM and TV. Most patients showed transient toxicity (grade 1-3), which completely and spontaneously recovered over a few days. Using TV, RM absorbed dose was in the range 2-5 Gy, with a median of 312 cGy for PLT in patients with toxicity and 247 cGy in those with no

  9. Multi-dose drug dispensing as a tool to improve medication adherence: A study in patients using vitamin K antagonists.

    Science.gov (United States)

    van Rein, Nienke; de Geus, Kristel S; Cannegieter, Suzanne C; Reitsma, Pieter H; van der Meer, Felix J M; Lijfering, Willem M

    2018-01-01

    Multi-dose drug dispensing (MDD) is a dosing aid that provides patients with disposable bags containing all drugs intended for 1 dosing moment. MDD is believed to increase medication adherence, but studies are based on self-reported data, and results may depend on socially desirable answers. Therefore, our purpose was to determine the effect of MDD on medication adherence in non-adherent patients taking vitamin K antagonists (VKAs), and to compare with instructing patients on medication use. We conducted a before-after study in non-adherent patients where MDD was the exposure and change in adherence after MDD initiation was the outcome (within patient comparison). Time in therapeutic range (TTR) was selected as a measure for adherence, as this reflects stability of VKA treatment. To analyze whether MDD improved adherence as compared with standard care (ie, letters or calls from nurses of the anticoagulation clinic), non-adherent patients without MDD were also followed to estimate their TTR change over time (between patient comparison). Eighty-three non-adherent VKA patients started using MDD. The median TTR was 63% before MDD and 73% 6 months after MDD. The within patient TTR increased on average by 13% (95%CI 6% to 21%) within 1 month after starting MDD and remained stable during the next 5 months. The TTR of MDD-patients increased 10% (95%CI 2% to 19%) higher as compared with non-MDD patients within 1 month but was similar after 4 months (TTR difference 3%, 95%CI -2% to 9%). Adherence improved after initiation of MDD. Compared with instructing patients, MDD was associated with better adherence within 1 month but was associated with similar improvement after 4 months. Copyright © 2017 John Wiley & Sons, Ltd.

  10. Multi-objective optimization strategy based on desirability functions used for electrophoratic separation and quantification of rosiglitazone and glimepiride in plasma and formulations.

    Science.gov (United States)

    Hefnawy, Mohamed M; Sultan, Maha A; Al-Johar, Haya I; Kassem, Mohamed G; Aboul-Enein, Hassan Y

    2012-01-01

    Multiple response simultaneous optimization employing Derringer's desirability function was used for the development of a capillary electrophoresis method for the simultaneous determination of rosiglitazone (RSG) and glimepiride (GLM) in plasma and formulations. Twenty experiments, taking the two resolutions, the analysis time, and the capillary current as the responses with three important factors--buffer morality, volte and column temperature--were used to design mathematical models. The experimental responses were fitted into a second order polynomial and the six responses were simultaneously optimized to predict the optimum conditions for the effective separation of the studied compounds. The separation was carried out by using capillary zone electrophoresis (CZE) with a silica capillary column and diode array detector at 210 nm. The optimum assay conditions were 52 mmol l⁻¹ phosphate buffer, pH 7, and voltage of 22 kV at 29 °C. The method showed good agreement between the experimental data and predictive value throughout the studied parameter space. The assay limit of detection was 0.02 µg ml⁻¹ and the effective working range at relative standard deviation (RSD) of ≤ 5% was 0.05-16 µg ml⁻¹ (r = 0.999) for both drugs. Analytical recoveries of the studied drugs from spiked plasma were 97.2-101.9 ± 0.31-3.0%. The precision of the assay was satisfactory; RSD was 1.07 and 1.14 for intra- and inter-assay precision, respectively. The proposed method has a great value in routine analysis of RSG and GLM for its therapeutic monitoring and pharmacokinetic studies. Copyright © 2011 John Wiley & Sons, Ltd.

  11. Equally sloped X-ray microtomography of living insects with low radiation dose and improved resolution capability

    International Nuclear Information System (INIS)

    Yao, Shengkun; Fan, Jiadong; Zong, Yunbing; Sun, Zhibin; Zhang, Jianhua; Jiang, Huaidong; He, You; Zhou, Guangzhao; Xiao, Tiqiao; Huang, Qingjie

    2016-01-01

    Three-dimensional X-ray imaging of living specimens is challenging due to the limited resolution of conventional absorption contrast X-ray imaging and potential irradiation damage of biological specimens. In this letter, we present microtomography of a living specimen combining phase-contrast imaging and a Fourier-based iterative algorithm termed equally sloped tomography. Non-destructive 3D imaging of an anesthetized living yellow mealworm Tenebrio molitor was demonstrated with a relatively low dose using synchrotron generated X-rays. Based on the high-quality 3D images, branching tracheoles and different tissues of the insect in a natural state were identified and analyzed, demonstrating a significant advantage of the technique over conventional X-ray radiography or histotomy. Additionally, the insect survived without problem after a 1.92-s X-ray exposure and subsequent absorbed radiation dose of ∼1.2 Gy. No notable physiological effects were observed after reviving the insect from anesthesia. The improved static tomographic method demonstrated in this letter shows advantage in the non-destructive structural investigation of living insects in three dimensions due to the low radiation dose and high resolution capability, and offers many potential applications in biological science.

  12. Equally sloped X-ray microtomography of living insects with low radiation dose and improved resolution capability

    Science.gov (United States)

    Yao, Shengkun; Fan, Jiadong; Zong, Yunbing; He, You; Zhou, Guangzhao; Sun, Zhibin; Zhang, Jianhua; Huang, Qingjie; Xiao, Tiqiao; Jiang, Huaidong

    2016-03-01

    Three-dimensional X-ray imaging of living specimens is challenging due to the limited resolution of conventional absorption contrast X-ray imaging and potential irradiation damage of biological specimens. In this letter, we present microtomography of a living specimen combining phase-contrast imaging and a Fourier-based iterative algorithm termed equally sloped tomography. Non-destructive 3D imaging of an anesthetized living yellow mealworm Tenebrio molitor was demonstrated with a relatively low dose using synchrotron generated X-rays. Based on the high-quality 3D images, branching tracheoles and different tissues of the insect in a natural state were identified and analyzed, demonstrating a significant advantage of the technique over conventional X-ray radiography or histotomy. Additionally, the insect survived without problem after a 1.92-s X-ray exposure and subsequent absorbed radiation dose of ˜1.2 Gy. No notable physiological effects were observed after reviving the insect from anesthesia. The improved static tomographic method demonstrated in this letter shows advantage in the non-destructive structural investigation of living insects in three dimensions due to the low radiation dose and high resolution capability, and offers many potential applications in biological science.

  13. Optimizing the dosing schedule of l-asparaginase improves its anti-tumor activity in breast tumor-bearing mice

    Directory of Open Access Journals (Sweden)

    Shoya Shiromizu

    2018-04-01

    Full Text Available Proliferation of acute lymphoblastic leukemic cells is nutritionally dependent on the external supply of asparagine. l-asparaginase, an enzyme hydrolyzing l-asparagine in blood, is used for treatment of acute lymphoblastic leukemic and other related blood cancers. Although previous studies demonstrated that l-asparaginase suppresses the proliferation of cultured solid tumor cells, it remains unclear whether this enzyme prevents the growth of solid tumors in vivo. In this study, we demonstrated the importance of optimizing dosing schedules for the anti-tumor activity of l-asparaginase in 4T1 breast tumor-bearing mice. Cultures of several types of murine solid tumor cells were dependent on the external supply of asparagine. Among them, we selected murine 4T1 breast cancer cells and implanted them into BALB/c female mice kept under standardized light/dark cycle conditions. The growth of 4T1 tumor cells implanted in mice was significantly suppressed by intravenous administration of l-asparaginase during the light phase, whereas its administration during the dark phase failed to show significant anti-tumor activity. Decreases in plasma asparagine levels due to the administration of l-asparaginase were closely related to the dosing time-dependency of its anti-tumor effects. These results suggest that the anti-tumor efficacy of l-asparaginase in breast tumor-bearing mice is improved by optimizing the dosing schedule. Keywords: l-asparaginase, Asparagine, Solid tumor, Chrono-pharmacotherapy

  14. Equally sloped X-ray microtomography of living insects with low radiation dose and improved resolution capability

    Energy Technology Data Exchange (ETDEWEB)

    Yao, Shengkun; Fan, Jiadong; Zong, Yunbing; Sun, Zhibin; Zhang, Jianhua; Jiang, Huaidong, E-mail: hdjiang@sdu.edu.cn [State Key Laboratory of Crystal Materials, Shandong University, Jinan 250100 (China); He, You; Zhou, Guangzhao; Xiao, Tiqiao [Shanghai Synchrotron Radiation Facility, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800 (China); Huang, Qingjie [School of Information Science and Engineering, Shandong University, Jinan 250100 (China)

    2016-03-21

    Three-dimensional X-ray imaging of living specimens is challenging due to the limited resolution of conventional absorption contrast X-ray imaging and potential irradiation damage of biological specimens. In this letter, we present microtomography of a living specimen combining phase-contrast imaging and a Fourier-based iterative algorithm termed equally sloped tomography. Non-destructive 3D imaging of an anesthetized living yellow mealworm Tenebrio molitor was demonstrated with a relatively low dose using synchrotron generated X-rays. Based on the high-quality 3D images, branching tracheoles and different tissues of the insect in a natural state were identified and analyzed, demonstrating a significant advantage of the technique over conventional X-ray radiography or histotomy. Additionally, the insect survived without problem after a 1.92-s X-ray exposure and subsequent absorbed radiation dose of ∼1.2 Gy. No notable physiological effects were observed after reviving the insect from anesthesia. The improved static tomographic method demonstrated in this letter shows advantage in the non-destructive structural investigation of living insects in three dimensions due to the low radiation dose and high resolution capability, and offers many potential applications in biological science.

  15. Optimizing the dosing schedule of l-asparaginase improves its anti-tumor activity in breast tumor-bearing mice.

    Science.gov (United States)

    Shiromizu, Shoya; Kusunose, Naoki; Matsunaga, Naoya; Koyanagi, Satoru; Ohdo, Shigehiro

    2018-04-01

    Proliferation of acute lymphoblastic leukemic cells is nutritionally dependent on the external supply of asparagine. l-asparaginase, an enzyme hydrolyzing l-asparagine in blood, is used for treatment of acute lymphoblastic leukemic and other related blood cancers. Although previous studies demonstrated that l-asparaginase suppresses the proliferation of cultured solid tumor cells, it remains unclear whether this enzyme prevents the growth of solid tumors in vivo. In this study, we demonstrated the importance of optimizing dosing schedules for the anti-tumor activity of l-asparaginase in 4T1 breast tumor-bearing mice. Cultures of several types of murine solid tumor cells were dependent on the external supply of asparagine. Among them, we selected murine 4T1 breast cancer cells and implanted them into BALB/c female mice kept under standardized light/dark cycle conditions. The growth of 4T1 tumor cells implanted in mice was significantly suppressed by intravenous administration of l-asparaginase during the light phase, whereas its administration during the dark phase failed to show significant anti-tumor activity. Decreases in plasma asparagine levels due to the administration of l-asparaginase were closely related to the dosing time-dependency of its anti-tumor effects. These results suggest that the anti-tumor efficacy of l-asparaginase in breast tumor-bearing mice is improved by optimizing the dosing schedule. Copyright © 2018 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  16. A programme to reduce down-time and site radiation dose through improvements in control rod design

    International Nuclear Information System (INIS)

    Izatt, J.A.; Scobie, J.

    1983-01-01

    In many nuclear facilities a high proportion of the total radiation dose to staff may be ascribed to very few routine operations. Often this critical operation will require significant shut-down time, both to perform the function itself and to allow sufficient decay time to reduce radiation levels to acceptable values. This situation arises on the UTR-300 reactor at S.U.R.R.C., where over the twenty years of operation it has been found necessary to carry out preventive, and on some occasions remedial, maintenance at least once per year on the in-core elements of the control rod assemblies. This had led inevitably to reduced availability of the reactor and to significant overall radiation doses to the few long-serving staff members who carry out this work. The source of the problem seems to lie in the basic design of the assemblies, which may have been adequate for the original 10 KW versions of this reactor, but has proven to be deficient in several respects at the present 300 KW operating level. In an attempt to reduce down-time and radiation dose to staff a radical re-design of the control assemblies was undertaken in-house, and a conversion programme has been underway over the last two years. Details of the design improvements are presented with a discussion of the operating experience to date. (author)

  17. Radiotherapy reference dose audit in the United Kingdom by the National Physical Laboratory: 20 years of consistency and improvements

    Directory of Open Access Journals (Sweden)

    Russell A.S. Thomas

    2017-07-01

    Conclusions: The introduction of the 2003 electron code of practice based on absorbed dose to water decreased the difference between absolute dose measurements by the centre and NPL. The use of a single photon code of practice over the period of measurements has contributed to a reduction in measurement variation. Within the clinical setting, on-site audit visits have been shown to identify areas of improvement for determining and implementing absolute dose calibrations.

  18. Leveraging multi-layer imager detector design to improve low-dose performance for megavoltage cone-beam computed tomography

    Science.gov (United States)

    Hu, Yue-Houng; Rottmann, Joerg; Fueglistaller, Rony; Myronakis, Marios; Wang, Adam; Huber, Pascal; Shedlock, Daniel; Morf, Daniel; Baturin, Paul; Star-Lack, Josh; Berbeco, Ross

    2018-02-01

    While megavoltage cone-beam computed tomography (CBCT) using an electronic portal imaging device (EPID) provides many advantages over kilovoltage (kV) CBCT, clinical adoption is limited by its high doses. Multi-layer imager (MLI) EPIDs increase DQE(0) while maintaining high resolution. However, even well-designed, high-performance MLIs suffer from increased electronic noise from each readout, degrading low-dose image quality. To improve low-dose performance, shift-and-bin addition (ShiBA) imaging is proposed, leveraging the unique architecture of the MLI. ShiBA combines hardware readout-binning and super-resolution concepts, reducing electronic noise while maintaining native image sampling. The imaging performance of full-resolution (FR); standard, aligned binned (BIN); and ShiBA images in terms of noise power spectrum (NPS), electronic NPS, modulation transfer function (MTF), and the ideal observer signal-to-noise ratio (SNR)—the detectability index (d‧)—are compared. The FR 4-layer readout of the prototype MLI exhibits an electronic NPS magnitude 6-times higher than a state-of-the-art single layer (SLI) EPID. Although the MLI is built on the same readout platform as the SLI, with each layer exhibiting equivalent electronic noise, the multi-stage readout of the MLI results in electronic noise 50% higher than simple summation. Electronic noise is mitigated in both BIN and ShiBA imaging, reducing its total by ~12 times. ShiBA further reduces the NPS, effectively upsampling the image, resulting in a multiplication by a sinc2 function. Normalized NPS show that neither ShiBA nor BIN otherwise affects image noise. The LSF shows that ShiBA removes the pixilation artifact of BIN images and mitigates the effect of detector shift, but does not quantifiably improve the MTF. ShiBA provides a pre-sampled representation of the images, mitigating phase dependence. Hardware binning strategies lower the quantum noise floor, with 2  ×  2 implementation reducing the

  19. Canagliflozin improves risk factors of metabolic syndrome in patients with type 2 diabetes mellitus and metabolic syndrome

    Directory of Open Access Journals (Sweden)

    Davies MJ

    2017-01-01

    Full Text Available Michael J Davies,1 Katherine W Merton,1 Ujjwala Vijapurkar,2 Dainius A Balis,2 Mehul Desai2 1Janssen Scientific Affairs, LLC, Titusville, NJ, USA; 2Janssen Research & Development, LLC, Raritan, NJ, USA Objective: Metabolic syndrome refers to a collection of risk factors associated with the development of cardiovascular disease and type 2 diabetes mellitus (T2DM. Canagliflozin, a sodium glucose co-transporter 2 inhibitor, improves glycemic control and reduces body weight and blood pressure (BP in a broad range of patients with T2DM. This post hoc analysis assessed the effects of canagliflozin on the components of metabolic syndrome in patients with T2DM and metabolic syndrome.Methods: This analysis was based on data from 2 head-to-head studies of canagliflozin in patients with T2DM on background metformin versus glimepiride (study 1 and background metformin plus sulfonylurea versus sitagliptin 100 mg (study 2. Changes from baseline in glycemic efficacy, anthropometric measures, BP, and lipids were evaluated with canagliflozin versus glimepiride and sitagliptin at week 52 in patients who met ≥2 of the criteria for metabolic syndrome (in addition to T2DM: triglycerides ≥1.7 mmol/L; high-density lipoprotein cholesterol (HDL-C <1.0 mmol/L (men or <1.3 mmol/L (women; waist circumference ≥102 cm (non-Asian men, ≥88 cm (non-Asian women, >90 cm (Asian men, or >80 cm (Asian women; diagnosis of hypertension or meeting BP-related criteria (systolic BP ≥130 mmHg or diastolic BP ≥85 mmHg. Safety was assessed based on adverse event reports.Results: In study 1, canagliflozin 100 and 300 mg provided similar and greater HbA1c reductions versus glimepiride, respectively. In study 2, canagliflozin 300 mg provided greater HbA1c lowering versus sitagliptin 100 mg. Canagliflozin also reduced fasting plasma glucose, body weight, body mass index, waist circumference, BP, and triglycerides, and increased HDL-C and low-density lipoprotein cholesterol versus

  20. Optimization of CW-OSL parameters for improved dose detection threshold in Al2O3:C

    International Nuclear Information System (INIS)

    Rawat, N.S.; Dhabekar, B.; Kulkarni, M.S.; Muthe, K.P.; Mishra, D.R.; Soni, A.; Gupta, S.K.; Babu, D.A.R.

    2014-01-01

    Continuous wave optically stimulated luminescence (CW-OSL) is relatively a simple technique that offers good signal to noise ratio (SNR) and involves simple instrumentation. This study reports the influence and optimization of CW-OSL parameters on minimum detectable dose (MDD) using α-Al 2 O 3 :C phosphor. It is found that at a given stimulation intensity MDD in CW-OSL mode depends on signal integration time. At lower integration times MDD is inferior. It exhibits an improvement for intermediate values, shows a plateau region and deteriorates as integration time increases further. MDD is found to be ∼127 μGy at 4 mW/cm 2 stimulation intensity for integration time of 0.1 s, which improves to ∼10.5 μGy for 60 s. At stimulation intensity of 72 mW/cm 2 , MDD is 37 μGy for integration time of 60 s and improves significantly to 7 μGy for 1 s. - Highlights: • CW-OSL parameters are optimized to obtain best SNR and MDD in Al 2 O 3 :C. • MDD is found to depend on signal integration time and stimulation intensity. • With time, MDD initially improves, stabilizes then deteriorates. • At a given intensity, MDD is optimum for a certain range of integration time

  1. Simulated rat intestinal fluid improves oral exposure prediction for poorly soluble compounds over a wide dose range

    Directory of Open Access Journals (Sweden)

    Joerg Berghausen

    2016-03-01

    Full Text Available Solubility can be the absorption limiting factor for drug candidates and is therefore a very important input parameter for oral exposure prediction of compounds with limited solubility. Biorelevant media of the fasted and fed state have been published for humans, as well as for dogs in the fasted state. In a drug discovery environment, rodents are the most common animal model to assess the oral exposure of drug candidates. In this study a rat simulated intestinal fluid (rSIF is proposed as a more physiologically relevant media to describe drug solubility in rats. Equilibrium solubility in this medium was tested as input parameter for physiologically-based pharmacokinetics (PBPK simulations of oral pharmacokinetics in the rat. Simulations were compared to those obtained using other solubility values as input parameters, like buffer at pH 6.8, human simulated intestinal fluid and a comprehensive dissolution assay based on rSIF. Our study on nine different compounds demonstrates that the incorporation of rSIF equilibrium solubility values into PBPK models of oral drug exposure can significantly improve the reliability of simulations in rats for doses up to 300 mg/kg compared to other media. The comprehensive dissolution assay may help to improve further simulation outcome, but the greater experimental effort as compared to equilibrium solubility may limit its use in a drug discovery environment. Overall, PBPK simulations based on solubility in the proposed rSIF medium can improve prioritizing compounds in drug discovery as well as planning dose escalation studies, e.g. during toxicological investigations.

  2. Modafinil improves attentional performance in healthy, non-sleep deprived humans at doses not inducing hyperarousal across species.

    Science.gov (United States)

    Cope, Zackary A; Minassian, Arpi; Kreitner, Dustin; MacQueen, David A; Milienne-Petiot, Morgane; Geyer, Mark A; Perry, William; Young, Jared W

    2017-10-01

    The wake-promoting drug modafinil is frequently used off-label to improve cognition in psychiatric and academic populations alike. The domain-specific attentional benefits of modafinil have yet to be quantified objectively in healthy human volunteers using tasks validated for comparison across species. Further, given that modafinil is a low-affinity inhibitor for the dopamine and norepinephrine transporters (DAT/NET respectively) it is unclear if any effects are attributable to a non-specific increase in arousal, a feature of many catecholamine reuptake inhibitors (e.g., cocaine, amphetamine). These experiments were designed to test for domain-specific enhancement of attention and cognitive control by modafinil (200 and 400 mg) in healthy volunteers using the 5-choice continuous performance task (5C-CPT) and Wisconsin Card Sort Task (WCST). An additional cross-species assessment of arousal and hyperactivity was performed in this group and in mice (3.2, 10, or 32 mg/kg) using species-specific versions of the behavioral pattern monitor (BPM). Modafinil significantly enhanced attention (d prime) in humans performing the 5C-CPT at doses that did not affect WCST performance or induce hyperactivity in the BPM. In mice, only the highest dose elicited increased activity in the BPM. These results indicate that modafinil produces domain-specific enhancement of attention in humans not driven by hyperarousal, unlike other drugs in this class, and higher equivalent doses were required for hyperarousal in mice. Further, these data support the utility of using the 5C-CPT across species to more precisely determine the mechanism(s) underlying the pro-cognitive effects of modafinil and potentially other pharmacological treatments. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Head CT: Image quality improvement with ASIR-V using a reduced radiation dose protocol for children

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Gi [Ajou University School of Medicine, Ajou University Medical Center, Department of Radiology, Yeongtong-gu, Suwon (Korea, Republic of); Lee, Ho-Joon; Lee, Seung-Koo; Kim, Myung-Joon [Severance Hospital, Yonsei University College of Medicine, Department of Radiology and Research Institute of Radiological Science, Seodaemun-gu, Seoul (Korea, Republic of); Kim, Hyun Ji [Ajou University School of Medicine, Office of Biostatistics, Department of Humanities and Social Medicine, Yeongtong-gu, Suwon (Korea, Republic of)

    2017-09-15

    To investigate the quality of images reconstructed with adaptive statistical iterative reconstruction V (ASIR-V), using pediatric head CT protocols. A phantom was scanned at decreasing 20% mA intervals using our standard pediatric head CT protocols. Each study was then reconstructed at 10% ASIR-V intervals. After the phantom study, we reduced mA by 10% in the protocol for <3-year-old patients and applied 30% ASIR-V and by 30% in the protocol for 3- to 15-year-old patients and applied 40% ASIR-V. Increasing the percentage of ASIR-V resulted in lower noise and higher contrast-to-noise ratio (CNR) and preserved spatial resolution in the phantom study. Compared to a conventional-protocol, reduced-dose protocol with ASIR-V achieved 12.8% to 34.0% of dose reduction and showed images of lower noise (9.22 vs. 10.73, P = 0.043) and higher CNR in different levels (centrum semiovale, 2.14 vs. 1.52, P = 0.003; basal ganglia, 1.46 vs. 1.07, P = 0.001; and cerebellum, 2.18 vs. 1.33, P < 0.001). Qualitative analysis showed higher gray-white matter differentiation and sharpness and preserved overall diagnostic quality in the images with ASIR-V. Use of ASIR-V allowed a 12.8% to 34.0% dose reduction in each age group with potential to improve image quality. (orig.)

  4. Head CT: Image quality improvement with ASIR-V using a reduced radiation dose protocol for children

    International Nuclear Information System (INIS)

    Kim, Hyun Gi; Lee, Ho-Joon; Lee, Seung-Koo; Kim, Myung-Joon; Kim, Hyun Ji

    2017-01-01

    To investigate the quality of images reconstructed with adaptive statistical iterative reconstruction V (ASIR-V), using pediatric head CT protocols. A phantom was scanned at decreasing 20% mA intervals using our standard pediatric head CT protocols. Each study was then reconstructed at 10% ASIR-V intervals. After the phantom study, we reduced mA by 10% in the protocol for <3-year-old patients and applied 30% ASIR-V and by 30% in the protocol for 3- to 15-year-old patients and applied 40% ASIR-V. Increasing the percentage of ASIR-V resulted in lower noise and higher contrast-to-noise ratio (CNR) and preserved spatial resolution in the phantom study. Compared to a conventional-protocol, reduced-dose protocol with ASIR-V achieved 12.8% to 34.0% of dose reduction and showed images of lower noise (9.22 vs. 10.73, P = 0.043) and higher CNR in different levels (centrum semiovale, 2.14 vs. 1.52, P = 0.003; basal ganglia, 1.46 vs. 1.07, P = 0.001; and cerebellum, 2.18 vs. 1.33, P < 0.001). Qualitative analysis showed higher gray-white matter differentiation and sharpness and preserved overall diagnostic quality in the images with ASIR-V. Use of ASIR-V allowed a 12.8% to 34.0% dose reduction in each age group with potential to improve image quality. (orig.)

  5. Improved electromagnetic tracking for catheter path reconstruction with application in high-dose-rate brachytherapy.

    Science.gov (United States)

    Lugez, Elodie; Sadjadi, Hossein; Joshi, Chandra P; Akl, Selim G; Fichtinger, Gabor

    2017-04-01

    Electromagnetic (EM) catheter tracking has recently been introduced in order to enable prompt and uncomplicated reconstruction of catheter paths in various clinical interventions. However, EM tracking is prone to measurement errors which can compromise the outcome of the procedure. Minimizing catheter tracking errors is therefore paramount to improve the path reconstruction accuracy. An extended Kalman filter (EKF) was employed to combine the nonlinear kinematic model of an EM sensor inside the catheter, with both its position and orientation measurements. The formulation of the kinematic model was based on the nonholonomic motion constraints of the EM sensor inside the catheter. Experimental verification was carried out in a clinical HDR suite. Ten catheters were inserted with mean curvatures varying from 0 to [Formula: see text] in a phantom. A miniaturized Ascension (Burlington, Vermont, USA) trakSTAR EM sensor (model 55) was threaded within each catheter at various speeds ranging from 7.4 to [Formula: see text]. The nonholonomic EKF was applied on the tracking data in order to statistically improve the EM tracking accuracy. A sample reconstruction error was defined at each point as the Euclidean distance between the estimated EM measurement and its corresponding ground truth. A path reconstruction accuracy was defined as the root mean square of the sample reconstruction errors, while the path reconstruction precision was defined as the standard deviation of these sample reconstruction errors. The impacts of sensor velocity and path curvature on the nonholonomic EKF method were determined. Finally, the nonholonomic EKF catheter path reconstructions were compared with the reconstructions provided by the manufacturer's filters under default settings, namely the AC wide notch and the DC adaptive filter. With a path reconstruction accuracy of 1.9 mm, the nonholonomic EKF surpassed the performance of the manufacturer's filters (2.4 mm) by 21% and the raw EM

  6. Repaglinide/metformin fixed-dose combination to improve glycemic control in patients with type 2 diabetes: an update

    Directory of Open Access Journals (Sweden)

    Robert G Moses

    2010-05-01

    Full Text Available Robert G MosesClinical Trials and Research Unit, South East Sydney and Illawarra Area Health Service, New South Wales, AustraliaAbstract: Type 2 diabetes is a progressive disease associated with high levels of morbidity and mortality and for which there is both a large and growing prevalence worldwide. Lifestyle advice plus metformin is commonly recommended initially to manage hyperglycemia and to minimize the risk of vascular complications. However, additional agents are required when glycemic targets cannot be achieved or maintained due to the progressive nature of the disease. Repaglinide/metformin fixed-dose combination (FDC therapy (PrandiMet®; Novo Nordisk, Bagsværd, Denmark has been approved for use in the USA. This FDC is a rational second-line therapy given the complementary mechanisms of action of the components. Repaglinide is a rapidly absorbed, short-acting insulin secretagogue targeting postprandial glucose excursions; metformin is an insulin sensitizer with a longer duration of action that principally regulates basal glucose levels. A pivotal, 26-week, randomized study with repaglinide/metformin FDC therapy has been conducted in patients experiencing suboptimal control with previous oral antidiabetes therapy. Repaglinide/metformin FDC improved glycemic control and weight neutrality without adverse effects on lipid profiles. There were no major hypoglycemic episodes and patients expressed greater satisfaction with repaglinide/metformin FDC than previous treatments. Repaglinide/metformin FDC is expected to be more convenient than individual tablets for patients taking repaglinide and metformin in loose combination, and it is expected to improve glycemic control in patients for whom meglitinide or metformin monotherapies provide inadequate control.Keywords: type 2 diabetes, metformin, repaglinide, PrandiMet®, fixed-dose combination

  7. Low dose of donepezil improves gabapentin analgesia in the rat spared nerve injury model of neuropathic pain

    DEFF Research Database (Denmark)

    Folkesson, Anna; Honoré, Per Hartvig; Andersen, Lene Munkholm

    2010-01-01

    the effect of the cholinesterase inhibitor donepezil when administered (1) alone and (2) as low-dose in combination with the first-line recommendation gabapentin. The co-administration studies were performed following single and multiple dosing. Single, parenteral dosing of donepezil (1, 1.5 and 3 mg...

  8. Low dose EGCG treatment beginning in adolescence does not improve cognitive impairment in a Down syndrome mouse model.

    Science.gov (United States)

    Stringer, Megan; Abeysekera, Irushi; Dria, Karl J; Roper, Randall J; Goodlett, Charles R

    2015-11-01

    Down syndrome (DS) or Trisomy 21 causes intellectual disabilities in humans and the Ts65Dn DS mouse model is deficient in learning and memory tasks. DYRK1A is triplicated in DS and Ts65Dn mice. Ts65Dn mice were given up to ~20mg/kg/day epigallocatechin-3-gallate (EGCG), a Dyrk1a inhibitor, or water beginning on postnatal day 24 and continuing for three or seven weeks, and were tested on a series of behavioral and learning tasks, including a novel balance beam test. Ts65Dn as compared to control mice exhibited higher locomotor activity, impaired novel object recognition, impaired balance beam and decreased spatial learning and memory. Neither EGCG treatment improved performance of the Ts65Dn mice on these tasks. Ts65Dn mice had a non-significant increase in Dyrk1a activity in the hippocampus and cerebellum. Given the translational value of the Ts65Dn mouse model, further studies will be needed to identify the EGCG doses (and mechanisms) that may improve cognitive function. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Tilting the jaw to improve the image quality or to reduce the dose in cone-beam computed tomography

    International Nuclear Information System (INIS)

    Luckow, Marlen; Deyhle, Hans; Beckmann, Felix; Dagassan-Berndt, Dorothea; Müller, Bert

    2011-01-01

    Objective: The image quality in cone-beam computed tomography (CBCT) should be improved tilting the mandible that contains two dental titanium implants, within the relevant range of motion. Materials and methods: Using the mandible of a five-month-old pig, CBCT was performed varying the accelerating voltage, beam current, the starting rotation angle of the mandible in the source-detector plane and the tilt angles of the jaw with respect to the source-detector plane. The different datasets were automatically registered with respect to micro CT data to extract the common volume and the deviance to the pre-defined standard that characterizes the image quality. Results: The variations of the accelerating voltage, beam current and the rotation within the source-detection plane provided the expected quantitative behavior indicating the appropriate choice of the imaging quality factor. The tilting of the porcine mandible by about 14° improves the image quality by almost a factor of two. Conclusions: The tilting of the mandible with two dental implants can be used to significantly reduce the artifacts of the strongly X-ray absorbing materials in the CBCT images. The comparison of 14° jaw tilting with respect to the currently recommended arrangement in plane with the teeth demonstrates that the applied exposure time and the related dose can be reduced by a factor of four without decreasing the image quality.

  10. Improving anatomical mapping of complexly deformed anatomy for external beam radiotherapy and brachytherapy dose accumulation in cervical cancer

    International Nuclear Information System (INIS)

    Vásquez Osorio, Eliana M.; Kolkman-Deurloo, Inger-Karine K.; Schuring-Pereira, Monica; Zolnay, András; Heijmen, Ben J. M.; Hoogeman, Mischa S.

    2015-01-01

    rigid transformation and nonrigid registration of all structures together (AST). Results: The rigid transformation achieved a good global alignment (mean outer anatomical correctness of 4.3 mm) but failed to align the deformed organs (mean inner anatomical correctness of 22.4 mm). Conversely, the AST registration produced a reasonable alignment for the organs (6.3 mm) but not for the surrounding region (16.9 mm). SW+VF registration achieved the best results for both regions (3.5 and 3.4 mm for the inner and outer anatomical correctness, respectively). All differences were significant (p < 0.02, Wilcoxon rank sum test). Additionally, optimization of the scope sizes determined that the method was robust for a large range of scope size values. Conclusions: The novel SW+VF method improved the mapping of large and complex deformations observed between EBRT and BT for cervical cancer patients. Future studies that quantify the mapping error in terms of dose errors are required to test the clinical applicability of dose accumulation by the SW+VF method

  11. Improving anatomical mapping of complexly deformed anatomy for external beam radiotherapy and brachytherapy dose accumulation in cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Vásquez Osorio, Eliana M., E-mail: e.vasquezosorio@erasmusmc.nl; Kolkman-Deurloo, Inger-Karine K.; Schuring-Pereira, Monica; Zolnay, András; Heijmen, Ben J. M.; Hoogeman, Mischa S. [Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam 3075 (Netherlands)

    2015-01-15

    rigid transformation and nonrigid registration of all structures together (AST). Results: The rigid transformation achieved a good global alignment (mean outer anatomical correctness of 4.3 mm) but failed to align the deformed organs (mean inner anatomical correctness of 22.4 mm). Conversely, the AST registration produced a reasonable alignment for the organs (6.3 mm) but not for the surrounding region (16.9 mm). SW+VF registration achieved the best results for both regions (3.5 and 3.4 mm for the inner and outer anatomical correctness, respectively). All differences were significant (p < 0.02, Wilcoxon rank sum test). Additionally, optimization of the scope sizes determined that the method was robust for a large range of scope size values. Conclusions: The novel SW+VF method improved the mapping of large and complex deformations observed between EBRT and BT for cervical cancer patients. Future studies that quantify the mapping error in terms of dose errors are required to test the clinical applicability of dose accumulation by the SW+VF method.

  12. Hypoxia-Inducible Factor Pathway Inhibition Resolves Tumor Hypoxia and Improves Local Tumor Control After Single-Dose Irradiation

    International Nuclear Information System (INIS)

    Helbig, Linda; Koi, Lydia; Brüchner, Kerstin; Gurtner, Kristin; Hess-Stumpp, Holger; Unterschemmann, Kerstin; Pruschy, Martin

    2014-01-01

    Purpose: To study the effects of BAY-84-7296, a novel orally bioavailable inhibitor of mitochondrial complex I and hypoxia-inducible factor 1 (HIF-1) activity, on hypoxia, microenvironment, and radiation response of tumors. Methods and Materials: UT-SCC-5 and UT-SCC-14 human squamous cell carcinomas were transplanted subcutaneously in nude mice. When tumors reached 4 mm in diameter BAY-84-7296 (Bayer Pharma AG) or carrier was daily administered to the animals. At 7 mm tumors were either excised for Western blot and immunohistologic investigations or were irradiated with single doses. After irradiation animals were randomized to receive BAY-84-7296 maintenance or carrier. Local tumor control was evaluated 150 days after irradiation, and the dose to control 50% of tumors (TCD 50 ) was calculated. Results: BAY-84-7296 decreased nuclear HIF-1α expression. Daily administration of inhibitor for approximately 2 weeks resulted in a marked decrease of pimonidazole hypoxic fraction in UT-SCC-5 (0.5% vs 21%, P 50 , with an enhancement ratio of 1.37 (95% confidence interval [CI] 1.13-1.72) in UT-SCC-5 and of 1.55 (95% CI 1.26-1.94) in UT-SCC-14. BAY-84-7296 maintenance after irradiation did not further decrease TCD 50 . Conclusions: BAY-84-7296 resulted in a marked decrease in tumor hypoxia and substantially reduced radioresistance of tumor cells with the capacity to cause a local recurrence after irradiation. The data suggest that reduction of cellular hypoxia tolerance by BAY-84-7296 may represent the primary biological mechanism underlying the observed enhancement of radiation response. Whether this mechanism contributes to the improved outcome of fractionated chemoradiation therapy warrants further investigation

  13. Combination of transcatheter arterial chemoembolization and interrupted dosing sorafenib improves patient survival in early–intermediate stage hepatocellular carcinoma

    Science.gov (United States)

    Lee, Teng-Yu; Lin, Chen-Chun; Chen, Chiung-Yu; Wang, Tsang-En; Lo, Gin-Ho; Chang, Chi-Sen; Chao, Yee

    2017-01-01

    Abstract Background/Objective: The survival benefit of treatment for unresectable hepatocellular carcinoma (HCC) with transcatheter arterial chemoembolization (TACE) combined with sorafenib remains uncertain. We compared the survival of patients treated with TACE and sorafenib with that of patients treated with TACE alone. Methods: This was a post hoc analysis of the Study in Asia of the Combination of TACE with Sorafenib in Patients with HCC (START) trial. All patients who received TACE and interrupted dosing of sorafenib for early or intermediate-stage HCC in Taiwan from 2009 to 2010 were recruited into the TACE and sorafenib group. They were randomly matched 1:1 by age, sex, Child–Pugh score, tumor size, tumor number, and tumor stage with patients from Taichung Veterans General Hospital in Taiwan who received TACE alone and who fulfilled the selection criteria of the START trial during the same time period (control group). Patient survival [cumulative incidence and hazard ratio (HR)] of the 2 groups were analyzed and compared. Results: The baseline characteristics of the 36 patients in each group were similar. Tumor response rates were significantly better in the TACE and sorafenib group (P < .04). Overall survival of the TACE and sorafenib group was also significantly better than that of the control (TACE alone) group over the 2 years [78%, 95% confidence interval (95% CI) 64–91 vs 49, 95% CI 32–66; P = .012]. In the multivariate regression analysis, TACE and sorafenib was found to be independently associated with a decreased risk of mortality (HR 0.33, 95% CI 0.12–0.89; P = .015). Multivariate stratified analyses verified this association in each patient subgroup (all HR < 1.0). Conclusion: With a high patient tolerance to an interrupted sorafenib dosing schedule, the combination of TACE with sorafenib was associated with improved overall survival in early–intermediate stage HCC when compared with treatment with TACE alone. PMID

  14. GEBR-7b, a novel PDE4D selective inhibitor that improves memory in rodents at non-emetic doses.

    Science.gov (United States)

    Bruno, O; Fedele, E; Prickaerts, J; Parker, L A; Canepa, E; Brullo, C; Cavallero, A; Gardella, E; Balbi, A; Domenicotti, C; Bollen, E; Gijselaers, H J M; Vanmierlo, T; Erb, K; Limebeer, C L; Argellati, F; Marinari, U M; Pronzato, M A; Ricciarelli, R

    2011-12-01

    Strategies designed to enhance cerebral cAMP have been proposed as symptomatic treatments to counteract cognitive deficits. However, pharmacological therapies aimed at reducing PDE4, the main class of cAMP catabolizing enzymes in the brain, produce severe emetic side effects. We have recently synthesized a 3-cyclopentyloxy-4-methoxybenzaldehyde derivative, structurally related to rolipram, and endowed with selective PDE4D inhibitory activity. The aim of the present study was to investigate the effect of the new drug, namely GEBR-7b, on memory performance, nausea, hippocampal cAMP and amyloid-β (Aβ) levels. To measure memory performance, we performed object recognition tests on rats and mice treated with GEBR-7b or rolipram. The emetic potential of the drug, again compared with rolipram, was evaluated in rats using the taste reactivity test and in mice using the xylazine/ketamine anaesthesia test. Extracellular hippocampal cAMP was evaluated by intracerebral microdialysis in freely moving rats. Levels of soluble Aβ peptides were measured in hippocampal tissues and cultured N2a cells by elisa. GEBR-7b increased hippocampal cAMP, did not influence Aβ levels and improved spatial, as well as object memory performance in the object recognition tests. The effect of GEBR-7b on memory was 3 to 10 times more potent than that of rolipram, and its effective doses had no effect on surrogate measures of emesis in rodents. Our results demonstrate that GEBR-7b enhances memory functions at doses that do not cause emesis-like behaviour in rodents, thus offering a promising pharmacological perspective for the treatment of memory impairment. © 2011 The Authors. British Journal of Pharmacology © 2011 The British Pharmacological Society.

  15. Hypoxia-Inducible Factor Pathway Inhibition Resolves Tumor Hypoxia and Improves Local Tumor Control After Single-Dose Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Helbig, Linda [OncoRay–National Center for Radiation Research in Oncology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden (Germany); Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden (Germany); Koi, Lydia [OncoRay–National Center for Radiation Research in Oncology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden (Germany); Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden (Germany); Deutsches Konsortium für Translationale Krebsforschung, Site Dresden, Dresden (Germany); Brüchner, Kerstin [Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden (Germany); Institute of Radiooncology Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Gurtner, Kristin [Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden (Germany); Hess-Stumpp, Holger; Unterschemmann, Kerstin [Global Drug Discovery, Bayer Pharma, Berlin (Germany); Pruschy, Martin [Radiation Oncology, University of Zurich, Zurich (Switzerland); and others

    2014-01-01

    Purpose: To study the effects of BAY-84-7296, a novel orally bioavailable inhibitor of mitochondrial complex I and hypoxia-inducible factor 1 (HIF-1) activity, on hypoxia, microenvironment, and radiation response of tumors. Methods and Materials: UT-SCC-5 and UT-SCC-14 human squamous cell carcinomas were transplanted subcutaneously in nude mice. When tumors reached 4 mm in diameter BAY-84-7296 (Bayer Pharma AG) or carrier was daily administered to the animals. At 7 mm tumors were either excised for Western blot and immunohistologic investigations or were irradiated with single doses. After irradiation animals were randomized to receive BAY-84-7296 maintenance or carrier. Local tumor control was evaluated 150 days after irradiation, and the dose to control 50% of tumors (TCD{sub 50}) was calculated. Results: BAY-84-7296 decreased nuclear HIF-1α expression. Daily administration of inhibitor for approximately 2 weeks resulted in a marked decrease of pimonidazole hypoxic fraction in UT-SCC-5 (0.5% vs 21%, P<.0001) and in UT-SCC-14 (0.3% vs 19%, P<.0001). This decrease was accompanied by a significant increase in fraction of perfused vessels in UT-SCC-14 but not in UT-SCC-5. Bromodeoxyuridine and Ki67 labeling indices were significantly reduced only in UT-SCC-5. No significant changes were observed in vascular area or necrosis. BAY-84-7296 before single-dose irradiation significantly decreased TCD{sub 50}, with an enhancement ratio of 1.37 (95% confidence interval [CI] 1.13-1.72) in UT-SCC-5 and of 1.55 (95% CI 1.26-1.94) in UT-SCC-14. BAY-84-7296 maintenance after irradiation did not further decrease TCD{sub 50}. Conclusions: BAY-84-7296 resulted in a marked decrease in tumor hypoxia and substantially reduced radioresistance of tumor cells with the capacity to cause a local recurrence after irradiation. The data suggest that reduction of cellular hypoxia tolerance by BAY-84-7296 may represent the primary biological mechanism underlying the observed enhancement of

  16. Preliminary investigation of the NMR, optical and x-ray CT dose-response of polymer gel dosimeters incorporating cosolvents to improve dose sensitivity

    Energy Technology Data Exchange (ETDEWEB)

    Koeva, V I; McAuley, K B [Department of Chemical Engineering, Queen' s University, Kingston, ON, K7L 3N6 (Canada); Olding, T [Department of Physics, Queen' s University, Kingston, ON, K7L 3N6 (Canada); Jirasek, A [Department of Physics and Astronomy, University of Victoria, Victoria, BC, V8W 3P6 (Canada); Schreiner, L J [Cancer Centre of Southeastern Ontario, Kingston, ON, K7L5P9 (Canada)], E-mail: kim.mcauley@chee.queensu.ca

    2009-05-07

    This study reports on efforts to increase the dose sensitivity of polymer gel dosimeters used in 3D radiation dosimetry. The potential of several different cosolvents is investigated, with the aim of increasing the solubility of N,N'-methylene-bisacrylamide crosslinker in polymer gel dosimeters. Glycerol and isopropanol increase the limit for the crosslinker solubility from approximately 3% to 5% and 10% by weight, respectively. This enables the manufacture of polymer gel dosimeters with much higher levels of crosslinking than was previously possible. New dosimeter recipes containing up to 5 wt% N,N'-methylene-bisacrylamide were subjected to spatially uniform radiation and were studied using nuclear magnetic resonance (NMR), as well as x-ray and optical CT techniques. The resulting dosimeters exhibit dose sensitivities that are up to 2.7 times higher than measured for a typical dosimeters with 3% N,N'-methylene-bisacrylamide without the addition of cosolvent. Two additional cosolvents (n-propanol and sec-butanol) were deemed unsuitable for practical dosimeters due to incompatibility with gelatin, cloudiness prior to irradiation, and immiscibility with water when large quantities of cosolvent were used. The dosimeters with high N,N'-methylene-bisacrylamide content that used isopropanol or glycerol as cosolvents had high optical clarity prior to irradiation, but did not produce suitable optical CT results for non-uniformly irradiated gels due to polymer development outside of the high dose regions of the pencil beams and significant light scatter. Further experiments are required to determine whether cosolvents can be used to manufacture gels with sufficiently high dose sensitivity for readout using x-ray computed tomography.

  17. Preliminary investigation of the NMR, optical and x-ray CT dose-response of polymer gel dosimeters incorporating cosolvents to improve dose sensitivity

    International Nuclear Information System (INIS)

    Koeva, V I; McAuley, K B; Olding, T; Jirasek, A; Schreiner, L J

    2009-01-01

    This study reports on efforts to increase the dose sensitivity of polymer gel dosimeters used in 3D radiation dosimetry. The potential of several different cosolvents is investigated, with the aim of increasing the solubility of N,N'-methylene-bisacrylamide crosslinker in polymer gel dosimeters. Glycerol and isopropanol increase the limit for the crosslinker solubility from approximately 3% to 5% and 10% by weight, respectively. This enables the manufacture of polymer gel dosimeters with much higher levels of crosslinking than was previously possible. New dosimeter recipes containing up to 5 wt% N,N'-methylene-bisacrylamide were subjected to spatially uniform radiation and were studied using nuclear magnetic resonance (NMR), as well as x-ray and optical CT techniques. The resulting dosimeters exhibit dose sensitivities that are up to 2.7 times higher than measured for a typical dosimeters with 3% N,N'-methylene-bisacrylamide without the addition of cosolvent. Two additional cosolvents (n-propanol and sec-butanol) were deemed unsuitable for practical dosimeters due to incompatibility with gelatin, cloudiness prior to irradiation, and immiscibility with water when large quantities of cosolvent were used. The dosimeters with high N,N'-methylene-bisacrylamide content that used isopropanol or glycerol as cosolvents had high optical clarity prior to irradiation, but did not produce suitable optical CT results for non-uniformly irradiated gels due to polymer development outside of the high dose regions of the pencil beams and significant light scatter. Further experiments are required to determine whether cosolvents can be used to manufacture gels with sufficiently high dose sensitivity for readout using x-ray computed tomography.

  18. High-dose radiation improved local tumor control and overall survival in patients with inoperable/unresectable non-small-cell lung cancer: Long-term results of a radiation dose escalation study

    International Nuclear Information System (INIS)

    Kong, F.-M.; Haken, Randall K. ten; Schipper, Matthew J.; Sullivan, Molly A.; Chen, Ming; Lopez, Carlos; Kalemkerian, Gregory P.; Hayman, James A.

    2005-01-01

    Purpose: To determine whether high-dose radiation leads to improved outcomes in patients with non-small-cell lung cancer (NSCLC). Methods and Materials: This analysis included 106 patients with newly diagnosed or recurrent Stages I-III NSCLC, treated with 63-103 Gy in 2.1-Gy fractions, using three-dimensional conformal radiation therapy (3D-CRT) per a dose escalation trial. Targets included the primary tumor and any lymph nodes ≥1 cm, without intentionally including negative nodal regions. Nineteen percent of patients (20/106) received neoadjuvant chemotherapy. Patient, tumor, and treatment factors were evaluated for association with outcomes. Estimated median follow-up was 8.5 years. Results: Median survival was 19 months, and 5-year overall survival (OS) was 13%. Multivariate analysis revealed weight loss (p = 0.011) and radiation dose (p = 0.0006) were significant predictors for OS. The 5-year OS was 4%, 22%, and 28% for patients receiving 63-69, 74-84, and 92-103 Gy, respectively. Although presence of nodal disease was negatively associated with locoregional control under univariate analysis, radiation dose was the only significant predictor when multiple variables were included (p = 0.015). The 5-year control rate was 12%, 35%, and 49% for 63-69, 74-84, and 92-103 Gy, respectively. Conclusions: Higher dose radiation is associated with improved outcomes in patients with NSCLC treated in the range of 63-103 Gy

  19. Improving hepatitis B birth dose in rural Lao People's Democratic Republic through the use of mobile phones to facilitate communication.

    Science.gov (United States)

    Xeuatvongsa, Anonh; Datta, Siddhartha Sankar; Moturi, Edna; Wannemuehler, Kathleen; Philakong, Phanmanisone; Vongxay, Viengnakhone; Vilayvone, Vansy; Patel, Minal K

    2016-11-11

    Hepatitis B vaccine birth dose (HepB-BD) was introduced in Lao People's Democratic Republic to prevent perinatal hepatitis B virus transmission in 2008; high coverage is challenging since only 38% of births occur in a health facility. Healthcare workers report being unaware of home births and thus unable to conduct timely postnatal care (PNC) home visits. A quasi-experimental pilot study was conducted wherein mobile phones and phone credits were provided to village health volunteers (VHV) and healthcare workers (HCWs) to assess whether this could improve HepB-BD administration, as well as birth notification and increase home visits. From April to September 2014, VHVs and HCWs in four selected intervention districts were trained, supervised, received outreach per diem for conducting home visits, and received mobile phones and phone credits. In three comparison districts, VHVs and HCWs were trained, supervised, and received outreach per diem for conducting home visits. A post-study survey compared HepB-BD coverage among children born during the study and children born one year before. HCWs and VHVs were interviewed about the study. Among intervention districts, 463 study children and 406 pre-study children were enrolled in the survey; in comparison districts, 347 study children and 309 pre-study children were enrolled. In both arms, there was a significant improvement in the proportion of children reportedly receiving a PNC home visit (intervention p<0.0001, comparison p=0.04). The median difference in village level HepB-BD coverage (study cohort minus pre-study cohort), was 57% (interquartile range [IQR] 32-88%, p<0.0001) in intervention districts, compared with 20% (IQR 0-50%, p<0.0001) in comparison districts. The improvement in the intervention districts was greater than in the comparison districts (p=0.0009). Our findings suggest that the provision of phones and phone credits might be one important factor for increasing coverage. However, reasons for improvement

  20. Compressed sensing electron tomography of needle-shaped biological specimens – Potential for improved reconstruction fidelity with reduced dose

    Energy Technology Data Exchange (ETDEWEB)

    Saghi, Zineb, E-mail: saghizineb@gmail.com [Department of Materials Science and Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge CB3 0FS (United Kingdom); Divitini, Giorgio [Department of Materials Science and Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge CB3 0FS (United Kingdom); Winter, Benjamin [Center for Nanoanalysis and Electron Microscopy (CENEM), Friedrich-Alexander-Universität Erlangen-Nürnberg, Cauerstraße 6, 91058 Erlangen (Germany); Leary, Rowan [Department of Materials Science and Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge CB3 0FS (United Kingdom); Spiecker, Erdmann [Center for Nanoanalysis and Electron Microscopy (CENEM), Friedrich-Alexander-Universität Erlangen-Nürnberg, Cauerstraße 6, 91058 Erlangen (Germany); Ducati, Caterina [Department of Materials Science and Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge CB3 0FS (United Kingdom); Midgley, Paul A., E-mail: pam33@cam.ac.uk [Department of Materials Science and Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge CB3 0FS (United Kingdom)

    2016-01-15

    Electron tomography is an invaluable method for 3D cellular imaging. The technique is, however, limited by the specimen geometry, with a loss of resolution due to a restricted tilt range, an increase in specimen thickness with tilt, and a resultant need for subjective and time-consuming manual segmentation. Here we show that 3D reconstructions of needle-shaped biological samples exhibit isotropic resolution, facilitating improved automated segmentation and feature detection. By using scanning transmission electron tomography, with small probe convergence angles, high spatial resolution is maintained over large depths of field and across the tilt range. Moreover, the application of compressed sensing methods to the needle data demonstrates how high fidelity reconstructions may be achieved with far fewer images (and thus greatly reduced dose) than needed by conventional methods. These findings open the door to high fidelity electron tomography over critically relevant length-scales, filling an important gap between existing 3D cellular imaging techniques. - Highlights: • On-axis electron tomography of a needle-shaped biological sample is presented. • A reconstruction with isotropic resolution is achieved. • Compressed sensing methods are compared to conventional reconstruction algorithms. • High fidelity reconstructions are achieved with greatly undersampled datasets.

  1. Compressed sensing electron tomography of needle-shaped biological specimens – Potential for improved reconstruction fidelity with reduced dose

    International Nuclear Information System (INIS)

    Saghi, Zineb; Divitini, Giorgio; Winter, Benjamin; Leary, Rowan; Spiecker, Erdmann; Ducati, Caterina; Midgley, Paul A.

    2016-01-01

    Electron tomography is an invaluable method for 3D cellular imaging. The technique is, however, limited by the specimen geometry, with a loss of resolution due to a restricted tilt range, an increase in specimen thickness with tilt, and a resultant need for subjective and time-consuming manual segmentation. Here we show that 3D reconstructions of needle-shaped biological samples exhibit isotropic resolution, facilitating improved automated segmentation and feature detection. By using scanning transmission electron tomography, with small probe convergence angles, high spatial resolution is maintained over large depths of field and across the tilt range. Moreover, the application of compressed sensing methods to the needle data demonstrates how high fidelity reconstructions may be achieved with far fewer images (and thus greatly reduced dose) than needed by conventional methods. These findings open the door to high fidelity electron tomography over critically relevant length-scales, filling an important gap between existing 3D cellular imaging techniques. - Highlights: • On-axis electron tomography of a needle-shaped biological sample is presented. • A reconstruction with isotropic resolution is achieved. • Compressed sensing methods are compared to conventional reconstruction algorithms. • High fidelity reconstructions are achieved with greatly undersampled datasets.

  2. Does the fluence map editing in electronic tissue compensator improve dose homogeneity in bilateral field plan of head and neck patients?

    Directory of Open Access Journals (Sweden)

    Kinhikar Rajesh

    2008-01-01

    Full Text Available The purpose of this study was to evaluate the effect of fluence map editing in electronic tissue compensator (ETC on the dose homogeneity for head and neck cancer patients. Treatment planning using 6-MV X-rays and bilateral field arrangement employing ETC was carried out on the computed tomography (CT datasets of 20 patients with head and neck cancer. All the patients were planned in Varian Eclipse three-dimensional treatment planning system (3DTPS with dynamic multileaf collimator (DMLC. The treatment plans, with and without fluence editing, was compared and the effect of pre-editing and post-editing the fluence maps in the treatment field was evaluated. The skin dose was measured with thermoluminescent dosimeters (TLDs and was compared with the skin dose estimated by TPS. The mean percentage volume of the tissue receiving at least 107% of the prescription dose was 5.4 (range 1.5-10; SD 2.4. Post-editing fluence map showed that the mean percentage volume of the tissue receiving at least 107% of the prescription dose was 0.47 (range 0.1-0.9; SD 0.3. The mean skin dose measured with TLD was found to be 74% (range 71-80% of the prescribed dose while the TPS showed the mean skin dose as 85% (range 80-90%. The TPS overestimated the skin dose by 11%. Fluence map editing thus proved to be a potential tool for improving dose homogeneity in head and neck cancer patients planned with ETC, thus reducing the hot spots in the treatment region as well. The treatment with ETC is feasible with DMLC and does not take any additional time for setup or delivery. The method used to edit the fluence maps is simple and time efficient. Manual control over a plan is essential to create the best treatment plan possible.

  3. EcoDoses - Improving radiological assessment of doses to man from terrestrial ecosystems. A status report for the NKS-B project 2005

    Energy Technology Data Exchange (ETDEWEB)

    Nielsen, Sven P.; Andersson, Kasper; Thoerring, H. (and others)

    2006-04-15

    Considerable variations in activity concentrations in milk of {sup 137}Cs and {sup 90}Sr were observed between countries or regions due to precipitation patterns, soil types and inhomogeneity of Chernobyl fallout. Time trends indicate that factors influencing ecological half-lives for {sup 90}Sr are not the same as for {sup 137}Cs in the pasturemilk system. Internal doses to Faroese people derive mainly from dairy products, lamb and potatoes. The largest doses were received from nuclear weapons fallout in the early 1960's. {sup 137}Cs causes higher doses than 90Sr, and the regional variability is larger for {sup 137}Cs than for {sup 90}Sr. {sup 137}Cs deposition maps were made of Sweden. Values of 137Cs deposition and precipitation were used in the calculations of Nuclear Weapons Fallout (NWF). The deposition of {sup 137}Cs from the Chernobyl accident was calculated for western Sweden. Lowest levels of NWF {sup 137}Cs deposition density were noted in the north-eastern and eastern Sweden and the highest levels in the western parts. The Chernobyl {sup 137}Cs deposition is highest along the coast and lowest in the south-eastern part and along the middle. The calculated deposition from NWF and Chernobyl in western Sweden was compared to observed deposition and showed good agreement. Ecological halftimes of {sup 137}Cs in perch in Finnish lakes vary by a factor of three. The longest halftime of {sup 137}Cs in perch was 9 y and the shortest 3 y. Norwegian lakes differ from each other with respect to the rates of decrease of {sup 137}Cs in fish. Ecological halftimes of {sup 137}Cs in trout and Arctic char varied from 1 to 5 y. A more rapid reduction of {sup 137}Cs in fish is found in certain Norwegian lakes compared to Finnish lakes. In two Norwegian lakes the 137Cs concentrations in trout remain at about 100 Bq/kg since 1990. The European decision support systems, ARGOS and RODOS, include foodchain modules with default parameters derived from southern Germany. Many

  4. EcoDoses - Improving radiological assessment of doses to man from terrestrial ecosystems. A status report for the NKS-B project 2005

    International Nuclear Information System (INIS)

    Nielsen, Sven P.; Andersson, Kasper; Thoerring, H.

    2006-04-01

    Considerable variations in activity concentrations in milk of 137 Cs and 90 Sr were observed between countries or regions due to precipitation patterns, soil types and inhomogeneity of Chernobyl fallout. Time trends indicate that factors influencing ecological half-lives for 90 Sr are not the same as for 137 Cs in the pasturemilk system. Internal doses to Faroese people derive mainly from dairy products, lamb and potatoes. The largest doses were received from nuclear weapons fallout in the early 1960's. 137 Cs causes higher doses than 90Sr, and the regional variability is larger for 137 Cs than for 90 Sr. 137 Cs deposition maps were made of Sweden. Values of 137Cs deposition and precipitation were used in the calculations of Nuclear Weapons Fallout (NWF). The deposition of 137 Cs from the Chernobyl accident was calculated for western Sweden. Lowest levels of NWF 137 Cs deposition density were noted in the north-eastern and eastern Sweden and the highest levels in the western parts. The Chernobyl 137 Cs deposition is highest along the coast and lowest in the south-eastern part and along the middle. The calculated deposition from NWF and Chernobyl in western Sweden was compared to observed deposition and showed good agreement. Ecological halftimes of 137 Cs in perch in Finnish lakes vary by a factor of three. The longest halftime of 137 Cs in perch was 9 y and the shortest 3 y. Norwegian lakes differ from each other with respect to the rates of decrease of 137 Cs in fish. Ecological halftimes of 137 Cs in trout and Arctic char varied from 1 to 5 y. A more rapid reduction of 137 Cs in fish is found in certain Norwegian lakes compared to Finnish lakes. In two Norwegian lakes the 137Cs concentrations in trout remain at about 100 Bq/kg since 1990. The European decision support systems, ARGOS and RODOS, include foodchain modules with default parameters derived from southern Germany. Many parameters describing foodchain transfer are subject to considerable variation

  5. Improvement on the KFOOD code for more realistic assessment of the annual food chain radiation dose due to operating nuclear facilities

    International Nuclear Information System (INIS)

    Choi, Yong Ho; Lee, Chang Woo; Kim, Jin Kyu; Lee, Myung Ho; Lee, Jeong Ho

    1993-01-01

    More realistic calculation models for evaluating man's annual intakes of radionuclides released from operating nuclear facilities were established. For the application of these models, the harvest years of food and feed crops consumed in the year of dose assessment and every year's average concentrations of a radionuclide in air and in water for the whole period of real operation had to be taken into account. KFOOD, an existing equilibrium food chain computer code for the Korean dose assessment, was modified according to the models. Sample runs of the modified code on the assumption of a constant release during 10 years' operation were made with three kinds of the input data files enabling the dose assessment in the improved method, the KFOOD method and another existing method, respectively, and the results were compared. Annual committed effective doses to Korean adult by intakes of Mn-54, Co-60, Sr-90, I-131 and Cs-137 calculated in the improved method were about 11, 2, 5, 60 and 3 %, respectively, lower than the corresponding KFOOD dose. To the intakes of the radionuclides except Sr-90 evaluated in the improved method, foliar uptake contributed much more than root uptake did but, in the case of Sr-90, the result was opposite. (Author)

  6. Risks of circulatory diseases among Mayak PA workers with radiation doses estimated using the improved Mayak Worker Dosimetry System 2008

    Energy Technology Data Exchange (ETDEWEB)

    Moseeva, Maria B.; Azizova, Tamara V.; Grigoryeva, Evgenia S. [Southern Urals Biophysics Institute (SUBI), Ozyorsk, Chelyabinsk Region (Russian Federation); Haylock, Richard [Public Health of England, London (United Kingdom)

    2014-05-15

    The new Mayak Worker Dosimetry System 2008 (MWDS-2008) was published in 2013 and supersedes the Doses-2005 dosimetry system for Mayak Production Association (PA) workers. It provides revised external and internal dose estimates based on the updated occupational history data. Using MWDS-2008, a cohort of 18,856 workers first employed at one of the main Mayak PA plants during 1948-1972 and followed up to 2005 was identified. Incidence and mortality risks from ischemic heart disease (IHD) (International Classification of Diseases (ICD)-9 codes 410-414) and from cerebrovascular diseases (CVD) (ICD-9 codes 430-438) were examined in this cohort and compared with previously published risk estimates in the same cohort based on the Doses-2005 dosimetry system. Significant associations were observed between doses from external gamma-rays and IHD and CVD incidence and also between internal doses from alpha-radiation and IHD mortality and CVD incidence. The estimates of excess relative risk (ERR)/Gy were consistent with those estimates from the previous studies based on Doses-2005 system apart from the relationship between CVD incidence and internal liver dose where the ERR/Gy based on MWDS-2008 was just over three times higher than the corresponding estimate based on Doses-2005 system. Adjustment for smoking status did not show any effect on the estimates of risk from internal alpha-particle exposure. (orig.)

  7. Head CT: Image quality improvement of posterior fossa and radiation dose reduction with ASiR - comparative studies of CT head examinations.

    Science.gov (United States)

    Guziński, Maciej; Waszczuk, Łukasz; Sąsiadek, Marek J

    2016-10-01

    To evaluate head CT protocol developed to improve visibility of the brainstem and cerebellum, lower bone-related artefacts in the posterior fossa and maintain patient radioprotection. A paired comparison of head CT performed without Adaptive Statistical Iterative Reconstruction (ASiR) and a clinically indicated follow-up with 40 % ASiR was acquired in one group of 55 patients. Patients were scanned in the axial mode with different scanner settings for the brain and the posterior fossa. Objective image quality analysis was performed with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality analysis was based on brain structure visibility and evaluation of the artefacts. We achieved 19 % reduction of total DLP and significantly better image quality of posterior fossa structures. SNR for white and grey matter in the cerebellum were 34 % to 36 % higher, respectively, CNR was improved by 142 % and subjective analyses were better for images with ASiR. When imaging parameters are set independently for the brain and the posterior fossa imaging, ASiR has a great potential to improve CT performance: image quality of the brainstem and cerebellum is improved, and radiation dose for the brain as well as total radiation dose are reduced. •With ASiR it is possible to lower radiation dose or improve image quality •Sequentional imaging allows setting scan parameters for brain and posterior-fossa independently •We improved visibility of brainstem structures and decreased radiation dose •Total radiation dose (DLP) was decreased by 19.

  8. Low-dose natural prostaglandin F2α (dinoprost) at timed insemination improves conception rate in dairy cattle.

    Science.gov (United States)

    Ambrose, Divakar J; Gobikrushanth, Mohanathas; Zuidhof, Sjoert; Kastelic, John P

    2015-03-01

    The primary objective was to determine if low doses of PGF2α (dinoprost) given intramuscularly (im) concurrent with timed artificial insemination (TAI) would improve conception rates in dairy cattle. A secondary objective was to determine if body condition score (BCS) and parity would influence conception rates, either independently or in interaction with PGF2α treatment. In experiment I, 307 lactating Holstein cows were randomly assigned to receive either 5-mg PGF2α im (PGF2α treated, n = 154) or 0-mg PGF2α (control, n = 153) at TAI (Day 0). Blood samples were obtained on Days -10, -3, 0, and 7 to determine plasma progesterone (P4) concentrations. Pregnancy was confirmed 30 to 32 days after insemination by transrectal ultrasonography. In experiment II, 451 cows were randomly assigned to receive either 10-mg PGF2α im (PGF2α treated, n = 226) or 0-mg PGF2α (control, n = 225) at TAI, and pregnancy was confirmed 45 to 50 days after TAI by palpation per rectum. Pregnancy data were analyzed by CATMOD (SAS). In experiment I, PGF2α treatment, BCS, and parity did not affect conception rate (35.7% vs. 37.0% for PGF2α treated vs. control; P > 0.05). However, in experiment II, conception rates were higher in cows given 10-mg PGF2α than those in control cows (45.8% vs. 36.0%; P conception rates. In summary, 5 mg of PGF2α given im concurrent with TAI failed to enhance conception rate in lactating dairy cows, whereas 10 mg of PGF2α significantly increased conception rate. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Single dose systemic acetaminophen to improve patient reported quality of recovery after ambulatory segmental mastectomy: A prospective, randomized, double-blinded, placebo controlled, clinical trial.

    Science.gov (United States)

    De Oliveira, Gildasio S; Rodes, Meghan E; Bialek, Jane; Kendall, Mark C; McCarthy, Robert J

    2017-11-15

    Few systemic drug interventions are efficacious to improve patient reported quality of recovery after ambulatory surgery. We aimed to evaluate whether a single dose systemic acetaminophen improve quality of recovery in female patients undergoing ambulatory breast surgery. We hypothesized that patients receiving a single dose systemic acetaminophen at the end of the surgical procedure would have a better global quality of postsurgical recovery compared to the ones receiving saline. The study was a prospective randomized double blinded, placebo controlled, clinical trial. Healthy female subjects were randomized to receive 1 g single dose systemic acetaminophen at the end of the surgery or the same volume of saline. The primary outcome was the Quality of Recovery 40 (QOR-40) questionnaire at 24 hours after surgery. Other data collected included opioid consumption and pain scores. Data were analyzed using group t tests and the Wilcoxon exact test. The association between opioid consumption and quality of recovery was evaluated using Spearman rho. P quality of recovery, P = .007. A single dose of systemic acetaminophen improves patient reported quality of recovery after ambulatory breast surgery. The use of systemic acetaminophen is an efficacious strategy to improve patient perceived quality of postsurgical recovery and analgesic outcomes after hospital discharge for ambulatory breast surgery. © 2017 Wiley Periodicals, Inc.

  10. Recovery Profiles of T-Cell Subsets Following Low-Dose Total Body Irradiation and Improvement With Cinnamon

    International Nuclear Information System (INIS)

    Zheng, Xiaodan; Guo, Yuqi; Wang, Lei; Zhang, Honghai; Wang, Shaobo; Wang, Li; An, Lei; Zhou, Xianbin; Li, Xia; Yao, Chengfang

    2015-01-01

    Purpose: Inefficient T-cell reconstitution from x-ray–induced immune damage reduces antitumor response. To understand the profile of T-cell reconstitution after irradiation will overcome the barrier of antitumor immunity. This study aimed to identify the recovery profile of T-cell subsets following x-ray irradiation and to highlight the role of cinnamon on efficient T-cell restoration postexposure in the antitumor response. Methods and Materials: CD3"+, CD8"+, and CD4"+ T cells and Th1, Th2, Th17, and regulatory T (Treg) cells were evaluated at different time points after single low-dose total body irradiation (SLTBI) with or without cinnamon treatments. T-bet, GATA3, RORγt, and Foxp3 signaling specific for Th1, Th2, Th17, and Treg were also analyzed by RT-PCR assay. The effects of cinnamon on efficient T-cell subset reconstitution was confirmed in a lung melanoma model in irradiated mice. Results: Reconstitution of CD4"+ T cells was delayed more than that of CD8"+ T cells in T-cell restoration after SLTBI. The production of IFNγ by Th1 or Tc1 cells was sharply decreased and was accompanied by reduced T-bet mRNA, even when total T-cell numbers had recovered; the frequencies of Th17 and Treg cells and their specific transcription factors (RORγt and Foxp3, respectively) were obviously increased. Irradiation-induced inefficient T-cell reconstitution impaired the antitumor capacities in the lung melanoma model. Pretreatment with cinnamon in irradiated mice accelerated the generation of Th1 and reduced the differentiation of Treg cells by activating T-bet and limiting transcriptions of Foxp3. Improvement resulting from cinnamon pretreatment on the efficient T-cell recovery profile from SLTBI promoted antitumor immunity in the lung melanoma model. Conclusions: T-cell reconstitution from SLTBI was characterized by impaired Th1 and elevated Th17 and Treg cells. Cinnamon effectively improved the imbalance of T-cell subsets by promoting the proliferation of Th1 and

  11. Recovery Profiles of T-Cell Subsets Following Low-Dose Total Body Irradiation and Improvement With Cinnamon

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Xiaodan [Key Laboratory for Tumor Immunology and Traditional Chinese Medicine Immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan (China); School of Medicine and Life Science, University of Jinan-Shandong Academy of Medical Science, Jinan (China); Guo, Yuqi [Key Laboratory for Tumor Immunology and Traditional Chinese Medicine Immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan (China); Wang, Lei [Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan (China); Zhang, Honghai [Key Laboratory for Tumor Immunology and Traditional Chinese Medicine Immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan (China); Wang, Shaobo [Shandong University, Jinan (China); Wang, Li [Key Laboratory for Tumor Immunology and Traditional Chinese Medicine Immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan (China); An, Lei [Key Laboratory for Tumor Immunology and Traditional Chinese Medicine Immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan (China); School of Medicine and Life Science, University of Jinan-Shandong Academy of Medical Science, Jinan (China); Zhou, Xianbin; Li, Xia [Key Laboratory for Tumor Immunology and Traditional Chinese Medicine Immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan (China); Yao, Chengfang, E-mail: yaocf9941@163.com [Key Laboratory for Tumor Immunology and Traditional Chinese Medicine Immunology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan (China)

    2015-12-01

    Purpose: Inefficient T-cell reconstitution from x-ray–induced immune damage reduces antitumor response. To understand the profile of T-cell reconstitution after irradiation will overcome the barrier of antitumor immunity. This study aimed to identify the recovery profile of T-cell subsets following x-ray irradiation and to highlight the role of cinnamon on efficient T-cell restoration postexposure in the antitumor response. Methods and Materials: CD3{sup +}, CD8{sup +}, and CD4{sup +} T cells and Th1, Th2, Th17, and regulatory T (Treg) cells were evaluated at different time points after single low-dose total body irradiation (SLTBI) with or without cinnamon treatments. T-bet, GATA3, RORγt, and Foxp3 signaling specific for Th1, Th2, Th17, and Treg were also analyzed by RT-PCR assay. The effects of cinnamon on efficient T-cell subset reconstitution was confirmed in a lung melanoma model in irradiated mice. Results: Reconstitution of CD4{sup +} T cells was delayed more than that of CD8{sup +} T cells in T-cell restoration after SLTBI. The production of IFNγ by Th1 or Tc1 cells was sharply decreased and was accompanied by reduced T-bet mRNA, even when total T-cell numbers had recovered; the frequencies of Th17 and Treg cells and their specific transcription factors (RORγt and Foxp3, respectively) were obviously increased. Irradiation-induced inefficient T-cell reconstitution impaired the antitumor capacities in the lung melanoma model. Pretreatment with cinnamon in irradiated mice accelerated the generation of Th1 and reduced the differentiation of Treg cells by activating T-bet and limiting transcriptions of Foxp3. Improvement resulting from cinnamon pretreatment on the efficient T-cell recovery profile from SLTBI promoted antitumor immunity in the lung melanoma model. Conclusions: T-cell reconstitution from SLTBI was characterized by impaired Th1 and elevated Th17 and Treg cells. Cinnamon effectively improved the imbalance of T-cell subsets by promoting the

  12. Effects of recording time and residue on dose-response by LiMgPO4: Tb, B ceramic disc synthesized via improved sintering process

    Science.gov (United States)

    Kong, Xirui; Fu, Zhilong; Que, Huiying; Fan, Yanwei; Chen, Zhaoyang; He, Chengfa

    2018-05-01

    The LiMgPO4: Tb, B ceramic disc is successfully synthesized via improved sintering method which enables the disc sample to have two flat and smooth surfaces. It is worth mentioning that the OSL signal intensity of LiMgPO4: Tb, B disc attenuates much faster than that of commercial Al2O3: C. It costs only 1 s to reduce the intensity to 10%, but the Al2O3:C needs more than 40 s to finish it. Some essential OSL properties related to the dose detection method of this sample also have been systematically investigated. Although the dose-response cure would have better linearity with longer recording time, extended recording time (≥6 s) will not make any contribution to the linearity of the curve. If the bleaching time is more than 35 s, the residue created by previous detection (high dose of 10 Gy) would do almost no influence (with a positive deviation lower than 5.59%) on next lower-dose detection (0.1 Gy). The material would reach its service life when the total-ionizing dose runs up to 30 k Gy. Therefore, the LiMgPO4: Tb, B ceramic material is a potential candidate for real-time dose monitoring with optical fiber telemetering technology.

  13. Knowledge-based iterative model reconstruction technique in computed tomography of lumbar spine lowers radiation dose and improves tissue differentiation for patients with lower back pain

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Cheng Hui [Department of Medical Imaging, Pojen General Hopsital, Taipei, Taiwan (China); School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Wu, Tung-Hsin [Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan (China); Lin, Chung-Jung, E-mail: bcjlin@me.com [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (China); Chiou, Yi-You; Chen, Ying-Chou; Sheu, Ming-Huei; Guo, Wan-Yuo; Chiu, Chen Fen [School of Medicine, National Yang-Ming University, Taipei, Taiwan (China); Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (China)

    2016-10-15

    Highlights: • Knowledge-based IMR improves tissue differentiation in CT of L-spine better than hybrid IR (iDose{sup 4}). • Higher strength IMR improves image qualities of the IVD and IVF in spinal stenosis. • IMR provides diagnostic lower dose CT of L-spine. - Abstract: Purpose: To evaluate the image quality and diagnostic confidence of reduced-dose computed tomography (CT) of the lumbar spine (L-spine) reconstructed with knowledge-based iterative model reconstruction (IMR). Materials and methods: Prospectively, group A consisted of 55 patients imaged with standard acquisition reconstructed with filtered back-projection. Group B consisted of 58 patients imaged with half tube current, reconstructed with hybrid iterative reconstruction (iDose{sup 4}) in Group B1 and knowledge-based IMR in Group B2. Signal-to-noise ratio (SNR) of different regions, the contrast-to-noise ratio between the intervetebral disc (IVD) and dural sac (D-D CNR), and subjective image quality of different regions were compared. Higher strength IMR was also compared in spinal stenosis cases. Results: The SNR of the psoas muscle and D-D CNR were significantly higher in the IMR group. Except for the facet joint, subjective image quality of other regions including IVD, intervertebral foramen (IVF), dural sac, peridural fat, ligmentum flavum, and overall diagnostic acceptability were best for the IMR group. Diagnostic confidence of narrowing IVF and IVD was good (kappa = 0.58–0.85). Higher strength IMR delineated IVD better in spinal stenosis cases. Conclusion: Lower dose CT of L-spine reconstructed with IMR demonstrates better tissue differentiation than iDose{sup 4} and standard dose CT with FBP.

  14. Knowledge-based iterative model reconstruction technique in computed tomography of lumbar spine lowers radiation dose and improves tissue differentiation for patients with lower back pain

    International Nuclear Information System (INIS)

    Yang, Cheng Hui; Wu, Tung-Hsin; Lin, Chung-Jung; Chiou, Yi-You; Chen, Ying-Chou; Sheu, Ming-Huei; Guo, Wan-Yuo; Chiu, Chen Fen

    2016-01-01

    Highlights: • Knowledge-based IMR improves tissue differentiation in CT of L-spine better than hybrid IR (iDose 4 ). • Higher strength IMR improves image qualities of the IVD and IVF in spinal stenosis. • IMR provides diagnostic lower dose CT of L-spine. - Abstract: Purpose: To evaluate the image quality and diagnostic confidence of reduced-dose computed tomography (CT) of the lumbar spine (L-spine) reconstructed with knowledge-based iterative model reconstruction (IMR). Materials and methods: Prospectively, group A consisted of 55 patients imaged with standard acquisition reconstructed with filtered back-projection. Group B consisted of 58 patients imaged with half tube current, reconstructed with hybrid iterative reconstruction (iDose 4 ) in Group B1 and knowledge-based IMR in Group B2. Signal-to-noise ratio (SNR) of different regions, the contrast-to-noise ratio between the intervetebral disc (IVD) and dural sac (D-D CNR), and subjective image quality of different regions were compared. Higher strength IMR was also compared in spinal stenosis cases. Results: The SNR of the psoas muscle and D-D CNR were significantly higher in the IMR group. Except for the facet joint, subjective image quality of other regions including IVD, intervertebral foramen (IVF), dural sac, peridural fat, ligmentum flavum, and overall diagnostic acceptability were best for the IMR group. Diagnostic confidence of narrowing IVF and IVD was good (kappa = 0.58–0.85). Higher strength IMR delineated IVD better in spinal stenosis cases. Conclusion: Lower dose CT of L-spine reconstructed with IMR demonstrates better tissue differentiation than iDose 4 and standard dose CT with FBP.

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

    International Nuclear Information System (INIS)

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

    2009-01-01

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

  16. Pediatric CT dose reduction for suspected appendicitis: a practice quality improvement project using artificial Gaussian noise--part 1, computer simulations.

    Science.gov (United States)

    Callahan, Michael J; Kleinman, Patricia L; Strauss, Keith J; Bandos, Andriy; Taylor, George A; Tsai, Andy; Kleinman, Paul K

    2015-01-01

    The purpose of this study was to develop a departmental practice quality improvement project to systematically reduce CT doses for the evaluation of suspected pediatric appendicitis by introducing computer-generated gaussian noise. Two hundred MDCT abdominopelvic examinations of patients younger than 20 years performed with girth-based scanning parameters for suspected appendicitis were reviewed. Two judges selected 45 examinations in which the diagnosis of appendicitis was excluded (14, appendix not visualized; 31, normal appendix visualized). Gaussian noise was introduced into axial image series, creating five additional series acquired at 25-76% of the original dose. Two readers reviewed 270 image series for appendix visualization (4-point Likert scale and arrow localization). Volume CT dose index (CTDIvol) and size-specific dose estimate (SSDE) were calculated by use of patient girth. Confidence ratings and localization accuracy were analyzed with mixed models and nonparametric bootstrap analysis at a 0.05 significance level. The mean baseline SSDE for the 45 patients was 16 mGy (95% CI, 12-20 mGy), and the corresponding CTDIvol was 10 mGy (95% CI, 4-16 mGy). Changes in correct appendix localization frequencies were minor. There was no substantial trend with decreasing simulated dose level (p = 0.46). Confidence ratings decreased with increasing dose reduction (p = 0.007). The average decreases were -0.27 for the 25% simulated dose (p = 0.01), -0.17 for 33% (p = 0.03), and -0.03 for 43% (p = 0.65). Pediatric abdominal MDCT can be performed with 43% of the original dose (SSDE, 7 mGy; CTDIvol, 4.3 mGy) without substantially affecting visualization of a normal appendix.

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

    Directory of Open Access Journals (Sweden)

    Delclos Marc E

    2011-06-01

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

  18. TU-F-18A-03: Improving Tissue Segmentation for Monte Carlo Dose Calculation Using DECT Data

    International Nuclear Information System (INIS)

    Di, Salvio A; Bedwani, S; Carrier, J

    2014-01-01

    Purpose: To develop a new segmentation technique using dual energy CT (DECT) to overcome limitations related to segmentation from a standard Hounsfield unit (HU) to electron density (ED) calibration curve. Both methods are compared with a Monte Carlo analysis of dose distribution. Methods: DECT allows a direct calculation of both ED and effective atomic number (EAN) within a given voxel. The EAN is here defined as a function of the total electron cross-section of a medium. These values can be effectively acquired using a calibrated method from scans at two different energies. A prior stoichiometric calibration on a Gammex RMI phantom allows us to find the parameters to calculate EAN and ED within a voxel. Scans from a Siemens SOMATOM Definition Flash dual source system provided the data for our study. A Monte Carlo analysis compares dose distribution simulated by dosxyz-nrc, considering a head phantom defined by both segmentation techniques. Results: Results from depth dose and dose profile calculations show that materials with different atomic compositions but similar EAN present differences of less than 1%. Therefore, it is possible to define a short list of basis materials from which density can be adapted to imitate interaction behavior of any tissue. Comparison of the dose distributions on both segmentations shows a difference of 50% in dose in areas surrounding bone at low energy. Conclusion: The presented segmentation technique allows a more accurate medium definition in each voxel, especially in areas of tissue transition. Since the behavior of human tissues is highly sensitive at low energies, this reduces the errors on calculated dose distribution. This method could be further developed to optimize the tissue characterization based on anatomic site

  19. TU-F-18A-03: Improving Tissue Segmentation for Monte Carlo Dose Calculation Using DECT Data

    Energy Technology Data Exchange (ETDEWEB)

    Di, Salvio A; Bedwani, S; Carrier, J [CHUM - Notre-Dame, Montreal, QC (Canada)

    2014-06-15

    Purpose: To develop a new segmentation technique using dual energy CT (DECT) to overcome limitations related to segmentation from a standard Hounsfield unit (HU) to electron density (ED) calibration curve. Both methods are compared with a Monte Carlo analysis of dose distribution. Methods: DECT allows a direct calculation of both ED and effective atomic number (EAN) within a given voxel. The EAN is here defined as a function of the total electron cross-section of a medium. These values can be effectively acquired using a calibrated method from scans at two different energies. A prior stoichiometric calibration on a Gammex RMI phantom allows us to find the parameters to calculate EAN and ED within a voxel. Scans from a Siemens SOMATOM Definition Flash dual source system provided the data for our study. A Monte Carlo analysis compares dose distribution simulated by dosxyz-nrc, considering a head phantom defined by both segmentation techniques. Results: Results from depth dose and dose profile calculations show that materials with different atomic compositions but similar EAN present differences of less than 1%. Therefore, it is possible to define a short list of basis materials from which density can be adapted to imitate interaction behavior of any tissue. Comparison of the dose distributions on both segmentations shows a difference of 50% in dose in areas surrounding bone at low energy. Conclusion: The presented segmentation technique allows a more accurate medium definition in each voxel, especially in areas of tissue transition. Since the behavior of human tissues is highly sensitive at low energies, this reduces the errors on calculated dose distribution. This method could be further developed to optimize the tissue characterization based on anatomic site.

  20. SU-E-I-82: Improving CT Image Quality for Radiation Therapy Using Iterative Reconstruction Algorithms and Slightly Increasing Imaging Doses

    International Nuclear Information System (INIS)

    Noid, G; Chen, G; Tai, A; Li, X

    2014-01-01

    Purpose: Iterative reconstruction (IR) algorithms are developed to improve CT image quality (IQ) by reducing noise without diminishing spatial resolution or contrast. For CT in radiation therapy (RT), slightly increasing imaging dose to improve IQ may be justified if it can substantially enhance structure delineation. The purpose of this study is to investigate and to quantify the IQ enhancement as a result of increasing imaging doses and using IR algorithms. Methods: CT images were acquired for phantoms, built to evaluate IQ metrics including spatial resolution, contrast and noise, with a variety of imaging protocols using a CT scanner (Definition AS Open, Siemens) installed inside a Linac room. Representative patients were scanned once the protocols were optimized. Both phantom and patient scans were reconstructed using the Sinogram Affirmed Iterative Reconstruction (SAFIRE) and the Filtered Back Projection (FBP) methods. IQ metrics of the obtained CTs were compared. Results: IR techniques are demonstrated to preserve spatial resolution as measured by the point spread function and reduce noise in comparison to traditional FBP. Driven by the reduction in noise, the contrast to noise ratio is doubled by adopting the highest SAFIRE strength. As expected, increasing imaging dose reduces noise for both SAFIRE and FBP reconstructions. The contrast to noise increases from 3 to 5 by increasing the dose by a factor of 4. Similar IQ improvement was observed on the CTs for selected patients with pancreas and prostrate cancers. Conclusion: The IR techniques produce a measurable enhancement to CT IQ by reducing the noise. Increasing imaging dose further reduces noise independent of the IR techniques. The improved CT enables more accurate delineation of tumors and/or organs at risk during RT planning and delivery guidance

  1. A quality improvement project to reduce the intraoperative use of single-dose fentanyl vials across multiple patients in a pediatric institution.

    Science.gov (United States)

    Buck, David; Subramanyam, Rajeev; Varughese, Anna

    2016-01-01

    The use of a single-dose vial across multiple patients presents a risk to sterility and is against CDC guidelines. We initiated a quality improvement (QI) project to reduce the intraoperative use of single-dose vials of fentanyl across multiple patients at Cincinnati Children's Hospital Medical Center (CCHMC). The initial step of the improvement project was the development of a Key Driver Diagram. The diagram has the SMART aim of the project, key drivers inherent to the process we are trying to improve, and specific interventions targeting the key drivers. The number of patients each week receiving an IV dose of fentanyl, from a vial previously accessed for another patient was tracked in a high turnover operating room (OR). The improvement model used was based on the concept of building Plan-Do-Study-Act (PDSA) cycles. Tests of change included provider education, provision of an increased number of fentanyl vials, alternate wasting processes, and provision of single-use fentanyl syringes by the pharmacy. Prior to initiation of this project, it was common for a single fentanyl vial to be accessed for multiple patients. Our data showed an average percentage of failures of just over 50%. During the end of the project, after 7 months, the mean percentage failures had dropped to 5%. Preparation of 20 mcg single-use fentanyl syringes by pharmacy, combined with education of providers on appropriate use, was successful in reducing failures to below our goal of 25%. Appropriately sized fentanyl syringes prepared by pharmacy, education on correct use of single-dose vials, and reminders in the OR, reduced the percentage of patients receiving a dose of fentanyl from a vial previously accessed for another patient in a high-volume otolaryngology room. © 2015 John Wiley & Sons Ltd.

  2. Characteristics of a New X-Ray Imaging System for Interventional Procedures: Improved Image Quality and Reduced Radiation Dose.

    Science.gov (United States)

    Schernthaner, Ruediger E; Haroun, Reham R; Nguyen, Sonny; Duran, Rafael; Sohn, Jae Ho; Sahu, Sonia; Chapiro, Julius; Zhao, Yan; Radaelli, Alessandro; van der Bom, Imramsjah M; Mauti, Maria; Hong, Kelvin; Geschwind, Jean-François H; Lin, MingDe

    2018-03-01

    To compare image quality and radiation exposure between a new angiographic imaging system and the preceding generation system during uterine artery embolization (UAE). In this retrospective, IRB-approved two-arm study, 54 patients with symptomatic uterine fibroids were treated with UAE on two different angiographic imaging systems. The new system includes optimized acquisition parameters and real-time image processing algorithms. Air kerma (AK), dose area product (DAP) and acquisition time for digital fluoroscopy (DF) and digital subtraction angiography (DSA) were recorded. Body mass index was noted as well. DF image quality was assessed objectively by image noise measurements. DSA image quality was rated by two blinded, independent readers on a four-rank scale. Statistical differences were assessed with unpaired t tests and Wilcoxon rank-sum tests. There was no significant difference between the patients treated on the new (n = 36) and the old system (n = 18) regarding age (p = 0.10), BMI (p = 0.18), DF time (p = 0.35) and DSA time (p = 0.17). The new system significantly reduced the cumulative AK and DAP by 64 and 72%, respectively (median 0.58 Gy and 145.9 Gy*cm 2 vs. 1.62 Gy and 526.8 Gy*cm 2 , p < 0.01 for both). Specifically, DAP for DF and DSA decreased by 59% (75.3 vs. 181.9 Gy*cm 2 , p < 0.01) and 78% (67.6 vs. 312.2 Gy*cm 2 , p < 0.01), respectively. The new system achieved a significant decrease in DF image noise (p < 0.01) and a significantly better DSA image quality (p < 0.01). The new angiographic imaging system significantly improved image quality and reduced radiation exposure during UAE procedures.

  3. Improvement in dose escalation using off-line and on-line image feedback in the intensity modulated beam design for prostate cancer treatment

    International Nuclear Information System (INIS)

    Yan, D.; Birkner, M.; Nuesslin, F.; Wong, J.; Martinez, A.

    2001-01-01

    planning was performed based on the predefined planning target volume (CTV + 1cm margin. The capability of safe dose escalation increases, on average, extra 15% in the first on-line strategy. The second on-line feedback strategy shows only a marginal improvement on the total treatment dose compared to the first one. However, it shows further improvement on the dose distribution in the normal organs. Conclusions: The capability of safe dose escalation can be significantly enhanced in both the off-line and the on-line image feedback strategies. In the off-line image feedback strategy, patient/organ geometric information obtained from the first week of treatment appears adequate to guide the inverse planning design for remaining treatment. In the on-line image feedback strategy, the knowledge of organ dose distribution received from the previous treatment improves the design of beam intensity

  4. Multileaf Collimator Tracking Improves Dose Delivery for Prostate Cancer Radiation Therapy: Results of the First Clinical Trial

    DEFF Research Database (Denmark)

    Colvill, Emma; Booth, Jeremy T; O'Brien, Ricky T

    2015-01-01

    was tested for each dose-volume value via analysis of variance using the F test. RESULTS: Of the 513 fractions delivered, 475 (93%) were suitable for analysis. The mean difference and standard deviation between the planned and treated MLC tracking doses and the planned and without-MLC tracking doses for all...... 475 fractions were, respectively, PTV D99% -0.8% ± 1.1% versus -2.1% ± 2.7%; CTV D99% -0.6% ± 0.8% versus -0.6% ± 1.1%; rectum V65% 1.6% ± 7.9% versus -1.2% ± 18%; and bladder V65% 0.5% ± 4.4% versus -0.0% ± 9.2% (P

  5. Dose evaluation using multiple-aliquot quartz OSL: Test of methods and a new protocol for improved accuracy and precision

    DEFF Research Database (Denmark)

    Jain, M.; Bøtter-Jensen, L.; Singhvi, A.K.

    2003-01-01

    -dose-dependent sensitivity changes during the pre-heat, and fundamental variability in the shapes of quartz OSL (blue-green or blue-light stimulated luminescence) decay forms. A new protocol using a combination of 'elevated temperature IR cleaning' (ETIR) and 'component-specific dose normalisation' (CSDN) has been developed....... CSDN accounts for variability in the OSL decay forms and absorbs such sensitivity changes. A combination of ETIR and CSDN protocol increased palaeodose precision from +/-100% to +/-4% in quartz separates from the fluvially transported sands in the Thar desert. A comparison with palaeodose estimates...

  6. Impulsiveness, overactivity, and poorer sustained attention improve by chronic treatment with low doses of l-amphetamine in an animal model of Attention-Deficit/Hyperactivity Disorder (ADHD).

    Science.gov (United States)

    Sagvolden, Terje

    2011-03-30

    ADHD is currently defined as a cognitive/behavioral developmental disorder where all clinical criteria are behavioral. Overactivity, impulsiveness, and inattentiveness are presently regarded as the main clinical symptoms. There is no biological marker, but there is considerable evidence to suggest that ADHD behavior is associated with poor dopaminergic and noradrenergic modulation of neuronal circuits that involve the frontal lobes. The best validated animal model of ADHD, the Spontaneously Hypertensive Rat (SHR), shows pronounced overactivity, impulsiveness, and deficient sustained attention. The primary objective of the present research was to investigate behavioral effects of a range of doses of chronic l-amphetamine on ADHD-like symptoms in the SHR. The present study tested the behavioral effects of 0.75 and 2.2 mg l-amphetamine base/kg i.p. in male SHRs and their controls, the Wistar Kyoto rat (WKY). ADHD-like behavior was tested with a visual discrimination task measuring overactivity, impulsiveness and inattentiveness. The striking impulsiveness, overactivity, and poorer sustained attention seen during baseline conditions in the SHR were improved by chronic treatment with l-amphetamine. The dose-response curves were, however, different for the different behaviors. Most significantly, the 0.75 mg/kg dose of l-amphetamine improved sustained attention without reducing overactivity and impulsiveness. The 2.2 mg/kg dose improved sustained attention as well as reduced SHR overactivity and impulsiveness. The effects of l-amphetamine to reduce the behavioral symptoms of ADHD in the SHR were maintained over the 14 days of daily dosing with no evidence of tolerance developing.

  7. The minimum measurable dose of CaF{sub 2}:Dy measured via an improved heating profile with an automatic 6600 thermoluminescent detector

    Energy Technology Data Exchange (ETDEWEB)

    Ben-Shachar, B; Weinstein, M; German, U [Israel Atomic Energy Commission, Beersheba (Israel). Nuclear Research Center-Negev

    1996-12-01

    One of the advantages of the thermoluminescent method is its ability to measure low doses, which is useful in environmental dosimetry, as well as in archaeology. The CaF{sub 2}:Dy (Crown as TLD-200), has a sensitivity of 10-30 times greater than the sensitivity of TLD-100, when irradiated by Cs-137. In the present work we evaluated the TL-dose response of CaF{sub 2}:Dy, by using an improved heating profile which is giving the main glow peak alone. The relative standard deviations were fitted to a semiempirical expression, from which the minimum measurable doses (MMD) were derived. The MMD were calculated by taking 3 times the standard deviation of the unirradiated chips. The results of the TL-dose response, as well as file fee calculated MMD by taxing 3 times the standard deviation of unirradiated chips, measured by file new 6600 automatic thermoluminescent detector, are presented in this work. We received a MMD of about 0.01 mGy (1 mrad), an improvement of a factor of 2.5 relatively to the integral light response evaluation using the standard heating profile (authors).

  8. Ultrasound-assisted powder-coating technique to improve content uniformity of low-dose solid dosage forms

    DEFF Research Database (Denmark)

    Genina, Natalja; Räikkönen, Heikki; Antikainen, Osmo

    2010-01-01

    An ultrasound-assisted powder-coating technique was used to produce a homogeneous powder formulation of a low-dose active pharmaceutical ingredient (API). The powdered particles of microcrystalline cellulose (MCC; Avicel® PH-200) were coated with a 4% m/V aqueous solution of riboflavin sodium...

  9. An experimental attenuation plate to improve the dose distribution in intraoperative electron beam radiotherapy for breast cancer.

    Science.gov (United States)

    Oshima, T; Aoyama, Y; Shimozato, T; Sawaki, M; Imai, T; Ito, Y; Obata, Y; Tabushi, K

    2009-06-07

    Intraoperative electron beam radiotherapy (IOERT) is a technique in which a single-fraction high dose is intraoperatively delivered to subclinical tumour cells using an electron beam after breast-conserving surgery. In IOERT, an attenuation plate consisting of a pair of metal disks is commonly used to protect the normal tissues posterior to the breast. However, the dose in front of the plate is affected by backscatter, resulting in an unpredictable delivered dose to the tumour cells. In this study, an experimental attenuation plate, termed a shielding plate, was designed using Monte Carlo simulation, which significantly diminished the electron beam without introducing any backscatter radiation. The plate's performance was verified by measurements. It was made of two layers, a first layer (source side) of polymethyl methacrylate (PMMA) and a second layer of copper, which was selected from among other metals (aluminium, copper and lead) after testing for shielding capability and the range and magnitude of backscatter. The optimal thicknesses of the PMMA (0.71 cm) and copper (0.3 cm) layers were determined by changing their thicknesses during simulations. On the basis of these results, a shielding plate was prototyped and depth doses with and without the plate were measured by radiophotoluminescence glass dosimeters using a conventional stationary linear accelerator and a mobile linear accelerator dedicated for IOERT. The trial shielding plate functioned as intended, indicating its applicability in clinical practice.

  10. Improvements in pencil beam scanning proton therapy dose calculation accuracy in brain tumor cases with a commercial Monte Carlo algorithm.

    Science.gov (United States)

    Widesott, Lamberto; Lorentini, Stefano; Fracchiolla, Francesco; Farace, Paolo; Schwarz, Marco

    2018-05-04

    validation of a commercial Monte Carlo (MC) algorithm (RayStation ver6.0.024) for the treatment of brain tumours with pencil beam scanning (PBS) proton therapy, comparing it via measurements and analytical calculations in clinically realistic scenarios. Methods: For the measurements a 2D ion chamber array detector (MatriXX PT)) was placed underneath the following targets: 1) anthropomorphic head phantom (with two different thickness) and 2) a biological sample (i.e. half lamb's head). In addition, we compared the MC dose engine vs. the RayStation pencil beam (PB) algorithm clinically implemented so far, in critical conditions such as superficial targets (i.e. in need of range shifter), different air gaps and gantry angles to simulate both orthogonal and tangential beam arrangements. For every plan the PB and MC dose calculation were compared to measurements using a gamma analysis metrics (3%, 3mm). Results: regarding the head phantom the gamma passing rate (GPR) was always >96% and on average > 99% for the MC algorithm; PB algorithm had a GPR ≤90% for all the delivery configurations with single slab (apart 95 % GPR from gantry 0° and small air gap) and in case of two slabs of the head phantom the GPR was >95% only in case of small air gaps for all the three (0°, 45°,and 70°) simulated beam gantry angles. Overall the PB algorithm tends to overestimate the dose to the target (up to 25%) and underestimate the dose to the organ at risk (up to 30%). We found similar results (but a bit worse for PB algorithm) for the two targets of the lamb's head where only two beam gantry angles were simulated. Conclusions: our results suggest that in PBS proton therapy range shifter (RS) need to be used with extreme caution when planning the treatment with an analytical algorithm due to potentially great discrepancies between the planned dose and the dose delivered to the patients, also in case of brain tumours where this issue could be underestimated. Our results also

  11. WE-AB-303-06: Combining DAO with MV + KV Optimization to Improve Skin Dose Sparing with Real-Time Fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Grelewicz, Z; Wiersma, R [The University of Chicago, Chicago, IL (United States)

    2015-06-15

    Purpose: Real-time fluoroscopy may allow for improved patient positioning and tumor tracking, particularly in the treatment of lung tumors. In order to mitigate the effects of the imaging dose, previous studies have demonstrated the effect of including both imaging dose and imaging constraints into the inverse treatment planning object function. That method of combined MV+kV optimization may Result in plans with treatment beams chosen to allow for more gentle imaging beam-on times. Direct-aperture optimization (DAO) is also known to produce treatment plans with fluence maps more conducive to lower beam-on times. Therefore, in this work we demonstrate the feasibility of a combination of DAO and MV+kV optimization for further optimized real-time kV imaging. Methods: Therapeutic and imaging beams were modeled in the EGSnrc Monte Carlo environment, and applied to a patient model for a previously treated lung patient to provide dose influence matrices from DOSXYZnrc. An MV + kV IMRT DAO treatment planning system was developed to compare DAO treatment plans with and without MV+kV optimization. The objective function was optimized using simulated annealing. In order to allow for comparisons between different cases of the stochastically optimized plans, the optimization was repeated twenty times. Results: Across twenty optimizations, combined MV+kV IMRT resulted in an average of 12.8% reduction in peak skin dose. Both non-optimized and MV+kV optimized imaging beams delivered, on average, mean dose of approximately 1 cGy per fraction to the target, with peak doses to target of approximately 6 cGy per fraction. Conclusion: When using DAO, MV+kV optimization is shown to Result in improvements to plan quality in terms of skin dose, when compared to the case of MV optimization with non-optimized kV imaging. The combination of DAO and MV+kV optimization may allow for real-time imaging without excessive imaging dose. Financial support for the work has been provided in part by NIH

  12. Volume arc therapy of gynaecological tumours: target volume coverage improvement without dose increase for critical organs; Arctherapie volumique des tumeurs gynecologiques: amelioration de la couverture du volume cible sans augmentation de la dose aux organes critiques

    Energy Technology Data Exchange (ETDEWEB)

    Ducteil, A.; Kerr, C.; Idri, K.; Fenoglietto, P.; Vieillot, S.; Ailleres, N.; Dubois, J.B.; Azria, D. [CRLC Val-d' Aurelle, Montpellier (France)

    2011-10-15

    The authors report the assessment of the application of conventional intensity-modulated conformational radiotherapy (IMRT) and volume arc-therapy (RapidArc) for the treatment of cervical cancers, with respect to conventional radiotherapy. Dosimetric plans associated with each of these techniques have been compared. Dose-volume histograms of these three plans have also been compared for the previsional target volume (PTV), organs at risk, and sane tissue. IMCT techniques are equivalent in terms of sparing of organs at risk, and improve target volume coverage with respect to conventional radiotherapy. Arc-therapy reduces significantly treatment duration. Short communication

  13. A second dose of kisspeptin-54 improves oocyte maturation in women at high risk of ovarian hyperstimulation syndrome: a Phase 2 randomized controlled trial.

    Science.gov (United States)

    Abbara, Ali; Clarke, Sophie; Islam, Rumana; Prague, Julia K; Comninos, Alexander N; Narayanaswamy, Shakunthala; Papadopoulou, Deborah; Roberts, Rachel; Izzi-Engbeaya, Chioma; Ratnasabapathy, Risheka; Nesbitt, Alexander; Vimalesvaran, Sunitha; Salim, Rehan; Lavery, Stuart A; Bloom, Stephen R; Huson, Les; Trew, Geoffrey H; Dhillo, Waljit S

    2017-09-01

    Can increasing the duration of LH-exposure with a second dose of kisspeptin-54 improve oocyte maturation in women at high risk of ovarian hyperstimulation syndrome (OHSS)? A second dose of kisspeptin-54 at 10 h following the first improves oocyte yield in women at high risk of OHSS. Kisspeptin acts at the hypothalamus to stimulate the release of an endogenous pool of GnRH from the hypothalamus. We have previously reported that a single dose of kisspeptin-54 results in an LH-surge of ~12-14 h duration, which safely triggers oocyte maturation in women at high risk of OHSS. Phase-2 randomized placebo-controlled trial of 62 women at high risk of OHSS recruited between August 2015 and May 2016. Following controlled ovarian stimulation, all patients (n = 62) received a subcutaneous injection of kisspeptin-54 (9.6 nmol/kg) 36 h prior to oocyte retrieval. Patients were randomized 1:1 to receive either a second dose of kisspeptin-54 (D; Double, n = 31), or saline (S; Single, n = 31) 10 h thereafter. Patients, embryologists, and IVF clinicians remained blinded to the dosing allocation. Study participants: Sixty-two women aged 18-34 years at high risk of OHSS (antral follicle count ≥23 or anti-Mullerian hormone level ≥40 pmol/L). Setting: Single centre study carried out at Hammersmith Hospital IVF unit, London, UK. Primary outcome: Proportion of patients achieving an oocyte yield (percentage of mature oocytes retrieved from follicles ≥14 mm on morning of first kisspeptin-54 trigger administration) of at least 60%. Secondary outcomes: Reproductive hormone levels, implantation rate and OHSS occurrence. A second dose of kisspeptin-54 at 10 h following the first induced further LH-secretion at 4 h after administration. A higher proportion of patients achieved an oocyte yield ≥60% following a second dose of kisspeptin-54 (Single: 14/31, 45%, Double: 21/31, 71%; absolute difference +26%, CI 2-50%, P = 0.042). Patients receiving two doses of kisspeptin-54 had a variable LH

  14. Incidence of colorectal cancer in new users and non-users of low-dose aspirin without existing cardiovascular disease: A cohort study using The Health Improvement Network.

    Science.gov (United States)

    Cea Soriano, Lucía; Soriano-Gabarró, Montse; García Rodríguez, Luis A

    2017-12-01

    Evidence regarding the chemo-protective effects of aspirin has influenced expert opinion in favour of low-dose aspirin use in certain patient populations without cardiovascular disease (CVD). The effects of aspirin in reducing the incidence of colorectal cancer (CRC) may be a large contributor to this favourable risk-benefit profile of low-dose aspirin in primary CVD prevention. Using The Health Improvement Network, we estimated the incidence of CRC in individuals free of CVD and either prescribed or not prescribed prophylactic low-dose aspirin. Two cohorts - new-users of low-dose aspirin (N=109,426) and a comparator cohort of non-users (N=154,056) at start of follow-up - were followed (maximum 13years) to identify incident CRC cases. Individuals with a record of CVD, cancer or low-dose aspirin prescription before start of follow-up were excluded. 2330 incident cases of CRC occurred; 885 in the aspirin cohort and 1445 in the comparator cohort, after mean follow-ups of 5.43years and 5.17years, respectively. Incidence rates of CRC per 10,000 person-years (95% confidence interval) were 14.90 (13.95-15.92) in the aspirin cohort and 18.15 (17.24-19.12) in the comparator cohort; incidence rate ratio 0.82 (0.76-0.89) adjusted for age, sex and primary care practitioner (PCP) visits in the previous year. Lower incidence rates were seen in the aspirin cohort for all strata evaluated (gender, age group and number of PCP visits in the previous year) except those aged ≥80years. Among most individuals without established CVD, initiation of low-dose aspirin is associated with a reduced incidence of CRC. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Dose reduction of risperidone and olanzapine can improve cognitive function and negative symptoms in stable schizophrenic patients: A single-blinded, 52-week, randomized controlled study.

    Science.gov (United States)

    Zhou, Yanling; Li, Guannan; Li, Dan; Cui, Hongmei; Ning, Yuping

    2018-05-01

    The long-term effects of dose reduction of atypical antipsychotics on cognitive function and symptomatology in stable patients with schizophrenia remain unclear. We sought to determine the change in cognitive function and symptomatology after reducing risperidone or olanzapine dosage in stable schizophrenic patients. Seventy-five stabilized schizophrenic patients prescribed risperidone (≥4 mg/day) or olanzapine (≥10 mg/day) were randomly divided into a dose-reduction group ( n=37) and a maintenance group ( n=38). For the dose-reduction group, the dose of antipsychotics was reduced by 50%; for the maintenance group, the dose remained unchanged throughout the whole study. The Positive and Negative Syndrome Scale, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects, and Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery were measured at baseline, 12, 28, and 52 weeks. Linear mixed models were performed to compare the Positive and Negative Syndrome Scale, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects and MATRICS Consensus Cognitive Battery scores between groups. The linear mixed model showed significant time by group interactions on the Positive and Negative Syndrome Scale negative symptoms, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects, speed of processing, attention/vigilance, working memory and total score of MATRICS Consensus Cognitive Battery (all pNegative Syndrome Scale negative subscale, Negative Symptom Assessment-16, Rating Scale for Extrapyramidal Side Effects, speed of processing, working memory and total score of MATRICS Consensus Cognitive Battery for the dose reduction group compared with those for the maintenance group (all pnegative symptoms in patients with stabilized schizophrenia.

  16. Marked improvement by high-dose chemotherapy and autologous stem cell transplantation in a case of light chain deposition disease.

    Science.gov (United States)

    Matsuzaki, Keiichi; Ohsawa, Isao; Nishitani, Tomohito; Takeda, Yukihiko; Inoshita, Hiroyuki; Ishii, Masaya; Takagi, Miyuki; Horikoshi, Satoshi; Tomino, Yasuhiko

    2011-01-01

    A 55-year-old woman presented with heavy proteinuria (6.2 g/day) in April 2007. Because monoclonal IgG-k was detected in serum and urine samples, bone marrow aspiration and renal biopsy were performed. She was diagnosed with plasma cell dyscrasia because a bone marrow aspiration specimen showed plasma cells at 6.1%. Renal tissues revealed the formation of nodular glomerulosclerosis which was negative for Congo-red staining. Renal immunohistochemistry showed positive staining for kappa light chains in the nodular lesions, proximal tubules and part of Bowman's capsules. Her renal involvement was diagnosed as light chain deposition disease. Proteinuria disappeared and renal function stabilized after high-dose chemotherapy and autologous stem cell transplantation. It appears that an early initiation of active therapy such as high-dose chemotherapy and autologous stem cell transplantation may be beneficial for patients with light chain deposition disease.

  17. Effect of improved TLD dosimetry on the determination of dose rate constants for 125I and 103Pd brachytherapy seeds

    International Nuclear Information System (INIS)

    Rodriguez, M.; Rogers, D. W. O.

    2014-01-01

    Purpose: To more accurately account for the relative intrinsic energy dependence and relative absorbed-dose energy dependence of TLDs when used to measure dose rate constants (DRCs) for 125 I and 103 Pd brachytherapy seeds, to thereby establish revised “measured values” for all seeds and compare the revised values with Monte Carlo and consensus values. Methods: The relative absorbed-dose energy dependence, f rel , for TLDs and the phantom correction, P phant , are calculated for 125 I and 103 Pd seeds using the EGSnrc BrachyDose and DOSXYZnrc codes. The original energy dependence and phantom corrections applied to DRC measurements are replaced by calculated (f rel ) −1 and P phant values for 24 different seed models. By comparing the modified measured DRCs to the MC values, an appropriate relative intrinsic energy dependence, k bq rel , is determined. The new P phant values and relative absorbed-dose sensitivities, S AD rel , calculated as the product of (f rel ) −1 and (k bq rel ) −1 , are used to individually revise the measured DRCs for comparison with Monte Carlo calculated values and TG-43U1 or TG-43U1S1 consensus values. Results: In general, f rel is sensitive to the energy spectra and models of the brachytherapy seeds. Values may vary up to 8.4% among 125 I and 103 Pd seed models and common TLD shapes. P phant values depend primarily on the isotope used. Deduced (k bq rel ) −1 values are 1.074 ± 0.015 and 1.084 ± 0.026 for 125 I and 103 Pd seeds, respectively. For (1 mm) 3 chips, this implies an overall absorbed-dose sensitivity relative to 60 Co or 6 MV calibrations of 1.51 ± 1% and 1.47 ± 2% for 125 I and 103 Pd seeds, respectively, as opposed to the widely used value of 1.41. Values of P phant calculated here have much lower statistical uncertainties than literature values, but systematic uncertainties from density and composition uncertainties are significant. Using these revised values with the literature’s DRC measurements, the

  18. Low-dose β-blocker in combination with milrinone safely improves cardiac function and eliminates pulsus alternans in patients with acute decompensated heart failure.

    Science.gov (United States)

    Kobayashi, Shigeki; Susa, Takehisa; Tanaka, Takeo; Murakami, Wakako; Fukuta, Seiko; Okuda, Shinichi; Doi, Masahiro; Wada, Yasuaki; Nao, Tomoko; Yamada, Jutaro; Okamura, Takayuki; Yano, Masafumi; Matsuzaki, Masunori

    2012-01-01

    The purpose of this study was to determine whether a low-dose β-blocker, in combination with milrinone, improves cardiac function in acute decompensated heart failure (ADHF) with tachycardia. Twenty ADHF patients (New York Heart Association classification III, n=1, and IV, n=19; heart rate [HR], 107±12 beats/min; left ventricular ejection fraction, 24±7%; cardiac index [CI], 2.2±0.6 L·min(-1)·m(-2); pulmonary capillary wedge pressure [PCWP], 26±8 mmHg) were enrolled in this study. The patients first underwent conventional therapy with milrinone, vasodilators and diuretics; landiolol (1.5-6.0 µg·kg(-1)·min(-1); i.v.), which is an ultra-short-acting β(1)-selective blocker, was then added to the treatment regimen to study its effect on hemodynamics. Low-dose landiolol (1.5 µg·kg(-1)·min(-1)) significantly reduced HR by 11% without changing blood pressure (BP) and CI, whereas higher doses (≥3.0 µg·kg(-1)·min(-1)) tended to decrease BP and CI while increasing PCWP and systemic vascular resistance. After treatment with landiolol (1.5 µg·kg(-1)·min(-1)), hemodynamic parameters such as PCWP, stroke volume index, SvO(2), rate pressure product, filling time/RR, E/e', and Tei index were significantly improved. A low-dose β-blocker in combination with milrinone improved cardiac function in ADHF patients with tachycardia; therefore, it may be considered as an adjunct therapy for use when standard therapy with milrinone is not effective at slowing HR.

  19. Collection and use of individual behavioral and consumption rate data to improve reconstruction of thyroid doses from nuclear weapons tests in Kazakhstan

    International Nuclear Information System (INIS)

    Drozdovitch, Vladimir; Schonfeld, Sara; Bouville, Andre; Land, Charles; Luckyanov, Nick; Simon, Steven L.; Schwerin, Michael

    2008-01-01

    Full text: Historical behavioral and consumption rate data were collected from residents of Kazakhstan exposed to nuclear weapons testing fallout using a focus group data collection strategy. These data will enable improved thyroid dose estimation in a radiation epidemiological study being carried out the U.S. National Cancer Institute. The study on the relationship of radiation exposure from weapons testing fallout and thyroid disease in a cohort of 2,994 subjects is now in a stage of improving earlier dose estimates based on individual information collected from a basic questionnaire administered to the study population in 1998. The study subjects of both Kazakh and Russian origin were exposed during childhood to radioactive fallout from nuclear weapons tests conducted at the Semipalatinsk Nuclear Test Site between 1949 and 1962. Due to the long time since exposure, a well developed strategy is necessary to encourage accurate memory recall. Limitations of the data collected in 1998 suggested the need to obtain reliable information that is tailored specific to the requirements of the dose reconstruction algorithm and to the evaluation of individual dose uncertainties. Focus group data collection in Kazakhstan in 2007 involved four 8-person focus groups (three of women and one of men) in each of four exposed settlements where thyroid disease screening was conducted in 1998. Age-specific data on relevant childhood behaviour, including time spent indoors and consumption of milk and other dairy products from cows, goats, horses, and sheep, were collected from women's groups. Men's focus groups were interviewed about construction materials of houses and schools as well as animal grazing patterns and supplemental feed to animals. Information obtained from the focus groups are being used to derive the settlement-, ethnicity-, age-, and gender-specific (where appropriate) probability density distributions on individual consumption rates of milk and dairy products

  20. Age-related changes in prefrontal norepinephrine transporter density: The basis for improved cognitive flexibility after low doses of atomoxetine in adolescent rats

    Science.gov (United States)

    Bradshaw, Sarah E.; Agster, Kara L.; Waterhouse, Barry D.; McGaughy, Jill A.

    2016-01-01

    Adolescence is a period of major behavioral and brain reorganization. As diagnoses and treatment of disorders like attention deficit hyperactivity disorder (ADHD) often occur during adolescence, it is important to understand how the prefrontal cortices change and how these changes may influence the response to drugs during development. The current study uses an adolescent rat model to study the effect of standard ADHD treatments, atomoxetine and methylphenidate on attentional set shifting and reversal learning. While both of these drugs act as norepinephrine reuptake inhibitors, higher doses of atomoxetine and all doses of methylphenidate also block dopamine transporters (DAT). Low doses of atomoxetine, were effective at remediating cognitive rigidity found in adolescents. In contrast, methylphenidate improved performance in rats unable to form an attentional set due to distractibility but was without effect in normal subjects. We also assessed the effects of GBR 12909, a selective DAT inhibitor, but found no effect of any dose on behavior. A second study in adolescent rats investigated changes in norepinephrine transporter (NET) and dopamine beta hydroxylase (DBH) density in five functionally distinct subregions of the prefrontal cortex: infralimbic, prelimbic, anterior cingulate, medial and lateral orbitofrontal cortices. These regions are implicated in impulsivity and distractibility. We found that NET, but not DBH, changed across adolescence in a regionally selective manner. The prelimbic cortex, which is critical to cognitive rigidity, and the lateral orbitofrontal cortex, critical to reversal learning and some forms of response inhibition, showed higher levels of NET at early than mid- to late adolescence. PMID:26774596

  1. Low-dose irradiation of fresh, non-frozen chicken and other preservation methods for shelf-life extension and for improving its public-health quality

    International Nuclear Information System (INIS)

    Kahan, R.S.; Howker, J.J.

    1978-01-01

    Fresh eviscerated broiler chicken, both with salt treatment (part of kosher processing) and without, were gamma irradiated and stored at -1, 0, +1.6 and +4.4 0 C for up to 31 days. At intervals samples were withdrawn for microbial, physical and sensory evaluations. Combination of a 250 krad irradiation dose and storage at 1.6 0 C were adequate for a radurized chicken process. The product was free from microbial spoilage and of excellent quality for at least 15 days and, in addition, was essentially free from Salmonella and other organisms of public-health significance. It is therefore proposed that the doses recommended recently by the Joint FAO/IAEA/WHO Committee are unnecessarily high and should be markedly reduced. A 500 krad dose caused marked flesh discolouring without improving the microbiological or enzymatic preservation, and this is likely to be found generally true for commercial poultry flocks under veterinary inspection. Flesh discolouring of chicken treated with 300 krad is unlikely to be detectable by the untrained eye and a maximum dose of 300 krad should be the target for non-frozen chicken irradiation processes. (author)

  2. Performance evaluation of an improved optical computed tomography polymer gel dosimeter system for 3D dose verification of static and dynamic phantom deliveries

    International Nuclear Information System (INIS)

    Lopatiuk-Tirpak, O.; Langen, K. M.; Meeks, S. L.; Kupelian, P. A.; Zeidan, O. A.; Maryanski, M. J.

    2008-01-01

    The performance of a next-generation optical computed tomography scanner (OCTOPUS-5X) is characterized in the context of three-dimensional gel dosimetry. Large-volume (2.2 L), muscle-equivalent, radiation-sensitive polymer gel dosimeters (BANG-3) were used. Improvements in scanner design leading to shorter acquisition times are discussed. The spatial resolution, detectable absorbance range, and reproducibility are assessed. An efficient method for calibrating gel dosimeters using the depth-dose relationship is applied, with photon- and electron-based deliveries yielding equivalent results. A procedure involving a preirradiation scan was used to reduce the edge artifacts in reconstructed images, thereby increasing the useful cross-sectional area of the dosimeter by nearly a factor of 2. Dose distributions derived from optical density measurements using the calibration coefficient show good agreement with the treatment planning system simulations and radiographic film measurements. The feasibility of use for motion (four-dimensional) dosimetry is demonstrated on an example comparing dose distributions from static and dynamic delivery of a single-field photon plan. The capability to visualize three-dimensional dose distributions is also illustrated

  3. Dose sculpting with generalized equivalent uniform dose

    International Nuclear Information System (INIS)

    Wu Qiuwen; Djajaputra, David; Liu, Helen H.; Dong Lei; Mohan, Radhe; Wu, Yan

    2005-01-01

    With intensity-modulated radiotherapy (IMRT), a variety of user-defined dose distribution can be produced using inverse planning. The generalized equivalent uniform dose (gEUD) has been used in IMRT optimization as an alternative objective function to the conventional dose-volume-based criteria. The purpose of this study was to investigate the effectiveness of gEUD optimization to fine tune the dose distributions of IMRT plans. We analyzed the effect of gEUD-based optimization parameters on plan quality. The objective was to determine whether dose distribution to selected structures could be improved using gEUD optimization without adversely altering the doses delivered to other structures, as in sculpting. We hypothesized that by carefully defining gEUD parameters (EUD 0 and n) based on the current dose distributions, the optimization system could be instructed to search for alternative solutions in the neighborhood, and we could maintain the dose distributions for structures already satisfactory and improve dose for structures that need enhancement. We started with an already acceptable IMRT plan optimized with any objective function. The dose distribution was analyzed first. For structures that dose should not be changed, a higher value of n was used and EUD 0 was set slightly higher/lower than the EUD value at the current dose distribution for critical structures/targets. For structures that needed improvement in dose, a higher to medium value of n was used, and EUD 0 was set to the EUD value or slightly lower/higher for the critical structure/target at the current dose distribution. We evaluated this method in one clinical case each of head and neck, lung and prostate cancer. Dose volume histograms, isodose distributions, and relevant tolerance doses for critical structures were used for the assessment. We found that by adjusting gEUD optimization parameters, the dose distribution could be improved with only a few iterations. A larger value of n could lead to

  4. Head CT: Image quality improvement of posterior fossa and radiation dose reduction with ASiR - comparative studies of CT head examinations

    International Nuclear Information System (INIS)

    Guzinski, Maciej; Waszczuk, Lukasz; Sasiadek, Marek J.

    2016-01-01

    To evaluate head CT protocol developed to improve visibility of the brainstem and cerebellum, lower bone-related artefacts in the posterior fossa and maintain patient radioprotection. A paired comparison of head CT performed without Adaptive Statistical Iterative Reconstruction (ASiR) and a clinically indicated follow-up with 40 % ASiR was acquired in one group of 55 patients. Patients were scanned in the axial mode with different scanner settings for the brain and the posterior fossa. Objective image quality analysis was performed with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality analysis was based on brain structure visibility and evaluation of the artefacts. We achieved 19 % reduction of total DLP and significantly better image quality of posterior fossa structures. SNR for white and grey matter in the cerebellum were 34 % to 36 % higher, respectively, CNR was improved by 142 % and subjective analyses were better for images with ASiR. When imaging parameters are set independently for the brain and the posterior fossa imaging, ASiR has a great potential to improve CT performance: image quality of the brainstem and cerebellum is improved, and radiation dose for the brain as well as total radiation dose are reduced. (orig.)

  5. Low-dose radiation pretreatment improves survival of human ceiling culture-derived proliferative adipocytes (ccdPAs) under hypoxia via HIF-1 alpha and MMP-2 induction

    International Nuclear Information System (INIS)

    Adachi, Naoki; Kubota, Yoshitaka; Kosaka, Kentarou; Akita, Shinsuke; Sasahara, Yoshitarou; Kira, Tomoe; Kuroda, Masayuki; Mitsukawa, Nobuyuki; Bujo, Hideaki; Satoh, Kaneshige

    2015-01-01

    Poor survival is a major problem of adipocyte transplantation. We previously reported that VEGF and MMPs secreted from transplanted adipocytes are essential for angiogenesis and adipogenesis. Pretreatment with low-dose (5 Gy) radiation (LDR) increased VEGF, MMP-2, and HIF-1 alpha mRNA expression in human ceiling culture-derived proliferative adipocytes (hccdPAs). Gene expression after LDR differed between adipose-derived stem cells (hASCs) and hccdPAs. Pretreatment with LDR improved the survival of hccdPAs under hypoxia, which is inevitable in the early stages after transplantation. Upregulation of VEGF and MMP-2 after LDR in hccdPAs is mediated by HIF-1 alpha expression. Our results suggest that pretreatment with LDR may improve adipocyte graft survival in a clinical setting through upregulation of VEGF and MMP-2 via HIF-1 alpha. - Highlights: • Ceiling culture-derived proliferative adipocytes (ccdPAs) react to radiation. • Low-dose radiation (LDR) pretreatment improves survival of ccdPAs under hypoxia. • Gene expression after LDR differs between ccdPAs and adipose-derived stem cells. • LDR-induced increase in MMP-2 and VEGF is dependent on HIF-1 alpha induction. • LDR pretreatment may improve the adipocyte graft survival rate in clinical settings

  6. Low-dose radiation pretreatment improves survival of human ceiling culture-derived proliferative adipocytes (ccdPAs) under hypoxia via HIF-1 alpha and MMP-2 induction

    Energy Technology Data Exchange (ETDEWEB)

    Adachi, Naoki [Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba, #260-8677 (Japan); Kubota, Yoshitaka, E-mail: kubota-cbu@umin.ac.jp [Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba, #260-8677 (Japan); Kosaka, Kentarou; Akita, Shinsuke; Sasahara, Yoshitarou; Kira, Tomoe [Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba, #260-8677 (Japan); Kuroda, Masayuki [Center for Advanced Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba, #260-8677 (Japan); Mitsukawa, Nobuyuki [Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba, #260-8677 (Japan); Bujo, Hideaki [Department of Clinical-Laboratory and Experimental-Research Medicine, Toho University, Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, #285-8741 (Japan); Satoh, Kaneshige [Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba, #260-8677 (Japan)

    2015-08-07

    Poor survival is a major problem of adipocyte transplantation. We previously reported that VEGF and MMPs secreted from transplanted adipocytes are essential for angiogenesis and adipogenesis. Pretreatment with low-dose (5 Gy) radiation (LDR) increased VEGF, MMP-2, and HIF-1 alpha mRNA expression in human ceiling culture-derived proliferative adipocytes (hccdPAs). Gene expression after LDR differed between adipose-derived stem cells (hASCs) and hccdPAs. Pretreatment with LDR improved the survival of hccdPAs under hypoxia, which is inevitable in the early stages after transplantation. Upregulation of VEGF and MMP-2 after LDR in hccdPAs is mediated by HIF-1 alpha expression. Our results suggest that pretreatment with LDR may improve adipocyte graft survival in a clinical setting through upregulation of VEGF and MMP-2 via HIF-1 alpha. - Highlights: • Ceiling culture-derived proliferative adipocytes (ccdPAs) react to radiation. • Low-dose radiation (LDR) pretreatment improves survival of ccdPAs under hypoxia. • Gene expression after LDR differs between ccdPAs and adipose-derived stem cells. • LDR-induced increase in MMP-2 and VEGF is dependent on HIF-1 alpha induction. • LDR pretreatment may improve the adipocyte graft survival rate in clinical settings.

  7. Head CT: Image quality improvement of posterior fossa and radiation dose reduction with ASiR - comparative studies of CT head examinations

    Energy Technology Data Exchange (ETDEWEB)

    Guzinski, Maciej; Waszczuk, Lukasz; Sasiadek, Marek J. [Wroclaw Medical University, Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw (Poland)

    2016-10-15

    To evaluate head CT protocol developed to improve visibility of the brainstem and cerebellum, lower bone-related artefacts in the posterior fossa and maintain patient radioprotection. A paired comparison of head CT performed without Adaptive Statistical Iterative Reconstruction (ASiR) and a clinically indicated follow-up with 40 % ASiR was acquired in one group of 55 patients. Patients were scanned in the axial mode with different scanner settings for the brain and the posterior fossa. Objective image quality analysis was performed with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality analysis was based on brain structure visibility and evaluation of the artefacts. We achieved 19 % reduction of total DLP and significantly better image quality of posterior fossa structures. SNR for white and grey matter in the cerebellum were 34 % to 36 % higher, respectively, CNR was improved by 142 % and subjective analyses were better for images with ASiR. When imaging parameters are set independently for the brain and the posterior fossa imaging, ASiR has a great potential to improve CT performance: image quality of the brainstem and cerebellum is improved, and radiation dose for the brain as well as total radiation dose are reduced. (orig.)

  8. Prostaglandin E1 in conjunction with high doses of vitamin B12 improves nerve conduction velocity of patients with diabetic peripheral neuropathy

    Institute of Scientific and Technical Information of China (English)

    Jilai Li; Zhirong Wan

    2008-01-01

    BACKGROUND: Prostaglandin E1 improves diabetic peripheral neuropathy in symptoms and sensory threshold. Vitamin B1 and methyl-vitamin B12 improve microcirculation to peripheral nerve tissue and promote neurotrophy.OBJECTIVE: To observe motor nerve and sensory nerve conduction velocity in patients with diabetic peripheral neuropathy, prior to and after treatment with prostaglandin E1, vitamin B1 and different doses of vitamin B12.DESIGN, TIME AND SETTING: Randomized, controlled experiment, performed at the Department of Neurology. Beijing Hantian Central Hospital, between February 2002 and September 2007.PARTICIPANTS: A total of 122 patients with type 2 diabetic peripheral neuropathy; 73 males and 49 females were included. All patients met the diagnostic criteria of diabetes mellitus, as determined by the World Health Organization in 1999 and 2006, and also the diagnostic criteria of diabetic peripheral neuropathy. For each subject, conduction disorders in the median nerve and in the common peroneal nerve were observed using electromyogram. Also, after diet and drug treatment, the blood glucose level of subjects was observed to be at a satisfactory level for more than two weeks, and the symptoms of diabetic peripheral neuropathy were not alleviated.METHODS: All patients were randomly divided into the following three groups. A control group (n=40), in which, 100mg vitamin B1 and 500μg vitamin B12 were intramuscularly injected. A vitamin B12 low-dose treated group (n=42), in which 10μg prostaglandin E1 in 250mL physiological saline was intravenously injected once a day and 100mg vitamin B1 and 500μg vitamin B12 was intramuscularly injected once a day. Lastly, a vitamin B12 high-dose treated group (n=40), in which administration was the same as in the vitamin B12 low-dose treated group, except that 500μg vitamin B12 was replaced by 1mg vitamin B12. Administration was performed for four weeks for each group.MAIN OUTCOME MEASURES: The motor nerve and sensory nerve

  9. Similar Improvements in Patient-Reported Outcomes Among Rheumatoid Arthritis Patients Treated with Two Different Doses of Methotrexate in Combination with Adalimumab: Results From the MUSICA Trial.

    Science.gov (United States)

    Kaeley, Gurjit S; MacCarter, Daryl K; Goyal, Janak R; Liu, Shufang; Chen, Kun; Griffith, Jennifer; Kupper, Hartmut; Garg, Vishvas; Kalabic, Jasmina

    2018-06-01

    In patients with rheumatoid arthritis (RA), combination treatment with methotrexate (MTX) and adalimumab is more effective than MTX monotherapy. From the patients' perspective, the impact of reduced MTX doses upon initiating adalimumab is not known. The objective was to evaluate the effects of low and high MTX doses in combination with adalimumab initiation on patient-reported outcomes (PROs), in MTX-inadequate responders (MTX-IR) with moderate-to-severe RA. MUSICA was a randomized, double-blind, controlled trial evaluating the efficacy of 7.5 or 20 mg/week MTX, in combination with adalimumab for 24 weeks in MTX-IR RA patients receiving prior MTX ≥ 15 mg/week for ≥ 12 weeks. PROs were recorded at each visit, including physical function, health-related quality-of-life, work productivity, quality-of-sleep, satisfaction with treatment medication, sexual impairment due to RA, patient global assessment of disease activity (PGA), and patient pain. Last observation carried forward was used to account for missing values. At baseline, patients in both MTX dosage groups had similar demographics, disease characteristics, and PRO scores. Overall, initiation of adalimumab led to significant improvements from baseline in the PROs assessed for both MTX dosage groups. Improvements in presenteeism from baseline were strongly correlated with corresponding improvements in SF-36 (vitality), pain, and physical function. Physical and mental well-being had a good correlation with improvement in sleep. Overall, improvements in disease activity from baseline were correlated with improvements in several PROs. The addition of adalimumab to MTX in MTX-IR patients with moderate-to-severe RA led to improvements in physical function, quality-of-life, work productivity, quality of sleep, satisfaction with treatment medication, and sexual impairment due to RA, regardless of the concomitant MTX dosage. AbbVie. Clinicaltrials.gov identifier, NCT01185288.

  10. LIGA 2. An improved computer code for the calculation of the local individual submersion dose in off-air plumes from nuclear facilities

    International Nuclear Information System (INIS)

    Rohloff, F.; Brunen, E.

    1981-08-01

    A model is presented to calculate the γ-submersion dose of persons which are exposed to off-air plumes. This model integrates the dose contributions of the spacial volume elements, taking into account the wheather dependent extension of the plume as well as γ-absorption and scattering in air. For data evaluation an essentially improved code LIGA II has been developed, leading to a higher accuracy due to an adequate application of Gauss integrations in MACRO-technique. The short-term propagation factors are calculated for a grid distance of 10-160 km with a logarithmic scale and for a 5 degree angular grid. As is shown by a sensitivity analysis, the mean values of the short-term propagation factors within a sector can be obtained by a simple Simpson-integration. These calculations have been performed explicitly for 10 degree and 30 degree sectors. (orig.) [de

  11. Dual-energy imaging method to improve the image quality and the accuracy of dose calculation for cone-beam computed tomography.

    Science.gov (United States)

    Men, Kuo; Dai, Jianrong; Chen, Xinyuan; Li, Minghui; Zhang, Ke; Huang, Peng

    2017-04-01

    To improve the image quality and accuracy of dose calculation for cone-beam computed tomography (CT) images through implementation of a dual-energy cone-beam computed tomography method (DE-CBCT), and evaluate the improvement quantitatively. Two sets of CBCT projections were acquired using the X-ray volumetric imaging (XVI) system on a Synergy (Elekta, Stockholm, Sweden) system with 120kV (high) and 70kV (low) X-rays, respectively. Then, the electron density relative to water (relative electron density (RED)) of each voxel was calculated using a projection-based dual-energy decomposition method. As a comparison, single-energy cone-beam computed tomography (SE-CBCT) was used to calculate RED with the Hounsfield unit-RED calibration curve generated by a CIRS phantom scan with identical imaging parameters. The imaging dose was measured with a dosimetry phantom. The image quality was evaluated quantitatively using a Catphan 503 phantom with the evaluation indices of the reproducibility of the RED values, high-contrast resolution (MTF 50% ), uniformity, and signal-to-noise ratio (SNR). Dose calculation of two simulated volumetric-modulated arc therapy plans using an Eclipse treatment-planning system (Varian Medical Systems, Palo Alto, CA, USA) was performed on an Alderson Rando Head and Neck (H&N) phantom and a Pelvis phantom. Fan-beam planning CT images for the H&N and Pelvis phantom were set as the reference. A global three-dimensional gamma analysis was used to compare dose distributions with the reference. The average gamma values for targets and OAR were analyzed with paired t-tests between DE-CBCT and SE-CBCT. In two scans (H&N scan and body scan), the imaging dose of DE-CBCT increased by 1.0% and decreased by 1.3%. It had a better reproducibility of the RED values (mean bias: 0.03 and 0.07) compared with SE-CBCT (mean bias: 0.13 and 0.16). It also improved the image uniformity (57.5% and 30.1%) and SNR (9.7% and 2.3%), but did not affect the MTF 50% . Gamma

  12. Vitamin E can improve behavioral tests impairment, cell loss, and dendrite changes in rats' medial prefrontal cortex induced by acceptable daily dose of aspartame.

    Science.gov (United States)

    Rafati, Ali; Noorafshan, Ali; Jahangir, Mahboubeh; Hosseini, Leila; Karbalay-Doust, Saied

    2018-01-01

    Aspartame is an artificial sweetener used in about 6000 sugar-free products. Aspartame consumption could be associated with various neurological disorders. This study aimed to evaluate the effect of aspartame onmedial Prefrontal Cortex (mPFC) as well as neuroprotective effects of vitamin E. The rats were divided into seven groups, including distilled water, corn oil, vitamin E (100mg/kg/day), and low (acceptable daily dose) and high doses of aspartame (40 and 200mg/kg/day) respectively, with or without vitamin E consumption, for 8 weeks. Behavioral tests were recorded and the brain was prepared for stereological assessments. Novel objects test and eight-arm radial maze showed impairmentoflong- and short-termmemoriesin aspartame groups. Besides, mPFC volume, infralimbic volume, neurons number, glial cells number, dendrites length per neuron,and number of spines per dendrite length were decreased by 7-61% in the rats treated with aspartame. However, neurons' number, glial cells number, and rats' performance in eight-arm radial mazes were improved by concomitant consumption of vitamin E and aspartame. Yet, the mPFC volume and infralimbic cortex were protected only in the rats receiving the low dose of aspartame+vitamin E. On the other hand, dendrites length, spines number,and novel object recognition were not protected by treatment with vitamin E+aspartame. The acceptable daily dose or higher doses of aspartame could induce memory impairments and cortical cells loss in mPFC. However, vitamin E could ameliorate some of these changes. Copyright © 2017 Elsevier GmbH. All rights reserved.

  13. Low-Dose Daily Intake of Vitamin K(2) (Menaquinone-7) Improves Osteocalcin γ-Carboxylation: A Double-Blind, Randomized Controlled Trials.

    Science.gov (United States)

    Inaba, Naoko; Sato, Toshiro; Yamashita, Takatoshi

    2015-01-01

    Vitamin K is essential for bone health, but the effects of low-dose vitamin K intake in Japanese subjects remain unclear. We investigated the effective minimum daily menaquinone-7 dose for improving osteocalcin γ-carboxylation. Study 1 was a double-blind, randomized controlled dose-finding trial; 60 postmenopausal women aged 50-69 y were allocated to one of four dosage group and consumed 0, 50, 100, or 200 μg menaquinone-7 daily for 4 wk, respectively, with a controlled diet in accordance with recommended daily intakes for 2010 in Japan. Study 2 was a double-blind, randomized placebo-controlled trial based on the results of Study 1; 120 subjects aged 20-69 y were allocated to the placebo or MK-7 group and consumed 0 or 100 μg menaquinone-7 daily for 12 wk, respectively. In both studies, circulating carboxylated osteocalcin and undercarboxylated osteocalcin were measured. The carboxylated osteocalcin/undercarboxylated osteocalcin ratio decreased significantly from baseline in the 0 μg menaquinone-7 group, in which subjects consumed the recommended daily intake of vitamin K with vitamin K1 and menaquinone-4 (Study 1). Menaquinone-7 increased the carboxylated osteocalcin/undercarboxylated osteocalcin ratio dose dependently, and significant effects were observed in both the 100 and 200 μg groups compared with the 0 μg group. Undercarboxylated osteocalcin concentrations decreased significantly, and the carboxylated osteocalcin/undercarboxylated osteocalcin ratio increased significantly in the 100 μg menaquinone-7 group compared with the placebo group (Study 2). Daily menaquinone-7 intake ≥100 μg was suggested to improve osteocalcin γ-carboxylation.

  14. Improved long-term survival after intra-operative single high-dose ATG-Fresenius induction in renal transplantation: a single centre experience.

    Science.gov (United States)

    Kaden, Jürgen; May, Gottfried; Völp, Andreas; Wesslau, Claus

    2009-01-01

    In organ grafts donor-specific sensitization is initiated immediately after revascularization. Therefore, in 1990 we introduced the intra-operative single high-dose ATG-Fresenius (ATG-F) induction in addition to standard triple drug therapy (TDT) consisting of steroids, azathioprine and cyclosporin. A total of 778 first renal transplantations from deceased donors, performed between 1987 and 1998, were included in this evaluation. This retrospective analysis of clinic records and electronic databases presents data of all recipients of first kidney grafts who received two different ATG-F inductions (1(st) group: 9 mg/kg body weight as single high-dose intra-operatively, n=484; 2(nd) group: 3 mg/kg body weight on 7 or 8 consecutive days as multiple-dose starting also intra-operatively, n=78) and standard TDT alone (3(rd) group: TDT alone, n=216). The 10-year patient survival rates were 72.6+/-2.6% (TDT + ATG-F single high-dose), 79.5+/-5.1% (TDT + ATG-F multiple-dose) and 67.2+/-3.7%% (TDT alone; Kaplan-Meier estimates with standard errors; ATG-F vs TDT alone, p=0.001). The 10-year graft survival rates with censoring of patients that died with a functioning graft were 73.8+/-2.4%, 57.7+/-5.8% and 58.4+/-3.6% (Kaplan-Meier estimates with standard errors; 1(st) vs 2(nd )and 3(rd) group, respectively, p<0.001) and the 10-year graft survival rates with patient death counted as graft failure were 58.3+/-2.7%, 55.7+/-5.8% and 48.2+/-3.5% (Kaplan-Meier estimates with standard errors; ATG-F single high-dose vs TDT, p=0.023). In pre-sensitized recipients there were also significant differences in favour of ATG-F, more notably in the single high-dose ATG-F induction. A total of 69% of the patients in the two cohorts receiving ATG-F did not experience any transplant rejections compared to 56% in patients undergoing TDT alone (p=0.018). The incidence of infectious complications was comparable across all groups. According to evidence obtained from the routine documentation of 778

  15. Mesenteric ischemia-reperfusion injury: clearly improved hemodynamics but only minor protection of the rat small intestine by (sub)therapeutic heparin sodium and enoxaparin doses.

    Science.gov (United States)

    Walensi, Mikolaj; de Groot, Herbert; Schulz, Rainer; Hartmann, Matthias; Petrat, Frank

    2013-01-01

    Tissue protection against ischemia (I)/reperfusion (R) injury by heparins can be due to their anticoagulant and/or non-anticoagulant properties. Here we studied the protective potential of the anticoagulant and the non-anticoagulant features of heparin sodium (HepSo) and enoxaparin (Enox) against mesenteric I/R injury in a rat model. Mesenteric I/R was induced in rats (n = 6 per group) by superior mesenteric artery occlusion (SMAO; 90 min) and reopening (120 min). Therapeutic/clinical and subtherapeutic/non-anticoagulant doses of HepSo (0.25 mg/kg bolus + 0.25 mg/kg × h; 0.05 mg/kg bolus + 0.1 mg/kg × h) or Enox (0.5 mg/kg bolus + 0.5 mg/kg × h; 0.05 mg/kg bolus + 0.1 mg/kg × h) were administered intravenously starting 30 min before SMAO to the end of reperfusion. Systemic/vital and intestinal microcirculatory parameters were measured during the whole experimental procedure, those of small intestine injury at the end. During intestinal reperfusion, mean arterial blood pressure and heart rates were significantly increased by HepSo and, less effectively, by Enox, in a dose-dependent manner. Intestinal microcirculation was only affected by the therapeutic HepSo dose, which decreased the microvascular flow and S(O2) during reperfusion. The subtherapeutic Enox treatment, as opposed to any HepSo dose, most effectively diminished I/R-induced intestinal hemorrhages, myeloperoxidase activity (as a measure of neutrophil invasion), and histopathological changes. Therapeutic but, to a lesser extent, also the subtherapeutic doses of both HepSo and Enox clearly improve hemodynamics during mesenteric reperfusion, while intestinal protection is exclusively provided by Enox, especially at its subtherapeutic dose. Alterations in intestinal microcirculation are not responsible for these effects. Thus, non-anticoagulant Enox doses and, preferably, heparin(oid)s unable to affect coagulation, could diminish clinical risks of I/R-induced gastrointestinal complications. Copyright

  16. On dose distribution comparison

    International Nuclear Information System (INIS)

    Jiang, Steve B; Sharp, Greg C; Neicu, Toni; Berbeco, Ross I; Flampouri, Stella; Bortfeld, Thomas

    2006-01-01

    In radiotherapy practice, one often needs to compare two dose distributions. Especially with the wide clinical implementation of intensity-modulated radiation therapy, software tools for quantitative dose (or fluence) distribution comparison are required for patient-specific quality assurance. Dose distribution comparison is not a trivial task since it has to be performed in both dose and spatial domains in order to be clinically relevant. Each of the existing comparison methods has its own strengths and weaknesses and there is room for improvement. In this work, we developed a general framework for comparing dose distributions. Using a new concept called maximum allowed dose difference (MADD), the comparison in both dose and spatial domains can be performed entirely in the dose domain. Formulae for calculating MADD values for various comparison methods, such as composite analysis and gamma index, have been derived. For convenience in clinical practice, a new measure called normalized dose difference (NDD) has also been proposed, which is the dose difference at a point scaled by the ratio of MADD to the predetermined dose acceptance tolerance. Unlike the simple dose difference test, NDD works in both low and high dose gradient regions because it considers both dose and spatial acceptance tolerances through MADD. The new method has been applied to a test case and a clinical example. It was found that the new method combines the merits of the existing methods (accurate, simple, clinically intuitive and insensitive to dose grid size) and can easily be implemented into any dose/intensity comparison tool

  17. Optimal doses of EGF and GDNF act as biological response modifiers to improve porcine oocyte maturation and quality

    DEFF Research Database (Denmark)

    Valleh, Mehdi Vafaye; Zandi, Nahid Karimi; Rasmussen, Mikkel Aabech

    2017-01-01

    It is well documented that both epidermal growth factor (EGF) and glial cell line-derived neurotrophic factor (GDNF) are critical for porcine oocyte maturation, however, little information is known about their mechanism of action in vitro. To gain insight into the mechanisms of action of the opti......It is well documented that both epidermal growth factor (EGF) and glial cell line-derived neurotrophic factor (GDNF) are critical for porcine oocyte maturation, however, little information is known about their mechanism of action in vitro. To gain insight into the mechanisms of action...... of the optimum doses of EGF and GDNF on porcine oocyte maturation, porcine cumulus-oocyte complexes (COCs) were matured in defined porcine oocyte medium supplemented with EGF, GDNF or a combination of both at varying concentrations (0-100 ng/ml) for 44 h. Nuclear and cytoplasmic maturation were determined...

  18. Improving Positioning in High-Dose Radiotherapy for Prostate Cancer: Safety and Visibility of Frequently Used Gold Fiducial Markers

    Energy Technology Data Exchange (ETDEWEB)

    Fonteyne, Valerie, E-mail: valerie.fonteyne@uzgent.be [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium); Ost, Piet [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium); Villeirs, Geert [Department of Radiology, Ghent University Hospital, Ghent (Belgium); Oosterlinck, Willem [Department of Urology, Ghent University Hospital, Ghent (Belgium); Impens, Aline; De Gersem, Werner; De Wagter, Carlos; De Meerleer, Gert [Department of Radiotherapy, Ghent University Hospital, Ghent (Belgium)

    2012-05-01

    Purpose: The use of gold fiducial markers (GFMs) for prostate positioning in high-dose radiotherapy is gaining interest. The purpose of this study was to compare five GFMs regarding feasibility of ultrasound-based implantation in the prostate and intraprostatic lesion (IPL); toxicity; visibility on transabdominal ultrasound (TU) and cone-beam CT (CBCT); reliability of automatic, soft tissue, and GFM-based CBCT patient positioning by comparing manual and automatic fusion CBCT. Methods and Materials: Twenty-five patients were included. Pain and toxicity were scored after implantation and high-dose radiotherapy. Fisher exact test was used to evaluate the correlation of patients' characteristics and prostatitis. Positioning was evaluated on TU and kilovoltage CBCT images. CBCT fusion was performed automatically (Elekta XVI technology, release 3.5.1 b27, based on grey values) and manually on soft tissue and GFMs. Pearson correlation statistics and Bland-Altman evaluation were used. Five GFMs were compared. Results: Twenty percent of the patients developed prostatitis despite antibiotic prophylaxis. Cigarette smoking was significantly correlated with prostatitis. The visualization of all GFMs on TU was disappointing. Consequently we cannot recommend the use of these GFMs for TU-based prostate positioning. For all GFMs, there was only fair to poor linear correlation between automatic and manual CBCT images, indicating that even when GFMs are used, an operator evaluation is imperative. However, when GFMs were analyzed individually, a moderate to very strong correlation between automatic and manual positioning was found for larger GFMs in all directions. Conclusion: The incidence of prostatitis in our series was high. Further research is imperative to define the ideal preparation protocol preimplantation and to select patients. Automatic fusion is more reliable with larger GFMs at the cost of more scatter. The stability of all GFMs was proven.

  19. Short-term Androgen-Deprivation Therapy Improves Prostate Cancer-Specific Mortality in Intermediate-Risk Prostate Cancer Patients Undergoing Dose-Escalated External Beam Radiation Therapy

    International Nuclear Information System (INIS)

    Zumsteg, Zachary S.; Spratt, Daniel E.; Pei, Xin; Yamada, Yoshiya; Kalikstein, Abraham; Kuk, Deborah; Zhang, Zhigang; Zelefsky, Michael J.

    2013-01-01

    Purpose: We investigated the benefit of short-term androgen-deprivation therapy (ADT) in patients with intermediate-risk prostate cancer (PC) receiving dose-escalated external beam radiation therapy. Methods and Materials: The present retrospective study comprised 710 intermediate-risk PC patients receiving external beam radiation therapy with doses of ≥81 Gy at a single institution from 1992 to 2005, including 357 patients receiving neoadjuvant and concurrent ADT. Prostate-specific antigen recurrence-free survival (PSA-RFS) and distant metastasis (DM) were compared using the Kaplan-Meier method and Cox proportional hazards models. PC-specific mortality (PCSM) was assessed using competing-risks analysis. Results: The median follow-up was 7.9 years. Despite being more likely to have higher PSA levels, Gleason score 4 + 3 = 7, multiple National Comprehensive Cancer Network intermediate-risk factors, and older age (P≤.001 for all comparisons), patients receiving ADT had improved PSA-RFS (hazard ratio [HR], 0.598; 95% confidence interval [CI], 0.435-0.841; P=.003), DM (HR, 0.424; 95% CI, 0.219-0.819; P=.011), and PCSM (HR, 0.380; 95% CI, 0.157-0.921; P=.032) on univariate analysis. Using multivariate analysis, ADT was an even stronger predictor of improved PSA-RFS (adjusted HR [AHR], 0.516; 95% CI, 0.360-0.739; P<.001), DM (AHR, 0.347; 95% CI, 0.176-0.685; P=.002), and PCSM (AHR, 0.297; 95% CI, 0.128-0.685; P=.004). Gleason score 4 + 3 = 7 and ≥50% positive biopsy cores were other independent predictors of PCSM. Conclusions: Short-term ADT improves PSA-RFS, DM, and PCSM in patients with intermediate-risk PC undergoing dose-escalated external beam radiation therapy

  20. Effect of different single-session educational modalities on improving medical students' ability to demonstrate proper pressurized metered dose inhaler technique.

    Science.gov (United States)

    Dominelli, Giulio S; Dominelli, Paolo B; Rathgeber, Steven L; Webster, Sheila B

    2012-05-01

    Pressurized metered dose inhalers (pMDIs) remain important therapeutic options for obstructive lung diseases. The ability to instruct and evaluate inhaler technique is a crucial skill that all medical professionals should possess; unfortunately, many professionals lack proficiency with pMDIs. We aimed to determine if brief education interventions of differing modalities can positively affect medical students' skills over the long term. The baseline ability of medical students and first year residents to use pMDIs was scored via a 10-point scoring system. Students were randomized to receive no education, one-on-one instruction, or video instruction. Students were then retested immediately after the education and at the 3-month mark for retention of acquired skills. Video, one-on-one and the placebo groups modalities statistically improved the average medical student's score in the immediate retesting (7.5 and 7.4 vs. 4.7, p grades at the immediate recall significantly improved for both modalities. During retention testing, only video education had a statistically significant improvement in pass rate over the control group, as defined by an average score of 7 or better (8 vs. 1, p improve medical students' ability to use pMDIs in short-term testing. However, only video education retained significant improvement compared with control after 3 months. This suggests that compared with traditional one-on-one teaching, video education is an effective means of teaching medical students how to improve their pMDI technique.

  1. Radiation dose ≥54 Gy and CA 19–9 response are associated with improved survival for unresectable, non-metastatic pancreatic cancer treated with chemoradiation

    Directory of Open Access Journals (Sweden)

    Golden Daniel W

    2012-09-01

    Full Text Available Abstract Background Unresectable pancreatic cancer (UPC has low survival. With improving staging techniques and systemic therapy, local control in patients without metastatic disease may have increasing importance. We investigated whether the radiation dose used in chemoradiation (CRT as definitive treatment for UPC and the CA 19–9 response to therapy have an impact on overall survival (OS. Methods From 1997–2009 46 patients were treated with CRT for non-metastatic UPC. Median prescribed RT dose was 54 Gy (range 50.4-59.4 Gy. All patients received concurrent chemotherapy (41: 5-fluorouracil, 5: other and 24 received adjuvant chemotherapy. Results 41 patients were inoperable due to T4 disease and 5 patients with T3 disease were medically inoperable. Five patients did not complete CRT due to progressive disease or treatment-related toxicity (median RT dose 43.2 Gy. Overall, 42 patients were dead of disease at the time of last follow-up. The median and 12 month OS were 8.8 months and 35%, respectively. By univariate analysis, minimum CA 19–9 post-CRT Conclusions CRT as definitive treatment for UPC had low survival. However, our retrospective data suggest that patients treated to ≥54 Gy or observed to have a minimum post-CRT CA 19–9

  2. Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.

    LENUS (Irish Health Repository)

    McCaul, Conán

    2009-10-01

    Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival.

  3. Modafinil improves attentional performance in healthy, non-sleep deprived humans at doses not inducing hyperarousal across species

    NARCIS (Netherlands)

    Cope, Zackary A; Minassian, Arpi; Kreitner, Dustin; MacQueen, David A; Milienne-Petiot, Morgane; Geyer, Mark A; Perry, William; Young, Jared W

    2017-01-01

    The wake-promoting drug modafinil is frequently used off-label to improve cognition in psychiatric and academic populations alike. The domain-specific attentional benefits of modafinil have yet to be quantified objectively in healthy human volunteers using tasks validated for comparison across

  4. Improved Stability of Tuberculosis Drug Fixed-Dose Combination Using Isoniazid-Caffeic Acid and Vanillic Acid Cocrystal.

    Science.gov (United States)

    Battini, Swapna; Mannava, M K Chaitanya; Nangia, Ashwini

    2018-06-01

    The classic fixed-dose combination (FDC) of 4 tuberculosis drugs, namely rifampicin (RIF), isoniazid (INH), pyrazinamide (PZA), and ethambutol dihydrochloride (EDH) has the twin issues of physical stability and RIF cross-reaction in the 4-FDC. The major reason for these quality issues is the interaction between RIF and INH to yield isonicotinyl hydrazone in drug tablets. Pharmaceutical cocrystals of INH with caffeic acid (CFA) (PZA + EDH + RIF + INH-CFA cocrystal) and vanillic acid (VLA) (PZA + EDH + RIF + INH-VLA cocrystal) are able to stabilize the FDC formulation compared with the reference batch (PZA + EDH + RIF + INH). Stability studies under accelerated humidity and temperature stress conditions of 40°C and 75% relative humidity showed that the physical stability of the cocrystal formulation was superior by powder X-ray diffraction and scanning electron microscopy analysis, and chemical purity was analyzed by high-performance liquid chromatography. Changes in the composition and structure were monitored on samples drawn at 7, 15, 22, and 30 days of storage. FDC-INH-CFA cocrystal batch exhibited greater stability compared with FDC-INH-VLA cocrystal and FDC reference drug batches. The superior stability of INH-CFA cocrystal is attributed to the presence of stronger hydrogen bonds and cyclic O-H⋯O synthon in the crystal structure. Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  5. Performance of Dry Powder Inhalers with Single Dosed Capsules in Preschool Children and Adults Using Improved Upper Airway Models

    Directory of Open Access Journals (Sweden)

    Sandra Lindert

    2014-02-01

    Full Text Available The pulmonary administration of pharmaceutical aerosols to patients is affected by age-dependent variations in the anatomy of the upper airways and the inhalation pattern. Considering this aspect, different upper airway models, representing the geometries of adults and preschool children, and a conventional induction port according to the European Pharmacopeia were used for in vitro testing of dry powder inhalers with single dosed capsules (Cyclohaler®, Handihaler® and Spinhaler®. Deposition measurements were performed using steady flow rates of 30 and 60 L/min for the Handihaler®/Spinhaler® and 30, 60 and 75 L/min for the Cyclohaler®. The inhalation volume was set at 1 L. For the Cyclohaler®, the in vitro testing was supplemented by a pediatric inhalation profile. Slight differences of pulmonary deposition between the idealized adult (11%–15% and pediatric (9%–11% upper airway model were observed for the Cyclohaler®. The applied pediatric inhalation profile resulted in a reduction of pulmonary deposition by 5% compared to steady conditions and indicated the influence of the inhalation pattern on the amount of pulmonary deposited particles. The comparison of two pediatric upper airway models showed no differences. The performance of the Handihaler® was similar to the Cyclohaler®. The Spinhaler® showed an insufficient performance and limited reproducibility in our investigations.

  6. Effect of a monthly dose of calcidiol in improving vitamin D deficiency and secondary hyperparathyroidism in HIV-infected patients.

    Science.gov (United States)

    Bañón, Sara; Rosillo, Marta; Gómez, Ana; Pérez-Elias, María J; Moreno, Santiago; Casado, José Luis

    2015-06-01

    There are no data about the optimal supplementation therapy in HIV-infected patients with vitamin D (25OHD) deficiency. The aim of this study was to assess the effect of an oral monthly dose of 16,000 IU calcidiol. We performed a longitudinal cohort study of 365 HIV-infected patients (24 % females) was with sequential determinations of 25OHD, serum parathyroid hormone (PTH), calcium, and alkaline phosphatase. The efficacy and safety of supplementation in 123 patients were compared against dietary and sun exposure advice. Overall, mean baseline 25OHD levels were 19.1 ng/ml (IQR 12-23.6), 63 % of patients had 25OHD deficiency and 27 % secondary hyperparathyroidism. After a median time of 9.3 months (95.61 patients-year on-treatment), 25OHD levels increased in comparison with non-supplemented patients (+16.4 vs. +3.2 ng/ml; p secondary hyperparathyroidism (from 43 to 31 %; p secondary hyperparathyroidism in HIV-infected patients.

  7. Improved spatial resolution and lower-dose pediatric CT imaging: a feasibility study to evaluate narrowing the X-ray photon energy spectrum

    Energy Technology Data Exchange (ETDEWEB)

    Benz, Mark G. [Safer Pediatric Imaging and Engineering Horizons International, Lincoln, VT (United States); Benz, Matthew W. [Southboro Medical Group, Southboro, MA (United States); Birnbaum, Steven B. [Dartmouth Hitchcock Clinic Manchester, Department of Radiology, Manchester, NH (United States); Chason, Eric; Sheldon, Brian W. [Brown University, Division of Engineering, Materials Science and Engineering Program, Providence, RI (United States); McGuire, Dale [R and D Manager, C and G Technologies Inc., Jeffersonville, IN (United States)

    2014-08-15

    This feasibility study has shown that improved spatial resolution and reduced radiation dose can be achieved in pediatric CT by narrowing the X-ray photon energy spectrum. This is done by placing a hafnium filter between the X-ray generator and a pediatric abdominal phantom. A CT system manufactured in 1999 that was in the process of being remanufactured was used as the platform for this study. This system had the advantage of easy access to the X-ray generator for modifications to change the X-ray photon energy spectrum; it also had the disadvantage of not employing the latest post-imaging noise reduction iterative reconstruction technology. Because we observed improvements after changing the X-ray photon energy spectrum, we recommend a future study combining this change with an optimized iterative reconstruction noise reduction technique. (orig.)

  8. Increasing the Dose of Autologous Chondrocytes Improves Articular Cartilage Repair: Histological and Molecular Study in the Sheep Animal Model.

    Science.gov (United States)

    Guillén-García, Pedro; Rodríguez-Iñigo, Elena; Guillén-Vicente, Isabel; Caballero-Santos, Rosa; Guillén-Vicente, Marta; Abelow, Stephen; Giménez-Gallego, Guillermo; López-Alcorocho, Juan Manuel

    2014-04-01

    We hypothesized that implanting cells in a chondral defect at a density more similar to that of the intact cartilage could induce them to synthesize matrix with the features more similar to that of the uninjured one. We compared the implantation of different doses of chondrocytes: 1 million (n = 5), 5 million (n = 5), or 5 million mesenchymal cells (n = 5) in the femoral condyle of 15 sheep. Tissue generated by microfracture at the trochlea, and normal cartilage from a nearby region, processed as the tissues resulting from the implantation, were used as references. Histological and molecular (expression of type I and II collagens and aggrecan) studies were performed. The features of the cartilage generated by implantation of mesenchymal cells and elicited by microfractures were similar and typical of a poor repair of the articular cartilage (presence of fibrocartilage, high expression of type I collagen and a low mRNA levels of type II collagen and aggrecan). Nevertheless, in the samples obtained from tissues generated by implantation of chondrocytes, hyaline-like cartilage, cell organization, low expression rates of type I collagen and high levels of mRNA corresponding to type II collagen and aggrecan were observed. These histological features, show less variability and are more similar to those of the normal cartilage used as control in the case of 5 million cells implantation than when 1 million cells were used. The implantation of autologous chondrocytes in type I/III collagen membranes at high density could be a promising tool to repair articular cartilage.

  9. Students who developed logical reasoning skills reported improved confidence in drug dose calculation: Feedback from remedial maths classes.

    Science.gov (United States)

    Shelton, Chris

    2016-06-01

    The safe administration of drugs is a focus of attention in healthcare. It is regarded as acceptable that a formula card or mnemonic can be used to find the correct dose and fill a prescription even though this removes any requirement for performing the underlying computation. Feedback and discussion in class reveal that confidence in arithmetic skills can be low even when students are able to pass the end of semester drug calculation exam. To see if confidence in the understanding and performance of arithmetic for drug calculations can be increased by emphasising student's innate powers of logical reasoning after reflection. Remedial classes offered for students who have declared a dislike or lack of confidence in arithmetic have been developed from student feedback adopting a reasoning by logical step methodology. Students who gave up two hours of their free learning time were observed to engage seriously with the learning methods, focussing on the innate ability to perform logical reasoning necessary for drug calculation problems. Working in small groups allowed some discussion of the route to the answer and this was followed by class discussion and reflection. The results were recorded as weekly self-assessment scores for confidence in calculation. A self-selecting group who successfully completed the end of semester drug calculation exam reported low to moderate confidence in arithmetic. After four weeks focussing on logical skills a significant increase in self-belief was measured. This continued to rise in students who remained in the classes. Many students hold a negative belief regarding their own mathematical abilities. This restricts the learning of arithmetic skills making alternate routes using mnemonics and memorised steps an attractive alternative. Practising stepwise logical reasoning skills consolidated by personal reflection has been effective in developing student's confidence and awareness of their innate powers of deduction supporting an

  10. A Single Dose of Beetroot Gel Rich in Nitrate Does Not Improve Performance but Lowers Blood Glucose in Physically Active Individuals

    Directory of Open Access Journals (Sweden)

    Julia Vasconcellos

    2017-01-01

    Full Text Available Background. Beetroot consumption has been proposed to improve exercise performance, since the nitrate content of this food is able to stimulate the synthesis of nitric oxide. Objective. The acute effect of 100 g of a beetroot gel containing ~10 mmol of nitrate was tested on the nitric oxide synthesis, on metabolic and biochemical parameters, and on performance in physically active individuals. Methods. Through a double blind, crossover, placebo-controlled study, 25 healthy runners ingested a single dose of beetroot and placebo gels. Participants performed an aerobic exercise protocol on a treadmill (3 min warm-up of 40% peak oxygen consumption, 4 min at 90% of gas exchange threshold I and 70% (Δ maximal end speed until volitional fatigue. Results. Urinary levels of nitrite and nitrate increased after 90 min of beetroot gel ingestion. Plasma glucose concentrations lowered after the exercise and the decrease was maintained for 20 min. Systolic and diastolic blood pressures, serum cortisol, and blood lactate were not altered after the beetroot gel ingestion compared to a placebo gel. Conclusion. The single dose of beetroot gel provoked an increase of nitric oxide synthesis although no improvement on the physical performance of athletes during aerobic submaximal exercise was observed.

  11. Longitudinal functional connectivity changes correlate with mood improvement after regular exercise in a dose-dependent fashion.

    Science.gov (United States)

    Tozzi, Leonardo; Carballedo, Angela; Lavelle, Grace; Doolin, Kelly; Doyle, Myles; Amico, Francesco; McCarthy, Hazel; Gormley, John; Lord, Anton; O'Keane, Veronica; Frodl, Thomas

    2016-04-01

    Exercise increases wellbeing and improves mood. It is however unclear how these mood changes relate to brain function. We conducted a randomized controlled trial investigating resting-state modifications in healthy adults after an extended period of aerobic physical exercise and their relationship with mood improvements. We aimed to identify novel functional networks whose activity could provide a physiological counterpart to the mood-related benefits of exercise. Thirty-eight healthy sedentary volunteers were randomised to either the aerobic exercise group of the study or a control group. Participants in the exercise group attended aerobic sessions with a physiotherapist twice a week for 16 weeks. Resting-state modifications using magnetic resonance imaging were assessed before and after the programme and related to mood changes. An unbiased approach using graph metrics and network-based statistics was adopted. Exercise reduced mood disturbance and improved emotional wellbeing. It also induced a decrease in local efficiency in the parahippocampal lobe through strengthening of the functional connections from this structure to the supramarginal gyrus, precentral area, superior temporal gyrus and temporal pole. Changes in mood disturbance following exercise were correlated with those in connectivity between parahippocampal gyrus and superior temporal gyrus as well as with the amount of training. No changes were detected in the control group. In conclusion, connectivity from the parahippocampal gyrus to motor, sensory integration and mood regulation areas was strengthened through exercise. These functional changes might be related to the benefits of regular physical activity on mood. © 2016 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

  12. Improved GMP-compliant multi-dose production and quality control of 6-[18F]fluoro-L-DOPA.

    Science.gov (United States)

    Luurtsema, G; Boersma, H H; Schepers, M; de Vries, A M T; Maas, B; Zijlma, R; de Vries, E F J; Elsinga, P H

    2017-01-01

    6-[ 18 F]Fluoro-L-3,4-dihydroxyphenylalanine (FDOPA) is a frequently used radiopharmaceutical for detecting neuroendocrine and brain tumors and for the differential diagnosis of Parkinson's disease. To meet the demand for FDOPA, a high-yield GMP-compliant production method is required. Therefore, this study aimed to improve the FDOPA production and quality control procedures to enable distribution of the radiopharmaceutical over distances.FDOPA was prepared by electrophilic fluorination of the trimethylstannyl precursor with [ 18 F]F 2 , produced from [ 18 O] 2 via the double-shoot approach, leading to FDOPA with higher specific activity as compared to FDOPA which was synthesized, using [ 18 F]F 2 produced from 20 Ne, leading to FDOPA with a lower specific activity. The quality control of the product was performed using a validated UPLC system and compared with quality control with a conventional HPLC system. Impurities were identified using UPLC-MS. The [ 18 O] 2 double-shoot radionuclide production method yielded significantly more [ 18 F]F 2 with less carrier F 2 than the conventional method starting from 20 Ne. After adjustment of radiolabeling parameters substantially higher amounts of FDOPA with higher specific activity could be obtained. Quality control by UPLC was much faster and detected more side-products than HPLC. UPLC-MS showed that the most important side-product was FDOPA-quinone, rather than 6-hydroxydopa as suggested by the European Pharmacopoeia. The production and quality control of FDOPA were significantly improved by introducing the [ 18 O] 2 double-shoot radionuclide production method, and product analysis by UPLC, respectively. As a result, FDOPA is now routinely available for clinical practice and for distribution over distances.

  13. Chronic Dosing with Membrane Sealant Poloxamer 188 NF Improves Respiratory Dysfunction in Dystrophic Mdx and Mdx/Utrophin-/- Mice.

    Directory of Open Access Journals (Sweden)

    Bruce E Markham

    Full Text Available Poloxamer 188 NF (national formulary (NF grade of P-188 improves cardiac muscle function in the mdx mouse and golden retriever muscular dystrophy models. However in vivo effects on skeletal muscle have not been reported. We postulated that P-188 NF might protect diaphragm muscle membranes from contraction-induced injury in mdx and mdx/utrophin-/- (dko muscular dystrophy models. In the first study 7-month old mdx mice were treated for 22 weeks with subcutaneous (s.c. injections of saline or P-188 NF at 3 mg/Kg. In the second, dkos were treated with saline or P-188 NF (1 mg/Kg for 8 weeks beginning at age 3 weeks. Prednisone was the positive control in both studies. Respiratory function was monitored using unrestrained whole body plethysmography. P-188 NF treatment affected several respiratory parameters including tidal volume/BW and minute volume/BW in mdx mice. In the more severe dko model, P-188 NF (1 mg/Kg significantly slowed the decline in multiple respiratory parameters compared with saline-treated dko mice. Prednisone's effects were similar to those seen with P-188 NF. Diaphragms from P-188 NF or prednisone treated mdx and dko mice showed signs of muscle fiber protection including less centralized nuclei, less variation in fiber size, greater fiber density, and exhibited a decreased amount of collagen deposition. P-188 NF at 3 mg/Kg s.c. also improved parameters of systolic and diastolic function in mdx mouse hearts. These results suggest that P-188 NF may be useful in treating respiratory and cardiac dysfunction, the leading causes of death in Duchenne muscular dystrophy patients.

  14. Low-dose metformin improves pregnancy rate in in vitro fertilization repeaters without polycystic ovary syndrome: prediction of effectiveness by multiple parameters related to insulin resistance.

    Science.gov (United States)

    Jinno, Masao; Kondou, Kenichi; Teruya, Koji

    2010-01-01

    Insulin resistance is associated with aging and stress, both common among patients repeatedly failing to conceive with in vitro fertilization (IVF repeaters). In the present study we examined whether low-dose metformin could improve the outcome in IVF repeaters without polycystic ovary syndrome (PCOS). Study I was a preliminary clinical trial aiming at defining indications for therapy; study II was a prospective randomized study. The studies involved a university hospital and a private infertility clinic. We studied 232 women without PCOS who had failed at least twice to conceive by previous IVF. Metformin (500 mg/ day) was administered for 8 to 12 weeks before and during ovarian stimulation (metformin IVF). In study I, IVF outcomes with metformin (n = 33) were compared to outcomes without metformin of previous IVF in the same subjects. A discriminant score (DS) was determined from nine parameters assessed before metformin administration to predict achievement of ongoing pregnancy by metformin IVF. In study II (n = 199), ongoing pregnancy rates were compared prospectively between groups with/without metformin and with DS above/below 0.6647. Study I. Ongoing pregnancy rate improved significantly with metformin compared with previous IVF, and pregnancy correlated significantly with a DS at an optimal threshold of 0.6647 (sensitivity, 0.90; specificity, 0.91). Study II. Ongoing pregnancy and implantation rates were significantly higher in women with a DS above 0.6647 who received metformin (56% and 33%) compared with those having a DS below 0.6647 with metformin (14% and 11%) and those having a DS above/below 0.6647 without metformin (20% and 7.1%/15% and 11%, respectively). Low-dose metformin improved pregnancy rate in IVF repeaters without PCOS, probably by decreasing insulin resistance. Indication can be determined from insulin-resistance-related multiple parameters assessed before metformin administration.

  15. Omega-3 fatty acid therapy dose-dependently and significantly decreased triglycerides and improved flow-mediated dilation, however, did not significantly improve insulin sensitivity in patients with hypertriglyceridemia.

    Science.gov (United States)

    Oh, Pyung Chun; Koh, Kwang Kon; Sakuma, Ichiro; Lim, Soo; Lee, Yonghee; Lee, Seungik; Lee, Kyounghoon; Han, Seung Hwan; Shin, Eak Kyun

    2014-10-20

    Experimental studies demonstrate that higher intake of omega-3 fatty acids (n-3 FA) improves insulin sensitivity, however, we reported that n-3 FA 2g therapy, most commonly used dosage did not significantly improve insulin sensitivity despite reducing triglycerides by 21% in patients. Therefore, we investigated the effects of different dosages of n-3 FA in patients with hypertriglyceridemia. This was a randomized, single-blind, placebo-controlled, parallel study. Age, sex, and body mass index were matched among groups. All patients were recommended to maintain a low fat diet. Forty-four patients (about 18 had metabolic syndrome/type 2 diabetes mellitus) in each group were given placebo, n-3 FA 1 (O1), 2 (O2), or 4 g (O4), respectively daily for 2 months. n-3 FA therapy dose-dependently and significantly decreased triglycerides and triglycerides/HDL cholesterol and improved flow-mediated dilation, compared with placebo (by ANOVA). However, each n-3 FA therapy did not significantly decrease high-sensitivity C-reactive protein and fibrinogen, compared with placebo. O1 significantly increased insulin levels and decreased insulin sensitivity (determined by QUICKI) and O2 significantly decreased plasma adiponectin levels relative to baseline measurements. Of note, when compared with placebo, each n-3 FA therapy did not significantly change insulin, glucose, adiponectin, glycated hemoglobin levels and insulin sensitivity (by ANOVA). We observed similar results in a subgroup of patients with the metabolic syndrome. n-3 FA therapy dose-dependently and significantly decreased triglycerides and improved flow-mediated dilation. Nonetheless, n-3 FA therapy did not significantly improve acute-phase reactants and insulin sensitivity in patients with hypertriglyceridemia, regardless of dosages. Copyright © 2014. Published by Elsevier Ireland Ltd.

  16. Improvement of heart function in postinfarct heart failure swine models after hepatocyte growth factor gene transfer: comparison of low-, medium- and high-dose groups.

    Science.gov (United States)

    Yang, Zhi-jian; Chen, Bo; Sheng, Zhang; Zhang, Ding-guo; Jia, En-zhi; Wang, Wei; Ma, Dong-chao; Zhu, Tie-bing; Wang, Lian-sheng; Li, Chun-jian; Wang, Hui; Cao, Ke-jiang; Ma, Wen-zhu

    2010-04-01

    Despite advances in surgical and reperfusion therapy, there is no effective therapy currently exists to prevent the progressive decline in cardiac function following myocardial infarction. Hepatocyte growth factor has potent angiogenic and anti-apoptotic activities. The aim of this study was to investigate the therapeutic effect and dose-effect relationship on postinfarction heart failure with different doses of adenovirus-mediated human hepatocyte growth factor (Ad(5)-HGF) transference in swine models. Totally twenty swine were randomly divided into four groups: (a) control group (null- Ad(5), 1 ml); (b) low-dose group (1 x 10(9) Pfu/ml Ad(5)-HGF, 1 ml); (c) medium-dose group (5 x 10(9) Pfu/ml Ad(5)-HGF, 1 ml); (d) high-dose group (1 x 10(10) Pfu/ml Ad(5)-HGF, 1 ml). Four weeks after left anterior descending coronary artery (LAD) ligation, different doses of Ad(5)-HGF were transferred in three therapeutic groups via right coronary artery. Four and seven weeks after LAD ligation, gate cardiac perfusion imaging was performed to evaluate cardiac perfusion and left ventricular ejection fraction (LVEF). Seven weeks after surgery, the apoptotic index of cardiocyte was observed by TUNEL, the expression of Bcl-2, Bax, alpha-SMA and Factor VIII in the border zones were evaluated by immunohistochemistry, respectively. Four weeks after myocardial infarction, no significant difference was observed among four groups. Three weeks after Ad(5)-HGF transfer, the improvement of cardiac perfusion and LVEF was obviously observed, especially after 1 x 10(10) Pfu Ad(5)-HGF transfer. TUNEL assay showed that 5 x 10(9) Pfu and 1 x 10(10) Pfu Ad(5)-HGF treatment had a obvious reduction in the apoptotic index compared with the null-Ad(5) group, especially after 1 x 10(10) Pfu Ad(5)-HGF treatment. The expression of Bcl-2 protein was increased and the expression of Bax protein was inhibited in the 5 x 10(9) Pfu and 1 x 10(10) Pfu Ad(5)-HGF groups compared with the null-Ad(5) group. The vessel

  17. High Dose MicroCT Does Not Contribute Toward Improved MicroPET/CT Image Quantitative Accuracy and Can Limit Longitudinal Scanning of Small Animals

    Directory of Open Access Journals (Sweden)

    Wendy A. McDougald

    2017-10-01

    Full Text Available Obtaining accurate quantitative measurements in preclinical Positron Emission Tomography/Computed Tomography (PET/CT imaging is of paramount importance in biomedical research and helps supporting efficient translation of preclinical results to the clinic. The purpose of this study was two-fold: (1 to investigate the effects of different CT acquisition protocols on PET/CT image quality and data quantification; and (2 to evaluate the absorbed dose associated with varying CT parameters.Methods: An air/water quality control CT phantom, tissue equivalent material phantom, an in-house 3D printed phantom and an image quality PET/CT phantom were imaged using a Mediso nanoPET/CT scanner. Collected data was analyzed using PMOD software, VivoQuant software and National Electric Manufactures Association (NEMA software implemented by Mediso. Measured Hounsfield Unit (HU in collected CT images were compared to the known HU values and image noise was quantified. PET recovery coefficients (RC, uniformity and quantitative bias were also measured.Results: Only less than 2 and 1% of CT acquisition protocols yielded water HU values < −80 and air HU values < −840, respectively. Four out of 11 CT protocols resulted in more than 100 mGy absorbed dose. Different CT protocols did not impact PET uniformity and RC, and resulted in <4% overall bias relative to expected radioactive concentration.Conclusion: Preclinical CT protocols with increased exposure times can result in high absorbed doses to the small animals. These should be avoided, as they do not contributed toward improved microPET/CT image quantitative accuracy and could limit longitudinal scanning of small animals.

  18. SU-E-T-230: Creating a Large Number of Focused Beams with Variable Patient Head Tilt to Improve Dose Fall-Off for Brain Radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Chiu, J; Ma, L [Department of Radiation Oncology, University of California San Francisco School of Medicine, San Francisco, CA (United States)

    2015-06-15

    Purpose: To develop a treatment delivery and planning strategy by increasing the number of beams to minimize dose to brain tissue surrounding a target, while maximizing dose coverage to the target. Methods: We analyzed 14 different treatment plans via Leksell PFX and 4C. For standardization, single tumor cases were chosen. Original treatment plans were compared with two optimized plans. The number of beams was increased in treatment plans by varying tilt angles of the patient head, while maintaining original isocenter and the beam positions in the x-, y- and z-axes, collimator size, and beam blocking. PFX optimized plans increased beam numbers with three pre-set tilt angles, 70, 90, 110, and 4C optimized plans increased beam numbers with tilt angles increasing arbitrarily from range of 30 to 150 degrees. Optimized treatment plans were compared dosimetrically with original treatment plans. Results: Comparing total normal tissue isodose volumes between original and optimized plans, the low-level percentage isodose volumes decreased in all plans. Despite the addition of multiple beams up to a factor of 25, beam-on times for 1 tilt angle versus 3 or more tilt angles were comparable (<1 min.). In 64% (9/14) of the studied cases, the volume percentage decrease by >5%, with the highest value reaching 19%. The addition of more tilt angles correlates to a greater decrease in normal brain irradiated volume. Selectivity and coverage for original and optimized plans remained comparable. Conclusion: Adding large number of additional focused beams with variable patient head tilt shows improvement for dose fall-off for brain radiosurgery. The study demonstrates technical feasibility of adding beams to decrease target volume.

  19. SU-E-T-230: Creating a Large Number of Focused Beams with Variable Patient Head Tilt to Improve Dose Fall-Off for Brain Radiosurgery

    International Nuclear Information System (INIS)

    Chiu, J; Ma, L

    2015-01-01

    Purpose: To develop a treatment delivery and planning strategy by increasing the number of beams to minimize dose to brain tissue surrounding a target, while maximizing dose coverage to the target. Methods: We analyzed 14 different treatment plans via Leksell PFX and 4C. For standardization, single tumor cases were chosen. Original treatment plans were compared with two optimized plans. The number of beams was increased in treatment plans by varying tilt angles of the patient head, while maintaining original isocenter and the beam positions in the x-, y- and z-axes, collimator size, and beam blocking. PFX optimized plans increased beam numbers with three pre-set tilt angles, 70, 90, 110, and 4C optimized plans increased beam numbers with tilt angles increasing arbitrarily from range of 30 to 150 degrees. Optimized treatment plans were compared dosimetrically with original treatment plans. Results: Comparing total normal tissue isodose volumes between original and optimized plans, the low-level percentage isodose volumes decreased in all plans. Despite the addition of multiple beams up to a factor of 25, beam-on times for 1 tilt angle versus 3 or more tilt angles were comparable (<1 min.). In 64% (9/14) of the studied cases, the volume percentage decrease by >5%, with the highest value reaching 19%. The addition of more tilt angles correlates to a greater decrease in normal brain irradiated volume. Selectivity and coverage for original and optimized plans remained comparable. Conclusion: Adding large number of additional focused beams with variable patient head tilt shows improvement for dose fall-off for brain radiosurgery. The study demonstrates technical feasibility of adding beams to decrease target volume

  20. The Potential Role of Grid-Like Software in Bedside Chest Radiography in Improving Image Quality and Dose Reduction: An Observer Preference Study.

    Science.gov (United States)

    Ahn, Su Yeon; Chae, Kum Ju; Goo, Jin Mo

    2018-01-01

    To compare the observer preference of image quality and radiation dose between non-grid, grid-like, and grid images. Each of the 38 patients underwent bedside chest radiography with and without a grid. A grid-like image was generated from a non-grid image using SimGrid software (Samsung Electronics Co. Ltd.) employing deep-learning-based scatter correction technology. Two readers recorded the preference for 10 anatomic landmarks and the overall appearance on a five-point scale for a pair of non-grid and grid-like images, and a pair of grid-like and grid images, respectively, which were randomly presented. The dose area product (DAP) was also recorded. Wilcoxon's rank sum test was used to assess the significance of preference. Both readers preferred grid-like images to non-grid images significantly ( p software significantly improved the image quality of non-grid images to a level comparable to that of grid images with a relatively lower level of radiation exposure.

  1. Metrological and treatment planning improvements on external beam radiotherapy. Detector size effect and dose calculation in low-density media (in Spanish)

    International Nuclear Information System (INIS)

    Garcia-Vicente, Feliciano

    2004-01-01

    The objective of this thesis is the improvement of the measurement and calculation accuracy for radiation therapy fields. Basically, it deals with two questions: the detector size effect and the heterogeneity dose calculation. The author analyzes both the metrological and computational effects and its clinical implications by simulation of the radiotherapy treatments in a treatment planning system. The detector size effect leads up to smoothing of the radiation profile increasing the penumbra (20%-80%) and beam fringe (50%-90%) values with the consequent clinical effect of over-irradiation of the organs at risk close to the planning target volume (PTV). In this thesis this problem is analyzed finding mathematical solutions based on profile deconvolution or the use of radiation detectors of adequate size. On the other side, the author analyzes the dose computation on heterogeneous media by the superposition algorithms versus classical algorithms. The derived conclusion from this thesis is that in locations like lung and breast, the classical algorithms lead to a significant underdosage of the PTV with an important decrease of tumor control probability (TCP). On this basis, the author does not recommend the clinical use of these algorithms in the mentioned tumor locations

  2. High-dose rate iridium-192 brachytherapy with flexible applicator. A trial toward decrease of stress during treatment and improvement of quality of life

    International Nuclear Information System (INIS)

    Inoue, Keiji; Kasahara, Kotaro; Karashima, Takashi; Inoue, Yuichiro; Kariya, Shinji; Inomata, Taisuke; Yoshida, Shoji; Shuin, Taro

    2001-01-01

    We tried to improve the materials and methods of high-dose rate Iridium-192 brachytherapy for localized prostate cancer and evaluated the stress during the treatment in 20 patients with whom the therapy was performed. Rigid applicators made of stainless steel of 1.6 mm in diameter were indwelt with a template as usual for 30 hours in 14 patients (group A). Flexible applicators made of polyoxymethylene rosin (POM) of 2.0 mm in diameter were indwelt without a template for 30 hours after the applicator insertion in 6 patients (group B). We made inquiries about lumbago, inconvenience and necessity of assistant help and sleep in the course of therapy, and urinary incontinence and erectile function after the course of therapy as the QOL. The stress during the course of therapy in the patients of group B was obviously less than that of group A. There were no significant differences in urinary incontinence and erectile function after the course of therapy between group A and B. In this study, our trial successfully reduced the stress during the course of therapy in the patients with localized prostate cancer in the course of high-dose rate Iridium-192 brachytherapy. (author)

  3. High-dose rate iridium-192 brachytherapy with flexible applicator. A trial toward decrease of stress during treatment and improvement of quality of life

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Keiji; Kasahara, Kotaro; Karashima, Takashi; Inoue, Yuichiro; Kariya, Shinji; Inomata, Taisuke; Yoshida, Shoji; Shuin, Taro [Kochi Medical School, Nankoku (Japan)

    2001-07-01

    We tried to improve the materials and methods of high-dose rate Iridium-192 brachytherapy for localized prostate cancer and evaluated the stress during the treatment in 20 patients with whom the therapy was performed. Rigid applicators made of stainless steel of 1.6 mm in diameter were indwelt with a template as usual for 30 hours in 14 patients (group A). Flexible applicators made of polyoxymethylene rosin (POM) of 2.0 mm in diameter were indwelt without a template for 30 hours after the applicator insertion in 6 patients (group B). We made inquiries about lumbago, inconvenience and necessity of assistant help and sleep in the course of therapy, and urinary incontinence and erectile function after the course of therapy as the QOL. The stress during the course of therapy in the patients of group B was obviously less than that of group A. There were no significant differences in urinary incontinence and erectile function after the course of therapy between group A and B. In this study, our trial successfully reduced the stress during the course of therapy in the patients with localized prostate cancer in the course of high-dose rate Iridium-192 brachytherapy. (author)

  4. A new dose of maximal-intensity interval training in hypoxia to improve body composition and hemoglobin and hematocrit levels: a pilot study.

    Science.gov (United States)

    Camacho-Cardenosa, Marta; Camacho-Cardenosa, Alba; Martínez Guardado, Ismael; Marcos-Serrano, Marta; Timon, Rafael; Olcina, Guillermo

    2017-01-01

    This pilot study had the aim to determine the effects of a new dose of maximal-intensity interval training in hypoxia in active adults. Twenty-four university student volunteers were randomly assigned to three groups: hypoxia group, normoxia group or control group. The eight training sessions consisted of 2 sets of 5 repeated sprints of 10 seconds with a recovery of 20 seconds between sprints and a recovery period of 10 minutes between sets. Body composition was measured following standard procedures. A blood sample was taken for an immediate hematocrit (HCT) and hemoglobin (Hb) concentration assessment. An all-out 3-ute test was performed to evaluate ventilation parameters and power. HCT and Hb were significantly higher for the hypoxia group in Post- and Det- (P=0.01; P=0.03). Fat mass percentage was significantly lower for the hypoxia group in both assessments (P=0.05; P=0.05). The hypoxia group underwent a significant increase in mean power after the recovery period. A new dose of 8 sessions of maximal-intensity interval training in hypoxia is enough to decrease the percentage of fat mass and to improve HCT and Hb parameters and mean muscle power in healthy and active adults.

  5. Prognostic Markers in Core-Binding Factor AML and Improved Survival with Multiple Consolidation Cycles of Intermediate/High-dose Cytarabine.

    Science.gov (United States)

    Prabahran, Ashvind; Tacey, Mark; Fleming, Shaun; Wei, Andrew; Tate, Courtney; Marlton, Paula; Wight, Joel; Grigg, Andrew; Tuckfield, Annabel; Szer, Jeff; Ritchie, David; Chee, Lynette

    2018-05-02

    Core-binding factor acute myeloid leukaemia (CBF AML) defined by t(8;21)(q22;q22) or inv(16)(p13q22)/t(16;16)(p13;q22) has a favourable prognosis, however 30-40% of patients still relapse after chemotherapy. We sought to evaluate risk factors for relapse in a de novo CBF AML cohort. A retrospective review of patients from 4 Australian tertiary centres from 2001-2012, comprising 40 t(8;21) and 30 inv(16) AMLs. Multivariate analysis identified age (p=0.032) and WCC>40 (p=0.025) as significant predictors for inferior OS and relapse respectively. Relapse risk was higher in the inv(16) group vs the t(8;21) group (57% vs 18%, HR 4.31, 95% CI: 1.78-10.42, p=0.001). Induction therapy had no bearing on OS or relapse free survival (RFS) however, consolidation treatment with >3 cycles of intermediate/high dose cytarabine improved OS (p=0.035) and relapse-free survival (RFS) (p=0.063). 5 patients demonstrated post-treatment stable q PCR positivity without relapse. (1)>3 consolidation cycles of intermediate/ high-dose cytarabine improves patient outcomes. (2)Age and inv(16) CBF AML subtype are predictors of inferior OS and RFS respectively. (3)Stable low-level MRD by qPCR does not predict relapse. (4)Similar OS in the inv(16) cohort compared to the t(8;21) cohort, despite a higher relapse rate, confirms salvageability of relapsed disease. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  6. Improving the knowledge of environment around French nuclear facilities for better dose assessment and post-accidental management

    Energy Technology Data Exchange (ETDEWEB)

    Parache, V.; Renaud, P. [Institut de Radioprotection et de Surete Nucleaire - IRSN (France)

    2014-07-01

    The consequences of an industrial pollution for the population and the environment depend not only on the nature and extent of the pollution, but also of the characteristics of concerned environment: the use that man made of it, and of the man's habits, notably food practices. To improve the consideration of the specificities of territories in its evaluations and its recommendations, in normal operation or in accident and post-accident situations, the Institute for Radioprotection and Nuclear Safety characterizes the environment of the nuclear installations. This standardised measurement of the environmental and population characteristics will be useful in risk assessment and management, and in all the operational stages of a nuclear installation. This characterization concerns the inventory of the main agricultural productions (vegetable and animal), the important agricultural dates (seeding, harvest) and the practices and eating habits of animals, the industry and the local food-processing, as well as on the food practices of the persons which live around the French nuclear power plant. National surveys have identified the major characteristics of French eating habits. Above and beyond the fact that these surveys do not consider local specificities, the use of their results for dosimetric assessments has certain drawbacks: the categories of foodstuffs most vulnerable to contamination in post-accident situations (fresh fruit and vegetables, fresh milk and cheeses) are very rarely described in detail; representation of the eating habits of an 'average' population does not give us as the behaviors of the most sensitive groups. The prime objective of local studies is to describe eating habits (rations and local production rates) of potentially most exposed population around nuclear facilities which may cultivate various foodstuffs. These comparative studies highlighted the important variability of the particular eating habits of the French population

  7. Acute, low-dose methamphetamine administration improves attention/information processing speed and working memory in methamphetamine-dependent individuals displaying poorer cognitive performance at baseline.

    Science.gov (United States)

    Mahoney, James J; Jackson, Brian J; Kalechstein, Ari D; De La Garza, Richard; Newton, Thomas F

    2011-03-30

    Abstinent methamphetamine (Meth) dependent individuals demonstrate poorer performance on tests sensitive to attention/information processing speed, learning and memory, and working memory when compared to non-Meth dependent individuals. The poorer performance on these tests may contribute to the morbidity associated with Meth-dependence. In light of this, we sought to determine the effects of acute, low-dose Meth administration on attention, working memory, and verbal learning and memory in 19 non-treatment seeking, Meth-dependent individuals. Participants were predominantly male (89%), Caucasian (63%), and cigarette smokers (63%). Following a four day, drug-free washout period, participants were given a single-blind intravenous infusion of saline, followed the next day by 30 mg of Meth. A battery of neurocognitive tasks was administered before and after each infusion, and performance on measures of accuracy and reaction time were compared between conditions. While acute Meth exposure did not affect test performance for the entire sample, participants who demonstrated relatively poor performance on these tests at baseline, identified using a median split on each test, showed significant improvement on measures of attention/information processing speed and working memory when administered Meth. Improved performance was seen on the following measures of working memory: choice reaction time task (p≤0.04), a 1-back task (p≤0.01), and a 2-back task (p≤0.04). In addition, those participants demonstrating high neurocognitive performance at baseline experienced similar or decreased performance following Meth exposure. These findings suggest that acute administration of Meth may temporarily improve Meth-associated neurocognitive performance in those individuals experiencing lower cognitive performance at baseline. As a result, stimulants may serve as a successful treatment for improving cognitive functioning in those Meth-dependent individuals experiencing

  8. Swim Training Improves HOMA-IR in Type 2 Diabetes Induced by High Fat Diet and Low Dose of Streptozotocin in Male Rats.

    Science.gov (United States)

    Ghiasi, Rafigheh; Ghadiri Soufi, Farhad; Somi, Mohammad Hossein; Mohaddes, Gisou; Mirzaie Bavil, Fariba; Naderi, Roya; Alipour, Mohammad Reza

    2015-09-01

    Insulin resistance plays a key role in the onset and development of type 2 diabetes mellitus (T2DM) and its complications. In this study, we evaluated the effect of swim training on insulin resistance in diabetic rats. Forty male Wistar rats were randomly divided into four groups (n=10): sedentary control (Con), sedentary diabetic (Dia), swim trained control (Exe) and swim trained diabetic (Dia+Exe) rats. Diabetes was induced by high fat diet (HFD) and a low dose of streptozotocin (35 mg/kg, i.p). In trained groups, one week after the induction of diabetes, animals were subjected to swimming (60 min/5 days a week) for 10 weeks. At the end of training, fasting blood sugar (FBS), oral glucose tolerance test (OGTT), fasting/basal insulin, glycosylated hemoglobin (HbA1c) levels, insulin resistance index, homeostasis model assessment method (HOMA-IR), triglycerides (TG,) total cholesterol (TCh), and high density lipoprotein (HDL) levels in blood were measured. Swimming significantly improved OGTT (PHOMA-IR (P<0.01). Swim training also significantly decreased FBS (p<0.01), fasting/basal insulin (P<0.01), HbA1C (p<0.01), TG (P<0.05), and TCh (P<0.05) levels. It also significantly increased HDL (p<0.05) level. Our findings indicate that swim training improved glycemic control and insulin sensitivity in type 2 diabetes caused by high fat diet in male rats.

  9. Association Between Exercise Therapy Dose and Functional Improvements in the Early Postoperative Phase After Hip and Knee Arthroplasty: An Observational Study.

    Science.gov (United States)

    Zech, Astrid; Hendrich, Simon; Pfeifer, Klaus

    2015-10-01

    To determine whether intensity and duration of standard exercise therapy are associated with changes in function after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Prospective cohort study. Orthopedic inpatient rehabilitation center. A total of 123 patients 2 weeks after THA (n = 58; age, 62.5 ± 10.4 years) and TKA (n = 65; age, 66.6 ± 7.6 years). Standard rehabilitation (hands-on physiotherapy, group exercise therapy, strength training, cycle ergometer therapy, continuous passive motion therapy, and water exercise therapy). The Western Ontario and McMaster Universities Arthritis Index (WOMAC) and hip and knee range of motion (ROM) were assessed before and after inpatient rehabilitation. The individual rehabilitation period varied between 12-25 days and included 48.1 ± 12.5 (THA) or 41.9 ± 9.7 (TKA) exercise interventions with intensities between 9.6 and 14.0 points on the Borg Rate of Perceived Exertion Scale. WOMAC pain (P hip (P < .001) and knee (P < .001) ROM, improved significantly in THA and TKA patients. Analysis of covariance showed that these changes could not be explained by the total duration or mean intensity of exercise therapy. The findings show a low dose-response relationship between early postoperative exercise therapy and the improvements in function or ROM after THA and TKA. Although the findings raise questions about the efficacy of existing rehabilitation programs, the small sample size, single setting, and geographic differences in postoperative treatment standards limit the generalizability of findings. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  10. Vildagliptin added to sulfonylurea improves glycemic control without hypoglycemia and weight gain in Chinese patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Yang, Wenying; Xing, Xiaoping; Lv, Xiaofeng; Li, Yiming; Ma, Jianhua; Yuan, Guoyue; Sun, Feifei; Wang, Wei; Woloschak, Michael; Lukashevich, Valentina; Kozlovski, Plamen; Kothny, Wolfgang

    2015-03-01

    The aim of the present study was to assess the efficacy and safety of vildagliptin as add-on to sulfonylurea therapy in Chinese patients with type 2 diabetes mellitus (T2DM) inadequately controlled on sulfonylurea monotherapy. The 24-week randomized double-blind placebo-controlled study compared vildagliptin 50 mg, q.d., with placebo as add-on to glimepiride in T2DM patients who were inadequately controlled (HbA1c 7.5%-11.0% [58-97 mmol/mol]) on a stable dose of sulfonylurea for ≥12 weeks before study entry. In all, 279 patients were randomized to receive either vildagliptin (n = 143) or placebo (n = 136). At baseline, overall mean age was 58.5 years, body weight 68.1 kg, duration of diabetes 6.9 years and daily glimepiride dose 3.3 mg. After 24 weeks, the adjusted mean change (AMΔ) in HbA1c was -0.7% (-8 mmol/mol; baseline 8.6%, 70 mmol/mol) in the vildagliptin group and -0.2% (-2 mmol/mol; baseline 8.7%, 72 mmol/mol) in the placebo group, with a treatment difference of -0.5% (-5 mmol/mol; P vildagliptin and placebo groups reported low and comparable incidences of adverse events (14.0% vs. 17.8%) and serious adverse events (0.7% in each group). Vildagliptin 50 mg, q.d., added to sulfonylurea monotherapy is effective in Chinese patients with T2DM, without increasing the risk of hypoglycemia and weight gain. © 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  11. Difficulty in estimation of dose for the abnormal patterns of the TLD disc readings - need investigation and improvement in work practices

    International Nuclear Information System (INIS)

    Madhumita, B.; Ande, C.D.; Sneha, C.; Bakshi, A.K.; Datta, D.

    2018-01-01

    TLD badge based on CaSO 4 :Dy detector used for external radiation monitoring of occupational workers of radiation facilities in India plays a vital role in radiation protection program. Energy and type of radiation in the work-field can be well identified from the dose evaluation algorithm. Algorithm developed earlier use the set of disc ratio from the three disc readings of the TLD badge to arrive at the dose and the type of radiation. Algorithm fails to estimate the dose for the abnormal patterns. The paper discusses the root cause of the abnormal patterns and investigation followed to arrive the estimation of dose

  12. Spectral correction factors for conventional neutron dose meters used in high-energy neutron environments improved and extended results based on a complete survey of all neutron spectra in IAEA-TRS-403

    International Nuclear Information System (INIS)

    Oparaji, U.; Tsai, Y. H.; Liu, Y. C.; Lee, K. W.; Patelli, E.; Sheu, R. J.

    2017-01-01

    This paper presents improved and extended results of our previous study on corrections for conventional neutron dose meters used in environments with high-energy neutrons (E n > 10 MeV). Conventional moderated-type neutron dose meters tend to underestimate the dose contribution of high-energy neutrons because of the opposite trends of dose conversion coefficients and detection efficiencies as the neutron energy increases. A practical correction scheme was proposed based on analysis of hundreds of neutron spectra in the IAEA-TRS-403 report. By comparing 252 Cf-calibrated dose responses with reference values derived from fluence-to-dose conversion coefficients, this study provides recommendations for neutron field characterization and the corresponding dose correction factors. Further sensitivity studies confirm the appropriateness of the proposed scheme and indicate that (1) the spectral correction factors are nearly independent of the selection of three commonly used calibration sources: 252 Cf, 241 Am-Be and 239 Pu-Be; (2) the derived correction factors for Bonner spheres of various sizes (6''-9'') are similar in trend and (3) practical high-energy neutron indexes based on measurements can be established to facilitate the application of these correction factors in workplaces. (authors)

  13. SU-E-I-10: Automatic Monitoring of Accumulated Dose Indices From DICOM RDSR to Improve Radiation Safety in X-Ray Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Omar, A; Bujila, R; Nowik, P; Karambatsakidou, A [Karolinska University Hospital, Stockholm (Sweden)

    2014-06-01

    Purpose: To investigate the potential benefits of automatic monitoring of accumulated patient and staff dose indicators, i.e., CAK and KAP, from DICOM Radiation Dose Structured Reports (RDSR) in x-ray angiography (XA). Methods: Recently RDSR has enabled the convenient aggregation of dose indices and technique parameters for XA procedures. The information contained in RDSR objects for three XA systems, dedicated to different types of clinical procedures, has been collected and aggregated in a database for over one year using a system developed with open-source software at the Karolinska University Hospital. Patient weight was complemented to the RDSR data via an interface with the Hospital Information System (HIS). Results: The linearly approximated trend in KAP over a time period of a year for cerebrovascular, pelvic/peripheral vascular, and cardiovascular procedures showed a decrease of 12%, 20%, and 14%, respectively. The decrease was mainly due to hardware/software upgrades and new low-dose imaging protocols, and partially due to ongoing systematic radiation safety education of the clinical staff. The CAK was in excess of 3 Gy for 15 procedures, and exceeded 5 Gy for 3 procedures. The dose indices have also shown a significant dependence on patient weight for cardiovascular and pelvic/peripheral vascular procedures; a 10 kg shift in mean patient weight can result in a dose index increase of 25%. Conclusion: Automatic monitoring of accumulated dose indices can be utilized to notify the clinical staff and medical physicists when the dose index has exceeded a predetermined action level. This allows for convenient and systematic follow-up of patients in risk of developing deterministic skin injuries. Furthermore, trend analyses of dose indices over time is a valuable resource for the identification of potential positive or negative effects (dose increase/decrease) from changes in hardware, software, and clinical work habits.

  14. SU-E-I-10: Automatic Monitoring of Accumulated Dose Indices From DICOM RDSR to Improve Radiation Safety in X-Ray Angiography

    International Nuclear Information System (INIS)

    Omar, A; Bujila, R; Nowik, P; Karambatsakidou, A

    2014-01-01

    Purpose: To investigate the potential benefits of automatic monitoring of accumulated patient and staff dose indicators, i.e., CAK and KAP, from DICOM Radiation Dose Structured Reports (RDSR) in x-ray angiography (XA). Methods: Recently RDSR has enabled the convenient aggregation of dose indices and technique parameters for XA procedures. The information contained in RDSR objects for three XA systems, dedicated to different types of clinical procedures, has been collected and aggregated in a database for over one year using a system developed with open-source software at the Karolinska University Hospital. Patient weight was complemented to the RDSR data via an interface with the Hospital Information System (HIS). Results: The linearly approximated trend in KAP over a time period of a year for cerebrovascular, pelvic/peripheral vascular, and cardiovascular procedures showed a decrease of 12%, 20%, and 14%, respectively. The decrease was mainly due to hardware/software upgrades and new low-dose imaging protocols, and partially due to ongoing systematic radiation safety education of the clinical staff. The CAK was in excess of 3 Gy for 15 procedures, and exceeded 5 Gy for 3 procedures. The dose indices have also shown a significant dependence on patient weight for cardiovascular and pelvic/peripheral vascular procedures; a 10 kg shift in mean patient weight can result in a dose index increase of 25%. Conclusion: Automatic monitoring of accumulated dose indices can be utilized to notify the clinical staff and medical physicists when the dose index has exceeded a predetermined action level. This allows for convenient and systematic follow-up of patients in risk of developing deterministic skin injuries. Furthermore, trend analyses of dose indices over time is a valuable resource for the identification of potential positive or negative effects (dose increase/decrease) from changes in hardware, software, and clinical work habits

  15. Half-dose non-contrast CT in the investigation of urolithiasis: image quality improvement with third-generation integrated circuit CT detectors.

    Science.gov (United States)

    Wang, Jun; Kang, Tony; Arepalli, Chesnal; Barrett, Sarah; O'Connell, Tim; Louis, Luck; Nicolaou, Savvakis; McLaughlin, Patrick

    2015-06-01

    The objective of this study is to establish the effect of third-generation integrated circuit (IC) CT detector on objective image quality in full- and half-dose non-contrast CT of the urinary tract. 51 consecutive patients with acute renal colic underwent non-contrast CT of the urinary tract using a 128-slice dual-source CT before (n = 24) and after (n = 27) the installation of third-generation IC detectors. Half-dose images were generated using projections from detector A using the dual-source RAW data. Objective image noise in the liver, spleen, right renal cortex, and right psoas muscle was compared between DC and IC cohorts for full-dose and half-dose images reconstructed with FBP and IR algorithms using 1 cm(2) regions of interest. Presence and size of obstructing ureteric calculi were also compared for full-dose and half-dose reconstructions using DC and IC detectors. No statistical difference in age and lateral body size was found between patients in the IC and DC cohorts. Radiation dose, as measured by size-specific dose estimates, did not differ significantly either between the two cohorts (10.02 ± 4.54 mGy IC vs. 12.28 ± 7.03 mGy DC). At full dose, objective image noise was not significantly lower in the IC cohort as compared to the DC cohort for the liver, spleen, and right psoas muscle. At half dose, objective image noise was lower in the IC cohort as compared to DC cohort at the liver (21.32 IC vs. 24.99 DC, 14.7% decrease, p 0.05 for all comparisons). Third-generation IC detectors result in lower objective image noise at full- and half-radiation dose levels as compared with traditional DC detectors. The magnitude of noise reduction was greater at half-radiation dose indicating that the benefits of using novel IC detectors are greater in low and ultra-low-dose CT imaging.

  16. Improve definition of titanium tandems in MR-guided high dose rate brachytherapy for cervical cancer using proton density weighted MRI

    International Nuclear Information System (INIS)

    Hu, Yanle; Esthappan, Jacqueline; Mutic, Sasa; Richardson, Susan; Gay, Hiram A; Schwarz, Julie K; Grigsby, Perry W

    2013-01-01

    For cervical cancer patients treated with MR-guided high dose rate brachytherapy, the accuracy of radiation delivery depends on accurate localization of both tumors and the applicator, e.g. tandem and ovoid. Standard T2-weighted (T2W) MRI has good tumor-tissue contrast. However, it suffers from poor uterus-tandem contrast, which makes the tandem delineation very challenging. In this study, we evaluated the possibility of using proton density weighted (PDW) MRI to improve the definition of titanium tandems. Both T2W and PDW MRI images were obtained from each cervical cancer patient. Imaging parameters were kept the same between the T2W and PDW sequences for each patient except the echo time (90 ms for T2W and 5.5 ms for PDW) and the slice thickness (0.5 cm for T2W and 0.25 cm for PDW). Uterus-tandem contrast was calculated by the equation C = (S u -S t )/S u , where S u and S t represented the average signal in the uterus and the tandem, respectively. The diameter of the tandem was measured 1.5 cm away from the tip of the tandem. The tandem was segmented by the histogram thresholding technique. PDW MRI could significantly improve the uterus-tandem contrast compared to T2W MRI (0.42±0.24 for T2W MRI, 0.77±0.14 for PDW MRI, p=0.0002). The average difference between the measured and physical diameters of the tandem was reduced from 0.20±0.15 cm by using T2W MRI to 0.10±0.11 cm by using PDW MRI (p=0.0003). The tandem segmented from the PDW image looked more uniform and complete compared to that from the T2W image. Compared to the standard T2W MRI, PDW MRI has better uterus-tandem contrast. The information provided by PDW MRI is complementary to those provided by T2W MRI. Therefore, we recommend adding PDW MRI to the simulation protocol to assist tandem delineation process for cervical cancer patients

  17. Dose limits

    International Nuclear Information System (INIS)

    Fitoussi, L.

    1987-12-01

    The dose limit is defined to be the level of harmfulness which must not be exceeded, so that an activity can be exercised in a regular manner without running a risk unacceptable to man and the society. The paper examines the effects of radiation categorised into stochastic and non-stochastic. Dose limits for workers and the public are discussed

  18. An Improved Methodology of Monetary Values of the Unit Collective Dose for Intervention Against Long-Term Exposure Following a Nuclear Accident

    International Nuclear Information System (INIS)

    Hwang, Won Tae; Kim, Eun Han; Suh, Kyung Suk; Choi, Young Gil; Han, Moon Hee

    2002-01-01

    A more practice approach for the determination of monetary values of the unit collective dose for intervention against long-term exposure following a nuclear accident was proposed. In addition, the monetary values of the unit collective dose estimated from the proposed approach were compared with those estimated from the previous model, which are derived from assumptions of routine exposure and the same values are applied in a nuclear accident without modification, using Korea economic data. The monetary values based on the proposed approach showed a distinct difference depending on inequity in the distribution of individual doses. The discounting rate was also an important factor in determination of monetary values of the unit collective dose

  19. An Improved Methodology of Monetary Values of the Unit Collective Dose for Intervention Against Long-Term Exposure Following a Nuclear Accident

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Won Tae; Kim, Eun Han; Suh, Kyung Suk; Choi, Young Gil; Han, Moon Hee [KAERI, Daejeon (Korea, Republic of)

    2002-06-15

    A more practice approach for the determination of monetary values of the unit collective dose for intervention against long-term exposure following a nuclear accident was proposed. In addition, the monetary values of the unit collective dose estimated from the proposed approach were compared with those estimated from the previous model, which are derived from assumptions of routine exposure and the same values are applied in a nuclear accident without modification, using Korea economic data. The monetary values based on the proposed approach showed a distinct difference depending on inequity in the distribution of individual doses. The discounting rate was also an important factor in determination of monetary values of the unit collective dose.

  20. Implications of improved diagnostic imaging of small nodal metastases in head and neck cancer: Radiotherapy target volume transformation and dose de-escalation.

    Science.gov (United States)

    van den Bosch, Sven; Vogel, Wouter V; Raaijmakers, Cornelis P; Dijkema, Tim; Terhaard, Chris H J; Al-Mamgani, Abrahim; Kaanders, Johannes H A M

    2018-05-03

    Diagnostic imaging continues to evolve, and now has unprecedented accuracy for detecting small nodal metastasis. This influences the tumor load in elective target volumes and subsequently has consequences for the radiotherapy dose required to control disease in these volumes. Small metastases that used to remain subclinical and were included in elective volumes, will nowadays be detected and included in high-dose volumes. Consequentially, high-dose volumes will more often contain low-volume disease. These target volume transformations lead to changes in the tumor burden in elective and "gross" tumor volumes with implications for the radiotherapy dose prescribed to these volumes. For head and neck tumors, nodal staging has evolved from mere palpation to combinations of high-resolution imaging modalities. A traditional nodal gross tumor volume in the neck typically had a minimum diameter of 10-15 mm, while nowadays much smaller tumor deposits are detected in lymph nodes. However, the current dose levels for elective nodal irradiation were empirically determined in the 1950s, and have not changed since. In this report the radiobiological consequences of target volume transformation caused by modern imaging of the neck are evaluated, and theoretically derived reductions of dose in radiotherapy for head and neck cancer are proposed. The concept of target volume transformation and subsequent strategies for dose adaptation applies to many other tumor types as well. Awareness of this concept may result in new strategies for target definition and selection of dose levels with the aim to provide optimal tumor control with less toxicity. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  1. Quantitative Evaluation of Compliance with Recommendation for Sulfonylurea Dose Co-Administered with DPP-4 Inhibitors in Japan

    Directory of Open Access Journals (Sweden)

    Motonobu Sakaguchi

    2012-09-01

    Full Text Available After the launch of dipeptidyl peptidase-4 (DPP-4, a new oral hypoglycemic drug (OHD, in December 2009, severe hypoglycemia cases were reported in Japan. Although the definite cause was unknown, co-administration with sulfonylureas (SU was suspected as one of the potential risk factors. The Japan Association for Diabetes Education and Care (JADEC released a recommendation in April 2010 to lower the dose of three major SUs (glimepiride, glibenclamide, and gliclazide when adding a DPP-4 inhibitor. To evaluate the effectiveness of this risk minimization action along with labeling changes, dispensing records for 114,263 patients prescribed OHDs between December 2008 and December 2010 were identified in the Nihon-Chouzai pharmacy claims database. The adherence to the recommended dosing of SU co-prescribed with DPP-4 inhibitors increased from 46.3% before to 63.8% after the JADEC recommendation (p < 0.01 by time-series analysis, while no change was found in those for SU monotherapy and SU with other OHD co-prescriptions. The adherence was significantly worse for those receiving a glibenclamide prescription. The JADEC recommendation, along with labeling changes, appeared to have a favorable effect on the risk minimization action in Japan. In these instances, a pharmacy claims database can be a useful tool to evaluate risk minimization actions.

  2. High-level immunogenicity is achieved vaccine with adjuvanted pandemic H1N1(2009) and improved with booster dosing in a randomized trial of HIV-infected adults.

    Science.gov (United States)

    Cooper, Curtis; Klein, Marina; Walmsley, Sharon; Haase, David; MacKinnon-Cameron, Donna; Marty, Kimberley; Li, Yan; Smith, Bruce; Halperin, Scott; Law, Barb; Scheifele, David

    2012-01-01

    More severe influenza disease and poor vaccine immunogenicity in HIV-infected patients necessitate improved immunization strategies to maximize vaccine efficacy. A phase III, randomized trial was conducted at 4 Canadian sites. Two dosing strategies (standard dose vs standard dose plus booster on day 21) were assessed in HIV patients aged 20 to 59 years during the H1N1(2009) pandemic. A single antigen, inactivated split adjuvanted (AS03(A)) influenza vaccine (Arepanrix) was utilized. Serum hemagglutination inhibition (HAI) titres were assessed at days 21 and 42 and at month 6. 150 participants received at least one injection. Baseline parameters were similar between groups: 83% male, 85% on HAART, median CD4 = 519 cells/mm(3), 84% with HIV RNA < 50 copies/mL. At day 21, seroprotection (HAI ≥1:40) was achieved in 80% (95% CI, 70-89) of participants. Seroconversion occurred in 74% (63-85). Seroprotection and seroconversion were further improved in those randomized to booster dosing: day 42, 94% (85-98) versus 73% (60-83) (P < .01) and 86% (75-93) versus 66% (5-77) (P = .01). Seroprotec-tion was retained in 40% (28-54) of recipients at month 6 with trends toward greater retention of immunity in booster recipients. High-level immunogenicity was achieved with a single dose of this adjuvanted vaccine. Immunogenicity was further improved with booster dosing. Use of this adjuvanted vaccine and booster represent an important approach to increasing immunogenicity in this vaccine hypo-responsive population.

  3. Radiation dose reduction in CT-guided periradicular injections in lumbar spine: Feasibility of a new institutional protocol for improved patient safety

    Directory of Open Access Journals (Sweden)

    Artner Juraj

    2012-08-01

    Full Text Available Abstract Background Image guided spinal injections are successfully used in the management of low back pain and sciatica. The main benefit of CT-guided injections is the safe, fast and precise needle placement, but the radiation exposure remains a serious concern. The purpose of the study was to test a new institutional low-dose protocol for CT-guided periradicular injections in lumbar spine to reduce radiation exposure while increasing accuracy and safety for the patients. Methods We performed a retrospective analysis of a prospective database during a 4-month period (Oct-Dec 2011 at a German University hospital using a newly established low-dose-CT-protocol for periradicular injections in patients suffering from lumbar disc herniation and nerve root entrapment. Inclusion criteria were acute or chronic nerve root irritation due to lumbar disc hernia, age over 18, compliance and informed consent. Excluded were patients suffering from severe obesity (BMI > 30, coagulopathy, allergy to injected substances, infection and non-compliant patients. Outcome parameters consisted of the measured dose length product (mGycm2, the amount of scans, age, gender, BMI and the peri-interventional complications. The results were compared to 50 patients, treated in the standard-interventional CT-protocol for spinal injections, performed in June-Oct 2011, who met the above mentioned inclusion criteria. Results A total amount of 100 patients were enrolled in the study. A significant radiation dose reduction (average 85.31% was achieved using the institutional low-dose protocol compared to standard intervention mode in CT-guided periradicular injections in lumbar spine. Using the low-dose protocol did not increase the complications rate in the analyzed cohort. Conclusions Low-dose-CT-protocols for lumbar perineural injections significantly reduce the exposure to radiation of non-obese patients without an increase of complications. This increases long-time patient

  4. Controllable dose

    International Nuclear Information System (INIS)

    Alvarez R, J.T.; Anaya M, R.A.

    2004-01-01

    With the purpose of eliminating the controversy about the lineal hypothesis without threshold which found the systems of dose limitation of the recommendations of ICRP 26 and 60, at the end of last decade R. Clarke president of the ICRP proposed the concept of Controllable Dose: as the dose or dose sum that an individual receives from a particular source which can be reasonably controllable by means of any means; said concept proposes a change in the philosophy of the radiological protection of its concern by social approaches to an individual focus. In this work a panorama of the foundations is presented, convenient and inconveniences that this proposal has loosened in the international community of the radiological protection, with the purpose of to familiarize to our Mexican community in radiological protection with these new concepts. (Author)

  5. PEGylation, increasing specific activity and multiple dosing as strategies to improve the risk-benefit profile of targeted radionuclide therapy with 177Lu-DOTA-bombesin analogues

    Science.gov (United States)

    2012-01-01

    Background Radiolabelled bombesin (BN) conjugates are promising radiotracers for imaging and therapy of breast and prostate tumours, in which BN2/gastrin-releasing peptide receptors are overexpressed. We describe the influence of the specific activity of a 177Lu-DOTA-PEG5k-Lys-B analogue on its therapeutic efficacy and compare it with its non-PEGylated counterpart. Methods Derivatisation of a stabilised DOTA-BN(7–14)[Cha13,Nle14] analogue with a linear PEG molecule of 5 kDa (PEG5k) was performed by PEGylation of the ϵ-amino group of a β3hLys-βAla-βAla spacer between the BN sequence and the DOTA chelator. The non-PEGylated and the PEGylated analogues were radiolabelled with 177Lu. In vitro evaluation was performed in human prostate carcinoma PC-3 cells, and in vivo studies were carried out in nude mice bearing PC-3 tumour xenografts. Different specific activities of the PEGylated BN analogue and various dose regimens were evaluated concerning their therapeutic efficacy. Results The specificity and the binding affinity of the BN analogue for BN2/GRP receptors were only slightly reduced by PEGylation. In vitro binding kinetics of the PEGylated analogue was slower since steady-state condition was reached after 4 h. PEGylation improved the stability of BN conjugate in vitro in human plasma by a factor of 5.6. The non-PEGylated BN analogue showed favourable pharmacokinetics already, i.e. fast blood clearance and renal excretion, but PEGylation improved the in vivo behaviour further. One hour after injection, the tumour uptake of the PEG5k-BN derivative was higher compared with that of the non-PEGylated analogue (3.43 ± 0.63% vs. 1.88 ± 0.4% ID/g). Moreover, the increased tumour retention resulted in a twofold higher tumour accumulation at 24 h p.i., and increased tumour-to-non-target ratios (tumour-to-kidney, 0.6 vs. 0.4; tumour-to-liver, 8.8 vs. 5.9, 24 h p.i.). In the therapy study, both 177Lu-labelled BN analogues significantly inhibited tumour

  6. Lack of Osteoradionecrosis of the Mandible After Intensity-Modulated Radiotherapy for Head and Neck Cancer: Likely Contributions of Both Dental Care and Improved Dose Distributions

    International Nuclear Information System (INIS)

    Ben-David, Merav A.; Diamante, Maximiliano; Radawski, Jeffrey D.; Vineberg, Karen A.; Stroup, Cynthia; Murdoch-Kinch, Carol-Anne; Zwetchkenbaum, Samuel R.; Eisbruch, Avraham

    2007-01-01

    Purpose: To assess the prevalence and dosimetric and clinical predictors of mandibular osteoradionecrosis (ORN) in patients with head and neck cancer who underwent a pretherapy dental evaluation and prophylactic treatment according to a uniform policy and were treated with intensity-modulated radiotherapy (IMRT). Methods and Materials: Between 1996 and 2005, all patients with head-and-neck cancer treated with parotid gland-sparing IMRT in prospective studies underwent a dental examination and prophylactic treatment according to a uniform policy that included extractions of high-risk, periodontally involved, and nonrestorable teeth in parts of the mandible expected to receive high radiation doses, fluoride supplements, and the placement of guards aiming to reduce electron backscatter off metal teeth restorations. The IMRT plans included dose constraints for the maximal mandibular doses and reduced mean parotid gland and noninvolved oral cavity doses. A retrospective analysis of Grade 2 or worse (clinical) ORN was performed. Results: A total of 176 patients had a minimal follow-up of 6 months. Of these, 31 (17%) had undergone teeth extractions before RT and 13 (7%) after RT. Of the 176 patients, 75% and 50% had received ≥65 Gy and ≥70 Gy to ≥1% of the mandibular volume, respectively. Falloff across the mandible characterized the dose distributions: the average gradient (in the axial plane containing the maximal mandibular dose) was 11 Gy (range, 1-27 Gy; median, 8 Gy). At a median follow-up of 34 months, no cases of ORN had developed (95% confidence interval, 0-2%). Conclusion: The use of a strict prophylactic dental care policy and IMRT resulted in no case of clinical ORN. In addition to the dosimetric advantages offered by IMRT, meticulous dental prophylactic care is likely an essential factor in reducing ORN risk

  7. [Directions for use of corticosteroids and calcineurin inhibitors against generalized myasthenia gravis: therapeutic strategies that can lead to early improvements and veer away from high-dose oral corticosteroids].

    Science.gov (United States)

    Utsugisawa, Kimiaki; Nagane, Yuriko; Suzuki, Shigeaki; Suzuki, Norihiro

    2012-01-01

    The advent of effective immune treatment has meant that myasthenia gravis (MG) is most often not lethal. However, many MG patients still find it difficult to maintain daily activities due to chronic residual fatigability and long-term side effects of medication, since full remission without immune treatment is not common. Our analysis demonstrated that disease severity, dose of oral corticosteroids, and depressive state are the major independent factors negatively associated with self-reported QOL (MG-QOL15-J score). It is noteworthy that oral corticosteroid, the first-line agent for MG, is negatively associated with patients' QOL. When the analysis took into account MGFA postintervention status and dose of oral prednisolne (PSL), the MG-QOL15-J score of MM status patients taking ≤ 5 mg PSL per day is identically low (i.e., just as good QOL) as that seen in CSR and is a target of treatment. In order to veer away from high-dose oral corticosteroids and to achieve early MM or better status with PSL ≤ 5 mg/day, we advocate the early aggressive treatment strategy that can achieve early improvement by performing an aggressive therapy using combined treatment with plasmapheresis and high-dose intravenous methylprednisolone and then maintain an improved clinical status using low-dose oral corticosteroids and calcineurin inhibitors (cyclosporine microemulsion and tacrolimus). The early stages of MG are susceptible to treatment with calcineurin inhibitors. When using cyclosporine microemulsion for MG, blood concentrations 2 h after administration (C2) correlate with clinical improvement and immediately before administration (C0) with side effects (increased serum creatinine and/or hypertension). Monitoring of C2 and C0 levels is useful to estimate efficacy and safety of the drug.

  8. A low-dose β1-blocker in combination with milrinone improves intracellular Ca2+ handling in failing cardiomyocytes by inhibition of milrinone-induced diastolic Ca2+ leakage from the sarcoplasmic reticulum.

    Directory of Open Access Journals (Sweden)

    Shigeki Kobayashi

    Full Text Available OBJECTIVES: The purpose of this study was to investigate whether adding a low-dose β1-blocker to milrinone improves cardiac function in failing cardiomyocytes and the underlying cardioprotective mechanism. BACKGROUND: The molecular mechanism underlying how the combination of low-dose β1-blocker and milrinone affects intracellular Ca(2+ handling in heart failure remains unclear. METHODS: We investigated the effect of milrinone plus landiolol on intracellular Ca(2+ transient (CaT, cell shortening (CS, the frequency of diastolic Ca(2+ sparks (CaSF, and sarcoplasmic reticulum Ca(2+ concentration ({Ca(2+}SR in normal and failing canine cardiomyocytes and used immunoblotting to determine the phosphorylation level of ryanodine receptor (RyR2 and phospholamban (PLB. RESULTS: In failing cardiomyocytes, CaSF significantly increased, and peak CaT and CS markedly decreased compared with normal myocytes. Administration of milrinone alone slightly increased peak CaT and CS, while CaSF greatly increased with a slight increase in {Ca(2+}SR. Co-administration of β1-blocker landiolol to failing cardiomyocytes at a dose that does not inhibit cardiomyocyte function significantly decreased CaSF with a further increase in {Ca(2+}SR, and peak CaT and CS improved compared with milrinone alone. Landiolol suppressed the hyperphosphorylation of RyR2 (Ser2808 in failing cardiomyocytes but had no effect on levels of phosphorylated PLB (Ser16 and Thr17. Low-dose landiolol significantly inhibited the alternans of CaT and CS under a fixed pacing rate (0.5 Hz in failing cardiomyocytes. CONCLUSION: A low-dose β1-blocker in combination with milrinone improved cardiac function in failing cardiomyocytes, apparently by inhibiting the phosphorylation of RyR2, not PLB, and subsequent diastolic Ca(2+ leak.

  9. A low-dose β1-blocker in combination with milrinone improves intracellular Ca2+ handling in failing cardiomyocytes by inhibition of milrinone-induced diastolic Ca2+ leakage from the sarcoplasmic reticulum.

    Science.gov (United States)

    Kobayashi, Shigeki; Susa, Takehisa; Ishiguchi, Hironori; Myoren, Takeki; Murakami, Wakako; Kato, Takayoshi; Fukuda, Masakazu; Hino, Akihiro; Suetomi, Takeshi; Ono, Makoto; Uchinoumi, Hitoshi; Tateishi, Hiroki; Mochizuki, Mamoru; Oda, Tetsuro; Okuda, Shinichi; Doi, Masahiro; Yamamoto, Takeshi; Yano, Masafumi

    2015-01-01

    The purpose of this study was to investigate whether adding a low-dose β1-blocker to milrinone improves cardiac function in failing cardiomyocytes and the underlying cardioprotective mechanism. The molecular mechanism underlying how the combination of low-dose β1-blocker and milrinone affects intracellular Ca(2+) handling in heart failure remains unclear. We investigated the effect of milrinone plus landiolol on intracellular Ca(2+) transient (CaT), cell shortening (CS), the frequency of diastolic Ca(2+) sparks (CaSF), and sarcoplasmic reticulum Ca(2+) concentration ({Ca(2+)}SR) in normal and failing canine cardiomyocytes and used immunoblotting to determine the phosphorylation level of ryanodine receptor (RyR2) and phospholamban (PLB). In failing cardiomyocytes, CaSF significantly increased, and peak CaT and CS markedly decreased compared with normal myocytes. Administration of milrinone alone slightly increased peak CaT and CS, while CaSF greatly increased with a slight increase in {Ca(2+)}SR. Co-administration of β1-blocker landiolol to failing cardiomyocytes at a dose that does not inhibit cardiomyocyte function significantly decreased CaSF with a further increase in {Ca(2+)}SR, and peak CaT and CS improved compared with milrinone alone. Landiolol suppressed the hyperphosphorylation of RyR2 (Ser2808) in failing cardiomyocytes but had no effect on levels of phosphorylated PLB (Ser16 and Thr17). Low-dose landiolol significantly inhibited the alternans of CaT and CS under a fixed pacing rate (0.5 Hz) in failing cardiomyocytes. A low-dose β1-blocker in combination with milrinone improved cardiac function in failing cardiomyocytes, apparently by inhibiting the phosphorylation of RyR2, not PLB, and subsequent diastolic Ca(2+) leak.

  10. Radiation tolerance of the spinal cord previously-damaged by tumor operation: long term neurological improvement and time-dose-volume relationships after irradiation of intraspinal gliomas

    International Nuclear Information System (INIS)

    Kopelson, G.

    1982-01-01

    Of 26 patients with intramedullary spinal cord gliomas (9 astrocytomas, 5 glioblastomas, 12 ependymomas) seen at the Massachusetts General Hospital from 1962-1980, 24 were irradiated (21 initially and 3 after post-surgical recurrence). Those 19 patients who survived at least 1 year after completion of irradiation were evaluated for post-irradiation neurological changes.No patient developed radiation myelopathy. Return to a permanently and completely normal neurological status occured for 33/51 (65%) of pre-irradiation neurological deficits. The major cause of post-irradiation neurological deterioration was tumor recurrence. Although 18/19 patients had their thoracic or lumbar spinal cords irradiated, each with field sizes greater than 10 cm, spinal cord doses approaching, equalling, or occasionally exceeding various definitions of spinal cord tolerance were tolerated well without evidence of radiation myelopathy. Spinal cords of patients with intramedullary gliomas, often with major neurological deficits prior to irradiation, may be treated safely to doses approaching or equalling spinal cord tolerance levels. These doses are expected to locally control most ependymomas and astrocytomas without an increased radiation myelopathy. Caution should be observed if doses higher than this are contemplated in an attempt to cure glioblastoma, because the 5% tolerance level of the damaged spinal remains to be defined

  11. Reduced lung dose and improved inspiration level reproducibility in visually guided DIBH compared to audio coached EIG radiotherapy for breast cancer patients

    DEFF Research Database (Denmark)

    Damkjær, Sidsel Marie Skov; Aznar, Marianne Camille; Pedersen, Anders Navrsted

    2013-01-01

    Patients with left-sided breast cancer with lymph node involvement have routinely been treated with enhanced inspiration gating (EIG) for a decade at our institution. In a transition from EIG to deep inspiration breath hold (DIBH) we compared the two techniques with focus on target coverage, dose...... to organs at risk and reproducibility of the inspiration level (IL)....

  12. Retrospective Evaluation Reveals That Long-term Androgen Deprivation Therapy Improves Cause-Specific and Overall Survival in the Setting of Dose-Escalated Radiation for High-Risk Prostate Cancer

    International Nuclear Information System (INIS)

    Feng, Felix Y.; Blas, Kevin; Olson, Karin; Stenmark, Matthew; Sandler, Howard; Hamstra, Daniel A.

    2013-01-01

    Purpose: To evaluate the role of androgen deprivation therapy (ADT) and duration for high-risk prostate cancer patients treated with dose-escalated radiation therapy (RT). Methods and Materials: A retrospective analysis of high-risk prostate cancer patients treated with dose-escalated RT (minimum 75 Gy) with or without ADT was performed. The relationship between ADT use and duration with biochemical failure (BF), metastatic failure (MF), prostate cancer-specific mortality (PCSM), non-prostate cancer death (NPCD), and overall survival (OS) was assessed as a function of pretreatment characteristics, comorbid medical illness, and treatment using Fine and Gray's cumulative incidence methodology. Results: The median follow-up time was 64 months. In men with National Comprehensive Cancer Network defined high-risk prostate cancer treated with dose-escalated RT, on univariate analysis, both metastasis (P<.0001; hazard ratio 0.34; 95% confidence interval 0.18-0.67; cumulative incidence at 60 months 13% vs 35%) and PCSM (P=.015; hazard ratio 0.41; 95% confidence interval 0.2-1.0; cumulative incidence at 60 months 6% vs 11%) were improved with the use of ADT. On multivariate analysis for all high-risk patients, Gleason score was the strongest negative prognostic factor, and long-term ADT (LTAD) improved MF (P=.002), PCSM (P=.034), and OS (P=.001). In men with prostate cancer and Gleason scores 8 to 10, on multivariate analysis after adjustment for other risk features, there was a duration-dependent improvement in BF, metastasis, PCSM, and OS, all favoring LTAD in comparison with STAD or RT alone. Conclusion: For men with high-risk prostate cancer treated with dose-escalated EBRT, this retrospective study suggests that the combination of LTAD and RT provided a significant improvement in clinical outcome, which was especially true for those with Gleason scores of 8 to 10

  13. A novel self-micro-emulsifying delivery system (SMEDS) formulation significantly improves the fasting absorption of EPA and DHA from a single dose of an omega-3 ethyl ester concentrate.

    Science.gov (United States)

    Qin, Yan; Nyheim, Hilde; Haram, Else Marie; Moritz, Joseph M; Hustvedt, Svein Olaf

    2017-10-16

    , respectively. C max was also increased for both EPA and DHA 2.7- to 9.2-fold. PRF-021 is a novel SMEDS formulation of Omega-3-acid EE demonstrating a marked improvement in absorption of a single dose of EPA and DHA EE under fasted conditions. This allows adequate absorption of Omega-3 from the supplement without the requirement of a high-fat meal.

  14. Assessment of internal doses

    CERN Document Server

    Rahola, T; Falk, R; Isaksson, M; Skuterud, L

    2002-01-01

    There is a definite need for training in dose calculation. Our first course was successful and was followed by a second, both courses were fully booked. An example of new tools for software products for bioassay analysis and internal dose assessment is the Integrated Modules for Bioassay Analysis (IMBA) were demonstrated at the second course. This suite of quality assured code modules have been adopted in the UK as the standard for regulatory assessment purposes. The intercomparison measurements are an important part of the Quality Assurance work. In what is known as the sup O utside workers ' directive it is stated that the internal dose measurements shall be included in the European Unions supervision system for radiation protection. The emergency preparedness regarding internal contamination was much improved by the training with and calibration of handheld instruments from participants' laboratories. More improvement will be gained with the handbook giving practical instructions on what to do in case of e...

  15. Prediction of improvement in global left ventricular function in patients with chronic coronary artery disease and impaired left ventricular function: rest thallium-201 SPET versus low-dose dobutamine echocardiography

    International Nuclear Information System (INIS)

    Pace, L.; Salvatore, M.; Perrone-Filardi, P.; Dellegrottaglie, S.; Prastaro, M.; Crisci, T.; Ponticelli, M.P.; Piscione, F.; Chiariello, M.; Storto, G.; Della Morte, A.M.

    2000-01-01

    Accurate assessment of myocardial viability permits selection of patients who would benefit from myocardial revascularization. Currently, rest-redistribution thallium-201 scintigraphy and low-dose dobutamine echocardiography are among the most used techniques for the identification of viable myocardium. Thirty-one consecutive patients (all men, mean age 60±8 years) with chronic coronary artery disease and reduced left ventricular ejection fraction (31%±7%) were studied. Rest 201 Tl single-photon emission tomography (SPET), low-dose dobutamine echocardiography and radionuclide angiography were performed before revascularization. Radionuclide angiography and echocardiography were repeated after revascularization. An a/dyskinetic segment was considered viable on 201 Tl SPET when tracer uptake was >65%, while improvement on low-dose dobutamine echocardiography was considered a marker of viability. Increase in global ejection fraction was considered significant at ≥5%. In identifying viable segments, rest 201 Tl SPET showed higher sensitivity than low-dose dobutamine echocardiography (72% vs 53%, P 201 Tl SPET in group 1 than in group 2 (2.6±1.9 vs 0.6±1.2, P 201 Tl SPET and post-revascularization changes in ejection fraction (r=0.52, P 201 Tl SPET had a higher sensitivity (82% vs 53%, P=0.07) and showed a trend towards higher accuracy and specificity (77% vs 58%, and 71% vs 64%, respectively) as compared with low-dose dobutamine echocardiography. In conclusion, these findings suggest that when severely reduced global function is present, rest 201 Tl SPET evaluation of viability is more accurate than low-dose dobutamine echocardiography for the identification of patients who will benefit most from revascularization. (orig.)

  16. Intraoperative radiation therapy in patients with bladder cancer. A review of techniques allowing improved tumor doses and providing high cure rates without loss of bladder function

    International Nuclear Information System (INIS)

    Shipley, W.U.; Kaufman, S.D.; Prout, G.R. Jr.

    1987-01-01

    Conventional external beam irradiation, using modern megavoltage techniques and doses that do not harm bladder function, will permanently eradicate local bladder cancer in 30% to 50% of patients, compared with 70% to 90% with cystectomy. In appropriately chosen patients, open surgery can safely provide excellent exposure for the selective delivery of more radiant energy directly to the tumor and less to the uninvolved portion of the bladder. Intraoperative radiation therapy, by either a removable radium or iridium implant or a large single dose of electrons, has been reported to be safe and can permanently cure the bladder of cancer and also preserve bladder function in more than 75% of patients with solitary tumors that invade into but not beyond the bladder muscle. With the increasing interest in and availability of intraoperative radiation therapy in the US, this curative and bladder-sparing treatment for operable patients with bladder cancer invading the trigone is appropriate for careful clinical trial. 13 references

  17. Improvement of image quality and radiation dose of CT perfusion of the brain by means of low-tube voltage (70 KV)

    International Nuclear Information System (INIS)

    Li, Zhen-lin; Zhang, Kai; Li, Wang-jiang; Chen, Xian; Wu, Bin; Song, Bin; Li, Hang

    2014-01-01

    To investigate the feasibility of 70 kV cerebral CT perfusion by comparing image quality and radiation exposure to 80 kV. Thirty patients with suspected cerebral ischemia who underwent dual-source CT perfusion were divided into group A (80 kV, 150 mAs) and group B (70 kV, 150 mAs). Quantitative comparisons were used for maximum enhancement, signal-to-noise index (SNI), and values of cerebral blood flow (CBF), cerebral blood flow (CBV), mean transit time (MTT) on CBF, CBV, and MTT images, and radiation dose from these two groups. Qualitative perfusion images were assessed by two readers. Maximum enhancement for group B was higher than group A (P < 0.05). There were no significant differences between the two groups for SNI on CBF and CBV maps (P = 0.06 - 0.576), but significant differences for MTT when SNI was measured on frontal white matter and temporo-occipital white matter (P < 0.05). There were no differences among values of CBF, CBV, and MTT for both groups (P = 0.251-0.917). Mean image quality score in group B was higher than group A for CBF (P < 0.05), but no differences for CBV (P = 0.542) and MTT (P = 0.962). Radiation dose for group B decreased compared with group A. 70 kV cerebral CT perfusion reduces radiation dose without compromising image quality. (orig.)

  18. Improvement of image quality and radiation dose of CT perfusion of the brain by means of low-tube voltage (70 KV)

    Energy Technology Data Exchange (ETDEWEB)

    Li, Zhen-lin; Zhang, Kai; Li, Wang-jiang; Chen, Xian; Wu, Bin; Song, Bin [West China Hospital of Sichuan University, Department of Radiology, Chengdu, Sichuan (China); Li, Hang [Sichuan Provincial People' s Hospital, Department of Radiology, Chengdu, Sichuan (China)

    2014-08-15

    To investigate the feasibility of 70 kV cerebral CT perfusion by comparing image quality and radiation exposure to 80 kV. Thirty patients with suspected cerebral ischemia who underwent dual-source CT perfusion were divided into group A (80 kV, 150 mAs) and group B (70 kV, 150 mAs). Quantitative comparisons were used for maximum enhancement, signal-to-noise index (SNI), and values of cerebral blood flow (CBF), cerebral blood flow (CBV), mean transit time (MTT) on CBF, CBV, and MTT images, and radiation dose from these two groups. Qualitative perfusion images were assessed by two readers. Maximum enhancement for group B was higher than group A (P < 0.05). There were no significant differences between the two groups for SNI on CBF and CBV maps (P = 0.06 - 0.576), but significant differences for MTT when SNI was measured on frontal white matter and temporo-occipital white matter (P < 0.05). There were no differences among values of CBF, CBV, and MTT for both groups (P = 0.251-0.917). Mean image quality score in group B was higher than group A for CBF (P < 0.05), but no differences for CBV (P = 0.542) and MTT (P = 0.962). Radiation dose for group B decreased compared with group A. 70 kV cerebral CT perfusion reduces radiation dose without compromising image quality. (orig.)

  19. Fertilizer micro-dosing

    International Development Research Centre (IDRC) Digital Library (Canada)

    Localized application of small quantities of fertilizer (micro-dosing), combined with improved planting pits for rainwater harvesting, has generated greater profits and food security for women farmers in the Sahel. • Women are 25% more likely to use combined applications, and have expanded areas of food crops (cowpea,.

  20. Antibodies to biotinylated red blood cells in adults and infants: improved detection, partial characterization, and dependence on red blood cell-biotin dose.

    Science.gov (United States)

    Schmidt, Robert L; Mock, Donald M; Franco, Robert S; Cohen, Robert M; North, Anne K; Cancelas, José A; Geisen, Christof; Strauss, Ronald G; Vlaar, Alexander P; Nalbant, Demet; Widness, John A

    2017-06-01

    Biotin-labeled red blood cells (BioRBCs) are used for in vivo kinetic studies. Because BioRBC dosing occasionally induces antibodies, a sensitive and specific anti-BioRBC detection assay is needed. Aims were to 1) develop a gel card assay to evaluate existing, naturally occurring and BioRBC-induced plasma antibodies, 2) compare gel card and tube agglutination detection results, and 3) test for a relationship of antibody induction and BioRBC dose. Reagent BioRBCs were prepared using sulfo-NHS biotin ranging from densities 18 (BioRBC-18) to 1458 (BioRBC-1458) µg/mL RBCs. Among BioRBC-exposed subjects, gel card and tube agglutination results were concordant in 21 of 22 adults and all 19 infant plasma samples. Gel card antibody detection sensitivity was more than 10-fold greater than tube agglutination. Twelve to 16 weeks after BioRBC exposure, induced anti-antibodies were detected by gel card in three of 26 adults (12%) at reagent densities BioRBC-256 or less, but in none of 41 infants. Importantly, induced anti-BioRBC antibodies were associated with higher BioRBC dose (p = 0.008); no antibodies were detected in 18 subjects who received BioRBC doses less than or equal to BioRBC-18. For noninduced BioRBC antibodies, six of 1125 naïve adults (0.3%) and none of 46 naïve infants demonstrated existing anti-BioRBC antibodies using reagent BioRBC-140 or -162. Existing anti-BioRBCs were all neutralized by biotin compounds, while induced antibodies were not. The gel card assay is more sensitive than the tube agglutination assay. We recommend reagent BioRBC-256 for identifying anti-BioRBCs. Use of a low total RBC biotin label dose (≤ BioRBC-18) may minimize antibody induction. © 2017 AABB.

  1. Experimental verification of dose calculation using the simplified Monte Carlo method with an improved initial beam model for a beam-wobbling system

    International Nuclear Information System (INIS)

    Tansho, Ryohei; Takada, Yoshihisa; Mizutani, Shohei; Kohno, Ryosuke; Hotta, Kenji; Akimoto, Tetsuo; Hara, Yousuke

    2013-01-01

    A beam delivery system using a single-radius-beam-wobbling method has been used to form a conformal irradiation field for proton radiotherapy in Japan. A proton beam broadened by the beam-wobbling system provides a non-Gaussian distribution of projection angle different in two mutually orthogonal planes with a common beam central axis, at a certain position. However, the conventional initial beam model for dose calculations has been using an approximation of symmetric Gaussian angular distribution with the same variance in both planes (called here a Gaussian model with symmetric variance (GMSV)), instead of the accurate one. We have developed a more accurate initial beam model defined as a non-Gaussian model with asymmetric variance (NonGMAV), and applied it to dose calculations using the simplified Monte Carlo (SMC) method. The initial beam model takes into account the different distances of two beam-wobbling magnets from the iso-center and also the different amplitudes of kick angle given by each magnet. We have confirmed that the calculation using the SMC with NonGMAV reproduced the measured dose distribution formed in air by a mono-energetic proton beam passing through a square aperture collimator better than with the GMSV and with a Gaussian model with asymmetric variance (GMAV) in which different variances of angular distributions are used in the two mutually orthogonal planes. Measured dose distributions in a homogeneous phantom formed by a modulated proton beam passing through a range shifter and an L-shaped range compensator, were consistent with calculations using the SMC with GMAV and NonGMAV, but in disagreement with calculations using the SMC with GMSV. Measured lateral penumbrae in a lateral direction were reproduced better by calculations using the SMC with NonGMAV than by those with GMAV, when an aperture collimator with a smaller opening was used. We found that such a difference can be attributed to the non-Gaussian angular distribution of the

  2. Low-dose ketamine improves pain relief in patients receiving intravenous opioids for acute pain in the emergency department: results of a randomized, double-blind, clinical trial.

    Science.gov (United States)

    Beaudoin, Francesca L; Lin, Charlie; Guan, Wentao; Merchant, Roland C

    2014-11-01

    Low-dose ketamine has been used perioperatively for pain control and may be a useful adjunct to intravenous (IV) opioids in the control of acute pain in the emergency department (ED). The aim of this study was to determine the effectiveness of low-dose ketamine as an adjunct to morphine versus standard care with morphine alone for the treatment of acute moderate to severe pain among ED patients. A double-blind, randomized, placebo-controlled trial with three study groups was conducted at a large, urban academic ED over a 10-month period. Eligible patients were 18 to 65 years old with acute moderate to severe pain (score of at least 5 out of 10 on the numerical pain rating scale [NRS] and pain duration ketamine (group 1), or 3) morphine and 0.3 mg/kg ketamine (group 2). Participants were assessed at 30, 60, and 120 minutes after study medication administration and received rescue analgesia as needed to target a 50% reduction in pain. The primary outcome measure of pain relief, or pain intensity reduction, was derived using the NRS and calculated as the summed pain-intensity (SPID) difference over 2 hours. The amount and timing of rescue opioid analgesia was evaluated as a secondary outcome. The occurrence of adverse events was also measured. Sixty patients were enrolled (n = 20 in each group). There were no differences between study groups with respect to age, sex, race/ethnicity, preenrollment analgesia, or baseline NRS. Over the 2-hour poststudy medication administration period, the SPIDs were higher (greater pain relief) for the ketamine study groups than the control group (standard care 4.0, interquartile range [IQR] = 1.8 to 6.5; group 1 7.0, IQR = 4.3 to 10.8; and group 2 7.8, IQR = 4.8 to 12.8; p ketamine groups were similar (p pain intensity up to 2 hours, whereas group 1 was similar to standard care by 2 hours. Similar numbers of patients received rescue analgesia: standard care group, seven of 20, 35%; group 1, four of 20, 20%; and group 2, four of 20, 20

  3. Dose and dose rate monitor

    International Nuclear Information System (INIS)

    Novakova, O.; Ryba, J.; Slezak, V.; Svobodova, B.; Viererbl, L.

    1984-10-01

    The methods are discussea of measuring dose rate or dose using a scintillation counte. A plastic scintillator based on polystyrene with PBD and POPOP activators and coated with ZnS(Ag) was chosen for the projected monitor. The scintillators were cylindrical and spherical in shape and of different sizes; black polypropylene tubes were chosen as the best case for the probs. For the counter with different plastic scintillators, the statistical error 2σ for natural background was determined. For determining the suitable thickness of the ZnS(Ag) layer the energy dependence of the counter was measured. Radioisotopes 137 Cs, 241 Am and 109 Cd were chosen as radiation sources. The best suited ZnS(Ag) thickness was found to be 0.5 μm. Experiments were carried out to determine the directional dependence of the detector response and the signal to noise ratio. The temperature dependence of the detector response and its compensation were studied, as were the time stability and fatigue manifestations of the photomultiplier. The design of a laboratory prototype of a dose rate and dose monitor is described. Block diagrams are given of the various functional parts of the instrument. The designed instrument is easiiy portable, battery powered, measures dose rates from natural background in the range of five orders, i.e., 10 -2 to 10 3 nGy/s, and allows to determine a dose of up to 10 mGy. Accouracy of measurement in the energy range of 50 keV to 1 MeV is better than +-20%. (E.S.)

  4. Radiotherapy of abdomen with precise renal assessment with SPECT/CT imaging (RAPRASI): design and methodology of a prospective trial to improve the understanding of kidney radiation dose response

    International Nuclear Information System (INIS)

    Lopez-Gaitan, Juanita; O’Mara, Brenton; Chu, Julie; Faggian, Jessica; Williams, Luke; Hofman, Michael S; Spry, Nigel A; Ebert, Martin A; Robins, Peter; Boucek, Jan; Leong, Trevor; Willis, David; Bydder, Sean; Podias, Peter; Waters, Gemma

    2013-01-01

    The kidneys are a principal dose-limiting organ in radiotherapy for upper abdominal cancers. The current understanding of kidney radiation dose response is rudimentary. More precise dose-volume response models that allow direct correlation of delivered radiation dose with spatio-temporal changes in kidney function may improve radiotherapy treatment planning for upper-abdominal tumours. Our current understanding of kidney dose response and tolerance is limited and this is hindering efforts to introduce advanced radiotherapy techniques for upper-abdominal cancers, such as intensity-modulated radiotherapy (IMRT). The aim of this study is to utilise radiotherapy and combined anatomical/functional imaging data to allow direct correlation of radiation dose with spatio-temporal changes in kidney function. The data can then be used to develop a more precise dose-volume response model which has the potential to optimise and individualise upper abdominal radiotherapy plans. The Radiotherapy of Abdomen with Precise Renal Assessment with SPECT/CT Imaging (RAPRASI) is an observational clinical research study with participating sites at Sir Charles Gairdner Hospital (SCGH) in Perth, Australia and the Peter MacCallum Cancer Centre (PMCC) in Melbourne, Australia. Eligible patients are those with upper gastrointestinal cancer, without metastatic disease, undergoing conformal radiotherapy that will involve incidental radiation to one or both kidneys. For each patient, total kidney function is being assessed before commencement of radiotherapy treatment and then at 4, 12, 26, 52 and 78 weeks after the first radiotherapy fraction, using two procedures: a Glomerular Filtration Rate (GFR) measurement using the 51 Cr-ethylenediamine tetra-acetic acid (EDTA) clearance; and a regional kidney perfusion measurement assessing renal uptake of 99m Tc-dimercaptosuccinic acid (DMSA), imaged with a Single Photon Emission Computed Tomography / Computed Tomography (SPECT/CT) system. The CT component

  5. The use of intensity-modulated radiation therapy photon beams for improving the dose uniformity of electron beams shaped with MLC.

    Science.gov (United States)

    Mosalaei, Homeira; Karnas, Scott; Shah, Sheel; Van Doodewaard, Sharon; Foster, Tim; Chen, Jeff

    2012-01-01

    Electrons are ideal for treating shallow tumors and sparing adjacent normal tissue. Conventionally, electron beams are collimated by cut-outs that are time-consuming to make and difficult to adapt to tumor shape throughout the course of treatment. We propose that electron cut-outs can be replaced using photon multileaf collimator (MLC). Two major problems of this approach are that the scattering of electrons causes penumbra widening because of a large air gap, and available commercial treatment planning systems (TPSs) do not support MLC-collimated electron beams. In this study, these difficulties were overcome by (1) modeling electron beams collimated by photon MLC for a commercial TPS, and (2) developing a technique to reduce electron beam penumbra by adding low-energy intensity-modulated radiation therapy (IMRT) photons (4 MV). We used blocks to simulate MLC shielding in the TPS. Inverse planning was used to optimize boost photon beams. This technique was applied to a parotid and a central nervous system (CNS) clinical case. Combined photon and electron plans were compared with conventional plans and verified using ion chamber, film, and a 2D diode array. Our studies showed that the beam penumbra for mixed beams with 90 cm source to surface distance (SSD) is comparable with electron applicators and cut-outs at 100 cm SSD. Our mixed-beam technique yielded more uniform dose to the planning target volume and lower doses to various organs at risk for both parotid and CNS clinical cases. The plans were verified with measurements, with more than 95% points passing the gamma criteria of 5% in dose difference and 5 mm for distance to agreement. In conclusion, the study has demonstrated the feasibility and potential advantage of using photon MLC to collimate electron beams with boost photon IMRT fields. Copyright © 2012 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  6. Dose-escalated intensity-modulated radiotherapy is feasible and may improve locoregional control and laryngeal preservation in laryngo-hypopharyngeal cancers.

    Science.gov (United States)

    Miah, Aisha B; Bhide, Shreerang A; Guerrero-Urbano, M Teresa; Clark, Catharine; Bidmead, A Margaret; St Rose, Suzanne; Barbachano, Yolanda; A'hern, Roger; Tanay, Mary; Hickey, Jennifer; Nicol, Robyn; Newbold, Kate L; Harrington, Kevin J; Nutting, Christopher M

    2012-02-01

    To determine the safety and outcomes of induction chemotherapy followed by dose-escalated intensity-modulated radiotherapy (IMRT) with concomitant chemotherapy in locally advanced squamous cell cancer of the larynx and hypopharynx (LA-SCCL/H). A sequential cohort Phase I/II trial design was used to evaluate moderate acceleration and dose escalation. Patients with LA-SCCL/H received IMRT at two dose levels (DL): DL1, 63 Gy/28 fractions (Fx) to planning target volume 1 (PTV1) and 51.8 Gy/28 Fx to PTV2; DL2, 67.2 Gy/28 Fx and 56 Gy/28 Fx to PTV1 and PTV2, respectively. Patients received induction cisplatin/5-fluorouracil and concomitant cisplatin. Acute and late toxicities and tumor control rates were recorded. Between September 2002 and January 2008, 60 patients (29 DL1, 31 DL2) with Stage III (41% DL1, 52% DL2) and Stage IV (52% DL1, 48% DL2) disease were recruited. Median (range) follow-up for DL1 was 51.2 (12.1-77.3) months and for DL2 was 36.2 (4.2-63.3) months. Acute Grade 3 (G3) dysphagia was higher in DL2 (87% DL2 vs. 59% DL1), but other toxicities were equivalent. One patient in DL1 required dilatation of a pharyngeal stricture (G3 dysphagia). In DL2, 2 patients developed benign pharyngeal strictures at 1 year. One underwent a laryngo-pharyngectomy and the other a dilatation. No other G3/G4 toxicities were reported. Overall complete response was 79% (DL1) and 84% (DL2). Two-year locoregional progression-free survival rates were 64.2% (95% confidence interval, 43.5-78.9%) in DL1 and 78.4% (58.1-89.7%) in DL2. Two-year laryngeal preservation rates were 88.7% (68.5-96.3%) in DL1 and 96.4% (77.7-99.5%) in DL2. At a mean follow-up of 36 months, dose-escalated chemotherapy-IMRT at DL2 has so far been safe to deliver. In this study, DL2 delivered high rates of locoregional control, progression-free survival, and organ preservation and has been selected as the experimental arm in a Cancer Research UK Phase III study. Copyright © 2012 Elsevier Inc. All rights

  7. Dose-Escalated Intensity-Modulated Radiotherapy Is Feasible and May Improve Locoregional Control and Laryngeal Preservation in Laryngo-Hypopharyngeal Cancers

    International Nuclear Information System (INIS)

    Miah, Aisha B.; Bhide, Shreerang A.; Guerrero-Urbano, M. Teresa; Clark, Catharine; Bidmead, A. Margaret; St Rose, Suzanne; Barbachano, Yolanda; A’Hern, Roger; Tanay, Mary; Hickey, Jennifer; Nicol, Robyn; Newbold, Kate L.; Harrington, Kevin J.; Nutting, Christopher M.

    2012-01-01

    Purpose: To determine the safety and outcomes of induction chemotherapy followed by dose-escalated intensity-modulated radiotherapy (IMRT) with concomitant chemotherapy in locally advanced squamous cell cancer of the larynx and hypopharynx (LA-SCCL/H). Methods and Materials: A sequential cohort Phase I/II trial design was used to evaluate moderate acceleration and dose escalation. Patients with LA-SCCL/H received IMRT at two dose levels (DL): DL1, 63 Gy/28 fractions (Fx) to planning target volume 1 (PTV1) and 51.8 Gy/28 Fx to PTV2; DL2, 67.2 Gy/28 Fx and 56 Gy/28 Fx to PTV1 and PTV2, respectively. Patients received induction cisplatin/5-fluorouracil and concomitant cisplatin. Acute and late toxicities and tumor control rates were recorded. Results: Between September 2002 and January 2008, 60 patients (29 DL1, 31 DL2) with Stage III (41% DL1, 52% DL2) and Stage IV (52% DL1, 48% DL2) disease were recruited. Median (range) follow-up for DL1 was 51.2 (12.1–77.3) months and for DL2 was 36.2 (4.2–63.3) months. Acute Grade 3 (G3) dysphagia was higher in DL2 (87% DL2 vs. 59% DL1), but other toxicities were equivalent. One patient in DL1 required dilatation of a pharyngeal stricture (G3 dysphagia). In DL2, 2 patients developed benign pharyngeal strictures at 1 year. One underwent a laryngo-pharyngectomy and the other a dilatation. No other G3/G4 toxicities were reported. Overall complete response was 79% (DL1) and 84% (DL2). Two-year locoregional progression-free survival rates were 64.2% (95% confidence interval, 43.5–78.9%) in DL1 and 78.4% (58.1–89.7%) in DL2. Two-year laryngeal preservation rates were 88.7% (68.5–96.3%) in DL1 and 96.4% (77.7–99.5%) in DL2. Conclusions: At a mean follow-up of 36 months, dose-escalated chemotherapy–IMRT at DL2 has so far been safe to deliver. In this study, DL2 delivered high rates of locoregional control, progression-free survival, and organ preservation and has been selected as the experimental arm in a Cancer Research UK

  8. Dose-Escalated Intensity-Modulated Radiotherapy Is Feasible and May Improve Locoregional Control and Laryngeal Preservation in Laryngo-Hypopharyngeal Cancers

    Energy Technology Data Exchange (ETDEWEB)

    Miah, Aisha B; Bhide, Shreerang A; Guerrero-Urbano, M Teresa [Head and Neck Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London (United Kingdom); Institute of Cancer Research, London (United Kingdom); Clark, Catharine; Bidmead, A Margaret [Institute of Cancer Research, London (United Kingdom); Department of Physics, The Royal Marsden NHS Foundation Trust, London (United Kingdom); St Rose, Suzanne; Barbachano, Yolanda; A' Hern, Roger [Department of Statistics, The Royal Marsden NHS Foundation Trust, London (United Kingdom); Tanay, Mary; Hickey, Jennifer; Nicol, Robyn; Newbold, Kate L [Head and Neck Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London (United Kingdom); Harrington, Kevin J [Head and Neck Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London (United Kingdom); Institute of Cancer Research, London (United Kingdom); Nutting, Christopher M., E-mail: chris.nutting@rmh.nhs.uk [Head and Neck Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London (United Kingdom); Institute of Cancer Research, London (United Kingdom)

    2012-02-01

    Purpose: To determine the safety and outcomes of induction chemotherapy followed by dose-escalated intensity-modulated radiotherapy (IMRT) with concomitant chemotherapy in locally advanced squamous cell cancer of the larynx and hypopharynx (LA-SCCL/H). Methods and Materials: A sequential cohort Phase I/II trial design was used to evaluate moderate acceleration and dose escalation. Patients with LA-SCCL/H received IMRT at two dose levels (DL): DL1, 63 Gy/28 fractions (Fx) to planning target volume 1 (PTV1) and 51.8 Gy/28 Fx to PTV2; DL2, 67.2 Gy/28 Fx and 56 Gy/28 Fx to PTV1 and PTV2, respectively. Patients received induction cisplatin/5-fluorouracil and concomitant cisplatin. Acute and late toxicities and tumor control rates were recorded. Results: Between September 2002 and January 2008, 60 patients (29 DL1, 31 DL2) with Stage III (41% DL1, 52% DL2) and Stage IV (52% DL1, 48% DL2) disease were recruited. Median (range) follow-up for DL1 was 51.2 (12.1-77.3) months and for DL2 was 36.2 (4.2-63.3) months. Acute Grade 3 (G3) dysphagia was higher in DL2 (87% DL2 vs. 59% DL1), but other toxicities were equivalent. One patient in DL1 required dilatation of a pharyngeal stricture (G3 dysphagia). In DL2, 2 patients developed benign pharyngeal strictures at 1 year. One underwent a laryngo-pharyngectomy and the other a dilatation. No other G3/G4 toxicities were reported. Overall complete response was 79% (DL1) and 84% (DL2). Two-year locoregional progression-free survival rates were 64.2% (95% confidence interval, 43.5-78.9%) in DL1 and 78.4% (58.1-89.7%) in DL2. Two-year laryngeal preservation rates were 88.7% (68.5-96.3%) in DL1 and 96.4% (77.7-99.5%) in DL2. Conclusions: At a mean follow-up of 36 months, dose-escalated chemotherapy-IMRT at DL2 has so far been safe to deliver. In this study, DL2 delivered high rates of locoregional control, progression-free survival, and organ preservation and has been selected as the experimental arm in a Cancer Research UK Phase III

  9. A Novel Highly Bioavailable Curcumin Formulation Improves Symptoms and Diagnostic Indicators in Rheumatoid Arthritis Patients: A Randomized, Double-Blind, Placebo-Controlled, Two-Dose, Three-Arm, and Parallel-Group Study.

    Science.gov (United States)

    Amalraj, Augustine; Varma, Karthik; Jacob, Joby; Divya, Chandradhara; Kunnumakkara, Ajaikumar B; Stohs, Sidney J; Gopi, Sreeraj

    2017-10-01

    Rheumatoid arthritis (RA) is an autoimmune, chronic systemic inflammatory disorder. The long-term use of currently available drugs for the treatment of RA has many potential side effects. Natural phytonutrients may serve as alternative strategies for the safe and effective treatment of RA, and curcuminoids have been used in Ayurvedic medicine for the treatment of inflammatory conditions for centuries. In this study, a novel, highly bioavailable form of curcumin in a completely natural turmeric matrix was evaluated for its ability to improve the clinical symptoms of RA. A randomized, double-blind, placebo-controlled, three-arm, parallel-group study was conducted to evaluate the comparative efficacy of two different doses of curcumin with that of a placebo in active RA patients. Twelve patients in each group received placebo, 250 or 500 mg of the curcumin product twice daily for 90 days. The responses of the patients were assessed using the American College of Rheumatology (ACR) response, visual analog scale (VAS), C-reactive protein (CRP), Disease Activity Score 28 (DAS28), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) values. RA patients who received the curcumin product at both low and high doses reported statistically significant changes in their clinical symptoms at the end of the study. These observations were confirmed by significant changes in ESR, CPR, and RF values in patients receiving the study product compared to baseline and placebo. The results indicate that this novel curcumin in a turmeric matrix acts as an analgesic and anti-inflammatory agent for the management of RA at a dose as low as 250 mg twice daily as evidenced by significant improvement in the ESR, CRP, VAS, RF, DAS28, and ACR responses compared to placebo. Both doses of the study product were well tolerated and without side effects.

  10. A small dose of whey protein co-ingested with mixed-macronutrient breakfast and lunch meals improves postprandial glycemia and suppresses appetite in men with type 2 diabetes: a randomized controlled trial.

    Science.gov (United States)

    King, David G; Walker, Mark; Campbell, Matthew D; Breen, Leigh; Stevenson, Emma J; West, Daniel J

    2018-04-01

    Large doses of whey protein consumed as a preload before single high-glycemic load meals has been shown to improve postprandial glycemia in type 2 diabetes. It is unclear if this effect remains with smaller doses of whey co-ingested at consecutive mixed-macronutrient meals. Moreover, whether hydrolyzed whey offers further benefit under these conditions is unclear. The aim of this study was to investigate postprandial glycemic and appetite responses after small doses of intact and hydrolyzed whey protein co-ingested with mixed-nutrient breakfast and lunch meals in men with type 2 diabetes. In a randomized, single-blind crossover design, 11 men with type 2 diabetes [mean ± SD age: 54.9 ± 2.3 y; glycated hemoglobin: 6.8% ± 0.3% (51.3 ± 3.4 mmol/mol)] attended the laboratory on 3 mornings and consumed 1) intact whey protein (15 g), 2) hydrolyzed whey protein (15 g), or 3) placebo (control) immediately before mixed-macronutrient breakfast and lunch meals, separated by 3 h. Blood samples were collected periodically and were processed for insulin, intact glucagon-like peptide 1 (GLP-1), gastric inhibitory polypeptide (GIP), leptin, peptide tyrosine tyrosine (PYY3-36), and amino acid concentrations. Interstitial glucose was measured during and for 24 h after each trial. Subjective appetite was assessed with the use of visual analog scales. Total postprandial glycemia area under the curve was reduced by 13% ± 3% after breakfast following the intact whey protein when compared with control (P  0.05). The consumption of a small 15-g dose of intact whey protein immediately before consecutive mixed-macronutrient meals improves postprandial glycemia, stimulates insulin release, and increases satiety in men with type 2 diabetes. This trial was registered at www.clinicialtrials.gov as NCT02903199.

  11. Cerebral bone subtraction CT angiography using 80 kVp and sinogram-affirmed iterative reconstruction: contrast medium and radiation dose reduction with improvement of image quality

    Energy Technology Data Exchange (ETDEWEB)

    Nagayama, Yasunori [Kumamoto City Hospital, Department of Radiology, Kumamoto (Japan); Kumamoto University, Department of Diagnostic Radiology, Chuo-ku, Kumamoto (Japan); Nakaura, Takeshi; Oda, Seitaro; Kidoh, Masafumi; Utsunomiya, Daisuke; Yamashita, Yasuyuki [Kumamoto University, Department of Diagnostic Radiology, Chuo-ku, Kumamoto (Japan); Tsuji, Akinori; Urata, Joji; Furusawa, Mitsuhiro; Yuki, Hideaki; Hirarta, Kenichiro [Kumamoto City Hospital, Department of Radiology, Kumamoto (Japan)

    2017-02-15

    The purpose of this study was to evaluate the feasibility of a contrast medium (CM), radiation dose reduction protocol for cerebral bone-subtraction CT angiography (BSCTA) using 80-kVp and sinogram-affirmed iterative reconstruction (SAFIRE). Seventy-five patients who had undergone BSCTA under the 120- (n = 37) or the 80-kVp protocol (n = 38) were included. CM was 370 mgI/kg for the 120-kVp and 296 mgI/kg for the 80-kVp protocol; the 120- and the 80-kVp images were reconstructed with filtered back-projection (FBP) and SAFIRE, respectively. We compared effective dose (ED), CT attenuation, image noise, and contrast-to-noise ratio (CNR) of two protocols. We also scored arterial contrast, sharpness, depiction of small arteries, visibility near skull base/clip, and overall image quality on a four-point scale. ED was 62% lower at 80- than 120-kVp (0.59 ± 0.06 vs 1.56 ± 0.13 mSv, p < 0.01). CT attenuation of the internal carotid artery (ICA) and middle cerebral artery (MCA) was significantly higher on 80- than 120-kVp (ICA: 557.4 ± 105.7 vs 370.0 ± 59.3 Hounsfield units (HU), p < 0.01; MCA: 551.9 ± 107.9 vs 364.6 ± 62.2 HU, p < 0.01). The CNR was also significantly higher on 80- than 120-kVp (ICA: 46.2 ± 10.2 vs 36.9 ± 7.6, p < 0.01; MCA: 45.7 ± 10.0 vs 35.7 ± 9.0, p < 0.01). Visibility near skull base and clip was not significantly different (p = 0.45). The other subjective scores were higher with the 80- than the 120-kVp protocol (p < 0.05). The 80-kVp acquisition with SAFIRE yields better image quality for BSCTA and substantial reduction in the radiation and CM dose compared to the 120-kVp with FBP protocol. (orig.)

  12. Dose rate constants for new dose quantities

    International Nuclear Information System (INIS)

    Tschurlovits, M.; Daverda, G.; Leitner, A.

    1992-01-01

    Conceptual changes and new quantities made is necessary to reassess dose rate quantities. Calculations of the dose rate constant were done for air kerma, ambient dose equivalent and directional dose equivalent. The number of radionuclides is more than 200. The threshold energy is selected as 20 keV for the dose equivalent constants. The dose rate constant for the photon equivalent dose as used mainly in German speaking countries as a temporary quantity is also included. (Author)

  13. Higher Biologically Effective Dose of Radiotherapy Is Associated With Improved Outcomes for Locally Advanced Non–Small Cell Lung Carcinoma Treated With Chemoradiation: An Analysis of the Radiation Therapy Oncology Group

    International Nuclear Information System (INIS)

    Machtay, Mitchell; Bae, Kyounghwa; Movsas, Benjamin; Paulus, Rebecca; Gore, Elizabeth M.; Komaki, Ritsuko; Albain, Kathy; Sause, William T.; Curran, Walter J.

    2012-01-01

    Purpose: Patients treated with chemoradiotherapy for locally advanced non–small-cell lung carcinoma (LA-NSCLC) were analyzed for local-regional failure (LRF) and overall survival (OS) with respect to radiotherapy dose intensity. Methods and Materials: This study combined data from seven Radiation Therapy Oncology Group (RTOG) trials in which chemoradiotherapy was used for LA-NSCLC: RTOG 88-08 (chemoradiation arm only), 90-15, 91-06, 92-04, 93-09 (nonoperative arm only), 94-10, and 98-01. The radiotherapeutic biologically effective dose (BED) received by each individual patient was calculated, as was the overall treatment time-adjusted BED (tBED) using standard formulae. Heterogeneity testing was done with chi-squared statistics, and weighted pooled hazard ratio estimates were used. Cox and Fine and Gray’s proportional hazard models were used for OS and LRF, respectively, to test the associations between BED and tBED adjusted for other covariates. Results: A total of 1,356 patients were analyzed for BED (1,348 for tBED). The 2-year and 5-year OS rates were 38% and 15%, respectively. The 2-year and 5-year LRF rates were 46% and 52%, respectively. The BED (and tBED) were highly significantly associated with both OS and LRF, with or without adjustment for other covariates on multivariate analysis (p < 0.0001). A 1-Gy BED increase in radiotherapy dose intensity was statistically significantly associated with approximately 4% relative improvement in survival; this is another way of expressing the finding that the pool-adjusted hazard ratio for survival as a function of BED was 0.96. Similarly, a 1-Gy tBED increase in radiotherapy dose intensity was statistically significantly associated with approximately 3% relative improvement in local-regional control; this is another way of expressing the finding that the pool-adjusted hazard ratio as a function of tBED was 0.97. Conclusions: Higher radiotherapy dose intensity is associated with improved local-regional control

  14. SU-E-T-13: A Feasibility Study of the Use of Hybrid Computational Phantoms for Improved Historical Dose Reconstruction in the Study of Late Radiation Effects for Hodgkin's Lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Petroccia, H; O' Reilly, S; Bolch, W [J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL (United States); Mendenhall, N; Li, Z; Slopsema, R [Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, FL (United States)

    2014-06-01

    Purpose: Radiation-induced cancer effects are well-documented following radiotherapy. Further investigation is needed to more accurately determine a dose-response relationship for late radiation effects. Recent dosimetry studies tend to use representative patients (Taylor 2009) or anthropomorphic phantoms (Wirth 2008) for estimating organ mean doses. In this study, we compare hybrid computational phantoms to patient-specific voxel phantoms to test the accuracy of University of Florida Hybrid Phantom Library (UFHP Library) for historical dose reconstructions. Methods: A cohort of 10 patients with CT images was used to reproduce the data that was collected historically for Hodgkin's lymphoma patients (i.e. caliper measurements and photographs). Four types of phantoms were generated to show a range of refinement from reference hybrid-computational phantom to patient-specific phantoms. Each patient is matched to a reference phantom from the UFHP Library based on height and weight. The reference phantom is refined in the anterior/posterior direction to create a ‘caliper-scaled phantom’. A photograph is simulated using a surface rendering from segmented CT images. Further refinement in the lateral direction is performed using ratios from a simulated-photograph to create a ‘photograph and caliper-scaled phantom’; breast size and position is visually adjusted. Patient-specific hybrid phantoms, with matched organ volumes, are generated and show the capabilities of the UF Hybrid Phantom Library. Reference, caliper-scaled, photograph and caliper-scaled, and patient-specific hybrid phantoms are compared with patient-specific voxel phantoms to determine the accuracy of the study. Results: Progression from reference phantom to patient specific hybrid shows good agreement with the patient specific voxel phantoms. Each stage of refinement shows an overall trend of improvement in dose accuracy within the study, which suggests that computational phantoms can show

  15. Mixed field dose equivalent measuring instruments

    International Nuclear Information System (INIS)

    Brackenbush, L.W.; McDonald, J.C.; Endres, G.W.R.; Quam, W.

    1985-01-01

    In the past, separate instruments have been used to monitor dose equivalent from neutrons and gamma rays. It has been demonstrated that it is now possible to measure simultaneously neutron and gamma dose with a single instrument, the tissue equivalent proportional counter (TEPC). With appropriate algorithms dose equivalent can also be determined from the TEPC. A simple ''pocket rem meter'' for measuring neutron dose equivalent has already been developed. Improved algorithms for determining dose equivalent for mixed fields are presented. (author)

  16. High doses of vitamin C plus E reduce strength training-induced improvements in areal bone mineral density in elderly men.

    Science.gov (United States)

    Stunes, Astrid Kamilla; Syversen, Unni; Berntsen, Sveinung; Paulsen, Gøran; Stea, Tonje H; Hetlelid, Ken J; Lohne-Seiler, Hilde; Mosti, Mats Peder; Bjørnsen, Thomas; Raastad, Truls; Haugeberg, Glenn

    2017-06-01

    Resistance training is beneficial for maintaining bone mass. We aimed to investigate the skeletal effects of high doses of antioxidants [vitamin C + E (α-tocopherol)] supplementation during 12-week supervised strength training in healthy, elderly men METHODS: Design: double-blinded randomized placebo-controlled study. Participants followed a supervised, undulating periodic exercise program with weekly adjusted load: 3 sessions/week and 3-15 repetitions maximum (RM) sets/exercise. The control group (CG, n = 17, 67 ± 5 years) received placebo and the antioxidant group (AO, n = 16, 70 ± 7 years) 1000 mg vitamin C + 235 mg vitamin E, daily. Areal bone mineral density (aBMD) at whole body, lumbar spine (L1-L4), total hip, and femoral neck were measured by dual energy X-ray absorptiometry and muscle strength by 1RM. Serum analyses of bone-related factors and adipokines were performed. In the CG, total hip aBMD increased by 1.0% (CI: 0.3-1.7) versus pretest and lumbar spine aBMD increased by 0.9% (CI: -0.2 to 2.0) compared to the AO. In the CG, there was an increase in serum concentrations of insulin-like growth factor 1 [+27.3% (CI: -0.3 to 54.9)] and leptin [+31.2% (CI: 9.8-52.6)) versus pretest, and a decrease in sclerostin [-9.9% (CI: 4.4-15.3)] versus pretest and versus AO. Serum bone formation markers P1NP and osteocalcin increased in both groups, while the bone resorption marker CTX-1 remained unchanged. High doses of antioxidant supplementations may constrain the favorable skeletal benefits of 12 weeks of resistance exercise in healthy elderly men.

  17. Patient dose measurement and dose reduction in East Anglia (UK)

    International Nuclear Information System (INIS)

    Wade, J.P.; Goldstone, K.E.; Dendy, P.P.

    1995-01-01

    At the end of 1990 a programme of patient dose measurements was introduced as part of the quality assurance service already provided for X ray departments throughout the East Anglian Health Region (UK). Thermoluminescence dosemeters (TLDs) were used to measure over 1200 skin entrance surface doses for four common radiographic views in 33 hospitals in both the NHS and private sector. The four views were chosen to cover a wide range of equipment and techniques. The data collected have enabled Regional reference doses to be set which, for all views considered, fall below the National Radiological Protection Board (NRPB) Reference levels. In departments which exceeded reference levels, techniques were reviewed, improvements suggested and doses re-measured, in accordance with the recommended procedure for patient dose audit. A significant finding was that, given appropriate controls, X ray departments in the private sector could achieve the same acceptably low doses as NHS departments. (Author)

  18. Integral dose conservation in radiotherapy

    International Nuclear Information System (INIS)

    Reese, Adam S.; Das, Shiva K.; Curle, Charles; Marks, Lawrence B.

    2009-01-01

    Treatment planners frequently modify beam arrangements and use IMRT to improve target dose coverage while satisfying dose constraints on normal tissues. The authors herein analyze the limitations of these strategies and quantitatively assess the extent to which dose can be redistributed within the patient volume. Specifically, the authors hypothesize that (1) the normalized integral dose is constant across concentric shells of normal tissue surrounding the target (normalized to the average integral shell dose), (2) the normalized integral shell dose is constant across plans with different numbers and orientations of beams, and (3) the normalized integral shell dose is constant across plans when reducing the dose to a critical structure. Using the images of seven patients previously irradiated for cancer of brain or prostate cancer and one idealized scenario, competing three-dimensional conformal and IMRT plans were generated using different beam configurations. Within a given plan and for competing plans with a constant mean target dose, the normalized integral doses within concentric ''shells'' of surrounding normal tissue were quantitatively compared. Within each patient, the normalized integral dose to shells of normal tissue surrounding the target was relatively constant (1). Similarly, for each clinical scenario, the normalized integral dose for a given shell was also relatively constant regardless of the number and orientation of beams (2) or degree of sparing of a critical structure (3). 3D and IMRT planning tools can redistribute, rather than eliminate dose to the surrounding normal tissues (intuitively known by planners). More specifically, dose cannot be moved between shells surrounding the target but only within a shell. This implies that there are limitations in the extent to which a critical structure can be spared based on the location and geometry of the critical structure relative to the target.

  19. The Percent of Positive Biopsy Cores Improves Prediction of Prostate Cancer-Specific Death in Patients Treated With Dose-Escalated Radiotherapy

    International Nuclear Information System (INIS)

    Qian Yushen; Feng, Felix Y.; Halverson, Schuyler; Blas, Kevin; Sandler, Howard M.; Hamstra, Daniel A.

    2011-01-01

    Purpose: To examine the prognostic utility of the percentage of positive cores (PPC) at the time of prostate biopsy for patients treated with dose-escalated external beam radiation therapy. Methods and Materials: We performed a retrospective analysis of patients treated at University of Michigan Medical Center to at least 75 Gy. Patients were stratified according to PPC by quartile, and freedom from biochemical failure (nadir + 2 ng/mL), freedom from metastasis (FFM), cause-specific survival (CSS), and overall survival (OS) were assessed by log-rank test. Receiver operator characteristic (ROC) curve analysis was used to determine the optimal cut point for PPC stratification. Finally, Cox proportional hazards multivariate regression was used to assess the impact of PPC on clinical outcome when adjusting for National Comprehensive Cancer Network (NCCN) risk group and androgen deprivation therapy. Results: PPC information was available for 651 patients. Increasing-risk features including T stage, prostate-specific antigen, Gleason score, and NCCN risk group were all directly correlated with increasing PPC. On log-rank evaluation, all clinical endpoints, except for OS, were associated with PPC by quartile, with worse clinical outcomes as PPC increased, with the greatest impact seen in the highest quartile (>66.7% of cores positive). ROC curve analysis confirmed that a cut point using two-thirds positive cores was most closely associated with CSS (p = 0.002; area under ROC curve, 0.71). On univariate analysis, stratifying patients according to PPC less than or equal to 66.7% vs. PPC greater than 66.7% was prognostic for freedom from biochemical failure (p = 0.0001), FFM (p = 0.0002), and CSS (p = 0.0003) and marginally prognostic for OS (p = 0.055). On multivariate analysis, after adjustment for NCCN risk group and androgen deprivation therapy use, PPC greater than 66.7% increased the risk for biochemical failure (p = 0.0001; hazard ratio [HR], 2.1 [95% confidence

  20. Short term (14 days) consumption of insoluble wheat bran fibre-containing breakfast cereals improves subjective digestive feelings, general wellbeing and bowel function in a dose dependent manner.

    Science.gov (United States)

    Lawton, Clare L; Walton, Jenny; Hoyland, Alexa; Howarth, Elaine; Allan, Peter; Chesters, David; Dye, Louise

    2013-04-22

    This study investigated whether increasing insoluble (predominantly wheat bran) fibre over 14 days improves subjective digestive feelings, general wellbeing and bowel function. A single centre, multi-site, open, within subjects design with a 14 day non-intervention (baseline) monitoring period followed by a 14 day fibre consumption (intervention) period was performed. 153 low fibre consumers (breakfast cereal containing at least 5.4 g fibre (3.5 g from wheat bran) for 14 days and completed a daily symptom diary. Significant improvements were demonstrated in subjective perception of bowel function (e.g., ease of defecation) and digestive feelings (bloating, constipation, feeling sluggish and digestive discomfort). Significant improvements were also found in subjective perception of general wellbeing (feeling less fat, more mentally alert, slim, happy and energetic whilst experiencing less stress, mental and physical tiredness, difficulty concentrating and fewer headaches). In general, improvements in study outcomes increased with increasing cereal/fibre consumption. However, consuming an additional minimum 5.4 g of fibre (3.5 g wheat bran) per day was shown to deliver measurable and significant benefits for digestive health, comfort and wellbeing. Encouraging consumption of relatively small amounts of wheat bran could also provide an effective method of increasing overall fibre consumption.

  1. Short Term (14 Days Consumption of Insoluble Wheat Bran Fibre-Containing Breakfast Cereals Improves Subjective Digestive Feelings, General Wellbeing and Bowel Function in a Dose Dependent Manner

    Directory of Open Access Journals (Sweden)

    Louise Dye

    2013-04-01

    Full Text Available This study investigated whether increasing insoluble (predominantly wheat bran fibre over 14 days improves subjective digestive feelings, general wellbeing and bowel function. A single centre, multi-site, open, within subjects design with a 14 day non-intervention (baseline monitoring period followed by a 14 day fibre consumption (intervention period was performed. 153 low fibre consumers (<15 g/day AOAC 985.29 completed a daily symptom diary for 14 days after which they consumed one bowl of ready-to-eat breakfast cereal containing at least 5.4 g fibre (3.5 g from wheat bran for 14 days and completed a daily symptom diary. Significant improvements were demonstrated in subjective perception of bowel function (e.g., ease of defecation and digestive feelings (bloating, constipation, feeling sluggish and digestive discomfort. Significant improvements were also found in subjective perception of general wellbeing (feeling less fat, more mentally alert, slim, happy and energetic whilst experiencing less stress, mental and physical tiredness, difficulty concentrating and fewer headaches. In general, improvements in study outcomes increased with increasing cereal/fibre consumption. However, consuming an additional minimum 5.4 g of fibre (3.5 g wheat bran per day was shown to deliver measurable and significant benefits for digestive health, comfort and wellbeing. Encouraging consumption of relatively small amounts of wheat bran could also provide an effective method of increasing overall fibre consumption.

  2. Short Term (14 Days) Consumption of Insoluble Wheat Bran Fibre-Containing Breakfast Cereals Improves Subjective Digestive Feelings, General Wellbeing and Bowel Function in a Dose Dependent Manner

    Science.gov (United States)

    Lawton, Clare L.; Walton, Jenny; Hoyland, Alexa; Howarth, Elaine; Allan, Peter; Chesters, David; Dye, Louise

    2013-01-01

    This study investigated whether increasing insoluble (predominantly wheat bran) fibre over 14 days improves subjective digestive feelings, general wellbeing and bowel function. A single centre, multi-site, open, within subjects design with a 14 day non-intervention (baseline) monitoring period followed by a 14 day fibre consumption (intervention) period was performed. 153 low fibre consumers (<15 g/day AOAC 985.29) completed a daily symptom diary for 14 days after which they consumed one bowl of ready-to-eat breakfast cereal containing at least 5.4 g fibre (3.5 g from wheat bran) for 14 days and completed a daily symptom diary. Significant improvements were demonstrated in subjective perception of bowel function (e.g., ease of defecation) and digestive feelings (bloating, constipation, feeling sluggish and digestive discomfort). Significant improvements were also found in subjective perception of general wellbeing (feeling less fat, more mentally alert, slim, happy and energetic whilst experiencing less stress, mental and physical tiredness, difficulty concentrating and fewer headaches). In general, improvements in study outcomes increased with increasing cereal/fibre consumption. However, consuming an additional minimum 5.4 g of fibre (3.5 g wheat bran) per day was shown to deliver measurable and significant benefits for digestive health, comfort and wellbeing. Encouraging consumption of relatively small amounts of wheat bran could also provide an effective method of increasing overall fibre consumption. PMID:23609776

  3. A new single-dose bivalent vaccine of porcine circovirus type 2 and Mycoplasma hyopneumoniae elicits protective immunity and improves growth performance under field conditions.

    Science.gov (United States)

    Jeong, Jiwoon; Park, Changhoon; Choi, Kyuhyung; Chae, Chanhee

    2016-01-15

    The efficacy of the new single-dose bivalent vaccine of porcine circovirus type 2 (PCV2) and Mycoplasma hyopneumoniae was evaluated under field conditions for registration as recommended by the Republic of Korea's Animal, Plant & Fisheries Quarantine & Inspection Agency. Three farms were selected based on their history of co-infection with PCV2 and M. hyopneumoniae. On each farm, a total of 80 3-week-old pigs were randomly allocated to one of two treatment groups: (i) vaccinated (n=40) and (ii) unvaccinated (n=40) animals at 3 weeks of age. Protection by the bivalent vaccine helped increase the market weight by 6.2 kg/pig (106.2 kg in vaccinated group vs. 100 kg in unvaccinated group; Phyopneumoniae-specific IFN-γ-SC. Vaccinated animals displayed a reduced PCV2 load in the blood and M. hyopneumoniae load in nasal swabs compared to unvaccinated animals. Vaccination of pigs against PCV2 and M. hyopneumoniae effectively reduced the lung and lymphoid lesion scores compared to unvaccinated animals in all 3 farms. The new bivalent vaccine is very efficacious in controlling PCV2 and M. hyopneumoniae infection based on clinical, immunological, virological, and pathological evaluations under field conditions. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. Dose postural control improve following application of transcutaneous electrical nerve stimulation in diabetic peripheral neuropathic patients? A randomized placebo control trial.

    Science.gov (United States)

    Saadat, Z; Rojhani-Shirazi, Z; Abbasi, L

    2017-12-01

    peripheral neuropathy is the most common problem of diabetes. Neuropathy leads to lower extremity somatosensory deficits and postural instability in these patients. However, there are not sufficient evidences for improving postural control in these patients. To investigate the effects of transcutaneous electrical nerve stimulation (TENS) on postural control in patients with diabetic neuropathy. Twenty eighth patients with diabetic neuropathy (40-55 Y/O) participated in this RCT study. Fourteen patients in case group received TENS and sham TENS was used for control group. Force plate platform was used to extract sway velocity and COP displacement parameters for postural control evaluation. The mean sway velocity and center of pressure displacement along the mediolateral and anteroposterior axes were not significantly different between two groups after TENS application (p>0.05). Application of 5min high frequency TENS on the knee joint could not improve postural control in patients with diabetic neuropathy. Copyright © 2017. Published by Elsevier Ltd.

  5. A Single Dose of Beetroot Gel Rich in Nitrate Does Not Improve Performance but Lowers Blood Glucose in Physically Active Individuals

    OpenAIRE

    Vasconcellos, Julia; Henrique Silvestre, Diego; dos Santos Bai?o, Diego; Werneck-de-Castro, Jo?o Pedro; Silveira Alvares, Thiago; Paschoalin, V?nia M. Flosi

    2017-01-01

    Background. Beetroot consumption has been proposed to improve exercise performance, since the nitrate content of this food is able to stimulate the synthesis of nitric oxide. Objective. The acute effect of 100 g of a beetroot gel containing ~10 mmol of nitrate was tested on the nitric oxide synthesis, on metabolic and biochemical parameters, and on performance in physically active individuals. Methods. Through a double blind, crossover, placebo-controlled study, 25 healthy runners ingested a ...

  6. High dose infusion of activated protein C (rhAPC) fails to improve neuronal damage and cognitive deficit after global cerebral ischemia in rats.

    Science.gov (United States)

    Brückner, Melanie; Lasarzik, Irina; Jahn-Eimermacher, Antje; Peetz, Dirk; Werner, Christian; Engelhard, Kristin; Thal, Serge C

    2013-09-13

    Recent studies demonstrated anticoagulatory, antiinflammatory, antiapoptotic, and neuroprotective properties of activated protein C (APC) in rodent models of acute neurodegenerative diseases, suggesting APC as promising broad acting therapeutic agent. Unfortunately, continuous infusion of recombinant human APC (rhAPC) failed to improve brain damage following cardiac arrest in rats. The present study was designed to investigate the neuroprotective effect after global cerebral ischemia (GI) with an optimized infusion protocol. Rats were subjected to bilateral clip occlusion of the common carotid arteries (BCAO) and controlled hemorrhagic hypotension to 40 mm Hg for 14 min and a subsequent 5h-infusion of rhAPC (2mg/kg bolus+6 mg/kg/h continuous IV) or vehicle (0.9% NaCl). The dosage was calculated to maintain plasma hAPC activity at 150%. Cerebral inflammation, apoptosis and neuronal survival was determined at day 10. rhAPC infusion did not influence cortical cerebral perfusion during reperfusion and failed to reduce neuronal cell loss, microglia activation, and caspase 3 activity. Even an optimized rhAPC infusion protocol designed to maintain a high level of APC plasma activity failed to improve the sequels following GI. Despite positive reports about protective effects of APC following, e.g., ischemic stroke, the present study supports the notion that infusion of APC during the early reperfusion phase does not result in sustained neuroprotection and fails to improve outcome after global cerebral ischemia. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  7. Improvement of off-axis SABR plan verification results by using adapted dose reconstruction algorithms for the Octavius 4D system.

    Science.gov (United States)

    Jeevanandam, Prakash; Agnew, Christina E; Irvine, Denise M; McGarry, Conor K

    2018-04-01

    Stereotactic ablative body radiotherapy (SABR) for lung patients can be performed with volumetric-modulated arc therapy (VMAT) plans using off-axis target geometry to allow treatment in their CBCT verified position. For patient-specific quality assurance measurements using the PTW Octavius 4D phantom (PTW, Freiburg, Germany) (OCT4D) in conjunction with an Octavius 1000SRS array (OCT1000) (PTW, Freiburg, Germany), repositioning the phantom off-axis is required to ensure the measurement area coincides with the tumor. The aim of this work is to quantify delivery errors using an array repositioned off-axis and evaluate new software which incorporates corrections for off-axis phantom measurements. Dynamic conformal arcs and 25 lung SABR plans were created with the isocenter at the patient midline and the target volume off-axis. Measurements were acquired with an OCT4D phantom in conjunction with a 729 array (PTW, Freiburg, Germany) (OCT729) placed at isocenter. These plans were recalculated and delivered to both the OCT729 and OCT1000 arrays repositioned so that the high-dose region was at the center of the phantom. Comparisons were made using VeriSoft v7.0 (PTW, Freiburg, Germany) and the newly implemented version 7.1 with 2%/2 mm gamma criterion (10% threshold) and results correlated with off-axis distance to the tumor. Average pass rates for VeriSoft v7.0 significantly reduced from 92.7 ± 2.4% to 84.9 ± 4.1% when the phantom was repositioned compared to the isocenter setup for the OCT729. The gamma pass rates significantly decreased the further the phantom was moved off-axis. Significantly higher pass rates were observed for the OCT1000 of 95.7 ± 3.6% and a significant decrease in gamma pass rate with off-axis phantom distance was again observed. In contrast, even with phantom repositioning, the pass rates for analysis with VeriSoft v7.1 were 93.7 ± 2.1% and 99.4 ± 1.1% for OCT729 and OCT1000, respectively. No significant difference in gamma pass rate

  8. Daily Nutritional Dose Supplementation with Antioxidant Nutrients and Phytochemicals Improves DNA and LDL Stability: A Double-Blind, Randomized, and Placebo-Controlled Trial

    Directory of Open Access Journals (Sweden)

    You Jin Kim

    2013-12-01

    Full Text Available Reactive oxygen species are important risk factors for age-related diseases, but they also act as signaling factors for endogenous antioxidative defense. The hypothesis that a multi-micronutrient supplement with nutritional doses of antioxidant nutrients and phytochemicals (MP may provide protection against oxidative damage and maintain the endogenous antioxidant defense capacity was assessed in subjects with a habitually low intake of fruits and vegetables. In a randomized, placebo-controlled, and parallel designed trial, 89 eligible subjects were assigned to either placebo or MP for eight weeks. Eighty subjects have completed the protocol and included for the analysis. MP treatment was superior at increasing serum folate (p < 0.0001 and resistance to DNA damage (p = 0.006, tail intensity; p = 0.030, tail moment by comet assay, and LDL oxidation (p = 0.009 compared with the placebo. Moreover, the endogenous oxidative defense capacity was not weakened after MP supplementation, as determined by the levels of glutathione peroxidase (p = 0.442, catalase (p = 0.686, and superoxide dismutase (p = 0.804. The serum folate level was negatively correlated with DNA damage (r = −0.376, p = 0.001 for tail density; r = −0.329, p = 0.003 for tail moment, but no correlation was found with LDL oxidation (r = −0.123, p = 0.275. These results suggest that MP use in healthy subjects with habitually low dietary fruit and vegetable intake may be beneficial in providing resistance to oxidative damage to DNA and LDL without suppressing the endogenous defense mechanisms.

  9. Improved growth velocity of a patient with Noonan-like syndrome with loose anagen hair (NS/LAH) without growth hormone deficiency by low-dose growth hormone therapy.

    Science.gov (United States)

    Takasawa, Kei; Takishima, Shigeru; Morioka, Chikako; Nishioka, Masato; Ohashi, Hirofumi; Aoki, Yoko; Shimohira, Masayuki; Kashimada, Kenichi; Morio, Tomohiro

    2015-10-01

    Noonan-like syndrome with loose anagen hair (NS/LAH; OMIM 607721) is caused by a heterozygous c.4A>G mutation in SHOC2. Most cases exhibit both growth hormone deficiency (GHD) and growth hormone insensitivity (GHI) and thus require a high dose of growth hormone (GH) therapy (e.g., 35-40 µg/kg/day). We report on a genetically diagnosed NS/LAH patient manifesting severe short stature (-3.85 SDs) with low serum level of IGF1, 30 ng/ml. The peak levels of GH stimulation tests were within the normal range, and GHI was not observed in the IGF1 generation test. However, with low-dose GH therapy (25 µg/kg/day) for two years, IGF1 level and height were remarkably improved (IGF1: 117 ng/ml, height SDs: -2.20 SDs). Further, catch-up of motor development and improvement of the proportion of extending limbs to trunk were observed (the Developmental Quotient score increased from 68 to 98 points, and the relative sitting height ratio decreased from 0.62 to 0.57). Our results suggest that endocrinological causes for short stature are variable in NS/LAH and that GH therapy should be considered as a possible treatment for delayed development in NS/LAH. © 2015 Wiley Periodicals, Inc.

  10. SU-F-T-234: Quality Improvements in the Electronic Medical Record of Patients Treated with High Dose-Rate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Diener, T [Cleveland State University, Cleveland, OH (United States); Wilkinson, D [Cleveland Clinic Foundation, Cleveland, OH (United States)

    2016-06-15

    Purpose: To improve workflow efficiency and patient safety by assessing the quality control documentation for HDR brachytherapy within our Electronic Medical Record System (Mosaiq). Methods: A list of parameters based on NRC regulations, our quality management program (QMP), recommendations of the ACR and the American Brachytherapy Society, and HDR treatment planning risks identified in our previous FMEA study was made. Next, the parameter entries were classified according to the type of data input—manual, electronic, or both. Manual entry included the electronic Brachytherapy Treatment Record (BTR) and pre-treatment Mosaiq Assessments list. Oncentra Treatment Reports (OTR) from the Oncentra Treatment Control System constituted the electronic data. The OTR includes a Pre-treatment Report for each fraction, and a Treatment Summary Report at the completion of treatment. Each entry was then examined for appropriateness and completeness of data; adjustments and additions as necessary were then made. Results: Ten out of twenty-one recorded treatment parameters were identified to be documented within both the BTR and OTR. Of these ten redundancies, eight were changed from recorded values to a simple checklist in the BTR to avoid recording errors. The other redundancies were kept in both documents due to their value to ensuring patient safety. An edit was made to the current BTR quality assessment; this change revises the definition of a medical event in accordance with ODH Regulation 3701:1-58-101. One addition was made to the current QMP documents regarding HDR. This addition requires a physician to be present through the duration of HDR treatment in accordance with ODH Regulation 3701:1-58-59; Paragraph (F); Section (2); Subsection (a). Conclusion: Careful examination of HDR documentation that originates from different sources can help to improve the accuracy and reliability of the documents. In addition, there may be a small improvement in efficiency due to

  11. Occupational dose trends in Tanzania

    International Nuclear Information System (INIS)

    Muhogora, W.E.; Nyanda, A.M.; Ngaile, J.E.; Lema, U.S.

    1998-01-01

    This paper describes the present status of occupational radiation exposure of monitored workers in Tanzania from 1986 to 1997. The analysis of dose records observes over this period, a fluctuating trend both in the individual and collective doses. The trend is more related to the fluctuations of the number of radiation workers than to the possible radiation safety changes of the working conditions. It has been found that, the maximum annual dose for the worker in all work categories was about 18 mSv y -1 . This suggests that the occupational radiation exposure in all practices satisfies the current dose limitation system. The national exposure summary shows that, the highest collective dose of 12.8 man-Sv which is 90% of the total collective dose, was due to medical applications. The applications in industry and research had a contribution of nearly 0.8 and 0.7 man-Sv respectively. From the professional point of view, the medical diagnostic radiographers received the highest collective dose of 11.2 man-Sv. Although the medical physicists recorded the minimum collective dose of nearly 0.07 man-Sv, the data shows that this profession received the highest mean dose of about 33 mSv in 12 years. Some achievements of the personnel monitoring services and suggestions for future improvement are pointed out. (author)

  12. The patient dose survey and dose reduction in diagnostic radiology

    International Nuclear Information System (INIS)

    Dang Thanh Luong; Duong Van Vinh; Ha Ngoc Thach

    2000-01-01

    This paper presented the results of the patient dose survey in some hospitals in Hanoi from 1995 to 1997. The main investigated types of the X-ray examination were: Chest PA, LAT; Skull PA/AP, LAT; Lumbar spine AP, LAT; and Pelvis AP. The fluctuation of the entrance surface doses (ESD) was too large, even in the same type of X-ray examination and X-ray facility. It was found that the ratio of maximum and minimum ESD were ranged from 1.5 to 18. The mean values of ESD for chest and skull were higher than CEC recommended values, while the mean values of lumbar spine and pelvis were smaller than that of CEC recommended values. The result of dose intercomparison was also reported. Some methods of dose reduction were applied for improving the patient dose in X-ray departments such as a high kV technique, high sensitive screen-film combination. (author)

  13. Dose concentration and dose verification for radiotherapy of cancer

    International Nuclear Information System (INIS)

    Maruyama, Koichi

    2005-01-01

    The number of cancer treatments using radiation therapy is increasing. The background of this increase is the accumulated fact that the number of successful cases is comparative to or even better than surgery for some types of cancer due to the improvement in irradiation technology and radiation planning technology. This review describes the principles and technology of radiation therapy, its characteristics, particle therapy that improves the dose concentration, its historical background, the importance of dose concentration, present situation and future possibilities. There are serious problems that hinder the superior dose concentration of particle therapy. Recent programs and our efforts to solve these problems are described. A new concept is required to satisfy the notion of evidence based medicine, i.e., one has to develop a method of dose verification, which is not yet available. This review is for researchers, medical doctors and radiation technologists who are developing this field. (author)

  14. Time-dose modifications

    International Nuclear Information System (INIS)

    Kian Ang, K.

    1987-01-01

    Changes in fractionation schedule can be made by various approaches. However, from the first principle, it is anticipated that strategies of hyperfractionation and/or accelerated fractionation offer the most promised in improving the therapeutic ratio. Hyperfractionation is defined as a treatment schedule in which a large number of significantly reduced dose fractions (--1.2 Gy/fraction) is used to give a greater total dose in a conventional overall time period. The results of the pilot studies testing the efficacy of hyperfractionation have been encouraging. The most valid clinical trial of pure hyperfractionation, however, is that conducted by the EORTC. This study compared 70 Gy in 35 fractions or 80.5 Gy in 70 fractions over 7 weeks in the treatment of patients with oropharyngeal carcinomas. The local tumor control was significantly improved in the hyperfractionated arm without increasing the morbidity. Accelerated fractionation is defined as a schedule in which the overall time of treatment is reduced without significant changes in the total dose and fraction size. The strategy has been used to treat patients with malignant gliomas, melanomas and Head and Neck cancers. The data in Head and Neck Cancers seem to be promising

  15. Quality control of 192Ir high dose rate after loading brachytherapy dose veracity

    International Nuclear Information System (INIS)

    Feng Zhongsu; Xu Xiao; Liu Fen

    2008-01-01

    Recently, 192 Ir high dose rate (HDR) afterloading are widely used in brachytherapy. The advantage of using HDR systems over low dose rate systems are shorter treatment time and higher fraction dose. To guarantee the veracity of the delivery dose, several quality control methods are deseribed in this work. With these we can improve the position precision, time precision and dose precision of the brachytherapy. (authors)

  16. Prospective ECG-triggered axial CT at 140-kV tube voltage improves coronary in-stent restenosis visibility at a lower radiation dose compared with conventional retrospective ECG-gated helical CT

    Energy Technology Data Exchange (ETDEWEB)

    Horiguchi, Jun; Fujioka, Chikako; Kiguchi, Masao; Kohno, Shingo [Hiroshima University Hospital, Department of Clinical Radiology, Hiroshima (Japan); Yamamoto, Hideya; Kitagawa, Toshiro [Hiroshima University, Department of Molecular and Internal Medicine, Division of Clinical Medical Science, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima (Japan); Ito, Katsuhide [Hiroshima University, Department of Radiology, Division of Medical Intelligence and Informatics, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima (Japan)

    2009-10-15

    The purpose of this study was to compare coronary 64-slice CT angiography (CTA) protocols, specifically prospective electrocardiograph (ECG)-triggered and retrospective ECG-gated CT acquisition performed using a tube voltage of 140 kV and 120 kV, regarding intracoronary stent imaging. Coronary artery stents (n=12) with artificial in-stent restenosis (50% luminal reduction, 40 HU) on a cardiac phantom were examined by CT at heart rates of 50-75 beats per minute (bpm). The subjective visibility of in-stent restenosis was evaluated with a three-point scale (1 clearly visible, 2 visible, and 3 not visible), and artificial lumen narrowing [(inner stent diameter - measured lumen diameter)/inner stent diameter], lumen attenuation increase ratio [(in-stent attenuation - coronary lumen attenuation)/coronary lumen attenuation], and signal-to-noise ratio of in-stent lumen were determined. The effective dose was estimated. The artificial lumen narrowing (mean 43%), the increase of lumen attenuation (mean 46%), and signal-to-noise ratio (mean 7.8) were not different between CT acquisitions (p=0.12-0.91). However, the visibility scores of in-stent restenosis were different (p<0.05) between ECG-gated CTA techniques: (a) 140-kV prospective (effective dose 4.6 mSv), 1.6; (b) 120-kV prospective (3.3 mSv), 1.8; (c) 140-kV retrospective (16.4-18.8 mSv), 1.9; and (d) 120-kV retrospective (11.0-13.4 mSv), 1.9. Thus, 140-kV prospective ECG-triggered CTA improves coronary in-stent restenosis visibility at a lower radiation dose compared with retrospective ECG-gated CTA. (orig.)

  17. Improvement effect on the depth-dose distribution by CSF drainage and air infusion of a tumour-removed cavity in boron neutron capture therapy for malignant brain tumours

    International Nuclear Information System (INIS)

    Sakurai, Yoshinori; Ono, Koji; Miyatake, Shin-ichi; Maruhashi, Akira

    2006-01-01

    Boron neutron capture therapy (BNCT) without craniotomy for malignant brain tumours was started using an epi-thermal neutron beam at the Kyoto University Reactor in June 2002. We have tried some techniques to overcome the treatable-depth limit in BNCT. One of the effective techniques is void formation utilizing a tumour-removed cavity. The tumorous part is removed by craniotomy about 1 week before a BNCT treatment in our protocol. Just before the BNCT irradiation, the cerebro-spinal fluid (CSF) in the tumour-removed cavity is drained out, air is infused to the cavity and then the void is made. This void improves the neutron penetration, and the thermal neutron flux at depth increases. The phantom experiments and survey simulations modelling the CSF drainage and air infusion of the tumour-removed cavity were performed for the size and shape of the void. The advantage of the CSF drainage and air infusion is confirmed for the improvement in the depth-dose distribution. From the parametric surveys, it was confirmed that the cavity volume had good correlation with the improvement effect, and the larger effect was expected as the cavity volume was larger

  18. Improvement effect on the depth-dose distribution by CSF drainage and air infusion of a tumour-removed cavity in boron neutron capture therapy for malignant brain tumours

    Science.gov (United States)

    Sakurai, Yoshinori; Ono, Koji; Miyatake, Shin-ichi; Maruhashi, Akira

    2006-03-01

    Boron neutron capture therapy (BNCT) without craniotomy for malignant brain tumours was started using an epi-thermal neutron beam at the Kyoto University Reactor in June 2002. We have tried some techniques to overcome the treatable-depth limit in BNCT. One of the effective techniques is void formation utilizing a tumour-removed cavity. The tumorous part is removed by craniotomy about 1 week before a BNCT treatment in our protocol. Just before the BNCT irradiation, the cerebro-spinal fluid (CSF) in the tumour-removed cavity is drained out, air is infused to the cavity and then the void is made. This void improves the neutron penetration, and the thermal neutron flux at depth increases. The phantom experiments and survey simulations modelling the CSF drainage and air infusion of the tumour-removed cavity were performed for the size and shape of the void. The advantage of the CSF drainage and air infusion is confirmed for the improvement in the depth-dose distribution. From the parametric surveys, it was confirmed that the cavity volume had good correlation with the improvement effect, and the larger effect was expected as the cavity volume was larger.

  19. Fixed-dose combination PRO 160/120 of sabal and urtica extracts improves nocturia in men with LUTS suggestive of BPH: re-evaluation of four controlled clinical studies.

    Science.gov (United States)

    Oelke, Matthias; Berges, Richard; Schläfke, Sandra; Burkart, Martin

    2014-10-01

    To determine the effects of the herbal fixed-dose combination PRO 160/120 (extracts from saw palmetto fruits and stinging nettle roots) on nocturnal voiding frequency, as measured by question 7 of the IPSS questionnaire, in patients with moderate-to-severe LUTS/BPH after 24 weeks of treatment compared to placebo, to the α-blocker tamsulosin, or to the 5α-reductase inhibitor finasteride. The study is about post hoc evaluation of four published randomized, double-blind clinical trials on PRO 160/120, two compared with placebo, one with finasteride and one with tamsulosin. In addition, a pooled data analysis of the two placebo-controlled trials was conducted. We analyzed data from a total of 922 patients with a mean age of 66 years and a mean baseline nocturnal voiding frequency of 2.1. In the pooled analysis of placebo-controlled trials, nocturnal voids improved by 0.8 (29 %) with PRO 160/120 compared to 0.6 (18 %) with placebo (p = 0.015, Wilcoxon test, one-tailed). The 69 % responder rate to PRO 160/120 was significantly superior to the placebo response (52 %; p = 0.003, χ (2)-test, two-tailed). The majority of responders improved by 1 void/night. Absolute improvements and response rates were consistently higher with PRO 160/120 than with placebo over a range of baseline nocturnal voiding frequencies. There were no differences between PRO 160/120 and finasteride or tamsulosin regarding absolute improvement of nocturnal voids or responds rates. PRO 160/120 significantly improved nocturnal voiding frequency compared to placebo and similar to tamsulosin or finasteride.

  20. A novel vascular-targeting peptide for gastric cancer delivers low-dose TNFα to normalize the blood vessels and improve the anti-cancer efficiency of 5-fluorouracil.

    Science.gov (United States)

    Lu, Lan; Li, Zhi Jie; Li, Long Fei; Shen, Jing; Zhang, Lin; Li, Ming Xing; Xiao, Zhan Gang; Wang, Jian Hao; Cho, Chi Hin

    2017-11-01

    Various vascular-targeted agents fused with tumor necrosis factor α (TNFα) have been shown to improve drug absorption into tumor tissues and enhance tumor vascular function. TCP-1 is a peptide selected through in vivo phage library biopanning against a mouse orthotopic colorectal cancer model and is a promising agent for drug delivery. This study further investigated the targeting ability of TCP-1 phage and peptide to blood vessels in an orthotopic gastric cancer model in mice and assessed the synergistic anti-cancer effect of 5-fluorouracil (5-FU) with subnanogram TNFα targeted delivered by TCP-1 peptide. In vivo phage targeting assay and in vivo colocalization analysis were carried out to test the targeting ability of TCP-1 phage/peptide. A targeted therapy for improvement of the therapeutic efficacy of 5-FU and vascular function was performed through administration of TCP-1/TNFα fusion protein in this model. TCP-1 phage exhibited strong homing ability to the orthotopic gastric cancer after phage injection. Immunohistochemical staining suggested that and TCP-1 phage/TCP-1 peptide could colocalize with tumor vascular endothelial cells. TCP-1/TNFα combined with 5-FU was found to synergistically inhibit tumor growth, induce apoptosis and reduce cell proliferation without evident toxicity. Simultaneously, subnanogram TCP-1/TNFα treatment normalized tumor blood vessels. Targeted delivery of low-dose TNFα by TCP-1 peptide can potentially modulate the vascular function of gastric cancer and increase the drug delivery of chemotherapeutic drugs. Copyright © 2017. Published by Elsevier Inc.

  1. From personnel dose to personal dose

    International Nuclear Information System (INIS)

    Hoefert, M.; Raffnsoe, R.C.; Tuyn, J.W.N.; Wittekind, D.

    1985-01-01

    From following the development of personnel doses at CERN over the past six years it has become evident that work in areas of induced radioactivity is the principal cause of exposure. The results of photon dose measurements free-in-air and around a phantom are presented and discussed in the light of new quantities in individual monitoring. The importance of these results, with respect to the practical situation, is discussed and the problem of phantom size is mentioned. Finally, the results of dose measurements in the phantom are presented, since such information is important in cases where it becomes necessary to transform personnel doses into personal doses. (author)

  2. A trial assessing N-3 as treatment for injury-induced cachexia (ATLANTIC trial: does a moderate dose fish oil intervention improve outcomes in older adults recovering from hip fracture?

    Directory of Open Access Journals (Sweden)

    Cleland Leslie

    2010-10-01

    Full Text Available Abstract Background Proximal femoral fractures are associated with increased morbidity and mortality. Pre-existing malnutrition and weight loss amongst this patient group is of primary concern, with conventional nutrition support being largely ineffective. The inflammatory response post proximal femoral fracture surgery and the subsequent risk of cachexia may explain the inability of conventional high energy high protein management to produce an anabolic response amongst these patients. Omega-3 fatty acids derived from fish oils have been extensively studied for their anti-inflammatory benefits. Due to their anti-inflammatory properties, the benefit of fish oil combined with individualized nutrition support amongst proximal femoral fracture patients post surgery is an attractive potential therapeutic strategy. The aim of the ATLANTIC trial is to assess the potential benefits of an anti-inflammatory dose of fish oil within the context of a 12 week individualised nutrition program, commencing seven days post proximal femoral fracture surgery. Methods/Design This randomized controlled, double blinded trial, will recruit 150 community dwelling elderly patients aged ≥65 years, within seven days of surgery for proximal femoral fracture. Participants will be randomly allocated to receive either a 12 week individualized nutrition support program complemented with 20 ml/day anti-inflammatory dose fish oil (~3.6 g eicosapentaenoic acid, ~2.4 g docosahexanoic acid; intervention, or, a 12 week individualized nutrition support program complemented with 20 ml/day low dose fish oil (~0.36 g eicosapentaenoic acid, ~0.24 g docosahexanoic acid; control. Discussion The ATLANTIC trial is the first of its kind to provide fish oil combined with individualized nutrition therapy as an intervention to address the inflammatory response experienced post proximal femoral fracture surgery amongst elderly patients. The final outcomes of this trial will assist clinicians in

  3. Comparison of three rapamycin dosing schedules in A/J Tsc2+/- mice and improved survival with angiogenesis inhibitor or asparaginase treatment in mice with subcutaneous tuberous sclerosis related tumors

    Directory of Open Access Journals (Sweden)

    Dabora Sandra L

    2010-02-01

    Full Text Available Abstract Background Tuberous Sclerosis Complex (TSC is an autosomal dominant tumor disorder characterized by the growth of hamartomas in various organs including the kidney, brain, skin, lungs, and heart. Rapamycin has been shown to reduce the size of kidney angiomyolipomas associated with TSC; however, tumor regression is incomplete and kidney angiomyolipomas regrow after cessation of treatment. Mouse models of TSC2 related tumors are useful for evaluating new approaches to drug therapy for TSC. Methods In cohorts of Tsc2+/- mice, we compared kidney cystadenoma severity in A/J and C57BL/6 mouse strains at both 9 and 12 months of age. We also investigated age related kidney tumor progression and compared three different rapamycin treatment schedules in cohorts of A/J Tsc2+/- mice. In addition, we used nude mice bearing Tsc2-/- subcutaneous tumors to evaluate the therapeutic utility of sunitinib, bevacizumab, vincristine, and asparaginase. Results TSC related kidney disease severity is 5-10 fold higher in A/J Tsc2+/- mice compared with C57BL/6 Tsc2+/- mice. Similar to kidney angiomyolipomas associated with TSC, the severity of kidney cystadenomas increases with age in A/J Tsc2+/- mice. When rapamycin dosing schedules were compared in A/J Tsc2+/- cohorts, we observed a 66% reduction in kidney tumor burden in mice treated daily for 4 weeks, an 82% reduction in mice treated daily for 4 weeks followed by weekly for 8 weeks, and an 81% reduction in mice treated weekly for 12 weeks. In the Tsc2-/- subcutaneous tumor mouse model, vincristine is not effective, but angiogenesis inhibitors (sunitinib and bevacizumab and asparaginase are effective as single agents. However, these drugs are not as effective as rapamycin in that they increased median survival only by 24-27%, while rapamycin increased median survival by 173%. Conclusions Our results indicate that the A/J Tsc2+/- mouse model is an improved, higher through-put mouse model for future TSC

  4. Improved treatment results in high-risk pediatric acute myeloid leukemia patients after intensification with high-dose cytarabine and mitoxantrone: results of Study Acute Myeloid Leukemia-Berlin-Frankfurt-Münster 93.

    Science.gov (United States)

    Creutzig, U; Ritter, J; Zimmermann, M; Reinhardt, D; Hermann, J; Berthold, F; Henze, G; Jürgens, H; Kabisch, H; Havers, W; Reiter, A; Kluba, U; Niggli, F; Gadner, H

    2001-05-15

    To improve outcome in high-risk patients, high-dose cytarabine and mitoxantrone (HAM) was introduced into the treatment of children with acute myelogenous leukemia (AML) in study AML-BFM 93. Patients were randomized to HAM as either the second or third therapy block, for the purpose of evaluation of efficacy and toxicity. A total of 471 children with de novo AML were entered onto the trial; 161 were at standard risk and 310 were at high risk. After the randomized induction (daunorubicin v idarubicin), further therapy, with the exception of HAM, was identical in the two risk groups and also comparable to that in study Acute Myeloid Leukemia-Berlin-Frankfurt-Münster (AML-BFM) 87. Overall, 387 (82%) of 471 patients achieved complete remission, and 5-year survival, event-free survival (EFS), and disease-free survival rates were 60%, 51%, and 62%, respectively. Idarubicin induction resulted in a significantly better blast cell reduction in the bone marrow on day 15. Estimated survival and probability of EFS were superior in study AML-BFM 93 compared with study AML-BFM 87 (P =.01, log-rank test). This improvement, however, was restricted to the 310 high-risk patients (remission rate and probability of 5-year EFS in study AML-BFM 93 v study AML-BFM 87: 78% v 68%, P =.007; and 44% v 31%, P =.01, log-rank test). Probability of 5-year EFS among standard-risk patients in study AML-BFM 93 was similar to that in study AML-BFM 87 (65% v 63%, P = not significant). Whether HAM was placed as the second or third therapy block was of minor importance. However, patients who received the less intensive daunorubicin treatment during induction benefited from early HAM. Improved treatment results in children with high-risk AML in study AML-BFM 93 must be attributed mainly to the introduction of HAM.

  5. Stereotactic intracranial radiotherapy: Dose prescription

    International Nuclear Information System (INIS)

    Schlienger, M.; Lartigau, E.; Nataf, F.; Mornex, F.; Latorzeff, I.; Lisbona, A.; Mahe, M.

    2012-01-01

    The aim of this article was the study of the successive steps permitting the prescription of dose in stereotactic intracranial radiotherapy, which includes radiosurgery and fractionated stereotactic radiotherapy. The successive steps studied are: the choice of stereotactic intracranial radiotherapy among the therapeutic options, based on curative or palliative treatment intent, then the selection of lesions according to size/volume, pathological type and their number permitting the choice between radiosurgery or fractionated stereotactic radiotherapy, which have the same methodological basis. Clinical experience has determined the level of dose to treat the lesions and limit the irradiation of healthy adjacent tissues and organs at risk structures. The last step is the optimization of the different parameters to obtain a safe compromise between the lesion dose and healthy adjacent structures. Study of dose-volume histograms, coverage indices and 3D imaging permit the optimization of irradiation. For lesions close to or included in a critical area, the prescribed dose is planned using the inverse planing method. Implementation of the successively described steps is mandatory to insure the prescription of an optimized dose. The whole procedure is based on the delineation of the lesion and adjacent healthy tissues. There are sometimes difficulties to assess the delineation and the volume of the target, however improvement of local control rates and reduction of secondary effects are the proof that the totality of the successive procedures are progressively improved. In practice, stereotactic intracranial radiotherapy is a continually improved treatment method, which constantly benefits from improvements in the choice of indications, imaging, techniques of irradiation, planing/optimization methodology and irradiation technique and from data collected from prolonged follow-up. (authors)

  6. Dose limits for ionising radiation

    International Nuclear Information System (INIS)

    Gifford, D.

    1989-01-01

    Dose limits for exposure to ionising radiation are assessed to see if they give sufficient protection both for the occupationally exposed and for the general public. It is concluded that current limits give a level of safety that satisfies the necessary criteria in the light of present knowledge and further reductions would be unlikely to improve standards of safety. (author)

  7. Pocket total dose meter

    International Nuclear Information System (INIS)

    Brackenbush, L.W.; Endres, G.W.R.

    1984-10-01

    Laboratory measurements have demonstrated that it is possible to simultaneously measure absorbed dose and dose equivalent using a single tissue equivalent proportional counter. Small, pocket sized instruments are being developed to determine dose equivalent as the worker is exposed to mixed field radiation. This paper describes the electronic circuitry and computer algorithms used to determine dose equivalent in these devices

  8. Combination Therapy with Zoledronic Acid and Parathyroid Hormone Improves Bone Architecture and Strength following a Clinically-Relevant Dose of Stereotactic Radiation Therapy for the Local Treatment of Canine Osteosarcoma in Athymic Rats.

    Science.gov (United States)

    Curtis, Ryan C; Custis, James T; Ehrhart, Nicole P; Ehrhart, E J; Condon, Keith W; Gookin, Sara E; Donahue, Seth W

    2016-01-01

    Clinical studies using definitive-intent stereotactic radiation therapy (SRT) for the local treatment of canine osteosarcoma (OSA) have shown canine patients achieving similar median survival times as the current standard of care (amputation and adjuvant chemotherapy). Despite this, there remains an unacceptable high risk of pathologic fracture following radiation treatment. Zoledronic acid (ZA) and parathyroid hormone (PTH) are therapeutic candidates for decreasing this fracture risk post-irradiation. Due to differing mechanisms, we hypothesized that the combined treatment with ZA and PTH would significantly improve bone healing more than ZA or PTH treatment alone. Using an orthotopic model of canine osteosarcoma in athymic rats, we evaluated bone healing following clinically-relevant doses of radiation therapy (12 Gy x 3 fractions, 36 Gy total). Groups included 36 Gy SRT only, 36 Gy SRT plus ZA, 36 Gy SRT plus ZA and PTH, 36 Gy SRT plus PTH, and 36 Gy SRT plus localized PTH treatment. Our study showed significant increases in bone volume and increased polar moments of inertia (in the distal femoral metaphysis) 8 weeks after radiation in the combined (ZA/PTH) treatment group as compared to radiation treatment alone. Histomorphometric analysis revealed evidence of active mineralization at the study endpoint as well as successful tumor-cell kill across all treatment groups. This work provides further evidence for the expanding potential indications for ZA and PTH therapy, including post-irradiated bone disease due to osteosarcoma.

  9. Combination Therapy with Zoledronic Acid and Parathyroid Hormone Improves Bone Architecture and Strength following a Clinically-Relevant Dose of Stereotactic Radiation Therapy for the Local Treatment of Canine Osteosarcoma in Athymic Rats.

    Directory of Open Access Journals (Sweden)

    Ryan C Curtis

    Full Text Available Clinical studies using definitive-intent stereotactic radiation therapy (SRT for the local treatment of canine osteosarcoma (OSA have shown canine patients achieving similar median survival times as the current standard of care (amputation and adjuvant chemotherapy. Despite this, there remains an unacceptable high risk of pathologic fracture following radiation treatment. Zoledronic acid (ZA and parathyroid hormone (PTH are therapeutic candidates for decreasing this fracture risk post-irradiation. Due to differing mechanisms, we hypothesized that the combined treatment with ZA and PTH would significantly improve bone healing more than ZA or PTH treatment alone. Using an orthotopic model of canine osteosarcoma in athymic rats, we evaluated bone healing following clinically-relevant doses of radiation therapy (12 Gy x 3 fractions, 36 Gy total. Groups included 36 Gy SRT only, 36 Gy SRT plus ZA, 36 Gy SRT plus ZA and PTH, 36 Gy SRT plus PTH, and 36 Gy SRT plus localized PTH treatment. Our study showed significant increases in bone volume and increased polar moments of inertia (in the distal femoral metaphysis 8 weeks after radiation in the combined (ZA/PTH treatment group as compared to radiation treatment alone. Histomorphometric analysis revealed evidence of active mineralization at the study endpoint as well as successful tumor-cell kill across all treatment groups. This work provides further evidence for the expanding potential indications for ZA and PTH therapy, including post-irradiated bone disease due to osteosarcoma.

  10. Validation of GPU based TomoTherapy dose calculation engine.

    Science.gov (United States)

    Chen, Quan; Lu, Weiguo; Chen, Yu; Chen, Mingli; Henderson, Douglas; Sterpin, Edmond

    2012-04-01

    The graphic processing unit (GPU) based TomoTherapy convolution/superposition(C/S) dose engine (GPU dose engine) achieves a dramatic performance improvement over the traditional CPU-cluster based TomoTherapy dose engine (CPU dose engine). Besides the architecture difference between the GPU and CPU, there are several algorithm changes from the CPU dose engine to the GPU dose engine. These changes made the GPU dose slightly different from the CPU-cluster dose. In order for the commercial release of the GPU dose engine, its accuracy has to be validated. Thirty eight TomoTherapy phantom plans and 19 patient plans were calculated with both dose engines to evaluate the equivalency between the two dose engines. Gamma indices (Γ) were used for the equivalency evaluation. The GPU dose was further verified with the absolute point dose measurement with ion chamber and film measurements for phantom plans. Monte Carlo calculation was used as a reference for both dose engines in the accuracy evaluation in heterogeneous phantom and actual patients. The GPU dose engine showed excellent agreement with the current CPU dose engine. The majority of cases had over 99.99% of voxels with Γ(1%, 1 mm) engine also showed similar degree of accuracy in heterogeneous media as the current TomoTherapy dose engine. It is verified and validated that the ultrafast TomoTherapy GPU dose engine can safely replace the existing TomoTherapy cluster based dose engine without degradation in dose accuracy.

  11. When is a dose not a dose?

    International Nuclear Information System (INIS)

    Green, Patrick

    1992-01-01

    There is confusion over radiation dose limits between the International Commission on Radiological Protection, the National Radiological Protection Board and the Ministry of Agriculture, Fisheries and Food (MAFF), reports a Friends of the Earth's radiation campaigner. MAFF is suggesting the inadequate ICRP public dose limit does not apply to public exposures which arise from environmental contamination from past radioactive discharges. (author)

  12. Improved survival of multiple myeloma patients with late relapse after high-dose treatment and stem cell support, a population-based study of 348 patients in Denmark in 1994-2004

    DEFF Research Database (Denmark)

    Vangsted, Annette Juul; Klausen, Tobias W; Andersen, Niels F

    2010-01-01

    To analyse if patients with early relapse after high-dose chemotherapy with stem cell support (HDT) benefit from new treatment strategies in a population-based setting.......To analyse if patients with early relapse after high-dose chemotherapy with stem cell support (HDT) benefit from new treatment strategies in a population-based setting....

  13. Dose from radiological examinations

    International Nuclear Information System (INIS)

    Imamura, Keiko; Uji, Teruyuki; Sakuyama, Keiko; Fujikawa, Mitsuhiro; Fujii, Masamichi

    1976-01-01

    Relatively high gonad doses, several hundred to one thousand mR, have been observed in case of pelvis, hip-joint, coccyx, lower abdomen and lumber examination. Dose to the ovary is especially high in barium enema and I.V.P. examinations. About 12 per cent of the 4-ray examination are high-dose. The gonad dose is relatively high in examination of abdomen and lower extremities, in infants. The dose to the eyes is especially high, 1.0 to 2.5R per exposure, in temporal bone and nasal sinuses tomography. X-ray doses have been compared with dose limits recommended by ICRP and with the gonad dose from natural radiations. The gonad dose in lumbar examination, barium enema, I.V.P. etc. is as high as the maximum permissible dose per year recommended by ICRP. Several devices have been made for dose reduction in the daily examinations: (1) separating the radiation field from the gonad by one centimeter decreases the gonad dose about one-half. (2) using sensitive screens and films. In pelvimetry and in infant hip-joint examination, the most sensitive screen and film are used. In the I.V.P. examination of adult, use of MS screen in place of FS screen decreases the dose to one-third, in combination with careful setting of radiation field, (3) use of grid increases the dose about 50 percent and the lead rubber protection (0.1mm lead equivalent) decreases the gonad dose to one-thirtieth in the spinal column examination of infant, (4) A lead protector, 1mm thickness and 2.5cm in diameter, on the eyes decreases the dose to about one-eighth in the face and nead examinations. These simple and effective methods for dose reduction. Should be carried out in as many examinations as possible in addition to observing dose limits recommended by ICRP. (Evans, J.)

  14. Low Dose Risk, Decisions, and Risk Communication

    International Nuclear Information System (INIS)

    Flynn, James

    2002-01-01

    The overall research objective was to establish new levels of information about how people, groups, and communities respond to low dose radiation exposure. This is basic research into the social psychology of individual, group, and community responses to radiation exposures. The results of this research are directed to improving risk communication and public participation in management of environmental problems resulting from low dose radiation

  15. Consultative exercise on dose assessments.

    Science.gov (United States)

    Bridges, B A; Parker, T; Simmonds, J R; Sumner, D

    2001-06-01

    A summary is given of a meeting held at Sussex University, UK, in October 2000, which allowed the exchange of ideas on methods of assessment of dose to the public arising from potential authorised radioactive discharges from nuclear sites in the UK. Representatives of groups with an interest in dose assessments were invited, and hence the meeting was called the Consultative Exercise on Dose Assessments (CEDA). Although initiated and funded by the Food Standards Agency, its organisation, and the writing of the report, were overseen by an independent Chairman and Steering Group. The report contains recommendations for improvement in co-ordination between different agencies involved in assessments, on method development and on the presentation of data on assessments. These have been prepared by the Steering Group, and will be taken forward by the Food Standards Agency and other agencies in the UK. The recommendations are included in this memorandum.

  16. Radiotherapy Breast Boost With Reduced Whole-Breast Dose Is Associated With Improved Cosmesis: The Results of a Comprehensive Assessment From the St. George and Wollongong Randomized Breast Boost Trial

    International Nuclear Information System (INIS)

    Hau, Eric; Browne, Lois H.; Khanna, Sam; Cail, Stacy; Cert, Grad; Chin, Yaw; Clark, Catherine; Inder, Stephanie; Szwajcer, Alison; Graham, Peter H.

    2012-01-01

    Purpose: To evaluate comprehensively the effect of a radiotherapy boost on breast cosmetic outcomes after 5 years in patients treated with breast-conserving surgery. Methods: The St. George and Wollongong trial (NCT00138814) randomized 688 patients with histologically proven Tis-2, N 0–1, M0 carcinoma to the control arm of 50 Gy in 25 fractions (342 patients) and the boost arm of 45 Gy in 25 fractions to the whole breast followed by a 16 Gy in 8 fraction electron boost (346 patients). Five-year cosmetic outcomes were assessed by a panel subjectively in 385 patients and objectively using pBRA (relative breast retraction assessment). A subset of patients also had absolute BRA measurements. Clinician assessment and patient self-assessment of overall cosmetic and specific items as well as computer BCCT.core analysis were also performed. Results: The boost arm had improved cosmetic overall outcomes as scored by the panel and BCCT.core software with 79% (p = 0.016) and 81% (p = 0.004) excellent/good cosmesis respectively compared with 68% in no-boost arm. The boost arm also had lower pBRA and BRA values with a mean difference of 0.60 and 1.82 mm, respectively, but was not statistically significant. There was a very high proportion of overall excellent/good cosmetic outcome in 95% and 93% in the boost and no–boost arms using patient self-assessment. However, no difference in overall and specific items scored by clinician assessment and patient self-assessment was found. Conclusion: The results show the negative cosmetic effect of a 16-Gy boost is offset by a lower whole-breast dose of 45 Gy.

  17. Pediatric radiation dose management in digital radiography

    International Nuclear Information System (INIS)

    Neitzel, U.

    2004-01-01

    Direct digital radiography (DR) systems based on flat-panel detectors offer improved dose management in pediatric radiography. Integration of X-ray generation and detection in one computer-controlled system provides better control and monitoring

  18. Insignificant levels of dose

    International Nuclear Information System (INIS)

    Webb, G.A.M.; McLean, A.S.

    1977-01-01

    The procedures recommended by the International Commission on Radiological Protection (ICRP) for making decisions concerning controllable sources of radiation exposure of the public include 'justification' and 'optimisation'. The tool recommended by the ICRP for reaching these decisions is collective dose or dose commitment supplemented by consideration of doses to individuals. In both these considerations the practical problem arises of whether very small doses to large numbers of people should contribute to the final decision-making process. It may be that at levels of dose which are small increments on natural background, the relationship between dose and effect is linear even though the slope may be close to zero. If so, collective dose is a meaningful concept and the calculation of total detriment for the purpose of justification could legitimately include all doses. In the calculation of collective doses for the purpose of optimisation, which involves decisions on how much money or resource should be allocated to dose reduction, it is necessary to appraise radiation detriment realistically. At low levels of dose to the individual such as those small by comparison with variations in natural background within the UK, the risk to the individual is such that his well-being will not be significantly changed by the presence or absence of the radiation dose. These small doses, which are well below the point at which an individual attaches significance, should not carry a societal significance. Societal acceptance of risk is analysed with a view to assessing a level of possible risk, and hence dose, below which resources should not in general be diverted to secure further reduction. A formulation for collective dose commitment is proposed incorporating a cut-off to exclude insignificant doses. The implications of this formulation in practical situations are discussed

  19. Total dose meter development

    International Nuclear Information System (INIS)

    Brackenbush, L.W.

    1986-09-01

    This report describes an alarming ''pocket'' monitor/dosimeter, based on a tissue-equivalent proportional counter, that measure both neutron and gamma dose and determines dose equivalent for the mixed radiation field. This report details the operation of the device and provides information on: the necessity for a device to measure dose equivalent in mixed radiation fields; the mathematical theory required to determine dose equivalent from tissue equivalent proportional; the detailed electronic circuits required; the algorithms required in the microprocessor used to calculate dose equivalent; the features of the instrument; program accomplishments and future plans

  20. Dose reader CD-02

    International Nuclear Information System (INIS)

    Jakowiuk, A.; Kaluska, I.; Machaj, B.

    2005-01-01

    Dose Reader CD-02 is designed for measurement of dose from a long narrow band of dosimetric foil used for check up and control of electron beam dose during sterilization of materials and products on conveyor belt. Irradiated foil after processing (heating) is inserted into foil driving (moving) system and when the foil is moved across focused light beam the absorbed dose is measured and displayed at the same time at computer monitor (in form of a diagram). The absorbed dose is measured on the principle of light attenuation at selected light wavelength (foil absorbance is measured). (author)

  1. Dose conversion factors

    International Nuclear Information System (INIS)

    Kocher, D.C.; Eckerman, K.F.

    1992-01-01

    The following is discussed in this report: concepts and quantities used in calculating radiation dose from internal and external exposure. Tabulations of dose conversion factor for internal and external exposure to radionuclides. Dose conversion factors give dose per unit intake (internal) or dose per unit concentration in environment (external). Intakes of radionuclides for internal exposure and concentrations of radionuclides in environment for external exposure are assumed to be known. Intakes and concentrations are obtained, e.g., from analyses of environmental transport and exposure pathways. differences between dosimetry methods for radionuclides and hazardous chemicals are highlighted

  2. Comparison of proton and photon dose distributions

    International Nuclear Information System (INIS)

    Goitein, Michael

    1995-01-01

    Recently, there has been considerable work, as yet largely theoretical, in developing ways to improve the dose distributions which can be achieved with x-rays. Foremost among these developments are the use of non-coplanar beam directions, the use of intensity-modulated beams, and the implementation of computer-controlled delivery of complex plans using new beam modifiers such as multi-leaf collimators and beam scanners. One way of improving the dose distributions which have been achieved with conventional radiations is to use protons, with their quite different physical characteristics but very similar radiobiological properties as compared with supervoltage x-rays. Some substantial experience has been gained in the use of protons which has confirmed clinically that better results have been obtained as a result of their better dose distributions. Indeed, it is fair to say that the advantages which protons have demonstrated are, in large part, responsible for the renewed interest in improving the dose distributions from all radiation modalities. So much better are the dose distributions which the new techniques, mentioned above, offer that there is the impression that, with their use, photons can deliver dose distributions as good as can be obtained with protons. In this paper, the extent of the possible improvement will be discussed. It will be suggested that the integral dose is relatively little affected by the treatment technique - so that the lower normal tissue doses which the new approaches offer is almost always at the price of delivering dose to a larger volume. Protons can be matched pencil beam for pencil beam with photons - and then almost always deliver substantially less dose outside the target volume. Ultimately, the clinical importance of the differences will have to decided by clinical trial

  3. Quercetin, ascorbic acid, caffeine and ellagic acid are more efficient than rosiglitazone, metformin and glimepiride in interfering with pathways leading to the development of neurological complications associated with diabetes: A comparative in-vitro study

    Directory of Open Access Journals (Sweden)

    Vineet Mehta

    2017-06-01

    Full Text Available Neuropathy is the least understood and most devastating complication associated with diabetes. Diabetic neuropathy develops in patients despite of regular therapy, indicating that marketed drugs has minimal effect on pathways leading to the development and progression of these complications. Present study was aimed to evaluate natural compounds for their ability to interfere with pathways leading to the development of diabetes mediated neurological complications and compare their efficacy with marketed anti-diabetic drugs. Anti-diabetic potential of ascorbic acid, gallic acid, quercetin, ellagic acid, cinnamic acid, caffeine and piperine was predicted by evaluating in-silico interaction energy (kcal/mol of these compounds with insulin receptor, peroxisome proliferator-activated receptor gamma-γ and dipeptidyl peptidase-4 proteins. Ascorbic acid, gallic acid, quercetin and ellagic acid showed excellent in-vitro antioxidant activity in DPPH radical scavenging and inhibition of lipid peroxidation assay, which was 1.5–3 folds better than the marketed drugs. Quercetin, gallic acid, cinnamic acid, piperine and caffeine efficiently prevented H2O2 induced genotoxicity, which commercial drugs failed to prevent. Further, quercetin, ellagic acid, caffeine and ascorbic acid were 3–4.7 folds better than marketed drugs in inhibiting α-amylase activity. Herbal molecules and rosiglitazone showed comparable results for glucose uptake, which may be attributed to enhanced GLUT4 translocation into primary neuronal culture under hyperglycemic conditions. In conclusion, currently available marketed anti-diabetic drugs have minimal effect on the pathways leading to diabetic neuropathy and supplementing diabetic therapeutics with quercetin, ascorbic acid, caffeine and ellagic acid may be better suited to counter diabetic neuropathy through inhibiting oxidative stress, genotoxicity and improving neuronal glucose utilization.

  4. Enjebi Island dose assessment

    International Nuclear Information System (INIS)

    Robison, W.L.; Conrado, C.L.; Phillips, W.A.

    1987-07-01

    We have updeated the radiological dose assessment for Enjebi Island at Enewetak Atoll using data derived from analysis of food crops grown on Enjebi. This is a much more precise assessment of potential doses to people resettling Enjebi Island than the 1980 assessment in which there were no data available from food crops on Enjebi. Details of the methods and data used to evaluate each exposure pathway are presented. The terrestrial food chain is the most significant potential exposure pathway and 137 Cs is the radionuclide responsible for most of the estimated dose over the next 50 y. The doses are calculated assuming a resettlement date of 1990. The average wholebody maximum annual estimated dose equivalent derived using our diet model is 166 mremy;the effective dose equivalent is 169 mremy. The estimated 30-, 50-, and 70-y integral whole-body dose equivalents are 3.5 rem, 5.1 rem, and 6.2 rem, respectively. Bone-marrow dose equivalents are only slightly higher than the whole-body estimates in each case. The bone-surface cells (endosteal cells) receive the highest dose, but they are a less sensitive cell population and are less sensitive to fatal cancer induction than whole body and bone marrow. The effective dose equivalents for 30, 50, and 70 y are 3.6 rem, 5.3 rem, and 6.6 rem, respectively. 79 refs., 17 figs., 24 tabs

  5. Dose evaluation from multiple detector outputs using convex optimisation

    International Nuclear Information System (INIS)

    Hashimoto, M.; Iimoto, T.; Kosako, T.

    2011-01-01

    A dose evaluation using multiple radiation detectors can be improved by the convex optimisation method. It enables flexible dose evaluation corresponding to the actual radiation energy spectrum. An application to the neutron ambient dose equivalent evaluation is investigated using a mixed-gas proportional counter. The convex derives the certain neutron ambient dose with certain width corresponding to the true neutron energy spectrum. The range of the evaluated dose is comparable to the error of conventional neutron dose measurement equipments. An application to the neutron individual dose equivalent measurement is also investigated. Convexes of particular dosemeter combinations evaluate the individual dose equivalent better than the dose evaluation of a single dosemeter. The combinations of dosemeters with high orthogonality of their response characteristics tend to provide a good suitability for dose evaluation. (authors)

  6. Dose measurements in mammography

    International Nuclear Information System (INIS)

    Kainberger, F.; Kallinger, W.

    1977-01-01

    Dose measurements at the mamma during mammography were carried out in the form of direct measurement with thermoluminescent dosimetry. Measurement was done for the in- and outcoming doses at the mamma, the dose exposure of the sternal region and the scattered rays above the symphysis, the latter as parameter for the genetic radiation exposure. As expected, the dose of the smooth radiation used for mammography showed a strong decrease at the outcome point in comparison with the income point. Surprisingly high was the scattered radiation in the sternal region. A corresponding protection by lead plates could be taken into consideration. Extremely low is the scattered radiation above the symphysis. Even measurements with the very sensitive calcium fluoride dosimeters did not reveal any practically important dose in the symphysis region. Most measurement values remained below the determinable dose of 0.3mR. Some maximal values varied in the range of 3-1 mR. (orig.) [de

  7. Vancomycin Dosing in Obese Patients: Special Considerations and Novel Dosing Strategies.

    Science.gov (United States)

    Durand, Cheryl; Bylo, Mary; Howard, Brian; Belliveau, Paul

    2018-06-01

    To review the literature regarding vancomycin pharmacokinetics in obese patients and strategies used to improve dosing in this population. PubMed, EMBASE (1974 to November 2017), and Google Scholar searches were conducted using the search terms vancomycin, obese, obesity, pharmacokinetics, strategy, and dosing. Additional articles were selected from reference lists of selected studies. Included articles were those published in English with a primary focus on vancomycin pharmacokinetic parameters in obese patients and practical vancomycin dosing strategies, clinical experiences, or challenges of dosing vancomycin in this population. Volume of distribution and clearance are the pharmacokinetic parameters that most often affect vancomycin dosing in obese patients; both are increased in this population. Challenges with dosing in obese patients include inconsistent and inadequate dosing, observations that the obese population may not be homogeneous, and reports of an increased likelihood of supratherapeutic trough concentrations. Investigators have revised and developed dosing and monitoring protocols to address these challenges. These approaches improved target trough attainment to varying degrees. Some of the vancomycin dosing approaches provided promising results in obese patients, but there were notable differences in methods used to develop these approaches, and sample sizes were small. Although some approaches can be considered for validation in individual institutions, further research is warranted. This may include validating approaches in larger populations with narrower obesity severity ranges, investigating target attainment in indication-specific target ranges, and evaluating the impact of different dosing weights and methods of creatinine clearance calculation.

  8. Registration of radiation doses

    International Nuclear Information System (INIS)

    2000-02-01

    In Finland the Radiation and Nuclear Safety Authority (STUK) is maintaining the register (called Dose Register) of the radiation exposure of occupationally exposed workers in order to ensure compliance with the principles of optimisation and individual protection. The guide contains a description of the Dose Register and specifies the responsibilities of the party running a radiation practice to report the relevant information to the Dose Register

  9. Paediatric dose display

    International Nuclear Information System (INIS)

    Griffin, D.W.; Derges, S.; Hesslewood, S.

    1984-01-01

    A compact, inexpensive unit, based on an 8085 microprocessor, has been designed for calculating doses of intravenous radioactive injections for children. It has been used successfully for over a year. The dose is calculated from the body surface area and the result displayed in MBq. The operator can obtain the required dose on a twelve character alphanumeric display by entering the age of the patient and the adult dose using a hexadecimal keyboard. Circuit description, memory map and input/output, and firmware are dealt with. (U.K.)

  10. An environmental dose experiment

    Science.gov (United States)

    Peralta, Luis

    2017-11-01

    Several radiation sources worldwide contribute to the delivered dose to the human population. This radiation also acts as a natural background when detecting radiation, for instance from radioactive sources. In this work a medium-sized plastic scintillation detector is used to evaluate the dose delivered by natural radiation sources. Calibration of the detector involved the use of radioactive sources and Monte Carlo simulation of the energy deposition per disintegration. A measurement of the annual dose due to background radiation to the body was then estimated. A dose value compatible with the value reported by the United Nations Scientific Committee on the Effects of Atomic Radiation was obtained.

  11. An environmental dose experiment

    International Nuclear Information System (INIS)

    Peralta, Luis

    2017-01-01

    Several radiation sources worldwide contribute to the delivered dose to the human population. This radiation also acts as a natural background when detecting radiation, for instance from radioactive sources. In this work a medium-sized plastic scintillation detector is used to evaluate the dose delivered by natural radiation sources. Calibration of the detector involved the use of radioactive sources and Monte Carlo simulation of the energy deposition per disintegration. A measurement of the annual dose due to background radiation to the body was then estimated. A dose value compatible with the value reported by the United Nations Scientific Committee on the Effects of Atomic Radiation was obtained. (paper)

  12. Doses from portable gauges

    International Nuclear Information System (INIS)

    Linauskas, S.H.

    1988-08-01

    Field studies to measure actual radiation exposures of operators of commercial moisture-density gauges were undertaken in several regions of Canada. Newly developed bubble detector dosimeter technology and conventional dosimetry such as thermoluminescent dosimeters (TLDs), integrating electronic dosimeters (DRDs), and CR-39 neutron track-etch detectors were used to estimate the doses received by 23 moisture-density gauge operators and maintenance staff. These radiation dose estimates were supported by mapping radiation fields and accounting for the time an operator was near a gauge. Major findings indicate that gauge maintenance and servicing workers were more likely than gauge operators to receive exposures above the level of 5 mSv, and that neutron doses were roughly the same as gamma doses. Gauge operators receive approximately 75% of their dose when transporting and carrying the gauge. Dose to their hands is similar to the dose to their trunks, but the dose to their feet area is 6 to 30 times higher. Gamma radiation is the primary source of radiation contributing to operator dose

  13. Radiation dose in vertebroplasty

    International Nuclear Information System (INIS)

    Mehdizade, A.; Lovblad, K.O.; Wilhelm, K.E.; Somon, T.; Wetzel, S.G.; Kelekis, A.D.; Yilmaz, H.; Abdo, G.; Martin, J.B.; Viera, J.M.; Ruefenacht, D.A.

    2004-01-01

    We wished to measure the absorbed radiation dose during fluoroscopically controlled vertebroplasty and to assess the possibility of deterministic radiation effects to the operator. The dose was measured in 11 consecutive procedures using thermoluminescent ring dosimeters on the hand of the operator and electronic dosimeters inside and outside of the operator's lead apron. We found doses of 0.022-3.256 mGy outside and 0.01-0.47 mGy inside the lead apron. Doses on the hand were higher, 0.5-8.5 mGy. This preliminary study indicates greater exposure to the operator's hands than expected from traditional apron measurements. (orig.)

  14. Dosimetry in Interventional Radiology - Effective Dose Estimation

    International Nuclear Information System (INIS)

    Miljanic, S.; Buls, N.; Clerinx, P.; Jarvinen, H.; Nikodemova, D.; Ranogajec-Komor, M; D'Errico, F.

    2008-01-01

    Interventional radiological procedures can lead to significant radiation doses to patients and to staff members. In order to evaluate the personal doses with respect to the regulatory dose limits, doses measured by dosimeters have to be converted to effective doses (E). Measurement of personal dose equivalent Hp(10) using a single unshielded dosimeter above the lead apron can lead to significant overestimation of the effective dose, while the measurement with dosimeter under the apron can lead to underestimation. To improve the accuracy, measurements with two dosimeters, one above and the other under the apron have been suggested ( d ouble dosimetry ) . The ICRP has recommended that interventional radiology departments develop a policy that staff should wear two dosimeters. The aim of this study was to review the double dosimetry algorithms for the calculation of effective dose in high dose interventional radiology procedures. The results will be used to develop general guidelines for personal dosimetry in interventional radiology procedures. This work has been carried out by Working Group 9 (Radiation protection dosimetry of medical staff) of the CONRAD project, which is a Coordination Action supported by the European Commission within its 6th Framework Program.(author)

  15. The impact of the oxygen scavenger on the dose-rate dependence and dose sensitivity of MAGIC type polymer gels

    Science.gov (United States)

    Khan, Muzafar; Heilemann, Gerd; Kuess, Peter; Georg, Dietmar; Berg, Andreas

    2018-03-01

    Recent developments in radiation therapy aimed at more precise dose delivery along with higher dose gradients (dose painting) and more efficient dose delivery with higher dose rates e.g. flattening filter free (FFF) irradiation. Magnetic-resonance-imaging based polymer gel dosimetry offers 3D information for precise dose delivery techniques. Many of the proposed polymer gels have been reported to exhibit a dose response, measured as relaxation rate ΔR2(D), which is dose rate dependent. A lack of or a reduced dose-rate sensitivity is very important for dosimetric accuracy, especially with regard to the increasing clinical use of FFF irradiation protocols with LINACs at high dose rates. Some commonly used polymer gels are based on Methacrylic-Acid-Gel-Initiated-by-Copper (MAGIC). Here, we report on the dose sensitivity (ΔR2/ΔD) of MAGIC-type gels with different oxygen scavenger concentration for their specific dependence on the applied dose rate in order to improve the dosimetric performance, especially for high dose rates. A preclinical x-ray machine (‘Yxlon’, E  =  200 kV) was used for irradiation to cover a range of dose rates from low \\dot{D} min  =  0.6 Gy min-1 to high \\dot{D} max  =  18 Gy min-1. The dose response was evaluated using R2-imaging of the gel on a human high-field (7T) MR-scanner. The results indicate that all of the investigated dose rates had an impact on the dose response in polymer gel dosimeters, being strongest in the high dose region and less effective for low dose levels. The absolute dose rate dependence \\frac{(Δ R2/Δ D)}{Δ \\dot{D}} of the dose response in MAGIC-type gel is significantly reduced using higher concentrations of oxygen scavenger at the expense of reduced dose sensitivity. For quantitative dose evaluations the relative dose rate dependence of a polymer gel, normalized to its sensitivity is important. Based on this normalized sensitivity the dose rate sensitivity was reduced distinctly

  16. DOSESCREEN: a computer program to aid dose placement

    Science.gov (United States)

    Kimberly C. Smith; Jacqueline L. Robertson

    1984-01-01

    Careful selection of an experimental design for a bioassay substantially improves the precision of effective dose (ED) estimates. Design considerations typically include determination of sample size, dose selection, and allocation of subjects to doses. DOSESCREEN is a computer program written to help investigators select an efficient design for the estimation of an...

  17. Inclusion of functional information from perfusion SPECT improves predictive value of dose-volume parameters in lung toxicity outcome after radiotherapy for non-small cell lung cancer: A prospective study

    DEFF Research Database (Denmark)

    Farr, Katherina P; Kallehauge, Jesper F; Møller, Ditte S

    2015-01-01

    for corresponding standard parameters, but they were not significantly different from each other. CONCLUSION: SPECT-based functional parameters were better to predict the risk of RP compared to standard CT-based dose-volume parameters. Functional parameters may be useful to guide radiotherapy planning in order...

  18. Improvement in insulin sensitivity without concomitant changes in body composition and cardiovascular risk markers following fixed administration of a very low growth hormone (GH) dose in adults with severe GH deficiency

    NARCIS (Netherlands)

    Yuen, Kevin C. J.; Frystyk, Jan; White, Deborah K.; Twickler, Th B.; Koppeschaar, Hans P. F.; Harris, Philip E.; Fryklund, Linda; Murgatroyd, Peter R.; Dunger, David B.

    2005-01-01

    OBJECTIVE: Untreated GH-deficient adults are predisposed to insulin resistance and excess cardiovascular mortality. We showed previously that short-term treatment with a very low GH dose (LGH) enhanced insulin sensitivity in young healthy adults. The present study was therefore designed to explore

  19. Relative efficacy of weekly and two differing doses of daily iron-folate supplementation in improving hemoglobin in mild and moderately anemic children between 3 and 5 years of age: a cluster randomized trial.

    Science.gov (United States)

    Kapil, U; Sachdev, H P S; Dwivedi, S N; Pandey, R M; Upadhyay, A D; Sareen, N

    2013-04-01

    In India, 75% of children hemoglobin response with two dosages of daily (20 mg iron and 100 μg folic acid, or 40 mg iron and 200 μg folic acid) and weekly (40 mg iron and 200 μg folic acid) IFA supplementation in children of 3-5 years of age with mild or moderate anemia (hemoglobin 7-10 g/dl). Community-based cluster randomized control trial in nine adjoining Anganwadi Centers. Four hundred twenty six enrolled participants received directly supervised IFA tablet supplementation as per the above three groups. After 100 days, the number of available subjects in the NNACP daily dose (A), daily dose doubled (B) and weekly dose (C) groups were 112, 114 and 110, respectively. Hemoglobin was estimated at baseline, 50 and 100 days by the Cynmeth hemoglobin method. At 50 days, there were no differences between the three groups, but at 100 days, adjusted hemoglobin was lowered with weekly supplementation. The mean (95% confidence interval) hemoglobin (g/dl) differences were: (i) A-B: -0.05 (-0.17, 0.05), (ii) A-C: -0.38 (-0.50, -0.27) and (iii) B-C: -0.33, (-0.45, -0.21). Anemia reduction was 18.8%, 18.4% and 10.9%, respectively, in the three groups. Directly supervised IFA supplementation at the NNACP or double dose is equally efficacious but superior to weekly regimen.

  20. Transforming dose management techniques through technology

    International Nuclear Information System (INIS)

    Bennett, M.; Morrissey, M.

    1995-01-01

    The development of real-time radiation dosimetry, improved remote monitoring capability and the use of computerized databases and electronic data transfer has led to a significant improvement in effective dose management. This paper describes how these advances have improved occupational dose control for personnel supporting the United Kingdom's naval nuclear plants. Until recently health physics personnel have experienced high levels of occupational exposure compared to other groups, because of manual survey work, but new technology, such as virtual reality models linked with predictive computer codes and other computer based innovations in remote monitoring and telemetry based dosimetry, is reversing this situation. (UK)

  1. Dose reduction at nuclear power plants

    International Nuclear Information System (INIS)

    Baum, J.W.; Dionne, B.J.

    1983-01-01

    The collective dose equivalent at nuclear power plants increased from 1250 rem in 1969 to nearly 54,000 rem in 1980. This rise is attributable primarily to an increase in nuclear generated power from 1289 MW-y to 29,155 MW-y; and secondly, to increased average plant age. However, considerable variation in exposure occurs from plant to plant depending on plant type, refueling, maintenance, etc. In order to understand the factors influencing these differences, an investigation was initiated to study dose-reduction techniques and effectiveness of as low as reasonably achievable (ALARA) planning at light water plants. Objectives are to: identify high-dose maintenance tasks and related dose-reduction techniques; investigate utilization of high-reliability, low-maintenance equipment; recommend improv