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Sample records for multidisciplinary strategy radiotherapie

  1. Intraoperative radiotherapy in the multidisciplinary management of soft tissue sarcomas

    International Nuclear Information System (INIS)

    Calvo, F.A.; Abuchaibe, O.; Escude, L.; Santos, M.; Villas, C.; Beguiristain, J.L.; Amillo, S.; Canadell, J.

    1989-01-01

    From 1984 to 1989 locally advanced stages of soft tissue sarcomas have been systematically approached with maximal surgical resection, IORT (10-20 Gy) boost to the tumor bed (high risk or residual disease areas) and conventional fractionated external beam postoperative radiotherapy. Chemotherapy was given to patients with high cellular grade sarcomas. Nineteen patients with localized soft tissue sarcomas of the extremities were treated and local control was obtained in 18/19 cases (95%). Distant metastasis developed in 2 patients and 15 patients are alive with no evidence of disease. The median follow-up time of the entire group is 27+ months (range 2+ to 43+ months). Severe IORT toxicity consisting in unreversible peripheral neuropathy has been observed in 3 patients. Another group of 24 patients had tumor located in central anatomical areas (3 head and neck, 7 trunk, 6 retroperitoneal, 3 glutens, 3 pelvis, 1 rectal, 1 bladder). Local control has been obtained in 15 patients (62%). Distant metastasis developed in 3 patients and 11 are alive and free of malignant disease. The median follow-up in this group is 14.5+ months (range from 4 to 50+ months). Severe neuropathy was observed in 1 patient. Severe neurological damage is a preoccupying finding that merits a word of caution in the development of IORT protocols, as what single dose can be selected in areas including nerves in treatment field

  2. Multidisciplinary strategies in the management of early chronic kidney disease.

    Science.gov (United States)

    Martínez-Ramírez, Héctor R; Cortés-Sanabria, Laura; Rojas-Campos, Enrique; Hernández-Herrera, Aurora; Cueto-Manzano, Alfonso M

    2013-11-01

    Chronic kidney disease (CKD) is a worldwide epidemic especially in developing countries, with clear deficiencies in identification and treatment. Better care of CKD requires more than only economic resources, utilization of health research in policy-making and health systems changes that produce better outcomes. A multidisciplinary approach may facilitate and improve management of patients from early CKD in the primary health-care setting. This approach is a strategy for improving comprehensive care, initiating and maintaining healthy behaviors, promoting teamwork, eliminating barriers to achieve goals and improving the processes of care. A multidisciplinary intervention may include educational processes guided by health professional, use of self-help groups and the development of a CKD management plan. The complex and fragmented care management of patients with CKD, associated with poor outcome, enhances the importance of implementing a multidisciplinary approach in the management of this disease from the early stages. Multidisciplinary strategies should focus on the needs of patients (to increase their empowerment) and should be adapted to the resources and health systems prevailing in each country; its systematic implementation can help to improve patient care and slow the progression of CKD. Copyright © 2013 IMSS. Published by Elsevier Inc. All rights reserved.

  3. [Global brain metastases management strategy: a multidisciplinary-based approach].

    Science.gov (United States)

    Métellus, P; Tallet, A; Dhermain, F; Reyns, N; Carpentier, A; Spano, J-P; Azria, D; Noël, G; Barlési, F; Taillibert, S; Le Rhun, É

    2015-02-01

    Brain metastases management has evolved over the last fifteen years and may use varying strategies, including more or less aggressive treatments, sometimes combined, leading to an improvement in patient's survival and quality of life. The therapeutic decision is subject to a multidisciplinary analysis, taking into account established prognostic factors including patient's general condition, extracerebral disease status and clinical and radiological presentation of lesions. In this article, we propose a management strategy based on the state of current knowledge and available therapeutic resources. Copyright © 2015. Published by Elsevier SAS.

  4. Managing brain metastases patients with and without radiotherapy: initial lessonsfrom a team-based consult service through a multidisciplinary integrated palliative oncology clinic.

    Science.gov (United States)

    Jung, Hellen; Sinnarajah, Aynharan; Enns, Bert; Voroney, Jon-Paul; Murray, Alison; Pelletier, Guy; Wu, Jackson Sai-Yiu

    2013-12-01

    A new ambulatory consultative clinic with integrated assessments by palliative care, radiation oncology, and allied health professionals was introduced to (1) assess patients with brain metastases at a regional comprehensive cancer center and (2) inform and guide patients on management strategies, including palliative radiotherapy, symptom control, and end-of-life care issues. We conducted a quality assurance study to inform clinical program development. Between January 2011 and May 2012, 100 consecutive brain metastases patients referred and assessed through a multidisciplinary clinic were evaluated for baseline characteristics, radiotherapy use, and supportive care decisions. Overall survival was examined by known prognostic groups. Proportion of patients receiving end-of-life radiotherapy (death within 30 and 14 days of brain radiotherapy) was used as a quality metric. The median age was 65 years, with non-small cell lung cancer (n = 38) and breast cancer (n = 23) being the most common primary cancers. At least 57 patients were engaged in advance care planning discussions at first consult visit. In total, 75 patients eventually underwent brain radiotherapy, whereas 25 did not. The most common reasons for nonradiotherapy management were patient preference and rapid clinical deterioration. Overall survival for prognostic subgroups was consistent with literature reports. End-of-life brain radiotherapy was observed in 9 % (death within 30 days) and 1 % (within 14 days) of treated patients. By integrating palliative care expertise to address the complex needs of patients with newly diagnosed brain metastases, end-of-life radiotherapy use appears acceptable and improved over historical rates at our institution. An appreciable proportion of patients are not suitable for palliative brain radiotherapy or opt against this treatment option, but the team approach involving nurses, palliative care experts, allied health, and clinical oncologists facilitates

  5. The rapid access palliative radiotherapy program: blueprint for initiation of a one-stop multidisciplinary bone metastases clinic.

    Science.gov (United States)

    Fairchild, A; Pituskin, E; Rose, B; Ghosh, S; Dutka, J; Driga, A; Tachynski, P; Borschneck, J; Gagnon, L; Macdonnell, S; Middleton, J; Thavone, K; Carstairs, S; Brent, D; Severin, D

    2009-02-01

    Radiotherapy (RT) for palliation of pain due to bone metastases (BM) is effective but underutilized likely due to the traditional practice of separate clinic visits for consultation, treatment planning, and RT delivery. However, recent evidence proves one RT treatment is as effective as multiple for analgesia, enabling investigation of an alternative model of RT delivery, the rapid access palliative radiotherapy program (RAPRP). Prior to the start of the program, needs assessment was performed to determine the composition of the optimal team. Screening tools were implemented to streamline holistic, multidisciplinary assessment. An advertising strategy, treatment and research protocols, and mechanisms for patient feedback were established. After RAPRP implementation, patient outcomes such as symptom relief were tracked. Eighty-six patients with painful BM were referred over the 25-week pilot. Median age was 69.9 years; 64% had prostate cancer, and median performance status was 70. Patient-rated pain was on average 6.1/10 at baseline, improving to 2.6/10 by week 4 post-RT. On average, 6.2 symptoms were reported (baseline) compared to 5.2 (week 4). Team members assessed 10-100% of patients and were successful in stabilizing or improving all symptoms in >75% contacted at week 4. One hundred percent of patients surveyed were satisfied with their experience. Early needs assessment was advantageous in determining the optimal team and methods of assessment for our 'one-stop' BM clinic. This approach was successful in improving pain and other symptoms, and the convenience of seeing multiple providers on 1 day was appreciated by the patients.

  6. Multidisciplinary Team Contributions Within a Dedicated Outpatient Palliative Radiotherapy Clinic: A Prospective Descriptive Study

    International Nuclear Information System (INIS)

    Pituskin, Edith; Fairchild, Alysa; Dutka, Jennifer; Gagnon, Lori; Driga, Amy; Tachynski, Patty; Borschneck, Jo-Ann; Ghosh, Sunita

    2010-01-01

    Purpose: Patients with bone metastases may experience pain, fatigue, and decreased mobility. Multiple medications for analgesia are often required, each with attendant side effects. Although palliative-intent radiotherapy (RT) is effective in decreasing pain, additional supportive care interventions may be overlooked. Our objective was to describe the feasibility of multidisciplinary assessment of patients with symptomatic bone metastases attending a dedicated outpatient palliative RT clinic. Methods and Materials: Consecutive patients referred for RT for painful bone metastases were screened for symptoms and needs relevant to their medications, nutritional intake, activities of daily living, and psychosocial and spiritual concerns from January 1 to December 31, 2007. Consultations by appropriate team members and resulting recommendations were collected prospectively. Patients who received RT were contacted by telephone 4 weeks later to assess symptom outcomes. Results: A total of 106 clinic visits by 82 individual patients occurred. As determined by screening form responses, the clinical Pharmacist, Occupational Therapist, Registered Dietician and Social Worker were consulted to provide assessments and recommendations within the time constraints presented by 1-day palliative RT delivery. In addition to pain relief, significant improvements in tiredness, depression, anxiety, drowsiness and overall well-being were reported at 4 weeks. Conclusions: Systematic screening of this population revealed previously unmet needs, addressed in the form of custom verbal and written recommendations. Multidisciplinary assessment is associated with a high number of recommendations and decreased symptom distress. Our findings lend strong support to the routine assessment by multiple supportive care professionals for patients with advanced cancer being considered for palliative RT.

  7. The impact of tumor biology on cancer treatment and multidisciplinary strategies

    International Nuclear Information System (INIS)

    Molls, Michael; Vaupel, Peter; Nieder, Carsten; Anscher, Mitchell S.

    2009-01-01

    This book provides an overview of the fundamentals of tumor biology and the influence of various biologic factors, including inhomogeneity of cancer cells, microenvironment, and host factors, on the design of therapeutic strategies and the outcome of established and emerging treatments. Particular attention is devoted to multidisciplinary combined modality therapy. The topics reviewed include tumorigenesis, cell proliferation, angiogenesis, physiology of malignant tissues, adhesion and invasion, development of metastases, and the role of the immune system in cancer development. Subsequent chapters focus on cancer prevention, detection, and treatment. The principles of chemotherapy, radiotherapy, and molecularly targeted therapy are discussed, treatment resistance is explained, and strategies for rational combinations are provided, including the design of translational studies. Furthermore, the principles and clinical implications of new diagnostic and therapeutic approaches, such as gene expression profiling, gene transfer and silencing, proteomics, and molecular imaging, are presented. The chapters in this book have been written by an outstanding group of basic scientists, clinical researchers, and cancer professionals with long experience in the field. Their aim is to educate and inspire all those who devote most of their work to research into cancer and its treatment. (orig.)

  8. Human Pathogens on Plants: Designing a Multidisciplinary Strategy for Research.

    Science.gov (United States)

    Fletcher, Jacqueline; Leach, Jan E; Eversole, Kellye; Tauxe, Robert

    2014-10-15

    cross-over issues that pertain also to HPOP research, and can suggest logical strategies for minimizing the risk of microbial contamination. Continued interactions and communication among these two disciplinary communities is essential and can be achieved by the creation of an interdisciplinary research coordination network. We hope that this article, an introduction to the multidisciplinary HPOP arena, will be useful to researchers in many related fields.

  9. Human pathogens on plants: designing a multidisciplinary strategy for research.

    Science.gov (United States)

    Fletcher, Jacqueline; Leach, Jan E; Eversole, Kellye; Tauxe, Robert

    2013-04-01

    cross-over issues that pertain also to HPOP research, and can suggest logical strategies for minimizing the risk of microbial contamination. Continued interactions and communication among these two disciplinary communities is essential and can be achieved by the creation of an interdisciplinary research coordination network. We hope that this article, an introduction to the multidisciplinary HPOP arena, will be useful to researchers in many related fields.

  10. Implementing apportionment strategy to identify costs in a multidisciplinary clinic.

    Science.gov (United States)

    Ferraz, Renato Ribeiro Nogueira; Neri, Anna Sofia Costa; Barbosa, Estela Capelas; Silva, Marcus Vinícius Cesso da

    2017-01-01

    To present the implementation of an apportionment strategy proportional to the productive areas of a multidisciplinary clinic, defining the minimum values to be passed monthly to health professionals who work there. A study of the clinic structure was carried out, in which the area of occupation of each service was defined. Later the cost was prorated, allocating a value to each room, proportional to the space occupied. The apportionment implementation allowed the clinic managers to visualize the cost of each room, providing a value base for formation of a minimum amount necessary to be passed monthly to each professional, as a form of payment for rent of using their facilities. The risk of financial loss of the clinic was minimized due to variation of its productivity, as well as the conditions of transference at the time of hiring by professionals were clear, promoting greater confidence and safety in contract relations. Apresentar a implantação de uma estratégia de rateio proporcional às áreas produtivas de uma clínica multidisciplinar, definindo valores mínimos a serem repassados mensalmente aos profissionais de saúde que as ocupam. Estudo da estrutura da clínica, no qual foi definida, em metros quadrados, a área de ocupação de cada serviço. Em seguida, o custo foi rateado, alocando um valor a cada sala, proporcional ao espaço ocupado. A implantação do rateio possibilitou aos gestores da clínica estudada visualizar o custo de cada sala, fornecendo uma base de valor para formação de um valor mínimo necessário a ser repassado mensalmente para cada profissional, como forma de pagamento pelo aluguel de utilização de suas instalações. Minimizou-se o risco de prejuízo da clínica pela variação de sua produtividade, bem como ficaram claras as condições de repasse no momento de contratação do aluguel pelos profissionais, promovendo maior confiança e segurança na relação contratual.

  11. Strategies for multi-disciplinary science innovation education

    NARCIS (Netherlands)

    Proveniers, A.; Westra, J.; Chova, L.G.; Belenguer, D.M.; Torres, I.C.

    2010-01-01

    Almost by definition, innovative, sustainable economics, technologies, derived services and products have to be developed in a multi-disciplinary way: all kinds of bits and parts from less sustainable methods, technologies, services and products have to be reshuffled in new innovative, sustainable

  12. Issues and Strategies in Solving Multidisciplinary Optimization Problems

    Science.gov (United States)

    Patnaik, Surya

    2013-01-01

    Optimization research at NASA Glenn Research Center has addressed the design of structures, aircraft and airbreathing propulsion engines. The accumulated multidisciplinary design activity is collected under a testbed entitled COMETBOARDS. Several issues were encountered during the solution of the problems. Four issues and the strategies adapted for their resolution are discussed. This is followed by a discussion on analytical methods that is limited to structural design application. An optimization process can lead to an inefficient local solution. This deficiency was encountered during design of an engine component. The limitation was overcome through an augmentation of animation into optimization. Optimum solutions obtained were infeasible for aircraft and airbreathing propulsion engine problems. Alleviation of this deficiency required a cascading of multiple algorithms. Profile optimization of a beam produced an irregular shape. Engineering intuition restored the regular shape for the beam. The solution obtained for a cylindrical shell by a subproblem strategy converged to a design that can be difficult to manufacture. Resolution of this issue remains a challenge. The issues and resolutions are illustrated through a set of problems: Design of an engine component, Synthesis of a subsonic aircraft, Operation optimization of a supersonic engine, Design of a wave-rotor-topping device, Profile optimization of a cantilever beam, and Design of a cylindrical shell. This chapter provides a cursory account of the issues. Cited references provide detailed discussion on the topics. Design of a structure can also be generated by traditional method and the stochastic design concept. Merits and limitations of the three methods (traditional method, optimization method and stochastic concept) are illustrated. In the traditional method, the constraints are manipulated to obtain the design and weight is back calculated. In design optimization, the weight of a structure becomes the

  13. A multi-disciplinary study investigating radiotherapy in Ewing's sarcoma - a final report of POG 8346

    International Nuclear Information System (INIS)

    Donaldson, S.; Torrey, M.; Link, M.; Glicksman, A.; Laurie, F.; Manning, J.; Neff, J.; Thompson, E.; Shuster, J.

    1997-01-01

    Purpose: To determine if involved field radiation (IF) is equivalent to standard whole bone radiation (SF) in local tumor control; to establish patterns of failure following treatment; and to determine response, event free (EFS) and overall survival rates from multi-disciplinary therapy in Ewing's Sarcoma (ES). Materials and Methods: Between 1983 and 1988, 184 children with ES were enrolled onto POG 8346. 178 (97%) met eligibility criteria; 6 had non-ES pathology. Induction treatment of Cyclophosphamide/Adriamycin (C/A) x 12 weeks was followed by local treatment either surgery or radiation therapy (XRT) and C/A, Dactinomycin and Vincristine for 50 weeks. Resection was advised for patients with small primary tumors if accomplished without functional loss. 40 patients were randomized to receive SF, whole bone XRT to 39.6 Gy plus a 16.2 Gy boost (total 55.8 Gy) or IF to 55.8 Gy while 84 were assigned to IF XRT. Results: Of 179 eligible patients, 141 (79%) had localized disease and 37 (21%) had metastases. Their 5 yr. EFS was 51% (SE = 5%) and 23% (SE = 7%) respectively. The response rate (RR) to induction chemotherapy was 88% (28% complete, 60% partial), but after XRT the RR increased to 98%. 37 of the localized patients underwent resection of whom 16 (43%) required post-operative XRT with 5 yr. EFS of 80% (SE = 7%). 104 of the localized patients received XRT and had a 5 year EFS of 41% (SE = 5%), with no difference in EFS between those randomized to SF vs. IF. Site of primary tumor correlated with 5 year EFS: Distal extremity - 65% (SE = 8%), Central - 63% (SE = 9%), Proximal extremity - 46% (SE = 8%), and Pelvis - 24% (SE = 10%). Tumor size did not influence EFS. Patterns of failure among the 141 localized patients were: local only - 18 (13%), local and systemic 14 (10%), systemic only 28 (20%). There were 4 (11%) local failures among those resected +/- XRT, but 28 (27%) following XRT alone. By protocol, patients suffering a relapse were required to undergo a biopsy

  14. Basis for new strategies in postoperative radiotherapy of bronchogenic carcinoma

    International Nuclear Information System (INIS)

    Choi, N.C.H.; Grillo, H.C.; Gardiello, M.; Scannel, J.G.; Wilkins, E.W. Jr.

    1980-01-01

    In order to improve our understanding of the role of postoperative radiotherapy and to search for new strategies in the management of N 1 , N 2 , T 3 stage carcinoma of the lung, we analyzed results of treatment in 148 of 166 patients who were registered at the Massachusetts General Hospital Tumor Registry from 1971 to 1977 with a pathological diagnosis of N 1 , N 2 , T 3 carcinoma of the lung after pulmonary resection. Ninety-three patients received postoperative radiotherapy and another 55 were followed without further treatment. Patients with adenocarcinoma showed significant improvement of survival by postoperative radiotherapy; actuarial NED (no evidence of disease) survival rates were 85% and 51% at 1 year, and 43% and 8% at 5 years for S + RT (patients treated with surgery plus postoperative radiotherapy) and S (patients treated with surgery only) groups, respectively, (P 2 , T 3 stages. Regional recurrence was the most common failure in squamous cell carcinoma; 76% (13/17) and 45% (10/22) of all failures were in the regional area in S and S + RT groups. Regional failure in S + RT group was noted with radiation dose up to 5000 rad (TDF 82) which suggests radiation dose higher than 5000 rad in future trial

  15. Cardiovascular radiotherapy. A multi-disciplinary textbook. 2. rev. and enl. ed.

    International Nuclear Information System (INIS)

    Hehrlein, C.

    2002-01-01

    Cardiovascular radiotherapy has made rapid progress over the past few years, thus necessitating a revision and re-edition of this textbook. The structure of the first edition has been largely retained, but there have nevertheless been some important new additions, including chapters on ''New insights on vessel thrombosis and the edge effect following vascular brachytherapy'', ''Catheter-based intracoronary brachytherapy using the β emitter phosphorus 32'', ''Intracoronary afterloading using the Novoste trademark system'' and ''Catheter-based γ-HDR brachytherapy of the peripheral vessels''. The contributions contained in the first edition have also been thoroughly revised

  16. Stereotactic body radiotherapy: current strategies and future development

    Science.gov (United States)

    2016-01-01

    Stereotactic body radiotherapy (SBRT) has emerged as the standard treatment for medically inoperable early-staged non-small cell lung cancer (NSCLC). The local control rate after SBRT is over 90%. Some forms of tumour motion management and image-guided radiation delivery techniques are the prerequisites for fulfilment of its goal to deliver a high radiation dose to the tumour target without overdosing surrounding normal tissues. In this review, the current strategies of tumour motion management will be discussed, followed by an overview of various image-guided radiotherapy (RT) systems and devices available for clinical practice. Besides medically inoperable stage I NSCLC, SBRT has also been widely adopted for treatment of oligometastasis involving the lungs. Its possible applications in various other cancer illnesses are under extensive exploration. The progress of SBRT is critically technology-dependent. With advancement of technology, the ideal of personalised, effective and yet safe SBRT is already on the horizon. PMID:27606082

  17. Integration of multidisciplinary technologies for real time target visualization and verification for radiotherapy.

    Science.gov (United States)

    Chang, Wen-Chung; Chen, Chin-Sheng; Tai, Hung-Chi; Liu, Chia-Yuan; Chen, Yu-Jen

    2014-01-01

    The current practice of radiotherapy examines target coverage solely from digitally reconstructed beam's eye view (BEV) in a way that is indirectly accessible and that is not in real time. We aimed to visualize treatment targets in real time from each BEV. The image data of phantom or patients from ultrasound (US) and computed tomography (CT) scans were captured to perform image registration. We integrated US, CT, US/CT image registration, robotic manipulation of US, a radiation treatment planning system, and a linear accelerator to constitute an innovative target visualization system. The performance of this algorithm segmented the target organ in CT images, transformed and reconstructed US images to match each orientation, and generated image registration in real time mode with acceptable accuracy. This image transformation allowed physicians to visualize the CT image-reconstructed target via a US probe outside the BEV that was non-coplanar to the beam's plane. It allowed the physicians to remotely control the US probe that was equipped on a robotic arm to dynamically trace and real time monitor the coverage of the target within the BEV during a simulated beam-on situation. This target visualization system may provide a direct remotely accessible and real time way to visualize, verify, and ensure tumor targeting during radiotherapy.

  18. Patterns of Utilization of Adjuvant Radiotherapy and Outcomes in Black Women After Breast Conservation at a Large Multidisciplinary Cancer Center

    International Nuclear Information System (INIS)

    Edwards-Bennett, Sophia M.; Jacks, Lindsay M.; McCormick, Beryl; Zhang, Zhigang; Azu, Michelle; Ho, Alice; Powell, Simon; Brown, Carol

    2011-01-01

    Purpose: Population-based studies have reported that as many of 35% of black women do not undergo radiotherapy (RT) after breast conservation surgery (BCS). The objective of the present study was to determine whether this trend persisted at a large multidisciplinary cancer center, and to identify the factors that predict for noncompliance with RT and determine the outcomes for this subset of patients. Methods and Materials: Between January 2002 and December 2007, 83 black women underwent BCS at Memorial Sloan-Kettering Cancer Center and were therefore eligible for the present study. Of the 83 women, 38 (46%) had Stage I, 38 (46%) Stage II, and 7 (8%) Stage III disease. Of the study cohort, 31 (37%) had triple hormone receptor-negative tumors. RT was recommended for 81 (98%) of the 83 patients (median dose, 60 Gy). Results: Of the 81 women, 12 (15%) did not receive the recommended adjuvant breast RT. Nonreceipt of chemotherapy (p = .003) and older age (p = .009) were associated with nonreceipt of RT. With a median follow-up of 70 months, the 3-year local control, locoregional control, recurrence-free survival, disease-free survival, and overall survival rate was 99% (actuarial 5-year rate, 97%), 96% (actuarial 5-year rate, 93%), 95% (actuarial 5-year rate, 92%), 92% (actuarial 5-year rate, 89%), and 95% (actuarial 5-year rate, 91%), respectively. Conclusion: We found a greater rate of utilization adjuvant breast RT (85%) among black women after BCS than has been reported in recent studies, indicating that excellent outcomes are attainable for black women after BCS when care is administered in a multidisciplinary cancer center.

  19. Integration of multidisciplinary technologies for real time target visualization and verification for radiotherapy

    Directory of Open Access Journals (Sweden)

    Chang WC

    2014-06-01

    Full Text Available Wen-Chung Chang,1,* Chin-Sheng Chen,2,* Hung-Chi Tai,3 Chia-Yuan Liu,4,5 Yu-Jen Chen3 1Department of Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan; 2Graduate Institute of Automation Technology, National Taipei University of Technology, Taipei, Taiwan; 3Department of Radiation Oncology, Mackay Memorial Hospital, Taipei, Taiwan; 4Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; 5Department of Medicine, Mackay Medical College, New Taipei City, Taiwan  *These authors contributed equally to this work Abstract: The current practice of radiotherapy examines target coverage solely from digitally reconstructed beam's eye view (BEV in a way that is indirectly accessible and that is not in real time. We aimed to visualize treatment targets in real time from each BEV. The image data of phantom or patients from ultrasound (US and computed tomography (CT scans were captured to perform image registration. We integrated US, CT, US/CT image registration, robotic manipulation of US, a radiation treatment planning system, and a linear accelerator to constitute an innovative target visualization system. The performance of this algorithm segmented the target organ in CT images, transformed and reconstructed US images to match each orientation, and generated image registration in real time mode with acceptable accuracy. This image transformation allowed physicians to visualize the CT image-reconstructed target via a US probe outside the BEV that was non-coplanar to the beam's plane. It allowed the physicians to remotely control the US probe that was equipped on a robotic arm to dynamically trace and real time monitor the coverage of the target within the BEV during a simulated beam-on situation. This target visualization system may provide a direct remotely accessible and real time way to visualize, verify, and ensure tumor targeting during radiotherapy. Keywords: ultrasound, computerized tomography

  20. Role of radiotherapy in the chemotherapy-containing multidisciplinary management of patients with resected pancreatic adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Sole, Claudio V. [Instituto de Radiomedicina (IRAM), Department of Radiation Oncology, Santiago (Chile); Complutense University, School of Medicine, Madrid (Spain); Calvo, Felipe A. [Complutense University, School of Medicine, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Atahualpa, Freddy; Gonzalez-Bayon, Luis; Garcia-Sabrido, Jose Luis [Complutense University, School of Medicine, Madrid (Spain); Hospital General Universitario Gregorio Maranon, General Surgery Service III, Madrid (Spain); Berlin, Alejandro [Clinica Alemana de Santiago, Department of Radiation Oncology, Santiago (Chile); Herranz, Rafael [Hospital General Universitario Gregorio Maranon, Department of Radiation Oncology, Madrid (Spain)

    2014-10-08

    To analyze prognostic factors associated with long-term outcomes in patients with resected pancreatic cancer treated with chemotherapy (CT) and surgery with or without external beam radiotherapy (EBRT). From January 1995 to December 2012, 95 patients with adenocarcinoma of the pancreas and locoregional disease [clinical stage IB-IIA (n = 45; 47 %), IIB-IIIC (n = 50; 53 %)] were treated with curative resection [R0 (n = 52; 55 %), R1 (n = 43, 45 %)] and CT with (n = 60; 63 %) or without (n = 35; 37 %) EBRT (45-50.4 Gy). Additionally, 29 patients (48 %) also received a pre-anastomosis IOERT boost (applicator diameter size, 7-10 cm; dose, 10-15 Gy; beam energy, 9-18 MeV). With a median follow-up of 17.2 months (range, 1-182), 2-year overall survival (OS), disease-free survival (DFS), and locoregional control were 28, 20, and 53 %, respectively. Univariate analyses showed that IIB-IIIC stage (HR, 2.23; p = 0.04), R1 margin resection status (HR, 2.09; p = 0.04), no vascular resection (HR, 0.42; p = 0.02), and not receiving external beam radiotherapy (HR, 2.70; p = 0.004) were associated with locoregional recurrence. In the multivariate analysis, only R1 margin resection status (HR, 2.63; p = 0.009) and not receiving EBRT (HR, 2.91; p = 0.002) retained significance with regard to locoregional recurrence. We observed no difference in toxicity between patients treated with or without EBRT (p = 0.44). Overall treatment mortality was 3 %. No long-term treatment-related death occurred. Although adjuvant CT is still the standard of care for resected pancreatic tumors, OS remains modest owing to the high risk of distant metastases. Locoregional treatment needs to be tested in the context of more efficient systemic therapy. (orig.) [German] Zur Evaluierung von Prognosefaktoren im Rahmen von Langzeitresultaten bei Patienten mit reseziertem Pankreaskarzinom und verabreichter Chemotherapie (CT) mit oder ohne zusaetzlicher externer Radiotherapie (EBRT). Von Januar 1995 bis Dezember

  1. Multidisciplinary treatment

    International Nuclear Information System (INIS)

    Hayabuchi, Naofumi; Jingu, Kenichi; Matsuura, Keiichi

    1985-01-01

    Multidisciplinary treatment for malignant lymphoma is reported in terms of indication, current status, and outcome of this approach to Hodgkin's disease (HD) and non-Hodgkin's lymphomas (NLH). HD is considered to be most successfully managed with multidisciplinary treatment. Success of treatment of HD in European countries and the US, which has resulted from accurate staging of HD and developments in radiotherapy and chemotherapy, is reviewed in the literature. Problems in the treatment of HD in Japan are presented. A treatment policy for NHL is discussed according to the original site, i.e. lymph nodes, Waldeyer's ring or other sites of tumor involvement. (Namekawa, K.)

  2. Radiotherapy

    International Nuclear Information System (INIS)

    Prosnitz, L.R.; Kapp, D.S.; Weissberg, J.B.

    1983-01-01

    This review highlights developments over the past decade in radiotherapy and attempts to summarize the state of the art in the management of the major diseases in which radiotherapy has a meaningful role. The equipment, radiobiology of radiotherapy and carcinoma of the lung, breast and intestines are highlighted

  3. Multidisciplinary approach for the esophageal carcinoma with intent to conserve the esophagus centering on high-dose radiotherapy and concurrent chemotherapy

    International Nuclear Information System (INIS)

    Murakami, Masao; Kuroda, Yasumasa; Okamoto, Yoshiaki

    1997-01-01

    Forty-seven patients with operable squamous cell carcinoma of the thoracic esophagus were treated by initial concurrent chemoradiotherapy (CDDP-5 FU-44 Gy) followed by definitive high-dose of radiotherapy (CRT group: 35 patients) or surgery (CRT-S group: 12 patients). Clinical CR rate showed 86% in CRT group; and pathological CR rate 18% in CRT-S group. The overall median survival was 45 months, survival at 1, 3, 5 years being 96%, 52%, 48%, respectively. No treatment-related mortality was observed. The rate of the 'esophagus conservation' was 66%. Our results demonstrated that the multidisciplinary approach with intent to conserve the esophagus centering on high-dose radiotherapy and concurrent chemotherapy provides a significant improvement of both survival and quality of life in patients with operable esophageal carcinoma. (author)

  4. Evaluation and Management of Neonatal Dysphagia: Impact of Pharyngoesophageal Motility Studies and Multidisciplinary Feeding Strategy

    Science.gov (United States)

    Jadcherla, Sudarshan R.; Stoner, Erin; Gupta, Alankar; Bates, D. Gregory; Fernandez, Soledad; Di Lorenzo, Carlo; Linscheid, Thomas

    2013-01-01

    Background and objectives Abnormal swallowing (dysphagia) among neonates is commonly evaluated using the videofluoroscopic swallow study (VSS). Radiological findings considered high risk for administration of oral feeding include nasopharyngeal reflux, laryngeal penetration, aspiration, or pooling. Our aims were to determine pharyngoesophageal motility correlates in neonates with dysphagia and the impact of multidisciplinary feeding strategy. Methods Twenty dysphagic neonates (mean gestation ± standard deviation [SD] = 30.9 ± 4.9 weeks; median 31.1 weeks; range = 23.7–38.6 weeks) with abnormal VSS results were evaluated at 49.9 ± 16.5 weeks (median 41.36 weeks) postmenstrual age. The subjects underwent a swallow-integrated pharyngoesophageal motility assessment of basal and adaptive swallowing reflexes using a micromanometry catheter and pneumohydraulic water perfusion system. Based on observations during the motility study, multidisciplinary feeding strategies were applied and included postural adaptation, sensory modification, hunger manipulation, and operant conditioning methods. To discriminate pharyngoesophageal manometry correlates between oral feeders and tube feeders, data were stratified based on the primary feeding method at discharge, oral feeding versus tube feeding. Results At discharge, 15 of 20 dysphagic neonates achieved oral feeding success, and the rest required chronic tube feeding. Pharyngoesophageal manometry correlates were significantly different (P dysphagia or its consequences. Manometry may be a better predictor than VSS in identifying patients who are likely to succeed in vigorous intervention programs. PMID:19179881

  5. Radiotherapy

    Directory of Open Access Journals (Sweden)

    Rema Jyothirmayi

    1999-01-01

    Full Text Available Purpose. Conservative treatment in the form of limited surgery and post-operative radiotherapy is controversial in hand and foot sarcomas, both due to poor radiation tolerance of the palm and sole, and due to technical difficulties in achieving adequate margins.This paper describes the local control and survival of 41 patients with soft tissue sarcoma of the hand or foot treated with conservative surgery and radiotherapy. The acute and late toxicity of megavoltage radiotherapy to the hand and foot are described. The technical issues and details of treatment delivery are discussed. The factors influencing local control after radiotherapy are analysed.

  6. Multi-Fidelity Multi-Strategy and Multi-Disciplinary Design Optimization Environment, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — Multidisciplinary design and optimization (MDO) tools developed to perform multi-disciplinary analysis based on low fidelity computation methods have been used in...

  7. Risk communication strategies : achieving a multidisciplinary consensus; La communication des risques : un consensus multidisciplinaire

    Energy Technology Data Exchange (ETDEWEB)

    Robert, B.; Cloutier, I. [Ecole Polytechnique, Montreal, PQ (Canada). Dept. de Mathematiques et de Genie Industriel; Sabourin, J.P. [Ville de Quebec, Quebec, PQ (Canada)

    2006-07-01

    Risk management related to floods and dam failures requires input from a variety of stakeholders from both the private and the public sector. This paper provided details of a risk management communication strategy based on a consequence approach that established work sequence modes to achieve a multidisciplinary consensus of opinion. The communication of risk was considered as a bilateral exchange of information between concerned parties, who were divided into 2 spheres: (1) a public sphere which included interest groups, government agencies, individuals and the media; and (2) a technical sphere comprised of industry members, scientific experts, and government agencies. Divided between the 2 spheres, government agencies play a distinct role in both the communication and understanding of risk. In Quebec, municipal agencies are required to identify risk and develop plans that ensure public safety. Risk management plans developed by industry members are a valuable source of information for municipal authorities, who can identify vulnerabilities in their own risk communication strategies. In addition, members of the public play an important role in eliciting further risk communications to improve areas of vulnerability. Interest groups can demand further analyses from impartial sources on sensitive issues. Conflicting results offer a plurality of opinions that must be considered to obtain a consensus in risk assessment, which is the ultimate aim of all risk analyses and communications strategies. It was concluded that risk communication strategies benefit from the engagement of a variety of often conflicting views. 8 refs., 3 figs.

  8. Locally advanced (neglected) breast cancer: the reality? relevance of two cases and reflection how to optimise the multidisciplinary approach

    International Nuclear Information System (INIS)

    Monnier, L.; Even, C.; Kirova, Y.M.; Even, C.; Cottu, P.H.

    2009-01-01

    The standard treatment for breast cancer patients with untreated locally advanced breast cancer is neo-adjuvant chemotherapy or hormonal treatment. In some cases, this treatment is followed by surgery and/or radiotherapy when the multidisciplinary approach is present. In some cases of patients presenting metastatic diseases, the radiotherapy is forgotten or proposed late when the local disease is extremely advanced with symptoms and decreased quality of life. Two cases of extremely advanced non operable T4 stage breast cancer are reported and the importance of multidisciplinary approach is discussed. The place and the right time of radiotherapy in this multidisciplinary strategy is reported. (authors)

  9. Radiotherapy

    International Nuclear Information System (INIS)

    Zedgenidze, G.A.; Kulikov, V.A.; Mardynskij, Yu.S.

    1984-01-01

    The technique for roentgenotopometric and medicamentous preparation of patients for radiotherapy has been reported in detail. The features of planning and performing of remote, intracavitary and combined therapy in urinary bladder cancer are considered. The more effective methods of radiotherapy have been proposed taking into account own experience as well as literature data. The comparative evaluation of treatment results and prognosis are given. Radiation pathomorphism of tumors and tissues of urinary bladder is considered in detail. The problems of diagnosis, prophylaxis and treatment of complications following radiodiagnosis and radiotherapy in patients with urinary bladder cancer are illustrated widely

  10. Playing the Indicator Game : Reflections on Strategies to Position an STS Group in a Multi-disciplinary Environment

    NARCIS (Netherlands)

    R.A. Bal (Roland)

    2017-01-01

    markdownabstractRoland Bal analyzes the strategies his research group developed to deal with the interlinked dynamics of research evaluation in a multi-disciplinary institutional environment characteristic of much STS research. Scholars in such environments constantly need to navigate and

  11. Issues and Strategies for Establishing Work-Integrated Learning for Multidisciplinary Teams: A Focus on Degrees in Sustainability

    Science.gov (United States)

    Wilson, Robyn Fay

    2015-01-01

    This study was conducted to identify challenges and potential strategies to streamline work-integrated learning placements for multidisciplinary teams of students undertaking degrees in sustainability. Face-to-face interviews using a semi-structured questionnaire were conducted with 15 academics and senior university staff, from four universities…

  12. Radiotherapy

    International Nuclear Information System (INIS)

    Wannenmacher, M.; Debus, J.; Wenz, F.

    2006-01-01

    The book is focussed on the actual knowledge on the clinical radiotherapy and radio-oncology. Besides fundamental and general contributions specific organ systems are treated in detail. The book contains the following contributions: Basic principles, radiobiological fundamentals, physical background, radiation pathology, basics and technique of brachytherapy, methodology and technique of the stereotactic radiosurgery, whole-body irradiation, operative radiotherapy, hadron therapy, hpyerthermia, combined radio-chemo-therapy, biometric clinical studies, intensity modulated radiotherapy, side effects, oncological diagnostics; central nervous system and sense organs, head-neck carcinomas, breast cancer, thorax organs, esophagus carcinoma, stomach carcinoma, pancreas carcinoma, heptabiliary cancer and liver metastases, rectal carcinomas, kidney and urinary tract, prostate carcinoma, testicular carcinoma, female pelvis, lymphatic system carcinomas, soft tissue carcinoma, skin cancer, bone metastases, pediatric tumors, nonmalignant diseases, emergency in radio-oncology, supporting therapy, palliative therapy

  13. Radiotherapy.

    Science.gov (United States)

    Krause, Sonja; Debus, Jürgen; Neuhof, Dirk

    2011-01-01

    Solitary plasmocytoma occurring in bone (solitary plasmocytoma of the bone, SBP) or in soft tissue (extramedullary plasmocytoma, EP) can be treated effectively and with little toxicity by local radiotherapy. Ten-year local control rates of up to 90% can be achieved. Patients with multiple myeloma often suffer from symptoms such as pain or neurological impairments that are amenable to palliative radiotherapy. In a palliative setting, short treatment schedules and lower radiation doses are used to reduce toxicity and duration of hospitalization. In future, low-dose total body irradiation (TBI) may play a role in a potentially curative regimen with nonmyeloablative conditioning followed by allogenic peripheral blood stem cell transplantation.

  14. Multidisciplinary strategy to reduce errors with the use of medical gases.

    Science.gov (United States)

    Amor-García, Miguel Ángel; Ibáñez-García, Sara; Díaz-Redondo, Alicia; Herranz Alonso, Ana; Sanjurjo Sáez, María

    2018-05-01

    Lack of awareness of the risks associated with the use of medical  gases amongst health professionals and health organizations is concerning. The  objective of this study is to redefine the use process of medical gases in a  hospital setting. A sentinel event took place in a clinical unit, the incorrect administration of a medical gas to an inpatient. A multidisciplinary  causeroot analysis of the sentinel event was carried out. Different improvement points were identified for each error detected and so we defined a  good strategy to ensure the safe use of these drugs. 9 errors were identified and the following improvement actions were  defined: storage (gases of clinical use were separated from those of industrial  use and proper identification signs were placed), prescription (6 protocols were  included in the hospital´s Computerized Physician Order Entry software),  validation (pharmacist validation of the prescription to ensure appropriate use of  these), dispensation (a new protocol for medical gases dispensation and  transportation was designed and implemented) and administration (information  on the pressure gauges used for each type of gas was collected and reviewed).  72 Signs with recommendations for medical gases identification and  administration were placed in all the clinical units. Specific training on the safe  use of medical gases and general safety training was imparted. The implementation of a process that integrates all phases of use  of medical gases and applies to all professionals involved is presented here as a  strategy to increase safety in the use of these medicines. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  15. Radiotherapy

    International Nuclear Information System (INIS)

    Pistenma, D.A.

    1980-01-01

    The need for radiotherapy research is exemplified by the 100,000 cancer patients who will fail treatment locally and/or regionally annually for the next several years but who would benefit from better local treatment modalities. Theoretically, all of the areas of investigation discussed in this projection paper have the potential to significantly improve local-regional treatment of cancer by radiotherapy alone or in combination with other modalities. In many of the areas of investigation discussed in this paper encouraging results have been obtained in cellular and animal tumor studies and in limited studies in humans as well. In the not too distant future the number of patients who would benefit from better local control may increase by tens of thousands if developments in chemotherapy and/or immunotherapy provide a means to eradicate disseminated microscopic foci of cancer. Thus the efforts to improve local-regional control take on even greater significance

  16. The dentist's role within the multi-disciplinary team maintaining quality of life for oral cancer patients in light of recent advances in radiotherapy.

    Science.gov (United States)

    Brody, Sarah; Omer, Osama; McLoughlin, Jacinta; Stassen, Leo

    2013-01-01

    Every year in Ireland over 400 people are diagnosed with head and neck cancer. Oral cancer, a specific type of head and neck cancer, is usually treated with surgery and often requires radiotherapy (RT). However, side effects of RT treatment, which include mucositis, xerostomia, radiation caries, trismus and osteoradionecrosis, can seriously compromise a patient's quality of life. Treatment for oral cancer patients is managed in a multidisciplinary team. General dental practitioners (GDPs), consultant/specialist dentists and oral-maxillofacial surgeons play an important role in these patients' care. Recent advances in the delivery of RT have not only improved locoregional control and survival rates, but have also reduced the incidence and severity of RT-associated side effects; however, no mode of RT delivery has successfully eliminated side effects. The role of dentists is essential in maintaining oral health and all patients should be dentally screened prior to commencing RT. Recent reports have attempted to standardise the quality of care for the oral cancer patient and have highlighted the significance of the role of the GDP. Despite the advancements in RT delivery, the dental team is still faced with a number of challenges, including the high number of patients lost to follow-up dental care, lack of an effective treatment for xerostomia, poor patient compliance, and a lack of standardised guidelines and funding. Addressing these challenges will involve increased communication between all members of the multidisciplinary team and increased involvement of the GDP, thereby ensuring that dental care continues to evolve concurrently with new methods of RT delivery.

  17. Playing the Indicator Game: Reflections on Strategies to Position an STS Group in a Multi-disciplinary Environment

    Directory of Open Access Journals (Sweden)

    Roland Bal

    2017-02-01

    Full Text Available Roland Bal analyzes the strategies his research group developed to deal with the interlinked dynamics of research evaluation in a multi-disciplinary institutional environment characteristic of much STS research. Scholars in such environments constantly need to navigate and negotiate the standards of evaluation, in complex choreographies of cooperation and competition with other disciplinary groups. Bal describes strategies his group has successfully used, and how these strategies have both shifted the way research quality is assessed within the department as well as changed the way his group works and publishes. In conclusion, he describes performance management systems and research practices as co-constituted and calls for a debate on which forms of evaluation infrastructures allow for better ways of doing research in STS.

  18. Nanovectorized radiotherapy: a new strategy to induce anti-tumor immunity

    International Nuclear Information System (INIS)

    Vanpouille-Box, Claire; Hindré, François

    2012-01-01

    Recent experimental findings show that activation of the host immune system is required for the success of chemo- and radiotherapy. However, clinically apparent tumors have already developed multiple mechanisms to escape anti-tumor immunity. The fact that tumors are able to induce a state of tolerance and immunosuppression is a major obstacle in immunotherapy. Hence, there is an overwhelming need to develop new strategies that overcome this state of immune tolerance and induce an anti-tumor immune response both at primary and metastatic sites. Nanovectorized radiotherapy that combines ionizing radiation and nanodevices, is one strategy that could boost the quality and magnitude of an immune response in a predictable and designable fashion. The potential benefits of this emerging treatment may be based on the unique combination of immunostimulatory properties of nanoparticles with the ability of ionizing radiation to induce immunogenic tumor cell death. In this review, we will discuss available data and propose that the nanovectorized radiotherapy could be a powerful new strategy to induce anti-tumor immunity required for positive patient outcome.

  19. Nanovectorized radiotherapy, a new strategy to induce anti-tumor immunity

    Directory of Open Access Journals (Sweden)

    Claire eVanpouille-Box

    2012-10-01

    Full Text Available Recent experimental findings show that activation of the host immune system is required for the success of chemo- and radio-therapy. However, clinically-apparent tumors have already developed multiple mechanisms to escape anti-tumor immunity. The fact that tumors are able to induce a state of tolerance and immunosuppression is a major obstacle in immunotherapy. Hence, there is an overwhelming need to develop new strategies that overcome this state of immune tolerance and induce an anti-tumor immune response both at primary and metastatic sites. Nanovectorized radiotherapy that combines ionizing radiation and nano-devices, is one strategy that could boost the quality and magnitude of an immune response in a predictable and designable fashion. The potential benefits of this emerging treatment may be based on the unique combination of immuno-stimulatory properties of nanoparticles with the ability of ionizing radiation to induce immunogenic tumor cell death. In this review, we will discuss available data and propose that the nanovectorized radiotherapy could be a powerful new strategy to induce anti-tumor immunity required for positive patient outcome.

  20. Late radiation-induced heart disease after radiotherapy. Clinical importance, radiobiological mechanisms and strategies of prevention

    International Nuclear Information System (INIS)

    Andratschke, Nicolaus; Maurer, Jean; Molls, Michael; Trott, Klaus-Ruediger

    2011-01-01

    The clinical importance of radiation-induced heart disease, in particular in post-operative radiotherapy of breast cancer patients, has been recognised only recently. There is general agreement, that a co-ordinated research effort would be needed to explore all the potential strategies of how to reduce the late risk of radiation-induced heart disease in radiotherapy. This approach would be based, on one hand, on a comprehensive understanding of the radiobiological mechanisms of radiation-induced heart disease after radiotherapy which would require large-scale long-term animal experiments with high precision local heart irradiation. On the other hand - in close co-operation with mechanistic in vivo research studies - clinical studies in patients need to determine the influence of dose distribution in the heart on the risk of radiation-induced heart disease. The aim of these clinical studies would be to identify the critical structures within the organ which need to be spared and their radiation sensitivity as well as a potential volume and dose effect. The results of the mechanistic studies might also provide concepts of how to modify the gradual progression of radiation damage in the heart by drugs or biological molecules. The results of the studies in patients would need to also incorporate detailed dosimetric and imaging studies in order to develop early indicators of impending radiation-induced heart disease which would be a pre-condition to develop sound criteria for treatment plan optimisation.

  1. Multidisciplinary perspectives for Alzheimer's and Parkinson's diseases: hydrogels for protein delivery and cell-based drug delivery as therapeutic strategies.

    Science.gov (United States)

    Giordano, Carmen; Albani, Diego; Gloria, Antonio; Tunesi, Marta; Batelli, Sara; Russo, Teresa; Forloni, Gianluigi; Ambrosio, Luigi; Cigada, Alberto

    2009-12-01

    This review presents two intriguing multidisciplinary strategies that might make the difference in the treatment of neurodegenerative disorders such as Alzheimer's and Parkinson's diseases. The first proposed strategy is based on the controlled delivery of recombinant proteins known to play a key role in these neurodegenerative disorders that are released in situ by optimized polymer-based systems. The second strategy is the use of engineered cells, encapsulated and delivered in situ by suitable polymer-based systems, that act as drug reservoirs and allow the delivery of selected molecules to be used in the treatment of Alzheimer's and Parkinson's diseases. In both these scenarios, the design and development of optimized polymer-based drug delivery and cell housing systems for central nervous system applications represent a key requirement. Materials science provides suitable hydrogel-based tools to be optimized together with suitably designed recombinant proteins or drug delivering-cells that, once in situ, can provide an effective treatment for these neurodegenerative disorders. In this scenario, only interdisciplinary research that fully integrates biology, biochemistry, medicine and materials science can provide a springboard for the development of suitable therapeutic tools, not only for the treatment of Alzheimer's and Parkinson's diseases but also, prospectively, for a wide range of severe neurodegenerative disorders.

  2. Evaluation of delivered dose for a clinical daily adaptive plan selection strategy for bladder cancer radiotherapy

    International Nuclear Information System (INIS)

    Lutkenhaus, Lotte J.; Visser, Jorrit; Jong, Rianne de; Hulshof, Maarten C.C.M.; Bel, Arjan

    2015-01-01

    Purpose: To account for variable bladder size during bladder cancer radiotherapy, a daily plan selection strategy was implemented. The aim of this study was to calculate the actually delivered dose using an adaptive strategy, compared to a non-adaptive approach. Material and methods: Ten patients were treated to the bladder and lymph nodes with an adaptive full bladder strategy. Interpolated delineations of bladder and tumor on a full and empty bladder CT scan resulted in five PTVs for which VMAT plans were created. Daily cone beam CT (CBCT) scans were used for plan selection. Bowel, rectum and target volumes were delineated on these CBCTs, and delivered dose for these was calculated using both the adaptive plan, and a non-adaptive plan. Results: Target coverage for lymph nodes improved using an adaptive strategy. The full bladder strategy spared the healthy part of the bladder from a high dose. Average bowel cavity V30Gy and V40Gy significantly reduced with 60 and 69 ml, respectively (p < 0.01). Other parameters for bowel and rectum remained unchanged. Conclusions: Daily plan selection compared to a non-adaptive strategy yielded similar bladder coverage and improved coverage for lymph nodes, with a significant reduction in bowel cavity V30Gy and V40Gy only, while other sparing was limited

  3. Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic

    International Nuclear Information System (INIS)

    Rütten, Heidi; Pop, Lucas A.M.; Janssens, Geert O.R.J.; Takes, Robert P.; Knuijt, Simone; Rooijakkers, Antoinette F.; Berg, Manon van den; Merkx, Matthias A.; Herpen, Carla M.L. van; Kaanders, Johannes H.A.M.

    2011-01-01

    Purpose: To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer. Methods and Materials: Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients. Results: Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence–free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients. Conclusion: This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.

  4. Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic

    Energy Technology Data Exchange (ETDEWEB)

    Ruetten, Heidi, E-mail: h.rutten@rther.umcn.nl [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Pop, Lucas A.M.; Janssens, Geert O.R.J. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Takes, Robert P. [Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Knuijt, Simone [Department of Rehabilitation/Speech Pathology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Rooijakkers, Antoinette F. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Berg, Manon van den [Department of Gastroenterology-Dietetics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Merkx, Matthias A. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Herpen, Carla M.L. van [Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Kaanders, Johannes H.A.M. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)

    2011-11-15

    Purpose: To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer. Methods and Materials: Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients. Results: Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence-free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients. Conclusion: This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.

  5. Regional MLEM reconstruction strategy for PET-based treatment verification in ion beam radiotherapy

    International Nuclear Information System (INIS)

    Gianoli, Chiara; Riboldi, Marco; Fattori, Giovanni; Baselli, Giuseppe; Baroni, Guido; Bauer, Julia; Debus, Jürgen; Parodi, Katia; De Bernardi, Elisabetta

    2014-01-01

    In ion beam radiotherapy, PET-based treatment verification provides a consistency check of the delivered treatment with respect to a simulation based on the treatment planning. In this work the region-based MLEM reconstruction algorithm is proposed as a new evaluation strategy in PET-based treatment verification. The comparative evaluation is based on reconstructed PET images in selected regions, which are automatically identified on the expected PET images according to homogeneity in activity values. The strategy was tested on numerical and physical phantoms, simulating mismatches between the planned and measured β + activity distributions. The region-based MLEM reconstruction was demonstrated to be robust against noise and the sensitivity of the strategy results were comparable to three voxel units, corresponding to 6 mm in numerical phantoms. The robustness of the region-based MLEM evaluation outperformed the voxel-based strategies. The potential of the proposed strategy was also retrospectively assessed on patient data and further clinical validation is envisioned. (paper)

  6. An adaptive radiotherapy planning strategy for bladder cancer using deformation vector fields

    International Nuclear Information System (INIS)

    Vestergaard, Anne; Kallehauge, Jesper Folsted; Petersen, Jørgen Breede Baltzer; Høyer, Morten; Søndergaard, Jimmi; Muren, Ludvig Paul

    2014-01-01

    Purpose: Adaptive radiotherapy (ART) has considerable potential in treatment of bladder cancer due to large inter-fractional changes in shape and size of the target. The aim of this study was to compare our clinically applied method for plan library creation that involves manual bladder delineations (Clin-ART) with a method using the deformation vector fields (DVFs) resulting from intensity-based deformable image registrations (DVF-based ART). Materials and methods: The study included thirteen patients with urinary bladder cancer who had daily cone beam CTs (CBCTs) acquired for set-up. In both ART strategies investigated, three plan selection volumes were generated using the CBCTs from the first four fractions; in Clin-ART boolean combinations of delineated bladders were used, while the DVF-based strategy applied combinations of the mean and standard deviation of patient-specific DVFs. The volume ratios (VRs) of the course-averaged PTV for the two ART strategies relative the non-adaptive PTV were calculated. Results: Both Clin-ART and DVF-based ART considerably reduced the course-averaged PTV, compared to non-adaptive RT. The VR for DVF-based ART was lower than for Clin-ART (0.65 vs. 0.73; p < 0.01). Conclusions: DVF-based ART for bladder irradiation has a considerable normal tissue sparing potential surpassing our already highly conformal clinically applied ART strategy

  7. An adaptive radiotherapy planning strategy for bladder cancer using deformation vector fields.

    Science.gov (United States)

    Vestergaard, Anne; Kallehauge, Jesper Folsted; Petersen, Jørgen Breede Baltzer; Høyer, Morten; Søndergaard, Jimmi; Muren, Ludvig Paul

    2014-09-01

    Adaptive radiotherapy (ART) has considerable potential in treatment of bladder cancer due to large inter-fractional changes in shape and size of the target. The aim of this study was to compare our clinically applied method for plan library creation that involves manual bladder delineations (Clin-ART) with a method using the deformation vector fields (DVFs) resulting from intensity-based deformable image registrations (DVF-based ART). The study included thirteen patients with urinary bladder cancer who had daily cone beam CTs (CBCTs) acquired for set-up. In both ART strategies investigated, three plan selection volumes were generated using the CBCTs from the first four fractions; in Clin-ART boolean combinations of delineated bladders were used, while the DVF-based strategy applied combinations of the mean and standard deviation of patient-specific DVFs. The volume ratios (VRs) of the course-averaged PTV for the two ART strategies relative the non-adaptive PTV were calculated. Both Clin-ART and DVF-based ART considerably reduced the course-averaged PTV, compared to non-adaptive RT. The VR for DVF-based ART was lower than for Clin-ART (0.65 vs. 0.73; p<0.01). DVF-based ART for bladder irradiation has a considerable normal tissue sparing potential surpassing our already highly conformal clinically applied ART strategy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. Strategies to improve the efficiency and utility of multidisciplinary team meetings in urology cancer care: a survey study.

    Science.gov (United States)

    Lamb, Benjamin W; Jalil, Rozh T; Sevdalis, Nick; Vincent, Charles; Green, James S A

    2014-09-08

    The prevalence of multidisciplinary teams (MDT) for the delivery of cancer care is increasing globally. Evidence exists of benefits to patients and healthcare professionals. However, MDT working is time and resource intensive. This study aims to explore members' views on existing practices of urology MDT working, and to identify potential interventions for improving the efficiency and productivity of the MDT meeting. Members of urology MDTs across the UK were purposively recruited to participate in an online survey. Survey items included questions about the utility and efficiency of MDT meetings, and strategies for improving the efficiency of MDT meetings: treating cases by protocol, prioritising cases, and splitting the MDT into subspeciality meetings. 173 MDT members participated (Oncologists n = 77, Cancer Nurses n = 54, Urologists n = 30, other specialities n = 12). 68% of respondents reported that attending the MDT meeting improves efficiency in care through improved clinical decisions, planning investigations, helping when discussing plans with patients, speciality referrals, documentation/patient records. Participants agreed that some cases including low risk, non-muscle invasive bladder cancer and localised, low-grade prostate cancer could be managed by pre-agreed pathways, without full MDT review. There was a consensus that cases at the MDT meeting could be prioritised by complexity, tumour type, or the availability of MDT members. Splitting the MDT meeting was unpopular: potential disadvantages included loss of efficiency, loss of team approach, unavailability of members and increased administrative work. Key urology MDT members find the MDT meeting useful. Improvements in efficiency and effectiveness may be possible by prioritising cases or managing some low-risk cases according to previously agreed protocols. Further research is needed to test the effectiveness of such strategies on MDT meetings, cancer care pathways and patient outcomes in clinical

  9. Nonrandom Intrafraction Target Motions and General Strategy for Correction of Spine Stereotactic Body Radiotherapy

    International Nuclear Information System (INIS)

    Ma Lijun; Sahgal, Arjun; Hossain, Sabbir; Chuang, Cynthia; Descovich, Martina; Huang, Kim; Gottschalk, Alex; Larson, David A.

    2009-01-01

    Purpose: To characterize nonrandom intrafraction target motions for spine stereotactic body radiotherapy and to develop a method of correction via image guidance. The dependence of target motions, as well as the effectiveness of the correction strategy for lesions of different locations within the spine, was analyzed. Methods and Materials: Intrafraction target motions for 64 targets in 64 patients treated with a total of 233 fractions were analyzed. Based on the target location, the cases were divided into three groups, i.e., cervical (n = 20 patients), thoracic (n = 20 patients), or lumbar-sacrum (n = 24 patients) lesions. For each case, time-lag autocorrelation analysis was performed for each degree of freedom of motion that included both translations (x, y, and z shifts) and rotations (roll, yaw, and pitch). A general correction strategy based on periodic interventions was derived to determine the time interval required between two adjacent interventions, to overcome the patient-specific target motions. Results: Nonrandom target motions were detected for 100% of cases regardless of target locations. Cervical spine targets were found to possess the highest incidence of nonrandom target motion compared with thoracic and lumbar-sacral lesions (p < 0.001). The average time needed to maintain the target motion to within 1 mm of translation or 1 deg. of rotational deviation was 5.5 min, 5.9 min, and 7.1 min for cervical, thoracic, and lumbar-sacrum locations, respectively (at 95% confidence level). Conclusions: A high incidence of nonrandom intrafraction target motions was found for spine stereotactic body radiotherapy treatments. Periodic interventions at approximately every 5 minutes or less were needed to overcome such motions.

  10. Strategies to tackle the challenges of external beam radiotherapy for liver tumors.

    Science.gov (United States)

    Lock, Michael I; Klein, Jonathan; Chung, Hans T; Herman, Joseph M; Kim, Edward Y; Small, William; Mayr, Nina A; Lo, Simon S

    2017-05-18

    Primary and metastatic liver cancer is an increasingly common and difficult to control disease entity. Radiation offers a non-invasive treatment alternative for these patients who often have few options and a poor prognosis. However, the anatomy and aggressiveness of liver cancer poses significant challenges such as accurate localization at simulation and treatment, management of motion and appropriate selection of dose regimen. This article aims to review the options available and provide information for the practical implementation and/or improvement of liver cancer radiation programs within the context of stereotactic body radiotherapy and image-guided radiotherapy guidelines. Specific patient inclusion and exclusion criteria are presented given the significant toxicity found in certain sub-populations treated with radiation. Indeed, certain sub-populations, such as those with tumor thrombosis or those with larger lesions treated with transarterial chemoembolization, have been shown to have significant improvements in outcome with the addition of radiation and merit special consideration. Implementing a liver radiation program requires three primary challenges to be addressed: (1) immobilization and motion management; (2) localization; and (3) dose regimen and constraint selection. Strategies to deal with motion include simple internal target volume (ITV) expansions, non-gated ITV reduction strategies, breath hold methods, and surrogate marker methods to enable gating or tracking. Localization of the tumor and organs-at-risk are addressed using contrast infusion techniques to take advantage of different normal liver and cancer vascular anatomy, imaging modalities, and margin management. Finally, a dose response has been demonstrated and dose regimens appear to be converging. A more uniform approach to treatment in terms of technique, dose selection and patient selection will allow us to study liver radiation in larger and, hopefully, multicenter randomized

  11. Intensity-Modulated Radiotherapy versus 3-Dimensional Conformal Radiotherapy Strategies for Locally Advanced Non-Small-Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Uğur Selek

    2014-12-01

    Full Text Available Chemoradiotherapy is the current standard of care in patients with advanced inoperable stage IIIA or IIIB non-small cell lung cancer (NSCLC. Three-dimensional radiotherapy (3DCRT has been a trusted method for a long time and has well-known drawbacks, most of which could be improved by Intensity Modulated Radiotherapy (IMRT. IMRT is not currently the standard treatment of locally advanced NSCLC, but almost all patients could benefit to a degree in organ at risk sparing, dose coverage conformality, or dose escalation. The most critical step for a radiation oncology department is to strictly evaluate its own technical and physical capabilities to determine the ability of IMRT to deliver an optimal treatment plan. This includes calculating the internal tumor motion (ideally 4DCT or equivalent techniques, treatment planning software with an up-to-date heterogeneity correction algorithm, and daily image guidance. It is crucial to optimise and individualise the therapeutic ratio for each patient during the decision of 3DCRT versus IMRT. The current literature rationalises the increasing use of IMRT, including 4D imaging plus PET/CT, and encourages the applicable knowledge-based and individualised dose escalation using advanced daily image-guided radiotherapy.

  12. Dosimetric impact of a frame-based strategy in stereotactic radiotherapy of lung tumors

    International Nuclear Information System (INIS)

    Waldeland, Einar; Ramberg, Christina; Arnesen, Marius Roethe; Helland, Aaslaug; Brustugun, Odd Terje; Malinen, Eirik

    2012-01-01

    Introduction. Technological innovations have taken stereotactic body radiotherapy (SBRT) from frame-based strategies to image-guided strategies. In this study, cone beam computed tomography (CBCT) images acquired prior to SBRT of patients with lung tumors was used to study the dosimetric impact of a pure frame-based strategy. Material and methods. Thirty patients with inoperable lung tumors were retrospectively analyzed. All patients had received CBCT-guided SBRT with 3 fractions of 15 Gy to the planning target volume (PTV) margin including immobilization in a stereotactic body frame (SBF). Using the set-up corrections from the co-registration of the CBCT with the planning CT, all individual dose plans were recalculated with an isocenter position equal to the initial set-up position. Dose Volume Histogram (DVH) parameters of the recalculated dose plans were then analyzed. Results. The simulated plans showed that 88% of all fractions resulted in minimum 14.5 Gy to the internal target volume (ITV). For the simulated summed treatment (3 fractions per patient), 83% of the patients would minimum receive the prescription dose (45 Gy) to 100% of the ITV and all except one would receive the prescription dose to more than 90% of the ITV. Conclusions. SBRT including SBF, but without image guidance, results in appropriate dose coverage in most cases, using the current margins. With image guidance, margins for SBRT of lung tumors could possibly be reduced

  13. Strategies for systemic radiotherapy of micrometastases using antibody-targeted 131I.

    Science.gov (United States)

    Wheldon, T E; O'Donoghue, J A; Hilditch, T E; Barrett, A

    1988-02-01

    A simple analysis is developed to evaluate the likely effectiveness of treatment of micrometastases by antibody-targeted 131I. Account is taken of the low levels of tumour uptake of antibody-conjugated 131I presently achievable and of the "energy wastage" in targeting microscopic tumours with a radionuclide whose disintegration energy is widely dissipated. The analysis shows that only modest doses can be delivered to micrometastases when total body dose is restricted to levels which allow recovery of bone marrow. Much higher doses could be delivered to micrometastases when bone marrow rescue is used. A rationale is presented for targeted systemic radiotherapy used in combination with external beam total body irradiation (TBI) and bone marrow rescue. This has some practical advantages. The effect of the targeted component is to impose a biological non-uniformity on the total body dose distribution with regions of high tumour cell density receiving higher doses. Where targeting results in high doses to particular normal organs (e.g. liver, kidney) the total dose to these organs could be kept within tolerable limits by appropriate shielding of the external beam radiation component of the treatment. Greater levels of tumour cell kill should be achievable by the combination regime without any increase in normal tissue damage over that inflicted by conventional TBI. The predicted superiority of the combination regime is especially marked for tumours just below the threshold for detectability (e.g. approximately 1 mm-1 cm diameter). This approach has the advantage that targeted radiotherapy provides only a proportion of the total body dose, most of which is given by a familiar technique. The proportion of dose given by the targeted component could be increased as experience is gained. The predicted superiority of the combination strategy should be experimentally testable using laboratory animals. Clinical applications should be cautiously approached, with due regard to

  14. A hybrid strategy of offline adaptive planning and online image guidance for prostate cancer radiotherapy

    International Nuclear Information System (INIS)

    Lei Yu; Wu Qiuwen

    2010-01-01

    Offline adaptive radiotherapy (ART) has been used to effectively correct and compensate for prostate motion and reduce the required margin. The efficacy depends on the characteristics of the patient setup error and interfraction motion through the whole treatment; specifically, systematic errors are corrected and random errors are compensated for through the margins. In online image-guided radiation therapy (IGRT) of prostate cancer, the translational setup error and inter-fractional prostate motion are corrected through pre-treatment imaging and couch correction at each fraction. However, the rotation and deformation of the target are not corrected and only accounted for with margins in treatment planning. The purpose of this study was to investigate whether the offline ART strategy is necessary for an online IGRT protocol and to evaluate the benefit of the hybrid strategy. First, to investigate the rationale of the hybrid strategy, 592 cone-beam-computed tomography (CBCT) images taken before and after each fraction for an online IGRT protocol from 16 patients were analyzed. Specifically, the characteristics of prostate rotation were analyzed. It was found that there exist systematic inter-fractional prostate rotations, and they are patient specific. These rotations, if not corrected, are persistent through the treatment fraction, and rotations detected in early fractions are representative of those in later fractions. These findings suggest that the offline adaptive replanning strategy is beneficial to the online IGRT protocol with further margin reductions. Second, to quantitatively evaluate the benefit of the hybrid strategy, 412 repeated helical CT scans from 25 patients during the course of treatment were included in the replanning study. Both low-risk patients (LRP, clinical target volume, CTV = prostate) and intermediate-risk patients (IRP, CTV = prostate + seminal vesicles) were included in the simulation. The contours of prostate and seminal vesicles were

  15. Dosimetric and geometric evaluation of a hybrid strategy of offline adaptive planning and online image guidance for prostate cancer radiotherapy

    International Nuclear Information System (INIS)

    Liu Han; Wu Qiuwen

    2011-01-01

    For prostate cancer patients, online image-guided (IG) radiotherapy has been widely used in clinic to correct the translational inter-fractional motion at each treatment fraction. For uncertainties that cannot be corrected online, such as rotation and deformation of the target volume, margins are still required to be added to the clinical target volume (CTV) for the treatment planning. Offline adaptive radiotherapy has been implemented to optimize the treatment for each individual patient based on the measurements at early stages of treatment process. It has been shown that offline adaptive radiotherapy can effectively reduce the required margin. Recently a hybrid strategy of offline adaptive replanning and online IG was proposed and the geometric evaluation was performed. It was found that the planning margins can further be reduced by 1-2 mm compared to online IG only strategy. The purpose of this study was to investigate the dosimetric benefits of such a hybrid strategy on the target and organs at risk. A total of 420 repeated helical computed tomography scans from 28 patients were included in the study. Both low-risk patients (LRP, CTV = prostate) and intermediate-risk patients (IRP, CTV = prostate + seminal vesicles, SV) were included in the simulation. Two registration methods, based on center-of-mass shift of prostate only and prostate plus SV, were performed for IRP. The intensity-modulated radiotherapy was used in the simulation. Criteria on both cumulative and fractional doses were evaluated. Furthermore, the geometric evaluation was extended to investigate the optimal number of fractions necessary to construct the internal target volume (ITV) for the hybrid strategy. The dosimetric margin improvement was smaller than its geometric counterpart and was in the range of 0-1 mm. The optimal number of fractions necessary for the ITV construction is 2 for LRPs and 3-4 for IRPs in a hypofractionation protocol. A new cumulative index of target volume was proposed

  16. A strategy for multimodal deformable image registration to integrate PET/MR into radiotherapy treatment planning

    International Nuclear Information System (INIS)

    Leibfarth, Sara; Moennich, David; Thorwarth, Daniela; Welz, Stefan; Siegel, Christine; Zips, Daniel; Schwenzer, Nina; Holger Schmidt, Holger

    2013-01-01

    Background: Combined positron emission tomography (PET)/magnetic resonance imaging (MRI) is highly promising for biologically individualized radiotherapy (RT). Hence, the purpose of this work was to develop an accurate and robust registration strategy to integrate combined PET/MR data into RT treatment planning. Material and methods: Eight patient datasets consisting of an FDG PET/computed tomography (CT) and a subsequently acquired PET/MR of the head and neck (HN) region were available. Registration strategies were developed based on CT and MR data only, whereas the PET components were fused with the resulting deformation field. Following a rigid registration, deformable registration was performed with a transform parametrized by B-splines. Three different optimization metrics were investigated: global mutual information (GMI), GMI combined with a bending energy penalty (BEP) for regularization (GMI + BEP) and localized mutual information with BEP (LMI + BEP). Different quantitative registration quality measures were developed, including volumetric overlap and mean distance measures for structures segmented on CT and MR as well as anatomical landmark distances. Moreover, the local registration quality in the tumor region was assessed by the normalized cross correlation (NCC) of the two PET datasets. Results: LMI + BEP yielded the most robust and accurate registration results. For GMI, GMI + BEP and LMI + BEP, mean landmark distances (standard deviations) were 23.9 mm (15.5 mm), 4.8 mm (4.0 mm) and 3.0 mm (1.0 mm), and mean NCC values (standard deviations) were 0.29 (0.29), 0.84 (0.14) and 0.88 (0.06), respectively. Conclusion: Accurate and robust multimodal deformable image registration of CT and MR in the HN region can be performed using a B-spline parametrized transform and LMI + BEP as optimization metric. With this strategy, biologically individualized RT based on combined PET/MRI in terms of dose painting is possible

  17. A new strategy for online adaptive prostate radiotherapy based on cone-beam CT

    International Nuclear Information System (INIS)

    Boggula, Ramesh; Lorenz, Friedlieb; Lohr, Frank; Wolff, Dirk; Boda-Heggemann, Judit; Hesser, Juergen; Wenz, Frederik; Wertz, Hansjoerg

    2009-01-01

    Interfractional organ motion and patient positioning errors during prostate radiotherapy can have deleterious clinical consequences. It has become clinical practice to re-position the patient with image-guided translational position correction before each treatment to compensate for those errors. However, tilt errors can only be corrected with table corrections in six degrees of freedom or ''full'' adaptive treatment planning strategies. Organ shape deformations can only be corrected by ''full'' plan adaptation. This study evaluates the potential of instant treatment plan adaptation (fast isodose line adaptation with real-time dose manipulating tools) based on cone-beam CT (CBCT) to further improve treatment quality. Using in-house software, CBCTs were modified to approximate a correct density calibration. To evaluate the dosimetric accuracy, dose distributions based on CBCTs were compared with dose distributions calculated on conventional planning CTs (PCT) for four datasets (one inhomogeneous phantom, three patient datasets). To determine the potential dosimetric benefit of a ''full'' plan adaptation over translational position correction, dose distributions were re-optimized using graphical ''online'' dose modification tools for three additional patients' CT-datasets with a substantially distended rectum while the original plans have been created with an empty rectum (single treatment fraction estimates). Absolute dose deviations of up to 51% in comparison to the PCT were observed when uncorrected CBCTs were used for replanning. After density calibration of the CBCTs, 97% of the dose deviations were ≤3% (gamma index: 3%/3 mm). Translational position correction restored the PTV dose (D 95 ) to 73% of the corresponding dose of the reference plan. After plan adaptation, larger improvements of dose restoration to 95% were observed. Additionally, the rectal dose (D 30 ) was further decreased by 42 percentage points (mean of three patient datasets). An accurate dose

  18. A strategy to objectively evaluate the necessity of correcting detected target deviations in image guided radiotherapy

    International Nuclear Information System (INIS)

    Yue, Ning J.; Kim, Sung; Jabbour, Salma; Narra, Venkat; Haffty, Bruce G.

    2007-01-01

    Image guided radiotherapy technologies are being increasingly utilized in the treatment of various cancers. These technologies have enhanced the ability to detect temporal and spatial deviations of the target volume relative to planned radiation beams. Correcting these detected deviations may, in principle, improve the accuracy of dose delivery to the target. However, in many situations, a clinical decision has to be made as to whether it is necessary to correct some of the deviations since the relevant dosimetric impact may or may not be significant, and the corresponding corrective action may be either impractical or time consuming. Ideally this decision should be based on objective and reproducible criteria rather than subjective judgment. In this study, a strategy is proposed for the objective evaluation of the necessity of deviation correction during the treatment verification process. At the treatment stage, without any alteration from the planned beams, the treatment beams should provide the desired dose coverage to the geometric volume identical to the planning target volume (PTV). Given this fact, the planned dose distribution and PTV geometry were used to compute the dose coverage and PTV enclosure of the clinical target volume (CTV) that was detected from imaging during the treatment setup verification. The spatial differences between the detected CTV and the planning CTV are essentially the target deviations. The extent of the PTV enclosure of the detected CTV as well as its dose coverage were used as criteria to evaluate the necessity of correcting any of the target deviations. This strategy, in principle, should be applicable to any type of target deviations, including both target deformable and positional changes and should be independent of how the deviations are detected. The proposed strategy was used on two clinical prostate cancer cases. In both cases, gold markers were implanted inside the prostate for the purpose of treatment setup

  19. A Multidisciplinary Evaluation of a Web-based eLearning Training Programme for SAFRON II (TROG 13.01): a Multicentre Randomised Study of Stereotactic Radiotherapy for Lung Metastases.

    Science.gov (United States)

    Pham, D; Hardcastle, N; Foroudi, F; Kron, T; Bressel, M; Hilder, B; Chesson, B; Oates, R; Montgomery, R; Ball, D; Siva, S

    2016-09-01

    In technically advanced multicentre clinical trials, participating centres can benefit from a credentialing programme before participating in the trial. Education of staff in participating centres is an important aspect of a successful clinical trial. In the multicentre study of fractionated versus single fraction stereotactic ablative body radiotherapy in lung oligometastases (TROG 13.01), knowledge transfer of stereotactic ablative body radiotherapy techniques to the local multidisciplinary team is intended as part of the credentialing process. In this study, a web-based learning platform was developed to provide education and training for the multidisciplinary trial teams at geographically distinct sites. A web-based platform using eLearning software consisting of seven training modules was developed. These modules were based on extracranial stereotactic theory covering the following discrete modules: Clinical background; Planning technique and evaluation; Planning optimisation; Four-dimensional computed tomography simulation; Patient-specific quality assurance; Cone beam computed tomography and image guidance; Contouring organs at risk. Radiation oncologists, medical physicists and radiation therapists from hospitals in Australia and New Zealand were invited to participate in this study. Each discipline was enrolled into a subset of modules (core modules) and was evaluated before and after completing each module. The effectiveness of the eLearning training will be evaluated based on (i) knowledge retention after participation in the web-based training and (ii) confidence evaluation after participation in the training. Evaluation consisted of a knowledge test and confidence evaluation using a Likert scale. In total, 130 participants were enrolled into the eLearning programme: 81 radiation therapists (62.3%), 27 medical physicists (20.8%) and 22 radiation oncologists (16.9%). There was an average absolute improvement of 14% in test score (P 4 weeks) after

  20. A strategy to correct for intrafraction target translation in conformal prostate radiotherapy: Simulation results

    International Nuclear Information System (INIS)

    Keall, P. J.; Lauve, A. D.; Hagan, M. P.; Siebers, J. V.

    2007-01-01

    simulated internal motion shifts. Dose increases for adjacent organs at risk were rare. D 33 of the rectum and D 20 of the bladder were increased by more than 5% of the prescription dose in 9 and 1 instances of the 3600 sampled internal motion shifts, respectively. D mean of the right femoral head increased by more than 5% of the prescription dose in 651 (18%) internal motion shifts, predominantly due to the projection of the lateral beams through the femoral head for anterior prostate motion. However, D 2 was not increased by more than 5% for any of the internal motion shifts. These data demonstrate the robustness of the proposed dynamic compensation strategy for correction of internal motion in conformal prostate radiotherapy, with minimal deviation from the original treatment plans even for errors exceeding those commonly encountered in the clinic. The compensation strategy could be performed automatically with appropriate enhancements to available delivery software

  1. White Paper Report of the 2011 RAD-AID Conference on International Radiology for Developing Countries: Integrating Multidisciplinary Strategies for Imaging Services in the Developing World

    Science.gov (United States)

    Mazal, Jonathan; Lexa, Frank; Starikovsky, Anna; Jimenez, Pablo; Jain, Sanjay; DeStigter, Kristen K.; Nathan, Robert; Krebs, Elizabeth; Noble, Vicki; Marks, William; Hirsh, Richard N.; Short, Brad; Sydnor, Ryan; Timmreck-Jackson, Emily; Lungren, Matthew P.; Maxfield, Charles; Azene, Ezana M.; Garra, Brian S.; Choi, Brian G.; Lewin, Jonathan S.; Mollura, Daniel J.

    2016-01-01

    The 2011 RAD-AID Conference on International Radiology for Developing Countries discussed data, experiences and models pertaining to radiology in the developing world, where widespread shortages of imaging services significantly reduce health care quality and increase health care disparity. This white paper from the 2011 RAD-AID Conference represents consensus advocacy of multidisciplinary strategies to improve planning, accessibility and quality of imaging services in the developing world. Conference presenters and participants discussed numerous solutions to imaging and healthcare disparities including: (1) economic development for radiology service planning, (2) public health mechanisms to address disease and prevention at the population and community levels, (3) comparative clinical models to implement various clinical and workflow strategies adapted to unique developing world community contexts, (4) education to improve training and optimize service quality, and (5) technology innovation to bring new technical capabilities to limited-resource regions. PMID:22748790

  2. Enhancing clinical effectiveness of pre-radiotherapy workflow by using multidisciplinary-cooperating e-control and e-alerts: A SQUIRE-compliant quality-improving study.

    Science.gov (United States)

    Lin, Yung-Hsiang; Hung, Shih-Kai; Lee, Moon-Sing; Chiou, Wen-Yen; Lai, Chun-Liang; Shih, Yi-Ting; Yeh, Pei-Han; Lin, Yi-An; Tsai, Wei-Ta; Hsieh, Hui-Ling; Chen, Liang-Cheng; Huang, Li-Wen; Lin, Po-Hao; Liu, Dai-Wei; Hsu, Feng-Chun; Tsai, Shiang-Jiun; Liu, Jia-Chi; Chung, En-Seu; Lin, Hon-Yi

    2017-06-01

    Radiotherapy (RT) is useful in managing cancer diseases. In clinical practice, early initiation of RT is crucial for enhancing tumor control. But, delivering precise RT requires a series of pre-RT working processes in a tight staff-cooperation manner. In this regard, using information system to conduct e-control and e-alerts has been suggested to improve practice effectiveness; however, this effect is not well defined in a real-world RT setting.We designed an information system to perform e-control and e-alerts for the whole process of pre-RT workflow to shorten processing time, to improve overall staff satisfaction, and to enhance working confidence.A quality-improving study conducted in a large RT center.Externally validated data were retrospectively analyzed for comparison before (from Sep. 2012 to Dec. 2012, n = 223) and after (from Sep. 2013 to Dec. 2013, n = 240) implementation of pre-RT e-control and e-alerts.Applying the e-control with delay-working e-alerts in pre-RT workflow was the main intervention.Nine workstations were identified in pre-RT workflow. The primary outcome measure was the processing time in each pre-RT workstations before and after implementing the e-control and e-alerts. Secondary measures were staff-working confidence and near-missing cases during the process of pre-RT workflow.After implementing e-control, overall processing time of pre-RT workflow was shortened from 12.2 days to 8.9 days (P workflow. Clinical effectiveness, staff satisfaction, and working confidence are able to be enhanced obviously.

  3. Cost-effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for nonspecific low back pain: design of a stepped-wedge cluster randomised controlled trial.

    Science.gov (United States)

    Suman, Arnela; Schaafsma, Frederieke G; Elders, Petra J M; van Tulder, Maurits W; Anema, Johannes R

    2015-05-31

    Low back pain (LBP) is one of the most prevalent and expensive health care problems in industrialised countries. LBP leads to high health care utility and productivity losses; leaving the individual, the employer, and society with substantial costs. To improve the care for LBP patients and reduce the high societal and financial burden of LBP, in 2010 the 'Multidisciplinary care guideline for nonspecific low back pain' was developed in the Netherlands. The current paper describes the design of a study aiming to evaluate the (cost-) effectiveness of a multifaceted strategy to implement this guideline. In a cluster-randomised controlled trial, the (cost-) effectiveness of a multifaceted implementation strategy will be compared to passive guideline dissemination. Using a stepped-wedge approach, participating general practitioners, physiotherapists, and occupational physicians are allocated into clusters and will attend a multidisciplinary continuing medical education training session. The timing these clusters receive the training is the unit of randomisation. LBP patients visiting the participating health care providers are invited to participate in the trial and will receive access to a multimedia intervention aimed at improving beliefs, cognitions, and self-management. The primary outcome measure of this study is patient back beliefs. Secondary outcome measures on patient level include pain, functional status, quality of life, health care utility, and productivity losses. Outcome measures on professional level include knowledge and attitude towards the guideline, and guideline adherence. A process evaluation for the implementation strategy will be performed among the health care providers and the patients. Furthermore, a qualitative subgroup analysis among patients with various ethnic backgrounds will be performed. This study will give insight into the (cost-) effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for non

  4. MRI-based measurements of respiratory motion variability and assessment of imaging strategies for radiotherapy planning

    International Nuclear Information System (INIS)

    Blackall, J M; Ahmad, S; Miquel, M E; McClelland, J R; Landau, D B; Hawkes, D J

    2006-01-01

    Respiratory organ motion has a significant impact on the planning and delivery of radiotherapy (RT) treatment for lung cancer. Currently widespread techniques, such as 4D-computed tomography (4DCT), cannot be used to measure variability of this motion from one cycle to the next. In this paper, we describe the use of fast magnetic resonance imaging (MRI) techniques to investigate the intra- and inter-cycle reproducibility of respiratory motion and also to estimate the level of errors that may be introduced into treatment delivery by using various breath-hold imaging strategies during lung RT planning. A reference model of respiratory motion is formed to enable comparison of different breathing cycles at any arbitrary position in the respiratory cycle. This is constructed by using free-breathing images from the inhale phase of a single breathing cycle, then co-registering the images, and thereby tracking landmarks. This reference model is then compared to alternative models constructed from images acquired during the exhale phase of the same cycle and the inhale phase of a subsequent cycle, to assess intra- and inter-cycle variability ('hysteresis' and 'reproducibility') of organ motion. The reference model is also compared to a series of models formed from breath-hold data at exhale and inhale. Evaluation of these models is carried out on data from ten healthy volunteers and five lung cancer patients. Free-breathing models show good levels of intra- and inter-cycle reproducibility across the tidal breathing range. Mean intra-cycle errors in the position of organ surface landmarks of 1.5(1.4)-3.5(3.3) mm for volunteers and 2.8(1.8)-5.2(5.2) mm for patients. Equivalent measures of inter-cycle variability across this range are 1.7(1.0)-3.9(3.3) mm for volunteers and 2.8(1.8)-3.3(2.2) mm for patients. As expected, models based on breath-hold sequences do not represent normal tidal motion as well as those based on free-breathing data, with mean errors of 4

  5. Radiotherapy for squamous cell carcinoma of maxillary sinus. Requirements for conservative treatment strategy

    International Nuclear Information System (INIS)

    Onishi, Hiroshi; Komiyama, Takafumi; Marino, Kan; Kuriyama, Kengo; Tanaka, Shiho; Araki, Tsutomu; Sano, Naoki

    2004-01-01

    We reviewed the records of 45 patients with squamous cell carcinoma of maxillary sinus who underwent radiotherapy and intra-arterial chemotherapy with or without maxillectomy. Of 45 patients, 10 patients (stage II:III:IV A=1:5:4) were operated with radical radiotherapy without maxillectomy and had no local failure for more than 1 year (conservative and no local failure group), and 9 patients (stage III:IV A=3:6) were performed with partial or total maxillectomy after pre-operative radiotherapy and had no malignant cells in the operated specimen (group B). Complete response on radiological images was shown in 70% of patients in group A, and 67% of patients in group B. In group A, local recurrence was found in 1 of 10 patients in group A and 1 of 9 patients in group B during a further follow-up period. Five-year overall survival rate was 53% and 67% in group A and B, respectively. Five-year cause-specific survival rate was 89% and 67% in group A and B, respectively. Maxillary conservative treatment is appropriate in cases showing good response on radiological images after radiotherapy combined with concurrent intra-arterial infusion chemotherapy. (author)

  6. The strategy of therapy of the axilla in early cancer. Surgery or radiotherapy

    International Nuclear Information System (INIS)

    Izuo, Masaru

    1998-01-01

    The therapy of the axillary lymph node in early breast cancer was assessed perspectively. Recently, axillary irradiation was carried out and compared with surgery. Radiotherapy was not evaluated more successful. To carry out in accordance with the present guide line, so called ''modern technique'' or ''modern dosage schedule'', radiotherapy of the axilla is effective as well as surgery. We have many agreements that the rate of incidence of complication associated with irradiation was decreased in accordance with ''modern technique''. It is reasonable to radiate additionally after the selection by the ''node sampling'' in the sense of decreasing unnecessary irradiation. But it is not sufficient in their reliability, it is hard to expect this method getting more popular than now. We cannot find any difference in the effect of the treatment itself between present dissection and radiotherapy. However we have many agreements that axillary dissection may give the information about n-stage, and the contribution to the suitable selection to the prognosis factor and adjuvant chemotherapy was not so less even in early cancer. Some early cancers (non-invasive carcinoma or micro carcinoma) will not need the axillary therapy. It is one of the options ''to combine mastectomy under local anesthesia and radiotherapy'' in close cooperation with the skilled radiologist. (K.H.) 120 refs

  7. A novel four-dimensional radiotherapy planning strategy from a tumor-tracking beam's eye view

    Science.gov (United States)

    Li, Guang; Cohen, Patrice; Xie, Huchen; Low, Daniel; Li, Diana; Rimner, Andreas

    2012-11-01

    To investigate the feasibility of four-dimensional radiotherapy (4DRT) planning from a tumor-tracking beam's eye view (ttBEV) with reliable gross tumor volume (GTV) delineation, realistic normal tissue representation, high planning accuracy and low clinical workload, we propose and validate a novel 4D conformal planning strategy based on a synthesized 3.5D computed tomographic (3.5DCT) image with a motion-compensated tumor. To recreate patient anatomy from a ttBEV in the moving tumor coordinate system for 4DRT planning (or 4D planning), the centers of delineated GTVs in all phase CT images of 4DCT were aligned, and then the aligned CTs were averaged to produce a new 3.5DCT image. This GTV-motion-compensated CT contains a motionless target (with motion artifacts minimized) and motion-blurred normal tissues (with a realistic temporal density average). Semi-automatic threshold-based segmentation of the tumor, lung and body was applied, while manual delineation was used for other organs at risk (OARs). To validate this 3.5DCT-based 4D planning strategy, five patients with peripheral lung lesions of small size (tumor and a minor beam aperture and weighting adjustment to maintain plan conformality. The dose-volume histogram (DVH) of the 4DCT plan was created with two methods: one is an integrated DVH (iDVH4D), which is defined as the temporal average of all 3D-phase-plan DVHs, and the other (DVH4D) is based on the dose distribution in a reference phase CT image by dose warping from all phase plans using the displacement vector field (DVF) from a free-form deformable image registration (DIR). The DVH3.5D (for the 3.5DCT plan) was compared with both iDVH4D and DVH4D. To quantify the DVH difference between the 3.5DCT plan and the 4DCT plan, two methods were used: relative difference (%) of the areas underneath the DVH curves and the volumes receiving more than 20% (V20) and 50% (V50) of prescribed dose of these 4D plans. The volume of the delineated GTV from different phase

  8. Damage Control Strategy and aggressive resuscitation in polytraumatized patient with severe hypothermia. Importance of multidisciplinary management from the territory to the operating room. Case report.

    Science.gov (United States)

    Bellanova, Giovanni; Motta, Alessandro; Mazzetti, Chiara; Motter, Michele; Fabris, Luca; DeVigili, Giorgio; Liguori, Gerardo

    2013-01-01

    Our objective is to describe a case of hypothermic politrauma management in our country. We report the case of a 29-year-old male who was a beating victim and fell off from 4 meters, and was afterwards found after an unknown time interval. The patient came to our DEA in cardiac arrest and underwent to a aggressive and prolonged resuscitation which included sternotomy and extracorporeal circulation. The patient was discharged in 40th postoperative day without neurologic complications and complete recovery. Even without a dedicated protocol for the hypothermic politrauma the correct multidisciplinary approach lead to the complete recovery of the patient. In literature many papers describe the aggressive resuscitation of hypothermic patients underlining that the politrauma management must be multidisciplinar. We want to underline the importance of the "Damage control strategy" in a politrauma team in the major hospitals in our country. Cardiopulmonary resuscitation, Extracorporeal circulation, Hypothermia, Polytrauma, Trauma team.

  9. Multidisciplinary team functioning.

    Science.gov (United States)

    Kovitz, K E; Dougan, P; Riese, R; Brummitt, J R

    1984-01-01

    This paper advocates the need to move beyond interdisciplinary team composition as a minimum criterion for multidisciplinary functioning in child abuse treatment. Recent developments within the field reflect the practice of shared professional responsibility for detection, case management and treatment. Adherence to this particular model for intervention requires cooperative service planning and implementation as task related functions. Implicitly, this model also carries the potential to incorporate the supportive functioning essential to effective group process. However, explicit attention to the dynamics and process of small groups has been neglected in prescriptive accounts of multidisciplinary child abuse team organization. The present paper therefore focuses upon the maintenance and enhancement aspects of multidisciplinary group functioning. First, the development and philosophy of service for the Alberta Children's Hospital Child Abuse Program are reviewed. Second, composition of the team, it's mandate for service, and the population it serves are briefly described. Third, the conceptual framework within which the program functions is outlined. Strategies for effective group functioning are presented and the difficulties encountered with this model are highlighted. Finally, recommendations are offered for planning and implementing a multidisciplinary child abuse team and for maintaining its effective group functioning.

  10. Adenosine can thwart antitumor immune responses elicited by radiotherapy. Therapeutic strategies alleviating protumor ADO activities

    Energy Technology Data Exchange (ETDEWEB)

    Vaupel, Peter [Klinikum rechts der Isar, Technische Universitaet Muenchen (TUM), Department of Radiation Oncology, Munich (Germany); Multhoff, Gabriele [Klinikum rechts der Isar, Technische Universitaet Muenchen (TUM), Department of Radiation Oncology, Munich (Germany); Helmholtz Zentrum Muenchen, Institute for innovative Radiotherapy (iRT), Experimental Immune Biology, Neuherberg (Germany)

    2016-05-15

    By studying the bioenergetic status we could show that the development of tumor hypoxia is accompanied, apart from myriad other biologically relevant effects, by a substantial accumulation of adenosine (ADO). ADO has been shown to act as a strong immunosuppressive agent in tumors by modulating the innate and adaptive immune system. In contrast to ADO, standard radiotherapy (RT) can either stimulate or abrogate antitumor immune responses. Herein, we present ADO-mediated mechanisms that may thwart antitumor immune responses elicited by RT. An overview of the generation, accumulation, and ADO-related multifaceted inhibition of immune functions, contrasted with the antitumor immune effects of RT, is provided. Upon hypoxic stress, cancer cells release ATP into the extracellular space where nucleotides are converted into ADO by hypoxia-sensitive, membrane-bound ectoenzymes (CD39/CD73). ADO actions are mediated upon binding to surface receptors, mainly A2A receptors on tumor and immune cells. Receptor activation leads to a broad spectrum of strong immunosuppressive properties facilitating tumor escape from immune control. Mechanisms include (1) impaired activity of CD4 + T and CD8 + T, NK cells and dendritic cells (DC), decreased production of immuno-stimulatory lymphokines, and (2) activation of Treg cells, expansion of MDSCs, promotion of M2 macrophages, and increased activity of major immunosuppressive cytokines. In addition, ADO can directly stimulate tumor proliferation and angiogenesis. ADO mechanisms described can thwart antitumor immune responses elicited by RT. Therapeutic strategies alleviating tumor-promoting activities of ADO include respiratory hyperoxia or mild hyperthermia, inhibition of CD39/CD73 ectoenzymes or blockade of A2A receptors, and inhibition of ATP-release channels or ADO transporters. (orig.) [German] Untersuchungen des bioenergetischen Status ergaben, dass Tumorhypoxie neben vielen anderen bedeutsamen biologischen Effekten zu einem starken

  11. Multi-Disciplinary Antimicrobial Strategies for Improving Orthopaedic Implants to Prevent Prosthetic Joint Infections in Hip and Knee

    Science.gov (United States)

    Getzlaf, Matthew A.; Lewallen, Eric A.; Kremers, Hilal M.; Jones, Dakota L.; Bonin, Carolina A.; Dudakovic, Amel; Thaler, Roman; Cohen, Robert C.; Lewallen, David G.; van Wijnen, Andre J.

    2016-01-01

    Like any foreign object, orthopaedic implants are susceptible to infection when introduced into the human body. Without additional preventative measures, the absolute number of annual prosthetic joint infections will continue to rise, and may exceed the capacity of health care systems in the near future. Bacteria are difficult to eradicate from synovial joints due to their exceptionally diverse taxonomy, complex mechanistic attachment capabilities, and tendency to evolve antibiotic resistance. When a primary orthopaedic implant fails from prosthetic joint infection, surgeons are generally challenged by limited options for intervention. In this review, we highlight the etiology and taxonomic groupings of bacteria known to cause prosthetic joint infections, and examine their key mechanisms of attachment. We propose that antimicrobial strategies should focus on the most harmful bacteria taxa within the context of occurrence, taxonomic diversity, adhesion mechanisms, and implant design. Patient-specific identification of organisms that cause prosthetic joint infections will permit assessment of their biological vulnerabilities. The latter can be targeted using a range of antimicrobial techniques that exploit different colonization mechanisms including implant surface attachment, biofilm formation, and/or hematogenous recruitment. We anticipate that customized strategies for each patient, joint, and prosthetic component will be most effective at reducing prosthetic joint infections, including those caused by antibiotic-resistant and polymicrobial bacteria. PMID:26449208

  12. Evolutionary optimization and game strategies for advanced multi-disciplinary design applications to aeronautics and UAV design

    CERN Document Server

    Periaux, Jacques; Lee, Dong Seop Chris

    2015-01-01

    Many complex aeronautical design problems can be formulated with efficient multi-objective evolutionary optimization methods and game strategies. This book describes the role of advanced innovative evolution tools in the solution, or the set of solutions of single or multi disciplinary optimization. These tools use the concept of multi-population, asynchronous parallelization and hierarchical topology which allows different models including precise, intermediate and approximate models with each node belonging to the different hierarchical layer handled by a different Evolutionary Algorithm. The efficiency of evolutionary algorithms for both single and multi-objective optimization problems are significantly improved by the coupling of EAs with games and in particular by a new dynamic methodology named “Hybridized Nash-Pareto games”. Multi objective Optimization techniques and robust design problems taking into account uncertainties are introduced and explained in detail. Several applications dealing with c...

  13. Strategies for Online Organ Motion Correction for Intensity-Modulated Radiotherapy of Prostate Cancer: Prostate, Rectum, and Bladder Dose Effects

    International Nuclear Information System (INIS)

    Rijkhorst, Erik-Jan; Lakeman, Annemarie; Nijkamp, Jasper; Bois, Josien de; Herk, Marcel van; Lebesque, Joos V.; Sonke, Jan-Jakob

    2009-01-01

    Purpose: To quantify and evaluate the accumulated prostate, rectum, and bladder dose for several strategies including rotational organ motion correction for intensity-modulated radiotherapy (IMRT) of prostate cancer using realistic organ motion data. Methods and Materials: Repeat computed tomography (CT) scans of 19 prostate patients were used. Per patient, two IMRT plans with different uniform margins were created. To quantify prostate and seminal vesicle motion, repeat CT clinical target volumes (CTVs) were matched onto the planning CTV using deformable registration. Four different strategies, from online setup to full motion correction, were simulated. Rotations were corrected for using gantry and collimator angle adjustments. Prostate, rectum, and bladder doses were accumulated for each patient, plan, and strategy. Minimum CTV dose (D min ), rectum equivalent uniform dose (EUD, n = 0.13), and bladder surface receiving ≥78 Gy (S78), were calculated. Results: With online CTV translation correction, a 7-mm margin was sufficient (i.e., D min ≥ 95% of the prescribed dose for all patients). A 4-mm margin required additional rotational correction. Margin reduction lowered the rectum EUD(n = 0.13) by ∼2.6 Gy, and the bladder S78 by ∼1.9%. Conclusions: With online correction of both translations and rotations, a 4-mm margin was sufficient for 15 of 19 patients, whereas the remaining four patients had an underdosed CTV volume <1%. Margin reduction combined with online corrections resulted in a similar or lower dose to the rectum and bladder. The more advanced the correction strategy, the better the planned and accumulated dose agreed.

  14. Radiotherapy for the eye - Tolerance issues and therapeutic strategies for benign and malignant problems

    International Nuclear Information System (INIS)

    Brady, Luther W.

    1997-01-01

    In general, there has been a reluctance on the part of radiation oncologists to undertake the responsibilities of treatment of patients with malignant and benign diseases involving the eye and periorbital tissues. With the changing technologies in diagnosis, alternative modalities for treatment as well as the significant impact of computed tomography and magnetic imaging technologies in the management of patients with eye tumors, there has been a resurgence of interest in treating not only malignant but benign ocular diseases. The refresher course will deal with the latest developments in the diagnosis and therapy of retinoblastomas, uveal melanomas, and malignant lymphomas with emphasis on optimization dosimetry as well as treatment planning along with presentation of the utilization of radioactive eye plaques in management of malignant tumors of the eye. The effects and side effects of radiation therapy will be discussed with emphasis on electron beam, photon beam, and plaque irradiation as well as proton beam irradiation of eye diseases with emphasis on minimization of those side effects. The resurgence of interest in treating benign diseases in the eye will be covered with emphasis on the treatment of the wet type of age related macular degeneration. Finally, the course will also cover radiotherapy for other benign conditions such as pterygium, choroidal and retinal hemangiomas

  15. Radiotherapy of brain metastases of a breast cancer: present strategies, technological innovations and biological perspectives

    International Nuclear Information System (INIS)

    Chargari, C.; Vedrine, L.; Bauduceau, O.; Jacob, J.; Fayolle, M.; Chargari, C.; Campana, F.; Pierga, J.Y.; Idrissi, H.R.; Fourquet, A.; Kirova, Y.

    2010-01-01

    The authors propose an overview of strategies which are presently used for the treatment of brain metastases related to a breast cancer. They outline the perspectives and recent developments of encephalic irradiation with new technologies allowing an increased conformation to be obtained, and also in terms of radiosensitization and radioprotection experiences. Short communication

  16. Multidisciplinary Management of Laryngeal Carcinoma

    International Nuclear Information System (INIS)

    Mendenhall, William M.; Mancuso, Anthony A.; Hinerman, Russell W.; Malyapa, Robert S.; Werning, John W.; Amdur, Robert J.; Villaret, Douglas B.

    2007-01-01

    The management of head and neck cancer has evolved into a multidisciplinary approach in which patients are evaluated before treatment and decisions depend on prospective multi-institutional trials, as well as retrospective outcome studies. The choice of one or more modalities to use in a given case varies with the tumor site and extent, as exemplified in the treatment of laryngeal squamous cell carcinomas. The goals of treatment include cure, laryngeal voice preservation, voice quality, optimal swallowing, and minimal xerostomia. Treatment options include transoral laser excision, radiotherapy (both definitive and postoperative), open partial laryngectomy, total laryngectomy, and neck dissection. The likelihood of local control and preservation of laryngeal function is related to tumor volume. Patients who have a relatively high risk of local recurrence undergo follow-up computed tomography scans every 3-4 months for the first 2 years after radiotherapy. Patients with suspicious findings on computed tomography might benefit from fluorodeoxyglucose positron emission tomography to differentiate post-radiotherapy changes from tumor

  17. The role and strategy of IMRT in radiotherapy of pelvic tumors: Dose escalation and critical organ sparing in prostate cancer

    International Nuclear Information System (INIS)

    Liu, Y.-M.; Shiau, C.-Y.; Lee, M.-L.; Huang, P.-I.; Hsieh, C.-M.; Chen, P.-H.; Lin, Y.-H.; Wang, L.-W.; Yen, S.-H.

    2007-01-01

    Purpose: To investigate the intensity-modulated radiotherapy (IMRT) strategy in dose escalation of prostate and pelvic lymph nodes. Methods and Materials: Plan dosimetric data of 10 prostate cancer patients were compared with two-dimensional (2D) or IMRT techniques for pelvis (two-dimensional whole pelvic radiation therapy [2D-WPRT] or IM-WPRT) to receive 50 Gy or 54 Gy and additional prostate boost by three-dimensional conformal radiation therapy or IMRT (3D-PBRT or IM-PBRT) techniques up to 72 Gy or 78 Gy. Dose-volume histograms (DVHs), normal tissue complication probabilities (NTCP) of critical organ, and conformity of target volume in various combinations were calculated. Results: In DVH analysis, the plans with IM-WPRT (54 Gy) and additional boost up to 78 Gy had lower rectal and bladder volume percentage at 50 Gy and 60 Gy, compared with those with 2D-WPRT (50 Gy) and additional boost up to 72 Gy or 78 Gy. Those with IM-WPRT (54 Gy) also had better small bowel sparing at 30 Gy and 50 Gy, compared with those with 2D-WPRT (50 Gy). In NTCP, those with IM-WPRT and total dose of 78 Gy achieved lower complication rates in rectum and small bowel, compared with those of 2D-WPRT with total dose of 72 Gy. In conformity, those with IM-WPRT had better conformity compared with those with 2D-WPRT with significance (p < 0.005). No significant difference in DVHs, NTCP, or conformity was found between IM-PBRT and 3D-PBRT after IM-WPRT. Conclusions: Initial pelvic IMRT is the most important strategy in dose escalation and critical organ sparing. IM-WPRT is recommended for patients requiring WPRT. There is not much benefit for critical organ sparing by IMRT after 2D-WPRT

  18. Respiration-Correlated Image Guidance Is the Most Important Radiotherapy Motion Management Strategy for Most Lung Cancer Patients

    International Nuclear Information System (INIS)

    Korreman, Stine; Persson, Gitte; Nygaard, Ditte; Brink, Carsten; Juhler-Nøttrup, Trine

    2012-01-01

    Purpose: The purpose of this study was to quantify the effects of four-dimensional computed tomography (4DCT), 4D image guidance (4D-IG), and beam gating on calculated treatment field margins in a lung cancer patient population. Materials and Methods: Images were acquired from 46 lung cancer patients participating in four separate protocols at three institutions in Europe and the United States. Seven patients were imaged using fluoroscopy, and 39 patients were imaged using 4DCT. The magnitude of respiratory tumor motion was measured. The required treatment field margins were calculated using a statistical recipe (van Herk M, et al. Int J Radiat Oncol Biol Phys 2000;474:1121–1135), with magnitudes of all uncertainties, except respiratory peak-to-peak displacement, the same for all patients, taken from literature. Required margins for respiratory motion management were calculated using the residual respiratory tumor motion for each patient for various motion management strategies. Margin reductions for respiration management were calculated using 4DCT, 4D-IG, and gated beam delivery. Results: The median tumor motion magnitude was 4.4 mm for the 46 patients (range 0–29.3 mm). This value corresponded to required treatment field margins of 13.7 to 36.3 mm (median 14.4 mm). The use of 4DCT, 4D-IG, and beam gating required margins that were reduced by 0 to 13.9 mm (median 0.5 mm), 3 to 5.2 mm (median 5.1 mm), and 0 to 7 mm (median 0.2 mm), respectively, to a total of 8.5 to 12.4 mm (median 8.6 mm). Conclusion: A respiratory management strategy for lung cancer radiotherapy including planning on 4DCT scans and daily image guidance provides a potential reduction of 37% to 47% in treatment field margins. The 4D image guidance strategy was the most effective strategy for >85% of the patients.

  19. The Congolobe project, a multidisciplinary study of Congo deep-sea fan lobe complex: Overview of methods, strategies, observations and sampling

    Science.gov (United States)

    Rabouille, C.; Olu, K.; Baudin, F.; Khripounoff, A.; Dennielou, B.; Arnaud-Haond, S.; Babonneau, N.; Bayle, C.; Beckler, J.; Bessette, S.; Bombled, B.; Bourgeois, S.; Brandily, C.; Caprais, J. C.; Cathalot, C.; Charlier, K.; Corvaisier, R.; Croguennec, C.; Cruaud, P.; Decker, C.; Droz, L.; Gayet, N.; Godfroy, A.; Hourdez, S.; Le Bruchec, J.; Saout, J.; Le Saout, M.; Lesongeur, F.; Martinez, P.; Mejanelle, L.; Michalopoulos, P.; Mouchel, O.; Noel, P.; Pastor, L.; Picot, M.; Pignet, P.; Pozzato, L.; Pruski, A. M.; Rabiller, M.; Raimonet, M.; Ragueneau, O.; Reyss, J. L.; Rodier, P.; Ruesch, B.; Ruffine, L.; Savignac, F.; Senyarich, C.; Schnyder, J.; Sen, A.; Stetten, E.; Sun, Ming Yi; Taillefert, M.; Teixeira, S.; Tisnerat-Laborde, N.; Toffin, L.; Tourolle, J.; Toussaint, F.; Vétion, G.; Jouanneau, J. M.; Bez, M.; Congolobe Group:

    2017-08-01

    The presently active region of the Congo deep-sea fan (around 330,000 km2), called the terminal lobes or lobe complex, covers an area of 2500 km2 at 4700-5100 m water depth and 750-800 km offshore. It is a unique sedimentary area in the world ocean fed by a submarine canyon and a channel-levee system which presently deliver large amounts of organic carbon originating from the Congo River by turbidity currents. This particularity is due to the deep incision of the shelf by the Congo canyon, up to 30 km into the estuary, which funnels the Congo River sediments into the deep-sea. The connection between the river and the canyon is unique for major world rivers. In 2011, two cruises (WACS leg 2 and Congolobe) were conducted to simultaneously investigate the geology, organic and inorganic geochemistry, and micro- and macro-biology of the terminal lobes of the Congo deep-sea fan. Using this multidisciplinary approach, the morpho-sedimentary features of the lobes were characterized along with the origin and reactivity of organic matter, the recycling and burial of biogenic compounds, the diversity and function of bacterial and archaeal communities within the sediment, and the biodiversity and functioning of the faunal assemblages on the seafloor. Six different sites were selected for this study: Four distributed along the active channel from the lobe complex entrance to the outer rim of the sediment deposition zone, and two positioned cross-axis and at increasing distance from the active channel, thus providing a gradient in turbidite particle delivery and sediment age. This paper aims to provide the general context of this multidisciplinary study. It describes the general features of the site and the overall sampling strategy and provides the initial habitat observations to guide the other in-depth investigations presented in this special issue. Detailed bathymetry of each sampling site using 0.1-1 m resolution multibeam obtained with a remotely operated vehicle (ROV

  20. Strategies to reduce the systematic error due to tumor and rectum motion in radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Hoogeman, Mischa S.; Herk, Marcel van; Bois, Josien de; Lebesque, Joos V.

    2005-01-01

    Background and purpose: The goal of this work is to develop and evaluate strategies to reduce the uncertainty in the prostate position and rectum shape that arises in the preparation stage of the radiation treatment of prostate cancer. Patients and methods: Nineteen prostate cancer patients, who were treated with 3-dimensional conformal radiotherapy, received each a planning CT scan and 8-13 repeat CT scans during the treatment period. We quantified prostate motion relative to the pelvic bone by first matching the repeat CT scans on the planning CT scan using the bony anatomy. Subsequently, each contoured prostate, including seminal vesicles, was matched on the prostate in the planning CT scan to obtain the translations and rotations. The variation in prostate position was determined in terms of the systematic, random and group mean error. We tested the performance of two correction strategies to reduce the systematic error due to prostate motion. The first strategy, the pre-treatment strategy, used only the initial rectum volume in the planning CT scan to adjust the angle of the prostate with respect to the left-right (LR) axis and the shape and position of the rectum. The second strategy, the adaptive strategy, used the data of repeat CT scans to improve the estimate of the prostate position and rectum shape during the treatment. Results: The largest component of prostate motion was a rotation around the LR axis. The systematic error (1 SD) was 5.1 deg and the random error was 3.6 deg (1 SD). The average LR-axis rotation between the planning and the repeat CT scans correlated significantly with the rectum volume in the planning CT scan (r=0.86, P<0.0001). Correction of the rotational position on the basis of the planning rectum volume alone reduced the systematic error by 28%. A correction, based on the data of the planning CT scan and 4 repeat CT scans reduced the systematic error over the complete treatment period by a factor of 2. When the correction was

  1. Multidisciplinary Approaches to Allergies

    NARCIS (Netherlands)

    Gao Zhongshan,; Shen, Hua-Hao; Zheng, M.; Frewer, L.J.; Gilissen, L.J.W.J.

    2012-01-01

    Allergy is an immunological disease caused by multiple factors and characterized by variability, specificity and complexity. "Multidisciplinary Approaches to Allergies" covers diverse aspects ranging from basic molecular mechanisms to societal issues within the framework of multidisciplinary

  2. EURECCA colorectal: multidisciplinary management: European consensus conference colon & rectum.

    Science.gov (United States)

    van de Velde, Cornelis J H; Boelens, Petra G; Borras, Josep M; Coebergh, Jan-Willem; Cervantes, Andres; Blomqvist, Lennart; Beets-Tan, Regina G H; van den Broek, Colette B M; Brown, Gina; Van Cutsem, Eric; Espin, Eloy; Haustermans, Karin; Glimelius, Bengt; Iversen, Lene H; van Krieken, J Han; Marijnen, Corrie A M; Henning, Geoffrey; Gore-Booth, Jola; Meldolesi, Elisa; Mroczkowski, Pawel; Nagtegaal, Iris; Naredi, Peter; Ortiz, Hector; Påhlman, Lars; Quirke, Philip; Rödel, Claus; Roth, Arnaud; Rutten, Harm; Schmoll, Hans J; Smith, Jason J; Tanis, Pieter J; Taylor, Claire; Wibe, Arne; Wiggers, Theo; Gambacorta, Maria A; Aristei, Cynthia; Valentini, Vincenzo

    2014-01-01

    Care for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Consensus was achieved using the Delphi method. For the Delphi process, multidisciplinary experts were invited to comment and vote three web-based online voting rounds and to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. This manuscript covers all sentences of the consensus document with the result of the voting. The consensus document represents sections on diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where

  3. Moving toward multi-dimensional radiotherapy and the role of radiobiology

    International Nuclear Information System (INIS)

    Oita, Masataka; Uto, Yoshihiro; Aoyama, Hideki

    2014-01-01

    Recent radiotherapy for cancer treatment enable the high-precision irradiation to the target under the computed image guidance. Developments of such radiotherapy has played large role in the improved strategy of cancer treatments. In addition, the molecular mechanistic studies related to proliferations of cancer cell contribute the multidisciplinary fields of clinical radiotherapies. Therefore, the combination of the image guidance and molecular targeting of cancer cells make it possible for individualized cancer treatment. Especially, the use of particle beam or boron neutron capture therapy (BNCT) has been spotlighted, and installations of such devices are planned widely. As the progress and collaborations of radiation biology and engineering physics, establishment of a new style of radiotherapy becomes available in post-genome era. In 2010s, the hi-tech machines controlling the spaciotemporal radiotherapy become in practice. Although, there still remains to be improved, e.g., more precise prediction of radiosensitivity or growth of individual tumors, and adverse outcomes after treatments, multi-dimensional optimizations of the individualized irradiations based on the molecular radiation biologies and medical physics are important for further development of radiotherapy. (author)

  4. Multidisciplinary Computational Research

    National Research Council Canada - National Science Library

    Visbal, Miguel R

    2006-01-01

    The purpose of this work is to develop advanced multidisciplinary numerical simulation capabilities for aerospace vehicles with emphasis on highly accurate, massively parallel computational methods...

  5. Radiotherapy physics

    International Nuclear Information System (INIS)

    Chen, G.T.Y.; Collier, J.M.; Lyman, J.T.; Pitluck, S.

    1982-01-01

    The Radiotherapy Physics Group works on the physical and biophysical aspects of charged particle radiotherapy. Our activities include the development of isosurvival beams (beams of uniform biological effect), computerized treatment planning development for charged particle radiotherapy, design of compensation to shape dose distributions, and development of dosimetry techniques to verify planned irradiations in both phantoms and patients

  6. Intricacies and strategies for the implementation of new technologies in radiotherapy: Reflections on the meaning and prevention of the error

    Science.gov (United States)

    Espejo-Villalobos, J. D.; Franco-Cabrera, M. C.; Estrada-Hernandez, C.; Quintero-Castelan, M. S.

    2012-10-01

    When facing the challenge of implementing new technologies in Radiotherapy, a reflection on philosophical and ethical principles is in order for the Medical Physicist to assume a reality of increased risks of harm to the patient. A series of ideas from philosophers and clinical professionals are reviewed to encourage an increased awareness of our ethical responsibility towards patients that entrust us with their hopes for alleviating their disease.

  7. Intricacies and strategies for the implementation of new technologies in radiotherapy: Reflections on the meaning and prevention of the error

    International Nuclear Information System (INIS)

    Espejo-Villalobos, J. D.; Franco-Cabrera, M. C.; Estrada-Hernandez, C.; Quintero-Castelan, M. S.

    2012-01-01

    When facing the challenge of implementing new technologies in Radiotherapy, a reflection on philosophical and ethical principles is in order for the Medical Physicist to assume a reality of increased risks of harm to the patient. A series of ideas from philosophers and clinical professionals are reviewed to encourage an increased awareness of our ethical responsibility towards patients that entrust us with their hopes for alleviating their disease.

  8. Intricacies and strategies for the implementation of new technologies in radiotherapy: Reflections on the meaning and prevention of the error

    Energy Technology Data Exchange (ETDEWEB)

    Espejo-Villalobos, J. D.; Franco-Cabrera, M. C.; Estrada-Hernandez, C.; Quintero-Castelan, M. S. [Centro Medico Hospital San Jose -TEC Salud, Department of Radiothrapy. Av. Ignacio Morones Prieto 3000 Pte. Col. Los Doctores, Monterrey, Nuevo Leon, 64710 (Mexico)

    2012-10-23

    When facing the challenge of implementing new technologies in Radiotherapy, a reflection on philosophical and ethical principles is in order for the Medical Physicist to assume a reality of increased risks of harm to the patient. A series of ideas from philosophers and clinical professionals are reviewed to encourage an increased awareness of our ethical responsibility towards patients that entrust us with their hopes for alleviating their disease.

  9. Contact radiotherapy. Report of technological assessment

    International Nuclear Information System (INIS)

    Ortholan, Cecile; Melin, Nicole; Lee-Robin, Sun Hae; David, Denis Jean; Pages, Frederique; Devaud, Christine; Noel, Georges; Biga, Julie; Moty-Monnereau, Celine; Canet, Philippe; Lascols, Sylvie; Lamas, Muriel; Ramdine, Jessica; Tuil, Louise

    2008-10-01

    This report aims at assessing safety, indications, the role in therapeutic strategy, and efficiency of contact radiotherapy. It also aims at answering questions like: is the contact radiotherapy technique validated? What are the indications for contact radiotherapy? What about the efficiency and safety of contact radiotherapy? After a presentation of preliminary notions on radiotherapy (radiation types, dose, and irradiation techniques), the report presents this specific technique of contact radiotherapy: definition, devices, use recommendations, issues of radiation protection, modalities of performance of a contact radiotherapy session, and concerned pathologies. Then, based on a literature survey, this report addresses the various concerned tumours (skin, rectum, brain, breast), indicates some general information about these tumours (epidemiological data, anatomy and classification, therapeutic options, radiotherapy), and proposes an assessment of the efficiency and safety of contact radiotherapy

  10. Strategies to evaluate the impact of rectal volume on prostate motion during three-dimensional conformal radiotherapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Poli, Ana Paula Diniz Fortuna, E-mail: anapaulafortuna@yahoo.com.br [Universidade Estadual de Campinas (CAISM/UNICAMP), Campinas, SP (Brazil). Centro de Atencao Integrada a Saude da Mulher. Divisao de Radioterapia; Dias, Rodrigo Souza; Giordani, Adelmo Jose; Segreto, Helena Regina Comodo; Segreto, Roberto Araujo [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina. Divisao de Radioterapia

    2016-01-15

    Objective: To evaluate the rectal volume influence on prostate motion during three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. Materials and Methods: Fifty-one patients with prostate cancer underwent a series of three computed tomography scans including an initial planning scan and two subsequent scans during 3D-CRT. The organs of interest were outlined. The prostate contour was compared with the initial CT images considering the anterior, posterior, superior, inferior and lateral edges of the organ. Variations in the anterior limits and volume of the rectum were assessed and correlated with prostate motion in the anteroposterior direction. Results: The maximum range of prostate motion was observed in the superoinferior direction, followed by the anteroposterior direction. A significant correlation was observed between prostate motion and rectal volume variation (p = 0.037). A baseline rectal volume superior to 70 cm{sup 3} had a significant influence on the prostate motion in the anteroposterior direction (p = 0.045). Conclusion: The present study showed a significant interfraction motion of the prostate during 3D-CRT with greatest variations in the superoinferior and anteroposterior directions, and that a large rectal volume influences the prostate motion with a cutoff value of 70 cm{sup 3}. Therefore, the treatment of patients with a rectal volume > 70 cm{sup 3} should be re-planned with appropriate rectal preparation. Keywords: Rectal volume; Prostate cancer; Three-dimensional conformal radiotherapy. (author)

  11. Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature.

    Science.gov (United States)

    Soukup, Tayana; Lamb, Benjamin W; Arora, Sonal; Darzi, Ara; Sevdalis, Nick; Green, James Sa

    2018-01-01

    In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs - including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don'ts) when setting up MDT-driven cancer care.

  12. CONTINUING EDUCATION: VOCATIONAL TRAINING IN THE CONTEXT OF HOSPITAL PHARMACY AS A STRATEGY FOR INTEGRATION IN A MULTIDISCIPLINARY TEAM OF SPECIALIZED HOSPITAL SERGIPE

    Directory of Open Access Journals (Sweden)

    Carlos Adriano Santos Souza

    2012-11-01

    Full Text Available The current reality of hospitals increasingly require professionals qualified to assume roles that require high levels of technical and scientific knowledge. The supervised internship in hospital pharmacy aims to train future professionals with critical awareness and ability to understand the reality and act on it. This study consists of an report of the experience of students supervised III internship of the graduate course in Pharmacy, Federal University of Sergipe. Initially the students made visits in the fields of pharmacy, warehouse, intensive care unit (ICU, emergency care to make the diagnosis of both situational and physical aspects of the information relating to medicines by nursing professionals. Later lectures were held, they were directed to health professionals and administrative staff of the pharmacy. From the results we observed that implement continuing education was of great importance to the quality of pharmacy professionals / warehouse and nursing staff, in which participants were able to actively interact with pharmacists and interns. This interaction reflected in increased communication and more concrete understanding of the multidisciplinary team.

  13. Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature

    Science.gov (United States)

    Soukup, Tayana; Lamb, Benjamin W; Arora, Sonal; Darzi, Ara; Sevdalis, Nick; Green, James SA

    2018-01-01

    In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs – including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don’ts) when setting up MDT-driven cancer care. PMID:29403284

  14. Whither radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ross, W M

    1987-03-01

    The 1986 Glyn Evans Memorial Lecture, given at the Joint Provincial Meeting of the Royal College of Radiologists, Sheffield, September 1986, sketches an outline of the history of radiotherapy and discusses the future development of the art. Topics included are siting of centres, training needs, the relationship of radiotherapy to other medical specialities, and the advantages and disadvantages of radiotherapy practitioners forming a separate medical College. (U.K.)

  15. Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature

    Directory of Open Access Journals (Sweden)

    Soukup T

    2018-01-01

    Full Text Available Tayana Soukup,1 Benjamin W Lamb,2 Sonal Arora,3 Ara Darzi,3 Nick Sevdalis,1 James SA Green4,5 1Health Service and Population Research Department, Centre for Implementation Science, King’s College London, London, UK; 2Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; 3Department of Surgery and Cancer, Center for Patient Safety and Service Quality, Imperial College London, 4Whipps Cross University Hospital, Barts Health NHS Trust, 5Faculty of Health and Social Care, London South Bank University, London, UK Abstract: In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs. A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs – including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos and practices to avoid (Don’ts when setting up MDT-driven cancer care. Keywords: cancer MDT, MDM, cancer meeting, patients with cancer

  16. Multidisciplinary Teams: The Next Step in Science.

    Directory of Open Access Journals (Sweden)

    Aldo Leal-Egaña.

    2006-07-01

    Full Text Available One of the current characteristics in science, is the high complexity and technical character that becomes over the last years. This has induced the development of a specific type of professionals, highly specialized in the disciplines that they are involved in, which has produced a communicational breach between the scientists involved on different branches of the science. One of the strategies intended to cross this breach, is the generation of multidisciplinary research strategies, in which professionals of every field of the science can take part, being a kind of scientific and human bridge between the different research teams where they are involved in. This new style to do investigation has made possible the generation of new branches in science, such as for example Biotechnology. In this field -Tissue Engineering- becomes to be a very interesting example of the potential to work in multidisciplinary teams. The reason for this is mainly to avoid technical mistakes, which could cause the death of some patients and which can only be solved by developing research under a multidisciplinary strategy. Nevertheless, and in spite of the success working with multidisciplinary teams, this kind of strategy is rarely used in Latin-American, where the reasons seems to be centered in some aspects personal and cultural. This work shows an example of the new style to develop complex research, which could suggest a new way of working in Latin-American, granted that there is the will to enhance current scientific level.

  17. Adjuvant and Definitive Radiotherapy for Adrenocortical Carcinoma

    International Nuclear Information System (INIS)

    Sabolch, Aaron; Feng, Mary; Griffith, Kent; Hammer, Gary; Doherty, Gerard; Ben-Josef, Edgar

    2011-01-01

    Purpose: To evaluate the impact of both adjuvant and definitive radiotherapy on local control of adrenocortical carcinoma. Methods and Materials: Outcomes were analyzed from 58 patients with 64 instances of treatment for adrenocortical carcinoma at the University of Michigan's Multidisciplinary Adrenal Cancer Clinic. Thirty-seven of these instances were for primary disease, whereas the remaining 27 were for recurrent disease. Thirty-eight of the treatment regimens involved surgery alone, 10 surgery plus adjuvant radiotherapy, and 16 definitive radiotherapy for unresectable disease. The effects of patient, tumor, and treatment factors were modeled simultaneously using multiple variable Cox proportional hazards regression for associations with local recurrence, distant recurrence, and overall survival. Results: Local failure occurred in 16 of the 38 instances that involved surgery alone, in 2 of the 10 that consisted of surgery plus adjuvant radiotherapy, and in 1 instance of definitive radiotherapy. Lack of radiotherapy use was associated with 4.7 times the risk of local failure compared with treatment regimens that involved radiotherapy (95% confidence interval, 1.2-19.0; p = 0.030). Conclusions: Radiotherapy seems to significantly lower the risk of local recurrence/progression in patients with adrenocortical carcinoma. Adjuvant radiotherapy should be strongly considered after surgical resection.

  18. Individualized Nonadaptive and Online-Adaptive Intensity-Modulated Radiotherapy Treatment Strategies for Cervical Cancer Patients Based on Pretreatment Acquired Variable Bladder Filling Computed Tomography Scans

    International Nuclear Information System (INIS)

    Bondar, M.L.; Hoogeman, M.S.; Mens, J.W.; Quint, S.; Ahmad, R.; Dhawtal, G.; Heijmen, B.J.

    2012-01-01

    Purpose: To design and evaluate individualized nonadaptive and online-adaptive strategies based on a pretreatment established motion model for the highly deformable target volume in cervical cancer patients. Methods and Materials: For 14 patients, nine to ten variable bladder filling computed tomography (CT) scans were acquired at pretreatment and after 40 Gy. Individualized model-based internal target volumes (mbITVs) accounting for the cervix and uterus motion due to bladder volume changes were generated by using a motion-model constructed from two pretreatment CT scans (full and empty bladder). Two individualized strategies were designed: a nonadaptive strategy, using an mbITV accounting for the full-range of bladder volume changes throughout the treatment; and an online-adaptive strategy, using mbITVs of bladder volume subranges to construct a library of plans. The latter adapts the treatment online by selecting the plan-of-the-day from the library based on the measured bladder volume. The individualized strategies were evaluated by the seven to eight CT scans not used for mbITVs construction, and compared with a population-based approach. Geometric uniform margins around planning cervix–uterus and mbITVs were determined to ensure adequate coverage. For each strategy, the percentage of the cervix–uterus, bladder, and rectum volumes inside the planning target volume (PTV), and the clinical target volume (CTV)-to-PTV volume (volume difference between PTV and CTV) were calculated. Results: The margin for the population-based approach was 38 mm and for the individualized strategies was 7 to 10 mm. Compared with the population-based approach, the individualized nonadaptive strategy decreased the CTV-to-PTV volume by 48% ± 6% and the percentage of bladder and rectum inside the PTV by 5% to 45% and 26% to 74% (p < 0.001), respectively. Replacing the individualized nonadaptive strategy by an online-adaptive, two-plan library further decreased the percentage of

  19. Current and future strategies in radiotherapy of childhood low-grade glioma of the brain. Part II. Treatment-related late toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Kortmann, R.D.; Timmermann, B.; Plasswilm, L.; Paulsen, F.; Jeremic, B.; Kay, S.; Bamberg, M. [Dept. of Radiooncology, Univ. of Tuebingen (Germany); Taylor, R.E. [Radiotherapy Dept., Cookridge Hospital, Leeds (United Kingdom); Scarzello, G. [Dept. of Radiotherapy, Padua General Hospital (Italy); Gnekow, A.K. [Children' s Hospital Augsburg (Germany); Dieckmann, K. [Dept. of Radiooncology, General Hospital Vienna (Austria)

    2003-09-01

    such as neurocognitive and endocrinological outcome are needed in order to clarify the impact of radiation therapy on the risk of late sequelae. Presently, the strategy to postpone radiotherapy in the younger children, especially with NF, is justified to reduce the risk of late effects. These information and the contribution of tumor, surgery and chemotherapy will help to define the role of radiation therapy in the future management of childhood low-grade glioma and whether the use of highly sophisticated and expensive treatment techniques is justifiable. The recently initiated prospective study of the APRO (Pediatric Radiooncology Working Party) on documentation of dose prescription to organs at risk and the network of the GPOH to explore late effects as well as the forthcoming prospective SIOP/GPOH (International Society of Pediatric Oncology/German Society of Pediatric Oncology and Hematology) LGG 2003 trial are addressing these issues. (orig.)

  20. Current and future strategies in radiotherapy of childhood low-grade glioma of the brain. Part II. Treatment-related late toxicity

    International Nuclear Information System (INIS)

    Kortmann, R.D.; Timmermann, B.; Plasswilm, L.; Paulsen, F.; Jeremic, B.; Kay, S.; Bamberg, M.; Taylor, R.E.; Scarzello, G.; Gnekow, A.K.; Dieckmann, K.

    2003-01-01

    such as neurocognitive and endocrinological outcome are needed in order to clarify the impact of radiation therapy on the risk of late sequelae. Presently, the strategy to postpone radiotherapy in the younger children, especially with NF, is justified to reduce the risk of late effects. These information and the contribution of tumor, surgery and chemotherapy will help to define the role of radiation therapy in the future management of childhood low-grade glioma and whether the use of highly sophisticated and expensive treatment techniques is justifiable. The recently initiated prospective study of the APRO (Pediatric Radiooncology Working Party) on documentation of dose prescription to organs at risk and the network of the GPOH to explore late effects as well as the forthcoming prospective SIOP/GPOH (International Society of Pediatric Oncology/German Society of Pediatric Oncology and Hematology) LGG 2003 trial are addressing these issues. (orig.)

  1. Radiotherapy for MTRA/RT; Strahlentherapie fuer MTRA/RT

    Energy Technology Data Exchange (ETDEWEB)

    Luetter, Christiana [Bonn Univ. (Germany). Radiologische Klinik

    2012-07-01

    The radiological practice textbook covers the following issues: tumor diseases, tumor diagnostics, fundamentals of radiotherapy, DIN, irradiation planning, documentation and quality assurance, strategies of tumor therapy, basic physics of radiotherapy and dosimetry, radiation protection - regulations and guidelines, radiobiology, biological radiation effects, special organ toxicity, psychological and medical attendance of patients, special oncology of the most important organ carcinomas, palliative radiotherapy, radiotherapy of benign diseases, other indications of radiotherapy, supportive therapy.

  2. Integrating Multidisciplinary Engineering Knowledge

    Science.gov (United States)

    Wolff, Karin; Luckett, Kathy

    2013-01-01

    In order to design two distinct engineering qualification levels for an existing University of Technology programme, empirical evidence based on the current diploma is necessary to illuminate the nature of and the relationship between the "contextual" and "conceptual" elements underpinning a multidisciplinary engineering…

  3. Multidisciplinary care of craniosynostosis

    Directory of Open Access Journals (Sweden)

    Buchanan EP

    2017-07-01

    Full Text Available Edward P Buchanan,1 Yunfeng Xue,1 Amy S Xue,1 Asaf Olshinka,1 Sandi Lam2 1Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, 2Michael E. DeBakey Department of Surgery, Division of Neurosurgery, Baylor College of Medicine, Houston, TX, USA Abstract: The management of craniosynostosis, especially in the setting of craniofacial syndromes, is ideally done in a multidisciplinary clinic with a team focused toward comprehensive care. Craniosynostosis is a congenital disorder of the cranium, caused by the premature fusion of one or more cranial sutures. This fusion results in abnormal cranial growth due to the inability of the involved sutures to accommodate the growing brain. Skull growth occurs only at the patent sutures, resulting in an abnormal head shape. If cranial growth is severely restricted, as seen in multisuture craniosynostosis, elevation in intracranial pressure can occur. Whereas most patients treated in a multidisciplinary craniofacial clinic have non-syndromic or isolated craniosynostosis, the most challenging patients are those with syndromic craniosynostosis. The purpose of this article was to discuss the multidisciplinary team care required to treat both syndromic and non-syndromic craniosynostosis. Keywords: multidisciplinary team care, syndromic craniosynostosis, nonsyndromic craniosynostosis

  4. Strategies to evaluate the impact of rectal volume on prostate motion during three-dimensional conformal radiotherapy for prostate cancer

    Directory of Open Access Journals (Sweden)

    Ana Paula Diniz Fortuna Poli

    2016-02-01

    Full Text Available Abstract Objective: To evaluate the rectal volume influence on prostate motion during three-dimensional conformal radiotherapy (3D-CRT for prostate cancer. Materials and Methods: Fifty-one patients with prostate cancer underwent a series of three computed tomography scans including an initial planning scan and two subsequent scans during 3D-CRT. The organs of interest were outlined. The prostate contour was compared with the initial CT images considering the anterior, posterior, superior, inferior and lateral edges of the organ. Variations in the anterior limits and volume of the rectum were assessed and correlated with prostate motion in the anteroposterior direction. Results: The maximum range of prostate motion was observed in the superoinferior direction, followed by the anteroposterior direction. A significant correlation was observed between prostate motion and rectal volume variation ( p = 0.037. A baseline rectal volume superior to 70 cm3 had a significant influence on the prostate motion in the anteroposterior direction ( p = 0.045. Conclusion: The present study showed a significant interfraction motion of the prostate during 3D-CRT with greatest variations in the superoinferior and anteroposterior directions, and that a large rectal volume influences the prostate motion with a cutoff value of 70 cm3. Therefore, the treatment of patients with a rectal volume > 70 cm3 should be re-planned with appropriate rectal preparation.

  5. Controlling methicillin-resistant Staphylococcus aureus by stepwise implementation of preventive strategies in a university hospital: impact of a link-nurse system on the basis of multidisciplinary approaches.

    Science.gov (United States)

    Miyachi, Hayato; Furuya, Hiroyuki; Umezawa, Kazuo; Itoh, Yumiko; Ohshima, Toshio; Miyamoto, Motoaki; Asai, Satomi

    2007-03-01

    Current approaches in the control of methicillin-resistant Staphylococcus aureus (MRSA) in the large tertiary referral hospital have not been universally successful. The trend of MRSA rates and their relationship with stepwise implementation of preventive strategies in Tokai University Hospital during a 76-month period from September 1998 to December 2004, was retrospectively analyzed with a quasi-experimental design. Implementation of strategies including a feedback process with case and epidemic reporting, an infection control team and office, and a preventive guideline for MRSA did not result in reduction in monthly MRSA rates in the hospital, as analyzed with Shewhart u charts. When infection control link nurses were organized and their activities became full-scale, there appeared significant reduction in arithmetic mean of the monthly rates of MRSA from 6.3% to 5.0% in June 2002. Meanwhile the mean values for monthly counts of new MRSA cases also dropped in 15 of 25 wards/units in June 2002, as analyzed with Exponentially Weighted Moving Average charts. Concurrently, there was a significant increase (17.3%) in the monthly consumption of handwashing liquid plain soap. Thereafter the MRSA rates remained low for 2 years within three standard deviations. The sustained reduction of MRSA rates in the hospital can be related to introduction of the infection control link-nurse system on the basis of continuous enforcement of basic and multidisciplinary approaches such as hand-hygiene compliance.

  6. Understanding Regional Effects on Climate Change and Multidisciplinary Approarch for Coping Strategies - Case Study at Rural Village in Sub-Saharan Africa -

    Science.gov (United States)

    Yoshimura, M.; Yamashita, M.

    2018-04-01

    This paper describes on understanding the regional effects on global climate change and subsistence farmers' coping strategies through our field investigation and multidimensional data analysis from the resilience point of view. The major research question of this study is to understand what actions villagers took as the coping strategy against the heavy rainfall shock caused by climate change. Our research interest is how geospatial information technique can contribute to this research question. The study area is located in Sinazongwe district, Southern province of Zambia. As for the field investigation, we set the study sites A, B and C where are located in the lower terrace, middle escarpment and upper terrace, respectively. In the rainy season of 2007/2008, our study site had a heavy rainfall and many crop fields were damaged. In this crop year, the annual rainfalls in site A and C were 1442 mm/year and 1332 mm/year respectively. This is about two times different with the long term average of rainfall 694.9 mm/year in Sinazongwe district. It is confirmed that approximately 20 % of crop fields were damaged by heavy rainfall through our field investigation. It was so severe negative consequences for all of villages because about 80 % of whole damaged crop fields were maize fields. Maize is staple food in this region. Here, we have analysed and discussed how villagers cope from the serious damage of crops. The maize harvest varies every year depending on rainfall and topographic position. If a farmer possesses maize fields at various topographic positions, they can avoid severe negative consequences of climate variability such as drought or heavy rainfall. However, not all farmers have access to fields at various topographic positions. It is important to know where each household's characteristics when we consider their strategy of livelihood for climate variabilities. Through this study, we confirmed the way to strengthen resilience of subsistence farmers as

  7. Comparison of IGRT Registration Strategies for Optimal Coverage of Primary Lung Tumors and Involved Nodes Based on Multiple Four-Dimensional CT Scans Obtained Throughout the Radiotherapy Course

    International Nuclear Information System (INIS)

    Mohammed, Nasiruddin; Kestin, Larry; Grills, Inga; Shah, Chirag; Glide-Hurst, Carri; Yan, Di; Ionascu, Dan

    2012-01-01

    Purpose: To investigate the impact of primary tumor and involved lymph node (LN) geometry (centroid, shape, volume) on internal target volume (ITV) throughout treatment for locally advanced non–small cell lung cancer using weekly four-dimensional computed tomography (4DCT). Methods and Materials: Eleven patients with advanced non–small cell lung cancer were treated using image-guided radiotherapy with acquisition of weekly 10-Phase 4DCTs (n = 51). Initial ITV was based on planning 4DCT. Master-ITV incorporated target geometry across the entire treatment (all 4DCTs). Geographic miss was defined as the % Master-ITV positioned outside of the initial planning ITV after registration is complete. Registration strategies considered were bony (B), primary tumor soft tissue alone (T), and registration based on primary tumor and involved LNs (T L N). Results: The % geographic miss for the primary tumor, mediastinal, and hilar lymph nodes based on each registration strategy were (1) B: 30%, 30%, 30%; (2) T: 21%, 40%, 36%; and (3) T L N: 26%, 26%, 27%. Mean geographic expansions to encompass 100% of the primary tumor and involved LNs were 1.2 ± 0.7 cm and 0.8 ± 0.3 cm, respectively, for B and T L N. Primary and involved LN expansions were 0.7 ± 0.5 cm and 1.1 ± 0.5 cm for T. Conclusion: T is best for solitary targets. When treatments include primary tumor and LNs, B and T L N provide more comprehensive geographic coverage. We have identified high % geographic miss when considering multiple registration strategies. The dosimetric implications are the subject of future study.

  8. Comparison of IGRT Registration Strategies for Optimal Coverage of Primary Lung Tumors and Involved Nodes Based on Multiple Four-Dimensional CT Scans Obtained Throughout the Radiotherapy Course

    Energy Technology Data Exchange (ETDEWEB)

    Mohammed, Nasiruddin; Kestin, Larry; Grills, Inga; Shah, Chirag; Glide-Hurst, Carri; Yan, Di [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Ionascu, Dan, E-mail: Dan.ionascu@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)

    2012-03-15

    Purpose: To investigate the impact of primary tumor and involved lymph node (LN) geometry (centroid, shape, volume) on internal target volume (ITV) throughout treatment for locally advanced non-small cell lung cancer using weekly four-dimensional computed tomography (4DCT). Methods and Materials: Eleven patients with advanced non-small cell lung cancer were treated using image-guided radiotherapy with acquisition of weekly 10-Phase 4DCTs (n = 51). Initial ITV was based on planning 4DCT. Master-ITV incorporated target geometry across the entire treatment (all 4DCTs). Geographic miss was defined as the % Master-ITV positioned outside of the initial planning ITV after registration is complete. Registration strategies considered were bony (B), primary tumor soft tissue alone (T), and registration based on primary tumor and involved LNs (T{sub L}N). Results: The % geographic miss for the primary tumor, mediastinal, and hilar lymph nodes based on each registration strategy were (1) B: 30%, 30%, 30%; (2) T: 21%, 40%, 36%; and (3) T{sub L}N: 26%, 26%, 27%. Mean geographic expansions to encompass 100% of the primary tumor and involved LNs were 1.2 {+-} 0.7 cm and 0.8 {+-} 0.3 cm, respectively, for B and T{sub L}N. Primary and involved LN expansions were 0.7 {+-} 0.5 cm and 1.1 {+-} 0.5 cm for T. Conclusion: T is best for solitary targets. When treatments include primary tumor and LNs, B and T{sub L}N provide more comprehensive geographic coverage. We have identified high % geographic miss when considering multiple registration strategies. The dosimetric implications are the subject of future study.

  9. Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012: science, opinions and experiences from the experts of surgery.

    Science.gov (United States)

    van de Velde, C J H; Boelens, P G; Tanis, P J; Espin, E; Mroczkowski, P; Naredi, P; Pahlman, L; Ortiz, H; Rutten, H J; Breugom, A J; Smith, J J; Wibe, A; Wiggers, T; Valentini, V

    2014-04-01

    The first multidisciplinary consensus conference on colon and rectal cancer was held in December 2012, achieving a majority of consensus for diagnostic and treatment decisions using the Delphi Method. This article will give a critical appraisal of the topics discussed during the meeting and in the consensus document by well-known leaders in surgery that were involved in this multidisciplinary consensus process. Scientific evidence, experience and opinions are collected to support multidisciplinary teams (MDT) with arguments for medical decision-making in diagnosis, staging and treatment strategies for patients with colon or rectal cancer. Surgery is the cornerstone of curative treatment for colon and rectal cancer. Standardizing treatment is an effective instrument to improve outcome of multidisciplinary cancer care for patients with colon and rectal cancer. In this article, a review of the following focuses; Perioperative care, age and colorectal surgery, obstructive colorectal cancer, stenting, surgical anatomical considerations, total mesorectal excision (TME) surgery and training, surgical considerations for locally advanced rectal cancer (LARC) and local recurrent rectal cancer (LRRC), surgery in stage IV colorectal cancer, definitions of quality of surgery, transanal endoscopic microsurgery (TEM), laparoscopic colon and rectal surgery, preoperative radiotherapy and chemoradiotherapy, and how about functional outcome after surgery? Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. [Radiotherapy for nasopharyngeal carcinoma].

    Science.gov (United States)

    Maingon, P; Blanchard, P; Bidault, F; Calmels, L

    2016-09-01

    Nasapharyngeal carcinoma is a rare disease. Oftenly, the diagnostic is made for advanced disease. Localized tumors, T1 or T2 NO observed a good prognosis and are locally controlled in more than 90 % of the cases by radiotherapy alone. The standard treatment of locally advanced disease is combined chemoradiation. A special vigilance of fast decrease of the volume of the pathological lymph nodes, sometimes associated to loss of weight might indicate an adaptive dosimetric revision. The treatment of recurrent disease is of great importance. Surgical indications are limited but should be discussed in multidisciplinary tumor board when possible. Surgical nodal sampling has to be proposed for nodal recurrence as well as reirradiation, which could be indicated according to the technical issues. Copyright © 2016. Published by Elsevier SAS.

  11. Image guided multibeam radiotherapy

    International Nuclear Information System (INIS)

    Freijo, J.L.

    2008-01-01

    This paper provides an outlook of the status of the first development stages for an updated design of radiotherapy conformal system based on tumor 3D images obtained as an output the last generation imaging machines as PET, CT and MR which offer a very valuable output in cancer diagnosis. Prospective evaluation of current software codes and acquisition of useful experience in surgical planning involves a multidisciplinary process as an initial and unavoidable stage to develop an expert software and user skills which assures the delivery of the radiation dose is done correctly in geometry and value in each voxel as a radiation protection basic condition. The validation of the images obtained has been done by the production of anatomical models of interest regions by rapid proto typing of the 3D segmented images and its evaluation by contrasting with the real regions during surgical procedures. (author)

  12. Building multidisciplinary business teams

    International Nuclear Information System (INIS)

    Dyson, C.J.; Winte, N.C.

    1991-01-01

    This paper is a description of an approach to managing Exploration and Production assets through the operation of multidisciplinary business teams. The business team approach can assist in improved asset performance in terms of efficiency, motivation and business results, compared with more traditional matrix style hierarchies. Within this paper certain critical success factors for the long term success of multidiscipline teams are outlined, together with some of the risk of business team operation

  13. Multidisciplinary Management of Mastocytosis

    DEFF Research Database (Denmark)

    Broesby-Olsen, Sigurd; Dybedal, Ingunn; Gülen, Theo

    2016-01-01

    Mastocytosis is a heterogeneous group of diseases defined by an increased number and accumulation of mast cells, and often also by signs and symptoms of mast cell activation. Disease subtypes range from indolent to rare aggressive forms. Mastocytosis affects people of all ages and has been...... an individualized, multidisciplinary approach. We present here consensus recommendations from a Nordic expert group for the diagnosis and general management of patients with mastocytosis....

  14. Multidisciplinary Management of Mastocytosis

    DEFF Research Database (Denmark)

    Broesby-Olsen, Sigurd; Dybedal, Ingunn; Gülen, Theo

    2016-01-01

    Mastocytosis is a heterogeneous group of diseases defined by an increased number and accumulation of mast cells, and often also by signs and symptoms of mast cell activation. Disease subtypes range from indolent to rare aggressive forms. Mastocytosis affects people of all ages and has been consid...... an individualized, multidisciplinary approach. We present here consensus recommendations from a Nordic expert group for the diagnosis and general management of patients with mastocytosis....

  15. Building multidisciplinary business teams

    International Nuclear Information System (INIS)

    Dyson, C.J.; Winter, N.C.

    1992-01-01

    This paper describes an approach to managing oil and gas industry E and P assets through the operation of multidisciplinary business teams (MBT's). This approach can result in improved asset performance in terms of efficiency, motivation, and business results compared with more traditional matrix-style hierarchies. This paper also outlines certain critical success factors for the long-term success of MBT's and discusses some of the risks of MBT operation

  16. Current and future strategies in radiotherapy of childhood low-grade glioma of the brain. Part I. Treatment modalities of radiation therapy

    International Nuclear Information System (INIS)

    Kortmann, R.D.; Timmermann, B.; Plasswilm, L.; Paulsen, F.; Jeremic, B.; Kay, S.; Bamberg, M.; Taylor, R.E.; Scarzello, G.; Gnekow, A.K.; Dieckmann, K.

    2003-01-01

    Background: Treatment of childhood low-grade gliomas is a challenging issue owing to their low incidence and the lack of consensus about ''optimal'' treatment approach. Material and Methods: Reports in the literature spanning 60 years of radiation therapy, including orthovoltage, megavoltage and recently modern high-precision treatments, were reviewed with respect to visual function, survival, prognostic factors, dose prescriptions, target volumes, and treatment techniques. Based on these experiences, future strategies in the management of childhood low-grade glioma are presented. Results: Evaluation of published reports is difficult because of inconsistencies in data presentation, relatively short follow-up in some series and failure to present findings and results in a comparable way. Even with the shortcomings of the reports available in the literature, primarily concerning indications, age at treatment, dose response, timing and use of ''optimal'' treatment fields, radiation therapy continues to play an important role in the management of these tumors achieving long-term survival rates up to 80% or more. Particularly in gliomas of the visual pathway, high local tumor control and improved or stable function is achieved in approximately 90% of cases. Data on dose-response relationships recommend dose prescriptions between 45 and 54 Gy with standard fractionation. There is consensus now to employ radiation therapy in older children in case of progressive disease only, regardless of tumor location and histologic subtype. In younger children, the role of radiotherapy is unclear. Recent advances in treatment techniques, such as 3-D treatment planning and various ''high-precision'' treatments achieved promising initial outcome, however with limited patient numbers and short follow-ups. Conclusions: Radiation therapy is an effective treatment modality in children with low-grade glioma regarding tumor control and improvement and/or preservation of neurologic function or

  17. First Clinical Release of an Online, Adaptive, Aperture-Based Image-Guided Radiotherapy Strategy in Intensity-Modulated Radiotherapy to Correct for Inter- and Intrafractional Rotations of the Prostate

    International Nuclear Information System (INIS)

    Deutschmann, Heinz; Kametriser, Gerhard; Steininger, Philipp; Scherer, Philipp; Schöller, Helmut; Gaisberger, Christoph; Mooslechner, Michaela; Mitterlechner, Bernhard; Weichenberger, Harald; Fastner, Gert; Wurstbauer, Karl; Jeschke, Stephan; Forstner, Rosemarie; Sedlmayer, Felix

    2012-01-01

    Purpose: We developed and evaluated a correction strategy for prostate rotations using direct adaptation of segments in intensity-modulated radiotherapy (IMRT). Method and Materials: Implanted fiducials (four gold markers) were used to determine interfractional translations, rotations, and dilations of the prostate. We used hybrid imaging: The markers were automatically detected in two pretreatment planar X-ray projections; their actual position in three-dimensional space was reconstructed from these images at first. The structure set comprising prostate, seminal vesicles, and adjacent rectum wall was transformed accordingly in 6 degrees of freedom. Shapes of IMRT segments were geometrically adapted in a class solution forward-planning approach, derived within seconds on-site and treated immediately. Intrafractional movements were followed in MV electronic portal images captured on the fly. Results: In 31 of 39 patients, for 833 of 1013 fractions (supine, flat couch, knee support, comfortably full bladder, empty rectum, no intraprostatic marker migrations >2 mm of more than one marker), the online aperture adaptation allowed safe reduction of margins clinical target volume–planning target volume (prostate) down to 5 mm when only interfractional corrections were applied: Dominant L-R rotations were found to be 5.3° (mean of means), standard deviation of means ±4.9°, maximum at 30.7°. Three-dimensional vector translations relative to skin markings were 9.3 ± 4.4 mm (maximum, 23.6 mm). Intrafractional movements in 7.7 ± 1.5 min (maximum, 15.1 min) between kV imaging and last beam’s electronic portal images showed further L-R rotations of 2.5° ± 2.3° (maximum, 26.9°), and three-dimensional vector translations of 3.0 ±3.7 mm (maximum, 10.2 mm). Addressing intrafractional errors could further reduce margins to 3 mm. Conclusion: We demonstrated the clinical feasibility of an online adaptive image-guided, intensity-modulated prostate protocol on a standard

  18. First clinical release of an online, adaptive, aperture-based image-guided radiotherapy strategy in intensity-modulated radiotherapy to correct for inter- and intrafractional rotations of the prostate.

    Science.gov (United States)

    Deutschmann, Heinz; Kametriser, Gerhard; Steininger, Philipp; Scherer, Philipp; Schöller, Helmut; Gaisberger, Christoph; Mooslechner, Michaela; Mitterlechner, Bernhard; Weichenberger, Harald; Fastner, Gert; Wurstbauer, Karl; Jeschke, Stephan; Forstner, Rosemarie; Sedlmayer, Felix

    2012-08-01

    We developed and evaluated a correction strategy for prostate rotations using direct adaptation of segments in intensity-modulated radiotherapy (IMRT). Implanted fiducials (four gold markers) were used to determine interfractional translations, rotations, and dilations of the prostate. We used hybrid imaging: The markers were automatically detected in two pretreatment planar X-ray projections; their actual position in three-dimensional space was reconstructed from these images at first. The structure set comprising prostate, seminal vesicles, and adjacent rectum wall was transformed accordingly in 6 degrees of freedom. Shapes of IMRT segments were geometrically adapted in a class solution forward-planning approach, derived within seconds on-site and treated immediately. Intrafractional movements were followed in MV electronic portal images captured on the fly. In 31 of 39 patients, for 833 of 1013 fractions (supine, flat couch, knee support, comfortably full bladder, empty rectum, no intraprostatic marker migrations >2 mm of more than one marker), the online aperture adaptation allowed safe reduction of margins clinical target volume-planning target volume (prostate) down to 5 mm when only interfractional corrections were applied: Dominant L-R rotations were found to be 5.3° (mean of means), standard deviation of means ±4.9°, maximum at 30.7°. Three-dimensional vector translations relative to skin markings were 9.3 ± 4.4 mm (maximum, 23.6 mm). Intrafractional movements in 7.7 ± 1.5 min (maximum, 15.1 min) between kV imaging and last beam's electronic portal images showed further L-R rotations of 2.5° ± 2.3° (maximum, 26.9°), and three-dimensional vector translations of 3.0 ±3.7 mm (maximum, 10.2 mm). Addressing intrafractional errors could further reduce margins to 3 mm. We demonstrated the clinical feasibility of an online adaptive image-guided, intensity-modulated prostate protocol on a standard linear accelerator to correct 6 degrees of freedom of

  19. Multidisciplinary approach to carotid stenting.

    Science.gov (United States)

    Mak, C S; Chambers, B R; Clark, D J; Molan, M; Brooks, M; Roberts, N; Fell, G; Roberts, A K; New, G; Donnan, G A

    2011-11-01

    Stroke neurologists, vascular surgeons, interventional neuroradiologists and interventional cardiologists have embraced carotid angioplasty and stenting (CAS) because of potential advantages over carotid endarterectomy (CEA). At Austin Health, a multidisciplinary neuro-interventional group was formed to standardise indications and facilitate training. The aims of this study were to describe our organisational model and to determine whether 30-day complications and early outcomes were similar to those of major trials. A clinical protocol was developed to ensure optimal management. CAS was performed on patients with high medical risk for CEA, with technically difficult anatomy for CEA, or who were randomised to CAS in a trial. From October 2003 to May 2008, 47 patients (34 male, mean age 71.5) underwent CAS of 50 carotid arteries. Forty-three cases had ipsilateral carotid territory symptoms within the previous 12 months. The main indications for CAS were high risk for CEA (n= 17) and randomised to CAS (n= 21). Interventionists were proctored in 27 cases. The procedural success rate was 94% with two cases abandoned because of anatomical problems and one because of on-table angina. Hypotension requiring vasopressor therapy occurred in 12 cases (24%). The duration of follow up was one to 44 months (mean 6.8 months). The 30-day rate of peri-procedural stroke or death was 6% and the one-year rate of peri-procedural stroke or death or subsequent ipsilateral stroke was 10.6%. Restenosis occurred in 13% (all asymptomatic). A multidisciplinary approach is a useful strategy for initiating and sustaining a CAS programme. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

  20. The development of radiotherapy in Slovenia

    International Nuclear Information System (INIS)

    Kuhelj, Janez; Ravnihar, Bozena

    1996-01-01

    The historical data on the development of radiotherapy in Slovenia are presented from its first use in this county in 1902 until the present. The Institute of Oncology in Ljubljana was established in 1938 with the intention of providing a sound development of radium and roentgen cancer treatment. After World War II, the development of radiotherapy was dynamic, which is evident from the data on new radiation sources in external beam therapy (accelerators, telecobalt units), in brachytherapy (various sealed radioisotopes) as well as in the introduction of therapy with unsealed radioisotopes. In 1947, a Chair of Oncology and Radiotherapy was instituted at the Medical Faculty of the University of Ljubljana (with the seat at the Institute of Oncology). In 1955, radiotherapy and oncology were officially recognized as separate branches of medicine requiring special obligatory postgraduate residency training. Within the Medical Society of Slovenia, the Section for Radiotherapy was established in 1987. The following year, the Section for Radiotherapy of Slovenia became a member of the European Society for Therapeutic Radiology and Oncology. Considering the size of population of Slovenia (nearly 2 million), it was reasonable that by this time radiotherapy became almost completely concentrated in one central institution, the Institute of Oncology, whose core and cohesive activity were represented in the multidisciplinary cancer treatment approach

  1. Radiotherapy; Strahlentherapie

    Energy Technology Data Exchange (ETDEWEB)

    Wannenmacher, M. [Heidelberg Univ., Mannheim (Germany). Abt. fuer Klinische Radiologie; Debus, J. [Univ. Heidelberg (Germany). Abt. Radioonkologie und Strahlentherapie; Wenz, F. (eds.) [Universitaetsklinikum Mannheim (Germany). Klinik fuer Strahlentherapie und Radioonkologie

    2006-07-01

    The book is focussed on the actual knowledge on the clinical radiotherapy and radio-oncology. Besides fundamental and general contributions specific organ systems are treated in detail. The book contains the following contributions: Basic principles, radiobiological fundamentals, physical background, radiation pathology, basics and technique of brachytherapy, methodology and technique of the stereotactic radiosurgery, whole-body irradiation, operative radiotherapy, hadron therapy, hpyerthermia, combined radio-chemo-therapy, biometric clinical studies, intensity modulated radiotherapy, side effects, oncological diagnostics; central nervous system and sense organs, head-neck carcinomas, breast cancer, thorax organs, esophagus carcinoma, stomach carcinoma, pancreas carcinoma, heptabiliary cancer and liver metastases, rectal carcinomas, kidney and urinary tract, prostate carcinoma, testicular carcinoma, female pelvis, lymphatic system carcinomas, soft tissue carcinoma, skin cancer, bone metastases, pediatric tumors, nonmalignant diseases, emergency in radio-oncology, supporting therapy, palliative therapy.

  2. Pre-Radiotherapy dental evaluation criteria and treatment needs of oral side effects after head and neck radiotherapy

    International Nuclear Information System (INIS)

    Gonzalez-Arriagada, Wilfredo Alejandro; Santos-Silva, Alan Roger; Carvalho de Andrade, Marco Aurelio; De Andrade Elias, Rogerio; Ajudarte Lopes, Marcio

    2010-01-01

    The objective of this review is to present pre-radiotherapy evaluation criteria and the main needs for treatment of these patients after the radiation therapy. Were revised articles in English, Spanish and Portuguese language between 1995 and 2009 indexed in Pubmed and Scielo. The keywords were oral cancer and radiotherapy, complications in head and neck radiotherapy, oral pre-radiotherapy evaluation.The adverse complications of radiotherapy in head and neck area could be temporary or late. The late effects, such as radiation caries and osteorradionecrosis could be directly associated with the fact that previous dental evaluation was not performed and can severely affect the post-operatory quality of life. The participation of the dentist in the multidisciplinary team and dental evaluation of the patients that will receive radiotherapy in the head and neck area are of vital importance to improve the post-operatory quality of life of these patients

  3. Radiotherapy for breast cancer and pacemaker

    International Nuclear Information System (INIS)

    Menard, J.; Campana, F.; Bollet, M.A.; Dendale, R.; Fournier-Bidoz, N.; Marchand, V.; Mazal, A.; Fourquet, A.; Kirova, Y.M.; Kirov, K.M.; Esteve, M.

    2011-01-01

    Purpose. - Patients with permanent cardiac pacemakers occasionally require radiotherapy. Therapeutic Irradiation may cause pacemakers to malfunction due to the effects of ionizing radiation or electromagnetic interference. We studied the breast cancer patients who needed breast and/or chest wall and lymph node irradiation to assess the feasibility and tolerance in this population of patients. Patients and methods. - From November 2008 to December 2009, more than 900 patients received radiotherapy for their breast cancer in our department using megavoltage linear accelerator (X 4-6 MV and electrons). Among them, seven patients were with permanent pacemaker. All patients have been treated to the breast and chest wall and/or lymph nodes. Total dose to breast and/or chest wall was 50 Gy/25 fractions and 46 Gy/23 fractions to lymph nodes. Patients who underwent conserving surgery followed by breast irradiation were boosted when indicated to tumour bed with 16 Gy/8 fractions. All patients were monitored everyday in presence of radiation oncologist to follow the function of their pacemaker. All pacemakers were controlled before and after radiotherapy by the patients' cardiologist. Results. - Seven patients were referred in our department for postoperative breast cancer radiotherapy. Among them, only one patient was declined for radiotherapy and underwent mastectomy without radiotherapy. In four cases the pacemaker was repositioned before the beginning of radiotherapy. Six patients, aged between 48 and 84 years underwent irradiation for their breast cancer. Four patients were treated with conserving surgery followed by breast radiotherapy and two with mastectomy followed by chest wall and internal mammary chain, supra- and infra-clavicular lymph node irradiation. The dose to the pacemaker generator was kept below 2 Gy. There was no pacemaker dysfunction observed during the radiotherapy. Conclusion. - The multidisciplinary work with position change of the pacemaker before

  4. Fatigue and radiotherapy. A literature review

    International Nuclear Information System (INIS)

    Dilhuydy, J.M.; Ouhtatou, F.; Laporte, C.; Nguyen, T.V.F.; Vendrely, V.; Dilhuydy, J.M.; Dilhuydy, M.S.

    2001-01-01

    Fatigue is a common complaint for the cancer patient during and after radiotherapy, according to the published studies. Fatigue is a subjective symptom mostly underestimated by oncologists and other care givers. Etiology is complex, poorly understood in spite of obvious causes like insomnia, nausea, pain, depression, psychological distress, anemia, hypothyroidism, menopause disturbances, treatment adverse effects. Fatigue presents multi-factorial and multidimensional aspects. To evaluate it, many tools can be used as single-item, unidimensional and multidimensional instruments. Practically, the open discussion with the patient throughout radiotherapy is essential to define it. Taking charge fatigue requires its acknowledgement by radiotherapist, treatment of associated symptoms with a multidisciplinary approach. (authors)

  5. Multidisciplinary workshops: learning to work together.

    Science.gov (United States)

    Fatchett, Anita; Taylor, Dawn

    2013-03-01

    Health and social care professional practice needs to move with the times and to respond to the ever-changing combination of health needs, economic realities and health-policy imperatives. A clear understanding of the variety of forces at play and the ability to marshal these to good effect by working in partnership with multidisciplinary colleagues and children/families is a must, not least in this time of economic austerity and ever-rising health inequalities, when vulnerable children's lives and complex family relationships and behaviours so easily become increasingly strained and challenged. This sad reality calls out for relevant joined-up solutions by all participants--an agenda so often called into question by court judgement after court judgement. The multidisciplinary workshops to be discussed have developed and changed over the past decade and provide a safe but realistic learning environment for students from health and social care backgrounds to experience the difficulties and barriers to good multidisciplinary working, to better understand others' perspectives and activities and consider and develop new and better practical strategies for working with multidisciplinary professional colleagues, children and families. All of the workshops are underpinned by specific discipline-focused theoretical work.

  6. Radiotherapy apparatus

    International Nuclear Information System (INIS)

    Leung, P.M.; Webb, H.P.J.

    1985-01-01

    This invention relates to apparatus for applying intracavitary radiotherapy. In previously-known systems radioactive material is conveyed to a desired location within a patient by transporting a chain of balls pneumatically to and from an appropriately inserted applicator. According to this invention a ball chain for such a purpose comprises several radioactive balls separated by non-radioactive tracer balls of radiographically transparent material of lower density and surface hardness than the radioactive balls. The invention also extends to radiotherapy treatment apparatus comprising a storage, sorting and assembly system

  7. Prevention and treatment of the orofacial complications of radiotherapy

    International Nuclear Information System (INIS)

    Rothwell, B.R.

    1987-01-01

    Radiotherapy of malignant head and neck tumors often causes extensive, permanent changes in salivary glands, peridental alveolar bone, and mucosal structures. Dental neglect and inappropriate dental management can cause complications. The potential orofacial side effects of radiotherapy are reviewed, as are preventive strategies for the dental treatment of patients scheduled to undergo radiotherapy

  8. Targeting IAP proteins in combination with radiotherapy

    International Nuclear Information System (INIS)

    Fulda, Simone

    2015-01-01

    The efficacy of radiotherapy critically depends on the activation of intrinsic cell death programs in cancer cells. This implies that evasion of cell death, a hallmark of human cancers, can contribute to radioresistance. Therefore, novel strategies to reactivate cell death programs in cancer cells are required in order to overcome resistance to radiotherapy. Since Inhibitor of Apoptosis (IAP) proteins are expressed at high levels in multiple cancers and block cell death induction at a central point, therapeutic targeting of IAP proteins represents a promising approach to potentiate the efficacy of radiotherapy. The current review discusses the concept of targeting IAP proteins in combination with radiotherapy

  9. Radiotherapy and Brachytherapy : Proceedings of the NATO Advanced Study Institute on Physics of Modern Radiotherapy & Brachytherapy

    CERN Document Server

    Lemoigne, Yves

    2009-01-01

    This volume collects a series of lectures presented at the tenth ESI School held at Archamps (FR) in November 2007 and dedicated to radiotherapy and brachytherapy. The lectures focus on the multiple facets of radiotherapy in general, including external radiotherapy (often called teletherapy) as well as internal radiotherapy (called brachytherapy). Radiotherapy strategy and dose management as well as the decisive role of digital imaging in the associated clinical practice are developed in several articles. Grouped under the discipline of Conformal Radiotherapy (CRT), numerous modern techniques, from Multi-Leaf Collimators (MLC) to Intensity Modulated RadioTherapy (IMRT), are explained in detail. The importance of treatment planning based upon patient data from digital imaging (Computed Tomography) is also underlined. Finally, despite the quasi- totality of patients being presently treated with gamma and X-rays, novel powerful tools are emerging using proton and light ions (like carbon ions) beams, bound to bec...

  10. International Multidisciplinary Microscopy Congress

    CERN Document Server

    Oral, Ahmet; Ozer, Mehmet; InterM; INTERM2013

    2014-01-01

    The International Multidisciplinary Microscopy Congress (INTERM2013) was organized on October 10-13, 2013. The aim of the congress was to bring together scientists from various branches to discuss the latest advances in the field of microscopy. The contents of the congress have been broadened to a more "interdisciplinary" scope, so as to allow all scientists working on related subjects to participate and present their work. These proceedings include 39 peer-reviewed technical papers, submitted by leading academic and research institutions from over 12 countries and representing some of the most cutting-edge research available. The 39 papers are grouped into the following sections: - Applications of Microscopy in the Physical Sciences - Applications of Microscopy in the Biological Sciences

  11. Supportive care for head and neck cancer patients receiving radiotherapy

    International Nuclear Information System (INIS)

    Zenda, Sadamoto

    2015-01-01

    Recently (chemo-)radiotherapy has been widely used in head and neck cancer with definite evidence. As long survivor has increased, social problems associated with late toxicity have become more. Late toxicities induced by radiotherapy for head and neck lesion are often severe. Xerostomia is one of the severe late toxicities conventionally and dysphagia after chemoradiotherapy is a new topic. Some industrial development (ex. Intensity Modulated Radiotherapy: IMRT) play a great role in toxicity management. Multidisciplinary approach (cooperation between not only physicians but also nurses and dentists) is necessary to control toxicities. The research of supportive care will be needed same as definitive treatment in the future. (author)

  12. Radiotherapy of invasive breast cancer: French national guidelines

    International Nuclear Information System (INIS)

    Besnard, S.; Mazeau-Woynar, V.; Verdoni, L.; Cutuli, B.; Fourquet, A.; Giard, S.; Hennequin, C.; Leblanc-Onfroy, M.

    2012-01-01

    The French National Cancer Institute (INCa) and Societe francaise de senologie et pathologie mammaire (SFSPM), in collaboration with a multidisciplinary experts group, have published the French national clinical practice guidelines on a selection of 11 currently debated questions regarding the management of invasive breast cancer. Those guidelines are based on a comprehensive analysis of the current published evidence dealing with those issues, secondly reviewed by 100 reviewers. Radiotherapy was concerned by five of the 11 questions: indications for the boost after whole gland irradiation; hypo-fractionated radiotherapy; partial breast irradiation; indications for mammary internal nodes irradiation, and indications of radiotherapy after neo-adjuvant chemotherapy. (authors)

  13. Interstitial radiotherapy

    International Nuclear Information System (INIS)

    Scardino, P.T.; Bretas, F.

    1987-01-01

    The authors now have 20 years of experience with modern techniques of brachytherapy. The large number of patients treated in medical centers around the world and the widespread use of this type of radiotherapy have provided us with substantial information about the indications and contraindications, advantages and disadvantages, pitfalls and complications, as well as the results of these techniques. Although the focus of this review is the experience at Baylor using the combined technique of gold seed implantation plus external beam irradiation, the alternative forms of brachytherapy will be described and compared. The authors' intention is to provide the busy clinician with a succinct and informative review indicating the status of modern interstitial radiotherapy and describing day-to-day approach and results

  14. Palliative Radiotherapy

    International Nuclear Information System (INIS)

    Salinas, J.

    2003-01-01

    Palliative care does not attempt to prolong survival but to the achieve the highest quality of life both for the patient and their family covering their physical, psychological, social and spiritual needs. Radiotherapy (RT), one of the most important therapeutic modalities, has a great significance in palliative medicine for cancer since it attempts to reduce as much as possible the acute reaction associated with the treatment for the patient. (Author)

  15. Radiotherapy for breast cancer and pacemaker; Radiotherapie pour un cancer du sein et stimulateur cardiaque

    Energy Technology Data Exchange (ETDEWEB)

    Menard, J.; Campana, F.; Bollet, M.A.; Dendale, R.; Fournier-Bidoz, N.; Marchand, V.; Mazal, A.; Fourquet, A.; Kirova, Y.M. [Oncologie-radiotherapie, institut Curie, 26, rue d' Ulm, 75005 Paris (France); Kirov, K.M.; Esteve, M. [Departement d' anesthesie-reanimation-douleur, institut Curie, 75005 Paris (France)

    2011-06-15

    Purpose. - Patients with permanent cardiac pacemakers occasionally require radiotherapy. Therapeutic Irradiation may cause pacemakers to malfunction due to the effects of ionizing radiation or electromagnetic interference. We studied the breast cancer patients who needed breast and/or chest wall and lymph node irradiation to assess the feasibility and tolerance in this population of patients. Patients and methods. - From November 2008 to December 2009, more than 900 patients received radiotherapy for their breast cancer in our department using megavoltage linear accelerator (X 4-6 MV and electrons). Among them, seven patients were with permanent pacemaker. All patients have been treated to the breast and chest wall and/or lymph nodes. Total dose to breast and/or chest wall was 50 Gy/25 fractions and 46 Gy/23 fractions to lymph nodes. Patients who underwent conserving surgery followed by breast irradiation were boosted when indicated to tumour bed with 16 Gy/8 fractions. All patients were monitored everyday in presence of radiation oncologist to follow the function of their pacemaker. All pacemakers were controlled before and after radiotherapy by the patients' cardiologist. Results. - Seven patients were referred in our department for postoperative breast cancer radiotherapy. Among them, only one patient was declined for radiotherapy and underwent mastectomy without radiotherapy. In four cases the pacemaker was repositioned before the beginning of radiotherapy. Six patients, aged between 48 and 84 years underwent irradiation for their breast cancer. Four patients were treated with conserving surgery followed by breast radiotherapy and two with mastectomy followed by chest wall and internal mammary chain, supra- and infra-clavicular lymph node irradiation. The dose to the pacemaker generator was kept below 2 Gy. There was no pacemaker dysfunction observed during the radiotherapy. Conclusion. - The multidisciplinary work with position change of the pacemaker

  16. Fatigue and radiotherapy. A literature review; Fatigue et radiotherapie. Revue de la litterature

    Energy Technology Data Exchange (ETDEWEB)

    Dilhuydy, J.M.; Ouhtatou, F.; Laporte, C.; Nguyen, T.V.F.; Vendrely, V. [Institut Bergonie Centre Regional de Lutte Contre le Cancer, 33 - Bordeaux (France); Dilhuydy, J.M. [Federation Nationale des Centres de Lutte Contre le Cancer, FNCLCC, Groupe Rehabilitation, 75 - Paris (France); Dilhuydy, M.S. [Hopital Saint-Andre, Service de Medecine Interne, 33 - Bordeaux (France)

    2001-11-01

    Fatigue is a common complaint for the cancer patient during and after radiotherapy, according to the published studies. Fatigue is a subjective symptom mostly underestimated by oncologists and other care givers. Etiology is complex, poorly understood in spite of obvious causes like insomnia, nausea, pain, depression, psychological distress, anemia, hypothyroidism, menopause disturbances, treatment adverse effects. Fatigue presents multi-factorial and multidimensional aspects. To evaluate it, many tools can be used as single-item, unidimensional and multidimensional instruments. Practically, the open discussion with the patient throughout radiotherapy is essential to define it. Taking charge fatigue requires its acknowledgement by radiotherapist, treatment of associated symptoms with a multidisciplinary approach. (authors)

  17. Multidisciplinary System Reliability Analysis

    Science.gov (United States)

    Mahadevan, Sankaran; Han, Song; Chamis, Christos C. (Technical Monitor)

    2001-01-01

    The objective of this study is to develop a new methodology for estimating the reliability of engineering systems that encompass multiple disciplines. The methodology is formulated in the context of the NESSUS probabilistic structural analysis code, developed under the leadership of NASA Glenn Research Center. The NESSUS code has been successfully applied to the reliability estimation of a variety of structural engineering systems. This study examines whether the features of NESSUS could be used to investigate the reliability of systems in other disciplines such as heat transfer, fluid mechanics, electrical circuits etc., without considerable programming effort specific to each discipline. In this study, the mechanical equivalence between system behavior models in different disciplines are investigated to achieve this objective. A new methodology is presented for the analysis of heat transfer, fluid flow, and electrical circuit problems using the structural analysis routines within NESSUS, by utilizing the equivalence between the computational quantities in different disciplines. This technique is integrated with the fast probability integration and system reliability techniques within the NESSUS code, to successfully compute the system reliability of multidisciplinary systems. Traditional as well as progressive failure analysis methods for system reliability estimation are demonstrated, through a numerical example of a heat exchanger system involving failure modes in structural, heat transfer and fluid flow disciplines.

  18. Breakfast: a multidisciplinary approach.

    Science.gov (United States)

    Affinita, Antonio; Catalani, Loredana; Cecchetto, Giovanna; De Lorenzo, Gianfranco; Dilillo, Dario; Donegani, Giorgio; Fransos, Lucia; Lucidi, Fabio; Mameli, Chiara; Manna, Elisa; Marconi, Paolo; Mele, Giuseppe; Minestroni, Laura; Montanari, Massimo; Morcellini, Mario; Rovera, Giuseppe; Rotilio, Giuseppe; Sachet, Marco; Zuccotti, Gian Vincenzo

    2013-07-10

    The role of breakfast as an essential part of an healthy diet has been only recently promoted even if breakfast practices were known since the Middle Age. The growing scientific evidences on this topic are extremely sector-based nevertheless breakfast could be regarded from different point of views and from different expertises. This approach, that take into account history, sociology, anthropology, medicine, psychology and pedagogy, is useful to better understand the value of this meal in our culture. The aim of this paper was to analyse breakfast-related issues based on a multidisciplinary approach with input by specialists from different fields of learning. Breakfast is now recommended as part of a diet because it is associated with healthier macro- and micronutrient intakes, body mass index and lifestyle. Moreover recent studies showed that breakfast improves cognitive function, intuitive perception and academic performance. Research demonstrates the importance of providing breakfast not only to children but in adults and elderly too. Although the important role breakfast plays in maintaining the health, epidemiological data from industrialised countries reveal that many individuals either eat a nutritionally unhealthy breakfast or skip it completely. The historical, bio-psychological and educational value of breakfast in our culture is extremely important and should be recognized and stressed by the scientific community. Efforts should be done to promote this practice for the individual health and well-being.

  19. Exploring Radiotherapy Targeting Strategy and Dose: A Pooled Analysis of Cooperative Group Trials of Combined Modality Therapy for Stage III Non-Small Cell Lung Cancer.

    Science.gov (United States)

    Schild, Steven E; Fan, Wen; Stinchcombe, Thomas E; Vokes, Everett E; Ramalingam, Suresh S; Bradley, Jeffrey D; Kelly, Karen; Pang, Herbert H; Wang, Xiaofei

    2018-04-21

    Concurrent chemoradiotherapy(CRT) is standard therapy for locally-advanced non-small-cell lung cancer(LA-NSCLC)patients. This study was performed to examine thoracic radiotherapy(TRT) parameters and their impact on patient survival. We collected Individual patient data(IPD) from 3600LA-NSCLC patients participating in 16 cooperative group trials of concurrent CRT. The primary TRT parameters examined included field design strategy(elective nodal irradiation(ENI) compared to involved field TRT(IF-TRT)), total dose, and biologically effective dose(BED). Hazard ratios(HRs) for overall survival were calculated with univariable and multivariable Cox models. TRT doses ranged from 60 to 74 Gy with most treatments administered once-daily. ENI was associated with poorer survival than IF-TRT(univariable HR,1.37;95%CI,1.24-1.51,pENI patients were 24 and 16 months, respectively. Patients were divided into 3 dose groups: low total dose(60 Gy), medium total dose(>60Gy-66Gy) and high total dose(>66Gy-74 Gy). With reference to the low dose group, the multivariable HR's were 1.08 for the medium dose group(95%CI=0.93-1.25) and 1.12 for the high dose group(CI=0.97-1.30).The univariate p=0.054 and multivariable p=0.17. BED was grouped as follows: low(55.5 Gy 10 ). With reference to the low BED group, the HR was 1.00(95%CI=0.85-1.18) for the medium BED group and 1.10(95%CI=0.93-1.31) for the high BED group. The univariable p=0.076 and multivariable p=0.16. For LA-NSCLC patients treated with concurrent CRT, IF-TRT was associated with significantly better survival than ENI-TRT. TRT total and BED dose levels were not significantly associated with patient survival. Future progress will require research focusing on better systemic therapy and TRT. Copyright © 2018. Published by Elsevier Inc.

  20. Conformation radiotherapy and conformal radiotherapy

    International Nuclear Information System (INIS)

    Morita, Kozo

    1999-01-01

    In order to coincide the high dose region to the target volume, the 'Conformation Radiotherapy Technique' using the multileaf collimator and the device for 'hollow-out technique' was developed by Prof. S. Takahashi in 1960. This technique can be classified a type of 2D-dynamic conformal RT techniques. By the clinical application of this technique, the late complications of the lens, the intestine and the urinary bladder after radiotherapy for the maxillary cancer and the cervical cancer decreased. Since 1980's the exact position and shape of the tumor and the surrounding normal tissues can be easily obtained by the tremendous development of the CT/MRI imaging technique. As a result, various kinds of new conformal techniques such as the 3D-CRT, the dose intensity modulation, the tomotherapy have been developed since the beginning of 1990'. Several 'dose escalation study with 2D-/3D conformal RT' is now under way to improve the treatment results. (author)

  1. Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support

    Science.gov (United States)

    Estcourt, Lise J; Malouf, Reem; Trivella, Marialena; Fergusson, Dean A; Hopewell, Sally; Murphy, Michael F

    2017-01-01

    Background Many people diagnosed with haematological malignancies experience anaemia, and red blood cell (RBC) transfusion plays an essential supportive role in their management. Different strategies have been developed for RBC transfusions. A restrictive transfusion strategy seeks to maintain a lower haemoglobin level (usually between 70 g/L to 90 g/L) with a trigger for transfusion when the haemoglobin drops below 70 g/L), whereas a liberal transfusion strategy aims to maintain a higher haemoglobin (usually between 100 g/L to 120 g/L, with a threshold for transfusion when haemoglobin drops below 100 g/L). In people undergoing surgery or who have been admitted to intensive care a restrictive transfusion strategy has been shown to be safe and in some cases safer than a liberal transfusion strategy. However, it is not known whether it is safe in people with haematological malignancies. Objectives To determine the efficacy and safety of restrictive versus liberal RBC transfusion strategies for people diagnosed with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without a haematopoietic stem cell transplant (HSCT). Search methods We searched for randomised controlled trials (RCTs) and non-randomised trials (NRS) in MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1982), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 6), and 10 other databases (including four trial registries) to 15 June 2016. We also searched grey literature and contacted experts in transfusion for additional trials. There was no restriction on language, date or publication status. Selection criteria We included RCTs and prospective NRS that evaluated a restrictive compared with a liberal RBC transfusion strategy in children or adults with malignant haematological disorders or undergoing HSCT. Data collection and analysis We used the standard methodological procedures expected by Cochrane. Main results

  2. Multidisciplinary accident investigation : volume 2

    Science.gov (United States)

    1976-05-01

    The Task II final report for 1974 of the Multidisciplinary Accident Investigation : Team of the Maryland Medical-Legal Foundation, Inc. is presented. This report describes some preliminary findings emanating from a series of comprehensive, multivaria...

  3. Multidisciplinary accident investigation : volume 1

    Science.gov (United States)

    1976-09-01

    The final report of the Multidisciplinary Accident Investigation Team of the Maryland Medical-Legal Foundation, Inc. is presented. The report describes the methodology, results, discussions, conclusions and recommendations pertaining to the investiga...

  4. Postmastectomy radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Shikama, Naoto; Koguchi, Masahiko; Sasaki, Shigeru; Kaneko, Tomoki; Shinoda, Atsunori; Nishikawa, Atsushi [Shinshu Univ., Matsumoto, Nagano (Japan). School of Medicine

    2000-10-01

    Since there have been few reports on postmastectomy radiotherapy having a high evidence level in Japan, the significance of postoperative radiotherapy and the irradiation techniques were reviewed based on reports from Western countries. Authors focused on the indications for postoperative irradiation, irradiation methods (irradiation sites, irradiation techniques; prosthetics, methods of irradiating the chest wall and lymph nodes, timing of irradiation), and complications, and discuss them. The factors thought to be adaptable to postmastectomy radiotherapy have been listed. Axillary lymph node metastasis and the size of the primary focus are thought to be important factors in locoregional recurrence. The chest wall and the supraclavicular lymph nodes are the usual sites of irradiation after mastectomy. The irradiation method consists of tangential irradiation of the chest wall and single-field irradiation of the supraclavicular lymph nodes, with 46-50 Gy in fractional doses of 1.8-2 Gy x 5/w is administered for 4.5-5.5 weeks. The timing of irradiation in the West is generally after chemotherapy. Adverse radiation effects include ischemic heart disease, pneumonitis, arm edema, rib fractures, and brachial plexus paralysis. The frequency of these complications is increased by the combined use of chemotherapy or surgery. The breast cancer cure rate in Japan is generally better than in the West. It remains to be determined whether the clinical data from Europe and America are applicable to the treatment of breast cancer in Japan. To address this issue, a clinical investigation should be performed in Japan with close cooperation between surgeons, physicians, pathologists, and radiotherapists. (K.H.)

  5. The effects of multidisciplinary rehabilitation: RePCa-a randomised study among primary prostate cancer patients

    DEFF Research Database (Denmark)

    Dieperink, K B; Johansen, C; Hansen, Steinbjørn

    2013-01-01

    Background:The objective of this study is the effectiveness of multidisciplinary rehabilitation on treatment-related adverse effects after completed radiotherapy in patients with prostate cancer (PCa).Methods:In a single-centre oncology unit in Odense, Denmark, 161 PCa patients treated...... with radiotherapy and androgen deprivation therapy were randomly assigned to either a programme of two nursing counselling sessions and two instructive sessions with a physical therapist (n=79) or to usual care (n=82). Primary outcome was Expanded Prostate Cancer Index Composite (EPIC-26) urinary irritative sum......-score.Before radiotherapy, pre-intervention 4 weeks after radiotherapy, and after a 20-week intervention, measurements included self-reported disease-specific quality of life (QoL; EPIC-26, including urinary, bowel, sexual, and hormonal symptoms), general QoL (Short-form-12, SF-12), pelvic floor muscle strength (Modified...

  6. Radiotherapy in bladder cancer

    International Nuclear Information System (INIS)

    Rozan, R.

    1992-01-01

    In 1992, the problem of the vesical radiotherapy is not resolved. The author presents the situation and the different techniques of radiotherapy in bladder cancers: external radiotherapy, only and associated with surgery, interstitial curietherapy and non-classical techniques as per operative radiotherapy, neutron therapy and concurrent radiotherapy with chemotherapy. In order to compare their efficiency, the five-year survival are given in all cases.(10 tabs)

  7. Radiotherapy of bronchogenic carcinoma

    International Nuclear Information System (INIS)

    Heilmann, H.P.

    1982-01-01

    Radiotherapy of branchogenic carcinoma comprises; palliative treatment, postoperative or pre-operative radiotherapy, radiotherapy as part of a combination of chemotherapy and radiotherapy of small cell carcinoma and curative radiotherapy of non-operable non-small cell carcinoma. Atelectasis and obstruction are indications for palliative radiotherapy. Postoperative radiotherapy is given only in cases of incomplete resection or mediastinal metastases. In the treatment of small cell carcinoma by combined irradiation and chemotherapy the mediastinum and primary tumour are irradiated, generally after chemotherapy, and the C.N.S. receives prophylactic radiotherapy. Curative radiotherapy is indicated in cases of non-operable small cell carcinoma. Irradiation with doses of 60-70 Gy produced 5-years-survival rates of 10-14% in cases classified as T 1 -T 2 N 0 M 0 . (orig.) [de

  8. Oral complications of radiotherapy in the head and neck

    International Nuclear Information System (INIS)

    Jham, Bruno Correi; Freire, Addah Regina da Silva

    2006-01-01

    Radiotherapy is a treatment modality largely used for head and neck malignancies. However, high doses of radiation in large areas, including the oral cavity, maxilla, mandible and salivary glands may result in several undesired reactions. Mucositis, candidosis, disgeusia, radiation caries, osteoradionecrosis, soft tissue necrosis and xerostomia are some of radiotherapy's complications.Aim: The aim of this study is to briefly review the side effects that may be seen in the oral cavity during or after radiotherapy treatment in the head and neck region.Basic Method Used: Review of relevant literature.Study Design: Literature review.Results: Radiotherapy is still associated with several side effects, significantly affecting patients quality of life.Conclusions: A multidisciplinary treatment, including physicians, dentists, speech therapists, nutritionists, and psychologists, is the best alternative to minimize, or even prevent such reactions. (author)

  9. EMSO: European Multidisciplinary Seafloor Observatory

    Science.gov (United States)

    Favali, P.; Partnership, Emso

    2009-04-01

    EMSO, a Research Infrastructure listed within ESFRI (European Strategy Forum on Research Infrastructures) Roadmap), is the European-scale network of multidisciplinary seafloor observatories from the Arctic to the Black Sea with the scientific objective of long-term real-time monitoring of processes related to geosphere/biosphere/hydrosphere interactions. EMSO will enhance our understanding of processes through long time series appropriate to the scale of the phenomena, constituting the new frontier of studying Earth interior, deep-sea biology and chemistry and ocean processes. EMSO will reply also to the need expressed in the frame of GMES (Global Monitoring for Environment and Security) to develop a marine segment integrated in the in situ and satellite global monitoring system. The EMSO development relays upon the synergy between the scientific community and the industry to improve the European competitiveness with respect to countries like USA/Canada, NEPTUNE, VENUS and MARS projects, Taiwan, MACHO project, and Japan, DONET project. In Europe the development of an underwater network is based on previous EU-funded projects since early '90, and presently supported by EU initiatives. The EMSO infrastructure will constitute the extension to the sea of the land-based networks. Examples of data recorded by seafloor observatories will be presented. EMSO is presently at the stage of Preparatory Phase (PP), funded in the EC FP7 Capacities Programme. The project has started in April 2008 and will last 4 years with the participation of 12 Institutions representing 12 countries. EMSO potential will be significantly increased also with the interaction with other Research Infrastructures addressed to Earth Science. 2. IFREMER-Institut Français de Recherche pour l'exploitation de la mer (France, ref. Roland Person); KDM-Konsortium Deutsche Meeresforschung e.V. (Germany, ref. Christoph Waldmann); IMI-Irish Marine Institute (Ireland, ref. Michael Gillooly); UTM-CSIC-Unidad de

  10. EMSO: European Multidisciplinary Seafloor Observatory

    Science.gov (United States)

    Favali, Paolo

    2010-05-01

    EMSO, a Research Infrastructure listed within ESFRI (European Strategy Forum on Research Infrastructures) Roadmap (Report 2006, http://cordis.europa.eu/esfri/roadmap.htm), is the European-scale network of multidisciplinary seafloor observatories from the Arctic to the Black Sea with the scientific objective of long-term real-time monitoring of processes related to geosphere/biosphere/hydrosphere interactions. EMSO will enhance our understanding of processes through long time series appropriate to the scale of the phenomena, constituting the new frontier of studying Earth interior, deep-sea biology and chemistry and ocean processes. The development of an underwater network is based on previous EU-funded projects since early '90 and is being supported by several EU initiatives, as the on-going ESONET-NoE, coordinated by IFREMER (2007-2011, http://www.esonet-emso.org/esonet-noe/), and aims at gathering together the Research Community of the Ocean Observatories. In 2006 the FP7 Capacities Programme launched a call for Preparatory Phase (PP) projects, that will provide the support to create the legal and organisational entities in charge of managing the infrastructures, and coordinating the financial effort among the countries. Under this call the EMSO-PP project was approved in 2007 with the coordination of INGV and the participation of other 11 Institutions of 11 countries. The project has started in April 2008 and will last 4 years. The EMSO is a key-infrastructure both for Ocean Sciences and for Solid Earth Sciences. In this respect it will enhance and complement profitably the capabilities of other European research infrastructures such as EPOS, ERICON-Aurora Borealis, and SIOS. The perspective of the synergy among EMSO and other ESFRI Research Infrastructures will be outlined. EMSO Partners: IFREMER-Institut Français de Recherche pour l'exploitation de la mer (France, ref. Roland Person); KDM-Konsortium Deutsche Meeresforschung e.V. (Germany, ref. Christoph

  11. EURECCA colorectal: multidisciplinary mission statement on better care for patients with colon and rectal cancer in Europe.

    Science.gov (United States)

    van de Velde, Cornelis J H; Aristei, Cynthia; Boelens, Petra G; Beets-Tan, Regina G H; Blomqvist, Lennart; Borras, Josep M; van den Broek, Colette B M; Brown, Gina; Coebergh, Jan-Willem; Cutsem, Eric Van; Espin, Eloy; Gore-Booth, Jola; Glimelius, Bengt; Haustermans, Karin; Henning, Geoffrey; Iversen, Lene H; Han van Krieken, J; Marijnen, Corrie A M; Mroczkowski, Pawel; Nagtegaal, Iris; Naredi, Peter; Ortiz, Hector; Påhlman, Lars; Quirke, Philip; Rödel, Claus; Roth, Arnaud; Rutten, Harm J T; Schmoll, Hans J; Smith, Jason; Tanis, Pieter J; Taylor, Claire; Wibe, Arne; Gambacorta, Maria Antonietta; Meldolesi, Elisa; Wiggers, Theo; Cervantes, Andres; Valentini, Vincenzo

    2013-09-01

    Care for patients with colon and rectal cancer has improved in the last twenty years however still considerable variation exists in cancer management and outcome between European countries. Therefore, EURECCA, which is the acronym of European Registration of cancer care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012 the first multidisciplinary consensus conference about colon and rectum was held looking for multidisciplinary consensus. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Experts commented and voted on the two web-based online voting rounds before the meeting (between 4th and 25th October and between the 20th November and 3rd December 2012) as well as one online round after the meeting (4th-20th March 2013) and were invited to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. All sentences that were voted on are available on the EURECCA website www.canceraudit.eu. The consensus document was divided in sections describing evidence based algorithms of diagnostics, pathology, surgery, medical

  12. Family physicians' perspectives regarding palliative radiotherapy

    International Nuclear Information System (INIS)

    Samant, Rajiv S.; Fitzgibbon, Edward; Meng, Joanne; Graham, Ian D.

    2006-01-01

    Purpose: To assess family physicians' views on common indications for palliative radiotherapy and to determine whether this influences patient referral. Methods and materials: A 30-item questionnaire evaluating radiotherapy knowledge and training developed at the Ottawa Regional Cancer Centre (ORCC) was mailed to a random sample of 400 family physicians in eastern Ontario, Canada. The completed surveys were collected and analyzed, and form the basis of this study. Results: A total of 172 completed surveys were received for a net response rate of 50% among practicing family physicians. Almost all of the physicians (97%) had recently seen cancer patients in their offices, with 85% regularly caring for patient with advanced cancer. Fifty-four percent had referred patients in the past for radiotherapy and 53% had contacted a radiation oncologist for advice. Physicians who were more knowledgeable about the common indications for palliative radiotherapy were significantly more likely to refer patients for radiotherapy (P<0.01). Inability to contact a radiation oncologist was correlated with not having referred patients for radiotherapy (P<0.01). Only 10% of the physicians had received radiotherapy education during their formal medical training. Conclusions: Many of the family physicians surveyed were unaware of the effectiveness of radiotherapy in a variety of common palliative situations, and radiotherapy referral was correlated with knowledge about the indications for palliative radiotherapy. This was not surprising given the limited education they received in this area and the limited contact they have had with radiation oncologists. Strategies need to be developed to improve continuing medical education opportunities for family physicians and to facilitate more interaction between these physicians and radiation oncologists

  13. Radiotherapy-induced emesis. An overview

    International Nuclear Information System (INIS)

    Feyer, P.; Buchali, A.; Hinkelbein, M.; Budach, V.; Zimmermann, J.S.; Titlbach, O.J.

    1998-01-01

    Background: A significant number of patients receiving radiotherapy experience the distressing side effects of emesis and nausea. These symptoms are some of the most distressing problems for the patients influencing their quality of life. Methods: International study results concerning radiotherapy-induced emesis are demonstrated. A German multicenter questionnaire examining the strategies to prevent or to treat radiotherapy-induced nausea and emesis is presented. An international analysis concerning incidence of emesis and nausea in fractionated radiotherapy patients is discussed. Finally the consensus of the consensus conference on antiemetic therapy from the Perugia International Cancer Conference V is introduced. Results: Untreated emesis can lead to complications like electrolyte disorders, dehydration, metabolic disturbances and nutrition problems with weight loss. Prophylactic antiemetics are often given to patients receiving single high-dose radiotherapy to the abdomen. A survey has revealed that antiemetic prophylaxis is not routinely offered to the patients receiving fractionated radiotherapy. However, there is a need for an effective treatment of emesis for use in this group of patients, too. In 20% of patients nausea and emesis can cause a treatment interruption because of an inadequate control of symptoms. Like in chemotherapy strategies there exist high, moderate, and low emetogenic treatment regimens in radiotherapy as well. The most emetogenic potential has the total body irradiation followed by radiotherapy to the abdomen. Radiotherapy induced emesis can be treated effectively with conventional antiemetics up to 50%. Conclusions: Studies with total body irradiation, fractionated treatment and high-dose single exposures have cleary demonstrated the value of 5-HT3-receptor antagonist antiemetics. There is a response between 60 and 97%. There is no difference in the efficacy of the different 5-HT3-antagonists. High-risk patients should be prophylactic

  14. Communication in multidisciplinary systems architecting

    NARCIS (Netherlands)

    Bonnema, Gerrit Maarten

    2014-01-01

    Systems architecting is multidisciplinary by nature. It is interesting to note that the methods and tools that are developed and presented in literature are mostly based on one or a very limited number of formalisms. This means that an often large part of the stakeholders involved in the

  15. Multidisciplinary Efforts Driving Translational Theranostics

    Science.gov (United States)

    Hu, Tony Y.

    2014-01-01

    This themed issue summarizes significant efforts aimed at using “biological language” to discern between “friends” and “foes” in the context of theranostics for true clinical application. It is expected that the success of theranostics depends on multidisciplinary efforts, combined to expedite our understanding of host responses to “customized” theranostic agents and formulating individualized therapies. PMID:25285169

  16. Automatic segmentation of thoracic and pelvic CT images for radiotherapy planning using implicit anatomic knowledge and organ-specific segmentation strategies

    International Nuclear Information System (INIS)

    Haas, B; Coradi, T; Scholz, M; Kunz, P; Huber, M; Oppitz, U; Andre, L; Lengkeek, V; Huyskens, D; Esch, A van; Reddick, R

    2008-01-01

    Automatic segmentation of anatomical structures in medical images is a valuable tool for efficient computer-aided radiotherapy and surgery planning and an enabling technology for dynamic adaptive radiotherapy. This paper presents the design, algorithms and validation of new software for the automatic segmentation of CT images used for radiotherapy treatment planning. A coarse to fine approach is followed that consists of presegmentation, anatomic orientation and structure segmentation. No user input or a priori information about the image content is required. In presegmentation, the body outline, the bones and lung equivalent tissue are detected. Anatomic orientation recognizes the patient's position, orientation and gender and creates an elastic mapping of the slice positions to a reference scale. Structure segmentation is divided into localization, outlining and refinement, performed by procedures with implicit anatomic knowledge using standard image processing operations. The presented version of algorithms automatically segments the body outline and bones in any gender and patient position, the prostate, bladder and femoral heads for male pelvis in supine position, and the spinal canal, lungs, heart and trachea in supine position. The software was developed and tested on a collection of over 600 clinical radiotherapy planning CT stacks. In a qualitative validation on this test collection, anatomic orientation correctly detected gender, patient position and body region in 98% of the cases, a correct mapping was produced for 89% of thorax and 94% of pelvis cases. The average processing time for the entire segmentation of a CT stack was less than 1 min on a standard personal computer. Two independent retrospective studies were carried out for clinical validation. Study I was performed on 66 cases (30 pelvis, 36 thorax) with dosimetrists, study II on 52 cases (39 pelvis, 13 thorax) with radio-oncologists as experts. The experts rated the automatically produced

  17. National arrangements for radiotherapy

    International Nuclear Information System (INIS)

    2007-01-01

    After a presentation of several letters exchanged between the French health ministry and public agencies in charge of public health or nuclear safety after a radiotherapy accident in Epinal, this report comments the evolution of needs in cancerology care and the place given to radiotherapy. It outlines the technological and organisational evolution of radiotherapy and presents the distribution of radiotherapy equipment, of radio-therapists and other radiotherapy professionals in France. Within the context of radiotherapy accidents which occurred in 2007, it presents the regulatory arrangements which aimed at improving the safety, short term and middle term arrangements which are needed to support and structure radiotherapy practice quality. It stresses the fact that the system will deeply evolve by implementing a radiotherapy vigilance arrangement and a permanent follow-on and adaptation plan based on surveys and the creation of a national committee

  18. Radiotherapy of malignant lymphomas

    Energy Technology Data Exchange (ETDEWEB)

    Kujawska, J [Instytut Onkologii, Krakow (Poland)

    1979-01-01

    The paper discusses current views on the role of radiotherapy in the treatment of patients with malignant lymphomas. Principles of radiotherapy employed in the Institute of Oncology in Cracow in case of patients with malignant lymphomas are also presented.

  19. Multidisciplinary and biodanza intervention for the management of fibromyalgia.

    Science.gov (United States)

    Carbonell-Baeza, Ana; Ruiz, Jonatan R; Aparicio, Virginia A; Martins-Pereira, Clelia M; Gatto-Cardia, M Claudia; Martinez, Jose M; Ortega, Francisco B; Delgado-Fernandez, Manuel

    2012-01-01

    To evaluate and compare the effectiveness of a 16-week multidisciplinary (exercise plus psychological therapy) and biodanza intervention in women with fibromyalgia. Thirty-eight women with fibromyalgia were distributed to a 16-week multidisciplinary (3-times/week) intervention (n=21) or Biodanza (1-time/week) intervention (n=17). We assessed tender point, body composition, physical fitness and psychological outcomes (Fibromyalgia Impact Questionnaire, the Short-Form Health Survey 36 questionnaire (SF-36), the Hospital Anxiety and Depression Scale, Vanderbilt Pain Management Inventory (VPMI), Rosenberg Self-Esteem Scale and General Self-Efficacy Scale). We observed a significant group*time interaction effect for the scales of SF-36 physical role (P=0.038) and social functioning (P=0.030) and for the passive coping scale in VPMI (P=0.043). Post hoc analysis revealed a significant improvement on social functioning (P=0.030) in the multidisciplinary group whereas it did not change in the Biodanza group. Post hoc analysis revealed a reduction in the use of passive coping (positive) (P less than 0.001) in the multidisciplinary group. There was no significant interaction or time effect in body composition and physical fitness. 16 weeks of multidisciplinary intervention induced greater benefits than a Biodanza intervention for social functioning and the use of passive coping strategies in women with fibromyalgia.

  20. Team players against headache: multidisciplinary treatment of primary headaches and medication overuse headache

    NARCIS (Netherlands)

    Gaul, C.; Visscher, C.M.; Bhola, R.; Sorbi, M.J.; Galli, F.; Rasmussen, A.V.; Jensen, R.

    2011-01-01

    Multidisciplinary approaches are gaining acceptance in headache treatment. However, there is a lack of scientific data about the efficacy of various strategies and their combinations offered by physiotherapists, physicians, psychologists and headache nurses. Therefore, an international platform for

  1. A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery

    NARCIS (Netherlands)

    van der Linden, P.; de Hert, S.; Daper, A.; Trenchant, A.; Jacobs, D.; de Boelpaepe, C.; Kimbimbi, P.; Defrance, P.; Simoens, G.

    2001-01-01

    PURPOSE: Individual and institutional practices remain an independent predictor factor for allogeneic blood transfusion. Application of a standardized multidisciplinary transfusion strategy should reduce the use of allogeneic blood transfusion in major surgical patients. METHODS: This prospective

  2. Hyperthermia and radiotherapy

    International Nuclear Information System (INIS)

    Fitspatrick, C.

    1990-01-01

    Hyperthermia and radiotherapy have for long been used to assist in the control of tumours, either as separate entities, or, in a combined treatment scheme. This paper outlines why hyperthermia works, thermal dose and the considerations required in the timing when hyperthermia is combined with radiotherapy. Previously reported results for hyperthermia and radiotherapy used together are also presented. 8 refs., 8 tabs

  3. A strategy for the use of image-guided radiotherapy (IGRT) on linear accelerators and its impact on treatment margins for prostate cancer patients

    International Nuclear Information System (INIS)

    Nairz, Olaf; Deutschmann, Heinz; Zehentmayr, Franz; Sedlmayer, Felix; Paracelsus Medical University Salzburg; Merz, Florian; Kopp, Peter; Schoeller, Helmut; Wurstbauer, Karl; Kametriser, Gerhard

    2008-01-01

    In external beam radiotherapy of prostate cancer, the consideration of various systematic error types leads to wide treatment margins compromising normal tissue tolerance. We investigated if systematic set-up errors can be reduced by a set of initial image-guided radiotherapy (IGRT) sessions. 27 patients received daily IGRT resulting in a set of 882 cone-beam computed tomographies (CBCTs). After matching to bony structures, we analyzed the dimensions of remaining systematic errors from zero up to six initial IGRT sessions and aimed at a restriction of daily IGRT for 10% of all patients. For threshold definition, we determined the standard deviations (SD) of the shift corrections and selected patients out of this range for daily image guidance. To calculate total treatment margins, we demanded for a cumulative clinical target volume (CTV) coverage of at least 95% of the specified dose in 90% of all patients. The gain of accuracy was largest during the first three IGRTs. In order to match precision and workload criteria, thresholds for the SD of the corrections of 3.5 mm, 2.0 mm and 4.5 mm in the left-right (L-R), cranial-caudal (C-C), and anterior-posterior (A-P) direction, respectively, were identified. Including all other error types, the total margins added to the CTV amounted to 8.6 mm in L-R, 10.4 mm in C-C, and 14.4 mm in A-P direction. Only initially performed IGRT might be helpful for eliminating gross systematic errors especially after virtual simulation. However, even with daily IGRT performance, a substantial PTV margin reduction is only achievable by matching internal markers instead of bony anatomical structures. (orig.)

  4. 34 CFR 303.17 - Multidisciplinary.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Multidisciplinary. 303.17 Section 303.17 Education... DISABILITIES General Purpose, Eligibility, and Other General Provisions § 303.17 Multidisciplinary. As used in this part, multidisciplinary means the involvement of two or more disciplines or professions in the...

  5. Recommending Research Profiles for Multidisciplinary Academic Collaboration

    Science.gov (United States)

    Gunawardena, Sidath Deepal

    2013-01-01

    This research investigates how data on multidisciplinary collaborative experiences can be used to solve a novel problem: recommending research profiles of potential collaborators to academic researchers seeking to engage in multidisciplinary research collaboration. As the current domain theories of multidisciplinary collaboration are insufficient…

  6. Statistical-learning strategies generate only modestly performing predictive models for urinary symptoms following external beam radiotherapy of the prostate: A comparison of conventional and machine-learning methods

    International Nuclear Information System (INIS)

    Yahya, Noorazrul; Ebert, Martin A.; Bulsara, Max; House, Michael J.; Kennedy, Angel; Joseph, David J.; Denham, James W.

    2016-01-01

    Purpose: Given the paucity of available data concerning radiotherapy-induced urinary toxicity, it is important to ensure derivation of the most robust models with superior predictive performance. This work explores multiple statistical-learning strategies for prediction of urinary symptoms following external beam radiotherapy of the prostate. Methods: The performance of logistic regression, elastic-net, support-vector machine, random forest, neural network, and multivariate adaptive regression splines (MARS) to predict urinary symptoms was analyzed using data from 754 participants accrued by TROG03.04-RADAR. Predictive features included dose-surface data, comorbidities, and medication-intake. Four symptoms were analyzed: dysuria, haematuria, incontinence, and frequency, each with three definitions (grade ≥ 1, grade ≥ 2 and longitudinal) with event rate between 2.3% and 76.1%. Repeated cross-validations producing matched models were implemented. A synthetic minority oversampling technique was utilized in endpoints with rare events. Parameter optimization was performed on the training data. Area under the receiver operating characteristic curve (AUROC) was used to compare performance using sample size to detect differences of ≥0.05 at the 95% confidence level. Results: Logistic regression, elastic-net, random forest, MARS, and support-vector machine were the highest-performing statistical-learning strategies in 3, 3, 3, 2, and 1 endpoints, respectively. Logistic regression, MARS, elastic-net, random forest, neural network, and support-vector machine were the best, or were not significantly worse than the best, in 7, 7, 5, 5, 3, and 1 endpoints. The best-performing statistical model was for dysuria grade ≥ 1 with AUROC ± standard deviation of 0.649 ± 0.074 using MARS. For longitudinal frequency and dysuria grade ≥ 1, all strategies produced AUROC>0.6 while all haematuria endpoints and longitudinal incontinence models produced AUROC<0.6. Conclusions

  7. Statistical-learning strategies generate only modestly performing predictive models for urinary symptoms following external beam radiotherapy of the prostate: A comparison of conventional and machine-learning methods

    Energy Technology Data Exchange (ETDEWEB)

    Yahya, Noorazrul, E-mail: noorazrul.yahya@research.uwa.edu.au [School of Physics, University of Western Australia, Western Australia 6009, Australia and School of Health Sciences, National University of Malaysia, Bangi 43600 (Malaysia); Ebert, Martin A. [School of Physics, University of Western Australia, Western Australia 6009, Australia and Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia 6008 (Australia); Bulsara, Max [Institute for Health Research, University of Notre Dame, Fremantle, Western Australia 6959 (Australia); House, Michael J. [School of Physics, University of Western Australia, Western Australia 6009 (Australia); Kennedy, Angel [Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia 6008 (Australia); Joseph, David J. [Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia 6008, Australia and School of Surgery, University of Western Australia, Western Australia 6009 (Australia); Denham, James W. [School of Medicine and Public Health, University of Newcastle, New South Wales 2308 (Australia)

    2016-05-15

    Purpose: Given the paucity of available data concerning radiotherapy-induced urinary toxicity, it is important to ensure derivation of the most robust models with superior predictive performance. This work explores multiple statistical-learning strategies for prediction of urinary symptoms following external beam radiotherapy of the prostate. Methods: The performance of logistic regression, elastic-net, support-vector machine, random forest, neural network, and multivariate adaptive regression splines (MARS) to predict urinary symptoms was analyzed using data from 754 participants accrued by TROG03.04-RADAR. Predictive features included dose-surface data, comorbidities, and medication-intake. Four symptoms were analyzed: dysuria, haematuria, incontinence, and frequency, each with three definitions (grade ≥ 1, grade ≥ 2 and longitudinal) with event rate between 2.3% and 76.1%. Repeated cross-validations producing matched models were implemented. A synthetic minority oversampling technique was utilized in endpoints with rare events. Parameter optimization was performed on the training data. Area under the receiver operating characteristic curve (AUROC) was used to compare performance using sample size to detect differences of ≥0.05 at the 95% confidence level. Results: Logistic regression, elastic-net, random forest, MARS, and support-vector machine were the highest-performing statistical-learning strategies in 3, 3, 3, 2, and 1 endpoints, respectively. Logistic regression, MARS, elastic-net, random forest, neural network, and support-vector machine were the best, or were not significantly worse than the best, in 7, 7, 5, 5, 3, and 1 endpoints. The best-performing statistical model was for dysuria grade ≥ 1 with AUROC ± standard deviation of 0.649 ± 0.074 using MARS. For longitudinal frequency and dysuria grade ≥ 1, all strategies produced AUROC>0.6 while all haematuria endpoints and longitudinal incontinence models produced AUROC<0.6. Conclusions

  8. Multidisciplinary teamwork and communication training.

    Science.gov (United States)

    Deering, Shad; Johnston, Lindsay C; Colacchio, Kathryn

    2011-04-01

    Every delivery is a multidisciplinary event, involving nursing, obstetricians, anesthesiologists, and pediatricians. Patients are often in labor across multiple provider shifts, necessitating numerous handoffs between teams. Each handoff provides an opportunity for errors. Although a traditional approach to improving patient outcomes has been to address individual knowledge and skills, it is now recognized that a significant number of complications result from team, rather than individual, failures. In 2004, a Sentinel Alert issued by the Joint Commission revealed that most cases of perinatal death and injury are caused by problems with an organization's culture and communication failures. It was recommended that hospitals implement teamwork training programs in an effort to improve outcomes. Instituting a multidisciplinary teamwork training program that uses simulation offers a risk-free environment to practice skills, including communication, role clarification, and mutual support. This experience should improve patient safety and outcomes, as well as enhance employee morale. Published by Elsevier Inc.

  9. Initial impact of a systematic multidisciplinary approach on the management of patients with gastroenteropancreatic neuroendocrine tumor.

    LENUS (Irish Health Repository)

    Tamagno, Gianluca

    2013-10-01

    According to the international guidelines, a multidisciplinary approach is currently advised for the optimal care of patients with a gastroenteropancreatic neuroendocrine tumor (GEP NET). In our institution (tertiary care center), a systematic multidisciplinary approach was established in May 2007. In this study, we have aimed to assess the initial impact of establishing a systematic multidisciplinary approach to the management of GEP NET patients. We have collected and compared the biochemical, imaging, and pathological data and the therapeutic strategies in GEP NET patients diagnosed, treated, or followed-up from January 1993 to April 2007 versus GEP NET patients attending our institution after the multidisciplinary approach starting, from May 2007 to October 2008. Data of 91 patients before and 42 patients after the establishment of the multidisciplinary approach (total: 133 consecutive GEP NET patients) have been finally collected and analyzed. Before the establishment of the multidisciplinary approach, a lack of consistency in the biochemical, imaging, and pathological findings before treatment initiation as well as during follow-up of GEP NET patients was identified. These inconsistencies have been reduced by the systematic multidisciplinary approach. In addition, the therapeutic management of GEP NET patients has been altered by the multidisciplinary approach and became more consistent with recommended guidelines. We think that a systematic multidisciplinary approach significantly impacts on GEP NET patient care and should be established in all centers dealing with these tumors.

  10. Multidisciplinary team care in rehabilitation

    DEFF Research Database (Denmark)

    Momsen, A.-M.; Nielsen, C.V.; Rasmussen, J.O.

    2012-01-01

    Objectives: To systematically investigate current scientific evidence about the effectiveness of multidisciplinary team rehabilitation for different health problems. Data sources: A comprehensive literature search was conducted in Cochrane, Medline, DARE, Embase, and Cinahl databases, and research...... for adults, without restrictions in terms of study population or outcomes. The most recent reviews examining a study population were selected. Data extraction: Two reviewers independently extracted information about study populations, sample sizes, study designs, rehabilitation settings, the team...

  11. Mathematical modeling with multidisciplinary applications

    CERN Document Server

    Yang, Xin-She

    2013-01-01

    Features mathematical modeling techniques and real-world processes with applications in diverse fields Mathematical Modeling with Multidisciplinary Applications details the interdisciplinary nature of mathematical modeling and numerical algorithms. The book combines a variety of applications from diverse fields to illustrate how the methods can be used to model physical processes, design new products, find solutions to challenging problems, and increase competitiveness in international markets. Written by leading scholars and international experts in the field, the

  12. Improving outcomes in lung cancer: the value of the multidisciplinary health care team

    Directory of Open Access Journals (Sweden)

    Denton E

    2016-03-01

    Full Text Available Eve Denton,1 Matthew Conron2 1Allergy, Immunology and Respiratory Department, Alfred Hospital, 2Department of Respiratory and Sleep Medicine, St Vincent's Hospital, Melbourne, VIC, Australia Abstract: Lung cancer is a major worldwide health burden, with high disease-related morbidity and mortality. Unlike other major cancers, there has been little improvement in lung cancer outcomes over the past few decades, and survival remains disturbingly low. Multidisciplinary care is the cornerstone of lung cancer treatment in the developed world, despite a relative lack of evidence that this model of care improves outcomes. In this article, the available literature concerning the impact of multidisciplinary care on key measures of lung cancer outcomes is reviewed. This includes the limited observational data supporting improved survival with multidisciplinary care. The impact of multidisciplinary care on other benchmark measures of quality lung cancer treatment is also examined, including staging accuracy, access to diagnostic investigations, improvements in clinical decision making, better utilization of radiotherapy and palliative care services, and improved quality of life for patients. Health service research suggests that multidisciplinary care improves care coordination, leading to a better patient experience, and reduces variation in care, a problem in lung cancer management that has been identified worldwide. Furthermore, evidence suggests that the multidisciplinary model of care overcomes barriers to treatment, promotes standardized treatment through adherence to guidelines, and allows audit of clinical services and for these reasons is more likely to provide quality care for lung cancer patients. While there is strengthening evidence suggesting that the multidisciplinary model of care contributes to improvements in lung cancer outcomes, more quality studies are needed. Keywords: lung cancer, multidisciplinary care, mortality, tumor board

  13. Prostate cancer radiotherapy in elderly person; Radiotherapie du cancer de la prostate chez la personne agee

    Energy Technology Data Exchange (ETDEWEB)

    Serre, A. [Centre Alexis-Vautrin, Nancy (France)

    2011-10-15

    The author discusses the issue of prostate cancer radiotherapy in the case of elderly persons. The choice of the therapeutic strategy (local, hormonotherapy, simple monitoring) is complex. Different aspects must be considered: the carcinologic situation assessment, the patient health condition, the patient life expectancy, and the possible side effects of treatment. Radiotherapy appears to be a major therapeutic asset, but dose levels, toxicity effects must then be considered. Short communication

  14. [Head and neck adaptive radiotherapy].

    Science.gov (United States)

    Graff, P; Huger, S; Kirby, N; Pouliot, J

    2013-10-01

    Onboard volumetric imaging systems can provide accurate data of the patient's anatomy during a course of head and neck radiotherapy making it possible to assess the actual delivered dose and to evaluate the dosimetric impact of complex daily positioning variations and gradual anatomic changes such as geometric variations of tumors and normal tissues or shrinkage of external contours. Adaptive radiotherapy is defined as the correction of a patient's treatment planning to adapt for individual variations observed during treatment. Strategies are developed to selectively identify patients that require replanning because of an intolerable dosimetric drift. Automated tools are designed to limit time consumption. Deformable image registration algorithms are the cornerstones of these strategies, but a better understanding of their limits of validity is required before adaptive radiotherapy can be safely introduced to daily practice. Moreover, strict evaluation of the clinical benefits is yet to be proven. Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  15. Multidisciplinary management of non small cell lung cancer (NSCLC in stage III: clinical case description. Recommendations and state of the art

    Directory of Open Access Journals (Sweden)

    Simona Carnio

    2013-03-01

    Full Text Available Lung cancer is the leading cause of cancer death in industrialized countries with progressive increase of its mortality rate. Non Small Cell Lung Cancer (NSCLC is approximately 80-85% of all lung cancers, being adenocarcinoma and squamous cell carcinoma the most common histologies. The majority of the patients with stage III clinical stage, presents a mediastinal lymph node involvement described with computed tomography (TC and/or positron emission tomography (PET. The current approach to patients with NSCLC is multidisciplinary, especially for those staged as potentially operable, both for staging and for a correct definition of best treatment strategy. Updated international and national Guidelines and recommendations can provide valuable support to the clinician.The case described concerns the accidental detection of a tumour in the lung in a 58-year-old man with arterial hypertension controlled with ACE inhibitors. The treatments agreed after a multidisciplinary approach are cisplatin and docetaxel, the surgical resection, and the radiotherapy. After three months the patient has neither metastasis nor relapse.

  16. Multidisciplinary team approach for the management of patients with locally advanced non-small cell lung cancer: Searching the evidence to guide the decision

    International Nuclear Information System (INIS)

    Oh, In Jae; Ahn, Sung Ja

    2017-01-01

    Locally advanced non-small cell lung cancer (LA-NSCLC) is composed of heterogeneous subgroups that require a multidisciplinary team approach in order to ensure optimal therapy for each patient. Since 2010, the National Comprehensive Cancer Network has recommended chemoradiation therapy (CRT) for bulky mediastinal disease and surgical combination for those patients with single-station N2 involvement who respond to neoadjuvant therapy. According to lung cancer tumor boards, thoracic surgeons make a decision on the resectability of the tumor, if it is determined to be unresectable, concurrent CRT (CCRT) is considered the next choice. However, the survival benefit of CCRT over sequential CRT or radiotherapy alone carries the risk of additional toxicity. Considering severe adverse events that may lead to death, fit patients who are able to tolerate CCRT must be identified by multidisciplinary tumor board. Decelerated approaches, such as sequential CRT or high-dose radiation alone may be a valuable alternative for patients who are not eligible for CCRT. As a new treatment strategy, investigators are interested in the application of the innovative radiation techniques, trimodality therapy combining surgery after high-dose definitive CCRT, and the combination of radiation with targeted or immunotherapy agents. The updated results and on-going studies are thoroughly reviewed in this article

  17. Multidisciplinary team approach for the management of patients with locally advanced non-small cell lung cancer: Searching the evidence to guide the decision

    Energy Technology Data Exchange (ETDEWEB)

    Oh, In Jae; Ahn, Sung Ja [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2017-03-15

    Locally advanced non-small cell lung cancer (LA-NSCLC) is composed of heterogeneous subgroups that require a multidisciplinary team approach in order to ensure optimal therapy for each patient. Since 2010, the National Comprehensive Cancer Network has recommended chemoradiation therapy (CRT) for bulky mediastinal disease and surgical combination for those patients with single-station N2 involvement who respond to neoadjuvant therapy. According to lung cancer tumor boards, thoracic surgeons make a decision on the resectability of the tumor, if it is determined to be unresectable, concurrent CRT (CCRT) is considered the next choice. However, the survival benefit of CCRT over sequential CRT or radiotherapy alone carries the risk of additional toxicity. Considering severe adverse events that may lead to death, fit patients who are able to tolerate CCRT must be identified by multidisciplinary tumor board. Decelerated approaches, such as sequential CRT or high-dose radiation alone may be a valuable alternative for patients who are not eligible for CCRT. As a new treatment strategy, investigators are interested in the application of the innovative radiation techniques, trimodality therapy combining surgery after high-dose definitive CCRT, and the combination of radiation with targeted or immunotherapy agents. The updated results and on-going studies are thoroughly reviewed in this article.

  18. Integrating pulmonary rehabilitation into the multidisciplinary management of lung cancer: a review.

    Science.gov (United States)

    Rivas-Perez, Hiram; Nana-Sinkam, Patrick

    2015-04-01

    Lung cancer is the number one cause of cancer related deaths. It is increasingly recognized that a multidisciplinary approach to the diagnosis and management of patients with lung cancer represents the ideal model for health care delivery. Given the high incidence of comorbid lung disease in lung cancer patients, strategies targeted at improving or optimizing these conditions may improve outcomes. Pulmonary rehabilitation (PR) has proven to be a useful management strategy for patients with chronic lung diseases including chronic obstructive pulmonary disease, interstitial lung disease and pulmonary hypertension. PR improves both exercise capacity and dyspnea. The effects of PR have also been studied in patients with lung cancer prior to and following surgical resection. Investigators have demonstrated significant improvements in six minute walk distance and lower extremity strength. In addition, patient recovery time is shorter when inpatient pulmonary rehabilitation is integrated prior to or following surgery. There are also positive reports regarding the benefits of exercise training in lung cancer patients receiving definite chemotherapy and radiotherapy. Pilot studies have demonstrated improvement in dyspnea scores as well as exercise capacity objectively measured by six minute walk distance. PR also offers an educational component in which patients have the opportunity to be educated regarding management of their disease as well as discuss goals of care. PR can be included as the standard of care for patients with advanced lung cancer with the goal of optimizing quality of life. Here, we provide a review of the current knowledge regarding PR in the management of patients with lung cancer. Published by Elsevier Ltd.

  19. How Multidisciplinary Are the Multidisciplinary Journals Science and Nature?

    Science.gov (United States)

    Solomon, Gregg E A; Carley, Stephen; Porter, Alan L

    2016-01-01

    Interest in cross-disciplinary research knowledge interchange runs high. Review processes at funding agencies, such as the U.S. National Science Foundation, consider plans to disseminate research across disciplinary bounds. Publication in the leading multidisciplinary journals, Nature and Science, may signify the epitome of successful interdisciplinary integration of research knowledge and cross-disciplinary dissemination of findings. But how interdisciplinary are they? The journals are multidisciplinary, but do the individual articles themselves draw upon multiple fields of knowledge and does their influence span disciplines? This research compares articles in three fields (Cell Biology, Physical Chemistry, and Cognitive Science) published in a leading disciplinary journal in each field to those published in Nature and Science. We find comparable degrees of interdisciplinary integration and only modest differences in cross-disciplinary diffusion. That said, though the rate of out-of-field diffusion might be comparable, the sheer reach of Nature and Science, indicated by their potent Journal Impact Factors, means that the diffusion of knowledge therein can far exceed that of leading disciplinary journals in some fields (such as Physical Chemistry and Cognitive Science in our samples).

  20. How Multidisciplinary Are the Multidisciplinary Journals Science and Nature?

    Science.gov (United States)

    Solomon, Gregg E. A.; Carley, Stephen; Porter, Alan L.

    2016-01-01

    Interest in cross-disciplinary research knowledge interchange runs high. Review processes at funding agencies, such as the U.S. National Science Foundation, consider plans to disseminate research across disciplinary bounds. Publication in the leading multidisciplinary journals, Nature and Science, may signify the epitome of successful interdisciplinary integration of research knowledge and cross-disciplinary dissemination of findings. But how interdisciplinary are they? The journals are multidisciplinary, but do the individual articles themselves draw upon multiple fields of knowledge and does their influence span disciplines? This research compares articles in three fields (Cell Biology, Physical Chemistry, and Cognitive Science) published in a leading disciplinary journal in each field to those published in Nature and Science. We find comparable degrees of interdisciplinary integration and only modest differences in cross-disciplinary diffusion. That said, though the rate of out-of-field diffusion might be comparable, the sheer reach of Nature and Science, indicated by their potent Journal Impact Factors, means that the diffusion of knowledge therein can far exceed that of leading disciplinary journals in some fields (such as Physical Chemistry and Cognitive Science in our samples). PMID:27043924

  1. The metabolic radiotherapy. La radiotherapie metabolique

    Energy Technology Data Exchange (ETDEWEB)

    Begon, F.; Gaci, M. (Centre Hospitalier Universitaire, 86 - Poitiers (France))

    In this article, the authors recall the principles of the metabolic radiotherapy and present these main applications in the treatment of thyroid cancers, hyperthyroidism, polycythemia, arthritis, bone metastases, adrenergic neoplasms. They also present the radioimmunotherapy.

  2. Learning Multidisciplinary Collaboration with Games

    DEFF Research Database (Denmark)

    Henriksen, Thomas Duus

    2015-01-01

    This chapter describes the design of a game-based learning process for developing communication in public organisations. The game-design presented here emphasises those parts of public organisations that tend to employ multidisciplinary teams for solving wicked problems. As such teams employ...... members from different, professional backgrounds, the game Public Professional sought to develop new understandings among team members and across professions. The purpose of this game was to facilitate an understanding among team members and across professions, a game-based learning process named Public...... from the game’s core mechanics....

  3. Retrospective analysis of multidisciplinary therapy for locally advanced squamous cell carcinoma of the maxillary sinus

    Energy Technology Data Exchange (ETDEWEB)

    Yoshida, Hiroshi; Seo, Yuji; Nakajima, Kaori; Miyano, Takashi [Asahikawa Medical Univ., Hokkaido (Japan); Kikuchi, Yuzou [Kanazawa Univ. (Japan). School of Medicine

    2002-06-01

    The purpose of this study was to retrospectively investigate the efficacy of multidisciplinary therapy (concomitant radiotherapy and intra-arterial infusion of 5-fluorouracil (5-FU) followed by maxillectomy) in the treatment of squamous cell carcinoma of the maxillary sinus. We reviewed 71 patient records with locally advanced but respectable carcinoma of the maxillary sinus treated by means of multidisciplinary therapy between 1978 through 1997. The clinical T factor for these patients, according to the UICC definitions (1997), was 12 for T2, 46 for T3, and 13 for T4. Twelve patients were diagnosed as node-positive at initial presentation. Intra-arterial 5-FU was delivered via a superficial temporal artery in accordance with radiotherapy, and the cumulative 5-FU dose ranged from 2,900 mg to 5,250 mg (median 5,000 mg). The total radiotherapy dose ranged from 29 Gy to 48 Gy (median 48 Gy) with conventional fractionation. Patients underwent radical maxillectomy thereafter. The 5-year overall survival rate and disease-specific survival rate of all the patients were 58% and 68%, respectively. There was no significant correlation of clinical T factor or N factor with disease-specific survival on univariate and multivariate analysis. The overall treatment-related mortality rate was 3.7%. Radiation cataract later developed in all evaluable patients whose lenses were within the treatment volume. About a half of the operable T4 patients survived over 5 years by means of the above-mentioned multidisciplinary therapy. This multidisciplinary therapy should be compared to treatment with a combination of surgery and postoperative chemoradiotherapy. (author)

  4. Retrospective analysis of multidisciplinary therapy for locally advanced squamous cell carcinoma of the maxillary sinus

    International Nuclear Information System (INIS)

    Yoshida, Hiroshi; Seo, Yuji; Nakajima, Kaori; Miyano, Takashi; Kikuchi, Yuzou

    2002-01-01

    The purpose of this study was to retrospectively investigate the efficacy of multidisciplinary therapy (concomitant radiotherapy and intra-arterial infusion of 5-fluorouracil (5-FU) followed by maxillectomy) in the treatment of squamous cell carcinoma of the maxillary sinus. We reviewed 71 patient records with locally advanced but respectable carcinoma of the maxillary sinus treated by means of multidisciplinary therapy between 1978 through 1997. The clinical T factor for these patients, according to the UICC definitions (1997), was 12 for T2, 46 for T3, and 13 for T4. Twelve patients were diagnosed as node-positive at initial presentation. Intra-arterial 5-FU was delivered via a superficial temporal artery in accordance with radiotherapy, and the cumulative 5-FU dose ranged from 2,900 mg to 5,250 mg (median 5,000 mg). The total radiotherapy dose ranged from 29 Gy to 48 Gy (median 48 Gy) with conventional fractionation. Patients underwent radical maxillectomy thereafter. The 5-year overall survival rate and disease-specific survival rate of all the patients were 58% and 68%, respectively. There was no significant correlation of clinical T factor or N factor with disease-specific survival on univariate and multivariate analysis. The overall treatment-related mortality rate was 3.7%. Radiation cataract later developed in all evaluable patients whose lenses were within the treatment volume. About a half of the operable T4 patients survived over 5 years by means of the above-mentioned multidisciplinary therapy. This multidisciplinary therapy should be compared to treatment with a combination of surgery and postoperative chemoradiotherapy. (author)

  5. What information should patients be given before radiotherapy?

    International Nuclear Information System (INIS)

    Bergerot, Ph.

    2009-01-01

    Following a number of accidents at radiotherapy units, at Epinal and Toulouse hospitals in particular, and the problems encountered in the summer 2008, mainly caused by a shortage of radiation physicians and probably due to legislation that bears little relation to reality, a national radiotherapy monitoring committee was set up on 15 December 2008 in the presence of Roselyne Bachelot-Narquin, France's Minister for Health and Sport. A first progress report was submitted to the Minister in May 2009. Twelve members sit on this national monitoring committee, including a CISS representative and a person that has received radiotherapy treatment. This demonstrates the seriousness and the commitment required of users on this issue. Radiotherapy, one of the main treatments for cancer, is a loco-regional treatment that uses radiation capable of destroying cancer cells. It can be used on its own, or before, during or after another treatment method (surgery or a medical treatment such as chemotherapy, for example). The decision to treat a patient by means of radiotherapy is based on the opinions of health care professionals discussed at a multidisciplinary team meeting, the minutes of which are sent to the various doctors involved. The radiotherapy treatment prescribed (the technique, total radiation dose, length of the treatment, number of sessions, etc.) is adapted to the individual situation of each patient. It is designed to be as effective as possible in light of the tumour pathology, while protecting neighbouring organs as far as is possible. (author)

  6. Multi-disciplinary management for patients with oligometastases to the brain: results of a 5 year cohort study

    International Nuclear Information System (INIS)

    Maclean, Jillian; Fersht, Naomi; Singhera, Mausam; Mulholland, Paul; McKee, Orla; Kitchen, Neil; Short, Susan C

    2013-01-01

    The incidence of oligometastases to the brain in good performance status patients is increasing due to improvements in systemic therapy and MRI screening, but specific management pathways are often lacking. We established a multi-disciplinary brain metastases clinic with specific referral guidelines and standard follow-up for good prognosis patients with the view that improving the process of care may improve outcomes. We evaluated patient demographic and outcome data for patients first seen between February 2007 and November 2011. The clinic was feasible to run and referrals were appropriate. 87% of patients referred received a localised therapy during their treatment course. 114 patients were seen and patient numbers increased during the 5 years that the clinic has been running as relationships between clinicians were developed. Median follow-up for those still alive was 23.1 months (6.1-79.1 months). Primary treatments were: surgery alone 52%, surgery plus whole brain radiotherapy (WBRT) 9%, radiosurgery 14%, WBRT alone 23%, supportive care 2%. 43% received subsequent treatment for brain metastases. 25%, 11% and 15% respectively developed local neurological progression only, new brain metastases only or both. Median overall survival following brain metastases diagnosis was 16.0 months (range 1–79.1 months). Breast (32%) and NSCLC (26%) were the most common primary tumours with median survivals of 26 and 16.9 months respectively (HR 0.6, p=0.07). Overall one year survival was 55% and two year survival 31.5%. 85 patients died of whom 37 (44%) had a neurological death. Careful patient selection and multi-disciplinary management identifies a subset of patients with oligometastatic brain disease who benefit from aggressive local treatment. A dedicated joint neurosurgical/ neuro-oncology clinic for such patients is feasible and effective. It also offers the opportunity to better define management strategies and further research in this field. Consideration should be

  7. Restorative dentistry and oral rehabilitation: United Kingdom National Multidisciplinary Guidelines.

    Science.gov (United States)

    Butterworth, C; McCaul, L; Barclay, C

    2016-05-01

    This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK and provides recommendations on the pre-treatment oral and dental assessment, during and after treatment and oral rehabilitation. Restorative dentists are core members of the multidisciplinary team treating head and neck cancer patients, involved from the treatment planning phase through to long-term rehabilitation. Recommendations • Preventative oral care must be delivered to patients whose cancer treatment will affect the oral cavity, jaws, salivary glands and oral accessibility. (G) • Close working and communication between the surgeons, oncologists and restorative dental specialists is important in ensuring optimal oral health outcomes. (G) • Intensity-modulated radiotherapy has been shown to reduce long-term xerostomia and should be offered to all appropriate patients. (R) • If patients are deemed at risk of trismus they should be warned and its progressive and potentially irreversible nature explained. (G) • Where it is known that adjuvant radiotherapy will be given, extractions should take place at primary surgery to maximise the time for healing and minimise the number of surgical events for patients. (G) • Osseointegrated implants should be considered for all patients having resection for head and neck cancer. (G).

  8. Radiotherapy in small countries.

    Science.gov (United States)

    Barton, Michael B; Zubizarreta, Eduardo H; Polo Rubio, J Alfredo

    2017-10-01

    To examine the availability of radiotherapy in small countries. A small country was defined as a country with a population less than one million persons. The economic status of each country was defined using the World Bank Classification. The number of cancers in each country was obtained from GLOBOCAN 2012. The number of cancer cases with an indication or radiotherapy was calculated using the CCORE model. There were 41 countries with a population of under 1 million; 15 were classified as High Income, 15 Upper Middle Income, 10 Lower Middle Income and one Low Income. 28 countries were islands. Populations ranged from 799 (Holy See) to 886450 (Fiji) and the total number of cancer cases occurring in small countries was 21,043 (range by country from 4 to 2476). Overall the total number of radiotherapy cases in small countries was 10982 (range by country from 2 to 1239). Radiotherapy was available in all HIC islands with 80 or more new cases of cancer in 2012 but was not available in any LMIC island. Fiji was the only LMIC island with a large radiotherapy caseload. Similar caseloads in non-island LMIC all had radiotherapy services. Most non-island HIC did not have radiotherapy services presumably because of the easy access to radiotherapy in neighbouring countries. There are no radiotherapy services in any LMIC islands. Copyright © 2017. Published by Elsevier Ltd.

  9. Stereotactic radiotherapy by cyberknife of sub-diaphragm digestive tumors; Radiotherapie stereotaxique par Cyberknife des tumeurs digestives sous diaphragmatiques

    Energy Technology Data Exchange (ETDEWEB)

    Taste, H.; Peiffert, D.; Beckendorf, V.; Marchesi, V.; Noel, A. [Centre Alexis-Vautrin, 54 - Vandoeuvre-les-Nancy (France)

    2009-10-15

    The stereotactic radiotherapy is a low toxic, efficient therapy offering a supplementary curative alternative, with promising first results, confirmed by literature. ts indications, its place in the therapy strategy stay to determine in the clinical research program. (N.C.)

  10. Anatomical imaging for radiotherapy

    International Nuclear Information System (INIS)

    Evans, Philip M

    2008-01-01

    scans is taken on different days. Both allow planning to account for variability intrinsic to the patient. Treatment verification has been carried out using a variety of technologies including: MV portal imaging, kV portal/fluoroscopy, MVCT, conebeam kVCT, ultrasound and optical surface imaging. The various methods have their pros and cons. The four x-ray methods involve an extra radiation dose to normal tissue. The portal methods may not generally be used to visualize soft tissue, consequently they are often used in conjunction with implanted fiducial markers. The two CT-based methods allow measurement of inter-fraction variation only. Ultrasound allows soft-tissue measurement with zero dose but requires skilled interpretation, and there is evidence of systematic differences between ultrasound and other data sources, perhaps due to the effects of the probe pressure. Optical imaging also involves zero dose but requires good correlation between the target and the external measurement and thus is often used in conjunction with an x-ray method. The use of anatomical imaging in radiotherapy allows treatment uncertainties to be determined. These include errors between the mean position at treatment and that at planning (the systematic error) and the day-to-day variation in treatment set-up (the random error). Positional variations may also be categorized in terms of inter- and intra-fraction errors. Various empirical treatment margin formulae and intervention approaches exist to determine the optimum strategies for treatment in the presence of these known errors. Other methods exist to try to minimize error margins drastically including the currently available breath-hold techniques and the tracking methods which are largely in development. This paper will review anatomical imaging techniques in radiotherapy and how they are used to boost the therapeutic benefit of the treatment. (topical review)

  11. How Do You Learn Multidisciplinary Idea?

    OpenAIRE

    Shigehiro Hashimoto

    2015-01-01

    The way how to learn multidisciplinary ideas has been discussed. Biomedical engineering is exemplified for a multidisciplinary field. "Biomedical Engineering" makes a multidisciplinary research area, which includes biology, medicine, engineering and others. The cross-cultural student seminars on biomedical engineering have been exemplified as the case studies. In the group fieldwork, students were divided into small groups. Each group visited the university hospital to find research topics re...

  12. Optimisation in radiotherapy II: Programmed and inversion optimisation algorithms

    International Nuclear Information System (INIS)

    Ebert, M.

    1997-01-01

    This is the second article in a three part examination of optimisation in radiotherapy. The previous article established the bases of optimisation in radiotherapy, and the formulation of the optimisation problem. This paper outlines several algorithms that have been used in radiotherapy, for searching for the best irradiation strategy within the full set of possible strategies. Two principle classes of algorithm are considered - those associated with mathematical programming which employ specific search techniques, linear programming type searches or artificial intelligence - and those which seek to perform a numerical inversion of the optimisation problem, finishing with deterministic iterative inversion. (author)

  13. Radical radiotherapy for urinary bladder cancer

    DEFF Research Database (Denmark)

    Fokdal, Lars; Høyer, Morten; von der Maase, Hans

    2006-01-01

    The exact value of radiotherapy in the treatment of muscle-invasive       bladder cancer is difficult to establish, as most studies exploring this       issue are retrospective with different procedures for selecting patients       for treatment, as well as varying treatment strategies. An estima...

  14. Extracranial radiotherapy in stereotaxic conditions

    International Nuclear Information System (INIS)

    Noel, Georges; Moty-Monnereau, Celine; Meyer, Aurelia; David, Pauline; Pages, Frederique; Muller, Felix; Lee-Robin, Sun Hae; David, Denis Jean

    2006-12-01

    This document reports a literature survey and the discussion of an expert group with the objective to assess the use of extracranial radiotherapy devices in stereotaxic conditions. After a brief overview of the technological context, the authors proposes a technical description of radiotherapy in stereotaxic conditions, of the CyberKnife, of others radiotherapy techniques in stereotaxic conditions for extracranial indications, and of alternate techniques. They give an overview of concerned pathologies: skeleton, hepatic, bronchopulmonary, pancreas, prostate, kidney, and paediatric tumours. They describe the present care condition in France in terms of classification of medial acts, and of patient homogeneous groups. They provide the identification of this practice in foreign nomenclature. In the next part, they report the assessment, first through a critical analysis of published data and information in terms of act feasibility, efficiency and safety, of act role in the therapeutic strategy, of conditions of execution, and of impact on public health, and secondly through a statement of opinion of the working group in terms of terminology, indications, safety, and conditions of execution

  15. Multimedia educational services in stereotactic radiotherapy

    International Nuclear Information System (INIS)

    Bazioglou, M.; Theodorou, K.; Kappas, C.

    1999-01-01

    The computer-based learning methods in medicine have been well established as stand-alone learning systems. Recently, these systems were enriched with the use of telematics technology to provide distance learning capabilities. Stereotactic radiotherapy is more of the most representative advanced radiotherapy techniques. Due to the multidisciplinary character of the technique and the rapid evolution of technology implemented, the demands in training have increased. The potential of interactive multimedia and Internet technologies for the achievement of distance learning capabilities in this domain are investigated. The realization of a computer-based educational program in stereotactic radiotherapy in a multimedia format is a new application in the computer-aided distance learning field. The system is built according to a client and server architecture, based on the Internet infrastructure, and composed of server nodes. The impact of the system may be described in terms of: time and transportation costs saving, flexibility in training (scheduling, rate and subject selection), online communication and interaction with experts, cost effective access to material (delivery or access by a large number of users and revision of the material by avoiding and database development. (authors)

  16. Operations research for resource planning and -use in radiotherapy: a literature review

    NARCIS (Netherlands)

    Vieira, Bruno; Hans, Elias W.; van Vliet-Vroegindeweij, Corine; van de Kamer, Jeroen; van Harten, Willem H.

    2016-01-01

    Background The delivery of radiotherapy (RT) involves the use of rather expensive resources and multi-disciplinary staff. As the number of cancer patients receiving RT increases, timely delivery becomes increasingly difficult due to the complexities related to, among others, variable patient inflow,

  17. The role of chemotherapy and radiotherapy in the treatment of advanced cervical cancer

    International Nuclear Information System (INIS)

    Marjamaegi, M.M.

    1998-01-01

    A retrospective analyses was performed in a series of patients with advanced cervix cancer. The aim of this analyses was to evaluate the efficiency of radiotherapy and chemotherapy for advanced cervix cancer. For the patients with advanced stages, active multidisciplinary treatment is necessary for local control and suppression of distant metastases

  18. Radiotherapy of early breast cancer in scleroderma patients: our experience with four cases and a short review of the literature

    Directory of Open Access Journals (Sweden)

    Kyrgias G

    2012-01-01

    been acceptable and are in full accordance with what have been reported in international literature.Conclusion: This study matches global experience, which shows that patients with scleroderma and breast cancer must be discussed by the multidisciplinary tumor board in order for a personalized treatment strategy to be formulated. Radiation therapy can be proposed as a postsurgical therapeutic option in selected cases.Keywords: breast radiotherapy, early toxicity, late complications, short review, scleroderma

  19. [Anorexia nervosa: a multidisciplinary approach].

    Science.gov (United States)

    Bastidas, A; Cantó, T; Font, E

    2000-06-01

    The childhood-adolescent psychiatrics field has, for various years, been confronted by a very significant increase in cases of nervous anorexia, a serious eating disorder characterized by a noticeable loss of weight. At the bottom of this situation lie complex biological, psychological and social-cultural problems, which demand an interdisciplinary approach to solve them. This article presents the predisposing factors, the initial factors, the factors which maintain this disorder...; what behaviors are considered to be normal; what the physical and psychological manifestations are; as well as what the medical evaluation carried out is ... to finalize with an explanation of the different functions to be performed by each member of a multidisciplinary team.

  20. Vocational rehabilitation: a multidisciplinary intervention.

    Science.gov (United States)

    Gobelet, C; Luthi, F; Al-Khodairy, A T; Chamberlain, M A

    2007-09-15

    Vocational rehabilitation is by definition a multidisciplinary intervention in a process linked to the facilitation of return to work or to the prevention of loss of the work. Clinical staff in contact with a person who has lost his job (general practitioner, specialized physician) must promote vocational rehabilitation. Medical rehabilitation for those with disabilities, whether new or old, has to be followed without delay by vocational rehabilitation. It is even better if these two intertwined processes are overlapping. They involve many professionals including physiotherapists, occupational therapists, psychologists, vocational trainers, job counsellors, teachers, case-managers, job placement agencies. Vocational rehabilitation has a financial cost, borne by many state organizations (security, social system, social affairs) as well as by employers and private insurances, which are in case of accident, concerned by this process. However, the evidence suggests that this is recouped 2- to 10-fold as suggested by the British Society of Rehabilitation Medicine.

  1. [Multidisciplinary practice guideline 'Marfan syndrome'].

    Science.gov (United States)

    Hilhorst-Hofstee, Yvonne

    2013-01-01

    Marfan syndrome is a multi-system disorder of dominant inheritance in which the cardiovasculature, in particular the aorta, the eyes and the skeleton are affected. Diagnostic assessment and treatment of patients who are suspected of or have Marfan syndrome should preferably be done by multidisciplinary teams such as those found in specialised Marfan syndrome centres. The practice guideline is intended for all care givers involved with the recognition, diagnosis, consultations and the medicinal and surgical treatment of Marfan patients; it includes referral criteria and information on the referral process. A diagnosis of Marfan syndrome is based on international criteria in which aortic root dilatation and dissection, ectopia lentis, an affected first-degree family member and a pathogenic FBN1 mutation are the cardinal features. Alternative diagnoses are also included in the practice guideline. Recommendations are given for the monitoring and treatment of Marfan patients during pregnancy and delivery. Advice on lifestyle is mainly focussed on sports activities.

  2. [Multidisciplinary treatment of orofacial pain].

    Science.gov (United States)

    Geurts, J W; Haumann, J; van Kleef, M

    2016-11-01

    The diagnosis and treatment of orofacial pain can be complex. The differential diagnosis is very extensive. Therefore, multidisciplinary diagnosis and treatment are often indicated. The diagnosis of chronic pain also entails the investigation of psychological factors. This is because psychological problems can play a role in the chronification of pain, but they can also be a consequence of chronic pain. Patients with persistent orofacial complaints should be seen by a medical team consisting of an oral and maxillofacial surgeon, a neurologist, an anaesthesiologist/pain specialist, a dentist-gnathologist, an orofacial physical therapist, and a psychologist or psychiatrist specialising in orofacial pain. Treatment options should be discussed, taking into account literature concerning their effectiveness. The general conclusion is that much research remains to be done into the causes of, and treatments for, orofacial pain.

  3. PLANNING NATIONAL RADIOTHERAPY SERVICES

    Directory of Open Access Journals (Sweden)

    Eduardo eRosenblatt

    2014-11-01

    Full Text Available Countries, states and island nations often need forward planning of their radiotherapy services driven by different motives. Countries without radiotherapy services sponsor patients to receive radiotherapy abroad. They often engage professionals for a feasibility study in order to establish whether it would be more cost-beneficial to establish a radiotherapy facility. Countries where radiotherapy services have developed without any central planning, find themselves in situations where many of the available centres are private and thus inaccessible for a majority of patients with limited resources. Government may decide to plan ahead when a significant exodus of cancer patients travel to another country for treatment, thus exposing the failure of the country to provide this medical service for its citizens. In developed countries the trigger has been the existence of highly visible waiting lists for radiotherapy revealing a shortage of radiotherapy equipment.This paper suggests that there should be a systematic and comprehensive process of long-term planning of radiotherapy services at the national level, taking into account the regulatory infrastructure for radiation protection, planning of centres, equipment, staff, education pr

  4. Treatment planning strategy for whole-brain radiotherapy with hippocampal sparing and simultaneous integrated boost for multiple brain metastases using intensity-modulated arc therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pokhrel, Damodar, E-mail: dpokhrel@kumc.edu; Sood, Sumit; McClinton, Christopher; Shen, Xinglei; Lominska, Christopher; Saleh, Habeeb; Badkul, Rajeev; Jiang, Hongyu; Mitchell, Melissa; Wang, Fen

    2016-01-01

    Purpose: To retrospectively evaluate the accuracy, plan quality and efficiency of intensity-modulated arc therapy (IMAT) for hippocampal sparing whole-brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) in patients with multiple brain metastases (m-BM). Materials and methods: A total of 5 patients with m-BM were retrospectively replanned for HS-WBRT with SIB using IMAT treatment planning. The hippocampus was contoured on diagnostic T1-weighted magnetic resonance imaging (MRI) which had been fused with the planning CT image set. The hippocampal avoidance zone (HAZ) was generated using a 5-mm uniform margin around the paired hippocampi. The m-BM planning target volumes (PTVs) were contoured on T1/T2-weighted MRI registered with the 3D planning computed tomography (CT). The whole-brain planning target volume (WB-PTV) was defined as the whole-brain tissue volume minus HAZ and m-BM PTVs. Highly conformal IMAT plans were generated in the Eclipse treatment planning system for Novalis-TX linear accelerator consisting of high-definition multileaf collimators (HD-MLCs: 2.5-mm leaf width at isocenter) and 6-MV beam. Prescription dose was 30 Gy for WB-PTV and 45 Gy for each m-BM in 10 fractions. Three full coplanar arcs with orbit avoidance sectors were used. Treatment plans were evaluated using homogeneity (HI) and conformity indices (CI) for target coverage and dose to organs at risk (OAR). Dose delivery efficiency and accuracy of each IMAT plan was assessed via quality assurance (QA) with a MapCHECK device. Actual beam-on time was recorded and a gamma index was used to compare dose agreement between the planned and measured doses. Results: All 5 HS-WBRT with SIB plans met WB-PTV D{sub 2%}, D{sub 98%}, and V{sub 30} {sub Gy} NRG-CC001 requirements. The plans demonstrated highly conformal and homogenous coverage of the WB-PTV with mean HI and CI values of 0.33 ± 0.04 (range: 0.27 to 0.36), and 0.96 ± 0.01 (range: 0.95 to 0.97), respectively. All 5

  5. Treatment planning strategy for whole-brain radiotherapy with hippocampal sparing and simultaneous integrated boost for multiple brain metastases using intensity-modulated arc therapy

    International Nuclear Information System (INIS)

    Pokhrel, Damodar; Sood, Sumit; McClinton, Christopher; Shen, Xinglei; Lominska, Christopher; Saleh, Habeeb; Badkul, Rajeev; Jiang, Hongyu; Mitchell, Melissa; Wang, Fen

    2016-01-01

    Purpose: To retrospectively evaluate the accuracy, plan quality and efficiency of intensity-modulated arc therapy (IMAT) for hippocampal sparing whole-brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) in patients with multiple brain metastases (m-BM). Materials and methods: A total of 5 patients with m-BM were retrospectively replanned for HS-WBRT with SIB using IMAT treatment planning. The hippocampus was contoured on diagnostic T1-weighted magnetic resonance imaging (MRI) which had been fused with the planning CT image set. The hippocampal avoidance zone (HAZ) was generated using a 5-mm uniform margin around the paired hippocampi. The m-BM planning target volumes (PTVs) were contoured on T1/T2-weighted MRI registered with the 3D planning computed tomography (CT). The whole-brain planning target volume (WB-PTV) was defined as the whole-brain tissue volume minus HAZ and m-BM PTVs. Highly conformal IMAT plans were generated in the Eclipse treatment planning system for Novalis-TX linear accelerator consisting of high-definition multileaf collimators (HD-MLCs: 2.5-mm leaf width at isocenter) and 6-MV beam. Prescription dose was 30 Gy for WB-PTV and 45 Gy for each m-BM in 10 fractions. Three full coplanar arcs with orbit avoidance sectors were used. Treatment plans were evaluated using homogeneity (HI) and conformity indices (CI) for target coverage and dose to organs at risk (OAR). Dose delivery efficiency and accuracy of each IMAT plan was assessed via quality assurance (QA) with a MapCHECK device. Actual beam-on time was recorded and a gamma index was used to compare dose agreement between the planned and measured doses. Results: All 5 HS-WBRT with SIB plans met WB-PTV D 2% , D 98% , and V 30 Gy NRG-CC001 requirements. The plans demonstrated highly conformal and homogenous coverage of the WB-PTV with mean HI and CI values of 0.33 ± 0.04 (range: 0.27 to 0.36), and 0.96 ± 0.01 (range: 0.95 to 0.97), respectively. All 5 hippocampal sparing

  6. TU-E-211-01: Establishing Multidisciplinary Collaboration as a Medical Physicist.

    Science.gov (United States)

    Xing, L; Fraass, B; Ford, E; Chang, S

    2012-06-01

    Many medical physicists are scientists at heart and their career fulfillment includes a balance of clinical service and research development. Multidisciplinary collaboration is a great way for the medical physicists to advance science and technology of our fields and the fields of our collaborators. Cross-pollination among scientists of different fields has been the key for some of the most significant breakthroughs in science and medicine and produced some of the most rewarding experiences for the individuals involved. However, medical physicists face unique challenges in establishing multidisciplinary collaboration because our time and resources for research are often quite limited compared to basic scientists. Yet we medical physicists are uniquely positioned and have a tremendous opportunity to create/contribute to multidisciplinary research: our fields are already multidisciplinary in nature and hospital environment is problem rich. How do we establish and carry out research collaboration with scientists of other fields? How to balance research with your higher priority clinical service? How do you find the right multidisciplinary collaboration in your own environment? We will discuss the challenges, provide real exemplary solutions to the above questions, and offer advise to medical physicists who are interested in starting or improving their multidisciplinary collaboration. There are different kinds of multidisciplinary collaborations a medical physicist can create and participate at different involvement levels. Multidisciplinary collaboration is not for every medical physicist but for those who seek and devote time to it, the experience can be truly rewarding and the impact can be enormous. 1. Learn the types of multidisciplinary collaboration medical physicists can created/participated 2. Learn the approaches and strategies to develop collaborations with scientists and professional of other fields3. Understand the challenges and different approaches to

  7. To understand radiotherapy

    International Nuclear Information System (INIS)

    2009-01-01

    Dealing with the use of radiotherapy for adults, this guide indicates when a radiotherapy is suggested, how it acts, how the treatment is chosen, which are the professionals involved. It describes how an external radiotherapy takes place and its various techniques, the different types of side effects (general, specific to the treated zone, late effects). It indicates which organs can be treated by curie-therapy, the different curie-therapy treatment modalities, how a curie-therapy takes place and which are its side effects. It outlines how to better cope with radiotherapy (how to be supported, the important role of relatives, everyday life questions, rights). It indicates and comments the different measures adopted for the safety and quality of radiotherapy

  8. Intensity modulated conformal radiotherapy

    International Nuclear Information System (INIS)

    Noel, Georges; Moty-Monnereau, Celine; Meyer, Aurelia; David, Pauline; Pages, Frederique; Muller, Felix; Lee-Robin, Sun Hae; David, Denis Jean

    2006-12-01

    This publication reports the assessment of intensity-modulated conformal radiotherapy (IMCR). This assessment is based on a literature survey which focussed on indications, efficiency and safety on the short term, on the risk of radio-induced cancer on the long term, on the role in the therapeutic strategy, on the conditions of execution, on the impact on morbidity-mortality and life quality, on the impact on the health system and on public health policies and program. This assessment is also based on the opinion of a group of experts regarding the technical benefit of IMCR, its indications depending on the cancer type, safety in terms of radio-induced cancers, and conditions of execution. Before this assessment, the report thus indicates indications for which the use of IMCR can be considered as sufficient or not determined. It also proposes a technical description of IMCR and helical tomo-therapy, discusses the use of this technique for various pathologies or tumours, analyses the present situation of care in France, and comments the identification of this technique in foreign classifications

  9. Anxiety and depression levels among multidisciplinary health residents

    Directory of Open Access Journals (Sweden)

    Daniela Salvagni Rotta

    2016-01-01

    Full Text Available Objective: to assess symptoms of anxiety and depression of professionals of Multidisciplinary Health Residence Programs. Methods: this is a cross-sectional study, performed with fifty professionals, using three instruments: one for socioeconomic and demographic data, and the Beck’s Anxiety and Depression Scale. Results: predominance of females (92.0%, average age 26 years old, single (88.0%, family income from two to five salaries (56.0% satisfied with the work (82.0% and thought about quitting the program (56.0% showed anxiety (50.0% and depression (28.0%. Conclusion: there was an association between anxiety and depression in multidisciplinary residents, which points to the need for rethinking strategies for identifying these symptoms and control of stress factors for the promotion of mental health.

  10. Effects of radiotherapy on anti-cancer immune response: mathematical modeling

    International Nuclear Information System (INIS)

    Isaeva, O.G.; Osipov, V.A.

    2009-01-01

    The influence of radiotherapy on the tumor-immune dynamics is studied within our recent model. Simulation of the standard course of radiotherapy shows that in the case of weak immune response a few months after cure the tumor achieves the maximum size, whereas the strong immune system is able to handle the growth of survived tumor cells population. Simulation of vaccine therapy after radiotherapy has been carried out. The high efficiency of vaccination is found provided that it is assigned during a certain period of time after radiotherapy. Different strategies of radiotherapy have been considered. It is shown that hyper rectification is more effective for treatment in comparison with other cures

  11. Managing the pediatric patient with celiac disease: a multidisciplinary approach

    Directory of Open Access Journals (Sweden)

    Isaac DM

    2016-10-01

    Full Text Available Daniela Migliarese Isaac,1 Jessica Wu,2 Diana R Mager,3,4 Justine M Turner1 1Department of Pediatric Gastroenterology and Nutrition, Faculty of Medicine and Dentistry, University of Alberta; 2Alberta Health Services–Child Health Nutrition Services, Stollery Children’s Hospital; 3Department of Agriculture, Food and Nutritional Science; 4Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Abstract: Celiac disease (CD is an autoimmune reaction to gluten, leading to intestinal inflammation, villous atrophy, and malabsorption. It is the most common autoimmune gastrointestinal disorder, with an increasing prevalence. A life-long gluten-free diet (GFD is an effective treatment to alleviate symptoms, normalize autoantibodies, and heal the intestinal mucosa in patients with CD. Poorly controlled CD poses a significant concern for ongoing malabsorption, growth restriction, and the long-term concern of intestinal lymphoma. Achieving GFD compliance and long-term disease control poses a challenge, with adolescents at particular risk for high rates of noncompliance. Attention has turned toward innovative management strategies to improve adherence and achieve better disease control. One such strategy is the development of multidisciplinary clinic approach, and CD is a complex life-long disease state that would benefit from a multifaceted team approach as recognized by multiple national and international bodies, including the National Institutes of Health. Utilizing the combined efforts of the pediatric gastroenterologist, registered dietitian, registered nurse, and primary care provider (general practitioner or general pediatrician in a CD multidisciplinary clinic model will be of benefit for patients and families in optimizing diagnosis, provision of GFD teaching, and long-term adherence to a GFD. This paper discusses the benefits and proposed structure for multidisciplinary care in improving management of CD. Keywords: celiac disease

  12. Radiotherapy access in Belgium: How far are we from evidence-based utilisation?

    Science.gov (United States)

    Lievens, Y; De Schutter, H; Stellamans, K; Rosskamp, M; Van Eycken, L

    2017-10-01

    Underutilisation of radiotherapy has been observed worldwide. To evaluate the current situation in Belgium, optimal utilisation proportions (OUPs) adopted from the European SocieTy for Radiotherapy and Oncology - Health Economics in Radiation Oncology (ESTRO-HERO) project were compared to actual utilisation proportions (AUPs) and with radiotherapy advised during the multidisciplinary cancer team (MDT) meetings. In addition, the impact of independent variables was analysed. AUPs and advised radiotherapy were calculated overall and by cancer type for 110,810 unique cancer diagnoses in 2009-2010. Radiotherapy utilisation was derived from reimbursement data and distinguished between palliative and curative intent external beam radiotherapy (EBRT) and/or brachytherapy (BT). Sensitivity analyses regarding the influence of the follow-up period, the survival length and patient's age were performed. Advised radiotherapy was calculated based on broad treatment categories as reported at MDT meetings. The overall AUP of 37% (39% including BT) was lower than the OUP of 53%, but in line with advised radiotherapy (35%). Large variations by tumour type were observed: in some tumours (e.g. lung and prostate cancer) AUP was considerably lower than OUP, whereas in others there was reasonable concordance (e.g. breast and rectal cancer). Overall, 84% of treatments started within 9 months following diagnosis. Survival time influenced AUP in a cancer type-dependent way. Elderly patients received less radiotherapy. Although the actually delivered radiotherapy in Belgium aligns well to MDT advices, it is lower than the evidence-based optimum. Further analysis of potential barriers is needed for radiotherapy forecasting and planning, and in order to promote adequate access to radiotherapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Radiotherapy in Cancer Care: Facing the Global Challenge

    International Nuclear Information System (INIS)

    Rosenblatt, Eduardo; Zubizarreta, Eduardo

    2017-06-01

    Cancer treatment is complex and calls for a diverse set of services. Radiotherapy is recognized as an essential tool in the cure and palliation of cancer. Currently, access to radiation treatment is limited in many countries and non-existent in some. This lack of radiotherapy resources exacerbates the burden of disease and underscores the continuing health care disparity among States. Closing this gap represents an essential measure in addressing this global health equity problem. This publication presents a comprehensive overview of the major topics and issues to be taken into consideration when planning a strategy to address this problem, in particular in low and middle income countries. With contributions from leaders in the field, it provides an introduction to the achievements and issues of radiation therapy as a cancer treatment modality around the world. Dedicated chapters focus on proton therapy, carbon ion radiotherapy, intraoperative radiotherapy, radiotherapy for children, HIV/AIDS related malignancies, and costing and quality management issues.

  14. Image-guided and adaptive radiotherapy

    International Nuclear Information System (INIS)

    Louvel, G.; Chajon, E.; Henry, O.; Cazoulat, G.; Le Maitre, A.; Simon, A.; Bensadoun, R.J.; Crevoisier, R. de

    2012-01-01

    Image-guided radiotherapy (IGRT) aims to take into account anatomical variations occurring during irradiation by visualization of anatomical structures. It may consist of a rigid registration of the tumour by moving the patient, in case of prostatic irradiation for example. IGRT associated with intensity-modulated radiotherapy (IMRT) is strongly recommended when high-dose is delivered in the prostate, where it seems to reduce rectal and bladder toxicity. In case of significant anatomical deformations, as in head and neck tumours (tumour shrinking and decrease in volume of the salivary glands), re-planning appears to be necessary, corresponding to the adaptive radiotherapy. This should ideally be 'monitored' and possibly triggered based on a calculation of cumulative dose, session after session, compared to the initial planning dose, corresponding to the concept of dose-guided adaptive radiotherapy. The creation of 'planning libraries' based on predictable organ positions (as in cervical cancer) is another way of adaptive radiotherapy. All of these strategies still appear very complex and expensive and therefore require stringent validation before being routinely applied. (authors)

  15. Historical review of radiotherapy

    International Nuclear Information System (INIS)

    Onai, Yoshio

    1993-01-01

    The techniques of radiotherapy have been improved by development of particle accelerators, radionuclides and computers. This paper presents a historical review of the physical and technical aspects of radiotherapy in Japan. Changes in the kinds of radiation, such as X-rays, gamma rays, electrons, neutrons and protons used for external radiotherapy, and the equipment involved are described chronologically, and historical changes in the quality of radiotherapy apparatus are outlined. Patient data acquisition equipment, such as X-ray simulator and X-ray CT, beam modifying devices, patient setup devices, and devices to verify treatment fields and patient doses are reviewed historically. Radiation sources for brachytherapy and internal radiotherapy, and remotely controlled afterloading systems are reviewed chronologically. Historical changes in methods to evaluate absorbed doses, dose monitor systems and beam data acquisition systems are outlined. Changes in methods of calculating dose distributions for external X-ray and electron therapy, brachytherapy and internal radiotherapy by unsealded radionuclides are described and calculation techniques for treatment planning system are reviewed. Annual figures in the numbers of radiotherapy equipment, such as telecobalt and telecesium units, linear accelerators, betatrons, microtrons, stereotactic gamma units, conformation radiotherapy units, remotely controlled afterloading systems, and associated equipment such as X-ray simulators and treatment planning systems are provided, as are changes in the number of accelerators by maximum X-ray energy and maximum electron energy, and in the number of licensed hospitals and clinics using small sealed sources. Changes in techniques of external radiotherapy and brachytherapy are described briefly from the point of view of dose distributions. (author)

  16. Radiological incidents in radiotherapy

    International Nuclear Information System (INIS)

    Hobzova, L.; Novotny, J.

    2008-01-01

    In many countries a reporting system of radiological incidents to national regulatory body exists and providers of radiotherapy treatment are obliged to report all major and/or in some countries all incidents occurring in institution. State Office for Nuclear Safety (SONS) is providing a systematic guidance for radiotherapy departments from 1997 by requiring inclusion of radiation safety problems into Quality assurance manual, which is the basic document for obtaining a license of SONS for handling with sources of ionizing radiation. For that purpose SONS also issued the recommendation 'Introduction of QA system for important sources in radiotherapy-radiological incidents' in which the radiological incidents are defined and the basic guidance for their classification (category A, B, C, D), investigation and reporting are given. At regular periods the SONS in co-operation with radiotherapy centers is making a survey of all radiological incidents occurring in institutions and it is presenting obtained information in synoptic communication (2003 Motolske dny, 2005 Novy Jicin). This presentation is another summary report of radiological incidents that occurred in our radiotherapy institutions during last 3 years. Emphasis is given not only to survey and statistics, but also to analysis of reasons of the radiological incidents and to their detection and prevention. Analyses of incidents in radiotherapy have led to a much broader understanding of incident causation. Information about the error should be shared as early as possible during or after investigation by all radiotherapy centers. Learning from incidents, errors and near misses should be a part of improvement of the QA system in institutions. Generally, it is recommended that all radiotherapy facilities should participate in the reporting, analyzing and learning system to facilitate the dissemination of knowledge throughout the whole country to prevent errors in radiotherapy.(authors)

  17. Radiotherapy indications - rectum cancer

    International Nuclear Information System (INIS)

    2009-05-01

    This document is addressed to oncologists radiotherapists and to any health professional concerned by rectum cancer treatment. Rectum cancer therapy is based on various technical procedures including surgery, radiotherapy and systemic treatments defined for each patient according to his clinical situation. This document precises the specific situations where radiotherapy can be employed. However, the radiotherapy decision must be taken with respect to other therapeutic alternatives. Such a decision must be validated and must be the object of a discussion in the framework of a pluri-disciplinary consultation. (J.S.)

  18. EMSO: European multidisciplinary seafloor observatory

    Science.gov (United States)

    Favali, Paolo; Beranzoli, Laura

    2009-04-01

    EMSO has been identified by the ESFRI Report 2006 as one of the Research Infrastructures that European members and associated states are asked to develop in the next decades. It will be based on a European-scale network of multidisciplinary seafloor observatories from the Arctic to the Black Sea with the aim of long-term real-time monitoring of processes related to geosphere/biosphere/hydrosphere interactions. EMSO will enhance our understanding of processes, providing long time series data for the different phenomenon scales which constitute the new frontier for study of Earth interior, deep-sea biology and chemistry, and ocean processes. The development of an underwater network is based on past EU projects and is supported by several EU initiatives, such as the on-going ESONET-NoE, aimed at strengthening the ocean observatories' scientific and technological community. The EMSO development relies on the synergy between the scientific community and industry to improve European competitiveness with respect to countries such as USA, Canada and Japan. Within the FP7 Programme launched in 2006, a call for Preparatory Phase (PP) was issued in order to support the foundation of the legal and organisational entity in charge of building up and managing the infrastructure, and coordinating the financial effort among the countries. The EMSO-PP project, coordinated by the Italian INGV with participation by 11 institutions from as many European countries, started in April 2008 and will last four years.

  19. Effectiveness of cytochrome C and cepharanthin for leukopenia following multidisciplinary treatment

    International Nuclear Information System (INIS)

    Tabata, Kumiko; Endow, Masaru; Suzuki, Hirotoshi

    1986-01-01

    Leukopenia is one of important problems for multidisciplinary treatment of malignant tumor. We could not be able to take a continuous cancer therapy because of leukopenia. And then we had a study of effectiveness combination treatment of cytochrome C with cepharanthin for leukopenia of cancer patient. We carried on the study of 3 classifications of treatment as follows, a) cytochrome C only, b) combined cytochrome C with cepharanthin, and c) control group without drugs. Bone marrow potentiality is individual differentiation and then the group was administrated both cytochrome C and cepharanthin following radiotherapy associated with postoperative breast cancer. The above description lead to conclusion that combination treatment of cytochrome C and cepharanthin was available for protective drugs from multidisciplinary treatment induced leukemia. (author)

  20. Multidisciplinary team conferences promote treatment according to guidelines in rectal cancer

    DEFF Research Database (Denmark)

    Brännström, Fredrik; Kroll Bjerregaard, Jon; Winbladh, Anders

    2015-01-01

    BACKGROUND: Multidisciplinary team (MDT) conferences have been introduced into standard cancer care, though evidence that it benefits the patient is weak. We used the national Swedish Rectal Cancer Register to evaluate predictors for case discussion at a MDT conference and its impact on treatment...... radiotherapy. These results indirectly support the introduction into clinical practice of discussing all rectal cancer patients at MDT conferences, not least those being treated at low-volume hospitals....... on the implementation of preoperative radiotherapy was evaluated in 1043 patients with pT3c-pT4 M0 tumours, and in 1991 patients with pN+ M0 tumours. RESULTS: Hospital volume, i.e. the number of rectal cancer surgical procedures performed per year, was the major predictor for MDT evaluation. Patients treated...... at hospitals with

  1. Inter- and Intrafraction Patient Positioning Uncertainties for Intracranial Radiotherapy: A Study of Four Frameless, Thermoplastic Mask-Based Immobilization Strategies Using Daily Cone-Beam CT

    International Nuclear Information System (INIS)

    Tryggestad, Erik; Christian, Matthew; Ford, Eric; Kut, Carmen; Le Yi; Sanguineti, Giuseppe; Song, Danny Y.; Kleinberg, Lawrence

    2011-01-01

    Purpose: To determine whether frameless thermoplastic mask-based immobilization is adequate for image-guided cranial radiosurgery. Methods and Materials: Cone-beam CT localization data from patients with intracranial tumors were studied using daily pre- and posttreatment scans. The systems studied were (1) Type-S IMRT (head only) mask (Civco) with head cushion; (2) Uni-Frame mask (Civco) with head cushion, coupled with a BlueBag body immobilizer (Medical Intelligence); (3) Type-S head and shoulder mask with head and shoulder cushion (Civco); (4) same as previous, coupled with a mouthpiece. The comparative metrics were translational shift magnitude and average rotation angle; systematic inter-, random inter-, and random intrafraction positioning error was computed. For strategies 1-4, respectively, the analysis for interfraction variability included data from 20, 9, 81, and 11 patients, whereas that for intrafraction variability included a subset of 7, 9, 16, and 8 patients. The results were compared for statistical significance using an analysis of variance test. Results: Immobilization system 4 provided the best overall accuracy and stability. The mean interfraction translational shifts (± SD) were 2.3 (± 1.4), 2.2 (± 1.1), 2.7 (± 1.5), and 2.1 (± 1.0) mm whereas intrafraction motion was 1.1 (± 1.2), 1.1 (± 1.1), 0.7 (± 0.9), and 0.7 (± 0.8) mm for devices 1-4, respectively. No significant correlation between intrafraction motion and treatment time was evident, although intrafraction motion was not purely random. Conclusions: We find that all frameless thermoplastic mask systems studied are viable solutions for image-guided intracranial radiosurgery. With daily pretreatment corrections, symmetric PTV margins of 1 mm would likely be adequate if ideal radiation planning and targeting systems were available.

  2. Inter- and intrafraction patient positioning uncertainties for intracranial radiotherapy: a study of four frameless, thermoplastic mask-based immobilization strategies using daily cone-beam CT.

    Science.gov (United States)

    Tryggestad, Erik; Christian, Matthew; Ford, Eric; Kut, Carmen; Le, Yi; Sanguineti, Giuseppe; Song, Danny Y; Kleinberg, Lawrence

    2011-05-01

    To determine whether frameless thermoplastic mask-based immobilization is adequate for image-guided cranial radiosurgery. Cone-beam CT localization data from patients with intracranial tumors were studied using daily pre- and posttreatment scans. The systems studied were (1) Type-S IMRT (head only) mask (Civco) with head cushion; (2) Uni-Frame mask (Civco) with head cushion, coupled with a BlueBag body immobilizer (Medical Intelligence); (3) Type-S head and shoulder mask with head and shoulder cushion (Civco); (4) same as previous, coupled with a mouthpiece. The comparative metrics were translational shift magnitude and average rotation angle; systematic inter-, random inter-, and random intrafraction positioning error was computed. For strategies 1-4, respectively, the analysis for interfraction variability included data from 20, 9, 81, and 11 patients, whereas that for intrafraction variability included a subset of 7, 9, 16, and 8 patients. The results were compared for statistical significance using an analysis of variance test. Immobilization system 4 provided the best overall accuracy and stability. The mean interfraction translational shifts (± SD) were 2.3 (± 1.4), 2.2 (± 1.1), 2.7 (± 1.5), and 2.1 (± 1.0) mm whereas intrafraction motion was 1.1 (± 1.2), 1.1 (± 1.1), 0.7 (± 0.9), and 0.7 (± 0.8) mm for devices 1-4, respectively. No significant correlation between intrafraction motion and treatment time was evident, although intrafraction motion was not purely random. We find that all frameless thermoplastic mask systems studied are viable solutions for image-guided intracranial radiosurgery. With daily pretreatment corrections, symmetric PTV margins of 1 mm would likely be adequate if ideal radiation planning and targeting systems were available. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. SU-E-J-129: A Strategy to Consolidate the Image Database of a VERO Unit Into a Radiotherapy Management System

    International Nuclear Information System (INIS)

    Yan, Y; Medin, P; Yordy, J; Zhao, B; Jiang, S

    2014-01-01

    Purpose: To present a strategy to integrate the imaging database of a VERO unit with a treatment management system (TMS) to improve clinical workflow and consolidate image data to facilitate clinical quality control and documentation. Methods: A VERO unit is equipped with both kV and MV imaging capabilities for IGRT treatments. It has its own imaging database behind a firewall. It has been a challenge to transfer images on this unit to a TMS in a radiation therapy clinic so that registered images can be reviewed remotely with an approval or rejection record. In this study, a software system, iPump-VERO, was developed to connect VERO and a TMS in our clinic. The patient database folder on the VERO unit was mapped to a read-only folder on a file server outside VERO firewall. The application runs on a regular computer with the read access to the patient database folder. It finds the latest registered images and fuses them in one of six predefined patterns before sends them via DICOM connection to the TMS. The residual image registration errors will be overlaid on the fused image to facilitate image review. Results: The fused images of either registered kV planar images or CBCT images are fully DICOM compatible. A sentinel module is built to sense new registered images with negligible computing resources from the VERO ExacTrac imaging computer. It takes a few seconds to fuse registered images and send them to the TMS. The whole process is automated without any human intervention. Conclusion: Transferring images in DICOM connection is the easiest way to consolidate images of various sources in your TMS. Technically the attending does not have to go to the VERO treatment console to review image registration prior delivery. It is a useful tool for a busy clinic with a VERO unit

  4. Male coping through a long-term cancer trajectory. Secondary outcomes from a RTC examining the effect of a multidisciplinary rehabilitation program (RePCa) among radiated men with prostate cancer

    DEFF Research Database (Denmark)

    Dieperink, Karin B; Johansen, Christoffer; Hansen, Steinbjørn

    2017-01-01

    patients treated with radiotherapy and androgen deprivation therapy were included in a randomized controlled trial from 2010 to 2012. The trial examined the effect of a multidisciplinary rehabilitation program within six months of treatment consisting of two nursing counseling sessions and two instructive...... sessions with a physical therapist (n = 79), or standard care (n = 82). As secondary outcomes coping was measured before radiotherapy, one month after radiotherapy (baseline), six month post-intervention (assessment) and three years after radiotherapy (follow-up) by the Mini-mental adjustment to cancer.......025) compared with controls, but after three years this difference evened out. After three years the intervention group had lower Cognitive Avoidance (p = 0.044) than the controls. Factors as educational level, and depression influenced the use of coping styles after three years. CONCLUSION: Multidisciplinary...

  5. Radiotherapy injuries in children

    International Nuclear Information System (INIS)

    Kalifa, G.; Bennet, J.; Couanet, D.; Masselot, J.

    1985-01-01

    Side effects of radiotherapy in pediatrics are reviewed including bone injuries and radio-induced bone tumors; nervous system injuries with emphasis on hypothalamus, pituitary gland, brain and spinal cord; lung, digestive system and urinary tract injuries [fr

  6. The metabolic radiotherapy

    International Nuclear Information System (INIS)

    Begon, F.; Gaci, M.

    1993-01-01

    In this article, the authors recall the principles of the metabolic radiotherapy and present these main applications in the treatment of thyroid cancers, hyperthyroidism, polycythemia, arthritis, bone metastases, adrenergic neoplasms. They also present the radioimmunotherapy

  7. Multidisciplinary studies of wildlife trade in primates: Challenges and priorities.

    Science.gov (United States)

    Blair, Mary E; Le, Minh D; Sterling, Eleanor J

    2017-11-01

    Wildlife trade is increasingly recognized as an unsustainable threat to primate populations and informing its management is a growing focus and application of primatological research. However, management policies based on ecological research alone cannot address complex socioeconomic or cultural contexts as drivers of wildlife trade. Multidisciplinary research is required to understand trade complexity and identify sustainable management strategies. Here, we define multidisciplinary research as research that combines more than one academic discipline, and highlight how the articles in this issue combine methods and approaches to fill key gaps and offer a more comprehensive understanding of underlying drivers of wildlife trade including consumer demand, enforcement patterns, source population status, and accessibility of targeted species. These articles also focus on how these drivers interact at different scales, how trade patterns relate to ethics, and the potential effectiveness of different policy interventions in reducing wildlife trade. We propose priorities for future research on primate trade including expanding from multidisciplinary to interdisciplinary research questions and approaches co-created by research teams that integrate across different disciplines such as cultural anthropology, ecology, economics, and public policy. We also discuss challenges that limit the integration of information across disciplines to meet these priorities. © 2017 Wiley Periodicals, Inc.

  8. Clinical practice of radiotherapy

    International Nuclear Information System (INIS)

    Tobias, J.S.

    1992-01-01

    After describing the recent advances in radiotherapy, this brief article presents in tabular form the changing indications for radiotherapy for tumours of the skin, head and neck, adult CNS, lung, thyroid, thymus, breast, female genital tract, soft tissue sarcoma, genitourinary tract, bone sarcoma, Hodgkin's disease, non-Hodgkin lymphoma, multiple myeloma, leukemia and paediatric malignancy. For each tumour type, information is provided for the radiosensitivity, the radiocurability, complications and five-year survival. Combined modality treatment is also briefly discussed. (UK)

  9. Nanoparticle-guided radiotherapy

    DEFF Research Database (Denmark)

    2012-01-01

    The present invention relates to a method and nano-sized particles for image guided radiotherapy (IGRT) of a target tissue. More specifically, the invention relates to nano-sized particles comprising X-ray-imaging contrast agents in solid form with the ability to block x-rays, allowing for simult...... for simultaneous or integrated external beam radiotherapy and imaging, e.g., using computed tomography (CT)....

  10. Clinical practice of radiotherapy

    International Nuclear Information System (INIS)

    Horiuchi, Junichi; Masaki, Norie; Onoyama, Yasuto

    1987-01-01

    This chapter presents in greater detail radiotherapy used in each clinical setting. The descriptions are given under the following sections: the tongue and oral cavity; the maxilla, larynx, and pharynx; brain tumors; the eyes and orbit; pediatric tumors; lung cancer; the esophagus; breast cancer; the abdominal digestive system; the urogenital system; the uterine cervix; the ovaries and vulva; bone and soft tissues; the skin; hematopoietic tumors; lymph node metastases; and radiotherapy as palliative treatment. (Namekawa, K.)

  11. Patients and radiotherapy

    International Nuclear Information System (INIS)

    Eardley, A.

    1986-01-01

    The results of interviews with thirty discharged patients who had undergone radical radiotherapy for cancer of the head and neck are presented. Patients were asked whether their side-effects had got worse or had stayed the same, what effect their side effects had had on eating and drinking and whether they had felt depressed during this period. Measures which could be taken to improve patients' experiences of radiotherapy are discussed. (U.K.)

  12. Radiotherapy and oral cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sealy, R [Cape Town Univ. (South Africa). Dept. of Radiotherapy

    1982-08-01

    A general review article for the non-radiotherapist. The historical, physical and biological background is briefly reviewed. Mention is made of the effects of fraction size, hyperbaric oxygen, neutron beams and radiation sensitizers. The use of chemotherapy and radiotherapy is discussed, as well as the selection of patients for radiotherapy and the treatment of neck nodes. The author suggests a therapeutic approach to the various disease sites and finally reviews some of the literature on radiation caries and jaw necrosis.

  13. A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery.

    Science.gov (United States)

    Van der Linden, P; De Hert, S; Daper, A; Trenchant, A; Jacobs, D; De Boelpaepe, C; Kimbimbi, P; Defrance, P; Simoens, G

    2001-10-01

    Individual and institutional practices remain an independent predictor factor for allogeneic blood transfusion. Application of a standardized multidisciplinary transfusion strategy should reduce the use of allogeneic blood transfusion in major surgical patients. This prospective non randomized observational study evaluated the effects of a standardized multidisciplinary transfusion strategy on allogeneic blood products exposure in patients undergoing non-emergent cardiac surgery. The developed strategy involved a standardized blood conservation program and a multidisciplinary allogeneic blood transfusion policy based mainly on clinical judgement, not only on a specific hemoglobin concentration. Data obtained in a first group including patients operated from September 1997 to August 1998 (Group pre: n=321), when the transfusion strategy was progressively developed, were compared to those obtained in a second group, including patients operated from September 1998 to August 1999 (Group post: n=315) when the transfusion strategy was applied uniformly. Patient populations and surgical procedures were similar. Patients in Group post underwent acute normovolemic hemodilution more frequently, had a higher core temperature at arrival in the intensive care unit and presented lower postoperative blood losses at day one. Three hundred forty units of packed red blood cells were transfused in 33% of the patients in Group pre whereas 161 units were transfused in 18% of the patients in Group post (P <0.001). Pre- and postoperative hemoglobin concentrations, mortality and morbidity were not different among groups. Development of a standardized multidisciplinary transfusion strategy markedly reduced the exposure of cardiac surgery patients to allogeneic blood.

  14. Integrated Multidisciplinary Optimization Objects, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — M4 Engineering proposes to implement physics-based, multidisciplinary analysis and optimization objects that will be integrated into a Python, open-source framework...

  15. An architecture for integration of multidisciplinary models

    DEFF Research Database (Denmark)

    Belete, Getachew F.; Voinov, Alexey; Holst, Niels

    2014-01-01

    Integrating multidisciplinary models requires linking models: that may operate at different temporal and spatial scales; developed using different methodologies, tools and techniques; different levels of complexity; calibrated for different ranges of inputs and outputs, etc. On the other hand......, Enterprise Application Integration, and Integration Design Patterns. We developed an architecture of a multidisciplinary model integration framework that brings these three aspects of integration together. Service-oriented-based platform independent architecture that enables to establish loosely coupled...

  16. [Bladder-conserving treatment for bladder cancer: potential of and developments in radiotherapy].

    Science.gov (United States)

    Hulshof, Maarten C C M; Pieters, Bradley R; Koning, Caro C E

    2013-01-01

    The standard treatment for muscle-invasive bladder cancer is surgical removal of the bladder and construction of a neobladder. Recently, important improvements have been made in the potential for bladder-conserving treatment using radiotherapy. External beam radiotherapy has undergone technological improvements, as a result of which it is possible to radiate the tumour more precisely while decreasing radiation to healthy tissue. Radiochemotherapy improves local recurrence-free and overall survival compared with radiotherapy alone. The results of this combined treatment are comparable with those of surgery. Additionally, Dutch radiotherapy departments have collected data in a national database of 1040 selected patients with confined bladder cancer. These patients were treated with external beam radiation, limited surgery and brachytherapy. The 5-year local recurrence-free survival was 75%. Bladder conserving treatment options for muscle-invasive bladder cancer should be discussed during the multidisciplinary meeting.

  17. Space Weather in the Machine Learning Era: A Multidisciplinary Approach

    Science.gov (United States)

    Camporeale, E.; Wing, S.; Johnson, J.; Jackman, C. M.; McGranaghan, R.

    2018-01-01

    The workshop entitled Space Weather: A Multidisciplinary Approach took place at the Lorentz Center, University of Leiden, Netherlands, on 25-29 September 2017. The aim of this workshop was to bring together members of the Space Weather, Mathematics, Statistics, and Computer Science communities to address the use of advanced techniques such as Machine Learning, Information Theory, and Deep Learning, to better understand the Sun-Earth system and to improve space weather forecasting. Although individual efforts have been made toward this goal, the community consensus is that establishing interdisciplinary collaborations is the most promising strategy for fully utilizing the potential of these advanced techniques in solving Space Weather-related problems.

  18. Radiotherapy of brain metastases and glioblastomas in elderly patients; Radiotherapie des metastases cerebrales et des glioblastomes chez le sujet age

    Energy Technology Data Exchange (ETDEWEB)

    Lauche, O.; Kerr, C.; Riou, O.; Dhermain, F. [Institut Gustave-Roussy, Villejuif (France)

    2011-10-15

    As the occurrence of malignant gliomas and brain metastases is increasing in elderly people, the authors report the definition of an optimal therapeutic strategy for these patients. For patients in good health condition, a prospective randomized showed a modest benefit of radiotherapy alone with respect to support cares in terms of survival. The radiotherapy scheme is discussed in terms of dose and number of fractions. It seems that the physiological age is a strong prognosis factor. Short communication

  19. Norwegian program of quality assurance in radiotherapy (KVIST) - Organisation, benefits and experience feedback

    International Nuclear Information System (INIS)

    Merete Olerud, H.; Levernes, S.; Hellebust, T.P.; Heikkela, I.E.; Bjerke, H.; Sundqvist, E.; Frykholm, G.

    2009-01-01

    In 2000, the Norwegian Radiation Protection Authority (N.R.P.A.) initiated work to develop a national quality assurance programme in radiotherapy. The program was named K.V.I.S.T.: i.e. Norwegian abbreviation of Quality Assurance in Radiotherapy (KValitetSikring STraleterapi). The programme is performed by the multidisciplinary K.V.I.S.T. Group and aims to stimulate collaboration by focussing on clinical, technical and administrative problems that can be addressed and solved on a national level. An important objective is to establish a positive attitude towards quality assurance and better communication between centres and the various professions and professionals involved in radiotherapy, i.e. the oncologists, medical physicists and radiation therapy technologists. Information is also provided to other stake holders such as health authorities, hospital administrators and patients. In 2007 radiotherapy in Norway represent 10 departments and forty accelerators. Since radiotherapy is given high priority in cancer care good quality assurance is required. The member of the K.V.I.S.T.-group are part time at N.R.P.A. and part time in different radiotherapy departments. Professionals with competencies within radiotherapy (R.T.) have permanent positions in a national public entity. The K.V.I.S.T.-group is multidisciplinary. The K.V.I.S.T.-group acts as a coordinating group for all type of national Q.A. projects. The recommendations/guidelines are developed by national consensus. The work is performed by the radiotherapy community it self, thus creating an atmosphere of ownership. (N.C.)

  20. Stereotactic Radiosurgery and Hypofractionated Radiotherapy for Glioblastoma.

    Science.gov (United States)

    Shah, Jennifer L; Li, Gordon; Shaffer, Jenny L; Azoulay, Melissa I; Gibbs, Iris C; Nagpal, Seema; Soltys, Scott G

    2018-01-01

    Glioblastoma is the most common primary brain tumor in adults. Standard therapy depends on patient age and performance status but principally involves surgical resection followed by a 6-wk course of radiation therapy given concurrently with temozolomide chemotherapy. Despite such treatment, prognosis remains poor, with a median survival of 16 mo. Challenges in achieving local control, maintaining quality of life, and limiting toxicity plague treatment strategies for this disease. Radiotherapy dose intensification through hypofractionation and stereotactic radiosurgery is a promising strategy that has been explored to meet these challenges. We review the use of hypofractionated radiotherapy and stereotactic radiosurgery for patients with newly diagnosed and recurrent glioblastoma. Copyright © 2017 by the Congress of Neurological Surgeons.

  1. Nutritional assistance to patients during radiotherapy

    International Nuclear Information System (INIS)

    Dias, Maria C.G.; Nadalin, Wladimir; Baxter, Yara C.; Faintuch, Joel; Waitzberg, Dan L.; Maculevicius, Janete

    1996-01-01

    With the aim of assessing the possible benefits of nutritional therapy , 140 patients were prospectively studied during radiotherapy of the head and neck (81%) and esophageal cancer (19%). Mean age was 56.0 (17-80), with 114 males and 26 females. Duration of both nutrition and radiotherapy was 78.0 ± 45 days. Tube feeding was the primary modality in 50.7% of the population, and oral regimens in the remaining 49.3%, but associations between the methods were also used. Enteral diets were supplied under the supervision of a specialized tem for home alimentation (PROSNED). Compliance to the program was 100% and a lymphocyte count diminished along this period (1933 ± 1033 vs 1265 ± 688, p.0.001). A subjective improvement was reported by 84% of the population, and total calorie intake, that was below 60% of estimated needs in 100% of the cases initially, significantly improved to just 40% inadequate at the end of the observations. Radiotherapy was associated with mucositis in 21% of the patients, taste changes in 79%, xerostomy in 81%, anorexia in 66% and odinophagia in 59%. In the individuals selected for enteral feeding, side effects were represented by technical problems (20%) and gastrointestinal disorders (13%). All patients completed the nutritional support program and there was no mortality in this series. It is conclude that: early nutritional support during radiotherapy was able to maintain or improve the nutritional status; tube feeding, alone or in combination with oral diets, was indicated whenever appropriate and contributed to fulfillment of the energy requirements; reduction of total lymphocytes could not be prevented by the mentioned therapy; complications of enteral alimentation were mild and affected a small proportion of the population; troubles induced by radiotherapy were as frequent as expected, and tended to disturb the intake of the food; the compliance of the therapeutic plan was excellent and can be attributed to the efforts of the

  2. Status and advances of p53-gene therapy and radiotherapy in malignant tumor

    International Nuclear Information System (INIS)

    Duan Xin; Chinese Academy of Sciences, Beijing; Zhang Hong

    2006-01-01

    Cancer treatment is one of the most important fields in medical research. All strategies such as radio-therapy, chemotherapy, surgery, and gene-based therapy have their own advantages and disadvantages. Nowadays, a novel method which combined p53-gene therapy with radiotherapy plays an important role in the field of cancer research. This review summarized the current state of combined therapies of p53-gene therapy and radiotherapy, possible mechanism and recent progress. (authors)

  3. Radiotherapy-induced emesis. An overview

    Energy Technology Data Exchange (ETDEWEB)

    Feyer, P.; Buchali, A.; Hinkelbein, M.; Budach, V. [Department Radiotherapy, Humboldt-University Berlin (Germany); Zimmermann, J.S. [Department Radiotherapy, Christian Albrechts-University Kiel (Germany); Titlbach, O.J. [Department of Medicine I, Hospital Friedrichshain, Berlin (Germany)

    1998-11-01

    Background: A significant number of patients receiving radiotherapy experience the distressing side effects of emesis and nausea. These symptoms are some of the most distressing problems for the patients influencing their quality of life. Methods: International study results concerning radiotherapy-induced emesis are demonstrated. A German multicenter questionnaire examining the strategies to prevent or to treat radiotherapy-induced nausea and emesis is presented. An international analysis concerning incidence of emesis and nausea in fractionated radiotherapy patients is discussed. Finally the consensus of the consensus conference on antiemetic therapy from the Perugia International Cancer Conference V is introduced. Results: Untreated emesis can lead to complications like electrolyte disorders, dehydration, metabolic disturbances and nutrition problems with weight loss. Prophylactic antiemetics are often given to patients receiving single high-dose radiotherapy to the abdomen. A survey has revealed that antiemetic prophylaxis is not routinely offered to the patients receiving fractionated radiotherapy. However, there is a need for an effective treatment of emesis for use in this group of patients, too. In 20% of patients nausea and emesis can cause a treatment interruption because of an inadequate control of symptoms. Like in chemotherapy strategies there exist high, moderate, and low emetogenic treatment regimens in radiotherapy as well. The most emetogenic potential has the total body irradiation followed by radiotherapy to the abdomen. Radiotherapy induced emesis can be treated effectively with conventional antiemetics up to 50%. Conclusions: Studies with total body irradiation, fractionated treatment and high-dose single exposures have cleary demonstrated the value of 5-HT3-receptor antagonist antiemetics. There is a response between 60 and 97%. There is no difference in the efficacy of the different 5-HT3-antagonists. High-risk patients should be prophylactic

  4. Advice concerning radiotherapy

    International Nuclear Information System (INIS)

    1984-01-01

    Dutch National cancer incidence figures were calculated by using the reliable data on cancer incidence in the Eindhoven area and population forecasts and information obtained from the Central Bureau of Statistics. Several radiotherapy departments suffer from under capacity (a lack of resources and understaffing). Data have also shown that 35% of cancer patients receive radiotherapy, instead of 50%. Calculations have been made by the committee on the present and future needs with regard to equipment and staff. In 1983, the number of megavoltage therapy units amounted to 38, but should have been 65. It should be 80 in 1990 and 90 in 2000. Since building and installing such equipment is a lengthy process a considerable effort is needed to make up for the arrears. The committee advocates the extension of the system of regional cooperation in cancer care (comprehensive cancer centres), in which radiotherapy departments play a crucial role. Working parties from the committee provided a comprehensive description of current radiotherapy practice with reference to physical, technical, clinical and management aspects. Another working party assessed the results of cancer treatment with regard to many different tumour sites. Recent and expected developments were analysed or indicated. The Radiotherapy Committee commissioned an external team to conduct a project to achieve a picture of future developments using methods different to those of the committee's. An interim advice has been added on this subject. (Auth.)

  5. Indications for quality assurance in conformal radiotherapy in Italy

    International Nuclear Information System (INIS)

    Banci Buonamici, F.; DE Angelis, C.; Rosi, A.; Tabocchini, M.A.; Iotti, C.; Olmi, P.

    2008-01-01

    Intensity-Modulated Radiation Therapy (IMRT) is an advanced and promising technique of external beam irradiation. IMRT is able to conform the dose distribution to the 3D tumour shape also for complex geometries, preserving surrounding normal tissues and reducing the probability of side effects. IMRT is a time consuming and complex technique and its use demands high level quality assurance. It is, therefore, very important to define conditions for its utilization. Professionals of Radiotherapy Centres, with experience in the IMRT use, have constituted a multidisciplinary working group with the aim of developing indications in this field. Purpose of the present document is to highlight relevant aspects of the technique, but also to underline the high complexity of the technique, whose implementation requires extreme attention of the staff of Radiotherapy Centres involved [it

  6. Clinical features and multidisciplinary approaches to dementia care

    Directory of Open Access Journals (Sweden)

    Gr

    2011-05-01

    Full Text Available Jacob HG Grand¹, Sienna Caspar², Stuart WS MacDonald11Department of Psychology, University of Victoria, Victoria, BC, Canada; 2Interdisciplinary Graduate Studies, University of British Columbia, Vancouver, BC, CanadaAbstract: Dementia is a clinical syndrome of widespread progressive deterioration of cognitive abilities and normal daily functioning. These cognitive and behavioral impairments pose considerable challenges to individuals with dementia, along with their family members and caregivers. Four primary dementia classifications have been defined according to clinical and research criteria: 1 Alzheimer’s disease; 2 vascular dementias; 3 frontotemporal dementias; and 4 dementia with Lewy bodies/Parkinson’s disease dementia. The cumulative efforts of multidisciplinary healthcare teams have advanced our understanding of dementia beyond basic descriptions, towards a more complete elucidation of risk factors, clinical symptoms, and neuropathological correlates. The characterization of disease subtypes has facilitated targeted management strategies, advanced treatments, and symptomatic care for individuals affected by dementia. This review briefly summarizes the current state of knowledge and directions of dementia research and clinical practice. We provide a description of the risk factors, clinical presentation, and differential diagnosis of dementia. A summary of multidisciplinary team approaches to dementia care is outlined, including management strategies for the treatment of cognitive impairments, functional deficits, and behavioral and psychological symptoms of dementia. The needs of individuals with dementia are extensive, often requiring care beyond traditional bounds of medical practice, including pharmacologic and non-pharmacologic management interventions. Finally, advanced research on the early prodromal phase of dementia is reviewed, with a focus on change-point models, trajectories of cognitive change, and threshold models of

  7. Radiosynoviorthesis in the treatment of chronic synoviorthesis. Multidisciplinary focuses

    International Nuclear Information System (INIS)

    Morin Zorrilla, Jose

    2006-01-01

    Those near 50 years of application of the radiosinovectomy like effective alternative in the treatment of the chronic synovitis of different origin, indicate the convenience and in cause the necessity to integrate focuses, knowledge and technologies in order to reach satisfactory results. In the marks of a brunch project of the Agency of Nuclear Energy and Technologies of Advanced the efforts of several institutions are joined with the purpose of introducing in Cuba this useful one and in certain cases obligatory therapeutic modality. The work talks about the problem, the boarding multidisciplinary, the global focuses, the advances and the challenges are indicated that has this modality of the metabolic radiotherapy. In the experience of the development of radiopharmaceutical for radiosinovectomy, is considered that it is not possible to reach the level of excellence that the treatment with open sources requires without the active participation of specialists of different profiles as vectors of the integration of institutions that give their experience and the focus of their institution (Author)

  8. Chemotherapy disruption of efficient radiotherapy

    International Nuclear Information System (INIS)

    Nervi, C.; Friedman, M.

    1974-01-01

    Studies on the use of chemotherapy in combination with radiotherapy are reviewed. Some topics discussed are: indications for the use of combined chemotherapy and radiotherapy; improvement of the therapeutic ratio following the use of methotrexate; advantages of preirradiation and postirradiation chemotherapy; side effects following simultaneous chemotherapy and radiotherapy; and effects of chemotherapy on cure rate of radiosensitive and radioresistant tumors. (U.S.)

  9. The current role of radiotherapy in colorectal cancer

    International Nuclear Information System (INIS)

    Aleman, B.M.P.; Bartelink, H.; Gunderson, L.L.

    1995-01-01

    During the last two decades, radiotherapy has become an integral part of the multidisciplinary approach in the treatment of patients with colorectal cancer. Currently, radiotherapy is seen mainly as an adjuvant therapy, sometimes in combination with chemotherapy, in a pre- or post-operative setting. Adjuvant radiotherapy alone leads to a significant reduction of local recurrence rates, but an impact on survival is seen only in subset analyses. Combined modality treatment can reduce local recurrence rates even further, and can also reduce the rate of distant relapses and increase survival. The acute toxicity of combined modality is considerably higher. Local radiation can also be used as a component of organ conserving local treatment for selected early lesions. Radiotherapy has been an important palliative treatment modality, diminishing symptoms in cases of inoperable primary rectal cancers or pelvic recurrences. The timing of radiation, surgery and chemotherapy has been under evaluation for years. For patients with locally advanced primary or recurrent malignancies (unresectable due to fixation), the preferred sequence is pre-operative irradiation with or without chemotherapy, followed by surgical resection. For mobile resectable lesions, sequencing issues are being tested in phase III randomised trials. (author)

  10. Radiotherapy of pineal tumors

    International Nuclear Information System (INIS)

    Danoff, B.; Sheline, G.E.

    1984-01-01

    Radiotherapy has universally been used in the treatment of pineal tumors and suprasellar germinomas. Recently however, major technical advances related to the use of the operating microscope and development of microsurgical techniques have prompted a renewed interest in the direct surgical approach for biopsy and/or excision. This interest has resulted in a controversy regarding the role of surgery prior to radiotherapy. Because of the heterogeneity of tumors occurring in the pineal region (i.e., germ cell tumors, pineal parenchymal tumors, glial tumors, and cysts) and their differing biological behavior, controversy also surrounds aspects of radiotherapy such as: the optimal radiation dose, the volume to be irradiated, and indications for prophylactic spinal irradiation. A review of the available data is presented in an attempt to answer these questions

  11. Cancer research and radiotherapy

    International Nuclear Information System (INIS)

    Matsuzawa, Taiju

    1978-01-01

    An actual condition of cancer, and the basis and a future view of radiotherapy were described by adding generally established biological and biochemical knowledge to the author's research. It was described that the relapse of cancer after irradiation was induced from outside of cancerous mass, and the nature of relapsed cancerous cells group was also stated. The histological structure of cancer from a view of cell movement and radioresistant cancerous cells group were described. The differentiation of cancerous cells were described, and a study of inhibition of cancer by redifferentiation was considered. It is important to grasp characteristics and a limit of radiotherapy for cancer, to systematize and materialize reasonable therapy which uses drug and immunotherapy together with surgery, and to use radiotherapy reasonably together with redifferentiation therapy of cancerous cells by extracting characteristics and a limit of radiationtherapy from an actual condition of cancer. (Serizawa, K.)

  12. A multidisciplinary treatment strategy for locally advanced rectal cancer

    International Nuclear Information System (INIS)

    Kimura, F.; Yanagi, Hidenori; Atono, R.

    2012-01-01

    The aim of this study is to examine the therapeutic effects and adverse events of preoperative chemoradiation therapy (CRT) for locally advanced rectal cancer in different radiation doses and fractions. A total of 142 consecutive patients with locally advanced (cT3-4 and/or cN1-2) adenocarcinoma of the rectum were treated with preoperative CRT and were operated radically. 121 patients with resectable cT3 or N1-2 rectal adenocarcinoma were assigned to receive pelvic radiation with single fractions of 2.5 Gy twice daily to a total dose of 25 Gy (Short CRT). Surgery was undergone within two weeks. 21 patients with clinical unresectable or marginally resectable cT4 rectal cancer were assigned to receive preoperative pelvic radiation therapy 45 to 50.4 Gy at 1.8 Gy per day. Surgery was performed 6 to 8 weeks after completion of neoadjuvant therapy (Long CRT). We examined retrospectively the preoperative therapeutic effect and adverse event of Short CRT and Long CRT. Short CRT; Overall R0 resection rate was 98%. Anus preserving rate was 95%. pCR rate was 5%. Median follow-up was 62 months. The actuarial 5-year-local-control rate was 94%. Overall survival for 5 years was 92%. Long neoadjuvant chemoradiation therapy (NCRT); Overall R0 resection rate was 90%. Anus preserving rate was 86%. pCR rate was 24%. Median follow-up was 60 months. The actuarial 5-year-local-control rate was 88%. Overall survival rate for 5 years was 88%. Radiation related adverse event such as pelvic infection and skin trouble was significantly higher in the long CRT group. Local control in primarily resectable rectal cancer after short chemoradiation was excellent. Long chemoradiation for unresectable or marginal cT4 rectum cancer was higher response ratio, but induced more radiation related adverse event than short course CRT. (author)

  13. Occupational Therapy in Multidisciplinary Residency in Family and Community Health

    Directory of Open Access Journals (Sweden)

    Luzianne Feijó Alexandre Paiva

    2013-12-01

    Full Text Available In this study, we report the experiences of occupational therapist during the Multidisciplinary Residency Program in Family and Community Health in Fortaleza, Ceará state, Brazil. With the creation of the Support Center for Family Health – NASF, occupational therapists began to participate more effectively in the Family Health Strategy of the Brazilian National Health System. Given this rocess, the category, which historically has trained its professionals following the biomedical model, is faced with the challenge to build a new field of knowledge. Objective: To analyze the inclusion of occupational therapy in the Family Health Strategy within the scope of Multidisciplinary Residency. Methodology: This is a descriptive study of qualitative approach, which was based on the experience of four occupational therapy resident students, performed through the documental analysis of field diaries, scientific papers, and case studies produced between 2009 and 2011. Results: The occupational therapists as well as the other NASF professionals operated the logic of Matrix Support to the Family Health teams, sharing their knowledge and assisting in resolving complex cases of the families, groups, and communities served. In this context, we found people with different relationships with their doings and a reduced repertoire of activities. The occupational therapists invested in the creation or consolidation of groups in the Family Health Centers and in the territory, which also stood as living and socializing spaces, focusing on prevention and health promotion.

  14. Radiotherapy for the medulloblastoma

    International Nuclear Information System (INIS)

    Gose, Kyuhei; Imajo, Yoshinari; Imanaka, Kazufumi

    1983-01-01

    Eighteen patients with medulloblastoma, treated between 1972 and 1981, at Kobe University School of Medicine, were retrospectively studied. Of those completing post operative irradiation, 50% have survived for 2 years, 15% for 5 years and mean survival periods was 22.2 months. 13 out of 18 patients developed local recurrence and spinal dissemination. The mean time from the initial radiotherapy to recurrence was 8.5 months. It was suggested that posterior fossa should recieve 5,000 rad, the spine should 2,000 rad and recurrences should be treated by the combination of radiotherapy and chemotherapy. (author)

  15. Arterial disease after radiotherapy

    International Nuclear Information System (INIS)

    Bigot, J.M.; Mathieu, D.; Reizine, D.

    1983-01-01

    Disease of the large arterial vessels is a relatively unknown complication of radiotherapy. However, it should be considered in the same manner as the other complications of irradiation when a tumour recurrence is suspected. The experimental studies of Kirkpatrick and Konings, demonstrating the synergy between irradiation and hypercholesterolemia in the precocity and gravity of vascular complications are recalled. The different localisations reported in the litterature are discussed: coronary, pulmonary, thoracic aorta, supra aortic, renal, digestive and ilio-femoral arteries. Finally, the difficulty of diagnosis of post-radiotherapy without clinical, radiological or anatomopathological confirmation, is underlined [fr

  16. Second cancers following radiotherapy

    International Nuclear Information System (INIS)

    Tubiana, M.

    1983-01-01

    Published reports have shown that there is an increased incidence of second malignancies, particularly sarcomas, following high dose radiotherapy in cancer treatment. However, this increased risk is very small and is relatively negligeable when one considers the beneficial effects of radiotherapy in cancer treatment. This incidence of radiation induced cancer appears to be higher in certain groups of patients, such as children and patients with Hodgkin's disease. In view of scarcity of published data, controlled surveys remain necessary for the quantitative assessment of the cancer risk in various subgroups of irradited patients [fr

  17. Xerostomia induced by radiotherapy

    Directory of Open Access Journals (Sweden)

    Alimi D

    2015-08-01

    Full Text Available David Alimi Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USAWe read with great interest the excellent review on xerostomia induced by radiotherapy, by Pinna et al.1 The authors should be congratulated for a very detailed review of the physiopathology, clinical symptoms, and therapeutic management of an extremely difficult condition. Although we agree that the use of anticholinergic medication represents treatment, it requires the patient to have residual salivary gland function. Unfortunately, it is well established that in most cases radiotherapy destroys most of the salivary gland and associated salivary secretions.     

  18. Comparison of different strategies of use of on-board imagery (high energy [MV], low energy [kV], cone beam tomography) in radiotherapy; Comparaison des differentes strategies d'utilisation de l'imagerie embarquee (haute energie [MV], basse energie [kV], tomographie conique) en radiotherapie

    Energy Technology Data Exchange (ETDEWEB)

    Serre, A.A.; Marchesi, V.; Beckendorf, V.; Peiffert, D. [Service de radiotherapie, centre Alexis-Vautrin, Vandoeuvre-les-Nancy (France); Noel, A. [UMR 7039, centre de recherche en automatique de Nancy, Nancy universite, Vandoeuvre-les-Nancy (France); UMR 7039, CNRS, Vandoeuvre-les-Nancy (France)

    2011-10-15

    The authors report the determination of a strategy of use of different available imagery modalities on the Varian 3 On-Board-Imager (OBI): low energy (kV) and high energy (MV) plane imageries, and volume imagery (Kv-CBCT, cone beam computed tomography). The dose delivered by each device has been quantified on a humanoid phantom with thermoluminescent dosimeters. A prospective clinical compared the three modalities in terms of patient positioning accuracy. It appears that low-energy imagery provides a good reproducibility, a negligible additional dose and a better image quality. Short communication

  19. Pelvic re-irradiation using stereotactic ablative radiotherapy (SABR): A systematic review.

    Science.gov (United States)

    Murray, Louise Janet; Lilley, John; Hawkins, Maria A; Henry, Ann M; Dickinson, Peter; Sebag-Montefiore, David

    2017-11-01

    To perform a systematic review regarding the use of stereotactic ablative radiotherapy (SABR) for the re-irradiation of recurrent malignant disease within the pelvis, to guide the clinical implementation of this technique. A systematic search strategy was adopted using the MEDLINE, EMBASE and Cochrane Library databases. 195 articles were identified, of which 17 were appropriate for inclusion. Studies were small and data largely retrospective. In total, 205 patients are reported to have received pelvic SABR re-irradiation. Dose and fractionation schedules and re-irradiated volumes are highly variable. Little information is provided regarding organ at risk constraints adopted in the re-irradiation setting. Treatment appears well-tolerated overall, with nine grade 3 and six grade 4 toxicities amongst thirteen re-irradiated patients. Local control at one year ranged from 51% to 100%. Symptomatic improvements were also noted. For previously irradiated patients with recurrent pelvic disease, SABR re-irradiation could be a feasible intervention for those who otherwise have limited options. Evidence to support this technique is limited but shows initial promise. Based on the available literature, suggestions for a more formal SABR re-irradiation pathway are proposed. Prospective studies and a multidisciplinary approach are required to optimise future treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Erythropoietin and radiotherapy; Erythropoietine et radiotherapie

    Energy Technology Data Exchange (ETDEWEB)

    Le Fur, E.; Albarghach, M.N.; Pradier, O. [CHU de Morvan, Dept. de radiotherapie, 29 - Brest (France)

    2010-01-15

    Erythropoietin (E.P.O.) is a glycoprotein hormone. This hormone is a growth factor for red blood cells precursors in the bone marrow. The decrease of oxygen partial pressure, a reduced number of erythrocytes caused by bleeding or excessive destruction, or increased tissues oxygen requirements lead to increased secretion of E.P.O.. Its action takes place on bone marrow erythroblastic cells through specific receptors. E.P.O. stimulates the proliferation of red cell precursors stem cells in the bone marrow, thus increasing their production in one to two weeks. The effectiveness of E.P.O. at increasing haemoglobin and improving patients quality of life has been demonstrated by several studies. However, its use in radiotherapy remains controversial. While tumour hypoxia caused by anaemia is a factor of radio resistance and thus a source of local failure, tumour expression of E.P.O. receptors presents a significant risk for tumour progression and neo-angiogenesis, which would be increased during the administration of E.P.O.. The purpose of this article is to answer the question: is there a place for E.P.O. in combination with radiotherapy in the management of cancer?

  1. The Potential Effect of Oral Microbiota in the Prediction of Mucositis During Radiotherapy for Nasopharyngeal Carcinoma

    Directory of Open Access Journals (Sweden)

    Xiao-Xia Zhu

    2017-04-01

    Interpretation: Oral microbiota changes correlate with the progression and aggravation of radiotherapy-induced mucositis in patients with nasopharyngeal carcinoma. Microbiota-based strategies can be used for the early prediction and prevention of the incidence of severe mucositis during radiotherapy.

  2. Evidences in multidisciplinary management of rectal cancer

    International Nuclear Information System (INIS)

    De Bari, B.; Bosset, J.F.; Gerard, J.P.; Maingon, P.; Valentini, V.

    2012-01-01

    In the last 10 years, a number of important European randomized published studies investigated the optimal management of rectal cancer. In order to define an evidence-based approach of the clinical practice based, an international consensus conference was organized in Italy under the endorsement of European Society of Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO) and European Society of Therapeutic Radiation Oncology (ESTRO). The aim of this article is to present highlights of multidisciplinary rectal cancer management and to compare the conclusions of the international conference on 'Multidisciplinary Rectal Cancer Treatment: looking for an European Consensus' (EURECA-CC2) with the new National Comprehensive Cancer Network (NCCN) guidelines. (authors)

  3. Using social practice theory to frame the contribution of social marketing in the multidisciplinary future of ‘behaviour change’

    OpenAIRE

    Spotswood, F.

    2014-01-01

    Background\\ud The 2011 House of Lords Behaviour Change report concluded that ‘behaviour change’ must become multi-disciplinary, criticising the government’s myopic commitment to ‘nudge’. It emphasised that any single-approach strategy will fail to tackle the scale of problems like incommunicable disease. Given this and other calls for multi-disciplinarity , , the lack of commentary around the place of social marketing (sm) within a multi-disciplinary framework is of concern. Rather, publicati...

  4. Multileaf collimator in radiotherapy

    International Nuclear Information System (INIS)

    Jeraj, M.; Robar, V.

    2004-01-01

    Background. Basic goal of radiotherapy treatment is the irradiation of a target volume while minimizing the amount of radiation absorbed in healthy tissue. Shaping the beam is an important way of minimizing the absorbed dose in healthy tissue and critical structures. Conventional collimator jaws are used for shaping a rectangular treatment field; but, as usually treatment volume is not rectangular, additional shaping is required. On a linear accelerator, lead blocks or individually made Cerroben TM blocks are attached onto the treatment head under standard collimating system. Another option is the use of multileaf collimator (MLC). Conclusions. Multileaf collimator is becoming the main tool for beam shaping on the linear accelerator. It is a simple and useful system in the preparation and performance of radiotherapy treatment. Multileaf collimators are reliable, as their manufacturers developed various mechanisms for their precision, control and reliability, together with reduction of leakage and transmission of radiation between and through the leaves. Multileaf collimator is known today as a very useful clinical system for simple field shaping, but its use is getting even more important in dynamic radiotherapy, with the leaves moving during irradiation. This enables a precise dose delivery on any part of a treated volume. Intensity modulated radiotherapy (IMRT), the therapy of the future, is based on the dynamic use of MLC. (author)

  5. [Radiotherapy of oropharynx carcinoma].

    Science.gov (United States)

    Servagi Vernat, S; Tochet, F; Vieillevigne, L; Pointreau, Y; Maingon, P; Giraud, P

    2016-09-01

    Indication, doses, technique of radiotherapy and concomitant chemotherapy for oropharynx carcinoma are presented. The recommendations for delineation of the target volumes and organs at risk are detailed. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  6. Quality indicators in radiotherapy

    International Nuclear Information System (INIS)

    Cionini, Luca; Gardani, Gianstefano; Gabriele, Pietro; Magri, Secondo; Morosini, Pier Luigi; Rosi, Antonella; Viti, Vincenza

    2007-01-01

    Background and purpose: There is a widespread and increasing tendency to develop hospital performance indicators in the field of accreditation/certification systems and quality benchmarking. A study has been undertaken to develop a set of performance indicators for a typical radiotherapy Centre and to evaluate their ability to provide a continuous quality improvement. Materials and methods: A working group consisting of radiation oncologists, medical physicists and radiation technologists under the coordination of experts in health technology assessment has elaborated a set of general indicators able to monitor performances and the quality level of a typical radiotherapy Centre. The work has been carried out through four steps: a preliminary set of indicators was selected; data on these indicators were collected in a number of Italian radiotherapy Centres and medical physics Services; problems in collection and analysis of data were discussed; a final set of indicators was developed. Results: A final set of 13 indicators is here presented. They concern general structural and/or operational features, health physics activities and accuracy and technical complexity of the treatment. Conclusions: The indicators tested in a few Italian Centres of radiotherapy and medical physics Services are now ready to be utilized by a larger community

  7. Bowel disease after radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Schofield, P.F.; Holden, D.; Carr, N.D. (Christie Hospital and Holt Radium Inst., Manchester (UK))

    1983-06-01

    The clinical presentation, operative findings and outcome in 40 patients who required surgery for bowel disease after radiotherapy are presented. The type of presentation varied according to the time after radiotherapy. In the first month, many patients had a proctitis but none required surgery. Five patients were operated on within one month, 2 for radiation-induced acute ileitis and 3 for exacerbations of pre-existing disease (diverticular disease 2, ulcerative colitis 1). The commonest time of presentation was between 3 and 18 months after radiotherapy, when 20 patients needed surgery for bowel disease caused by radiation-induced local ischaemia. Twelve of these patients had chronic perforation, 6 had severe rectal bleeding and 2 had painful anorectal ulceration. Fifteen patients presented between 2 and 24 years after radiotherapy, usually with incomplete intestinal obstruction due to a fibrous stricture, but 2 patients had rectal carcinoma. Wide resection of the involved bowel was the principal method of treatment but any anastomosis was protected by a proximal defunctioning stoma. There was no operative mortality but 10 patients have died subsequently. The danger of dismissing these patients as having incurable malignancy is stressed because, although the condition is infrequent, it is usually amenable to adequate surgery.

  8. Radiotherapy of breast fibrosis

    International Nuclear Information System (INIS)

    Heibel, J.H.

    1979-01-01

    In a retrospective study radiotherapy of breast fibrosis in hormone-treated men with histologically confirmed prostate carcinoma was examined. 10 patients had received hormones even before irradiation, 113 obtained hormone administration only after irradiation. The objective size of the glandular body and the overall size of the breast were measured with a special method developed by the author. 46 patients indicated complaints. With hypertrophic mamma and hypertrophic mamilla in 67 examined patients, 127 different symptoms resulted in total. Four patients of the group who had obtained hormones before irradiation, suffered from subjective symptoms. It resulted that radiotherapy of breast fibrosis carried out during hormone treatment is no gynecomastia prophylaxis, that already existent mamma hypertrophies are irreversible, but that existent sensations were notably reduced within 6 months after irradiation therapy. These results indicate the necessity of a radiotherapy of the mamma fibrosis before the hormone treatment is begun. Particularly in cases of higher operative risks, also the possibility of preferring radiotherapy to mastectomy should be fully utilized, in view of adequate or even better therapeutic results. (orig./MG) [de

  9. Gamma apparatuses for radiotherapy

    International Nuclear Information System (INIS)

    Sul'kin, A.G.

    1986-01-01

    Scientific and technical achievements in development and application of gamma therapeutic apparatuses for external and intracavity irradiations are generalized. Radiation-physical parameters of apparatuses providing usability of progressive methods in radiotherapy of onclogical patients are given. Optimization of main apparatus elements, ensurance of its operation reliability, reduction of errors of irradiation plan reproduction are considered. Attention is paid to radiation safety

  10. Four R's of radiotherapy

    International Nuclear Information System (INIS)

    Withers, H.R.

    1975-01-01

    Radiotherapy given as multiple doses can be effective in sterilizing cancers, but the processes whereby the neoplasm is eradicated and the normal tissues are preserved are not fully understood. The differential between normal tissue and tumor response is enhanced by dose fractionation, single doses resulting in severe normal tissue injury when the dose is sufficient to control a proportion of treated tumors. Data are reviewed from radiobiological studies on laboratory animals and cultured cells that have thrown some light on four of the phenomena that influence the outcome of fractionated-dose radiotherapy, one or more of which may account for the relative sparing of normal tissues. These are repair of sublethal injury in normal and neoplastic cells, reoxygenation of the tumor, redistribution through the division cycle, and regeneration of surviving normal and malignant cells between dose fractions. These have been called the four R's of fractionated radiotherapy. Other factors are involved in the outcome of multifraction radiotherapy, including maintenance of the architectural integrity of the normal tissues, the volume of tissue irradi []ted, the tumor bed, and the immunocompetence of the host. (90 references) (CH)

  11. Proposal of a model for multidisciplinary treatment program of chronic migraine with medication overuse: preliminary study.

    Science.gov (United States)

    Grazzi, L; Prunesti, A; Bussone, G

    2015-05-01

    The treatment of patients with chronic migraine associated with medication overuse is challenging in clinical practice; different strategies of treatment have been recently developed, multidisciplinary treatment approaches have been developed in academic headache centers. Education and support of patients are necessary to improve patients' adherence to pharmacological treatments as well as to non-pharmacological therapies. This study reports a clinical experience conducted at our Headache center with a group of female patients, suffering from chronic migraine complicated by medication overuse, treated by a multidisciplinary approach and followed for a period of 1 year after withdrawal. Results confirm the efficacy of a multifaceted treatment to manage this problematic category of patients.

  12. Quality assurance in radiotherapy

    International Nuclear Information System (INIS)

    2003-03-01

    Good radiotherapy results and safety of treatment require the radiation to be optimally applied to a specified target area and the correct dose. According to international recommendations, the average uncertainty in therapeutic dose should not exceed 5%. The need for high precision in therapeutic dose requires quality assurance covering the entire radiotherapy process. Besides the physical and technical characteristics of the therapy equipment, quality assurance must include all radiotherapy equipment and procedures that are significant for the correct magnitude and precision of application of the therapeutic dose. The duties and responsibilities pertaining to various stages of treatment must also be precisely defined. These requirements may be best implemented through a quality system. The general requirements for supervision and quality assurance of medical radiation apparatus are prescribed in section 40 of the Radiation Act (592/1991, amendment 1142/1998) and in sections 18 and 32 of the Decree of the Ministry of Social Affairs and Health on the medical use of radiation (423/2000). Guide ST 2.2 imposes requirements on structural radiation shielding of radiotherapy equipment and the premises in which it is used, and on warning and safety arrangements. Guide ST 1.1 sets out the general safety principles for radiation practices and regulatory control procedure for the use of radiation. Guide ST 1.6 provides general requirements for operational measures in the use of radiation. This Guide sets out the duties of responsible parties (the party running a radiation practice) in respect of arranging and maintaining radiotherapy quality assurance. The principles set out in this Guide and Guide ST 6.3 may be applied to radionuclide therapy

  13. Radiotherapy of prostate cancer

    International Nuclear Information System (INIS)

    Krause, S.; Herfarth, K.

    2011-01-01

    With the development of modern radiation techniques, such as intensity-modulated radiotherapy (IMRT), a dose escalation in the definitive radiotherapy of prostate cancer and a consecutive improvement in biochemical recurrence-free survival (BFS) could be achieved. Among others, investigators at the Memorial Sloan-Kettering Cancer Center (MSKCC) saw 5-year BFS rates of up to 98%. A further gain in effectiveness and safety is expected of hypofractionation schedules, as suggested by data published by Kupelian et al., who saw a low 5-year rate of grade ≥2 rectal side-effects of 4.5%. However, randomized studies are just beginning to mature. Patients with intermediate or high-risk tumors should receive neoadjuvant (NHT) and adjuvant (AHT) androgen deprivation. Bolla et al. could show an increase in 5-year overall survival from 62-78%. The inclusion of the whole pelvis in the treatment field (WPRT) is still controversial. The RTOG 94-13 study showed a significant advantage in disease-free survival after 60 months but long-term data did not yield significant differences between WPRT and irradiation of the prostate alone. The German Society of Urology strongly recommends adjuvant radiotherapy of the prostate bed for pT3 N0 tumors with positive margins. In a pT3 N0 R0 or pT2 N0 R+ situation, adjuvant radiotherapy should at least be considered. So far, no randomized data on NHT and AHT have been published, so androgen deprivation remains an individual decision in the postoperative setting. In a retrospective analysis Spiotto et al. reported a positive effect for adjuvant WPRT and biochemical control. This article summarizes the essential publications on definitive and adjuvant radiotherapy and discusses the additional use of androgen deprivation and WPRT. (orig.) [de

  14. Radiotherapy and brachytherapy

    International Nuclear Information System (INIS)

    2007-02-01

    This presentation first defines the radiotherapy and brachytherapy techniques, indicates the used ionizing radiations (electromagnetic and particles), describes the mechanisms and processes of action of ionizing radiations: they can be physical by photon-matter interactions (Compton effect and photoelectric effect) or due to electron-matter interactions (excitation, ionization), physical-chemical by direct or indirect action (DNA damage), cellular (mitotic or apoptotic death), tissue (sane and tumorous tissues and differential effect). It discusses the biological efficiency of these treatments which depends on different parameters: intrinsic radio-sensitivity, time (session fractioning and organisation in time), oxygen, radiation quality, cellular cycle, dose rate, temperature. It presents the different types of radiotherapy: external radiotherapy (general sequence, delineation, dosimetry, protection of critical organs, treatment session, quality control, monitoring consultation) and briefly presents some specific techniques (total body irradiation, total cutaneous electron therapy, pre-operation radiotherapy, radio-surgery, hadron-therapy). It proposes an overview of the main indications for this treatment: brain tumours, upper aero digestive tract tumours, bronchial tumours, oesophagus, stomach and pancreas tumours, breast tumours, cervix cancer, rectum tumour, and so on, and indicates the possible associated treatments. The next part addresses brachytherapy. It presents the principles and comments the differences with radiotherapy. It indicates the used radio-elements (Caesium 137, Iridium 192, Iodine 125), describes the implementation techniques (plastic tubes, use of iodine 125, intracavitary and endo-luminal radiation therapy). It proposes an overview of the different treated tumours (skin, breast, prostates, bronchial, oesophagus, ENT) and indicates possible early and late secondary effects for different organs

  15. Daily Megavoltage Computed Tomography in Lung Cancer Radiotherapy: Correlation Between Volumetric Changes and Local Outcome

    International Nuclear Information System (INIS)

    Bral, Samuel; De Ridder, Mark; Duchateau, Michael; Gevaert, Thierry; Engels, Benedikt; Schallier, Denis; Storme, Guy

    2011-01-01

    Purpose: To assess the predictive or comparative value of volumetric changes, measured on daily megavoltage computed tomography during radiotherapy for lung cancer. Patients and Methods: We included 80 patients with locally advanced non-small-cell lung cancer treated with image-guided intensity-modulated radiotherapy. The radiotherapy was combined with concurrent chemotherapy, combined with induction chemotherapy, or given as primary treatment. Patients entered two parallel studies with moderately hypofractionated radiotherapy. Tumor volume contouring was done on the daily acquired images. A regression coefficient was derived from the volumetric changes on megavoltage computed tomography, and its predictive value was validated. Logarithmic or polynomial fits were applied to the intratreatment changes to compare the different treatment schedules radiobiologically. Results: Regardless of the treatment type, a high regression coefficient during radiotherapy predicted for a significantly prolonged cause-specific local progression free-survival (p = 0.05). Significant differences were found in the response during radiotherapy. The significant difference in volumetric treatment response between radiotherapy with concurrent chemotherapy and radiotherapy plus induction chemotherapy translated to a superior long-term local progression-free survival for concurrent chemotherapy (p = 0.03). An enhancement ratio of 1.3 was measured for the used platinum/taxane doublet in comparison with radiotherapy alone. Conclusion: Contouring on daily megavoltage computed tomography images during radiotherapy enabled us to predict the efficacy of a given treatment. The significant differences in volumetric response between treatment strategies makes it a possible tool for future schedule comparison.

  16. Operations research for resource planning and -use in radiotherapy: a literature review

    OpenAIRE

    Vieira, Bruno; Hans, Erwin W.; van Vliet-Vroegindeweij, Corine; van de Kamer, Jeroen; van Harten, Wim

    2016-01-01

    Background The delivery of radiotherapy (RT) involves the use of rather expensive resources and multi-disciplinary staff. As the number of cancer patients receiving RT increases, timely delivery becomes increasingly difficult due to the complexities related to, among others, variable patient inflow, complex patient routing, and the joint planning of multiple resources. Operations research (OR) methods have been successfully applied to solve many logistics problems through the development of a...

  17. An experiment in multidisciplinary digital design

    NARCIS (Netherlands)

    Tuncer, B.; De Ruiter, P.; Mulders, S.

    2008-01-01

    The design and realization of complex buildings requires multidisciplinary design collaboration from early on in the design process. The intensive use of digital design environments in this process demands new knowledge and skills from the involved players including integrating and managing digital

  18. Improving Student Achievement in a Multidisciplinary Context

    Science.gov (United States)

    Chapman, Amanda; Bloxham, Sue

    2004-01-01

    This article analyses interim findings of an ongoing action research project into the use of assessment criteria and grade descriptors in the assessment process. The project is multidisciplinary and covers areas as diverse as Sports Sociology, Economics, Youth and Community Studies, and Education. The idea is to equip first-year students with the…

  19. Sustaining impactful multidisciplinary contributions over five decades

    Directory of Open Access Journals (Sweden)

    Kulbhushan Balooni

    2017-06-01

    By tracing the trajectory of Singh's vast and varied experience, attitude and approach to research, and scholarly output in international publications that have advanced knowledge and found applications from management to biological and social sciences, this interview offer pathways to research scholars for sustained multidisciplinary and impactful research in their careers.

  20. Stronger Disciplinary Identities in Multidisciplinary Research Schools

    Science.gov (United States)

    Geschwind, Lars; Melin, Göran

    2016-01-01

    In this study, two multidisciplinary Social Sciences and Humanities research schools in Sweden have been investigated regarding disciplinary identity-making. This study investigates the meetings between different disciplines around a common thematic area of study for Ph.D. students. The Ph.D. students navigate through a complex social and…

  1. Augmented Reality for Multi-disciplinary Collaboration

    OpenAIRE

    Wang, Xiangyu; Rui,

    2010-01-01

    This chapter presents a framework for multi-disciplinary collaboration. Tangible Augmented Reality has been raised as one of suitable systems for design collaboration. Furthermore, it emphasizes the advantages of Tangible Augmented Reality to illustrate the needs for integrating the Tangible User Interfaces and Augmented Reality Systems.

  2. Multidisciplinary training of cancer specialists in Europe

    DEFF Research Database (Denmark)

    Benstead, Kim; Turhal, Nazim Serdar; O'Higgins, Niall

    2017-01-01

    The best care for patients with cancer is most likely to be achieved when decisions about diagnosis, staging and treatment are made at multidisciplinary and multiprofessional meetings, preferably when all the professional expertise relevant to the patient's condition is gathered together. Questio......The best care for patients with cancer is most likely to be achieved when decisions about diagnosis, staging and treatment are made at multidisciplinary and multiprofessional meetings, preferably when all the professional expertise relevant to the patient's condition is gathered together....... Questionnaires were sent to National Societies of Radiation Oncology and Medical Oncology concerning similarities and differences in training programs and multidisciplinary care in member states in Europe. Results indicated wide variation in training systems and practice. Data were lacking for Surgery because...... surgeons training in cancer surgery) is recommended. This is likely to improve the value of multidisciplinary meetings and may result in improved patient care. The Expert Group on Cancer Control of the European Commission has endorsed this recommendation....

  3. Multidisciplinary Analysis of a Hypersonic Engine

    Science.gov (United States)

    Suresh, Ambady; Stewart, Mark

    2003-01-01

    The objective is to develop high fidelity tools that can influence ISTAR design In particular, tools for coupling Fluid-Thermal-Structural simulations RBCC/TBCC designers carefully balance aerodynamic, thermal, weight, & structural considerations; consistent multidisciplinary solutions reveal details (at modest cost) At Scram mode design point, simulations give details of inlet & combustor performance, thermal loads, structural deflections.

  4. Multidisciplinary approaches to climate change questions

    Science.gov (United States)

    Middleton, Beth A.; LePage, Ben A.

    2011-01-01

    Multidisciplinary approaches are required to address the complex environmental problems of our time. Solutions to climate change problems are good examples of situations requiring complex syntheses of ideas from a vast set of disciplines including science, engineering, social science, and the humanities. Unfortunately, most ecologists have narrow training, and are not equipped to bring their environmental skills to the table with interdisciplinary teams to help solve multidisciplinary problems. To address this problem, new graduate training programs and workshops sponsored by various organizations are providing opportunities for scientists and others to learn to work together in multidisciplinary teams. Two examples of training in multidisciplinary thinking include those organized by the Santa Fe Institute and Dahlem Workshops. In addition, many interdisciplinary programs have had successes in providing insight into climate change problems including the International Panel on Climate Change, the Joint North American Carbon Program, the National Academy of Science Research Grand Challenges Initiatives, and the National Academy of Science. These programs and initiatives have had some notable success in outlining some of the problems and solutions to climate change. Scientists who can offer their specialized expertise to interdisciplinary teams will be more successful in helping to solve the complex problems related to climate change.

  5. The Multidisciplinary Economics of Money Laundering

    NARCIS (Netherlands)

    Ferwerda, J.|info:eu-repo/dai/nl/314405526

    2012-01-01

    Money laundering has been studied for many years, but mainly by lawyers and criminologists. This dissertation presents a number of ways on how an economist – mainly in a multidisciplinary fashion – can contribute to this field of research. This dissertation answers four important questions about

  6. Selective Mutism in Elementary School: Multidisciplinary Interventions.

    Science.gov (United States)

    Giddan, Jane J.; And Others

    1997-01-01

    Presents the symptoms of selective mutism and historical background for treatment. It provides a case study which illustrates successful multidisciplinary treatment outcomes for a child who was selectively mute. Issues relevant to speech-language pathologists working with elementary school children are discussed and treatment guidelines provided.…

  7. Placenta accreta and anesthesia: A multidisciplinary approach

    OpenAIRE

    R S Khokhar; J Baaj; M U Khan; F A Dammas; N Rashid

    2016-01-01

    Placenta accreta (an abnormally adherent placenta) is one of the two leading causes of peripartum hemorrhage and the most common indication for peripartum hysterectomy. Placenta accreta may be associated with significant maternal hemorrhage at delivery owing to the incomplete placental separation. When placenta accreta is diagnosed before delivery, a multidisciplinary approach may improve patient outcome.

  8. Placenta accreta and anesthesia: A multidisciplinary approach

    Directory of Open Access Journals (Sweden)

    R S Khokhar

    2016-01-01

    Full Text Available Placenta accreta (an abnormally adherent placenta is one of the two leading causes of peripartum hemorrhage and the most common indication for peripartum hysterectomy. Placenta accreta may be associated with significant maternal hemorrhage at delivery owing to the incomplete placental separation. When placenta accreta is diagnosed before delivery, a multidisciplinary approach may improve patient outcome.

  9. Towards multidisciplinary support tools for innovation tasks

    NARCIS (Netherlands)

    Wits, Wessel Willems; Bakker, H.M.; Chechurin, L.S.

    2012-01-01

    This paper highlights the imperative need for innovation and characterizes a promising support tool to stimulate this process. The importance of innovation for both a global economy and specifically for engineering education is discussed. Additionally, the urgency for multidisciplinary skills for

  10. Exploration of fluorine chemistry at the multidisciplinary interface of chemistry and biology.

    Science.gov (United States)

    Ojima, Iwao

    2013-07-05

    Over the last three decades, my engagement in "fluorine chemistry" has evolved substantially because of the multidisciplinary nature of the research programs. I began my research career as a synthetic chemist in organometallic chemistry and homogeneous catalysis directed toward organic synthesis. Then, I was brought into a very unique world of "fluorine chemistry" in the end of 1970s. I started exploring the interface of fluorine chemistry and transition metal homogeneous catalysis first, which was followed by amino acids, peptides, and peptidomimetics for medicinal chemistry. Since then, I have been exploring the interfaces of fluorine chemistry and multidisciplinary fields of research involving medicinal chemistry, chemical biology, cancer biology, and molecular imaging. This perspective intends to cover my fruitful endeavor in the exploration of fluorine chemistry at the multidisciplinary interface of chemistry and biology in a chronological order to show the evolution of my research interest and strategy.

  11. Multifidelity, multidisciplinary optimization of turbomachines with shock interaction

    Science.gov (United States)

    Joly, Michael Marie

    Research on high-speed air-breathing propulsion aims at developing aircraft with antipodal range and space access. Before reaching high speed at high altitude, the flight vehicle needs to accelerate from takeoff to scramjet takeover. Air turbo rocket engines combine turbojet and rocket engine cycles to provide the necessary thrust in the so-called low-speed regime. Challenges related to turbomachinery components are multidisciplinary, since both the high compression ratio compressor and the powering high-pressure turbine operate in the transonic regime in compact environments with strong shock interactions. Besides, lightweight is vital to avoid hindering the scramjet operation. Recent progress in evolutionary computing provides aerospace engineers with robust and efficient optimization algorithms to address concurrent objectives. The present work investigates Multidisciplinary Design Optimization (MDO) of innovative transonic turbomachinery components. Inter-stage aerodynamic shock interaction in turbomachines are known to generate high-cycle fatigue on the rotor blades compromising their structural integrity. A soft-computing strategy is proposed to mitigate the vane downstream distortion, and shown to successfully attenuate the unsteady forcing on the rotor of a high-pressure turbine. Counter-rotation offers promising prospects to reduce the weight of the machine, with fewer stages and increased load per row. An integrated approach based on increasing level of fidelity and aero-structural coupling is then presented and allows achieving a highly loaded compact counter-rotating compressor.

  12. [Multidisciplinary management of gastroplasty candidates: example of Avicenne Hospital].

    Science.gov (United States)

    Bihan, Hélène; Choleau, Carine; Catheline, Jean-Marc; Reach, Gérard; Fournier, Jean-Luc; Garnier, Nathalie; Robert, Françoise; Poulhès, Christiane; Sidotmane, Fatma; Bénichou, Joseph; Cohen, Régis

    2008-03-01

    The decision to perform gastroplasty must be made by a multidisciplinary team. This organization ensures compliance with good practice guidelines. Multidisciplinary management after surgery is also essential but patients' adhesion to follow-up is relatively poor.

  13. External audit in radiotherapy dosimetry

    International Nuclear Information System (INIS)

    Thwaites, D.I.; Western General Hospital, Edinburgh

    1996-01-01

    Quality audit forms an essential part of any comprehensive quality assurance programme. This is true in radiotherapy generally and in specific areas such as radiotherapy dosimetry. Quality audit can independently test the effectiveness of the quality system and in so doing can identify problem areas and minimize their possible consequences. Some general points concerning quality audit applied to radiotherapy are followed by specific discussion of its practical role in radiotherapy dosimetry, following its evolution from dosimetric intercomparison exercises to routine measurement-based on-going audit in the various developing audit networks both in the UK and internationally. Specific examples of methods and results are given from some of these, including the Scottish+ audit group. Quality audit in radiotherapy dosimetry is now well proven and participation by individual centres is strongly recommended. Similar audit approaches are to be encouraged in other areas of the radiotherapy process. (author)

  14. Radiotherapy of lymphogranulomatosis

    International Nuclear Information System (INIS)

    Roettinger, E.M.; Sack, H.

    1976-01-01

    Increased knowledge about the course of lymphogranulomatosis and technological progress in radiotherapy during the past 20 years have brought permanent recovery for a major part of patients from this disease which had been infaust before. The supplementation of the local radiotherapy by the systematic effects of chemotherapy enables us at the same time to control the infiltrations and disseminations which cannot be manifested clinically especially in malignant forms and later stages. The good healing results obtained presuppose careful clinical examination of the patient and attentive care during the therapy with regard to the potential complications of radio- and chemotherapy. As potential complications which may occur according to the method used we may name damage to the kidneys, radiopneumonia or pulmonal fibrosis, myocarditis or pericarditis, oeosophagitis, enteritis, and hepatitis. Relatively seldom we see the permanent depression of the bone marrow, induction of leucaemia, and myxoedema. All these complications can occure more frequently in the case of additional chemotherapy. (orig./MG) [de

  15. Combined radiotherapy-chemotherapy

    International Nuclear Information System (INIS)

    Steel, G.G.

    1989-01-01

    This paper presents the clinically confirmed benefits of combined chemotherapy-radiotherapy. They have been found in a small group of diseases that respond to chemotherapy alone. According to the author, only when a drug or drug combination has the ability to eradicate occult disease or substantially to reduce the size of objectively measurable disease is there likely to be an demonstrable benefit from its use in conjunction with radiotherapy. It is the author's belief that the immediate future lies in selecting drugs and patients in which a good chemotherapeutic response can be expected, avoiding drugs that seriously enhance radiation damage to normal tissues and keeping drug and radiation treatments far enough apart in time to minimize interactions

  16. Oral complications of radiotherapy in the head and neck; Complicacoes bucais da radioterapia em cabeca e pescoco

    Energy Technology Data Exchange (ETDEWEB)

    Jham, Bruno Correi; Freire, Addah Regina da Silva [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Faculdade de Odontologia

    2006-09-15

    Radiotherapy is a treatment modality largely used for head and neck malignancies. However, high doses of radiation in large areas, including the oral cavity, maxilla, mandible and salivary glands may result in several undesired reactions. Mucositis, candidosis, disgeusia, radiation caries, osteoradionecrosis, soft tissue necrosis and xerostomia are some of radiotherapy's complications.Aim: The aim of this study is to briefly review the side effects that may be seen in the oral cavity during or after radiotherapy treatment in the head and neck region.Basic Method Used: Review of relevant literature.Study Design: Literature review.Results: Radiotherapy is still associated with several side effects, significantly affecting patients quality of life.Conclusions: A multidisciplinary treatment, including physicians, dentists, speech therapists, nutritionists, and psychologists, is the best alternative to minimize, or even prevent such reactions. (author)

  17. Conformal radiotherapy: a glossary

    International Nuclear Information System (INIS)

    Dubray, B.; Giraud, P.; Beaudre, A.

    1999-01-01

    Most of the concepts and terms related to conformal radiotherapy were produced by English-speaking authors and eventually validated by international groups of experts, whose working language was also English. Therefore, a significant part of this literature is poorly accessible to the French-speaking radiation oncology community. The present paper gathers the 'official' definitions already published in French, along with propositions for the remaining terms which should be submitted to a more formal and representative validation process. (author)

  18. Imagination in radiotherapy

    International Nuclear Information System (INIS)

    Pourrez, A.; Truc, G.; Santona, M.; Crehange, G.; Peignaux, K.; Martin, E.; Maingon, P.

    2010-01-01

    Based on a questionnaire given to the patients of a radiotherapy department and to the personnel of a centre of struggle against cancer, the study aimed at revealing imagination and representations about such an advanced medical technology, radio-physics and radioactivity. The patients and personnel were asked to answer the questionnaire with free words, images, or by expressing their own intimate or cultural visions of this environment. Implications on patients' anguish are foreseen. Short communication

  19. The pioneer of radiotherapy

    International Nuclear Information System (INIS)

    Camilleri, J.P.; Coursaget, J.

    2005-09-01

    This work narrates the history of the birth of a new field, the radiology and its application to radiotherapy for these multiform pathologies that are the cancers. Two leading figures will favour this field: Marie Curie, physicist and twice awarded by nobel price, and Claudius Regaud, histologist and become a specialist of the action of ionizing radiations on tissues. They will create the Curie Institute, in relation with the Radium Institute and the support of the Pasteur Institute in 1920. (N.C.)

  20. Quality control in radiotherapy

    International Nuclear Information System (INIS)

    Batalla, A.

    2009-01-01

    The authors discuss the modalities and periodicities of internal quality control on radiotherapy installations. They indicate the different concerned systems and the aspects and items to be controlled (patient and personnel security, apparatus mechanical characteristics, beam quality, image quality, isodose and irradiation duration calculation, data transfer). They present the measurement instruments and tools used for the mechanical controls, dose measurement, beam homogeneity and symmetry, anatomic data acquisition systems, and dose distribution and control imagery calculation

  1. Radiotherapy of endocrine orbitopathy

    International Nuclear Information System (INIS)

    Weischedel, U.; Wieland, C.

    1985-01-01

    After a review of the history and a discussion of recent theories about pathogenesis of endocrine ophthalmopathy the authros give a report on their radiotherapeutical treatment results with cobalt-60-γ-rays in 50 patients. Amelioration was achieved in 50% of the cases, in the other 50% no progression was seen. Radiotherapy is of antiphlogistic and functional effectivity and should be integrated in the treatment regime in early stages. (orig.) [de

  2. Surveillance after prostate cancer radiotherapy

    International Nuclear Information System (INIS)

    Supiot, S.; Rio, E.; Clement-Colmou, K.; Bouchot, O.; Rigaud, J.

    2011-01-01

    Follow-up after prostate cancer radiotherapy aims at detecting local or metastatic relapse, as well as long-term toxicity, requiring adapted treatments. Several scientific societies have published guidelines including clinical, biological and imaging recommendations. More data suggest a role for aggressive salvage therapy in case of local failure following radiotherapy. An adequate follow-up is required for the sake of patients' safety, i.e. to a posteriori validate dose constraints and radiation technique in each radiotherapy department. (authors)

  3. Radiotherapy of vertebral hemangiomas

    International Nuclear Information System (INIS)

    Sakata, Kohichi; Hareyama, Masato; Oouchi, Atushi; Sido, Mitsuo; Nagakura, Hisayasu; Tamakawa, Mituharu; Akiba, Hidenari; Morita, Kazuo

    1997-01-01

    Between 1975 and 1996, 14 patients (11 females, 3 males) with vertebral hemangioma received treatment with radiotherapy. Thirteen patients had a history of back pain or lumbago and 2 patients had neurological symptoms such as sensory impairment or paraplegia. The standard dose administered was 36 Gy in 18 fractions (five treatments per week). In the 13 patients with pain, this was completely or partially relieved. The condition of a man with hypesthesia of the legs deteriorated and a woman with paraplegia who was treated with decompressive laminectomy followed by radiotherapy recovered completely after irradiation. CT scan before irradiation showed thickened trabeculae as small punctate areas of sclerosis in all patients. At MR imaging before irradiation, T2-weighted MR images showed areas of high intensity in all patients and MR images demonstrated lesion enhancement. However, none of the patients who were treated successfully with radiation demonstrated any changes of the affected vertebra in the conventional radiographic films, CT scan or MR imaging, even 5 years after irradiation. Radiological imaging is indispensable for the diagnosis of vertebral hemangiomas but does not appear to be useful for evaluating the effects of radiotherapy. (orig.)

  4. Radiotherapy in Cancer Management

    International Nuclear Information System (INIS)

    Abdel-Wahab, M.

    2015-01-01

    Radiotherapy has been used for curative or palliative treatment of cancer, either alone or increasingly as part of a multimodality approach in conjunction with chemotherapy, immunotherapy or surgery. Radiation must be delivered in the safest and most effective way. The use of radiologic and nuclear medicine diagnostic techniques, e.g., the use of CT (Computerized Tomography) and PET/CT allow better detection and staging of diseases by displaying both morphological and functional abnormalities within the affected organs and are essential in the process of radiotherapy planning. Technical advances in radiotherapy have allowed better targeting of tumors, sparing of normal tissue and, in the case of radiosurgery, a decrease in the number of treatments. The IAEA Programme in Human Health aims to enhance the capabilities in Member States to address needs related to the treatment of diseases, including cancer, through the application of nuclear techniques. The Programme supports quality assurance in radiation medicine; DIRAC, the only radiation oncology-specific resource database world-wide; significant, innovative education and training programmes through telemedicine and e-learning accessible via the human health campus website. Technical expertise for country– and region–specific technical cooperation radiation-medicine projects is provided to establish or enhance radiation medicine worldwide. (author)

  5. Norwegian program of quality assurance in radiotherapy (KVIST) - Organisation, benefits and experience feedback;Programme norvegien d'assurance qualite dans la radiotherapie (KVIST) - Organisation, benefices et retour d'experience

    Energy Technology Data Exchange (ETDEWEB)

    Merete Olerud, H. [Oslo Univ., Autorite Norvegienne de Radioprotection, Osteras, Institut de Physique et Biophysique (Norway); Levernes, S. [Oslo Univ., Centre Hospitalier, Autorite Norvegienne de Radioprotection, Osteras - DNR, Montebello (Norway); Hellebust, T.P. [Autorite Norvegienne de Radioprotection, Osteras, Centre Hospitalier, DNR, Montebello (Norway); Heikkela, I.E. [Autorite Norvegienne de Radioprotection, Osteras D.C., Johannessen, Centre Hospitalier Universitaire - Ulleval, Oslo (Norway); Bjerke, H. [Autorite Norvegienne de Radioprotection, Osteras, Rekstad BL, Centre Hospitalier Universitaire - Ulleval, Oslo (Norway); Sundqvist, E. [Programme Radiographie, Faculte de la Sante, Oslo, College Universitaire, Oslo (Norway); Frykholm, G. [Oslo Univ., Centre Hospitalier Universitaire, Autorite Norvegienne de Radioprotection, Osteras, St.Olav, Trondheim (Norway)

    2009-12-15

    In 2000, the Norwegian Radiation Protection Authority (N.R.P.A.) initiated work to develop a national quality assurance programme in radiotherapy. The program was named K.V.I.S.T.: i.e. Norwegian abbreviation of Quality Assurance in Radiotherapy (KValitetSikring STraleterapi). The programme is performed by the multidisciplinary K.V.I.S.T. Group and aims to stimulate collaboration by focussing on clinical, technical and administrative problems that can be addressed and solved on a national level. An important objective is to establish a positive attitude towards quality assurance and better communication between centres and the various professions and professionals involved in radiotherapy, i.e. the oncologists, medical physicists and radiation therapy technologists. Information is also provided to other stake holders such as health authorities, hospital administrators and patients. In 2007 radiotherapy in Norway represent 10 departments and forty accelerators. Since radiotherapy is given high priority in cancer care good quality assurance is required. The member of the K.V.I.S.T.-group are part time at N.R.P.A. and part time in different radiotherapy departments. Professionals with competencies within radiotherapy (R.T.) have permanent positions in a national public entity. The K.V.I.S.T.-group is multidisciplinary. The K.V.I.S.T.-group acts as a coordinating group for all type of national Q.A. projects. The recommendations/guidelines are developed by national consensus. The work is performed by the radiotherapy community it self, thus creating an atmosphere of ownership. (N.C.)

  6. Multidisciplinary approach in the treatment of T1 glottic cancer. The role of patient preference in an homogenous patient population

    International Nuclear Information System (INIS)

    Dinapoli, Nicola; Parrilla, Claudio; Galli, Jacopo

    2010-01-01

    To compare oncological outcome and voice quality among a uniform and well-defined subset of patients with T1 glottic carcinoma. Patients, affected by laryngeal glottic carcinoma, treated by laser CO 2 surgery or radiotherapy, have been analyzed. Overall survival and disease-free survival were calculated. In order to verify differences in functional outcomes and voice quality, all patients were interviewed during their last follow-up visit during 2009 using the VHI (Voice Handicap Index) questionnaire. The data were analyzed using the MedCalc software. A total of 143 patients were analyzed: 73 underwent surgery and 70 underwent radiotherapy. No statistically significant differences were found between the two groups in terms of overall survival and disease-free survival; dividing patients into stages T1a and T1b also made no difference. In order to evaluate the differences in outcomes for surgery and radiotherapy, patients were interviewed using the VHI questionnaire. Better scores for each category in the VHI were found for patients receiving radiotherapy compared to surgery (physical: p = 0.0023; functional: p < 0.0001; environmental: p < 0.001). The median VHI score for radiotherapy patients was 4, while for surgical patients it was 18 (p < 0.0001). This study confirms the well-known knowledge that results from radiotherapy and surgery in early glottic cancer treatment are equivalent. Furthermore, the role of patient preference in the treatment modality choice and the value of a multidisciplinary approach for a detailed and multi-oriented discussion with the patient are outlined. (orig.)

  7. Multidisciplinary approach in the treatment of T1 glottic cancer. The role of patient preference in an homogenous patient population

    Energy Technology Data Exchange (ETDEWEB)

    Dinapoli, Nicola [Catholic Univ. of the Sacred Heart, Rome (Italy). Dept. of Radiation Oncology; Parrilla, Claudio; Galli, Jacopo [Catholic Univ. of the Sacred Heart, Rome (IT). Dept. of Otorhinolaryngoiatry] (and others)

    2010-11-15

    To compare oncological outcome and voice quality among a uniform and well-defined subset of patients with T1 glottic carcinoma. Patients, affected by laryngeal glottic carcinoma, treated by laser CO{sub 2} surgery or radiotherapy, have been analyzed. Overall survival and disease-free survival were calculated. In order to verify differences in functional outcomes and voice quality, all patients were interviewed during their last follow-up visit during 2009 using the VHI (Voice Handicap Index) questionnaire. The data were analyzed using the MedCalc software. A total of 143 patients were analyzed: 73 underwent surgery and 70 underwent radiotherapy. No statistically significant differences were found between the two groups in terms of overall survival and disease-free survival; dividing patients into stages T1a and T1b also made no difference. In order to evaluate the differences in outcomes for surgery and radiotherapy, patients were interviewed using the VHI questionnaire. Better scores for each category in the VHI were found for patients receiving radiotherapy compared to surgery (physical: p = 0.0023; functional: p < 0.0001; environmental: p < 0.001). The median VHI score for radiotherapy patients was 4, while for surgical patients it was 18 (p < 0.0001). This study confirms the well-known knowledge that results from radiotherapy and surgery in early glottic cancer treatment are equivalent. Furthermore, the role of patient preference in the treatment modality choice and the value of a multidisciplinary approach for a detailed and multi-oriented discussion with the patient are outlined. (orig.)

  8. Long-term unmaintained remissions after agressive multidisciplinary treatment of advanced non-seminomatous testicular germ cell tumors.

    Science.gov (United States)

    Carey, R W; Weitzman, S A; Wilkins, E W; Chu, A M; Prout, G R

    1977-10-01

    Five patients with disseminated non-seminomatous testicular germ cell tumors are described. These patients have been clinically free of disease for 25 to more than 99 months and may be cured, since the interval after last treatment ranges from 13 to more than 76 months. Two patients, including 1 with pure choriocarcinoma, represent chemotherapeutic successes. In 3 patients the advantages of an individualized, multidisciplinary approach with surgery, radiotherapy and chemotherapy are shown. The benefits of continued aggressive treatment using residual therapeutic modalities despite prior failure with other therapy are documented.

  9. Recent advances in multidisciplinary critical care.

    Science.gov (United States)

    Blot, Stijn; Afonso, Elsa; Labeau, Sonia

    2015-01-01

    The intensive care unit is a work environment where superior dedication is crucial for optimizing patients' outcomes. As this demanding commitment is multidisciplinary in nature, it requires special qualities of health care workers and organizations. Thus research in the field covers a broad spectrum of activities necessary to deliver cutting-edge care. However, given the numerous research articles and education activities available, it is difficult for modern critical care clinicians to keep up with the latest progress and innovation in the field. This article broadly summarizes new developments in multidisciplinary intensive care. It provides elementary information about advanced insights in the field via brief descriptions of selected articles grouped by specific topics. Issues considered include care for heart patients, mechanical ventilation, delirium, nutrition, pressure ulcers, early mobility, infection prevention, transplantation and organ donation, care for caregivers, and family matters. ©2015 American Association of Critical-Care Nurses.

  10. Initial Multidisciplinary Design and Analysis Framework

    Science.gov (United States)

    Ozoroski, L. P.; Geiselhart, K. A.; Padula, S. L.; Li, W.; Olson, E. D.; Campbell, R. L.; Shields, E. W.; Berton, J. J.; Gray, J. S.; Jones, S. M.; hide

    2010-01-01

    Within the Supersonics (SUP) Project of the Fundamental Aeronautics Program (FAP), an initial multidisciplinary design & analysis framework has been developed. A set of low- and intermediate-fidelity discipline design and analysis codes were integrated within a multidisciplinary design and analysis framework and demonstrated on two challenging test cases. The first test case demonstrates an initial capability to design for low boom and performance. The second test case demonstrates rapid assessment of a well-characterized design. The current system has been shown to greatly increase the design and analysis speed and capability, and many future areas for development were identified. This work has established a state-of-the-art capability for immediate use by supersonic concept designers and systems analysts at NASA, while also providing a strong base to build upon for future releases as more multifidelity capabilities are developed and integrated.

  11. Case study thoracic radiotherapy in an elderly patient with pacemaker: The issue of pacing leads

    Energy Technology Data Exchange (ETDEWEB)

    Kirova, Youlia M., E-mail: youlia.kirova@curie.net [Department of Radiation Oncology, Institut Curie, Paris (France); Menard, Jean; Chargari, Cyrus; Mazal, Alejandro [Department of Radiation Oncology, Institut Curie, Paris (France); Kirov, Krassen [Department of Anesthesiology and Reanimation, Institut Curie, Paris (France)

    2012-07-01

    To assess clinical outcome of patients with pacemaker treated with thoracic radiation therapy for T8-T9 paravertebral chloroma. A 92-year-old male patient with chloroma presenting as paravertebral painful and compressive (T8-T9) mass was referred for radiotherapy in the Department of Radiation Oncology, Institut Curie. The patient presented with cardiac dysfunction and a permanent pacemaker that had been implanted prior. The decision of Multidisciplinary Meeting was to deliver 30 Gy in 10 fractions for reducing the symptoms and controlling the tumor growth. The patient received a total dose of 30 Gy in 10 fractions using 4-field conformal radiotherapy with 20-MV photons. The dose to pacemaker was 0.1 Gy but a part of the pacing leads was in the irradiation fields. The patient was treated the first time in the presence of his radiation oncologist and an intensive care unit doctor. Moreover, the function of his pacemaker was monitored during the entire radiotherapy course. No change in pacemaker function was observed during any of the radiotherapy fractions. The radiotherapy was very well tolerated without any side effects. The function of the pacemaker was checked before and after the radiotherapy treatment by the cardiologist and no pacemaker dysfunction was observed. Although updated guidelines are needed with acceptable dose criteria for implantable cardiac devices, it is possible to treat patients with these devices and parts encroaching on the radiation field. This case report shows we were able to safely treat our patient through a multidisciplinary approach, monitoring the patient during each step of the treatment.

  12. Case study thoracic radiotherapy in an elderly patient with pacemaker: The issue of pacing leads

    International Nuclear Information System (INIS)

    Kirova, Youlia M.; Menard, Jean; Chargari, Cyrus; Mazal, Alejandro; Kirov, Krassen

    2012-01-01

    To assess clinical outcome of patients with pacemaker treated with thoracic radiation therapy for T8-T9 paravertebral chloroma. A 92-year-old male patient with chloroma presenting as paravertebral painful and compressive (T8-T9) mass was referred for radiotherapy in the Department of Radiation Oncology, Institut Curie. The patient presented with cardiac dysfunction and a permanent pacemaker that had been implanted prior. The decision of Multidisciplinary Meeting was to deliver 30 Gy in 10 fractions for reducing the symptoms and controlling the tumor growth. The patient received a total dose of 30 Gy in 10 fractions using 4-field conformal radiotherapy with 20-MV photons. The dose to pacemaker was 0.1 Gy but a part of the pacing leads was in the irradiation fields. The patient was treated the first time in the presence of his radiation oncologist and an intensive care unit doctor. Moreover, the function of his pacemaker was monitored during the entire radiotherapy course. No change in pacemaker function was observed during any of the radiotherapy fractions. The radiotherapy was very well tolerated without any side effects. The function of the pacemaker was checked before and after the radiotherapy treatment by the cardiologist and no pacemaker dysfunction was observed. Although updated guidelines are needed with acceptable dose criteria for implantable cardiac devices, it is possible to treat patients with these devices and parts encroaching on the radiation field. This case report shows we were able to safely treat our patient through a multidisciplinary approach, monitoring the patient during each step of the treatment.

  13. Radiotherapy for stage IV oropharyngeal cancer

    International Nuclear Information System (INIS)

    Nakamura, Kaori; Akimoto, Tetsuo; Motegi, Atsushi

    2008-01-01

    Fifty-seven patients with stage IVA-B oropharyngeal cancer treated by definitive radiotherapy in our facility from January 1993 to August 2005 were retrospectively analyzed. The age of the patients was 34-84 (median 62) years old. Thirty-four were male and 14 were female. Subsite of the tumor was anterior: 16, lateral: 39, posterior: 1, and superior: 1. Forty-nine patients were treated with chemotherapy. Induction chemotherapy (ICT) was done in 25 patients, ICT+concurrent chemoradiotherapy (CCRT) in 15 patients, and CCRT in 9 patients. A dose of 60-82 Gy (median 72 Gy) by hyperfractionated radiotherapy, at 1.2 Gy/fraction twice a day, was delivered in 37 patients, and 60-72 Gy (median 66 Gy) with a conventional daily fractionation in 20 patients. Salvage surgery was performed in 5 patients as a part of primary treatment after radiotherapy. The 5-year cause-specific survival rate and disease-free survival rate were 52.9% and 51.4%, respectively. By univariate analysis, the impact of age, sex, T-stage, N-stage, histological differentiation, chemotherapy and fractionation of radiation therapy on survivals were evaluated. T-stage, N-stage and histological differentiation were significantly covariate correlated with survival. The treatment results were not satisfactory. Further investigation of the treatment strategy to improve the treatment outcome of advanced oropharyngeal cancer is desired. (author)

  14. The Multidisciplinary Economics of Money Laundering

    OpenAIRE

    Ferwerda, J.

    2012-01-01

    Money laundering has been studied for many years, but mainly by lawyers and criminologists. This dissertation presents a number of ways on how an economist – mainly in a multidisciplinary fashion – can contribute to this field of research. This dissertation answers four important questions about money laundering: Why should we fight money laundering? How is money laundered? In which sectors is money laundered? And how can we fight money laundering? The literature mentions 25 effects of money ...

  15. Adjuvant radiotherapy in high-grade extremity sarcomas

    International Nuclear Information System (INIS)

    Franca, Carlos Antonio da Silva; Penna, Antonio Belmiro Rodrigues Campbell; Carvalho, Antonio Carlos Pires; Vieira, Sergio Lannes

    2010-01-01

    Objective: to evaluate the therapies utilized in the authors' institution for management of high-grade extremity sarcomas, analyzing the overall survival rates following multidisciplinary treatment. Materials and methods: retrospective study developed in the period from 1993 to 2007 with 36 patients diagnosed with stages IIb/III, submitted to postoperative external beam radiotherapy, with or without boost dose, utilizing high-dose brachytherapy. Results: thirty-six patients underwent surgery followed by adjuvant external beam radiation therapy. Four patients (11%) received boost dose with brachytherapy, and seven (19%) received chemotherapy. The average dose for radiotherapy was 50 Gy (CI 95%: 47-53 Gy), and the four patients with brachytherapy boost received doses ranging from 16.2 to 35 Gy. Chemotherapy was indicated for seven patients (19%) with positive margins. Fifteen patients (42%) presented local or distant recurrence, and all of them progressed to death. Twenty-one patients (58%) remain with no clinical/radiological evidence of local/distant recurrence. The mean follow-up time was 88 months (IC 95%: 74-102). The overall seven years survival rate was 80%. Conclusion: combined surgery and radiotherapy is an effective treatment with excellent outcomes in cases where brachytherapy is associated, with improved overall survival rates. (author)

  16. Preliminary experience with frameless stereotactic radiotherapy

    International Nuclear Information System (INIS)

    Buatti, John M.; Bova, Frank J.; Friedman, William A.; Meeks, Sanford L.; Ellis, Thomas L.; Marcus, Robert B.; Zuofeng, Li; Mendenhall, William M.

    1997-01-01

    Purpose/Objective: To report our initial clinical experience using a novel high-precision frameless stereotactic radiotherapy system in 50 patients who have received 1271 treatments. Materials and Methods: Fifty patients ranging in age from 2 to 72 yr were treated with fractionated stereotactic radiotherapy. Thirty-two were treated with stereotactic radiotherapy alone, and 18 had stereotactic radiotherapy interdigitated as a boost in addition to standard irradiation. Pathologies treated included meningioma (13), low grade astrocytoma (10), germinoma (9), craniopharyngioma (4), schwannoma (2), and pituitary adenoma (2). Two additional patients had miscellaneous benign neoplasms and 8 patients had the technique used as a dose escalation strategy for malignant lesions including chordoma, primitive neuroectodermal tumor, sarcoma, and anaplastic oligoastrocytoma. Treatment reproducibility was initially gauged by comparing the bite plate position using infrared light emitting diodes (irleds) with the stereotactic radiosurgery reference system. This test of accuracy consisted of 10 bite plate repositionings for each patient and 100 readings of each of the 6 irleds on the bite plate at each new position. Each of the 1271 patient treatments was monitored for continuous digital position, and a reading was made before treating each arc of radiation. We chose 0.3 mm translation and 0.3 degrees rotation as the maximum tolerated misalignment before treating each arc. Results: With a mean follow-up of 9 mo, no patient had a marginal or distal failure. One patient with a malignant glioma had central disease progression. Acute side effects were minimal. In 3 of 9 low grade astrocytomas, a marked increase in imaging enhancement and edema occurred in the first year after treatment that resolved with steroids. The initial test of accuracy revealed bite plate reproducibility as follows. Translational errors (mm): Anterior-posterior, 0.06 ± 0.06; lateral, 0.03 ± 0.05; axial, 0.07 ± 0

  17. Intraoperative and external beam radiotherapy for pancreatic carcinoma; Intraoperative und perkutane Radiotherapie des Pankreaskarzinoms

    Energy Technology Data Exchange (ETDEWEB)

    Eble, M.J. [Abt. Klinische Radiologie, Radiologische Universitaetsklinik Heidelberg (Germany); Maurer, U. [Klinikum der Stadt Mannheim (Germany). Inst. fuer Radiologie

    1996-05-01

    Therapeutic strategies in the treatment of pancreatic carcinoma are based on the high number of non-resectable cancers, the high relative radioresistance and the high distant metastases rate. Even in curatively resected carcinomas, a locally effective treatment modality is needed because of the risk of microscopical residual disease in the peripancreatic tissue. The efficacy of radiotherapy is dose dependent. Based on an analysis of published data a dose of more than 50 Gy is recommended, resulting in a high morbidity rate with external beam radiotherapy alone. The use of intraoperative radiotherapy allows locally restricted dose escalation without increased perioperative morbidity. In adjuvant and in primary treatment, local tumor control was improved (70-90%). With palliative intent, pain relief was obtained rapidly in over 60% of patients and led to improved patient performance. As a result of the high distant metastases rate, even in curatively resected carcinomas, the overall prognosis could not be significantly improved. Further dose escalation is limited by the increasing incidence of upper gastrointestinal bleeding (20-30%). (orig.) [Deutsch] Therapiestrategien beim Pankreaskarzinom werden bestimmt durch den hohen Anteil primaer nicht resektabler Karzinome, der hohen relativen Strahlenresistenz und der hohen Fernmetastasierungsrate. Selbst kurativ resezierte Karzinome erfordern durch ihre hohe lokale Tumorzellpersistenz eine lokal effektive adjuvante Behandlungsmassnahme. Die Effektivitaet einer Radiotherapie ist dosisabhaengig. Aus der Analyse publizierter Daten wird eine Dosis von >50 Gy, welche bei der alleinigen perkutanen Bestrahlung mit einer hohen Morbiditaet verbunden ist, empfohlen. Mit der intraoperativen Radiotherapie ist eine lokal begrenzte Dosiseskalation ohne erhoehte perioperative Morbiditaet moeglich. Sowohl in der adjuvanten als auch in der primaeren Behandlung kann die lokale Tumorkontrolle deutlich verbessert werden (70-90%). Unter

  18. Adjuvant Versus Salvage Radiotherapy for Patients With Adverse Pathological Findings Following Radical Prostatectomy: A Decision Analysis

    Directory of Open Access Journals (Sweden)

    Christopher J. D. Wallis MD

    2017-05-01

    Full Text Available Background: Patients undergoing surgery for prostate cancer who have adverse pathological findings experience high rates of recurrence. While there are data supporting adjuvant radiotherapy compared to a wait-and-watch strategy to reduce recurrence rates, there are no randomized controlled trials comparing adjuvant radiotherapy with the other standard of care, salvage radiotherapy (radiotherapy administered at the time of recurrence. Methods: We constructed a health state transition (Markov model employing two-dimensional Monte Carlo simulation using a lifetime horizon to compare the quality-adjusted survival associated with postoperative strategies using adjuvant or salvage radiotherapy. Prior to analysis, we calibrated and validated our model using the results of previous randomized controlled trials. We considered clinically important oncological health states from immediately postoperative to prostate cancer–specific death, commonly described complications from prostate cancer treatment, and other causes of mortality. Transition probabilities and utilities for disease states were derived from a literature search of MEDLINE and expert consensus. Results: Salvage radiotherapy was associated with an increased quality-adjusted life expectancy (QALE (58.3 months as compared with adjuvant radiotherapy (53.7 months, a difference of 4.6 months (standard deviation 8.8. Salvage radiotherapy had higher QALE in 53% of hypothetical cohorts. There was a minimal difference in overall life expectancy (-0.1 months. Examining recurrence rates, our model showed validity when compared with available randomized controlled data. Conclusions: A salvage radiotherapy strategy appears to provide improved QALE for patients with adverse pathological findings following radical prostatectomy, compared with adjuvant radiotherapy. As these findings reflect, population averages, specific patient and tumor factors, and patient preferences remain central for individualized

  19. Demand for radiotherapy in Spain.

    Science.gov (United States)

    Rodríguez, A; Borrás, J M; López-Torrecilla, J; Algara, M; Palacios-Eito, A; Gómez-Caamaño, A; Olay, L; Lara, P C

    2017-02-01

    Assessing the demand for radiotherapy in Spain based on existing evidence to estimate the human resources and equipment needed so that every person in Spain has access to high-quality radiotherapy when they need it. We used data from the European Cancer Observatory on the estimated incidence of cancer in Spain in 2012, along with the evidence-based indications for radiotherapy developed by the Australian CCORE project, to obtain an optimal radiotherapy utilisation proportion (OUP) for each tumour. About 50.5 % of new cancers in Spain require radiotherapy at least once over the course of the disease. Additional demand for these services comes from reradiation therapy and non-melanoma skin cancer. Approximately, 25-30 % of cancer patients with an indication for radiotherapy do not receive it due to factors that include access, patient preference, familiarity with the treatment among physicians, and especially resource shortages, all of which contribute to its underutilisation. Radiotherapy is underused in Spain. The increasing incidence of cancer expected over the next decade and the greater frequency of reradiations necessitate the incorporation of radiotherapy demand into need-based calculations for cancer services planning.

  20. Bystander effects and radiotherapy.

    Science.gov (United States)

    Marín, Alicia; Martín, Margarita; Liñán, Olga; Alvarenga, Felipe; López, Mario; Fernández, Laura; Büchser, David; Cerezo, Laura

    2015-01-01

    Radiation-induced bystander effects are defined as biological effects expressed after irradiation by cells whose nuclei have not been directly irradiated. These effects include DNA damage, chromosomal instability, mutation, and apoptosis. There is considerable evidence that ionizing radiation affects cells located near the site of irradiation, which respond individually and collectively as part of a large interconnected web. These bystander signals can alter the dynamic equilibrium between proliferation, apoptosis, quiescence or differentiation. The aim of this review is to examine the most important biological effects of this phenomenon with regard to areas of major interest in radiotherapy. Such aspects include radiation-induced bystander effects during the cell cycle under hypoxic conditions when administering fractionated modalities or combined radio-chemotherapy. Other relevant aspects include individual variation and genetics in toxicity of bystander factors and normal tissue collateral damage. In advanced radiotherapy techniques, such as intensity-modulated radiation therapy (IMRT), the high degree of dose conformity to the target volume reduces the dose and, therefore, the risk of complications, to normal tissues. However, significant doses can accumulate out-of-field due to photon scattering and this may impact cellular response in these regions. Protons may offer a solution to reduce out-of-field doses. The bystander effect has numerous associated phenomena, including adaptive response, genomic instability, and abscopal effects. Also, the bystander effect can influence radiation protection and oxidative stress. It is essential that we understand the mechanisms underlying the bystander effect in order to more accurately assess radiation risk and to evaluate protocols for cancer radiotherapy.

  1. Radiotherapy and pulmonary fibrosis

    Energy Technology Data Exchange (ETDEWEB)

    Sone, S; Miyata, Y; Tachiiri, H [Osaka Univ. (Japan). Faculty of Medicine

    1975-04-01

    Clinical findings of radiation pneumonitis and pulmonary fibrosis were outlined, and the relationship between occurence of these disorders and radiotherapy, clinical findings and X-ray picture were studied. Standard radiation dose as cell lethal response of carcinoma of the lung were 4,500 to 5,500 rad in 4 to 5.5 weeks in undifferentiated carcinoma, 6,000 to 7,000 rad in 6 to 7 weeks in squamous cell carcinoma, 7,000 to 9,000 rad in 7 to 9 weeks in adenocarcinoma, 4,500 to 5,000 rad in 4 to 5 weeks in the large sized cancer of the esophagus, 6,500 to 7,000 rad in 5 to 7 weeks in the small sized cancer of the esophagus, and irradiation of these amount of dose caused hazards in pulmonary function. Pathological and clinical findings of pulmonary hazards within 6 month period after irradiation, factors causing them and changes in X-ray pictures before and after irradiation were observed and discussed in clinical cases: the case of breast cancer in which 3,000 R/6 times/18 days of 5.5 MeV Liniac electron was irradiated to the chest wall, and the case of pulmonary cancer in which 5,000 rad/25 times/34 days of 6 MeV Liniac X-ray was irradiated in opposite 2 ports radiation beam treatment. The former revealed alveolar lesion and interlobular pleuritis at 4 month later, and remarkable lesion of pulmonary fibrosis was followed at 9 month after radiotherapy. The later developed radiation pneumonitis 1 month after radiotherapy, of which lesion extended to the upper part by 3 months later, and cancer recurred 6.5 month later.

  2. Radiotherapy for eyelid cancer

    International Nuclear Information System (INIS)

    Saika, Kazumi

    2001-01-01

    Some studies on radiotherapy for eyelid cancer have been reported, but the optimal radiation doses for different histological types and tumor sizes have not been detailed. So I studied the optimal radiation doses in radiotherapy for eyelid cancer. The patients were fourteen and histological diagnoses were made on the basis of biopsies or surgery before radiotherapy. Surgical cut margins were positive in 10 cases. In 5 of these cases, tumors were visible. There were 9 sebaceous adenocarcinomas (SAC), 4 squamous cell carcinomas (SCC), and 1 basal cell carcinoma (BCC). In 13 of 14 cases, radiation was applied to eyelids in which tumor-surgical cut margin distances were 3 mm or less. The eyeballs were covered with lead or tungsten shields, and the eyelids were irradiated with a total dose of 50 to 66.6 Gy. In 5 cases, radiation was applied prophylactically for ipsilateral pre-auricle lymph node areas. 11 of 13 cases were locally controlled. I gave greater radiation doses for SAC than for SCC or BCC. I also gave greater doses for in visible tumors than for invisible ones. In the acute phase dermatitis, inflammation of the cornea, conjunctivitis, etc. occurred but they were mild. Later reactions were decreased cilia, dry eye, inflammation of cornea, conjunctivitis, discomfort of the scar, etc. Cataracts were also seen, but they were of senile origen. Because 81.8% of the tumors were controlled, this radiation method was useful with salvage therapies to select an optimal radiation dose according to the differences among histological types and tumor sizes. 60% of visible tumors were also controlled so I think that radical therapy using radiation alone is possible. (author)

  3. Radiotherapy of benign diseases

    International Nuclear Information System (INIS)

    Haase, W.

    1982-01-01

    Still today radiotherapy is of decisive relevance for several benign diseases. The following ones are briefly described in this introductory article: 1. Certain inflammatory and degenerative diseases as furuncles in the face, acute thrombophlebitis, recurrent sudoriparous abscesses, degenerative skeletal diseases, cervical syndrome and others; 2. rheumatic joint diseases; 3. Bechterew's disease; 4. primary presenile osteoporosis; 5. synringomyelia; 6. endocrine ophthalmopathy; 7. hypertrophic processes of the connective tissue; 8. hemangiomas. A detailed discussion and a profit-risk analysis is provided in the individual chapters of the magazine. (MG) [de

  4. Large field radiotherapy

    International Nuclear Information System (INIS)

    Vanasek, J.; Chvojka, Z.; Zouhar, M.

    1984-01-01

    Calculations may prove that irradiation procedures, commonly used in radiotherapy and represented by large-capacity irradiation techniques, do not exceed certain limits of integral doses with favourable radiobiological action on the organism. On the other hand integral doses in supralethal whole-body irradiation, used in the therapy of acute leukemia, represent radiobiological values which without extreme and exceptional further interventions and teamwork are not compatible with life, and the radiotherapeutist cannot use such high doses without the backing of a large team. (author)

  5. Microplanar beams for radiotherapy

    International Nuclear Information System (INIS)

    Company, F.Z.; Allen, B.J.

    1996-01-01

    Recent advances in synchrotron generated X-ray beams with high fluence rate permit the investigation of the application of an array of closely spaced, parallel or converging microbeams in radiotherapy. The proposed technique takes advantage of the hypothesised repair mechanism of capillary cells between alternate microbeam zones, which replaces the lethally irradiated endothelial cells. In this study using the Monte Carlo method, the lateral and depth dose of a single planar microbeam of 100 keV in a tissue/lung/tissue phantom is investigated. Poster 195. (author)

  6. Validation and practical implementation of a multidisciplinary cancer distress screening questionnaire

    Energy Technology Data Exchange (ETDEWEB)

    Kirchheiner, K.; Czajka, A.; Komarek, E.; Hohenberg, G.; Poetter, R. [Medical University of Vienna (Austria). Dept. of Radiation Oncology; Ponocny-Seliger, E. [Sigmund Freud Private University, Vienna (Austria). Dept. of Psychology; Doerr, W. [Medical University of Vienna (Austria). Dept. of Radiation Oncology; Medical University of Vienna (Austria). Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology

    2013-07-15

    Background: In order to identify cancer patients with psychosocial needs during radiotherapy, a routine screening questionnaire is widely recommended in the literature. Several tools focusing mainly on psychological issues have been developed during the past decade. However, problems with their implementation into clinical routine have been repeatedly reported, due to a lack of practicability for clinicians and nurses. This study reports the compilation of a multidisciplinary screening questionnaire and an analysis of the effectiveness of its implementation into clinical routine at the Department of Radiotherapy, Medical University of Vienna. Materials and methods: The screening questionnaire is based on a compilation of several subscales from established and validated assessment tools. It focuses on comprehensive information with high a clinical relevance for all professions. In a pilot study, patients' acceptance was assessed qualitatively. Analysis of missing screening data in consecutively admitted patients reflects the effectiveness of implementation and representativity of the data. A validation analysis of the psychological subscales was performed using external criteria and its internal consistency was tested with Cronbachs' {alpha}. Results: Qualitative patient acceptance of the screening questionnaire is good. The overall response rate in the screening procedure was 75 %. Missing patient screening data sets arose randomly - mainly due to organizational problems - and did not result in systematic errors. The psychological subscales identify highly distressed patients with a sensitivity of 89 and 78 %, and an internal consistency of 0.843 and 0.617. Conclusion: The multidisciplinary screening questionnaire compiled in this study has a high patient acceptance, provides reliable and representative data and identifies highly distressed patients with excellent sensitivity. Although requiring additional personnel resources, it can be implemented

  7. 5-year review of a unique multidisciplinary nonmelanoma skin cancer clinic.

    Science.gov (United States)

    Culleton, Shaelyn; Breen, Dale; Assaad, Dalal; Zhang, Liying; Balogh, Judith; Tsao, May; Kamra, Juhu; Czarnota, Greg; Antonyshyn, Oleh; Fialkov, Jeffery; Barnes, Elizabeth

    2011-01-01

    A multidisciplinary nonmelanoma skin cancer (NMSC) clinic is held weekly at our center, where all new patients are jointly assessed by dermatology/dermatopathology, radiation oncology, and plastic surgery. A new patient database was established in 2004. The purpose of this study was to provide a preliminary report on the patients seen in the NMSC clinic and the treatment recommendations rendered. The new patient database was reviewed from January 2004 to December 2008, and patient demographics, tumor characteristics, and treatment recommendations were extracted. Cochran-Mantel-Harnszel (CMH) testing and chi-square analysis were used to detect any associations or relationships between variables within the database. A p value of less than .05 was considered significant. During the 5-year study period, 2,146 new patients were seen in the NMSC clinic. The majority of patients presented with basal cell carcinoma (64%) or squamous cell carcinoma (22%), with a median tumor size of 1 to 2 cm (range 0 to > 9 cm). Tumors were located in the head and neck region (80%), extremities (14%), and torso (6%). Previous treatment included biopsy only (62%), surgery (20%), electrodesiccation and curettage (11%), topical imiquimod (3%), and radiotherapy (1%). Treatment recommendations included surgery (55%) (with either simple excision [31%] or excision with margin control under frozen-section guidance [24%]), radiotherapy (19%), topical imiquimod (10%), observation (7%), and electrodesiccation and curettage (4%). The NMSC clinic at our center sees a high volume of patients who benefit from the multidisciplinary assessment provided. Treatment recommendations were based on patient and disease characteristics as well as patient preference.

  8. Validation and practical implementation of a multidisciplinary cancer distress screening questionnaire

    International Nuclear Information System (INIS)

    Kirchheiner, K.; Czajka, A.; Komarek, E.; Hohenberg, G.; Poetter, R.; Ponocny-Seliger, E.; Doerr, W.; Medical University of Vienna

    2013-01-01

    Background: In order to identify cancer patients with psychosocial needs during radiotherapy, a routine screening questionnaire is widely recommended in the literature. Several tools focusing mainly on psychological issues have been developed during the past decade. However, problems with their implementation into clinical routine have been repeatedly reported, due to a lack of practicability for clinicians and nurses. This study reports the compilation of a multidisciplinary screening questionnaire and an analysis of the effectiveness of its implementation into clinical routine at the Department of Radiotherapy, Medical University of Vienna. Materials and methods: The screening questionnaire is based on a compilation of several subscales from established and validated assessment tools. It focuses on comprehensive information with high a clinical relevance for all professions. In a pilot study, patients' acceptance was assessed qualitatively. Analysis of missing screening data in consecutively admitted patients reflects the effectiveness of implementation and representativity of the data. A validation analysis of the psychological subscales was performed using external criteria and its internal consistency was tested with Cronbachs' α. Results: Qualitative patient acceptance of the screening questionnaire is good. The overall response rate in the screening procedure was 75 %. Missing patient screening data sets arose randomly - mainly due to organizational problems - and did not result in systematic errors. The psychological subscales identify highly distressed patients with a sensitivity of 89 and 78 %, and an internal consistency of 0.843 and 0.617. Conclusion: The multidisciplinary screening questionnaire compiled in this study has a high patient acceptance, provides reliable and representative data and identifies highly distressed patients with excellent sensitivity. Although requiring additional personnel resources, it can be implemented successfully in

  9. How to Boost the Breast Tumor Bed? A Multidisciplinary Approach in Eight Steps

    International Nuclear Information System (INIS)

    Kirova, Youlia M.; Fournier-Bidoz, Nathalie; Servois, Vincent; Laki, Fatima; Pollet, Guillaume A.; Salmon, Remy; Thomas, Alexandra; Dendale, Remi; Bollet, Marc A.; Campana, Francois M.D.; Fourquet, Alain

    2008-01-01

    Purpose: To describe a new procedure for breast radiotherapy that will improve tumor bed localization and radiotherapy treatment using a multidisciplinary approach. Patients and Methods: This pilot study was conducted by departments of radiation oncology, surgery, and radiology. A new procedure has been implemented, summarized as eight steps: from pre-surgery contrast CT to surgery, tumor bed planning target volume (PTV) determination, and finally breast and tumor bed irradiation. Results: Twenty patients presenting with T1N0M0 tumors were enrolled in the study. All patients underwent lumpectomy with the placement of surgical clips in the tumor bed region. During surgery, 1 to 5 clips were placed in the lumpectomy cavity before the plastic procedure. All patients underwent pre- and postoperative CT scans in the treatment position. The two sets of images were registered with a match-point registration. All volumes were contoured and the results evaluated. The PTV included the clips region, the gross tumor volume, and the surgical scar, with an overall margin of 5-10 mm in all directions, corresponding to localization and setup uncertainties. For each patient the boost PTV was discussed and compared with our standard forward-planned PTV. Conclusions: We demonstrate the feasibility of a tumor bed localization and treatment procedure that seems adaptable to routine practice. Our study shows the advantages of a multidisciplinary approach for tumor bed localization and treatment. The use of more than 1 clip associated with pre- to postoperative CT image registration allows better definition of the PTV boost volume

  10. Intraoperative radiotherapy (IORT) for prostatic cancer

    International Nuclear Information System (INIS)

    Kojima, Shinichi; Satake, Ichiro; Tujii, Toshihiko; Tari, Kiyonobu; Sakura, Mizuyoshi

    1988-01-01

    Between February 1982 and February 1986, 30 patients with prostatic cancer received intaoperative radiotherapy (IORT). First 10 cases were treated by the transperineal approach, and after April 1983, 20 cases were done by the retropubic approach. We chose the retropubic approach, because it has advantages over the transperineal approach, which has a risk of rectal damage, lymph-adenectomy can not be performed and the patient can not sit down for a long time after the operation. In the IORT procedure for prostatic cancer by the retropubic approach, a longitudinal lower abdominal incision is made, and pushing down the bladder, the treatment cone is inserted to the prostate. We performed lymph-adenectomy at the same operation, if hard and large lymph-nodes were touched. Of 30 patients, 2 had stage B disease, 10 had stage C and 18 had stage D disease. The overall 5-year survival rate (Kaplan-Meier method) after IORT was 42.6 % where as that the 31 cases seen (stage C : 6 cases, stage D : 25 cases) since the Center was founded (October 1975) until the introduction of IORT was 3.2 %. Although no definite conclusion can be drawn because all cases received multidisciplinary therapy, IORT appears useful for the treatment of carcinoma of the prostate. (author)

  11. [Current status and potential perspectives in classical radiotherapy technology].

    Science.gov (United States)

    Dabić-Stanković, Kata M; Stanković, Jovan B; Radosević-Jelić, Ljiljana M

    2004-01-01

    After purchase of radiotherapy equipment in 2003, classic radiation therapy in Serbia will reach the highest world level. In order to define the highest standards in radiation technology, we analyzed the current status and potential perspectives of radiation therapy. An analysis of present situation in the USA, assumed as the most developed in the world, was done. Available data, collected in the last 3 years (equipment assortment, therapy modalities, workload and manpower) for 284 radiotherapy centers, out of potential 2050, were analyzed. Results were presented as crude percentage and matched to point current status. The analysis showed that CLINAC accelerators are the most popular (82.7%), as well as, ADAC (43.7%) and Focus (CMS) (27.4%) systems for therapy planning. Movement towards virtual simulation is evident (59.3%), although classic "simulation" is not fully eliminated from the radiotherapy chain. The most popular brachytherapy afterloader is Microselectron HDR (71%). About 64.4% centers use IMPAC communication/verification/record system that seems more open than Varis. All centers practice modern radiotherapy modalities and techniques (CPRT, IMRT, SRS/SRT, TBI, IORT, IVBHRT, HDR BHRT, etc.). CT and MRI availability is out of question, but PET is available in 3% of centers, however this percentage is rapidly growing. Up to 350 new patients per year are treated by one accelerator (about 35 pts. a day). Centers are relatively small and utilize 2-3 accelerators on average. Average FTE staffing norm is 4 radiation oncologists, 2-3 medical radiotherapy physicists, about 3 certified medical dosimetrists and about 6 radiotherapy technologists. In the past 5 years relative stagnation in classic radiotherapy has been observed. In spite of substantial investments in technology and consequent improvements, as well as wide introduction of computers in radiotherapy, radiotherapy results have not changed significantly. Vendor developement strategies do not point that

  12. Radiotherapy physics research in the UK: challenges and proposed solutions

    Science.gov (United States)

    Mackay, R I; Burnet, N G; Green, S; Illidge, T M; Staffurth, J N

    2012-01-01

    In 2011, the Clinical and Translational Radiotherapy Research Working Group (CTRad) of the National Cancer Research Institute brought together UK radiotherapy physics leaders for a think tank meeting. Following a format that CTRad had previously and successfully used with clinical oncologists, 23 departments were asked to complete a pre-meeting evaluation of their radiotherapy physics research infrastructure and the strengths, weaknesses, opportunities and threats within their own centre. These departments were brought together with the CTRad Executive Group and research funders to discuss the current state of radiotherapy physics research, perceived barriers and possible solutions. In this Commentary, we summarise the submitted materials, presentations and discussions from the meeting and propose an action plan. It is clear that there are challenges in both funding and staffing of radiotherapy physics research. Programme and project funding streams sometimes struggle to cater for physics-led work, and increased representation on research funding bodies would be valuable. Career paths for academic radiotherapy physicists need to be examined and an academic training route identified within Modernising Scientific Careers; the introduction of formal job plans may allow greater protection of research time, and should be considered. Improved access to research facilities, including research linear accelerators, would enhance research activity and pass on developments to patients more quickly; research infrastructure could be benchmarked against centres in the UK and abroad. UK National Health Service departments wishing to undertake radiotherapy research, with its attendant added value for patients, need to develop a strategy with their partner higher education institution, and collaboration between departments may provide enhanced opportunities for funded research. PMID:22972972

  13. Radiotherapy physics research in the UK: challenges and proposed solutions.

    Science.gov (United States)

    Mackay, R I; Burnet, N G; Green, S; Illidge, T M; Staffurth, J N

    2012-10-01

    In 2011, the Clinical and Translational Radiotherapy Research Working Group (CTRad) of the National Cancer Research Institute brought together UK radiotherapy physics leaders for a think tank meeting. Following a format that CTRad had previously and successfully used with clinical oncologists, 23 departments were asked to complete a pre-meeting evaluation of their radiotherapy physics research infrastructure and the strengths, weaknesses, opportunities and threats within their own centre. These departments were brought together with the CTRad Executive Group and research funders to discuss the current state of radiotherapy physics research, perceived barriers and possible solutions. In this Commentary, we summarise the submitted materials, presentations and discussions from the meeting and propose an action plan. It is clear that there are challenges in both funding and staffing of radiotherapy physics research. Programme and project funding streams sometimes struggle to cater for physics-led work, and increased representation on research funding bodies would be valuable. Career paths for academic radiotherapy physicists need to be examined and an academic training route identified within Modernising Scientific Careers; the introduction of formal job plans may allow greater protection of research time, and should be considered. Improved access to research facilities, including research linear accelerators, would enhance research activity and pass on developments to patients more quickly; research infrastructure could be benchmarked against centres in the UK and abroad. UK National Health Service departments wishing to undertake radiotherapy research, with its attendant added value for patients, need to develop a strategy with their partner higher education institution, and collaboration between departments may provide enhanced opportunities for funded research.

  14. Breast cancer radiotherapy: controversies and prospectives

    Institute of Scientific and Technical Information of China (English)

    YU Jin-ming; WANG Yong-sheng

    2008-01-01

    @@ Despite consensus on breast cancer radiotherapy, there are still some controversies over post-mastectomy radiotherapy (PMRT) in patients with 1-3 positive lymph nodes, accelerated partial breast irradiation (APBI), appropriate sequence of radiotherapy, chemotherapy and hormonal treatment, and radiotherapy after preoperative systemic therapy.

  15. Multidisciplinary management for esophageal and gastric cancer

    Directory of Open Access Journals (Sweden)

    Boniface MM

    2016-04-01

    Full Text Available Megan M Boniface,1 Sachin B Wani,2 Tracey E Schefter,3 Phillip J Koo,4 Cheryl Meguid,1 Stephen Leong,5 Jeffrey B Kaplan,6 Lisa J Wingrove,7 Martin D McCarter1 1Section of Surgical Oncology, Division of GI, Tumor and Endocrine Surgery, Department of Surgery, 2Division of Gastroenterology and Hepatology, Department of Therapeutic and Interventional Endoscopy, 3Department of Radiation Oncology, 4Division of Radiology-Nuclear Medicine, Department of Radiology, 5Division of Medical Oncology, 6Department of Pathology, University of Colorado Denver, 7Department of Food and Nutrition Services, University of Colorado Hospital Cancer Center, Aurora, CO, USA Abstract: The management of esophageal and gastric cancer is complex and involves multiple specialists in an effort to optimize patient outcomes. Utilizing a multidisciplinary team approach starting from the initial staging evaluation ensures that all members are in agreement with the plan of care. Treatment selection for esophageal and gastric cancer often involves a combination of chemotherapy, radiation, surgery, and palliative interventions (endoscopic and surgical, and direct communication between specialists in these fields is needed to ensure appropriate clinical decision making. At the University of Colorado, the Esophageal and Gastric Multidisciplinary Clinic was created to bring together all experts involved in treating these diseases at a weekly conference in order to provide patients with coordinated, individualized, and patient-centered care. This review details the essential elements and benefits of building a multidisciplinary program focused on treating esophageal and gastric cancer patients. Keywords: tumor board, upper gastrointestinal malignancies, patient centered

  16. Sensitivity Analysis of Multidisciplinary Rotorcraft Simulations

    Science.gov (United States)

    Wang, Li; Diskin, Boris; Biedron, Robert T.; Nielsen, Eric J.; Bauchau, Olivier A.

    2017-01-01

    A multidisciplinary sensitivity analysis of rotorcraft simulations involving tightly coupled high-fidelity computational fluid dynamics and comprehensive analysis solvers is presented and evaluated. An unstructured sensitivity-enabled Navier-Stokes solver, FUN3D, and a nonlinear flexible multibody dynamics solver, DYMORE, are coupled to predict the aerodynamic loads and structural responses of helicopter rotor blades. A discretely-consistent adjoint-based sensitivity analysis available in FUN3D provides sensitivities arising from unsteady turbulent flows and unstructured dynamic overset meshes, while a complex-variable approach is used to compute DYMORE structural sensitivities with respect to aerodynamic loads. The multidisciplinary sensitivity analysis is conducted through integrating the sensitivity components from each discipline of the coupled system. Numerical results verify accuracy of the FUN3D/DYMORE system by conducting simulations for a benchmark rotorcraft test model and comparing solutions with established analyses and experimental data. Complex-variable implementation of sensitivity analysis of DYMORE and the coupled FUN3D/DYMORE system is verified by comparing with real-valued analysis and sensitivities. Correctness of adjoint formulations for FUN3D/DYMORE interfaces is verified by comparing adjoint-based and complex-variable sensitivities. Finally, sensitivities of the lift and drag functions obtained by complex-variable FUN3D/DYMORE simulations are compared with sensitivities computed by the multidisciplinary sensitivity analysis, which couples adjoint-based flow and grid sensitivities of FUN3D and FUN3D/DYMORE interfaces with complex-variable sensitivities of DYMORE structural responses.

  17. Radiotherapy for esophageal cancer

    International Nuclear Information System (INIS)

    Oshitani, Takashi; Kuwata, Yoichiro; Kano, Kyoko

    1988-01-01

    Esophageal carcinoma were treated by high-dose-rate intracavitary irradiation using specially designed balloon application at Hyogo medical Center for Adults. 32 patients were treated from January 1982 through July 1986. According to the stage of UICC (1978), 10 patients were classified into stage I, 7 into II, 13 into III and 2 into IV. Acturial 5 year survival rate was 17.9 % in all 32 patients and that of 23 patients who received radical radiotherapy was 24 %. Local CR rate was 66 %. However, since 9 (53 %) of 17 CR patients were relapsed, local control rate for 2 years was 25 %. Mild adverse effects were experienced in 9 (47 %) of 19 CR patients. Our balloon applicator was easily fixed, could have an adequate space from esophageal mucosa and clarify the tumor site by filling with 20 % gastrografin. It is concluded that high-dose-rate intracavitary irradiation with our balloon applicator is an effective boost therapy and decline a lethal adverse effect in radiotherapy for esophageal carcinoma. (author)

  18. Radiotherapy in free practice

    International Nuclear Information System (INIS)

    Schmelz, H.P.

    1974-01-01

    Relating the X-ray ordinance cases of the fourth quarter 1971 to the whole year a total surface and incident dose of 2,107,656 R was administered in 2,189 cases (1,881 patients) in the course of 16,574 sessions. During the same period, 364 patients were treated in the 14 consultation rooms by radiotherapy because of malignant diseases. The genetically significant dose of 0,6 mrem/a is composed of the GSD of 0,194 in practice and 0,407 mrem in clinics and corresponds in its proportions to the GSD calculated and estimated in recent times. Compared with GSD values from other spheres of the application of ionizing radiation in medical practice, the calculated GSD of 0,6 mrem/a in radiotherapy for benign diseases corresponds to the GSD of approximately 0,5 mrem/a for the nuclear medicine in West-Berlin as stated by Hinz and Weil. It corresponds to 1% of the GSD of approximately/a as estimated recently for X-ray diagnostic applications. (orig./HP) [de

  19. Radiotherapy of bladder cancer

    International Nuclear Information System (INIS)

    Ikeda, Yoshiyuki

    1978-01-01

    Methods of treating bladder cancer include surgery, radiotherapy and chemotherapy, as well as various combinations of these. The author investigated clinically and histopathologically the therapeutic results of preoperative irradiation in cases of bladder cancer. 1. The survival rates (crude survival rates) in forty cases of bladder cancer were 90% after one year, 62.5% after three years and 46% after five years from the treatment. 2. As the result of irradiation, urogram improved in 25%, which was comparatively remarkable in high stage cases. There were no cases of deterioration of urogram findings caused by irradiation. Cystoscopy revealed disappearance or remarkable shrinkage of the tumors in 35% of the total cases and effects of the irradiation was observed not correlated to the stage and grade. 3. With respect to the histopathological changes, the changes became greater as the dosage increased and the higher the stage and grade were the more remarkable tendency was observed. 4. From our clinical observations such as urogram, cystoscopy and histopathologically, we estimated the optimum dosage of preoperative irradiation for bladder cancer is 3000 - 4000 rad. Thus, we concluded that the radiotherapy is effective in reducing both surgical invasion and postoperative recurrence. (author)

  20. Proton minibeam radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Girst, Stefanie

    2016-03-08

    The risk of developing adverse side effects in the normal tissue after radiotherapy is often limiting for the dose that can be applied to the tumor. Proton minibeam radiotherapy, a spatially fractionated radiotherapy method using sub-millimeter proton beams, similar to grid therapy or microbeam radiation radiotherapy (MRT) using X-rays, has recently been invented at the ion microprobe SNAKE in Munich. The aim of this new concept is to minimize normal tissue injuries in the entrance channel and especially in the skin by irradiating only a small percentage of the cells in the total irradiation field, while maintaining tumor control via a homogeneous dose in the tumor, just like in conventional broad beam radiotherapy. This can be achieved by optimizing minibeam sizes and distances according to the prevailing tumor size and depth such that after widening of the minibeams due to proton interactions in the tissue, the overlapping minibeams produce a homogeneous dose distribution throughout the tumor. The aim of this work was to elucidate the prospects of minibeam radiation therapy compared to conventional homogeneous broad beam radiotherapy in theory and in experimental studies at the ion microprobe SNAKE. Treatment plans for model tumors of different sizes and depths were created using the planning software LAPCERR, to elaborate suitable minibeam sizes and distances for the individual tumors. Radiotherapy-relevant inter-beam distances required to obtain a homogeneous dose in the target volume were found to be in the millimeter range. First experiments using proton minibeams of only 10 μm and 50 μm size (termed microchannels in the corresponding publication Zlobinskaya et al. 2013) and therapy-conform larger dimensions of 100 μm and 180 μm were performed in the artificial human in-vitro skin model EpiDermFT trademark (MatTek). The corresponding inter-beam distances were 500 μm, 1mm and 1.8 mm, respectively, leading to irradiation of only a few percent of the cells

  1. General principles of radiotherapy

    International Nuclear Information System (INIS)

    Easson, E.C.

    1985-01-01

    The daily practice of any established branch of medicine should be based on some acceptable principles. This chapter is concerned with the general principles on which the radiotherapy of the Manchester school is based. Though many radiotherapists in other centres would doubtless accept these principles, there are sufficiently wide differences in practice throughout the world to suggest that some therapists adhere to a fundamentally different philosophy. The authors believe it is important, especially for those beginning their formal training in radiotherapy, to subscribe to an internally consistent school of thought, employing methods of treatment for each type of lesion in each anatomical site that are based on accepted principles and subjected to continuous rigorous scrutiny to test their effectiveness. Not only must each therapeutic technique be evaluated, but the underlying principles too must be questioned if and when this seems indicated. It is a feature of this hospital that similar lesions are all treated by the same technique, so long as statistical evidence justifies such a policy. All members of the staff adhere to the accepted policy until or unless reliable reasons are adduced to change this policy

  2. Fertility impairment in radiotherapy

    Directory of Open Access Journals (Sweden)

    Marta Biedka

    2016-02-01

    Full Text Available Infertility as a result of antineoplastic therapy is becoming a very important issue due to the growing incidence of neoplastic diseases. Routinely applied antineoplastic treatments and the illness itself lead to fertility disorders. Therapeutic methods used in antineoplastic treatment may cause fertility impairment or sterilization due to permanent damage to reproductive cells. The risk of sterilization depends on the patient’s sex, age during therapy, type of neoplasm, radiation dose and treatment area. It is known that chemotherapy and radiotherapy can lead to fertility impairment and the combination of these two gives an additive effect. The aim of this article is to raise the issue of infertility in these patients. It is of growing importance due to the increase in the number of children and young adults who underwent radiotherapy in the past. The progress in antineoplastic therapy improves treatment results, but at the same time requires a deeper look at existential needs of the patient. Reproductive function is an integral element of self-esteem and should be taken into account during therapy planning.

  3. Transverse tomography and radiotherapy

    International Nuclear Information System (INIS)

    Leer, J.W.H.

    1982-01-01

    This study was intended to delineate the indications for radiotherapy treatment-planning with the help of computerized axial tomography (C.T.) and transverse analog tomography (T.A.T.). Radiotherapy localisation procedures with the conventional method (simulator), with the CT-scanner and with the transverse analog tomograph (T.A.T., Simtomix, Oldelft) were compared. As criterium for evaluation differences in reconstruction drawing based on these methods were used. A certain method was judged ''superior'' to another if the delineation of the target volume was more accurate, if a better impression was gained of the site of (for irradiation) organs at risk, or if the localisation could only be performed with that method. The selected group of patients consisted of 120 patients for whom a reconstruction drawing in the transverse plane was made according to the treatment philosophy. In this group CT-assisted localisation was judged on 68 occasions superior to the conventional method. In a number of cases it was found that a ''standard'' change in a standard target volume, on the base of augmented anatomical knowledge, made the conventional method sufficient. The use of CT-scanner for treatment planning was estimated. For ca. 270/1000 new patients a CT-scan is helpful (diagnostic scan), for 140 of them the scan is necessary (planning scan). The quality of the anatomical information obtained with the T.A.T. does not yet fall within acceptable limits, but progress has been made. (Auth.)

  4. Concurrent radiotherapy and chemotherapy

    International Nuclear Information System (INIS)

    Fu, K.K.

    1985-01-01

    The principal objective of combining chemotherapy with radiotherapy (XRT) for the treatment of advanced head and neck cancer is to improve the therapeutic ratio through the enhancement of local control and reduction of distant metastases without excessively enhancing normal tissue effects. Improved tumour control can result from sole additivity of either therapy or direct interactions between drug and radiation leading to increased tumour cell kill. Chemotherapy may sensitize the cells to radiation, interfere with repair of sublethal or potentially lethal radiation damage, induce cell synchrony, and reduce tumour mass leading to reoxygenation and decreased fraction of resistant hypoxic cells. Radiation may improve drug accessibility to tumour cells and reduce tumour volume leading to increased cell proliferation and chemosensitivity. If the enhanced effects of combined therapy are purely additive, then the two modalities can be administered either sequentially or concurrently with the same results. However, if the enhanced effects result from the direct interaction between drug and radiation, it is necessary that the two modalities be administered concurrently and in close temporal proximity. This review summarizes the results of clinical studies in which chemotherapy was administered concurrently during the course of radiotherapy for patients with previously untreated advanced squamous cell carcinoma in the head and neck

  5. Erythropoietin and radiotherapy

    International Nuclear Information System (INIS)

    Le Fur, E.; Albarghach, M.N.; Pradier, O.

    2010-01-01

    Erythropoietin (E.P.O.) is a glycoprotein hormone. This hormone is a growth factor for red blood cells precursors in the bone marrow. The decrease of oxygen partial pressure, a reduced number of erythrocytes caused by bleeding or excessive destruction, or increased tissues oxygen requirements lead to increased secretion of E.P.O.. Its action takes place on bone marrow erythroblastic cells through specific receptors. E.P.O. stimulates the proliferation of red cell precursors stem cells in the bone marrow, thus increasing their production in one to two weeks. The effectiveness of E.P.O. at increasing haemoglobin and improving patients quality of life has been demonstrated by several studies. However, its use in radiotherapy remains controversial. While tumour hypoxia caused by anaemia is a factor of radio resistance and thus a source of local failure, tumour expression of E.P.O. receptors presents a significant risk for tumour progression and neo-angiogenesis, which would be increased during the administration of E.P.O.. The purpose of this article is to answer the question: is there a place for E.P.O. in combination with radiotherapy in the management of cancer?

  6. Multidisciplinary Techniques and Novel Aircraft Control Systems

    Science.gov (United States)

    Padula, Sharon L.; Rogers, James L.; Raney, David L.

    2000-01-01

    The Aircraft Morphing Program at NASA Langley Research Center explores opportunities to improve airframe designs with smart technologies. Two elements of this basic research program are multidisciplinary design optimization (MDO) and advanced flow control. This paper describes examples where MDO techniques such as sensitivity analysis, automatic differentiation, and genetic algorithms contribute to the design of novel control systems. In the test case, the design and use of distributed shape-change devices to provide low-rate maneuvering capability for a tailless aircraft is considered. The ability of MDO to add value to control system development is illustrated using results from several years of research funded by the Aircraft Morphing Program.

  7. Multidisciplinary Graduate Education in Bioprocess Engineering

    Energy Technology Data Exchange (ETDEWEB)

    Mark A. Eiteman

    2006-04-18

    This report describes the accomplishments of the University of Georgia in establishing an academic program geared toward the emerging biobased products industry. By virtue of its strengths and structure, the University of Georgia is particularly well-suited for developing a program focused on plant- and microbial-based bioproducts, and it was in this general area that this program was developed. The program had several unique characteristics. First, we implemented a distinguished lecture series that brought outstanding scientists and engineers to our University to interact with students and share their vision of the biobased economy. Second, we offered industrially-oriented and multidisciplinary courses that provided students with a broad background on various facets of biobased business and technology. Third, we provided the students with opportunities to expand beyond the classroom by engaging in research lab rotations and industrial internships. Fourth, each student was engaged in a creative research project as led by a multidisciplinary faculty team. Throughout the implementation of these activities, we maintained a student-centered, mentoring approach to education. The most tangible outcome of this project was the graduation of two students who participated in a variety of scholarly activities, culminating in research toward the completion of a thesis and dissertation. Both research projects involved the use of microorganisms to produce industrial products from agricultural substrates via fermentation processes. The research advanced our understanding of microorganisms as used for industrial processes and products, as described in several articles published in scholarly journals and presentations made at scientific conferences (see information on pp. 14-15). Another outcome is one graduate course, Fermentation Engineering Laboratory, which is a unique experiential and multidisciplinary course. This course will be offered in the future as an elective to

  8. American Vacuum Society: A multidisciplinary organization

    International Nuclear Information System (INIS)

    Beavis, L.C.

    1979-01-01

    This presentation is based upon that which was to be given by the Society President at the 25th National Symposium of the American Vacuum Society, 29 November 1978, in San Francisco, California. The talk to the Society by its President was an innovation of the 1979 Program Committee. The intention is that such a presentation be given each year at the awards acceptance plenary session along with those of the Welch and, when appropriate, Gaede--Langmuir awards. To be discussed are the recent highlights of Society activity, the direction the Society is taking, and an example of the multidisciplinary activities of Society members

  9. Advances in radiotherapy

    International Nuclear Information System (INIS)

    Mackie, T.R.

    2005-01-01

    Radiation therapy is in the midst of a rebirth largely driven by the use of computers for treatment planning and beam delivery. The first edge of this renaissance was the advent of three-dimensional conformal radiation therapy (3-D CRT). This was enabled by the widespread availability and utilization of three-dimensional imaging such as computed tomography and magnetic resonance scanning, themselves products of the computer revolution. For the first time this allowed radiation oncologists to segment and visualize the tumor in association with it neighboring sensitive soft-tissue structures. Software tools to visualize the beam paths through the body enabled the beam directions and beam shapes to be manually optimized. Simultaneously, improved dose calculations utilizing the CT images of the patient anatomy produced more accurate distributions of dose. The dose was delivered with custom-shaped blocks or recently collimators with multiple leaves that allow complex shaped fields to be delivered without the need for block fabrication. In the last couple of decades new treatment delivery methodologies have emerged. The first has been stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) which is the purview of neurosurgeons (who call it SRS) as well as radiation oncologists (who usually call it SRT). SRS and SRT are premised on multiple beams focusing on one location typically with circular aperture collimators but increasingly with fields shaped by multi-leaved collimators. Often only a single treatment session (the usual for SRS) is used when the treatment volume is small, but for larger lesions several treatment sessions, or fractions, are used (most often for SRT) to allow for normal tissue repair. The new equipment market for SRS and SRT is about 10% of the total for radiation therapy. Intensity-modulated radiation therapy (IMRT) is the latest treatment methodology and its adoption has been extremely rapid, particularly in the United States. IMRT uses

  10. Oral health considerations in anorexia and bulimia nervosa. 2. Multidisciplinary management and personalized dental care.

    Science.gov (United States)

    Bassiouny, Mohamed A; Tweddale, Elizabeth

    2017-01-01

    This article outlines a comprehensive, multidisciplinary strategy for treatment of patients with anorexia and bulimia nervosa. In this approach, primary medical intervention and emergency dental care are followed by the staging of treatment phases that integrate medical care, psychotherapy, nutritional counseling, and dental management, which may encompass various treatment options for repair of damaged dentition. Emphasis is placed on prevention of further tissue damage during all phases of management and following completion of the treatment course.

  11. African monsoon multidisciplinary analysis - An international research project and field campaign

    OpenAIRE

    Redelsperger, J. L.; Thorncroft, C. D.; Diedhiou, Arona; Lebel, Thierry; Parker, D. J.; Polcher, J.

    2006-01-01

    African Monsoon Multidisciplinary Analysis (AMMA) is an international project to improve our knowledge and understanding of the West African monsoon (WAM) and its variability with an emphasis on daily-to-interannual time scales. AMMA is motivated by an interest in fundamental scientific issues and by the societal need for improved prediction of the WAM and its impacts on West African nations. Recognizing the societal need to develop strategies that reduce the socioeconomic impacts of the vari...

  12. Interest of radiotherapy of rectal cancer with synchronous metastases

    International Nuclear Information System (INIS)

    Tournat, H.; Vendrely, V.; Smith, D.; Capdepont, M.; Maire, J.P.; Cherciu, B.; Laurent, C.; Kantor, G.

    2008-01-01

    Purpose: There is no consensus about the treatment of rectal tumour when there are synchronous metastases. The interest of radiotherapy is debated. Patients and methods: Thirty-seven patients with rectal tumour and synchronous metastases were treated with radiotherapy first between September 1994 and December 2004. We analysed the tolerance, local control, resectability, overall survival of such a therapeutic strategy. Results: The mean follow-up was 30 months. Twenty-four tumors were resectable for both the primary site and the metastases. Thirteen were unresectable at the time of diagnosis. Thirty-three patients were treated with radio chemotherapy, ten with radiotherapy alone. Eighty-six decimal five percent of them had no pelvic symptom six weeks after the treatment. Twenty-one rectal tumours were finally resected. The disease progressed in six cases during the radiotherapy. Surgery of the metastases was possible for 12 patients with tumour initially resectable. Conclusion: Radio chemotherapy is a 'tolerable' treatment, in spite of more frequent urinary or digestive side-effects. But, if there is no surgery, palliative effect of radiotherapy is limited. (authors)

  13. Postoperative radiotherapy of uterine sarcoma: A multicentric retrospective study

    International Nuclear Information System (INIS)

    Champetier, C.; Cowen, D.; Hannoun-Levi, J.M.; Resbeut, M.; Azria, D.; Salem, N.; Tessier, E.; Ellis, S.

    2011-01-01

    Purpose. - Surgery is the treatment of choice for localized uterine sarcomas. We conducted a retrospective study to define prognostic factors. Patients and methods. - We studied 111 cases of patients treated by adjuvant radiotherapy for uterine sarcoma in seven French centers. The median decline was 31 months. We conducted a univariate analysis to identify factors correlated with local recurrence. The statistically significant factors were studied in multivariate analysis by Cox model. Results. - The median dose of external beam radiotherapy was 45 Gy. Forty-three percent of patients had vaginal vault brachytherapy and 21 % chemotherapy. Only 6.3 % of patients had complications of acute grade III and 8.1 % of long-term sequelae of radiotherapy. The survival rate at 5 years was 74.6 %. They noted 12.6 % of isolated locoregional recurrences, against 29.7 % for distant recurrences, 80 % were pulmonary. Factors correlated with the risk of locoregional relapse were menopausal status (P = 0.045) and surgical margins suspicious or not healthy (P = 0.0095). The chemotherapy did not improve overall survival or disease free survival but the numbers were low. Conclusion. - The postoperative radiotherapy provides good local control in this disease. Brachytherapy is sometimes done, but it does not improve local control. Chemotherapy is not a standard localized stage but the rate of metastatic recurrence calls for the development of strategies involving systemic treatment with radiotherapy. (authors)

  14. Preclinical evaluation of molecular-targeted anticancer agents for radiotherapy

    International Nuclear Information System (INIS)

    Krause, Mechthild; Zips, Daniel; Thames, Howard D.; Kummermehr, Johann; Baumann, Michael

    2006-01-01

    The combination of molecular-targeted agents with irradiation is a highly promising avenue for cancer research and patient care. Molecular-targeted agents are in themselves not curative in solid tumours, whereas radiotherapy is highly efficient in eradicating tumour stem cells. Recurrences after high-dose radiotherapy are caused by only one or few surviving tumour stem cells. Thus, even if a novel agent has the potential to kill only few tumour stem cells, or if it interferes in mechanisms of radioresistance of tumours, combination with radiotherapy may lead to an important improvement in local tumour control and survival. To evaluate the effects of novel agents combined with radiotherapy, it is therefore necessary to use experimental endpoints which reflect the killing of tumour stem cells, in particular tumour control assays. Such endpoints often do not correlate with volume-based parameters of tumour response such as tumour regression and growth delay. This calls for radiotherapy specific research strategies in the preclinical testing of novel anti-cancer drugs, which in many aspects are different from research approaches for medical oncology

  15. Energy efficiency and the law: A multidisciplinary approach

    Directory of Open Access Journals (Sweden)

    Willemien du Plessis

    2015-01-01

    Full Text Available South Africa is an energy-intensive country. The inefficient use of, mostly, coal-generated energy is the cause of South Africa's per capita contribution to greenhouse gas emissions, pollution and environmental degradation and negative health impacts. The inefficient use of the country's energy also amounts to the injudicious use of natural resources. Improvements in energy efficiency are an important strategy to stabilise the country's energy crisis. Government responded to this challenge by introducing measures such as policies and legislation to change energy consumption patterns by, amongst others, incentivising the transition to improved energy efficiencies. A central tenet underpinning this review is that the law and energy nexus requires a multidisciplinary approach as well as a multi-pronged adoption of diverse policy instruments to effectively transform the country's energy use patterns. Numerous, innovative instruments are introduced by relevant legislation to encourage the transformation of energy generation and consumption patterns of South Africans. One such innovative instrument is the ISO 50001 energy management standard. It is a voluntary instrument, to plan for, measure and verify energy-efficiency improvements. These improvements may also trigger tax concessions. In this paper, the nature and extent of the various policy instruments and legislation that relate to energy efficiency are explored, while the interactions between the law and the voluntary ISO 50001 standard and between the law and the other academic disciplines are highlighted. The introduction of energy-efficiency measures into law requires a multidisciplinary approach, as lawyers may be challenged to address the scientific and technical elements that characterise these legal measures and instruments. Inputs by several other disciplines such as engineering, mathematics or statistics, accounting, environmental management and auditing may be needed. Law is often

  16. Combined modality treatment including intraoperative radiotherapy in locally advanced and recurrent rectal cancer

    International Nuclear Information System (INIS)

    Tveit, Kjell Maque; Wiig, Johan N.; Olsen, Dag Rune; Storaas, Andreas; Poulsen, Jan Peter; Giercksky, Karl-Erik

    1997-01-01

    Background: Treatment of locally advanced and recurrent rectal cancer usually has a high local recurrence rate and poor survival. Promising results have been reported by combined external radiotherapy, extensive surgery and intraoperative radiotherapy (IORT). Methods: One hundred fifteen patients with locally advanced rectal cancers fixed to the pelvic wall or locally recurrent rectal cancers underwent preoperative external radiotherapy with 46-50 Gy. Six to 8 weeks later radical pelvic surgery was attempted, and was combined with intraoperative electron beam radiotherapy (15-20 Gy) in 66 patients. The patients were followed closely to evaluate complication rate, local and distant recurrence rate and survival. Results: Surgery with no macroscopic tumour remaining was obtained in 65% of the patients with no postoperative deaths. Pelvic infection was the major complication (21%). Although the observation time is short (3-60 months), the local recurrence rate seems low (22%) and survival seems promising (about 60% at 4 years) in patients with complete tumour resection, in contrast to patients with residual tumour (none living at 4 years). Conclusions: The combined modality treatment with preoperative external radiotherapy and extensive pelvic surgery with IORT is sufficiently promising to start a randomized trial on the clinical value of IORT as a boost treatment in the multidisciplinary approach to this disease

  17. Preliminary experience with frameless stereotactic radiotherapy

    International Nuclear Information System (INIS)

    Buatti, John M.; Bova, Francis J.; Friedman, William A.; Meeks, Sanford L.; Marcus, Robert B.; Mickle, J. Parker; Ellis, Thomas L.; Mendenhall, William M.

    1998-01-01

    Purpose: To report initial clinical experience with a novel high-precision stereotactic radiotherapy system. Methods and Materials: Sixty patients ranging in age from 2 to 82 years received a total of 1426 treatments with the University of Florida frameless stereotactic radiotherapy system. Of the total, 39 (65%) were treated with stereotactic radiotherapy (SRT) alone, and 21 (35%) received SRT as a component of radiotherapy. Pathologic diagnoses included meningiomas (15 patients), low-grade astrocytomas (11 patients), germinomas (9 patients), and craniopharyngiomas (5 patients). The technique was used as means of dose escalation in 11 patients (18%) with aggressive tumors. Treatment reproducibility was measured by comparing bite plate positioning registered by infrared light-emitting diodes (IRLEDs) with the stereotactic radiosurgery reference system, and with measurements from each treatment arc for the 1426 daily treatments (5808 positions). We chose 0.3 mm vector translation error and 0.3 deg. rotation about each axis as the maximum tolerated misalignment before treating each arc. Results: With a mean follow-up of 11 months, 3 patients had recurrence of malignant disease. Acute side effects were minimal. Of 11 patients with low grade astrocytomas, 4 (36%) had cerebral edema and increased enhancement on MR scans in the first year, and 2 required steroids. All had resolution and marked tumor involution on follow-up imaging. Bite plate reproducibility was as follows. Translational errors: anterior-posterior, 0.01 ± 0.10; lateral, 0.02 ± 0.07; axial, 0.01 ± 0.10. Rotational errors (degrees): anterior-posterior, 0.00 ± 0.03; lateral, 0.00 ± 0.06; axial, 0.01 ± 0.04. No patient treatment was delivered beyond the maximum tolerated misalignment. Daily treatment was delivered in approximately 15 min per patient. Conclusion: Our initial experience with stereotactic radiotherapy using the infrared camera guidance system was good. Patient selection and treatment

  18. Curent requirements for image management in radiotherapy

    International Nuclear Information System (INIS)

    Steil, V.; Schneider, F.; Wenz, F.; Lohr, F.; Roehner, F.; Weisser, G.

    2012-01-01

    Treatment techniques of increasing complexity such as dynamic/rotational techniques mandate digital management and increasingly image guidance. This constantly increases requirements for image management and archiving. This article discusses the current status of these requirements and will present potential image administration strategies. Fundamentals of image administration and storage/archiving are presented (DICOM Standard, radiotherapy-specific issues) along the typical patient pathway (demographic data, radiotherapy treatment planning, signatures/approval of plan and image data, archiving of plan and image data). Different strategies for image management are presented (archiving centered on individual application vs. integral approach with central archiving in a DICOM-RT-PACS governed by a radiation oncology information system (ROCIS)). Infrastructural requirements depending on the amount of image data generated in the department are discussed. Application-centered image management provides access to image data including all relevant RT-specific elements. This approach, however, is not migration-safe, requires significant administrative work to ensure a redundancy level that protects against data loss and does not provide datasets that are linked to respective therapeutic interventions. Therefore, centralized image management and archiving that links images to patients and individual steps in the treatment pathway within a standardized DICOM(-RT) environment is preferable despite occasional problems with visualization of specific data elements. (orig.)

  19. European Union - Space of Regeneration, Learning and Innovation in the Context of Sustainable Multidisciplinary Research

    Directory of Open Access Journals (Sweden)

    Florin Răzvan Bălășescu

    2010-07-01

    Full Text Available Objective The Lisbon Strategy set a new goal for the EU economy: the transition to a knowledge based economy, competitive and sustainable at macro and regional levels, by creating the European Research Area – a geographic area without frontiers for researches, where scientific resources are better managed to create more jobs and improve Europe's competitiveness. That means an interaction between specific and multidisciplinary research network. Approach However, general research methodology sustains the importance of static and revolutionary specific criteria of Scientific Research Programs but also reveals the natural process of multidisciplinary researches. In this context, the European Union could be regarded as a specific and multidisciplinary research area, as a network of flows, connections, relationships, interdependencies, and interferences between natural - experimental and social-humanistic research spheres (economics, management, sociology and complex systems ecology. Prior Work: In this respect some researchers suggested that both natural and social systems could be considered as multidisciplinary complex adaptive systems consisting of specific cluster network connections ( in the form of biotic and abiotic nodes, respectively, the competitive and regional poles with the ability to continuous self-organizing, learning and regenerating process especially in crisis situations. Implications and Value Paper Utility The present paper might be useful to illustrate the contribution of technical-economic and socio-ecological researches to increasing the sustainability framework of European Research Area by considering the transition from the R&D approach (development through research process to the L&D approach (development through learning process.

  20. Radiotherapy gel dosimetry

    International Nuclear Information System (INIS)

    Baldock, C.

    2002-01-01

    In radiotherapy, the primary objective is to deliver a prescribed dose of radiation to a tumour or lesion within a patient while minimising the dose delivered to the surrounding healthy tissue. Traditional radiotherapy treatments usually involve simple external or internal irradiations of a tumour. External irradiations are normally achieved in the clinic with photon or electron beams produced by high energy linear accelerators. The photon or electron beams are collimated into regular shapes as they emerge from the treatment head of the unit which is supported by a gantry that can be rotated isocentrically to any position. A discrete number of photon or electron beams with different angles of incidence that intersect at the iso-centre are used to produce a region of high dose around the tumour volume (positioned at the iso-centre). Internal irradiations are normally achieved in the clinic by implanting radioactive sources in and around the tumour or lesion. Such irradiations are characterised by very high doses local to the tumour. Radioactive sources are also used to prevent post-angioplasty restenosis by inserting sources into arteries. Usually when treating a tumour, a compromise is made between tumour control and complications arising from normal tissue damage. One measure of this compromise, the therapeutic ratio, is defined as the radiation dose producing complications in 50% of patients divided by the dose providing tumour control in 50% of the patients. The therapeutic ratio depends on the radiobiological characteristics of the cancerous tissue and surrounding healthy tissues and on the radiation dose distribution achieved by the radiotherapy treatment. It is generally believed that the therapeutic ratio can be minimised by optimising the conformation of the radiation dose distribution to the target volume. This is difficult with traditional radiotherapy techniques since they do not produce dose distributions that adequately cover tumour volumes of complex

  1. Multidisciplinary management of the locally advanced unresectable non-small cell lung cancer

    International Nuclear Information System (INIS)

    Cho, Kwan Ho

    2004-01-01

    Locally advanced (Stage III) non-small cell lung cancer (NSCLC) accounts for approximately one third of all cases of NSCLC. Few patients with locally advanced NSCLC present with disease amenable to curative surgical resection. Historically, these patients were treated with primary thoracic radiation therapy (RT) and had poor long term survival rates, due to both progression of local disease and development of distant metastases. Over the last two decades, the use of multidisciplinary approach has improved the outcome for patients with locally advanced NSCLC. Combined chemoradiotherapy is the most favored approach for treatment of locally advanced unresectable NSCLC. There are two basic treatment protocols for administering combined chemotherapy and radiation, sequential versus concurrent. The rationale for using chemotherapy is to eliminate subclinical metastatic disease while improving local control. Sequential use of chemotherapy followed by radiotherapy has improved median and long term survival compared to radiation therapy alone. This approach appears to decrease the risk of distant metastases, but local failure rates remain the same as radiation alone. Concurrent chemoradiotherapy has been studied extensively. The potential advantages of this approach may include sensitization of tumor cells to radiation by the administration of chemotherapy, and reduced overall treatment time compared to sequential therapy; which is known to be important for improving local control in radiation biology. This approach improves survival primarily as a result of improved local control. However, it doesn't seem to decrease the risk of distant metastases probably because concurrent chemoradiation requires dose reductions in chemotherapy due to increased risks of acute morbidity such as acute esophageal toxicity. Although multidisciplinary therapy has led to improved survival rates compared to radiation therapy alone and has become the new standard of care, the optimal therapy of

  2. Opus: A Coordination Language for Multidisciplinary Applications

    Directory of Open Access Journals (Sweden)

    Barbara Chapman

    1997-01-01

    Full Text Available Data parallel languages, such as High Performance Fortran, can be successfully applied to a wide range of numerical applications.However, many advanced scientific and engineering applications are multidisciplinary and heterogeneous in nature, and thus do not fit well into the data parallel paradigm. In this paper we present Opus, a language designed to fill this gap. The central concept of Opus is a mechanism called ShareD Abstractions (SDA. An SDA can be used as a computation server, i.e., a locus of computational activity, or as a data repository for sharing data between asynchronous tasks. SDAs can be internally data parallel, providing support for the integration of data and task parallelism as well as nested task parallelism. They can thus be used to express multidisciplinary applications in a natural and efficient way. In this paper we describe the features of the language through a series of examples and give an overview of the runtime support required to implement these concepts in parallel and distributed environments.

  3. ASTROS: A multidisciplinary automated structural design tool

    Science.gov (United States)

    Neill, D. J.

    1989-01-01

    ASTROS (Automated Structural Optimization System) is a finite-element-based multidisciplinary structural optimization procedure developed under Air Force sponsorship to perform automated preliminary structural design. The design task is the determination of the structural sizes that provide an optimal structure while satisfying numerous constraints from many disciplines. In addition to its automated design features, ASTROS provides a general transient and frequency response capability, as well as a special feature to perform a transient analysis of a vehicle subjected to a nuclear blast. The motivation for the development of a single multidisciplinary design tool is that such a tool can provide improved structural designs in less time than is currently needed. The role of such a tool is even more apparent as modern materials come into widespread use. Balancing conflicting requirements for the structure's strength and stiffness while exploiting the benefits of material anisotropy is perhaps an impossible task without assistance from an automated design tool. Finally, the use of a single tool can bring the design task into better focus among design team members, thereby improving their insight into the overall task.

  4. Developing a Collaborative Multidisciplinary Online Design Course

    Directory of Open Access Journals (Sweden)

    Diane M. Bender, Ph.D.

    2005-07-01

    Full Text Available Technology is transforming the practice of architecture and design from the conceptual stages right down to the actual construction. One would assume technology is being readily integrated into current design education. Unfortunately, this is not the case. The purpose of this study is to explore the integration of online education into the curriculum of architecture and design. The three primary obstacles to integrating technology with education in these disciplines are identified as: 1 the limited evidence of online education in the fields of architecture and design (Sagun, Demirkan, & Goktepe, 2001; 2 the reluctance of design educators to teach in an online environment (Bender & Good, 2003; and 3 the lack of multidisciplinary coursework currently available between architecture, design, and other related fields (IIDA Report, 1998. This paper will discuss online education in the context of traditional architecture and design studio instruction. A case study of the development of a collaborative, multidisciplinary online course offered between five major universities will be presented as a catalyst for change. The paper concludes with reflections on the pedagogical advantages and disadvantages of this new educational model and its implications for instructors involved in online education.

  5. Information Management for a Large Multidisciplinary Project

    Science.gov (United States)

    Jones, Kennie H.; Randall, Donald P.; Cronin, Catherine K.

    1992-01-01

    In 1989, NASA's Langley Research Center (LaRC) initiated the High-Speed Airframe Integration Research (HiSAIR) Program to develop and demonstrate an integrated environment for high-speed aircraft design using advanced multidisciplinary analysis and optimization procedures. The major goals of this program were to evolve the interactions among disciplines and promote sharing of information, to provide a timely exchange of information among aeronautical disciplines, and to increase the awareness of the effects each discipline has upon other disciplines. LaRC historically has emphasized the advancement of analysis techniques. HiSAIR was founded to synthesize these advanced methods into a multidisciplinary design process emphasizing information feedback among disciplines and optimization. Crucial to the development of such an environment are the definition of the required data exchanges and the methodology for both recording the information and providing the exchanges in a timely manner. These requirements demand extensive use of data management techniques, graphic visualization, and interactive computing. HiSAIR represents the first attempt at LaRC to promote interdisciplinary information exchange on a large scale using advanced data management methodologies combined with state-of-the-art, scientific visualization techniques on graphics workstations in a distributed computing environment. The subject of this paper is the development of the data management system for HiSAIR.

  6. Postoperative radiotherapy of uterine sarcoma: A multicentric retrospective study; Radiotherapie postoperatoire dans les sarcomes uterins: etude retrospective multicentrique

    Energy Technology Data Exchange (ETDEWEB)

    Champetier, C.; Cowen, D. [Service de radiotherapie, hopital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05 (France); Hannoun-Levi, J.M. [Centre Antoine-Lacassagne, 33, avenue Valombrose, 06100 Nice (France); Resbeut, M. [Centre de radiotherapie Saint-Louis, rue Andre-Blondel, 83100 Toulon (France); Azria, D. [Centre Val-d' Aurelle-Paul-Lamarque, 208, rue des Apothicaires, 34298 Montpellier cedex 5 (France); Salem, N. [Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille (France); Tessier, E. [Centre azureen de radiotherapie, 1, place du Docteur-Jean-Luc-Broquerie, 06250 Mougins (France); Ellis, S. [Centre catalan de radiotherapie, 80, rue Pascal-Marie-Agasse, 66000 Perpignan (France)

    2011-04-15

    Purpose. - Surgery is the treatment of choice for localized uterine sarcomas. We conducted a retrospective study to define prognostic factors. Patients and methods. - We studied 111 cases of patients treated by adjuvant radiotherapy for uterine sarcoma in seven French centers. The median decline was 31 months. We conducted a univariate analysis to identify factors correlated with local recurrence. The statistically significant factors were studied in multivariate analysis by Cox model. Results. - The median dose of external beam radiotherapy was 45 Gy. Forty-three percent of patients had vaginal vault brachytherapy and 21 % chemotherapy. Only 6.3 % of patients had complications of acute grade III and 8.1 % of long-term sequelae of radiotherapy. The survival rate at 5 years was 74.6 %. They noted 12.6 % of isolated locoregional recurrences, against 29.7 % for distant recurrences, 80 % were pulmonary. Factors correlated with the risk of locoregional relapse were menopausal status (P = 0.045) and surgical margins suspicious or not healthy (P = 0.0095). The chemotherapy did not improve overall survival or disease free survival but the numbers were low. Conclusion. - The postoperative radiotherapy provides good local control in this disease. Brachytherapy is sometimes done, but it does not improve local control. Chemotherapy is not a standard localized stage but the rate of metastatic recurrence calls for the development of strategies involving systemic treatment with radiotherapy. (authors)

  7. Stereotactic radiotherapy in pediatric indications

    International Nuclear Information System (INIS)

    Bernier-Chastagner, V.; Supiot, S.; Carrie, C.; Helfre, S.

    2012-01-01

    Stereotactic radiotherapy is a very high precision procedure, which has been limited to radiosurgery for a long time. Technological improvements allowed the development of radiotherapy in stereotactic conditions, leading to a lot of innovations. Previously indicated for cerebral pathologies, this procedure is now developed for extra-cerebral locations. In paediatrics, stereotactic radiotherapy is still limited, delivered precociously, due to the possibility of long-term late effects that needs to be addressed. This review reports the different useful conditions, technical evolutions, and the current validated paediatric indications, with differences from adults, and future directions. (authors)

  8. Adaptive Motion Compensation in Radiotherapy

    CERN Document Server

    Murphy, Martin J

    2011-01-01

    External-beam radiotherapy has long been challenged by the simple fact that patients can (and do) move during the delivery of radiation. Recent advances in imaging and beam delivery technologies have made the solution--adapting delivery to natural movement--a practical reality. Adaptive Motion Compensation in Radiotherapy provides the first detailed treatment of online interventional techniques for motion compensation radiotherapy. This authoritative book discusses: Each of the contributing elements of a motion-adaptive system, including target detection and tracking, beam adaptation, and pati

  9. Development of targeted radiotherapy systems

    International Nuclear Information System (INIS)

    Ferro, Guillermina; Villarreal, Jose E.; Garcia, Laura; Tendilla, Jose I.; Paredes, Lydia; Murphy, Consuelo A.; Pedraza, Martha

    2001-01-01

    Conventional or external beam radiotherapy, has been a viable alternative for cancer treatment. Although this technique is effective, its use is limited if the patient has multiple malignant lesions (metastases). An alternative approach is based on the design of radiopharmaceuticals that, to be administered in the patient, are directed specifically toward the target cell producing a selective radiation delivery. This treatment is known as targeted radiotherapy. We have summarized and discussed some results related to our investigations on the development of targeted radiotherapy systems, including aspects of internal dosimetry

  10. The dosimetric control in radiotherapy

    International Nuclear Information System (INIS)

    Veres, A.

    2009-01-01

    The author first presents the thermoluminescent dosimetry method developed by the Equal-Estro Laboratory to control radiotherapy systems, according to which dosimeters are mailed by the radiotherapy centres to the laboratory, and then analyzed with respect to the level of dose bias. In a second part, he discusses the different techniques used for the dosimetric control of new radiotherapy methods (intensity-modulated radiation therapy, tomo-therapy) for which film dosimetry is applied. He also evokes the development of new phantoms and the development of a method for the dosimetric control of proton beams

  11. PET/CT and radiotherapy

    International Nuclear Information System (INIS)

    Messa, C.; CNR, Milano; S. Gerardo Hospital, Monza; Di Muzio, N.; Picchio, M.; Bettinardi, V.; Gilardi, M.C.; CNR, Milano; San Raffaele Scientific Institute, Milano; Fazio, F.; CNR, Milano; San Raffaele Scientific Institute, Milano; San Raffaele Scientific Institute, Milano

    2006-01-01

    This article reviews the state of the art of PET/CT applications in radiotherapy, specifically its use in disease staging, patient selection, treatment planning and treatment evaluation. Diseases for which radiotherapy with radical intent is indicated will be considered, as well as those in which PET/CT may actually change the course of disease. The methodological and technological aspects of PET/CT in radiotherapy are discussed, focusing on the problem of target volume definition with CT and PET functional imaging and the problem of tumor motion with respect to imaging and dose delivery

  12. Rationale and development of image-guided intensity-modulated radiotherapy post-prostatectomy: the present standard of care?

    Directory of Open Access Journals (Sweden)

    Murray JR

    2015-11-01

    Full Text Available Julia R Murray,1,2 Helen A McNair,2 David P Dearnaley1,2 1Academic Urology Unit, Institute of Cancer Research, London, 2Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK Abstract: The indications for post-prostatectomy radiotherapy have evolved over the last decade, although the optimal timing, dose, and target volume remain to be well defined. The target volume is susceptible to anatomical variations with its borders interfacing with the rectum and bladder. Image-guided intensity-modulated radiotherapy has become the gold standard for radical prostate radiotherapy. Here we review the current evidence for image-guided techniques with intensity-modulated radiotherapy to the prostate bed and describe current strategies to reduce or account for interfraction and intrafraction motion. Keywords: radiotherapy, prostate cancer, post-prostatectomy, image-guided radiation therapy

  13. Unity in Diversity: Electronic Patient Record Use in Multidisciplinary Practice

    OpenAIRE

    Oborn, Eivor; Barrett, Michael; Davidson, Elizabeth

    2011-01-01

    In this paper we examine the use of electronic patient records (EPR) by clinical specialists in their development of multidisciplinary care for diagnosis and treatment of breast cancer. We develop a practice theory lens to investigate EPR use across multidisciplinary team practice. Our findings suggest that there are oppositional tendencies towards diversity in EPR use and unity which emerges across multidisciplinary work, and this influences the outcomes of EPR use. The value of this persp...

  14. Tumours following retinoblastoma radiotherapy

    International Nuclear Information System (INIS)

    Mollot, J.-P.

    1978-01-01

    Radioinduced tumours in young patients irradiated in childhood for retinoblastoma take on a particularly deadly aspect. The onset of this true clinical entity characterized by a long post-irradiation latency period induced by a dose above 6000 rads is a real tragedy. The vast majority of patients then enter into a long martyrdom ending in death. The only cure is surgical, but seldom possible. Treatment is limited to palliative radiotherapy, effective for a while, and chemiotherapy as a last resort but often difficult to prescribe. Prevention alone is the answer. The quality and reliability of the radiotherapeutic treatment depend not only on the personal talent of the radiotherapist but above all on the standard of the equipment. A strong reduction in the doses employed as well as recent technological progress improving the material, its precision and reproducibility appear already to have lowered the frequency curve of these fatal radioinduced tumours [fr

  15. Device for radiotherapy

    International Nuclear Information System (INIS)

    Levinta, A.

    2002-01-01

    The invention refers to medicine, in particular to radiology. Summary of the invention consists in that the device for the radiotherapy includes a base a headrest, a mechanism for head fixation, means for placement of the formation element, the mechanism for head fixation representing a semicircle situated in horizontal position and fixed to the base with the possibility of displacement, in the centre of which it is installed a fixing arm, and the means for placement of the formation elements representing at least two semicircles, mounted in vertical position and fixed into supports with the possibility of mutual swiveling of each of them, between the headrest and the base being installed the neck support

  16. Radiotherapy. 2. rev. ed.

    International Nuclear Information System (INIS)

    Wannenmacher, Michael; Debus, Juergen; Wenz, Frederik

    2013-01-01

    The purpose of this medical specialty book, besides presenting the state of the art in clinical radiotherapy and radiooncology, is to explain the basic principles of medical physics and radiobiology. Following a number of chapters on general topics and theory it provides detailed coverage of the individual organ systems, briefly addressing future aspects in the process. The authors relate their view that radiooncology as a medical specialty will continue to be under pressure to change and that it will take continuous innovation to secure its status within the interdisciplinary context around the treatment of cancer patients. The authors of this, the textbook's second edition, have dedicated much space to modern methods and techniques in order to do justice to these developments.

  17. Radiotherapy on hidradenocarcinoma.

    Science.gov (United States)

    Lalya, Issam; Hadadi, Khalid; Tazi, El Mehdi; Lalya, Ilham; Bazine, Amine; Andaloussy, Khalid; Elmarjany, Mohamed; Sifat, Hassan; Hassouni, Khalid; Kebdani, Tayeb; Mansouri, Hamid; Benjaafar, Noureddine; Elgueddari, Brahim Khalil

    2011-01-01

    Clear cell Hidradenocarcinoma is a rare carcinoma arising from sweat glands. It is an aggressive tumor that most metastasizes to regional lymph nodes and distant viscera; surgery with safe margins is the mainstay of treatment. We report a case of 68-year-old woman who presented with an invasive clear cell hidradenocarcinoma situated in the left parotid area which recurred 5 months after surgery, this recurrence was managed successfully by high-dose irradiation of the tumor bed (66 Gy) and regional lymphatic chains (50 Gy), after a follow-up of more than 15 months, the patient is in good local control without significant toxicity. POST OPERATIVE RADIOTHERAPY ALLOWS BETTER LOCAL CONTROL AND SHOULD BE MANDATORY WHEN HISTOLOGICAL FEATURES PREDICTIVE OF RECURRENCE ARE PRESENT: positive margins, histology poorly differentiated, perineural invasion, vascular and lymphatic invasion, lymph node involvement, and extracapsular spread.

  18. Decision logics in radiotherapy

    International Nuclear Information System (INIS)

    Gauwerky, F.

    1979-01-01

    Decisions in planning procedures can generally, at least for beam therapy to deep seated tumors, be based on a self-consistent system of criteria of optimization, namely: 1. The absorbed dose to the target volume must be applied as uniformly as possible. 2. Absorbed doses to organs (volumes) at risk must be as low as possible, at least below an accepted limit. 3. Radiation effects to outside volumes must be kept as low as possible. Whereas these criteria, as being reduced to the simplest possible requirements, have to be regarded as the stable elements, the radiotherapy parameters, such as geometric arrangements, special techniques, absorbed dose contributions to reference points or systems, have to be taken as the variables within decision processes. The properties of the criteria which have widely proved to be valuable in routine clinical practice, have been investigated in relation to the theoretical system of axioms as it is e.g. offered by Karl Popper's general logics of scientific research. An axiomatic system, as it is demanded (after Popper) must be a) free of discrepancies, i.e. self-consistent (not any sentence can be derived), b) independent, that is, one axiom cannot be derived from another one within the system, c) sufficient for deduction of statements needed, d) necessary, that is complete. All these requirements are fitting also to the offered system of radiotherapy optimization criteria. It has been demonstrated, that Popper's axiomatic system can be regarded as to be the general case for all scientific fields of application, the set of optimization criteria being a special system for radiation therapy, which would have been derivable from Popper's theory. Also practical use could be demonstrated. (orig./ORU) [de

  19. Mobilization of intensive care patients: a multidisciplinary practical guide for clinicians

    Directory of Open Access Journals (Sweden)

    Green M

    2016-05-01

    Full Text Available Margot Green1, Vince Marzano1, I Anne Leditschke2,3, Imogen Mitchell2,3, Bernie Bissett1,4,5 1Physiotherapy Department, Canberra Hospital, Canberra, ACT, Australia; 2Intensive Care Unit, Canberra Hospital, Canberra, ACT, Australia; 3School of Medicine, Australian National University, Canberra, ACT, Australia; 4Discipline of Physiotherapy, University of Canberra, Canberra, ACT, Australia; 5School of Medicine, University of Queensland, Brisbane, QLD, Australia Objectives: To describe our experience and the practical tools we have developed to facilitate early mobilization in the intensive care unit (ICU as a multidisciplinary team.Background: Despite the evidence supporting early mobilization for improving outcomes for ICU patients, recent international point-prevalence studies reveal that few patients are mobilized in the ICU. Existing guidelines rarely address the practical issues faced by multidisciplinary ICU teams attempting to translate evidence into practice. We present a comprehensive strategy for safe mobilization utilized in our ICU, incorporating the combined skills of medical, nursing, and physiotherapy staff to achieve safe outcomes and establish a culture which prioritizes this intervention.Methods: A raft of tools and strategies are described to facilitate mobilization in ICU by the multidisciplinary team. Patients without safe unsupported sitting balance and without ≥3/5 (Oxford scale strength in the lower limbs commence phase 1 mobilization, including training of sitting balance and use of the tilt table. Phase 2 mobilization involves supported or active weight-bearing, incorporating gait harnesses if necessary. The Plan B mnemonic guides safe multidisciplinary mobilization of invasively ventilated patients and emphasizes the importance of a clearly articulated plan in delivering this valuable treatment as a team.Discussion: These tools have been used over the past 5 years in a tertiary ICU with a very low incidence of

  20. Why Radiotherapy Works. Chapter 6

    International Nuclear Information System (INIS)

    Tashiro, S.; Nishibuchi, I.; Wondergem, J.

    2017-01-01

    The history of radiotherapy began in 1895, when Röntgen discovered X rays, and in the following year, radiation was used for medical treatment. In the early days, the development of radiotherapy was based extensively on empiricism. Radiotherapists worked closely with radiation biologists in attempting to describe and understand the phenomena produced by ionizing radiation in the clinic and in biological systems. During the ensuing 120 years, radiotherapy has been improved significantly and, in addition to radiation biology, medical physics has played an important role in the design and development of equipment, quality assurance and dosimetry. Over recent decades, advances have been made in the field of molecular biology. Currently available techniques enable us to elucidate the molecular mechanisms of cellular response to ionizing irradiation, and it is anticipated that the role and contributions of radiation biology in radiotherapy will remain relevant. This chapter describes the clinically important biological points, including knowledge from current molecular biology.

  1. Radiotherapy in the Hodgkin's disease

    International Nuclear Information System (INIS)

    Pinto, A.C.L.C.; Moura, J.E.F.M. de; Leite, M.T.T.; Santa Casa de Misericordia de Belo Horizonte

    1983-01-01

    An up-to-date summary of Hodgkin's disease is presented taking into account its natural history, dissemination patterns, history, staging and therapeutic sugestions, with special regard to radiotherapy. (Author) [pt

  2. Targeted intraoperative radiotherapy in oncology

    CERN Document Server

    Keshtgar, Mohammed; Wenz, Frederik

    2014-01-01

    Targeted intraoperative radiotherapy is a major advance in the management of cancer patients. With an emphasis on practical aspects, this book offers an ideal introduction to this innovative  technology for clinicians.

  3. The biological basis of radiotherapy

    International Nuclear Information System (INIS)

    Steel, G.G.; Adams, G.E.; Horwich, A.

    1989-01-01

    The focus of this book is the biological basis of radiotherapy. The papers presented include: Temporal stages of radiation action:free radical processes; The molecular basis of radiosensitivity; and Radiation damage to early-reacting normal tissue

  4. Radiotherapy of presenile spinal osteoporosis

    International Nuclear Information System (INIS)

    Keim, H.M.; Schiebusch, M.

    1982-01-01

    Painfull conditions of presenile spinal osteoporosis may no longer respond to medication or physical therapy. Analgesic radiotherapy coupled with mild physical therapy and if necessary supported by orthopedic measures frequently results in pain relief and physical stability. Fifty-two cases of osteoporosis and osteoporotic spinal fractures illustrate how better longterm results are achieved by increasing the customary dosage and speeding up radiotherapy. (orig.) [de

  5. Implementing web-based ping-pong-type e-communication to enhance staff satisfaction, multidisciplinary cooperation, and clinical effectiveness

    Science.gov (United States)

    Yeh, Pei-Han; Hung, Shih-Kai; Lee, Moon-Sing; Chiou, Wen-Yen; Lai, Chun-Liang; Tsai, Wei-Ta; Hsieh, Hui-Ling; Shih, Yi-Ting; Chen, Liang-Cheng; Huang, Li-Wen; Lin, Yi-An; Lin, Po-Hao; Lin, Yung-Hsiang; Liu, Dai-Wei; Hsu, Feng-Chun; Tsai, Shiang-Jiun; Liu, Jia-Chi; Chung, En-Seu; Lin, Hon-Yi

    2016-01-01

    Abstract Background: Frequent multidisciplinary communication is essential in conducting daily radiotherapy (RT) practice. However, traditional oral or paper-based communication has limitations. E-communication has been suggested, but its effects are still not well demarcated in the field of radiation oncology. Objects: In our web-based integrated information platform, we constructed a ping-pong-type e-communication function to transfer specific notations among multidisciplinary RT staffs. The purpose was to test whether applying this e-communication can increase effectiveness of multidisciplinary cooperation when compared with oral or paper-based practice. Staff satisfaction and clinical benefits were also demonstrated. Design and setting: A real-world quality-improving study was conducted in a large center of radiation oncology. Participants and dataset used: Before and after applying multidisciplinary e-communication (from 2014 to 2015), clinical RT staffs were surveyed for their user experience and satisfaction (n = 23). For measuring clinical effectiveness, a secondary database of irradiated head and neck cancer patients was re-analyzed for comparing RT toxicities (n = 402). Interventions: Applying ping-pong-type multidisciplinary reflective e-communication was the main intervention. Outcome measures: For measuring staff satisfaction, eight domains were surveyed, such as timeliness, convenience, and completeness. For measuring clinical effectiveness of multidisciplinary cooperation, event rates of severe (i.e., grade 3–4) RT mucositis and dermatitis were recorded. Results: Overall, when compared with oral communication only, e-communication demonstrated multiple benefits, particularly on notation-review convenience (2.00 ± 1.76 vs 9.19 ± 0.81; P communication showed statistically significant benefits on all eight domains, especially on notation-review convenience (5.05 ± 2.11 vs 9.19 ± 0.81; P communication (8.76 ± 0

  6. Intraoperative radiotherapy in breast cancer: literature review

    International Nuclear Information System (INIS)

    Alfaro Hidalgo, Sabrina A.

    2013-01-01

    A literature review was performed on intraoperative radiotherapy of breast cancer. The strength and attractiveness is established of techniques of partial irradiation in the treatment of breast cancer. The benefit is originated to restrict the area immediate of radiotherapy to the tumor bed or quadrant index and identifying the benefit of being applied during the radiotherapy while surgical lumpectomy. The impact of local recurrence has been established using intraoperative radiotherapy. The advantages of intraoperative radiotherapy was compared in the management of the conservative surgery in early stages of breast cancer with external radiotherapy. Different methods of intraoperative radiotherapy have been compared and individual impact on local recurrence ranges. Intraoperative radiotherapy has had many advantages: radiobiological, technical, clinical, psychological and economical in the handling of conservative surgery in early stages of breast cancer, compared with external radiotherapy [es

  7. Bone Health and Pelvic Radiotherapy.

    Science.gov (United States)

    Higham, C E; Faithfull, S

    2015-11-01

    Survivors who have received pelvic radiotherapy make up many of the long-term cancer population, with therapies for gynaecological, bowel, bladder and prostate malignancies. Individuals who receive radiotherapy to the pelvis as part of their cancer treatment are at risk of insufficiency fractures. Symptoms of insufficiency fractures include pelvic and back pain and immobility, which can affect substantially quality of life. This constellation of symptoms can occur within 2 months of radiotherapy up to 63 months post-treatment, with a median incidence of 6-20 months. As a condition it is under reported and evidence is poor as to the contributing risk factors, causation and best management to improve the patient's bone health and mobility. As radiotherapy advances, chronic symptoms, such as insufficiency fractures, as a consequence of treatment need to be better understood and reviewed. This overview explores the current evidence for the effect of radiotherapy on bone health and insufficiency fractures and identifies what we know and where gaps in our knowledge lie. The overview concludes with the need to take seriously complaints of pelvic pain from patients after pelvic radiotherapy and to investigate and manage these symptoms more effectively. There is a clear need for definitive research in this field to provide the evidence-based guidance much needed in practice. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  8. Education in physics of radiotherapy

    International Nuclear Information System (INIS)

    Kessler, Judith; Feld, Diana B.; Portillo, Perla A.; Casal, Mariana R.; Menendez, Pablo R.

    2008-01-01

    Radiotherapy is the clinical application which requires the highest precision in dose delivery because of the very high doses administrated to patients, taking into account that new diagnostic methods and new modalities and treatment machines give greater possibilities of dose escalation. These higher doses may also produce serious side effects if not accurately administered. High qualified personnel is therefore needed for dealing with these new complex modalities, assuring that dose prescribed is correctly administered and providing adequate radiation protection to patients, public and staff. Education in Physics of Radiotherapy aims to provide students with solid theoretical and practical basis in order to be able to work with great responsibility and understanding in a Radiotherapy Department and assure that appropriate radiation protection to patients, public and staff. Since 1964 the National Atomic Energy Commission (CNEA) gives course related to Radiotherapy and since 2002, due to a collaborative project, these courses are given at the Oncology Institute 'Angel H. Roffo' (IOAR) which belongs to the University of Buenos Aires (UBA). The IOAR is well equipped in Radiotherapy and new techniques are continuously introduced. That is why, being a University Institution and having highly specialized staff, it is the ideal hospital for teaching Radiotherapy in Buenos Aires, not only for regular courses but also for implementing workshops, seminars and updating courses as well. Continuous education helps to create and increase awareness of the importance of radiation protection in patients as well as in public and staff. (author)

  9. Robust Parameter Coordination for Multidisciplinary Design

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    This paper introduced a robust parameter coordination method to analyze parameter uncertainties so as to predict conflicts and coordinate parameters in multidisciplinary design. The proposed method is based on constraints network, which gives a formulated model to analyze the coupling effects between design variables and product specifications. In this model, interval boxes are adopted to describe the uncertainty of design parameters quantitatively to enhance the design robustness. To solve this constraint network model, a general consistent algorithm framework is designed and implemented with interval arithmetic and the genetic algorithm, which can deal with both algebraic and ordinary differential equations. With the help of this method, designers could infer the consistent solution space from the given specifications. A case study involving the design of a bogie dumping system demonstrates the usefulness of this approach.

  10. Multi-disciplinary collaboration in radiopharmaceutical chemistry

    International Nuclear Information System (INIS)

    Nozaki, Tadashi

    1989-01-01

    Various possibilities often exist in each step of radiopharmaceutical preparation, and multi-disciplinary knowledge and collaboration are necessary for improved choice of the preparation conditions. In the radionuclide production step, proton bombardment of a separated nuclide target usually exceeds other bombardments of natural targets. Isotope separation by laser-chemical method is expected to soon offer several enriched nuclides useful as the target in enough amount and moderate price. The design and preparation of radiopharmaceuticals will be directly influenced by further progress of enzymology and immunology. Nondestructive, continuous observation of chemical changes in vivo is a longing of radiochemists, and may be realized gradually through elaborate examination of chemical effects in Mossbauer absorption, γ-γ angular correlation, EC X-ray properties, and positron annihilation. Present knowledge and techniques in radiopharmaceutical chemistry, on the other hand, can be utilized effectively in other fields of life sciences

  11. Juvenile Fibromyalgia: A Multidisciplinary Approach to Treatment.

    Science.gov (United States)

    Tesher, Melissa S

    2015-06-01

    A 14-year-old boy presented with months of severe widespread musculoskeletal pain. He was profoundly fatigued and unable to attend school. Laboratory evaluation, including complete blood count, comprehensive metabolic panel, inflammatory markers, and thyroid function, was unrevealing. Physical examination was also normal except for multiple tender points. The patient was diagnosed with juvenile primary fibromyalgia syndrome and referred for multidisciplinary treatment including physical therapy, exercise, and counseling, and his daily functioning gradually improves. Juvenile fibromyalgia is a complex syndrome that often severely limits patients' activities and can impede normal adolescent development. Effective treatment requires an understanding of the biologic, psychologic, and social factors contributing to the perpetuation of chronic pain. The author reviews the diagnostic criteria, pathophysiology, and treatment of juvenile fibromyalgia. Medications, particularly antidepressants and anticonvulsants, can be useful adjuncts to therapy. However, multimodal pain management including intensive physical therapy, exercise, counseling, and sleep hygiene is most effective in treating fibromyalgia. Copyright 2015, SLACK Incorporated.

  12. Multidisciplinary treatment approach in Treacher Collins syndrome.

    Science.gov (United States)

    Hylton, Joseph B; Leon-Salazar, Vladimir; Anderson, Gary C; De Felippe, Nanci L O

    2012-01-01

    Treacher Collins syndrome (TCS) is a common genetic disorder with high penetrance and phenotypic variability. First and second branchial arches are affected in TCS, resulting in craniofacial and intraoral anomalies such as: severe convex facial profile; mid-face hypoplasia; microtia; eyelid colobomas; mandibular retrognathism; cleft palate; dental hypoplasia; heterotopic teeth; maxillary transverse hypoplasia; anterior open bite; and Angle Class II molar relationship. A high incidence of caries is also a typical finding in TCS patients. Nonetheless, even simple dental restorative procedures can be challenging in this patient population due to other associated medical conditions, such as: congenital heart defects; decreased oropharyngeal airways; hearing loss; and anxiety toward treatment. These patients often require a multidisciplinary treatment approach, including: audiology; speech and language pathology; otorhinolaryngology; general dentistry; orthodontics; oral and maxillofacial surgery; and plastic and reconstructive surgeries to improve facial appearance. This paper's purpose was to present a current understanding of Treacher Collins syndrome etiology, phenotype, and current treatment approaches.

  13. Challenge: A Multidisciplinary Degree Program in Bioinformatics

    Directory of Open Access Journals (Sweden)

    Mudasser Fraz Wyne

    2006-06-01

    Full Text Available Bioinformatics is a new field that is poorly served by any of the traditional science programs in Biology, Computer science or Biochemistry. Known to be a rapidly evolving discipline, Bioinformatics has emerged from experimental molecular biology and biochemistry as well as from the artificial intelligence, database, pattern recognition, and algorithms disciplines of computer science. While institutions are responding to this increased demand by establishing graduate programs in bioinformatics, entrance barriers for these programs are high, largely due to the significant prerequisite knowledge which is required, both in the fields of biochemistry and computer science. Although many schools currently have or are proposing graduate programs in bioinformatics, few are actually developing new undergraduate programs. In this paper I explore the blend of a multidisciplinary approach, discuss the response of academia and highlight challenges faced by this emerging field.

  14. [Low back pain during pregnancy. Multidisciplinary approach].

    Science.gov (United States)

    Gallo-Padilla, D; Gallo-Padilla, C; Gallo-Vallejo, F J; Gallo-Vallejo, J L

    2016-09-01

    After explaining that low back pain is considered the most common pregnancy complication, its pathogenesis, risk factors and the clinical characteristics of the very painful symptoms of this condition are described. As for its approach, it is stressed that it must be multidisciplinary, introducing very important preventive measures, including proper postural hygiene. For its treatment, the methods may be based on non-surgical or pharmacological interventions of a conservative non-invasive nature. Thus, physiotherapy, osteopathic manipulation, multimodal intervention (exercise and education), exercises performed in water environment, acupuncture, etc., have proven to be effective. Finally, it is emphasised that given the significant impact on their quality of life, different health professionals must be proactive and treat the lumbar disease in pregnant women. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Gummy smile: A contemporary and multidisciplinary overview

    Directory of Open Access Journals (Sweden)

    Marcelo Tomás Oliveira

    2013-01-01

    Full Text Available The aim of this study was to elucidate the diagnosis, etiology, and therapeutic options for the treatment of gummy smile. The smile level is an imaginary line after the lower superior lip and used seems to be convex. The presence of 3 mm or grater continuous gingival band exposures to natural smile or speech performs the gummy smile. Original articles studying the diagnosis, etiology, and therapeutic alternatives for the treatment of gummy smile were searched in the Medline, Scopus, Science direct, and EBSCO host databases. Together with some example and diagnosis method was purposed. The authors conclude that the etiology is multifactorial and can be showed excessive vertical maxillary grow up, excessive labial contraction, shorter upper lip, gingival excess, and extrusion of the anterior teeth. The therapeutics alternative are often multidisciplinary, besides can be used orthognathic, plastic and periodontal surgery, and orthodontic.

  16. Multidisciplinary systems engineering architecting the design process

    CERN Document Server

    Crowder, James A; Demijohn, Russell

    2016-01-01

    This book presents Systems Engineering from a modern, multidisciplinary engineering approach, providing the understanding that all aspects of systems design, systems, software, test, security, maintenance and the full life-cycle must be factored in to any large-scale system design; up front, not factored in later. It lays out a step-by-step approach to systems-of-systems architectural design, describing in detail the documentation flow throughout the systems engineering design process. It provides a straightforward look and the entire systems engineering process, providing realistic case studies, examples, and design problems that will enable students to gain a firm grasp on the fundamentals of modern systems engineering.  Included is a comprehensive design problem that weaves throughout the entire text book, concluding with a complete top-level systems architecture for a real-world design problem.

  17. Children’s experiences and responses towards an intervention for psychological preparation for radiotherapy

    OpenAIRE

    Engvall, Gunn; Lindh, Viveca; Mullaney, Tara; Nyholm, Tufve; Lindh, Jack; Ångström-Brännström, Charlotte

    2018-01-01

    Background: Children can experience distress when undergoing radiotherapy as a reaction to being scared of and unfamiliar with the procedure. The aim was to evaluate children's experiences and responses towards an intervention for psychological preparation for radiotherapy. Methods: A case control design with qualitative content analysis of semi-structured interviews and statistical analysis of anxiety ratings were used for evaluating a strategy for psychological preparation and distraction. ...

  18. Hypohidrotic ectodermal dysplasia: a multidisciplinary approach.

    Science.gov (United States)

    Bildik, Tezan; Ozbaran, Burcu; Kose, Sezen; Koturoglu, Guldane; Gokce, Bulent; Gunaydin, Asli; Altintas, Inci

    2012-01-01

    Hypohidrotic ectodermal dysplasia (HED; Christ-Siemens-Touraine syndrome) is a genetic disorder characterized by sparse hair, oligodontia with peg-shaped teeth, reduced sweating, and defects in a number of other ectodermal organs. A partial or complete absence of eccrine glands can lead to recurrent severe overheating that may cause seizures and neurological deficits. This clinical report presents a 14-year-old male patient with hypohidrotic ectodermal dysplasia, including the clinical and radiographic findings, and multidisciplinary treatment. The Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) was administered to patient along with mother to assess for any psychiatric disorders. The screening and rating scales completed by mother and two teachers to evaluate the severity of attention deficit hyperactivity disorder (ADHD) symptoms, and other behavioral problems. Patient's academic performance, adaptive functioning, and problem behavior was evaluated using. The Teacher Report Form. Mental capacity was assessed with the Wechsler Intelligence Scale for Children (WISC-R). Illness Perception Questionnaire Revised was used to systematically assess illness representation attributes and emotional representations of illness. On the psychiatric diagnosis assessment using K-SADS-PL sub-threshold attention deficits and anxiety symptoms were determined. In this case we established a multidisciplinary approach in his treatment with pediatric, dermatological, and dental examinations, beside his psychiatric evaluation. The prosthetic rehabilitation included restoring upper teeth with copings and fabrication of upper and lower complete dentures. Metal framework was not incorporated in the partial denture design allowing modifications as the oral and maxillofacial development continued. Removable complete or partial dentures without metal framework is a treatment of choice until the completion of facial growth at

  19. WEE1 inhibition sensitizes osteosarcoma to radiotherapy

    International Nuclear Information System (INIS)

    PosthumaDeBoer, Jantine; Würdinger, Thomas; Graat, Harm CA; Beusechem, Victor W van; Helder, Marco N; Royen, Barend J van; Kaspers, Gertjan JL

    2011-01-01

    The use of radiotherapy in osteosarcoma (OS) is controversial due to its radioresistance. OS patients currently treated with radiotherapy generally are inoperable, have painful skeletal metastases, refuse surgery or have undergone an intralesional resection of the primary tumor. After irradiation-induced DNA damage, OS cells sustain a prolonged G 2 cell cycle checkpoint arrest allowing DNA repair and evasion of cell death. Inhibition of WEE1 kinase leads to abrogation of the G 2 arrest and could sensitize OS cells to irradiation induced cell death. WEE1 expression in OS was investigated by gene-expression data analysis and immunohistochemistry of tumor samples. WEE1 expression in OS cell lines and human osteoblasts was investigated by Western blot. The effect of WEE1 inhibition on the radiosensitivity of OS cells was assessed by cell viability and caspase activation analyses after combination treatment. The presence of DNA damage was visualized using immunofluorescence microscopy. Cell cycle effects were investigated by flow cytometry and WEE1 kinase regulation was analyzed by Western blot. WEE1 expression is found in the majority of tested OS tissue samples. Small molecule drug PD0166285 inhibits WEE1 kinase activity. In the presence of WEE1-inhibitor, irradiated cells fail to repair their damaged DNA, and show higher levels of caspase activation. The inhibition of WEE1 effectively abrogates the irradiation-induced G 2 arrest in OS cells, forcing the cells into premature, catastrophic mitosis, thus enhancing cell death after irradiation treatment. We show that PD0166285, a small molecule WEE1 kinase inhibitor, can abrogate the G 2 checkpoint in OS cells, pushing them into mitotic catastrophe and thus sensitizing OS cells to irradiation-induced cell death. This suggests that WEE1 inhibition may be a promising strategy to enhance the radiotherapy effect in patients with OS

  20. Recommendations for the clinical practice: Standards, options and recommendations 2003 for the use of recombinant erythropoietin (alpha and beta epoetine, alpha darbepoetine, EPO) in the taking charge of anemia in oncology for the patients treated by radiotherapy, update

    International Nuclear Information System (INIS)

    Marchal, Ch.; Spaeth, C.; Casadevall, N.; Daouphars, M.; Marec-Berard, P.; Fabre, N.; Haugh, M.

    2004-01-01

    Standards, Options and Recommendations for the use of recombinant erythropoietin (epoietin alpha and beta darbepoietin alpha, EPO) in the management of anaemia in oncology for patient undergoing radiotherapy - UPDATE 2003. Context. - 'The Standards, Options and Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the twenty French cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. Objectives. - To update the Standards, Options and Recommendations clinical practice guidelines for the use of recombinant erythropoietin (epoietin alpha and beta darbepoietin-alpha, EPO) in the management of anaemia in oncology for patient undergoing radiotherapy. Methods. - The working group identified the questions requiring up-dating from the previous guideline. Medline and Embase were searched using specific search strategies from January 1999 to October 2002. Literature monitoring was performed to identify randomized clinical trials published between October 2002 to November 2003. In addition several Internet sites were searched in October 2002. Results. - There is no standard attitude for use of rHuEPO in patients undergoing radiotherapy. There is no evidence to support use of rHuEPO in patients with ENT cancer receiving radiotherapy alone. In patients undergoing curative radiotherapy, it is recommended to correct anaemia under 10 g/dL using transfusion rather than rHuEPO. When the haemoglobin concentration is between 12 g/dL and 14 g/dL initial use of rHuEPO can be an option under certain conditions for radio-chemotherapy if the risk of anaemia is

  1. Gene therapy and radiotherapy in malignant tumor

    International Nuclear Information System (INIS)

    Zhang Yaowen; Cao Yongzhen; Li Jin; Wang Qin

    2008-01-01

    Tumor treatment is one of the most important fields in medical research. Nowadays, a novel method which is combined gene therapy with radiotherapy plays an important role in the field of cancer research, and mainly includes immune gene therapy combined with radiotherapy, suicide gene therapy or tumor suppressor gene therapy combined with radiotherapy, antiangiogenesis gene therapy combined with radiotherapy and protective gene therapy combined with radiotherapy based on the technical features. This review summarized the current status of combined therapies of gene therapy and radiotherapy and possible mechanism. (authors)

  2. Radioprotectors in Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Nair, C.K.K. [Bhabha Atomic Research Centre, Mumbai (India); Parida, D.K.; Nomura, Taisei

    2001-03-01

    This review article focuses on clinically relevant radioprotectors and their mechanisms of radioprotection. Radiotherapy is the most common modality of human cancer therapy. Obtaining optimal results requires a judicious balance between the total dose of radiotherapy delivered and the threshold limit of critical surrounding normal tissues, and the normal tissues need to be protected against radiation injury to obtain better tumor control by using a higher dose. For this reason, radiation-protective agents play an important role in clinical radiotherapy. Radiation-protective agents can be classified into three groups: radioprotectors, adaptogens, and absorbents. The first group generally consists of sulfhydryl compounds and other antioxidants. They include several myelo-, entero-, and cerebro-protectors. Adaptogens act as promotors of radioresistance. They are natural protectors that offer chemical protection against low levels of ionizing radiation. Absorbents protect organs from internal radiation and chemicals. They include drugs that prevent incorporation of radioiodine by the thyroid gland and absorption of radionuclides. This article thoroughly describes the properties, mechanisms of action, and perspectives on clinical application of the following categories of radioprotectors: sulfhydryl compounds (e.g., cysteine, cysteamine, glutathione, AET, WR 2127, and other WR-compounds), antioxidants (e.g., tempace, Hoechst 33342, vitamin A, E, and C, TMG, melatonin), angiotensin-converting enzyme (ACE) inhibitors (e.g., captopril, elanopril, penicillamine, pentoxifylline, L-158, 809), cytoprotective agents (mesna, dexrazoxane, and amifostin), metalloelements (e.g., manganese chloride, cadmium salts, bismuth subnitrate), immunomodulators (gamma-interferon, polysaccharides AM5, AM218, heat-killed lactobacillus cells, broncho-vaxom, trehalose dicorynomycolate, and AS101), lipopolysaccharides and prostaglandins, plant extracts and compounds isolated from plants (curcmin

  3. Multidisciplinary Teamwork in Autism: Can One Size Fit All?

    Science.gov (United States)

    Dillenburger, Karola; Röttgers, Hanns-Rüdiger; Dounavi, Katerina; Sparkman, Coleen; Keenan, Mickey; Thyer, Bruce; Nikopoulos, Christos

    2014-01-01

    Multidisciplinary practice has become an accepted approach in many education and social and health care fields. In fact, the right to a multidisciplinary assessment is enshrined in the United Nations Convention of the Rights for Persons with Disabilities (United Nations, 2007). In order to avert a "one size fits all" response to…

  4. The result of implementation of multidisciplinary teams in rectal cancer

    DEFF Research Database (Denmark)

    Wille-Jørgensen, Peer; Sparre, Peter; Glenthøj, Anders

    2013-01-01

    Aim:  In 2003 colorectal multidisciplinary teams (MDT) were established in all major Danish hospitals treating colorectal cancer. The aim was to improve the prognosis by a multidisciplinary evaluation and decision about surgical and oncological treatment, based on medical history, clinical...

  5. Multidisciplinary Special Education Efforts: A Transactional-Ecological Approach.

    Science.gov (United States)

    Buktenica, Norman A.

    The rationale and philosophy for multidisciplinary activities by school psychologists and educators are presented with an emphasis on the acquisition of information on the social context of children's behavior and needs. Multidisciplinary training teams (MDTT) established over an eight-year period in elementary schools in Nashville, Kentucky, are…

  6. A blueprint for multidisciplinary fast track gastrointestinal oncology care

    NARCIS (Netherlands)

    Basta, Y.L.

    2017-01-01

    In this thesis, we have evaluated the implementation of two key concepts of the Gastro Intestinal oncology Center Amsterdam (GIOCA): multidisciplinary teams (MDT) and the fast delivery of care in fast track clinics (FTC). The first part of this thesis investigates the value of multidisciplinary

  7. The multidisciplinary approach to the management toxic epidermal ...

    African Journals Online (AJOL)

    Complete haematological and biochemical tests were carried out and management was symptomatic. This report shows the multidisciplinary approach to the management and highlights the role of the dental surgeon in the management. It concludes that multidisciplinary approach to healthcare provision will be of benefit to ...

  8. Use of Multi-Disciplinary Projects To Develop Competence.

    Science.gov (United States)

    Trotman-Dickenson, Danusia

    1992-01-01

    Undergraduate technology and business students at the Polytechnic of Wales (United Kingdom) participated in multi-disciplinary team projects to experience real life business challenges and develop competences that employers expect in professionals. Lists characteristics of successful multi-disciplinary projects, discusses cost and industry…

  9. Stochastic integer programming for multi-disciplinary outpatient clinic planning

    NARCIS (Netherlands)

    Leeftink, A. G.; Vliegen, I. M.H.; Hans, E. W.

    2017-01-01

    Scheduling appointments in a multi-disciplinary clinic is complex, since coordination between disciplines is required. The design of a blueprint schedule for a multi-disciplinary clinic with open access requirements requires an integrated optimization approach, in which all appointment schedules are

  10. Using Sustainability Themes and Multidisciplinary Approaches to Enhance STEM Education

    Science.gov (United States)

    Rogers, Michael; Pfaff, Thomas; Hamilton, Jason; Erkan, Ali

    2015-01-01

    Purpose: The purpose of this paper is to report on the Multidisciplinary Sustainability Education Project (MSEP) as a framework using sustainability-themed education modules to introduce students to the need for multidisciplinary approaches to solving twenty-first-century problems while retaining traditional course strengths and content.…

  11. Elder abuse: The role of general practitioners in community-based screening and multidisciplinary action

    Science.gov (United States)

    Ries, Nola M; Mansfield, Elise

    2018-04-01

    There are growing calls for elder abuse screening to be conducted by a range of community-based service providers, including general practitioners (GPs), practice nurses, home care workers and lawyers. Improved screening may be a valuable first step towards improving elder abuse detection and response; however, practitioners need evidence-based strategies for screening and follow-up. This article summarises several brief screening tools for various forms of elder abuse. Screening tool properties and evidence gaps are noted. As elder abuse often requires multidisciplinary responses, initiatives to connect health, legal and other service providers are highlighted. GPs are trusted professionals who are well placed to identify older patients at risk of, or experiencing, various forms of abuse. They should be aware of available screening tools and consider how best to incorporate them into their own practice. They also play an important role in multidisciplinary action to address elder abuse.  .

  12. Voice following radiotherapy

    International Nuclear Information System (INIS)

    Stoicheff, M.L.

    1975-01-01

    This study was undertaken to provide information on the voice of patients following radiotherapy for glottic cancer. Part I presents findings from questionnaires returned by 227 of 235 patients successfully irradiated for glottic cancer from 1960 through 1971. Part II presents preliminary findings on the speaking fundamental frequencies of 22 irradiated patients. Normal to near-normal voice was reported by 83 percent of the 227 patients; however, 80 percent did indicate persisting vocal difficulties such as fatiguing of voice with much usage, inability to sing, reduced loudness, hoarse voice quality and inability to shout. Amount of talking during treatments appeared to affect length of time for voice to recover following treatments in those cases where it took from nine to 26 weeks; also, with increasing years since treatment, patients rated their voices more favorably. Smoking habits following treatments improved significantly with only 27 percent smoking heavily as compared with 65 percent prior to radiation therapy. No correlation was found between smoking (during or after treatments) and vocal ratings or between smoking and length of time for voice to recover. There was no relationship found between reported vocal ratings and stage of the disease

  13. Proton radiotherapy: some perspectives

    International Nuclear Information System (INIS)

    Kirn, T.F.

    1988-01-01

    A news article highlighting the use of protons in radiotherapy is presented. Development of stereotaxic radiosurgery is the result of contributions from physicists, radiologists, and neurosurgeons, says Jacob Fabrikant, MD, head of the Arteriovenous Malformation Program at the University of California's Lawrence Berkeley laboratory. It also appears to have been the product of Harvard University (Boston) and University of California (Berkeley) cooperation. Robert R. Wilson, PhD, now a professor emeritus at Cornell University, Ithaca, NY, is credited with proposing the medical use of charged particles. Wilson, a physicist, says that the idea occurred to him while he was at Berkeley in the mid-1940's, designing the cyclotron to be built at Harvard. Although he was aware of their work, he does not remember discussing it with Robert Stone, MD, or John Lawrence, MD, who only a few years earlier at Berkeley had begun the initial medical experiments with neutrons. Wilson says that it simply occurred to him that in certain instances charged particles had two advantages over x-rays

  14. Automatization in radiotherapy

    International Nuclear Information System (INIS)

    Schraub, S.; Dutou, L.; Bernard, D.; Koechlin, M.; Beer-Gabel, J.

    1978-01-01

    Data-processing in external radiotherapy has to be adapted to each local situation, taking into account the patients to be treated, the irradiation equipment, the data-processing centers available locally, regionally, and nationally, and the rentability of the data-processing system required. It should be recalled that most dosimetric methods used today can be treated manually, and the question of rentability has to be kept in mind when deciding to buy a data-processing system. The radiotherapist should, therefore, prepare a list of costs for each situation, and verify the validity of each programme proposed by the supplier. It is difficult to make a definite choice between the presently available systems. The radiotherapist has to choose in relation to his activity, his availability and the systems available to him. It can sometimes be more advantageous to have a terminal linked to a large computer, rather than to readapt a series of programmes for a data-processing system available locally: many such solutions, though original, cannot be 'exported'. It should be recalled that a large number of dosimetries can be obtained manually, and on the rare occasions when the aid of a computer is essential, the assistance of better equipped neighbouring centers can be obtained. The decision as to whether a data-processing system needs to be acquired has to take all these imperatives into account [fr

  15. Erythropoietin in radiotherapy

    International Nuclear Information System (INIS)

    Guttenburger, R.

    2003-01-01

    A high blood hemoglobin level is an independent factor for good prognosis as demonstrated in retrospective and prospective studies in a number of cancer sites. However, there is still debate on how hemoglobin affects outcome after radiotherapy. The issues are: 1. How about the predictive power and the magnitude of effect in various tumor entities? 2. Are all potential mechanisms for the hemoglobin effect considered? 3. Do EPO receptors found on tumor and normal cells outside the bone marrow play a role? Experimental and clinical data on anemia and its treatment have been extensively discussed. So far, the means to manipulate the hemoglobin level, their indication and administration are to be clarified. The issues are: 1. Why does transfusion not improve prognosis? 2. What have we learned from trials using EPO to stimulate endogenous Hb production? 3. What are the potential pitfalls of correcting anemia with EPO? 4. What is the optimal design of EPO-RT trials? Although there are still more questions than answers, the therapeutic potential of erythropoietin is of considerable interest to radiation oncologists. This report gives a summary reviewing the topic and ends on a note of caution: Mild anemia in cancer patients is no indication to use EPO outside clinical trials

  16. Hyperthermia and radiotherapy

    International Nuclear Information System (INIS)

    Dietzel, F.

    1979-01-01

    Of decisive importance for superadditive enhancement is the close temporal correlation of hyperthermia and radiotherapy. It is recommended to first irradiate and then use heat treatment in order to ensure that dividable tumour cells are irradiated before hyperthermia. To achieve an optimal enhancing effect, temperatures of appr. 42 0 are sufficient. In order to be able to neglect temperature regulation and convection effects, hyperthermia for clinical use must be carried out in doses high enough to ensure that it can be finished within 3-4 minutes. It is necessary to make efforts to find out which forms of application can be realised in order to reach deeper tissue regions, thus making possible at least a half-depth-therapy. Up to day, only the 2 cm near to the surface can be heated in a sufficiently homogeneous way. In the FRG, there are more than 200 high-volt-therapy systems, including electron accelerators and telegamma systems. This is a dense network of radiation-therapeutical supply. An improved therapy effect of loose ionising rays which, with the help of the hypertherming, would almost be equal to irradiation with high ionisation density, is not only of scientific interest, but also of high interest for public health. (orig./MG) 891 MG/orig.- 892 RDG [de

  17. The exploration-exploitation dilemma: a multidisciplinary framework.

    Directory of Open Access Journals (Sweden)

    Oded Berger-Tal

    Full Text Available The trade-off between the need to obtain new knowledge and the need to use that knowledge to improve performance is one of the most basic trade-offs in nature, and optimal performance usually requires some balance between exploratory and exploitative behaviors. Researchers in many disciplines have been searching for the optimal solution to this dilemma. Here we present a novel model in which the exploration strategy itself is dynamic and varies with time in order to optimize a definite goal, such as the acquisition of energy, money, or prestige. Our model produced four very distinct phases: Knowledge establishment, Knowledge accumulation, Knowledge maintenance, and Knowledge exploitation, giving rise to a multidisciplinary framework that applies equally to humans, animals, and organizations. The framework can be used to explain a multitude of phenomena in various disciplines, such as the movement of animals in novel landscapes, the most efficient resource allocation for a start-up company, or the effects of old age on knowledge acquisition in humans.

  18. Current management of oral cancer. A multidisciplinary approach.

    Science.gov (United States)

    Ord, R A; Blanchaert, R H

    2001-11-01

    Recent basic science discoveries have contributed to our understanding of the etiology of oral cancer and allowed us to consider innovative approaches to therapy. The authors evaluated and summarized current approaches to the management of oral cancer, emphasizing the multidisciplinary team approach to coordinate surgery, radiation therapy and chemotherapy. Current concepts in management, including complications of therapy, are described. State-of-the-art surgical techniques can spare patients with oral cancer from much of the morbidity and complications common in the past. The refinement of treatment strategies reduces complications and improves efficacy. Many exciting new clinical trials in the areas of gene therapy and immunomodulation are showing promise. Management of oral cancer has undergone radical change in the past 10 years and continues to evolve rapidly. Discoveries in molecular biology, diagnosis, surgery, radiation therapy and medical oncology have altered many traditional concepts and practices. General dental practitioners need to understand current treatment modalities for oral and pharyngeal cancers to determine to whom they should refer patients for the most appropriate treatment, and to make recommendations regarding complications associated with these cancers.

  19. Psychopathological aspects of kidney transplantation: Efficacy of a multidisciplinary team

    Science.gov (United States)

    De Pasquale, Concetta; Veroux, Massimiliano; Indelicato, Luisa; Sinagra, Nunzia; Giaquinta, Alessia; Fornaro, Michele; Veroux, Pierfrancesco; Pistorio, Maria L

    2014-01-01

    Renal transplantation is a well established treatment for end-stage renal disease, allowing most patients to return to a satisfactory quality of life. Studies have identified many problems that may affect adaptation to the transplanted condition and post-operative compliance. The psychological implications of transplantation have important consequences even on strictly physical aspects. Organ transplantation is very challenging for the patient and acts as an intense stressor stimulus to which the patient reacts with neurotransmitter and endocrine-metabolic changes. Transplantation can result in a psychosomatic crisis that requires the patient to mobilize all bio-psycho-social resources during the process of adaptation to the new foreign organ which may result in an alteration in self-representation and identity, with possible psychopathologic repercussions. These reactions are feasible in mental disorders, e.g., post-traumatic stress disorder, adjustment disorder, and psychosomatic disorders. In organ transplantation, the fruitful collaboration between professionals with diverse scientific expertise, calls for both a guarantee for mental health and greater effectiveness in challenging treatments for a viable association between patients, family members and doctors. Integrated and multidisciplinary care should include uniform criteria and procedures for standard assessments, for patient autonomy, adherence to therapy, new coping strategies and the adoption of more appropriate lifestyles. PMID:25540735

  20. In silico pharmacology for a multidisciplinary drug discovery process.

    Science.gov (United States)

    Ortega, Santiago Schiaffino; Cara, Luisa Carlota López; Salvador, María Kimatrai

    2012-01-01

    The process of bringing new and innovative drugs, from conception and synthesis through to approval on the market can take the pharmaceutical industry 8-15 years and cost approximately $1.8 billion. Two key technologies are improving the hit-to-drug timeline: high-throughput screening (HTS) and rational drug design. In the latter case, starting from some known ligand-based or target-based information, a lead structure will be rationally designed to be tested in vitro or in vivo. Computational methods are part of many drug discovery programs, including the assessment of ADME (absorption-distribution-metabolism-excretion) and toxicity (ADMET) properties of compounds at the early stages of discovery/development with impressive results. The aim of this paper is to review, in a simple way, some of the most popular strategies used by modelers and some successful applications on computational chemistry to raise awareness of its importance and potential for an actual multidisciplinary drug discovery process.

  1. [Multidisciplinary approach of hip fractures based on Hungarian data].

    Science.gov (United States)

    Juhász, Krisztina; Turchányi, Béla; Mintál, Tibor; Somogyi, Péter

    2016-09-01

    Hip fractures are described by increased mortality, loss of quality of life, functional decline and burden of diseases. They show a growing number worldwide. The aim of the present study is to summarise the existing data on the incidence, mortality, complications and rehabilitation of hip fractures, which relevance is reported only by few studies. To reduce mortality and complications of hip fractures the authors emphasize the importance of primary treatment within 12 hours, appropriate selection of surgical methods corresponding to the fracture type after the assessment of femoral head viability, vitamin D supplementation, same conditions for primary treatment during everyday of the week, and an adequate acute treatment and rehabilitation for patient's general health status. In the future integrated processing of multidisciplinary results of hip fractures based on Hungarian data can support the development of efficient treatment and prevention strategies, which can be advantageous for the patient, families, health care system, and the society, too, by the reduction of costly complications of hip fracture healing and mortality. Orv. Hetil., 2016, 157(37), 1469-1475.

  2. Hand hygiene strategies

    OpenAIRE

    Yazaji, Eskandar Alex

    2011-01-01

    Hand hygiene is one of the major players in preventing healthcare associated infections. However, healthcare workers compliance with hand hygiene continues to be a challenge. This article will address strategies to help improving hand hygiene compliance. Keywords: hand hygiene; healthcare associated infections; multidisciplinary program; system change; accountability; education; feedback(Published: 18 July 2011)Citation: Journal of Community Hospital Internal Medicine Perspectives 2011, 1: 72...

  3. Image-guided radiotherapy for effective radiotherapy delivery

    CERN Document Server

    Karlsson, Ulf Lennart

    2016-01-01

    Image-guided radiotherapy (IGRT) is a new radiotherapy technology that combines the rapid dose fall off associated with intensity-modulated radiotherapy (IMRT) and daily tumor imaging allowing for high precision tumor dose delivery and effective sparing of surrounding normal organs. The new radiation technology requires close collaboration between radiologists, nuclear medicine specialists, and radiation oncologists to avoid marginal miss. Modern diagnostic imaging such as positron emission tomography (PET) scans, positron emission tomography with Computed Tomograpgy (PET-CT), and magnetic resonance imaging (MRI) allows the radiation oncologist to target the positive tumor with high accuracy. As the tumor is well visualized during radiation treatment, the margins required to avoid geographic miss can be safely reduced , thus sparing the normal organs from excessive radiation. When the tumor is located close to critical radiosensitive structures such as the spinal cord, IGRT can deliver a high dose of radiatio...

  4. Epigenetics in radiotherapy: Where are we heading?

    International Nuclear Information System (INIS)

    Smits, Kim M.; Melotte, Veerle; Niessen, Hanneke E.C.; Dubois, Ludwig; Oberije, Cary; Troost, Esther G.C.; Starmans, Maud H.W.; Boutros, Paul C.; Vooijs, Marc; Engeland, Manon van; Lambin, Philippe

    2014-01-01

    Radiotherapy is an important component of anti-cancer treatment. However, not all cancer patients respond to radiotherapy, and with current knowledge clinicians are unable to predict which patients are at high risk of recurrence after radiotherapy. There is therefore an urgent need for biomarkers to guide clinical decision-making. Although the importance of epigenetic alterations is widely accepted, their application as biomarkers in radiotherapy has not been studied extensively. In addition, it has been suggested that radiotherapy itself introduces epigenetic alterations. As epigenetic alterations can potentially be reversed by drug treatment, they are interesting candidate targets for anticancer therapy or radiotherapy sensitizers. The application of demethylating drugs or histone deacetylase inhibitors to sensitize patients for radiotherapy has been studied in vitro, in vivo as well as in clinical trials with promising results. This review describes the current knowledge on epigenetics in radiotherapy

  5. Technological advances in radiotherapy of rectal cancer

    DEFF Research Database (Denmark)

    Appelt, Ane L; Sebag-Montefiore, David

    2016-01-01

    PURPOSE OF REVIEW: This review summarizes the available evidence for the use of modern radiotherapy techniques for chemoradiotherapy for rectal cancer, with specific focus on intensity-modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) techniques. RECENT FINDINGS: The dosimetric...

  6. A new EU-funded project for enhanced real-time imaging for radiotherapy

    CERN Multimedia

    KTT Life Sciences Unit

    2011-01-01

    ENTERVISION (European training network for digital imaging for radiotherapy) is a new Marie Curie Initial Training Network coordinated by CERN, which brings together multidisciplinary researchers to carry out R&D in physics techniques for application in the clinical environment.   ENTERVISION was established in response to a critical need to reinforce research in online 3D digital imaging and to train professionals in order to deliver some of the key elements for early detection and more precise treatment of tumours. The main goal of the project is to train researchers who will help contribute to technical developments in an exciting multidisciplinary field, where expertise from physics, medicine, electronics, informatics, radiobiology and engineering merges and catalyses the advancement of cancer treatment. With this aim in mind, ENTERVISION brings together ten academic institutes and research centres, as well as the two leading European companies in particle therapy, IBA and Siemens. &ldq...

  7. Enhancing Transparency in Multidisciplinary Expert Communication

    International Nuclear Information System (INIS)

    Hukki, Kristiina; Pulkkinen, Urho

    2003-01-01

    Faced with problems of public acceptance most nuclear waste management organisations now acknowledge the importance of transparency in their pursuit of solutions for high-level nuclear waste disposal. To make progress the implementing organizations need the trust of other stakeholders in the decision-making process. For such trust these outside stakeholders need knowledge on the grounds for the judgments and decisions made in different scientific and technical disciplines. Transparency is, however, at least as important for the multidisciplinary expert communication itself. As a matter of fact, the transparency of the internal expert interaction processes is a prerequisite for the true transparency of the communication between the implementer and the external stakeholder groups. The introduced conceptual framework has been developed for the identification of the requirements of safety-informed communication in multidisciplinary expert work in nuclear waste management. The framework offers a common thinking model and common concepts which can be utilized in the development of the communication practices. The basis of the framework is on the possibility to understand the safety-critical significance of one's work. The transparency of communication is, for its part, based on making explicit the relevant knowledge necessary for gaining the understanding. This supplementary knowledge, which is related to the substance issues but is not scientific-technical by nature, enhances the experts' awareness of the context of their own contribution and of the background of the other experts' contributions. The common conceptualization and modelling of the knowledge-related dependencies between the tasks make it possible to realize the significance of the supplementary knowledge for transparent communication in actual situations. They also facilitate the recognition of the need for different types of supplementary knowledge in the interfaces between the tasks. By enhancing mutual

  8. Protection of patient In radiotherapy

    International Nuclear Information System (INIS)

    Deiyi, P.

    2013-04-01

    The purpose of this project is to clarify some aspects about protection of patient in radiotherapy. Therefore, some basic information about how the use of ionizing radiation in medicine has brought tremendous health benefits to the population globally, the requirement of radiation protection (Justification of practices, Dose limitation and Optimization of protection), and the deterministic and stochastic effects of radiation are presented. The aim of radiotherapy is to use ionizing radiation to cure diseases or make the symptoms of a disease less severe. Also presented are layout of a radiotherapy facility (controlled areas, supervised areas, mazes, door and interlocks, patient observation and communication, and warning sign and lights), radionuclides commonly used for radiation therapy and their main emissions, equipment and devices used in radiotherapy, aspect of protection of patient in radiotherapy such as: leakage test, source on/off, emergency buttons, radiation oncology team, treatment planning, room monitoring, equipment or for protection and Cobalt-60 unit stuck source. The advantages of brachytherapy, leakage from the treatment head and radiation incidents resulting from incorrect dose calibration are discussed. The importance of minimization dose exposure, by considering the basic principles of: time, distance and shielding are also stated. These principles prevent deterministic effects and limit stochastic effects of radiation. (author)

  9. Small animal radiotherapy research platforms

    Energy Technology Data Exchange (ETDEWEB)

    Verhaegen, Frank; Granton, Patrick [Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6201 BN (Netherlands); Tryggestad, Erik, E-mail: frank.verhaegen@maastro.nl [Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21231 (United States)

    2011-06-21

    Advances in conformal radiation therapy and advancements in pre-clinical radiotherapy research have recently stimulated the development of precise micro-irradiators for small animals such as mice and rats. These devices are often kilovolt x-ray radiation sources combined with high-resolution CT imaging equipment for image guidance, as the latter allows precise and accurate beam positioning. This is similar to modern human radiotherapy practice. These devices are considered a major step forward compared to the current standard of animal experimentation in cancer radiobiology research. The availability of this novel equipment enables a wide variety of pre-clinical experiments on the synergy of radiation with other therapies, complex radiation schemes, sub-target boost studies, hypofractionated radiotherapy, contrast-enhanced radiotherapy and studies of relative biological effectiveness, to name just a few examples. In this review we discuss the required irradiation and imaging capabilities of small animal radiation research platforms. We describe the need for improved small animal radiotherapy research and highlight pioneering efforts, some of which led recently to commercially available prototypes. From this, it will be clear that much further development is still needed, on both the irradiation side and imaging side. We discuss at length the need for improved treatment planning tools for small animal platforms, and the current lack of a standard therein. Finally, we mention some recent experimental work using the early animal radiation research platforms, and the potential they offer for advancing radiobiology research. (topical review)

  10. Small animal radiotherapy research platforms

    Science.gov (United States)

    Verhaegen, Frank; Granton, Patrick; Tryggestad, Erik

    2011-06-01

    Advances in conformal radiation therapy and advancements in pre-clinical radiotherapy research have recently stimulated the development of precise micro-irradiators for small animals such as mice and rats. These devices are often kilovolt x-ray radiation sources combined with high-resolution CT imaging equipment for image guidance, as the latter allows precise and accurate beam positioning. This is similar to modern human radiotherapy practice. These devices are considered a major step forward compared to the current standard of animal experimentation in cancer radiobiology research. The availability of this novel equipment enables a wide variety of pre-clinical experiments on the synergy of radiation with other therapies, complex radiation schemes, sub-target boost studies, hypofractionated radiotherapy, contrast-enhanced radiotherapy and studies of relative biological effectiveness, to name just a few examples. In this review we discuss the required irradiation and imaging capabilities of small animal radiation research platforms. We describe the need for improved small animal radiotherapy research and highlight pioneering efforts, some of which led recently to commercially available prototypes. From this, it will be clear that much further development is still needed, on both the irradiation side and imaging side. We discuss at length the need for improved treatment planning tools for small animal platforms, and the current lack of a standard therein. Finally, we mention some recent experimental work using the early animal radiation research platforms, and the potential they offer for advancing radiobiology research.

  11. Small animal radiotherapy research platforms

    International Nuclear Information System (INIS)

    Verhaegen, Frank; Granton, Patrick; Tryggestad, Erik

    2011-01-01

    Advances in conformal radiation therapy and advancements in pre-clinical radiotherapy research have recently stimulated the development of precise micro-irradiators for small animals such as mice and rats. These devices are often kilovolt x-ray radiation sources combined with high-resolution CT imaging equipment for image guidance, as the latter allows precise and accurate beam positioning. This is similar to modern human radiotherapy practice. These devices are considered a major step forward compared to the current standard of animal experimentation in cancer radiobiology research. The availability of this novel equipment enables a wide variety of pre-clinical experiments on the synergy of radiation with other therapies, complex radiation schemes, sub-target boost studies, hypofractionated radiotherapy, contrast-enhanced radiotherapy and studies of relative biological effectiveness, to name just a few examples. In this review we discuss the required irradiation and imaging capabilities of small animal radiation research platforms. We describe the need for improved small animal radiotherapy research and highlight pioneering efforts, some of which led recently to commercially available prototypes. From this, it will be clear that much further development is still needed, on both the irradiation side and imaging side. We discuss at length the need for improved treatment planning tools for small animal platforms, and the current lack of a standard therein. Finally, we mention some recent experimental work using the early animal radiation research platforms, and the potential they offer for advancing radiobiology research. (topical review)

  12. Curative radiotherapy of supraglottic cancer

    International Nuclear Information System (INIS)

    Kim, Yong Ho; Chai, Gyu Young

    1998-01-01

    The purpose of this study was to evaluate the efficacy of curative radiotherapy in the management of supraglottic cancer. Twenty-one patients with squamous cell carcinoma of the supraglottis were treated with radiotherapy at Gyeongsang National University Hospital between 1990 and 1994. Median follow-up period was 36 months and 95% were observed for at least 2 years. Actuarial survival rate at 5 years was 39.3% for 21 patients. The 5-year actuarial survival rate was 75.0% in Stage I, 42.9% in Stage II, 33.3% in Stage III, and 28.6% in Stage IV(p=0.54). The 5-year local control rate was 52.0% for 21 patients. The 5-year local control rate was 75.0% in Stage I, 57.1% in Stage II, 66.7% in Stage III, and 28.6% in Stage IV(p=0.33). Double primary cancer was developed in 3 patients and those were all esophageal cancers. In early stage(Stage I and II) supraglottic cancer, curative radiotherapy would be a treatment of choice and surgery would be better to be reserved for salvage of radiotherapy failure. In advanced stage(Stage III and IV), radiotherapy alone is inadequate for curative therapy and combination with surgery should be done in operable patients. This report emphasizes the importance of esophagoscopy and esophagogram at the follow-up of patients with supraglottic cancer

  13. Radiotherapy and skin tumors; Radiotherapie et tumeurs curanees

    Energy Technology Data Exchange (ETDEWEB)

    Calitchi, E.; KIrova, Y.; Le bourgeois, J.P. [Hopital Henri-Mondor, 94 - Creteil (France)

    1998-09-01

    Radiotherapy plays an important role in treatment of skin tumours. For skin carcinomas, external irradiation (kilo-voltage X-rays or electrons according to clinical characteristics) is more valuable than interstitial brachytherapy, which is recommended for tumours of the lip and of the nasal vestibule. In mycosis fungoides, total cutaneous electron beam radiation therapy is efficient for patients with limited superficial plaques. In the classical form of Kaposi`s sarcoma, radiotherapy can achieve local control-whereas it obtains good palliative results in the epidemic form. (author)

  14. ACCELERATED REGIMENS OF ADJUVANT RADIOTHERAPY IN THE TREATMENT OF BREAST CANCER

    Directory of Open Access Journals (Sweden)

    G. V. Afonin

    2017-01-01

    Full Text Available Treatment of breast cancer (BC is a complex multidisciplinary problem. Often, radiation therapy is an obligatory component of treatment of breast cancer patients. Numerous large randomized trials have proved the efficacy of adjuvant radiotherapy in both the standard fractionation regimen in a single focal dose of 2 Gy to a total focal dose of 50 Gy for 25 fractions and in modes of hypofractionation using radiation exposure at a larger daily dose with a reduction in the total treatment time. The presented review summarizes the data of the largest studies on the modes of hypofractionation of postoperative radiotherapy for breast cancer. Most of the studies comparing the standard mode of fractionation of postoperative radiotherapy with the modes of hypofractionation showed comparable results for the main oncological parameters with similar tolerability, frequency of complications and good cosmetic results. It also shows the economic feasibility of applying accelerated regimes in everyday practice. Despite the fact that radiotherapy in the mode of hypofractionation has already become the standard of treatment and is recommended for use by the largest European and American cancer associations, indications for its conduct, the criteria for selection in the studies and the range of recommended single focal doses differ. The obtained results do not give an opportunity to confidently judge the advantage of one or another regime. It is necessary to determine the factors of a favorable and unfavorable prognosis, to clarify the indications for the use of various radiotherapy techniques. Therefore, questions about the optimal mode of hypo-fractionation of adjuvant radiotherapy, the timing of its initiation and the criteria for selecting patients for this type of therapy as part of the comprehensive treatment of breast cancer have not yet been fully resolved. Also open is the choice of optimal single and total doses of radiation, its combination with drug

  15. The future of personalised radiotherapy for head and neck cancer.

    Science.gov (United States)

    Caudell, Jimmy J; Torres-Roca, Javier F; Gillies, Robert J; Enderling, Heiko; Kim, Sungjune; Rishi, Anupam; Moros, Eduardo G; Harrison, Louis B

    2017-05-01

    Radiotherapy has long been the mainstay of treatment for patients with head and neck cancer and has traditionally involved a stage-dependent strategy whereby all patients with the same TNM stage receive the same therapy. We believe there is a substantial opportunity to improve radiotherapy delivery beyond just technological and anatomical precision. In this Series paper, we explore several new ideas that could improve understanding of the phenotypic and genotypic differences that exist between patients and their tumours. We discuss how exploiting these differences and taking advantage of precision medicine tools-such as genomics, radiomics, and mathematical modelling-could open new doors to personalised radiotherapy adaptation and treatment. We propose a new treatment shift that moves away from an era of empirical dosing and fractionation to an era focused on the development of evidence to guide personalisation and biological adaptation of radiotherapy. We believe these approaches offer the potential to improve outcomes and reduce toxicity. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Design Environment for Multifidelity and Multidisciplinary Components

    Science.gov (United States)

    Platt, Michael

    2014-01-01

    One of the greatest challenges when developing propulsion systems is predicting the interacting effects between the fluid loads, thermal loads, and structural deflection. The interactions between technical disciplines often are not fully analyzed, and the analysis in one discipline often uses a simplified representation of other disciplines as an input or boundary condition. For example, the fluid forces in an engine generate static and dynamic rotor deflection, but the forces themselves are dependent on the rotor position and its orbit. It is important to consider the interaction between the physical phenomena where the outcome of each analysis is heavily dependent on the inputs (e.g., changes in flow due to deflection, changes in deflection due to fluid forces). A rigid design process also lacks the flexibility to employ multiple levels of fidelity in the analysis of each of the components. This project developed and validated an innovative design environment that has the flexibility to simultaneously analyze multiple disciplines and multiple components with multiple levels of model fidelity. Using NASA's open-source multidisciplinary design analysis and optimization (OpenMDAO) framework, this multifaceted system will provide substantially superior capabilities to current design tools.

  17. "Redefining smile-a multidisciplinary approach".

    Science.gov (United States)

    Manne, Prakash; Zakkula, Srujana; Atla, Jyothi; Muvva, Suresh Babu; Sampath, Anche

    2013-07-01

    This article presents a case report of a 20 year old female who was very much dissatisfied with her facial appearance and smile.On examination, it was found that there was a Angles class II division 1 malocclusion and a generalised spacing in the anterior teeth, with a retained, deciduous, left maxillary canine and a malposed 15. On radiographic examination, an impacted 18, 23 was noticed. As the part of the treatment plan, the retained deciduous canine and the impacted permanent canine were extracted and an orthodontic correction of the malocclusion was accomplished. The missing canine was planned to be replaced with a fixed partial denture.The short clinical crown height of the abutment teeth was increased by crown lengthening procedures and the pontic space was contoured to receive a ovate pontic by using diode lasers. The missing tooth was restored by using an all ceramic three unit zirconia bridge. This multi-disciplinary approach improved the smile of the patient and it ultimately enhanced her aesthetics and self confidence.

  18. Multidisciplinary management of intrahepatic cholangiocarcinoma: Current approaches.

    Science.gov (United States)

    Guro, Hanisah; Kim, Jin Won; Choi, YoungRok; Cho, Jai Young; Yoon, Yoo-Seok; Han, Ho-Seong

    2017-06-01

    Intrahepatic cholangiocarcinoma (ICC) is a common primary hepatic tumor. However, its outcomes are usually worse than those of hepatocellular carcinoma owing to its non-specific presentation and detection at an advanced stage. The most widely used serum marker, carbohydrate antigen 19-9, is non-specific. Furthermore, imaging studies rarely identify any pathognomonic features. Surgery is the only treatment option that offers a chance of long-term survival. However, the resectability rate is low owing to the high frequencies of intrahepatic metastases, peritoneal carcinomatosis, or extrahepatic metastases. Surgical treatment should be tailored according to the macroscopic classification of ICC (e.g. mass-forming, periductal infiltrating, and intraductal growth types) because it reflects the tumor's dissemination pattern. Although lymph node metastasis is a negative prognostic factor, the importance and extent of lymph node dissection is still controversial. To improve patient survival, liver transplantation is considered in some patients with unresectable ICC, especially in those with an insufficient remnant liver volume. Minimally invasive procedures, including laparoscopic and robotic liver resection, have been tested and achieved comparable outcomes to conventional surgery in preliminary studies. No randomized trials have confirmed the efficacy of adjuvant chemotherapy in ICC, and several trials have evaluated molecular-targeted agents as monotherapy or in combination with cytotoxic chemotherapy. Multidisciplinary approaches are necessary to improve the outcomes of ICC. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Instruction of Multidisciplinary Content in Introductory Courses

    Science.gov (United States)

    Shaibani, Saami J.

    2017-01-01

    There has been an ever-increasing emphasis on the integration of material in the areas of science, technology, engineering and mathematics during the past decade or so. However, there are two major requirements for accomplishing the effective delivery of such multidisciplinary content in the classroom: having high levels of expertise in all of the subjects; and, having the ability to combine the separate fields in a consistent manner without compromising academic purity. The research reported here involves a teacher with this skill set and it includes an example from kinematics, which is initially explored with standard treatment of concepts in mechanics and then developed with analysis employing algebra. As often happens, the non-trivial nature of the result in this case does not readily allow students to have a sense that the physics-based outcome is correct. This shortfall is remedied by adopting a complementary approach with geometry and calculus, which adds an independent perspective that reassures students by confirming the validity of the original answer. The enhanced quality of instruction achieved with the above methodology produces many benefits, including greater student understanding and more opportunities for active involvement by students in the learning process.

  20. Multidisciplinary approach for patients with esophageal cancer

    Institute of Scientific and Technical Information of China (English)

    Victoria M Villaflor; Marco E Allaix; Bruce Minsky; Fernando A Herbella; Marco G Patti

    2012-01-01

    Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced.There are no screening recommendations for patients unless they have Barrett's esophagitis or a significant family history of this disease.Often,esophageal cancer is not diagnosed until patients present with dysphagia,odynophagia,anemia or weight loss.When symptoms occur,the stage is often stage Ⅲ or greater.Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection.The treatment of patients who have locally advanced esophageal cancer is more complex and controversial.Despite multiple trials,treatment recommendations are still unclear due to conflicting data.Sadly,much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically.Additionally,studies have been underpowered or stopped early due to poor accrual.In the United States,concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient.Patients who have metastatic disease are treated palliatively.The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer,and to review the literature which guides our treatment recommendations.

  1. Multi-Disciplinary System Reliability Analysis

    Science.gov (United States)

    Mahadevan, Sankaran; Han, Song

    1997-01-01

    The objective of this study is to develop a new methodology for estimating the reliability of engineering systems that encompass multiple disciplines. The methodology is formulated in the context of the NESSUS probabilistic structural analysis code developed under the leadership of NASA Lewis Research Center. The NESSUS code has been successfully applied to the reliability estimation of a variety of structural engineering systems. This study examines whether the features of NESSUS could be used to investigate the reliability of systems in other disciplines such as heat transfer, fluid mechanics, electrical circuits etc., without considerable programming effort specific to each discipline. In this study, the mechanical equivalence between system behavior models in different disciplines are investigated to achieve this objective. A new methodology is presented for the analysis of heat transfer, fluid flow, and electrical circuit problems using the structural analysis routines within NESSUS, by utilizing the equivalence between the computational quantities in different disciplines. This technique is integrated with the fast probability integration and system reliability techniques within the NESSUS code, to successfully compute the system reliability of multi-disciplinary systems. Traditional as well as progressive failure analysis methods for system reliability estimation are demonstrated, through a numerical example of a heat exchanger system involving failure modes in structural, heat transfer and fluid flow disciplines.

  2. Desensitization to rituximab in a multidisciplinary setting.

    Science.gov (United States)

    Amorós-Reboredo, Patrícia; Sánchez-López, Jaime; Bastida-Fernández, Carla; do Pazo-Oubiña, Fernando; Borràs-Maixenchs, Núria; Giné, Eva; Valero, Antonio; Creus-Baró, Natàlia

    2015-10-01

    The need to offer first-line therapy to the increasing number of patients who have suffered an hypersensitivity reaction has stimulated the use of rapid desensitization protocols. To present our experience working as a multidisciplinary team using a rituximab rapid desensitization scheme. Patient demographics, allergic reaction, skin tests to rituximab, number of desensitizations, reactions during the desensitization protocol and actions taken, number of administered and completed cycles, were retrospectively collected in patients who received at least one desensitization to rituximab. Number of desensitizations successfully managed. Between 2012 and June 2013 five patients received a total of 19 desensitizations to rituximab using a 12 step rapid desensitization protocol. All patients received the scheduled chemotherapeutic cycles as inpatients, with no delay in administration dates. Three patients presented a hypersensitivity reaction during the first desensitization and in one patient the event occurred again during the second treatment cycle. All reactions occurred in the last step, when the infusion rate reached the maximum speed. The developed protocol for rapid desensitization was successful in five patients receiving rituximab. Patients could receive the full intended dose.

  3. Dental needs in Brazilian patients subjected to head and neck radiotherapy.

    Science.gov (United States)

    Rosales, Ana Carolina de Mesquita Netto; Esteves, Sérgio Carlos Barros; Jorge, Jacks; Almeida, Oslei Paes de; Lopes, Márcio Ajudarte

    2009-01-01

    In spite of its recognized benefits in the treatment of malignant tumors, radiation therapy have several side effects in the head and neck region. The evaluation of oral conditions by a dentist is important to prevent or minimize these problems. The aim of this retrospective review was to analyze the dental needs in 357 patients who received radiotherapy in the head and neck region and were treated at Orocentro/FOP/UNICAMP, between January 1990 and December 2004. Review of patient files showed that dental examination before radiotherapy was not performed in 148 patients (41.5%) and was done in 209 patients (58.5%). From the total of examined patients, 94 (45%) did not require dental procedures at the moment of examination, while 115 (55%) presented some sort of dental need. Following the patients after the radiotherapy, it was observed that the group of patients that was evaluated before radiation presented less need of restorations, root canal filling and dental extractions than those who were not evaluated. The results of this study confirm that the evaluation of oral conditions prior to radiotherapy is essential to minimize the dental needs, emphasizing the importance of the dentist in the multidisciplinary team that treats cancer patients.

  4. Dental needs in Brazilian patients subjected to head and neck radiotherapy

    International Nuclear Information System (INIS)

    Rosales, Ana Carolina de Mesquita Netto; Jorge, Jacks; Almeida, Oslei Paes de; Lopes, Marcio Ajudarte

    2009-01-01

    In spite of its recognized benefits in the treatment of malignant tumors, radiation therapy have several side effects in the head and neck region. The evaluation of oral conditions by a dentist is important to prevent or minimize these problems. The aim of this retrospective review was to analyze the dental needs in 357 patients who received radiotherapy in the head and neck region and were treated at Orocentro/FOP/UNICAMP, between January 1990 and December 2004. Review of patient files showed that dental examination before radiotherapy was not performed in 148 patients (41.5%) and was done in 209 patients (58.5%). From the total of examined patients, 94 (45%) did not require dental procedures at the moment of examination, while 115 (55%) presented some sort of dental need. Following the patients after the radiotherapy, it was observed that the group of patients that was evaluated before radiation presented less need of restorations, root canal filling and dental extractions than those who were not evaluated. The results of this study confirm that the evaluation of oral conditions prior to radiotherapy is essential to minimize the dental needs, emphasizing the importance of the dentist in the multidisciplinary team that treats cancer patients. (author)

  5. Conformity Index and Homogeneity Index of the Postoperative Whole Breast Radiotherapy.

    Science.gov (United States)

    Petrova, Deva; Smickovska, Snezana; Lazarevska, Emilija

    2017-10-15

    The treatment of breast cancer involves a multidisciplinary approach in which radiotherapy plays a key role. The conformity index and the homogeneity index are two analysis tools of a treatment plan using conformal radiotherapy. The purpose of this article is an analysis of these two parameters in the assessment of the treatment plans in 58 patients undergoing postoperative radiotherapy of the whole breast. All 58 patients participating in the study had a conservatively treated early-stage breast cancer. The treatment was performed using a standard regimen of fractionation in 25 fractions up to a total dose of 50 Gy. Dose-volume histograms were generated for both plans with and without segmental fields. Pair samples t-test was used. The technique with segmental fields allowed us more homogeneity distribution when compared to standard two tangential field techniques. The HI values were 1.08 ± 0.01 and 1.09 ± 0.01 for segment and technique with two tangential fields (p conformity and the homogeneity index are important tools in the analysis of the treatment plans during radiation therapy in patients with early-stage breast cancer. Adding segment fields in the administration of radiotherapy in patients with conservatively treated breast cancer can lead to improved dosage homogeneity and conformity.

  6. X-ray radiotherapy

    International Nuclear Information System (INIS)

    Tronc, D.

    1995-01-01

    Full text: The most common form of radio therapy is X-ray therapy, where a beam of photons or their parent electrons break down hydrogen bonds within the body's cells and remove certain DNA information necessary for cell multiplication. This process can eradicate malignant cells leading to complete recovery, to the remission of some cancers, or at least to a degree of pain relief. The radiotherapy instrument is usually an electron linac, and the electrons are used either directly in 'electrotherapy' for some 10% of patients, or the electrons bombard a conversion target creating a broad beam of high energy photons or 'penetration X-rays'. The simplest machine consists of several accelerating sections at around 3 GHz, accelerating electrons to 6 MeV; a cooled tungsten target is used to produce a 4 Gray/min X-ray field which can be collimated into a rectangular shape at the patient position. This tiny linac is mounted inside a rotating isocentric gantry above the patient who must remain perfectly still. Several convergent beams can also be used to increase the delivered dose. More sophisticated accelerators operate at up to 18 MeV to increase penetration depths and decrease skin exposure. Alternatively, electrotherapy can be used with different energies for lower and variable penetration depths - approximately 0.5 cm per MeV. In this way surface tissue may be treated without affecting deeper and more critical anatomical regions. This type of linac, 1 to 2 metres long, is mounted parallel to the patient with a bending magnet to direct the beam to the radiotherapy system, which includes the target, thick movable collimator jaws, a beam field equalizer, dose rate and optical field simulation and energy controls. There are over 2000 acceleratorbased X-ray treatment units worldwide. Western countries have up to two units per million population, whereas in developing countries such as Bangladesh, the density is only one per 100 million. Several

  7. Radiotherapy Dose Fractionation under Parameter Uncertainty

    International Nuclear Information System (INIS)

    Davison, Matt; Kim, Daero; Keller, Harald

    2011-01-01

    In radiotherapy, radiation is directed to damage a tumor while avoiding surrounding healthy tissue. Tradeoffs ensue because dose cannot be exactly shaped to the tumor. It is particularly important to ensure that sensitive biological structures near the tumor are not damaged more than a certain amount. Biological tissue is known to have a nonlinear response to incident radiation. The linear quadratic dose response model, which requires the specification of two clinically and experimentally observed response coefficients, is commonly used to model this effect. This model yields an optimization problem giving two different types of optimal dose sequences (fractionation schedules). Which fractionation schedule is preferred depends on the response coefficients. These coefficients are uncertainly known and may differ from patient to patient. Because of this not only the expected outcomes but also the uncertainty around these outcomes are important, and it might not be prudent to select the strategy with the best expected outcome.

  8. Radiotherapy in Cancer Care. Chapter 1

    International Nuclear Information System (INIS)

    Rosenblatt, E.; Zubizarreta, E.; Camacho, R.; Vikram, B.

    2017-01-01

    Cancer control, cancer care and cancer treatment are three different concepts, although the terms are often used interchangeably. Cancer control is the reduction in the incidence, morbidity and mortality of cancer, as well as the improvement in the quality of life of cancer patients and their families. As such, cancer control includes actions relating to prevention, early detection and screening, diagnosis, treatment and palliative care. Cancer care includes all actions and interventions aimed at supporting, assisting and treating cancer patients. Cancer care includes cancer treatment, but also other forms of support such as nutrition, symptom relief, speech therapy, physiotherapy, stoma care, nursing care, lymphoedema care and psychosocial care. Cancer treatment includes medical interventions aimed at the cure or palliation of a patient who has been diagnosed with cancer. As such, cancer treatment modalities include surgery, radiotherapy, systemic therapies such as chemotherapy, hormone therapy, immunotherapy, gene therapy and other investigational strategies.

  9. The problem: Tumor radioresistance in clinical radiotherapy

    International Nuclear Information System (INIS)

    Peters, L.J.; Withers, H.R.; Thames, H.D.; Fletcher, G.H.; M.D. Anderson Hospital and Tumor Inst., Houston, TX)

    1983-01-01

    Tumor radioresistance in clinical radiotherapy implies failure to achieve local-regional disease control with radiation doses producing an acceptable degree of morbidity. Such radioresistance may be due to many different causes (biological and technical) which are reviewed in terms of possible remedial actions. Dose-response relationships for human cancers suggest that, in many sites, tumors are heterogeneous with respect to their cure-limiting characteristics. The case is developed that unless the predominant cure-limiting factor can be predicted, little benefit may be seen in trials of new treatment strategies using heterogeneous tumor populations. The fundamental problem of clinical radioresistance is therefore perceived as the inability to identify predictively its cause in the individual patient

  10. Stereotactic radiotherapy for vestibular schwannoma

    DEFF Research Database (Denmark)

    Muzevic, Dario; Legcevic, Jelena; Splavski, Bruno

    2014-01-01

    BACKGROUND: Vestibular schwannomas (acoustic neuromas) are common benign tumours that arise from the Schwann cells of the vestibular nerve. Management options include observation with neuroradiological follow-up, microsurgical resection and stereotactic radiotherapy. OBJECTIVES: To assess...... the effect of stereotactic radiotherapy compared to observation, microsurgical resection, any other treatment modality, or a combination of two or more of the above approaches for vestibular schwannoma. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL......; Web of Science; CAB Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the search was 24 July 2014. SELECTION CRITERIA: Randomised controlled trials (RCTs) exploring the efficacy of stereotactic radiotherapy compared with observation alone, microsurgical...

  11. Dosimetry in radiotherapy. V.1

    International Nuclear Information System (INIS)

    1988-01-01

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

  12. Computerised tomography in radiotherapy planning

    International Nuclear Information System (INIS)

    Badcock, P.C.

    1983-01-01

    This study evaluates the effectiveness of computed tomography as an adjunct to radiotherapy planning. Until recently, acquisition of accurate data concerning tumour anatomy lagged behind other developments in radiotherapy. With the advent of computer-tomography (CT), these data can be displayed and transmitted to a treatment planning computer. It is concluded that the greatest inaccuracies in the radiation treatment of patients are to be found in both the inadequate delineation of the target volume within the patient and changes in body outline relative to the target volume over the length of the irradiated volume. The technique was useful in various subgroups (pelvic, intra-thoracic and chest-wall tumours) and for those patients being treated palliatively. With an estimated improvement in cure rate of 4.5% and cost-effective factors of between 3.3 and 5, CT-assisted radiotherapy planning appears to be a worthwhile procedure. (orig.)

  13. Expanding global access to radiotherapy.

    Science.gov (United States)

    Atun, Rifat; Jaffray, David A; Barton, Michael B; Bray, Freddie; Baumann, Michael; Vikram, Bhadrasain; Hanna, Timothy P; Knaul, Felicia M; Lievens, Yolande; Lui, Tracey Y M; Milosevic, Michael; O'Sullivan, Brian; Rodin, Danielle L; Rosenblatt, Eduardo; Van Dyk, Jacob; Yap, Mei Ling; Zubizarreta, Eduardo; Gospodarowicz, Mary

    2015-09-01

    Radiotherapy is a critical and inseparable component of comprehensive cancer treatment and care. For many of the most common cancers in low-income and middle-income countries, radiotherapy is essential for effective treatment. In high-income countries, radiotherapy is used in more than half of all cases of cancer to cure localised disease, palliate symptoms, and control disease in incurable cancers. Yet, in planning and building treatment capacity for cancer, radiotherapy is frequently the last resource to be considered. Consequently, worldwide access to radiotherapy is unacceptably low. We present a new body of evidence that quantifies the worldwide coverage of radiotherapy services by country. We show the shortfall in access to radiotherapy by country and globally for 2015-35 based on current and projected need, and show substantial health and economic benefits to investing in radiotherapy. The cost of scaling up radiotherapy in the nominal model in 2015-35 is US$26·6 billion in low-income countries, $62·6 billion in lower-middle-income countries, and $94·8 billion in upper-middle-income countries, which amounts to $184·0 billion across all low-income and middle-income countries. In the efficiency model the costs were lower: $14·1 billion in low-income, $33·3 billion in lower-middle-income, and $49·4 billion in upper-middle-income countries-a total of $96·8 billion. Scale-up of radiotherapy capacity in 2015-35 from current levels could lead to saving of 26·9 million life-years in low-income and middle-income countries over the lifetime of the patients who received treatment. The economic benefits of investment in radiotherapy are very substantial. Using the nominal cost model could produce a net benefit of $278·1 billion in 2015-35 ($265·2 million in low-income countries, $38·5 billion in lower-middle-income countries, and $239·3 billion in upper-middle-income countries). Investment in the efficiency model would produce in the same period an even

  14. Hyperthermia and radiotherapy

    International Nuclear Information System (INIS)

    Lindholm, C.E.

    1992-01-01

    Combined hyperthermia (HT 45 min once or twice per week) and low dose radiotherapy (LDRT 30-34.5 Gy in 2-3 weeks) have been given to 182 locally recurrent or metastatic superficial tumours in 133 patients. Tumour response was analysed in 137 tumours in 100 patients. The overall complete response (CR) was 50% with a median duration (DCR) of 13±3 months. When mammary carcinoma, representing 62% of the treated tumours, were analysed, CR was 62% with a DCR of 14±4 months. In a comparative, non-randomized study, on 34 matched tumour pairs in 24 patients, treatment was given with LDRT+HT to the larger and the same LDRT to the smaller tumour, the patients acting as their own control. A significant difference in CR was obtained in favour of the combined treatment (p=0.0013 all diagnosis and p=0.0027 mammary carcinoma). There was no significant difference in DCR between the two modalities. No significant difference in CR was seen when tumours were randomely treated with HT once (CR 56%) or twice (CR 69%) per week combined with the same LDRT. Predictive factors for CR, multivariately analysed (15 parameters), in mammary carcinoma recurring in earlier irradiated regions, were; the present LDRT absorbed dose (p=0.02) and the average minimum temperature in the best HT session (p=0.03). Significant skin toxicity was seen in 28% of all the 182 heated regions. Prognostic factors for skin damage, multivariately analysed, were; the extension of the heated region (p=0.007) and the highest average maximum temperature in any of the HT sessions (p=0.04). Pain was in some way correlated to severe toxicity but was not considered to be an optimal monitor for HT as many patients with severe and moderate pain were without any serious skin reactions, while slight or no pain sometimes were associated with severe reactions. 401 refs

  15. Multidisciplinary management of cervical neuroblastoma in infants.

    Science.gov (United States)

    Csanády, Miklós; Vass, Gábor; Bartyik, Katalin; Majoros, Valéria; Rovó, László

    2014-12-01

    Neuroblastoma is the most common malignancy in infancy, it is a histologically and genetically heterogeneous tumor, the therapy and outcome of which is influenced by age, histological variant and genetic background as well. We present two consecutive infant patients with neuroblastoma of the neck discussing the etiology, the diagnosis and the surgical and oncological treatment of the tumor, which was observed in a relatively rare manifestation in the head-neck region. Our first patient (age: 5.5 months) was MYCN (v-myc myelocytomatosis viral related oncogene, neuroblastoma derived) negative, INSS (International Neuroblastoma Staging System) Stage 3 and INRGSS (International Neuroblastoma Risk Group Staging System) Stage 3 because of the contralateral lymph node involvement while the complete gross resection of the primary tumor mass was feasible. The patient is tumor free after three years of follow-up. Our second patient (age: 5 months) was MYCN negative, INSS Stage 2 and INRGSS Stage 1, as both the primary tumor and the ipsilateral lymph nodes were totally removed via a modified radical neck dissection. The patient is tumor free after three years of follow-up. For MYCN negative patients, especially in early age, the prognosis of neuroblastoma is good, surgical resection and chemotherapy together is an adequate treatment protocol (as in our two patients). While MYCN-amplified patients require a combined and aggressive treatment with surgery, chemotherapy, radiotherapy, and immunotherapy to be able to obtain a favorable survival rate according to the literature. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. Clinical quality standards for radiotherapy

    Science.gov (United States)

    2012-01-01

    Aim of the study The technological progress that is currently being witnessed in the areas of diagnostic imaging, treatment planning systems and therapeutic equipment has caused radiotherapy to become a high-tech and interdisciplinary domain involving staff of various backgrounds. This allows steady improvement in therapy results, but at the same time makes the diagnostic, imaging and therapeutic processes more complex and complicated, requiring every stage of those processes to be planned, organized, controlled and improved so as to assure high quality of services provided. The aim of this paper is to present clinical quality standards for radiotherapy as developed by the author. Material and methods In order to develop the quality standards, a comparative analysis was performed between European and Polish legal acts adopted in the period of 1980-2006 and the universal industrial ISO 9001:2008 standard, defining requirements for quality management systems, and relevant articles published in 1984-2009 were reviewed, including applicable guidelines and recommendations of American, international, European and Polish bodies, such as the American Association of Physicists in Medicine (AAPM), the European Society for Radiotherapy & Oncology (ESTRO), the International Atomic Energy Agency (IAEA), and the Organisation of European Cancer Institutes (OECI) on quality assurance and management in radiotherapy. Results As a result, 352 quality standards for radiotherapy were developed and categorized into the following three groups: 1 – organizational standards; 2 – physico-technical standards and 3 – clinical standards. Conclusion Proposed clinical quality standards for radiotherapy can be used by any institution using ionizing radiation for medical purposes. However, standards are of value only if they are implemented, reviewed, audited and improved, and if there is a clear mechanism in place to monitor and address failure to meet agreed standards. PMID:23788854

  17. DEGRO practical guidelines. Radiotherapy of breast cancer I. Radiotherapy following breast conserving therapy for invasive breast cancer

    International Nuclear Information System (INIS)

    Sedlmayer, F.

    2013-01-01

    Background and purpose: The aim of the present paper is to update the practical guidelines for postoperative adjuvant radiotherapy of breast cancer published in 2007 by the breast cancer expert panel of the German Society for Radiooncology (Deutsche Gesellschaft fuer Radioonkologie, DEGRO). The present recommendations are based on a revision of the German interdisciplinary S-3 guidelines published in July 2012. Methods: A comprehensive survey of the literature concerning radiotherapy following breast conserving therapy (BCT) was performed using the search terms 'breast cancer', 'radiotherapy', and 'breast conserving therapy'. Data from lately published meta-analyses, recent randomized trials, and guidelines of international breast cancer societies, yielding new aspects compared to 2007, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the DKG (Deutsche Krebsgesellschaft), this paper addresses indications, target definition, dosage, and technique of radiotherapy of the breast after conservative surgery for invasive breast cancer. Results: Among numerous reports on the effect of radiotherapy during BCT published since the last recommendations, the recent EBCTCG report builds the largest meta-analysis so far available. In a 15 year follow-up on 10,801 patients, whole breast irradiation (WBI) halves the average annual rate of disease recurrence (RR 0.52, 0.48-0.56) and reduces the annual breast cancer death rate by about one sixth (RR 0.82, 0.75-0.90), with a similar proportional, but different absolute benefit in prognostic subgroups (EBCTCG 2011). Furthermore, there is growing evidence that risk-adapted dose augmentation strategies to the tumor bed as well as the implementation of high precision RT techniques (e.g., intraoperative radiotherapy) contribute substantially to a further reduction of local relapse rates. A main focus of ongoing research lies in partial breast

  18. Multi-disciplinary decision making in general practice.

    Science.gov (United States)

    Kirby, Ann; Murphy, Aileen; Bradley, Colin

    2018-04-09

    Purpose Internationally, healthcare systems are moving towards delivering care in an integrated manner which advocates a multi-disciplinary approach to decision making. Such an approach is formally encouraged in the management of Atrial Fibrillation patients through the European Society of Cardiology guidelines. Since the emergence of new oral anticoagulants switching between oral anticoagulants (OACs) has become prevalent. This case study considers the role of multi-disciplinary decision making, given the complex nature of the agents. The purpose of this paper is to explore Irish General Practitioners' (GPs) experience of switching between all OACs for Arial Fibrillation (AF) patients; prevalence of multi-disciplinary decision making in OAC switching decisions and seeks to determine the GP characteristics that appear to influence the likelihood of multi-disciplinary decision making. Design/methodology/approach A probit model is used to determine the factors influencing multi-disciplinary decision making and a multinomial logit is used to examine the factors influencing who is involved in the multi-disciplinary decisions. Findings Results reveal that while some multi-disciplinary decision-making is occurring (64 per cent), it is not standard practice despite international guidelines on integrated care. Moreover, there is a lack of patient participation in the decision-making process. Female GPs and GPs who have initiated prescriptions for OACs are more likely to engage in multi-disciplinary decision-making surrounding switching OACs amongst AF patients. GPs with training practices were less likely to engage with cardiac consultants and those in urban areas were more likely to engage with other (non-cardiac) consultants. Originality/value For optimal decision making under uncertainty multi-disciplinary decision-making is needed to make a more informed judgement and to improve treatment decisions and reduce the opportunity cost of making the wrong decision.

  19. Adaptive radiotherapy based on contrast enhanced cone beam CT imaging

    International Nuclear Information System (INIS)

    Soevik, Aaste; Skogmo, Hege K.; Roedal, Jan; Lervaag, Christoffer; Eilertsen, Karsten; Malinen, Eirik

    2010-01-01

    Cone beam CT (CBCT) imaging has become an integral part of radiation therapy, with images typically used for offline or online patient setup corrections based on bony anatomy co-registration. Ideally, the co-registration should be based on tumor localization. However, soft tissue contrast in CBCT images may be limited. In the present work, contrast enhanced CBCT (CECBCT) images were used for tumor visualization and treatment adaptation. Material and methods. A spontaneous canine maxillary tumor was subjected to repeated cone beam CT imaging during fractionated radiotherapy (10 fractions in total). At five of the treatment fractions, CECBCT images, employing an iodinated contrast agent, were acquired, as well as pre-contrast CBCT images. The tumor was clearly visible in post-contrast minus pre-contrast subtraction images, and these contrast images were used to delineate gross tumor volumes. IMRT dose plans were subsequently generated. Four different strategies were explored: 1) fully adapted planning based on each CECBCT image series, 2) planning based on images acquired at the first treatment fraction and patient repositioning following bony anatomy co-registration, 3) as for 2), but with patient repositioning based on co-registering contrast images, and 4) a strategy with no patient repositioning or treatment adaptation. The equivalent uniform dose (EUD) and tumor control probability (TCP) calculations to estimate treatment outcome for each strategy. Results. Similar translation vectors were found when bony anatomy and contrast enhancement co-registration were compared. Strategy 1 gave EUDs closest to the prescription dose and the highest TCP. Strategies 2 and 3 gave EUDs and TCPs close to that of strategy 1, with strategy 3 being slightly better than strategy 2. Even greater benefits from strategies 1 and 3 are expected with increasing tumor movement or deformation during treatment. The non-adaptive strategy 4 was clearly inferior to all three adaptive strategies

  20. Costing in Radiotherapy. Chapter 18

    International Nuclear Information System (INIS)

    Zubizarreta, E.; Lievens, Y.; Levin, V.C.; Van Der Merwe, D.

    2017-01-01

    The available literature on the cost of radiotherapy yields a large variation in data related to the specifics of the methodology used (the viewpoint of the analysis, time frame, health care system, etc.) and to the cost components and radiotherapy activities included. To overcome this difficulty, the reimbursement paid by medical insurance is commonly used as a proxy for the actual radiotherapy costs. Costs, however, generally bear little or no resemblance to charges, as the latter also include allowances for non-capacity use and profit margins. Accurate resource cost data are therefore more valid and should ideally be used in the context of economic evaluations and public health provisions. In addition to the theoretical problems related to obtaining accurate costs, it is difficult to interpret cost data across country borders because of differences in economics. If this is already the case for high income countries, using these cost data for low and middle income countries (LMICs) is even more problematic. Thus, there clearly is a need for calculations performed from the viewpoint of LMICs to prevent misapprehensions based on conclusions derived from data from their high income counterparts. The IAEA endeavours to assist Member States in accumulating appropriate and sufficient cost data for the initiation or expansion of radiation oncology services. Although relatively simple and easy to understand, the IAEA has found that in many countries where it has been involved in the establishment of new radiotherapy departments, the basic principles of cost calculation for radiotherapy facilities were not followed by the local planners. Radiotherapy needs careful planning, organization and a strong quality assurance (QA) programme in order to deliver safe treatments, due to the complexity of the planning and treatment process and the possibility of systematic errors. Administrators should be aware that the cost of building a radiotherapy facility and buying machines

  1. Who risk profile in radiotherapy

    International Nuclear Information System (INIS)

    Barton, M.; Sharfiq, J.; Nobleet, D.; Lemer, C.

    2009-01-01

    The different steps of a treatment in radiotherapy are: patient evaluation, decision to treat, prescription of the treatment protocol, positioning and immobilization, simulation, imaging and volume determination, planning and implementation of materials and software, transfer of treatment data, patient positioning, treatment realisation, treatment checking and follow-up. It exist processes of safety for any step of a radiotherapy realisation: patient identification, accreditation of equipment and processes, evaluation of the personnel competencies, quality assurance of equipment and management of the processes quality, redundancy during the data transfer, control of processes, errors reports and quality improvement, external controls, appropriateness of the workforce. (N.C.)

  2. Nasopharyngeal angiofibroma treated with radiotherapy

    Directory of Open Access Journals (Sweden)

    Janaki M

    2007-01-01

    Full Text Available Nasopharyngeal angiofibroma is a rare, highly vascular, benign, locally aggressive tumor, affecting boys of adolescent age. The aggressiveness and high vascularity makes surgery and even a biopsy difficult in majority of cases. Although surgery is the treatment of choice in early cases, considerable debate exists regarding the treatment of advanced disease with intracranial extension. Radiotherapy provides a good response and also avoids surgery-associated morbidity. We are herewith reporting a case of nasopharyngeal angiofibroma who showed complete hemostasis and improvement in vision to radiotherapy

  3. Metrological issues in molecular radiotherapy

    International Nuclear Information System (INIS)

    D'Arienzo, Marco; Capogni, Marco; Smyth, Vere; Cox, Maurice; Johansson, Lena; Bobin, Christophe

    2014-01-01

    The therapeutic effect from molecular radiation therapy (MRT), on both tumour and normal tissue, is determined by the radiation absorbed dose. Recent research indicates that as a consequence of biological variation across patients the absorbed dose can vary, for the same administered activity, by as much as two orders of magnitude. The international collaborative EURAMET-EMRP project Metrology for molecular radiotherapy (MetroMRT) is addressing this problem. The overall aim of the project is to develop methods of calibrating and verifying clinical dosimetry in MRT. In the present paper an overview of the metrological issues in molecular radiotherapy is provided. (authors)

  4. Multidisciplinary safety team (MDST) factors of success.

    Science.gov (United States)

    2014-11-01

    This project included a literature review and summary that focused on subjects related to team building, team/committee member : motivational strategies, and tools for effective and efficient committee meetings. It also completed an online survey of ...

  5. [Thermoplastic mask in radiotherapy: a source of anxiety for the patient?].

    Science.gov (United States)

    Arino, C; Stadelmaier, N; Dupin, C; Kantor, G; Henriques de Figueiredo, B

    2014-12-01

    The thermoplastic mask often used to immobilize patients in radiotherapy can cause varying levels of stress and anxiety. This study aimed at evaluating the anxiety related to the use of radiotherapy masks and the coping strategies adopted by patients. Nineteen patients treated with radiotherapy mask for head and neck cancer, a brain tumour or a lymphoma, were met twice by a psychologist, either after the making of the mask and the first course of radiotherapy, or in the middle and at the end of treatment. Thirty-four semi-structured interviews were treated using a thematic content analysis and 13 patients answered to anxiety (STAI-YB) and coping (WCC) scales. The STAI-YB anxiety scores related to wearing the masks were low during the radiotherapy treatment period, and were confirmed by the remarks of patients recorded during the semi-structured interviews. Most patients had a positive perception of the mask, and considered it as a friend or protection. Twelve out of the 13 patients admitting to anxiety benefited from problem focused coping strategies. Thermoplastic mask-related anxiety is low and possibly lies in the positive representation patients have about the mask. The explanations provided by health professionals on the radiotherapy mask possibly have a very positive effect on this perception. Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  6. Can collaboration within multidisciplinary teamwork be explained using Belbin?

    DEFF Research Database (Denmark)

    Dederichs, Anne; Karlshøj, Jan

    2013-01-01

    case study is performed within a project-oriented course offered for students within the civil engineering - and architectural engineering programme. The task of the course is to plan a high-rise office building in multidisciplinary student teams. The course was held by a multidisciplinary team...... of teachers for 13 multidisciplinary teams of students. Belbin’s theory on teamwork was introduced and the teams were formed according to the theory, in order to optimize the collaboration. Students were given a standard- and course specific questionnaire including the possibility for making individual notes...

  7. TH-C-12A-02: Comparison of Two RapidArc Delivery Strategies in Stereotactic Body Radiotherapy of Stage I and II Peripheral Lung Tumors with Unflattened Beams

    International Nuclear Information System (INIS)

    Huang, B; Lu, J; Chen, J; Chen, C; Lin, P; Kuang, Y

    2014-01-01

    Purpose: The full arcs strategy used in SBRT with RapidArc and unflattened (FFF) beams in large and heterogeneous peripheral non-smallcell lung cancer (NSCLC) appears to be suboptimal as it increases the disadvantageous dose to the contralateral lung, which potentially increases the toxicity to surrounding tissues. In this study, we investigated, for the first time, the dose delivery strategies using partial arcs (PA) and the fully rotational arcs with avoidance sectors (FAAS) for SBRT with FFF beams in peripheral NSCLC patients. Methods: Eighteen patients with NSCLC (stage I and II) were selected for this study. Nine patients with a GTV <= 10cc were designated as the small tumor group. The remaining nine patients with a GTV between 10 cc and 44 cc were assigned to the large tumor group. The treatment plans were generated in eighteen patients using PA and FAAS, respectively, and delivered with a Varian TrueBeam Linac. Dosimetry of the target and organs at risk (OAR), total MU, out-of-field dose, and delivery time were analyzed. Delta4 and Portal dosimetry were employed to evaluate the delivery accuracy. Results: or the small tumor group, the FAAS plans significantly achieved a better conformity index, the lower total MU and out-of-field dose, a shorter treatment time, and the reduced doses to cord, heart, and lung (p < 0.05). But the target doses were slightly higher than that delivered by PA plans. For the large tumor group, the PA plans significantly attained a better conformity index and a shorter treatment time (p < 0.05). Furthermore, all plans achieved a high pass rate, with all the gamma indices greater than 97% at the Γ 3mm, 3% threshold. Conclusion: This study suggests that FAAS strategy is more beneficial for small tumor patients undergoing lung SBRT with FFF beams. However, for large tumor patients, PA strategy is recommended. NIH/NIGMS grant U54 GM104944, Lincy Endowed Assistant Professorship

  8. Radiotherapy infrastructure and human resources in Switzerland : Present status and projected computations for 2020.

    Science.gov (United States)

    Datta, Niloy Ranjan; Khan, Shaka; Marder, Dietmar; Zwahlen, Daniel; Bodis, Stephan

    2016-09-01

    The purpose of this study was to evaluate the present status of radiotherapy infrastructure and human resources in Switzerland and compute projections for 2020. The European Society of Therapeutic Radiation Oncology "Quantification of Radiation Therapy Infrastructure and Staffing" guidelines (ESTRO-QUARTS) and those of the International Atomic Energy Agency (IAEA) were applied to estimate the requirements for teleradiotherapy (TRT) units, radiation oncologists (RO), medical physicists (MP) and radiotherapy technologists (RTT). The databases used for computation of the present gap and additional requirements are (a) Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN) for cancer incidence (b) the Directory of Radiotherapy Centres (DIRAC) of the IAEA for existing TRT units (c) human resources from the recent ESTRO "Health Economics in Radiation Oncology" (HERO) survey and (d) radiotherapy utilization (RTU) rates for each tumour site, published by the Ingham Institute for Applied Medical Research (IIAMR). In 2015, 30,999 of 45,903 cancer patients would have required radiotherapy. By 2020, this will have increased to 34,041 of 50,427 cancer patients. Switzerland presently has an adequate number of TRTs, but a deficit of 57 ROs, 14 MPs and 36 RTTs. By 2020, an additional 7 TRTs, 72 ROs, 22 MPs and 66 RTTs will be required. In addition, a realistic dynamic model for calculation of staff requirements due to anticipated changes in future radiotherapy practices has been proposed. This model could be tailor-made and individualized for any radiotherapy centre. A 9.8 % increase in radiotherapy requirements is expected for cancer patients over the next 5 years. The present study should assist the stakeholders and health planners in designing an appropriate strategy for meeting future radiotherapy needs for Switzerland.

  9. Radiotherapy infrastructure and human resources in Switzerland. Present status and projected computations for 2020

    International Nuclear Information System (INIS)

    Datta, Niloy Ranjan; Khan, Shaka; Marder, Dietmar; Zwahlen, Daniel; Bodis, Stephan

    2016-01-01

    The purpose of this study was to evaluate the present status of radiotherapy infrastructure and human resources in Switzerland and compute projections for 2020. The European Society of Therapeutic Radiation Oncology ''Quantification of Radiation Therapy Infrastructure and Staffing'' guidelines (ESTRO-QUARTS) and those of the International Atomic Energy Agency (IAEA) were applied to estimate the requirements for teleradiotherapy (TRT) units, radiation oncologists (RO), medical physicists (MP) and radiotherapy technologists (RTT). The databases used for computation of the present gap and additional requirements are (a) Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN) for cancer incidence (b) the Directory of Radiotherapy Centres (DIRAC) of the IAEA for existing TRT units (c) human resources from the recent ESTRO ''Health Economics in Radiation Oncology'' (HERO) survey and (d) radiotherapy utilization (RTU) rates for each tumour site, published by the Ingham Institute for Applied Medical Research (IIAMR). In 2015, 30,999 of 45,903 cancer patients would have required radiotherapy. By 2020, this will have increased to 34,041 of 50,427 cancer patients. Switzerland presently has an adequate number of TRTs, but a deficit of 57 ROs, 14 MPs and 36 RTTs. By 2020, an additional 7 TRTs, 72 ROs, 22 MPs and 66 RTTs will be required. In addition, a realistic dynamic model for calculation of staff requirements due to anticipated changes in future radiotherapy practices has been proposed. This model could be tailor-made and individualized for any radiotherapy centre. A 9.8 % increase in radiotherapy requirements is expected for cancer patients over the next 5 years. The present study should assist the stakeholders and health planners in designing an appropriate strategy for meeting future radiotherapy needs for Switzerland. (orig.) [de

  10. Multidisciplinary cognitive content of nanoscience and nanotechnology

    International Nuclear Information System (INIS)

    Milojević, Staša

    2012-01-01

    This article examines the cognitive evolution and disciplinary diversity of nanoscience/nanotechnology (nano research) as expressed through the terminology used in titles of nano journal articles. The analysis is based on the NanoBank bibliographic database of 287,106 nano articles published between 1981 and 2004. We perform multifaceted analyses of title words, focusing on 100 most frequent words or phrases (terms). Hierarchical clustering of title terms reveals three distinct time periods of cognitive development of nano research: formative (1981–1990), early (from 1991 to 1998), and current (after 1998). Early period is characterized by the introduction of thin film deposition techniques, while the current period is characterized by the increased focus on carbon nanotube and nanoparticle research. We introduce a method to identify disciplinary components of nanotechnology. It shows that the nano research is being carried out in a number of diverse parent disciplines. Currently, only 5% of articles are published in dedicated nano-only journals. We find that some 85% of nano research today is multidisciplinary. The case study of the diffusion of several nano-specific terms (e.g., “carbon nanotube”) shows that concepts spread from the initially few disciplinary components to the majority of them in a time span of around a decade. Hierarchical clustering of disciplinary components reveals that the cognitive content of current nanoscience can be divided into nine clusters. Some clusters account for a large fraction of nano research and are identified with such parent disciplines as the condensed matter and applied physics, materials science, and analytical chemistry. Other clusters represent much smaller parts of nano research, but are as cognitively distinct. In the decreasing order of size, these fields are: polymer science, biotechnology, general chemistry, surface science, and pharmacology. Cognitive content of research published in nano-only journals is

  11. Therapeutic Results of Radiotherapy in Rectal Carcinoma -Comparison of Sandwich Technique Radiotherapy with Postoperative Radiotherapy

    International Nuclear Information System (INIS)

    Huh, Gil Cha; Suh, Hyun Suk; Lee, Hyuk Sang; Kim, Re Hwe; Kim, Chul Soo; Kim, Hong Yong; Kim, Sung Rok

    1996-01-01

    Purpose : To evaluate the potential advantage for 'sandwich' technique radiotherapy compared to postoperative radiotherapy in respectable rectal cancer. Between January 1989 and May 1994, 60 patients with respectable rectal cancer were treated at Inje University Seoul and Sanggye Paik Hospital.Fifty one patients were available for analysis : 20 patients were treated with sandwich technique radiotherapy and 31 patients were treated with postoperative radiotherapy. In sandwich technique radiotherapy(RT), patients were treated with preoperative RT 1500 cGy/5fx followed by immediate curative resection. Patients staged as Astler-Coller B2, C were considered for postoperative RT with 2500-4500 cGy. In postoperative RT, total radiation dose of 4500-6120 cGy, 180 cGy daily at 4-6 weeks was delivered. Patients were followed for median period of 25 months. Results : The overall 5-year survival rates for sandwich technique RT group and postoperative RT group were 60% and 71%, respectively(p>0.05). The 5-year disease free survival rates for each group were 63%. There was no difference in local failure rate between two groups(11% versus 7%). Incidence of distant metastasis was 11%(2/20) in the sandwich technique RT group and 20%(6/31) in the postoperative RT group(p>0.05). The frequencies of acute and chronic complications were comparable in both groups. Conclusion : The sandwich technique radiotherapy group shows local recurrence and survival similar to those of postoperative RT alone group but reduced distant metastasis compared to postoperative RT group. But long term follow-up and large number of patients is needed to make an any firm conclusion regarding the value of this sandwich technique RT

  12. Construction of a remote radiotherapy planning system

    International Nuclear Information System (INIS)

    Ogawa, Yoshihiro; Nemoto, Kenji; Takahashi, Chiaki; Takai, Yoshihiro; Yamada, Shogo; Seiji, Hiromasa; Sasaki, Kazuya

    2005-01-01

    We constructed a remote radiotherapy planning system, and we examined the usefulness of and faults in our system in this study. Two identical radiotherapy planning systems, one installed at our institution and the other installed at an affiliated hospital, were used for radiotherapy planning. The two systems were connected by a wide area network (WAN), using a leased line. Beam data for the linear accelerator at the affiliated hospital were installed in the two systems. During the period from December 2001 to December 2002, 43 remote radiotherapy plans were made using this system. Data were transmitted using a file transfer protocol (FTP) software program. The 43 radiotherapy plans examined in this study consisted of 13 ordinary radiotherapy plans, 28 radiotherapy plans sent to provide assistance for medical residents, and 2 radiotherapy plans for emergency cases. There were ten minor planning changes made in radiotherapy plans sent to provide assistance for medical residents. Our remote radiotherapy planning system based on WAN using a leased line is useful for remote radiotherapy, with advantages for both radiation oncologists and medical residents. (author)

  13. Charting Multidisciplinary Team External Dynamics Using a Systems Thinking Approach

    Science.gov (United States)

    Barthelemy, Jean-Francois; Waszak, Martin R.; Jones, Kenneth M.; Silcox, Richard J.; Silva, Walter A.; Nowaczyk, Ronald H.

    1998-01-01

    Using the formalism provided by the Systems Thinking approach, the dynamics present when operating multidisciplinary teams are examined in the context of the NASA Langley Research and Technology Group, an R&D organization organized along functional lines. The paper focuses on external dynamics and examines how an organization creates and nurtures the teams and how it disseminates and retains the lessons and expertise created by the multidisciplinary activities. Key variables are selected and the causal relationships between the variables are identified. Five "stories" are told, each of which touches on a different aspect of the dynamics. The Systems Thinking Approach provides recommendations as to interventions that will facilitate the introduction of multidisciplinary teams and that therefore will increase the likelihood of performing successful multidisciplinary developments. These interventions can be carried out either by individual researchers, line management or program management.

  14. [The multidisciplinary practice guideline 'The responsible use of biologicals'].

    NARCIS (Netherlands)

    Bijlsma, J.W.J.; Hagemeijer, J.W.; Bijl, M. van der; Jansen, T.L.Th.A.; Laar, M.A. van der; Landewe, R.B.; Nurmohamed, M.T.

    2011-01-01

    - A multidisciplinary working group has developed a practice guideline containing various recommendations on the responsible and efficient use of biologicals.- These biologicals include both soluble immune-receptor proteins and monoclonal antibodies that are aimed at immune mediators, receptors or

  15. The Assessment of Hyperactivity in Preschool Populations: A Multidisciplinary Perspective.

    Science.gov (United States)

    Rosenberg, Michael S.; And Others

    1989-01-01

    The variety of methods available for the assessment of hyperactivity in preschool populations is reviewed. Specific procedures for assessment are presented from a multidisciplinary perspective, integrating biophysical, behavioral, cognitive, and ecological models. (Author/JDD)

  16. Multidisciplinary Training to Undergraduate Students in the Faculty ...

    African Journals Online (AJOL)

    Multidisciplinary Training to Undergraduate Students in the Faculty of Health ... other disciplines in order to achieve an effective and cohesive working relationship. ... theoretical knowledge regarding blood pressure measurement and exercise, ...

  17. Multidisciplinary Design Optimization for High Reliability and Robustness

    National Research Council Canada - National Science Library

    Grandhi, Ramana

    2005-01-01

    .... Over the last 3 years Wright State University has been applying analysis tools to predict the behavior of critical disciplines to produce highly robust torpedo designs using robust multi-disciplinary...

  18. Transforming Multidisciplinary Customer Requirements to Product Design Specifications

    Science.gov (United States)

    Ma, Xiao-Jie; Ding, Guo-Fu; Qin, Sheng-Feng; Li, Rong; Yan, Kai-Yin; Xiao, Shou-Ne; Yang, Guang-Wu

    2017-09-01

    With the increasing of complexity of complex mechatronic products, it is necessary to involve multidisciplinary design teams, thus, the traditional customer requirements modeling for a single discipline team becomes difficult to be applied in a multidisciplinary team and project since team members with various disciplinary backgrounds may have different interpretations of the customers' requirements. A new synthesized multidisciplinary customer requirements modeling method is provided for obtaining and describing the common understanding of customer requirements (CRs) and more importantly transferring them into a detailed and accurate product design specifications (PDS) to interact with different team members effectively. A case study of designing a high speed train verifies the rationality and feasibility of the proposed multidisciplinary requirement modeling method for complex mechatronic product development. This proposed research offersthe instruction to realize the customer-driven personalized customization of complex mechatronic product.

  19. High Fidelity Multidisciplinary Tool Development for Helicopter Quieting

    National Research Council Canada - National Science Library

    Chen, Chung-Lung; Chen, Ya-Chi; Chen, Bing; Jain, Rohit; Lund, Tom; Zhao, Hongwu; Wang, Z.-J; Sun, Yuzhi; Saberi, Hossein; Shih, T.-H

    2007-01-01

    .... The problem is indeed multidisciplinary. Current helicopter blade designers use computational models, which depend heavily on experimental data and cannot be used to predict any novel design, which is a significant departure from existing designs...

  20. Current opinions on radiotherapy of pediatric central nervous system tumors

    International Nuclear Information System (INIS)

    Chojnacka, M.; Skowronska-Gardas, A.

    2006-01-01

    Primary central nervous system (CNS) neoplasms are the most frequent solid tumors in childhood accounting for 20% of all pediatric malignancies. Despite developments in neurosurgery, radiotherapy and chemotherapy, a significant proportion of these patients suffer progressive disease. A good treatment management strategy should consider not only survival but also the quality of life of the child. Irradiation is ann essential part of the management of the majority of CNS tumors. During then last decade, there significant advances in the technology of planning and delivery of radiation treatment. These new radiotherapy techniques such as conformal, intensity modulated photon beam and stereotactic methods allow a high homogenous dose to the tumor region with minimal doses to normal tissue. This is particularly important in children with localized low-grade tumors, whose prognosis of long-term survival is often excellent and should be accompanied by smallest risk of treatment toxicity. For small tumors fractionated radiotherapy stereotactic radiotherapy using multiple fixed non-coplanar beams is an appropriate treatment. Modification of craniospinal technique, lowering of the total craniospinal dose with adjuvant chemotherapy, new radiotherapy modalities to treat the posterior fossa may be employed to possibly decrease the late rectifies of radiation therapy. For malignant glioma and brain stem tumors we need new approaches, as chemo sensitization, angiogenesis inhibitors and gene therapies. These new methods in therapy of pediatric brain tumors and our experience in treatment of children with medulloblastoma, low-grade astrocytoma, craniopharyngioma and brain stem tumors are presented. We summarize therapeutic aspects of most childhood brain tumors. (author)

  1. Transfer of communication skills to the workplace: impact of a 38-hour communication skills training program designed for radiotherapy teams.

    Science.gov (United States)

    Merckaert, Isabelle; Delevallez, France; Gibon, Anne-Sophie; Liénard, Aurore; Libert, Yves; Delvaux, Nicole; Marchal, Serge; Etienne, Anne-Marie; Bragard, Isabelle; Reynaert, Christine; Slachmuylder, Jean-Louis; Scalliet, Pierre; Van Houtte, Paul; Coucke, Philippe; Razavi, Darius

    2015-03-10

    This study assessed the efficacy of a 38-hour communication skills training program designed to train a multidisciplinary radiotherapy team. Four radiotherapy teams were randomly assigned to a training program or a waiting list. Assessments were scheduled at baseline and after training for the training group and at baseline and 4 months later for the waiting list group. Assessments included an audio recording of a radiotherapy planning session to assess team members' communication skills and expression of concerns of patients with breast cancer (analyzed with content analysis software) and an adapted European Organisation for Research and Treatment of Cancer satisfaction with care questionnaire completed by patients at the end of radiotherapy. Two hundred thirty-seven radiotherapy planning sessions were recorded. Compared with members of the untrained teams, members of the trained teams acquired, over time, more assessment skills (P = .003) and more supportive skills (P = .050) and provided more setting information (P = .010). Over time, patients interacting with members of the trained teams asked more open questions (P = .022), expressed more emotional words (P = .025), and exhibited a higher satisfaction level regarding nurses' interventions (P = .028). The 38-hour training program facilitated transfer of team member learned communication skills to the clinical practice and improved patients' satisfaction with care. © 2015 by American Society of Clinical Oncology.

  2. Radiotherapy of chondrosarcoma of bone

    International Nuclear Information System (INIS)

    Harwood, A.R.; Krajbich, J.I.; Fornasier, V.L.

    1980-01-01

    A retrospective analysis of 31 cases of chondrosarcoma of bone treated by radiotherapy is presented. In comparison with other large series, our group of patients were found to have been unfavourably selected with respect to the known prognostic factors: histology site, adequacy of operative treatment, and presenting symptoms. Twelve patients with primary chondrosarcoma were radically irradiated; 6 of these 12 have been alive and well without tumor for periods ranging from three and a half to 16 years and 3 of these are alive and well for 15 years or more following radiotherapy. The other 6 patients responded or desease stabilized following radiotherapy for periods ranging from 16 months to eight years. One poorly differentiated tumor was radically irradiated and did not respond. Eleven patients were irradiated palliatively, generally with low doses of irradiation, and only 4 responded transiently for periods ranging from three to 12 months. Seven patients with mesenchymal and dedifferentiated tumors were radically irradiated. Four responded or disease stabilized, and 1 of these patients was alive and well at 3 years; 3 did not respond. Six died with distant metastasis. It is concluded that chondrosarcoma of bone is a radioresponsive tumor and the place of radiotherapy in the treatment of this disease and the reason for its being labelled a radioresistant tumor are discussed. The problems of assessing response of chondrosarcoma to therapy are also discussed. It is suggested that chemotherapy may have a role in the management of mesenchymal and dedifferentiated chondrosarcoma

  3. Genetic Radiotherapy of Prostate Cancer

    Science.gov (United States)

    2004-12-01

    14. Lamberts SWJ, van der Lely A-J, de Herder WW, Hofland 30. Danielson S, Kilstrup M, Barilla K, Jochimsen B, Neuhard LJ. Octreotide. N Engl J Med...Kilstrup M, Barilla K, et al: Characteriza- Cobngcysiedans xpsin,5furytieexposure, and radiotherapy increases cytotoxicity to cholangio- tion of the

  4. Palliative radiotherapy in developing countries

    International Nuclear Information System (INIS)

    Allen, B.J.

    2010-01-01

    Full text: The International Agency for Research on Cancer predicts that cancer incidence in developing countries will increase dramatically in the first two decades of this millennium. Already some 80% of cancer patients in developing countries present with incurable disease. [n many cases pain is a severe problem and palliation is needed to improve quality of life as well as extending survival. This paper will consider the physical and clinical aspects of palliative radiotherapy (PRT), choice of radiation modality, alternative approaches to imaging and therapy and cost-benefit considerations. The potential benefits of a dedicated palliative centre include lower cost and therefore more centres, enabling more patients access to regional palliative care. Whilst there is an obvious need for palliative radiotherapy, simple curative treatments could also be managed. C060 radiotherapy has important advantages in developing countries, because of the higher initial cost of a linear accelerator, as well as the need for reliable power supply and the level of skill required by linac technicians and physicists. The beam characteristics of both C060 units and low energy linacs are compared and both are found to be acceptable for palliation. The concept of telemedicine is also discussed, using mobile phones and internet communication to allow rural clinics to receive support from specialists based in the cities, to send images for remote diagnosis and remote dose planning for radiotherapy. (author)

  5. Radiotherapy in primary cerebral lymphoma

    International Nuclear Information System (INIS)

    Legros, L.; Benezery, K.; Lagrange, J.L.

    1999-01-01

    Primary cerebral lymphoma is a rare disease with an unfavorable prognosis. Whole brain radiotherapy has been the standard treatment, but neither the optimal radiation fields nor optimal dose level of the regimen are as yet firmly establisheD. From this review of the literature, it seems that the whole brain must be treated, and a boost to the area of the primary site must be discussed. With regard to dose, the radiation dose-response relationship is not clearly proven. Yet, a minimum dose of 40 Gy is necessary, and the maximum dose is set at 50 Gy because of late neurological sequelae. Because of the poor prognosis of this disease and the risk of late sequelae, other avenues have been explored. Chemotherapy has been studied, seem to have a survival advantage and combinations of radiotherapy and chemotherapy, especially with high-dose methotrexate. Because primary cerebral lymphoma is an uncommon disease, randomized clinical trials that compare radiotherapy alone to chemotherapy plus radiotherapy may not be feasible. Finally, even if chemotherapy seems to have a survival advantage, the regimen of chemotherapy is still a matter of debate. (authors)

  6. Thalassaemic osteoarthropathy treated with radiotherapy

    International Nuclear Information System (INIS)

    Davies, A.N.

    1993-01-01

    Patients with beta thalassaemia may develop a specific osteoarthropathy involving the feet. A number of different treatments for this condition have been tried, including rest, analgesia and hypertransfusion. We report a case of a patient with thalassaemic osteoarthropathy who responded to radiotherapy after failing conventional treatment. (author)

  7. Arterial occlusive disease after radiotherapy

    International Nuclear Information System (INIS)

    Piedbois, P.; Mazeron, J.J.; Le Bourgeois, J.P.; Becquemin, J.P.; Blanc, I.; Lange, F.; Melliere, D.

    1990-01-01

    Fourteen cases of arterial occlusion or severe narrowing following radiotherapy are studied in order to assess the possible etiological role of such therapy in arterial lesion. Surgical results are also discussed in terms of long-term efficacy. The average time of occurrence after radiotherapy was 8 years post-radiotherapy. This series includes 7 supra-aortic trunk stenoses and 7 abdominal aorta trunk stenoses. The doses received in the volumes iradiated ranged from 47 to 70 Gy with standard fractionation. Association of atherosclerotic risk factors was present in 12 patients, but stenoses were usually confined to irradiated areas, and at imes occurred in uncommon sites. Surgical management included 11 by-passes, 2 endarterectomies and one percutaneous transluminal angioplasty. All patients experienced immediate and satisfactory functional improvements. Three patients were re-operated on because of the re-occlusion of the by-pass and graft infection. On the whole, stenoses in previously irradiated areas showed no particular difficulties for surgical treatment. It was concluded that radiotherapy seems to be a definite risk factor for arterial occlusion or narrowing, especially in association in association with atherosclerotic risk factors. (author). 45 refs.; 3 figs.; 2 tabs

  8. Effects of a Multidisciplinary Approach to Improve Volume of Diagnostic Material in CT-Guided Lung Biopsies.

    Science.gov (United States)

    Ferguson, Philip E; Sales, Catherine M; Hodges, Dalton C; Sales, Elizabeth W

    2015-01-01

    Recent publications have emphasized the importance of a multidisciplinary strategy for maximum conservation and utilization of lung biopsy material for advanced testing, which may determine therapy. This paper quantifies the effect of a multidisciplinary strategy implemented to optimize and increase tissue volume in CT-guided transthoracic needle core lung biopsies. The strategy was three-pronged: (1) once there was confidence diagnostic tissue had been obtained and if safe for the patient, additional biopsy passes were performed to further increase volume of biopsy material, (2) biopsy material was placed in multiple cassettes for processing, and (3) all tissue ribbons were conserved when cutting blocks in the histology laboratory. This study quantifies the effects of strategies #1 and #2. This retrospective analysis comparing CT-guided lung biopsies from 2007 and 2012 (before and after multidisciplinary approach implementation) was performed at a single institution. Patient medical records were reviewed and main variables analyzed include biopsy sample size, radiologist, number of blocks submitted, diagnosis, and complications. The biopsy sample size measured was considered to be directly proportional to tissue volume in the block. Biopsy sample size increased 2.5 fold with the average total biopsy sample size increasing from 1.0 cm (0.9-1.1 cm) in 2007 to 2.5 cm (2.3-2.8 cm) in 2012 (Pstrategy to CT-guided lung biopsies was effective in significantly increasing tissue volume and number of blocks available for advanced diagnostic testing.

  9. Use of research reactors in multidisciplinary education at Cornell University

    International Nuclear Information System (INIS)

    Clark, D.D.

    1992-01-01

    Multidisciplinary aspects of nuclear science and technology form a large part of the research and teaching activities of the Nuclear Science and Engineering (NS and E) Program at Cornell, and the two reactors housed in Ward Laboratory - a 500-kW TRIGA and a 100-W critical facility [zero-power reactor (ZPR)]- play a central role in those activities. Several primarily educational and multidisciplinary features of the NS and E program are described in this paper

  10. External radiotherapy of pituitary adenomas

    International Nuclear Information System (INIS)

    Zierhut, Dietmar; Flentje, Michael; Adolph, Juergen; Erdmann, Johannes; Raue, Friedhelm; Wannenmacher, Michael

    1995-01-01

    Purpose: To evaluate therapeutic outcome and side effects of radiotherapy in pituitary adenomas as sole or combined treatment. Methods and Materials: Retrospective analysis of 138 patients (74 male, 64 female) irradiated for pituitary adenoma from 1972 to 1991 was performed. Mean age was 49.7 years (15-80 years). Regular follow-up (in the mean 6.53 ± 3.99 years) included radiodiagnostical [computed tomography (CT), magnetic resonance imaging (MRI), x-ray], endocrinological, and ophthalmological examinations. Seventy patients suffered from nonfunctional pituitary adenoma, 50 patients suffered from growth-hormone producing adenomas, 11 had prolactinomas, and 7 patients had adrenocorticotropic hormone (ACTH) producing pituitary adenomas. In 99 patients surgery was followed by radiotherapy in case of suspected remaining tumor (invasive growth of the adenoma, assessment of the surgeon, pathologic CT after surgery, persisting hormonal overproduction). Twenty-three patients were treated for recurrence of disease after surgery and 16 patients received radiation as primary treatment. Total doses from 40-60 Gy (mean: 45.5 Gy) were given with single doses of 2 Gy 4 to five times a week. Results: Tumor control was achieved in 131 patients (94.9%). In seven patients, recurrence of disease was diagnosed in the mean 2.9 years (9-98 months) after radiotherapy and salvaged by surgery. A statistically significant dose-response relationship was found in favor of doses ≥ 45 Gy. Ninety percent of the patients with hormonally active pituitary adenomas had a benefit from radiotherapy in means of complete termination (38%) or at least reduction (52%) of hormonal overproduction. Partial or complete hypopituitarism after radiotherapy developed, depending on hormonal axis, in 12 (prolactin) to 27% (follicle-stimulating hormone FSH) of patients who had not already had hypopituitarism prior to radiation. Two out of 138 patients suffered reduction of visual acuity, which was, in part

  11. New ideas in asthma and allergy research: creating a multidisciplinary graduate school

    Science.gov (United States)

    Björkstén, Bengt; Graninger, Göran; Ekman, Gunilla Jacobsson

    2003-01-01

    The spring term of 2001 saw the start of a new, unique graduate research training program at the Centre for Allergy Research at the Karolinska Institutet in Stockholm, Sweden. The program was created to bridge the gaps between basic, clinical, social, and behavioral sciences and to establish a global approach to the study of asthma and allergy. A reflection, two years on, discusses the strategies that are key to this model’s success and the challenges in introducing a multidisciplinary research program. PMID:12975463

  12. Multidisciplinary Care Models for Patients With Psoriatic Arthritis.

    Science.gov (United States)

    Queiro, Rubén; Coto, Pablo; Rodríguez, Jesús; Notario, Jaume; Navío Marco, Teresa; de la Cueva, Pablo; Pujol Busquets, Manel; García Font, Mercè; Joven, Beatriz; Rivera, Raquel; Alvarez Vega, Jose Luis; Chaves Álvarez, Antonio Javier; Sánchez Parera, Ricardo; Ruiz Carrascosa, Jose Carlos; Rodríguez Martínez, Fernando José; Pardo Sánchez, José; Feced Olmos, Carlos; Pujol, Conrad; Galindez, Eva; Pérez Barrio, Silvia; Urruticoechea Arana, Ana; Hergueta, Mercedes; Luelmo, Jesús; Gratacós, Jordi

    To describe (structure, processes) of the multidisciplinary care models in psoriatic arthritis (PsA) in Spain, as well as barriers and facilitators of their implementation. A qualitative study was performed following structured interviews with 24 professionals (12 rheumatologists, 12 dermatologists who provide multidisciplinary care for patients with PsA). We collected data related to the hospital, department, population and multidisciplinary care model (type, physical and human resources, professional requirements, objectives, referral criteria, agendas, protocols, responsibilities, decision- making, research and education, clinical sessions, development and planning of the model, advantages and disadvantages of the model, barriers and facilitators in the implementation of the model. The models characteristics are described. We analyzed 12 multidisciplinary care models in PsA, with at least 1-2 years of experience, and 3 subtypes of models, face-to-face, parallel, and preferential circuit. All are adapted to the hospital and professionals characteristics. A proper implementation planning is essential. The involvement and empathy between professionals and an access and well-defined referral criteria are important facilitators in the implementation of a model. The management of agendas and data collection to measure the multidisciplinary care models health outcomes are the main barriers. There are different multidisciplinary care models in PsA that can improve patient outcomes, system efficiency and collaboration between specialists. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  13. Head and neck multidisciplinary team meetings: Effect on patient management.

    Science.gov (United States)

    Brunner, Markus; Gore, Sinclair M; Read, Rebecca L; Alexander, Ashlin; Mehta, Ankur; Elliot, Michael; Milross, Chris; Boyer, Michael; Clark, Jonathan R

    2015-07-01

    The purpose of this study was for us to present our findings on the prospectively audited impact of head and neck multidisciplinary team meetings on patient management. We collected clinical data, the pre-multidisciplinary team meeting treatment plan, the post-multidisciplinary team meeting treatment plans, and follow-up data from all patients discussed at a weekly multidisciplinary team meeting and we recorded the changes in management. One hundred seventy-two patients were discussed in 39 meetings. In 52 patients (30%), changes in management were documented of which 20 (67%) were major. Changes were statistically more likely when the referring physician was a medical or radiation oncologist, when the initial treatment plan did not include surgery, and when the histology was neither mucosal squamous cell cancer nor a skin malignancy. Compliance to the multidisciplinary team meeting treatment recommendation was 84% for all patients and 70% for patients with changes in their treatment recommendation. Head and neck multidisciplinary team meetings changed management in almost a third of the cases. © 2014 Wiley Periodicals, Inc.

  14. Training multidisciplinary biomedical informatics students: three years of experience.

    Science.gov (United States)

    van Mulligen, Erik M; Cases, Montserrat; Hettne, Kristina; Molero, Eva; Weeber, Marc; Robertson, Kevin A; Oliva, Baldomero; de la Calle, Guillermo; Maojo, Victor

    2008-01-01

    The European INFOBIOMED Network of Excellence recognized that a successful education program in biomedical informatics should include not only traditional teaching activities in the basic sciences but also the development of skills for working in multidisciplinary teams. A carefully developed 3-year training program for biomedical informatics students addressed these educational aspects through the following four activities: (1) an internet course database containing an overview of all Medical Informatics and BioInformatics courses, (2) a BioMedical Informatics Summer School, (3) a mobility program based on a 'brokerage service' which published demands and offers, including funding for research exchange projects, and (4) training challenges aimed at the development of multi-disciplinary skills. This paper focuses on experiences gained in the development of novel educational activities addressing work in multidisciplinary teams. The training challenges described here were evaluated by asking participants to fill out forms with Likert scale based questions. For the mobility program a needs assessment was carried out. The mobility program supported 20 exchanges which fostered new BMI research, resulted in a number of peer-reviewed publications and demonstrated the feasibility of this multidisciplinary BMI approach within the European Union. Students unanimously indicated that the training challenge experience had contributed to their understanding and appreciation of multidisciplinary teamwork. The training activities undertaken in INFOBIOMED have contributed to a multi-disciplinary BMI approach. It is our hope that this work might provide an impetus for training efforts in Europe, and yield a new generation of biomedical informaticians.

  15. Multidisciplinary chronic pain management in a rural Canadian setting.

    Science.gov (United States)

    Burnham, Robert; Day, Jeremiah; Dudley, Wallace

    2010-01-01

    Chronic pain is prevalent, complex and most effectively treated by a multidisciplinary team, particularly if psychosocial issues are dominant. The limited access to and high costs of such services are often prohibitive for the rural patient. We describe the development and 18-month outcomes of a small multidisciplinary chronic pain management program run out of a physician's office in rural Alberta. The multidisciplinary team consisted of a family physician, physiatrist, psychologist, physical therapist, kinesiologist, nurse and dietician. The allied health professionals were involved on a part-time basis. The team triaged referral information and patients underwent either a spine or medical care assessment. Based on the findings of the assessment, the team managed the care of patients using 1 of 4 methods: consultation only, interventional spine care, supervised medication management or full multidisciplinary management. We prospectively and serially recorded self-reported measures of pain and disability for the supervised medication management and full multidisciplinary components of the program. Patients achieved clinically and statistically significant improvements in pain and disability. Successful multidisciplinary chronic pain management services can be provided in a rural setting.

  16. Stereotactic intracranial radiotherapy: Dose prescription

    International Nuclear Information System (INIS)

    Schlienger, M.; Lartigau, E.; Nataf, F.; Mornex, F.; Latorzeff, I.; Lisbona, A.; Mahe, M.

    2012-01-01

    The aim of this article was the study of the successive steps permitting the prescription of dose in stereotactic intracranial radiotherapy, which includes radiosurgery and fractionated stereotactic radiotherapy. The successive steps studied are: the choice of stereotactic intracranial radiotherapy among the therapeutic options, based on curative or palliative treatment intent, then the selection of lesions according to size/volume, pathological type and their number permitting the choice between radiosurgery or fractionated stereotactic radiotherapy, which have the same methodological basis. Clinical experience has determined the level of dose to treat the lesions and limit the irradiation of healthy adjacent tissues and organs at risk structures. The last step is the optimization of the different parameters to obtain a safe compromise between the lesion dose and healthy adjacent structures. Study of dose-volume histograms, coverage indices and 3D imaging permit the optimization of irradiation. For lesions close to or included in a critical area, the prescribed dose is planned using the inverse planing method. Implementation of the successively described steps is mandatory to insure the prescription of an optimized dose. The whole procedure is based on the delineation of the lesion and adjacent healthy tissues. There are sometimes difficulties to assess the delineation and the volume of the target, however improvement of local control rates and reduction of secondary effects are the proof that the totality of the successive procedures are progressively improved. In practice, stereotactic intracranial radiotherapy is a continually improved treatment method, which constantly benefits from improvements in the choice of indications, imaging, techniques of irradiation, planing/optimization methodology and irradiation technique and from data collected from prolonged follow-up. (authors)

  17. Cartography and risk management in radiotherapy: a collaborative work of the department of radiotherapy and the department of quality and risk management Institute Jean-Godinot

    International Nuclear Information System (INIS)

    Nguyen, T.D.; Loiseau, M.; Devie, I.; Heusghem, M.; Gaillot-Petit, N.

    2010-01-01

    Purpose To deploy an inductive process for radiotherapy risk management in a regional cancer centre and to infer the actions required to solve the situations of criticality. Methods Close collaboration between the department of radiation oncology-biophysics and the department of quality and risk management in the same institution allowed to create a multi professional and multidisciplinary task force and to make the experience feedback easier. A preliminary risk analysis method was used to identify the generic dangers, the mapping of risks and the specification of the scales of criticality. This method helped to evaluate and to rate each apprehended event. Four scales have been defined: seriousness scale in five levels, likelihood scale in five classes, endeavour scale in four levels and criticality scale in three categories: acceptable (criticality 1) tolerable under control (criticality 2) and unacceptable (criticality 3). Results Fifty-seven level 1 dangerous situations linked to 78 scenarios of criticality acceptable, tolerable and unacceptable in 24, 44 and 10 cases respectively have been identified in the department of radiotherapy leading to carry out 28 risk reduction actions. Conclusions The performed risk analysis offered an original frame for a collective thinking among the care providers and contributed to modify their mode of conceiving both security and radioprotection. The study allowed us to give a relevant answer to the High Authority of Health and the Authority of Nuclear Security demands either in terms of efficient management of the risks in radiotherapy or regarding the daily concerns of the care-givers. (authors)

  18. Effect of radiotherapy on immunity function of cancer patients receiving radiotherapy

    International Nuclear Information System (INIS)

    Li Xinli; Zhu Shentao; Xu Jiuhong

    2003-01-01

    Objective: In order to observe the effect of radiotherapy on immunity function of cancer patients receiving radiotherapy. Methods: Cellular immunity is determined by APAAP; Humoral immunity is determined by transmission method. Results: The items of cellular immunity is lower than the control after radiotherapy. These items decrease continually. The difference between before and after radiotherapy has statistic significance. Of all Humoral immunity items, IgA, IgM decreased after radiotherapy and the difference has statistic significance. Conclusions: Radiotherapy can damage patients' immunity function

  19. Multi-Disciplinary Design Optimization Using WAVE

    Science.gov (United States)

    Irwin, Keith

    2000-01-01

    develop an associative control structure (framework) in the UG WAVE environment enabling multi-disciplinary design of turbine propulsion systems. The capabilities of WAVE were evaluated to assess its use as a rapid optimization and productivity tool. This project also identified future WAVE product enhancements that will make the tool still more beneficial for product development.

  20. Minimising food waste: a call for multidisciplinary research.

    Science.gov (United States)

    Alamar, Maria Del Carmen; Falagán, Natalia; Aktas, Emel; Terry, Leon A

    2018-01-01

    Food losses and waste have always been a significant global problem for mankind, and one which has become increasingly recognised as such by policy makers, food producers, processors, retailers, and consumers. It is, however, an emotive subject whereby the extent, accuracy and resolution of available data on postharvest loss and waste are questionable, such that key performance indicators on waste can be misinformed. The nature and extent of food waste differ among developed economies, economies in transition and developing countries. While most emphasis has been put on increasing future crop production, far less resource has been and is still channelled towards enabling both established and innovative food preservation technologies to reduce food waste while maintaining safety and quality. Reducing food loss and waste is a more tractable problem than increasing production in the short to medium term, as its solution is not directly limited, for instance, by available land and water resources. Here we argue the need for a paradigm shift of current funding strategies and research programmes that will encourage the development, implementation and translation of collective biological, engineering and management solutions to better preserve and utilise food. Such multidisciplinary thinking across global supply chains is an essential element in the pursuit of achieving sustainable food and nutritional security. The implementation of allied technological and management solutions is reliant on there being sufficient skilled human capital and resources. There is currently a lack of robust postharvest research networks outside of the developed world, and insufficient global funding mechanisms that can support such interdisciplinary collaborations. There is, thus, a collective need for schemes that encourage inter-supply chain research, knowledge exchange and capacity building to reduce food losses and waste. © 2017 Society of Chemical Industry. © 2017 Society of Chemical