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Sample records for median cumulative dose

  1. Age- and gender-specific estimates of cumulative CT dose over 5 years using real radiation dose tracking data in children

    International Nuclear Information System (INIS)

    Lee, Eunsol; Goo, Hyun Woo; Lee, Jae-Yeong

    2015-01-01

    It is necessary to develop a mechanism to estimate and analyze cumulative radiation risks from multiple CT exams in various clinical scenarios in children. To identify major contributors to high cumulative CT dose estimates using actual dose-length product values collected for 5 years in children. Between August 2006 and July 2011 we reviewed 26,937 CT exams in 13,803 children. Among them, we included 931 children (median age 3.5 years, age range 0 days-15 years; M:F = 533:398) who had 5,339 CT exams. Each child underwent at least three CT scans and had accessible radiation dose reports. Dose-length product values were automatically extracted from DICOM files and we used recently updated conversion factors for age, gender, anatomical region and tube voltage to estimate CT radiation dose. We tracked the calculated CT dose estimates to obtain a 5-year cumulative value for each child. The study population was divided into three groups according to the cumulative CT dose estimates: high, ≥30 mSv; moderate, 10-30 mSv; and low, <10 mSv. We reviewed clinical data and CT protocols to identify major contributors to high and moderate cumulative CT dose estimates. Median cumulative CT dose estimate was 5.4 mSv (range 0.5-71.1 mSv), and median number of CT scans was 4 (range 3-36). High cumulative CT dose estimates were most common in children with malignant tumors (57.9%, 11/19). High frequency of CT scans was attributed to high cumulative CT dose estimates in children with ventriculoperitoneal shunt (35 in 1 child) and malignant tumors (range 18-49). Moreover, high-dose CT protocols, such as multiphase abdomen CT (median 4.7 mSv) contributed to high cumulative CT dose estimates even in children with a low number of CT scans. Disease group, number of CT scans, and high-dose CT protocols are major contributors to higher cumulative CT dose estimates in children. (orig.)

  2. Cumulative effective dose associated with radiography and CT of adolescents with spinal injuries.

    Science.gov (United States)

    Lemburg, Stefan P; Peters, Soeren A; Roggenland, Daniela; Nicolas, Volkmar; Heyer, Christoph M

    2010-12-01

    The purpose of this study was to analyze the quantity and distribution of cumulative effective doses in diagnostic imaging of adolescents with spinal injuries. At a level 1 trauma center from July 2003 through June 2009, imaging procedures during initial evaluation and hospitalization and after discharge of all patients 10-20 years old with spinal fractures were retrospectively analyzed. The cumulative effective doses for all imaging studies were calculated, and the doses to patients with spinal injuries who had multiple traumatic injuries were compared with the doses to patients with spinal injuries but without multiple injuries. The significance level was set at 5%. Imaging studies of 72 patients (32 with multiple injuries; average age, 17.5 years) entailed a median cumulative effective dose of 18.89 mSv. Patients with multiple injuries had a significantly higher total cumulative effective dose (29.70 versus 10.86 mSv, p cumulative effective dose to multiple injury patients during the initial evaluation (18.39 versus 2.83 mSv, p cumulative effective dose. Adolescents with spinal injuries receive a cumulative effective dose equal to that of adult trauma patients and nearly three times that of pediatric trauma patients. Areas of focus in lowering cumulative effective dose should be appropriate initial estimation of trauma severity and careful selection of CT scan parameters.

  3. Cumulative effective and individual organ dose levels in paediatric patients undergoing multiple catheterizations for congenital heart disease

    International Nuclear Information System (INIS)

    Jones, T.P.; Brennan, P.C.; Ryan, E.

    2017-01-01

    This study examines the cumulative radiation dose levels received by a group of children who underwent multiple cardiac catheterisation procedures during the investigation and management of congenital heart disease (CHD). The purpose is to calculate cumulative doses, identify higher dose individuals, outline the inconsistencies with risk assessment and encourage the establishment of dose databases in order to facilitate the longitudinal research necessary to better understand health risks. A retrospective review of patient records for 117 paediatric patients who have undergone two or more cardiac catheterizations for the investigation of CHD was undertaken. This cohort consisted of patients who were catheterised over a period from September 2002 to August 2014. The age distribution was from newborn to 17 y. Archived kerma-area product (P KA ) and fluoroscopy time (T) readings were retrieved and analysed. Cumulative effective and individual organ doses were determined. The cumulative P KA levels ranged from 1.8 to 651.2 Gycm 2 , whilst cumulative effective dose levels varied from 2 to 259 mSv. The cumulative fluoroscopy time was shown to vary from 8.1 to 193.5 min. Median cumulative organ doses ranged from 3 to 94 mGy. Cumulative effective dose levels are highly variable but may exceed 250 mSv. Individual organ and effective dose measurements remain useful for comparison purposes between institutions although current methodologies used for determining lifetime risks are inadequate. (authors)

  4. Cumulative radiation dose of multiple trauma patients during their hospitalization

    International Nuclear Information System (INIS)

    Wang Zhikang; Sun Jianzhong; Zhao Zudan

    2012-01-01

    Objective: To study the cumulative radiation dose of multiple trauma patients during their hospitalization and to analyze the dose influence factors. Methods: The DLP for CT and DR were retrospectively collected from the patients during June, 2009 and April, 2011 at a university affiliated hospital. The cumulative radiation doses were calculated by summing typical effective doses of the anatomic regions scanned. Results: The cumulative radiation doses of 113 patients were collected. The maximum,minimum and the mean values of cumulative effective doses were 153.3, 16.48 mSv and (52.3 ± 26.6) mSv. Conclusions: Multiple trauma patients have high cumulative radiation exposure. Therefore, the management of cumulative radiation doses should be enhanced. To establish the individualized radiation exposure archives will be helpful for the clinicians and technicians to make decision whether to image again and how to select the imaging parameters. (authors)

  5. Maintenance hemodialysis patients have high cumulative radiation exposure.

    LENUS (Irish Health Repository)

    Kinsella, Sinead M

    2010-10-01

    Hemodialysis is associated with an increased risk of neoplasms which may result, at least in part, from exposure to ionizing radiation associated with frequent radiographic procedures. In order to estimate the average radiation exposure of those on hemodialysis, we conducted a retrospective study of 100 patients in a university-based dialysis unit followed for a median of 3.4 years. The number and type of radiological procedures were obtained from a central radiology database, and the cumulative effective radiation dose was calculated using standardized, procedure-specific radiation levels. The median annual radiation dose was 6.9 millisieverts (mSv) per patient-year. However, 14 patients had an annual cumulative effective radiation dose over 20 mSv, the upper averaged annual limit for occupational exposure. The median total cumulative effective radiation dose per patient over the study period was 21.7 mSv, in which 13 patients had a total cumulative effective radiation dose over 75 mSv, a value reported to be associated with a 7% increased risk of cancer-related mortality. Two-thirds of the total cumulative effective radiation dose was due to CT scanning. The average radiation exposure was significantly associated with the cause of end-stage renal disease, history of ischemic heart disease, transplant waitlist status, number of in-patient hospital days over follow-up, and death during the study period. These results highlight the substantial exposure to ionizing radiation in hemodialysis patients.

  6. Cumulative or delayed nephrotoxicity after cisplatin (DDP) treatment.

    Science.gov (United States)

    Pinnarò, P; Ruggeri, E M; Carlini, P; Giovannelli, M; Cognetti, F

    1986-04-30

    The present retrospective study reports data regarding renal toxicity in 115 patients (63 males, 52 females; median age, 56 years) who received cumulative doses of cisplatin (DDP) greater than or equal to 200 mg/m2. DDP was administered alone or in combination at a dose of 50-70 mg/m2 in 91 patients, and at a dose of 100 mg/m2 in 22 patients. Two patients after progression of ovarian carcinoma treated with conventional doses of DDP received 4 and 2 courses, respectively, of high-dose DDP (40 mg/m2 for 5 days) in hypertonic saline. The median number of DDP courses was 6 (range 2-14), and the median cumulative dose was 350 mg/m2 (range, 200-1200). Serum creatinine and urea nitrogen were determined before initiating the treatment and again 13-16 days after each administration. The incidence of azotemia (creatinina levels that exceeded 1.5 mg/dl) was similar before (7.8%) and after (6.1%) DDP doses of 200 mg/m2. Azotemia appears to be related to the association of DDP with other potentially nephrotoxic antineoplastic drugs (methotrexate) more than to the dose per course of DDP. Of 59 patients followed for 2 months or more after discontinuing the DDP treatment, 3 (5.1%) presented creatinine values higher than 1.5 mg/dl. The data deny that the incidence of nephrotoxicity is higher in patients receiving higher cumulative doses of DDP and confirm that increases in serum creatinine levels may occur some time after discontinuation of the drug.

  7. Lead in teeth from lead-dosed goats: Microdistribution and relationship to the cumulative lead dose

    International Nuclear Information System (INIS)

    Bellis, David J.; Hetter, Katherine M.; Jones, Joseph; Amarasiriwardena, Dula; Parsons, Patrick J.

    2008-01-01

    Teeth are commonly used as a biomarker of long-term lead exposure. There appear to be few data, however, on the content or distribution of lead in teeth where data on specific lead intake (dose) are also available. This study describes the analysis of a convenience sample of teeth from animals that were dosed with lead for other purposes, i.e., a proficiency testing program for blood lead. Lead concentration of whole teeth obtained from 23 animals, as determined by atomic absorption spectrometry, varied from 0.6 to 80 μg g -1 . Linear regression of whole tooth lead (μg g -1 ) on the cumulative lead dose received by the animal (g) yielded a slope of 1.2, with r 2 =0.647 (p -1 , were found in circumpulpal dentine. Linear regression of circumpulpal lead (μg g -1 ) on cumulative lead dose (g) yielded a slope of 23 with r 2 =0.961 (p=0.0001). The data indicated that whole tooth lead, and especially circumpulpal lead, of dosed goats increased linearly with cumulative lead exposure. These data suggest that circumpulpal dentine is a better biomarker of cumulative lead exposure than is whole tooth lead, at least for lead-dosed goats

  8. Cumulative radiation dose caused by radiologic studies in critically ill trauma patients.

    Science.gov (United States)

    Kim, Patrick K; Gracias, Vicente H; Maidment, Andrew D A; O'Shea, Michael; Reilly, Patrick M; Schwab, C William

    2004-09-01

    Critically ill trauma patients undergo many radiologic studies, but the cumulative radiation dose is unknown. The purpose of this study was to estimate the cumulative effective dose (CED) of radiation resulting from radiologic studies in critically ill trauma patients. The study group was composed of trauma patients at an urban Level I trauma center with surgical intensive care unit length of stay (LOS) greater than 30 days. The radiology records were reviewed. A typical effective dose per study for each type of plain film radiograph, computed tomographic scan, fluoroscopic study, and nuclear medicine study was used to calculate CED. Forty-six patients met criteria. The mean surgical intensive care unit and hospital LOS were 42.7 +/- 14.0 and 59.5 +/- 28.5 days, respectively. The mean Injury Severity Score was 32.2 +/- 15.0. The mean number of studies per patient was 70.1 +/- 29.0 plain film radiographs, 7.8 +/- 4.1 computed tomographic scans, 2.5 +/- 2.6 fluoroscopic studies, and 0.065 +/- 0.33 nuclear medicine study. The mean CED was 106 +/- 59 mSv per patient (range, 11-289 mSv; median, 104 mSv). Among age, mechanism, Injury Severity Score, and LOS, there was no statistically significant predictor of high CED. The mean CED in the study group was 30 times higher than the average yearly radiation dose from all sources for individuals in the United States. The theoretical additional morbidity attributable to radiologic studies was 0.78%. From a radiobiologic perspective, risk-to-benefit ratios of radiologic studies are favorable, given the importance of medical information obtained. Current practice patterns regarding use of radiologic studies appear to be acceptable.

  9. Cumulative doses analysis in young trauma patients: a single-centre experience.

    Science.gov (United States)

    Salerno, Sergio; Marrale, Maurizio; Geraci, Claudia; Caruso, Giuseppe; Lo Re, Giuseppe; Lo Casto, Antonio; Midiri, Massimo

    2016-02-01

    Multidetector computed tomography (MDCT) represents the main source of radiation exposure in trauma patients. The radiation exposure of young patients is a matter of considerable medical concern due to possible long-term effects. Multiple MDCT studies have been observed in the young trauma population with an increase in radiation exposure. We have identified 249 young adult patients (178 men and 71 women; age range 14-40 years) who had received more than one MDCT study between June 2010 and June 2014. According to the International Commission on Radiological Protection publication, we have calculated the cumulative organ dose tissue-weighting factors by using CT-EXPO software(®). We have observed a mean cumulative dose of about 27 mSv (range from 3 to 297 mSv). The distribution analysis is characterised by low effective dose, below 20 mSv, in the majority of the patients. However, in 29 patients, the effective dose was found to be higher than 20 mSv. Dose distribution for the various organs analysed (breasts, ovaries, testicles, heart and eye lenses) shows an intense peak for lower doses, but in some cases high doses were recorded. Even though cumulative doses may have long-term effects, which are still under debate, high doses are observed in this specific group of young patients.

  10. Evaluation of a post-analysis method for cumulative dose distribution in stereotactic body radiotherapy

    International Nuclear Information System (INIS)

    Imae, Toshikazu; Takenaka, Shigeharu; Saotome, Naoya

    2016-01-01

    The purpose of this study was to evaluate a post-analysis method for cumulative dose distribution in stereotactic body radiotherapy (SBRT) using volumetric modulated arc therapy (VMAT). VMAT is capable of acquiring respiratory signals derived from projection images and machine parameters based on machine logs during VMAT delivery. Dose distributions were reconstructed from the respiratory signals and machine parameters in the condition where respiratory signals were without division, divided into 4 and 10 phases. The dose distribution of each respiratory phase was calculated on the planned four-dimensional CT (4DCT). Summation of the dose distributions was carried out using deformable image registration (DIR), and cumulative dose distributions were compared with those of the corresponding plans. Without division, dose differences between cumulative distribution and plan were not significant. In the condition Where respiratory signals were divided, dose differences were observed over dose in cranial region and under dose in caudal region of planning target volume (PTV). Differences between 4 and 10 phases were not significant. The present method Was feasible for evaluating cumulative dose distribution in VMAT-SBRT using 4DCT and DIR. (author)

  11. Current and historical individual data about exposure of workers in the rayon industry to carbon disulfide and their validity in calculating the cumulative dose.

    Science.gov (United States)

    Göen, Thomas; Schramm, Axel; Baumeister, Thomas; Uter, Wolfgang; Drexler, Hans

    2014-08-01

    The objective of the study was to investigate how exposure to carbon disulfide (CS2) in a rayon-manufacturing plant has changed within two decades and whether it is possible to calculate valid data for the individual cumulative exposure. The data for CS2 concentration in air and biological exposure monitoring (2-thio-1,3-thiaxolidine-4-carboxylic acid (TTCA) in urine) from two cross-sectional studies, performed in 1992 (n = 362) and 2009 (n = 212) in a German rayon-manufacturing plant, were compared to data obtained from company-internal measurements between the studies. Using the data from the cross-sectional studies and company-internal data, cumulative external exposure and the cumulative internal exposure were calculated for each worker. External and internal CS2 exposure of the employees decreased from 1992 (medians 4.0 ppm and 1.63 mgTTCA/g creatinine) to 2009 (medians 2.5 ppm and 0.86 mg/g). However, company-internal CS2 data do not show a straight trend for this period. The annual medians of the company-internal measurement of external exposure to CS2 have varied between 2.7 and 8.4 ppm, in which median values exceeded 5 ppm generally since 2000. The annual medians for the company-internal biomonitoring assessment ranged between 1.2 and 2.8 mg/g creatinine. The cumulative CS2 exposure ranged from 8.5 to 869.5 ppm years for external exposure and between 1.30 and 176.2 mg/g creatinine years for the internal exposure. Significant correlations were found between the current air pollution and the internal exposure in 2009 but also between the cumulative external and internal CS2 exposure. Current exposure data, usually collected in cross-sectional studies, rarely allow a reliable statement on the cumulative dose, because of higher exposure in the past and of fluctuating courses of exposure. On the other hand, company-internal exposure data may be affected by non-representative measurement strategies. Some verification of the reliability of

  12. Technical Note: SCUDA: A software platform for cumulative dose assessment

    Energy Technology Data Exchange (ETDEWEB)

    Park, Seyoun; McNutt, Todd; Quon, Harry; Wong, John; Lee, Junghoon, E-mail: rshekhar@childrensnational.org, E-mail: junghoon@jhu.edu [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21231 (United States); Plishker, William [IGI Technologies, Inc., College Park, Maryland 20742 (United States); Shekhar, Raj, E-mail: rshekhar@childrensnational.org, E-mail: junghoon@jhu.edu [IGI Technologies, Inc., College Park, Maryland 20742 and Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, DC 20010 (United States)

    2016-10-15

    Purpose: Accurate tracking of anatomical changes and computation of actually delivered dose to the patient are critical for successful adaptive radiation therapy (ART). Additionally, efficient data management and fast processing are practically important for the adoption in clinic as ART involves a large amount of image and treatment data. The purpose of this study was to develop an accurate and efficient Software platform for CUmulative Dose Assessment (SCUDA) that can be seamlessly integrated into the clinical workflow. Methods: SCUDA consists of deformable image registration (DIR), segmentation, dose computation modules, and a graphical user interface. It is connected to our image PACS and radiotherapy informatics databases from which it automatically queries/retrieves patient images, radiotherapy plan, beam data, and daily treatment information, thus providing an efficient and unified workflow. For accurate registration of the planning CT and daily CBCTs, the authors iteratively correct CBCT intensities by matching local intensity histograms during the DIR process. Contours of the target tumor and critical structures are then propagated from the planning CT to daily CBCTs using the computed deformations. The actual delivered daily dose is computed using the registered CT and patient setup information by a superposition/convolution algorithm, and accumulated using the computed deformation fields. Both DIR and dose computation modules are accelerated by a graphics processing unit. Results: The cumulative dose computation process has been validated on 30 head and neck (HN) cancer cases, showing 3.5 ± 5.0 Gy (mean±STD) absolute mean dose differences between the planned and the actually delivered doses in the parotid glands. On average, DIR, dose computation, and segmentation take 20 s/fraction and 17 min for a 35-fraction treatment including additional computation for dose accumulation. Conclusions: The authors developed a unified software platform that provides

  13. Application of the ELDO approach to assess cumulative eye lens doses for interventional cardiologists

    International Nuclear Information System (INIS)

    Farah, J.; Jacob, S.; Clairand, I.; Struelens, L.; Vanhavere, F.; Auvinen, A.; Koukorava, C.; Schnelzer, M.

    2015-01-01

    In preparation of a large European epidemiological study on the relation between eye lens dose and the occurrence of lens opacities, the European ELDO project focused on the development of practical methods to estimate retrospectively cumulative eye lens dose for interventional medical professionals exposed to radiation. The present paper applies one of the ELDO approaches, correlating eye lens dose to whole-body doses, to assess cumulative eye lens dose for 14 different Finnish interventional cardiologists for whom annual whole-body dose records were available for their entire working period. The estimated cumulative left and right eye lens dose ranged from 8 to 264 mSv and 6 to 225 mSv, respectively. In addition, calculations showed annual eye lens doses sometimes exceeding the new ICRP annual limit of 20 mSv. The work also highlights the large uncertainties associated with the application of such an approach proving the need for dedicated dosimetry systems in the routine monitoring of the eye lens dose. (authors)

  14. TH-AB-207A-04: Assessment of Patients’ Cumulative Effective Dose From CT Examinations

    Energy Technology Data Exchange (ETDEWEB)

    Bostani, M; Cagnon, C; Sepahdari, A; Beckett, K; Oshiro, T; McNitt-Gray, M [UCLA School of Medicine, Los Angeles, CA (United States)

    2016-06-15

    Purpose: The Joint Commission requires institutions to consider patient’s age and recent imaging exams when deciding on the most appropriate type of imaging exam. Additionally, knowing patient’s imaging history can help prevent duplicate scans. Radiation dose management software affords new opportunities to identify and utilize patients with high cumulative doses as one proxy for subsequent review of imaging history and opportunities in avoiding redundant exams. Methods: Using dose management software (Radimetrics, Bayer Healthcare) a total of 72073 CT examinations performed from Jan 2015 to Jan 2016 were examined to categorize patients with a cumulative effective dose of 100 mSv and above. This threshold was selected based on epidemiological studies on populations exposed to radiation, which demonstrate a statistical increase of cancer risk at doses above 100 mSv. Histories of patients with highest cumulative dose and highest number of exams were further investigated by a Radiologist for appropriateness of recurrent studies and potential opportunities for reduction. Results: Out of 34762 patients, 927 (2.7%) were identified with a cumulative dose of 100 mSv and above. The highest cumulative dose (842 mSv) belonged to an oncology patient who underwent 2 diagnostic exams and 9 interventional ablative CT guided procedures. The patient with highest number of exams (56 counts) and cumulative dose of 170 mSv was a 17 year old trauma patient. An imaging history review of these two patients did not suggest any superfluous scans. Conclusion: Our limited pilot study suggests that recurrent CT exams for patients with oncologic or severe trauma history may be warranted and appropriate. As a result, for future studies we will be focusing on high dose patient cohorts not associated with oncology or severe trauma. Additionally, the review process itself has suggested areas for potential improvement in patient care, including improved documentation and Radiologist involvement

  15. TH-AB-207A-04: Assessment of Patients’ Cumulative Effective Dose From CT Examinations

    International Nuclear Information System (INIS)

    Bostani, M; Cagnon, C; Sepahdari, A; Beckett, K; Oshiro, T; McNitt-Gray, M

    2016-01-01

    Purpose: The Joint Commission requires institutions to consider patient’s age and recent imaging exams when deciding on the most appropriate type of imaging exam. Additionally, knowing patient’s imaging history can help prevent duplicate scans. Radiation dose management software affords new opportunities to identify and utilize patients with high cumulative doses as one proxy for subsequent review of imaging history and opportunities in avoiding redundant exams. Methods: Using dose management software (Radimetrics, Bayer Healthcare) a total of 72073 CT examinations performed from Jan 2015 to Jan 2016 were examined to categorize patients with a cumulative effective dose of 100 mSv and above. This threshold was selected based on epidemiological studies on populations exposed to radiation, which demonstrate a statistical increase of cancer risk at doses above 100 mSv. Histories of patients with highest cumulative dose and highest number of exams were further investigated by a Radiologist for appropriateness of recurrent studies and potential opportunities for reduction. Results: Out of 34762 patients, 927 (2.7%) were identified with a cumulative dose of 100 mSv and above. The highest cumulative dose (842 mSv) belonged to an oncology patient who underwent 2 diagnostic exams and 9 interventional ablative CT guided procedures. The patient with highest number of exams (56 counts) and cumulative dose of 170 mSv was a 17 year old trauma patient. An imaging history review of these two patients did not suggest any superfluous scans. Conclusion: Our limited pilot study suggests that recurrent CT exams for patients with oncologic or severe trauma history may be warranted and appropriate. As a result, for future studies we will be focusing on high dose patient cohorts not associated with oncology or severe trauma. Additionally, the review process itself has suggested areas for potential improvement in patient care, including improved documentation and Radiologist involvement

  16. Switching From Age-Based Stimulus Dosing to Dose Titration Protocols in Electroconvulsive Therapy: Empirical Evidence for Better Patient Outcomes With Lower Peak and Cumulative Energy Doses.

    Science.gov (United States)

    O'Neill-Kerr, Alex; Yassin, Anhar; Rogers, Stephen; Cornish, Janie

    2017-09-01

    The aim of this study was to test the proposition that adoption of a dose titration protocol may be associated with better patient outcomes, at lower treatment dose, and with comparable cumulative dose to that in patients treated using an age-based stimulus dosing protocol. This was an analysis of data assembled from archived records and based on cohorts of patients treated respectively on an age-based stimulus dosing protocol and on a dose titration protocol in the National Health Service in England. We demonstrated a significantly better response in the patient cohort treated with dose titration than with age-based stimulus dosing. Peak doses were less and the total cumulative dose was less in the dose titration group than in the age-based stimulus dosing group. Our findings are consistent with superior outcomes in patients treated using a dose titration protocol when compared with age-based stimulus dosing in a similar cohort of patients.

  17. Gamma knife radiosurgery for ten or more brain metastases. Analysis of the whole brain irradiation doses

    International Nuclear Information System (INIS)

    Nakaya, Kotaro; Hori, Tomokatsu; Izawa, Masahiro; Yamamoto, Masaaki

    2002-01-01

    Gamma knife (GK) radiosurgery has recently been recognized as the most powerful treatment modality in managing patients with brain metastasis, be they radioresistant or not, solitary or multiple. Very recently, this treatment has been employed in patients with numerous brain metastases, even those with 10 or more lesions. However, cumulative irradiation doses to the whole brain, with such treatment, remain unknown. Since the Gamma Plan ver. 5.10 (ver. 5.30 is presently available, Leksell Gamma Plan) became available in November, 1998, 105 GK procedures have been performed at our two facilities, Tokyo Women's Medical University and Katsuta Hospital Mito Gamma House. The median lesion number was 17, ranging 10-43, and the median cumulative volume of all tumors was 8.72 cm 3 , ranging 0.41-81.41 cm 3 . The selected doses at the lesion periphery ranged 12-25 Gy, the median being 20 Gy. Based on these treatment protocols, the cumulative irradiation dose was computed. The median cumulative irradiation dose to the whole brain was 4.83, ranging 2.16-8.51 Gy: the median integrated dose to the whole brain was 6.2 J, ranging 2.16-11.9 J. The median brain volumes receiving ≥2, ≥5, ≥10, ≥15 and ≥20 Gy were 1105 (range: 410-1501), 309 (46-1247), 64 (13-282), 24 (2-77), and 8 (0-40) cm 3 , respectively. The cumulative whole brain irradiation doses for patients with numerous radiosurgical targets were considered not to exceed the threshold level of normal brain necrosis. (author)

  18. Accurate convolution/superposition for multi-resolution dose calculation using cumulative tabulated kernels

    International Nuclear Information System (INIS)

    Lu Weiguo; Olivera, Gustavo H; Chen Mingli; Reckwerdt, Paul J; Mackie, Thomas R

    2005-01-01

    Convolution/superposition (C/S) is regarded as the standard dose calculation method in most modern radiotherapy treatment planning systems. Different implementations of C/S could result in significantly different dose distributions. This paper addresses two major implementation issues associated with collapsed cone C/S: one is how to utilize the tabulated kernels instead of analytical parametrizations and the other is how to deal with voxel size effects. Three methods that utilize the tabulated kernels are presented in this paper. These methods differ in the effective kernels used: the differential kernel (DK), the cumulative kernel (CK) or the cumulative-cumulative kernel (CCK). They result in slightly different computation times but significantly different voxel size effects. Both simulated and real multi-resolution dose calculations are presented. For simulation tests, we use arbitrary kernels and various voxel sizes with a homogeneous phantom, and assume forward energy transportation only. Simulations with voxel size up to 1 cm show that the CCK algorithm has errors within 0.1% of the maximum gold standard dose. Real dose calculations use a heterogeneous slab phantom, both the 'broad' (5 x 5 cm 2 ) and the 'narrow' (1.2 x 1.2 cm 2 ) tomotherapy beams. Various voxel sizes (0.5 mm, 1 mm, 2 mm, 4 mm and 8 mm) are used for dose calculations. The results show that all three algorithms have negligible difference (0.1%) for the dose calculation in the fine resolution (0.5 mm voxels). But differences become significant when the voxel size increases. As for the DK or CK algorithm in the broad (narrow) beam dose calculation, the dose differences between the 0.5 mm voxels and the voxels up to 8 mm (4 mm) are around 10% (7%) of the maximum dose. As for the broad (narrow) beam dose calculation using the CCK algorithm, the dose differences between the 0.5 mm voxels and the voxels up to 8 mm (4 mm) are around 1% of the maximum dose. Among all three methods, the CCK algorithm

  19. Cumulative ionizing radiation exposure in patients with end stage kidney disease: a 6-year retrospective analysis.

    LENUS (Irish Health Repository)

    Coyle, Joe

    2011-08-13

    OBJECTIVE: To quantify cumulative exposure to ionizing radiation in patients with end stage kidney disease (ESKD). To investigate factors which may be independently associated with risk of high cumulative effective dose (CED). MATERIALS AND METHODS: The study had local institutional review board ethical approval. We conducted a retrospective study of 394 period prevalent ESKD patients attending a single tertiary referral centre between 2004 and 2009. Patient demographics were obtained from case records. Details of radiological investigations were obtained from the institutional radiology computerized database. CED was calculated using standard procedure specific radiation levels. High exposure was defined as CED > 50 mSv, an exposure which has been reported to increase cancer mortality by 5%. Data were compared using Pearson χ(2) and Mann-Whitney U test or Kruskal-Wallis tests. RESULTS: 394 patients were followed for a median of 4 years (1518 patient years follow-up). Of these 63% were male. Seventeen percent of patients had a CED of >50 mSv. Computed tomography (CT) accounted for 9% of total radiological studies\\/procedures while contributing 61.4% of total study dose. Median cumulative dose and median dose per patient year were significantly higher in the hemodialysis (HD) group (15.13 and 5.79 mSv, respectively) compared to the post-transplant group (2.9 and 0.52 mSv, respectively) (P < 0.001). CONCLUSION: ESKD patients are at risk of cumulative exposure to significant levels of diagnostic radiation. The majority of this exposure is imparted as a result of CT examinations to patients in the HD group.

  20. Relationship between mutation frequency of GPA locus and cumulative dose among medical diagnostic X-ray workers

    International Nuclear Information System (INIS)

    Wang Jixian; Yu Wenru; Li Benxiao; Fan Tiqiang; Li Zhen; Gao Zhiwei; Chen Zhenjun; Zhao Yongcheng

    2000-01-01

    Objective: To explore the feasibility of using GPA locus mutation assay as a bio-dosimeter for occupational exposure to ionizing radiation. Methods: An improved technique of GPA locus mutation assay was used in th study. The frequencies of mutant RBC in peripheral blood of 55 medical X-ray workers and 50 controls employed in different calendar-year periods were detected. The relationship between mutation frequencies (MFs) and period of entry, working years and cumulative doses were analyzed. Results: The MFs were significantly elevated among X-ray workers employed before 1970. This finding is similar to the result of cancer epidemiological study among medical X-ray workers , in which the cancer risk was significantly increased only X-ray workers employed before 1970. The MFs of GPA increased with increasing cumulative dose. The dose-effect relationship of Nφ MF with cumulative dose was closer than that of NN MF. Conclusion: There are many problems to be solved for using GPA MF assay as a bio-dosimeter such as individual variation, specificity and calibration curve of dose-effect relationship

  1. Prediction of the cumulated dose for external beam irradiation of prostate cancer patients with 3D-CRT technique

    Directory of Open Access Journals (Sweden)

    Giżyńska Marta

    2016-03-01

    Full Text Available Nowadays in radiotherapy, much effort is taken to minimize the irradiated volume and consequently minimize doses to healthy tissues. In our work, we tested the hypothesis that the mean dose distribution calculated from a few first fractions can serve as prediction of the cumulated dose distribution, representing the whole treatment. We made our tests for 25 prostate cancer patients treated with three orthogonal fields technique. We did a comparison of dose distribution calculated as a sum of dose distribution from each fraction with a dose distribution calculated with isocenter shifted for a mean setup error from a few first fractions. The cumulative dose distribution and predicted dose distributions are similar in terms of gamma (3 mm 3% analysis, under condition that we know setup error from seven first fractions. We showed that the dose distribution calculated for the original plan with the isocenter shifted to the point, defined as the original isocenter corrected of the mean setup error estimated from the first seven fractions supports our hypothesis, i.e. can serve as a prediction for cumulative dose distribution.

  2. Radiologic imaging in cystic fibrosis: cumulative effective dose and changing trends over 2 decades.

    LENUS (Irish Health Repository)

    O'Connell, Oisin J

    2012-06-01

    With the increasing life expectancy for patients with cystic fibrosis (CF), and a known predisposition to certain cancers, cumulative radiation exposure from radiologic imaging is of increasing significance. This study explores the estimated cumulative effective radiation dose over a 17-year period from radiologic procedures and changing trends of imaging modalities over this period.

  3. Patterns of prednisone use during pregnancy in women with rheumatoid arthritis: Daily and cumulative dose.

    Science.gov (United States)

    Palmsten, Kristin; Rolland, Matthieu; Hebert, Mary F; Clowse, Megan E B; Schatz, Michael; Xu, Ronghui; Chambers, Christina D

    2018-04-01

    To characterize prednisone use in pregnant women with rheumatoid arthritis using individual-level heat-maps and clustering individual trajectories of prednisone dose, and to evaluate the association between prednisone dose trajectory groups and gestational length. This study included pregnant women with rheumatoid arthritis who enrolled in the MotherToBaby Autoimmune Diseases in Pregnancy Study (2003-2014) before gestational week 20 and reported prednisone use without another oral glucocorticoid during pregnancy (n = 254). Information on medication use and pregnancy outcomes was collected by telephone interview plus by medical record review. Prednisone daily dose and cumulative dose were plotted by gestational day using a heat map for each individual. K-means clustering was used to cluster individual trajectories of prednisone dose into groups. The associations between trajectory group and demographics, disease severity measured by the Health Assessment Questionnaire at enrollment, and gestational length were evaluated. Women used prednisone 3 to 292 days during pregnancy, with daily doses ranging from <1 to 60 mg. Total cumulative dose ranged from 8 to 6225 mg. Disease severity, non-biologic disease modifying anti-rheumatic drug use, and gestational length varied significantly by trajectory group. After adjusting for disease severity, non-biologic disease modifying anti-rheumatic drug use, and other covariates, the highest vs lowest daily dose trajectory group was associated with reduced gestational age at delivery (β: -2.3 weeks (95%: -3.4, -1.3)), as was the highest vs lowest cumulative dose trajectory group (β: -2.6 weeks (95%: -3.6, -1.5)). In pregnant women with rheumatoid arthritis, patterns of higher prednisone dose were associated with shorter gestational length compared with lower dose. Copyright © 2018 John Wiley & Sons, Ltd.

  4. Median prior constrained TV algorithm for sparse view low-dose CT reconstruction.

    Science.gov (United States)

    Liu, Yi; Shangguan, Hong; Zhang, Quan; Zhu, Hongqing; Shu, Huazhong; Gui, Zhiguo

    2015-05-01

    It is known that lowering the X-ray tube current (mAs) or tube voltage (kVp) and simultaneously reducing the total number of X-ray views (sparse view) is an effective means to achieve low-dose in computed tomography (CT) scan. However, the associated image quality by the conventional filtered back-projection (FBP) usually degrades due to the excessive quantum noise. Although sparse-view CT reconstruction algorithm via total variation (TV), in the scanning protocol of reducing X-ray tube current, has been demonstrated to be able to result in significant radiation dose reduction while maintain image quality, noticeable patchy artifacts still exist in reconstructed images. In this study, to address the problem of patchy artifacts, we proposed a median prior constrained TV regularization to retain the image quality by introducing an auxiliary vector m in register with the object. Specifically, the approximate action of m is to draw, in each iteration, an object voxel toward its own local median, aiming to improve low-dose image quality with sparse-view projection measurements. Subsequently, an alternating optimization algorithm is adopted to optimize the associative objective function. We refer to the median prior constrained TV regularization as "TV_MP" for simplicity. Experimental results on digital phantoms and clinical phantom demonstrated that the proposed TV_MP with appropriate control parameters can not only ensure a higher signal to noise ratio (SNR) of the reconstructed image, but also its resolution compared with the original TV method. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. The association between cumulative adversity and mental health: considering dose and primary focus of adversity.

    Science.gov (United States)

    Keinan, Giora; Shrira, Amit; Shmotkin, Dov

    2012-09-01

    The study addressed the dose-response model in the association of cumulative adversity with mental health. Data of 1,725 participants aged 50+ were drawn from the Israeli component of the Survey of Health, Ageing, and Retirement in Europe. Measures included an inventory of potentially traumatic events, distress (lifetime depression, depressive symptoms), and well-being (quality of life, optimism/hope). The maximal effect of cumulative trauma emerged in the contrast between 0-2 and 3+ events, where the higher number of events related to higher distress but also to higher well-being. While self-oriented adversity revealed no, or negative, association with well-being, other-oriented adversity revealed a positive association. The study suggests an experiential dose of cumulative adversity leading to a co-activation of distress and well-being. The source of this co-activation seems to be other-oriented adversity.

  6. Tolerance of the Brachial Plexus to High-Dose Reirradiation

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Allen M., E-mail: achen5@kumc.edu; Yoshizaki, Taeko; Velez, Maria A.; Mikaeilian, Argin G.; Hsu, Sophia; Cao, Minsong

    2017-05-01

    Purpose: To study the tolerance of the brachial plexus to high doses of radiation exceeding historically accepted limits by analyzing human subjects treated with reirradiation for recurrent tumors of the head and neck. Methods and Materials: Data from 43 patients who were confirmed to have received overlapping dose to the brachial plexus after review of radiation treatment plans from the initial and reirradiation courses were used to model the tolerance of this normal tissue structure. A standardized instrument for symptoms of neuropathy believed to be related to brachial plexus injury was utilized to screen for toxicity. Cumulative dose was calculated by fusing the initial dose distributions onto the reirradiation plan, thereby creating a composite plan via deformable image registration. The median elapsed time from the initial course of radiation therapy to reirradiation was 24 months (range, 3-144 months). Results: The dominant complaints among patients with symptoms were ipsilateral pain (54%), numbness/tingling (31%), and motor weakness and/or difficulty with manual dexterity (15%). The cumulative maximum dose (Dmax) received by the brachial plexus ranged from 60.5 Gy to 150.1 Gy (median, 95.0 Gy). The cumulative mean (Dmean) dose ranged from 20.2 Gy to 111.5 Gy (median, 63.8 Gy). The 1-year freedom from brachial plexus–related neuropathy was 67% and 86% for subjects with a cumulative Dmax greater than and less than 95.0 Gy, respectively (P=.05). The 1-year complication-free rate was 66% and 87%, for those reirradiated within and after 2 years from the initial course, respectively (P=.06). Conclusion: The development of brachial plexus–related symptoms was less than expected owing to repair kinetics and to the relatively short survival of the subject population. Time-dose factors were demonstrated to be predictive of complications.

  7. Cumulative Training Dose's Effects on Interrelationships Between Common Training-Load Models During Basketball Activity.

    Science.gov (United States)

    Scanlan, Aaron T; Fox, Jordan L; Borges, Nattai R; Dascombe, Ben J; Dalbo, Vincent J

    2017-02-01

    The influence of various factors on training-load (TL) responses in basketball has received limited attention. This study aimed to examine the temporal changes and influence of cumulative training dose on TL responses and interrelationships during basketball activity. Ten state-level Australian male junior basketball players completed 4 × 10-min standardized bouts of simulated basketball activity using a circuit-based protocol. Internal TL was quantified using the session rating of perceived exertion (sRPE), summated heart-rate zones (SHRZ), Banister training impulse (TRIMP), and Lucia TRIMP models. External TL was assessed via measurement of mean sprint and circuit speeds. Temporal TL comparisons were performed between 10-min bouts, while Pearson correlation analyses were conducted across cumulative training doses (0-10, 0-20, 0-30, and 0-40 min). sRPE TL increased (P basketball activity. sRPE TL was only significantly related to Lucia TRIMP (r = .66-.69; P basketball training doses lasting beyond 20 min. Thus, the interchangeability of commonly used internal and external TL approaches appears dose-dependent during basketball activity, with various psychophysiological mediators likely underpinning temporal changes.

  8. Cumulative effective dose and cancer risk for pediatric population in repetitive full spine follow-up imaging: How micro dose is the EOS microdose protocol?

    Science.gov (United States)

    Law, Martin; Ma, Wang-Kei; Lau, Damian; Cheung, Kenneth; Ip, Janice; Yip, Lawrance; Lam, Wendy

    2018-04-01

    To evaluate and to obtain analytic formulation for the calculation of the effective dose and associated cancer risk using the EOS microdose protocol for scoliotic pediatric patients undergoing full spine imaging at different age of exposure; to demonstrate the microdose protocol capable of delivering lesser radiation dose and hence of further reducing cancer risk induction when compared with the EOS low dose protocol; to obtain cumulative effective dose and cancer risk for both genders scoliotic pediatrics of US and Hong Kong population using the microdose protocol. Organ absorbed doses of full spine exposed scoliotic pediatric patients have been simulated with the use of EOS microdose protocol imaging parameters input to the Monte Carlo software PCXMC. Gender and age specific effective dose has been calculated with the simulated organ absorbed dose using the ICRP-103 approach. The associated radiation induced cancer risk, expressed as lifetime attributable risk (LAR), has been estimated according to the method introduced in the Biological Effects of Ionizing Radiation VII report. Values of LAR have been estimated for scoliotic patients exposed repetitively during their follow up period at different age for US and Hong Kong population. The effective doses of full spine imaging with simultaneous posteroanterior and lateral projection for patients exposed at the age between 5 and 18 years using the EOS microdose protocol have been calculated within the range of 2.54-14.75 μSv. The corresponding LAR for US and Hong Kong population was ranged between 0.04 × 10 -6 and 0.84 × 10 -6 . Cumulative effective dose and cancer risk during follow-up period can be estimated using the results and are of information to patients and their parents. With the use of computer simulation and analytic formulation, we obtained the cumulative effective dose and cancer risk at any age of exposure for pediatric patients of US and Hong Kong population undergoing repetitive

  9. Estimated cumulative radiation dose received by diagnostic imaging during staging and treatment of operable Ewing sarcoma 2005-2012

    International Nuclear Information System (INIS)

    Johnsen, Boel; Fasmer, Kristine Eldevik; Boye, Kjetil; Rosendahl, Karen; Aukland, Stein Magnus; Trovik, Clement; Biermann, Martin

    2017-01-01

    Patients with Ewing sarcoma are subject to various diagnostic procedures that incur exposure to ionising radiation. To estimate the radiation doses received from all radiologic and nuclear imaging episodes during diagnosis and treatment, and to determine whether 18 F-fluorodeoxyglucose positron emission tomography - computed tomography ( 18 F-FDG PET-CT) is a major contributor of radiation. Twenty Ewing sarcoma patients diagnosed in Norway in 2005-2012 met the inclusion criteria (age <30 years, operable disease, uncomplicated chemotherapy and surgery, no metastasis or residual disease within a year of diagnosis). Radiation doses from all imaging during the first year were calculated for each patient. The mean estimated cumulative radiation dose for all patients was 34 mSv (range: 6-70), radiography accounting for 3 mSv (range: 0.2-12), CT for 13 mSv (range: 2-28) and nuclear medicine for 18 mSv (range: 2-47). For the patients examined with PET-CT, the mean estimated cumulative effective dose was 38 mSv, of which PET-CT accounted for 14 mSv (37%). There was large variation in number and type of examinations performed and also in estimated cumulative radiation dose. The mean radiation dose for patients examined with PET-CT was 23% higher than for patients not examined with PET-CT. (orig.)

  10. Cumulative cisplatin dose in concurrent chemoradiotherapy for head and neck cancer : A systematic review

    NARCIS (Netherlands)

    Strojan, Primoz; Vermorken, Jan B.; Beitler, Jonathan J.; Saba, Nabil F.; Haigentz, Missak; Bossi, Paolo; Worden, Francis P.; Langendijk, Johannes A.; Eisbruch, Avraham; Mendenhall, William M.; Lee, Anne W. M.; Harrison, Louis B.; Bradford, Carol R.; Smee, Robert; Silver, Carl E.; Rinaldo, Alessandra; Ferlito, Alfio

    Background. The optimal cumulative dose and timing of cisplatin administration in various concurrent chemoradiotherapy protocols for nonmetastatic head and neck squamous cell carcinoma (HNSCC) has not been determined. Methods. The absolute survival benefit at 5 years of concurrent chemoradiotherapy

  11. Estimated cumulative radiation dose received by diagnostic imaging during staging and treatment of operable Ewing sarcoma 2005-2012

    Energy Technology Data Exchange (ETDEWEB)

    Johnsen, Boel [Haukeland University Hospital, Centre for Nuclear Medicine and PET, Department of Radiology, P.O. Box 1400, Bergen (Norway); Fasmer, Kristine Eldevik [Haukeland University Hospital, Department of Oncology, Medical Physics Section, Bergen (Norway); Boye, Kjetil [Norwegian Radium Hospital, Oslo University Hospital, Department of Oncology, Oslo (Norway); Rosendahl, Karen; Aukland, Stein Magnus [Haukeland University Hospital, Department of Radiology, Paediatric Section, Bergen (Norway); University of Bergen, Department of Clinical Medicine, Bergen (Norway); Trovik, Clement [University of Bergen, Department of Clinical Medicine, Bergen (Norway); Haukeland University Hospital, Department of Surgery, Orthopaedic Section, Bergen (Norway); Biermann, Martin [Haukeland University Hospital, Centre for Nuclear Medicine and PET, Department of Radiology, P.O. Box 1400, Bergen (Norway); University of Bergen, Department of Clinical Medicine, Bergen (Norway)

    2017-01-15

    Patients with Ewing sarcoma are subject to various diagnostic procedures that incur exposure to ionising radiation. To estimate the radiation doses received from all radiologic and nuclear imaging episodes during diagnosis and treatment, and to determine whether {sup 18}F-fluorodeoxyglucose positron emission tomography - computed tomography ({sup 18}F-FDG PET-CT) is a major contributor of radiation. Twenty Ewing sarcoma patients diagnosed in Norway in 2005-2012 met the inclusion criteria (age <30 years, operable disease, uncomplicated chemotherapy and surgery, no metastasis or residual disease within a year of diagnosis). Radiation doses from all imaging during the first year were calculated for each patient. The mean estimated cumulative radiation dose for all patients was 34 mSv (range: 6-70), radiography accounting for 3 mSv (range: 0.2-12), CT for 13 mSv (range: 2-28) and nuclear medicine for 18 mSv (range: 2-47). For the patients examined with PET-CT, the mean estimated cumulative effective dose was 38 mSv, of which PET-CT accounted for 14 mSv (37%). There was large variation in number and type of examinations performed and also in estimated cumulative radiation dose. The mean radiation dose for patients examined with PET-CT was 23% higher than for patients not examined with PET-CT. (orig.)

  12. Low Birth Weight, Cumulative Obesity Dose, and the Risk of Incident Type 2 Diabetes

    OpenAIRE

    Feng, Cindy; Osgood, Nathaniel D.; Dyck, Roland F.

    2018-01-01

    Background. Obesity history may provide a better understanding of the contribution of obesity to T2DM risk. Methods. 17,634 participants from the 1958 National Child Development Study were followed from birth to 50 years. Cumulative obesity dose, a measure of obesity history, was calculated by subtracting the upper cut-off of the normal BMI from the actual BMI at each follow-up and summing the areas under the obesity dose curve. Hazard ratios (HRs) for diabetes were calculated using Cox regre...

  13. Measurement of soil contamination by radionuclides due to the Fukushima Dai-ichi Nuclear Power Plant accident and associated estimated cumulative external dose estimation

    International Nuclear Information System (INIS)

    Endo, S.; Kimura, S.; Takatsuji, T.; Nanasawa, K.; Imanaka, T.; Shizuma, K.

    2012-01-01

    Soil sampling was carried out at an early stage of the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident. Samples were taken from areas around FDNPP, at four locations northwest of FDNPP, at four schools and in four cities, including Fukushima City. Radioactive contaminants in soil samples were identified and measured by using a Ge detector and included 129m Te, 129 Te, 131 I, 132 Te, 132 I, 134 Cs, 136 Cs, 137 Cs, 140 Ba and 140 La. The highest soil depositions were measured to the northwest of FDNPP. From this soil deposition data, variations in dose rates over time and the cumulative external doses at the locations for 3 months and 1 y after deposition were estimated. At locations northwest of FDNPP, the external dose rate at 3 months after deposition was 4.8–98 μSv/h and the cumulative dose for 1 y was 51 to 1.0 × 10 3 mSv; the highest values were at Futaba Yamada. At the four schools, which were used as evacuation shelters, and in the four urban cities, the external dose rate at 3 months after deposition ranged from 0.03 to 3.8 μSv/h and the cumulative doses for 1 y ranged from 3 to 40 mSv. The cumulative dose at Fukushima Niihama Park was estimated as the highest in the four cities. The estimated external dose rates and cumulative doses show that careful countermeasures and remediation will be needed as a result of the accident, and detailed measurements of radionuclide deposition densities in soil will be important input data to conduct these activities.

  14. Acute and Cumulative Effects of Unmodified 50-nm Nano-ZnO on Mice.

    Science.gov (United States)

    Kong, Tao; Zhang, Shu-Hui; Zhang, Ji-Liang; Hao, Xue-Qin; Yang, Fan; Zhang, Cai; Yang, Zi-Jun; Zhang, Meng-Yu; Wang, Jie

    2018-01-02

    Nanometer zinc oxide (nano-ZnO) is widely used in diverse industrial and agricultural fields. Due to the extensive contact humans have with these particles, it is crucial to understand the potential effects that nano-ZnO have on human health. Currently, information related to the toxicity and mechanisms of nano-ZnO is limited. The aim of the present study was to investigate acute and cumulative toxic effects of 50-nm unmodified ZnO in mice. This investigation will seek to establish median lethal dose (LD50), a cumulative coefficient, and target organs. The acute and cumulative toxicity was investigated by Karber's method and via a dose-increasing method, respectively. During the experiment, clinical signs, mortality, body weights, hematology, serum biochemistry, gross pathology, organ weight, and histopathology were examined. The LD50 was 5177-mg/kg·bw; the 95% confidence limits for the LD50 were 5116-5238-mg/kg·bw. It could be concluded that the liver, kidney, lung, and gastrointestinal tract were target organs for the 50-nm nano-ZnO acute oral treatment. The cumulative coefficient (K) was 1.9 which indicated that the cumulative toxicity was apparent. The results also indicated that the liver, kidney, lung, and pancrea were target organs for 50-nm nano-ZnO cumulative oral exposure and might be target organs for subchronic and chronic toxicity of oral administered 50-nm ZnO.

  15. The dose-response relationship between cumulative lifting load and lumbar disk degeneration based on magnetic resonance imaging findings.

    Science.gov (United States)

    Hung, Yu-Ju; Shih, Tiffany T-F; Chen, Bang-Bin; Hwang, Yaw-Huei; Ma, Li-Ping; Huang, Wen-Chuan; Liou, Saou-Hsing; Ho, Ing-Kang; Guo, Yue L

    2014-11-01

    Lumbar disk degeneration (LDD) has been related to heavy physical loading. However, the quantification of the exposure has been controversial, and the dose-response relationship with the LDD has not been established. The purpose of this study was to investigate the dose-response relationship between lifetime cumulative lifting load and LDD. This was a cross-sectional study. Every participant received assessments with a questionnaire, magnetic resonance imaging (MRI) of the lumbar spine, and estimation of lumbar disk compression load. The MRI assessments included assessment of disk dehydration, annulus tear, disk height narrowing, bulging, protrusion, extrusion, sequestration, degenerative and spondylolytic spondylolisthesis, foramina narrowing, and nerve root compression on each lumbar disk level. The compression load was predicted using a biomechanical software system. A total of 553 participants were recruited in this study and categorized into tertiles by cumulative lifting load (ie, lifting load. The best dose-response relationships were found at the L5-S1 disk level, in which high cumulative lifting load was associated with elevated odds ratios of 2.5 (95% confidence interval [95% CI]=1.5, 4.1) for dehydration and 4.1 (95% CI=1.9, 10.1) for disk height narrowing compared with low lifting load. Participants exposed to intermediate lifting load had an increased odds ratio of 2.1 (95% CI=1.3, 3.3) for bulging compared with low lifting load. The tests for trend were significant. There is no "gold standard" assessment tool for measuring the lumbar compression load. The results suggest a dose-response relationship between cumulative lifting load and LDD. © 2014 American Physical Therapy Association.

  16. Association of cumulative dose of haloperidol with next-day delirium in older medical ICU patients.

    Science.gov (United States)

    Pisani, Margaret A; Araujo, Katy L B; Murphy, Terrence E

    2015-05-01

    To evaluate the association between cumulative dose of haloperidol and next-day diagnosis of delirium in a cohort of older medical ICU patients, with adjustment for its time-dependent confounding with fentanyl and intubation. Prospective, observational study. Medical ICU at an urban, academic medical center. Age 60 years and older admitted to the medical ICU who received at least one dose of haloperidol (n = 93). Of these, 72 patients were intubated at some point in their medical ICU stay, whereas 21 were never intubated. None. Detailed data were collected concerning time, dosage, route of administration of all medications, as well as for important clinical covariates, and daily status of intubation and delirium using the confusion assessment method for the ICU and a chart-based algorithm. Among nonintubated patients, and after adjustment for time-dependent confounding and important covariates, each additional cumulative milligram of haloperidol was associated with 5% higher odds of next-day delirium with odds ratio of 1.05 (credible interval [CI], 1.02-1.09). After adjustment for time-dependent confounding and covariates, intubation was associated with a five-fold increase in odds of next-day delirium with odds ratio of 5.66 (CI, 2.70-12.02). Cumulative dose of haloperidol among intubated patients did not change their already high likelihood of next-day delirium. After adjustment for time-dependent confounding, the positive associations between indicators of intubation and of cognitive impairment and next-day delirium became stronger. These results emphasize the need for more studies regarding the efficacy of haloperidol for treatment of delirium among older medical ICU patients and demonstrate the value of assessing nonintubated patients.

  17. A personal radio-frequency dosimeter with cumulative-dose recording capabilities

    International Nuclear Information System (INIS)

    Rochelle, R.W.; Moore, M.R.; Thomas, R.S.; Ewing, P.D.; Hess, R.A.; Hoffheins, B.S.

    1990-01-01

    The radio-frequency (rf) dosimeter developed by the Oak Ridge National Laboratory is a portable, pocket-sized cumulative-dose recording device designed to detect and record the strengths and durations of electric fields present in the work areas of naval vessels. The device measures an integrated dose and records the electric fields that exceed the permissible levels set by the American National Standards Institute. Features of the rf dosimeter include a frequency range of 30 MHz to 10 GHz and a three-dimensional sensor. Data obtained with the rf dosimeter will be used to determine the ambient field-strength profile for shipboard personnel over an extended time. Readings are acquired and averaged over a 6-min period corresponding to the rise time of the core body temperature. These values are stored for up to 6 months, after which the data are transferred to a computer via the dosimeter's serial port. The rf dosimeter should increase knowledge of the levels of electric fields to which individuals are exposed. 13 refs., 16 figs., 2 tabs

  18. Applicability of the tissue stem cell turnover concept on the validity of cumulative dose based radiation risk evaluation

    International Nuclear Information System (INIS)

    Otsuka, Kensuke; Hamada, Nobuyuki; Iwasaki, Toshiyasu; Yoshida, Kazuo

    2011-01-01

    The radiation protection system adopts the linear no-threshold model to achieve proper radiation protection for considering cancer risks resulting from radiation exposure. This model uses cumulative dose to a tissue for risk evaluation in which cumulative dose is related to the amount of DNA damage and consequential induction of gene mutation. In this concept, gene mutation accumulates in tissue stem cells, the putative target of carcinogenesis, with total dose given to the tissue. Unlike high-dose-rate exposure, epidemiological studies in high radiation background areas, such as Kerala in India, revealed that cancer risks is not elevated by the dose to the inhabitants, suggesting that there exists some mechanisms to eliminate the damage/mutation in the exposed tissue under extremely low-dose-rate exposure situations. In this report, the dynamics of tissue stem cell turnover is evaluated as a possible mechanism under extremely low-dose-rate exposure situations. To this end, we reviewed recent literatures studying tissue stem cell turnover, and found that great advances in stem cell research have made it possible to trace a fate of stem cells in tissues. Furthermore, turnover of tissue stem cells is found to occur after irradiation, due to competition of stem cells within tissues. This raises a possibility that radiation effects may not accumulate in a tissue depending on the dose-rate and duration of exposure period. (author)

  19. Cumulative total effective whole-body radiation dose in critically ill patients.

    Science.gov (United States)

    Rohner, Deborah J; Bennett, Suzanne; Samaratunga, Chandrasiri; Jewell, Elizabeth S; Smith, Jeffrey P; Gaskill-Shipley, Mary; Lisco, Steven J

    2013-11-01

    Uncertainty exists about a safe dose limit to minimize radiation-induced cancer. Maximum occupational exposure is 20 mSv/y averaged over 5 years with no more than 50 mSv in any single year. Radiation exposure to the general population is less, but the average dose in the United States has doubled in the past 30 years, largely from medical radiation exposure. We hypothesized that patients in a mixed-use surgical ICU (SICU) approach or exceed this limit and that trauma patients were more likely to exceed 50 mSv because of frequent diagnostic imaging. Patients admitted into 15 predesignated SICU beds in a level I trauma center during a 30-day consecutive period were prospectively observed. Effective dose was determined using Huda's method for all radiography, CT imaging, and fluoroscopic examinations. Univariate and multivariable linear regressions were used to analyze the relationships between observed values and outcomes. Five of 74 patients (6.8%) exceeded exposures of 50 mSv. Univariate analysis showed trauma designation, length of stay, number of CT scans, fluoroscopy minutes, and number of general radiographs were all associated with increased doses, leading to exceeding occupational exposure limits. In a multivariable analysis, only the number of CT scans and fluoroscopy minutes remained significantly associated with increased whole-body radiation dose. Radiation levels frequently exceeded occupational exposure standards. CT imaging contributed the most exposure. Health-care providers must practice efficient stewardship of radiologic imaging in all critically ill and injured patients. Diagnostic benefit must always be weighed against the risk of cumulative radiation dose.

  20. Estimation of organ cumulated activities and absorbed doses on intakes of several 11C labelled radiopharmaceuticals from external measurement with thermoluminescent dosimeters.

    Science.gov (United States)

    Nakamura, T; Hayashi, Y; Watabe, H; Matsumoto, M; Horikawa, T; Fujiwara, T; Ito, M; Yanai, K

    1998-02-01

    We have developed a method for obtaining the cumulated activities in organs from radionuclides, which are injected into the patient in nuclear medicine procedures, by external exposure measurement with thermoluminescent dosimeters (TLDs) which are attached to the patient's body surface close to source organs to obtain information on body-surface doses. As the surface dose is connected to the cumulated activities in source organs through radiation transmission in the human body which can be estimated with the aid of a mathematical phantom, the organ cumulated activities can be obtained by the inverse transform method. The accuracy of this method was investigated by using a water phantom in which several gamma-ray volume sources of known activity were placed to simulate source organs. We then estimated by external measurements the organ cumulated activities and absorbed doses in subjects to whom the radiopharmaceuticals 11C-labelled Doxepin, 11C-labelled YM09151-2 and 11C-labelled Benzotropin were administered in clinical nuclear medicine procedures. The cumulated activities in the brain obtained with TLDs for Doxepin and YM09151-2 are 63.6 +/- 6.2 and 32.1 +/- 12.0 kBq h MBq-1 respectively, which are compared with the respective values of 33.3 +/- 9.9 and 23.9 +/- 6.2 kBq h MBq-1 with direct PET (positron emission tomography) measurements. The agreement between the two methods is within a factor of two. The effective doses of Doxepin, YM09151-2 and Benzotropin are determined as 6.92 x 10(-3), 7.08 x 10(-3) and 7.65 x 10(-3) mSv MBq-1 respectively with the TLD method. This method has great advantages, in that cumulated activities in several organs can be obtained easily with a single procedure, and the measurements of body surface doses are performed simultaneously with the nuclear medicine procedure, as TLDs are too small to interfere with other medical measurements.

  1. Cumulative high doses of inhaled formoterol have less systemic effects in asthmatic children 6-11 years-old than cumulative high doses of inhaled terbutaline.

    Science.gov (United States)

    Kaae, Rikke; Agertoft, Lone; Pedersen, Sören; Nordvall, S Lennart; Pedroletti, Christophe; Bengtsson, Thomas; Johannes-Hellberg, Ingegerd; Rosenborg, Johan

    2004-10-01

    To evaluate high dose tolerability and relative systemic dose potency between inhaled clinically equipotent dose increments of formoterol and terbutaline in children. Twenty boys and girls (6-11 years-old) with asthma and normal ECGs were studied. Ten doses of formoterol (Oxis) 4.5 microg (F4.5) or terbutaline (Bricanyl) 500 microg (T500) were inhaled cumulatively via a dry powder inhaler (Turbuhaler) over 1 h (three patients) or 2.5 h (17 patients) and compared to a day of no treatment, in a randomised, double-blind (active treatments only), crossover trial. Blood pressure (BP), ECG, plasma potassium, glucose, lactate, and adverse events were monitored up to 10 h to assess tolerability and relative systemic dose potency. Formoterol and terbutaline had significant beta2-adrenergic effects on most outcomes. Apart from the effect on systolic BP, QRS duration and PR interval, the systemic effects were significantly more pronounced with terbutaline than with formoterol. Thus, mean minimum plasma potassium, was suppressed from 3.56 (95% confidence interval, CI: 3.48-3.65) mmol l(-1) on the day of no treatment to 2.98 (CI: 2.90-3.08) after 10 x F4.5 and 2.70 (CI: 2.61-2.78) mmol l(-1) after 10 x T500, and maximum Q-Tc (heart rate corrected Q-T interval [Bazett's formula]) was prolonged from 429 (CI: 422-435) ms on the day of no treatment, to 455 (CI: 448-462) ms after 10 x F4.5 and 470 (CI: 463-476) ms after 10 x T500. Estimates of relative dose potency indicated that F4.5 microg had the same systemic activity as the clinically less effective dose of 250 microg terbutaline. The duration of systemic effects differed marginally between treatments. Spontaneously reported adverse events (most frequently tremor) were fewer with formoterol (78% of the children) than with terbutaline (95%). A serious adverse event occurred after inhalation of 45 microg formoterol over the 1 h dosing time, that prompted the extension of dosing time to 2.5 h. Multiple inhalations over 2.5 h of

  2. Estimation of organ cumulated activities and absorbed doses on intakes of several {sup 11}C labelled radiopharmaceuticals from external measurement with thermoluminescent dosimeters

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Takashi; Hayashi, Yoshiharu; Watabe, Hiroshi; Matsumoto, Masaki; Horikawa, Tohru; Fujiwara, Takehiko; Ito, Masatoshi; Yanai, Kazuhiko [Cyclotron and Radioisotope Center, Tohoku University, Aoba, Aramaki, Sendai 980-77 (Japan)

    1998-02-01

    We have developed a method for obtaining the cumulated activities in organs from radionuclides, which are injected into the patient in nuclear medicine procedures, by external exposure measurement with thermoluminescent dosimeters (TLDs) which are attached to the patient's body surface close to source organs to obtain information on body-surface doses. As the surface dose is connected to the cumulated activities in source organs through radiation transmission in the human body which can be estimated with the aid of a mathematical phantom, the organ cumulated activities can be obtained by the inverse transform method. The accuracy of this method was investigated by using a water phantom in which several gamma-ray volume sources of known activity were placed to simulate source organs. We then estimated by external measurements the organ cumulated activities and absorbed doses in subjects to whom the radiopharmaceuticals {sup 11}C-labelled Doxepin, {sup 11}C-labelled YM09151-2 and {sup 11}C-labelled Benzotropin were administered in clinical nuclear medicine procedures. The cumulated activities in the brain obtained with TLDs for Doxepin and YM09151-2 are 63.6{+-}6.2 and 32.1{+-}12.0 kBq h MBq{sup -1} respectively, which are compared with the respective values of 33.3{+-}9.9 and 23.9{+-}6.2 kBq h MBq{sup -1} with direct PET (positron emission tomography) measurements. The agreement between the two methods is within a factor of two. The effective doses of Doxepin, YM09151-2 and Benzotropin are determined as 6.92x10{sup -3}, 7.08x10{sup -3} and 7.65x10{sup -3} mSv MBq{sup -1} respectively with the TLD method. This method has great advantages, in that cumulated activities in several organs can be obtained easily with a single procedure, and the measurements of body surface doses are performed simultaneously with the nuclear medicine procedure, as TLDs are too small to interfere with other medical measurements. (author)

  3. Risk of therapy-related leukaemia and preleukaemia after Hodgkin's disease. Relation to age, cumulative dose of alkylating agents, and time from chemotherapy

    DEFF Research Database (Denmark)

    Pedersen-Bjergaard, J.; Specht, L.; Larsen, S.O.

    1987-01-01

    391 patients treated intensively for Hodgkin's disease were followed for up to 15 years to evaluate the risk of therapy-related acute non-lymphocytic leukaemia (t-ANLL) and preleukaemia. Only two independent factors, patient age and cumulative dose of alkylating agents, were related to the risk...... of t-ANLL. The hazard rate of t-ANLL was roughly proportional to the square of patient age and to the total cumulative dose of alkylating agents. In 320 patients treated with alkylating agents the cumulative risk of t-ANLL increased steadily from 1 year after the start of treatment and reached 13.......0% (SE 3.0) at 10 years after which time there were no further cases. Calculated from cessation of therapy with alkylating agents, however, the cumulative risk curve increased steeply during the first 1-2 years then gradually levelled out and no new cases were observed beyond 7 years. With a 15-year...

  4. Cumulative high doses of inhaled formoterol have less systemic effects in asthmatic children 6–11 years-old than cumulative high doses of inhaled terbutaline

    Science.gov (United States)

    Kaae, Rikke; Agertoft, Lone; Pedersen, Sören; Nordvall, S Lennart; Pedroletti, Christophe; Bengtsson, Thomas; Johannes-Hellberg, Ingegerd; Rosenborg, Johan

    2004-01-01

    Objectives To evaluate high dose tolerability and relative systemic dose potency between inhaled clinically equipotent dose increments of formoterol and terbutaline in children. Methods Twenty boys and girls (6–11 years-old) with asthma and normal ECGs were studied. Ten doses of formoterol (Oxis®) 4.5 µg (F4.5) or terbutaline (Bricanyl®) 500 µg (T500) were inhaled cumulatively via a dry powder inhaler (Turbuhaler®) over 1 h (three patients) or 2.5 h (17 patients) and compared to a day of no treatment, in a randomised, double-blind (active treatments only), crossover trial. Blood pressure (BP), ECG, plasma potassium, glucose, lactate, and adverse events were monitored up to 10 h to assess tolerability and relative systemic dose potency. Results Formoterol and terbutaline had significant β2-adrenergic effects on most outcomes. Apart from the effect on systolic BP, QRS duration and PR interval, the systemic effects were significantly more pronounced with terbutaline than with formoterol. Thus, mean minimum plasma potassium, was suppressed from 3.56 (95% confidence interval, CI: 3.48–3.65) mmol l−1 on the day of no treatment to 2.98 (CI: 2.90–3.08) after 10 × F4.5 and 2.70 (CI: 2.61–2.78) mmol l−1 after 10 × T500, and maximum Q-Tc (heart rate corrected Q-T interval [Bazett's formula]) was prolonged from 429 (CI: 422–435) ms on the day of no treatment, to 455 (CI: 448–462) ms after 10 × F4.5 and 470 (CI: 463–476) ms after 10 × T500. Estimates of relative dose potency indicated that F4.5 µg had the same systemic activity as the clinically less effective dose of 250 µg terbutaline. The duration of systemic effects differed marginally between treatments. Spontaneously reported adverse events (most frequently tremor) were fewer with formoterol (78% of the children) than with terbutaline (95%). A serious adverse event occurred after inhalation of 45 µg formoterol over the 1 h dosing time, that prompted the extension of dosing time to 2.5 h

  5. Cumulative radiation exposure in children with cystic fibrosis.

    LENUS (Irish Health Repository)

    O'Reilly, R

    2010-02-01

    This retrospective study calculated the cumulative radiation dose for children with cystic fibrosis (CF) attending a tertiary CF centre. Information on 77 children with a mean age of 9.5 years, a follow up time of 658 person years and 1757 studies including 1485 chest radiographs, 215 abdominal radiographs and 57 computed tomography (CT) scans, of which 51 were thoracic CT scans, were analysed. The average cumulative radiation dose was 6.2 (0.04-25) mSv per CF patient. Cumulative radiation dose increased with increasing age and number of CT scans and was greater in children who presented with meconium ileus. No correlation was identified between cumulative radiation dose and either lung function or patient microbiology cultures. Radiation carries a risk of malignancy and children are particularly susceptible. Every effort must be made to avoid unnecessary radiation exposure in these patients whose life expectancy is increasing.

  6. Pharmacoepidemiology of opiate use in the neonatal ICU: Increasing cumulative doses and iatrogenic opiate withdrawal.

    Science.gov (United States)

    Lewis, Tamorah; Erfe, Betty Luan; Ezell, Tarrah; Gauda, Estelle

    2015-01-01

    Neonatal intensive care unit (ICU) care involves use of opiates to treat postoperative, ventilated, or chronically ill infants. Opiates provide necessary analgesia and sedation, but the morbidities include prolonged neonatal abstinence syndrome (NAS) and extended length of stay for dose tapering. Our objective was to quantify trends in opiate exposure in a tertiary care NICU. The authors hypothesize that medical opiate exposure and resultant ICU-acquired NAS would increase over time. Retrospective cross-sectional cohort study. Tertiary care NICU. High-risk inborn infants admitted in fiscal years 2003-2004, 2007-2008, and 2010-2011. Average cumulative morphine exposure (all opiate doses converted to morphine equivalents) per time epoch was compared in cohorts of clinically similar infants. Linear regression was used to assess the primary outcome, assessing changes in opiate exposure over time. Sixty-three infants were included in the final analysis. The primary analysis assessing cumulative opiate exposure per infant showed an increase of 134 mg per time epoch (95% CI-12, 279 mg, p-value 0.071). There was a statistically significant increase in the percent of infants with a diagnosis of iatrogenic NAS, increasing from 9 to 35 to 50 percent (p-value 0.012).

  7. Repeat Gamma-Knife Radiosurgery for Refractory or Recurrent Trigeminal Neuralgia with Consideration About the Optimal Second Dose.

    Science.gov (United States)

    Park, Seong-Cheol; Kwon, Do Hoon; Lee, Do Hee; Lee, Jung Kyo

    2016-02-01

    To investigate adequate radiation doses for repeat Gamma Knife radiosurgery (GKS) for trigeminal neuralgia in our series and meta-analysis. Fourteen patients treated by ipsilateral repeat GKS for trigeminal neuralgia were included. Median age of patients was 65 years (range, 28-78), the median target dose, 140-180). Patients were followed a median of 10.8 months (range, 1-151) after the second gamma-knife surgery. Brainstem dose analysis and vote-counting meta-analysis of 19 studies were performed. After the second gamma-knife radiosurgeries, pain was relieved effectively in 12 patients (86%; Barrow Neurological Institute Pain Intensity Score I-III). Post-gamma-knife radiosurgery trigeminal nerve deficits were mild in 5 patients. No serious anesthesia dolorosa was occurred. The second GKS radiation dose ≤ 60 Gy was significantly associated with worse pain control outcome (P = 0.018 in our series, permutation analysis of variance, and P = 0.009 in the meta-analysis, 2-tailed Fisher's exact test). Cumulative dose ≤ 140-150 Gy was significantly associated with poor pain control outcome (P = 0.033 in our series and P = 0.013 in the meta-analysis, 2-tailed Fisher's exact test). A cumulative brainstem edge dose >12 Gy tended to be associated with trigeminal nerve deficit (P = 0.077). Our study suggests that the second GKS dose is a potentially important factor. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Dose dependency of the frequency of micronucleated binucleated clone cells and of division related median clone sizes difference. Pt. 2

    International Nuclear Information System (INIS)

    Hagemann, G,; Kreczik, A.; Treichel, M.

    1996-01-01

    Following irradiation of the progenitor cells the clone growth of CHO cells decreases as a result of cell losses. Lethally acting expressions of micronuclei are produced by heritable lethal mutations. The dependency of the frequency of micronucleated binucleated clone cells and of the median clone sizes difference on the radiation dose was measured and compared to non-irradiated controls. Using the cytokinesis-block-micronucleus-method binucleated cells with micronuclei were counted as ratio of all binucleated cells within a clone size distribution. This ratio (shortened: micronucleus yield) was determined for all clone size distributions, which had been exposed to different irradiation doses and incubation times. The micronucleus yields were compared to the corresponding median clone sizes differences. The micronucleus yield is linearly dependent on the dose and is independent of the incubation time. The same holds true for the division related median clone sizes difference, which as a result is also linearly dependent on the micronucleus yield. Due to the inevitably errors of the cell count of micronucleated binucleated cells, an automatic measurement of the median clone sizes differences is the preferred method for evaluation of cellular radiation sensitivity for heritable lethal mutations. This value should always be determined in addition, if clone survival fractions are used as predictive test because it allows for an estimation of the remission probability of surviving cells. (orig.) [de

  9. A study of the relationship between peak skin dose and cumulative air kerma in interventional neuroradiology and cardiology

    International Nuclear Information System (INIS)

    Neil, S; Padgham, C; Martin, C J

    2010-01-01

    A study of peak skin doses (PSDs) during neuroradiology and cardiology interventional procedures has been carried out using Gafchromic XR-RV2 film. Use of mosaics made from squares held in cling film has allowed doses to the head to be mapped successfully. The displayed cumulative air kerma (CAK) has been calibrated in terms of cumulative entrance surface dose (CESD) and results indicate that this can provide a reliable indicator of the PSD in neuroradiology. Results linking PSD to CESD for interventional cardiology were variable, but CAK is still considered to provide the best option for use as an indicator of potential radiation-induced effects. A CESD exceeding 3 Gy is considered a suitable action level for triggering follow-up of patients in neuroradiology and cardiology for possible skin effects. Application of dose action levels defined in this way would affect 8% of neurological embolisation procedures and 5% of cardiology ablation and multiple stent procedures at the hospitals where the investigations were carried out. A close relationship was observed between CESD and dose-area product (DAP) for particular types of procedure, and DAPs of 200-300 Gy cm 2 could be used as trigger levels where CAK readings were not available. The DAP value would depend on the mean field size and would need to be determined for each application.

  10. Estimated cumulative radiation dose from PET/CT in children with malignancies: a 5-year retrospective review

    International Nuclear Information System (INIS)

    Chawla, Soni C.; Federman, Noah; Zhang, Di; Nagata, Kristen; Nuthakki, Soujanya; McNitt-Gray, Michael; Boechat, M.I.

    2010-01-01

    The increasing use of serial PET/CT scans in the management of pediatric malignancies raises the important consideration of radiation exposure in children. To estimate the cumulative radiation dose from PET/CT studies to children with malignancy and to compare with the data in literature. Two hundred forty-eight clinical PET/CT studies performed on 78 patients (50 boys/28 girls, 1.3 to 18 years old from December 2002 to October 2007) were retrospectively reviewed under IRB approval. The whole-body effective dose (ED) estimates for each child were obtained by estimating the effective dose from each PET/CT exam performed using the ImPACT Patient Dosimetry Calculator for CT and OLINDA for PET. The average number of PET/CT studies was 3.2 per child (range: 1 to 14 studies). The average ED of an individual CT study was 20.3 mSv (range: 2.7 to 54.2), of PET study was 4.6 mSv (range: 0.4 to 7.7) and of PET/CT study was 24.8 mSv (range: 6.2 to 60.7). The average cumulative radiation dose per patient from CT studies was 64.4 mSv (range: 2.7 to 326), from PET studies was 14.5 mSv (range: 2.8 to 73) and from PET/CT studies was 78.9 mSv (range: 6.2 to 399). The radiation exposure from serial PET/CT studies performed in pediatric malignancies was considerable; however, lower doses can be used for both PET and CT studies. The ALARA principle must be applied without sacrificing diagnostic information. (orig.)

  11. Dose-Response Relationship between Cumulative Occupational Lead Exposure and the Associated Health Damages: A 20-Year Cohort Study of a Smelter in China.

    Science.gov (United States)

    Wu, Yue; Gu, Jun-Ming; Huang, Yun; Duan, Yan-Ying; Huang, Rui-Xue; Hu, Jian-An

    2016-03-16

    Long-term airborne lead exposure, even below official occupational limits, has been found to cause lead poisoning at higher frequencies than expected, which suggests that China's existing occupational exposure limits should be reexamined. A retrospective cohort study was conducted on 1832 smelting workers from 1988 to 2008 in China. These were individuals who entered the plant and came into continuous contact with lead at work for longer than 3 months. The dose-response relationship between occupational cumulative lead exposure and lead poisoning, abnormal blood lead, urinary lead and erythrocyte zinc protoporphyrin (ZPP) were analyzed and the benchmark dose lower bound confidence limits (BMDLs) were calculated. Statistically significant positive correlations were found between cumulative lead dust and lead fumes exposures and workplace seniority, blood lead, urinary lead and ZPP values. A dose-response relationship was observed between cumulative lead dust or lead fumes exposure and lead poisoning (p lead dust and fumes doses were 0.68 mg-year/m³ and 0.30 mg-year/m³ for lead poisoning, respectively. The BMDLs of workplace airborne lead concentrations associated with lead poisoning were 0.02 mg/m³ and 0.01 mg/m³ for occupational exposure lead dust and lead fume, respectively. In conclusion, BMDLs for airborne lead were lower than occupational exposure limits, suggesting that the occupational lead exposure limits need re-examination and adjustment. Occupational cumulative exposure limits (OCELs) should be established to better prevent occupational lead poisoning.

  12. Method for calculating individual equivalent doses and cumulative dose of population in the vicinity of nuclear power plant site

    International Nuclear Information System (INIS)

    Namestek, L.; Khorvat, D; Shvets, J.; Kunz, Eh.

    1976-01-01

    A method of calculating the doses of external and internal person irradiation in the nuclear power plant vicinity under conditions of normal operation and accident situations has been described. The main difference between the above method and methods used up to now is the use of a new antropomorphous representation of a human body model together with all the organs. The antropomorphous model of human body and its organs is determined as a set of simple solids, coordinates of disposistion of the solids, sizes, masses, densities and composition corresponding the genuine organs. The use of the Monte-Carlo method is the second difference. The results of the calculations according to the model suggested can be used for determination: a critical group of inhabitans under conditions of normal plant operation; groups of inhabitants most subjected to irradiation in the case of possible accident; a critical sector with a maximum collective dose in the case of an accident; a critical radioisotope favouring the greatest contribution to an individual equivalent dose; critical irradiation ways promoting a maximum contribution to individual equivalent doses; cumulative collective doses for the whole region or for a chosen part of the region permitting to estimate a population dose. The consequent method evoluation suggests the development of separate units of the calculationg program, critical application and the selection of input data of physical, plysiological and ecological character and improvement of the calculated program for the separate concrete events [ru

  13. Bone cancer from radium: canine dose response explains data for mice and humans

    International Nuclear Information System (INIS)

    Raabe, O.G.; Book, S.A.; Parks, N.J.

    1980-01-01

    Analysis of lifetime studies of 243 beagles with skeletal burdens of radium-226 shows that the distribution of bone cancers clusters about a linear function of the logarithms of radiation dose rate to the skeleton and time from exposure until death. Similar relations displaced by species-dependent response ratios also provide satisfactory descriptions of the reported data on deaths from primary bone cancers in people and mice exposed to radium-226. The median cumulative doses (or times) leading to death from bone tumors are 2.9 times larger for dogs than for mice and 3.6 times larger for people than for dogs. These response ratios are well correlated with the normal life expectancies. The cumulative radiation dose required to give significant risk of bone cancer is found to be much less at lower dose rates than at higher rates, but the time required for the tumors to be manifested is longer. At low dose rates, this time exceeds the normal life-span and appears as a practical threshold, which for bone cancer is estimated to occur at an average cumulative radiation dose to the skeleton of about 50 to 110 rads for the three species

  14. High-dose-rate brachytherapy in the treatment of uterine cervix cancer. Analysis of dose effectiveness and late complications

    International Nuclear Information System (INIS)

    Ferrigno, Robson; Novaes, Paulo Eduardo Ribeiro dos Santos; Pellizzon, Antonio Cassio Assis; Maia, Maria Aparecida Conte; Fogarolli, Ricardo Cesar; Gentil, Andre Cavalcanti; Salvajoli, Joao Victor

    2001-01-01

    Purpose: This retrospective analysis aims to report results of patients with cervix cancer treated by external beam radiotherapy (EBR) and high-dose-rate (HDR) brachytherapy. Methods and Materials: From September 1992 to December 1996, 138 patients with FIGO Stages II and III and mean age of 56 years were treated. Median EBR to the whole pelvis was 45 Gy in 25 fractions. Parametrial boost was performed in 93% of patients, with a median dose of 14.4 Gy. Brachytherapy with HDR was performed during EBR or following its completion with a dose of 24 Gy in four weekly fractions of 6 Gy to point A. Median overall treatment time was of 60 days. Patient age, tumor stage, and overall treatment time were variables analyzed for survival and local control. Cumulative biologic effective dose (BED) at rectal and bladder reference points were correlated with late complications in these organs and dose of EBR at parametrium was correlated with small bowel complications. Results: Median follow-up time was 38 months. Overall survival, disease-free survival, and local control at 5 years was 53.7%, 52.7%, and 62%, respectively. By multivariate and univariate analysis, overall treatment time up to 50 days was the only statistically significant adverse variable for overall survival (p=0.003) and actuarial local control (p=0.008). The 5-year actuarial incidence of rectal, bladder, and small bowel late complications was 16%, 11%, and 14%, respectively. Patients treated with cumulative BED at rectum points above 110 Gy 3 and at bladder point above 125 Gy 3 had a higher but not statistically significant 5-year actuarial rate of complications at these organs (18% vs. 12%, p=0.49 and 17% vs. 9%, p=0.20, respectively). Patients who received parametrial doses larger than 59 Gy had a higher 5-year actuarial rate of complications in the small bowel; however, this was not statistically significant (19% vs. 10%, p=0.260). Conclusion: This series suggests that 45 Gy to the whole pelvis combined with

  15. Re-irradiation: Outcome, cumulative dose and toxicity in patients retreated with stereotactic radiotherapy in the abdominal or pelvic region

    NARCIS (Netherlands)

    H. Abusaris (Huda); M.S. Hoogeman (Mischa); J.J.M.E. Nuyttens (Joost)

    2012-01-01

    textabstractThe purpose of the present study was to explore the outcome, cumulative dose in tumor and organs at risk and toxicity after extra-cranial stereotactic re-irradiation. Twenty-seven patients were evaluated who had been re-irradiated with stereotactic body radiotherapy (SBRT) after

  16. SU-E-J-106: The Use of Deformable Image Registration with Cone-Beam CT for a Better Evaluation of Cumulative Dose to Organs

    Energy Technology Data Exchange (ETDEWEB)

    Fillion, O; Gingras, L; Archambault, L [Universite Laval, Quebec, Quebec (Canada); Centre de recherche du CHU de Quebec, Quebec, Quebec (Canada); Centre de recherche sur le cancer, Quebec, Quebec (Canada)

    2015-06-15

    Purpose: The knowledge of dose accumulation in the patient tissues in radiotherapy helps in determining the treatment outcomes. This project aims at providing a workflow to map cumulative doses that takes into account interfraction organ motion without the need for manual re-contouring. Methods: Five prostate cancer patients were studied. Each patient had a planning CT (pCT) and 5 to 13 CBCT scans. On each series, a physician contoured the prostate, rectum, bladder, seminal vesicles and the intestine. First, a deformable image registration (DIR) of the pCTs onto the daily CBCTs yielded registered CTs (rCT) . This rCT combined the accurate CT numbers of the pCT with the daily anatomy of the CBCT. Second, the original plans (220 cGy per fraction for 25 fractions) were copied on the rCT for dose re-calculation. Third, the DIR software Elastix was used to find the inverse transform from the rCT to the pCT. This transformation was then applied to the rCT dose grid to map the dose voxels back to their pCT location. Finally, the sum of these deformed dose grids for each patient was applied on the pCT to calculate the actual dose delivered to organs. Results: The discrepancy between the planned D98 and D2 and these indices re-calculated on the rCT, are, on average, of −1 ± 1 cGy and 1 ± 2 cGy per fraction, respectively. For fractions with large anatomical motion, the D98 discrepancy on the re-calculated dose grid mapped onto the pCT can raise to −17 ± 4 cGy. The obtained cumulative dose distributions illustrate the same behavior. Conclusion: This approach allowed the evaluation of cumulative doses to organs with the help of uncontoured daily CBCT scans. With this workflow, the easy evaluation of doses delivered for EBRT treatments could ultimately lead to a better follow-up of prostate cancer patients.

  17. SU-E-J-106: The Use of Deformable Image Registration with Cone-Beam CT for a Better Evaluation of Cumulative Dose to Organs

    International Nuclear Information System (INIS)

    Fillion, O; Gingras, L; Archambault, L

    2015-01-01

    Purpose: The knowledge of dose accumulation in the patient tissues in radiotherapy helps in determining the treatment outcomes. This project aims at providing a workflow to map cumulative doses that takes into account interfraction organ motion without the need for manual re-contouring. Methods: Five prostate cancer patients were studied. Each patient had a planning CT (pCT) and 5 to 13 CBCT scans. On each series, a physician contoured the prostate, rectum, bladder, seminal vesicles and the intestine. First, a deformable image registration (DIR) of the pCTs onto the daily CBCTs yielded registered CTs (rCT) . This rCT combined the accurate CT numbers of the pCT with the daily anatomy of the CBCT. Second, the original plans (220 cGy per fraction for 25 fractions) were copied on the rCT for dose re-calculation. Third, the DIR software Elastix was used to find the inverse transform from the rCT to the pCT. This transformation was then applied to the rCT dose grid to map the dose voxels back to their pCT location. Finally, the sum of these deformed dose grids for each patient was applied on the pCT to calculate the actual dose delivered to organs. Results: The discrepancy between the planned D98 and D2 and these indices re-calculated on the rCT, are, on average, of −1 ± 1 cGy and 1 ± 2 cGy per fraction, respectively. For fractions with large anatomical motion, the D98 discrepancy on the re-calculated dose grid mapped onto the pCT can raise to −17 ± 4 cGy. The obtained cumulative dose distributions illustrate the same behavior. Conclusion: This approach allowed the evaluation of cumulative doses to organs with the help of uncontoured daily CBCT scans. With this workflow, the easy evaluation of doses delivered for EBRT treatments could ultimately lead to a better follow-up of prostate cancer patients

  18. Aortic dose constraints when reirradiating thoracic tumors

    International Nuclear Information System (INIS)

    Evans, Jaden D.; Gomez, Daniel R.; Amini, Arya; Rebueno, Neal; Allen, Pamela K.; Martel, Mary K.; Rineer, Justin M.; Ang, Kie Kian; McAvoy, Sarah; Cox, James D.; Komaki, Ritsuko; Welsh, James W.

    2013-01-01

    Background and purpose: Improved radiation delivery and planning has allowed, in some instances, for the retreatment of thoracic tumors. We investigated the dose limits of the aorta wherein grade 5 aortic toxicity was observed after reirradiation of lung tumors. Material and methods: In a retrospective analysis, 35 patients were identified, between 1993 and 2008, who received two rounds of external beam irradiation that included the aorta in the radiation fields of both the initial and retreatment plans. We determined the maximum cumulative dose to 1 cm 3 of the aorta (the composite dose) for each patient, normalized these doses to 1.8 Gy/fraction, and corrected them for long-term tissue recovery between treatments (NID R ). Results: The median time interval between treatments was 30 months (range, 1–185 months). The median follow-up of patients alive at analysis was 42 months (range, 14–70 months). Two of the 35 patients (6%) were identified as having grade 5 aortic toxicities. There was a 25% rate of grade 5 aortic toxicity for patients receiving composite doses ⩾120.0 Gy (vs. 0% for patients receiving R ⩾90.0 Gy) to 1 cm 3 of the aorta

  19. Synergistic effect of cumulative corticosteroid dose and immunosuppressants on avascular necrosis in patients with systemic lupus erythematosus.

    Science.gov (United States)

    Kwon, H H; Bang, S Y; Won, S; Park, Y; Yi, J H; Joo, Y B; Lee, H S; Bae, S C

    2018-01-01

    Objectives Avascular necrosis (AVN) is one of the most common causes of organ damage in patients with systemic lupus erythematosus (SLE) and often causes serious physical disability. The aims of this study were to investigate clinical risk factors associated with symptomatic AVN and to analyze their synergistic effects in a large SLE cohort in Korea. Methods Patients with SLE were enrolled and followed from 1998 to 2014 in the Hanyang BAE Lupus cohort, and damage was measured annually according to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). AVN was confirmed by imaging study if patients had symptoms. To determine risk factors for AVN, clinical, laboratory and therapeutic variables were analyzed by logistic regression. Relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S) were calculated to measure interactions between significant variables. Results Among 1219 SLE patients, symptomatic AVN was the most common type of musculoskeletal damage (10.8%, n = 132). SLE patients with AVN showed an earlier onset age, demonstrated AVN more commonly in conjunction with certain other clinical manifestations such as renal and neuropsychiatric disorders, and received significantly higher total cumulative corticosteroid dose and immunosuppressive agents than did patients without AVN. However, in multivariable analysis, only two variables including use of a cumulative corticosteroid dose greater than 20 g (odds ratio (OR) 3.62, p = 0.015) and use of immunosuppressants including cyclophosphamide or mycophenolate mofetil (OR 4.51, p AVN. Patients with cumulative corticosteroid dose > 20 g and immunosuppressant use had a 15.44-fold increased risk for AVN, compared with patients without these risk factors ( p AVN in our Korean lupus cohort. Conclusions An individual risk assessment for AVN development should be made prior to and during treatment for SLE

  20. Relationship of cumulative low-level dose of ionizing radiation on human eye lens and occurrence of cataract

    International Nuclear Information System (INIS)

    Deolalikar, Raghavendra

    2015-01-01

    International Commission on Radiological Protection (ICRP), issued a statement on Tissue Reaction, lowering the equivalent dose limit for eye lens for occupational exposure to 20 mSv per year. With a view to determine presence of any relationship between the cumulative low-level occupational radiation dose to the eye lens and occurrence of cataract, departmental records of the annual medical examination of employees of Narora Atomic Power Plant were examined along with the NAPS eye camps and surgical records of the employees. Analysis of the data showed no demonstrable definite relationship between the two. The analysis of the data and the observations are discussed in this paper. (author)

  1. Negative impact of high cumulative glucocorticoid dose on bone metabolism of patients with myasthenia gravis.

    Science.gov (United States)

    Braz, Nayara Felicidade Tomaz; Rocha, Natalia Pessoa; Vieira, Érica Leandro Marciano; Gomez, Rodrigo Santiago; Barbosa, Izabela Guimarães; Malheiro, Olívio Brito; Kakehasi, Adriana Maria; Teixeira, Antonio Lucio

    2017-08-01

    This current study aimed to evaluate the frequency of low bone mass, osteopenia, and osteoporosis in patients with myasthenia gravis (MG) and to investigate the possible association between bone mineral density (BMD) and plasma levels of bone metabolism markers. Eighty patients with MG and 62 controls BMD were measured in the right femoral neck and lumbar spine by dual-energy X-ray absorptiometry. Plasma concentrations of osteocalcin, osteopontin, osteoprotegerin, tumor necrosis factor (TNF-α), interleukin (IL)-1β, IL-6, dickkopf (DKK-1), sclerostin, insulin, leptin, adrenocorticotropic hormone, parathyroid hormone, and fibroblast growth factor (FGF-23) were analyzed by Luminex®. The mean age of patients was 41.9 years, with 13.5 years of length of illness, and a mean cumulative dose of glucocorticoids 38,123 mg. Patients had significant reduction in BMD of the lumbar, the femoral neck, and in the whole body when compared with controls. Fourteen percent MG patients had osteoporosis at the lumbar spine and 2.5% at the femoral neck. In comparison with controls, patients with MG presented lower levels of osteocalcin, adrenocorticotropic hormone, parathyroid hormone, sclerostin, TNF-α, and DKK-1 and higher levels of FGF-23, leptin, and IL-6. There was a significant negative correlation between cumulative glucocorticoid dose and serum calcium, lumbar spine T-score, femoral neck BMD, T-score, and Z-score. After multivariate analysis, higher TNF-α levels increased the likelihood of presenting low bone mass by 2.62. MG patients under corticotherapy presented low BMD and altered levels of bone markers.

  2. Measurement of radiocesium concentration in trees using cumulative gamma radiation dose rate detection systems - A simple presumption for radiocesium concentration in living woods using glass-badge based gamma radiation dose rate detection system

    Energy Technology Data Exchange (ETDEWEB)

    Yoshihara, T.; Hashida, S.N. [Plant Molecular Biology, Laboratory of Environmental Science, Central Research Institute of Electric Power Industry (CRIEPI), 1646 Abiko, Chiba 270-1194 (Japan); Kawachi, N.; Suzui, N.; Yin, Y.G.; Fujimaki, S. [Radiotracer Imaging Gr., Quantum Beam Science Center, Japan Atomic Energy Agency (JAEA), 1233 Watanuki, Takasaki, Gunma 370-1292 (Japan); Nagao, Y.; Yamaguchi, M. [Takasaki Advanced Radiation Research Institute, Japan Atomic Energy Agency (JAEA), 1233 Watanuki, Takasaki, Gunma 370-1292 (Japan)

    2014-07-01

    Radiocesium from the severe accident at the Fukushima Dai-ichi Nuclear Power Plant on 11 March 2011 contaminates large areas. After this, a doubt for forest products, especially of mushroom, is indelible at the areas. Pruned woody parts and litters are containing a considerable amount of radiocesium, and generates a problem at incineration and composting. These mean that more attentive survey for each subject is expected; however, the present survey system is highly laborious/expensive and/or non-effective for this purpose. On the other hand, we can see a glass-badge based gamma radiation dose rate detection system. This system always utilized to detect a personal cumulative radiation dose, and thus, it is not suitable to separate a radiation from a specific object. However, if we can separate a radiation from a specific object and relate it with the own radiocesium concentration, it would enable us to presume the specific concentration with just an easy monitoring but without a destruction of the target nature and a complicated process including sampling, pre-treatment, and detection. Here, we present the concept of the measurement and results of the trials. First, we set glass-badges (type FS, Chiyoda Technol Corp., Japan) on a part of bough (approximately 10 cm in diameter) of Japanese flowering cherry trees (Prunus x yedoensis cv. Somei-Yoshino) with four different settings: A, a direct setting without any shield; B, a setting with an aluminum shield between bough and the glass-badge; C, a setting with a lead shield between bough and the glass-badge; D, a setting with a lead shield covering the glass-badge to shut the radiation from the surrounding but from bough. The deduction between the amount of each setting should separate a specific radiation of the bough from unlimited radiation from the surrounding. Even if the hourly dose rate is not enough to count the difference, a moderate cumulative dose would clear the difference. In fact, results demonstrated a

  3. An assessment of cumulative external doses from Chernobyl fallout for a forested area in Russia using the optically stimulated luminescence from quartz inclusions in bricks

    DEFF Research Database (Denmark)

    Ramzaev, V.; Bøtter-Jensen, Lars; Thomsen, Kristina Jørkov

    2008-01-01

    . The area was significantly contaminated by Chernobyl fallout with initial (CS)-C-137 ground deposition level of similar to 1.1 MBq m(-2). The accumulated OSL doses in sections of the bricks varied from 141 to 207 mGy, of which between 76 and 146 mGy are attributable to Chernobyl fallout. Using the OSL...... depth-dose profiles obtained from the exposed bricks and the results from a gamma-ray-survey of the area, the Chernobyl-related cumulative gamma-ray dose for a point detector located in free air at a height of 1 m above the ground in the study area was estimated to be ca. 240 mGy for the time period...... starting on 27 April 1986 and ending on 31 July 2004. This result is in good agreement with the result of deterministic modelling of the cumulative gamma-ray dose in free air above undisturbed ground from the Chernobyl source in the Bryansk Region. Over the same time period, the external Chernobyl...

  4. Cumulative Lung Dose for Several Motion Management Strategies as a Function of Pretreatment Patient Parameters

    International Nuclear Information System (INIS)

    Hugo, Geoffrey D.; Campbell, Jonathon; Zhang Tiezhi; Yan Di

    2009-01-01

    Purpose: To evaluate patient parameters that may predict for relative differences in cumulative four-dimensional (4D) lung dose among several motion management strategies. Methods and Materials: Deformable image registration and dose accumulation were used to generate 4D treatment plans for 18 patients with 4D computed tomography scans. Three plans were generated to simulate breath hold at normal inspiration, target tracking with the beam aperture, and mid-ventilation aperture (control of the target at the mean daily position and application of an iteratively computed margin to compensate for respiration). The relative reduction in mean lung dose (MLD) between breath hold and mid-ventilation aperture (ΔMLD BH ) and between target tracking and mid-ventilation aperture (ΔMLD TT ) was calculated. Associations between these two variables and parameters of the lesion (excursion, size, location, and deformation) and dose distribution (local dose gradient near the target) were also calculated. Results: The largest absolute and percentage differences in MLD were 1.0 Gy and 21.5% between breath hold and mid-ventilation aperture. ΔMLD BH was significantly associated (p TT was significantly associated with excursion, deformation, and local dose gradient. A linear model was constructed to represent ΔMLD vs. excursion. For each 5 mm of excursion, target tracking reduced the MLD by 4% compared with the results of a mid-ventilation aperture plan. For breath hold, the reduction was 5% per 5 mm of excursion. Conclusions: The relative difference in MLD among different motion management strategies varied with patient and tumor characteristics for a given dosimetric target coverage. Tumor excursion is useful to aid in stratifying patients according to appropriate motion management strategies.

  5. Successful Desensitization of T cell Flow Cytometry Crossmatch Positive Renal Transplant Recipients Using Plasmapheresis and Super High-Dose Intravenous Immunoglobulin

    Directory of Open Access Journals (Sweden)

    Yoichi Kakuta, MD, PhD

    2018-01-01

    Full Text Available Background. High-dose IVIG (2 g/kg alone or low-dose IVIG (100 mg/kg in conjunction with plasma exchange is typically administered as a renal transplantation desensitization therapy. Herein, we monitored changes in T cell and B cell flow cytometry crossmatch (FCXM to assess the effects of short-term super high-dose IVIG (4 g/kg administration with plasmapheresis before living-donor renal transplantation. Methods. Seventeen patients, each showing positive T cell FCXM (median ratio, ≥ 1.4 after 2 rounds of double-filtration plasmapheresis, received 4-day regimens of IVIG (1 g/kg per day over 1-week periods. T cell and B cell FCXM determinations were obtained after every IVIG dose and again up to 4 weeks after initiating IVIG to ascertain negative conversion of T cell FCXM (median ratio < 1.4. The primary study endpoint was the percentage of patients achieving T cell FCXM-negative status after the 4-dose IVIG regimen. Results. Upon completion (4 g/kg total or discontinuation of IVIG administration, 8 (47.1% of 17 patients displayed negative T cell FCXM. Based on Kaplan-Meier estimates, the cumulative T cell FCXM-negative conversion rate 4 weeks after IVIG administration initiation was 60.3%. The T cell FCXM-negative conversion rates after cumulative doses of 1, 2, 3, and 4 g/kg IVIG were 29.4%, 35.3%, 56.3%, and 46.7%, respectively. Conclusions. Desensitization of donor-specific antibody-positive renal transplant recipients seems achievable in only a subset of recipients through IVIG dosing (1 g/kg × 4 within 1 week after double-filtration plasmapheresis. The T cell FCXM-negative conversion rate resulting from a cumulative IVIG dose of 3 g/kg or greater surpassed that attained via conventional single-dose IVIG (2 g/kg protocol. This short-term high-dose IVIG desensitization protocol may be an alternative to conventional protocols for recipients with donor-specific antibody.

  6. Direct measurement of a patient's entrance skin dose during pediatric cardiac catheterization

    International Nuclear Information System (INIS)

    Sun, Lue; Mizuno, Yusuke; Goto, Takahisa; Iwamoto, Mari; Koguchi, Yasuhiro; Miyamoto, Yuka; Tsuboi, Koji; Chida, Koichi; Moritake, Takashi

    2014-01-01

    Children with complex congenital heart diseases often require repeated cardiac catheterization; however, children are more radiosensitive than adults. Therefore, radiation-induced carcinogenesis is an important consideration for children who undergo those procedures. We measured entrance skin doses (ESDs) using radio-photoluminescence dosimeter (RPLD) chips during cardiac catheterization for 15 pediatric patients (median age, 1.92 years; males, n = 9; females, n = 6) with cardiac diseases. Four RPLD chips were placed on the patient's posterior and right side of the chest. Correlations between maximum ESD and dose-area products (DAP), total number of frames, total fluoroscopic time, number of cine runs, cumulative dose at the interventional reference point (IRP), body weight, chest thickness, and height were analyzed. The maximum ESD was 80 ± 59 (mean ± standard deviation) mGy. Maximum ESD closely correlated with both DAP (r = 0.78) and cumulative dose at the IRP (r = 0.82). Maximum ESD for coiling and ballooning tended to be higher than that for ablation, balloon atrial septostomy, and diagnostic procedures. In conclusion, we directly measured ESD using RPLD chips and found that maximum ESD could be estimated in real-time using angiographic parameters, such as DAP and cumulative dose at the IRP. Children requiring repeated catheterizations would be exposed to high radiation levels throughout their lives, although treatment influences radiation dose. Therefore, the radiation dose associated with individual cardiac catheterizations should be analyzed, and the effects of radiation throughout the lives of such patients should be followed. (author)

  7. Duration of symptomatology and median segmental sensory latency in 993 carpal tunnel syndrome hands (668 cases

    Directory of Open Access Journals (Sweden)

    KOUYOUMDJIAN JOAO ARIS

    1999-01-01

    Full Text Available According to median sensory nerve action potential onset-latency to index finger in a 140 mm fixed distance, 993 carpal tunnel syndrome (CTS hands from 668 patients were grouped into MIld (3.0 to 3.5 ms, 384 hands, MOderate (3.6 to 4.4 ms, 332 hands, SEvere (> 4.4 ms, 135 hands and UNrecordable (142 hands and correlated with CTS symptomatology duration. All patients have sensory antidromic median-radial latency difference (MRD e > or = 1.0 ms without any doubt about CTS diagnosis. Patients with systemic disease, trauma or previous surgery were excluded. There is a remarkable cumulative percentage increase from 1 to 12 months in group UN (3.5% to 38.7%, 11 folds, much less than the group MI (13.8% to 54.6%, 3.9 folds. There is also a remarkable non-cumulative percentage increase in group UN, from 1 to 4-12 months; the group MI had a relatively uniform distribution in all symptomatic duration groups from 1 to > 60 months. The conclusion is that median nerve compression at carpal tunnel can lead to unrecordable potentials in a relatively short period from 1 to 12 months of evolution, suggesting acute/subacute deterioration. Electrophysiological evaluation must be done periodically in patients that underwent clinical treatment, since cumulative 38.7% of group UN was found in 12 months period.

  8. Median effective dose of isoflurane, sevoflurane, and desflurane in green iguanas.

    Science.gov (United States)

    Barter, Linda S; Hawkins, Michelle G; Brosnan, Robert J; Antognini, Joseph F; Pypendop, Bruno H

    2006-03-01

    To determine the median effective dose (ED(50); equivalent to the minimum alveolar concentration [MAC]) of isoflurane, sevoflurane, and desflurane for anesthesia in iguanas. 6 healthy adult green iguanas. In unmedicated iguanas, anesthesia was induced and maintained with each of the 3 volatile drugs administered on separate days according to a Latin square design. Iguanas were endotracheally intubated, mechanically ventilated, and instrumented for cardiovascular and respiratory measurements. During each period of anesthesia, MAC was determined in triplicate. The mean value of 2 consecutive expired anesthetic concentrations, 1 that just permitted and 1 that just prevented gross purposeful movement in response to supramaximal electrical stimulus, and that were not different by more than 15%, was deemed the MAC. Mean +/- SD values for the third MAC determination for isoflurane, sevoflurane, and desflurane were 1.8 +/- 0.3%, 3.1 +/- 1.0%, and 8.9 +/- 2.1% of atmospheric pressure, respectively. The MAC for all inhaled agents was, on average, 22% greater for the first measurement than for the third measurement. Over time, MACs decreased for all 3 agents. Final MAC measurements were similar to values reported for other species. The decrease in MACs over time may be at least partly explained by limitations of anesthetic uptake and distribution imposed by the reptilian cardiorespiratory system. Hence, for a constant end-tidal anesthetic concentration in an iguana, the plane of anesthesia may deepen over time, which could contribute to increased morbidity during prolonged procedures.

  9. ASCENDE-RT: An Analysis of Treatment-Related Morbidity for a Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost with a Dose-Escalated External Beam Boost for High- and Intermediate-Risk Prostate Cancer

    International Nuclear Information System (INIS)

    Rodda, Sree; Tyldesley, Scott; Morris, W. James; Keyes, Mira; Halperin, Ross; Pai, Howard; McKenzie, Michael; Duncan, Graeme; Morton, Gerard; Hamm, Jeremy; Murray, Nevin

    2017-01-01

    Purpose: To report the genitourinary (GU) and gastrointestinal (GI) morbidity and erectile dysfunction in a randomized trial comparing 2 methods of dose escalation for high- and intermediate-risk prostate cancer. Methods and Materials: ASCENDE-RT (Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy) enrolled 398 men, median age 68 years, who were then randomized to either a standard arm that included 12 months of androgen deprivation therapy and pelvic irradiation to 46 Gy followed by a dose-escalated external beam radiation therapy (DE-EBRT) boost to 78 Gy, or an experimental arm that substituted a low-dose-rate prostate brachytherapy (LDR-PB) boost. At clinic visits, investigators recorded GU and GI morbidity and information on urinary continence, catheter use, and erectile function. Exclusion of 15 who received nonprotocol treatment and correction of 14 crossover events left 195 men who actually received a DE-EBRT boost and 188, an LDR-PB boost. Median follow-up was 6.5 years. Results: The LDR-PB boost increased the risk of needing temporary catheterization and/or requiring incontinence pads. At 5 years the cumulative incidence of grade 3 GU events was 18.4% for LDR-PB, versus 5.2% for DE-EBRT (P<.001). Compared with the cumulative incidence, the 5-year prevalence of grade 3 GU morbidity was substantially lower for both arms (8.6% vs 2.2%, P=.058). The 5-year cumulative incidence of grade 3 GI events was 8.1% for LDR-PB, versus 3.2% for DE-EBRT (P=.124). The 5-year prevalence of grade 3 GI toxicity was lower than the cumulative incidence for both arms (1.0% vs 2.2%, respectively). Among men reporting adequate baseline erections, 45% of LDR-PB patients reported similar erectile function at 5 years, versus 37% after DE-EBRT (P=.30). Conclusions: The incidence of acute and late GU morbidity was higher after LDR-PB boost, and there was a nonsignificant trend for worse GI morbidity. No differences in the frequency of

  10. ASCENDE-RT: An Analysis of Treatment-Related Morbidity for a Randomized Trial Comparing a Low-Dose-Rate Brachytherapy Boost with a Dose-Escalated External Beam Boost for High- and Intermediate-Risk Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Rodda, Sree [British Columbia (BC) Cancer Agency, Vancouver Centre, Vancouver, British Columbia (Canada); Tyldesley, Scott [British Columbia (BC) Cancer Agency, Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Morris, W. James, E-mail: jmorris@bccancer.bc.ca [British Columbia (BC) Cancer Agency, Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Keyes, Mira [British Columbia (BC) Cancer Agency, Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Halperin, Ross [Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); BC Cancer Agency, Centre for the Southern Interior, Kelowna, British Columbia (Canada); Pai, Howard [Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); BC Cancer Agency, Vancouver Island Centre, Victoria, British Columbia (Canada); McKenzie, Michael; Duncan, Graeme [British Columbia (BC) Cancer Agency, Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Morton, Gerard [Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Hamm, Jeremy [Department of Population Oncology, BC Cancer Agency, Vancouver, British Columbia (Canada); Murray, Nevin [British Columbia (BC) Cancer Agency, Vancouver Centre, Vancouver, British Columbia (Canada); Department of Medicine, University of British Columbia, Vancouver, British Columbia (Canada)

    2017-06-01

    Purpose: To report the genitourinary (GU) and gastrointestinal (GI) morbidity and erectile dysfunction in a randomized trial comparing 2 methods of dose escalation for high- and intermediate-risk prostate cancer. Methods and Materials: ASCENDE-RT (Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy) enrolled 398 men, median age 68 years, who were then randomized to either a standard arm that included 12 months of androgen deprivation therapy and pelvic irradiation to 46 Gy followed by a dose-escalated external beam radiation therapy (DE-EBRT) boost to 78 Gy, or an experimental arm that substituted a low-dose-rate prostate brachytherapy (LDR-PB) boost. At clinic visits, investigators recorded GU and GI morbidity and information on urinary continence, catheter use, and erectile function. Exclusion of 15 who received nonprotocol treatment and correction of 14 crossover events left 195 men who actually received a DE-EBRT boost and 188, an LDR-PB boost. Median follow-up was 6.5 years. Results: The LDR-PB boost increased the risk of needing temporary catheterization and/or requiring incontinence pads. At 5 years the cumulative incidence of grade 3 GU events was 18.4% for LDR-PB, versus 5.2% for DE-EBRT (P<.001). Compared with the cumulative incidence, the 5-year prevalence of grade 3 GU morbidity was substantially lower for both arms (8.6% vs 2.2%, P=.058). The 5-year cumulative incidence of grade 3 GI events was 8.1% for LDR-PB, versus 3.2% for DE-EBRT (P=.124). The 5-year prevalence of grade 3 GI toxicity was lower than the cumulative incidence for both arms (1.0% vs 2.2%, respectively). Among men reporting adequate baseline erections, 45% of LDR-PB patients reported similar erectile function at 5 years, versus 37% after DE-EBRT (P=.30). Conclusions: The incidence of acute and late GU morbidity was higher after LDR-PB boost, and there was a nonsignificant trend for worse GI morbidity. No differences in the frequency of

  11. Comparison of measured and estimated maximum skin doses during CT fluoroscopy lung biopsies

    Energy Technology Data Exchange (ETDEWEB)

    Zanca, F., E-mail: Federica.Zanca@med.kuleuven.be [Department of Radiology, Leuven University Center of Medical Physics in Radiology, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium and Imaging and Pathology Department, UZ Leuven, Herestraat 49, Box 7003 3000 Leuven (Belgium); Jacobs, A. [Department of Radiology, Leuven University Center of Medical Physics in Radiology, UZ Leuven, Herestraat 49, 3000 Leuven (Belgium); Crijns, W. [Department of Radiotherapy, UZ Leuven, Herestraat 49, 3000 Leuven (Belgium); De Wever, W. [Imaging and Pathology Department, UZ Leuven, Herestraat 49, Box 7003 3000 Leuven, Belgium and Department of Radiology, UZ Leuven, Herestraat 49, 3000 Leuven (Belgium)

    2014-07-15

    Purpose: To measure patient-specific maximum skin dose (MSD) associated with CT fluoroscopy (CTF) lung biopsies and to compare measured MSD with the MSD estimated from phantom measurements, as well as with the CTDIvol of patient examinations. Methods: Data from 50 patients with lung lesions who underwent a CT fluoroscopy-guided biopsy were collected. The CT protocol consisted of a low-kilovoltage (80 kV) protocol used in combination with an algorithm for dose reduction to the radiology staff during the interventional procedure, HandCare (HC). MSD was assessed during each intervention using EBT2 gafchromic films positioned on patient skin. Lesion size, position, total fluoroscopy time, and patient-effective diameter were registered for each patient. Dose rates were also estimated at the surface of a normal-size anthropomorphic thorax phantom using a 10 cm pencil ionization chamber placed at every 30°, for a full rotation, with and without HC. Measured MSD was compared with MSD values estimated from the phantom measurements and with the cumulative CTDIvol of the procedure. Results: The median measured MSD was 141 mGy (range 38–410 mGy) while the median cumulative CTDIvol was 72 mGy (range 24–262 mGy). The ratio between the MSD estimated from phantom measurements and the measured MSD was 0.87 (range 0.12–4.1) on average. In 72% of cases the estimated MSD underestimated the measured MSD, while in 28% of the cases it overestimated it. The same trend was observed for the ratio of cumulative CTDIvol and measured MSD. No trend was observed as a function of patient size. Conclusions: On average, estimated MSD from dose rate measurements on phantom as well as from CTDIvol of patient examinations underestimates the measured value of MSD. This can be attributed to deviations of the patient's body habitus from the standard phantom size and to patient positioning in the gantry during the procedure.

  12. Comparison of measured and estimated maximum skin doses during CT fluoroscopy lung biopsies

    International Nuclear Information System (INIS)

    Zanca, F.; Jacobs, A.; Crijns, W.; De Wever, W.

    2014-01-01

    Purpose: To measure patient-specific maximum skin dose (MSD) associated with CT fluoroscopy (CTF) lung biopsies and to compare measured MSD with the MSD estimated from phantom measurements, as well as with the CTDIvol of patient examinations. Methods: Data from 50 patients with lung lesions who underwent a CT fluoroscopy-guided biopsy were collected. The CT protocol consisted of a low-kilovoltage (80 kV) protocol used in combination with an algorithm for dose reduction to the radiology staff during the interventional procedure, HandCare (HC). MSD was assessed during each intervention using EBT2 gafchromic films positioned on patient skin. Lesion size, position, total fluoroscopy time, and patient-effective diameter were registered for each patient. Dose rates were also estimated at the surface of a normal-size anthropomorphic thorax phantom using a 10 cm pencil ionization chamber placed at every 30°, for a full rotation, with and without HC. Measured MSD was compared with MSD values estimated from the phantom measurements and with the cumulative CTDIvol of the procedure. Results: The median measured MSD was 141 mGy (range 38–410 mGy) while the median cumulative CTDIvol was 72 mGy (range 24–262 mGy). The ratio between the MSD estimated from phantom measurements and the measured MSD was 0.87 (range 0.12–4.1) on average. In 72% of cases the estimated MSD underestimated the measured MSD, while in 28% of the cases it overestimated it. The same trend was observed for the ratio of cumulative CTDIvol and measured MSD. No trend was observed as a function of patient size. Conclusions: On average, estimated MSD from dose rate measurements on phantom as well as from CTDIvol of patient examinations underestimates the measured value of MSD. This can be attributed to deviations of the patient's body habitus from the standard phantom size and to patient positioning in the gantry during the procedure

  13. Comparison of patient doses in interventional radiology procedures performed in two large hospitals in Greece

    International Nuclear Information System (INIS)

    Papageorgiou, E.; Tsapaki, V.; Tsalafoutas, I. A.; Maurikou, E.; Kottou, S.; Orfanos, A.; Karidas, G.; Fidanis, T.; Zafiriadou, E.; Neofotistou, V.

    2007-01-01

    Purpose of the study was to determine patient doses in the most common interventional radiology (IR) procedures performed in two large Greek hospitals. A total of 164 patients who underwent 4 types of IR procedures were studied. Fluoroscopy time, total exposure time, number of frames, number of runs, radiation field size, and cumulative dose-area product (DAP) were recorded. The median DAP values for carotid arteriography and lower limb arteriography were 66 and 123 Gy cm 2 for hospital 'A' and 21 and 49 Gy cm 2 for hospital 'B'. For the cerebral arteriographies performed in hospital 'A', the median DAP was 116 Gy cm 2 while for the hepatic embolizations performed in hospital 'B', it was 104 Gy cm 2 . The DAP values observed in hospital 'A' for carotid arteriography and lower limb arteriography were almost three times than those of hospital 'B'. From the data analysis, it is evident that dose optimization in hospital 'A' should be pursued through revision of the techniques used. (authors)

  14. Alternative methods for the median lethal dose (LD(50)) test: the up-and-down procedure for acute oral toxicity.

    Science.gov (United States)

    Rispin, Amy; Farrar, David; Margosches, Elizabeth; Gupta, Kailash; Stitzel, Katherine; Carr, Gregory; Greene, Michael; Meyer, William; McCall, Deborah

    2002-01-01

    The authors have developed an improved version of the up-and-down procedure (UDP) as one of the replacements for the traditional acute oral toxicity test formerly used by the Organisation for Economic Co-operation and Development member nations to characterize industrial chemicals, pesticides, and their mixtures. This method improves the performance of acute testing for applications that use the median lethal dose (classic LD50) test while achieving significant reductions in animal use. It uses sequential dosing, together with sophisticated computer-assisted computational methods during the execution and calculation phases of the test. Staircase design, a form of sequential test design, can be applied to acute toxicity testing with its binary experimental endpoints (yes/no outcomes). The improved UDP provides a point estimate of the LD50 and approximate confidence intervals in addition to observed toxic signs for the substance tested. It does not provide information about the dose-response curve. Computer simulation was used to test performance of the UDP without the need for additional laboratory validation.

  15. Cumulative effective dose associated with computed tomography examinations in adolescent trauma patients.

    Science.gov (United States)

    Choi, Seung Joon; Kim, Eun Young; Kim, Hyung Sik; Choi, Hye-Young; Cho, Jinseong; Yang, Hyuk Jun; Chung, Yong Eun

    2014-07-01

    The aims of this study were to analyze cumulative effective dose (cED) and to assess lifetime attributable risk (LAR) of cancer due to radiation exposure during computed tomography (CT) examinations in adolescent trauma patients. Between January 2010 and May 2011, the adolescent patients with trauma were enrolled in this study. Numbers of CT examinations and body regions examined were collated, and cEDs were calculated using dose-length product values and conversion factors. Lifetime attributable risk for cancer incidence and cancer-associated mortality were quantified based on the studies of survivors of the atomic bombs on Japan. Data were stratified according to severity of trauma: minor trauma, injury severity score of less than 16; and major trauma, injury severity score of 16 or greater. A total of 698 CT scans were obtained on the following regions of 484 adolescent patients: head CT, n = 647; rest of the body, n = 41; and thorax, n = 10. Mean cED per patient was 3.4 mSv, and mean LARs for cancer incidence and mortality were 0.05% and 0.02%, respectively. The majority of patients (98.4%) experienced minor trauma, and their mean cED and LARs for cancer incidence and mortality (3.0 mSv and 0.04% and 0.02%, respectively) were significantly lower than those of patients with major trauma (24.3 mSv and 0.31% and 0.15%, respectively, all P values trauma was found to be relatively low in adolescent patients. However, adolescent patients with major trauma were exposed to a substantial amount of radiation during multiple CT examinations.

  16. An inter-hospital comparison of patient dose based on clinical indications

    International Nuclear Information System (INIS)

    Teeuwisse, W.; Geleijns, J.; Veldkamp, W.

    2007-01-01

    Patient dose is usually estimated for a single radiographic projection or computed tomography (CT) series. In this study, patient dose was calculated for predefined clinical indications (24 radiography, 11 CT). Members of the radiology staff of each of 11 hospitals were trained in dose measurement and calculation techniques. Based on clinical indications participants decided on imaging protocols and calculated cumulative effective dose for a complete examination. Effective dose ranged from <1 μSv to 0.6 mSv for examinations with radiographs and from 0.2 to 12 mSv for CT scans. Differences in the imaging protocols contributedd to a substantial variation in patient dose. For mammography, average glandular dose (AGD) was estimated for 32-, 53- and 90-mm compressed breast thicknesses, with a median value of 0.74, 1.74 and 3.40 mGy, respectively. The results presented here demonstrate that a pragmatic choice of dosimetry methods enables local staff to estimate effective dose. The inclusion of imaging protocols in the dose surveys provided a broader view on the variations in patient dose between hospitals. (orig.)

  17. Clinical significance of cumulative biological effective dose and overall treatment time in the treatment of carcinoma cervix

    Directory of Open Access Journals (Sweden)

    Mandal Abhijit

    2007-01-01

    Full Text Available The purpose of this retrospective study is to report the radiotherapy treatment response of, and complications in, patients with cervical cancer on the basis of cumulative biologic effective dose (BED and overall treatment time (OTT. Sixty-four (stage II - 35/64; stage III - 29/64 patients of cervical cancer were treated with combination of external beam radiotherapy (EBRT and low dose rate intracavitary brachytherapy (ICBT. The cumulative BED was calculated at Point A (BED 10 ; and bladder, rectal reference points (BED 2.5 using the linear-quadratic BED equations. The local control (LC rate and 5-year disease-free survival (DFS rate in patients of stage II were comparable for BED 10 < 84.5 and BED 10 > 84.5 but were much higher for BED 10 > 84.5 than BED 10 < 84.5 ( P < 0.01 in stage III patients. In the stage II patients, The LC rate and 5-year DFS rate were comparable for OTT < 50 days and for OTT> 50 days but were much higher in stage III patients with OTT < 50 than OTT> 50 days ( P < 0.001. It was also observed that patients who received BED 2.5 < 105 had lesser rectal ( P < 0.001 and bladder complications than BED 2.5 > 105. Higher rectal complication-free survival (CFS R rate, bladder complication-free survival (CFS B rate and all-type late complication-free survival rate were observed in patients who received BED 2.5 < 105 than BED 2.5 > 105. A balanced, optimal and justified radiotherapy treatment schedule to deliver higher BED 10 (>84.5 and lower BED 2.5 (< 105 in lesser OTT (< 50 days is essential in carcinoma cervix to expect a better treatment outcome in all respects.

  18. Cumulative dose 60Co gamma irradiation effects on AlGaN/GaN Schottky diodes and its area dependence

    Science.gov (United States)

    Sharma, Chandan; Laishram, Robert; Rawal, Dipendra Singh; Vinayak, Seema; Singh, Rajendra

    2018-04-01

    Cumulative dose gamma radiation effects on current-voltage characteristics of GaN Schottky diodes have been investigated. The different area diodes have been fabricated on AlGaN/GaN high electron mobility transistor (HEMT) epi-layer structure grown over SiC substrate and irradiated with a dose up to the order of 104 Gray (Gy). Post irradiation characterization shows a shift in the turn-on voltage and improvement in reverse leakage current. Other calculated parameters include Schottky barrier height, ideality factor and reverse saturation current. Schottky barrier height has been decreased whereas reverse saturation current shows an increase in the value post irradiation with improvement in the ideality factor. Transfer length measurement (TLM) characterization shows an improvement in the contact resistance. Finally, diodes with larger area have more variation in the calculated parameters due to the induced local heating effect.

  19. Dose fractionated gamma knife radiosurgery for large arteriovenous malformations on daily or alternate day schedule outside the linear quadratic model: Proof of concept and early results. A substitute to volume fractionation.

    Science.gov (United States)

    Mukherjee, Kanchan Kumar; Kumar, Narendra; Tripathi, Manjul; Oinam, Arun S; Ahuja, Chirag K; Dhandapani, Sivashanmugam; Kapoor, Rakesh; Ghoshal, Sushmita; Kaur, Rupinder; Bhatt, Sandeep

    2017-01-01

    To evaluate the feasibility, safety and efficacy of dose fractionated gamma knife radiosurgery (DFGKRS) on a daily schedule beyond the linear quadratic (LQ) model, for large volume arteriovenous malformations (AVMs). Between 2012-16, 14 patients of large AVMs (median volume 26.5 cc) unsuitable for surgery or embolization were treated in 2-3 of DFGKRS sessions. The Leksell G frame was kept in situ during the whole procedure. 86% (n = 12) patients had radiologic evidence of bleed, and 43% (n = 6) had presented with a history of seizures. 57% (n = 8) patients received a daily treatment for 3 days and 43% (n = 6) were on an alternate day (2 fractions) regimen. The marginal dose was split into 2 or 3 fractions of the ideal prescription dose of a single fraction of 23-25 Gy. The median follow up period was 35.6 months (8-57 months). In the three-fraction scheme, the marginal dose ranged from 8.9-11.5 Gy, while in the two-fraction scheme, the marginal dose ranged from 11.3-15 Gy at 50% per fraction. Headache (43%, n = 6) was the most common early postoperative complication, which was controlled with short course steroids. Follow up evaluation of at least three years was achieved in seven patients, who have shown complete nidus obliteration in 43% patients while the obliteration has been in the range of 50-99% in rest of the patients. Overall, there was a 67.8% reduction in the AVM volume at 3 years. Nidus obliteration at 3 years showed a significant rank order correlation with the cumulative prescription dose (p 0.95, P value 0.01), with attainment of near-total (more than 95%) obliteration rates beyond 29 Gy of the cumulative prescription dose. No patient receiving a cumulative prescription dose of less than 31 Gy had any severe adverse reaction. In co-variate adjusted ordinal regression, only the cumulative prescription dose had a significant correlation with common terminology criteria for adverse events (CTCAE) severity (P value 0.04), independent of age, AVM volume

  20. High-dose irradiation and misonidazole in the treatment of malignant gliomas

    International Nuclear Information System (INIS)

    Kogelnik, H.D.; Kaercher, K.H.; Szepesi, T.; Schratter-Sehn, A.V.

    1982-01-01

    Thirty-three patients with grade III and IV supratentorial astrocytomas who were entered into a radomized two-arm study to evaluate the effect of misonidazole in conjunction with postoperative irradiation are available for analysis. All patients received the same radiation dose: 6650 rads (43 MeV photons) in 31 fractions over 7 1/2 weeks. Misonidazole was given orally 4 to 5 hours before irradiation on those treatment days when fractional radiation doses of 400 rads were used. The cumulative dose of misonidazole was 27 g, corresponding to 12.6 to 16.4 g/m 2 . With a minimum follow-up time of one year, median survival for patients receiving postoperative irradiation had a median survival of 57.1 weeks. The difference in the distribution of survival times between both groups is statistically significant (p < 0.02). From an analysis of variance for age, it cannot be ruled out that the survival difference between the two groups is at least partly due to differences in ages. Side effects of misonidazole were minimal, with only 2 patients experiencing mild paresthesias and 4 noting a transient tinnitus

  1. Investigation of practical approaches to evaluating cumulative dose for cone beam computed tomography (CBCT) from standard CT dosimetry measurements: a Monte Carlo study.

    Science.gov (United States)

    Abuhaimed, Abdullah; Martin, Colin J; Sankaralingam, Marimuthu; Gentle, David J

    2015-07-21

    A function called Gx(L) was introduced by the International Commission on Radiation Units and Measurements (ICRU) Report-87 to facilitate measurement of cumulative dose for CT scans within long phantoms as recommended by the American Association of Physicists in Medicine (AAPM) TG-111. The Gx(L) function is equal to the ratio of the cumulative dose at the middle of a CT scan to the volume weighted CTDI (CTDIvol), and was investigated for conventional multi-slice CT scanners operating with a moving table. As the stationary table mode, which is the basis for cone beam CT (CBCT) scans, differs from that used for conventional CT scans, the aim of this study was to investigate the extension of the Gx(L) function to CBCT scans. An On-Board Imager (OBI) system integrated with a TrueBeam linac was simulated with Monte Carlo EGSnrc/BEAMnrc, and the absorbed dose was calculated within PMMA, polyethylene (PE), and water head and body phantoms using EGSnrc/DOSXYZnrc, where the body PE body phantom emulated the ICRU/AAPM phantom. Beams of width 40-500 mm and beam qualities at tube potentials of 80-140 kV were studied. Application of a modified function of beam width (W) termed Gx(W), for which the cumulative dose for CBCT scans f (0) is normalized to the weighted CTDI (CTDIw) for a reference beam of width 40 mm, was investigated as a possible option. However, differences were found in Gx(W) with tube potential, especially for body phantoms, and these were considered to be due to differences in geometry between wide beams used for CBCT scans and those for conventional CT. Therefore, a modified function Gx(W)100 has been proposed, taking the form of values of f (0) at each position in a long phantom, normalized with respect to dose indices f 100(150)x measured with a 100 mm pencil ionization chamber within standard 150 mm PMMA phantoms, using the same scanning parameters, beam widths and positions within the phantom. f 100(150)x averages the dose resulting from

  2. Parotid Gland Dose in Intensity-Modulated Radiotherapy for Head and Neck Cancer: Is What You Plan What You Get?

    International Nuclear Information System (INIS)

    O'Daniel, Jennifer C.; Garden, Adam S.; Schwartz, David L.; Wang He; Ang, Kian K.; Ahamad, Anesa; Rosenthal, David I.; Morrison, William H.; Asper, Joshua A.; Zhang Lifei; Tung Shihming; Mohan, Radhe; Dong Lei

    2007-01-01

    Purpose: To quantify the differences between planned and delivered parotid gland and target doses, and to assess the benefits of daily bone alignment for head and neck cancer patients treated with intensity-modulated radiotherapy (IMRT). Methods and Materials: Eleven head and neck cancer patients received two CT scans per week with an in-room CT scanner over the course of their radiotherapy. The clinical IMRT plans, designed with 3-mm to 4-mm planning margins, were recalculated on the repeat CT images. The plans were aligned using the actual treatment isocenter marked with radiopaque markers (BB) and bone alignment to the cervical vertebrae to simulate image-guided setup. In-house deformable image registration software was used to map daily dose distributions to the original treatment plan and to calculate a cumulative delivered dose distribution for each patient. Results: Using conventional BB alignment led to increases in the parotid gland mean dose above the planned dose by 5 to 7 Gy in 45% of the patients (median, 3.0 Gy ipsilateral, p = 0.026; median, 1.0 Gy contralateral, p = 0.016). Use of bone alignment led to reductions relative to BB alignment in 91% of patients (median, 2 Gy; range, 0.3-8.3 Gy; 15 of 22 parotids improved). However, the parotid dose from bone alignment was still greater than planned (median, 1.0 Gy, p = 0.007). Neither approach affected tumor dose coverage. Conclusions: With conventional BB alignment, the parotid gland mean dose was significantly increased above the planned mean dose. Using daily bone alignment reduced the parotid dose compared with BB alignment in almost all patients. A 3- to 4-mm planning margin was adequate for tumor dose coverage

  3. Cumulative Radiation Exposure during Follow-Up after Curative Surgery for Gastric Cancer

    International Nuclear Information System (INIS)

    Lee, Yeo Jin; Chung, Yong Eun; Lim, Joon Seok; Kim, Joo Hee; Kim, Young Jin; Lee, Hye Jeong; Kim, Myeong Jin; Kim, Ki Whang; You, Je Sung

    2012-01-01

    To quantify the cumulative effective dose (cED) of radiation due to repeated CT and PET/CT examinations after curative resection of gastric cancer and to assess the lifetime attributable risk (LAR) estimates based on Biological Effects of Ionizing Radiation VII models. Patients who underwent a curative resection for gastric cancer between January 2006 and December 2006 and were followed-up until May 2010 were included in this study. The cED was calculated by using the dose-length product values and conversion factors for quantitative risk assessment of radiation exposure. cED and LAR were compared between early and advanced gastric cancer patients and among American Joint Committee on Cancer TNM stage groups (stage I, II, and III). The nonparametric Mann-Whitney U and Kruskal-Wallis tests, followed by a post-hoc analysis with Bonferroni adjustment, were employed as part of the statistical analysis. The overall median cED was 57.8 mSv (interquartile range [IQR], 43.9-74.7). The cED was significantly higher in the advanced (median, 67.0; IQR, 49.1-102.3) than in the early gastric cancer group (median, 52.3; IQR, 41.5-67.9) (p < 0.001), and increased as the TNM stage increased. For radiation exposure, 62% of all patients received an estimated cED of over 50 mSv, while 11% of patients received over 100 mSv. The median LAR of cancer incidence was 0.28% (IQR, 0.20-0.40) and there were significant differences between the early gastric cancer and advanced gastric cancer group (p < 0.001) as well as among the three TNM stage groups (p = 0.015). The LAR of cancer incidence exceeded 1% in 2.4% of the patients. The cED increases proportionally along with tumor stage and, even in early gastric cancer or stage I patients, cED is much higher than that found among the general population. Considering the very good prognosis of early gastric cancer after curative surgery, the cED should be considered when designing a postoperative follow-up CT protocol.

  4. Preliminary results of concurrent chemotherapy and radiation therapy using high-dose-rate brachytherapy for cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Ja; Lee, Ji Hye; Lee, Re Na; Suh, Hyun Suk [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)

    2006-09-15

    To determine the efficacy and safety of concurrent chemotherapy and radiation therapy with high-dose-rate brachytherapy for cervical cancer. From January 2001 to December 2002, 30 patients with cervical cancer were treated with concurrent chemotherapy (cisplatin and 5-FU) and definitive radiation therapy. The median age was 58 (range 34 {approx} 74) year old. The pathology of the biopsy sections was squamous cell carcinoma in 29 patients and one was adenocarcinoma. The distribution to FIGO staging system was as follow: stage IB, 7 (23%); IIA, 3 (10%); IIB, 12 (40%); IIIA, 3 (10%); IIIB, 5 (17%). All patients received pelvic external beam irradiation (EBRT) to a total dose of 45 {approx} 50.4 Gy (median: 50.4 Gy) over 5 {approx} 5.5 weeks. Ir-192 HDR intracavity brachytherapy (ICBT) was given after a total dose of 41.1 Gy. HDR-ICBT was performed twice a week, with a fraction point. A dose of 4 Gy and median dose to point A was 28 Gy (range: 16 {approx} 32 Gy) in 7 fractions. The median cumulative biologic effective dose (BED) at point A (EBRT + ICBT) was 88 Gy{sub 10} (range:77 {approx} 94 Gy{sub 10}). The median cumulative BED at ICRU 38 reference point (EBRT + ICBT) was 131 Gy{sub 3} (range: 122 {approx} 140 Gy{sub 3}) at point A, 109 Gy{sub 3} (range:88{approx} 125 Gy{sub 3}) at the rectum and 111 Gy{sub 3} (range: 91 {approx} 123 Gy{sub 3}) at the urinary bladder. Cisplatin (60 mg/m{sup 2}) and 5-FU (1,000 mg/m{sup 2}) was administered intravenously at 2 weeks interval from the first day of radiation for median 5 (range:2 {approx} 6) cycles. The assessment was performed at 1 month after completion of radiation therapy by clinical examination and CT scan. The median follow-up time was 36 months (range:8{approx} 50 months). The complete response rate after concurrent chemo radiation therapy was 93.3%. The 3-yr actuarial pelvic control rate was 87% and 3-yr actuarial overall survival and disease-free survival rate was 93% and 87%, respectively. The local failure

  5. Preliminary results of concurrent chemotherapy and radiation therapy using high-dose-rate brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    Lee, Kyung Ja; Lee, Ji Hye; Lee, Re Na; Suh, Hyun Suk

    2006-01-01

    To determine the efficacy and safety of concurrent chemotherapy and radiation therapy with high-dose-rate brachytherapy for cervical cancer. From January 2001 to December 2002, 30 patients with cervical cancer were treated with concurrent chemotherapy (cisplatin and 5-FU) and definitive radiation therapy. The median age was 58 (range 34 ∼ 74) year old. The pathology of the biopsy sections was squamous cell carcinoma in 29 patients and one was adenocarcinoma. The distribution to FIGO staging system was as follow: stage IB, 7 (23%); IIA, 3 (10%); IIB, 12 (40%); IIIA, 3 (10%); IIIB, 5 (17%). All patients received pelvic external beam irradiation (EBRT) to a total dose of 45 ∼ 50.4 Gy (median: 50.4 Gy) over 5 ∼ 5.5 weeks. Ir-192 HDR intracavity brachytherapy (ICBT) was given after a total dose of 41.1 Gy. HDR-ICBT was performed twice a week, with a fraction point. A dose of 4 Gy and median dose to point A was 28 Gy (range: 16 ∼ 32 Gy) in 7 fractions. The median cumulative biologic effective dose (BED) at point A (EBRT + ICBT) was 88 Gy 10 (range:77 ∼ 94 Gy 10 ). The median cumulative BED at ICRU 38 reference point (EBRT + ICBT) was 131 Gy 3 (range: 122 ∼ 140 Gy 3 ) at point A, 109 Gy 3 (range:88∼ 125 Gy 3 ) at the rectum and 111 Gy 3 (range: 91 ∼ 123 Gy 3 ) at the urinary bladder. Cisplatin (60 mg/m 2 ) and 5-FU (1,000 mg/m 2 ) was administered intravenously at 2 weeks interval from the first day of radiation for median 5 (range:2 ∼ 6) cycles. The assessment was performed at 1 month after completion of radiation therapy by clinical examination and CT scan. The median follow-up time was 36 months (range:8∼ 50 months). The complete response rate after concurrent chemo radiation therapy was 93.3%. The 3-yr actuarial pelvic control rate was 87% and 3-yr actuarial overall survival and disease-free survival rate was 93% and 87%, respectively. The local failure rate was 13% and distant metastatic rate was 3.3%. The crude rate of minor hematologic

  6. Curvilinear bodies are associated with adverse effects on muscle function but not with hydroxychloroquine dosing.

    Science.gov (United States)

    Khoo, Thomas; Otto, Sophia; Smith, Caroline; Koszyca, Barbara; Lester, Sue; Blumbergs, Peter; Limaye, Vidya

    2017-03-01

    The clinical significance of curvilinear bodies (CB) seen in association with hydroxychloroquine (HCQ) therapy is uncertain. Patients with CB on muscle biopsy performed between 2006 and the present were identified, and their clinical features including body mass index and cumulative HCQ dose were recorded. A control group of 16 patients with idiopathic inflammatory myositis (IIM) on HCQ at time of biopsy but without evidence of CB was identified. Nineteen patients with CB were identified; details were available for 18. Among patients with CB, 7/18 also had IIM. Seven out of ten patients with CB who did not have IIM or MHCI/II expression had proximal weakness; 7/11 had raised serum creatinine kinase (CK) levels. There was no difference in body weight (p = 0.47), body mass index (p = 0.93), cumulative HCQ dose (p = 0.52) or cumulative dose adjusted for body weight (p = 0.39) or body mass index (p = 0.32) between patients with CB and controls. Patients with CB had lower median CK levels than controls (p = 0.034). Weakness was present in 12/17 patients and 12/16 controls (p = 1.0). Concurrent proton-pump inhibitors were co-prescribed in 12/18 (67 %) patients with CB and in 6/16 (38 %) controls (p = 0.17). Development of CB does not appear to be related to cumulative HCQ dose or body weight. Patients with CB frequently have muscle weakness in the absence of MHC1 expression suggesting a role for non-immune mechanisms of muscle injury. A high proportion of patients with CB are co-prescribed proton-pump inhibitors raising the possibility that co-prescription of both agents may disrupt lysosomal function and adversely affect muscle function.

  7. Dose estimation from residual and fallout radioactivity, 1

    International Nuclear Information System (INIS)

    Takeshita, Kenji

    1975-01-01

    External dose rates and cumulative doses for early entrants from areal surveys and simulated experiments are reviewed. The average cumulative doses to infinity at the hypocenters were 101 rad in Hiroshima and 32 rad in Nagasaki, with a variation of about 60 percent. Radioactive fallout areas nearly matched the ''black rain'' areas in Nagasaki and in Hiroshima. Radioactivity in the fallout areas was affected by radioactive decay and by the leaching and dissipation by rains. Considering these factors, the cumulative dose to infinity in the fallout area of Hiroshima was estimated to be 13 rad, excluding internal radiation doses from inhaled and ingested radionuclides. Attempts to estimate radiation dose from internally deposited radionuclides are also described. (auth.)

  8. The injury and cumulative effects on human skin by UV exposure from artificial fluorescence emission.

    Science.gov (United States)

    Tian, Yan; Liu, Wei; Niu, TianHui; Dai, CaiHong; Li, Xiaoxin; Cui, Caijuan; Zhao, Xinyan; E, Yaping; Lu, Hui

    2014-01-01

    The injury and cumulative effects of UV emission from fluorescence lamp were studied. UV intensity from fluorescence lamp was measured, and human skin samples (hips, 10 volunteers) were exposed to low-dose UV irradiation (three times per week for 13 consecutive weeks). Three groups were examined: control group without UV radiation; low-dose group with a cumulative dose of 50 J cm(-2) which was equivalent to irradiation of the face during indoor work for 1.5 years; and high-dose group with 1000 J cm(-2) cumulative dose equivalent to irradiation of the face during outdoor activities for 1 year. Specific indicators were measured before and after UVA irradiation. The findings showed that extending the low-dose UVA exposure decreased the skin moisture content and increased the transepidermal water loss as well as induced skin color changes (decreased L* value, increased M index). Furthermore, irradiated skin showed an increased thickness of cuticle and epidermis, skin edema, light color and unclear staining collagen fibers in the dermis, and elastic fiber fragmentation. In addition, MMP-1, p53 and SIRT1 expression was also increased. Long-term exposure of low-dose UVA radiation enhanced skin photoaging. The safety of the fluorescent lamp needs our attention. © 2014 The American Society of Photobiology.

  9. 78 FR 25440 - Request for Information and Citations on Methods for Cumulative Risk Assessment

    Science.gov (United States)

    2013-05-01

    ... Citations on Methods for Cumulative Risk Assessment AGENCY: Office of the Science Advisor, Environmental... influence exposures, dose-response or risk/hazard posed by environmental contaminant exposures, and methods... who wish to receive further information about submitting information on methods for cumulative risk...

  10. Preliminary mortality survey from 1973 to 1977 of Japanese radiological technologists and analyses of the association of mortality with cumulative doses

    International Nuclear Information System (INIS)

    Aoyama, Takashi; Ishizaka, Masatsuna; Yamamoto, Yoichi; Kano, Eiichi; Nikaido, Osamu.

    1981-01-01

    The Japan Association of Radiologic Technologists reported that, from 1941 to 1978, 395 deaths occurred among Japanese radiological technologists who belong to the association. Using these data, Sakka, Kitabatake and colleagues, and the present authors studied mortality and cause of death among these technologists for 11 years from 1955 to 1965, for 7 years from 1966 to 1972, and for 5 years from 1973 to 1977, respectively. In general, the number of cancer deaths in the three studies was less than expected. However, Kitabatake et al. and the present authors found that deaths from skin cancer were significantly more frequent than expected. The present authors recently estimated the cumulative doses of radiation exposure for the majority of deaths (268 out of 395). The mean dose of radiation related to cancer deaths was then compared with that for non-cancer deaths. Also the proportional mortality ratios for cancers were observed in relation to the estimated dose level. In the present study, however, statistical tests to assess for the relationship between mortality and dose of radiation exposure showed no correlation, for the majority of deaths from cancer. (author)

  11. Cumulative high doses of inhaled formoterol have less systemic effects in asthmatic children 6-11 years-old than cumulative high doses of inhaled terbutaline

    DEFF Research Database (Denmark)

    Kaae, Rikke; Agertoft, Lone; Pedersen, Sören

    2004-01-01

    OBJECTIVES: To evaluate high dose tolerability and relative systemic dose potency between inhaled clinically equipotent dose increments of formoterol and terbutaline in children. METHODS: Twenty boys and girls (6-11 years-old) with asthma and normal ECGs were studied. Ten doses of formoterol (Oxi...

  12. Cumulative toxicity of neonicotinoid insecticide mixtures to Chironomus dilutus under acute exposure scenarios.

    Science.gov (United States)

    Maloney, Erin M; Morrissey, Christy A; Headley, John V; Peru, Kerry M; Liber, Karsten

    2017-11-01

    Extensive agricultural use of neonicotinoid insecticide products has resulted in the presence of neonicotinoid mixtures in surface waters worldwide. Although many aquatic insect species are known to be sensitive to neonicotinoids, the impact of neonicotinoid mixtures is poorly understood. In the present study, the cumulative toxicities of binary and ternary mixtures of select neonicotinoids (imidacloprid, clothianidin, and thiamethoxam) were characterized under acute (96-h) exposure scenarios using the larval midge Chironomus dilutus as a representative aquatic insect species. Using the MIXTOX approach, predictive parametric models were fitted and statistically compared with observed toxicity in subsequent mixture tests. Single-compound toxicity tests yielded median lethal concentration (LC50) values of 4.63, 5.93, and 55.34 μg/L for imidacloprid, clothianidin, and thiamethoxam, respectively. Because of the similar modes of action of neonicotinoids, concentration-additive cumulative mixture toxicity was the predicted model. However, we found that imidacloprid-clothianidin mixtures demonstrated response-additive dose-level-dependent synergism, clothianidin-thiamethoxam mixtures demonstrated concentration-additive synergism, and imidacloprid-thiamethoxam mixtures demonstrated response-additive dose-ratio-dependent synergism, with toxicity shifting from antagonism to synergism as the relative concentration of thiamethoxam increased. Imidacloprid-clothianidin-thiamethoxam ternary mixtures demonstrated response-additive synergism. These results indicate that, under acute exposure scenarios, the toxicity of neonicotinoid mixtures to C. dilutus cannot be predicted using the common assumption of additive joint activity. Indeed, the overarching trend of synergistic deviation emphasizes the need for further research into the ecotoxicological effects of neonicotinoid insecticide mixtures in field settings, the development of better toxicity models for neonicotinoid mixture

  13. Cumulative inhibitory effect of low-dose aspirin on vascular prostacyclin and platelet thromboxane production in patients with atherosclerosis.

    Science.gov (United States)

    Weksler, B B; Tack-Goldman, K; Subramanian, V A; Gay, W A

    1985-02-01

    The relationship between the antithrombotic and antiplatelet effects of aspirin is complex, since aspirin influences other systems that protect against thrombosis as well as inhibiting platelet function. We investigated possible cumulative effects of low-dose aspirin on vascular production of prostacyclin in patients with documented atherosclerotic cardiovascular disease. Candidates for coronary artery vein graft bypass ingested 20 mg of aspirin daily during the week before surgery, and platelet aggregation, platelet formation of thromboxane A2 (TXA2), aortic and saphenous vein production of prostacyclin (PGI2), and hemostatic status were measured at the time of the bypass surgery. Low-dose aspirin markedly inhibited platelet aggregation responses and reduced TXA2 generation by greater than 90%, effects similar to those observed with much higher doses of aspirin. Both aortic and saphenous vein production of PGI2 were inhibited by 50% compared with PGI2 produced by vascular tissues of control subjects who received no aspirin preoperatively (51 +/- 10 pg 6-keto-PGF1 alpha/mg aortic wet weight [mean +/- SEM] in aspirin-treated subjects vs 130 +/- 16 pg/mg in control subjects, and 71 +/- 8 pg/mg saphenous vein wet weight vs 131 +/- 17 pg/mg). Blood loss at surgery was not significantly increased by preoperative low-dose aspirin as measured by chest tube drainage (754 +/- 229 ml in aspirin-treated subjects vs 645 +/- 271 ml in control subjects), hematocrit nadir (31.2 +/- 1.9% vs 31.8 +/- 1.7%), or transfusions (2.2 +/- 1.3 units of red blood cells vs 2.2 +/- 1.7 units).(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Case Example of Dose Optimization Using Data From Bortezomib Dose-Finding Clinical Trials.

    Science.gov (United States)

    Lee, Shing M; Backenroth, Daniel; Cheung, Ying Kuen Ken; Hershman, Dawn L; Vulih, Diana; Anderson, Barry; Ivy, Percy; Minasian, Lori

    2016-04-20

    The current dose-finding methodology for estimating the maximum tolerated dose of investigational anticancer agents is based on the cytotoxic chemotherapy paradigm. Molecularly targeted agents (MTAs) have different toxicity profiles, which may lead to more long-lasting mild or moderate toxicities as well as to late-onset and cumulative toxicities. Several approved MTAs have been poorly tolerated during long-term administration, leading to postmarketing dose optimization studies to re-evaluate the optimal treatment dose. Using data from completed bortezomib dose-finding trials, we explore its toxicity profile, optimize its dose, and examine the appropriateness of current designs for identifying an optimal dose. We classified the toxicities captured from 481 patients in 14 bortezomib dose-finding studies conducted through the National Cancer Institute Cancer Therapy Evaluation Program, computed the incidence of late-onset toxicities, and compared the incidence of dose-limiting toxicities (DLTs) among groups of patients receiving different doses of bortezomib. A total of 13,008 toxicities were captured: 46% of patients' first DLTs and 88% of dose reductions or discontinuations of treatment because of toxicity were observed after the first cycle. Moreover, for the approved dose of 1.3 mg/m(2), the estimated cumulative incidence of DLT was > 50%, and the estimated cumulative incidence of dose reduction or treatment discontinuation because of toxicity was nearly 40%. When considering the entire course of treatment, the approved bortezomib dose exceeds the conventional ceiling DLT rate of 20% to 33%. Retrospective analysis of trial data provides an opportunity for dose optimization of MTAs. Future dose-finding studies of MTAs should take into account late-onset toxicities to ensure that a tolerable dose is identified for future efficacy and comparative trials. © 2016 by American Society of Clinical Oncology.

  15. Effects of Respiration-Induced Density Variations on Dose Distributions in Radiotherapy of Lung Cancer

    International Nuclear Information System (INIS)

    Mexner, Vanessa; Wolthaus, Jochem W.H.; Herk, Marcel van; Damen, Eugene M.F.; Sonke, Jan-Jakob

    2009-01-01

    Purpose: To determine the effect of respiration-induced density variations on the estimated dose delivered to moving structures and, consequently, to evaluate the necessity of using full four-dimensional (4D) treatment plan optimization. Methods and Materials: In 10 patients with large tumor motion (median, 1.9 cm; range, 1.1-3.6 cm), the clinical treatment plan, designed using the mid-ventilation ([MidV]; i.e., the 4D-CT frame closest to the time-averaged mean position) CT scan, was recalculated on all 4D-CT frames. The cumulative dose was determined by transforming the doses in all breathing phases to the MidV geometry using deformable registration and then averaging the results. To determine the effect of density variations, this cumulative dose was compared with the accumulated dose after similarly deforming the planned (3D) MidV-dose in each respiratory phase using the same transformation (i.e., 'blurring the dose'). Results: The accumulated tumor doses, including and excluding density variations, were almost identical. Relative differences in the minimum gross tumor volume (GTV) dose were less than 2% for all patients. The relative differences were even smaller in the mean lung dose and the V20 (<0.5% and 1%, respectively). Conclusions: The effect of respiration-induced density variations on the dose accumulated over the respiratory cycle was very small, even in the presence of considerable respiratory motion. A full 4D-dose calculation for treatment planning that takes into account such density variations is therefore not required. Planning using the MidV-CT derived from 4D-CT with an appropriate margin for geometric uncertainties is an accurate and safe method to account for respiration-induced anatomy variations.

  16. Intensity Modulated Radiation Therapy With Dose Painting to Treat Rhabdomyosarcoma

    International Nuclear Information System (INIS)

    Yang, Joanna C.; Dharmarajan, Kavita V.; Wexler, Leonard H.; La Quaglia, Michael P.; Happersett, Laura; Wolden, Suzanne L.

    2012-01-01

    Purpose: To examine local control and patterns of failure in rhabdomyosarcoma patients treated with intensity modulated radiation therapy (RT) with dose painting (DP-IMRT). Patients and Methods: A total of 41 patients underwent DP-IMRT with chemotherapy for definitive treatment. Nineteen also underwent surgery with or without intraoperative RT. Fifty-six percent had alveolar histologic features. The median interval from beginning chemotherapy to RT was 17 weeks (range, 4-25). Very young children who underwent second-look procedures with or without intraoperative RT received reduced doses of 24-36 Gy in 1.4-1.8-Gy fractions. Young adults received 50.4 Gy to the primary tumor and lower doses of 36 Gy in 1.8-Gy fractions to at-risk lymph node chains. Results: With 22 months of median follow-up, the actuarial local control rate was 90%. Patients aged ≤7 years who received reduced overall and fractional doses had 100% local control, and young adults had 79% (P=.07) local control. Three local failures were identified in young adults whose primary target volumes had received 50.4 Gy in 1.8-Gy fractions. Conclusions: DP-IMRT with lower fractional and cumulative doses is feasible for very young children after second-look procedures with or without intraoperative RT. DP-IMRT is also feasible in adolescents and young adults with aggressive disease who would benefit from prophylactic RT to high-risk lymph node chains, although dose escalation might be warranted for improved local control. With limited follow-up, it appears that DP-IMRT produces local control rates comparable to those of sequential IMRT in patients with rhabdomyosarcoma.

  17. Personalized Feedback on Staff Dose in Fluoroscopy-Guided Interventions: A New Era in Radiation Dose Monitoring.

    Science.gov (United States)

    Sailer, Anna M; Vergoossen, Laura; Paulis, Leonie; van Zwam, Willem H; Das, Marco; Wildberger, Joachim E; Jeukens, Cécile R L P N

    2017-11-01

    Radiation safety and protection are a key component of fluoroscopy-guided interventions. We hypothesize that providing weekly personal dose feedback will increase radiation awareness and ultimately will lead to optimized behavior. Therefore, we designed and implemented a personalized feedback of procedure and personal doses for medical staff involved in fluoroscopy-guided interventions. Medical staff (physicians and technicians, n = 27) involved in fluoroscopy-guided interventions were equipped with electronic personal dose meters (PDMs). Procedure dose data including the dose area product and effective doses from PDMs were prospectively monitored for each consecutive procedure over an 8-month period (n = 1082). A personalized feedback form was designed displaying for each staff individually the personal dose per procedure, as well as relative and cumulative doses. This study consisted of two phases: (1) 1-5th months: Staff did not receive feedback (n = 701) and (2) 6-8th months: Staff received weekly individual dose feedback (n = 381). An anonymous evaluation was performed on the feedback and occupational dose. Personalized feedback was scored valuable by 76% of the staff and increased radiation dose awareness for 71%. 57 and 52% reported an increased feeling of occupational safety and changing their behavior because of personalized feedback, respectively. For technicians, the normalized dose was significantly lower in the feedback phase compared to the prefeedback phase: [median (IQR) normalized dose (phase 1) 0.12 (0.04-0.50) µSv/Gy cm 2 versus (phase 2) 0.08 (0.02-0.24) µSv/Gy cm 2 , p = 0.002]. Personalized dose feedback increases radiation awareness and safety and can be provided to staff involved in fluoroscopy-guided interventions.

  18. Patient doses in interventional cardiology procedures

    International Nuclear Information System (INIS)

    Domienik, J.; Papierz, S.; Jankowski, J.; Peruga, J.Z.

    2008-01-01

    In most countries of European Union legislation requires the determination of the total skin dose to patient resulting from interventional procedures to assess the risk of deterministic effect. To this end, various dose indicators like dose area product (DAP), cumulative dose (CD) and entrance dose at the patient plane (EFD) are used in clinical practice. The study aims at relating those dose indicators with doses ascribe to the most irradiated areas of the patient skin usually expressed in terms of local maximal skin dose (MSD). For the study the local MSD and related to their areas are investigated and compared for coronary angiography CA and intervention (PCI). Two methods implying radiographic films Kodak EDR2 and matrixes of thermoluminescent dosimeters (TLDs) are applied for direct measurements of dose distribution for selected procedures. Both methods are compared. Additionally, for patient dosimetry the following data: MSD, CD, EFD, fluoroscopy time (FT), number of acquired images, total DAP, fluoro-DAP and record-DAP were collected for randomly selected procedure. The statistical quantities like: median, 3 rd quartile, mean and standard deviation for all dosimetric parameters are determined. Preliminary study showed that the values of data collected for coronary procedures are in the ranges 0,7 - 27,3 min for fluoroscopy time, 50 - 350 Gy cm 2 for total DAP, 300 - 2000 mGy for CD, 140 - 2000 mGy for EFD and 100 - 1500 mGy for local maximal skin dose. For interventions the ranges are, accordingly 3,0 - 43,6 min , 25 - 450 Gy cm 2 , 270 - 6600 mGy, 80 - 2600 mGy and 80 - 1500 mGy. As a result of the study the correlations between dose indicators and local MSD are analyzed. The concentration of dose on irradiated films are going to be investigated in some detail as well. (author)

  19. Functional Median Polish

    KAUST Repository

    Sun, Ying

    2012-08-03

    This article proposes functional median polish, an extension of univariate median polish, for one-way and two-way functional analysis of variance (ANOVA). The functional median polish estimates the functional grand effect and functional main factor effects based on functional medians in an additive functional ANOVA model assuming no interaction among factors. A functional rank test is used to assess whether the functional main factor effects are significant. The robustness of the functional median polish is demonstrated by comparing its performance with the traditional functional ANOVA fitted by means under different outlier models in simulation studies. The functional median polish is illustrated on various applications in climate science, including one-way and two-way ANOVA when functional data are either curves or images. Specifically, Canadian temperature data, U. S. precipitation observations and outputs of global and regional climate models are considered, which can facilitate the research on the close link between local climate and the occurrence or severity of some diseases and other threats to human health. © 2012 International Biometric Society.

  20. Analysis of Cumulative Dose to Implanted Pacemaker According to Various IMRT Delivery Methods: Optimal Dose Delivery Versus Dose Reduction Strategy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Woo; Hong, Se Mie [Dept. of Radiation Oncology, Konkuk University Medical Center, Seoul (Korea, Republic of)

    2011-11-15

    Cancer patients with implanted cardiac pacemaker occasionally require radiotherapy. Pacemaker may be damaged or malfunction during radiotherapy due to ionizing radiation or electromagnetic interference. Although radiotherapy should be planned to keep the dose to pacemaker as low as possible not to malfunction ideally, current radiation treatment planning (RTP) system does not accurately calculate deposited dose to adjacent field border or area beyond irradiated fields. In terms of beam delivery techniques using multiple intensity modulated fields, dosimetric effect of scattered radiation in high energy photon beams is required to be detailed analyzed based on measurement data. The aim of this study is to evaluate dose discrepancies of pacemaker in a RTP system as compared to measured doses. We also designed dose reduction strategy limited value of 2 Gy for radiation treatment patients with cardiac implanted pacemaker. Total accumulated dose of 145 cGy based on in-vivo dosimetry was satisfied with the recommendation criteria to prevent malfunction of pacemaker in SS technique. However, the 2 mm lead shielder enabled the scattered doses to reduce up to 60% and 40% in the patient and the phantom, respectively. The SS technique with the lead shielding could reduce the accumulated scattered doses less than 100 cGy. Calculated and measured doses were not greatly affected by the beam delivery techniques. In-vivo and measured doses on pacemaker position showed critical dose discrepancies reaching up to 4 times as compared to planned doses in RTP. The current SS technique could deliver lower scattered doses than recommendation criteria, but use of 2 mm lead shielder contributed to reduce scattered doses by 60%. The tertiary lead shielder can be useful to prevent malfunction or electrical damage of implanted pacemakers during radiotherapy. It is required to estimate more accurate scattered doses of the patient or medical device in RTP to design proper dose reduction strategy.

  1. Analysis of Cumulative Dose to Implanted Pacemaker According to Various IMRT Delivery Methods: Optimal Dose Delivery Versus Dose Reduction Strategy

    International Nuclear Information System (INIS)

    Lee, Jeong Woo; Hong, Se Mie

    2011-01-01

    Cancer patients with implanted cardiac pacemaker occasionally require radiotherapy. Pacemaker may be damaged or malfunction during radiotherapy due to ionizing radiation or electromagnetic interference. Although radiotherapy should be planned to keep the dose to pacemaker as low as possible not to malfunction ideally, current radiation treatment planning (RTP) system does not accurately calculate deposited dose to adjacent field border or area beyond irradiated fields. In terms of beam delivery techniques using multiple intensity modulated fields, dosimetric effect of scattered radiation in high energy photon beams is required to be detailed analyzed based on measurement data. The aim of this study is to evaluate dose discrepancies of pacemaker in a RTP system as compared to measured doses. We also designed dose reduction strategy limited value of 2 Gy for radiation treatment patients with cardiac implanted pacemaker. Total accumulated dose of 145 cGy based on in-vivo dosimetry was satisfied with the recommendation criteria to prevent malfunction of pacemaker in SS technique. However, the 2 mm lead shielder enabled the scattered doses to reduce up to 60% and 40% in the patient and the phantom, respectively. The SS technique with the lead shielding could reduce the accumulated scattered doses less than 100 cGy. Calculated and measured doses were not greatly affected by the beam delivery techniques. In-vivo and measured doses on pacemaker position showed critical dose discrepancies reaching up to 4 times as compared to planned doses in RTP. The current SS technique could deliver lower scattered doses than recommendation criteria, but use of 2 mm lead shielder contributed to reduce scattered doses by 60%. The tertiary lead shielder can be useful to prevent malfunction or electrical damage of implanted pacemakers during radiotherapy. It is required to estimate more accurate scattered doses of the patient or medical device in RTP to design proper dose reduction strategy.

  2. Prospective Multi-Institutional Study of Definitive Radiotherapy With High-Dose-Rate Intracavitary Brachytherapy in Patients With Nonbulky (<4-cm) Stage I and II Uterine Cervical Cancer (JAROG0401/JROSG04-2)

    Energy Technology Data Exchange (ETDEWEB)

    Toita, Takafumi, E-mail: b983255@med.u-ryukyu.ac.jp [Department of Radiology, Graduate School of Medical Science, University of Ryukyus, Okinawa (Japan); Kato, Shingo [Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Niibe, Yuzuru [Department of Radiology, School of Medicine, Kitasato University, Sagamihara (Japan); Ohno, Tatsuya [Gunma University Heavy Ion Medical Center, Maebashi (Japan); Kazumoto, Tomoko [Department of Radiology, Saitama Cancer Center, Saitama (Japan); Kodaira, Takeshi [Department of Radiation Oncology, Aichi Cancer Center, Nagoya (Japan); Kataoka, Masaaki [Department of Radiology, National Shikoku Cancer Center, Ehime (Japan); Shikama, Naoto [Department of Radiation Oncology, Saku Central Hospital, Saku (Japan); Kenjo, Masahiro [Department of Radiation Oncology, Graduate School of Medical Science, Hiroshima University, Hiroshima (Japan); Tokumaru, Sunao [Department of Radiology, Saga University, Saga (Japan); Yamauchi, Chikako [Department of Radiation Oncology, Shiga Medical Center for Adults, Moriyama (Japan); Suzuki, Osamu [Department of Radiation Oncology, Osaka Medical Center for Cancer, Osaka (Japan); Sakurai, Hideyuki [Proton Medical Research Center and Tsukuba University, Tsukuba (Japan); Numasaki, Hodaka; Teshima, Teruki [Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University, Suita, Osaka (Japan); Oguchi, Masahiko [Department of Radiation Oncology, Cancer Institute Hospital, Tokyo (Japan); Kagami, Yoshikazu [Radiation Oncology Division, National Cancer Center Hospital, Tokyo (Japan); Nakano, Takashi [Department of Radiation Oncology, Gunma University, Graduate School of Medicine, Maebashi (Japan); Hiraoka, Masahiro [Department of Radiation Oncology and Image-applied Therapy, Kyoto University, Graduate School of Medicine, Kyoto (Japan); Mitsuhashi, Norio [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan)

    2012-01-01

    Purpose: To determine the efficacy of a definitive radiotherapy protocol using high-dose-rate intracavitary brachytherapy (HDR-ICBT) with a low cumulative dose schedule in nonbulky early-stage cervical cancer patients, we conducted a prospective multi-institutional study. Methods and Materials: Eligible patients had squamous cell carcinoma of the intact uterine cervix, Federation of Gynecologic Oncology and Obstetrics (FIGO) stages Ib1, IIa, and IIb, tumor size <40 mm in diameter (assessed by T2-weighted magnetic resonance imaging), and no pelvic/para-aortic lymphadenopathy. The treatment protocol consisted of whole-pelvis external beam radiotherapy (EBRT) of 20 Gy/10 fractions, pelvic EBRT with midline block of 30 Gy/15 fractions, and HDR-ICBT of 24 Gy/4 fractions (at point A). The cumulative biologically effective dose (BED) was 62 Gy{sub 10} ({alpha}/{beta} = 10) at point A. The primary endpoint was the 2-year pelvic disease progression-free (PDPF) rate. All patients received a radiotherapy quality assurance review. Results: Between September 2004 and July 2007, 60 eligible patients were enrolled. Thirty-six patients were assessed with FIGO stage Ib1; 12 patients with stage IIa; and 12 patients with stage IIb. Median tumor diameter was 28 mm (range, 6-39 mm). Median overall treatment time was 43 days. Median follow-up was 49 months (range, 7-72 months). Seven patients developed recurrences: 3 patients had pelvic recurrences (2 central, 1 nodal), and 4 patients had distant metastases. The 2-year PDPF was 96% (95% confidence interval [CI], 92%-100%). The 2-year disease-free and overall survival rates were 90% (95% CI, 82%-98%) and 95% (95% CI, 89%-100%), respectively. The 2-year late complication rates (according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer of Grade {>=}1) were 18% (95% CI, 8%-28%) for large intestine/rectum, 4% (95% CI, 0%-8%) for small intestine, and 0% for bladder. No Grade {>=}3 cases were

  3. Mathematical model for evaluation of dose-rate effect on biological responses to low dose γ-radiation

    International Nuclear Information System (INIS)

    Ogata, H.; Kawakami, Y.; Magae, J.

    2003-01-01

    Full text: To evaluate quantitative dose-response relationship on the biological response to radiation, it is necessary to consider a model including cumulative dose, dose-rate and irradiation time. In this study, we measured micronucleus formation and [ 3 H] thymidine uptake in human cells as indices of biological response to gamma radiation, and analyzed mathematically and statistically the data for quantitative evaluation of radiation risk at low dose/low dose-rate. Effective dose (ED x ) was mathematically estimated by fitting a general function of logistic model to the dose-response relationship. Assuming that biological response depends on not only cumulative dose but also dose-rate and irradiation time, a multiple logistic function was applied to express the relationship of the three variables. Moreover, to estimate the effect of radiation at very low dose, we proposed a modified exponential model. From the results of fitting curves to the inhibition of [ 3 H] thymidine uptake and micronucleus formation, it was obvious that ED 50 in proportion of inhibition of [ 3 H] thymidine uptake increased with longer irradiation time. As for the micronuclei, ED 30 also increased with longer irradiation times. These results suggest that the biological response depends on not only total dose but also irradiation time. The estimated response surface using the three variables showed that the biological response declined sharply when the dose-rate was less than 0.01 Gy/h. These results suggest that the response does not depend on total cumulative dose at very low dose-rates. Further, to investigate the effect of dose-rate within a wider range, we analyzed the relationship between ED x and dose-rate. Fitted curves indicated that ED x increased sharply when dose-rate was less than 10 -2 Gy/h. The increase of ED x signifies the decline of the response or the risk and suggests that the risk approaches to 0 at infinitely low dose-rate

  4. SU-C-207A-07: Cumulative 18F-FDG Uptake Histogram Relative to Radiation Dose Volume Histogram of Lung After IMRT Or PSPT and Their Association with Radiation Pneumonitis

    International Nuclear Information System (INIS)

    Shusharina, N; Choi, N; Bortfeld, T; Liao, Z; Mohan, R

    2016-01-01

    Purpose: To determine whether the difference in cumulative 18F-FDG uptake histogram of lung treated with either IMRT or PSPT is associated with radiation pneumonitis (RP) in patients with inoperable stage II and III NSCLC. Methods: We analyzed 24 patients from a prospective randomized trial to compare IMRT (n=12) with vs. PSPT (n=12) for inoperable NSCLC. All patients underwent PET-CT imaging between 35 and 88 days post-therapy. Post-treatment PET-CT was aligned with planning 4D CT to establish a voxel-to-voxel correspondence between post-treatment PET and planning dose images. 18F-FDG uptake as a function of radiation dose to normal lung was obtained for each patient. Distribution of the standard uptake value (SUV) was analyzed using a volume histogram method. The image quantitative characteristics and DVH measures were correlated with clinical symptoms of pneumonitis. Results: Patients with RP were present in both groups: 5 in the IMRT and 6 in the PSPT. The analysis of cumulative SUV histograms showed significantly higher relative volumes of the normal lung having higher SUV uptake in the PSPT patients for both symptomatic and asymptomatic cases (VSUV=2: 10% for IMRT vs 16% for proton RT and VSUV=1: 10% for IMRT vs 23% for proton RT). In addition, the SUV histograms for symptomatic cases in PSPT patients exhibited a significantly longer tail at the highest SUV. The absolute volume of the lung receiving the dose >70 Gy was larger in the PSPT patients. Conclusion: 18F-FDG uptake – radiation dose response correlates with RP in both groups of patients by means of the linear regression slope. SUV is higher for the PSPT patients for both symptomatic and asymptomatic cases. Higher uptake after PSPT patients is explained by larger volumes of the lung receiving high radiation dose.

  5. The effects of dose and diet on the pharmacodynamics of omeprazole in the horse.

    Science.gov (United States)

    Sykes, B W; Underwood, C; Greer, R; McGowan, C M; Mills, P C

    2017-07-01

    Conflicting data are presented in the current literature regarding the efficacy of omeprazole for suppressing gastric acidity in the horse. The objective of this study was to investigate the duration of intraday acid suppression achieved with two doses of omeprazole under two different dietary conditions. A four-way crossover design. Six adult Thoroughbred horses instrumented with percutaneous gastrotomy tubes were used. Intragastric pH was measured for continuous 23 h periods (08.00-07.00 h) for six consecutive days (Days 0-5). Baseline data was recorded on Day 0 and omeprazole administered on Days 1-5. Two doses (1 mg/kg and 4 mg/kg bwt per os once a day) and two diets (a high grain/low fibre [HG/LF] and ad libitum hay [HAY)] diet) were studied. Data for the percent (%) time pH was above 4 (%tpH>4) and median intraday pH was reported for two measurement locations and analysed using generalised estimating equations. An effect of both diet and dose was evident with mean %tpH>4 and the mean of the median intraday pHs typically higher at the higher (4 mg/kg bwt) dose and in HG/LF diet. The overall efficacy of omeprazole in raising intragastric pH was good under the HG/LF conditions but relatively poor in the HAY diet. A cumulative effect of dosing, not previously reported in the horse, was observed. The overall efficacy of omeprazole in raising ventral gastric pH was less than previously reported. Both dose and diet may play a role in the efficacy of omeprazole in the horse. Therefore, the use of singular dosing recommendations that encompass all horse types and management conditions may not be appropriate and dosing recommendations that take into account the diet of the horse may be advantageous. © 2016 EVJ Ltd.

  6. Physiological and immunological changes following exposure to low versus high-dose ionizing irradiation; comparative analysis with dose rate and cumulative dose

    International Nuclear Information System (INIS)

    Heesun, Kim; Heewon, Jang; Soungyeon, Song; Shinhye, Oh; Cukcheul, Shin; Meeseon, Jeong; Chasoon, Kim; Kwnaghee, Yang; Seonyoung, Nam; Jiyoung, Kim; Youngwoo, Jin; Changyoung, Cha

    2008-01-01

    Full text: While high-dose of ionizing radiation is generally harmful and causes damage to living organisms some reports suggest low-dose of radiation may not be as damaging as previously thought. Despite increasing evidence regarding the protective effect of low-dose radiation, no studies have directly compared the exact dose-response pattern by high- and low-dose of radiation exposed at high-and low-dose rate. This study aims to explore the cellular and molecular changes in mice exposed to low- and high-dose of radiation exposed at low- and high-dose rate. When C57BL/6 mice (Female, 6 weeks) were exposed at high-dose rate, 0.8 Gy/min, no significant change on the level of WBC, RBC, or platelets was observed up to total dose of 0.5 Gy. However, 2 Gy of radiation caused dramatic reduction in the level of white blood cells (WBC) and platelets. This reduction was accompanied by increased DNA damage in hematopoietic environments. The reduction of WBC was mainly due to the reduction in the number of CD4+ T cells and CD19+ B cells. CD8+ T cells and NK cells appeared to be relatively resistant to high-dose of radiation. This change was also accompanied by the reduction of T- and B- progenitor cells in the bone marrow. In contrast, no significant changes of the number of CD4+ T, CD8+ T, NK, and B cells were observed in the spleen of mice exposed at low-dose-rate (0.7 m Gy/h or 3.95 mGy/h) for up to 2 Gy, suggesting that low-dose radiation does not alter cellular distribution in the spleen. Nevertheless, mice exposed to low-dose radiation exhibited elevation of VEGF, MCP-1, IL-4, Leptin, IL-3, and Tpo in the peripheral blood and slight increases in MIP-2, RANTES, and IL-2 in the spleen. This suggests that chronic γ-radiation can stimulate immune function without causing damage to the immune components of the body. Taken together, these data indicate hormesis of low-dose radiation, which could be attributed to the stimulation of immune function. Dose rate rather than total

  7. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation

    Science.gov (United States)

    Van Dongen, Hans P A.; Maislin, Greg; Mullington, Janet M.; Dinges, David F.

    2003-01-01

    OBJECTIVES: To inform the debate over whether human sleep can be chronically reduced without consequences, we conducted a dose-response chronic sleep restriction experiment in which waking neurobehavioral and sleep physiological functions were monitored and compared to those for total sleep deprivation. DESIGN: The chronic sleep restriction experiment involved randomization to one of three sleep doses (4 h, 6 h, or 8 h time in bed per night), which were maintained for 14 consecutive days. The total sleep deprivation experiment involved 3 nights without sleep (0 h time in bed). Each study also involved 3 baseline (pre-deprivation) days and 3 recovery days. SETTING: Both experiments were conducted under standardized laboratory conditions with continuous behavioral, physiological and medical monitoring. PARTICIPANTS: A total of n = 48 healthy adults (ages 21-38) participated in the experiments. INTERVENTIONS: Noctumal sleep periods were restricted to 8 h, 6 h or 4 h per day for 14 days, or to 0 h for 3 days. All other sleep was prohibited. RESULTS: Chronic restriction of sleep periods to 4 h or 6 h per night over 14 consecutive days resulted in significant cumulative, dose-dependent deficits in cognitive performance on all tasks. Subjective sleepiness ratings showed an acute response to sleep restriction but only small further increases on subsequent days, and did not significantly differentiate the 6 h and 4 h conditions. Polysomnographic variables and delta power in the non-REM sleep EEG-a putative marker of sleep homeostasis--displayed an acute response to sleep restriction with negligible further changes across the 14 restricted nights. Comparison of chronic sleep restriction to total sleep deprivation showed that the latter resulted in disproportionately large waking neurobehavioral and sleep delta power responses relative to how much sleep was lost. A statistical model revealed that, regardless of the mode of sleep deprivation, lapses in behavioral alertness

  8. Peptide receptor radionuclide therapy with {sup 177}Lu-DOTATATE: the IEO phase I-II study

    Energy Technology Data Exchange (ETDEWEB)

    Bodei, Lisa; Grana, Chiara M.; Baio, Silvia M.; Lombardo, Dario; Chinol, Marco; Paganelli, Giovanni [European Institute of Oncology, Division of Nuclear Medicine, Milan (Italy); Cremonesi, Marta; Ferrari, Mahila E. [European Institute of Oncology, Division of Medical Physics, Milan (Italy); Fazio, Nicola [European Institute of Oncology, Division of Medical Oncology, Milan (Italy); Iodice, Simona [European Institute of Oncology, Division of Epidemiology and Biostatistics, Milan (Italy); Bartolomei, Mirco [European Institute of Oncology, Division of Nuclear Medicine, Milan (Italy); M. Bufalini Hospital, Division of Nuclear Medicine, Cesena, FC (Italy); Sansovini, Maddalena [Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Unit of Radiometabolic Medicine, Meldola, FC (Italy)

    2011-12-15

    Peptide receptor radionuclide therapy (PRRT) is used in tumours expressing type 2 somatostatin receptors (sst{sub 2}), mainly neuroendocrine. The aim of this prospective phase I-II study was to evaluate the toxicity and efficacy of {sup 177}Lu-DOTATATE in multiple cycles. Fifty-one consecutive patients with unresectable/metastatic sst{sub 2}-positive tumours, divided into two groups, received escalating activities (3.7-5.18 GBq/cycle, group 1; 5.18-7.4 GBq/cycle, group 2) of {sup 177}Lu-DOTATATE. Cumulative activities ranged from 3.7 to 29.2 GBq (median 26.4 GBq in median 6 cycles, group 1, 21 patients) and 5.55 to 28.9 GBq (median 25.2 GBq in 4 cycles, group 2, 30 patients), based on dosimetry. No major acute or delayed renal or haematological toxicity occurred (one grade 3 leukopenia and thrombocytopenia). Cumulative renal absorbed doses were 8-37 Gy (9-41 Gy bioeffective doses). A median decrease of creatinine clearance of 21.7% 6 months after PRRT, 23.9% after 1 year and 27.6% after 2 years was observed. Higher losses (>20%) occurred in patients with risk factors for renal toxicity, particularly hypertension and diabetes. Cumulative bone marrow doses were <1.5 Gy. Blood elements showed a progressive mild drop during cycles and recovered during follow-up (median 30 months). Thirty-nine patients were progressive at enrolment. Partial and complete responses occurred in 15 of 46 (32.6%) assessable patients. The median time to progression was 36 months. Overall survival was 68% at 36 months. Non-responders and patients with extensive tumour involvement had lower survival. {sup 177}Lu-DOTATATE was well tolerated up to 29 GBq cumulative activity (up to 7.4 GBq/cycle). The maximum tolerated dose/cycle was not reached. However, considering the individual bone marrow function and the presence of risk factors for kidney toxicity, it seems safer to divide cumulative activities into lower activity cycles. (orig.)

  9. Effects of low-dose continuously fractionated X-ray irradiation on murine peripheral blood lymphocytes

    International Nuclear Information System (INIS)

    Xie Yi; Zhang Hong; Dang Bingrong; Hao Jifang; Guo Hongyun; Wang Xiaohu

    2007-01-01

    For estimating biological risks from low doses continual irradiation, we investigated the effects of exposure to continuously fractionated X-rays on murine immune system. The BALB/c mice were irradiated with 0.07Gy at the first day and 0.08 Gy/d in the following 12 days at a dose rate of 0.2 Gy/min. The peripheral blood lymphocyte cycle and death were determined by flow cytometry at the cumulative doses of 0, 0.07, 0.23, 0.39, 0.55, 0.71, 0.87 and 1.03 Gy respectively. The results showed that the cycle of peripheral blood lymphocyte was arrested in G 0 /G 1 at cumulative doses of 0.07, 0.23, 0.71 and 0.87 Gy, and in G 2 /M at cumulative doses of 0.39 and 1.03 Gy; the percentage of death of peripheral blood lymphocyte was ascended with dose increasing, and reached the death peak at cumulative doses of 0.71 Gy. The results suggested that low doses continual X-rays total-body irradiated could result in changes of cellular cycle and death, and some damages to immunocytes, which accorded to linear square model. (authors)

  10. Quantitative assessment of cumulative damage from repetitive exposures to suberythemogenic doses of UVA in human skin

    International Nuclear Information System (INIS)

    Lavker, R.M.; Kaidbey, K.H.

    1995-01-01

    Daily exposures to relatively small suberythemogenic fluences of UVA (50-200 kJ/m 2 ) for 8 days resulted in cumulative morphological skin alterations indicative of early tissue injury. Histologically, irradiated skin revealed epidermal hyperplasia, inflammation and deposition of lysozyme along the dermal elastic fiber network. Sunburn cells were also present within the epidermis. These changes were quantified by image analysis and were found to be related to the cumulative UVA fluence. A long UVA waveband (UVAI, 340-400 nm) was as effective as a broad UVA band (320-400 nm), suggesting that these changes are induced by longer UVA wavelengths. (author)

  11. Evaluating the maximum patient radiation dose in cardiac interventional procedures

    International Nuclear Information System (INIS)

    Kato, M.; Chida, K.; Sato, T.; Oosaka, H.; Tosa, T.; Kadowaki, K.

    2011-01-01

    Many of the X-ray systems that are used for cardiac interventional radiology provide no way to evaluate the patient maximum skin dose (MSD). The authors report a new method for evaluating the MSD by using the cumulative patient entrance skin dose (ESD), which includes a back-scatter factor and the number of cine-angiography frames during percutaneous coronary intervention (PCI). Four hundred consecutive PCI patients (315 men and 85 women) were studied. The correlation between the cumulative ESD and number of cine-angiography frames was investigated. The irradiation and overlapping fields were verified using dose-mapping software. A good correlation was found between the cumulative ESD and the number of cine-angiography frames. The MSD could be estimated using the proportion of cine-angiography frames used for the main angle of view relative to the total number of cine-angiography frames and multiplying this by the cumulative ESD. The average MSD (3.0±1.9 Gy) was lower than the average cumulative ESD (4.6±2.6 Gy). This method is an easy way to estimate the MSD during PCI. (authors)

  12. Cumulative Poisson Distribution Program

    Science.gov (United States)

    Bowerman, Paul N.; Scheuer, Ernest M.; Nolty, Robert

    1990-01-01

    Overflow and underflow in sums prevented. Cumulative Poisson Distribution Program, CUMPOIS, one of two computer programs that make calculations involving cumulative Poisson distributions. Both programs, CUMPOIS (NPO-17714) and NEWTPOIS (NPO-17715), used independently of one another. CUMPOIS determines cumulative Poisson distribution, used to evaluate cumulative distribution function (cdf) for gamma distributions with integer shape parameters and cdf for X (sup2) distributions with even degrees of freedom. Used by statisticians and others concerned with probabilities of independent events occurring over specific units of time, area, or volume. Written in C.

  13. Patient and staff dose during hysterosalpinography

    International Nuclear Information System (INIS)

    Buls, N.; Osteaux, M.

    2001-01-01

    Hysterosalpingography (HSG) is a useful and widely employed technique which uses X-ray fluoroscopy to investigate the female genital tract. Fluoroscopy is assessed by a gynaecologist, a physician who is not always trained to work with ionising radiation. Dose-area product measurements in a group of 34 patients allowed an estimation of the median effective dose (0,83 mSv) and the median dose to the ovaries (1,63 mGy) of the patient per procedure. The dose to the staff was estimated using thermoluminescent dosimetry. The following median entrance surface doses were estimated per procedure: 0,22 mGy to the lens of the eye, 0,15 mGy to the neck at thyroid level and 0,19 mGy to the back of the hand. The annual eye dose limit could be exceeded if the gynaecologist is a member of the public. (author)

  14. Dose-volumetric parameters for predicting hypothyroidism after radiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Kim, Mi Young; Yu, Tosol; Wu, Hong-Gyun

    2014-01-01

    To investigate predictors affecting the development of hypothyroidism after radiotherapy for head and neck cancer, focusing on radiation dose-volumetric parameters, and to determine the appropriate radiation dose-volumetric threshold of radiation-induced hypothyroidism. A total of 114 patients with head and neck cancer whose radiotherapy fields included the thyroid gland were analysed. The purpose of the radiotherapy was either definitive (n=81) or post-operative (n=33). Thyroid function was monitored before starting radiotherapy and after completion of radiotherapy at 1 month, 6 months, 1 year and 2 years. A diagnosis of hypothyroidism was based on a thyroid stimulating hormone value greater than the maximum value of laboratory range, regardless of symptoms. In all patients, dose volumetric parameters were analysed. Median follow-up duration was 25 months (range; 6-38). Forty-six percent of the patients were diagnosed as hypothyroidism after a median time of 8 months (range; 1-24). There were no significant differences in the distribution of age, gender, surgery, radiotherapy technique and chemotherapy between the euthyroid group and the hypothyroid group. In univariate analysis, the mean dose and V35-V50 results were significantly associated with hypothyroidism. The V45 is the only variable that independently contributes to the prediction of hypothyroidism in multivariate analysis and V45 of 50% was a threshold value. If V45 was <50%, the cumulative incidence of hypothyroidism at 1 year was 22.8%, whereas the incidence was 56.1% if V45 was ≥50%. (P=0.034). The V45 may predict risk of developing hypothyroidism after radiotherapy for head and neck cancer, and a V45 of 50% can be a useful dose-volumetric threshold of radiation-induced hypothyroidism. (author)

  15. Radiation exposure assessment for Portsmouth Naval Shipyard health studies

    International Nuclear Information System (INIS)

    Daniels, R. D.; Taulbee, T. D.; Chen, P.

    2004-01-01

    Occupational radiation exposures of 13,475 civilian nuclear shipyard workers were investigated as part of a retrospective mortality study. Estimates of annual, cumulative and collective doses were tabulated for future dose-response analysis. Record sets were assembled and amended through range checks, examination of distributions and inspection. Methods were developed to adjust for administrative overestimates and dose from previous employment. Uncertainties from doses below the recording threshold were estimated. Low-dose protracted radiation exposures from submarine overhaul and repair predominated. Cumulative doses are best approximated by a hybrid log-normal distribution with arithmetic mean and median values of 20.59 and 3.24 mSv, respectively. The distribution is highly skewed with more than half the workers having cumulative doses 95% having doses <100 mSv. The maximum cumulative dose is estimated at 649.39 mSv from 15 person-years of exposure. The collective dose was 277.42 person-Sv with 96.8% attributed to employment at Portsmouth Naval Shipyard. (authors)

  16. Tracking the dose distribution in radiation therapy by accounting for variable anatomy

    International Nuclear Information System (INIS)

    Schaly, B; Kempe, J A; Bauman, G S; Battista, J J; Van Dyk, J

    2004-01-01

    The goal of this research is to calculate the daily and cumulative dose distribution received by the radiotherapy patient while accounting for variable anatomy, by tracking the dose distribution delivered to tissue elements (voxels) that move within the patient. Non-linear image registration techniques (i.e., thin-plate splines) are used along with a conventional treatment planning system to combine the dose distributions computed for each 3D computed tomography (CT) study taken during treatment. For a clinical prostate case, we demonstrate that there are significant localized dose differences due to systematic voxel motion in a single fraction as well as in 15 cumulative fractions. The largest positive dose differences in rectum, bladder and seminal vesicles were 29%, 2% and 24%, respectively, after the first fraction of radiation treatment compared to the planned dose. After 15 cumulative fractions, the largest positive dose differences in rectum, bladder and seminal vesicles were 23%, 32% and 18%, respectively, compared to the planned dose. A sensitivity analysis of control point placement is also presented. This method provides an important understanding of actual delivered doses and has the potential to provide quantitative information to use as a guide for adaptive radiation treatments

  17. Multifocal Electroretinography after High Dose Chloroquine Therapy for Malaria

    Directory of Open Access Journals (Sweden)

    Aline Correa de Carvalho

    2013-01-01

    Full Text Available Purpose: To investigate changes in multifocal electroretinography (mfERG parameters associated with high dose chloroquine therapy for treatment of malaria in the Amazonia region of Brazil. Methods: Forty-eight subjects who had received chloroquine treatment for single or multiple malaria infections with a cumulative dose ranging from 1,050 to 27,000mg were included. The control group consisted of 37 healthy aged-matched subjects. Data was collected on amplitude and implicit time of the N1, P1 and N2 waves in the central macular hexagon (R1 and in five concentric rings at different retinal eccentricities (R2-R6. Results: No significant difference was observed in any mfERG parameter between chloroquine treated patients and control subjects. A comparison with previous data obtained from patients with rheumatologic disorders in the same region of Brazil who had received larger cumulative doses of chloroquine and had displayed mfERG changes, indicated that retinal toxicity seems to be dependent on cumulative dose. Conclusion: Lack of mfERG changes in the current study suggests that intensive high dose chloroquine therapy for treatment of malaria is not associated with retinal toxicity.

  18. Fetal dose evaluation during breast cancer radiotherapy

    International Nuclear Information System (INIS)

    Antypas, Christos; Sandilos, Panagiotis; Kouvaris, John; Balafouta, Ersi; Karinou, Eleftheria; Kollaros, Nikos; Vlahos, Lambros

    1998-01-01

    Purpose: The aim of the work was to estimate the radiation dose delivered to the fetus in a pregnant patient irradiated for breast cancer. Methods and Materials: A 45-year woman was treated for left breast cancer using a 6 MV photon beam with two isocentric opposing tangential unwedged fields. Daily dose was 2.3 Gy at 95% isodose line given by two fields/day, 5 days/week. A total dose of 46 Gy was given in 20 fractions over a 4-week period. Pregnancy confirmed during the second therapeutic week. Treatment lasted between the second and sixth gestation week. Radiation dose to fetus was estimated from in vivo and phantom measurements using thermoluminescence dosimeters and an ionization chamber. In vivo measurements were performed by inserting either a catheter with TL dosimeters or ionization chamber into the patient's rectum. Phantom measurements were performed by simulating the treatment conditions on an anthropomorphic phantom. Results: TLD measurements (in vivo and phantom) revealed fetal dose to be 0.085% of the tumor dose, corresponding to a cumulative fetal dose of 3.9 cGy for the entire treatment of 46 Gy. Chamber measurements (in vivo and phantom) revealed a fetal dose less than the TLD result: 0.079 and 0.083% of the tumor dose corresponding to cumulative fetal dose of 3.6 cGy and 3.8 cGy for in vivo and phantom measurement, respectively. Conclusions: It was concluded that the cumulative dose delivered to the unshielded fetus was 3.9 cGy for a 46 Gy total tumor dose. The estimated fetal dose is low compared to the total tumor dose given due to the early stage of pregnancy, the large distance between fundus-radiation field, and the fact that no wedges and/or lead blocks were used. No deterministic biological effects of radiation on the live-born embryo are expected. The lifetime risk for radiation-induced fatal cancer is higher than the normal incidence, but is considered as inconsequential

  19. High cumulative insulin exposure : a risk factor of atherosclerosis in type 1 diabetes?

    NARCIS (Netherlands)

    Muis, MJ; Bots, ML; Bilo, HJG; Hoogma, RPLM; Hoekstra, JBL; Grobbee, DE; Stolk, RP

    Background: Since insulin therapy might have an atherogenic effect, we studied the relationship between cumulative insulin dose and atherosclerosis in type 1 diabetes. We have focused on patients with type 1 diabetes instead of type 2 diabetes to minimise the effect of insulin resistance as a

  20. High cumulative insulin exposure: a risk factor of atherosclerosis in type 1 diabetes?

    NARCIS (Netherlands)

    Muis, Marian J.; Bots, Michiel L.; Bilo, Henk J. G.; Hoogma, Roel P. L. M.; Hoekstra, Joost B. L.; Grobbee, Diederick E.; Stolk, Ronald P.

    2005-01-01

    Background: Since insulin therapy might have an atherogenic effect, we studied the relationship between cumulative insulin dose and atherosclerosis in type 1 diabetes. We have focused on patients with type 1 diabetes instead of type 2 diabetes to minimise the effect of insulin resistance as a

  1. Cumulative keyboard strokes: a possible risk factor for carpal tunnel syndrome

    Directory of Open Access Journals (Sweden)

    Eleftheriou Andreas

    2012-08-01

    Full Text Available Abstract Background Contradictory reports have been published regarding the association of Carpal Tunnel Syndrome (CTS and the use of computer keyboard. Previous studies did not take into account the cumulative exposure to keyboard strokes among computer workers. The aim of the present study was to investigate the association between cumulative keyboard use (keyboard strokes and CTS. Methods Employees (461 from a Governmental data entry & processing unit agreed to participate (response rate: 84.1 % in a cross-sectional study. Α questionnaire was distributed to the participants to obtain information on socio-demographics and risk factors for CTS. The participants were examined for signs and symptoms related to CTS and were asked if they had previous history or surgery for CTS. The cumulative amount of the keyboard strokes per worker per year was calculated by the use of payroll’s registry. Two case definitions for CTS were used. The first included subjects with personal history/surgery for CTS while the second included subjects that belonged to the first case definition plus those participants were identified through clinical examination. Results Multivariate analysis used for both case definitions, indicated that those employees with high cumulative exposure to keyboard strokes were at increased risk of CTS (case definition A: OR = 2.23;95 % CI = 1.09-4.52 and case definition B: OR = 2.41; 95%CI = 1.36-4.25. A dose response pattern between cumulative exposure to keyboard strokes and CTS has been revealed (p  Conclusions The present study indicated a possible association between cumulative exposure to keyboard strokes and development of CTS. Cumulative exposure to key-board strokes would be taken into account as an exposure indicator regarding exposure assessment of computer workers. Further research is needed in order to test the results of the current study and assess causality between cumulative keyboard strokes and

  2. Analysis of the occupational doses of female radiation workers in India

    Energy Technology Data Exchange (ETDEWEB)

    Pardasani, P B; Joshi, V D; Awari, J M; Kher, R K [Bhabha Atomic Research Centre, Mumbai (India). Radiation Protection Services Div.

    1994-04-01

    Basis for control of occupational exposures of women are same as that of men except for pregnant women. Analysis of annual and cumulative occupational doses of female radiation workers as a group has been done. The average annual dose data in the four broad categories and age wise dose distribution is presented. The average working period for female radiation workers is about 3 to 5 years which is same as that of all the radiation workers on our records. The average cumulative dose for female workers is about 3 mSv. (author). 4 refs., 4 tabs.

  3. Analysis of the occupational doses of female radiation workers in India

    International Nuclear Information System (INIS)

    Pardasani, P.B.; Joshi, V.D.; Awari, J.M.; Kher, R.K.

    1994-01-01

    Basis for control of occupational exposures of women are same as that of men except for pregnant women. Analysis of annual and cumulative occupational doses of female radiation workers as a group has been done. The average annual dose data in the four broad categories and age wise dose distribution is presented. The average working period for female radiation workers is about 3 to 5 years which is same as that of all the radiation workers on our records. The average cumulative dose for female workers is about 3 mSv. (author). 4 refs., 4 tabs

  4. The Prognostic Impact of K-RAS Mutations in Adult Acute Myeloid Leukemia Patients Treated with High Dose Cytarabine

    International Nuclear Information System (INIS)

    Ahmad, E.I.; Gawish, H.H.; Al-Azizi, N.M.A.; El-Hefni, A.M.

    2009-01-01

    Activating point mutation of the RAS gene has been generally accepted as an oncogenic event in a variety of malignancies. It represents one of the most common genetic alterations in acute myeloid leukemia (AML). However there is still controversy about its clinical relevance on the treatment outcome of this leukemia. Objective: This study aimed to clarify the biologic and prognostic impact of K-RAS mutations in relation to the dose of cytarabine (ara-C) used in post induction consolidation chemotherapy in adult AML patients. Patients and Methods: The study comprised 71de novo AML patients with a male: Female ratio of 1.4: 1; their ages ranged from 21-59 years with a median of 37 years. They were subjected to full clinical evaluation, routine laboratory investigations, cytogenetic studies by G banding and K-RAS mutation detection using realtime PCR. The patients were randomized into 2 groups (gps) according to the ara-C dose used in consolidation treatment, HDAC gp receiving 400 mg ara-C and LDAC gp receiving 100 mg ara-C. They were followed over a period of 5 years. Results: Mutations in the K-RAS gene (mutRAS) were detected in 23 patients (32%) with the remaining 48 patients (68%) having wild type RAS (wtRAS). Blast cell percentage was significantly lower in mutRAS compared to wtRAS patients (p=<0.001). The M4 subtype of AML and cases with Inv 16 showed significantly higher frequencies in mutRAS compared to wtRAS patients, (p=0.015, 0.003, respectively). The patients were followed up for a median of 43 months (range 11-57 months). There was no significant difference in overall survival (OS) between mutRAS and wtRAS patients (p=0.326). Within the mutRAS patients treated with HDAC, cumulative OS was significantly higher than those treated with LDAC (p=0.001). This was not the case in the wtRAS group (p=0.285). There was no significant difference in disease The Prognostic Impact of K-RAS Mutations in Adult Acute Myeloid Leukemia Patients Treated with High Dose

  5. Adaptive strategies for cumulative cultural learning.

    Science.gov (United States)

    Ehn, Micael; Laland, Kevin

    2012-05-21

    The demographic and ecological success of our species is frequently attributed to our capacity for cumulative culture. However, it is not yet known how humans combine social and asocial learning to generate effective strategies for learning in a cumulative cultural context. Here we explore how cumulative culture influences the relative merits of various pure and conditional learning strategies, including pure asocial and social learning, critical social learning, conditional social learning and individual refiner strategies. We replicate the Rogers' paradox in the cumulative setting. However, our analysis suggests that strategies that resolved Rogers' paradox in a non-cumulative setting may not necessarily evolve in a cumulative setting, thus different strategies will optimize cumulative and non-cumulative cultural learning. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. The prognostic impact of K-RAS mutations in adult acute myeloid leukemia patients treated with high-dose cytarabine

    Directory of Open Access Journals (Sweden)

    Ahmad EI

    2011-07-01

    RAS patients treated with HDAC, cumulative OS was significantly higher than those treated with LDAC (P = 0.001. This was not the case in the wtRAS group (P = 0.285. There was no significant difference in disease-free survival (DFS between mutRAS and wtRAS groups (P = 0.923. mutRAS patients treated with HDAC had a statistically higher cumulative DFS than mutRAS patients treated with LDAC (P = 0.001. Patients with wtRAS also benefited from HDAC, but to a lesser extent. Among patients with wtRAS, those treated with HDAC showed higher cumulative and median DFS than patients treated with LDAC (P = 0.031. Conclusion: It was concluded that adult AML patients carrying mutations in the K-RAS gene benefit from higher ara-C doses more than wtRAS patients, so pretreatment mutation detection could be an important predictor for treatment strategy and survival of adult AML patients. These findings counter the prevailing bias that oncogene mutations lead to more aggressive behavior in human malignancies.Keywords: K-RAS gene, acute myeloid leukemia, cytarabine (ara-C

  7. Dose reduction in evacuation proctography

    International Nuclear Information System (INIS)

    Hare, C.; Halligan, S.; Bartram, C.I.; Gupta, R.; Walker, A.E.; Renfrew, I.

    2001-01-01

    The goal of this study was to reduce the patient radiation dose from evacuation proctography. Ninety-eight consecutive adult patients referred for proctography to investigate difficult rectal evacuation were studied using a digital imaging system with either a standard digital program for barium examinations, a reduced dose digital program (both with and without additional copper filtration), or Video fluoroscopy. Dose-area products were recorded for each examination and the groups were compared. All four protocols produced technically acceptable examinations. The low-dose program with copper filtration (median dose 382 cGy cm 2 ) and Video fluoroscopy (median dose 705 cGy cm 2 ) were associated with significantly less dose than other groups (p < 0.0001). Patient dose during evacuation proctography can be reduced significantly without compromising the diagnostic quality of the examination. A digital program with added copper filtration conveyed the lowest dose. (orig.)

  8. Sosiaalisen median mahdollisuudet Tilastokeskukselle

    OpenAIRE

    Vesterinen, Anu

    2011-01-01

    Tämän opinnäytetyön aiheena oli sosiaalisen median mahdollisuudet Tilastokeskuksen viestinnässä. Työn tavoitteena oli kartoittaa sosiaalisen median käyttöön liittyviä mahdollisuuksia ja haasteita sekä selvittää siihen liittyviä odotuksia Tilastokeskuksen henkilöstön keskuudessa. Työn teoriaosuudessa tarkasteltiin sosiaalista mediaa käsitteenä ja esiteltiin sosiaalisen median käyttöä organisaation ulkoisen viestinnän välineenä. Opinnäytetyössä selvitettiin teoriatietoon pohjautuen sekä ca...

  9. Sosiaalisen median markkinointistrategia

    OpenAIRE

    Tran, Jenny

    2017-01-01

    Insinöörityön tavoitteena oli suunnitella toimeksiantajayritykselle sopiva sosiaalisen median markkinointistrategia ja avustaa sen toteutuksessa sekä tuottaen sisältöä sovittuihin kanaviin. Pyrkimyksenä oli myös kouluttaa yrityksen henkilökuntaa käyttämään sosiaalista mediaa yleisellä tasolla ja markkinoinnissa tutustuttamalla heidät sosiaalisen median erilaisiin kanaviin ja mainostyökaluihin. Opinnäytetyössä keskityttiin tutkimaan Facebookissa toimivaa markkinointia ja siinä toimivia mai...

  10. Secondary leukemia associated with a conventional dose of etoposide: review of serial germ cell tumor protocols.

    Science.gov (United States)

    Nichols, C R; Breeden, E S; Loehrer, P J; Williams, S D; Einhorn, L H

    1993-01-06

    Case reports have suggested that treatment with high-dose etoposide can result in development of a unique secondary leukemia. This study was designed to estimate the risk of developing leukemia for patients receiving conventional doses of etoposide along with cisplatin and bleomycin. We reviewed the records at Indiana University of all untreated patients entering clinical trials using etoposide at conventional doses (cumulative dose, 2000 mg/m2 or less) for germ cell cancer between 1982 and 1991. The records of all patients who received a chemotherapy regimen containing etoposide, ifosfamide, or cisplatin after failing to respond to primary chemotherapy were also reviewed. Between 1982 and 1991, 538 patients entered serial clinical trials with planned cumulative etoposide doses of 1500-2000 mg/m2 in combination with cisplatin plus either ifosfamide or bleomycin. Of these 538 patients, 348 received an etoposide combination as initial chemotherapy and 190 received etoposide as part of salvage treatment. To date, 315 patients are alive, with median follow-up of 4.9 years, and 337 patients have had follow-up beyond 2 years. Two patients (0.37%) developed leukemia. One developed acute undifferentiated leukemia with a t(4;11) (q21;q23) cytogenetic abnormality 2.0 years after starting etoposide-based therapy, and one developed acute myelomonoblastic leukemia with no chromosome abnormalities 2.3 years after beginning chemotherapy. During this period, several hundred patients were treated with etoposide-based chemotherapy and did not enter clinical trials. Three of these patients are known to have developed hematologic abnormalities, including one patient with acute monoblastic leukemia with a t(11;19)(q13;p13) abnormality. Secondary leukemia after treatment with a conventional dose of etoposide does occur, but the low incidence does not alter the risk-to-benefit ratio of etoposide-based chemotherapy in germ cell cancer. The reports of leukemia associated with high doses of

  11. [Combination of busulfan with increased-dose of fludarabine as conditioning regimen for MDS and MDS-AML patients with allo-HSCT].

    Science.gov (United States)

    Yuan, Jing; Ren, Hanyun; Qiu, Zhixiang; Li, Yuan; Wang, Mangju; Liu, Wei; Xu, Weilin; Sun, Yuhua; Wang, Lihong; Liang, Zeyin; Dong, Yujun; Ou, Jinping; Wang, Wensheng; Yin, Yue; Cen, Xinan; Wang, Qian

    2015-06-01

    To investigate the safety and efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for myelodysplastic syndrome (MDS) and secondary acute myelogenous leukemia (MDS-AML) using conditioning regimen with busulfan (Bu) and increased-dose of fludarabine (ID-Flu). A total of 49 patients with MDS or MDS-AML were treated by allo-HSCT, the clinical data was analyzed retrospectively. All patients achieved hematopoietic reconstitution. Neutrophil engraftment was at 10 - 22 days (median 13 days), and platelet engraftment was at 8 - 66 days (median 16 days). The cumulative incidences of Ⅱ-Ⅳ degree acute graft-versus-host disease (GVHD), hemorrhagic cystitis (HC), and hepatic venous occlusive disease (VOD) were 28.6%, 14.3% and 2.0%, respectively. The transplant-related mortality (TRM) was only 4.1% at 100d and 8.2% at 1-92 months of followed-up (median 14 months) period. Overall survival (OS) and disease free survival (DFS) was 75.5%, 73.5%, respectively. Kaplan-Meier curve showed that 3-year OS and 3-year DFS was (71.1 ± 7.8)%, (66.7 ± 8.3)%, respectively, with a relapse incidence (RI) 16.3%. OS for MDS and MDS-AML was 81.5% and 68.2%, and RI in two settings was 3.7%, 31.8%, respectively. OS for MDS-AML at complete remission (CR) and non-CR subgroup was 83.3% and 50.0%, respectively, while cumulative RR was 16.7% and 50.0%, respectively. OS and RI except for non-CR subgroup were 82.1% and 7.7%. Univariate analysis showed that pre-HSCT disease status had correlation with OS (P=0.031), but age, decitabine in conditioning regimen, stem cell source, HLA matching, patient-donor gender, dose of mononuclear cells and GVHD had no correlation with OS. Bu/ID-Flu conditioning regimen for MDS and MDS-AML has high efficiency, fewer complications, lower toxicity and TRM. The OS and DFS were higher and RI was lower except for refractory MDS-AML patients. The regimen is valuable for clinical application.

  12. Antipsychotic dose equivalents and dose-years: a standardized method for comparing exposure to different drugs.

    Science.gov (United States)

    Andreasen, Nancy C; Pressler, Marcus; Nopoulos, Peg; Miller, Del; Ho, Beng-Choon

    2010-02-01

    A standardized quantitative method for comparing dosages of different drugs is a useful tool for designing clinical trials and for examining the effects of long-term medication side effects such as tardive dyskinesia. Such a method requires establishing dose equivalents. An expert consensus group has published charts of equivalent doses for various antipsychotic medications for first- and second-generation medications. These charts were used in this study. Regression was used to compare each drug in the experts' charts to chlorpromazine and haloperidol and to create formulas for each relationship. The formulas were solved for chlorpromazine 100 mg and haloperidol 2 mg to derive new chlorpromazine and haloperidol equivalents. The formulas were incorporated into our definition of dose-years such that 100 mg/day of chlorpromazine equivalent or 2 mg/day of haloperidol equivalent taken for 1 year is equal to one dose-year. All comparisons to chlorpromazine and haloperidol were highly linear with R(2) values greater than .9. A power transformation further improved linearity. By deriving a unique formula that converts doses to chlorpromazine or haloperidol equivalents, we can compare otherwise dissimilar drugs. These equivalents can be multiplied by the time an individual has been on a given dose to derive a cumulative value measured in dose-years in the form of (chlorpromazine equivalent in mg) x (time on dose measured in years). After each dose has been converted to dose-years, the results can be summed to provide a cumulative quantitative measure of lifetime exposure. Copyright 2010 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  13. The Effect of Total Cumulative Dose, Number of Treatment Cycles, Interval between Injections, and Length of Treatment on the Frequency of Occurrence of Antibodies to Botulinum Toxin Type A in the Treatment of Muscle Spasticity

    Science.gov (United States)

    Bakheit, Abdel Magid O.; Liptrot, Anthea; Newton, Rachel; Pickett, Andrew M.

    2012-01-01

    A large cumulative dose of botulinum toxin type A (BoNT-A), frequent injections, a short interval between treatment cycles, and a long duration of treatment have all been suggested, but not confirmed, to be associated with a high incidence of neutralizing antibodies to the neurotoxin. The aim of this study was to investigate whether these…

  14. Complete cumulative index (1963-1983)

    International Nuclear Information System (INIS)

    1983-01-01

    This complete cumulative index covers all regular and special issues and supplements published by Atomic Energy Review (AER) during its lifetime (1963-1983). The complete cumulative index consists of six Indexes: the Index of Abstracts, the Subject Index, the Title Index, the Author Index, the Country Index and the Table of Elements Index. The complete cumulative index supersedes the Cumulative Indexes for Volumes 1-7: 1963-1969 (1970), and for Volumes 1-10: 1963-1972 (1972); this Index also finalizes Atomic Energy Review, the publication of which has recently been terminated by the IAEA

  15. Thyroid doses from external gamma-exposure following the Chernobyl accident

    International Nuclear Information System (INIS)

    Tretyakevich, Sergey; Kukhta, Tatyana; Minenko, Victor; Drozdovitch, Vladimir; Luckyanov, Nickolas; Gavrilin, Yury; Khrouch, Valeri; Shinkarev, Sergey

    2008-01-01

    Full text: An increase of thyroid cancer incidence among children in Belarus has been observed after the Chernobyl accident. The main contributor to the thyroid dose was caused by 131 I intake with fresh milk in 1986. Other contributions to the thyroid dose (external gamma-exposure, short-lived iodine isotopes, internal radiocesium) were small in comparison to the dose from 131 I intakes soon after the accident. However, exposures to external radiation continued for a number of years after the accident. Thyroid doses from external gamma-exposure following the Chernobyl accident were mainly caused by gamma-exposure to 24 nuclides: 95 Zr, 95 Nb, 99 Mo, 99 mTc, 103 Ru, 103m Rh, 106 Ru, 125 Sb, 125m Te, 131m Te, 131 I, 132 Te, 132 I, 133 I, 135 I, 134 Cs, 136 Cs, 137 Cs, 140 Ba, 140 La, 141 Ce, 144 Ce, 144 Pr, 239 Np. Data of personal interview were used to take into account the personal residence history for the time elapsed from the Chernobyl accident until the interview (10 to 15 years later). Cumulative thyroid doses caused by external gamma-exposure during the passage of the radioactive cloud and from the ground contamination following the Chernobyl accident have been reconstructed. The median thyroid dose from external gamma-exposure to ∼11,770 cohort members of an epidemiological study was estimated to be ∼6 mGy. There are ∼3,400 persons with external dose estimates that exceed 20 mGy. Exposure from radionuclides deposited on the ground was the main source of external dose. The contribution from the passing radioactive cloud to external dose was found to be negligible. (author)

  16. Gamma irradiator dose mapping simulation using the MCNP code and benchmarking with dosimetry

    International Nuclear Information System (INIS)

    Sohrabpour, M.; Hassanzadeh, M.; Shahriari, M.; Sharifzadeh, M.

    2002-01-01

    The Monte Carlo transport code, MCNP, has been applied in simulating dose rate distribution in the IR-136 gamma irradiator system. Isodose curves, cumulative dose values, and system design data such as throughputs, over-dose-ratios, and efficiencies have been simulated as functions of product density. Simulated isodose curves, and cumulative dose values were compared with dosimetry values obtained using polymethyle-methacrylate, Fricke, ethanol-chlorobenzene, and potassium dichromate dosimeters. The produced system design data were also found to agree quite favorably with those of the system manufacturer's data. MCNP has thus been found to be an effective transport code for handling of various dose mapping excercises for gamma irradiators

  17. A model to accumulate fractionated dose in a deforming organ

    International Nuclear Information System (INIS)

    Yan Di; Jaffray, D.A.; Wong, J.W.

    1999-01-01

    Purpose: Measurements of internal organ motion have demonstrated that daily organ deformation exists throughout the course of radiation treatment. However, a method of constructing the resultant dose delivered to the organ volume remains a difficult challenge. In this study, a model to quantify internal organ motion and a method to construct a cumulative dose in a deforming organ are introduced. Methods and Materials: A biomechanical model of an elastic body is used to quantify patient organ motion in the process of radiation therapy. Intertreatment displacements of volume elements in an organ of interest is calculated by applying an finite element method with boundary conditions, obtained from multiple daily computed tomography (CT) measurements. Therefore, by incorporating also the measurements of daily setup error, daily dose delivered to a deforming organ can be accumulated by tracking the position of volume elements in the organ. Furthermore, distribution of patient-specific organ motion is also predicted during the early phase of treatment delivery using the daily measurements, and the cumulative dose distribution in the organ can then be estimated. This dose distribution will be updated whenever a new measurement becomes available, and used to reoptimize the ongoing treatment. Results: An integrated process to accumulate dosage in a daily deforming organ was implemented. In this process, intertreatment organ motion and setup error were systematically quantified, and incorporated in the calculation of the cumulative dose. An example of the rectal wall motion in a prostate treatment was applied to test the model. The displacements of volume elements in the rectal wall, as well as the resultant doses, were calculated. Conclusion: This study is intended to provide a systematic framework to incorporate daily patient-specific organ motion and setup error in the reconstruction of the cumulative dose distribution in an organ of interest. The realistic dose

  18. Publication of new results from the INWORKS epidemiological study about the risk of cancer among nuclear industry workers chronically exposed to low ionizing radiation doses

    International Nuclear Information System (INIS)

    2015-01-01

    In this cohort study, 308297 workers in the nuclear industry from France, the United Kingdom, and the United States with detailed monitoring data for external exposure to ionising radiation were linked to death registries. Excess relative rate per Gy of radiation dose for mortality from cancer was estimated. Follow-up encompassed 8.2 million person years. Of 66632 known deaths by the end of follow-up, 17?957 were due to solid cancers. Results suggest a linear increase in the rate of cancer with increasing radiation exposure. The average cumulative colon dose estimated among exposed workers was 20.9 mGy (median 4.1 mGy). The estimated rate of mortality from all cancers excluding leukaemia increased with cumulative dose by 48% per Gy (90% confidence interval 20% to 79%), lagged by 10 years. Similar associations were seen for mortality from all solid cancers (47% (18% to 79%)), and within each country. The estimated association over the dose range of 0-100 mGy was similar in magnitude to that obtained over the entire dose range but less precise. Smoking and occupational asbestos exposure are potential confounders; however, exclusion of deaths from lung cancer and pleural cancer did not affect the estimated association. Despite substantial efforts to characterise the performance of the radiation dosimeters used, the possibility of measurement error remains. The study provides a direct estimate of the association between protracted low dose exposure to ionising radiation and solid cancer mortality. Although high dose rate exposures are thought to be more dangerous than low dose rate exposures, the risk per unit of radiation dose for cancer among radiation workers was similar to estimates derived from studies of Japanese atomic bomb survivors. Quantifying the cancer risks associated with protracted radiation exposures can help strengthen the foundation for radiation protection standards

  19. Parotid Glands Dose–Effect Relationships Based on Their Actually Delivered Doses: Implications for Adaptive Replanning in Radiation Therapy of Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hunter, Klaudia U. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Fernandes, Laura L. [Department of Biostatistics, University of Michigan, Ann Arbor, Michigan (United States); Vineberg, Karen A.; McShan, Daniel; Antonuk, Alan E. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Cornwall, Craig [Department of Hospital Dentistry, University of Michigan, Ann Arbor, Michigan (United States); Feng, Mary [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Schipper, Mathew J. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Department of Biostatistics, University of Michigan, Ann Arbor, Michigan (United States); Balter, James M. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Eisbruch, Avraham, E-mail: eisbruch@umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)

    2013-11-15

    Purpose: Doses actually delivered to the parotid glands during radiation therapy often exceed planned doses. We hypothesized that the delivered doses correlate better with parotid salivary output than the planned doses, used in all previous studies, and that determining these correlations will help make decisions regarding adaptive radiation therapy (ART) aimed at reducing the delivered doses. Methods and Materials: In this prospective study, oropharyngeal cancer patients treated definitively with chemoirradiation underwent daily cone-beam computed tomography (CBCT) with clinical setup alignment based on the C2 posterior edge. Parotid glands in the CBCTs were aligned by deformable registration to calculate cumulative delivered doses. Stimulated salivary flow rates were measured separately from each parotid gland pretherapy and periodically posttherapy. Results: Thirty-six parotid glands of 18 patients were analyzed. Average mean planned doses was 32 Gy, and differences from planned to delivered mean gland doses were −4.9 to +8.4 Gy, median difference +2.2 Gy in glands in which delivered doses increased relative to planned. Both planned and delivered mean doses were significantly correlated with posttreatment salivary outputs at almost all posttherapy time points, without statistically significant differences in the correlations. Large dispersions (on average, SD 3.6 Gy) characterized the dose–effect relationships for both. The differences between the cumulative delivered doses and planned doses were evident at first fraction (r=.92, P<.0001) because of complex setup deviations (eg, rotations and neck articulations), uncorrected by the translational clinical alignments. Conclusions: After daily translational setup corrections, differences between planned and delivered doses in most glands were small relative to the SDs of the dose–saliva data, suggesting that ART is not likely to gain measurable salivary output improvement in most cases. These differences were

  20. Dose-Dependent Protective Effect of Inhalational Anesthetics Against Postoperative Respiratory Complications

    DEFF Research Database (Denmark)

    Grabitz, Stephanie D; Farhan, Hassan N; Ruscic, Katarina J

    2017-01-01

    OBJECTIVES: Inhalational anesthetics are bronchodilators with immunomodulatory effects. We sought to determine the effect of inhalational anesthetic dose on risk of severe postoperative respiratory complications. DESIGN: Prospective analysis of data on file in surgical cases between January 2007...... with endotracheal intubation. INTERVENTIONS: Median effective dose equivalent of inhalational anesthetics during surgery (derived from mean end-tidal inhalational anesthetic concentrations). MEASUREMENTS AND MAIN RESULTS: Postoperative respiratory complications occurred in 6,979 of 124,497 cases (5.61%). High...... inhalational anesthetic dose of 1.20 (1.13-1.30) (median [interquartile range])-fold median effective dose equivalent versus 0.57 (0.45-0.64)-fold median effective dose equivalent was associated with lower odds of postoperative respiratory complications (odds ratio, 0.59; 95% CI, 0.53-0.65; p

  1. Maximum tolerated dose in a phase I trial on adaptive dose painting by numbers for head and neck cancer

    International Nuclear Information System (INIS)

    Madani, Indira; Duprez, Fréderic; Boterberg, Tom; Van de Wiele, Christophe; Bonte, Katrien; Deron, Philippe; De Gersem, Werner; Coghe, Marc; De Neve, Wilfried

    2011-01-01

    Purpose: To determine the maximum tolerated dose (MTD) in a phase I trial on adaptive dose-painting-by-numbers (DPBN) for non-metastatic head and neck cancer. Materials and methods: Adaptive intensity-modulated radiotherapy was based on voxel intensity of pre-treatment and per-treatment [ 18 F]fluoro-2-deoxy-D-glucose positron emission tomography ( 18 F-FDG-PET) scans. Dose was escalated to a median total dose of 80.9 Gy in the high-dose clinical target volume (dose level I) and 85.9 Gy in the gross tumor volume (dose level II). The MTD would be reached, if ⩾33% of patients developed any grade ⩾4 toxicity (DLT) up to 3 months follow-up. Results: Between February 2007 and August 2009, seven patients at dose level I and 14 at dose level II were treated. All patients completed treatment without interruption. At a median follow-up for surviving patients of 38 (dose level I) and 22 months (dose level II) there was no grade ⩾4 toxicity during treatment and follow-up but six cases of mucosal ulcers at latency of 4–10 months, of which five (36%) were observed at dose level II. Mucosal ulcers healed spontaneously in four patients. Conclusions: Considering late mucosal ulcers as DLT, the MTD of a median dose of 80.9 Gy has been reached in our trial.

  2. Framing Climate Goals in Terms of Cumulative CO2-Forcing-Equivalent Emissions

    Science.gov (United States)

    Jenkins, S.; Millar, R. J.; Leach, N.; Allen, M. R.

    2018-03-01

    The relationship between cumulative CO2 emissions and CO2-induced warming is determined by the Transient Climate Response to Emissions (TCRE), but total anthropogenic warming also depends on non-CO2 forcing, complicating the interpretation of emissions budgets based on CO2 alone. An alternative is to frame emissions budgets in terms of CO2-forcing-equivalent (CO2-fe) emissions—the CO2 emissions that would yield a given total anthropogenic radiative forcing pathway. Unlike conventional "CO2-equivalent" emissions, these are directly related to warming by the TCRE and need to fall to zero to stabilize warming: hence, CO2-fe emissions generalize the concept of a cumulative carbon budget to multigas scenarios. Cumulative CO2-fe emissions from 1870 to 2015 inclusive are found to be 2,900 ± 600 GtCO2-fe, increasing at a rate of 67 ± 9.5 GtCO2-fe/yr. A TCRE range of 0.8-2.5°C per 1,000 GtC implies a total budget for 0.6°C of additional warming above the present decade of 880-2,750 GtCO2-fe, with 1,290 GtCO2-fe implied by the Coupled Model Intercomparison Project Phase 5 median response, corresponding to 19 years' CO2-fe emissions at the current rate.

  3. Thrombosed persistent median artery causing carpal tunnel syndrome associated with bifurcated median nerve: A case report

    International Nuclear Information System (INIS)

    Salter, M.; Sinha, N. R.; Szmigielski, W.

    2011-01-01

    Background: Carpal tunnel syndrome is a sporadically occurring abnormality due to compression of median nerve. It is exceedingly rare for it to be caused by thrombosis of persistent median artery. Case Report: A forty two year old female was referred for ultrasound examination due to ongoing wrist pain, not relived by pain killers and mild paraesthesia on the radial side of the hand. High resolution ultrasound and Doppler revealed a thrombosed persistent median artery and associated bifurcated median nerve. The thrombus resolved on treatment with anticoagulants. Conclusions: Ultrasound examination of the wrist when done for patients with carpal tunnel syndrome should preferably include looking for persistent median artery and its patency. (authors)

  4. Optimum radiotherapy schedule for uterine cervical cancer based-on the detailed information of dose fractionation and radiotherapy technique

    International Nuclear Information System (INIS)

    Cho, Jae Ho; Kim, Hyun Chang; Suh, Chang Ok

    2005-01-01

    and between V-BED Gy 3 and bladder complications were assessed using multiple logistic regression models after adjustment for age, stage, tumor size and treatment duration. Serial Coxs proportional hazard regression models were used to estimate the relative risks of recurrence due to MD-BED Gy 10 and the treatment duration. The overall complication rate for RTOG Grades 1 ∼ 4 toxicities was 33.1%. The 5-year actuarial pelvic control rate for all 743 patients was 83%. The midline cumulative BED dose, which is the sum of external midline BED and HDR-ICBT point A BED, ranged from 62.0 to 121.9 Gy 10 (median 93.0) for tumors and from 93.6 to 187.3 Gy 3 (median 137.6) for late responding tissues. The median cumulative values of actual rectal (R-BED Gy 3 ) and bladder point BED (V-BED Gy 3 ) were 118.7 Gy 3 (range 48.8 ∼ 265.2) and 126.1 Gy 3 (range: 54.9∼ 267.5), respectively. MD-BED Gy 3 showed a good correlation with rectal (ρ =0.003), but not with bladder complications (ρ = 0.095), R-BED Gy 3 had a very strong association (ρ = 3 , B-BED Gy 3 also showed significance in the prediction of bladder complications in a trend test (ρ = 0.0298). No statistically significant dose-response relationship for pelvic control was observed. The Sandwich and Continuous techniques, which differ according to when the ICR was inserted during the EBRT and due to the physicians preference, showed no differences in the local control and complication rates; there were also no differences in the 3 vs. 5 Gy fraction size of HDR-ICBT. The main reasons optimal dose-fractionation guidelines are not easily established is due to the absence of a dose-response relationship for tumor control as a result of the high-dose gradient of HDR-ICBT, individual differences in tumor responses to radiation therapy and the complexity of affecting factors. Therefore, in our opinion, there is a necessity for individualized tailored therapy, along with general guidelines, in the definitive radiation

  5. Repeated Radionuclide therapy in metastatic paraganglioma leading to the highest reported cumulative activity of 131I-MIBG

    International Nuclear Information System (INIS)

    Ezziddin, Samer; Sabet, Amir; Ko, Yon-Dschun; Xun, Sunny; Matthies, Alexander; Biersack, Hans-Jürgen

    2012-01-01

    131 I-MIBG therapy for neuroendocrine tumours may be dose limited. The common range of applied cumulative activities is 10-40 GBq. We report the uneventful cumulative administration of 111 GBq (= 3 Ci) 131 I-MIBG in a patient with metastatic paraganglioma. Ten courses of 131 I-MIBG therapy were given within six years, accomplishing symptomatic, hormonal and tumour responses with no serious adverse effects. Chemotherapy with cisplatin/vinblastine/dacarbazine was the final treatment modality with temporary control of disease, but eventually the patient died of progression. The observed cumulative activity of 131 I-MIBG represents the highest value reported to our knowledge, and even though 12.6 GBq of 90 Y-DOTATOC were added intermediately, no associated relevant bone marrow, hepatic or other toxicity were observed. In an individual attempt to palliate metastatic disease high cumulative activity alone should not preclude the patient from repeat treatment

  6. Anthracycline-induced cardiotoxicity in patients with paediatric bone sarcoma and soft tissue sarcoma.

    Science.gov (United States)

    Bini, Ilaria; Asaftei, Sebastian D; Riggi, Chiara; Tirtei, Elisa; Manicone, Rosaria; Biasin, Eleonora; Basso, Maria Eleonora; Agnoletti, Gabriella; Fagioli, Franca

    2017-11-01

    Anthracycline cardiotoxicity is an important side-effect in long-term childhood cancer survivors. We evaluated the incidence of and factors associated with anthracycline cardiotoxicity in a population of patients diagnosed with bone or soft tissue sarcoma. Materials and methods We retrospectively enrolled patients diagnosed with bone or soft tissue sarcoma, from 1995 to 2011, treated with anthracycline chemotherapy at our Centre and with a follow-up echocardiography carried out ⩾3 years from cardiotoxic therapy completion. Cardiac toxicity was graded using Common Terminology Criteria for Adverse Events version 4.0. A total of 82 patients were eligible. The median age at treatment was 11.9 years (1.44-18). We evaluated the median cumulative anthracycline dose, age at treatment, sex, thoracic radiotherapy, hematopoietic stem cell transplantation, and high-dose cyclophosphamide treatment as possible risk factors for cardiotoxicity. The median cumulative anthracycline dose was 390.75 mg/m2 (80-580). Of the 82 patients, 12 (14.6%) developed cardiotoxicity with grade ⩾2 ejection fraction decline: four patients were asymptomatic and did not receive any treatment; six patients were treated with pharmacological heart failure therapy; one patient with severe cardiomyopathy underwent heart transplantation and did not need any further treatment; and one patient died while waiting for heart transplantation. The median time at cardiac toxicity, from the end of anthracycline frontline chemotherapy, was 4.2 years (0.05-9.6). Cumulative anthracycline dose ⩾300 mg/m2 (p 0.04) was the only risk factor for cardiotoxicity on statistical analyses. In our population, the cumulative incidence of cardiotoxicity is comparable to rates in the literature. This underlines the need for primary prevention and lifelong cardiac toxicity surveillance programmes in long-term childhood cancer survivors.

  7. 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

  8. Considerations on absorbed dose estimates based on different β-dose point kernels in internal dosimetry

    International Nuclear Information System (INIS)

    Uchida, Isao; Yamada, Yasuhiko; Yamashita, Takashi; Okigaki, Shigeyasu; Oyamada, Hiyoshimaru; Ito, Akira.

    1995-01-01

    In radiotherapy with radiopharmaceuticals, more accurate estimates of the three-dimensional (3-D) distribution of absorbed dose is important in specifying the activity to be administered to patients to deliver a prescribed absorbed dose to target volumes without exceeding the toxicity limit of normal tissues in the body. A calculation algorithm for the purpose has already been developed by the authors. An accurate 3-D distribution of absorbed dose based on the algorithm is given by convolution of the 3-D dose matrix for a unit cubic voxel containing unit cumulated activity, which is obtained by transforming a dose point kernel into a 3-D cubic dose matrix, with the 3-D cumulated activity distribution given by the same voxel size. However, beta-dose point kernels affecting accurate estimates of the 3-D absorbed dose distribution have been different among the investigators. The purpose of this study is to elucidate how different beta-dose point kernels in water influence on the estimates of the absorbed dose distribution due to the dose point kernel convolution method by the authors. Computer simulations were performed using the MIRD thyroid and lung phantoms under assumption of uniform activity distribution of 32 P. Using beta-dose point kernels derived from Monte Carlo simulations (EGS-4 or ACCEPT computer code), the differences among their point kernels gave little differences for the mean and maximum absorbed dose estimates for the MIRD phantoms used. In the estimates of mean and maximum absorbed doses calculated using different cubic voxel sizes (4x4x4 mm and 8x8x8 mm) for the MIRD thyroid phantom, the maximum absorbed doses for the 4x4x4 mm-voxel were estimated approximately 7% greater than the cases of the 8x8x8 mm-voxel. They were found in every beta-dose point kernel used in this study. On the other hand, the percentage difference of the mean absorbed doses in the both voxel sizes for each beta-dose point kernel was less than approximately 0.6%. (author)

  9. Computed tomography dose optimisation in cystic fibrosis: A review.

    LENUS (Irish Health Repository)

    Ferris, Helena

    2016-04-28

    Cystic fibrosis (CF) is the most common autosomal recessive disease of the Caucasian population worldwide, with respiratory disease remaining the most relevant source of morbidity and mortality. Computed tomography (CT) is frequently used for monitoring disease complications and progression. Over the last fifteen years there has been a six-fold increase in the use of CT, which has lead to a growing concern in relation to cumulative radiation exposure. The challenge to the medical profession is to identify dose reduction strategies that meet acceptable image quality, but fulfil the requirements of a diagnostic quality CT. Dose-optimisation, particularly in CT, is essential as it reduces the chances of patients receiving cumulative radiation doses in excess of 100 mSv, a dose deemed significant by the United Nations Scientific Committee on the Effects of Atomic Radiation. This review article explores the current trends in imaging in CF with particular emphasis on new developments in dose optimisation.

  10. Is Dose Deformation–Invariance Hypothesis Verified in Prostate IGRT?

    Energy Technology Data Exchange (ETDEWEB)

    Simon, Antoine, E-mail: antoine.simon@univ-rennes1.fr [INSERM, U1099, 35000 Rennes (France); Laboratoire Traitement du Signal et de l' Image, Université de Rennes 1, 35000 Rennes (France); Le Maitre, Amandine; Nassef, Mohamed; Rigaud, Bastien [INSERM, U1099, 35000 Rennes (France); Laboratoire Traitement du Signal et de l' Image, Université de Rennes 1, 35000 Rennes (France); Castelli, Joël [INSERM, U1099, 35000 Rennes (France); Laboratoire Traitement du Signal et de l' Image, Université de Rennes 1, 35000 Rennes (France); Department of Radiotherapy, Centre Eugène Marquis, 35000 Rennes (France); Acosta, Oscar; Haigron, Pascal [INSERM, U1099, 35000 Rennes (France); Laboratoire Traitement du Signal et de l' Image, Université de Rennes 1, 35000 Rennes (France); Lafond, Caroline; Crevoisier, Renaud de [INSERM, U1099, 35000 Rennes (France); Laboratoire Traitement du Signal et de l' Image, Université de Rennes 1, 35000 Rennes (France); Department of Radiotherapy, Centre Eugène Marquis, 35000 Rennes (France)

    2017-03-15

    Purpose: To assess dose uncertainties resulting from the dose deformation–invariance hypothesis in prostate cone beam computed tomography (CT)–based image guided radiation therapy (IGRT), namely to evaluate whether rigidly propagated planned dose distribution enables good estimation of fraction dose distributions. Methods and Materials: Twenty patients underwent a CT scan for planning intensity modulated radiation therapy–IGRT delivering 80 Gy to the prostate, followed by weekly CT scans. Two methods were used to obtain the dose distributions on the weekly CT scans: (1) recalculating the dose using the original treatment plan; and (2) rigidly propagating the planned dose distribution. The cumulative doses were then estimated in the organs at risk for each dose distribution by deformable image registration. The differences between recalculated and propagated doses were finally calculated for the fraction and the cumulative dose distributions, by use of per-voxel and dose-volume histogram (DVH) metrics. Results: For the fraction dose, the mean per-voxel absolute dose difference was <1 Gy for 98% and 95% of the fractions for the rectum and bladder, respectively. The maximum dose difference within 1 voxel reached, however, 7.4 Gy in the bladder and 8.0 Gy in the rectum. The mean dose differences were correlated with gas volume for the rectum and patient external contour variations for the bladder. The mean absolute differences for the considered volume receiving greater than or equal to dose x (V{sub x}) of the DVH were between 0.37% and 0.70% for the rectum and between 0.53% and 1.22% for the bladder. For the cumulative dose, the mean differences in the DVH were between 0.23% and 1.11% for the rectum and between 0.55% and 1.66% for the bladder. The largest dose difference was 6.86%, for bladder V{sub 80Gy}. The mean dose differences were <1.1 Gy for the rectum and <1 Gy for the bladder. Conclusions: The deformation–invariance hypothesis was

  11. Cumulative effects of wind turbines. A guide to assessing the cumulative effects of wind energy development

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-07-01

    This guidance provides advice on how to assess the cumulative effects of wind energy developments in an area and is aimed at developers, planners, and stakeholders interested in the development of wind energy in the UK. The principles of cumulative assessment, wind energy development in the UK, cumulative assessment of wind energy development, and best practice conclusions are discussed. The identification and assessment of the cumulative effects is examined in terms of global environmental sustainability, local environmental quality and socio-economic activity. Supplementary guidance for assessing the principle cumulative effects on the landscape, on birds, and on the visual effect is provided. The consensus building approach behind the preparation of this guidance is outlined in the annexes of the report.

  12. The challenge of cumulative impacts

    Energy Technology Data Exchange (ETDEWEB)

    Masden, Elisabeth

    2011-07-01

    Full text: As governments pledge to combat climate change, wind turbines are becoming a common feature of terrestrial and marine environments. Although wind power is a renewable energy source and a means of reducing carbon emissions, there is a need to ensure that the wind farms themselves do not damage the environment. There is particular concern over the impacts of wind farms on bird populations, and with increasing numbers of wind farm proposals, the concern focuses on cumulative impacts. Individually, a wind farm, or indeed any activity/action, may have minor effects on the environment, but collectively these may be significant, potentially greater than the sum of the individual parts acting alone. Cumulative impact assessment is a legislative requirement of environmental impact assessment but such assessments are rarely adequate restricting the acquisition of basic knowledge about the cumulative impacts of wind farms on bird populations. Reasons for this are numerous but a recurring theme is the lack of clear definitions and guidance on how to perform cumulative assessments. Here we present a conceptual framework and include illustrative examples to demonstrate how the framework can be used to improve the planning and execution of cumulative impact assessments. The core concept is that explicit definitions of impacts, actions and scales of assessment are required to reduce uncertainty in the process of assessment and improve communication between stake holders. Only when it is clear what has been included within a cumulative assessment, is it possible to make comparisons between developments. Our framework requires improved legislative guidance on the actions to include in assessments, and advice on the appropriate baselines against which to assess impacts. Cumulative impacts are currently considered on restricted scales (spatial and temporal) relating to individual development assessments. We propose that benefits would be gained from elevating cumulative

  13. Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method.

    Science.gov (United States)

    Yamaguchi, Tomohiro; Kinugasa, Yusuke; Shiomi, Akio; Sato, Sumito; Yamakawa, Yushi; Kagawa, Hiroyasu; Tomioka, Hiroyuki; Mori, Keita

    2015-07-01

    Few data are available to assess the learning curve for robotic-assisted surgery for rectal cancer. The aim of the present study was to evaluate the learning curve for robotic-assisted surgery for rectal cancer by a surgeon at a single institute. From December 2011 to August 2013, a total of 80 consecutive patients who underwent robotic-assisted surgery for rectal cancer performed by the same surgeon were included in this study. The learning curve was analyzed using the cumulative sum method. This method was used for all 80 cases, taking into account operative time. Operative procedures included anterior resections in 6 patients, low anterior resections in 46 patients, intersphincteric resections in 22 patients, and abdominoperineal resections in 6 patients. Lateral lymph node dissection was performed in 28 patients. Median operative time was 280 min (range 135-683 min), and median blood loss was 17 mL (range 0-690 mL). No postoperative complications of Clavien-Dindo classification Grade III or IV were encountered. We arranged operative times and calculated cumulative sum values, allowing differentiation of three phases: phase I, Cases 1-25; phase II, Cases 26-50; and phase III, Cases 51-80. Our data suggested three phases of the learning curve in robotic-assisted surgery for rectal cancer. The first 25 cases formed the learning phase.

  14. Ablative dose proton beam therapy for stage I and recurrent non-small cell lung carcinomas. Ablative dose PBT for NSCLC

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sung Uk; Cho, Kwan Ho; Kim, Joo Young; Kim, Dae Yong; Kim, Tae Hyun; Suh, Yang-Gun; Kim, Yeon-Joo [Research Institute and Hospital, National Cancer Center, Proton Therapy Center, Goyang (Korea, Republic of); Moon, Sung Ho [Research Institute and Hospital, National Cancer Center, Proton Therapy Center, Goyang (Korea, Republic of); Research Institute and Hospital, National Cancer Center, Center for Lung Cancer, Goyang (Korea, Republic of); Research Institute and Hospital, National Cancer Center, Proton Therapy Center, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769 (Korea, Republic of); Pyo, Hong Ryull [Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Radiation Oncology, Seoul (Korea, Republic of)

    2016-09-15

    To evaluate the efficacy and safety of ablative dose hypofractionated proton beam therapy (PBT) for patients with stage I and recurrent non-small cell lung carcinoma (NSCLC). A total of 55 patients with stage I (n = 42) and recurrent (n = 13) NSCLC underwent hypofractionated PBT and were retrospectively reviewed. A total dose of 50-72 CGE (cobalt gray equivalent) in 5-12 fractions was delivered. The median follow-up duration was 29 months (range 4-95 months). There were 24 deaths (43.6%) during the follow-up period: 11 died of disease progression and 13 from other causes. Kaplan-Meier overall survival rate (OS) at 3 years was 54.9% and the median OS was 48.6 months (range 4-95 months). Local progression was observed in 7 patients and the median time to local progression was 9.3 months (range 5-14 months). Cumulative actuarial local control rate (LCR), lymph node metastasis-free survival, and distant metastasis-free survival rates at 3 years were 85.4, 78.4, and 76.5%, respectively. Larger tumor diameter was significantly associated with poorer LCR (3-year: 94% for ≤3 cm vs. 65% for >3 cm, p = 0.006) on univariate analysis and also an independent prognostic factor for LCR (HR 6.9, 95% CI = 1.3-37.8, p = 0.026) on multivariate analysis. No grade 3 or 4 treatment-related toxicities developed. One grade 5 treatment-related adverse event occurred in a patient with symptomatic idiopathic pulmonary fibrosis. Ablative dose hypofractionated PBT was safe and promising for stage I and recurrent NSCLC. (orig.) [German] Beurteilung von Wirksamkeit und Sicherheit hypofraktionierter Protonentherapie (PBT) mit ablativen Dosen fuer nichtkleinzellige Lungenkarzinome (NSCLC) im Stadium I und rekurrierende NSCLC. Retrospektiv wurden insgesamt 55 NSCLC-Patienten (Stadium I: n = 42; rekurrierender Tumor: n = 13), analysiert. Sie waren mit einer Gesamtdosis von 50-72 CGE (''cobalt gray equivalent'') in 5-12 Fraktionen behandelt worden. Der Median der Follow

  15. A comparison of freeway median crash frequency, severity, and barrier strike outcomes by median barrier type.

    Science.gov (United States)

    Russo, Brendan J; Savolainen, Peter T

    2018-08-01

    Median-crossover crashes are among the most hazardous events that can occur on freeways, often resulting in severe or fatal injuries. The primary countermeasure to reduce the occurrence of such crashes is the installation of a median barrier. When installation of a median barrier is warranted, transportation agencies are faced with the decision among various alternatives including concrete barriers, beam guardrail, or high-tension cable barriers. Each barrier type differs in terms of its deflection characteristics upon impact, the required installation and maintenance costs, and the roadway characteristics (e.g., median width) where installation would be feasible. This study involved an investigation of barrier performance through an in-depth analysis of crash frequency and severity data from freeway segments where high-tension cable, thrie-beam, and concrete median barriers were installed. A comprehensive manual review of crash reports was conducted to identify crashes in which a vehicle left the roadway and encroached into the median. This review also involved an examination of crash outcomes when a barrier strike occurred, which included vehicle containment, penetration, or re-direction onto the travel lanes. The manual review of crash reports provided critical supplementary information through narratives and diagrams not normally available through standard fields on police crash report forms. Statistical models were estimated to identify factors that affect the frequency, severity, and outcomes of median-related crashes, with particular emphases on differences between segments with varying median barrier types. Several roadway-, traffic-, and environmental-related characteristics were found to affect these metrics, with results varying across the different barrier types. The results of this study provide transportation agencies with important guidance as to the in-service performance of various types of median barrier. Copyright © 2018 Elsevier Ltd. All rights

  16. NRPB TLD and dose record keeping service - further progress

    International Nuclear Information System (INIS)

    Greenslade, E.

    1979-01-01

    Various aspects of the National Radiological Protection Board's service are described. An increasing number of UK employers are transferring from film monitors, and record keeping is now provided for both large and small groups of workers. Data entry directly from punched cards prepared by the larger employers has reduced initial costs and therefore carries a reduced registration fee for these users. Computerized dose record keeping allows automatic retrieval of cumulative dose information from any NRPB record of previous employment, thus safeguarding itinerant workers. Warning Dose Reports are issued automatically when cumulative dose totals reach or exceed 60% of a limit, or when a dose rate greater than 0.1 rem per 4 weeks is recorded. Flexibility in wearing period results in dosemeter economy and reduces laboratory work load. High recorded doses can be checked by UV stimulation of both disks to confirm the accuracy of the previous measurement. Employers are provided with a comprehensive and accurate monitoring package, fulfilling HSE requirements and exempting employers from their former responsibility to keep their own comprehensive records. (UK)

  17. Pediatric patient doses in interventional cardiology procedures; Doses em paciente pediatrico em procedimentos de cardiologia intervencionista

    Energy Technology Data Exchange (ETDEWEB)

    Medeiros, R.B.; Murata, C.H.; Moreira, A.C., E-mail: rbitelli2012@gmail.com, E-mail: camila.murata@gmail.com, E-mail: antonio.xray@gmail.com [Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP (Brazil). Escola Pulista de Medicina; Khoury, H.J.; Borras, C., E-mail: hjkhoury@gmail.com, E-mail: cariborras@starpower.net [Universidade Federal de Pernambuco (DEN/UFPE), Recife, PE (Brazil). Dept. de Engenharia Nuclear; Silva, M.S.R da, E-mail: msrochas2003@yahoo.com.br [Instituto Federal de Educacao, Ciencia e Tecnologia de Pernambuco (IFPE), Recife, PE (Brazil)

    2014-07-01

    The radiation doses from interventional procedures is relevant when treating children because of their greater radiosensitivity compared with adults. The purposes of this paper were to estimate the dose received by 18 pediatric patients who underwent cardiac interventional procedures and to correlate the maximum entrance surface air kerma (Ke,max), estimated with radiochromic films, with the cumulative air kerma values displayed at the end of procedures. This study was performed in children up to 6 years. The study was performed in two hospitals, one located in Recife and the other one in São Paulo. The x-ray imaging systems used were Phillips Allura 12 model with image intensifier system and a Phillips Allura FD10 flat panel system. To estimate the Ke,max on the patient’s skin radiochromic films(Gafchromic XR-RV2) were used. These values were estimated from the maximum optical density measured on film using a calibration curve. The results showed cumulative air kerma values ranging from 78.3- 500.0mGy, with a mean value of 242,3 mGy. The resulting Ke,max values ranged from 20.0-461.8 mGy, with a mean value of 208,8 mGy. The Ke,max values were correlated with the displayed cumulative air kerma values. The correlation factor R² was 0.78, meaning that the value displayed in the equipment’s console can be useful for monitoring the skin absorbed dose throughout the procedure. The routine fluoroscopy time records is not able by itself alert the physician about the risk of dose exceeding the threshold of adverse reactions, which can vary from an early erythema to serious harmful skin damage. (author)

  18. Sosiaalisen median riskit yritysmaailmassa

    OpenAIRE

    Kilpinen, Joni

    2015-01-01

    Sosiaalisen median palveluista on kirjoitettu lukuisia kirjoja ja artikkeleita, joissa niitä ylistetään varsinkin yritysnäkökulmasta. Vaikka sosiaalinen media on muuttanut olennaisesti tapaa, jolla keskustella, mainostaa, etsiä ja jakaa tietoa, piilee sen palveluiden käytössä kuitenkin erilaisia uhkakuvia. Yritykset ja asiantuntijat pelkäävät sosiaalisen median avoimuuden aiheuttavan suuria tietoturvariskejä. Lisäksi asiantuntijat ovat varoitelleet sosiaalisessa mediassa olevista haittaohjelm...

  19. GPU Accelerated Vector Median Filter

    Science.gov (United States)

    Aras, Rifat; Shen, Yuzhong

    2011-01-01

    Noise reduction is an important step for most image processing tasks. For three channel color images, a widely used technique is vector median filter in which color values of pixels are treated as 3-component vectors. Vector median filters are computationally expensive; for a window size of n x n, each of the n(sup 2) vectors has to be compared with other n(sup 2) - 1 vectors in distances. General purpose computation on graphics processing units (GPUs) is the paradigm of utilizing high-performance many-core GPU architectures for computation tasks that are normally handled by CPUs. In this work. NVIDIA's Compute Unified Device Architecture (CUDA) paradigm is used to accelerate vector median filtering. which has to the best of our knowledge never been done before. The performance of GPU accelerated vector median filter is compared to that of the CPU and MPI-based versions for different image and window sizes, Initial findings of the study showed 100x improvement of performance of vector median filter implementation on GPUs over CPU implementations and further speed-up is expected after more extensive optimizations of the GPU algorithm .

  20. Prospective evaluation of the radiologist's hand dose in CT-guided interventions

    International Nuclear Information System (INIS)

    Rogits, B.; Jungnickel, K.; Loewenthal, D.; Dudeck, O.; Pech, M.; Ricke, J.; Kropf, S.; Nekolla, E.A.; Wieners, G.

    2013-01-01

    Purpose: Assessment of radiologist's hand dose in CT-guided interventions and determination of influencing factors. Materials and Methods: The following CT-guided interventions were included: Core biopsy, drainage, periradicular therapy, and celiac plexus neurolysis. The hand dose was measured with an immediately readable dosimeter, the EDD-30 (Unfors, Sweden). The default parameters for CT fluoroscopy were 120 kV, 90 mA and a 4 mm slice thickness. All interventions were performed on a 16-slice CT unit (Aquilion 16 Toshiba, Japan). The tumor size, degree of difficulty (1 - 3), level of experience and device parameters (mAs, dose-length product, scan time) were documented. Results: 138 CT-guided interventions (biopsy n = 99, drainage n = 23, pain therapy n = 16) at different locations (lung n = 41, retroperitoneum n = 53, liver n = 25, spine n = 19) were included. The lesion size was 4 - 240 mm (median: 23 mm). The fluoroscopy time per intervention was 4.6 - 140.2 s (median: 24.2 s). The measured hand dose ranged from 0.001 - 3.02 mSv (median: 0.22 mSv). The median hand dose for lung puncture (n = 41) was slightly higher (median: 0.32 mSv, p = 0.01) compared to that for the liver, retroperitoneum and other. Besides physical influencing factors, the degree of difficulty (p = 0.001) and summed puncture depth (p = 0.004) correlated significantly with the hand dose. Conclusion: The median hand dose for different CT-guided interventions was 0.22 mSv. Therefore, the annual hand dose limit would normally only be reached with about 2000 interventions. (orig.)

  1. External dose reconstruction in tooth enamel of Techa riverside residents

    Energy Technology Data Exchange (ETDEWEB)

    Shishkina, E.A.; Volchkova, A.Yu.; Krivoschapov, V.A.; Degteva, M.O. [Urals Research Center for Radiation Medicine, Chelyabinsk (Russian Federation); Timofeev, Y.S.; Zalyapin, V.I. [Southern Urals State University, Chelyabinsk (Russian Federation); Fattibene, P.; Della Monaca, S.; De Coste, V. [Istituto Superiore di Sanita e Istituto Nazionale di Fisica Nucleare, Rome (Italy); Wieser, A. [Helmholtz Zentrum Muenchen, German Research Centre for Environmental Health, Neuherberg (Germany); Ivanov, D.V. [M.N. Mikheev Institute of Metal Physics, Ural Division of the Russian Academy of Sciences, Ekaterinburg (Russian Federation); Ural Federal University, Yekaterinburg (Russian Federation); Anspaugh, L.R. [University of Utah, Salt Lake City, UT (United States)

    2016-11-15

    This study summarizes the 20-year efforts for dose reconstruction in tooth enamel of the Techa riverside residents exposed to ionizing radiation as a result of radionuclide releases into the river in 1949-1956. It represents the first combined analysis of all the data available on EPR dosimetry with teeth of permanent residents of the Techa riverside territory. Results of electron paramagnetic resonance (EPR) measurements of 302 teeth donated by 173 individuals living permanently in Techa riverside settlements over the period of 1950-1952 were analyzed. These people were residents of villages located at the free-flowing river stream or at the banks of stagnant reservoirs such as ponds or blind river forks. Cumulative absorbed doses measured using EPR are from several sources of exposure, viz., background radiation, internal exposure due to bone-seeking radionuclides ({sup 89}Sr, {sup 90}Sr/{sup 90}Y), internal exposure due to {sup 137}Cs/{sup 137m}Ba incorporated in soft tissues, and anthropogenic external exposure. The purpose of the present study was to evaluate the contribution of different sources of enamel exposure and to deduce external doses to be used for validation of the Techa River Dosimetry System (TRDS). Since various EPR methods were used, harmonization of these methods was critical. Overall, the mean cumulative background dose was found to be 63 ± 47 mGy; cumulative internal doses due to {sup 89}Sr and {sup 90}Sr/{sup 90}Y were within the range of 10-110 mGy; cumulative internal doses due to {sup 137}Cs/{sup 137m}Ba depend on the distance from the site of releases and varied from 1 mGy up to 90 mGy; mean external doses were maximum for settlements located at the banks of stagnant reservoirs (∝500 mGy); in contrast, external doses for settlements located along the free-flowing river stream did not exceed 160 mGy and decreased downstream with increasing distance from the site of release. External enamel doses calculated using the TRDS code and

  2. 32 CFR 651.16 - Cumulative impacts.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Cumulative impacts. 651.16 Section 651.16... § 651.16 Cumulative impacts. (a) NEPA analyses must assess cumulative effects, which are the impact on the environment resulting from the incremental impact of the action when added to other past, present...

  3. Direct dose mapping versus energy/mass transfer mapping for 4D dose accumulation: fundamental differences and dosimetric consequences.

    Science.gov (United States)

    Li, Haisen S; Zhong, Hualiang; Kim, Jinkoo; Glide-Hurst, Carri; Gulam, Misbah; Nurushev, Teamour S; Chetty, Indrin J

    2014-01-06

    The direct dose mapping (DDM) and energy/mass transfer (EMT) mapping are two essential algorithms for accumulating the dose from different anatomic phases to the reference phase when there is organ motion or tumor/tissue deformation during the delivery of radiation therapy. DDM is based on interpolation of the dose values from one dose grid to another and thus lacks rigor in defining the dose when there are multiple dose values mapped to one dose voxel in the reference phase due to tissue/tumor deformation. On the other hand, EMT counts the total energy and mass transferred to each voxel in the reference phase and calculates the dose by dividing the energy by mass. Therefore it is based on fundamentally sound physics principles. In this study, we implemented the two algorithms and integrated them within the Eclipse treatment planning system. We then compared the clinical dosimetric difference between the two algorithms for ten lung cancer patients receiving stereotactic radiosurgery treatment, by accumulating the delivered dose to the end-of-exhale (EE) phase. Specifically, the respiratory period was divided into ten phases and the dose to each phase was calculated and mapped to the EE phase and then accumulated. The displacement vector field generated by Demons-based registration of the source and reference images was used to transfer the dose and energy. The DDM and EMT algorithms produced noticeably different cumulative dose in the regions with sharp mass density variations and/or high dose gradients. For the planning target volume (PTV) and internal target volume (ITV) minimum dose, the difference was up to 11% and 4% respectively. This suggests that DDM might not be adequate for obtaining an accurate dose distribution of the cumulative plan, instead, EMT should be considered.

  4. Cumulative and antagonistic effects of a mixture of the antiandrogens vinclozolin and iprodione in the pubertal male rat.

    Science.gov (United States)

    Blystone, Chad R; Lambright, Christy S; Cardon, Mary C; Furr, Johnathan; Rider, Cynthia V; Hartig, Phillip C; Wilson, Vickie S; Gray, Leon E

    2009-09-01

    Vinclozolin and iprodione are dicarboximide fungicides that display antiandrogenic effects in the male rat, which suggests that a mixture would lead to cumulative effects on androgen-sensitive end points. Iprodione is a steroid synthesis inhibitor, but androgen receptor antagonist activity, which is displayed by vinclozolin, has not been fully evaluated. Here, we demonstrate that iprodione binds to the human androgen receptor (IC(50) = 86.0 microM), reduces androgen-dependent gene expression, and reduces androgen-sensitive tissue weights in castrated male rats (Hershberger assay). Since vinclozolin and iprodione affect common targets in the pubertal male rat, we tested the hypothesis that a mixture would have cumulative antiandrogenic effects. An iprodione dose, that does not significantly affect androgen-dependent morphological end points, was combined with vinclozolin doses (2 x 5 factorial design). Sprague-Dawley rats were dosed by gavage with vinclozolin at 0, 10, 30, 60, and 100 mg/kg/day with and without 50 mg iprodione/kg/day from postnatal day (PND) 23 to 55-57 (n = 8 per group). The age at puberty (preputial separation [PPS]), organ weights, serum hormones, and ex vivo testis steroid hormone production were measured. Vinclozolin delayed PPS, reduced androgen-sensitive organ weights, and increased serum testosterone. The addition of iprodione enhanced the vinclozolin inhibition of PPS (PND 47.5 vs.49.1; two-way ANOVA: iprodione main effect p = 0.0002). The dose response for several reproductive and nonreproductive organ weights was affected in a cumulative manner. In contrast, iprodione antagonized the vinclozolin-induced increase in serum testosterone. These results demonstrate that these fungicides interact on common targets in a tissue-specific manner when coadministered to the pubertal male rat.

  5. Switching non-local median filter

    Science.gov (United States)

    Matsuoka, Jyohei; Koga, Takanori; Suetake, Noriaki; Uchino, Eiji

    2015-06-01

    This paper describes a novel image filtering method for removal of random-valued impulse noise superimposed on grayscale images. Generally, it is well known that switching-type median filters are effective for impulse noise removal. In this paper, we propose a more sophisticated switching-type impulse noise removal method in terms of detail-preserving performance. Specifically, the noise detector of the proposed method finds out noise-corrupted pixels by focusing attention on the difference between the value of a pixel of interest (POI) and the median of its neighboring pixel values, and on the POI's isolation tendency from the surrounding pixels. Furthermore, the removal of the detected noise is performed by the newly proposed median filter based on non-local processing, which has superior detail-preservation capability compared to the conventional median filter. The effectiveness and the validity of the proposed method are verified by some experiments using natural grayscale images.

  6. Phase I Trial of Pelvic Nodal Dose Escalation With Hypofractionated IMRT for High-Risk Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Adkison, Jarrod B.; McHaffie, Derek R.; Bentzen, Soren M.; Patel, Rakesh R.; Khuntia, Deepak [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States); Petereit, Daniel G. [Department of Radiation Oncology, John T. Vucurevich Regional Cancer Care Institute, Rapid City Regional Hospital, Rapid City, SD (United States); Hong, Theodore S.; Tome, Wolfgang [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States); Ritter, Mark A., E-mail: ritter@humonc.wisc.edu [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States)

    2012-01-01

    Purpose: Toxicity concerns have limited pelvic nodal prescriptions to doses that may be suboptimal for controlling microscopic disease. In a prospective trial, we tested whether image-guided intensity-modulated radiation therapy (IMRT) can safely deliver escalated nodal doses while treating the prostate with hypofractionated radiotherapy in 5 Vulgar-Fraction-One-Half weeks. Methods and Materials: Pelvic nodal and prostatic image-guided IMRT was delivered to 53 National Comprehensive Cancer Network (NCCN) high-risk patients to a nodal dose of 56 Gy in 2-Gy fractions with concomitant treatment of the prostate to 70 Gy in 28 fractions of 2.5 Gy, and 50 of 53 patients received androgen deprivation for a median duration of 12 months. Results: The median follow-up time was 25.4 months (range, 4.2-57.2). No early Grade 3 Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events v.3.0 genitourinary (GU) or gastrointestinal (GI) toxicities were seen. The cumulative actuarial incidence of Grade 2 early GU toxicity (primarily alpha blocker initiation) was 38%. The rate was 32% for Grade 2 early GI toxicity. None of the dose-volume descriptors correlated with GU toxicity, and only the volume of bowel receiving {>=}30 Gy correlated with early GI toxicity (p = 0.029). Maximum late Grades 1, 2, and 3 GU toxicities were seen in 30%, 25%, and 2% of patients, respectively. Maximum late Grades 1 and 2 GI toxicities were seen in 30% and 8% (rectal bleeding requiring cautery) of patients, respectively. The estimated 3-year biochemical control (nadir + 2) was 81.2 {+-} 6.6%. No patient manifested pelvic nodal failure, whereas 2 experienced paraaortic nodal failure outside the field. The six other clinical failures were distant only. Conclusions: Pelvic IMRT nodal dose escalation to 56 Gy was delivered concurrently with 70 Gy of hypofractionated prostate radiotherapy in a convenient, resource-efficient, and well-tolerated 28-fraction schedule. Pelvic nodal dose

  7. Radiation doses in endoscopic interventional procedures

    International Nuclear Information System (INIS)

    Tsapaki, V.; Paraskeva, K.; Mathou, N.; Aggelogiannopoulou, P.; Triantopoulou, C.; Karagianis, J.; Giannakopoulos, A.; Paspatis, G.; Voudoukis, E.; Athanasopoulos, N.; Lydakis, I.; Scotiniotis, H.; Georgopoulos, P.; Finou, P.; Kadiloru, E.

    2012-01-01

    Purpose: Extensive literature exists on patient radiation doses in various interventional procedures. This does not stand for endoscopic retrograde cholangiopancreatography (ERCP) where the literature is very limited. This study compares patient dose during ERCP procedures performed with different types of X-ray systems. Methods and Materials: Four hospitals participated in the study with the following X-ray systems: A) X-ray conventional system (X-ray tube over table), 137 pts, B) X-ray conventional system (X-ray tube under table), 114 pts, C) C-arm system, 79 pts, and D) angiography system, 57 pts. A single experienced endoscopist performed the ERCP in each hospital. Kerma Area Product (KAP), fluoroscopy time (T) and total number of X-ray films (F) were collected. Results: Median patient dose was 6.2 Gy.cm 2 (0.02-130.2 Gy.cm 2 ). Medium linear correlation between KAP and T (0.6) and F (0.4) were observed. Patient doses were 33 % higher than the reference value in UK (4.15 Gy.cm 2 with a sample of 6089 patients). Median KAP for each hospital was: A) 3.1, B) 9.2, C) 3.9 and D) 6.2 Gy.cm 2 . Median T was: A) 2.6, B) 4.1, C) 2.8 and D) 3.4 min. Median F was: A) 2, B) 7, C) 2 and D) 2 films. Conclusion: Patient radiation dose during ERCP depends on: a) fluoroscopy time and films taken, b) the type of the X-ray system used, with the C arm and the conventional over the couch systems carrying the lower patient radiation dose and the angiography system the higher. (authors)

  8. Cumulative effective radiation dose received by blunt trauma patients arriving to a military level I trauma center from point of injury and interhospital transfers.

    Science.gov (United States)

    Van Arnem, Kerri A; Supinski, David P; Tucker, Jonathan E; Varney, Shawn

    2016-12-01

    Trauma patients sustaining blunt injuries are exposed to multiple radiologic studies. Evidence indicates that the risk of cancer from exposure to ionizing radiation rises in direct proportion to the cumulative effective dose (CED) received. The purpose of this study is to quantify the amount of ionizing radiation accumulated when arriving directly from point of injury to San Antonio Military Medical Center (SAMMC), a level I trauma center, compared with those transferred from other facilities. A retrospective record review was conducted from 1st January 2010 through 31st December 2012. The SAMMC trauma registry, electronic medical records, and the digital radiology imaging system were searched for possible candidates. The medical records were then analyzed for sex, age, mechanism of injury, received directly from point of injury (direct group), transfer from another medical facility (transfer group), computed tomographic scans received, dose-length product, CED of radiation, and injury severity score. A diagnostic imaging physicist then calculated the estimated CED each subject received based on the dose-length product of each computed tomographic scan. A total of 300 patients were analyzed, with 150 patients in the direct group and 150 patients in the transfer group. Both groups were similar in age and sex. Patients in the transfer group received a significantly greater CED of radiation compared with the direct group (mean, 37.6 mSv vs 28 mSv; P=.001). The radiation received in the direct group correlates with a lifetime attributable risk (LAR) of 1 in 357 compared with the transfer group with an increase in LAR to 1 in 266. Patients transferred to our facility received a 34% increase in ionizing radiation compared with patients brought directly from the injury scene. This increased dose of ionizing radiation contributes to the LAR of cancer and needs to be considered before repeating imaging studies. III. Published by Elsevier Inc.

  9. Functional Median Polish

    KAUST Repository

    Sun, Ying; Genton, Marc G.

    2012-01-01

    polish is demonstrated by comparing its performance with the traditional functional ANOVA fitted by means under different outlier models in simulation studies. The functional median polish is illustrated on various applications in climate science

  10. Five Roots Pattern of Median Nerve Formation

    Directory of Open Access Journals (Sweden)

    Konstantinos Natsis

    2016-04-01

    Full Text Available An unusual combination of median nerve’s variations has been encountered in a male cadaver during routine educational dissection. In particular, the median nerve was formed by five roots; three roots originated from the lateral cord of the brachial plexus joined individually the median nerve’s medial root. The latter (fourth root was united with the lateral (fifth root of the median nerve forming the median nerve distally in the upper arm and not the axilla as usually. In addition, the median nerve was situated medial to the brachial artery. We review comprehensively the relevant variants, their embryologic development and their potential clinical applications.

  11. Divergent Cumulative Cultural Evolution

    OpenAIRE

    Marriott, Chris; Chebib, Jobran

    2016-01-01

    Divergent cumulative cultural evolution occurs when the cultural evolutionary trajectory diverges from the biological evolutionary trajectory. We consider the conditions under which divergent cumulative cultural evolution can occur. We hypothesize that two conditions are necessary. First that genetic and cultural information are stored separately in the agent. Second cultural information must be transferred horizontally between agents of different generations. We implement a model with these ...

  12. Post-treatment visual acuity in patients treated with episcleral plaque therapy for choroidal melanoma: Dose and dose rate effects

    International Nuclear Information System (INIS)

    Jones, Robert; Gore, Elizabeth; Mieler, William; Gillin, Michael; Albano, Katherine; Erickson, Beth

    1996-01-01

    Purpose: To determine the relationship between the long-term visual function and the dose and dose rates delivered to critical ocular structures in patients with choroidal melanoma treated with 125 I episcleral plaque radiotherapy. Methods and Materials: From 1987 to 1993, 63 patients underwent 125 I episcleral plaque application for the treatment of choroidal melanoma. Mean tumor height was 4.6 mm (range 1.7-8.3 mm). Plaques utilized were of COMS design. Doses and dose rates at the tumor apex, macula, and optic disc were obtained. Visual acuity data prior to and after plaque application was available for 52 patients. 9 patients were excluded from analysis secondary to co-morbidities or disease progression. 43 records were scored to assess if a decrease in visual acuity of ≥ 2 lines on a standard Snellen eye chart had occurred. Statistical analysis was performed using chi-square tests of significance. Results: Of the 63 total patients, 59 (93.7%) were alive at a median follow-up of 36 months. Local progression occurred in (7(63)) (11.1%). Median dose and dose rate to the tumor apex were 90 Gy and 97.2 cGy/hr, respectively. Of the 43 patients with post-treatment visual acuity analysis, 28 (65.1%) experienced visual loss of ≥ 2 lines on a standard eye chart. Median time to altered visual acuity was 20 months. Median dose and dose rates to the macula in patients with a significant visual loss were 123.3 Gy and 122.5 cGy/hr, respectively, compared with 38 Gy and 51.9 cGy/hr in those without notable visual change. These differences reached statistical significance at a dose and dose rate to the macula of 82.0 Gy (p 125 I plaque brachytherapy for choroidal melanoma experienced favorable tumor control, but with a measurable incidence of decreased visual acuity. Both total dose and dose rates to the macula and optic disc correlated strongly with post-treatment visual outcome. This information may be valuable in decisions about the dose and dose rates used to treat

  13. Post-treatment visual acuity in patients treated with episcleral plaque therapy for choroidal melanoma: dose and dose rate effects

    International Nuclear Information System (INIS)

    Jones, Robert; Gore, Elizabeth; Mieler, William; Murray, Kevin; Gillin, Michael; Albano, Katherine; Erickson, Beth

    1996-01-01

    Purpose: To determine the relationship between the long-term visual function and the dose and dose rates delivered to critical ocular structures in patients with choroidal melanoma treated with 125 I episcleral plaque radiotherapy. Methods and Materials: From 1987 to 1994, 63 patients underwent 125 I episcleral plaque application for the treatment of choroidal melanoma. Mean tumor height was 4.6 mm (range 1.7-8.3 mm). Plaques utilized were of COMS design. Doses and dose rates at the tumor apex, macula, and optic disc were obtained. Visual acuity data prior to and after plaque application was available for 52 patients. Nine patients were excluded from analysis secondary to co-morbidities or disease progression. Forty-three records were scored to assess if a decrease in visual acuity of ≥ 2 lines on a standard Snellen eye chart had occurred. Statistical analysis was performed using chi-square tests of significance. Results: Of the 63 total patients, 59 (93.7%) were alive at a median follow-up of 36 months. Local progression occurred in 7/63 (11.1%). Median dose and dose rate to the tumor apex were 90 Gy and 97.2 cGy/hr, respectively. Of the 43 patients with post-treatment visual acuity analysis, 28 (65.1%) experienced visual loss of ≥ 2 lines on a standard eye chart. Median time to altered visual acuity was 20 months. Median dose and dose rates to the macula in patients with a significant visual loss were 123.3 Gy and 122.5 cGy/hr, respectively, compared with 38 Gy and 51.9 cGy/hr in those without notable visual change. These differences reached statistical significance at a dose and dose rate to the macula of 82.0 Gy (p 125 I plaque brachytherapy for choroidal melanoma experienced favorable tumor control, but with a measurable incidence of decreased visual acuity. Both total dose and dose rates to the macula and optic disc correlated strongly with post-treatment visual outcome. This information may be valuable in decisions about the dose and dose rates used to

  14. The impact of ergonomics intervention on trunk posture and cumulative compression load among carpet weavers.

    Science.gov (United States)

    Afshari, Davood; Motamedzade, Majid; Salehi, Reza; Soltanian, Alir Raze

    2015-01-01

    Work-related musculoskeletal disorders of back among weavers are prevalent. Epidemiological studies have shown an association between poor working postures and back disorders among carpet weavers. Therefore, the present study aimed to evaluate the impact of the traditional (A) and ergonomically designed (B) workstations on trunk posture and cumulative compression load in carpet weavers. In this study, subtasks were identified in terms of stressful postures and carpet weaving process. Postural data were collected during knotting and compacting subtasks using inclinometer during four hours for each workstation. Postural data, weight and height of the weavers were entered into the University of Michigan three-dimensional static biomechanical model for estimation of the compression load and cumulative load were estimated from the resultant load and exposure time. Thirteen healthy carpet weavers (four males and nine females) participated in the study. Median trunk flexion angle was reduced with workstation B during knotting subtask (18° versus 8.5°, pergonomically designed workstation.

  15. Association of elevated radiation dose with mortality in patients with acute myocardial infarction undergoing percutaneous coronary intervention

    Energy Technology Data Exchange (ETDEWEB)

    Parikh, Puja B.; Prakash, Sheena; Tahir, Usman; Kort, Smadar; Gruberg, Luis; Jeremias, Allen, E-mail: allen.jeremias@stonybrook.edu

    2014-09-15

    Objectives: This study sought to identify clinical and procedural predictors of elevated radiation dose received by patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) and to determine if elevated radiation dose was predictive of mortality in this population. Background: Little data exist regarding the impact of excessive radiation burden on clinical outcomes in patients undergoing PCI. Methods: The study population included 1,039 patients who underwent PCI for an AMI between January 1, 2007 and December 31, 2008 at an academic tertiary care teaching hospital. Cumulative skin dose (measured in milligray [mGy]) was selected as a measurement of patient radiation burden. Clinical and procedural variables were analyzed in multiple logistic and linear regression models to determine predictors of higher skin dose, and its impact was evaluated on all-cause intermediate-term mortality at two years. Results: Median skin dose was 2120 mGy (IQR 1379–3190 mGy) in the overall population, of which 153 (20.8%) patients received an elevated skin dose (defined as a skin dose > 4,000 mGy). Independent predictors of elevated skin dose included male gender, obesity, multivessel intervention, and presentation with a non-ST-elevation MI (NSTEMI) versus an ST-elevation MI (STEMI). Increased skin dose was not predictive of intermediate-term mortality by multivariate analysis in the overall population or in either subgroup of STEMI and NSTEMI. Conclusions: In this contemporary observational study examining patients with AMI undergoing PCI, male gender, obesity, multivessel intervention, and presentation with a NSTEMI were associated with increased radiation exposure.

  16. Intravenous Iron Therapy in Patients with Iron Deficiency Anemia: Dosing Considerations

    Directory of Open Access Journals (Sweden)

    Todd A. Koch

    2015-01-01

    Full Text Available Objective. To provide clinicians with evidence-based guidance for iron therapy dosing in patients with iron deficiency anemia (IDA, we conducted a study examining the benefits of a higher cumulative dose of intravenous (IV iron than what is typically administered. Methods. We first individually analyzed 5 clinical studies, averaging the total iron deficit across all patients utilizing a modified Ganzoni formula; we then similarly analyzed 2 larger clinical studies. For the second of the larger studies (Study 7, we also compared the efficacy and retreatment requirements of a cumulative dose of 1500 mg ferric carboxymaltose (FCM to 1000 mg iron sucrose (IS. Results. The average iron deficit was calculated to be 1531 mg for patients in Studies 1–5 and 1392 mg for patients in Studies 6-7. The percentage of patients who were retreated with IV iron between Days 56 and 90 was significantly (p<0.001 lower (5.6% in the 1500 mg group, compared to the 1000 mg group (11.1%. Conclusions. Our data suggests that a total cumulative dose of 1000 mg of IV iron may be insufficient for iron repletion in a majority of patients with IDA and a dose of 1500 mg is closer to the actual iron deficit in these patients.

  17. Avascular necrosis of femoral and/or humeral heads in multiple myeloma: results of a prospective study of patients treated with dexamethasone-based regimens and high-dose chemotherapy.

    Science.gov (United States)

    Talamo, Giampaolo; Angtuaco, Edgardo; Walker, Ronald C; Dong, Li; Miceli, Marisa H; Zangari, Maurizio; Tricot, Guido; Barlogie, Bart; Anaissie, Elias

    2005-08-01

    To assess the prevalence, time of onset, risk factors, and outcome of avascular necrosis (AVN) of bone in patients with multiple myeloma undergoing antineoplastic therapy. A total of 553 consecutive assessable patients were enrolled onto a treatment protocol consisting of dexamethasone-containing induction chemotherapy, autologous stem-cell transplantation, consolidation chemotherapy, and maintenance with interferon alfa. Patients were randomly assigned to receive thalidomide (269 patients) or no thalidomide (284 patients) throughout the study period. With a median follow-up of 33 months (range, 5 to 114 months), AVN of the femoral head(s) developed in 49 patients (9%). Median time to onset of AVN was 12 months (range, 2 to 41 months). Three risk factors for AVN were identified by multivariate analysis: cumulative dexamethasone dose (odds ratio [OR], 1.028; 95% CI, 1.012 to 1.044; P = .0006 [per 40 mg dexamethasone]), male sex (OR, 0.390; 95% CI, 0.192 to 0.790; P = .009), and younger age (OR, 0.961; 95% CI, 0.934 to 0.991 per year; P = .0122). Thalidomide-treated patients had a prevalence of AVN similar to that of the control group (8% v 10%, respectively; P = .58). AVN-related pain and limited range of motion of the affected joint were present in only nine and four patients, respectively, and four patients underwent hip replacement because of AVN. Fluorine-18 fluorodeoxyglucose positron emission tomography failed to detect abnormal uptake in the AVN-affected bones. AVN is a rare and usually asymptomatic complication during myeloma therapy. Cumulative dexamethasone dose, male sex, and younger age, but not thalidomide, increase the risk of AVN.

  18. Preliminary evaluation of lung doses for dogs exposed to 239PuO2

    International Nuclear Information System (INIS)

    Fisher, D.R.; Cannon, W.C.; Hadley, R.T.; Park, J.F.

    1986-01-01

    A group of beagle dogs exposed to inhaled 239 PuO 2 is being followed for life-span effects. This paper reports preliminary lung dose estimates and dose-response relationships for incidence of lung tumors and radiation pneumonitis which have been observed to date. Doses were estimated by using both conventional dose-averaging and microdosimetric techniques. Cascade impactor sampling data were used to reconstruct the original plutonium aerosol size distributions unique to each of about 120 individual dogs exposed to 239 PuO 2 . Data providing the initial plutonium lung burden and lifetime lung retention-clearance functions of plutonium for each dog were used for calculating average dose rates, cumulative absorbed doses, and specific energy distributions. A linear dose-response relationship for lung tumor induction was estimated on the basis of cumulative lung dose. Average time to death was estimated as a function of average dose rate. Conclusions regarding the potential value of microdosimetry in the interpretation of such dose-response relationships are discussed. 8 refs., 5 figs., 1 tab

  19. Radioiodine therapy in Graves' disease - A retrospective analysis

    International Nuclear Information System (INIS)

    Mittal, B.R.; Bhattacharya, A.; Dutta, P.; Bhansali, A.

    2007-01-01

    Full text: Radioiodine is a safe form of treatment for all patients with primary hyperthyroidism. The thyroid's unique capacity to store iodine (thus also radioiodine) makes it a natural target for radioiodine therapy. We retrospectively analyzed the outcome of radioiodine therapy in a cohort of 151 patients of primary hyperthyroidism treated on an outpatient basis in our institute from January 2001 to November 2006. Of these 151 patients, 113 (38 male, 75 female; age range: 17- 65 years) were of Graves' disease. The median duration of symptoms in these patients was 4 years. (Range: 3 months to 20 years). Diagnosis was established on basis of clinical, biochemical and scintigraphic features. All the patients were treated medically with Neomercazole (Carbimazole) for varying durations (median 3.5 years). The dose range varied from 5 to 80 mg per day (median 20 mg per day). Clinical assessment of thyroid size revealed 39 patients with grade 0, 14 with grade 1, 30 with grade 2, and 30 with grade 3 goiters. Pre-therapy radioactive iodine uptake was done in 28 patients, which showed median values of 50 % at 4 hrs, 57.45 % at 24 hrs, and 56.2 % at 48 hrs respectively. These patients were treated empirically with I-131 in a dose range of 5 to 15 mCi, depending upon the clinical presentation and the RAIU values. Remission of symptoms with a single dose therapy was noticed in 68 patients. Of the 83 patients, 15 became hypothyroid within 3 months. These patients were on Neomercazole for a varying period of 2 to 20 years, at a dose range of 10 to 80 mg per day. 14 patients achieved remission after 2 doses with a cumulative RAI dose in the range of 10 to 19 mCi, at a median period of 7 to 24 months. Eight patients still showed hyperthyroid activity even after a second dose and are on follow-up. Seven patients achieved remission with a cumulative dose range of 17 to 35 mCi at a median duration of 10 months. One patient of Graves' disease who took Neomercazole for 10 years, at

  20. Calculate the maximum expected dose for technical radio physicists a cobalt machine

    International Nuclear Information System (INIS)

    Avila Avila, Rafael; Perez Velasquez, Reytel; Gonzalez Lapez, Nadia

    2009-01-01

    Considering the daily operations carried out by technicians Radiophysics Medical Service Department of Radiation Oncology Hospital V. General Teaching I. Lenin in the city of Holguin, during a working week (Between Monday and Friday) as an important element in calculating the maximum expected dose (MDE). From the exponential decay law which is subject the source activity, we propose corrections to the cumulative doses in the weekly period, leading to obtaining a formula which takes into a cumulative dose during working days and sees no dose accumulation of rest days (Saturday and Sunday). The estimate factor correction is made from a power series expansion convergent is truncated at the n-th term coincides with the week period for which you want to calculate the dose. As initial condition is adopted ambient dose equivalent rate as a given, which allows estimate MDE in the moments after or before this. Calculations were proposed use of an Excel spreadsheet that allows simple and accessible processing the formula obtained. (author)

  1. Causes of Mortality After Dose-Escalated Radiation Therapy and Androgen Deprivation for High-Risk Prostate Cancer

    International Nuclear Information System (INIS)

    Tendulkar, Rahul D.; Hunter, Grant K.; Reddy, Chandana A.; Stephans, Kevin L.; Ciezki, Jay P.; Abdel-Wahab, May; Stephenson, Andrew J.; Klein, Eric A.; Mahadevan, Arul; Kupelian, Patrick A.

    2013-01-01

    Purpose: Men with high-risk prostate cancer have other competing causes of mortality; however, current risk stratification schema do not account for comorbidities. We aim to identify the causes of death and factors predictive for mortality in this population. Methods and Materials: A total of 660 patients with high-risk prostate cancer were treated with definitive high-dose external beam radiation therapy (≥74 Gy) and androgen deprivation (AD) between 1996 and 2009 at a single institution. Cox proportional hazards regression analysis was conducted to determine factors predictive of survival. Results: The median radiation dose was 78 Gy, median duration of AD was 6 months, and median follow-up was 74 months. The 10-year overall survival (OS) was 60.6%. Prostate cancer was the leading single cause of death, with 10-year mortality of 14.1% (95% CI 10.7-17.6), compared with other cancers (8.4%, 95% CI 5.7-11.1), cardiovascular disease (7.3%, 95% CI 4.7-9.9), and all other causes (10.4%, 95% CI 7.2-13.6). On multivariate analysis, older age (HR 1.55, P=.002) and Charlson comorbidity index score (CS) ≥1 (HR 2.20, P<.0001) were significant factors predictive of OS, whereas Gleason score, T stage, prostate-specific antigen, duration of AD, radiation dose, smoking history, and body mass index were not. Men younger than 70 years of age with CS = 0 were more likely to die of prostate cancer than any other cause, whereas older men or those with CS ≥1 more commonly suffered non-prostate cancer death. The cumulative incidences of prostate cancer-specific mortality were similar regardless of age or comorbidities (P=.60). Conclusions: Men with high-risk prostate cancer are more likely to die of causes other than prostate cancer, except for the subgroup of men younger than 70 years of age without comorbidities. Only older age and presence of comorbidities significantly predicted for OS, whereas prostate cancer- and treatment-related factors did not

  2. Safety and efficacy of fixed-dose 10 mg daily isotretinoin treatment for acne vulgaris in Malaysia.

    Science.gov (United States)

    Yap, Felix Boon-Bin

    2017-09-01

    Low-dose isotretinoin is used to reduce side effects albeit higher relapse. This study aimed to determine the efficacy and safety of fixed-dose 10 mg daily isotretinoin for the treatment of acne. This prospective study was performed between 2011 and 2015. All 150 patients were given 10 mg daily isotretinoin until a cumulative dose of 90-110 mg/kg. The mean age was 26.6 years with 64.7% moderate acne, 29.3% severe, and 6% very severe. The mean cumulative dose was 98.8 ± 6.05 mg/kg. All 150 patients had total clearance with a mean time to clearance of 24.0 weeks. Patients with severe/very severe acne had higher cumulative dosage (102.1 vs. 97.0, P < 0.001) and longer duration to clearance (32.9 weeks vs. 19.1 weeks, P < 0.001). Mild relapse was seen in 4%. The mean time to relapse was 32.3 weeks. Lip dryness was the commonest side effects (100%). Mild transient elevation of liver enzymes was detected in 3.3% and a slight increase of serum lipid in 2.7% with no treatment discontinuation. Fixed-dose 10 mg daily treatment with isotretinoin until a cumulative dose of 90-110 mg/kg is safe with low relapse rate. © 2016 Wiley Periodicals, Inc.

  3. Cumulative risk, cumulative outcome: a 20-year longitudinal study.

    Directory of Open Access Journals (Sweden)

    Leslie Atkinson

    Full Text Available Cumulative risk (CR models provide some of the most robust findings in the developmental literature, predicting numerous and varied outcomes. Typically, however, these outcomes are predicted one at a time, across different samples, using concurrent designs, longitudinal designs of short duration, or retrospective designs. We predicted that a single CR index, applied within a single sample, would prospectively predict diverse outcomes, i.e., depression, intelligence, school dropout, arrest, smoking, and physical disease from childhood to adulthood. Further, we predicted that number of risk factors would predict number of adverse outcomes (cumulative outcome; CO. We also predicted that early CR (assessed at age 5/6 explains variance in CO above and beyond that explained by subsequent risk (assessed at ages 12/13 and 19/20. The sample consisted of 284 individuals, 48% of whom were diagnosed with a speech/language disorder. Cumulative risk, assessed at 5/6-, 12/13-, and 19/20-years-old, predicted aforementioned outcomes at age 25/26 in every instance. Furthermore, number of risk factors was positively associated with number of negative outcomes. Finally, early risk accounted for variance beyond that explained by later risk in the prediction of CO. We discuss these findings in terms of five criteria posed by these data, positing a "mediated net of adversity" model, suggesting that CR may increase some central integrative factor, simultaneously augmenting risk across cognitive, quality of life, psychiatric and physical health outcomes.

  4. Secant cumulants and toric geometry

    NARCIS (Netherlands)

    Michalek, M.; Oeding, L.; Zwiernik, P.W.

    2012-01-01

    We study the secant line variety of the Segre product of projective spaces using special cumulant coordinates adapted for secant varieties. We show that the secant variety is covered by open normal toric varieties. We prove that in cumulant coordinates its ideal is generated by binomial quadrics. We

  5. Neurological Toxicity in Metastatic Colorectal Cancer Patients Treated with Modified FOLFOX6 plus Bevacizumab

    Directory of Open Access Journals (Sweden)

    Satoshi Otsu

    2014-01-01

    Full Text Available This study was conducted to investigate the toxicity and efficacy of modified FOLFOX6 plus bevacizumab in patients with metastatic colorectal cancer with particular regard to oxaliplatin-induced neuropathy. Toxicity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE (version 3.0. The evaluation was especially focused on grade 2 oxaliplatin-induced neuropathy. The estimated median treatment time to occurrence of grade 2 sensory neuropathy was 7.3 months. The estimated median cumulative dose to occurrence of grade 2 sensory neuropathy was 931 mg/m 2 . This study clarified the treatment time from first dose as well as the cumulative dose of oxaliplatin leading to grade 2 neuropathy. It may be important to institute some clinical countermeasures when grade 2 neuropathy occurs so as to reduce the chance of progression to irreversible grade 3 neuropathy.

  6. Pediatric patient doses in interventional cardiology procedures

    International Nuclear Information System (INIS)

    Medeiros, R.B.; Murata, C.H.; Moreira, A.C.

    2014-01-01

    The radiation doses from interventional procedures is relevant when treating children because of their greater radiosensitivity compared with adults. The purposes of this paper were to estimate the dose received by 18 pediatric patients who underwent cardiac interventional procedures and to correlate the maximum entrance surface air kerma (Ke,max), estimated with radiochromic films, with the cumulative air kerma values displayed at the end of procedures. This study was performed in children up to 6 years. The study was performed in two hospitals, one located in Recife and the other one in São Paulo. The x-ray imaging systems used were Phillips Allura 12 model with image intensifier system and a Phillips Allura FD10 flat panel system. To estimate the Ke,max on the patient’s skin radiochromic films(Gafchromic XR-RV2) were used. These values were estimated from the maximum optical density measured on film using a calibration curve. The results showed cumulative air kerma values ranging from 78.3- 500.0mGy, with a mean value of 242,3 mGy. The resulting Ke,max values ranged from 20.0-461.8 mGy, with a mean value of 208,8 mGy. The Ke,max values were correlated with the displayed cumulative air kerma values. The correlation factor R² was 0.78, meaning that the value displayed in the equipment’s console can be useful for monitoring the skin absorbed dose throughout the procedure. The routine fluoroscopy time records is not able by itself alert the physician about the risk of dose exceeding the threshold of adverse reactions, which can vary from an early erythema to serious harmful skin damage. (author)

  7. Cumulative Culture and Future Thinking: Is Mental Time Travel a Prerequisite to Cumulative Cultural Evolution?

    Science.gov (United States)

    Vale, G. L.; Flynn, E. G.; Kendal, R. L.

    2012-01-01

    Cumulative culture denotes the, arguably, human capacity to build on the cultural behaviors of one's predecessors, allowing increases in cultural complexity to occur such that many of our cultural artifacts, products and technologies have progressed beyond what a single individual could invent alone. This process of cumulative cultural evolution…

  8. Association Between Cumulative Psychosocial Risk and Cervical Human Papillomavirus Infection Among Female Adolescents in a Free Vaccination Program.

    Science.gov (United States)

    Linares, Lourdes Oriana; Shankar, Viswanathan; Diaz, Angela; Nucci-Sack, Anne; Strickler, Howard D; Peake, Ken; Weiss, Jocelyn; Burk, Robert D; Schlecht, Nicolas F

    2015-10-01

    This study investigated the association of cervical human papillomavirus (HPV) infection with cumulative psychosocial risk reflecting family disadvantage, psychological distress, and unhealthy lifestyle. The sample (N = 745) comprised sexually active female adolescent patients (12-19 yr), primarily ethnic minorities, enrolled in a free HPV vaccination program. Subjects completed questionnaires and provided cervical swabs for HPV DNA testing. Unweighted and weighted principal component analyses for categorical data were used to derive multisystemic psychosocial risk indices using 9 indicators: low socioeconomic status, lack of adult involvement, not attending high school/college, history of treatment for depression/anxiety, antisocial/delinquent behavior, number of recent sexual partners, use of alcohol, use of drugs, and dependency risk for alcohol/drugs. The association between cervical HPV (any type, high-risk types, vaccine types) assayed by polymerase chain reaction and self-reported number of psychosocial risk indicators was estimated using multivariable logistic regression. Subjects had a median of 3 psychosocial risk indicators. Multiple logistic regression analyses showed associations with unweighted and weighted number of psychosocial indicators for HPV any type (adjusted odds ratio [aOR] = 1.1; 95% confidence interval [CI], 1.0-1.2), with the strongest associations between weighted drug/alcohol use, drug/alcohol dependency risk, and antisocial/delinquent behavior and detection of HPV vaccine types (aOR = 1.5; 95% CI, 1.1-2.0) independent of number of recent sexual partners and vaccine dose (0-3). Increased HPV infections including HPV vaccine types were associated with greater number of psychosocial risk indicators even after controlling for demographics, sexual behavior, history of chlamydia, and vaccine dose.

  9. Permasalahan P-Hub Median Dengan Lintasan Terpendek

    OpenAIRE

    Pasaribu, Raja David

    2013-01-01

    Hub are facilities that serve as sorting, switching, and transhipment in a transportation network. P-hub median problem is a discrete case location allocation problem which all hub is fully connected. In this paper will be intoduced Mixed Integrer Linear Programming (MILP) formulation models of cost for p-hub median problem allocation for uncapacitaced single allocation p-hub median(USApHMP). In this paper also introduced Floyd-Warshall shortest path algorithm to solve p-hub median problems a...

  10. Dose titration to reduce dipyridamole-related headache.

    Science.gov (United States)

    Chang, Yeu-Jhy; Ryu, Shan-Jin; Lee, Tsong-Hai

    2006-01-01

    Combination of low-dose aspirin and modified-release dipyridamole (ASA+MR-DP) provides a significantly increased benefit in stroke prevention over aspirin alone. However, headaches were reported in more patients receiving dipyridamole-containing agents than in those receiving placebo. We undertook a randomized, double-blind, placebo-controlled trial to evaluate which dosing regimens of ASA+MR-DP have better tolerance. This trial randomized 146 patients with a history of ischemic cerebrovascular disease into three groups: placebo (days 1-28), reduced dose (placebo on days 1-4, ASA+MR-DP once daily before bed during days 5-14, and b.i.d. on days 15-28), and regular dose (placebo on days 1-4, and ASA+MR-DP b.i.d. on days 5-28). Using Chinese diary card, headache was assessed as mean cumulated headache (Sigma frequency x intensity/occurrence days x study days) over the study period, and was graded 0-4 according to Cancer Therapy Evaluation Program, Common Toxicity Criteria, Version 2.0. Intent-to-treat patients after randomization was 46 in placebo group, 45, reduced dose, and 49, regular dose. Among commonly reported adverse effects, headache of any grade occurred significantly more in the regular dose group (38.8%), as compared to the other two groups (p < 0.05). Mean cumulated headache was higher (p < 0.05) in the regular dose group than in the reduced group during days 5-14. Of 27 patients who dropped out, 15 (55.6%) were due to headache, which was substantially more in regular dose (8, 53.3%), though the difference was statistically insignificant. Initial reduced dose treatment with ASA+MR-DP may cause fewer headaches than regular dosing, and seems better tolerated by those susceptible to phosphodiesterase inhibitor-induced headache. Copyright 2006 S. Karger AG, Basel.

  11. A review of the cohorts with environmental and occupational mineral fiber exposure.

    Science.gov (United States)

    Metintas, Selma; Ak, Guntulu; Metintas, Muzaffer

    2018-04-20

    The aim of the study was to examine factors associated with Malignant Mesothelioma (MM) incidence rate of the groups with occupational asbestos and environmental asbestos or erionite exposure in rural area. In this ecological study, a total of 21 cohort datasets (8 environmental and 13 occupational) were evaluated. Data were analyzed using a multiple linear regression analysis model. In environmental cohorts, the risk of MM incidence was higher in women and people exposed to erionite. In this cohort, the incidence rate of MM increased as the median exposure time increased, while the incidence decreased as the median cumulative exposure dose increased. In occupational cohorts, the incidence rate of MM was positively correlated with the median cumulative exposure dose. The risk of mesothelioma was lower in those exposed to tremolite than others. Environmental asbestos exposure is as important as occupational exposure to develop MM, and it has its own unique exposure features on the risk of MM.

  12. Optimum power of radiation dose in X ray television systems of flaw inspection in industry

    International Nuclear Information System (INIS)

    Denbnovetskii, S.V.; Troitskii, V.A.; Belyi, N.G.; Grom, V.S.; Kuz'micheva, N.V.; Leshchishin, A.V.; Mikhailov, V.N.; Shutenko, O.V.

    1990-01-01

    The authors present the experimental dose characteristics of a x ray television system based on x ray vidicons with the diameter of the working field of 900 mm which operate in the continuous and pulsed conditions with the longer time of cumulation of radiation images on the target of the x ray vidicon. For each type of the inspected material, its thickness, and cumulation time, the dose characteristics were used to determine the optimum power of the exposure dose ensuring the maximum signal/noise ratio and detectability of the defects at the output of the system. (author)

  13. Patient dose in neonatal units

    International Nuclear Information System (INIS)

    Smans, K.; Struelens, L.; Smet, M.; Bosmans, H.; Vanhavere, F.

    2008-01-01

    Lung disease represents one of the most life-threatening conditions in prematurely born children. In the evaluation of the neonatal chest, the primary and most important diagnostic study is therefore the chest radiograph. Since prematurely born children are very sensitive to radiation, those radiographs may lead to a significant radiation detriment. Hence, knowledge of the patient dose is necessary to justify the exposures. A study to assess the patient doses was started at the neonatal intensive care unit (NICU) of the Univ. Hospital in Leuven. Between September 2004 and September 2005, prematurely born babies underwent on average 10 X-ray examinations in the NICU. In this sample, the maximum was 78 X-ray examinations. For chest radiographs, the median entrance skin dose was 34 μGy and the median dose area product was 7.1 mGy.cm 2 . By means of conversion coefficients, the measured values were converted to organ doses. Organ doses were calculated for three different weight classes: extremely low birth weight infants ( 2500 g). The doses to the lungs for a single chest radiograph for infants with extremely low birth weights, low birth weights and normal birth weights were 24, 25 and 32 μGy, respectively. (authors)

  14. Acoustic neuromas: single dose vs fractionated therapy

    Energy Technology Data Exchange (ETDEWEB)

    Fuss, M; Debus, J; Lohr, F; Engenhart-Cabillic, R; Wannenmacher, M

    1997-07-01

    Purpose: Radiosurgical treatment (RS) of acoustic neuromas is a well established treatment. However, few data are available concerning conformal fractionated radiotherapy (FT) of this tumor entity. We evaluated treatment outcome and toxicity for both treatment modalities in 41 patients treated at our institution between 1984 and 1997. Material and Methods: All treatments were performed using a specially adapted linear accelerator and circular collimators for convergent beam RS or multi-leaf collimators (leaf thickness 1 or 3mm) for multi-field RS or fractionated treatment. 22 patients (7 male, 15 female, median age 60 years, range 20-83 years) were treated radiosurgically with single doses between 7 and 28 Gray (median 15 Gy) prescribed to the 80% isodose line. Tumor volumes ranged from 0.7 to 10.5 ccm with a median volume of 3.4 ccm. The median number of isocenters was 2 (1-4 isocenters). One patient was treated by a multi-field technique (14 isocentric irregularly shaped noncoplanar fields). 19 patients (5 male, 14 female, median age 55 years, range 20-81 years) were treated with stereotactic conformal radiotherapy. Median dose was 60 Gray with a median daily fraction size of 2 Gy and a median of 3 (1-4) irregularly shaped isocentric fields. Tumor volumes ranged from 0.7 to 32.4 ccm (median 15 ccm). Median follow-up was 30 months (7-149 months) for radiosurgical and 30 months (2-88 months) for fractionated treatment. Seven patients who underwent fractionated treatment had previously undergone neurosurgical resection on the contralateral side. One had undergone radiosurgery on the opposite side before. Results: All tumors were locally controlled. A volume reduction of more than 20% was seen in 16% after RS and 18% following FT. Typical posttherapeutic central reduction of contrast media enhancement was found in 73% following RS after a median of 8 (3-12) months and in 63% following FT after a median of 6 (1-12) months. Temporary brainstem edema was diagnosed in 4

  15. Brachytherapy for early oral tongue cancer. Low dose rate to high dose rate

    International Nuclear Information System (INIS)

    Yamazaki, Hideya; Inoue, Takehiro; Yoshida, Ken; Yoshioka, Yasuo; Shimizutani, Kimishige; Inoue, Toshihiko; Furukawa, Souhei; Kakimoto, Naoya

    2003-01-01

    To examine the compatibility of low dose rate (LDR) with high dose rate (HDR) brachytherapy, we reviewed 399 patients with early oral tongue cancer (T1-2N0M0) treated solely by brachytherapy at Osaka University Hospital between 1967 and 1999. For patients in the LDR group (n=341), the treatment sources consisted of Ir-192 pin for 227 patients (1973-1996; irradiated dose, 61-85 Gy; median, 70 Gy), Ra-226 needle for 113 patients (1967-1986; 55-93 Gy; median, 70 Gy). Ra-226 and Ir-192 were combined for one patient. Ir-192 HDR (microSelectron-HDR) was used for 58 patients in the HDR group (1991-present; 48-60 Gy; median, 60 Gy). LDR implantations were performed via oral and HDR via a submental/submandibular approach. The dose rates at the reference point for the LDR group were 0.30 to 0.8 Gy/h, and for the HDR group 1.0 to 3.4 Gy/min. The patients in the HDR group received a total dose of 48-60 Gy (8-10 fractions) during one week. Two fractions were administered per day (at least a 6-h interval). The 3- and 5-year local control rates for patients in the LDR group were 85% and 80%, respectively, and those in the HDR group were both 84%. HDR brachytherapy showed the same lymph-node control rate as did LDR brachytherapy (67% at 5 years). HDR brachytherapy achieved the same locoregional result as did LDR brachytherapy. A converting factor of 0.86 is applicable for HDR in the treatment of early oral tongue cancer. (author)

  16. Interstitial high-dose rate brachytherapy as boost for anal canal cancer

    International Nuclear Information System (INIS)

    Falk, Alexander Tuan; Claren, Audrey; Benezery, Karen; François, Eric; Gautier, Mathieu; Gerard, Jean-Pierre; Hannoun-Levi, Jean-Michel

    2014-01-01

    To assess clinical outcomes of patients treated with a high-dose rate brachytherapy boost for anal canal cancer (ACC). From August 2005 to February 2013, 28 patients presenting an ACC treated by split-course external beam radiotherapy (EBRT) and HDR brachytherapy with or without chemotherapy in a French regional cancer center in Nice were retrospectively analyzed. Median age was 60.6 years [34 – 83], 25 patients presented a squamous cell carcinoma and 3 an adenocarcinoma; 21 received chemotherapy. Median dose of EBRT was 45 Gy [43.2 – 52]. Median dose of HDR brachytherapy was 12 Gy [10 - 15] with a median duration of 2 days. Median overall treatment time was 63 days and median delay between EBRT and brachytherapy was 20 days. Two-year local relapse free, metastatic free, disease free and overall survivals were 83%, 81.9%, 71.8% and 87.7% respectively. Acute toxicities were frequent but not severe with mostly grade 1 toxicities: 37% of genito-urinary, 40.7% of gastro-intestinal and 3.7% of cutaneous toxicities. Late toxicities were mainly G1 (43.1%) and G2 (22%). Two-year colostomy-free survival was 75.1%, one patient had a definitive sphincter amputation. High-dose rate brachytherapy for anal canal carcinoma as boost represents a feasible technique compared to low or pulsed-dose rate brachytherapy. This technique remains an excellent approach to precisely boost the tumor in reducing the overall treatment time

  17. Variability of Marker-Based Rectal Dose Evaluation in HDR Cervical Brachytherapy

    International Nuclear Information System (INIS)

    Wang Zhou; Jaggernauth, Wainwright; Malhotra, Harish K.; Podgorsak, Matthew B.

    2010-01-01

    In film-based intracavitary brachytherapy for cervical cancer, position of the rectal markers may not accurately represent the anterior rectal wall. This study was aimed at analyzing the variability of rectal dose estimation as a result of interfractional variation of marker placement. A cohort of five patients treated with multiple-fraction tandem and ovoid high-dose-rate (HDR) brachytherapy was studied. The cervical os point and the orientation of the applicators were matched among all fractional plans for each patient. Rectal points obtained from all fractions were then input into each clinical treated plan. New fractional rectal doses were obtained and a new cumulative rectal dose for each patient was calculated. The maximum interfractional variation of distances between rectal dose points and the closest source positions was 1.1 cm. The corresponding maximum variability of fractional rectal dose was 65.5%. The percentage difference in cumulative rectal dose estimation for each patient was 5.4%, 19.6%, 34.6%, 23.4%, and 13.9%, respectively. In conclusion, care should be taken when using rectal markers as reference points for estimating rectal dose in HDR cervical brachytherapy. The best estimate of true rectal dose for each fraction should be determined by the most anterior point among all fractions.

  18. Radiation absorbed dose estimates for [1-carbon-11]-glucose in adults: The effects of hyperinsulinemia

    International Nuclear Information System (INIS)

    Powers, W.J.

    1996-01-01

    As preparation for studies of blood-brain glucose transport in diabetes mellitus, radiation absorbed dose estimates from intravenous administration of [1- 11 C]-glucose for 24 internal organs, lens, blood and total body were calculated for three physiologic conditions: euinsulinemic euglycemia, hyperinsulinemic euglycemia and hyperinsulinemic hyperglycemia. Cumulated activities in blood, insulin-independent and insulin-dependent compartments were calculated from blood time-activity curves in normal human volunteers and macaques. Apportionment of cumulated activity to individual organs in insulin-dependent and insulin-independent compartments was based on previously published data. Absorbed doses were calculated with the computer program MIRDOSE 3 for the 70-kg adult phantom. S for blood was calculated separately. The heart wall, lungs and spleen were the organs receiving the highest dose. The effect of hyperinsulinemia was demonstrated by the increase in adsorbed dose to the muscle, heart and blood with a decrease to other internal organs. This effect was more pronounced during hyperinsulinemic hyperglycemia. Hyperinsulinemia produced a decrease in effective dose due to the decrease in cumulated activity in organs with specified weighting factors greater than 0.05. The effective dose per study for [1- 11 C]-glucose is comparable to that reported for 2-deoxy-[2- 18 F]-glucose. 43 refs., 1 fig., 4 tabs

  19. System-Reliability Cumulative-Binomial Program

    Science.gov (United States)

    Scheuer, Ernest M.; Bowerman, Paul N.

    1989-01-01

    Cumulative-binomial computer program, NEWTONP, one of set of three programs, calculates cumulative binomial probability distributions for arbitrary inputs. NEWTONP, CUMBIN (NPO-17555), and CROSSER (NPO-17557), used independently of one another. Program finds probability required to yield given system reliability. Used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. Program written in C.

  20. Cumulative human impacts on marine predators.

    Science.gov (United States)

    Maxwell, Sara M; Hazen, Elliott L; Bograd, Steven J; Halpern, Benjamin S; Breed, Greg A; Nickel, Barry; Teutschel, Nicole M; Crowder, Larry B; Benson, Scott; Dutton, Peter H; Bailey, Helen; Kappes, Michelle A; Kuhn, Carey E; Weise, Michael J; Mate, Bruce; Shaffer, Scott A; Hassrick, Jason L; Henry, Robert W; Irvine, Ladd; McDonald, Birgitte I; Robinson, Patrick W; Block, Barbara A; Costa, Daniel P

    2013-01-01

    Stressors associated with human activities interact in complex ways to affect marine ecosystems, yet we lack spatially explicit assessments of cumulative impacts on ecologically and economically key components such as marine predators. Here we develop a metric of cumulative utilization and impact (CUI) on marine predators by combining electronic tracking data of eight protected predator species (n=685 individuals) in the California Current Ecosystem with data on 24 anthropogenic stressors. We show significant variation in CUI with some of the highest impacts within US National Marine Sanctuaries. High variation in underlying species and cumulative impact distributions means that neither alone is sufficient for effective spatial management. Instead, comprehensive management approaches accounting for both cumulative human impacts and trade-offs among multiple stressors must be applied in planning the use of marine resources.

  1. Understanding the Relation of Low Income to HPA-Axis Functioning in Preschool Children: Cumulative Family Risk and Parenting as Pathways to Disruptions in Cortisol

    Science.gov (United States)

    Zalewski, Maureen; Lengua, Liliana J.; Kiff, Cara J.; Fisher, Philip A.

    2012-01-01

    This study examined the relation of low income and poverty to cortisol levels, and tested potential pathways from low income to disruptions in cortisol through cumulative family risk and parenting. The sample of 306 mothers and their preschool children included 29 % families at or near poverty, 27 % families below the median income, and the…

  2. Assessment of individual dose utilization vs. physician prescribing recommendations for recombinant activated factor VII (rFVIIa) in paediatric and adult patients with congenital haemophilia and alloantibody inhibitors (CHwI): the Dosing Observational Study in Hemophilia (DOSE).

    Science.gov (United States)

    Gruppo, R A; Kessler, C M; Neufeld, E J; Cooper, D L

    2013-07-01

    Recent data from the Dosing Observational Study in Hemophilia diary study has described home treatment with recombinant activated factor VII (rFVIIa) in congenital haemophilia with inhibitors (CHwI). The current analysis compares prescribed and patient/caregiver-reported rFVIIa administration in paediatric and adult CHwI patients in this study. Patients with ≥ 4 bleeding episodes within a 3-month period prescribed rFVIIa as first-line therapy for bleeding episodes were eligible. Patients/caregivers completed a diary for ≥ 90 days or until the patient experienced four bleeds. Initial, total and mean rFVIIa doses reported for each bleeding episode were calculated and compared with the physician-prescribed doses. Of 52 enrolled patients (25 children; 27 adults), 39 (75%) completed the study. Children and adults had similar mean durations of bleeding episodes. Both patient groups were administered higher initial rFVIIa doses for joint bleeds than prescribed: median (range) 215.2 (74.1-400.0) mcg kg(-1) vs. 200.0 (61.0-270.0) mcg kg(-1) for children, and 231.3 (59.3-379.7) mcg kg(-1) vs. 123.0 (81.0-289.0) mcg kg(-1) for adults. The median infused dose for joint bleeds was higher in adults than children (175.2 vs. 148.0 mcg kg(-1) ), but children received significantly more doses per joint bleed than adults (median 6.5 vs. 3.0). The median total dose per joint bleed was higher in children than adults (1248.7 vs. 441.6). For children and adults, both initial and additional doses administered for bleeds were higher than prescribed. Children received higher total doses per bleed due to an increased number of infusions per bleed. © 2013 John Wiley & Sons Ltd.

  3. Influence of random setup error on dose distribution

    International Nuclear Information System (INIS)

    Zhai Zhenyu

    2008-01-01

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

  4. Radiation Dose Risk and Diagnostic Benefit in Imaging Investigations

    OpenAIRE

    Dobrescu, Lidia; Rădulescu, Gheorghe-Cristian

    2015-01-01

    The paper presents many facets of medical imaging investigations radiological risks. The total volume of prescribed medical investigations proves a serious lack in monitoring and tracking of the cumulative radiation doses in many health services. Modern radiological investigations equipment is continuously reducing the total dose of radiation due to improved technologies, so a decrease in per caput dose can be noticed, but the increasing number of investigations has determined a net increase ...

  5. The Ultrasonographic Findings of Bifid Median Nerve

    International Nuclear Information System (INIS)

    Park, Hee Jin; Park, Noh Hyuck; Joh, Joon Hee; Lee, Sung Moon

    2009-01-01

    We wanted to evaluate the ultrasonographic findings of bifid median nerve and its clinical significance. We retrospectively reviewed five cases (three men and two women, mean age: 54 years) of incidentally found bifid median nerve from 264 cases of clinically suspected carpal-tunnel syndrome that were seen at our hospital during last 6 years. Doppler sonography was performed in all five cases and MR angiography was done in one case for detecting a persistent median artery. The difference (ΔCSA) between the sum of the cross-sectional areas of the bifid median nerve at the pisiform level (CSA2) and the cross-sectional area proximal to the bifurcation(CSA1) was calculated. The incidence of a bifid median nerve was 1.9%. All the patients presented with a tingling sensation on a hand and two patients had nocturnal pain. All the cases showed bifurcation of the nerve bundle proximal to the carpal tunnel. The margins appeared relatively smooth and each bundle showed a characteristic fascicular pattern. A persistent median artery was noted between the bundles in four cases. ΔCSA was more than 2 mm 2 in four cases. Bifid median nerve with a persistent median artery is a relatively rare normal variance and these are very important findings before performing surgical intervention to avoid potential nerve injury and massive bleeding. We highly suggest that radiologists should understand the anatomical characteristics of this anomaly and make efforts to detect it

  6. The occurrence of primary pulmonary neoplasms in rats after inhalation of 147Pm in fused aluminosilicate particles

    International Nuclear Information System (INIS)

    Herbert, R.A.; Scott, B.R.; Hahn, F.F.; Newton, G.J.; Snipes, M.B.; Damon, E.G.; Boecker, B.B.

    1988-01-01

    To determine the biological response following low-energy, beta irradiation of the lung, F344/Crl rats were exposed to aerosols of promethium-147 in fused aluminosilicate particles and observed for their life spans. Radiation pneumonitis and pulmonary fibrosis caused the majority of deaths during the first year after exposure with cumulative doses to the lungs of 210 to 630 Gy. Primary pulmonary neoplasms were responsible for the majority of deaths that occurred beyond 1 yr after exposure and in rats receiving lower cumulative doses to the lung. Hemangiosarcomas and squamous cell carcinomas were the most prevalent pulmonary neoplasms. Three adenocarcinomas were found. The uncorrected crude incidence of primary lung tumors increased with increasing dose to the lung for cumulative doses less than 140 Gy. With higher doses, the incidence declined. Adjusting the data for competing risks eliminated the turnover in the dose-response curve. The times of onset of pulmonary tumors and median survival times were dose-dependent. Rats with higher accumulated radiation doses developed fatal lung tumors at earlier times after exposure. (author)

  7. Synchrotron microbeam radiation therapy for rat brain tumor palliation-influence of the microbeam width at constant valley dose

    International Nuclear Information System (INIS)

    Serduc, Raphael; Fonta, Caroline; Renaud, Luc; Bouchet, Audrey; Braeuer-Krisch, Elke; Sarun, Sukhena; Bravin, Alberto; Le Duc, Geraldine; Laissue, Jean A; Spiga, Jenny; Boutonnat, Jean; Siegbahn, Erik Albert; Esteve, Francois

    2009-01-01

    To analyze the effects of the microbeam width (25, 50 and 75 μm) on the survival of 9L gliosarcoma tumor-bearing rats and on toxicity in normal tissues in normal rats after microbeam radiation therapy (MRT), 9L gliosarcomas implanted in rat brains, as well as in normal rat brains, were irradiated in the MRT mode. Three configurations (MRT25, MRT50, MRT75), each using two orthogonally intersecting arrays of either 25, 50 or 75 μm wide microbeams, all spaced 211 μm on center, were tested. For each configuration, peak entrance doses of 860, 480 and 320 Gy, respectively, were calculated to produce an identical valley dose of 18 Gy per individual array at the center of the tumor. Two, 7 and 14 days after radiation treatment, 42 rats were killed to evaluate histopathologically the extent of tumor necrosis, and the presence of proliferating tumors cells and tumor vessels. The median survival times of the normal rats were 4.5, 68 and 48 days for MRT25, 50 and 75, respectively. The combination of the highest entrance doses (860 Gy per array) with 25 μm wide beams (MRT25) resulted in a cumulative valley dose of 36 Gy and was excessively toxic, as it led to early death of all normal rats and of ∼50% of tumor-bearing rats. The short survival times, particularly of rats in the MRT25 group, restricted adequate observance of the therapeutic effect of the method on tumor-bearing rats. However, microbeams of 50 μm width led to the best median survival time after 9L gliosarcoma MRT treatment and appeared as the better compromise between tumor control and normal brain toxicity compared with 75 μm or 25 μm widths when used with a 211 μm on-center distance. Despite very high radiation doses, the tumors were not sterilized; viable proliferating tumor cells remained present at the tumor margin. This study shows that microbeam width and peak entrance doses strongly influence tumor responses and normal brain toxicity, even if valley doses are kept constant in all groups. The use

  8. Synchrotron microbeam radiation therapy for rat brain tumor palliation-influence of the microbeam width at constant valley dose

    Energy Technology Data Exchange (ETDEWEB)

    Serduc, Raphael; Fonta, Caroline; Renaud, Luc [Universite de Toulouse, UPS, Centre de Recherche Cerveau et Cognition (France); Bouchet, Audrey; Braeuer-Krisch, Elke; Sarun, Sukhena; Bravin, Alberto; Le Duc, Geraldine [European Synchrotron Radiation Facility, F38043 Grenoble (France); Laissue, Jean A [Institute of Pathology, University of Bern (Switzerland); Spiga, Jenny [Department of Physics, University of Cagliari, s.p. Monserrato-Sestu, Monserrato (Canada) 09042 (Italy); Boutonnat, Jean [TIMC lab, UMR CNRS 5525, Univ Joseph Fourier, CHU, Grenoble (France); Siegbahn, Erik Albert [Department of Medical Physics, Karolinska Universitetssjukhuset, 17176 Stockholm (Sweden); Esteve, Francois [INSERM U836, Equipe 6, Institut des Neurosciences de Grenoble, 38043 Grenoble Cedex (France)], E-mail: raph.serduc@gmail.com

    2009-11-07

    To analyze the effects of the microbeam width (25, 50 and 75 {mu}m) on the survival of 9L gliosarcoma tumor-bearing rats and on toxicity in normal tissues in normal rats after microbeam radiation therapy (MRT), 9L gliosarcomas implanted in rat brains, as well as in normal rat brains, were irradiated in the MRT mode. Three configurations (MRT25, MRT50, MRT75), each using two orthogonally intersecting arrays of either 25, 50 or 75 {mu}m wide microbeams, all spaced 211 {mu}m on center, were tested. For each configuration, peak entrance doses of 860, 480 and 320 Gy, respectively, were calculated to produce an identical valley dose of 18 Gy per individual array at the center of the tumor. Two, 7 and 14 days after radiation treatment, 42 rats were killed to evaluate histopathologically the extent of tumor necrosis, and the presence of proliferating tumors cells and tumor vessels. The median survival times of the normal rats were 4.5, 68 and 48 days for MRT25, 50 and 75, respectively. The combination of the highest entrance doses (860 Gy per array) with 25 {mu}m wide beams (MRT25) resulted in a cumulative valley dose of 36 Gy and was excessively toxic, as it led to early death of all normal rats and of {approx}50% of tumor-bearing rats. The short survival times, particularly of rats in the MRT25 group, restricted adequate observance of the therapeutic effect of the method on tumor-bearing rats. However, microbeams of 50 {mu}m width led to the best median survival time after 9L gliosarcoma MRT treatment and appeared as the better compromise between tumor control and normal brain toxicity compared with 75 {mu}m or 25 {mu}m widths when used with a 211 {mu}m on-center distance. Despite very high radiation doses, the tumors were not sterilized; viable proliferating tumor cells remained present at the tumor margin. This study shows that microbeam width and peak entrance doses strongly influence tumor responses and normal brain toxicity, even if valley doses are kept constant in

  9. Excess Mortality in Treated and Untreated Hyperthyroidism Is Related to Cumulative Periods of Low Serum TSH.

    Science.gov (United States)

    Lillevang-Johansen, Mads; Abrahamsen, Bo; Jørgensen, Henrik Løvendahl; Brix, Thomas Heiberg; Hegedüs, Laszlo

    2017-07-01

    Cumulative time-dependent excess mortality in hyperthyroid patients has been suggested. However, the effect of antithyroid treatment on mortality, especially in subclinical hyperthyroidism, remains unclarified. We investigated the association between hyperthyroidism and mortality in both treated and untreated hyperthyroid individuals. Register-based cohort study of 235,547 individuals who had at least one serum thyroid-stimulating hormone (TSH) measurement in the period 1995 to 2011 (7.3 years median follow-up). Hyperthyroidism was defined as at least two measurements of low serum TSH. Mortality rates for treated and untreated hyperthyroid subjects compared with euthyroid controls were calculated using multivariate Cox regression analyses, controlling for age, sex, and comorbidities. Cumulative periods of decreased serum TSH were analyzed as a time-dependent covariate. Hazard ratio (HR) for mortality was increased in untreated [1.23; 95% confidence interval (CI), 1.12 to 1.37; P hyperthyroid patients. When including cumulative periods of TSH in the Cox regression analyses, HR for mortality per every 6 months of decreased TSH was 1.11 (95% CI, 1.09 to 1.13; P hyperthyroid patients (n = 1137) and 1.13 (95% CI, 1.11 to 1.15; P hyperthyroidism, respectively. Mortality is increased in hyperthyroidism. Cumulative periods of decreased TSH increased mortality in both treated and untreated hyperthyroidism, implying that excess mortality may not be driven by lack of therapy, but rather inability to keep patients euthyroid. Meticulous follow-up during treatment to maintain biochemical euthyroidism may be warranted. Copyright © 2017 by the Endocrine Society

  10. Comparison of low dose with standard dose abdominal/pelvic multidetector CT in patients with stage 1 testicular cancer under surveillance

    Energy Technology Data Exchange (ETDEWEB)

    O' Malley, Martin E. [Joint Department of Medical Imaging, Toronto, ON (Canada); Chung, Peter; Warde, Padraig [Princess Margaret Hospital, Department of Radiation Oncology, Toronto, ON (Canada); Haider, Masoom; Jhaveri, Kartik; Khalili, Korosh [Princess Margaret Hospital, Joint Department of Medical Imaging, Toronto, ON (Canada); Jang, Hyun-Jung [Toronto General Hospital, Joint Department of Medical Imaging, Toronto, ON (Canada); Panzarella, Tony [Princess Margaret Hospital, Department of Biostatistics, Toronto, ON (Canada)

    2010-07-15

    To compare the image quality and acceptability of a low dose with those of standard dose abdominal/pelvic multidetector CT in patients with stage 1 testicular cancer managed by surveillance. One hundred patients (median age 31 years; range 19-83 years), 79 with seminoma and 21 with non-seminoma, underwent abdominal/pelvic imaging with low and standard dose protocols on 64-slice multidetector CT. Three reviewers independently evaluated images for noise and diagnostic quality on a 5-point scale and for diagnostic acceptability. On average, each reader scored noise and diagnostic quality of standard dose images significantly better than corresponding low dose images (p < 0.0001). One reader found all CT examinations acceptable; two readers each found 1/100 (1%) low dose examinations unacceptable. Median and mean dose-length product for low and standard dose protocols were 416.0 and 452.2 (range 122.9-913.4) and 931.9 and 999.8 (range 283.8-1,987.7) mGy cm, respectively. The low dose protocol provided diagnostically acceptable images for at least 99% of patients and achieved mean dose reduction of 55% compared with the standard dose protocol. (orig.)

  11. Common-Reliability Cumulative-Binomial Program

    Science.gov (United States)

    Scheuer, Ernest, M.; Bowerman, Paul N.

    1989-01-01

    Cumulative-binomial computer program, CROSSER, one of set of three programs, calculates cumulative binomial probability distributions for arbitrary inputs. CROSSER, CUMBIN (NPO-17555), and NEWTONP (NPO-17556), used independently of one another. Point of equality between reliability of system and common reliability of components found. Used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. Program written in C.

  12. Cumulative effects assessment: Does scale matter?

    International Nuclear Information System (INIS)

    Therivel, Riki; Ross, Bill

    2007-01-01

    Cumulative effects assessment (CEA) is (or should be) an integral part of environmental assessment at both the project and the more strategic level. CEA helps to link the different scales of environmental assessment in that it focuses on how a given receptor is affected by the totality of plans, projects and activities, rather than on the effects of a particular plan or project. This article reviews how CEAs consider, and could consider, scale issues: spatial extent, level of detail, and temporal issues. It is based on an analysis of Canadian project-level CEAs and UK strategic-level CEAs. Based on a review of literature and, especially, case studies with which the authors are familiar, it concludes that scale issues are poorly considered at both levels, with particular problems being unclear or non-existing cumulative effects scoping methodologies; poor consideration of past or likely future human activities beyond the plan or project in question; attempts to apportion 'blame' for cumulative effects; and, at the plan level, limited management of cumulative effects caused particularly by the absence of consent regimes. Scale issues are important in most of these problems. However both strategic-level and project-level CEA have much potential for managing cumulative effects through better siting and phasing of development, demand reduction and other behavioural changes, and particularly through setting development consent rules for projects. The lack of strategic resource-based thresholds constrains the robust management of strategic-level cumulative effects

  13. Adjuvant Radiation Therapy for Margin-Positive Vulvar Squamous Cell Carcinoma: Defining the Ideal Dose-Response Using the National Cancer Data Base

    International Nuclear Information System (INIS)

    Chapman, Bhavana V.; Gill, Beant S.; Viswanathan, Akila N.; Balasubramani, Goundappa K.; Sukumvanich, Paniti; Beriwal, Sushil

    2017-01-01

    Purpose: Positive surgical margins after radical vulvectomy for vulvar cancer portend a high risk for local relapse, which may be challenging to salvage. We assessed the impact of adjuvant radiation therapy (aRT) on overall survival (OS) and the dose-response relationship using the National Cancer Data Base. Methods and Materials: Patients with vulvar squamous cell carcinoma who underwent initial extirpative surgery with positive margins from 1998 to 2012 were included. Factors associated with aRT and specific dose levels were analyzed using logistic regression. Log-rank and multivariable Cox proportional hazards modeling were used for OS analysis. Results: We identified 3075 patients with a median age of 66 years (range, 22-90 years); the median follow-up time was 36.4 months (interquartile range [IQR] 15.4-71.0 months). Stage IA/B disease represented 41.2% of the cohort. Sixty-three percent underwent lymph node assessment, with a 45% positivity rate. In total, 1035 patients (35.3%) received aRT, with a median dose of 54.0 Gy (IQR 48.6-60.0 Gy). The 3-year OS improved from 58.5% to 67.4% with aRT (P<.001). On multivariable analysis, age, Charlson-Deyo score ≥1, stage ≥II, tumors ≥4 cm, no aRT, and adverse nodal characteristics led to inferior survival. Dose of aRT was positively associated with OS as a continuous variable on univariate analysis (P<.001). The unadjusted 3-year OS for dose subsets 30.0 to 45.0 Gy, 45.1 to 53.9 Gy, 54.0 to 59.9 Gy, and ≥60 Gy was 54.3%, 55.7%, 70.1%, and 65.3%, respectively (P<.001). Multivariable analysis using a 4-month conditional landmark revealed that the greatest mortality reduction occurred in cumulative doses ≥54 Gy: 45.1 to 53.9 Gy (hazard ratio [HR] 0.94, P=.373), 54.0 to 59.9 Gy (HR 0.75, P=.024), ≥60 Gy (HR 0.71, P=.015). No survival benefit was seen with ≥60 Gy compared with 54.0 to 59.9 Gy (HR 0.95, P=.779). Conclusions: Patients with vulvar squamous cell carcinoma and positive surgical

  14. Testing the gravity p-median model empirically

    Directory of Open Access Journals (Sweden)

    Kenneth Carling

    2015-12-01

    Full Text Available Regarding the location of a facility, the presumption in the widely used p-median model is that the customer opts for the shortest route to the nearest facility. However, this assumption is problematic on free markets since the customer is presumed to gravitate to a facility by the distance to and the attractiveness of it. The recently introduced gravity p-median model offers an extension to the p-median model that account for this. The model is therefore potentially interesting, although it has not yet been implemented and tested empirically. In this paper, we have implemented the model in an empirical problem of locating vehicle inspections, locksmiths, and retail stores of vehicle spare-parts for the purpose of investigating its superiority to the p-median model. We found, however, the gravity p-median model to be of limited use for the problem of locating facilities as it either gives solutions similar to the p-median model, or it gives unstable solutions due to a non-concave objective function.

  15. Cumulative cultural learning: Development and diversity

    Science.gov (United States)

    2017-01-01

    The complexity and variability of human culture is unmatched by any other species. Humans live in culturally constructed niches filled with artifacts, skills, beliefs, and practices that have been inherited, accumulated, and modified over generations. A causal account of the complexity of human culture must explain its distinguishing characteristics: It is cumulative and highly variable within and across populations. I propose that the psychological adaptations supporting cumulative cultural transmission are universal but are sufficiently flexible to support the acquisition of highly variable behavioral repertoires. This paper describes variation in the transmission practices (teaching) and acquisition strategies (imitation) that support cumulative cultural learning in childhood. Examining flexibility and variation in caregiver socialization and children’s learning extends our understanding of evolution in living systems by providing insight into the psychological foundations of cumulative cultural transmission—the cornerstone of human cultural diversity. PMID:28739945

  16. Cumulative cultural learning: Development and diversity.

    Science.gov (United States)

    Legare, Cristine H

    2017-07-24

    The complexity and variability of human culture is unmatched by any other species. Humans live in culturally constructed niches filled with artifacts, skills, beliefs, and practices that have been inherited, accumulated, and modified over generations. A causal account of the complexity of human culture must explain its distinguishing characteristics: It is cumulative and highly variable within and across populations. I propose that the psychological adaptations supporting cumulative cultural transmission are universal but are sufficiently flexible to support the acquisition of highly variable behavioral repertoires. This paper describes variation in the transmission practices (teaching) and acquisition strategies (imitation) that support cumulative cultural learning in childhood. Examining flexibility and variation in caregiver socialization and children's learning extends our understanding of evolution in living systems by providing insight into the psychological foundations of cumulative cultural transmission-the cornerstone of human cultural diversity.

  17. Switching non-local vector median filter

    Science.gov (United States)

    Matsuoka, Jyohei; Koga, Takanori; Suetake, Noriaki; Uchino, Eiji

    2016-04-01

    This paper describes a novel image filtering method that removes random-valued impulse noise superimposed on a natural color image. In impulse noise removal, it is essential to employ a switching-type filtering method, as used in the well-known switching median filter, to preserve the detail of an original image with good quality. In color image filtering, it is generally preferable to deal with the red (R), green (G), and blue (B) components of each pixel of a color image as elements of a vectorized signal, as in the well-known vector median filter, rather than as component-wise signals to prevent a color shift after filtering. By taking these fundamentals into consideration, we propose a switching-type vector median filter with non-local processing that mainly consists of a noise detector and a noise removal filter. Concretely, we propose a noise detector that proactively detects noise-corrupted pixels by focusing attention on the isolation tendencies of pixels of interest not in an input image but in difference images between RGB components. Furthermore, as the noise removal filter, we propose an extended version of the non-local median filter, we proposed previously for grayscale image processing, named the non-local vector median filter, which is designed for color image processing. The proposed method realizes a superior balance between the preservation of detail and impulse noise removal by proactive noise detection and non-local switching vector median filtering, respectively. The effectiveness and validity of the proposed method are verified in a series of experiments using natural color images.

  18. Epidemiological study of cumulative trauma disorder in Kerman\\'s state office workers in 2007

    Directory of Open Access Journals (Sweden)

    Saberi

    2011-03-01

    Full Text Available Occupational diseases are consequences of various workplace hazards. Cumulative trauma disorder or repetitive strain injury indicates the effect of repeated physical movements and partial pressure on muscles, tendons and other soft tissues of body. This is the most common disease caused by work. Materials and Methods: This descriptive cross-sectional study performed on state office workers in Kerman city in 2007. Data was collected using examination and three questionnaires about work-related diseases, job satisfaction and job stress. After completion of the questionnaires, a trained researcher analyzed the collected data by SPSS 13 and Chi square test. A level of P≤0.05 was considered significant. Results: Data analysis showed that factors such as repeated writing, typing, using computers at work, repeated lifting objects at the table level, traffic through the steps, traffic through the office corridor, reach of foot to the ground when sitting on the chair, using footrests under desk, using chair cushions, using lumber pillows, or swivel chair were not the cause of cumulative trauma disorder. Repetitive bending and refusal to lean against the seat when sitting were effective in causing the disease. Other findings of our research were employees’ ergonomic awareness status, job satisfaction and job stress being calculated according to the median scores for all three factors as average. Conclusion: Repetitive bending and avoidance from leaning against the chair were significant factors causing high rates of cumulative trauma disorder in office workers of Kerman city. Modification of these factors or even using lumbar supportive equipment may reduce the high prevalence of this disease. Cumulative trauma disorder was found less in employees under the age of thirty and the rates increased with age and work history, linearly.

  19. Phase I study of continuous MKC-1 in patients with advanced or metastatic solid malignancies using the modified Time-to-Event Continual Reassessment Method (TITE-CRM) dose escalation design.

    Science.gov (United States)

    Tevaarwerk, Amye; Wilding, George; Eickhoff, Jens; Chappell, Rick; Sidor, Carolyn; Arnott, Jamie; Bailey, Howard; Schelman, William; Liu, Glenn

    2012-06-01

    MKC-1 is an oral cell-cycle inhibitor with broad antitumor activity in preclinical models. Clinical studies demonstrated modest antitumor activity using intermittent dosing schedule, however additional preclinical data suggested continuous dosing could be efficacious with additional effects against the mTor/AKT pathway. The primary objectives were to determine the maximum tolerated dose (MTD) and response of continuous MKC-1. Secondary objectives included characterizing the dose limiting toxicities (DLTs) and pharmacokinetics (PK). Patients with solid malignancies were eligible, if they had measurable disease, ECOG PS ≤1, and adequate organ function. Exclusions included brain metastases and inability to receive oral drug. MKC-1 was dosed twice daily, continuously in 28-day cycles. Other medications were eliminated if there were possible drug interactions. Doses were assigned using a TITE-CRM algorithm following enrollment of the first 3 pts. Disease response was assessed every 8 weeks. Between 5/08-9/09, 24 patients enrolled (15 M/9 F, median 58 years, range 44-77). Patients 1-3 received 120 mg/d of MKC-1; patients 4-24 were dosed per the TITE-CRM algorithm: 150 mg [n = 1], 180 [2], 200 [1], 230 [1], 260 [5], 290 [6], 320 [5]. The median time on drug was 8 weeks (range 4-28). The only DLT occurred at 320 mg (grade 3 fatigue). Stable disease occurred at 150 mg/d (28 weeks; RCC) and 320 mg/d (16 weeks; breast, parotid). Escalation halted at 320 mg/d. Day 28 pharmacokinetics indicated absorption and active metabolites. Continuous MKC-1 was well-tolerated; there were no RECIST responses, although clinical benefit occurred in 3/24 pts. Dose escalation stopped at 320 mg/d, and this is the MTD as defined by the CRM dose escalation algorithm; this cumulative dose/cycle exceeds that determined from intermittent dosing studies. A TITE-CRM allowed for rapid dose escalation and was able to account for late toxicities with continuous dosing via a modified algorithm.

  20. The role of cumulative physical work load in symptomatic knee osteoarthritis – a case-control study in Germany

    Directory of Open Access Journals (Sweden)

    Abolmaali Nasreddin

    2008-07-01

    Full Text Available Abstract Objectives To examine the dose-response relationship between cumulative exposure to kneeling and squatting as well as to lifting and carrying of loads and symptomatic knee osteoarthritis (OA in a population-based case-control study. Methods In five orthopedic clinics and five practices we recruited 295 male patients aged 25 to 70 with radiographically confirmed knee osteoarthritis associated with chronic complaints. A total of 327 male control subjects were recruited. Data were gathered in a structured personal interview. To calculate cumulative exposure, the self-reported duration of kneeling and squatting as well as the duration of lifting and carrying of loads were summed up over the entire working life. Results The results of our study support a dose-response relationship between kneeling/squatting and symptomatic knee osteoarthritis. For a cumulative exposure to kneeling and squatting > 10.800 hours, the risk of having radiographically confirmed knee osteoarthritis as measured by the odds ratio (adjusted for age, region, weight, jogging/athletics, and lifting or carrying of loads is 2.4 (95% CI 1.1–5.0 compared to unexposed subjects. Lifting and carrying of loads is significantly associated with knee osteoarthritis independent of kneeling or similar activities. Conclusion As the knee osteoarthritis risk is strongly elevated in occupations that involve both kneeling/squatting and heavy lifting/carrying, preventive efforts should particularly focus on these "high-risk occupations".

  1. Non-Chemical Stressors and Cumulative Risk Assessment: An Overview of Current Initiatives and Potential Air Pollutant Interactions

    Science.gov (United States)

    Lewis, Ari S.; Sax, Sonja N.; Wason, Susan C.; Campleman, Sharan L.

    2011-01-01

    Regulatory agencies are under increased pressure to consider broader public health concerns that extend to multiple pollutant exposures, multiple exposure pathways, and vulnerable populations. Specifically, cumulative risk assessment initiatives have stressed the importance of considering both chemical and non-chemical stressors, such as socioeconomic status (SES) and related psychosocial stress, in evaluating health risks. The integration of non-chemical stressors into a cumulative risk assessment framework has been largely driven by evidence of health disparities across different segments of society that may also bear a disproportionate risk from chemical exposures. This review will discuss current efforts to advance the field of cumulative risk assessment, highlighting some of the major challenges, discussed within the construct of the traditional risk assessment paradigm. Additionally, we present a summary of studies of potential interactions between social stressors and air pollutants on health as an example of current research that supports the incorporation of non-chemical stressors into risk assessment. The results from these studies, while suggestive of possible interactions, are mixed and hindered by inconsistent application of social stress indicators. Overall, while there have been significant advances, further developments across all of the risk assessment stages (i.e., hazard identification, exposure assessment, dose-response, and risk characterization) are necessary to provide a scientific basis for regulatory actions and effective community interventions, particularly when considering non-chemical stressors. A better understanding of the biological underpinnings of social stress on disease and implications for chemical-based dose-response relationships is needed. Furthermore, when considering non-chemical stressors, an appropriate metric, or series of metrics, for risk characterization is also needed. Cumulative risk assessment research will benefit

  2. Calculating Cumulative Binomial-Distribution Probabilities

    Science.gov (United States)

    Scheuer, Ernest M.; Bowerman, Paul N.

    1989-01-01

    Cumulative-binomial computer program, CUMBIN, one of set of three programs, calculates cumulative binomial probability distributions for arbitrary inputs. CUMBIN, NEWTONP (NPO-17556), and CROSSER (NPO-17557), used independently of one another. Reliabilities and availabilities of k-out-of-n systems analyzed. Used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. Used for calculations of reliability and availability. Program written in C.

  3. Cumulative human impacts on marine predators

    DEFF Research Database (Denmark)

    Maxwell, Sara M; Hazen, Elliott L; Bograd, Steven J

    2013-01-01

    Stressors associated with human activities interact in complex ways to affect marine ecosystems, yet we lack spatially explicit assessments of cumulative impacts on ecologically and economically key components such as marine predators. Here we develop a metric of cumulative utilization and impact...

  4. Radiation doses received by premature babies in the neonatal intensive care unit

    International Nuclear Information System (INIS)

    Thierry-Chef, I.; Maccia, C.; Thierry-Chef, I.; Laurier, D.; Tirmarche, M.; Costil, J.

    2005-01-01

    Purpose. Because of frequent radiological investigations performed in 1 neonatal intensive care unit, a dosimetry study was carried out to assess the level of doses received by premature babies. Materials and methods. In vivo measurements were performed and effective doses were evaluated for single radiographs. Individual cumulative doses received over the period of stay were then estimated, for each premature baby entering the intensive care unit in 2002, taking into account the number of radiographs they underwent. Results. On average, babies stayed for a week and more than one radio-graph was taken per day. Results showed that, even if average doses per radiograph were relatively low (25μSv), cumulative doses strongly depended on the length of stay, and can reach a few mSv. Conclusion. Even if doses per radiograph are in agreement with European recommendations, optimisation of doses is particularly important because premature babies are more sensitive to radiation than adults and because they usually undergo further radiological examinations in other services. On the basis of the results of this dosimetry study, the implementation of a larger study is being discussed. (author)

  5. Favorable Preliminary Outcomes for Men With Low- and Intermediate-risk Prostate Cancer Treated With 19-Gy Single-fraction High-dose-rate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Krauss, Daniel J., E-mail: dkrauss@beaumont.edu [Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States); Ye, Hong [Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States); Martinez, Alvaro A. [21st Century Oncology, Farmington Hills, Michigan (United States); Mitchell, Beth; Sebastian, Evelyn; Limbacher, Amy; Gustafson, Gary S. [Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States)

    2017-01-01

    Purpose: To report the toxicity and preliminary clinical outcomes of a prospective trial evaluating 19-Gy, single-fraction high-dose-rate (HDR) brachytherapy for men with low- and intermediate-risk prostate cancer. Methods and Materials: A total of 63 patients were treated according to an institutional review board-approved prospective study of single-fraction HDR brachytherapy. Eligible patients had tumor stage ≤T2a, prostate-specific antigen level ≤15 ng/mL, and Gleason score ≤7. Patients with a prostate gland volume >50 cm{sup 3} and baseline American Urologic Association symptom score >12 were ineligible. Patients underwent transrectal ultrasound-guided transperineal implantation of the prostate, followed by single-fraction HDR brachytherapy. Treatment was delivered using {sup 192}Ir to a dose of 19 Gy prescribed to the prostate, with no additional margin applied. Results: Of the 63 patients, 58 had data available for analysis. Five patients had withdrawn consent during the follow-up period. The median follow-up period was 2.9 years (range 0.3-5.2). The median age was 61.4 years. The median gland volume at treatment was 34.8 cm{sup 3}. Of the 58 patients, 91% had T1 disease, 71% had Gleason score ≤6 (29% with Gleason score 7), and the median pretreatment prostate-specific antigen level was 5.1 ng/mL. The acute and chronic grade 2 genitourinary toxicity incidence was 12.1% and 10.3%, respectively. No grade 3 urinary toxicity occurred. No patients experienced acute rectal toxicity grade ≥2, and 2 experienced grade ≥2 chronic gastrointestinal toxicity. Three patients experienced biochemical failure, yielding a 3-year cumulative incidence estimate of 6.8%. Conclusions: Single-fraction HDR brachytherapy is well-tolerated, with favorable preliminary biochemical and clinical disease control rates.

  6. The cumulative effect of air pollutants on the acute exacerbation of COPD in Shanghai, China.

    Science.gov (United States)

    Sun, Xian Wen; Chen, Pei Li; Ren, Lei; Lin, Ying Ni; Zhou, Jian Ping; Ni, Lei; Li, Qing Yun

    2018-05-01

    Epidemiologic studies have shown the effect of air pollutants on acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, little is known regarding the dose-response relationship. This study aimed to investigate the cumulative effect of air pollutants on AECOPD. We collected 101 patients with AECOPD from November 2010 through August 2011 in Shanghai. Multiple logistic regression was used to estimate associations between air pollutants and AECOPD. Poisson regression was then applied to determine the cumulative effect of air pollutants including particulate matter 10 (PM10), PM2.5, nitrogen dioxide (NO 2 ), sulphur dioxide (SO 2 ) and ozone (O 3 ) on AECOPD, of which the seasonal variation was further explored. The monthly episodes of AECOPD were associated with the concentrations of PM2.5 (r=0.884, peffect in cold season, whereas 7days in warm season. The RR for AECOPD for per 10μg/m 3 increment in NO 2 was 1.07, with a 5-day cumulative effect without seasonal variation. High consecutive levels of PM2.5 and NO 2 increase the risk of developing AECOPD. Cumulative effect of PM2.5 and NO 2 appears before the exacerbation onset. These gradations were more evident in the PM2.5 during different seasons. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Dose gradient curve: A new tool for evaluating dose gradient.

    Science.gov (United States)

    Sung, KiHoon; Choi, Young Eun

    2018-01-01

    Stereotactic radiotherapy, which delivers an ablative high radiation dose to a target volume for maximum local tumor control, requires a rapid dose fall-off outside the target volume to prevent extensive damage to nearby normal tissue. Currently, there is no tool to comprehensively evaluate the dose gradient near the target volume. We propose the dose gradient curve (DGC) as a new tool to evaluate the quality of a treatment plan with respect to the dose fall-off characteristics. The average distance between two isodose surfaces was represented by the dose gradient index (DGI) estimated by a simple equation using the volume and surface area of isodose levels. The surface area was calculated by mesh generation and surface triangulation. The DGC was defined as a plot of the DGI of each dose interval as a function of the dose. Two types of DGCs, differential and cumulative, were generated. The performance of the DGC was evaluated using stereotactic radiosurgery plans for virtual targets. Over the range of dose distributions, the dose gradient of each dose interval was well-characterized by the DGC in an easily understandable graph format. Significant changes in the DGC were observed reflecting the differences in planning situations and various prescription doses. The DGC is a rational method for visualizing the dose gradient as the average distance between two isodose surfaces; the shorter the distance, the steeper the dose gradient. By combining the DGC with the dose-volume histogram (DVH) in a single plot, the DGC can be utilized to evaluate not only the dose gradient but also the target coverage in routine clinical practice.

  8. Risk of Late Urinary Complications Following Image Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: Refining Bladder Dose-Volume Parameters.

    Science.gov (United States)

    Manea, Elena; Escande, Alexandre; Bockel, Sophie; Khettab, Mohamed; Dumas, Isabelle; Lazarescu, Ioana; Fumagalli, Ingrid; Morice, Philippe; Deutsch, Eric; Haie-Meder, Christine; Chargari, Cyrus

    2018-06-01

    To study correlations between dose-volume parameters of the whole bladder and bladder trigone and late urinary toxicity in locally advanced cervical cancer patients treated with pulsed-dose-rate brachytherapy. Patients with locally advanced cervical cancer treated with chemoradiation therapy and pulsed-dose-rate brachytherapy from 2004 to 2015 were included. Cumulative dose-volume parameters of the whole bladder and bladder trigone were converted into 2-Gy/fraction equivalents (EQD2, with α/β = 3 Gy); these parameters, as well as clinical factors, were analyzed as predictors of toxicity in patients without local relapse. A total of 297 patients fulfilled the inclusion criteria. The median follow-up period was 4.9 years (95% confidence interval 4.5-5.3 years). In patients without local relapse (n = 251), the Kaplan-Meier estimated grade 2 or higher urinary toxicity rates at 3 years and 5 years were 25.4% and 32.1%, respectively. Minimal dose to the most exposed 2 cm 3 of the whole bladder [Formula: see text] , bladder International Commission on Radiation Units & Measurements (ICRU) (B ICRU ) dose, and trigone dose-volume parameters correlated with grade 2 or higher toxicity. At 3 years, the cumulative incidence of grade 2 or higher complications was 22.8% (standard error, 2.9%) for bladder [Formula: see text]   60 Gy EQD2 was significant for grade 2 or higher toxicity (P = .027). The probability of grade 3 or higher toxicities increased with bladder [Formula: see text]  > 80 Gy EQD2 (16.7% vs 1.6%; hazard ratio [HR], 5.77; P = .039), B ICRU dose > 65 Gy EQD2 (4.9% vs 1.3%; HR, 6.36; P = .018), and trigone D 50%  > 60 Gy EQD2 (3.1% vs 1.2%; HR, 6.29; P = .028). Pearson correlation coefficients showed a moderate correlation between bladder [Formula: see text] , B ICRU dose, and bladder trigone D 50% (P < .0001). These data suggest that [Formula: see text]  ≤ 80 Gy EQD2 should be advised for minimizing the risk of severe urinary

  9. Stereotactic Ablative Radiation Therapy for Pulmonary Metastases: Histology, Dose, and Indication Matter

    Energy Technology Data Exchange (ETDEWEB)

    Helou, Joelle [Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario (Canada); Thibault, Isabelle [Département de Radio-Oncologie, Centre Hospitalier Universitaire de Québec, Québec City, Québec (Canada); Poon, Ian [Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Chiang, Andrew [Northeast Cancer Centre, Health Sciences North, Sudbury, Ontario (Canada); Jain, Suneil [Centre for Cancer Research and Cell Biology, Queen' s University, Belfast, Northern Ireland (United Kingdom); Soliman, Hany; Erler, Darby [Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Yeung, Latifa [Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario (Canada); Cheung, Patrick, E-mail: patrick.cheung@sunnybrook.ca [Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada)

    2017-06-01

    Purpose: To assess the association between colorectal cancer (CRC) histology, dose, and local failure (LF) after stereotactic ablative radiation therapy (SABR) for pulmonary metastases, and to describe subsequent cancer progression, change of systemic therapy (CST), survival, and their association with treatment indications. Methods and Materials: From a prospective SABR cohort, 180 pulmonary metastases in 120 patients were identified. Treatment indications were single metastasis, oligometastases, oligoprogression, and dominant areas of progression. Doses of 48 to 52 Gy/4 to 5 fractions were delivered. Since 2010 the dose for peripheral CRC metastases was increased to 60 Gy/4 fractions. Cumulative incidence function (CIF) was used to report LF, progression probability, and CST. The Kaplan-Meier method estimated overall survival (OS). Univariate and multivariable analyses to assess variable associations were conducted. Results: Median follow-up was 22 months (interquartile range, 14-33 months). At 24 months, the CIF of LF was 23.6% (95% confidence interval [CI] 15.1%-33.3%) and 8.3% (95% CI 2.6%-18.6%), respectively, for CRC and non-CRC metastases (P<.001). This association remained significant after adjusting for confounders (subdistribution hazard ratio [SHR] 13.6, 95% CI 4.2-44.1, P<.001). Among CRC metastases, 56 and 45 received <60 Gy and 60 Gy, respectively. Delivering 60 Gy was independently associated with a lower hazard of LF (SHR 0.271, 95% CI 0.078-0.940, P=.040). At 12 months the CIF of progression was 41.67% (95% CI 21.69%-60.56%), 42.51% (95% CI 29.09%-55.29%), 62.96% (95% CI 41.25%-78.53%), and 78.57% (95% CI 42.20%-93.48%), respectively, for patients treated for single metastasis, oligometastases, oligoprogression, and dominant area of progression (P<.001). A CST was observed, respectively, in 4 (17%), 17 (31%), 12 (44%), and 10 (71%) patients with a median time of 13.1, 11.1, 8.4, and 8.4 months. Conclusion: Colorectal cancer lung

  10. Intracranial germinomas: a case for low dose radiation therapy alone

    International Nuclear Information System (INIS)

    Harrigan, Patricia M.; Loeffler, Jay S.; Shrieve, Dennis; Tarbell, Nancy J.

    1995-01-01

    Purpose: To determine the optimal dose and treatment outcome of patients treated with radiation for intracranial germinoma. Materials and Methods: Between 1975 and 1995, 39 patients with a diagnosis of intracranial germinoma were treated with radiation (RT) to the central nervous system. All but one pt received whole brain (WB) RT, (median dose: 3240 cGy range: 1500-4437 cGy) and a boost to the tumor volume (median total tumor volume dose: 5200 cGy, range: 3960-5950 cGy). Thirty-one pts received RT to the spine (median dose: 2500, range: 1875-3750). Eleven pts were treated with low dose RT and a tumor volume boost, (WB dose ≤ 2550 cGy, and spine dose ≤ 2160 cGy). Five pts were treated with cisplatin-based chemotherapy and low dose WB RT. Fifteen pts were biopsy-proven and 18 presented with multiple midline germinomas (MMG). Among all pts, 33% had serum or CSF positive for low levels of HCG and none of 19 (9 biopsy-proven) germinomas measured positive for AFP tumor marker. Six of 22 (27%) pts who had spine imaging or CSF cytology had evidence of tumor seeding. The male-to female-ratio was 1.4. Median age at diagnosis was 14 yrs for male pts and 9.5 yrs for females (p=.02, overall age range: 1-31 yrs). Median follow-up for survivors is 64 months (range: 1-226 months). Toxicity of treatment relative to dose was assessed. Results: The 5-yr. actuarial rate of disease-free survival (DFS) and overall survival for presumed germinomas was 97%. No pts died of germinoma. One pt died of a shunt infection who had received concurrent chemotherapy and low dose whole brain RT. Among the low dose RT alone group 6 pts received whole brain RT of ≤ 2550 cGy and 9 pts were treated with spinal RT of ≤ 2160 cGy without chemotherapy. Two of these pts had CSF cytology positive for tumor seeding. Additionally, 8 pts received a total dose to the tumor volume of ≤ 4800 cGy without chemotherapy. The 5-yr DFS was 100%. Five pts were treated with cisplatin-based chemotherapy followed

  11. Intracranial germinomas: a case for low dose radiation therapy alone

    Energy Technology Data Exchange (ETDEWEB)

    Harrigan, Patricia M; Loeffler, Jay S; Shrieve, Dennis; Tarbell, Nancy J

    1995-07-01

    Purpose: To determine the optimal dose and treatment outcome of patients treated with radiation for intracranial germinoma. Materials and Methods: Between 1975 and 1995, 39 patients with a diagnosis of intracranial germinoma were treated with radiation (RT) to the central nervous system. All but one pt received whole brain (WB) RT, (median dose: 3240 cGy range: 1500-4437 cGy) and a boost to the tumor volume (median total tumor volume dose: 5200 cGy, range: 3960-5950 cGy). Thirty-one pts received RT to the spine (median dose: 2500, range: 1875-3750). Eleven pts were treated with low dose RT and a tumor volume boost, (WB dose {<=} 2550 cGy, and spine dose {<=} 2160 cGy). Five pts were treated with cisplatin-based chemotherapy and low dose WB RT. Fifteen pts were biopsy-proven and 18 presented with multiple midline germinomas (MMG). Among all pts, 33% had serum or CSF positive for low levels of HCG and none of 19 (9 biopsy-proven) germinomas measured positive for AFP tumor marker. Six of 22 (27%) pts who had spine imaging or CSF cytology had evidence of tumor seeding. The male-to female-ratio was 1.4. Median age at diagnosis was 14 yrs for male pts and 9.5 yrs for females (p=.02, overall age range: 1-31 yrs). Median follow-up for survivors is 64 months (range: 1-226 months). Toxicity of treatment relative to dose was assessed. Results: The 5-yr. actuarial rate of disease-free survival (DFS) and overall survival for presumed germinomas was 97%. No pts died of germinoma. One pt died of a shunt infection who had received concurrent chemotherapy and low dose whole brain RT. Among the low dose RT alone group 6 pts received whole brain RT of {<=} 2550 cGy and 9 pts were treated with spinal RT of {<=} 2160 cGy without chemotherapy. Two of these pts had CSF cytology positive for tumor seeding. Additionally, 8 pts received a total dose to the tumor volume of {<=} 4800 cGy without chemotherapy. The 5-yr DFS was 100%. Five pts were treated with cisplatin-based chemotherapy

  12. An analysis of cumulative risks based on biomonitoring data for six phthalates using the Maximum Cumulative Ratio

    Science.gov (United States)

    The Maximum Cumulative Ratio (MCR) quantifies the degree to which a single chemical drives the cumulative risk of an individual exposed to multiple chemicals. Phthalates are a class of chemicals with ubiquitous exposures in the general population that have the potential to cause ...

  13. The median effective concentration (EC50) of propofol with different doses of fentanyl during colonoscopy in elderly patients.

    Science.gov (United States)

    Li, Shiyang; Yu, Fang; Zhu, Huichen; Yang, Yuting; Yang, Liqun; Lian, Jianfeng

    2016-04-21

    Propofol and fentanyl are the most widely administered anesthesia maintaining drugs during colonoscopy. In this study, we determined the median effective concentration (EC50) of propofol required for colonoscopy in elderly patients, and the purpose of this study was to describe the pharmacodynamic interaction between fentanyl and propofol when used in combination for colonoscopy in elderly patients. Ninety elderly patients scheduled for colonoscopy were allocated into three groups in a randomized, double-blinded manner as below, F0.5 group (0.5 μg.kg(-1) fentanyl), F1.0 group (1.0 μg.kg(-1) fentanyl) and saline control group. Anaesthesia was achieved by target-controlled infusion of propofol (Marsh model, with an initial plasma concentration of 2.0 μg.ml(-1)) and fentanyl. Colonoscopy was started 3 min after the injection of fentanyl. The EC50 of propofol for colonoscopy with different doses of fentanyl was measured by using an up-and-down sequential method with an adjacent concentration gradient at 0.5 μg.ml(-1) to inhibit purposeful movements. Anaesthesia associated adverse events and recovery characters were also recorded. The EC50 of propofol for colonoscopy in elderly patients were 2.75 μg.ml(-1) (95% CI, 2.50-3.02 μg.ml(-1)) in F0.5 group, 2.05 μg.ml(-1) (95% CI, 1.98-2.13 μg.ml(-1)) in F1.0 group and 3.08 μg.ml(-1) (95% CI, 2.78-3.42 μg.ml(-1)) in control group respectively (P fentanyl up to 1.0 μg.kg(-1) reduces the propofol EC50 required for elderly patients undergoing colonoscopy, and there was no significant difference in anaesthesia associated adverse events but prolonged awake and discharge time. Chinese Clinical Trial Registry ChiCTR15006368. Date of registration: May 3, 2015.

  14. Does iterative reconstruction lower CT radiation dose: evaluation of 15,000 examinations.

    Directory of Open Access Journals (Sweden)

    Peter B Noël

    Full Text Available PURPOSE: Evaluation of 15,000 computed tomography (CT examinations to investigate if iterative reconstruction (IR reduces sustainably radiation exposure. METHOD AND MATERIALS: Information from 15,000 CT examinations was collected, including all aspects of the exams such as scan parameter, patient information, and reconstruction instructions. The examinations were acquired between January 2010 and December 2012, while after 15 months a first generation IR algorithm was installed. To collect the necessary information from PACS, RIS, MPPS and structured reports a Dose Monitoring System was developed. To harvest all possible information an optical character recognition system was integrated, for example to collect information from the screenshot CT-dose report. The tool transfers all data to a database for further processing such as the calculation of effective dose and organ doses. To evaluate if IR provides a sustainable dose reduction, the effective dose values were statistically analyzed with respect to protocol type, diagnostic indication, and patient population. RESULTS: IR has the potential to reduce radiation dose significantly. Before clinical introduction of IR the average effective dose was 10.1±7.8mSv and with IR 8.9±7.1mSv (p*=0.01. Especially in CTA, with the possibility to use kV reduction protocols, such as in aortic CTAs (before IR: average14.2±7.8mSv; median11.4mSv /with IR:average9.9±7.4mSv; median7.4mSv, or pulmonary CTAs (before IR: average9.7±6.2mSV; median7.7mSv /with IR: average6.4±4.7mSv; median4.8mSv the dose reduction effect is significant(p*=0.01. On the contrary for unenhanced low-dose scans of the cranial (for example sinuses the reduction is not significant (before IR:average6.6±5.8mSv; median3.9mSv/with IR:average6.0±3.1mSV; median3.2mSv. CONCLUSION: The dose aspect remains a priority in CT research. Iterative reconstruction algorithms reduce sustainably and significantly radiation dose in the clinical routine

  15. Radiation Doses in Intravenous Urography And Potentials For Optimization

    International Nuclear Information System (INIS)

    Halato, M.A.; Badawi, A.; Gassom, G.A.; Barsham, M.A.; Ibrahim, A.F.; Suliman, I.I.; Sulieman, A.A.

    2011-01-01

    In this study radiation doses in IVU clinical examinations were measured in three public hospitals and a sample of 44 patients. In each room the machine output was measured for different peak tube voltages. Patient's data such as (age and weight) and exposure parameters (kVp) and mAs) were recorded. Entrance Surface Air Kerma (ESAK) for patients was determined by using the tube output and the patient exposure parameters. The ESAK ranged from 0.76 to 6.75 mGy. The cumulative ESAK ranged from 3.5 to 34.6 mGy. In conclusion, the obtained results are in agreement with the standard reference ESAK levels. The study showed that the cumulative ESAK can approach a level known to increase the probability of stochastic effect. Keywords: Patient dose, intravenous Urography, radiation protection

  16. Effective radiation doses in CT colonography: results of an inventory among research institutions

    International Nuclear Information System (INIS)

    Jensch, Sebastiaan; Gelder, Rogier E. van; Lameris, Johan S.; Stoker, Jaap; Venema, Henk W.; Reitsma, Johannes B.; Bossuyt, Patrick M.M.

    2006-01-01

    The purpose of this study was to estimate the effective dose that is currently used in CT colonography using scan parameters that were collected for this purpose, and to investigate trends in time. PubMed was systematically searched from 1996 until January 2004 for studies investigating CT colonography. Research institutions were contacted and asked for their current scan protocol. Thirty-six institutions published 74 studies. Twenty-eight of the 36 institutions provided their current protocol. The median effective dose in 2004 was 5.1 mSv (range 1.2-11.7 mSv) per position. Most institutions (93%) scan in both the supine and prone positions. The median mAs value was 67 mAs (range 20-200), median collimation was 2.5 mm (range 0.75-5). From 1996 until 2004 a significant decrease in mAs and collimation (P=0.006, P<0.0001, respectively) was observed, while institutions that used a multislice scanner increased (P<0.0001). The effective dose remained constant (P=0.76). In 2004 the median effective dose for a complete CT colonography was 10.2 mSv. Despite the increasing use of multislice scanners, which are slightly less dose-efficient, the median effective dose remained approximately constant between 1996 and 2004. This is mainly caused by the use of lower mAs settings. (orig.)

  17. Use of three-dimensional lognormal dose-response surfaces in lifetime studies of radiation-induced cancer

    International Nuclear Information System (INIS)

    Raabe, O.G.

    1986-01-01

    The three-dimensional lognormal cumulative probability power function was used to provide a unifying dose-response description of the lifetime cancer risk for chronic exposure of experimental animals and people, for risk evaluation, and for scaling between species. Bone tumor fatilities, primarily from alpha irradiation of the skeleton in lifetime studies of beagles injected with 226 Ra, were shown to be well described by this function. This function described cancer risk in lifetime studies as a curved smooth surface depending on radiation exposure rate and elapsed time, such that the principal risk at low dose rates occurred near the end of the normal life span without significant life shortening. Essentially identical functions with the median value of the power function displaced with respect to appropriate RBE values were shown to describe bone-cancer induction primarily from alpha irradiation of the skeleton in lifetime beagle studies with injected 226 Ra, 228 Th, 239 Pu and 241 Am, and with inhaled 238 Pu. Application of this model to human exposures to 226 Ra yielded a response ratio of 3.6; that is, the time required for development of bone cancer in people was 3.6 times longer than for beagles at the same average skeletal dose rate. It was suggested that similar techniques were appropriate to other carcinogens and other critical organs. 20 refs., 8 figs., 3 tabs

  18. Level of patient and operator dose in the largest cardiac centre in Greece

    International Nuclear Information System (INIS)

    Tsapaki, V.; Patsilinakos, S.; Voudris, V.; Magginas, A.; Pavlidis, S.; Maounis, T.; Theodorakis, G.; Koutelou, M.; Vrantza, T.; Nearchou, M.; Nikolaki, N.; Kollaros, N.; Kyrozi, E.; Kottou, S.; Karaiskos, P.; Neofotistou, E.; Cokkinos, D.

    2008-01-01

    The objective of this study was to investigate the patient and staff doses in the most frequent interventional cardiology (IC) procedures performed in Onassio, the largest Cardiac Centre in Greece. Data were collected from three digital X-ray systems for 212 coronary angiographies, 203 percutaneous transluminal coronary angio-plasties (PTCA) and 134 various electrophysiological studies. Patient skin dose was measured using suitably calibrated slow radiotherapy films and cardiologist dose using suitably calibrated thermoluminescent dosemeters placed on left arm, hand and foot. Patient median dose area product (DAP) (all examinations) ranged between 6.7 and 83.5 Gy cm 2 . Patient median skin dose in PTCA was 799 mGy (320-1660 mGy) and in RF ablation 160 mGy (35-1920 mGy). Median arm, hand and foot dose to the cardiologist were 12.6, 27 and 13 μSv, respectively, per procedure. The great range of radiation doses received by both patients and operators confirms the need for continuous monitoring of all IC techniques. (authors)

  19. Dosimetric Evaluation of High-Dose-Rate Interstitial Brachytherapy Boost Treatments for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Froehlich, Georgina; Agoston, Peter; Loevey, Jozsef; Somogyi, Andras; Fodor, Janos; Polgar, Csaba; Major, Tibor

    2010-01-01

    Purpose: to quantitatively evaluate the dose distributions of high-dose-rate (HDR) prostate implants regarding target coverage, dose homogeneity, and dose to organs at risk. Material and methods: treatment plans of 174 implants were evaluated using cumulative dose-volume histograms (DVHs). The planning was based on transrectal ultrasound (US) imaging, and the prescribed dose (100%) was 10 Gy. The tolerance doses to rectum and urethra were 80% and 120%, respectively. Dose-volume parameters for target (V90, V100, V150, V200, D90, D min ) and quality indices (DNR [dose nonuniformity ratio], DHI [dose homogeneity index], CI [coverage index], COIN [conformal index]) were calculated. Maximum dose in reference points of rectum (D r ) and urethra (D u ), dose to volume of 2 cm 3 of the rectum (D 2ccm ), and 0.1 cm 3 and 1% of the urethra (D 0.1ccm and D1) were determined. Nonparametric correlation analysis was performed between these parameters. Results: the median number of needles was 16, the mean prostate volume (V p ) was 27.1 cm 3 . The mean V90, V100, V150, and V200 were 90%, 97%, 39% and 13%, respectively. The mean D90 was 109%, and the D min was 87%. The mean doses in rectum and urethra reference points were 75% and 119%, respectively. The mean volumetric doses were D 2ccm = 49% for the rectum, D 0.1ccm = 126%, and D1 = 140% for the urethra. The mean DNR was 0.37, while the DHI was 0.60. The mean COIN was 0.66. The Spearman rank order correlation coefficients for volume doses to rectum and urethra were R(D r , D 2ccm ) = 0.69, R(D u , D 0.1ccm ) = 0.64, R(D u , D1) = 0.23. Conclusion: US-based treatment plans for HDR prostate implants based on the real positions of catheters provided acceptable dose distributions. In the majority of the cases, the doses to urethra and rectum were kept below the defined tolerance levels. For rectum, the dose in reference points correlated well with dose-volume parameters. For urethra dose characterization, the use of D1 volumetric

  20. Dosimetric evaluation of high-dose-rate interstitial brachytherapy boost treatments for localized prostate cancer.

    Science.gov (United States)

    Fröhlich, Georgina; Agoston, Péter; Lövey, József; Somogyi, András; Fodor, János; Polgár, Csaba; Major, Tibor

    2010-07-01

    To quantitatively evaluate the dose distributions of high-dose-rate (HDR) prostate implants regarding target coverage, dose homogeneity, and dose to organs at risk. Treatment plans of 174 implants were evaluated using cumulative dose-volume histograms (DVHs). The planning was based on transrectal ultrasound (US) imaging, and the prescribed dose (100%) was 10 Gy. The tolerance doses to rectum and urethra were 80% and 120%, respectively. Dose-volume parameters for target (V90, V100, V150, V200, D90, D(min)) and quality indices (DNR [dose nonuniformity ratio], DHI [dose homogeneity index], CI [coverage index], COIN [conformal index]) were calculated. Maximum dose in reference points of rectum (D(r)) and urethra (D(u)), dose to volume of 2 cm(3) of the rectum (D(2ccm)), and 0.1 cm(3) and 1% of the urethra (D(0.1ccm) and D1) were determined. Nonparametric correlation analysis was performed between these parameters. The median number of needles was 16, the mean prostate volume (V(p)) was 27.1 cm(3). The mean V90, V100, V150, and V200 were 99%, 97%, 39%, and 13%, respectively. The mean D90 was 109%, and the D(min) was 87%. The mean doses in rectum and urethra reference points were 75% and 119%, respectively. The mean volumetric doses were D(2ccm) = 49% for the rectum, D(0.1ccm) = 126%, and D1 = 140% for the urethra. The mean DNR was 0.37, while the DHI was 0.60. The mean COIN was 0.66. The Spearman rank order correlation coefficients for volume doses to rectum and urethra were R(D(r),D(2ccm)) = 0.69, R(D(u),D0.(1ccm)) = 0.64, R(D(u),D1) = 0.23. US-based treatment plans for HDR prostate implants based on the real positions of catheters provided acceptable dose distributions. In the majority of the cases, the doses to urethra and rectum were kept below the defined tolerance levels. For rectum, the dose in reference points correlated well with dose-volume parameters. For urethra dose characterization, the use of D1 volumetric parameter is recommended.

  1. Median Nerve Conduction in Healthy Nigerians: Normative Data

    African Journals Online (AJOL)

    of median nerve disease using multiple studies, and rendering ... Aim: To develop normative values for motor and sensory median nerve ..... Table 5: Comparison of median motor nerve conduction study parameters to studies elsewhere. Study.

  2. GTV-based prescription in SBRT for lung lesions using advanced dose calculation algorithms

    International Nuclear Information System (INIS)

    Lacornerie, Thomas; Lisbona, Albert; Mirabel, Xavier; Lartigau, Eric; Reynaert, Nick

    2014-01-01

    The aim of current study was to investigate the way dose is prescribed to lung lesions during SBRT using advanced dose calculation algorithms that take into account electron transport (type B algorithms). As type A algorithms do not take into account secondary electron transport, they overestimate the dose to lung lesions. Type B algorithms are more accurate but still no consensus is reached regarding dose prescription. The positive clinical results obtained using type A algorithms should be used as a starting point. In current work a dose-calculation experiment is performed, presenting different prescription methods. Three cases with three different sizes of peripheral lung lesions were planned using three different treatment platforms. For each individual case 60 Gy to the PTV was prescribed using a type A algorithm and the dose distribution was recalculated using a type B algorithm in order to evaluate the impact of the secondary electron transport. Secondly, for each case a type B algorithm was used to prescribe 48 Gy to the PTV, and the resulting doses to the GTV were analyzed. Finally, prescriptions based on specific GTV dose volumes were evaluated. When using a type A algorithm to prescribe the same dose to the PTV, the differences regarding median GTV doses among platforms and cases were always less than 10% of the prescription dose. The prescription to the PTV based on type B algorithms, leads to a more important variability of the median GTV dose among cases and among platforms, (respectively 24%, and 28%). However, when 54 Gy was prescribed as median GTV dose, using a type B algorithm, the variability observed was minimal. Normalizing the prescription dose to the median GTV dose for lung lesions avoids variability among different cases and treatment platforms of SBRT when type B algorithms are used to calculate the dose. The combination of using a type A algorithm to optimize a homogeneous dose in the PTV and using a type B algorithm to prescribe the

  3. Chapter 19. Cumulative watershed effects and watershed analysis

    Science.gov (United States)

    Leslie M. Reid

    1998-01-01

    Cumulative watershed effects are environmental changes that are affected by more than.one land-use activity and that are influenced by.processes involving the generation or transport.of water. Almost all environmental changes are.cumulative effects, and almost all land-use.activities contribute to cumulative effects

  4. The Association between Cumulative Psychosocial Risk and Cervical HPV Infection Among Female Adolescents in a Free Vaccination Program

    Science.gov (United States)

    Linares, Lourdes Oriana; Shankar, Viswanathan; Diaz, Angela; Nucci-Sack, Anne; Strickler, Howard D.; Peake, Ken; Weiss, Jocelyn; Burk, Robert D.; Schlecht, Nicolas F.

    2016-01-01

    Objective This study investigated the association of cervical Human Papillomavirus (HPV) infection with cumulative psychosocial risk reflecting family disadvantage, psychological distress, and unhealthy life style. Methods The sample (N=745) was comprised of sexually-active female adolescent patients (12-19 years), primarily ethnic minorities, enrolled in a free HPV vaccination program. Subjects completed questionnaires and provided cervical swabs for HPV DNA testing. Unweighted and weighted Principal Component Analyses (PCA) for categorical data were used to derive multi-systemic psychosocial risk indices using nine indicators: low socioeconomic status, lack of adult involvement, not attending high-school/college, history of treatment for depression/anxiety, antisocial/delinquent behavior, number of recent sexual partners, use of alcohol, use of drugs, and dependency risk for alcohol/drugs. The association between cervical HPV (any-type, high risk-types, vaccine-types) assayed by polymerase chain reaction and self-reported number of psychosocial risk indicators was estimated using multivariable logistic regression. Results Subjects had a median of three psychosocial risk indicators. Multiple logistic regression analyses showed associations with unweighted and weighted number of psychosocial indicators for HPV any-type (adjusted odds ratio [aOR]=1.1; 95% confidence interval [CI]: 1.0-1.2 ); with the strongest associations between weighted drug/alcohol use, drug/alcohol dependency risk, and antisocial/delinquent behavior and detection of HPV vaccine-types (aOR=1.5; 95%CI: 1.1-2.0) independent of number of recent sexual partners and vaccine dose (0-3). Conclusion Increased HPV infections including HPV vaccine-types were associated with greater number of psychosocial risk indicators even after controlling for demographics, sexual behavior, history of chlamydia, and vaccine dose. PMID:25985216

  5. Biological indicators for radiation absorbed dose: a review

    International Nuclear Information System (INIS)

    Paul, S.F.D.; Venkatachalam, P.; Jeevanram, R.K.

    1996-01-01

    Biological dosimetry has an important role to play in assessing the cumulative radiation exposure of persons working with radiation and also in estimating the true dose received during accidents involving external and internal exposure. Various biodosimetric methods have been tried to estimate radiation dose for the above purposes. Biodosimetric methods include cytogenetic, immunological and mutational assays. Each technique has certain advantages and disadvantages. We present here a review of each technique, the actual method used for detection of dose, the sensitivity of detection and its use in long term studies. (author)

  6. An Analysis of Cumulative Risks Indicated by Biomonitoring Data of Six Phthalates Using the Maximum Cumulative Ratio

    Science.gov (United States)

    The Maximum Cumulative Ratio (MCR) quantifies the degree to which a single component of a chemical mixture drives the cumulative risk of a receptor.1 This study used the MCR, the Hazard Index (HI) and Hazard Quotient (HQ) to evaluate co-exposures to six phthalates using biomonito...

  7. Fractionation in medium dose rate brachytherapy of cancer of the cervix

    International Nuclear Information System (INIS)

    Leborgne, Felix; Fowler, Jack F.; Leborgne, Jose H.; Zubizarreta, Eduardo; Chappell, Rick

    1996-01-01

    Purpose: To establish an optimum fractionation for medium dose rate (MDR) brachytherapy from retrospective data of patients treated with different MDR schedules in comparison with a low dose rate (LDR) schedule. Methods and Materials: The study population consists of consecutive Stage IB-IIA-IIB patients who received radiotherapy alone with full dose brachytherapy plus external beam pelvic and parametrial irradiation from 1986-1993. Patients also receiving surgery or chemotherapy were excluded. The LDR group (n = 102, median follow-up: 80 months) received a median dose to Point A of two 32.5 Gy fractions at 0.44 Gy/h plus 18 Gy of external whole pelvic irradiation. The MDR1 group (n = 30, median follow-up: 45 months) received a mean dose of two 32 Gy fractions at 1.68 Gy/h. An individual dose reduction of 12.5% was planned for this group according to the Manchester experience, but only a 4.8% dose reduction was achieved. The MDR2 group (n = 10, median follow-up: 36 months) received a dose of two 24 Gy fractions at 1.65 Gy/h. The MDR3 group (n = 10, median follow-up 33 months) received a mean dose of three 15.3 Gy fractions at 1.64 Gy/h. And finally, the MDR4 group (n = 38, median follow-up: 24 months) received six 7.7 Gy fractions from two pulses 6 h apart in each of three insertions at 1.61 Gy/h. The median external pelvic dose to MDR schedules was between 12 and 20 Gy. The linear quadratic (LQ) formula was used to calculate the biologically effective dose (BED) to tumor (Gy 10 ) and rectum (Gy 3 ), assuming T(1(2)) for repair = 1.5 h. Results: The crude central recurrence rate was 6% for LDR (mean BED = 95.4 Gy 10 ) and 10% for MDR4 (mean BED = 77.0 Gy 10 ) (p = NS). The remaining MDR groups had no recurrences. Grade 2 and 3 rectal or bladder complications were 0% for LDR (rectal BED = 109 Gy 3 ), 83% for MDR1 (BED = 206 Gy 3 ), and 30% for MDR3 (BED = 127 Gy 3 ). The MDR2 and MDR4 groups presented no complications (BED, 123 Gy 3 , and 105 Gy 3 , respectively

  8. Doses to head and neck normal tissues for early stage Hodgkin lymphoma after involved node radiotherapy

    International Nuclear Information System (INIS)

    Maraldo, M.V.; Brodin, N.P.; Aznar, M.C.; Vogelius, I.R.; Munck af Rosenschöld, P.; Petersen, P.M.; Specht, L.

    2014-01-01

    Purpose: To evaluate dose plans for head and neck organs at risk (OARs) for classical Hodgkin lymphoma (HL) patients using involved node radiotherapy (INRT) delivered as 3D conformal radiotherapy (3DCRT), volumetric modulated arc therapy (VMAT), and intensity modulated proton therapy (PT), in comparison to the past mantle field (MF). Materials and methods: Data from 37 patients with cervical lymph node involvement were used. All patients originally received chemotherapy followed by 3DCRT–INRT (30.6 Gy). A VMAT–INRT, PT–INRT (both 30.6 Gy), and a MF plan (36 Gy) were simulated. Doses to head and neck OARs were compared with cumulative DVHs and repeated measures ANOVA. Results: The estimated median mean doses were 15.3, 19.3, 15.4, and 37.3 Gy (thyroid), 10.9, 12.0, 7.9, and 34.5 Gy (neck muscles), 2.3, 11.1, 1.8, and 37.1 Gy (larynx), 1.7, 5.1, 1.3, and 23.8 Gy (pharynx), 0.5, 0.8, 0.01, and 32.3 Gy (ipsilateral parotid), and 2.4, 3.8, 0.7, and 34.7 Gy (ipsilateral submandibular) with 3DCRT, VMAT, PT, and MF (all p < 0.0001), respectively. Conclusion: The use of INRT significantly lowered the estimated radiation dose to the head and neck OARs. VMAT appeared suboptimal compared to 3DCRT and PT, and for some patients, PT offered an additional gain

  9. Synergistic effects of total ionizing dose on single event upset sensitivity in static random access memory under proton irradiation

    International Nuclear Information System (INIS)

    Xiao Yao; Guo Hong-Xia; Zhang Feng-Qi; Zhao Wen; Wang Yan-Ping; Zhang Ke-Ying; Ding Li-Li; Luo Yin-Hong; Wang Yuan-Ming; Fan Xue

    2014-01-01

    Synergistic effects of the total ionizing dose (TID) on the single event upset (SEU) sensitivity in static random access memories (SRAMs) were studied by using protons. The total dose was cumulated with high flux protons during the TID exposure, and the SEU cross section was tested with low flux protons at several cumulated dose steps. Because of the radiation-induced off-state leakage current increase of the CMOS transistors, the noise margin became asymmetric and the memory imprint effect was observed. (interdisciplinary physics and related areas of science and technology)

  10. Dose from drinking water Finland

    International Nuclear Information System (INIS)

    Maekelaeinen, Ilona; Salonen, Laina; Huikuri, Pia; Arvela, Hannu

    1999-01-01

    The dose from drinking water originates almost totally from naturally occurring radionuclides in the uranium-238 series, the most important nuclide being radon-222. Second comes lead-210, and third polonium-210. The mean age-group-weighted dose received by ingestion of drinking water is 0.14 mSv per year. More than half of the total cumulative dose of 750 manSv is received by the users of private wells, forming 13% of the population. The most exposed group comprises the users of wells drilled in bedrock, who receive 320 manSv while comprising only 4% of the population. The calculated number of annual cancer incidences due to drinking water is very sensitive to the dose-conversion factors of ingested radon used, as well as to the estimated lung cancer incidences caused by radon released from water into indoor air. (au)

  11. Relationships between the Brook Street Terrane and Median Tectonic Zone (Median Batholith) : evidence from Jurassic conglomerates

    International Nuclear Information System (INIS)

    Tulloch, A.J.; Kimbrough, D.L.; Landis, C.A.; Mortimer, N.; Johnston, M.R.

    1999-01-01

    U-Pb zircon ages of 237-180 Ma and c. 280 Ma of seven granitoid clasts from the Rainy River Conglomerate which lies within the eastern Median Tectonic Zone (Median Batholith) in Nelson, and the Barretts Formation of the Brook Street Terrane in Southland, constrain the depositional ages of both units to be no older than c. 180-200 Ma (Early Jurassic). The minimum age of the Rainy River Conglomerate is constrained by the 147 +2 -1 Ma (Latest Jurassic) emplacement age of the One Mile Gabbronorite (new name: previously western Buller Diorite). The ages and chemistry of five of the granitoid clasts are broadly compatible with derivation from rocks that are now represented by Triassic plutons of the Median Tectonic Zone (Median Batholith), although ages as young as 180 Ma are slightly outside the range of the latter as currently exposed in New Zealand. The age (273-290 Ma, 237 +/- 3 Ma) and chemistry of the other two clasts (one each from Rainy River Conglomerate and Barretts Formation) suggest derivation from the Brook Street Terrane. Similarity in stratigraphic age, depositional characteristics, granitoid clast ages and composition between Rainy River Conglomerate and Barretts Formation suggests that they are broadly correlative and collectively overlapped a combined Brook Street Terrane - Median Batholith (MTZ) before the Late Jurassic (147 +2 -1 Ma). Sedimentary overlap may also have continued across to Middle Jurassic conglomeratic strata in the Murihiku Terrane to the east of the Brook Street Terrane. A U-Pb zircon age of 261 +/- 2 Ma is reported for Pourakino Trondhjemite of the Brook Street Terrane. (author). 56 refs., 10 figs., 4 tabs

  12. Median and ulnar neuropathies in university guitarists.

    Science.gov (United States)

    Kennedy, Rachel H; Hutcherson, Kimberly J; Kain, Jennifer B; Phillips, Alicia L; Halle, John S; Greathouse, David G

    2006-02-01

    Descriptive study. To determine the presence of median and ulnar neuropathies in both upper extremities of university guitarists. Peripheral nerve entrapment syndromes of the upper extremities are well documented in musicians. Guitarists and plucked-string musicians are at risk for entrapment neuropathies in the upper extremities and are prone to mild neurologic deficits. Twenty-four volunteer male and female guitarists (age range, 18-26 years) were recruited from the Belmont University School of Music and the Vanderbilt University Blair School of Music. Individuals were excluded if they were pregnant or had a history of recent upper extremity or neck injury. Subjects completed a history form, were interviewed, and underwent a physical examination. Nerve conduction status of the median and ulnar nerves of both upper extremities was obtained by performing motor, sensory, and F-wave (central) nerve conduction studies. Descriptive statistics of the nerve conduction study variables were computed using Microsoft Excel. Six subjects had positive findings on provocative testing of the median and ulnar nerves. Otherwise, these guitarists had normal upper extremity neural and musculoskeletal function based on the history and physical examinations. When comparing the subjects' nerve conduction study values with a chart of normal nerve conduction studies values, 2 subjects had prolonged distal motor latencies (DMLs) of the left median nerve of 4.3 and 4.7 milliseconds (normal, DMLs are compatible with median neuropathy at or distal to the wrist. Otherwise, all electrophysiological variables were within normal limits for motor, sensory, and F-wave (central) values. However, comparison studies of median and ulnar motor latencies in the same hand demonstrated prolonged differences of greater than 1.0 milliseconds that affected the median nerve in 2 additional subjects, and identified contralateral limb involvement in a subject with a prolonged distal latency. The other 20

  13. Assessment of late cardiotoxicity of pirarubicin (THP) in children with acute lymphoblastic leukemia.

    Science.gov (United States)

    Shimomura, Yasuto; Baba, Reizo; Watanabe, Arata; Horikoshi, Yasuo; Asami, Keiko; Hyakuna, Nobuyuki; Iwai, Asayuki; Matsushita, Takeshi; Yamaji, Kazutaka; Hori, Toshinori; Tsurusawa, Masahito

    2011-09-01

    Pirarubicin (tetrahydropyranyl-adriamycin: THP) is a derivative of doxorubicin with reportedly less cardiotoxicity in adults. However no studies of cardiotoxicity in children treated with THP have been reported. This study was performed to assess the THP-induced cardiotoxicity for children with acute lymphoblastic leukemia (ALL). This study comprised 61 asymptomatic patients aged from 7.6 to 25.7 years old. Median follow-up time after completion of anthracycline treatment was 8.1 years (range: 1.7-12.5). The cumulative dose of THP ranged from 120 to 740 mg/m(2) with a median of 180 mg/m(2) . Patients underwent electrocardiogram (ECG), echocardiography, the 6-min walk test (6MWT), and measurements of serum brain natriuretic peptide (BNP) before and after exercise. All subjects showed normal left ventricular function assessed by echocardiography. Ventricular premature contraction in Holter ECG and reduced exercise tolerance in the 6MWT were detected in 2/46 (3.3%) and 5/41(12.2%), respectively. Abnormal BNP levels were detected in 6/60 (10%) both before and after exercise. The cumulative dose of THP was significantly correlated with BNP levels after exercise (r = 0.27, P = 0.03), but not with any other cardiac measurements. Further analysis revealed that subjects with a high cumulative dose ≧300 mg/m(2) had significantly higher BNP levels after exercise compared with subjects with a low cumulative dose THP treatment. The use of post-exercise BNP level to indicate high cardiotoxicity risk should be verified by further study. Copyright © 2011 Wiley-Liss, Inc.

  14. Managing cumulative impacts: A key to sustainability?

    Energy Technology Data Exchange (ETDEWEB)

    Hunsaker, C.T.

    1994-12-31

    This paper addresses how science can be more effectively used in creating policy to manage cumulative effects on ecosystems. The paper focuses on the scientific techniques that we have to identify and to assess cumulative impacts on ecosystems. The term ``sustainable development`` was brought into common use by the World Commission on Environment and Development (The Brundtland Commission) in 1987. The Brundtland Commission report highlighted the need to simultaneously address developmental and environmental imperatives simultaneously by calling for development that ``meets the needs of the present generation without compromising the needs of future generations.`` We cannot claim to be working toward sustainable development until we can quantitatively assess cumulative impacts on the environment: The two concepts are inextricibally linked in that the elusiveness of cumulative effects likely has the greatest potential of keeping us from achieving sustainability. In this paper, assessment and management frameworks relevant to cumulative impacts are discussed along with recent literature on how to improve such assessments. When possible, examples are given for marine ecosystems.

  15. Dose volume assessment of high dose rate 192IR endobronchial implants

    International Nuclear Information System (INIS)

    Cheng, B. Saw; Korb, Leroy J.; Pawlicki, Todd; Wu, Andrew

    1996-01-01

    Purpose: To study the dose distributions of high dose rate (HDR) endobronchial implants using the dose nonuniformity ratio (DNR) and three volumetric irradiation indices. Methods and Materials: Multiple implants were configured by allowing a single HDR 192 Ir source to step through a length of 6 cm along an endobronchial catheter. Dwell times were computed to deliver a dose of 5 Gy to points 1 cm away from the catheter axis. Five sets of source configurations, each with different dwell position spacings from 0.5 to 3.0 cm, were evaluated. Three-dimensional (3D) dose distributions were then generated for each source configuration. Differential and cumulative dose-volume curves were generated to quantify the degree of target volume coverage, dose nonuniformity within the target volume, and irradiation of tissues outside the target volume. Evaluation of the implants were made using the DNR and three volumetric irradiation indices. Results: The observed isodose distributions were not able to satisfy all the dose constraints. The ability to optimally satisfy the dose constraints depended on the choice of dwell position spacing and the specification of the dose constraint points. The DNR and irradiation indices suggest that small dwell position spacing does not result in a more homogeneous dose distribution for the implant. This study supports the existence of a relationship between the dwell position spacing and the distance from the catheter axis to the reference dose or dose constraint points. Better dose homogeneity for an implant can be obtained if the spacing of the dwell positions are about twice the distance from the catheter axis to the reference dose or dose constraint points

  16. VMAT QA: Measurement-guided 4D dose reconstruction on a patient

    Energy Technology Data Exchange (ETDEWEB)

    Nelms, Benjamin E.; Opp, Daniel; Robinson, Joshua; Wolf, Theresa K.; Zhang, Geoffrey; Moros, Eduardo; Feygelman, Vladimir [Canis Lupus LLC, Merrimac, Wisconsin 53561 (United States); Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida 33612 (United States); Department of Physics, University of South Florida, Tampa, Florida 33612 (United States); Live Oak Technologies LLC, Kirkwood, Missouri 63122 (United States); Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida 33612 (United States)

    2012-07-15

    Purpose: To develop and validate a volume-modulated arc therapy (VMAT) quality assurance (QA) tool that takes as input a time-resolved, low-density ({approx}10 mm) cylindrical surface dose map from a commercial helical diode array, and outputs a high density, volumetric, time-resolved dose matrix on an arbitrary patient dataset. This first validation study is limited to a homogeneous 'patient.'Methods: A VMAT treatment is delivered to a diode array phantom (ARCCHECK, Sun Nuclear Corp., Melbourne, FL). 3DVH software (Sun Nuclear) derives the high-density volumetric dose using measurement-guided dose reconstruction (MGDR). MGDR cylindrical phantom results are then used to perturb the three-dimensional (3D) treatment planning dose on the patient dataset, producing a semiempirical volumetric dose grid. Four-dimensional (4D) dose reconstruction on the patient is also possible by morphing individual sub-beam doses instead of the composite. For conventional (3D) dose comparison two methods were developed, using the four plans (Multi-Target, C-shape, Mock Prostate, and Head and Neck), including their structures and objectives, from the AAPM TG-119 report. First, 3DVH and treatment planning system (TPS) cumulative point doses were compared to ion chamber in a cube water-equivalent phantom ('patient'). The shape of the phantom is different from the ARCCHECK and furthermore the targets were placed asymmetrically. Second, coronal and sagittal absolute film dose distributions in the cube were compared with 3DVH and TPS. For time-resolved (4D) comparisons, three tests were performed. First, volumetric dose differences were calculated between the 3D MGDR and cumulative time-resolved patient (4D MGDR) dose at the end of delivery, where they ideally should be identical. Second, time-resolved (10 Hz sampling rate) ion chamber doses were compared to cumulative point dose vs time curves from 4D MGDR. Finally, accelerator output was varied to assess the linearity of

  17. Spent fuel transportation on highways: the radioactive dose to the traffic

    International Nuclear Information System (INIS)

    Yadigaroglu, G.

    1975-01-01

    The radioactive exposure of the traffic moving on the same highway as spent fuel shipments has been neglected in the past. Methods developed for calculating peak exposures, the number of individuals receiving a dose in excess of a certain limiting value, and the cumulative population doses for the occupants of the vehicles under a variety of highway and accident conditions allow comparisons to the corresponding stationary-population doses. Consideration of both routine direct-radiation exposures and accidental releases indicates that the traffic doses can be of equal or greater importance than the stationary-population doses

  18. Radiation exposure of ventilated trauma patients in intensive care: a retrospective study comparing two time periods.

    Science.gov (United States)

    Yee, Micaela V; Barron, Rochelle A; Knobloch, Tom A; Pandey, Umesh; Twyford, Catherine; Freebairn, Ross C

    2012-08-01

    To describe the cumulative effective dose of radiation that was received during the initial Emergency Department assessment and ICU stay of patients admitted with trauma, who required mechanical ventilation, during two time periods. A retrospective analysis of radiological and clinical data, set in a regional nonurban ICU. Two cohorts (starting 1 January 2004 and 1 January 2009), each comprising 45 adult patients admitted with trauma who were mechanically ventilated in intensive care, were studied. Frequency and type of radiological examinations, demographic information, and clinical data were collated from the radiological database, hospital admission record and Australian Outcomes Research Tool for Intensive Care database. Cumulative effective doses were calculated and expressed as a total dose and average daily dose for each cohort. The median cumulative effective dose per patient (in milliSieverts) increased from 34.59 [interquartile range (IQR) 9.08-43.91] in 2004 to 40.51 (IQR 22.01-48.87) in 2009, P=0.045. An increased number of computed tomography examinations per patient was also observed over the same interval from an average of 2.11 (median 2, IQR 1-3) in 2004 to an average of 2.62 (2, 2-4) in 2009, P=0.046. The radiation exposure of mechanically ventilated trauma patients in intensive care has increased over time. Radiation exposure should be prospectively monitored and staff should be aware of the increased risk resulting from this change in practice.

  19. Weekly, low-dose docetaxel combined with estramustine for Japanese castration-resistant prostate cancer: its efficacy and safety profile compared with tri-weekly standard-dose treatment.

    Science.gov (United States)

    Nakai, Yasutomo; Nishimura, Kazuo; Nakayama, Masashi; Uemura, Motohide; Takayama, Hitoshi; Nonomura, Norio; Tsujimura, Akira

    2014-02-01

    We retrospectively investigated the efficacy and safety profile of weekly low-dose docetaxel (DTX) with estramustine in comparison with triweekly standard-dose DTX treatment for Japanese patients with castration-resistant prostate cancer (CRPC). Between April 2002 and January 2011, 75 CRPC patients were treated with triweekly DTX (60-75 mg/m(2) every 3 weeks) (standard-dose group), and 76 CRPC patients were treated with weekly low-dose DTX (20-30 mg/m(2) on days 2 and 9 with estramustine 560 mg on days 1-3 and 8-10) every 3 weeks (low-dose group). Prostate-specific antigen (PSA) response and progression-free and overall survival were analyzed in each group. Median serum PSA level of the standard-dose group and low-dose group was 25.0 and 35.5 ng/ml, respectively. In the standard-dose and low-dose groups, 57.8 and 65.2 % of patients, respectively, achieved a PSA decline ≥ 50 %. There was no significant difference in either median time to progression between the standard-dose group (10.0 months) and low-dose group (7.1 months) or in median duration of survival between the standard-dose group (24.2 months) and low-dose group (30.6 months). Multivariate analysis with a Cox proportional hazards regression model showed that DTX treatment protocol did not influence the risk of death. Incidences of grade 3-4 neutropenia, febrile neutropenia, and thrombocytopenia were significantly higher in the standard-dose versus low-dose group (58.7 vs. 7.9 %, 16.0 vs. 3.9 %, and 8.0 vs. 0 %, respectively). For Japanese CRPC patients, weekly low-dose DTX combined with estramustine has similar efficacy to standard-dose DTX but with fewer adverse events.

  20. Cytogenetic biodosimetry and dose-rate effect after radioiodine therapy for thyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    Khvostunov, Igor K. [Russian Ministry of Health Care, A.F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Centre, Obninsk, Kaluga Region (Russian Federation); Nagasaki University, Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki (Japan); Saenko, Vladimir A.; Yamashita, Shunichi [Nagasaki University, Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki (Japan); Krylov, Valeri; Rodichev, Andrei [Russian Ministry of Health Care, A.F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Centre, Obninsk, Kaluga Region (Russian Federation)

    2017-08-15

    This study set out to investigate chromosomal damage in peripheral blood lymphocytes of thyroid cancer patients receiving {sup 131}I for thyroid remnant ablation or treatment of metastatic disease. The observed chromosomal damage was further converted to the estimates of whole-body dose to project the adverse side effects. Chromosomal aberration analysis was performed in 24 patients treated for the first time or after multiple courses. Blood samples were collected before treatment and 3 or 4 days after administration of 2-4 GBq of {sup 131}I. Both conventional cytogenetic and chromosome 2, 4 and 12 painting assays were used. To account for dose-rate effect, a dose-protraction factor was applied to calculate the whole-body dose. The mean dose was 0.62 Gy (95% CI: 0.44-0.77 Gy) in the subgroup of patients treated one time and 0.67 Gy (95% CI: 0.03-1.00 Gy) in re-treated patients. These dose estimates are about 1.7-fold higher than those disregarding the effect of exposure duration. In re-treated patients, the neglected dose-rate effect can result in underestimation of the cumulative whole-body dose by the factor ranging from 2.6 to 6.8. Elevated frequency of chromosomal aberrations observed in re-treated patients before radioiodine therapy allows estimation of a cumulative dose received from all previous treatments. (orig.)

  1. PET/CT-guided Interventions: Personnel Radiation Dose

    Energy Technology Data Exchange (ETDEWEB)

    Ryan, E. Ronan, E-mail: ronan@ronanryan.com; Thornton, Raymond; Sofocleous, Constantinos T.; Erinjeri, Joseph P. [Memorial Sloan-Kettering Cancer Center, Department of Radiology (United States); Hsu, Meier [Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics (United States); Quinn, Brian; Dauer, Lawrence T. [Memorial Sloan-Kettering Cancer Center, Department of Medical Physics (United States); Solomon, Stephen B. [Memorial Sloan-Kettering Cancer Center, Department of Radiology (United States)

    2013-08-01

    PurposeTo quantify radiation exposure to the primary operator and staff during PET/CT-guided interventional procedures.MethodsIn this prospective study, 12 patients underwent PET/CT-guided interventions over a 6 month period. Radiation exposure was measured for the primary operator, the radiology technologist, and the nurse anesthetist by means of optically stimulated luminescence dosimeters. Radiation exposure was correlated with the procedure time and the use of in-room image guidance (CT fluoroscopy or ultrasound).ResultsThe median effective dose was 0.02 (range 0-0.13) mSv for the primary operator, 0.01 (range 0-0.05) mSv for the nurse anesthetist, and 0.02 (range 0-0.05) mSv for the radiology technologist. The median extremity dose equivalent for the operator was 0.05 (range 0-0.62) mSv. Radiation exposure correlated with procedure duration and with the use of in-room image guidance. The median operator effective dose for the procedure was 0.015 mSv when conventional biopsy mode CT was used, compared to 0.06 mSv for in-room image guidance, although this did not achieve statistical significance as a result of the small sample size (p = 0.06).ConclusionThe operator dose from PET/CT-guided procedures is not significantly different than typical doses from fluoroscopically guided procedures. The major determinant of radiation exposure to the operator from PET/CT-guided interventional procedures is time spent in close proximity to the patient.

  2. El Carreto o Cumulá - Aspidosperma Dugandii Standl El Carreto o Cumulá - Aspidosperma Dugandii Standl

    Directory of Open Access Journals (Sweden)

    Dugand Armando

    1944-03-01

    Full Text Available Nombres vulgares: Carreto (Atlántico, Bolívar, Magdalena; Cumulá, Cumulá (Cundinamarca, ToIima. Según el Dr. Emilio Robledo (Lecciones de Bot. ed. 3, 2: 544. 1939 el nombre Carreto también es empleado en Puerto Berrío (Antioquia. El mismo autor (loc. cit. da el nombre Comulá para una especie indeterminada de Viburnum en Mariquita (Tolima y J. M. Duque, refiriendose a la misma planta y localidad (en Bot. Gen. Colomb. 340, 356. 1943 atribuye este nombre vulgar al Aspidosperma ellipticum Rusby.  Sin embargo, las muestras de madera de Cumulá o Comulá que yo he examinado, procedentes de la región de Mariquita -una de las cuales me fue recientemente enviada por el distinguido ictiólogo Sr. Cecil Miles- pertenecen sin duda alguna al A. Dugandii StandI. Por otra parte, Santiago Cortés (FI. Colomb. 206. 1898; ed, 2: 239. 1912 cita el Cumulá "de Anapoima y otros lugares del (rio Magdalena" diciendo que pertenece a las Leguminosas, pero la brevísima descripción que este autor hace de la madera "naranjada y notable por densidad, dureza y resistencia a la humedad", me induce a creer que se trata del mismo Cumula coleccionado recientemente en Tocaima, ya que esta población esta situada a pocos kilómetros de Anapoima. Nombres vulgares: Carreto (Atlántico, Bolívar, Magdalena; Cumulá, Cumulá (Cundinamarca, ToIima. Según el Dr. Emilio Robledo (Lecciones de Bot. ed. 3, 2: 544. 1939 el nombre Carreto también es empleado en Puerto Berrío (Antioquia. El mismo autor (loc. cit. da el nombre Comulá para una especie indeterminada de Viburnum en Mariquita (Tolima y J. M. Duque, refiriendose a la misma planta y localidad (en Bot. Gen. Colomb. 340, 356. 1943 atribuye este nombre vulgar al Aspidosperma ellipticum Rusby.  Sin embargo, las muestras de madera de Cumulá o Comulá que yo he examinado, procedentes de la región de Mariquita -una de las cuales me fue recientemente enviada por el distinguido ictiólogo Sr. Cecil Miles- pertenecen sin

  3. Predicting Cumulative Incidence Probability by Direct Binomial Regression

    DEFF Research Database (Denmark)

    Scheike, Thomas H.; Zhang, Mei-Jie

    Binomial modelling; cumulative incidence probability; cause-specific hazards; subdistribution hazard......Binomial modelling; cumulative incidence probability; cause-specific hazards; subdistribution hazard...

  4. 7 CFR 42.132 - Determining cumulative sum values.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Determining cumulative sum values. 42.132 Section 42... Determining cumulative sum values. (a) The parameters for the on-line cumulative sum sampling plans for AQL's... 3 1 2.5 3 1 2 1 (b) At the beginning of the basic inspection period, the CuSum value is set equal to...

  5. The Algebra of the Cumulative Percent Operation.

    Science.gov (United States)

    Berry, Andrew J.

    2002-01-01

    Discusses how to help students avoid some pervasive reasoning errors in solving cumulative percent problems. Discusses the meaning of ."%+b%." the additive inverse of ."%." and other useful applications. Emphasizes the operational aspect of the cumulative percent concept. (KHR)

  6. Radiation dose effects, hardening of electronic components

    International Nuclear Information System (INIS)

    Dupont-Nivet, E.

    1991-01-01

    This course reviews the mechanism of interaction between ionizing radiation and a silicon oxide type dielectric, in particular the effect of electron-hole pairs creation in the material. Then effects of cumulated dose on electronic components and especially in MOS technology are examined. Finally methods hardening of these components are exposed. 93 refs

  7. Dose escalation with 3D conformal treatment: five year outcomes, treatment optimization, and future directions

    International Nuclear Information System (INIS)

    Hanks, Gerald E.; Hanlon, Alexandra L. M.S.; Schultheiss, Timothy E.; Pinover, Wayne H.; Movsas, Benjamin; Epstein, Barry E.; Hunt, Margie

    1998-01-01

    Purpose: To report the 5-year outcomes of dose escalation with 3D conformal treatment (3DCRT) of prostate cancer. Methods and Materials: Two hundred thirty-two consecutive patients were treated with 3DCRT alone between 6/89 and 10/92 with ICRU reporting point dose that increased from 63 to 79 Gy. The median follow-up was 60 months, and any patient free of clinical or biochemical evidence of disease was termed bNED. Biochemical failure was defined as prostate-specific antigen (PSA) rising on two consecutive recordings and exceeding 1.5 ng/ml. Morbidity was reported by the Radiation Therapy Oncology Group (RTOG) scale, the Late Effects Normal Tissue (LENT) scale, and a Fox Chase modification of the latter (FC-LENT). All patients were treated with a four-field technique with a 1 cm clinical target volume (CTV) to planning target volume (PTV) margin to the prostate or prostate boost; the CTV and gross tumor volume (GTV) were the same. Actuarial rates of outcome were calculated by Kaplan-Meier and cumulative incidence methods and compared using the log rank and Gray's test statistic, respectively. Cox regression models were used to establish prognostic factors predictive of the various measures of outcome. Five-year Kaplan-Meier bNED rates were utilized by dose group to estimate logit response models for bNED and late morbidity. Results: PSA 10 ng/ml based on 5-year bNED results. No dose response was observed for patients with pretreatment PSA 10 ng/ml strongly suggests that clinical trials employing radiation should investigate the use of 3DCRT and prostate doses of 76-80 Gy

  8. Cumulative radiation effect

    International Nuclear Information System (INIS)

    Kirk, J.; Cain, O.; Gray, W.M.

    1977-01-01

    Cumulative Radiation Effect (CRE) represents a scale of accumulative sub-tolerance radiation damage, with a unique value of the CRE describing a specific level of radiation effect. Computer calculations have been used to simplify the evaluation of problems associated with the applications of the CRE-system in radiotherapy. In a general appraisal of the applications of computers to the CRE-system, the various problems encountered in clinical radiotherapy have been categorised into those involving the evaluation of a CRE at a point in tissue and those involving the calculation of CRE distributions. As a general guide, the computer techniques adopted at the Glasgow Institute of Radiotherapeutics for the solution of CRE problems are presented, and consist basically of a package of three interactive programs for point CRE calculations and a Fortran program which calculates CRE distributions for iso-effect treatment planning. Many examples are given to demonstrate the applications of these programs, and special emphasis has been laid on the problem of treating a point in tissue with different doses per fraction on alternate treatment days. The wide range of possible clinical applications of the CRE-system has been outlined and described under the categories of routine clinical applications, retrospective and prospective surveys of patient treatment, and experimental and theoretical research. Some of these applications such as the results of surveys and studies of time optimisation of treatment schedules could have far-reaching consequences and lead to significant improvements in treatment and cure rates with the minimum damage to normal tissue. (author)

  9. Effects of prenatal low dose beta radiation from tritiated water on rat hippocampus neurons. Electrophysiological and neuro behavioural changes

    International Nuclear Information System (INIS)

    Gao Weimin; Zhou Xiangyan

    1997-01-01

    Pregnent Wistar rats were exposed to tritiated water (HTO) on day 13 of gestation so that for their offsprings, the absorbed doses were estimated to be 0.000, 0.044, 0.088 and 0.264 Gy. The influence of HTO to the morphology and number of hippocampus pyramidal neurons and the maximum electric current of Ca 2+ in neurons was observed for the in-vitro-cultured hippocampus of new-born rats and the learning and memory behaviours were assessed by the electric avoidance reflex test in a Y-maze and the condition reflex test for young rats. The results show that prenatal exposure to HTO in a cumulative dose of 0.088 Gy can cause a reduction in number of neurons in hippocampus cultured in vitro, and that the electric current of Ca 2+ tends to decline with cumulative dose increasing, with the significant decrease in offsprings prenatally exposed to HTO in dose of 0.264 Gy. The results of electric avoidance reflex test in a Y-maze and condition reflex test indicate that for young rats prenatally exposed to HTO, a cumulative dose of 0.088 Gy could induce damage in their learning and memory behaviours

  10. Individualized versus standard FSH dosing in women starting IVF/ICSI: An RCT. Part 2: The predicted hyper responder

    OpenAIRE

    Oudshoorn, Simone C.; Van Tilborg, Theodora C.; Eijkemans, Marinus J. C.; Oosterhuis, G. Jur E.; Friederich, Jaap; van Hooff, Marcel H. A.; van Santbrink, Evert J. P.; Brinkhuis, Egbert A.; Smeenk, Jesper M. J.; Kwee, Janet; de Koning, Corry H.; Groen, Henk; Lambalk, Cornelis B.; Mol, Ben Willem J.; Broekmans, Frank J. M.

    2017-01-01

    STUDY QUESTION: Does a reduced FSH dose in women with a predicted hyper response, apparent from a high antral follicle count (AFC), who are scheduled for IVF/ICSI lead to a different outcome with respect to cumulative live birth rate and safety? SUMMARY ANSWER: Although in women with a predicted hyper response (AFC > 15) undergoing IVF/ICSI a reduced FSH dose (100 IU per day) results in similar cumulative live birth rates and a lower occurrence of any grade of ovarian hyperstimulation syndrom...

  11. EXAFS cumulants of CdSe

    International Nuclear Information System (INIS)

    Diop, D.

    1997-04-01

    EXAFS functions had been extracted from measurements on the K edge of Se at different temperatures between 20 and 300 K. The analysis of the EXAFS of the filtered first two shells has been done in the wavevector range laying between 2 and 15.5 A -1 in terms of the cumulants of the effective distribution of distances. The cumulants C 3 and C 4 obtained from the phase difference and the amplitude ratio methods have shown the anharmonicity in the vibrations of atoms around their equilibrium position. (author). 13 refs, 3 figs

  12. Probabilistic assessment of the cumulative dietary acute exposure of the population of Denmark to organophosphorus and carbamate pesticides

    DEFF Research Database (Denmark)

    Jensen, Bodil Hamborg; Petersen, Annette; Christensen, Tue

    2009-01-01

    and methamidophos. RPF values derived from the literature were used in the calculations. We calculated the cumulative acute exposure to 1.8% and 0.8% of the acute reference dose (ARfD) of 100 mu g kg(-1) body weight (bw) day(-1) of chlorpyrifos as an index compound at the 99.9th percentile (P99.5) for children...

  13. Lung cancer incidence after exposure of rats to low doses of radon: influence of dose rate

    Energy Technology Data Exchange (ETDEWEB)

    Morlier, J.P.; Morin, M.; Monchaux, G.; Fritsch, P.; Lafuma, J.; Masse, R. [CEA Centre d`Etudes Nucleaires de Fontenay-aux-Roses, 92 (France). Dept. de Protection Technique; Pineau, J.F. [ALGADE, Bessines (France); Chameaud, J. [Compagnie Generale des Matieres Nucleaires (COGEMA), 87 - Razes (France)

    1994-12-31

    To study the effect on lung cancer incidence of a long exposure to low levels of radon, 500 male 3-months-old Sprague-Dawley rats, were exposed to a cumulative dose of 25 WLM of radon and its daughters, 6 hours a day, 5 days a week, during 18 months. Exposure conditions were controlled in order to maintain a defined PAEC: 42 x 10{sup 6} J.m{sup -3} (2 WL), in the range of domestic and environmental exposures. Animals were kept until they died or given euthanasia when moribund. Mean survival times were similar in both irradiated and control groups: 828 days (SD = 169) and 830 days (SD = 137), as well as lung cancer incidence, 0.60% at 25 WLM and 0.63% for controls. The incidence of lung lesions was compared statistically with controls and those previously obtained at cumulative exposures of 25 and 50 WLM delivered over a 4-6 month period, inducing a significant increase of lung cancer, 2.2% and 3.8% respectively. Such a comparison showed a decreased lung cancer incidence related to a decrease in the dose rate for low levels of radon exposure. (author).

  14. Lung cancer incidence after exposure of rats to low doses of radon: influence of dose rate

    International Nuclear Information System (INIS)

    Morlier, J.P.; Morin, M.; Monchaux, G.; Fritsch, P.; Lafuma, J.; Masse, R.; Chameaud, J.

    1994-01-01

    To study the effect on lung cancer incidence of a long exposure to low levels of radon, 500 male 3-months-old Sprague-Dawley rats, were exposed to a cumulative dose of 25 WLM of radon and its daughters, 6 hours a day, 5 days a week, during 18 months. Exposure conditions were controlled in order to maintain a defined PAEC: 42 x 10 6 J.m -3 (2 WL), in the range of domestic and environmental exposures. Animals were kept until they died or given euthanasia when moribund. Mean survival times were similar in both irradiated and control groups: 828 days (SD = 169) and 830 days (SD = 137), as well as lung cancer incidence, 0.60% at 25 WLM and 0.63% for controls. The incidence of lung lesions was compared statistically with controls and those previously obtained at cumulative exposures of 25 and 50 WLM delivered over a 4-6 month period, inducing a significant increase of lung cancer, 2.2% and 3.8% respectively. Such a comparison showed a decreased lung cancer incidence related to a decrease in the dose rate for low levels of radon exposure. (author)

  15. Estimation of absorbed dose for 2-[F-18]fluoro-2-deoxy-d- glucose using whole-body positron emission tomography and magnetic resonance imaging

    International Nuclear Information System (INIS)

    Deloar, H.M.; Fujiwara, Takehiko; Shidahara, Miho; Nakamura, Takashi; Watabe, Hiroshi; Narita, Yuichiro; Itoh, Masatoshi; Miyake, Masayasu; Watanuki, Shoichi

    1998-01-01

    The purpose of this study was to measure the cumulated activity and absorbed dose in organs after i.v. administration of 18 F-FDG using whole-body PET and MRI. Whole-body dynamic emission scans for 18 F-FDG were performed in six normal volunteers after transmission scans. The total activity of a source organ was obtained from the activity concentration of the organ measured by whole-body PET and the volume of that organ measured by whole-body T1-weighted MRI. The cumulated activity of each source organ was calculated from the time-activity curve. Absorbed doses to the individuals were estimated by the MIRD (medical internal radiation dosimetry) method. Another calculation of cumulated activities and absorbed doses was performed using the organ volumes from the MIRD phantom and the ''Japanese reference man'' to investigate the discrepancy of actual individual results against the phantom results. The cumulated activities of 18 source organs were calculated, and absorbed doses of 27 target organs estimated. Among the target organs, bladder wall, brain and kidney received the highest doses for the above three sets of organ volumes. Using measured individual organ volumes, the average absorbed doses for those organs were found to be 3.1 x 10 -1 , 3.7 x 10 -2 and 2.8 x 10 -2 mGy/MBq, respectively. The mean effective doses in this study for individuals of average body weight (64.5 kg) and the MIRD phantom of 70 kg were the same, i.e. 2.9 x 10 -2 mSv/MBq, while for the Japanese reference man of 60 kg the effective dose was 2.1 x 10 -2 mSv/MBq. The results for measured organ volumes derived from MRI were comparable to those obtained for organ volumes from the MIRD phantom. Although this study considered 18 F-FDG, combined use of whole-body PET and MRI might be quite effective for improving the accuracy of estimations of the cumulated activity and absorbed dose of positron-labelled radiopharmaceuticals.(orig./MG) (orig.)

  16. Cerebrovascular Diseases in Childhood Cancer Survivors: Role of the Radiation Dose to Willis Circle Arteries

    Energy Technology Data Exchange (ETDEWEB)

    El-Fayech, Chiraz; Haddy, Nadia; Allodji, Rodrigue Sètchéou; Veres, Cristina; Diop, Fara; Kahlouche, Amar; Llanas, Damien; Jackson, Angela; Rubino, Carole; Guibout, Catherine [Inserm U1018, Villejuif (France); Gustave Roussy, Villejuif (France); University of Paris XI, Villejuif (France); Pacquement, Hélène [Institut Curie, Paris (France); Oberlin, Odile [Gustave Roussy, Villejuif (France); Thomas-Teinturier, Cécile [Inserm U1018, Villejuif (France); Hôpital Bicêtre, Le Kremlin Bicêtre (France); Scarabin, Pierre-Yves [Inserm U1018, Villejuif (France); Chavaudra, Jean; Lefkopoulos, Dimitry [Gustave Roussy, Villejuif (France); Giroud, Maurice; Bejot, Yannick [Registre Dijonnais des accidents vasculaires cérébraux, Dijon (France); Bernier, Valérie [Centre Alexis Vautrin, Vandoeuvre-lès-Nancy (France); Carrie, Christian [Centre Léon Bérard, Lyon (France); and others

    2017-02-01

    Background and Purpose: The aim of this study was to investigate the role of radiation dose received to the circle of Willis (WC) during radiation therapy (RT) and of potential dose-response modifiers on the risk of stroke after treatment of childhood cancer. Methods: We evaluated the risk factors for stroke in a cohort of 3172 5-year survivors of childhood cancer who were followed up for a median time of 26 years. Radiation doses to the WC and brain structures were estimated for each of the 2202 children who received RT. Results: Fifty-four patients experienced a confirmed stroke; 39 were ischemic. Patients not receiving RT had a stroke risk similar to that of the general population, whereas those who received RT had an 8.5-fold increased risk (95% confidence interval [CI]: 6.3-11.0). The excess of incidence of stroke increased yearly. The dose of radiation to the WC, rather than to other brain structures, was found to be the best predictor of stroke. The relative risk was 15.7 (95% CI: 4.9-50.2) for doses of 40 Gy or more. At 45 years of age, the cumulative stroke incidence was 11.3% (95% CI: 7.1%-17.7%) in patients who received 10 Gy or more to the WC, compared with 1% expected from general population data. Radiation doses received to the heart and neck also increased the risk. Surgery for childhood brain cancer was linked to hemorrhagic strokes in these patients. Conclusion: The WC should be considered as a major organ at risk during RT for childhood brain cancers. The incidence of radiation-induced ischemic stroke strongly increases with long-term follow-up.

  17. Cerebrovascular Diseases in Childhood Cancer Survivors: Role of the Radiation Dose to Willis Circle Arteries

    International Nuclear Information System (INIS)

    El-Fayech, Chiraz; Haddy, Nadia; Allodji, Rodrigue Sètchéou; Veres, Cristina; Diop, Fara; Kahlouche, Amar; Llanas, Damien; Jackson, Angela; Rubino, Carole; Guibout, Catherine; Pacquement, Hélène; Oberlin, Odile; Thomas-Teinturier, Cécile; Scarabin, Pierre-Yves; Chavaudra, Jean; Lefkopoulos, Dimitry; Giroud, Maurice; Bejot, Yannick; Bernier, Valérie; Carrie, Christian

    2017-01-01

    Background and Purpose: The aim of this study was to investigate the role of radiation dose received to the circle of Willis (WC) during radiation therapy (RT) and of potential dose-response modifiers on the risk of stroke after treatment of childhood cancer. Methods: We evaluated the risk factors for stroke in a cohort of 3172 5-year survivors of childhood cancer who were followed up for a median time of 26 years. Radiation doses to the WC and brain structures were estimated for each of the 2202 children who received RT. Results: Fifty-four patients experienced a confirmed stroke; 39 were ischemic. Patients not receiving RT had a stroke risk similar to that of the general population, whereas those who received RT had an 8.5-fold increased risk (95% confidence interval [CI]: 6.3-11.0). The excess of incidence of stroke increased yearly. The dose of radiation to the WC, rather than to other brain structures, was found to be the best predictor of stroke. The relative risk was 15.7 (95% CI: 4.9-50.2) for doses of 40 Gy or more. At 45 years of age, the cumulative stroke incidence was 11.3% (95% CI: 7.1%-17.7%) in patients who received 10 Gy or more to the WC, compared with 1% expected from general population data. Radiation doses received to the heart and neck also increased the risk. Surgery for childhood brain cancer was linked to hemorrhagic strokes in these patients. Conclusion: The WC should be considered as a major organ at risk during RT for childhood brain cancers. The incidence of radiation-induced ischemic stroke strongly increases with long-term follow-up.

  18. Radiation dose assessment for 137Cs from fish in the Aegean Sea before and after the Chernobyl accident

    International Nuclear Information System (INIS)

    Danali-Cotsaki, S.; Liritzis, Y.

    1988-01-01

    The effective doses in fish from the Aegean Sea were calculated for the nuclide 137 Cs covering the period 1975-1982. The effective dose varies between 3x10 -5 and 10x10 -5 mSv y -1 for adults and 14x10 -5 to 56x10 -5 y -1 for children, while the cumulative effective dose for the period 1975-1982 equals to 40.86x10 -5 and 229.57x10 -5 for adults and children of 10 y old, resp. When compared to doses derived from the Chernobyl accident (May 1986) it was found that the additional dose incurred by Greek individuals in May 1986 was approximately equal to the cumulative dose of 8 y contribution period (1975-1982) for adults and to a year's contribution for children of 10 y old. (author) 9 refs.; 3 figs

  19. Patient radiation dose audits for fluoroscopically guided interventional procedures

    International Nuclear Information System (INIS)

    Balter, Stephen; Rosenstein, Marvin; Miller, Donald L.; Schueler, Beth; Spelic, David

    2011-01-01

    Purpose: Quality management for any use of medical x-ray imaging should include monitoring of radiation dose. Fluoroscopically guided interventional (FGI) procedures are inherently clinically variable and have the potential for inducing deterministic injuries in patients. The use of a conventional diagnostic reference level is not appropriate for FGI procedures. A similar but more detailed quality process for management of radiation dose in FGI procedures is described. Methods: A method that takes into account both the inherent variability of FGI procedures and the risk of deterministic injuries from these procedures is suggested. The substantial radiation dose level (SRDL) is an absolute action level (with regard to patient follow-up) below which skin injury is highly unlikely and above which skin injury is possible. The quality process for FGI procedures collects data from all instances of a given procedure from a number of facilities into an advisory data set (ADS). An individual facility collects a facility data set (FDS) comprised of all instances of the same procedure at that facility. The individual FDS is then compared to the multifacility ADS with regard to the overall shape of the dose distributions and the percent of instances in both the ADS and the FDS that exceed the SRDL. Results: Samples of an ADS and FDS for percutaneous coronary intervention, using the dose metric of reference air kerma (K a,r ) (i.e., the cumulative air kerma at the reference point), are used to illustrate the proposed quality process for FGI procedures. Investigation is warranted whenever the FDS is noticeably different from the ADS for the specific FGI procedure and particularly in two circumstances: (1) When the facility's local median K a,r exceeds the 75th percentile of the ADS and (2) when the percent of instances where K a,r exceeds the facility-selected SRDL is greater for the FDS than for the ADS. Conclusions: Analysis of the two data sets (ADS and FDS) and of the

  20. MEDIAN: Wireless broadband LAN for multimedia applications

    NARCIS (Netherlands)

    Vliet, P.J. van

    1998-01-01

    MEDIAN is one of the projects in the mobile domain of the Advanced Communications Technologies and Services (ACTS) programme of the European Commission. The main obiective of the MEDIAN project is to evaluate and implement a high speed Wireless Customer Premises / Local Area Network (WCPN/WLAN)

  1. Patient dose map indications on interventional X-ray systems and validation with Gafchromic XR-RV3 film

    International Nuclear Information System (INIS)

    Bordier, C.; Klausz, R.; Desponds, L.

    2015-01-01

    To help avoiding secondary effects of interventional procedures like skin damage, a dose map method has been developed to provide an indication of the local dose on a surface representative of individual patient shapes. To minimise user interactions, patient envelope shapes are automatically determined depending on simple patient data information. Local doses are calculated in 1-cm 2 areas depending on the estimated air kerma, table and gantry positions and system settings, taking into account the table and mattress attenuations and estimated backscatter from the patient. These local doses are cumulated for each location of the patient envelope during the clinical procedure. To assess the accuracy of the method, Gafchromic XR-RV3 films have been used in several operating configurations. Good visual agreements on cumulated dose localisation were obtained within the 1-cm 2 precision of the map and the dose values agreed within 24.9 % accuracy. The resulting dose map method has been integrated into GE Healthcare X-Ray angiographic systems and should help in the management of the dose by the users during the procedure. (authors)

  2. On Preliminary Test Estimator for Median

    OpenAIRE

    Okazaki, Takeo; 岡崎, 威生

    1990-01-01

    The purpose of the present paper is to discuss about estimation of median with a preliminary test. Two procedures are presented, one uses Median test and the other uses Wilcoxon two-sample test for the preliminary test. Sections 3 and 4 give mathematical formulations of such properties, including mean square errors with one specified case. Section 5 discusses their optimal significance levels of the preliminary test and proposes their numerical values by Monte Carlo method. In addition to mea...

  3. PET/CT-guided Interventions: Personnel Radiation Dose

    International Nuclear Information System (INIS)

    Ryan, E. Ronan; Thornton, Raymond; Sofocleous, Constantinos T.; Erinjeri, Joseph P.; Hsu, Meier; Quinn, Brian; Dauer, Lawrence T.; Solomon, Stephen B.

    2013-01-01

    PurposeTo quantify radiation exposure to the primary operator and staff during PET/CT-guided interventional procedures.MethodsIn this prospective study, 12 patients underwent PET/CT-guided interventions over a 6 month period. Radiation exposure was measured for the primary operator, the radiology technologist, and the nurse anesthetist by means of optically stimulated luminescence dosimeters. Radiation exposure was correlated with the procedure time and the use of in-room image guidance (CT fluoroscopy or ultrasound).ResultsThe median effective dose was 0.02 (range 0–0.13) mSv for the primary operator, 0.01 (range 0–0.05) mSv for the nurse anesthetist, and 0.02 (range 0–0.05) mSv for the radiology technologist. The median extremity dose equivalent for the operator was 0.05 (range 0–0.62) mSv. Radiation exposure correlated with procedure duration and with the use of in-room image guidance. The median operator effective dose for the procedure was 0.015 mSv when conventional biopsy mode CT was used, compared to 0.06 mSv for in-room image guidance, although this did not achieve statistical significance as a result of the small sample size (p = 0.06).ConclusionThe operator dose from PET/CT-guided procedures is not significantly different than typical doses from fluoroscopically guided procedures. The major determinant of radiation exposure to the operator from PET/CT-guided interventional procedures is time spent in close proximity to the patient

  4. The association of rectal equivalent dose in 2 Gy fractions (EQD2) to late rectal toxicity in locally advanced cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University

    Energy Technology Data Exchange (ETDEWEB)

    Tharavichtikul, Ekkasit; Chitapanarux, Taned; Chakrabandhu, Somvilai; Klunklin, Pitchayaponne; Onchan, Wimrak; Wanwilairat, Somsak; Chitapanarux, Imjai [Faculty of Medicine, Chiang Mai University, Chiang Mai (Thailand); Meungwong, Pooriwat [Lampang Cancer Hospital, Lampang (Thailand); Traisathit, Patrinee [Faculty of Science, Chiang Mai University, Chiang Mai (Thailand); Galalae, Razvan [aculty of Medicine, Christian-Albrechts University at Kiel, Kiei (Germany)

    2014-06-15

    To evaluate association between equivalent dose in 2 Gy (EQD2) to rectal point dose and gastrointestinal toxicity from whole pelvic radiotherapy (WPRT) and intracavitary brachytherapy (ICBT) in cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University. Retrospective study was designed for the patients with locally advanced cervical cancer, treated by radical radiotherapy from 2004 to 2009 and were evaluated by rectosigmoidoscopy. The cumulative doses of WPRT and ICBT to the maximally rectal point were calculated to the EQD2 and evaluated the association of toxicities. Thirty-nine patients were evaluated for late rectal toxicity. The mean cumulative dose in term of EQD2 to rectum was 64.2 Gy. Grade 1 toxicities were the most common findings. According to endoscopic exam, the most common toxicities were congested mucosa (36 patients) and telangiectasia (32 patients). In evaluation between rectal dose in EQD2 and toxicities, no association of cumulative rectal dose to rectal toxicity, except the association of cumulative rectal dose in EQD2 >65 Gy to late effects of normal tissue (LENT-SOMA) scale > or = grade 2 (p = 0.022; odds ratio, 5.312; 95% confidence interval, 1.269-22.244). The cumulative rectal dose in EQD2 >65 Gy have association with > or = grade 2 LENT-SOMA scale.

  5. The association of rectal equivalent dose in 2 Gy fractions (EQD2) to late rectal toxicity in locally advanced cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University.

    Science.gov (United States)

    Tharavichtikul, Ekkasit; Meungwong, Pooriwat; Chitapanarux, Taned; Chakrabandhu, Somvilai; Klunklin, Pitchayaponne; Onchan, Wimrak; Wanwilairat, Somsak; Traisathit, Patrinee; Galalae, Razvan; Chitapanarux, Imjai

    2014-06-01

    To evaluate association between equivalent dose in 2 Gy (EQD2) to rectal point dose and gastrointestinal toxicity from whole pelvic radiotherapy (WPRT) and intracavitary brachytherapy (ICBT) in cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University. Retrospective study was designed for the patients with locally advanced cervical cancer, treated by radical radiotherapy from 2004 to 2009 and were evaluated by rectosigmoidoscopy. The cumulative doses of WPRT and ICBT to the maximally rectal point were calculated to the EQD2 and evaluated the association of toxicities. Thirty-nine patients were evaluated for late rectal toxicity. The mean cumulative dose in term of EQD2 to rectum was 64.2 Gy. Grade 1 toxicities were the most common findings. According to endoscopic exam, the most common toxicities were congested mucosa (36 patients) and telangiectasia (32 patients). In evaluation between rectal dose in EQD2 and toxicities, no association of cumulative rectal dose to rectal toxicity, except the association of cumulative rectal dose in EQD2 >65 Gy to late effects of normal tissue (LENT-SOMA) scale ≥ grade 2 (p = 0.022; odds ratio, 5.312; 95% confidence interval, 1.269-22.244). The cumulative rectal dose in EQD2 >65 Gy have association with ≥ grade 2 LENT-SOMA scale.

  6. Dose and dose rate effects of whole-body gamma-irradiation: II. Hematological variables and cytokines

    Science.gov (United States)

    Gridley, D. S.; Pecaut, M. J.; Miller, G. M.; Moyers, M. F.; Nelson, G. A.

    2001-01-01

    The goal of part II of this study was to evaluate the effects of gamma-radiation on circulating blood cells, functional characteristics of splenocytes, and cytokine expression after whole-body irradiation at varying total doses and at low- and high-dose-rates (LDR, HDR). Young adult C57BL/6 mice (n = 75) were irradiated with either 1 cGy/min or 80 cGy/min photons from a 60Co source to cumulative doses of 0.5, 1.5, and 3.0 Gy. The animals were euthanized at 4 days post-exposure for in vitro assays. Significant dose- (but not dose-rate-) dependent decreases were observed in erythrocyte and blood leukocyte counts, hemoglobin, hematocrit, lipopolysaccharide (LPS)-induced 3H-thymidine incorporation, and interleukin-2 (IL-2) secretion by activated spleen cells when compared to sham-irradiated controls (p factor-beta 1 (TGF-beta 1) and splenocyte secretion of tumor necrosis factor-alpha (TNF-alpha) were not affected by either the dose or dose rate of radiation. The data demonstrate that the responses of blood and spleen were largely dependent upon the total dose of radiation employed and that an 80-fold difference in the dose rate was not a significant factor in the great majority of measurements.

  7. About the cumulants of periodic signals

    Science.gov (United States)

    Barrau, Axel; El Badaoui, Mohammed

    2018-01-01

    This note studies cumulants of time series. These functions originating from the probability theory being commonly used as features of deterministic signals, their classical properties are examined in this modified framework. We show additivity of cumulants, ensured in the case of independent random variables, requires here a different hypothesis. Practical applications are proposed, in particular an analysis of the failure of the JADE algorithm to separate some specific periodic signals.

  8. Correlation of cumulative corticosteroid treatment with magnetic resonance imaging assessment of avascular femoral head necrosis in patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Nilufer Kale

    2010-10-01

    Full Text Available Increased risk of osteoporosis, fractures, and avascular necrosis (AVN has been suggested in multiple sclerosis (MS. Patients with MS are often exposed to corticosteroid treatment (CST during the disease course and conflicting reports exist regarding complications of CST. Our study aims to investigate the association between cumulative doses of CST and radiographic evaluation of AVN of the femoral head in MS. Twenty-six MS patients (mean age, 38.4±10 yr were enrolled and prospectively evaluated for AVN by magnetic resonance imaging (MRI. The mean disease duration was 11.5±8.5 years and mean expanded disability status scale (EDSS score was 3±2. The cumulative dosage of CST varied between 20 g and 60 g; patients were grouped into two categories: 1 CST between 20-40 g, 17 (65% patients; 2 CST ≥40 g; 9 (35% patients. The relationship between cumulative CST dosage and MRI diagnosis of AVN was stat­istically insignificant (P>0.9. Clarification of the cumulative effect of CST in the development of AVN is of great importance for future long-term steroid treatment strategies.

  9. Measurement of multi-slice computed tomography dose profile with the Dose Magnifying Glass and the MOSkin radiation dosimeter

    International Nuclear Information System (INIS)

    Lian, C.P.L.; Wong, J.H.D.; Young, A.; Cutajar, D.; Petasecca, M.; Lerch, M.L.F.; Rosenfeld, A.B.

    2013-01-01

    This study describes the application of two in-house developed dosimeters, the Dose Magnifying Glass (DMG) and the MOSkin dosimeter at the Centre for Medical Radiation Physics, University of Wollongong, Australia, for the measurement of CT dose profiles for a clinical diagnostic 16-slice MSCT scanner. Two scanner modes were used; axial mode and helical mode, and the effect of varying beam collimation and pitch was studied. With an increase in beam collimation in axial mode and an increase of CT pitch in helical mode, cumulative point dose at scanner isocentre decreased while FWHM increased. There was generally good agreement to within 3% between the acquired dose profiles obtained by the DMG and the film except at dose profile tails, where film over-responded by up to 30% due to its intrinsic depth dose dependence at low doses. -- Highlights: ► This study shows the CT beam profiles acquired with our institution's detectors. ► The DMG is a relative dosimeter calibrated to absolute MOSkin readings. ► There was good agreement between dose profiles acquired by the DMG and the film

  10. Dosimetric Evaluation of High-Dose-Rate Interstitial Brachytherapy Boost Treatments for Localized Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Froehlich, Georgina [Semmelweis Univ., Budapest (Hungary); Dept. of Radiotherapy, National Inst. of Oncology, Budapest (Hungary); Agoston, Peter; Loevey, Jozsef; Somogyi, Andras; Fodor, Janos; Polgar, Csaba; Major, Tibor [Dept. of Radiotherapy, National Inst. of Oncology, Budapest (Hungary)

    2010-07-15

    Purpose: to quantitatively evaluate the dose distributions of high-dose-rate (HDR) prostate implants regarding target coverage, dose homogeneity, and dose to organs at risk. Material and methods: treatment plans of 174 implants were evaluated using cumulative dose-volume histograms (DVHs). The planning was based on transrectal ultrasound (US) imaging, and the prescribed dose (100%) was 10 Gy. The tolerance doses to rectum and urethra were 80% and 120%, respectively. Dose-volume parameters for target (V90, V100, V150, V200, D90, D{sub min}) and quality indices (DNR [dose nonuniformity ratio], DHI [dose homogeneity index], CI [coverage index], COIN [conformal index]) were calculated. Maximum dose in reference points of rectum (D{sub r}) and urethra (D{sub u}), dose to volume of 2 cm{sup 3} of the rectum (D{sub 2ccm}), and 0.1 cm{sup 3} and 1% of the urethra (D{sub 0.1ccm} and D1) were determined. Nonparametric correlation analysis was performed between these parameters. Results: the median number of needles was 16, the mean prostate volume (V{sub p}) was 27.1 cm{sup 3}. The mean V90, V100, V150, and V200 were 90%, 97%, 39% and 13%, respectively. The mean D90 was 109%, and the D{sub min} was 87%. The mean doses in rectum and urethra reference points were 75% and 119%, respectively. The mean volumetric doses were D{sub 2ccm} = 49% for the rectum, D{sub 0.1ccm} = 126%, and D1 = 140% for the urethra. The mean DNR was 0.37, while the DHI was 0.60. The mean COIN was 0.66. The Spearman rank order correlation coefficients for volume doses to rectum and urethra were R(D{sub r}, D{sub 2ccm}) = 0.69, R(D{sub u}, D{sub 0.1ccm}) = 0.64, R(D{sub u}, D1) = 0.23. Conclusion: US-based treatment plans for HDR prostate implants based on the real positions of catheters provided acceptable dose distributions. In the majority of the cases, the doses to urethra and rectum were kept below the defined tolerance levels. For rectum, the dose in reference points correlated well with dose

  11. Evaluation of various approaches for assessing dose indicators and patient organ doses resulting from radiotherapy cone-beam CT

    International Nuclear Information System (INIS)

    Rampado, Osvaldo; Giglioli, Francesca Romana; Rossetti, Veronica; Ropolo, Roberto; Fiandra, Christian; Ragona, Riccardo

    2016-01-01

    Purpose: The aim of this study was to evaluate various approaches for assessing patient organ doses resulting from radiotherapy cone-beam CT (CBCT), by the use of thermoluminescent dosimeter (TLD) measurements in anthropomorphic phantoms, a Monte Carlo based dose calculation software, and different dose indicators as presently defined. Methods: Dose evaluations were performed on a CBCT Elekta XVI (Elekta, Crawley, UK) for different protocols and anatomical regions. The first part of the study focuses on using PCXMC software (PCXMC 2.0, STUK, Helsinki, Finland) for calculating organ doses, adapting the input parameters to simulate the exposure geometry, and beam dose distribution in an appropriate way. The calculated doses were compared to readouts of TLDs placed in an anthropomorphic Rando phantom. After this validation, the software was used for analyzing organ dose variability associated with patients’ differences in size and gender. At the same time, various dose indicators were evaluated: kerma area product (KAP), cumulative air-kerma at the isocenter (K_a_i_r), cone-beam dose index, and central cumulative dose. The latter was evaluated in a single phantom and in a stack of three adjacent computed tomography dose index phantoms. Based on the different dose indicators, a set of coefficients was calculated to estimate organ doses for a range of patient morphologies, using their equivalent diameters. Results: Maximum organ doses were about 1 mGy for head and neck and 25 mGy for chest and pelvis protocols. The differences between PCXMC and TLDs doses were generally below 10% for organs within the field of view and approximately 15% for organs at the boundaries of the radiation beam. When considering patient size and gender variability, differences in organ doses up to 40% were observed especially in the pelvic region; for the organs in the thorax, the maximum differences ranged between 20% and 30%. Phantom dose indexes provided better correlation with organ doses

  12. Sub-milliSievert (sub-mSv) CT colonography: a prospective comparison of image quality and polyp conspicuity at reduced-dose versus standard-dose imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lubner, Meghan G.; Pooler, B.D.; Kitchin, Douglas R.; Kim, David H.; Munoz del Rio, Alejandro; Pickhardt, Perry J. [University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, Departments of Radiology, Madison, WI (United States); Tang, Jie [University of Wisconsin School of Medicine and Public Health, Medical Physics, Madison, WI (United States); Li, Ke; Chen, Guang-Hong [University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, Departments of Radiology, Madison, WI (United States); University of Wisconsin School of Medicine and Public Health, Medical Physics, Madison, WI (United States)

    2015-07-15

    To prospectively compare reduced-dose (RD) CT colonography (CTC) with standard-dose (SD) imaging using several reconstruction algorithms. Following SD supine CTC, 40 patients (mean age, 57.3 years; 17 M/23 F; mean BMI, 27.2) underwent an additional RD supine examination (targeted dose reduction, 70-90 %). DLP, CTDI{sub vol}, effective dose, and SSDE were compared. Several reconstruction algorithms were applied to RD series. SD-FBP served as reference standard. Objective image noise, subjective image quality and polyp conspicuity were assessed. Mean CTDI{sub vol} and effective dose for RD series was 0.89 mGy (median 0.65) and 0.6 mSv (median 0.44), compared with 3.8 mGy (median 3.1) and 2.8 mSv (median 2.3) for SD series, respectively. Mean dose reduction was 78 %. Mean image noise was significantly reduced on RD-PICCS (24.3 ± 19HU) and RD-MBIR (19 ± 18HU) compared with RD-FBP (90 ± 33), RD-ASIR (72 ± 27) and SD-FBP (47 ± 14 HU). 2D image quality score was higher with RD-PICCS, RD-MBIR, and SD-FBP (2.7 ± 0.4/2.8 ± 0.4/2.9 ± 0.6) compared with RD-FBP (1.5 ± 0.4) and RD-ASIR (1.8 ± 0.44). A similar trend was seen with 3D image quality scores. Polyp conspicuity scores were similar between SD-FBP/RD-PICCS/RD-MBIR (3.5 ± 0.6/3.2 ± 0.8/3.3 ± 0.6). Sub-milliSievert CTC performed with iterative reconstruction techniques demonstrate decreased image quality compared to SD, but improved image quality compared to RD images reconstructed with FBP. (orig.)

  13. Radiation doses and cause-specific mortality among workers at a nuclear materials fabrication plant

    International Nuclear Information System (INIS)

    Checkoway, H.; Pearce, N.; Crawford-Brown, D.J.; Cragle, D.L.

    1988-01-01

    A historical cohort mortality study was conducted among 6781 white male employees from a nuclear weapons materials fabrication plant for the years 1947-1979. Exposures of greatest concern are alpha and gamma radiation emanating primarily from insoluble uranium compounds. Among monitored workers, the mean cumulative alpha radiation dose to the lung was 8.21 rem, and the mean cumulative external whole body penetrating dose from gamma radiation was 0.96 rem. Relative to US white males, the cohort experienced mortality deficits from all causes combined, cardiovascular diseases, and from most site-specific cancers. Mortality excesses of lung and brain and central nervous system cancers were seen from comparisons with national and state rates. Dose-response trends were detected for lung cancer mortality with respect to cumulative alpha and gamma radiation, with the most pronounced trend occurring for gamma radiation among workers who received greater than or equal to 5 rem of alpha radiation. These trends diminished in magnitude when a 10-year latency assumption was applied. Under a zero-year latency assumption, the rate ratio for lung cancer mortality associated with joint exposure of greater than or equal to 5 versus less than 1 rem of both types of radiation is 4.60 (95% confidence limits (CL) 0.91, 23.35), while the corresponding result, assuming a 10-year latency, is 3.05 (95% CL 0.37, 24.83). While these rate ratios, which are based on three and one death, respectively, lack statistical precision, the observed dose-response trends indicate potential carcinogenic effects to the lung of relatively low-dose radiation. There are no dose-response trends for mortality from brain and central nervous system cancers

  14. Cumulative Student Loan Debt in Minnesota, 2015

    Science.gov (United States)

    Williams-Wyche, Shaun

    2016-01-01

    To better understand student debt in Minnesota, the Minnesota Office of Higher Education (the Office) gathers information on cumulative student loan debt from Minnesota degree-granting institutions. These data detail the number of students with loans by institution, the cumulative student loan debt incurred at that institution, and the percentage…

  15. Average annual doses, lifetime doses and associated risk of cancer death for radiation workers in various fuel fabrication facilities in India

    International Nuclear Information System (INIS)

    Iyer, P.S.; Dhond, R.V.

    1980-01-01

    Lifetime doses based on average annual doses are estimated for radiation workers in various fuel fabrication facilities in India. For such cumulative doses, the risk of radiation-induced cancer death is computed. The methodology for arriving at these estimates and the assumptions made are discussed. Based on personnel monitoring records from 1966 to 1978, the average annual dose equivalent for radiation workers is estimated as 0.9 mSv (90 mrem), and the maximum risk of cancer death associated with this occupational dose as 1.35x10 -5 a -1 , as compared with the risk of death due to natural causes of 7x10 -4 a -1 and the risk of death due to background radiation alone of 1.5x10 -5 a -1 . (author)

  16. Safety analysis of holmium-166 microsphere scout dose imaging during radioembolisation work-up. A cohort study

    Energy Technology Data Exchange (ETDEWEB)

    Braat, Arthur J.A.T.; Prince, Jip F.; Rooij, Rob van; Bruijnen, Rutger C.G.; Bosch, Maurice A.A.J. van den; Lam, Marnix G.E.H. [University Medical Center Utrecht, Department of Radiology and Nuclear Medicine, Utrecht (Netherlands)

    2018-03-15

    Radioembolisation is generally preceded by a scout dose of technetium-99m-macroaggregated albumin to estimate extrahepatic shunting of activity. Holmium-166 microspheres can be used as a scout dose (±250 MBq) and as a therapeutic dose. The general toxicity of a holmium-166 scout dose ({sup 166}Ho-SD) and safety concerns of an accidental extrahepatic deposition of {sup 166}Ho-SD were investigated. All patients who received a {sup 166}Ho-SD in our institute were reviewed for general toxicity and extrahepatic depositions. The absorbed dose in extrahepatic tissue was calculated on SPECT/CT and correlated to clinical toxicities. In total, 82 patients were included. No relevant clinical toxicity occurred. Six patients had an extrahepatic deposition of {sup 166}Ho-SD (median administered activity 270 MBq). The extrahepatic depositions (median activity 3.7 MBq) were located in the duodenum (3x), gastric fundus, falciform ligament and the lesser curvature of the stomach, and were deposited in a median volume of 15.3 ml, which resulted in an estimated median absorbed dose of 3.6 Gy (range 0.3-13.8 Gy). No adverse events related to the extrahepatic deposition of the {sup 166}Ho-SD occurred after a median follow-up of 4 months (range 1-12 months). These results support the safety of 250 MBq {sup 166}Ho-SD in a clinical setting. (orig.)

  17. Synchronized dynamic dose reconstruction

    International Nuclear Information System (INIS)

    Litzenberg, Dale W.; Hadley, Scott W.; Tyagi, Neelam; Balter, James M.; Ten Haken, Randall K.; Chetty, Indrin J.

    2007-01-01

    Variations in target volume position between and during treatment fractions can lead to measurable differences in the dose distribution delivered to each patient. Current methods to estimate the ongoing cumulative delivered dose distribution make idealized assumptions about individual patient motion based on average motions observed in a population of patients. In the delivery of intensity modulated radiation therapy (IMRT) with a multi-leaf collimator (MLC), errors are introduced in both the implementation and delivery processes. In addition, target motion and MLC motion can lead to dosimetric errors from interplay effects. All of these effects may be of clinical importance. Here we present a method to compute delivered dose distributions for each treatment beam and fraction, which explicitly incorporates synchronized real-time patient motion data and real-time fluence and machine configuration data. This synchronized dynamic dose reconstruction method properly accounts for the two primary classes of errors that arise from delivering IMRT with an MLC: (a) Interplay errors between target volume motion and MLC motion, and (b) Implementation errors, such as dropped segments, dose over/under shoot, faulty leaf motors, tongue-and-groove effect, rounded leaf ends, and communications delays. These reconstructed dose fractions can then be combined to produce high-quality determinations of the dose distribution actually received to date, from which individualized adaptive treatment strategies can be determined

  18. Correlation of patient maximum skin doses in cardiac procedures with various dose indicators

    International Nuclear Information System (INIS)

    Domienik, J.; Papierz, S.; Jankowski, J.; Peruga, J.Z.; Werduch, A.; Religa, W.

    2008-01-01

    In most countries of European Union, legislation requires the determination of the total skin dose received by patients during interventional procedures in order to prevent deterministic damages. Various dose indicators like dose-area product (DAP), cumulative dose (CD) and entrance dose at the patient plane (EFD) are used for patient dosimetry purposes in clinical practice. This study aimed at relating those dose indicators with doses ascribed to the most irradiated areas of the patient skin usually expressed in terms of local maximal skin dose (MSD). The study was performed in two different facilities for two most common cardiac procedures coronary angiography (CA) and percutaneous coronary interventions (PCI). For CA procedures, the registered values of fluoroscopy time, total DAP and MSD were in the range (0.7-27.3) min, (16-317) Gy cm 2 and (43-1507) mGy, respectively, and for interventions, accordingly (2.1-43.6) min, (17-425) Gy cm 2 , (71-1555) mGy. Moreover, for CA procedures, CD and EFD were in the ranges (295-4689) mGy and (121-1768) mGy and for PCI (267-6524) mGy and (68-2279) mGy, respectively. No general and satisfactory correlation was found for safe estimation of MSD. However, results show that the best dose indicator which might serve for rough, preliminary estimation is DAP value. In the study, the appropriate trigger levels were proposed for both facilities. (authors)

  19. High cumulants of conserved charges and their statistical uncertainties

    Science.gov (United States)

    Li-Zhu, Chen; Ye-Yin, Zhao; Xue, Pan; Zhi-Ming, Li; Yuan-Fang, Wu

    2017-10-01

    We study the influence of measured high cumulants of conserved charges on their associated statistical uncertainties in relativistic heavy-ion collisions. With a given number of events, the measured cumulants randomly fluctuate with an approximately normal distribution, while the estimated statistical uncertainties are found to be correlated with corresponding values of the obtained cumulants. Generally, with a given number of events, the larger the cumulants we measure, the larger the statistical uncertainties that are estimated. The error-weighted averaged cumulants are dependent on statistics. Despite this effect, however, it is found that the three sigma rule of thumb is still applicable when the statistics are above one million. Supported by NSFC (11405088, 11521064, 11647093), Major State Basic Research Development Program of China (2014CB845402) and Ministry of Science and Technology (MoST) (2016YFE0104800)

  20. Dual pathology proximal median nerve compression of the forearm.

    LENUS (Irish Health Repository)

    Murphy, Siun M

    2013-12-01

    We report an unusual case of synchronous pathology in the forearm- the coexistence of a large lipoma of the median nerve together with an osteochondroma of the proximal ulna, giving rise to a dual proximal median nerve compression. Proximal median nerve compression neuropathies in the forearm are uncommon compared to the prevalence of distal compression neuropathies (eg Carpal Tunnel Syndrome). Both neural fibrolipomas (Refs. 1,2) and osteochondromas of the proximal ulna (Ref. 3) in isolation are rare but well documented. Unlike that of a distal compression, a proximal compression of the median nerve will often have a definite cause. Neural fibrolipoma, also called fibrolipomatous hamartoma are rare, slow-growing, benign tumours of peripheral nerves, most often occurring in the median nerve of younger patients. To our knowledge, this is the first report of such dual pathology in the same forearm, giving rise to a severe proximal compression of the median nerve. In this case, the nerve was being pushed anteriorly by the osteochondroma, and was being compressed from within by the intraneural lipoma. This unusual case highlights the advantage of preoperative imaging as part of the workup of proximal median nerve compression.

  1. Efficient Scalable Median Filtering Using Histogram-Based Operations.

    Science.gov (United States)

    Green, Oded

    2018-05-01

    Median filtering is a smoothing technique for noise removal in images. While there are various implementations of median filtering for a single-core CPU, there are few implementations for accelerators and multi-core systems. Many parallel implementations of median filtering use a sorting algorithm for rearranging the values within a filtering window and taking the median of the sorted value. While using sorting algorithms allows for simple parallel implementations, the cost of the sorting becomes prohibitive as the filtering windows grow. This makes such algorithms, sequential and parallel alike, inefficient. In this work, we introduce the first software parallel median filtering that is non-sorting-based. The new algorithm uses efficient histogram-based operations. These reduce the computational requirements of the new algorithm while also accessing the image fewer times. We show an implementation of our algorithm for both the CPU and NVIDIA's CUDA supported graphics processing unit (GPU). The new algorithm is compared with several other leading CPU and GPU implementations. The CPU implementation has near perfect linear scaling with a speedup on a quad-core system. The GPU implementation is several orders of magnitude faster than the other GPU implementations for mid-size median filters. For small kernels, and , comparison-based approaches are preferable as fewer operations are required. Lastly, the new algorithm is open-source and can be found in the OpenCV library.

  2. Cumulative stress and autonomic dysregulation in a community sample.

    Science.gov (United States)

    Lampert, Rachel; Tuit, Keri; Hong, Kwang-Ik; Donovan, Theresa; Lee, Forrester; Sinha, Rajita

    2016-05-01

    Whether cumulative stress, including both chronic stress and adverse life events, is associated with decreased heart rate variability (HRV), a non-invasive measure of autonomic status which predicts poor cardiovascular outcomes, is unknown. Healthy community dwelling volunteers (N = 157, mean age 29 years) participated in the Cumulative Stress/Adversity Interview (CAI), a 140-item event interview measuring cumulative adversity including major life events, life trauma, recent life events and chronic stressors, and underwent 24-h ambulatory ECG monitoring. HRV was analyzed in the frequency domain and standard deviation of NN intervals (SDNN) calculated. Initial simple regression analyses revealed that total cumulative stress score, chronic stressors and cumulative adverse life events (CALE) were all inversely associated with ultra low-frequency (ULF), very low-frequency (VLF) and low-frequency (LF) power and SDNN (all p accounting for additional appreciable variance. For VLF and LF, both total cumulative stress and chronic stress significantly contributed to the variance alone but were not longer significant after adjusting for race and health behaviors. In summary, total cumulative stress, and its components of adverse life events and chronic stress were associated with decreased cardiac autonomic function as measured by HRV. Findings suggest one potential mechanism by which stress may exert adverse effects on mortality in healthy individuals. Primary preventive strategies including stress management may prove beneficial.

  3. Cumulative processes and quark distribution in nuclei

    International Nuclear Information System (INIS)

    Kondratyuk, L.; Shmatikov, M.

    1984-01-01

    Assuming existence of multiquark (mainly 12q) bags in nuclei the spectra of cumulative nucleons and mesons produced in high-energy particle-nucleus collisions are discussed. The exponential form of quark momentum distribution in 12q-bag (agreeing well with the experimental data on lepton-nucleus interactions at large q 2 ) is shown to result in quasi-exponential distribution of cumulative particles over the light-cone variable αsub(B). The dependence of f(αsub(B); psub(perpendicular)) (where psub(perpendicular) is the transverse momentum of the bag) upon psub(perpendicular) is considered. The yields of cumulative resonances as well as effects related to the u- and d-quark distributions in N > Z nuclei being different are dicscussed

  4. Summary of recorded external radiation doses for Hanford workers 1944--1989

    International Nuclear Information System (INIS)

    Buschbom, R.L.; Gilbert, E.S.

    1993-10-01

    This report summarizes recorded external radiation doses for the years 1944 through 1989 received by operations workers who were included in the Hanford Mortality Study. This study population includes all operations workers who were initially employed at the Hanford site from 1944 through 1978. Descriptive summaries are provided for both annual and cumulative whole body penetrating doses. Although the main emphasis of the report is on recorded whole body penetrating dose, summary tables are included for the components of whole body penetrating dose, non-penetrating dose, and extremity dose. Summaries are provided for the entire study population and for subgroups of the population defined by sex, age, number of years since first monitoring, and socioeconomic groups

  5. Predicting Cumulative Incidence Probability: Marginal and Cause-Specific Modelling

    DEFF Research Database (Denmark)

    Scheike, Thomas H.; Zhang, Mei-Jie

    2005-01-01

    cumulative incidence probability; cause-specific hazards; subdistribution hazard; binomial modelling......cumulative incidence probability; cause-specific hazards; subdistribution hazard; binomial modelling...

  6. Portfolio optimization using median-variance approach

    Science.gov (United States)

    Wan Mohd, Wan Rosanisah; Mohamad, Daud; Mohamed, Zulkifli

    2013-04-01

    Optimization models have been applied in many decision-making problems particularly in portfolio selection. Since the introduction of Markowitz's theory of portfolio selection, various approaches based on mathematical programming have been introduced such as mean-variance, mean-absolute deviation, mean-variance-skewness and conditional value-at-risk (CVaR) mainly to maximize return and minimize risk. However most of the approaches assume that the distribution of data is normal and this is not generally true. As an alternative, in this paper, we employ the median-variance approach to improve the portfolio optimization. This approach has successfully catered both types of normal and non-normal distribution of data. With this actual representation, we analyze and compare the rate of return and risk between the mean-variance and the median-variance based portfolio which consist of 30 stocks from Bursa Malaysia. The results in this study show that the median-variance approach is capable to produce a lower risk for each return earning as compared to the mean-variance approach.

  7. A model to incorporate organ deformation in the evaluation of dose/volume relationship

    International Nuclear Information System (INIS)

    Yan, D.; Jaffray, D.; Wong, J.; Brabbins, D.; Martinez, A. A.

    1997-01-01

    Purpose: Measurements of internal organ motion have demonstrated that daily organ deformation exists during the course of radiation treatment. However, a model to evaluate the resultant dose delivered to a daily deformed organ remains a difficult challenge. Current methods which model such organ deformation as rigid body motion in the dose calculation for treatment planning evaluation are incorrect and misleading. In this study, a new model for treatment planning evaluation is introduced which incorporates patient specific information of daily organ deformation and setup variation. The model was also used to retrospectively analyze the actual treatment data measured using daily CT scans for 5 patients with prostate treatment. Methods and Materials: The model assumes that for each patient, the organ of interest can be measured during the first few treatment days. First, the volume of each organ is delineated from each of the daily measurements and cumulated in a 3D bit-map. A tissue occupancy distribution is then constructed with the 50% isodensity representing the mean, or effective, organ volume. During the course of treatment, each voxel in the effective organ volume is assumed to move inside a local 3D neighborhood with a specific distribution function. The neighborhood and the distribution function are deduced from the positions and shapes of the organ in the first few measurements using the biomechanics model of viscoelastic body. For each voxel, the local distribution function is then convolved with the spatial dose distribution. The latter includes also the variation in dose due to daily setup error. As a result, the cumulative dose to the voxel incorporates the effects of daily setup variation and organ deformation. A ''variation adjusted'' dose volume histogram, aDVH, for the effective organ volume can then be constructed for the purpose of treatment evaluation and optimization. Up to 20 daily CT scans and daily portal images for 5 patients with prostate

  8. Decision analysis with cumulative prospect theory.

    Science.gov (United States)

    Bayoumi, A M; Redelmeier, D A

    2000-01-01

    Individuals sometimes express preferences that do not follow expected utility theory. Cumulative prospect theory adjusts for some phenomena by using decision weights rather than probabilities when analyzing a decision tree. The authors examined how probability transformations from cumulative prospect theory might alter a decision analysis of a prophylactic therapy in AIDS, eliciting utilities from patients with HIV infection (n = 75) and calculating expected outcomes using an established Markov model. They next focused on transformations of three sets of probabilities: 1) the probabilities used in calculating standard-gamble utility scores; 2) the probabilities of being in discrete Markov states; 3) the probabilities of transitioning between Markov states. The same prophylaxis strategy yielded the highest quality-adjusted survival under all transformations. For the average patient, prophylaxis appeared relatively less advantageous when standard-gamble utilities were transformed. Prophylaxis appeared relatively more advantageous when state probabilities were transformed and relatively less advantageous when transition probabilities were transformed. Transforming standard-gamble and transition probabilities simultaneously decreased the gain from prophylaxis by almost half. Sensitivity analysis indicated that even near-linear probability weighting transformations could substantially alter quality-adjusted survival estimates. The magnitude of benefit estimated in a decision-analytic model can change significantly after using cumulative prospect theory. Incorporating cumulative prospect theory into decision analysis can provide a form of sensitivity analysis and may help describe when people deviate from expected utility theory.

  9. First Year of the Development of the central State Dose Register in Slovenia

    International Nuclear Information System (INIS)

    Janzekovic, H.; Breznik, B.; Jovanovic, P.; Zdesar, U.; Rojc, J.; Stuhec, M.; Vaupotic, J.

    2001-01-01

    Full text: In order to improve the registration of doses received by around 4500 workers who annually work with the ionising radiation sources in Slovenia the Health Inspectorate started to build a Central State Dose Register in 1999. Today the register includes data concerning all workers including outside workers and is filled by six laboratories from four institutions. The doses are measured in around 500 enterprises. The register built in Access 97 accepts data in electronic forms periodically from the dosimetry services. The external doses are reported monthly and the internal doses are reported usually once per year. The identification of a person is based on personal data which are not a subject of changes generally. The received doses are related to the time period during which the doses were received, licensee, employer, type of the work, type of the source and also to the cumulative dose received in the current year. The reported doses are always related to the dosimetry service so that a revaluation of the dose is always possible if necessary. As a rule the part of health surveillance data and the education of workers related to the radiation protection are also given. The cumulative doses of workers received before January 1, 2000 are reported as well. The developmental problems of the register related to extensiveness of the use of the ionising radiation sources in Slovenia will be discussed and the applied solutions based on ICRP 60 and 96/29/Euratom will be given. (author)

  10. Comparison of two dose and three dose human papillomavirus vaccine schedules: cost effectiveness analysis based on transmission model.

    Science.gov (United States)

    Jit, Mark; Brisson, Marc; Laprise, Jean-François; Choi, Yoon Hong

    2015-01-06

    To investigate the incremental cost effectiveness of two dose human papillomavirus vaccination and of additionally giving a third dose. Cost effectiveness study based on a transmission dynamic model of human papillomavirus vaccination. Two dose schedules for bivalent or quadrivalent human papillomavirus vaccines were assumed to provide 10, 20, or 30 years' vaccine type protection and cross protection or lifelong vaccine type protection without cross protection. Three dose schedules were assumed to give lifelong vaccine type and cross protection. United Kingdom. Males and females aged 12-74 years. No, two, or three doses of human papillomavirus vaccine given routinely to 12 year old girls, with an initial catch-up campaign to 18 years. Costs (from the healthcare provider's perspective), health related utilities, and incremental cost effectiveness ratios. Giving at least two doses of vaccine seems to be highly cost effective across the entire range of scenarios considered at the quadrivalent vaccine list price of £86.50 (€109.23; $136.00) per dose. If two doses give only 10 years' protection but adding a third dose extends this to lifetime protection, then the third dose also seems to be cost effective at £86.50 per dose (median incremental cost effectiveness ratio £17,000, interquartile range £11,700-£25,800). If two doses protect for more than 20 years, then the third dose will have to be priced substantially lower (median threshold price £31, interquartile range £28-£35) to be cost effective. Results are similar for a bivalent vaccine priced at £80.50 per dose and when the same scenarios are explored by parameterising a Canadian model (HPV-ADVISE) with economic data from the United Kingdom. Two dose human papillomavirus vaccine schedules are likely to be the most cost effective option provided protection lasts for at least 20 years. As the precise duration of two dose schedules may not be known for decades, cohorts given two doses should be closely

  11. Sub-dissociative-dose intranasal ketamine for moderate to severe pain in adult emergency department patients.

    Science.gov (United States)

    Yeaman, Fiona; Meek, Robert; Egerton-Warburton, Diana; Rosengarten, Pamela; Graudins, Andis

    2014-06-01

    There are currently no studies assessing effectiveness of sub-dissociative intranasal (IN) ketamine as the initial analgesic for adult patients in the ED. The study aims to examine the effectiveness of sub-dissociative IN ketamine as a primary analgesic agent for adult patients in the ED. This is a prospective, observational study of adult ED patients presenting with severe pain (≥6 on 11-point scale at triage). IN ketamine dose was 0.7 mg/kg, with secondary dose of 0.5 mg/kg at 15 min if pain did not improve. After 6 months, initial dose was increased to 1.0 mg/kg with the same optional secondary dose. The primary outcomes are change in VAS rating at 30 min; percentage of patients reporting clinically significant reduction in VAS (≥20 mm) at 30 min; dose resulting in clinically significant pain reduction. Of the 72 patients available for analysis, median age was 34.5 years and 64% were men. Median initial VAS rating was 76 mm (interquartile range [IQR]: 65-82). Median total dose of IN ketamine for all patients was 0.98 mg/kg (IQR: 0.75-1.15, range: 0.59-1.57). Median reduction in VAS rating at 30 min was 24 mm (IQR: 2-45). Forty (56%, 95% CI: 44.0-66.7) reported VAS reduction ≥20 mm, these patients having had a total median ketamine dose of 0.94 mg/kg (IQR: 0.72-1.04). IN ketamine, at a dose of about 1 mg/kg, was an effective analgesic agent in 56% of study patients. The place of IN ketamine in analgesic guidelines for adults requires further investigation. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  12. Radiation dose monitoring in the clinical routine

    Energy Technology Data Exchange (ETDEWEB)

    Guberina, Nika [UK Essen (Germany). Radiology

    2017-04-15

    Here we describe the first clinical experiences regarding the use of an automated radiation dose management software to monitor the radiation dose of patients during routine examinations. Many software solutions for monitoring radiation dose have emerged in the last decade. The continuous progress in radiological techniques, new scan features, scanner generations and protocols are the primary challenge for radiation dose monitoring software systems. To simulate valid dose calculations, radiation dose monitoring systems have to follow current trends and stay constantly up-to-date. The dose management software is connected to all devices at our institute and conducts automatic data acquisition and radiation dose calculation. The system incorporates 18 virtual phantoms based on the Cristy phantom family, estimating doses in newborns to adults. Dose calculation relies on a Monte Carlo simulation engine. Our first practical experiences demonstrate that the software is capable of dose estimation in the clinical routine. Its implementation and use have some limitations that can be overcome. The software is promising and allows assessment of radiation doses, like organ and effective doses according to ICRP 60 and ICRP 103, patient radiation dose history and cumulative radiation doses. Furthermore, we are able to determine local diagnostic reference doses. The radiation dose monitoring software systems can facilitate networking between hospitals and radiological departments, thus refining radiation doses and implementing reference doses at substantially lower levels.

  13. Radiation dose assessment for /sup 137/Cs from fish in the Aegean Sea before and after the Chernobyl accident

    Energy Technology Data Exchange (ETDEWEB)

    Danali-Cotsaki, S; Liritzis, Y

    1988-02-15

    The effective doses in fish from the Aegean Sea were calculated for the nuclide /sup 137/Cs covering the period 1975-1982. The effective dose varies between 3x10/sup -5/ and 10x10/sup -5/ mSv y/sup -1/ for adults and 14x10/sup -5/ to 56x10/sup -5/ y/sup -1/ for children, while the cumulative effective dose for the period 1975-1982 equals to 40.86x10/sup -5/ and 229.57x10/sup -5/ for adults and children of 10 y old, resp. When compared to doses derived from the Chernobyl accident (May 1986) it was found that the additional dose incurred by Greek individuals in May 1986 was approximately equal to the cumulative dose of 8 y contribution period (1975-1982) for adults and to a year's contribution for children of 10 y old. (author) 9 refs.; 3 figs.

  14. Papillary carcinoma in median aberrant thyroid (ectopic) - case report.

    Science.gov (United States)

    Hebbar K, Ashwin; K, Shashidhar; Deshmane, Vijaya Laxmi; Kumar, Veerendra; Arjunan, Ravi

    2014-06-01

    Median ectopic thyroid may be encountered anywhere from the foramen caecum to the diaphragm. Non lingual median aberrant thyroid (incomplete descent) usually found in the infrahyoid region and malignant transformation in this ectopic thyroid tissue is very rare. We report an extremely rare case of papillary carcinoma in non lingual median aberrant thyroid in a 25-year-old female. The differentiation between a carcinoma arising in the median ectopic thyroid tissue and a metastatic papillary carcinoma from an occult primary in the main thyroid gland is also discussed.

  15. Robust median estimator in logisitc regression

    Czech Academy of Sciences Publication Activity Database

    Hobza, T.; Pardo, L.; Vajda, Igor

    2008-01-01

    Roč. 138, č. 12 (2008), s. 3822-3840 ISSN 0378-3758 R&D Projects: GA MŠk 1M0572 Grant - others:Instituto Nacional de Estadistica (ES) MPO FI - IM3/136; GA MŠk(CZ) MTM 2006-06872 Institutional research plan: CEZ:AV0Z10750506 Keywords : Logistic regression * Median * Robustness * Consistency and asymptotic normality * Morgenthaler * Bianco and Yohai * Croux and Hasellbroeck Subject RIV: BB - Applied Statistics, Operational Research Impact factor: 0.679, year: 2008 http://library.utia.cas.cz/separaty/2008/SI/vajda-robust%20median%20estimator%20in%20logistic%20regression.pdf

  16. Original and cumulative prospect theory: a discussion of empirical differences

    NARCIS (Netherlands)

    Wakker, P.P.; Fennema, H.

    1997-01-01

    This note discusses differences between prospect theory and cumulative prospect theory. It shows that cumulative prospect theory is not merely a formal correction of some theoretical problems in prospect theory, but it also gives different predictions. Experiments are described that favor cumulative

  17. RADIOIODINE TREATMENT OF GRAVES’ DISEASE – DOSE/RESPONSE ANALYSIS

    Directory of Open Access Journals (Sweden)

    Jitka Čepková

    2014-01-01

    Full Text Available The clinical outcome of 153 Graves’ disease patients treated with a wide dose range of radioactive iodine-131 (RAI was analyzed retrospectively. Six to nine months after the first dose of RAI 60 patients (39% were hypothyroid (or rather thyroxine-substituted and 26 (17% were euthyroid, while 67 patients (44% did not respond properly: in 32 (21% their antithyroid drug (ATD dose could be reduced but not withdrawn (partial response and 35 (23% remained hyperthyroid or the same dose of ATD was necessary (no response. The outcome did not correspond significantly to the administered activity of RAI (medians 259, 259, 222, and 259 MBq for hypothyroid, euthyroid, partial, and no response subgroups, respectively, or the activity retained in the gland at 24 h (medians 127, 105, 143, and 152 MBq. The effect was, however, clearly, and in a stepwise pattern, dependent on initial thyroid volume (17, 26, 33 and 35 ml, P  6 MBq/g, cure rate 80% and lower (≤ 6 MBq/g, cure rate 46% doses gave highly significant difference (P < 0.001. With our dosing range we found a dose-dependent clinical outcome that suggests an optimum delivered dose near 6.5 MBq/g, resulting in successful treatment of ca 80% patients.

  18. Dual pathology proximal median nerve compression of the forearm.

    Science.gov (United States)

    Murphy, Siun M; Browne, Katherine; Tuite, David J; O'Shaughnessy, Michael

    2013-12-01

    We report an unusual case of synchronous pathology in the forearm- the coexistence of a large lipoma of the median nerve together with an osteochondroma of the proximal ulna, giving rise to a dual proximal median nerve compression. Proximal median nerve compression neuropathies in the forearm are uncommon compared to the prevalence of distal compression neuropathies (eg Carpal Tunnel Syndrome). Both neural fibrolipomas (Refs. 1,2) and osteochondromas of the proximal ulna (Ref. 3) in isolation are rare but well documented. Unlike that of a distal compression, a proximal compression of the median nerve will often have a definite cause. Neural fibrolipoma, also called fibrolipomatous hamartoma are rare, slow-growing, benign tumours of peripheral nerves, most often occurring in the median nerve of younger patients. To our knowledge, this is the first report of such dual pathology in the same forearm, giving rise to a severe proximal compression of the median nerve. In this case, the nerve was being pushed anteriorly by the osteochondroma, and was being compressed from within by the intraneural lipoma. This unusual case highlights the advantage of preoperative imaging as part of the workup of proximal median nerve compression. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  19. Perspectives on cumulative risks and impacts.

    Science.gov (United States)

    Faust, John B

    2010-01-01

    Cumulative risks and impacts have taken on different meanings in different regulatory and programmatic contexts at federal and state government levels. Traditional risk assessment methodologies, with considerable limitations, can provide a framework for the evaluation of cumulative risks from chemicals. Under an environmental justice program in California, cumulative impacts are defined to include exposures, public health effects, or environmental effects in a geographic area from the emission or discharge of environmental pollution from all sources, through all media. Furthermore, the evaluation of these effects should take into account sensitive populations and socioeconomic factors where possible and to the extent data are available. Key aspects to this potential approach include the consideration of exposures (versus risk), socioeconomic factors, the geographic or community-level assessment scale, and the inclusion of not only health effects but also environmental effects as contributors to impact. Assessments of this type extend the boundaries of the types of information that toxicologists generally provide for risk management decisions.

  20. Cumulative particle production in the quark recombination model

    International Nuclear Information System (INIS)

    Gavrilov, V.B.; Leksin, G.A.

    1987-01-01

    Production of cumulative particles in hadron-nuclear inteactions at high energies is considered within the framework of recombination quark model. Predictions for inclusive cross sections of production of cumulative particles and different resonances containing quarks in s state are made

  1. A Dose-Volume Analysis of Magnetic Resonance Imaging-Aided High-Dose-Rate Image-Based Interstitial Brachytherapy for Uterine Cervical Cancer

    International Nuclear Information System (INIS)

    Yoshida, Ken; Yamazaki, Hideya; Takenaka, Tadashi; Kotsuma, Tadayuki; Yoshida, Mineo; Furuya, Seiichi; Tanaka, Eiichi; Uegaki, Tadaaki; Kuriyama, Keiko; Matsumoto, Hisanobu; Yamada, Shigetoshi; Ban, Chiaki

    2010-01-01

    Purpose: To investigate the feasibility of our novel image-based high-dose-rate interstitial brachytherapy (HDR-ISBT) for uterine cervical cancer, we evaluated the dose-volume histogram (DVH) according to the recommendations of the Gynecological GEC-ESTRO Working Group for image-based intracavitary brachytherapy (ICBT). Methods and Materials: Between June 2005 and June 2007, 18 previously untreated cervical cancer patients were enrolled. We implanted magnetic resonance imaging (MRI)-available plastic applicators by our unique ambulatory technique. Total treatment doses were 30-36 Gy (6 Gy per fraction) combined with external beam radiotherapy (EBRT). Treatment plans were created based on planning computed tomography with MRI as a reference. DVHs of the high-risk clinical target volume (HR CTV), intermediate-risk CTV (IR CTV), and the bladder and rectum were calculated. Dose values were biologically normalized to equivalent doses in 2-Gy fractions (EQD 2 ). Results: The median D90 (HR CTV) and D90 (IR CTV) per fraction were 6.8 Gy (range, 5.5-7.5) and 5.4 Gy (range, 4.2-6.3), respectively. The median V100 (HR CTV) and V100 (IR CTV) were 98.4% (range, 83-100) and 81.8% (range, 64-93.8), respectively. When the dose of EBRT was added, the median D90 and D100 of HR CTV were 80.6 Gy (range, 65.5-96.6) and 62.4 Gy (range, 49-83.2). The D 2cc of the bladder was 62 Gy (range, 51.4-89) and of the rectum was 65.9 Gy (range, 48.9-76). Conclusions: Although the targets were advanced and difficult to treat effectively by ICBT, MRI-aided image-based ISBT showed favorable results for CTV and organs at risk compared with previously reported image-based ICBT results.

  2. A dose-volume analysis of magnetic resonance imaging-aided high-dose-rate image-based interstitial brachytherapy for uterine cervical cancer.

    Science.gov (United States)

    Yoshida, Ken; Yamazaki, Hideya; Takenaka, Tadashi; Kotsuma, Tadayuki; Yoshida, Mineo; Furuya, Seiichi; Tanaka, Eiichi; Uegaki, Tadaaki; Kuriyama, Keiko; Matsumoto, Hisanobu; Yamada, Shigetoshi; Ban, Chiaki

    2010-07-01

    To investigate the feasibility of our novel image-based high-dose-rate interstitial brachytherapy (HDR-ISBT) for uterine cervical cancer, we evaluated the dose-volume histogram (DVH) according to the recommendations of the Gynecological GEC-ESTRO Working Group for image-based intracavitary brachytherapy (ICBT). Between June 2005 and June 2007, 18 previously untreated cervical cancer patients were enrolled. We implanted magnetic resonance imaging (MRI)-available plastic applicators by our unique ambulatory technique. Total treatment doses were 30-36 Gy (6 Gy per fraction) combined with external beam radiotherapy (EBRT). Treatment plans were created based on planning computed tomography with MRI as a reference. DVHs of the high-risk clinical target volume (HR CTV), intermediate-risk CTV (IR CTV), and the bladder and rectum were calculated. Dose values were biologically normalized to equivalent doses in 2-Gy fractions (EQD(2)). The median D90 (HR CTV) and D90 (IR CTV) per fraction were 6.8 Gy (range, 5.5-7.5) and 5.4 Gy (range, 4.2-6.3), respectively. The median V100 (HR CTV) and V100 (IR CTV) were 98.4% (range, 83-100) and 81.8% (range, 64-93.8), respectively. When the dose of EBRT was added, the median D90 and D100 of HR CTV were 80.6 Gy (range, 65.5-96.6) and 62.4 Gy (range, 49-83.2). The D(2cc) of the bladder was 62 Gy (range, 51.4-89) and of the rectum was 65.9 Gy (range, 48.9-76). Although the targets were advanced and difficult to treat effectively by ICBT, MRI-aided image-based ISBT showed favorable results for CTV and organs at risk compared with previously reported image-based ICBT results. (c) 2010 Elsevier Inc. All rights reserved.

  3. Estimation of staff lens doses during interventional procedures. Comparing cardiology, neuroradiology and interventional radiology

    International Nuclear Information System (INIS)

    Vano, E.; Sanchez, R.M.; Fernandez, J.M.

    2015-01-01

    The purpose of this article is to estimate lens doses using over apron active personal dosemeters in interventional catheterisation laboratories (cardiology IC, neuroradiology IN and radiology IR) and to investigate correlations between occupational lens doses and patient doses. Active electronic personal dosemeters placed over the lead apron were used on a sample of 204 IC procedures, 274 IN and 220 IR (all performed at the same university hospital). Patient dose values (kerma area product) were also recorded to evaluate correlations with occupational doses. Operators used the ceiling-suspended screen in most cases. The median and third quartile values of equivalent dose Hp(10) per procedure measured over the apron for IC, IN and IR resulted, respectively, in 21/67, 19/44 and 24/54 μSv. Patient dose values (median/third quartile) were 75/128, 83/176 and 61/159 Gy cm 2 , respectively. The median ratios for dosemeters worn over the apron by operators ( protected by the ceiling-suspended screen) and patient doses were 0.36; 0.21 and 0.46 μSv Gy -1 cm -2 , respectively. With the conservative approach used (lens doses estimated from the over apron chest dosemeter) we came to the conclusion that more than 800 procedures y -1 and per operator were necessary to reach the new lens dose limit for the three interventional specialties. (authors)

  4. Dose evaluation for digital X-ray imaging of premature neonates

    International Nuclear Information System (INIS)

    Minkels, T.J.M.; Jeukens, C.R.L.P.N.; Andriessen, P.; Van der Linden, A.N.; Dam, A.J.; Van Straaten, H.L.M.; Cottaar, E.J.E.; Van Pul, C.

    2017-01-01

    X-ray radiography is a commonly used diagnostic method for premature neonates. However, because of higher radiosensitivity and young age, premature neonates are more sensitive to the detrimental effects of ionising radiation. Therefore, it is important to monitor and optimise radiation doses at the neonatal intensive care unit (NICU). The number of X-ray examinations, dose area product (DAP) and effective doses are evaluated for three Dutch NICUs using digital flat panel detectors. Thorax, thorax abdomen and abdomen protocols are included in this study. Median number of examinations is equal to 1 for all three hospitals. Median DAP ranges between 0.05 and 1.02 μGy m2 for different examination types and different weight categories. These examinations result in mean effective doses between 4 ± 4 and 30 ± 10 μSv per examination. Substantial differences in protocols and doses can be observed between hospitals. This emphasises the need for up-to-date reference levels formulated specifically for premature neonates. (authors)

  5. High intertester reliability of the cumulated ambulation score for the evaluation of basic mobility in patients with hip fracture

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Andersen, Lene; Bech-Jensen, Rie

    2009-01-01

    OBJECTIVE: To examine the intertester reliability of the three activities of the Cumulated Ambulation Score (CAS) and the total CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with hip fracture. DESIGN: An intertester reliability study....... SETTING: An acute 20-bed orthopaedic hip fracture unit. SUBJECTS: Fifty consecutive patients with a median age of 83 (25-75% quartile, 68-86) years. INTERVENTIONS: The CAS, which describes the patient's independency in three activities - (1) getting in and out of bed, (2) sit to stand from a chair, and (3...

  6. Median nail dystrophy involving the thumb nail

    Directory of Open Access Journals (Sweden)

    Rahulkrishna Kota

    2016-01-01

    Full Text Available Median canaliform dystrophy of Heller is a rare entity characterized by a midline or a paramedian ridge or split and canal formation in nail plate of one or both the thumb nails. It is an acquired condition resulting from a temporary defect in the matrix that interferes with nail formation. Habitual picking of the nail base may be responsible for some cases. Histopathology classically shows parakeratosis, accumulation of melanin within and between the nail bed keratinocytes. Treatment of median nail dystrophy includes injectable triamcinalone acetonide, topical 0.1% tacrolimus, and tazarotene 0.05%, which is many a times challenging for a dermatologist. Psychiatric opinion should be taken when associated with the depressive, obsessive-compulsive, or impulse-control disorder. We report a case of 19-year-old male diagnosed as median nail dystrophy.

  7. Large window median filtering on Clip7

    Energy Technology Data Exchange (ETDEWEB)

    Mathews, K N

    1983-07-01

    Median filtering has been found to be a useful operation to perform on images in order to reduce random noise while preserving edges of objects. However, in some cases, as the resolution of the image increases, so too does the required window size of the filter. For parallel array processors, this leads to problems when dealing with the large amount of data involved. That is to say that there tend to be problems over slow access of data from pixels over a large neighbourhood, lack of available storage of this data during the operation and long computational times for finding the median. An algorithm for finding the median, designed for use on byte wide architecture parallel array processors is presented together with its implementation on Clip7, a scanning array of such processors. 6 references.

  8. Dose-effect relationship in production of dicentrics and rings in blood lymphocytes of individuals living in high background radiation area

    International Nuclear Information System (INIS)

    Jiang Tao; Hayata, I.; Wang Cunyan

    1999-01-01

    Objective: To explore the dose-effect relationship in the production of chromosome aberrations by high background radiation by using statistically appropriate individual measurements. Methods: Chromosome analysis was performed in separated blood lymphocytes of 39 family members of different ages from either high background radiation area (HBRA) or control area (CA). Individual cumulative doses ranged from 23.9-261.3 and 5.2-29.8 mGy for HBRA and CA, respectively. A total of about 100,000 cells were scored and dicentric and ring chromosome (dic + Rc) aberrations recorded. Results: In the case of HBRA, individual chromosome aberration frequencies increased with age within each family. The increasing trend was in general not significantly different among families. The increase in individual aberration was closely correlated with age and cumulative dose. Age-and dose-effect relationship fit well the linear equation: Y = 0.0448X + 0.4913 (R 2 = 0.7814) for age and Y 0.0156X + 0.5715 (R 2 = 0.7061) for cumulative dose, respectively. In the case of CA, there was no significant difference in aberration yields among individuals of different ages, and the group mean aberration frequency was 1.24 +- 0.69 x 10 -3 . Conclusions: Dic and Rc can continuously accumulate over a lifetime chronic low dose exposures, and can serve as a reliable biological indicator. However, the ultimate sensitivity is about 50 mGy

  9. Dose and dose rate effects of whole-body gamma-irradiation: II. Hematological variables and cytokines

    Science.gov (United States)

    Gridley, D. S.; Pecaut, M. J.; Miller, G. M.; Moyers, M. F.; Nelson, G. A.

    2001-01-01

    The goal of part II of this study was to evaluate the effects of gamma-radiation on circulating blood cells, functional characteristics of splenocytes, and cytokine expression after whole-body irradiation at varying total doses and at low- and high-dose-rates (LDR, HDR). Young adult C57BL/6 mice (n = 75) were irradiated with either 1 cGy/min or 80 cGy/min photons from a 60Co source to cumulative doses of 0.5, 1.5, and 3.0 Gy. The animals were euthanized at 4 days post-exposure for in vitro assays. Significant dose- (but not dose-rate-) dependent decreases were observed in erythrocyte and blood leukocyte counts, hemoglobin, hematocrit, lipopolysaccharide (LPS)-induced 3H-thymidine incorporation, and interleukin-2 (IL-2) secretion by activated spleen cells when compared to sham-irradiated controls (p < 0.05). Basal proliferation of leukocytes in the blood and spleen increased significantly with increasing dose (p < 0.05). Significant dose rate effects were observed only in thrombocyte counts. Plasma levels of transforming growth factor-beta 1 (TGF-beta 1) and splenocyte secretion of tumor necrosis factor-alpha (TNF-alpha) were not affected by either the dose or dose rate of radiation. The data demonstrate that the responses of blood and spleen were largely dependent upon the total dose of radiation employed and that an 80-fold difference in the dose rate was not a significant factor in the great majority of measurements.

  10. Reaction of the hematopoietic system under long-term emotional stress developed after preliminary gamma-irradiation with low doses

    International Nuclear Information System (INIS)

    Moroz, B.B.; Deshevoj, Yu.B.; Lebedev, V.G.; Lyrshchikova, A.V.; Vorotnikova, T.V.

    1997-01-01

    In experiments on rats and mice it was shown that the preliminary protected gamma-irradiation with cumulative dose of 0.9 Gy (dose rate - 0.03 Gy/day) or single short-term gamma-irradiation with dose of 0.9 Gy (dose rate - 1.61 Gy/min) inhibited development of adaptive reactions and compensatory abilities of the hematopoietic system under long-term emotional stress

  11. Acoustic neuromas: single dose vs fractionated therapy

    International Nuclear Information System (INIS)

    Fuss, M.; Debus, J.; Lohr, F.; Engenhart-Cabillic, R.; Wannenmacher, M.

    1997-01-01

    Purpose: Radiosurgical treatment (RS) of acoustic neuromas is a well established treatment. However, few data are available concerning conformal fractionated radiotherapy (FT) of this tumor entity. We evaluated treatment outcome and toxicity for both treatment modalities in 41 patients treated at our institution between 1984 and 1997. Material and Methods: All treatments were performed using a specially adapted linear accelerator and circular collimators for convergent beam RS or multi-leaf collimators (leaf thickness 1 or 3mm) for multi-field RS or fractionated treatment. 22 patients (7 male, 15 female, median age 60 years, range 20-83 years) were treated radiosurgically with single doses between 7 and 28 Gray (median 15 Gy) prescribed to the 80% isodose line. Tumor volumes ranged from 0.7 to 10.5 ccm with a median volume of 3.4 ccm. The median number of isocenters was 2 (1-4 isocenters). One patient was treated by a multi-field technique (14 isocentric irregularly shaped noncoplanar fields). 19 patients (5 male, 14 female, median age 55 years, range 20-81 years) were treated with stereotactic conformal radiotherapy. Median dose was 60 Gray with a median daily fraction size of 2 Gy and a median of 3 (1-4) irregularly shaped isocentric fields. Tumor volumes ranged from 0.7 to 32.4 ccm (median 15 ccm). Median follow-up was 30 months (7-149 months) for radiosurgical and 30 months (2-88 months) for fractionated treatment. Seven patients who underwent fractionated treatment had previously undergone neurosurgical resection on the contralateral side. One had undergone radiosurgery on the opposite side before. Results: All tumors were locally controlled. A volume reduction of more than 20% was seen in 16% after RS and 18% following FT. Typical posttherapeutic central reduction of contrast media enhancement was found in 73% following RS after a median of 8 (3-12) months and in 63% following FT after a median of 6 (1-12) months. Temporary brainstem edema was diagnosed in 4

  12. Radiation dose to the heart in paediatric interventional cardiology

    International Nuclear Information System (INIS)

    Keiller, D A; Martin, C J

    2015-01-01

    Recent ICRP publications have reviewed evidence for induction of heart disease. Studies suggest the threshold dose to the heart may be as low as 500 mGy. Doses to the heart from paediatric interventional procedures performed in Glasgow between April 2012 and July 2013 to correct congenital heart defects were investigated to assess the level of potential risk of cardiovascular disease. For common procedures, doses were found to be typically less than 50 mGy, with the highest dose in the period for which data are available estimated to be 330 mGy. These results suggest that any increased risk due to paediatric interventional cardiology is likely to be small, but cumulative doses over a number of years could reach the threshold for effects. (paper)

  13. Maternal Methadone Dose, Placental Methadone Concentrations, and Neonatal Outcomes

    Science.gov (United States)

    de Castro, Ana; Jones, Hendreé E.; Johnson, Rolley E.; Gray, Teresa R.; Shakleya, Diaa M.; Huestis, Marilyn A.

    2015-01-01

    BACKGROUND Few investigations have used placenta as an alternative matrix to detect in utero drug exposure, despite its availability at the time of birth and the large amount of sample. Methadone-maintained opioid-dependent pregnant women provide a unique opportunity to examine the placental disposition of methadone and metabolite [2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP)], to explore their correlations with maternal methadone dose and neonatal outcomes, and to test the ability to detect in utero exposure to illicit drugs. METHODS We calculated the correlations of placental methadone and EDDP concentrations and their correlations with maternal methadone doses and neonatal outcomes. Cocaine- and opiate-positive placenta results were compared with the results for meconium samples and for urine samples collected throughout gestation. RESULTS Positive correlations were found between placental methadone and EDDP concentrations (r = 0.685), and between methadone concentration and methadone dose at delivery (r = 0.542), mean daily dose (r = 0.554), mean third-trimester dose (r = 0.591), and cumulative daily dose (r = 0.639). The EDDP/methadone concentration ratio was negatively correlated with cumulative daily dose (r = 0.541) and positively correlated with peak neonatal abstinence syndrome (NAS) score (r = 0.513). Placental EDDP concentration was negatively correlated with newborn head circumference (r = 0.579). Cocaine and opiate use was detected in far fewer placenta samples than in thrice-weekly urine and meconium samples, a result suggesting a short detection window for placenta. CONCLUSIONS Quantitative methadone and EDDP measurement may predict NAS severity. The placenta reflects in utero drug exposure for a shorter time than meconium but may be useful when meconium is unavailable or if documentation of recent exposure is needed. PMID:21245372

  14. Optimization of dose distributions for adjuvant locoregional radiotherapy of gastric cancer by IMRT

    International Nuclear Information System (INIS)

    Lohr, F.; Dobler, B.; Mai, S.; Hermann, B.; Tiefenbacher, U.; Wieland, P.; Steil, V.; Wenz, F.

    2003-01-01

    Background and Purpose: Locoregional relapse is a problem frequently encountered with advanced gastric cancer. Data from the randomized Intergroup trial 116 suggest effectiveness of adjuvant radiochemotherapy, albeit with significant toxicity. The potential of intensity-modulated radiotherapy (IMRT) to reduce toxicity by significantly reducing maximum and median doses to organs at risk while still applying sufficient dose to the target volume in the upper abdomen was studied. Patient and Methods: For a typical configuration of target volumes and organs, a step-and-shoot IMRT plan (eight beam orientations), developed as a class solution for treatment of tumors in the upper abdomen (Figures 1 to 3), a conventional plan, a combination of the conventional plan with a kidney-sparing boost plan, and a conventional plan with noncoplanar ap and pa fields for improved kidney sparing were compared with respect to coverage of target volume and dose to organs at risk with a dose of 45 Gy delivered as the median dose to the target volume. Results: When using the conventional three-dimensionally planned box techniques, the right kidney could be kept below tolerance, but median dose to the left kidney amounted to between 14.8 and 26.9 Gy, depending on the plan. IMRT reduced the median dose to the left kidney to 10.5 Gy, while still keeping the dose to the right kidney 90% of prescription dose were delivered to > 90% of target volume with IMRT (Table 1). Conclusion: IMRT has the potential to deliver efficient doses to target volumes in the upper abdomen, while delivering dose to organs at risk in a more advantageous fashion than a conventional technique. For clinical implementation, the possibility of extensive organ motion in the upper abdomen has to be taken into account for treatment planning and patient positioning. The multitude of potential risks related to its application has to be the subject of thorough follow-up and further studies. (orig.)

  15. The Role of High Dose Interleukin-2 in the Era of Targeted Therapy.

    Science.gov (United States)

    Gills, Jessie; Parker, William P; Pate, Scott; Niu, Sida; Van Veldhuizen, Peter; Mirza, Moben; Holzbeierlein, Jeffery M; Lee, Eugene K

    2017-09-01

    We assessed survival outcomes following high dose interleukin-2 in a contemporary cohort of patients during the era of targeted agents. We retrospectively reviewed the records of patients with metastatic renal cell carcinoma treated with high dose interleukin-2 between July 2007 and September 2014. Clinicopathological data were abstracted and patient response to therapy was based on RECIST (Response Evaluation Criteria In Solid Tumors), version 1.1 criteria. The Kaplan-Meier method was used to estimate progression-free and overall survival in the entire cohort, the response to high dose interleukin-2 in regard to previous targeted agent therapy and the response to the targeted agent in relation to the response to high dose interleukin-2. We identified 92 patients, of whom 87 had documentation of a response to high dose interleukin-2. Median overall survival was 34.4 months from the initiation of high dose interleukin-2 therapy in the entire cohort. Patients who received targeted therapy before high dose interleukin-2 had overall survival (median 34.4 and 30.0 months, p = 0.88) and progression-free survival (median 1.5 and 1.7 months, p = 0.8) similar to those in patients who received no prior therapy, respectively. Additionally, patients with a complete or partial response to high dose interleukin-2 had similar outcomes for subsequent targeted agents compared to patients whose best response was stable or progressive disease (median overall survival 30.1 vs 25.4 months, p = 0.4). Our data demonstrate that patient responses to high dose interleukin-2 and to targeted agents before and after receiving high dose interleukin-2 are independent. As such, carefully selected patients should be offered high dose interleukin-2 for the possibility of a complete and durable response without the fear of limiting the treatment benefit of targeted agents. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  16. Ranitidine Can Potentiate The Prokinetic Effect Of Itopride At Low Doses- An In Vitro Study.

    Science.gov (United States)

    Butt, Aroosa Ishtiaq; Khan, Bushra Tayyaba; Khan, Asma; Khan, Qamar-Uz-Zaman

    2017-01-01

    Gastroparesis and GERD occur concomitantly in 40 percent of the cases. Prokinetic drugs and acid blockers are employed as the main treatment modality. Ranitidine is an acid blocker with additional prokinetic activity and Itopride is a known prokinetic drug. This study was designed to observe the synergistic potentiating prokinetic effect of Ranitidine on itopride on isolated duodenum of rabbits. Ranitidine (10-5-10-3) and itopride (10-6-10-5) were added in increasing concentrations to isolated duodenum of rabbits and contractions were recorded on PowerLab Data acquisition unit AHK/214. Cumulative dose response curves were constructed. The potentiating prokinetic effect of Ranitidine on itopride was seen by using a fixed dose of ranitidine and cumulatively enhancing doses of itopride on iWorx. Ranitidine and itopride produced a dose dependent reversible contraction of the isolated tissue of rabbits with ranitidine showing a max response of 0.124mV and itopride showing a maximum response of 0.131mV. Ranitidine was able to potentiate the prokinetic effect of itopride at low doses but at high dose the effect began to wane off. Ranitidine and itopride produce a statistically significant synergistic potentiating prokinetic effect at low doses in vitro.

  17. Prospective Evaluation to Establish a Dose Response for Clinical Oral Mucositis in Patients Undergoing Head-and-Neck Conformal Radiotherapy

    International Nuclear Information System (INIS)

    Narayan, Samir; Lehmann, Joerg; Coleman, Matthew A.; Vaughan, Andrew; Yang, Claus Chunli; Enepekides, Danny; Farwell, Gregory; Purdy, James A.; Laredo, Grace; Nolan, Kerry A.S.; Pearson, Francesca S.; Vijayakumar, Srinivasan

    2008-01-01

    Purpose: We conducted a clinical study to correlate oral cavity dose with clinical mucositis, perform in vivo dosimetry, and determine the feasibility of obtaining buccal mucosal cell samples in patients undergoing head-and-neck radiation therapy. The main objective is to establish a quantitative dose response for clinical oral mucositis. Methods and Materials: Twelve patients undergoing radiation therapy for head-and-neck cancer were prospectively studied. Four points were chosen in separate quadrants of the oral cavity. Calculated dose distributions were generated by using AcQPlan and Eclipse treatment planning systems. MOSFET dosimeters were used to measure dose at each sampled point. Each patient underwent buccal sampling for future RNA analysis before and after the first radiation treatment at the four selected points. Clinical and functional mucositis were assessed weekly according to National Cancer Institute Common Toxicity Criteria, Version 3. Results: Maximum and average doses for sampled sites ranged from 7.4-62.3 and 3.0-54.3 Gy, respectively. A cumulative point dose of 39.1 Gy resulted in mucositis for 3 weeks or longer. Mild severity (Grade ≤ 1) and short duration (≤1 week) of mucositis were found at cumulative point doses less than 32 Gy. Polymerase chain reaction consistently was able to detect basal levels of two known radiation responsive genes. Conclusions: In our sample, cumulative doses to the oral cavity of less than 32 Gy were associated with minimal acute mucositis. A dose greater than 39 Gy was associated with longer duration of mucositis. Our technique for sampling buccal mucosa yielded sufficient cells for RNA analysis using polymerase chain reaction

  18. Evaluating Pharmacokinetic and Pharmacodynamic Interactions with Computational Models in Supporting Cumulative Risk Assessment

    Science.gov (United States)

    Tan, Yu-Mei; Clewell, Harvey; Campbell, Jerry; Andersen, Melvin

    2011-01-01

    Simultaneous or sequential exposure to multiple chemicals may cause interactions in the pharmacokinetics (PK) and/or pharmacodynamics (PD) of the individual chemicals. Such interactions can cause modification of the internal or target dose/response of one chemical in the mixture by other chemical(s), resulting in a change in the toxicity from that predicted from the summation of the effects of the single chemicals using dose additivity. In such cases, conducting quantitative cumulative risk assessment for chemicals present as a mixture is difficult. The uncertainties that arise from PK interactions can be addressed by developing physiologically based pharmacokinetic (PBPK) models to describe the disposition of chemical mixtures. Further, PK models can be developed to describe mechanisms of action and tissue responses. In this article, PBPK/PD modeling efforts conducted to investigate chemical interactions at the PK and PD levels are reviewed to demonstrate the use of this predictive modeling framework in assessing health risks associated with exposures to complex chemical mixtures. PMID:21655141

  19. Residual, direct and cumulative effect of zinc application on wheat and rice yield under rice-wheat syst

    Directory of Open Access Journals (Sweden)

    R. Khan

    2009-05-01

    Full Text Available Zinc (Zn deficiency is prevalent particularly on calcareous soils of arid and semiarid region. A field experiment was conducted to investigate the direct, residual and cumulative effect of zinc on the yield of wheat and rice in permanent layout for two consecutive years, 2004-05 and 2005-06 at Arid Zone Research Institute D.I. Khan. Soil under study was deficient in Zn (0.8 mg kg-1. Effect of Zn on yield, Zn concentrations in leaf and soils were assessed using wheat variety Naseer-2000 and rice variety IRRI-6. Three rates of Zn, ranging from 0 to 10 kg ha-1 in soil, were applied as zinc sulphate (ZnSO4. 7H2O along with basal dose fertilization of nitrogen, phosphorus and potassium. Mature leaf and soil samples were collected at panicle initiation stage. The results showed that grain yield of wheat and rice was significantly increased by the direct application of 5 and 10 kg Zn ha-1. Highest grain yield of wheat (5467 kg ha-1 was recorded with the direct application of 10 kg Zn ha-1 while 4994 kg ha-1 was recorded with the cumulative application of 10 kg Zn ha-1 but the yield increase due to residual effect of Zn was statistically lower than the cumulative effect of Zn. Maximum paddy yield was recorded with the cumulative application ofZn followed by residual and direct applied 10 and 5 kg Zn kg ha-1, respectively. Zn concentration in soils ranged from 0.3 to 1.5 mg kg-1 in wheat and 0.24 to 2.40 mg kg-1 in rice, while in leaves it ranged from 18-48 mg kg-1 in wheat and 15-52 mg kg-1 in rice. The concentration of Zn in soil and leaves increased due to the treatments in the order; cumulative > residual > direct effect > control (without Zn. The yield attributes like 1000- grain weight, number of spikes, spike length and plant height were increased by the residual, direct and cumulative effect of Zn levels; however, the magnitude of increase was higher in cumulative effect than residual and direct effect of Zn, respectively. Under Zn-deficient soil

  20. Analysis of Biochemical Control and Prognostic Factors in Patients Treated With Either Low-Dose Three-Dimensional Conformal Radiation Therapy or High-Dose Intensity-Modulated Radiotherapy for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Vora, Sujay A.; Wong, William W.; Schild, Steven E.; Ezzell, Gary A.; Halyard, Michele Y.

    2007-01-01

    Purpose: To identify prognostic factors and evaluate biochemical control rates for patients with localized prostate cancer treated with either high-dose intensity-modulated radiotherapy (IMRT) or conventional-dose three-dimensional conformal radiotherapy 3D-CRT. Methods: Four hundred sixteen patients with a minimum follow-up of 3 years (median, 5 years) were included. Two hundred seventy-one patients received 3D-CRT with a median dose of 68.4 Gy (range, 66-71 Gy). The next 145 patients received IMRT with a median dose of 75.6 Gy (range, 70.2-77.4 Gy). Biochemical control rates were calculated according to both American Society for Therapeutic Radiology and Oncology (ASTRO) consensus definitions. Prognostic factors were identified using both univariate and multivariate analyses. Results: The 5-year biochemical control rate was 60.4% for 3D-CRT and 74.1% for IMRT (p < 0.0001, first ASTRO Consensus definition). Using the ASTRO Phoenix definition, the 5-year biochemical control rate was 74.4% and 84.6% with 3D-RT and IMRT, respectively (p = 0.0326). Univariate analyses determined that PSA level, T stage, Gleason score, perineural invasion, and radiation dose were predictive of biochemical control. On multivariate analysis, dose, Gleason score, and perineural invasion remained significant. Conclusion: On the basis of both ASTRO definitions, dose, Gleason score, and perineural invasion were predictive of biochemical control. Intensity-modulated radiotherapy allowed delivery of higher doses of radiation with very low toxicity, resulting in improved biochemical control

  1. Male gonadal dose an adjuvant 3-D-pelvic irradiation after anterior resection of rectal cancer. Influence to fertility

    International Nuclear Information System (INIS)

    Piroth, M.D.; Hensley, F.; Wannenmacher, M.; Zierhut, D.

    2003-01-01

    Background: Rectal cancer is a common malignant disease and occurs not infrequently in younger men. We verified the dose to the testes from scattered radiation in adjuvant pelvic irradiation following anterior resection of rectal cancer. Patients and Method: We measured the scattered gonadal dose of 18 patients in vivo with thermoluminescence detectors, which were fixed on four defined points on the scrotum during radiation on three consecutive days. All patients were treated three-dimensionally planned using a three-field box lying in prone position in a bellyboard. A total dose of 50.4 Gy was given in 28 fractions of 1.8 Gy. From 45 up to 50.4 Gy the radiation fields were modified to lateral-opposing fields which were shortened from the top to protect the small bowel. Results: The mean gonadal dose per fraction of all patients was 0.057 Gy (median 0.05 Gy) with a range between 0.035 and 0.114 Gy. The standard deviation was 0.02 Gy. The calculated cumulative mean gonadal dose after 28 fractions was 1.60 Gy (0.98-3.19 Gy). Conclusions: Germinal epithelium is very sensitive to low-dose irradiation, according to a negative fractionation effect. It is known that gonadal total doses of 1 Gy with single doses of 0.03-0.05 Gy can result in a temporary azoospermia with following recovery in most cases. If gonadal total doses exceed 1.5 Gy a substantial increase in irreversible azoospermia must be expected. With respect to the data reported in the literature our measured mean gonadal total dose of 1.60 Gy will lead with high probability to an irreversible infertility. Because of the small number of patients in our study, the data must be interpreted with caution, however, it is very important in patient's informed consent to draw attention to the high risk of infertility. The possibility of sperm cryoconservation should be discussed with the patient. (orig.) [de

  2. Remarks on reporting and recording consistent with the ICRU Reference Dose

    Directory of Open Access Journals (Sweden)

    Gainey Mark

    2009-10-01

    Full Text Available Abstract Background ICRU 50/62 provides a framework to facilitate the reporting of external beam radiotherapy treatments from different institutions. A predominant role is played by points that represent "the PTV dose". However, for new techniques like Intensity Modulated Radiotherapy (IMRT - especially step and shoot IMRT - it is difficult to define a point whose dose can be called "characteristic" of the PTV dose distribution. Therefore different volume based methods of reporting of the prescribed dose are in use worldwide. Several of them were compared regarding their usability for IMRT and compatibility with the ICRU Reference Point dose for conformal radiotherapy (CRT in this study. Methods The dose distributions of 45 arbitrarily chosen volumes treated by CRT plans and 57 volumes treated by IMRT plans were used for comparison. Some of the IMRT methods distinguish the planning target volume (PTV and its central part PTVx (PTV minus a margin region of × mm. The reporting of dose prescriptions based on mean and median doses together with the dose to 95% of the considered volume (D95 were compared with each other and in respect of a prescription report with the aid of one or several possible ICRU Reference Points. The correlation between all methods was determined using the standard deviation of the ratio of all possible pairs of prescription reports. In addition the effects of boluses and the characteristics of simultaneous integrated boosts (SIB were examined. Results Two types of methods result in a high degree of consistency with the hitherto valid ICRU dose reporting concept: the median dose of the PTV and the mean dose to the central part of the PTV (PTVx. The latter is similar to the CTV, if no nested PTVs are used and no patient model surfaces are involved. A reporting of dose prescription using the CTV mean dose tends to overestimate the plateau doses of the lower dose plateaus of SIB plans. PTVx provides the possibility to approach

  3. Remarks on reporting and recording consistent with the ICRU Reference Dose

    International Nuclear Information System (INIS)

    Bratengeier, Klaus; Oechsner, Markus; Gainey, Mark; Flentje, Michael

    2009-01-01

    ICRU 50/62 provides a framework to facilitate the reporting of external beam radiotherapy treatments from different institutions. A predominant role is played by points that represent 'the PTV dose'. However, for new techniques like Intensity Modulated Radiotherapy (IMRT) - especially step and shoot IMRT - it is difficult to define a point whose dose can be called 'characteristic' of the PTV dose distribution. Therefore different volume based methods of reporting of the prescribed dose are in use worldwide. Several of them were compared regarding their usability for IMRT and compatibility with the ICRU Reference Point dose for conformal radiotherapy (CRT) in this study. The dose distributions of 45 arbitrarily chosen volumes treated by CRT plans and 57 volumes treated by IMRT plans were used for comparison. Some of the IMRT methods distinguish the planning target volume (PTV) and its central part PTV x (PTV minus a margin region of × mm). The reporting of dose prescriptions based on mean and median doses together with the dose to 95% of the considered volume (D 95 ) were compared with each other and in respect of a prescription report with the aid of one or several possible ICRU Reference Points. The correlation between all methods was determined using the standard deviation of the ratio of all possible pairs of prescription reports. In addition the effects of boluses and the characteristics of simultaneous integrated boosts (SIB) were examined. Two types of methods result in a high degree of consistency with the hitherto valid ICRU dose reporting concept: the median dose of the PTV and the mean dose to the central part of the PTV (PTV x ). The latter is similar to the CTV, if no nested PTVs are used and no patient model surfaces are involved. A reporting of dose prescription using the CTV mean dose tends to overestimate the plateau doses of the lower dose plateaus of SIB plans. PTV x provides the possibility to approach biological effects

  4. Evaluation of adverse events noted in children receiving continuous infusions of dexmedetomidine in the intensive care unit.

    Science.gov (United States)

    Honey, Brooke L; Harrison, Donald L; Gormley, Andrew K; Johnson, Peter N

    2010-01-01

    Dexmedetomidine is an α(2)-adrenergic receptor agonist with sedative and analgesic effects in mechanically ventilated adults and children. Safety and efficacy data are limited in children. The purpose of this study is to retrospectively identify the incidence and types of adverse events noted in children receiving continuous infusions of dexmedetomidine and evaluate potential risk factors for adverse events. Between July 1, 2006, and July 31, 2007, data were collected on all children (events. The primary endpoint was the total number of adverse events noted, including: transient hypertension, hypotension, neurological manifestations, apnea, and bradycardia. Secondary endpoints included categorization of each type of adverse event and an assessment of risk factors. A logistic regression model was used to assess the relationship of adverse events with independent variables including length of ICU stay, cumulative dose, peak infusion rate, duration of therapy, PRISM III score, and bolus dose. Thirty-six patients received dexmedetomidine representing 41 infusions. The median age was 16 months (range, 0.1-204 months) and median PRISM III score was 2 (range, 0-18). Eighteen (43.9%) patients received a bolus dose of dexmedetomidine. The median cumulative dose (mcg/kg) and peak dose (mcg/kg/hr) were 8.5 (range, 2.2-193.7) and 0.5 (range, 0.2-0.7), respectively. Dexmedetomidine was continued for a median of 20 (range, 3-263) hours. Six (14.6%) patients were slowly tapered off the continuous infusions. Twenty-one adverse events were noted in 17 patients, including 4 neurologic manifestations. Fourteen patients required interventions for adverse events. ICU length of stay was the only independent risk factor (p=0.036) for development of adverse events. Several potential adverse events were noted with dexmedetomidine continuous infusions including possible neurological manifestations. Further studies are needed looking at adverse events associated with dexmedetomidine use in

  5. Measurement of four-particle cumulants and symmetric cumulants with subevent methods in small collision systems with the ATLAS detector

    CERN Document Server

    Derendarz, Dominik; The ATLAS collaboration

    2018-01-01

    Measurements of symmetric cumulants SC(n,m)=⟨v2nv2m⟩−⟨v2n⟩⟨v2m⟩ for (n,m)=(2,3) and (2,4) and asymmetric cumulant AC(n) are presented in pp, p+Pb and peripheral Pb+Pb collisions at various collision energies, aiming to probe the long-range collective nature of multi-particle production in small systems. Results are obtained using the standard cumulant method, as well as the two-subevent and three-subevent cumulant methods. Results from the standard method are found to be strongly biased by non-flow correlations as indicated by strong sensitivity to the chosen event class definition. A systematic reduction of non-flow effects is observed when using the two-subevent method and the results become independent of event class definition when the three-subevent method is used. The measured SC(n,m) shows an anti-correlation between v2 and v3, and a positive correlation between v2 and v4. The magnitude of SC(n,m) is constant with Nch in pp collisions, but increases with Nch in p+Pb and Pb+Pb collisions. ...

  6. Sosiaalisen median markkinoinnin vuosikello Weecos Oy:lle

    OpenAIRE

    Heinämäki, Lotta; Huuskonen, Leena

    2015-01-01

    Opinnäytetyön tarkoitus oli luoda kokonaisvaltainen ja selkeä suunnitelma Weecos Oy:n markkinointitoimenpiteille valituissa sosiaalisen median kanavissa. Weecos on vuonna 2012 perustettu ekologisia yrityksiä yhteen keräävä verkkokauppa-alusta. Pienestä koostaan johtuen se ei ole pystynyt toteuttamaan sosiaalisen median markkinointia toivomallaan tavalla ja markkinoinnin suunnittelu ja toteutus on ollut epäsäännöllistä. Markkinointisuunnitelman tavoitteena oli helpottaa yrityksen markkinoi...

  7. Cumulative risk assessment for plasticizer-contaminated food using the hazard index approach

    International Nuclear Information System (INIS)

    Chang, J.W.; Yan, B.R.; Chang, M.H.; Tseng, S.H.; Kao, Y.M.; Chen, J.C.; Lee, C.C.

    2014-01-01

    Phthalates strongly and adversely affect reproduction, development and liver function. We did a cumulative risk assessment for simultaneous exposure to nine phthalates using the hazard index (HI) and the levels of nine phthalates in 1200 foodstuff samples. DEHP (di-2-ethylhexyl phthalate) present the highest level (mean: 0.443 mg/kg) in 1200 samples, and the highest average daily dose (ADD) was found in DEHP, ΣDBP (i + n) (the sum of dibutyl phthalate [DBP] isomers [DnBP + DiBP]) posed the highest risk potential of all the phthalates. In seven phthalates, the 95th percentiles of the ADDs for ΣDBP (i + n) in 0–6-yr-old children accounted for 91% (79–107%) of the tolerable daily intake, and the 95th percentiles of the HIs for the anti-androgenic effects of five phthalates in 0–3-yr-old children and 4–6-yr-old girls were >1. We conclude that the health of younger Taiwanese may be adversely affected by overexposure of phthalate-contaminated foods. - Graphical abstract: In seven phthalates, the 95th percentile of the average daily dose (ADD) for ΣDBP (i + n) (the sum of dibutyl phthalate [DBP] isomers [DnBP + DiBP]) in 0–3-yr-old male (0–3 M) and female (0–3 F) children accounted for 97% and 84% of TDIs, respectively. For 4–6-yr-old and 7–12-yr-old males and 7–12-yr-old females, ADDs for ΣDBP (i + n) accounted for 79%, 72%, and 65% of TDIs, respectively. - Highlights: • A cumulative risk assessment of PAEs was used in a severe plasticizer-contaminated food episode. • ΣDBP (i + n) posed the highest risk potential of all the dietary phthalates. • Females 4–6 yr old had the highest risk for anti-androgenic effects. • Beverages, milk and dairy products were the major contributors to average daily dose of phthalate esters. - The health of young Taiwanese may be adversely affected by overexposure of plasticizer-contaminated food

  8. Patient radiation dose during fluoroscopy testes with contrast medium

    International Nuclear Information System (INIS)

    Darsalih, Abir Abdelrady El noor

    2016-09-01

    The purpose of this study was to assess the patient radiation dose received in fluoroscopy examinations during contrast medium. The cumulative air kerma (Ck), kerma area product (KAP) and fluoroscopy time were measured for sixty ( male and female ) patients undergoing five fluoroscopy examinations KAP metre which was installed for the purpose of this study. The mean kerma area product were found to be 2.681, 5.1561, 9.85529. 5.7974 and 13.09 Gy.cm"2 for HSG, A.S and D.S, GI Track and sonogram tests, respectively. The obtained mean cumulative dose was were 6.31, 13.88, 24.61, 22.56 and 32.14 mGy for HSG, A.S, A.S and D.S , GI Track, respectively, the mean fluoroscopy time were. 0.18, 0.51,0.89,1.57 and 1.75 min, for HSG, A.S, A.S, and D.S, G1 Track and sonogram test respectively. Patient dose is mainly dependent on the patient size, procedure, equipment used exposure factor and user experience. As KV and mA were controlled by the AEC and it was found to be well calibrated, possible optimization could be achieved by radiologist by decreasing the exposure time if possible. (Author)

  9. Nonmetastatic osteosarcoma of the extremity. Neoadjuvant chemotherapy with methotrexate, cisplatin, doxorubicin and ifosfamide. An Italian Sarcoma Group study (ISG/OS-Oss).

    Science.gov (United States)

    Ferrari, Stefano; Meazza, Cristina; Palmerini, Emanuela; Tamburini, Angela; Fagioli, Franca; Cozza, Raffaele; Ferraresi, Virginia; Bisogno, Gianni; Mascarin, Maurizio; Cefalo, Graziella; Manfrini, Marco; Capanna, Rodolfo; Biagini, Roberto; Donati, Davide; Picci, Piero

    2014-01-01

    Based on the results of the ISG/OS-1 study, the MAP regimen (methotrexate [MTX], doxorubicin [ADM] and cisplatin [CDP] with the addition of ifosfamide [IFO] in poor-responder patients) was investigated in patients with nonmetastatic osteosarcoma of the extremity (ISG/OS-Oss study). Compared with the ISG/OS-1 study (cumulative doses: ADM 420 mg/m(2), MTX 120 g/m(2), CDP 600 mg/m(2), IFO 30 g/m(2)), the ISG/OS-Oss study reduced the number of MTX cycles from 10 to 5 (cumulative MTX dose: 60 g/m(2)) in order to diminish treatment duration and toxicity. From January 2007 to June 2011, 171 patients (median age 16 years, 60% males) were registered. The limb salvage rate was 94% and the good pathologic response rate 51% (these figures were 92% and 48%, respectively, in the ISG/OS-1 study). At a median follow-up of 39 months (range, 4-80), the 5-year overall survival rate was 80% (95% CI, 73%-87%) and the event-free survival was 50% (95% CI, 39%-59%). For comparison, the 5-year overall and event-free survival rates in ISG/OS-1 were 73% (95% CI, 65%-81%) and 64% (95% CI, 56%-73%), respectively. This study confirms that in nonmetastatic osteosarcoma of the extremity, conservative surgery in more than 90% and a good pathologic response rate of 50% can be expected with primary chemotherapy based on the MAP regimen. The response and resection rates in the ISG/OS-Oss study are in the same range as those of the previous study, whereas the event-free survival is lower than that previously achieved. Since the only difference between the two studies was the cumulative dose of postoperatively given MTX, our data support the importance of the cumulative dose of MTX in the MAP regimen.

  10. Planning Target Volume D95 and Mean Dose Should Be Considered for Optimal Local Control for Stereotactic Ablative Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Lina [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zhou, Shouhao [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Balter, Peter [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Shen, Chan [Department of Health Service Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gomez, Daniel R.; Welsh, James D.; Lin, Steve H. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Joe Y., E-mail: jychang@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2016-07-15

    Purpose: To identify the optimal dose parameters predictive for local/lobar control after stereotactic ablative radiation therapy (SABR) in early-stage non-small cell lung cancer (NSCLC). Methods and Materials: This study encompassed a total of 1092 patients (1200 lesions) with NSCLC of clinical stage T1-T2 N0M0 who were treated with SABR of 50 Gy in 4 fractions or 70 Gy in 10 fractions, depending on tumor location/size, using computed tomography-based heterogeneity corrections and a convolution superposition calculation algorithm. Patients were monitored by chest CT or positron emission tomography/CT and/or biopsy after SABR. Factors predicting local/lobar recurrence (LR) were determined by competing risk multivariate analysis. Continuous variables were divided into 2 subgroups at cutoff values identified by receiver operating characteristic curves. Results: At a median follow-up time of 31.7 months (interquartile range, 14.8-51.3 months), the 5-year time to local recurrence within the same lobe and overall survival rates were 93.8% and 44.8%, respectively. Total cumulative number of patients experiencing LR was 40 (3.7%), occurring at a median time of 14.4 months (range, 4.8-46 months). Using multivariate competing risk analysis, independent predictive factors for LR after SABR were minimum biologically effective dose (BED{sub 10}) to 95% of planning target volume (PTVD95 BED{sub 10}) ≤86 Gy (corresponding to PTV D95 physics dose of 42 Gy in 4 fractions or 55 Gy in 10 fractions) and gross tumor volume ≥8.3 cm{sup 3}. The PTVmean BED{sub 10} was highly correlated with PTVD95 BED{sub 10.} In univariate analysis, a cutoff of 130 Gy for PTVmean BED{sub 10} (corresponding to PTVmean physics dose of 55 Gy in 4 fractions or 75 Gy in 10 fractions) was also significantly associated with LR. Conclusions: In addition to gross tumor volume, higher radiation dose delivered to the PTV predicts for better local/lobar control. We recommend that both PTVD95 BED

  11. Online Scheduling in Manufacturing A Cumulative Delay Approach

    CERN Document Server

    Suwa, Haruhiko

    2013-01-01

    Online scheduling is recognized as the crucial decision-making process of production control at a phase of “being in production" according to the released shop floor schedule. Online scheduling can be also considered as one of key enablers to realize prompt capable-to-promise as well as available-to-promise to customers along with reducing production lead times under recent globalized competitive markets. Online Scheduling in Manufacturing introduces new approaches to online scheduling based on a concept of cumulative delay. The cumulative delay is regarded as consolidated information of uncertainties under a dynamic environment in manufacturing and can be collected constantly without much effort at any points in time during a schedule execution. In this approach, the cumulative delay of the schedule has the important role of a criterion for making a decision whether or not a schedule revision is carried out. The cumulative delay approach to trigger schedule revisions has the following capabilities for the ...

  12. Cancer risk of low dose/low dose rate radiation: a meta-analysis of cancer data of mammals exposed to low doses of radiation

    International Nuclear Information System (INIS)

    Ogata, Hiromitsu; Magae, Junji

    2008-01-01

    Full text: Linear No Threshold (LNT) model is a basic theory for radioprotection, but the adaptability of this hypothesis to biological responses at low doses or at low dose rates is not sufficiently investigated. Simultaneous consideration of the cumulative dose and the dose rate is necessary for evaluating the risk of long-term exposure to ionizing radiation at low dose. This study intends to examine several numerical relationships between doses and dose rates in biological responses to gamma radiation. Collected datasets on the relationship between dose and the incidence of cancer in mammals exposed to low doses of radiation were analysed using meta-regression models and modified exponential (MOE) model, which we previously published, that predicts irradiation time-dependent biological response at low dose rate ionizing radiation. Minimum doses of observable risk and effective doses with a variety of dose rates were calculated using parameters estimated by fitting meta-regression models to the data and compared them with other statistical models that find values corresponding to 'threshold limits'. By fitting a weighted regression model (fixed-effects meta-regression model) to the data on risk of all cancers, it was found that the log relative risk [log(RR)] increased as the total exposure dose increased. The intersection of this regression line with the x-axis denotes the minimum dose of observable risk. These estimated minimum doses and effective doses increased with decrease of dose rate. The goodness of fits of MOE-model depended on cancer types, but the total cancer risk is reduced when dose rates are very low. The results suggest that dose response curve for cancer risk is remarkably affected by dose rate and that dose rate effect changes as a function of dose rate. For scientific discussion on the low dose exposure risk and its uncertainty, the term 'threshold' should be statistically defined, and dose rate effects should be included in the risk

  13. Dose and diameter relationships for facial, trigeminal, and acoustic neuropathies following acoustic neuroma radiosurgery

    International Nuclear Information System (INIS)

    Flickinger, John C.; Kondziolka, Douglas; Lunsford, L. Dade

    1996-01-01

    Purpose and objective: To define the relationships between dose and tumor diameter for the risks of developing trigeminal, facial, and acoustic neuropathies after acoustic neuroma radiosurgery, a large single-institution experience was analyzed. Materials and methods: Two hundred and thirty-eight patients with unilateral acoustic neuromas who underwent Gamma knife radiosurgery between 1987-1994 with 6-91 months of follow-up (median 30 months) were studied. Minimum tumor doses were 12-20 Gy (median 15 Gy). Transverse tumor diameter varied from 0.3-5.5 cm (median 2.1 cm). The relationships of dose and diameter to the development of cranial neuropathies were delineated by multivariate logistic regression. Results: The development of post-radiosurgery neuropathies affecting cranial nerves V, VII, and VIII were correlated with minimum tumor dose and transverse tumor diameter (P min for VIII where P=0.10). A comparison of the dose-diameter response curves showed the acoustic nerve to be the most sensitive to doses of 12-16 Gy and the facial nerve to be the least sensitive. Conclusion: The risks of developing trigeminal, facial, and acoustic neuropathies following acoustic neuroma radiosurgery can be predicted from the transverse tumor diameter and the minimum tumor dose using models constructed from data presently available

  14. Estimation of staff lens doses during interventional procedures. Comparing cardiology, neuroradiology and interventional radiology.

    Science.gov (United States)

    Vano, E; Sanchez, R M; Fernandez, J M

    2015-07-01

    The purpose of this article is to estimate lens doses using over apron active personal dosemeters in interventional catheterisation laboratories (cardiology IC, neuroradiology IN and radiology IR) and to investigate correlations between occupational lens doses and patient doses. Active electronic personal dosemeters placed over the lead apron were used on a sample of 204 IC procedures, 274 IN and 220 IR (all performed at the same university hospital). Patient dose values (kerma area product) were also recorded to evaluate correlations with occupational doses. Operators used the ceiling-suspended screen in most cases. The median and third quartile values of equivalent dose Hp(10) per procedure measured over the apron for IC, IN and IR resulted, respectively, in 21/67, 19/44 and 24/54 µSv. Patient dose values (median/third quartile) were 75/128, 83/176 and 61/159 Gy cm(2), respectively. The median ratios for dosemeters worn over the apron by operators (protected by the ceiling-suspended screen) and patient doses were 0.36; 0.21 and 0.46 µSv Gy(-1) cm(-2), respectively. With the conservative approach used (lens doses estimated from the over apron chest dosemeter) we came to the conclusion that more than 800 procedures y(-1) and per operator were necessary to reach the new lens dose limit for the three interventional specialties. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. Eye lens dosimetry in interventional cardiology: Results of staff dose measurements and link to patient dose levels

    International Nuclear Information System (INIS)

    Antic, V.; Ciraj-Bjelac, O.; Rehani, M.; Aleksandric, S.; Arandjic, D.; Ostojic, M.

    2013-01-01

    Workers involved in interventional cardiology procedures receive high eye lens dose if protection is not used. Currently, there is no suitable method for routine use for the measurement of eye dose. Since most angiography machines are equipped with suitable patient dosemeters, deriving factors linking staff eye doses to the patient doses can be helpful. In this study the patient kerma-area product, cumulative dose at an interventional reference point and eye dose in terms of Hp(3) of the cardiologists, nurses and radiographers for interventional cardiology procedures have been measured. Correlations between the patient dose and the staff eye dose were obtained. The mean eye dose was 121 mSv for the first operator, 33 mSv for the second operator/nurse and 12 mSv for radiographer. Normalised eye lens doses per unit kerma-area product were 0.94 mSv Gy -1 cm -2 for the first operator, 0.33 mSv Gy -1 cm -2 for the second operator/nurse and 0.16 mSv Gy -1 cm -2 for radiographers. Statistical analysis indicated that there is a weak but significant (p < 0.01) correlation between the eye dose and the kerma-area product for all three staff categories. These values are based on a local practice and may provide useful reference for other studies for validation and for wider utilisation in assessing the eye dose using patient dose values. (authors)

  16. ICRU reference dose in an era of intensity-modulated radiation therapy clinical trials: Correlation with planning target volume mean dose and suitability for intensity-modulated radiation therapy dose prescription

    International Nuclear Information System (INIS)

    Yaparpalvi, Ravindra; Hong, Linda; Mah, Dennis; Shen Jin; Mutyala, Subhakar; Spierer, Marnee; Garg, Madhur; Guha, Chandan; Kalnicki, Shalom

    2008-01-01

    Background and Purpose: IMRT clinical trials lack dose prescription and specification standards similar to ICRU standards for two- and three-dimensional external beam planning. In this study, we analyzed dose distributions for patients whose treatment plans incorporated IMRT, and compared the dose determined at the ICRU reference point to the PTV doses determined from dose-volume histograms. Additionally, we evaluated if ICRU reference type single-point dose prescriptions are suitable for IMRT dose prescriptions. Materials and methods: For this study, IMRT plans of 117 patients treated at our institution were randomly selected and analyzed. The treatment plans were clinically applied to the following disease sites: abdominal (11), anal (10), brain (11), gynecological (15), head and neck (25), lung (15), male pelvis (10) and prostate (20). The ICRU reference point was located in each treatment plan following ICRU Report 50 guidelines. The reference point was placed in the central part of the PTV and at or near the isocenter. In each case, the dose was calculated and recorded to this point. For each patient - volume and dose (PTV, PTV mean, median and modal) information was extracted from the planned dose-volume histogram. Results: The ICRU reference dose vs PTV mean dose relationship in IMRT exhibited a weak positive association (Pearson correlation coefficient 0.63). In approximately 65% of the cases studied, dose at the ICRU reference point was greater than the corresponding PTV mean dose. The dose difference between ICRU reference and PTV mean doses was ≤2% in approximately 79% of the cases studied (average 1.21% (±1.55), range -4% to +4%). Paired t-test analyses showed that the ICRU reference doses and PTV median doses were statistically similar (p = 0.42). The magnitude of PTV did not influence the difference between ICRU reference and PTV mean doses. Conclusions: The general relationship between ICRU reference and PTV mean doses in IMRT is similar to that

  17. Improving cumulative effects assessment in Alberta: Regional strategic assessment

    International Nuclear Information System (INIS)

    Johnson, Dallas; Lalonde, Kim; McEachern, Menzie; Kenney, John; Mendoza, Gustavo; Buffin, Andrew; Rich, Kate

    2011-01-01

    The Government of Alberta, Canada is developing a regulatory framework to better manage cumulative environmental effects from development in the province. A key component of this effort is regional planning, which will lay the primary foundation for cumulative effects management into the future. Alberta Environment has considered the information needs of regional planning and has concluded that Regional Strategic Assessment may offer significant advantages if integrated into the planning process, including the overall improvement of cumulative environmental effects assessment in the province.

  18. Estimation of absorbed doses in humans due to intravenous administration of fluorine-18-fluorodeoxyglucose in PET studies

    International Nuclear Information System (INIS)

    Mejia, A.A.; Nakamura, T.; Masatoshi, I.; Hatazawa, J.; Masaki, M.; Watanuki, S.

    1991-01-01

    Radiation absorbed doses due to intravenous administration of fluorine-18-fluorodeoxyglucose in positron emission tomography (PET) studies were estimated in normal volunteers. The time-activity curves were obtained for seven human organs (brain, heart, kidney, liver, lung, pancreas, and spleen) by using dynamic PET scans and for bladder content by using a single detector. These time-activity curves were used for the calculation of the cumulative activity in these organs. Absorbed doses were calculated by the MIRD method using the absorbed dose per unit of cumulated activity, 'S' value, transformed for the Japanese physique and the organ masses of the Japanese reference man. The bladder wall and the heart were the organs receiving higher doses of 1.2 x 10(-1) and 4.5 x 10(-2) mGy/MBq, respectively. The brain received a dose of 2.9 x 10(-2) mGy/MBq, and other organs received doses between 1.0 x 10(-2) and 3.0 x 10(-2) mGy/MBq. The effective dose equivalent was estimated to be 2.4 x 10(-2) mSv/MBq. These results were comparable to values of absorbed doses reported by other authors on the radiation dosimetry of this radiopharmaceutical

  19. Medium-dose-rate intracavitary brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    Tanaka, Eiichi; Isohashi, Fumiaki; Oh, Ryoong-Jin

    2003-01-01

    The purpose of this study was to evaluate the results of medium-dose-rate (MDR) intracavitary brachytherapy (ICRT) for cervical cancer. Between May 1991 and March 2001, 80 patients with cervical cancer were treated with external radiotherapy combined with MDR-ICRT. Two patients were excluded from this study. The median age of patients was 61 years (range: 30-87 years). Seventy-five patients had pathologically proved squamous cell carcinoma, and 3 had adenocarcinoma. The patients were staged by Union Internationale Contre le Cancer (UICC) classification as follows: Stage IA (2), Stage IB (4), Stage IIA (5), Stage IIB (22), Stage IIIA (1), Stage IIIB (32), Stage IVA (5), Stage IVB (7). Median follow-up for survivor was 68 months (range: 12-131 months). The radiation therapy was based on a combination of ICRT and external pelvic irradiation. Patients with stages II, III and IVA were treated with whole-pelvic irradiation with respective total doses of 20, 30, and 40 Gy. Doses of 40, 30, 20, and 20 Gy parametrial irradiation were added with central shield pelvic irradiation for stages IB, II, III and IVA lesions respectively. For MDR-ICRT, from May 1991 to December 1995, point A dose were 40 Gy/4 fractions for stages I and II, 38 Gy/4 fractions for stage III, and 28.5 Gy/3 fractions for stage IVA. And from January 1996 to March 2001, point A dose of 36 Gy/4 fractions for stages I and II, 34 Gy/4 fractions for stage III, and 25.5 Gy/3 fractions for stage IVA. The median dose rate at point A was 1.7 Gy/hour (range: 1.3-2.2 Gy/hour). The 5-year cause-specific survival rates were 100%, 76%, 51% and 40% for stages I, II, III and IVA respectively. All patients with stage IVB died from the tumor with a median survival time of 12 months. The 5-year pelvic control rates were 100%, 88%, 69% and 40% for stages I, II, III and IVA respectively. Major late complications occurred in 2 patients (3%). One patient developed vesico- and recto-vaginal fistulae, and died of pelvic infection

  20. Gamma Low-Dose-Rate Ionizing Radiation Stimulates Adaptive Functional and Molecular Response in Human Aortic Endothelial Cells in a Threshold-, Dose-, and Dose Rate-Dependent Manner.

    Science.gov (United States)

    Vieira Dias, Juliana; Gloaguen, Celine; Kereselidze, Dimitri; Manens, Line; Tack, Karine; Ebrahimian, Teni G

    2018-01-01

    A central question in radiation protection research is whether low-dose and low-dose-rate (LDR) exposures to ionizing radiation play a role in progression of cardiovascular disease. The response of endothelial cells to different LDR exposures may help estimate risk of cardiovascular disease by providing the biological mechanism involved. We investigated the effect of chronic LDR radiation on functional and molecular responses of human aorta endothelial cells (HAoECs). Human aorta endothelial cells were continuously irradiated at LDR (6 mGy/h) for 15 days and analyzed at time points when the cumulative dose reached 0.05, 0.5, 1.0, and 2.0 Gy. The same doses were administered acutely at high-dose rate (HDR; 1 Gy/min). The threshold for the loss of angiogenic capacity for both LDR and HDR radiations was between 0.5 and 1.0 Gy. At 2.0 Gy, angiogenic capacity returned to normal only for HAoEC exposed to LDR radiation, associated with increased expression of antioxidant and anti-inflammatory genes. Pre-LDR, but not pre-HDR, radiation, followed by a single acute 2.0 Gy challenge dose sustained the expression of antioxidant and anti-inflammatory genes and stimulated angiogenesis. Our results suggest that dose rate is important in cellular response and that a radioadaptive response is involved for a 2.0 Gy dose at LDR.

  1. Gamma Low-Dose-Rate Ionizing Radiation Stimulates Adaptive Functional and Molecular Response in Human Aortic Endothelial Cells in a Threshold-, Dose-, and Dose Rate–Dependent Manner

    Science.gov (United States)

    Vieira Dias, Juliana; Gloaguen, Celine; Kereselidze, Dimitri; Manens, Line; Tack, Karine; Ebrahimian, Teni G

    2018-01-01

    A central question in radiation protection research is whether low-dose and low-dose-rate (LDR) exposures to ionizing radiation play a role in progression of cardiovascular disease. The response of endothelial cells to different LDR exposures may help estimate risk of cardiovascular disease by providing the biological mechanism involved. We investigated the effect of chronic LDR radiation on functional and molecular responses of human aorta endothelial cells (HAoECs). Human aorta endothelial cells were continuously irradiated at LDR (6 mGy/h) for 15 days and analyzed at time points when the cumulative dose reached 0.05, 0.5, 1.0, and 2.0 Gy. The same doses were administered acutely at high-dose rate (HDR; 1 Gy/min). The threshold for the loss of angiogenic capacity for both LDR and HDR radiations was between 0.5 and 1.0 Gy. At 2.0 Gy, angiogenic capacity returned to normal only for HAoEC exposed to LDR radiation, associated with increased expression of antioxidant and anti-inflammatory genes. Pre-LDR, but not pre-HDR, radiation, followed by a single acute 2.0 Gy challenge dose sustained the expression of antioxidant and anti-inflammatory genes and stimulated angiogenesis. Our results suggest that dose rate is important in cellular response and that a radioadaptive response is involved for a 2.0 Gy dose at LDR. PMID:29531508

  2. A bivariate optimal replacement policy with cumulative repair cost ...

    Indian Academy of Sciences (India)

    Min-Tsai Lai

    Shock model; cumulative damage model; cumulative repair cost limit; preventive maintenance model. 1. Introduction ... with two types of shocks: one type is failure shock, and the other type is damage ...... Theory, methods and applications.

  3. Esophageal Toxicity From High-Dose, Single-Fraction Paraspinal Stereotactic Radiosurgery

    International Nuclear Information System (INIS)

    Cox, Brett W.; Jackson, Andrew; Hunt, Margie; Bilsky, Mark; Yamada, Yoshiya

    2012-01-01

    Purpose: To report the esophageal toxicity from single-fraction paraspinal stereotactic radiosurgery (SRS) and identify dosimetric and clinical risk factors for toxicity. Methods and Materials: A total of 204 spinal metastases abutting the esophagus (182 patients) were treated with high-dose single-fraction SRS during 2003-2010. Toxicity was scored using the National Cancer Institute Common Toxicity Criteria for Adverse Events, version 4.0. Dose-volume histograms were combined to generate a comprehensive atlas of complication incidence that identifies risk factors for toxicity. Correlation of dose-volume factors with esophageal toxicity was assessed using Fisher’s exact test and logistic regression. Clinical factors were correlated with toxicity. Results: The median dose to the planning treatment volume was 24 Gy. Median follow-up was 12 months (range, 3-81). There were 31 (15%) acute and 24 (12%) late esophageal toxicities. The rate of grade ≥3 acute or late toxicity was 6.8% (14 patients). Fisher’s exact test resulted in significant median splits for grade ≥3 toxicity at V12 = 3.78 cm 3 (relative risk [RR] 3.7, P=.05), V15 = 1.87 cm 3 (RR 13, P=.0013), V20 = 0.11 cm 3 (RR 6, P=0.01), and V22 = 0.0 cm 3 (RR 13, P=.0013). The median split for D2.5 cm 3 (14.02 Gy) was also a significant predictor of toxicity (RR 6; P=.01). A highly significant logistic regression model was generated on the basis of D2.5 cm 3 . One hundred percent (n = 7) of grade ≥4 toxicities were associated with radiation recall reactions after doxorubicin or gemcitabine chemotherapy or iatrogenic manipulation of the irradiated esophagus. Conclusions: High-dose, single-fraction paraspinal SRS has a low rate of grade ≥3 esophageal toxicity. Severe esophageal toxicity is minimized with careful attention to esophageal doses during treatment planning. Iatrogenic manipulation of the irradiated esophagus and systemic agents classically associated with radiation recall reactions are

  4. Intracranial germinoma: the case for lower dose radiation therapy

    International Nuclear Information System (INIS)

    Hardenbergh, Patricia Harrigan; Golden, Jeffrey; Billet, Amy; Scott, R. Michael; Shrieve, Dennis C.; Silver, Barbara; Loeffler, Jay S.; Tarbell, Nancy J.

    1997-01-01

    Purpose: To determine the optimal dose and treatment outcome of patients treated with radiation for intracranial germinoma. Methods and Materials: Between 1975 and 1995, 40 patients with the diagnosis of intracranial germinoma were treated with radiation (RT) to the central nervous system. All patients received whole-brain (WB) RT (median dose: 32.4 Gy, range: 15-44.37 Gy) and a boost to the tumor volume (median total tumor volume dose: 52 Gy, range: 45-59.5 Gy). Thirty patients received RT to the spine (median dose: 26 Gy, range: 18.75-37.5 Gy). Four patients were treated with cisplatin-based chemotherapy and WB RT with a boost to the tumor volume (dose range: 51-54 Gy). A low-dose RT only group was defined as ≤25.5 Gy to the WB (9 patients); <50 Gy to the primary site (14 patients); and <22 Gy to the spine (9 patients) Seventeen tumors were biopsy-proven germinoma, and 17 patients presented with multiple midline germinomas (MMG). Among 26 patients who had tumor markers measured, 27% had elevation of β-human chorionic gonadotropin and by definition, no patient had an elevation of AFP. Twenty-four percent of 26 patients who had spine imaging or cerebral spinal fluid cytology had evidence of tumor seeding at diagnosis. The male to female ratio was 1.9:1. Median age at diagnosis was 14 years for male patients and 9.5 years for female patients (p = 0.02), (overall age ranges: 0.5-31 years). Median follow-up was 62 months (range: 3-226 months). Late effects of 29 patients with follow-up of ≥20 months and adequate documentation in their medical records were analyzed. Results: The 5-year actuarial rate of disease-free survival (DFS) and overall survival (OS) for biopsy-proven germinomas and presumed germinomas was 97%. No patient died of germinoma. There were no local failures regardless of the dose of RT, elevation of HCG tumor marker, or CSF dissemination at presentation. At presentation 22 patients had evidence of at least one endocrine abnormality. At follow

  5. Pediatric cleft palate patients show a 3- to 5-fold increase in cumulative radiation exposure from dental radiology compared with an age- and gender-matched population: a retrospective cohort study.

    Science.gov (United States)

    Jacobs, Reinhilde; Pauwels, Ruben; Scarfe, William C; De Cock, Carl; Dula, Karl; Willems, Guy; Verdonck, An; Politis, Constantinus

    2018-05-01

    The objective of the study was to compare estimates of pediatric cumulative exposure and lifetime attributable risk (LAR) of radiation-induced cancer from dental radiology between cleft palate (CP) subjects and age- and gender-matched controls (non-CP), with and without orthodontic treatment. The radiation exposure frequency of CP subjects and non-CP controls with and without orthodontic treatment was compared for two-dimensional radiography (intra-oral, panoramic and cephalometric radiography), computed tomography (CT), and cone-beam CT (CBCT) using cumulative radiation dose as an estimate. From this dose estimate, the age- and gender-dependent risk for radiation-induced stochastic effects was calculated for each patient group. CP patients received more radiographic examinations than non-CP controls, with the exception of intra-oral radiographs. The cumulative dose to CP patients was considerably higher (1963 μSv at the age of 20 years) than non-CP patients with (597 μSv) and without (383 μSv) orthodontic treatment, primarily due to the higher frequency of CT scanning. Accordingly, CP patients had a three to five times higher LAR than non-CP patients. This study suggests a significantly higher lifetime radiation exposure to CP patients than non-CP controls from dental radiographic procedures. Diagnostic benefits from the use of CT and CBCT in children must be justified and appropriate dose optimization strategies implemented. The present study indicates the need for proper justification and optimization of pediatric exposures in dentistry, with a special focus on high-risk groups.

  6. Dose apportionment using statistical modeling of the effluent release

    International Nuclear Information System (INIS)

    Datta, D.

    2011-01-01

    Nuclear power plants are always operated under the guidelines stipulated by the regulatory body. These guidelines basically contain the technical specifications of the specific power plant and provide the knowledge of the discharge limit of the radioactive effluent into the environment through atmospheric and aquatic route. However, operational constraints sometimes may violate the technical specification due to which there may be a failure to satisfy the stipulated dose apportioned to that plant. In a site having multi facilities sum total of the dose apportioned to all the facilities should be constrained to 1 mSv/year to the members of the public. Dose apportionment scheme basically stipulates the limit of the gaseous and liquid effluent released into the environment. Existing methodology of dose apportionment is subjective in nature that may result the discharge limit of the effluent in atmospheric and aquatic route in an adhoc manner. Appropriate scientific basis for dose apportionment is always preferable rather than judicial basis from the point of harmonization of establishing the dose apportionment. This paper presents an attempt of establishing the discharge limit of the gaseous and liquid effluent first on the basis of the existing value of the release of the same. Existing release data for a few years (for example 10 years) for any nuclear power station have taken into consideration. Bootstrap, a resampling technique, has been adopted on this data sets to generate the population which subsequently provide the corresponding population distribution of the effluent release. Cumulative distribution of the population distribution obtained is constructed and using this cumulative distribution, 95th percentile (upper bound) of the discharge limit of the radioactive effluents is computed. Dose apportioned for a facility is evaluated using this estimated upper bound of the release limit. Paper describes the detail of the bootstrap method in evaluating the

  7. Evaluation of median survival patients with acute lymphoblastic leukemia exposed ionizing radiation by the Chornobyl accident, depending on the aminoacid composition of stromal fibroblasts bone marrow and indicators of myelogram

    International Nuclear Information System (INIS)

    Bebeshko, V.G.; Bruslova, K.M.; Tsvjetkova, N.M.; Pushkar'ova, T.Yi.; Panchenko, L.M.; Yatsemirs'kij, S.N.; Volodyina, T.T.; Lyashenko, L.O.

    2015-01-01

    The aminoacid composition in the stromal fibroblasts of bone marrow and indexes of hemogram in children with acute lymphoblastic leukemias, which exposed to radiation from the Chornobyl accident, for evaluation of the median survival was investigated. In the study 54 patients with acute lymphoblastic leukemia, residents of Kyiv, Zhytomyr and Chernihiv regions of Ukraine were involved. Effectiveness of stromal fibroblasts colony forming units of bone marrow and aminoacid composition of fibroblasts were studied. Bone marrow examination was conducted on day 33 and after stop of chemotherapy, the median survival of patients and exposure dose were evaluated. In children with acute leukemias effectiveness of stromal fibroblasts of bone marrow was 2-2.3 times lower than normative. Correlation (r_s = +0.83) between the number of erythroid progenitor cells in the bone marrow and proline content in stromal fibroblasts established . The correlation between patients median survival and number of granulocytes in myelogram (r_s = + 0.82) was proven. Mean exposure doses in patients was (5.86 ±1.11) mSv and it did not correlate with myelogram results, effectiveness of stromal fibroblasts of bone marrow and median survival. The median survival of patients with acute leukemias depends on the content of amino acids in stromal fibroblasts of bone marrow and recover of hematopoiesis after chemotherapy

  8. Multi-Institution Prospective Trial of Reduced-Dose Craniospinal Irradiation (23.4 Gy) Followed by Conformal Posterior Fossa (36 Gy) and Primary Site Irradiation (55.8 Gy) and Dose-Intensive Chemotherapy for Average-Risk Medulloblastoma

    International Nuclear Information System (INIS)

    Merchant, Thomas E.; Kun, Larry E.; Krasin, Matthew J.; Wallace, Dana; Chintagumpala, Murali M.; Woo, Shiao Y.; Ashley, David M.; Sexton, Maree; Kellie, Stewart J.; Ahern, Verity M.B.B.S.; Gajjar, Amar

    2008-01-01

    Purpose: Limiting the neurocognitive sequelae of radiotherapy (RT) has been an objective in the treatment of medulloblastoma. Conformal RT to less than the entire posterior fossa (PF) after craniospinal irradiation might reduce neurocognitive sequelae and requires evaluation. Methods and Materials: Between October 1996 and August 2003, 86 patients, 3-21 years of age, with newly diagnosed, average-risk medulloblastoma were treated in a prospective, institutional review board-approved, multi-institution trial of risk-adapted RT and dose-intensive chemotherapy. RT began within 28 days of definitive surgery and consisted of craniospinal irradiation (23.4 Gy), conformal PF RT (36.0 Gy), and primary site RT (55.8 Gy). The planning target volume for the primary site included the postoperative tumor bed surrounded by an anatomically confined margin of 2 cm that was then expanded with a geometric margin of 0.3-0.5 cm. Chemotherapy was initiated 6 weeks after RT and included four cycles of high-dose cyclophosphamide, cisplatin, and vincristine. Results: At a median follow-up of 61.2 months (range, 5.2-115.0 months), the estimated 5-year event-free survival and cumulative incidence of PF failure rate was 83.0% ± 5.3% and 4.9% ± 2.4% (± standard error), respectively. The targeting guidelines used in this study resulted in a mean reduction of 13% in the volume of the PF receiving doses >55 Gy compared with conventionally planned RT. The reductions in the dose to the temporal lobes, cochleae, and hypothalamus were statistically significant. Conclusion: This prospective trial has demonstrated that irradiation of less than the entire PF after 23.4 Gy craniospinal irradiation for average-risk medulloblastoma results in disease control comparable to that after treatment of the entire PF

  9. A Monte Carlo study of the impact of the choice of rectum volume definition on estimates of equivalent uniform doses and the volume parameter

    International Nuclear Information System (INIS)

    Kvinnsland, Yngve; Muren, Ludvig Paul; Dahl, Olav

    2004-01-01

    Calculations of normal tissue complication probability (NTCP) values for the rectum are difficult because it is a hollow, non-rigid, organ. Finding the true cumulative dose distribution for a number of treatment fractions requires a CT scan before each treatment fraction. This is labour intensive, and several surrogate distributions have therefore been suggested, such as dose wall histograms, dose surface histograms and histograms for the solid rectum, with and without margins. In this study, a Monte Carlo method is used to investigate the relationships between the cumulative dose distributions based on all treatment fractions and the above-mentioned histograms that are based on one CT scan only, in terms of equivalent uniform dose. Furthermore, the effect of a specific choice of histogram on estimates of the volume parameter of the probit NTCP model was investigated. It was found that the solid rectum and the rectum wall histograms (without margins) gave equivalent uniform doses with an expected value close to the values calculated from the cumulative dose distributions in the rectum wall. With the number of patients available in this study the standard deviations of the estimates of the volume parameter were large, and it was not possible to decide which volume gave the best estimates of the volume parameter, but there were distinct differences in the mean values of the values obtained

  10. Multiple dose study of the combined radiosensitizers Ro 03-8799 (pimonidazole) and SR 2508 (etanidazole)

    International Nuclear Information System (INIS)

    Bleehen, N.M.; Newman, H.F.; Maughan, T.S.; Workman, P.

    1989-01-01

    The hypoxic cell radiosensitizers Ro 03-8799 and SR 2508 have different clinical toxicities. The former produces an acute but transient central nervous system syndrome, whereas the latter produces cumulative peripheral neuropathy. Following single dose studies, an escalating multiple dose schedule using both drugs in combination showed no unexpected adverse reactions at lower doses. This study identifies the clinical tolerance and pharmacokinetics when doses in the region of the maximal tolerated dose are given to 26 patients receiving infusions of 0.75 g/m2 Ro 03-8799 and 2 g/m2 SR 2508 three times per week. At 15 doses, 3/4 patients experienced WHO grade 2 peripheral neuropathy, whereas at 12 doses 1/9 developed grade 2 and 6/9 developed grade 1 neuropathies. This represents a lower dose of SR 2508 than can be given alone suggesting that some interaction between the two drugs does exist in terms of chronic peripheral neurotoxicity. Pharmacokinetic studies show no adverse interactions between the two drugs and minimal inter-patient variation. From bivariate analysis, cumulative AUC for Ro 03-8799 has the most significant correlation with the development of peripheral neuropathy. Tumor drug concentrations normalized to the administered dose show mean values of 34 micrograms/g Ro 03-8799 and 76 micrograms/g SR 2508 30 minutes after infusion. These could be expected to produce a single dose sensitizer enhancement ratio of 1.5. The combination of the two sensitizers at the maximum tolerable dose may be expected to give an increased therapeutic efficacy over either drug alone

  11. An evaluation paradigm for cumulative impact analysis

    Science.gov (United States)

    Stakhiv, Eugene Z.

    1988-09-01

    Cumulative impact analysis is examined from a conceptual decision-making perspective, focusing on its implicit and explicit purposes as suggested within the policy and procedures for environmental impact analysis of the National Environmental Policy Act of 1969 (NEPA) and its implementing regulations. In this article it is also linked to different evaluation and decision-making conventions, contrasting a regulatory context with a comprehensive planning framework. The specific problems that make the application of cumulative impact analysis a virtually intractable evaluation requirement are discussed in connection with the federal regulation of wetlands uses. The relatively familiar US Army Corps of Engineers' (the Corps) permit program, in conjunction with the Environmental Protection Agency's (EPA) responsibilities in managing its share of the Section 404 regulatory program requirements, is used throughout as the realistic context for highlighting certain pragmatic evaluation aspects of cumulative impact assessment. To understand the purposes of cumulative impact analysis (CIA), a key distinction must be made between the implied comprehensive and multiobjective evaluation purposes of CIA, promoted through the principles and policies contained in NEPA, and the more commonly conducted and limited assessment of cumulative effects (ACE), which focuses largely on the ecological effects of human actions. Based on current evaluation practices within the Corps' and EPA's permit programs, it is shown that the commonly used screening approach to regulating wetlands uses is not compatible with the purposes of CIA, nor is the environmental impact statement (EIS) an appropriate vehicle for evaluating the variety of objectives and trade-offs needed as part of CIA. A heuristic model that incorporates the basic elements of CIA is developed, including the idea of trade-offs among social, economic, and environmental protection goals carried out within the context of environmental

  12. Double dose: the cumulative effect of TV viewing at home and in preschool on children's activity patterns and weight status.

    Science.gov (United States)

    Taverno Ross, Sharon; Dowda, Marsha; Saunders, Ruth; Pate, Russell

    2013-05-01

    Little is known about how screen-based sedentary behavior at home and in preschool influences children's health and activity patterns. The current study examined the individual and cumulative influence of TV viewing at home and in preschool on children's physical activity (PA) and weight status. Children (n = 339) attending 16 preschools in South Carolina were grouped into high and low TV groups based on parent report of children's TV viewing at home and director report of TV use/rules in preschool. T-tests and mixed model ANOVAs examined differences in weight status and PA (min/hr) by high and low TV groups. Results revealed that children who were classified as High TV both at home and in pre- school had significantly lower levels of moderate-to-vigorous PA compared with their Low TV counterparts (8.3 (0.3) min/hr vs. 7.6 (0.2) min/hr, p TV groups at home or in preschool when examined individually. These findings demonstrate the importance of total environmental TV exposure on preschooler's PA. Longitudinal and observational research to assess preschoolers' cumulative screen-based sedentary behavior and its relationship with PA and weight status is needed.

  13. Treatment of Recurrent Bronchial Carcinoma: The Role of High-Dose-Rate Endoluminal Brachytherapy

    International Nuclear Information System (INIS)

    Hauswald, Henrik; Stoiber, Eva; Rochet, Nathalie; Lindel, Katja; Grehn, Christian; Becker, Heinrich D.; Debus, Juergen; Harms, Wolfgang

    2010-01-01

    Purpose: This study's aim was to assess outcome and toxicity of high-dose-rate endoluminal brachytherapy (HDREB) for recurrent bronchial carcinoma. Methods and Materials: From 1987 to 2005, 41 patients were treated with HDREB for symptomatic recurrent bronchial carcinoma. All patients had previously undergone external beam radiotherapy (EBRT) with a median dose of 56 Gy (range, 30-70 Gy). The median HDREB dose applied was 15 Gy (range, 5-29 Gy). The median time interval between primary EBRT and reirradiation was 9 months (range, 2-54 months). Results: After a median follow-up of 6.7 months, the 6-, 12-, and 24-month overall survival rates were 58%, 18%, and 7%, respectively. The median overall survival time was 6.7 months. Local remission was achieved in 73% of patients (n = 30). A total of 24% of patients (n = 10) showed no response or progressive disease within 8 weeks after treatment. In 1 patient, treatment response was not documented. The 6-, 12-, and 24-month local control rates were 38%, 17%, and 3%, respectively. The median local progression-free survival time was 4 months (range, 1-23 months). Prognostic factors were a total dose of ≥15 Gy of HDREB (p = 0.029) and a Karnofsky performance score of ≥80% (p = 0.0012). The cause of death was locoregional progression in 27% of patients (n = 11), distant metastases in 24% of patients (n = 10), fatal hemorrhage in 15% of patients (n = 6), and other causes in 29% of patients (n = 12). None of the patients with locally controlled disease showed grade 3 or 4 late effects. Conclusions: Palliative treatment of symptomatic, locally recurrent bronchial carcinoma with HDREB can effectively relieve symptoms in the majority of patients while causing only few complications. Still, time to progression is short.

  14. Cumulants in perturbation expansions for non-equilibrium field theory

    International Nuclear Information System (INIS)

    Fauser, R.

    1995-11-01

    The formulation of perturbation expansions for a quantum field theory of strongly interacting systems in a general non-equilibrium state is discussed. Non-vanishing initial correlations are included in the formulation of the perturbation expansion in terms of cumulants. The cumulants are shown to be the suitable candidate for summing up the perturbation expansion. Also a linked-cluster theorem for the perturbation series with cumulants is presented. Finally a generating functional of the perturbation series with initial correlations is studied. We apply the methods to a simple model of a fermion-boson system. (orig.)

  15. Using the 60Co source to assess the dose received by risky organs during a cancer brain treatment

    International Nuclear Information System (INIS)

    Faik Ouahab, Z.; Jehouani, A.; Ghassoun, J.; Senhou, N.; Mouhssine, D.; Groetz, J.E.

    2010-01-01

    Summary of an investigation of exposures associated with brain cancer treatment for a child in order to determine the level of doses received by the different organs at risk during the treatment. Measurements have been performed at the vicinity of a cobalto therapy apparatus. Then, cumulative doses in each organ have been compared to admitted doses with respect to the organ

  16. Low-dose total skin electron beam therapy for cutaneous lymphoma : Minimal risk of acute toxicities.

    Science.gov (United States)

    Kroeger, Kai; Elsayad, Khaled; Moustakis, Christos; Haverkamp, Uwe; Eich, Hans Theodor

    2017-12-01

    Low-dose total skin electron beam therapy (TSEBT) is attracting increased interest for the effective palliative treatment of primary cutaneous T‑cell lymphoma (pCTCL). In this study, we compared toxicity profiles following various radiation doses. We reviewed the records of 60 patients who underwent TSEBT for pCTCL between 2000 and 2016 at the University Hospital of Munster. The treatment characteristics of the radiotherapy (RT) regimens and adverse events (AEs) were then analyzed and compared. In total, 67 courses of TSEBT were administered to 60 patients. Of these patients, 34 (51%) received a standard dose with a median surface dose of 30 Gy and 33 patients (49%) received a low dose with the median surface dose of 12 Gy (7 salvage low-dose TSEBT courses were administered to 5 patients). After a median follow-up of 15 months, the overall AE rate was 100%, including 38 patients (57%) with grade 2 and 7 (10%) with grade 3 AEs. Patients treated with low-dose TSEBT had significantly fewer grade 2 AEs than those with conventional dose regimens (33 vs. 79%, P dose regimen compared to those with the conventional dose regimens (6 vs. 15%, P = 0.78). Multiple/salvage low-dose TSEBT courses were not associated with an increased risk of acute AEs. Low-dose TSEBT regimens are associated with significantly fewer grade 2 acute toxicities compared with conventional doses of TSEBT. Repeated/Salvage low-dose TSEBT, however, appears to be tolerable and can even be applied safely in patients with cutaneous relapses.

  17. Fast motion-including dose error reconstruction for VMAT with and without MLC tracking

    DEFF Research Database (Denmark)

    Ravkilde, Thomas; Keall, Paul J.; Grau, Cai

    2014-01-01

    of the algorithm for reconstruction of dose and motion-induced dose errors throughout the tracking and non-tracking beam deliveries was quantified. Doses were reconstructed with a mean dose difference relative to the measurements of -0.5% (5.5% standard deviation) for cumulative dose. More importantly, the root...... validate a simple model for fast motion-including dose error reconstruction applicable to intrafractional QA of MLC tracking treatments of moving targets. MLC tracking experiments were performed on a standard linear accelerator with prototype MLC tracking software guided by an electromagnetic transponder......-mean-square deviation between reconstructed and measured motion-induced 3%/3 mm γ failure rates (dose error) was 2.6%. The mean computation time for each calculation of dose and dose error was 295 ms. The motion-including dose reconstruction allows accurate temporal and spatial pinpointing of errors in absorbed dose...

  18. CUMBIN - CUMULATIVE BINOMIAL PROGRAMS

    Science.gov (United States)

    Bowerman, P. N.

    1994-01-01

    The cumulative binomial program, CUMBIN, is one of a set of three programs which calculate cumulative binomial probability distributions for arbitrary inputs. The three programs, CUMBIN, NEWTONP (NPO-17556), and CROSSER (NPO-17557), can be used independently of one another. CUMBIN can be used by statisticians and users of statistical procedures, test planners, designers, and numerical analysts. The program has been used for reliability/availability calculations. CUMBIN calculates the probability that a system of n components has at least k operating if the probability that any one operating is p and the components are independent. Equivalently, this is the reliability of a k-out-of-n system having independent components with common reliability p. CUMBIN can evaluate the incomplete beta distribution for two positive integer arguments. CUMBIN can also evaluate the cumulative F distribution and the negative binomial distribution, and can determine the sample size in a test design. CUMBIN is designed to work well with all integer values 0 < k <= n. To run the program, the user simply runs the executable version and inputs the information requested by the program. The program is not designed to weed out incorrect inputs, so the user must take care to make sure the inputs are correct. Once all input has been entered, the program calculates and lists the result. The CUMBIN program is written in C. It was developed on an IBM AT with a numeric co-processor using Microsoft C 5.0. Because the source code is written using standard C structures and functions, it should compile correctly with most C compilers. The program format is interactive. It has been implemented under DOS 3.2 and has a memory requirement of 26K. CUMBIN was developed in 1988.

  19. Second malignancies in high-dose areas of previous tumor radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Welte, Birgitta; Suhr, Peter; Bottke, Dirk; Bartkowiak, Detlef; Wiegel, Thomas [Dept. of Radiotherapy and Radiation Oncology, Univ. of Ulm (Germany); Doerr, Wolfgang [Dept. of Radiotherapy and Radiation Oncology, Radiobiology Lab., Univ. of Technology Dresden (Germany); Trott, Klaus Ruediger [UCL Cancer Centre, Univ. Coll. London (United Kingdom)

    2010-03-15

    Purpose: To characterize second tumors that developed in or near the high-dose areas of a previous radiotherapy, regarding their frequency, entities, latency, and dose dependence. Patients and Methods: 9,995/15,449 tumor patients of the Radiation Oncology Department in Ulm, Germany, treated between 1981 and 2003, survived at least 1 year after radiotherapy. By long-term follow-up and review of treatment documentation, 100 of them were identified who developed an independent second cancer in or near the irradiated first tumor site. Results: Major primary malignancies were breast cancer (27%), lymphoma (24%), and pelvic gynecologic tumors (17%). Main second tumors were carcinomas of the upper (18%) and lower (12%) gastrointestinal tract, head and neck tumors (10%), lymphoma (10%), breast cancer (9%), sarcoma (9%), and lung cancer (8%). Overall median second tumor latency was 7.4 years (1-42 years). For colorectal cancer it was 3.5 and for leukemia 4.3 years, but for sarcoma 11.7 and for breast cancer 17.1 years. The relatively frequent second tumors of the upper gastrointestinal tract were associated with median radiation doses of 24 Gy. By contrast, second colorectal cancer and sarcoma developed after median doses of 50 Gy. Conclusion: The 5- and 15-year probability to develop a histopathologically independent second tumor in or near the irradiated first tumor site, i.e., after intermediate or high radiation doses, was 0.5% and 2.2%, respectively. To identify potentially radiogenic second malignancies, a follow-up far beyond 5 years is mandatory. The incidence and potential dose-response relationship intermediate will be analyzed by a case-case and a case-control study of the Ulm data. (orig.)

  20. Posttreatment visual acuity in patients treated with episcleral plaque therapy for choroidal melanomas: dose and dose rate effects

    International Nuclear Information System (INIS)

    Jones, Robert; Gore, Elizabeth; Mieler, William; Murray, Kevin; Gillin, Michael; Albano, Katherine; Erickson, Beth

    2002-01-01

    Purpose: To determine the relationship between the long-term visual function and the dose and dose rates delivered to critical ocular structures in patients with choroidal melanoma treated with 125 I episcleral plaque radiotherapy. Methods and Materials: From 1987 to 1994, 63 patients underwent 125 I episcleral plaque (Collaborative Ocular Melanoma Study [COMS] design) application for the treatment of choroidal melanoma. The mean tumor height was 4.5 mm (range 1.7-8.3). Doses and dose rates at the tumor apex, macula, and optic disc were calculated. Forty-three records were scored to assess whether a decrease in visual acuity of >2 lines on a standard Snellen eye chart had occurred. Patient age and the presence of hypertension or diabetes were noted. Statistical analysis was performed to assess both the rate at which visual decline had occurred and the presence of significant factors that had contributed to this decline. Results: With a median follow-up of 36 months, the 3-year actuarial survival rate was 93.6%. The 3-year actuarial local control rate was 86.9%. The median time to visual loss after therapy was 18.7 months. The 3-year actuarial rate of visual preservation was 40.5%. Multivariate analysis demonstrated higher macula dose rates (p=0.003) to forecast visual decline. Macula dose rates of 111±11.1 cGy/h were associated with a 50% risk of significant visual loss. Conclusion: Patients in our series treated with 125 I plaque brachytherapy for choroidal melanoma experienced favorable tumor control, but with a measurable incidence of visual decline. Higher dose rates to the macula correlated strongly with poorer posttreatment visual outcome. This information may be valuable in selecting the optimal dose rates to treat choroidal melanomas and to predict the risk of visual decline

  1. Randomized phase 2 study of low-dose decitabine vs low-dose azacitidine in lower-risk MDS and MDS/MPN.

    Science.gov (United States)

    Jabbour, Elias; Short, Nicholas J; Montalban-Bravo, Guillermo; Huang, Xuelin; Bueso-Ramos, Carlos; Qiao, Wei; Yang, Hui; Zhao, Chong; Kadia, Tapan; Borthakur, Gautam; Pemmaraju, Naveen; Sasaki, Koji; Estrov, Zeev; Cortes, Jorge; Ravandi, Farhad; Alvarado, Yesid; Komrokji, Rami; Sekeres, Mikkael A; Steensma, David P; DeZern, Amy; Roboz, Gail; Kantarjian, Hagop; Garcia-Manero, Guillermo

    2017-09-28

    Hypomethylating agents (HMAs) improve survival in patients with higher-risk myelodysplastic syndromes (MDS) but are less well-studied in lower-risk disease. We compared the safety and efficacy of low-dose decitabine vs low-dose azacitidine in this group of patients. Adults with low- or intermediate 1-risk MDS or MDS/myeloproliferative neoplasm (MPN), including chronic myelomonocytic leukemia, according to the International Prognostic Scoring System, were randomly assigned using a Bayesian adaptive design to receive either azacitidine 75 mg/m 2 intravenously/subcutaneously daily or decitabine 20 mg/m 2 intravenously daily for 3 consecutive days on a 28-day cycle. The primary outcome was overall response rate (ORR). Between November 2012 and February 2016, 113 patients were treated: 40 (35%) with azacitidine and 73 (65%) with decitabine. The median age was 70 years; 81% of patients were intermediate 1-risk patients. The median number of cycles received was 9. The ORRs were 70% and 49% ( P = .03) for patients treated with decitabine and azacitidine, respectively. Thirty-two percent of patients treated with decitabine became transfusion independent compared with 16% of patients treated with azacitidine ( P = .2). Cytogenetic response rates were 61% and 25% ( P = .02), respectively. With a median follow-up of 20 months, the overall median event-free survival was 18 months: 20 and 13 months for patients treated with decitabine and azacitidine, respectively ( P = .1). Treatment was well tolerated, with a 6-week mortality rate of 0%. The use of low-dose HMAs is safe and effective in patients with lower-risk MDS and MDS/MPN. Their effect on the natural history of lower-risk disease needs to be further studied. This trial was registered at clinicaltrials.gov (identifier NCT01720225). © 2017 by The American Society of Hematology.

  2. Cumulative effect in multiple production processes on nuclei

    International Nuclear Information System (INIS)

    Golubyatnikova, E.S.; Shmonin, V.L.; Kalinkin, B.N.

    1989-01-01

    It is shown that the cumulative effect is a natural result of the process of hadron multiple production in nuclear reactions. Interpretation is made of the universality of slopes of inclusive spectra and other characteristics of cumulative hadrons. The character of information from such reactions is discussed, which could be helpful in studying the mechanism of multiparticle production. 27 refs.; 4 figs

  3. Determination of gonad doses during robotic stereotactic radiosurgery for various tumor sites

    International Nuclear Information System (INIS)

    Zorlu, Faruk; Dugel, Gozde; Ozyigit, Gokhan; Hurmuz, Pervin; Cengiz, Mustafa; Yildiz, Ferah; Akyol, Fadil; Gurkaynak, Murat

    2013-01-01

    Purpose: The authors evaluated the absorbed dose received by the gonads during robotic stereotactic radiosurgery (SRS) for the treatment of different tumor localizations. Methods: The authors measured the gonad doses during the treatment of head and neck, thoracic, abdominal, or pelvic tumors in both RANDO phantom and actual patients. The computerized tomography images were transferred to the treatment planning system. The contours of tumor and critical organs were delineated on each slice, and treatment plans were generated. Measurements for gonad doses were taken from the geometric projection of the ovary onto the skin for female patients, and from the scrotal skin for male patients by attaching films and Thermoluminescent dosimeters (TLDs). SRS was delivered with CyberKnife (Accuray Inc., Sunnyvale, CA). Results: The median gonadal doses with TLD and film dosimeter in actual patients were 0.19 Gy (range, 0.035–2.71 Gy) and 0.34 Gy (range, 0.066–3.18 Gy), respectively. In the RANDO phantom, the median ovarian doses with TLD and film dosimeter were 0.08 Gy (range, 0.03–0.159 Gy) and 0.05 Gy (range, 0.015–0.13 Gy), respectively. In the RANDO phantom, the median testicular doses with TLD and film dosimeter were 0.134 Gy (range 0.056–1.97 Gy) and 0.306 Gy (range, 0.065–2.25 Gy). Conclusions: Gonad doses are below sterility threshold in robotic SRS for different tumor localizations. However, particular attention should be given to gonads during robotic SRS for pelvic tumors.

  4. Determination of gonad doses during robotic stereotactic radiosurgery for various tumor sites

    Energy Technology Data Exchange (ETDEWEB)

    Zorlu, Faruk; Dugel, Gozde; Ozyigit, Gokhan; Hurmuz, Pervin; Cengiz, Mustafa; Yildiz, Ferah; Akyol, Fadil; Gurkaynak, Murat [Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara 06100 (Turkey)

    2013-04-15

    Purpose: The authors evaluated the absorbed dose received by the gonads during robotic stereotactic radiosurgery (SRS) for the treatment of different tumor localizations. Methods: The authors measured the gonad doses during the treatment of head and neck, thoracic, abdominal, or pelvic tumors in both RANDO phantom and actual patients. The computerized tomography images were transferred to the treatment planning system. The contours of tumor and critical organs were delineated on each slice, and treatment plans were generated. Measurements for gonad doses were taken from the geometric projection of the ovary onto the skin for female patients, and from the scrotal skin for male patients by attaching films and Thermoluminescent dosimeters (TLDs). SRS was delivered with CyberKnife (Accuray Inc., Sunnyvale, CA). Results: The median gonadal doses with TLD and film dosimeter in actual patients were 0.19 Gy (range, 0.035-2.71 Gy) and 0.34 Gy (range, 0.066-3.18 Gy), respectively. In the RANDO phantom, the median ovarian doses with TLD and film dosimeter were 0.08 Gy (range, 0.03-0.159 Gy) and 0.05 Gy (range, 0.015-0.13 Gy), respectively. In the RANDO phantom, the median testicular doses with TLD and film dosimeter were 0.134 Gy (range 0.056-1.97 Gy) and 0.306 Gy (range, 0.065-2.25 Gy). Conclusions: Gonad doses are below sterility threshold in robotic SRS for different tumor localizations. However, particular attention should be given to gonads during robotic SRS for pelvic tumors.

  5. Regularization of DT-MRI Using 3D Median Filtering Methods

    Directory of Open Access Journals (Sweden)

    Soondong Kwon

    2014-01-01

    Full Text Available DT-MRI (diffusion tensor magnetic resonance imaging tractography is a method to determine the architecture of axonal fibers in the central nervous system by computing the direction of the principal eigenvectors obtained from tensor matrix, which is different from the conventional isotropic MRI. Tractography based on DT-MRI is known to need many computations and is highly sensitive to noise. Hence, adequate regularization methods, such as image processing techniques, are in demand. Among many regularization methods we are interested in the median filtering method. In this paper, we extended two-dimensional median filters already developed to three-dimensional median filters. We compared four median filtering methods which are two-dimensional simple median method (SM2D, two-dimensional successive Fermat method (SF2D, three-dimensional simple median method (SM3D, and three-dimensional successive Fermat method (SF3D. Three kinds of synthetic data with different altitude angles from axial slices and one kind of human data from MR scanner are considered for numerical implementation by the four filtering methods.

  6. Safety performance evaluation of cable median barriers on freeways in Florida.

    Science.gov (United States)

    Alluri, Priyanka; Haleem, Kirolos; Gan, Albert; Mauthner, John

    2016-07-03

    This article aims to evaluate the safety performance of cable median barriers on freeways in Florida. The safety performance evaluation was based on the percentages of barrier and median crossovers by vehicle type, crash severity, and cable median barrier type (Trinity Cable Safety System [CASS] and Gibraltar system). Twenty-three locations with cable median barriers totaling about 101 miles were identified. Police reports of 6,524 crashes from years 2005-2010 at these locations were reviewed to verify and obtain detailed crash information. A total of 549 crashes were determined to be barrier related (i.e., crashes involving vehicles hitting the cable median barrier) and were reviewed in further detail to identify crossover crashes and the manner in which the vehicles crossed the barriers; that is, by either overriding, underriding, or penetrating the barriers. Overall, 2.6% of vehicles that hit the cable median barrier crossed the median and traversed into the opposite travel lane. Overall, 98.1% of cars and 95.5% of light trucks that hit the barrier were prevented from crossing the median. In other words, 1.9% of cars and 4.5% of light trucks that hit the barrier had crossed the median and encroached on the opposite travel lanes. There is no significant difference in the performance of cable median barrier for cars versus light trucks in terms of crossover crashes. In terms of severity, overrides were more severe compared to underrides and penetrations. The statistics showed that the CASS and Gibraltar systems performed similarly in terms of crossover crashes. However, the Gibraltar system experienced a higher proportion of penetrations compared to the CASS system. The CASS system resulted in a slightly higher percentage of moderate and minor injury crashes compared to the Gibraltar system. Cable median barriers are successful in preventing median crossover crashes; 97.4% of the cable median barrier crashes were prevented from crossing over the median. Of all of

  7. Performance evaluation of cable median barrier systems in Texas.

    Science.gov (United States)

    2009-08-01

    Since 2003, the Texas Department of Transportation (TxDOT) has embarked on an aggressive campaign to install : median barriers to prevent cross-median crashes on freeway facilities statewide. In the few years prior to 2003, : virtually all fatalities...

  8. Extremity and eye lens dosimetry for medical staff performing vertebroplasty and kyphoplasty procedures

    International Nuclear Information System (INIS)

    Struelens, L; Schoonjans, W; Vanhavere, F; Schils, F; De Smedt, K

    2013-01-01

    Measurements of doses to hands, legs and eyes are reported for operators in four different hospitals performing vertebroplasty or kyphoplasty. The results confirm that occupational doses can be high for interventional spine procedures. Extremity and eye lens doses were measured with thermoluminescent dosimeters positioned on the ring fingers, wrists, legs and near the eyes of interventional radiologists and neurosurgeons, over a period of 15 months. Doses were generally larger on the left side for all positions monitored. The median dose to the left finger was 225 μSv per procedure, although a maximum of 7.3 mSv was found. The median dose to the right finger was 118 μSv, but with an even higher maximum of 7.7 mSv. A median left eye dose of 34 μSv (maximum 836 μSv) was found, while the legs received the lowest doses with a median of 13 μSv (maximum 332 μSv) to the left leg. Annual dose to the hand assessed by the cumulated doses almost reached the annual dose limit of 500 mSv, while annual dose to the eyes exceeded the eye lens dose limit of 20 mSv yr −1 . Different x-ray systems and radiation protection measures were tested, like the use of lead gloves and glasses, tweezers, cement delivery systems and a magnetic navigation system. These measurements showed that doses can be significantly reduced. The use of lead glasses is strongly recommended for protection of the eyes. (paper)

  9. The status of low dose rate and future of high dose rate Cf-252 brachytherapy

    International Nuclear Information System (INIS)

    Rivard, M.J.; Wierzbicki, J.G.; Van den Heuvel, F.; Chuba, P.J.; Fontanesi, J.

    1997-12-01

    This work describes the current status of the US low dose rate (LDR) Cf-252 brachytherapy program. The efforts undertaken towards development of a high dose rate (HDR) remotely after loaded Cf-252 source, which can accommodate 1 mg or greater Cf-252, are also described. This HDR effort is a collaboration between Oak Ridge National Laboratory (ORNL), commercial remote after loader manufactures, the Gershenson Radiation Oncology Center (ROC), and Wayne State University. To achieve this goal, several advances in isotope chemistry and source preparation at ORNL must be achieved to yield a specific material source loading of greater than or equal 1 mg Cf-252 per mm3. Development work with both radioactive and non-radioactive stand-ins for Cf-252 have indicated the feasibility of fabricating such sources. As a result, the decreased catheter diameter and computer controlled source placement will permit additional sites (e.g. brain, breast, prostate, lung, parotid, etc.) to be treated effectively with Cf-252 sources. Additional work at the Radiochemical Engineering and Development Center (REDC) remains in source fabrication, after loader modification, and safe design. The current LDR Cf-252 Treatment Suite at the ROC is shielded and licensed to hold up to 1 mg of Cf-252. This was designed to maintain cumulative personnel exposure, both external to the room and in direct isotope handling, at less than 20 microSv/hr. However, cumulative exposure may be greatly decreased if a Cf-252 HDR unit is employed which would eliminate direct isotope handling and decrease treatment times from tilde 3 hours to an expected range of 3 to 15 minutes. Such a Cf-252 HDR source will also demonstrate improved dose distributions over current LDR treatments due to the ability to step the point-like source throughout the target volume and weight the dwell time accordingly

  10. Locoregional Tumor Progression After Radiation Therapy Influences Overall Survival in Pediatric Patients With Neuroblastoma

    International Nuclear Information System (INIS)

    Pai Panandiker, Atmaram S.; McGregor, Lisa; Krasin, Matthew J.; Wu Shengjie; Xiong Xiaoping; Merchant, Thomas E.

    2010-01-01

    Purpose: There is renewed attention to primary site irradiation and local control for patients with high-risk neuroblastoma (NB). We conducted a retrospective review to identify factors that might predict for locoregional tumor control and its impact on overall survival. Methods and Materials: Between July 2000 through August 2006, a total of 44 pediatric patients with NB received radiation therapy (RT) with curative intent using computed tomography (CT)-based treatment planning. The median age was 3.4 years and the median cumulative dose was 23.4 Gy. Overall survival and locoregional tumor control were measured from the start of RT to the date of death or event as determined by CT/magnetic resonance imaging/meta-iodobenzylguanidine. The influence of age at irradiation, gender, race, cumulative radiation dose, International Neuroblastoma Staging System stage, treatment protocol and resection status was determined with respect to locoregional tumor control. Results: With a median follow-up of 34 months ± 21 months, locoregional tumor progression was observed in 11 (25%) and was evenly divided between primary site and adjacent nodal/visceral site failure. The influence of locoregional control reached borderline statistical significance (p = 0.06). Age (p = 0.5), dose (p = 0.6), resection status (p = 0.7), and International Neuroblastoma Staging System stage (p = 0.08) did not influence overall survival. Conclusions: Overall survival in high-risk neuroblastoma is influenced by locoregional tumor control. Despite CT-based planning, progression in adjacent nodal/visceral sites appears to be common; this requires further investigation regarding target volume definitions, dose, and the effects of systemic therapy.

  11. Double Dose: The cumulative effect of TV viewing at home and in preschool on children’s activity patterns and weight status

    Science.gov (United States)

    Ross, Sharon Taverno; Dowda, Marsha; Saunders, Ruth P.; Pate, Russell R.

    2015-01-01

    Little is known about how screen-based sedentary behavior at home and in preschool influences children’s health and activity patterns. The current study examined the individual and cumulative influence of TV viewing at home and in preschool on children’s physical activity (PA) and weight status. Children (n=339) attending 16 preschools in South Carolina were grouped into high and low TV groups based on parent report of children’s TV viewing at home and director report of TV use/rules in preschool. T-tests and mixed model ANOVAs examined differences in weight status and PA (min/hr) by high and low TV groups. Results revealed that children who were classified as High TV both at home and in preschool had significantly lower levels of moderate-to-vigorous PA compared with their Low TV counterparts. These findings demonstrate the importance of total environmental TV exposure on preschooler’s PA. Longitudinal and observational research to assess preschoolers’ cumulative screen-based sedentary behavior and its relationship with PA and weight status is needed. PMID:23502043

  12. CDF-XL: computing cumulative distribution functions of reaction time data in Excel.

    Science.gov (United States)

    Houghton, George; Grange, James A

    2011-12-01

    In experimental psychology, central tendencies of reaction time (RT) distributions are used to compare different experimental conditions. This emphasis on the central tendency ignores additional information that may be derived from the RT distribution itself. One method for analysing RT distributions is to construct cumulative distribution frequency plots (CDFs; Ratcliff, Psychological Bulletin 86:446-461, 1979). However, this method is difficult to implement in widely available software, severely restricting its use. In this report, we present an Excel-based program, CDF-XL, for constructing and analysing CDFs, with the aim of making such techniques more readily accessible to researchers, including students (CDF-XL can be downloaded free of charge from the Psychonomic Society's online archive). CDF-XL functions as an Excel workbook and starts from the raw experimental data, organised into three columns (Subject, Condition, and RT) on an Input Data worksheet (a point-and-click utility is provided for achieving this format from a broader data set). No further preprocessing or sorting of the data is required. With one click of a button, CDF-XL will generate two forms of cumulative analysis: (1) "standard" CDFs, based on percentiles of participant RT distributions (by condition), and (2) a related analysis employing the participant means of rank-ordered RT bins. Both analyses involve partitioning the data in similar ways, but the first uses a "median"-type measure at the participant level, while the latter uses the mean. The results are presented in three formats: (i) by participants, suitable for entry into further statistical analysis; (ii) grand means by condition; and (iii) completed CDF plots in Excel charts.

  13. Evaluation of dose from external irradiation for individuals living in areas affected by the Fukushima Daiichi nuclear plant accident

    International Nuclear Information System (INIS)

    Naito, Wataru; Uesaka, Motoki; Yamada, Chie; Ishii, Hideki

    2015-01-01

    In order to effectively and appropriately manage external radiation doses in the affected areas of Fukushima, it is important to identify when, where and how much exposure occurred. It is also necessary to quantitatively measure external exposure and air dose rates for different activity patterns in individuals living and working in Japanese-style buildings. The authors used a new personal dosemeter (D-shuttle) along with a global positioning system and geographical information system to relate personal dose rate with activity patterns and air dose rate. Hourly individual doses obtained by D-shuttle can provide an effective communication tool for those who want to identify when and how much exposure occurs. Personal monitoring of 26 volunteers showed that personal doses obtained from D-shuttle were ∼30 % of cumulative air dose estimated by data from the airborne monitoring survey. This analysis showed that, for most study volunteers, the exposure from staying at home represented about half of the total cumulative dose. This suggests that even though the peak exposure doses may be observed outside of working hours, to develop appropriate countermeasures for external dose reduction, it is thus important to identify the contributions of individuals' time-activities. This study provides a valuable basis for developing a realistic and pragmatic method to estimate external doses of individuals in Fukushima. (authors)

  14. Estimating a population cumulative incidence under calendar time trends

    DEFF Research Database (Denmark)

    Hansen, Stefan N; Overgaard, Morten; Andersen, Per K

    2017-01-01

    BACKGROUND: The risk of a disease or psychiatric disorder is frequently measured by the age-specific cumulative incidence. Cumulative incidence estimates are often derived in cohort studies with individuals recruited over calendar time and with the end of follow-up governed by a specific date....... It is common practice to apply the Kaplan-Meier or Aalen-Johansen estimator to the total sample and report either the estimated cumulative incidence curve or just a single point on the curve as a description of the disease risk. METHODS: We argue that, whenever the disease or disorder of interest is influenced...

  15. Reirradiation of Large-Volume Recurrent Glioma With Pulsed Reduced-Dose-Rate Radiotherapy

    International Nuclear Information System (INIS)

    Adkison, Jarrod B.; Tome, Wolfgang; Seo, Songwon; Richards, Gregory M.; Robins, H. Ian; Rassmussen, Karl; Welsh, James S.; Mahler, Peter A.; Howard, Steven P.

    2011-01-01

    Purpose: Pulsed reduced-dose-rate radiotherapy (PRDR) is a reirradiation technique that reduces the effective dose rate and increases the treatment time, allowing sublethal damage repair during irradiation. Patients and Methods: A total of 103 patients with recurrent glioma underwent reirradiation using PRDR (86 considered to have Grade 4 at PRDR). PRDR was delivered using a series of 0.2-Gy pulses at 3-min intervals, creating an apparent dose rate of 0.0667 Gy/min to a median dose of 50 Gy (range, 20-60) delivered in 1.8-2.0-Gy fractions. The mean treatment volume was 403.5 ± 189.4 cm 3 according to T 2 -weighted magnetic resonance imaging and a 2-cm margin. Results: For the initial or upgraded Grade 4 cohort (n = 86), the median interval from the first irradiation to PRDR was 14 months. Patients undergoing PRDR within 14 months of the first irradiation (n = 43) had a median survival of 21 weeks. Those treated ≥14 months after radiotherapy had a median survival of 28 weeks (n = 43; p = 0.004 and HR = 1.82 with a 95% CI ranging from 1.25 to 3.10). These data compared favorably to historical data sets, because only 16% of the patients were treated at first relapse (with 46% treated at the second relapse, 32% at the third or fourth relapse, and 4% at the fourth or fifth relapse). The median survival since diagnosis and retreatment was 6.3 years and 11.4 months for low-grade, 4.1 years and 5.6 months for Grade 3, and 1.6 years and 5.1 months for Grade 4 tumors, respectively, according to the initial histologic findings. Multivariate analysis revealed age at the initial diagnosis, initial low-grade disease, and Karnofsky performance score of ≥80 to be significant predictors of survival after initiation of PRDR. Conclusion: PRDR allowed for safe retreatment of larger volumes to high doses with palliative benefit.

  16. Dose calculations algorithm for narrow heavy charged-particle beams

    Energy Technology Data Exchange (ETDEWEB)

    Barna, E A; Kappas, C [Department of Medical Physics, School of Medicine, University of Patras (Greece); Scarlat, F [National Institute for Laser and Plasma Physics, Bucharest (Romania)

    1999-12-31

    The dose distributional advantages of the heavy charged-particles can be fully exploited by using very efficient and accurate dose calculation algorithms, which can generate optimal three-dimensional scanning patterns. An inverse therapy planning algorithm for dynamically scanned, narrow heavy charged-particle beams is presented in this paper. The irradiation `start point` is defined at the distal end of the target volume, right-down, in a beam`s eye view. The peak-dose of the first elementary beam is set to be equal to the prescribed dose in the target volume, and is defined as the reference dose. The weighting factor of any Bragg-peak is determined by the residual dose at the point of irradiation, calculated as the difference between the reference dose and the cumulative dose delivered at that point of irradiation by all the previous Bragg-peaks. The final pattern consists of the weighted Bragg-peaks irradiation density. Dose distributions were computed using two different scanning steps equal to 0.5 mm, and 1 mm respectively. Very accurate and precise localized dose distributions, conform to the target volume, were obtained. (authors) 6 refs., 3 figs.

  17. Comparison of Patient Dose in Two-Dimensional Carotid Arteriography and Three-Dimensional Rotational Angiography

    International Nuclear Information System (INIS)

    Tsapaki, Virginia; Vano, Eliseo; Mavrikou, Irini; Neofotistou, Vassiliki; Gallego, Juan Jose; Fernandez, Jose Miguel; Santos, Ernesto; Mendez, Jose

    2008-01-01

    Background and Purpose. It is known that interventional neuroradiology (IN) involves high radiation dose to both patients and staff even if performed by trained operators using modern fluoroscopic X-ray equipment and dose-reducing technology. Therefore, every new technology or imaging tool introduced, such as three-dimensional rotational angiography (3D RA), should be evaluated in terms of radiation dose. 3D RA requires a series with a large number of images in comparison with 2D angiography and it is sometimes considered a high-dose IN procedure. The literature is scarce on the 3D RA radiation dose and in particular there are no data on carotid arteriography (CA). The aim of this study was to investigate patient dose differences between 2D and 3D CA. Methods. The study included 35 patients undergoing 2D CA in hospital 1 and 25 patients undergoing 3D CA in hospital 2. Patient technical data collection included information on the kerma area product (KAP), fluoroscopy time (T), total number of series (S), and total number of acquired images (F). Results. Median KAP was 112 Gy cm 2 and 41 Gy cm 2 for hospitals 1 and 2, respectively, median T was 8.2 min and 5.1 min, median S was 13 and 4, and median F was 247 and 242. Entrance surface air-kerma rate, as measured in 'medium' fluoroscopy mode measured in 2D acquisition using a 20 cm phantom of polymethylmethacrylate, was 17.3 mGy/min for hospital 1 and 9.2 mGy/min for hospital 2. Conclusion. 3D CA allows a substantial reduction in patient radiation dose compared with 2D CA, while providing the necessary diagnostic information

  18. Toward an ozone standard to protect vegetation based on effective dose: A review of deposition resistances and a possible metric

    Science.gov (United States)

    W. J. Massman

    2004-01-01

    Present air quality standards to protect vegetation from ozone are based on measured concentrations (i.e., exposure) rather than on plant uptake rates (or dose). Some familiar cumulative exposure-based indices include SUM06, AOT40, and W126. However, plant injury is more closely related to dose, or more appropriately to effective dose, than to exposure. This study...

  19. Single-fraction stereotactic radiotherapy: a dose-response analysis of arteriovenous malformation obliteration

    International Nuclear Information System (INIS)

    Touboul, Emmanuel; Al Halabi, Assem; Buffat, Laurent; Merienne, Louis; Huart, Judith; Schlienger, Michel; Lefkopoulos, Dimitrios; Mammar, Hamid; Missir, Odile; Meder, Jean-Francois; Laurent, Alex; Housset, Martin

    1998-01-01

    Purpose: Stereotactic radiotherapy delivered in a high-dose single fraction is an effective technique to obliterate intracranial arteriovenous malformations (AVM). To attempt to analyze the relationships between dose, volume, and obliteration rates, we studied a group of patients treated using single-isocenter treatment plans. Methods and Materials: From May 1986 to December 1989, 100 consecutive patients with angiographically proven AVM had stereotactic radiotherapy delivered as a high-dose single fraction using a single-isocenter technique. Distribution according to Spetzler-Martin grade was as follows: 79 grade 1-3, three grade 4, 0 grade 5, and 18 grade 6. The target volume was spheroid in 74 cases, ellipsoid in 11, and large and irregular in 15. The targeted volume of the nidus was estimated using two-dimensional stereotactic angiographic data and, calculated as an ovoid-shaped lesion, was 1900 ± 230 mm 3 (median 968 mm 3 ; range 62-11, 250 mm 3 ). The mean minimum target dose (D min ) was 19 ± 0.6 Gy (median 20 Gy; range: 3-31.5). The mean volume within the isodose which corresponded to the minimum target dose was 2500 ± 300 mm 3 (median 1200 mm 3 ; range 75-14 900 mm 3 ). The mean maximum dose (D max ) was 34.5 ± 0.5 Gy (median 35 Gy; range 15-45). The mean angiographic follow-up was 42 ± 2.3 months (median 37.5; range 7-117). Results: The absolute obliteration rate was 51%. The 5-year actuarial obliteration rate was 62.5 ± 7%. After univariate analysis, AVM obliteration was influenced by previous surgery (p = 0.0007), D min by steps of 5 Gy (p = 0.005), targeted volume of the nidus (≤968 mm 3 vs. >968 mm 3 ; p = 0.015), and grade according to Spetzler-Martin (grade 1-3 vs. grade 4-6; p = 0.011). After multivariate analysis, the independent factors influencing AVM obliteration were the D min [relative risk (RR) 1.9; 95% confidence interval (CI) 1.4-2.5; p min but does not seem to be influenced by D max and the targeted volume of the nidus

  20. Study of recurrent branch of median nerve (Thenar's muscular branch in relation to the flexor retinaculum and median in 64 hands (32 Men

    Directory of Open Access Journals (Sweden)

    Amirsadri R

    1998-07-01

    Full Text Available Variation of recurred branch of median nerve in relation to the median and flexor retinaculum are significant for both hand surgeons and specialists always. In this study, 64 cadaver hands (32 men have been dissected. The median nerve was identified at the proximal edge of the flexor retinaculum, and in order to expose carpal tunnel the ligament was divided, and the above subjects were studied. The results are: 1 The relation of recurrent nerve to the flexor retinaculum was classified into 4 types: A In (53.1% of subjects, this branch arises from the median after the flexor retinaculum. B In (31.3% of subjects, it arises from the median in the carpal tunnel and the moves around the lower edge of flexor retinaculum and enters the thenar region. C In (14.1% of subjects, it arises from the median in the carpal tunnel and pierces the flexor retinaculum. D In (1.56% of subjects it arises, in the carpal tunnel and it divides into two subbranches here. One follows pattern A and the other pattern C. 2 In this step, the relation of the recurrent branch to the median nerve was studied. The results show that inspite of this image even though most often the recurrent branch arises from the lateral side of median, in (68.75% of subjects it arises from it's anterior surface. The MC Nemar test reveals that there is no relation between manifestation of mentioned patterns with right or left hands.

  1. Cumulative occupational lumbar load and lumbar disc disease – results of a German multi-center case-control study (EPILIFT

    Directory of Open Access Journals (Sweden)

    Michaelis Martina

    2009-05-01

    Full Text Available Abstract Background The to date evidence for a dose-response relationship between physical workload and the development of lumbar disc diseases is limited. We therefore investigated the possible etiologic relevance of cumulative occupational lumbar load to lumbar disc diseases in a multi-center case-control study. Methods In four study regions in Germany (Frankfurt/Main, Freiburg, Halle/Saale, Regensburg, patients seeking medical care for pain associated with clinically and radiologically verified lumbar disc herniation (286 males, 278 females or symptomatic lumbar disc narrowing (145 males, 206 females were prospectively recruited. Population control subjects (453 males and 448 females were drawn from the regional population registers. Cases and control subjects were between 25 and 70 years of age. In a structured personal interview, a complete occupational history was elicited to identify subjects with certain minimum workloads. On the basis of job task-specific supplementary surveys performed by technical experts, the situational lumbar load represented by the compressive force at the lumbosacral disc was determined via biomechanical model calculations for any working situation with object handling and load-intensive postures during the total working life. For this analysis, all manual handling of objects of about 5 kilograms or more and postures with trunk inclination of 20 degrees or more are included in the calculation of cumulative lumbar load. Confounder selection was based on biologic plausibility and on the change-in-estimate criterion. Odds ratios (OR and 95% confidence intervals (CI were calculated separately for men and women using unconditional logistic regression analysis, adjusted for age, region, and unemployment as major life event (in males or psychosocial strain at work (in females, respectively. To further elucidate the contribution of past physical workload to the development of lumbar disc diseases, we performed lag

  2. A Framework for Treating Cumulative Trauma with Art Therapy

    Science.gov (United States)

    Naff, Kristina

    2014-01-01

    Cumulative trauma is relatively undocumented in art therapy practice, although there is growing evidence that art therapy provides distinct benefits for resolving various traumas. This qualitative study proposes an art therapy treatment framework for cumulative trauma derived from semi-structured interviews with three art therapists and artistic…

  3. Absorbed dose distributions in patients with bone metastases from hormone refractory prostate cancer treated with Re-186 HEDP

    International Nuclear Information System (INIS)

    Denis Bacelar, A.M.; Dearnaley, D.P.; Divoli, A.; Chittenden, S.; Du, Y.; Flux, G.D.; O'Sullivan, J.M.

    2015-01-01

    Full text of publication follows. Aim: intravenous administration of Re-186 hydroxyethylidene-diphosphonate (HEDP) is used for metastatic bone pain palliation in hormone refractory prostate cancer patients. Dosimetry for bone seeking radionuclides is challenging due to the complex structure with osteoblastic, osteolytic and mixed lesions. The aim of this study was to perform image-based patient-specific 3D convolution dosimetry to obtain a distribution of the absorbed doses to each lesion and estimate inter- and intra-patient variations. Materials and methods: 28 patients received a fixed 5 GBq activity of Re-186 HEDP followed by peripheral blood stem cell rescue at 14 days in a phase II trial. A FORTE dual-headed gamma camera was used to acquire sequential Single-Photon-Emission Computed Tomography (SPECT) data of the thorax and pelvis area at 1, 4, 24, 48 and 72 hours following administration. The projection data were reconstructed using filtered-back projection and were corrected for attenuation and scatter. Voxelised cumulated activity distributions were obtained with two different methods. First, the scans were co-registered and the time-activity curves were obtained on a voxel-by-voxel basis. Second, the clearance curve was obtained from the mean number of counts in each individual lesion and used to scale the uptake distribution taken at 24 hours. The calibration factors required for image quantification were obtained from a phantom experiment. An in-house developed EGSnrc Monte Carlo code was used for the calculation of dose voxel kernels for soft-tissue and cortical/trabecular bone used to perform convolution dosimetry. Cumulative dose-volume histograms were produced and mean absorbed doses calculated for each spinal and pelvic lesion. Results: preliminary results show that the lesion mean absorbed doses ranged from 25 to 55 Gy when the medium was soft tissue and decreased by 40% if bone was considered. The use of the cumulated activity distribution

  4. Cumulative Environmental Impacts: Science and Policy to Protect Communities.

    Science.gov (United States)

    Solomon, Gina M; Morello-Frosch, Rachel; Zeise, Lauren; Faust, John B

    2016-01-01

    Many communities are located near multiple sources of pollution, including current and former industrial sites, major roadways, and agricultural operations. Populations in such locations are predominantly low-income, with a large percentage of minorities and non-English speakers. These communities face challenges that can affect the health of their residents, including limited access to health care, a shortage of grocery stores, poor housing quality, and a lack of parks and open spaces. Environmental exposures may interact with social stressors, thereby worsening health outcomes. Age, genetic characteristics, and preexisting health conditions increase the risk of adverse health effects from exposure to pollutants. There are existing approaches for characterizing cumulative exposures, cumulative risks, and cumulative health impacts. Although such approaches have merit, they also have significant constraints. New developments in exposure monitoring, mapping, toxicology, and epidemiology, especially when informed by community participation, have the potential to advance the science on cumulative impacts and to improve decision making.

  5. Assessment of dose load of personnel in intratissue gamma beam therapy

    International Nuclear Information System (INIS)

    Stavitskij, R.V.; Zamyatin, O.A.; Varennikov, O.I.; Astakhova, I.V.

    1995-01-01

    Suggest a method for retrospective assessment of levels of irradiation of small groups of personnel exposed to radiation sources. Presents estimated values of cumulative and local doses obtained by personnel during intratissue gamma beam therapy carried out by manual consecutive injections of intrastats and irradiation sources. 3 refs.; 5 tabs

  6. Repeated dose titration versus age-based method in electroconvulsive therapy: a pilot study.

    Science.gov (United States)

    Aten, Jan Jaap; Oudega, Mardien; van Exel, Eric; Stek, Max L; van Waarde, Jeroen A

    2015-06-01

    In electroconvulsive therapy (ECT), a dose titration method (DTM) was suggested to be more individualized and therefore more accurate than formula-based dosing methods. A repeated DTM (every sixth session and dose adjustment accordingly) was compared to an age-based method (ABM) regarding treatment characteristics, clinical outcome, and cognitive functioning after ECT. Thirty-nine unipolar depressed patients dosed using repeated DTM and 40 matched patients treated with ABM were compared. Montgomery-Åsberg Depression Rating Scale (MADRS) and Mini-Mental State Examination (MMSE) were assessed at baseline and at the end of the index course, as well as the total number of ECT sessions. Both groups were similar regarding age, sex, psychotic features, mean baseline MADRS, and median baseline MMSE. At the end of the index course, the two methods showed equal outcome (mean end MADRS, 11.6 ± 8.3 in DTM and 9.5 ± 7.6 in ABM (P = 0.26); median end MMSE, 28 (25-29) and 28 (25-29.8), respectively (P = 0.81). However, the median number of all ECT sessions differed 16 (11-22) in DTM versus 12 (10-14.8) in ABM; P = 0.02]. Using regression analysis, dosing method and age were independently associated with the total number of ECT sessions, with less sessions needed in ABM (P = 0.02) and in older patients (P = 0.001). In this comparative cohort study, ABM and DTM showed equal outcome for depression and cognition. However, the median ECT course duration in repeated DTM appeared longer. Additionally, higher age was associated with shorter ECT courses regardless of the dosing method. Further prospective studies are needed to confirm these findings.

  7. Baltic Sea biodiversity status vs. cumulative human pressures

    DEFF Research Database (Denmark)

    Andersen, Jesper H.; Halpern, Benjamin S.; Korpinen, Samuli

    2015-01-01

    Abstract Many studies have tried to explain spatial and temporal variations in biodiversity status of marine areas from a single-issue perspective, such as fishing pressure or coastal pollution, yet most continental seas experience a wide range of human pressures. Cumulative impact assessments have...... been developed to capture the consequences of multiple stressors for biodiversity, but the ability of these assessments to accurately predict biodiversity status has never been tested or ground-truthed. This relationship has similarly been assumed for the Baltic Sea, especially in areas with impaired...... status, but has also never been documented. Here we provide a first tentative indication that cumulative human impacts relate to ecosystem condition, i.e. biodiversity status, in the Baltic Sea. Thus, cumulative impact assessments offer a promising tool for informed marine spatial planning, designation...

  8. Conceptual models for cumulative risk assessment.

    Science.gov (United States)

    Linder, Stephen H; Sexton, Ken

    2011-12-01

    In the absence of scientific consensus on an appropriate theoretical framework, cumulative risk assessment and related research have relied on speculative conceptual models. We argue for the importance of theoretical backing for such models and discuss 3 relevant theoretical frameworks, each supporting a distinctive "family" of models. Social determinant models postulate that unequal health outcomes are caused by structural inequalities; health disparity models envision social and contextual factors acting through individual behaviors and biological mechanisms; and multiple stressor models incorporate environmental agents, emphasizing the intermediary role of these and other stressors. The conclusion is that more careful reliance on established frameworks will lead directly to improvements in characterizing cumulative risk burdens and accounting for disproportionate adverse health effects.

  9. Dose-volume analysis of predictors for chronic rectal toxicity after treatment of prostate cancer with adaptive image-guided radiotherapy

    International Nuclear Information System (INIS)

    Vargas, Carlos; Martinez, Alvaro; Kestin, Larry L.; Yan Di; Grills, Inga; Brabbins, Donald S.; Lockman, David M.; Liang Jian; Gustafson, Gary S.; Chen, Peter Y.; Vicini, Frank A.; Wong, John W.

    2005-01-01

    Purpose We analyzed our experience treating localized prostate cancer with image-guided off-line correction with adaptive high-dose radiotherapy (ART) in our Phase II dose escalation study to identify factors predictive of chronic rectal toxicity. Materials and Methods From 1999-2002, 331 patients with clinical stage T1-T3N0M0 prostate cancer were prospectively treated in our Phase II 3D conformal dose escalation ART study to a median dose of 75.6 Gy (range, 63.0-79.2 Gy), minimum dose to confidence limited-planning target volume (cl-PTV) in 1.8 Gy fractions (median isocenter dose = 79.7 Gy). Seventy-four patients (22%) also received neoadjuvant/adjuvant androgen deprivation therapy. A patient-specific cl-PTV was constructed using 5 computed tomography scans and 4 sets of electronic portal images by applying an adaptive process to assure target accuracy and minimize PTV margin. For each case, the rectum (rectal solid) was contoured from the sacroiliac joints or rectosigmoid junction (whichever was higher) to the anal verge or ischial tuberosities (whichever was lower), with a median volume of 81.2 cc. The rectal wall was defined using the rectal solid with an individualized 3-mm wall thickness (median volume = 29.8 cc). Rectal wall dose-volume histogram was used to determine the prescribed dose. Toxicity was quantified using the National Cancer Institute Common Toxicity Criteria 2.0. Multiple dose-volume endpoints were evaluated for their association with chronic rectal toxicity. Results Median follow-up was 1.6 years. Thirty-four patients (crude rate 10.3%) experienced Grade 2 chronic rectal toxicity at a median interval of 1.1 years. Nine patients (crude rate = 2.7%) experienced Grade ≥3 chronic rectal toxicity (1 was Grade 4) at a median interval of 1.2 years. The 3-year rates of Grade ≥2 and Grade ≥3 chronic rectal toxicity were 20% and 4%, respectively. Acute toxicity predicted for chronic: Acute Grade 2-3 rectal toxicity (p 40% respectively. The volume

  10. Allegheny County Median Age at Death

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The median age at death is calculated for each municipality in Allegheny County. Data is based on the decedent's residence at the time of death, not the location...

  11. A theoretical analysis of the median LMF adaptive algorithm

    DEFF Research Database (Denmark)

    Bysted, Tommy Kristensen; Rusu, C.

    1999-01-01

    Higher order adaptive algorithms are sensitive to impulse interference. In the case of the LMF (Least Mean Fourth), an easy and effective way to reduce this is to median filter the instantaneous gradient of the LMF algorithm. Although previous published simulations have indicated that this reduces...... the speed of convergence, no analytical studies have yet been made to prove this. In order to enhance the usability, this paper presents a convergence and steady-state analysis of the median LMF adaptive algorithm. As expected this proves that the median LMF has a slower convergence and a lower steady...

  12. Emphysema quantification and lung volumetry in chest X-ray equivalent ultralow dose CT - Intra-individual comparison with standard dose CT.

    Science.gov (United States)

    Messerli, Michael; Ottilinger, Thorsten; Warschkow, René; Leschka, Sebastian; Alkadhi, Hatem; Wildermuth, Simon; Bauer, Ralf W

    2017-06-01

    To determine whether ultralow dose chest CT with tin filtration can be used for emphysema quantification and lung volumetry and to assess differences in emphysema measurements and lung volume between standard dose and ultralow dose CT scans using advanced modeled iterative reconstruction (ADMIRE). 84 consecutive patients from a prospective, IRB-approved single-center study were included and underwent clinically indicated standard dose chest CT (1.7±0.6mSv) and additional single-energy ultralow dose CT (0.14±0.01mSv) at 100kV and fixed tube current at 70mAs with tin filtration in the same session. Forty of the 84 patients (48%) had no emphysema, 44 (52%) had emphysema. One radiologist performed fully automated software-based pulmonary emphysema quantification and lung volumetry of standard and ultralow dose CT with different levels of ADMIRE. Friedman test and Wilcoxon rank sum test were used for multiple comparison of emphysema and lung volume. Lung volumes were compared using the concordance correlation coefficient. The median low-attenuation areas (LAA) using filtered back projection (FBP) in standard dose was 4.4% and decreased to 2.6%, 2.1% and 1.8% using ADMIRE 3, 4, and 5, respectively. The median values of LAA in ultralow dose CT were 5.7%, 4.1% and 2.4% for ADMIRE 3, 4, and 5, respectively. There was no statistically significant difference between LAA in standard dose CT using FBP and ultralow dose using ADMIRE 4 (p=0.358) as well as in standard dose CT using ADMIRE 3 and ultralow dose using ADMIRE 5 (p=0.966). In comparison with standard dose FBP the concordance correlation coefficients of lung volumetry were 1.000, 0.999, and 0.999 for ADMIRE 3, 4, and 5 in standard dose, and 0.972 for ADMIRE 3, 4 and 5 in ultralow dose CT. Ultralow dose CT at chest X-ray equivalent dose levels allows for lung volumetry as well as detection and quantification of emphysema. However, longitudinal emphysema analyses should be performed with the same scan protocol and

  13. Neoadjuvant concurrent chemoradiotherapy followed by definitive high-dose radiotherapy or surgery for operable thoracic esophageal carcinoma

    International Nuclear Information System (INIS)

    Masao, Murakami; Yasumasa, Kuroda; Yosiaki, Okamoto; Koichi, Kono; Eisaku, Yoden; Fusako, Kusumi; Kiyoshi, Hajiro; Satoru, Matsusue; Hiroshi, Takeda

    1997-01-01

    Purpose: A prospective clinical trial was undertaken to investigate the feasibility of concurrent chemoradiotherapy for the esophageal carcinoma. Materials and Methods: Between June 1989 and May 1996, forty patients with operable squamous cell carcinoma of the thoracic esophagus (stage 0 to III: UICC 1987), aged 45 to 78 (mean:64), were enrolled in a study of neoadjuvant concurrent chemoradiotherapy followed by definitive high-dose radiotherapy (CRT group) or surgery (CRT-S group). Neoadjuvant chemoradiotherapy consisted of 44Gy in 40 fractions for 4 weeks (2.2Gy/2Fr./day) through 10MVX rays, with one or two courses of cisplatin (80-150mg/body, mean:90mg/m 2 , day 1, bolus injection) and 5-fluorouracil (500-1500mg/body/day, mean:600mg/m 2 , day 1-4, continuous infusion). After completion of neoadjuvant chemoradiotherapy, clinical complete response (CR) was observed in 16 patients, partial response (PR) in 22, and no change (NC) in 2. Thirty responding patients (CR:16, PR:14) entered in CRT group, and 10 non-responding patients (PR:8, NC:2) followed by surgery (CRT-S group). A cumulative median dose of 66Gy for Tis,T1 and 71Gy for T2-T4 tumor with/without high-dose-rate intraluminal brachytherapy, and one to three courses of chemotherapy were delivered in CRT group. Intraoperative radiotherapy for abdominal lymphatic system and postoperative supraclavicular irradiation were added in CRT-S group. Results: Clinical CR rate at the completion of treatment showed 90% in CRT group, and pathological CR rate 10% in CRT-S group. The overall median survival was 45 months, survival at 1, 2, 3 years being 100%, 72%, 56%, respectively. Loco-regional failure was observed in 7 patients (all in CRT group), distant failure in 6 (3 in CRT group, 3 in CRT-S group) and loco-regional with distant failure in 1 (CRT group). Four patients of loco-regional recurrence in CRT group were salvaged by surgery. Overall survival at 2-, 3-years for CRT vs. CRT-S group was 72%, 64% vs. (1(1)); 100

  14. Impact of ibrutinib dose adherence on therapeutic efficacy in patients with previously treated CLL/SLL.

    Science.gov (United States)

    Barr, Paul M; Brown, Jennifer R; Hillmen, Peter; O'Brien, Susan; Barrientos, Jacqueline C; Reddy, Nishitha M; Coutre, Steven; Mulligan, Stephen P; Jaeger, Ulrich; Furman, Richard R; Cymbalista, Florence; Montillo, Marco; Dearden, Claire; Robak, Tadeusz; Moreno, Carol; Pagel, John M; Burger, Jan A; Suzuki, Samuel; Sukbuntherng, Juthamas; Cole, George; James, Danelle F; Byrd, John C

    2017-05-11

    Ibrutinib, an oral inhibitor of Bruton's tyrosine kinase (BTK), at a once-daily dose of 420 mg achieved BTK active-site occupancy in patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) that was maintained at 24 hours. It is unknown if intermittent interruption of ibrutinib therapy contributes to altered clinical outcomes. We therefore evaluated the effect of ibrutinib dose adherence on patient outcomes in the phase 3 RESONATE trial. The overall mean dose intensity (DI) was 95% with median treatment duration of ∼9 months. Pharmacokinetic assessment of ibrutinib exposure at 420-mg dose suggested similar exposure regardless of patient weight or age. As assessed by independent review committee, patients with higher DI experienced longer median progression-free survival (PFS) compared with those with lower DI regardless of del17p and/or TP53 status. Of 79 patients requiring a drug hold, treatment was restarted at the original dose in 73 (92%) patients. Mean duration of a missed-dose event was 18.7 days (range, 8-56). Patients missing ≥8 consecutive days of ibrutinib had a shorter median PFS vs those missing ibrutinib dosing at 420 mg as clinically feasible to achieve optimal outcomes in patients with previously treated CLL. The trial was registered at www.clinicaltrials.gov as #NCT01578707. © 2017 by The American Society of Hematology.

  15. High dose vitamin K3 infusion in advanced hepatocellular carcinoma.

    Science.gov (United States)

    Sarin, Shiv K; Kumar, Manoj; Garg, Sanjay; Hissar, Syed; Pandey, Chandana; Sharma, Barjesh C

    2006-09-01

    The survival of patients with unresectable advanced hepatocellular carcinoma (HCC) with portal vein thrombosis is dismal. Current therapeutic options have limited efficacy. Vitamin K has been shown to have antitumor effect on HCC cells both in cell lines and patients with advanced HCC. The aim of this study was to assess the clinical efficacy of high dose vitamin K3 in the treatment of advanced HCC with portal vein thrombosis. Forty-two consecutive patients with advanced HCC (Stage C according to BCLC staging system) with portal vein thrombosis were randomized into two groups: (i) high dose vitamin K3 (n = 23); and (ii) placebo (n = 19). The vitamin K3 was administered by i.v. infusion of 50 mg/day with daily increase of dose by 50 mg for 6 days, followed by 20 mg i.m. twice daily for 2 weeks. Of the 23 patients treated with vitamin K, one (4.3%) achieved complete response and three (13%) partial response, for a total of four (17.4%) objective responders overall. The overall mean survival was 8.9 +/- 8.8 months (median: 6; range 1-37 months) in the vitamin K group and 6.8 +/- 5.3 months (median: 5; range 1.5-21 months) in the placebo group (P = 0.552). The mean duration of survival was longer in patients in the vitamin K group who achieved objective response (22.5 +/- 12.2; median: 21; range 11-37 months) as compared to patients not achieving objective response (6.1 +/- 4.6; median: 5; range 1-16 months) (P = 0.0.002). Portal vein thrombosis resolved with complete patency in one (4.35%) patient. Treatment with high dose vitamin K produces objective response in 17% patients with improved survival in patients achieving objective response; however, it does not affect the overall survival.

  16. The Investigation of Median Frequency Changes in Paraspinal Muscles Following Fatigue

    Directory of Open Access Journals (Sweden)

    Saeed Talebian

    2009-10-01

    Conclusion: Median frequency shift toward low values following fatigue in global and local paraspinal muscles was seen. However, median frequency values for the local stabilizer muscle were higher than median frequency values for the global muscles.

  17. Cumulative query method for influenza surveillance using search engine data.

    Science.gov (United States)

    Seo, Dong-Woo; Jo, Min-Woo; Sohn, Chang Hwan; Shin, Soo-Yong; Lee, JaeHo; Yu, Maengsoo; Kim, Won Young; Lim, Kyoung Soo; Lee, Sang-Il

    2014-12-16

    Internet search queries have become an important data source in syndromic surveillance system. However, there is currently no syndromic surveillance system using Internet search query data in South Korea. The objective of this study was to examine correlations between our cumulative query method and national influenza surveillance data. Our study was based on the local search engine, Daum (approximately 25% market share), and influenza-like illness (ILI) data from the Korea Centers for Disease Control and Prevention. A quota sampling survey was conducted with 200 participants to obtain popular queries. We divided the study period into two sets: Set 1 (the 2009/10 epidemiological year for development set 1 and 2010/11 for validation set 1) and Set 2 (2010/11 for development Set 2 and 2011/12 for validation Set 2). Pearson's correlation coefficients were calculated between the Daum data and the ILI data for the development set. We selected the combined queries for which the correlation coefficients were .7 or higher and listed them in descending order. Then, we created a cumulative query method n representing the number of cumulative combined queries in descending order of the correlation coefficient. In validation set 1, 13 cumulative query methods were applied, and 8 had higher correlation coefficients (min=.916, max=.943) than that of the highest single combined query. Further, 11 of 13 cumulative query methods had an r value of ≥.7, but 4 of 13 combined queries had an r value of ≥.7. In validation set 2, 8 of 15 cumulative query methods showed higher correlation coefficients (min=.975, max=.987) than that of the highest single combined query. All 15 cumulative query methods had an r value of ≥.7, but 6 of 15 combined queries had an r value of ≥.7. Cumulative query method showed relatively higher correlation with national influenza surveillance data than combined queries in the development and validation set.

  18. Dose-response effects in an outbreak of Salmonella enteritidis.

    Science.gov (United States)

    Mintz, E D; Cartter, M L; Hadler, J L; Wassell, J T; Zingeser, J A; Tauxe, R V

    1994-02-01

    The effects of ingested Salmonella enteritidis (SE) dose on incubation period and on the severity and duration of illness were estimated in a cohort of 169 persons who developed gastroenteritis after eating hollandaise sauce made from grade-A shell eggs. The cohort was divided into three groups based on self-reported dose of sauce ingested. As dose increased, median incubation period decreased (37 h in the low exposure group v. 21 h in the medium exposure group v. 17.5 h in the high exposure group, P = 0.006) and greater proportions reported body aches (71 v. 85 v. 94%, P = 0.0009) and vomiting (21 v. 56 v. 57%, P = 0.002). Among 118 case-persons who completed a follow-up questionnaire, increased dose was associated with increases in median weight loss in kilograms (3.2 v. 4.5 v. 5.0, P = 0.0001), maximum daily number of stools (12.5 v. 15.0 v. 20.0, P = 0.02), subjective rating of illness severity (P = 0.0007), and the number of days of confinement to bed (3.0 v. 6.5 v. 6.5, P = 0.04). In this outbreak, ingested dose was an important determinant of the incubation period, symptoms and severity of acute salmonellosis.

  19. Impact on Medical Cost, Cumulative Survival, and Cost-Effectiveness of Adding Rituximab to First-Line Chemotherapy for Follicular Lymphoma in Elderly Patients: An Observational Cohort Study Based on SEER-Medicare

    International Nuclear Information System (INIS)

    Griffiths, R. I.; Gleeson, M. L.; Danese, M. D.; Griffiths, R. I.; Mikhael, J.

    2012-01-01

    Rituximab improves survival in follicular lymphoma (FL), but is considerably more expensive than conventional chemotherapy. We estimated the total direct medical costs, cumulative survival, and cost-effectiveness of adding rituximab to first-line chemotherapy for FL, based on a single source of data representing routine practice in the elderly. Using surveillance, epidemiology, and end results (SEER) registry data plus Medicare claims, we identified 1,117 FL patients who received first-line CHOP (cyclophosphamide (C), doxorubicin, vincristine (V), and prednisone (P)) or CVP +/− rituximab. Multivariate regression was used to estimate adjusted cumulative cost and survival differences between the two groups over four years after beginning treatment. The median age was 73 years (minimum 66 years), 56% had stage III-IV disease, and 67% received rituximab. Adding rituximab to first-line chemotherapy was associated with higher adjusted incremental total cost ($18,695; 95% Confidence Interval (CI) $9,302-$28,643) and longer adjusted cumulative survival (0.18 years; 95% CI 0.10-0.27) over four years of followup. The expected cost-effectiveness was $102,142 (95% CI $34,531-296,337) per life-year gained. In routine clinical practice, adding rituximab to first-line chemotherapy for elderly patients with FL results in higher direct medical costs to Medicare and longer cumulative survival after four years.

  20. Outdoor γ-ray dose rate in Shariki Village and environmental factors affecting outdoor γ-ray dose rate in IES

    International Nuclear Information System (INIS)

    Iyogi, Takashi; Hisamatsu, Shun'ichi; Inaba, Jiro

    2000-01-01

    Previously, we surveyed the outdoor γ-ray dose rate throughout Aomori Prefecture from 1992 to 1995, and found an annual mean dose rate of 51 nGy h -1 . Relatively high dose rates were also observed in several areas (municipalities) of the survey locations. In this study, we examined the detailed distribution of the γ-ray dose rate in one such high dose rate area, Shariki Village. Glass dosemeters were used for the monitoring of cumulative γ-ray dose rate at 10 locations in the village. The dose rate from each radioactive nuclide in the ground at the monitoring locations was measured by using an in situ γ-ray spectrometer with a Ge detector. The results obtained with the glass dosemeters showed that the γ-ray dose rates in Shariki Village varied from 49 to 55 nGy h -1 . Although the dose rates were generally higher than the mean dose in Aomori Prefecture (1992-1995), the rates were lower than other high dose rate areas which had already been measured. The in situ γ-ray spectrometry revealed that these relatively high dose rates were mainly caused by 40 K and Th series radionuclides in the village. The effect of meteorological conditions on the γ-ray dose rate was studied at a monitoring station in the IES site. The dose rate was continuously recorded by a DBM NaI(Tl) scintillation detector system. The mean dose rate obtained when precipitation was sensed was 27 nGy h -1 and higher than when no precipitation was sensed (25 nGy h -1 ). (author)

  1. Outdoor γ-ray dose rate in Mutsu city and environmental factors affecting outdoor γ-ray dose rate in IES

    International Nuclear Information System (INIS)

    Iyogi, Takashi; Hisamatsu, Shun'ichi; Inaba, Jiro

    2001-01-01

    Previously, we surveyed outdoor γ-ray dose rates throughout Aomori Prefecture from 1992 to 1995, and found a mean annual dose rate of 28 nGy h -1 . Relatively high dose rates were also observed in several areas (municipalities) of the survey locations. In this study, we examined the detailed distribution of the γ-ray dose rate in one such high dose rate area, Mutsu City. Glass dosemeters were used for the monitoring of cumulative γ-ray dose rate at 10 locations in the city. The dose rate from each radioactive nuclide in the ground at the monitoring locations was measured by using an in situ γ-ray spectrometer with a Ge detector. The results obtained with the glass dosemeters showed that the γ-ray dose rates in Mutsu City varied from 17 to 32 nGy h -1 . Although the dose rates were almost the same as the mean dose in Aomori Prefecture (1992-1995), the rates were lower than other high dose rate areas which had already been measured. The in situ γ-ray spectrometry revealed that these relatively high dose rates were mainly caused by 40 K and Th series radionuclides in the local ground. The effect of meteorological conditions on the γ-ray dose rate was studied at a monitoring station in the IES site. The dose rate was continuously recorded by a DBM NaI(Tl) scintillation detector system. The mean dose rate obtained when precipitation was sensed was 26 nGy h -1 and higher than when no precipitation was sensed (24 nGy h -1 ). (author)

  2. Quantitative model of evaluation of the contribution of each radioactive source in the individual external dose Hx in nuclear medicine service personnel; Modelo quantitativo de avaliacao da contribuicao de cada fonte radioativa na dose individual externa Hx em trabalhador de servico de medicina nuclear

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Nathalie Canhameiro; Tinois, Eduardo; Koga, Katia Hiromoto; Bezerra, Aline da Silva; Ferreira, Vinicius Capistrano; Azevedo, Thaisa Resende; Moriguchi, Sonia Marta, E-mail: soniamoriguchi@fmb.unesp.br [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    2016-07-01

    Assess whether the activities performed in the Nuclear Medicine service are significant in the total dose received by the workers and their relative contributions. Methods: measured independent variables: number of scintigraphies remaining in the examination room (N); eluted activity (E); Total activity marked in pharmaceuticals kits (K); num-ber of times that was scheduled to work in the Hot room (Q); Variable dependent measured: cumulative effective dose in the period 10/2012 to 04/2013 added to each worker, obtained by information registered daily and monthly on activities and doses received in the period. Held Multiple Linear Regression (D = a + β{sub 1} N + E + β{sub 2} β{sub 3} K + β{sub 4} Q) with α = 0.05 significance level. It was concluded that the independent variables N (p = 0.097) and E (p = 0.086) did not significantly interfere with the Cumulative dose in the period. The K variables (p = 0.017) and Q (p = 0.028) were significant in the proposed model. (author)

  3. Albumin treatment regimen for type 1 hepatorenal syndrome: a dose-response meta-analysis.

    Science.gov (United States)

    Salerno, Francesco; Navickis, Roberta J; Wilkes, Mahlon M

    2015-11-25

    Recommended treatment for type 1 hepatorenal syndrome consists of albumin and vasoconstrictor. The optimal albumin dose remains poorly characterized. This meta-analysis aimed to determine the impact of albumin dose on treatment outcomes. Clinical studies of type 1 hepatorenal syndrome treatment with albumin and vasoconstrictor were sought. Search terms included: hepatorenal syndrome; albumin; vasoconstrictor; terlipressin; midodrine; octreotide; noradrenaline; and norepinephrine. A meta-analysis was performed of hepatorenal syndrome reversal and survival in relation to albumin dose. Nineteen clinical studies with 574 total patients were included, comprising 8 randomized controlled trials, 8 prospective studies and 3 retrospective studies. The pooled