A Systematic Review of Training Interventions Addressing Sexual Violence against Marginalized At-Risk Groups of Women

Science.gov (United States)

Kouta, Christiana; Pithara, Christalla; Zobnina, Anna; Apostolidou, Zoe; Christodoulou, Josie; Papadakaki, Maria; Chliaoutakis, Joannes

2015-01-01

Women from marginalized groups working in occupations such as domestic work are at increased risk for sexual violence. Scarce evidence exists about training interventions targeting such groups. The article aims to identify community and workplace-based training interventions aiming to increase capacity among marginalized at-risk women to deal with…

Head and Neck Margin Reduction With Adaptive Radiation Therapy: Robustness of Treatment Plans Against Anatomy Changes

International Nuclear Information System (INIS)

Kranen, Simon van; Hamming-Vrieze, Olga; Wolf, Annelisa; Damen, Eugène; Herk, Marcel van; Sonke, Jan-Jakob

2016-01-01

Purpose: We set out to investigate loss of target coverage from anatomy changes in head and neck cancer patients as a function of applied safety margins and to verify a cone beam computed tomography (CBCT)–based adaptive strategy with an average patient anatomy to overcome possible target underdosage. Methods and Materials: For 19 oropharyngeal cancer patients, volumetric modulated arc therapy treatment plans (2 arcs; simultaneous integrated boost, 70 and 54.25 Gy; 35 fractions) were automatically optimized with uniform clinical target volume (CTV)–to–planning target volume margins of 5, 3, and 0 mm. We applied b-spline CBCT–to–computed tomography (CT) deformable registration to allow recalculation of the dose on modified CT scans (planning CT deformed to daily CBCT following online positioning) and dose accumulation in the planning CT scan. Patients with deviations in primary or elective CTV coverage >2 Gy were identified as candidates for adaptive replanning. For these patients, a single adaptive intervention was simulated with an average anatomy from the first 10 fractions. Results: Margin reduction from 5 mm to 3 mm to 0 mm generally led to an organ-at-risk (OAR) mean dose (D_m_e_a_n) sparing of approximately 1 Gy/mm. CTV shrinkage was mainly seen in the elective volumes (up to 10%), likely related to weight loss. Despite online repositioning, substantial systematic errors were present (>3 mm) in lymph node CTV, the parotid glands, and the larynx. Nevertheless, the average increase in OAR dose was small: maximum of 1.2 Gy (parotid glands, D_m_e_a_n) for all applied margins. Loss of CTV coverage >2 Gy was found in 1, 3, and 7 of 73 CTVs, respectively. Adaptive intervention in 0-mm plans substantially improved coverage: in 5 of 7 CTVs (in 6 patients) to 2 Gy in 0-mm plans may be identified early in treatment using dose accumulation. A single intervention with an average anatomy derived from CBCT effectively mitigates discrepancies.

Clearing margin system in the futures markets—Applying the value-at-risk model to Taiwanese data

Science.gov (United States)

Chiu, Chien-Liang; Chiang, Shu-Mei; Hung, Jui-Cheng; Chen, Yu-Lung

2006-07-01

This article sets out to investigate if the TAIFEX has adequate clearing margin adjustment system via unconditional coverage, conditional coverage test and mean relative scaled bias to assess the performance of three value-at-risk (VaR) models (i.e., the TAIFEX, RiskMetrics and GARCH-t). For the same model, original and absolute returns are compared to explore which can accurately capture the true risk. For the same return, daily and tiered adjustment methods are examined to evaluate which corresponds to risk best. The results indicate that the clearing margin adjustment of the TAIFEX cannot reflect true risks. The adjustment rules, including the use of absolute return and tiered adjustment of the clearing margin, have distorted VaR-based margin requirements. Besides, the results suggest that the TAIFEX should use original return to compute VaR and daily adjustment system to set clearing margin. This approach would improve the funds operation efficiency and the liquidity of the futures markets.

Artificial neural network based gynaecological image-guided adaptive brachytherapy treatment planning correction of intra-fractional organs at risk dose variation.

Science.gov (United States)

Jaberi, Ramin; Siavashpour, Zahra; Aghamiri, Mahmoud Reza; Kirisits, Christian; Ghaderi, Reza

2017-12-01

Intra-fractional organs at risk (OARs) deformations can lead to dose variation during image-guided adaptive brachytherapy (IGABT). The aim of this study was to modify the final accepted brachytherapy treatment plan to dosimetrically compensate for these intra-fractional organs-applicators position variations and, at the same time, fulfilling the dosimetric criteria. Thirty patients with locally advanced cervical cancer, after external beam radiotherapy (EBRT) of 45-50 Gy over five to six weeks with concomitant weekly chemotherapy, and qualified for intracavitary high-dose-rate (HDR) brachytherapy with tandem-ovoid applicators were selected for this study. Second computed tomography scan was done for each patient after finishing brachytherapy treatment with applicators in situ. Artificial neural networks (ANNs) based models were used to predict intra-fractional OARs dose-volume histogram parameters variations and propose a new final plan. A model was developed to estimate the intra-fractional organs dose variations during gynaecological intracavitary brachytherapy. Also, ANNs were used to modify the final brachytherapy treatment plan to compensate dosimetrically for changes in 'organs-applicators', while maintaining target dose at the original level. There are semi-automatic and fast responding models that can be used in the routine clinical workflow to reduce individually IGABT uncertainties. These models can be more validated by more patients' plans to be able to serve as a clinical tool.

Artificial neural network based gynaecological image-guided adaptive brachytherapy treatment planning correction of intra-fractional organs at risk dose variation

Directory of Open Access Journals (Sweden)

Ramin Jaberi

2017-12-01

Full Text Available Purpose : Intra-fractional organs at risk (OARs deformations can lead to dose variation during image-guided adaptive brachytherapy (IGABT. The aim of this study was to modify the final accepted brachytherapy treatment plan to dosimetrically compensate for these intra-fractional organs-applicators position variations and, at the same time, fulfilling the dosimetric criteria. Material and methods : Thirty patients with locally advanced cervical cancer, after external beam radiotherapy (EBRT of 45-50 Gy over five to six weeks with concomitant weekly chemotherapy, and qualified for intracavitary high-dose-rate (HDR brachytherapy with tandem-ovoid applicators were selected for this study. Second computed tomography scan was done for each patient after finishing brachytherapy treatment with applicators in situ. Artificial neural networks (ANNs based models were used to predict intra-fractional OARs dose-volume histogram parameters variations and propose a new final plan. Results : A model was developed to estimate the intra-fractional organs dose variations during gynaecological intracavitary brachytherapy. Also, ANNs were used to modify the final brachytherapy treatment plan to compensate dosimetrically for changes in ‘organs-applicators’, while maintaining target dose at the original level. Conclusions : There are semi-automatic and fast responding models that can be used in the routine clinical workflow to reduce individually IGABT uncertainties. These models can be more validated by more patients’ plans to be able to serve as a clinical tool.

A systematic review of training interventions addressing sexual violence against marginalized at-risk groups of women.

Science.gov (United States)

Kouta, Christiana; Pithara, Christalla; Zobnina, Anna; Apostolidou, Zoe; Christodoulou, Josie; Papadakaki, Maria; Chliaoutakis, Joannes

2015-12-01

Women from marginalized groups working in occupations such as domestic work are at increased risk for sexual violence. Scarce evidence exists about training interventions targeting such groups. The article aims to identify community and workplace-based training interventions aiming to increase capacity among marginalized at-risk women to deal with sexual violence. A systematic review was applied. Inclusion criteria were English language published between 2003 and 2013; reporting on delivery and/or evaluation; focusing on any form of sexual violence; delivered to professionals, affected or at-risk women; targeting migrant, at-risk women or domestic workers. Data were extracted on the setting, content, evaluation process and target population. Four studies which focused on prevention or responding to sexual violence were included. One study provided sexual violence training to vulnerable female and one provided a HIV prevention intervention to marginalized women. Learning objectives included increasing knowledge around issues of sexual violence and/or gender and human rights, prevention and response strategies. Two studies aimed to train trainers. All studies conducted an outcome evaluation and two a process evaluation. It seems there is a gap on participatory empowerment training for marginalized women. Community train-the-trainer interventions are imperative to protect themselves and deal with the risk of sexual violence. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Validity of PRV margins around lung and heart during left breast irradiation

International Nuclear Information System (INIS)

Stefanovski, Zoran

2010-01-01

Planning organ at risk volumes (PRV) has a minor use in radiotherapy treatment planning. During left breast irradiation two critical volumes are of special importance the lung and the heart. The aim of this study was to evaluate the changes in volume doses after adding appropriate margins around these organs at risk and compare them with the effect that the systematic positioning error has on the volume doses. Methods: Treatment plans for 44 patients with left breast cancer were analyzed. Two changes for each plan were made, and dose-volume histogram values for hearts and lungs volumes were recorded. In the first case margins of 5 mm to hearts and lungs were added. Volumes that were enclosed by 30% isodose for hearts and volumes that were enclosed by 20% isodose of lungs were recorded. In the second case plans were made with a systematic error of 5 mm employed, depicting a translation of isocenter posterior and to the right. In this second case, monitor units were taken from the original plan. The critical volumes for hearts and lungs were recorded as in the first case. Results: Our policy for breast cancer irradiation demands that the lung volume receiving 20 Gy should be kept under 25% of the whole left-lung volume, and no more than 10% of the heart volume should receive more than 30 Gy. The first case simulation showed that 23% of the patients have a heart overdose while 11% of them have a lung overdose according to the criteria above. Simulation of the second kind showed that the systematic error in isocenter positioning of 5 mm gives bigger a volume of the heart (in average 0.69% of heart volume) to be enclosed in critical isodose than in PRV case. For the lung the situation was opposite; namely in PRV case the lung volume that is encompassed with critical isodose is greater (in average 1.47% of lung volume) than in a case of displaced isocenter. Conclusions: Adding PRV margins around the heart and the lung does not give straightforward and unambiguous result

Review of the project risk management plan in the capital projects organization at ConocoPhillips

OpenAIRE

Meidell, Camilla

2011-01-01

Master's thesis in Risk management Project Risk Management (PRM) has in recent years become an important aspect of business organization and project management. There has always been a requirement for some risk management at COPNO. However about 3 years ago the process became much more defined and has become a requirement for the contingency used on projects to be based upon the risking process. Since risk management in projects is a requirement in the CP organization it is ...

Clinical implementation of dose-volume histogram predictions for organs-at-risk in IMRT planning

International Nuclear Information System (INIS)

Moore, K L; Appenzoller, L M; Tan, J; Michalski, J M; Thorstad, W L; Mutic, S

2014-01-01

True quality control (QC) of the planning process requires quantitative assessments of treatment plan quality itself, and QC in IMRT has been stymied by intra-patient anatomical variability and inherently complex three-dimensional dose distributions. In this work we describe the development of an automated system to reduce clinical IMRT planning variability and improve plan quality using mathematical models that predict achievable OAR DVHs based on individual patient anatomy. These models rely on the correlation of expected dose to the minimum distance from a voxel to the PTV surface, whereby a three-parameter probability distribution function (PDF) was used to model iso-distance OAR subvolume dose distributions. DVH models were obtained by fitting the evolution of the PDF with distance. Initial validation on clinical cohorts of 40 prostate and 24 head-and-neck plans demonstrated highly accurate model-based predictions for achievable DVHs in rectum, bladder, and parotid glands. By quantifying the integrated difference between candidate DVHs and predicted DVHs, the models correctly identified plans with under-spared OARs, validated by replanning all cases and correlating any realized improvements against the predicted gains. Clinical implementation of these predictive models was demonstrated in the PINNACLE treatment planning system by use of existing margin expansion utilities and the scripting functionality inherent to the system. To maintain independence from specific planning software, a system was developed in MATLAB to directly process DICOM-RT data. Both model training and patient-specific analyses were demonstrated with significant computational accelerations from parallelization.

Evaluation of margining algorithms in commercial treatment planning systems

International Nuclear Information System (INIS)

Pooler, Alistair M.; Mayles, Helen M.; Naismith, Olivia F.; Sage, John P.; Dearnaley, David P.

2008-01-01

Introduction: During commissioning of the Pinnacle (Philips) treatment planning system (TPS) the margining algorithm was investigated and was found to produce larger PTVs than Plato (Nucletron) for identical GTVs. Subsequent comparison of PTV volumes resulting from the QA outlining exercise for the CHHIP (Conventional or Hypofractionated High Dose IMRT for Prostate Ca.) trial confirmed that there were differences in TPS's margining algorithms. Margining and the clinical impact of the different PTVs in seven different planning and virtual simulation systems (Pinnacle, Plato, Prosoma (MedCom), Eclipse (7.3 and 7.5) (Varian), MasterPlan (Nucletron), Xio (CMS) and Advantage Windows (AW) (GE)) is investigated, and a simple test for 3D margining consistency is proposed. Methods: Using each TPS, two different sets of prostate GTVs on 2.5 mm and 5 mm slices were margined according to the CHHIP protocol to produce PTV3 (prostate + 5 mm/0 mm post), PTV2 (PTV3 + 5 mm) and PTV1 (prostate and seminal vesicles + 10 mm). GTVs and PTVs were imported into Pinnacle for volume calculation. DVHs for 5 mm slice plans, created using the smallest PTVs, were recalculated on the largest PTV dataset and vice versa. Since adding a margin of 50 mm to a structure should give the same result as adding five margins of 10 mm, this was tested for each TPS (consistency test) using an octahedron as the GTV and CT datasets with 2.5 mm and 5 mm slices. Results: The CHHIP PTV3 and PTV1 volumes had a standard deviation, across the seven systems, of 5% and PTV2 (margined twice) 9%, on the 5 mm slices. For 2.5 mm slices the standard deviations were 4% and 6%. The ratio of the Pinnacle and the Eclipse 7.3 PTV2 volumes was 1.25. Rectal doses were significantly increased when encompassing Pinnacle PTVs (V 50 42.8%), compared to Eclipse 7.3 PTVs (V 50 = 36.4%). Conversely, fields that adequately treated an Eclipse 7.3 PTV2 were inadequate for a Pinnacle PTV2. AW and Plato PTV volumes were the most consistent

Information Assurance for Enterprise Resource Planning Systems: Risk Considerations in Public Sector Organizations

International Nuclear Information System (INIS)

Naeem, S.; Islam, M.H.

2016-01-01

ERP (Enterprise Resource Planning) systems reveal and pose non-typical risks due to its dependencies of interlinked business operations and process reengineering. Understanding of such type of risks is significant conducting and planning assurance involvement of the reliability of these complicated computer systems. Specially, in case of distributed environment where data reside at multiple sites and risks are of unique nature. Until now, there are brief pragmatic grounds on this public sector ERP issue. To analyze this subject, a partially organized consultation study was carried out with 15 skilled information systems auditors who are specialists in evaluating ERP systems risks. This methodology permitted to get more elaborated information about stakeholder's opinions and customer experiences. In addition, interviewees mentioned a numerous basic execution troubles (e.g. inadequately skilled human resource and insufficient process reengineering attempts) that lead into enhanced hazards. It was also reported by the interviewees that currently risks vary across vendors and across applications. Eventually, in offering assurance with ERP systems participants irresistibly stresses examining the process instead of system end product. (author)

Information Assurance for Enterprise Resource Planning Systems: Risk Considerations in Public Sector Organizations

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SHAHZAD NAEEM

2016-10-01

Full Text Available ERP (Enterprise Resource Planning systems reveal and pose non-typical risks due to its dependencies of interlinked business operations and process reengineering. Understanding of such type of risks is significant conducting and planning assurance involvement of the reliability of these complicated computer systems. Specially, in case of distributed environment where data reside at multiple sites and risks are of unique nature. Until now, there are brief pragmatic grounds on this public sector ERP issue. To analyze this subject, a partially organized consultation study was carried out with 15 skilled information systems auditors who are specialists in evaluating ERP systems risks. This methodology permitted to get more elaborated information about stakeholder?s opinions and customer experiences. In addition, interviewees mentioned a numerous basic execution troubles (e.g. inadequately skilled human resource and insufficient process reengineering attempts that lead into enhanced hazards. It was also reported by the interviewees that currently risks vary across vendors and across applications. Eventually, in offering assurance with ERP systems participants irresistibly stresses examining the process instead of system end product.

Development of Organ-Specific Donor Risk Indices

OpenAIRE

Akkina, Sanjeev K.; Asrani, Sumeet K.; Peng, Yi; Stock, Peter; Kim, Ray; Israni, Ajay K.

2012-01-01

Due to the shortage of deceased donor organs, transplant centers accept organs from marginal deceased donors, including older donors. Organ-specific donor risk indices have been developed to predict graft survival using various combinations of donor and recipient characteristics. We will review the kidney donor risk index (KDRI) and liver donor risk index (LDRI) and compare and contrast their strengths, limitations, and potential uses. The Kidney Donor Risk Index has a potential role in devel...

Enabling the participation of marginalized populations: case studies from a health service organization in Ontario, Canada.

Science.gov (United States)

Montesanti, Stephanie R; Abelson, Julia; Lavis, John N; Dunn, James R

2017-08-01

We examined efforts to engage marginalized populations in Ontario Community Health Centers (CHCs), which are primary health care organizations serving 74 high-risk communities. Qualitative case studies of community participation in four Ontario CHCs were carried out through key informant interviews with CHC staff to identify: (i) the approaches, strategies and methods used in participation initiatives aimed specifically at engaging marginalized populations in the planning of and decision making for health services; and (ii) the challenges and enablers for engaging these populations. The marginalized populations involved in the community participation initiatives studied included Low-German Speaking Mennonites in a rural town, newcomer immigrants and refugees in an urban downtown city, immigrant and francophone seniors in an inner city and refugee women in an inner city. Our analysis revealed that enabling the participation of marginalized populations requires CHCs to attend to the barriers experienced by marginalized populations that constrain their participation. Key informants outlined the features of a 'community development approach' that they rely on to address the barriers to marginalized peoples' involvement by strengthening their skills, abilities and leadership in capacity-building activities. The community development approach also shaped the participation methods that were used in the engagement process of CHCs. However, key informants also described the challenges of applying this approach, influenced by the cultural values of some groups, which shaped their willingness and motivation to participate. This study provides further insight into the approach, strategies and methods used in the engagement process to enable the participation of marginalized populations, which may be transferable to other health services settings. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

MRI-assisted versus conventional treatment planning in brachytherapy of cervical and endometrial carcinoma: The impact of individual anatomy on dose distribution in target volume and organs at risk

International Nuclear Information System (INIS)

Wulf, Joern; Sauer, Otto A.; Herbolsheimer, Michael; Oppitz, Ulrich; Flentje, Michael

1996-01-01

Objective: Dose prescription and definition of target volume in brachytherapy of cervical and endometrial cancer are calculated to standard points as Manchester point A or point My(ometrium) in most centers. Calculation of doses to organs at risk mainly relies on ICRU-report 38. But standard dose prescription neglects individual patient anatomy. While MRI and CT had widespread impact on individual planning in external beam radiotherapy, there is still a minor influence on brachytherapy. The impact of individual anatomy on dose distribution in target volume and organs at risk demonstrates the objective of individual brachytherapy planning. Materials and Methods: 8 patients with cervical and 4 patients with endometrial carcinoma underwent MRI of the pelvis with in-situ applicators (ring-tandem applicators for cervical carcinoma and modified Heyman-capsules for endometrial carcinoma). T1w slices were angulated coronal and sagittal to get rectangular reproductions to applicator axis. Orthogonal or isocentric X-ray films for conventional treatment planning were done. MRI-information on target and organs at risk was transformed into coordinates relative to applicator axis and dose calculation on the database of conventional treatment planning was performed by Nucletron Planning System PLATO. Isodoses were projected into MRI slices. Prescribed dose to patients with cervical cancer was 8.5 Gy to point A resp. 10 Gy to point My (2cm below fundal myometrium and 2cm lateral applicator axis) in endometrial cancer. Results: Dose prescription to Manchester point A or point My represented in only 50% of cases uterine serosa. Instead of 2cm lateral of applicator axis, uterine surface ranged from 1.0 cm to 3.9 cm at the level of point A (mean 2.25 cm coronal and 1.77 cm sagittal) and from 1.5 cm to 4.4 cm at the level of point My (mean 2.7 cm coronal and 2.1 cm sagittal). Uterine volume ranged from 69 cc to 277 cc, mean volume was 150cc. Dose-volume histograms of patients with

The Role of Field Margins in Agro-biodiversity Management at the Farm Level

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Giulio Lazzerini

2007-06-01

Full Text Available The agroecosystem could be considered as a mosaic so large to involve fields with annual and perennial crops, pastures, spots of wildwood, semi-natural habitats, vegetation in the edges of fields. In the agroecosystem these ecological infrastructures have a positive effects on the crops because of the exchange among community of organisms, materials and energy. The aim of this research is to evaluate the effects of field margins on some biodiversity components (plant species and carabid beetles of four farms located in Val d’Orcia (Tuscany. We compared three types of field margins: 1. Cultivated margin strips; 2. Sown grass margin strips; 3. Wild margin strips with hedgerow. In a very simplified typology of farming system, like the one studied (Val d’Orcia, the presence of field margins (hedges, margin strips and semi-natural habitats associated with the boundary is very important for its ecological effects: it improves the planned biodiversity, gives habitat, refuge, food and corridors for the movement to the different species of organisms in the area. Applying the multivariate analysis to the experimental data, we can notice a positive effect of the presence of field margins on the trend of both components of biodiversity. This positive effect, which support the mechanisms of autoregulation of the agroecosystems, is very important especially for organic and biodynamic agriculture, where the use of pesticides is not allowed.

Is it necessary to plan with safety margins for actively scanned proton therapy?

Science.gov (United States)

Albertini, F.; Hug, E. B.; Lomax, A. J.

2011-07-01

In radiation therapy, a plan is robust if the calculated and the delivered dose are in agreement, even in the case of different uncertainties. The current practice is to use safety margins, expanding the clinical target volume sufficiently enough to account for treatment uncertainties. This, however, might not be ideal for proton therapy and in particular when using intensity modulated proton therapy (IMPT) plans as degradation in the dose conformity could also be found in the middle of the target resulting from misalignments of highly in-field dose gradients. Single field uniform dose (SFUD) and IMPT plans have been calculated for different anatomical sites and the need for margins has been assessed by analyzing plan robustness to set-up and range uncertainties. We found that the use of safety margins is a good way to improve plan robustness for SFUD and IMPT plans with low in-field dose gradients but not necessarily for highly modulated IMPT plans for which only a marginal improvement in plan robustness could be detected through the definition of a planning target volume.

Marginal kidney donor

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Ganesh Gopalakrishnan

2007-01-01

Full Text Available Renal transplantation is the treatment of choice for a medically eligible patient with end stage renal disease. The number of renal transplants has increased rapidly over the last two decades. However, the demand for organs has increased even more. This disparity between the availability of organs and waitlisted patients for transplants has forced many transplant centers across the world to use marginal kidneys and donors. We performed a Medline search to establish the current status of marginal kidney donors in the world. Transplant programs using marginal deceased renal grafts is well established. The focus is now on efforts to improve their results. Utilization of non-heart-beating donors is still in a plateau phase and comprises a minor percentage of deceased donations. The main concern is primary non-function of the renal graft apart from legal and ethical issues. Transplants with living donors outnumbered cadaveric transplants at many centers in the last decade. There has been an increased use of marginal living kidney donors with some acceptable medical risks. Our primary concern is the safety of the living donor. There is not enough scientific data available to quantify the risks involved for such donation. The definition of marginal living donor is still not clear and there are no uniform recommendations. The decision must be tailored to each donor who in turn should be actively involved at all levels of the decision-making process. In the current circumstances, our responsibility is very crucial in making decisions for either accepting or rejecting a marginal living donor.

Planning target volumes for radiotherapy: how much margin is needed?

International Nuclear Information System (INIS)

Antolak, John A.; Rosen, Isaac I.

1999-01-01

Purpose: The radiotherapy planning target volume (PTV) encloses the clinical target volume (CTV) with anisotropic margins to account for possible uncertainties in beam alignment, patient positioning, organ motion, and organ deformation. Ideally, the CTV-PTV margin should be determined solely by the magnitudes of the uncertainties involved. In practice, the clinician usually also considers doses to abutting healthy tissues when deciding on the size of the CTV-PTV margin. This study calculates the ideal size of the CTV-PTV margin when only physical position uncertainties are considered. Methods and Materials: The position of the CTV for any treatment is assumed to be described by independent Gaussian distributions in each of the three Cartesian directions. Three strategies for choosing a CTV-PTV margin are analyzed. The CTV-PTV margin can be based on: 1. the probability that the CTV is completely enclosed by the PTV; 2. the probability that the projection of the CTV in the beam's eye view (BEV) is completely enclosed by the projection of the PTV in the BEV; and 3. the probability that a point on the edge of the CTV is within the PTV. Cumulative probability distributions are derived for each of the above strategies. Results: Expansion of the CTV by 1 standard deviation (SD) in each direction results in the CTV being entirely enclosed within the PTV 24% of the time; the BEV projection of the CTV is enclosed within the BEV projection of the PTV 39% of the time; and a point on the edge of the CTV is within the PTV 84% of the time. To have the CTV enclosed entirely within the PTV 95% of the time requires a margin of 2.8 SD. For the BEV projection of the CTV to be within the BEV projection of the PTV 95% of the time requires a margin of 2.45 SD. To have any point on the surface of the CTV be within the PTV 95% of the time requires a margin of 1.65 SD. Conclusion: In the first two strategies for selecting a margin, the probability of finding the CTV within the PTV is

Organic carbon production, mineralisation and preservation on the Peruvian margin

Science.gov (United States)

Dale, A. W.; Sommer, S.; Lomnitz, U.; Montes, I.; Treude, T.; Liebetrau, V.; Gier, J.; Hensen, C.; Dengler, M.; Stolpovsky, K.; Bryant, L. D.; Wallmann, K.

2015-03-01

Carbon cycling in Peruvian margin sediments (11 and 12° S) was examined at 16 stations, from 74 m water depth on the middle shelf down to 1024 m, using a combination of in situ flux measurements, sedimentary geochemistry and modelling. Bottom water oxygen was below detection limit down to ca. 400 m and increased to 53 μM at the deepest station. Sediment accumulation rates decreased sharply seaward of the middle shelf and subsequently increased at the deep stations. The organic carbon burial efficiency (CBE) was unusually low on the middle shelf (60%) at the deep oxygenated sites. In line with other studies, CBE was elevated under oxygen-deficient waters in the mid-water oxygen minimum zone. Organic carbon rain rates calculated from the benthic fluxes alluded to efficient mineralisation of organic matter in the water column compared to other oxygen-deficient environments. The observations at the Peruvian margin suggest that a lack of oxygen does not greatly affect the degradation of organic matter in the water column but promotes the preservation of organic matter in sediments.

Involved-nodal radiation therapy leads to lower doses to critical organs-at-risk compared to involved-field radiation therapy

International Nuclear Information System (INIS)

Mulvihill, David J.; McMichael, Kevin; Goyal, Sharad; Drachtman, Richard; Weiss, Aaron; Khan, Atif J.

2014-01-01

Background: Involved field radiotherapy (IFRT) after cytotoxic chemotherapy has become the standard of care in treating pediatric patients with Hodgkin lymphoma. However, recent interest in shrinking the treatment volume to involved node radiotherapy (INRT) may allow lower doses to critical organ structures. We dosimetrically compared IFRT and INRT treatment approaches. Methods: INRT treatment plans were retrospectively constructed from 17 consecutively treated pediatric patients identified with Hodgkin lymphoma who had been previously treated with conventional IFRT. The radiation doses delivered to organs-at-risk (OARs) with virtual INRT treatment plans based on INRT field design were then compared to the original IFRT treatment plans. Metrics for comparison included mean doses to organs and volumes of organ receiving at least 50% of the original prescription dose (V50%). A one-tailed, paired t-test was then performed to verify statistical significance at an alpha level of 0.05. Results: All organs at risk compared in this investigation (kidneys, heart, thyroid, parotids, and lungs) had significantly lower doses of radiation with INRT when compared to IFRT (p < 0.05). Furthermore, the volume of the breast receiving at least 50% of the initial prescription dose was statistically lower in the INRT plans. Conclusions: Utilizing the concept of INRT results in a reduction of radiation dose to critical organ structures in pediatric patients with Hodgkin lymphoma when compared to the more traditional method of IFRT

User Interaction in Semi-Automatic Segmentation of Organs at Risk: a Case Study in Radiotherapy

NARCIS (Netherlands)

A. Ramkumar (Anjana); J. Dolz (Jose); H.A. Kirisli (Hortense); S. Adebahr (Sonja); T. Schimek-Jasch (Tanja); U. Nestle (Ursula); L. Massoptier (Laurent); E. Varga (Edit); P.J. Stappers (P.); W.J. Niessen (Wiro); Y. Song (Yu)

2016-01-01

textabstractAccurate segmentation of organs at risk is an important step in radiotherapy planning. Manual segmentation being a tedious procedure and prone to inter- and intra-observer variability, there is a growing interest in automated segmentation methods. However, automatic methods frequently

User Interaction in Semi-Automatic Segmentation of Organs at Risk : A Case Study in Radiotherapy

NARCIS (Netherlands)

Ramkumar, A.; Dolz, J.; Kirisli, H.A.; Adebahr, S.; Schimek-Jasch, T.; Nestle, U.; Massoptier, L.; Varga, E.; Stappers, P.J.; Niessen, W.J.; Song, Y.

2015-01-01

Accurate segmentation of organs at risk is an important step in radiotherapy planning. Manual segmentation being a tedious procedure and prone to inter- and intra-observer variability, there is a growing interest in automated segmentation methods. However, automatic methods frequently fail to

Output Price Risk, Material Input Price Risk, and Price Margins: Evidence from the US Catfish Industry.

Directory of Open Access Journals (Sweden)

David Bouras

2017-07-01

Full Text Available Aim/purpose - To develop a conceptual model for analyzing the impact of output price risk and material input price risk on price margins. Design/methodology/approach - To analyze the combined effect of output price risk and material input risk on price margins, we use a series of comparative static analyses, GARCH models, and data ranging from 1990/01 to 2012/12. Findings - The theoretical results indicate that the impact of output price risk and the impact of material input price risk on price margins are ambiguous and, to a great extent, hinge on the correlation between output price and material input price. The empirical results show that whole frozen catfish price risk and live catfish price risk negatively affect the price margin for frozen catfish. The empirical results, however, indicate that the risk of the price of live catfish affects markedly the price margin for frozen whole catfish in contrast to the impact of the risk of the price of frozen whole catfish. Research implications/limitations - The empirical results have significant implications for managerial decision-making especially when crafting strategies for improving price margins. Accordingly, in order to beef up the price margin for frozen whole catfish, catfish processors may consider engaging in vertical integration. This paper has some limitations: first, it assumes that firms operate in competitive markets; second, it assumes that firms produce and sell a single product. Originality/value/contribution - Unlike earlier studies that focused solely on the effect of output price risk on price margins, this paper analyzes theoretically and empirically the impact of output price risk and material input price risk on price margins.

Risk, Robustness and Water Resources Planning Under Uncertainty

Science.gov (United States)

Borgomeo, Edoardo; Mortazavi-Naeini, Mohammad; Hall, Jim W.; Guillod, Benoit P.

2018-03-01

Risk-based water resources planning is based on the premise that water managers should invest up to the point where the marginal benefit of risk reduction equals the marginal cost of achieving that benefit. However, this cost-benefit approach may not guarantee robustness under uncertain future conditions, for instance under climatic changes. In this paper, we expand risk-based decision analysis to explore possible ways of enhancing robustness in engineered water resources systems under different risk attitudes. Risk is measured as the expected annual cost of water use restrictions, while robustness is interpreted in the decision-theoretic sense as the ability of a water resource system to maintain performance—expressed as a tolerable risk of water use restrictions—under a wide range of possible future conditions. Linking risk attitudes with robustness allows stakeholders to explicitly trade-off incremental increases in robustness with investment costs for a given level of risk. We illustrate the framework through a case study of London's water supply system using state-of-the -art regional climate simulations to inform the estimation of risk and robustness.

Organic carbon production, mineralization and preservation on the Peruvian margin

Science.gov (United States)

Dale, A. W.; Sommer, S.; Lomnitz, U.; Montes, I.; Treude, T.; Gier, J.; Hensen, C.; Dengler, M.; Stolpovsky, K.; Bryant, L. D.; Wallmann, K.

2014-09-01

Carbon cycling in Peruvian margin sediments (11° S and 12° S) was examined at 16 stations from 74 m on the inner shelf down to 1024 m water depth by means of in situ flux measurements, sedimentary geochemistry and modeling. Bottom water oxygen was below detection limit down to ca. 400 m and increased to 53 μM at the deepest station. Sediment accumulation rates and benthic dissolved inorganic carbon fluxes decreased rapidly with water depth. Particulate organic carbon (POC) content was lowest on the inner shelf and at the deep oxygenated stations (< 5%) and highest between 200 and 400 m in the oxygen minimum zone (OMZ, 15-20%). The organic carbon burial efficiency (CBE) was unexpectedly low on the inner shelf (< 20%) when compared to a global database, for reasons which may be linked to the frequent ventilation of the shelf by oceanographic anomalies. CBE at the deeper oxygenated sites was much higher than expected (max. 81%). Elsewhere, CBEs were mostly above the range expected for sediments underlying normal oxic bottom waters, with an average of 51 and 58% for the 11° S and 12° S transects, respectively. Organic carbon rain rates calculated from the benthic fluxes alluded to a very efficient mineralization of organic matter in the water column, with a Martin curve exponent typical of normal oxic waters (0.88 ± 0.09). Yet, mean POC burial rates were 2-5 times higher than the global average for continental margins. The observations at the Peruvian margin suggest that a lack of oxygen does not affect the degradation of organic matter in the water column but promotes the preservation of organic matter in marine sediments.

Comparing risk in conventional and organic dairy farming in the Netherlands: an empirical analysis.

Science.gov (United States)

Berentsen, P B M; Kovacs, K; van Asseldonk, M A P M

2012-07-01

This study was undertaken to contribute to the understanding of why most dairy farmers do not convert to organic farming. Therefore, the objective of this research was to assess and compare risks for conventional and organic farming in the Netherlands with respect to gross margin and the underlying price and production variables. To investigate the risk factors a farm accountancy database was used containing panel data from both conventional and organic representative Dutch dairy farms (2001-2007). Variables with regard to price and production risk were identified using a gross margin analysis scheme. Price risk variables were milk price and concentrate price. The main production risk variables were milk yield per cow, roughage yield per hectare, and veterinary costs per cow. To assess risk, an error component implicit detrending method was applied and the resulting detrended standard deviations were compared between conventional and organic farms. Results indicate that the risk included in the gross margin per cow is significantly higher in organic farming. This is caused by both higher price and production risks. Price risks are significantly higher in organic farming for both milk price and concentrate price. With regard to production risk, only milk yield per cow poses a significantly higher risk in organic farming. Copyright © 2012 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Sci—Thur PM: Planning and Delivery — 04: Respiratory margin derivation and verification in partial breast irradiation

International Nuclear Information System (INIS)

Quirk, S; Conroy, L; Smith, WL

2014-01-01

Partial breast irradiation (PBI) following breast-conserving surgery is emerging as an effective means to achieve local control and reduce irradiated breast volume. Patients are planned on a static CT image; however, treatment is delivered while the patient is free-breathing. Respiratory motion can degrade plan quality by reducing target coverage and/or dose homogeneity. A variety of methods can be used to determine the required margin for respiratory motion in PBI. We derive geometric and dosimetric respiratory 1D margin. We also verify the adequacy of the typical 5 mm respiratory margin in 3D by evaluating plan quality for increasing respiratory amplitudes (2–20 mm). Ten PBI plans were used for dosimetric evaluation. A database of volunteer respiratory data, with similar characteristics to breast cancer patients, was used for this study. We derived a geometric 95%-margin of 3 mm from the population respiratory data. We derived a dosimetric 95%-margin of 2 mm by convolving 1D dose profiles with respiratory probability density functions. The 5 mm respiratory margin is possibly too large when 1D coverage is assessed and could lead to unnecessary normal tissue irradiation. Assessing margins only for coverage may be insufficient; 3D dosimetric assessment revealed degradation in dose homogeneity is the limiting factor, not target coverage. Hotspots increased even for the smallest respiratory amplitudes, while target coverage only degraded at amplitudes greater than 10 mm. The 5 mm respiratory margin is adequate for coverage, but due to plan quality degradation, respiratory management is recommended for patients with respiratory amplitudes greater than 10 mm

Sigmoid Colon is an Unexpected Organ at Risk in Brachytherapy for Cervix Cancer

International Nuclear Information System (INIS)

Ffrrcsi, H.F.; Mrcpfrcr, I.B.; Appleby, H.

2006-01-01

Purpose: To identify organs at risk (OAR) and analyze the dose volume histograms (DVHs) for intracavitary brachytherapy in cancer of the cervix. Late toxicities are our concern in treatment of cancer cervix especially as it is presenting in younger age population. Material and Methods: Patients with cancer of the cervix were treated using CT and MRI compatible, high dose rate, (HDR) applicators. CT images were acquired with the intra-uterine tube and colpostats in place and subsequently imported into Varian Brachyvision planning software. We identified the gross tumour volume (GTV) and organs at risk (OARs) and analyzed the dose distribution using dose volume histograms (DVHs). Doses were calculated according to ICRU 38. Critical tissue DVHs were analysed following the American Brachytherapy Society rules. Dose points are recorded as the dose encompassed by the greatest contiguous I cm3, 2 cm3, and 5 cm3 volumes in the plan. Results: We found the sigmoid colon to be a relatively immobile structure that repeatedly received doses in excess of 70% of the intended point A dose. The only solution in order to bring sigmoid DVHs within 5% toxicity limits was to reduce the dose to point A. Planning images and DVHs for the OARs are shown as an example of our work. Conclusion: The recto-sigmoid colon is identified as an unexpected OAR in a majority of cervix brachytherapy plans. A new consensus on the DVH limit of this structure will be needed in the era of CT planned brachytherapy, if arbitrary dose reductions to point A are to be the solution to the problem of sigmoid DVHs that exceed conventional tolerance limits

Volume dose of organs at risk in the irradiated volume

International Nuclear Information System (INIS)

Hishikawa, Yoshio; Tanaka, Shinichi; Miura, Takashi

1984-01-01

Absorbed dose of organs at risk in the 50% irradiated volume needs to be carefully monitored because there is high risk of radiation injury. This paper reports on the histogram of threedimensional volume dose of organs at risk, which is obtained by computer calculation of CT scans. In order to obtain this histogram, CT is first performed in the irradiation field. The dose in each pixel is then examined by the computer as to each slice. After the pixels of all slices in the organ at risk of the irradiated field are classified according to the doses, the number of pixels in the same dose class is counted. The result is expressed in a histogram. The histogram can show the differences of influence to organs at risk given by various radiation treatment techniques. Total volume dose of organs at risk after radiotherapy can also be obtained by integration of each dose of different treatment techniques. (author)

RISK-INFORMED SAFETY MARGIN CHARACTERIZATION

International Nuclear Information System (INIS)

Dinh, Nam; Szilard, Ronaldo

2009-01-01

The concept of safety margins has served as a fundamental principle in the design and operation of commercial nuclear power plants (NPPs). Defined as the minimum distance between a system's 'loading' and its 'capacity', plant design and operation is predicated on ensuring an adequate safety margin for safety-significant parameters (e.g., fuel cladding temperature, containment pressure, etc.) is provided over the spectrum of anticipated plant operating, transient and accident conditions. To meet the anticipated challenges associated with extending the operational lifetimes of the current fleet of operating NPPs, the United States Department of Energy (USDOE), the Idaho National Laboratory (INL) and the Electric Power Research Institute (EPRI) have developed a collaboration to conduct coordinated research to identify and address the technological challenges and opportunities that likely would affect the safe and economic operation of the existing NPP fleet over the postulated long-term time horizons. In this paper we describe a framework for developing and implementing a Risk-Informed Safety Margin Characterization (RISMC) approach to evaluate and manage changes in plant safety margins over long time horizons

Barriers to Offering Vasectomy at Publicly Funded Family Planning Organizations in Texas.

Science.gov (United States)

White, Kari; Campbell, Anthony; Hopkins, Kristine; Grossman, Daniel; Potter, Joseph E

2017-05-01

Few publicly funded family planning clinics in the United States offer vasectomy, but little is known about the reasons this method is not more widely available at these sources of care. Between February 2012 and February 2015, three waves of in-depth interviews were conducted with program administrators at 54 family planning organizations in Texas. Participants described their organization's vasectomy service model and factors that influenced how frequently vasectomy was provided. Interview transcripts were coded and analyzed using a theme-based approach. Service models and barriers to providing vasectomy were compared by organization type (e.g., women's health center, public health clinic) and receipt of Title X funding. Two thirds of organizations did not offer vasectomy on-site or pay for referrals with family planning funding; nine organizations frequently provided vasectomy. Organizations did not widely offer vasectomy because they could not find providers that would accept the low reimbursement for the procedure or because they lacked funding for men's reproductive health care. Respondents often did not perceive men's reproductive health care as a service priority and commented that men, especially Latinos, had limited interest in vasectomy. Although organizations of all types reported barriers, women's health centers and Title X-funded organizations more frequently offered vasectomy by conducting tailored outreach to men and vasectomy providers. A combination of factors operating at the health systems and provider level influence the availability of vasectomy at publicly funded family planning organizations in Texas. Multilevel approaches that address key barriers to vasectomy provision would help organizations offer comprehensive contraceptive services.

Variations in the Contouring of Organs at Risk: Test Case From a Patient With Oropharyngeal Cancer

Energy Technology Data Exchange (ETDEWEB)

Nelms, Benjamin E., E-mail: alpha@canislupusllc.com [Canis Lupus LLC, Merrimac, WI (United States); Tome, Wolfgang A. [Department of Human Oncology, University of Wisconsin, Madison, WI (United States); Robinson, Greg [Radiation Oncology Resources, Goshen, IN (United States); Wheeler, James [Department of Radiation Oncology, Goshen Health System Goshen, IN (United States)

2012-01-01

Purpose: Anatomy contouring is critical in radiation therapy. Inaccuracy and variation in defining critical volumes will affect everything downstream: treatment planning, dose-volume histogram analysis, and contour-based visual guidance used in image-guided radiation therapy. This study quantified: (1) variation in the contouring of organs at risk (OAR) in a clinical test case and (2) corresponding effects on dosimetric metrics of highly conformal plans. Methods and Materials: A common CT data set with predefined targets from a patient with oropharyngeal cancer was provided to a population of clinics, which were asked to (1) contour OARs and (2) design an intensity-modulated radiation therapy plan. Thirty-two acceptable plans were submitted as DICOM RT data sets, each generated by a different clinical team. Using those data sets, we quantified: (1) the OAR contouring variation and (2) the impact this variation has on dosimetric metrics. New technologies were employed, including a software tool to quantify three-dimensional structure comparisons. Results: There was significant interclinician variation in OAR contouring. The degree of variation is organ-dependent. We found substantial dose differences resulting strictly from contouring variation (differences ranging from -289% to 56% for mean OAR dose; -22% to 35% for maximum dose). However, there appears to be a threshold in the OAR comparison metric beyond which the dose differences stabilize. Conclusions: The effects of interclinician variation in contouring organs-at-risk in the head and neck can be large and are organ-specific. Physicians need to be aware of the effect that variation in OAR contouring can play on the final treatment plan and not restrict their focus only to the target volumes.

WE-AB-207B-09: Margin Reduction for Planning Target Volume (PTV) in Patients with Localized Prostate Cancer: Impact On Delivered Dose and Quality of Life

Energy Technology Data Exchange (ETDEWEB)

Kumarasiri, A; Liu, C; Brown, S; Glide-Hurst, C; Elshaikh, M; Chetty, I; Movsas, B [Henry Ford Health System, Detroit, MI (United States)

2016-06-15

Purpose: To estimate the delivered (cumulative) dose to targets and organs at risk for localized prostate cancer patients treated with reduced PTV margins and to evaluate preliminary patient reported quality-of-life (QOL). Methods: Under an IRB-approved protocol, 20 prostate cancer patients (including 11 control patients) were treated with reduced planning margins (5 mm uniform with 4 mm at prostate/rectum interface). Control patients had standard margin (10/6 mm)-based treatments. A parameter-optimized Elastix algorithm along with energy-mass mapping was used to deform and resample dose of the day onto the planning CT for each fraction to estimate the delivered dose over all fractions. QOL data were collected via Expanded Prostate cancer Index Composite (EPIC-26) questionnaires at time points pre-treatment, post-treatment, and at 2, 6, 12, 18 month follow-ups. Standardized QOL scores [range: 0–100] were determined and baseline-corrected by subtracting pre-treatment QOL data. Mean QOL differences between the margin reduced group and control group (QOLmr-QOLcontrol) were calculated for first 18 months. Results: The difference between the cumulative mean dose (Dmean) and the planned mean dose (±SD) for PTV, prostate, bladder, and rectum were −2.2±1.0, 0.3±0.5, −0.7±2.6, and −2.1±1.3 Gy respectively for the margin-reduced group, and −0.8±2.0, 0.9±1.4, - 0.7±3.1 and −1.0±2.4 Gy for the control group. Difference between the two groups was statistically insignificant (p=0.1). Standardized and baseline corrected QOLmr-QOLcontrol for EPIC domains categorized as “Urinary Incontinence”, “Urinary Irritative/Obstructive”, “Bowel”, “Sexual”, and “Hormonal” were 0.6, 12.1, 9.1, 13.3, and −0.9 for the 18 months following radiation therapy (higher values better). Delivered dose to rectum showed a weak correlation to “Bowel” domain (Pearson’s coefficient −0.24, p<0.001), while bladder dose did not correlate to Urinary Incontinence

WE-AB-207B-09: Margin Reduction for Planning Target Volume (PTV) in Patients with Localized Prostate Cancer: Impact On Delivered Dose and Quality of Life

International Nuclear Information System (INIS)

Kumarasiri, A; Liu, C; Brown, S; Glide-Hurst, C; Elshaikh, M; Chetty, I; Movsas, B

2016-01-01

Purpose: To estimate the delivered (cumulative) dose to targets and organs at risk for localized prostate cancer patients treated with reduced PTV margins and to evaluate preliminary patient reported quality-of-life (QOL). Methods: Under an IRB-approved protocol, 20 prostate cancer patients (including 11 control patients) were treated with reduced planning margins (5 mm uniform with 4 mm at prostate/rectum interface). Control patients had standard margin (10/6 mm)-based treatments. A parameter-optimized Elastix algorithm along with energy-mass mapping was used to deform and resample dose of the day onto the planning CT for each fraction to estimate the delivered dose over all fractions. QOL data were collected via Expanded Prostate cancer Index Composite (EPIC-26) questionnaires at time points pre-treatment, post-treatment, and at 2, 6, 12, 18 month follow-ups. Standardized QOL scores [range: 0–100] were determined and baseline-corrected by subtracting pre-treatment QOL data. Mean QOL differences between the margin reduced group and control group (QOLmr-QOLcontrol) were calculated for first 18 months. Results: The difference between the cumulative mean dose (Dmean) and the planned mean dose (±SD) for PTV, prostate, bladder, and rectum were −2.2±1.0, 0.3±0.5, −0.7±2.6, and −2.1±1.3 Gy respectively for the margin-reduced group, and −0.8±2.0, 0.9±1.4, - 0.7±3.1 and −1.0±2.4 Gy for the control group. Difference between the two groups was statistically insignificant (p=0.1). Standardized and baseline corrected QOLmr-QOLcontrol for EPIC domains categorized as “Urinary Incontinence”, “Urinary Irritative/Obstructive”, “Bowel”, “Sexual”, and “Hormonal” were 0.6, 12.1, 9.1, 13.3, and −0.9 for the 18 months following radiation therapy (higher values better). Delivered dose to rectum showed a weak correlation to “Bowel” domain (Pearson’s coefficient −0.24, p<0.001), while bladder dose did not correlate to Urinary Incontinence

Baseline risk and marginal willingness to pay for health risk reduction.

Science.gov (United States)

Gerking, Shelby; Adamowicz, Wiktor; Dickie, Mark; Veronesi, Marcella

2017-01-01

Empirical results presented in this paper suggest that parents' marginal willingness to pay (MWTP) for a reduction in morbidity risk from heart disease is inversely related to baseline risk (i.e., the amount of risk initially faced) both for themselves and for their children. For instance, a 40% reduction from the mean of baseline risk results in an increase in MWTP by 70% or more. Thus, estimates of monetary benefits of public programs to reduce heart disease risk would be understated if the standard practice is followed of evaluating MWTP at initial risk levels and then multiplying this value by the number of cases avoided. Estimates are supported by: (1) unique quantitative information on perceptions of the risk of getting heart disease that allow baseline risk to be defined at an individual level and (2) improved econometric procedures to control for well-known difficulties associated with stated preference data.

Study on structural seismic margin and probabilistic seismic risk. Development of a structural capacity-seismic risk diagram

International Nuclear Information System (INIS)

Nakajima, Masato; Ohtori, Yasuki; Hirata, Kazuta

2010-01-01

Seismic margin is extremely important index and information when we evaluate and account seismic safety of critical structures, systems and components quantitatively. Therefore, it is required that electric power companies evaluate the seismic margin of each plant in back-check of nuclear power plants in Japan. The seismic margin of structures is usually defined as a structural capacity margin corresponding to design earthquake ground motion. However, there is little agreement as to the definition of the seismic margin and we have no knowledge about a relationship between the seismic margin and seismic risk (annual failure probability) which is obtained in PSA (Probabilistic Safety Assessment). The purpose of this report is to discuss a definition of structural seismic margin and to develop a diagram which can identify a relation between seismic margin and seismic risk. The main results of this paper are described as follows: (1) We develop seismic margin which is defined based on the fact that intensity of earthquake ground motion is more appropriate than the conventional definition (i.e., the response-based seismic margin) for the following reasons: -seismic margin based on earthquake ground motion is invariant where different typed structures are considered, -stakeholders can understand the seismic margin based on the earthquake ground motion better than the response-based one. (2) The developed seismic margin-risk diagram facilitates us to judge easily whether we need to perform detailed probabilistic risk analysis or only deterministic analysis, given that the reference risk level although information on the uncertainty parameter beta is not obtained. (3) We have performed numerical simulations based on the developed method for four sites in Japan. The structural capacity-risk diagram differs depending on each location because the diagram is greatly influenced by seismic hazard information for a target site. Furthermore, the required structural capacity

Dosimetric and motion analysis of margin-intensive therapy by stereotactic ablative radiotherapy for resectable pancreatic cancer

Directory of Open Access Journals (Sweden)

Heinzerling John H

2011-10-01

Full Text Available Abstract Background The retroperitoneal margin is a common site of positive surgical margins in patients with resectable pancreatic cancer. Preoperative margin-intensive therapy (MIT involves delivery of a single high dose of ablative radiotherapy (30 Gy focused on this surgically inaccessible margin, utilizing stereotactic techniques in an effort to reduce local failure following surgery. In this study, we investigated the motion of regional organs at risk (OAR utilizing 4DCT, evaluated the dosimetric effects of abdominal compression (AC to reduce regional motion, and compared various planning techniques to optimize MIT. Methods 10 patients were evaluated with 4DCT scans. All 10 patients had scans using AC and seven of the 10 patients had scans both with and without AC. The peak respiratory abdominal organ and major vessel centroid excursion was measured. A "sub-GTV" region was defined by a radiation oncologist and surgical oncologist encompassing the retroperitoneal margin typically lateral and posterior to the superior mesenteric artery (SMA, and a 3-5 mm margin was added to constitute the PTV. Identical 3D non-coplanar SABR (3DSABR plans were designed for the average compression and non-compression scans. Compression scans were planned with 3DSABR, coplanar IMRT (IMRT, and Cyberknife (CK planning techniques. Dose volume analysis was undertaken for various endpoints, comparing OAR doses with and without AC and for different planning methods. Results The mean PTV size was 20.2 cm3. Regional vessel motion of the SMA, celiac trunk, and renal vessels was small ( 5 mm, so AC has been used in all patients enrolled thus far. AC did not significantly increase OAR dose including the stomach and traverse colon. There were several statistically significant differences in the doses to OARs as a function of the type of planning modality used. Conclusions AC does not significantly reduce the limited motion of structures in close proximity to the MIT target

SU-E-T-381: Evaluation of Calculated Dose Accuracy for Organs-At-Risk Located at Out-Of-Field in a Commercial Treatment Planning System for High Energy Photon Beams Produced From TrueBeam Accelerators

International Nuclear Information System (INIS)

Wang, L; Ding, G

2015-01-01

Purpose: Dose calculation accuracy for the out-of-field dose is important for predicting the dose to the organs-at-risk when they are located outside primary beams. The investigations on evaluating the calculation accuracy of treatment planning systems (TPS) on out-of-field dose in existing publications have focused on low energy (6MV) photon. This study evaluates out-of-field dose calculation accuracy of AAA algorithm for 15MV high energy photon beams. Methods: We used the EGSnrc Monte Carlo (MC) codes to evaluate the AAA algorithm in Varian Eclipse TPS (v.11). The incident beams start with validated Varian phase-space sources for a TrueBeam linac equipped with Millennium 120 MLC. Dose comparisons between using AAA and MC for CT based realistic patient treatment plans using VMAT techniques for prostate and lung were performed and uncertainties of organ dose predicted by AAA at out-of-field location were evaluated. Results: The results show that AAA calculations under-estimate doses at the dose level of 1% (or less) of prescribed dose for CT based patient treatment plans using VMAT techniques. In regions where dose is only 1% of prescribed dose, although AAA under-estimates the out-of-field dose by 30% relative to the local dose, it is only about 0.3% of prescribed dose. For example, the uncertainties of calculated organ dose to liver or kidney that is located out-of-field is <0.3% of prescribed dose. Conclusion: For 15MV high energy photon beams, very good agreements (<1%) in calculating dose distributions were obtained between AAA and MC. The uncertainty of out-of-field dose calculations predicted by the AAA algorithm for realistic patient VMAT plans is <0.3% of prescribed dose in regions where the dose relative to the prescribed dose is <1%, although the uncertainties can be much larger relative to local doses. For organs-at-risk located at out-of-field, the error of dose predicted by Eclipse using AAA is negligible. This work was conducted in part using the

Recommendations for use of marginal donors in heart transplantation: Brazilian Association of Organs Transplantation guideline.

Science.gov (United States)

Fiorelli, A I; Stolf, N A G; Pego-Fernandes, P M; Oliveira Junior, J L; Santos, R H B; Contreras, C A M; Filho, D D L; Dinkhuysen, J J; Moreira, M C V; Mejia, J A C; Castro, M C R

2011-01-01

The high prevalence of heart failure has increased the candidate list for heart transplantation; however, there is a shortage of viable donated organs, which is responsible for the high mortality of patients awaiting a transplantation. Because the marginal donor presents additional risk factors, it is not considered to be an ideal donor. The use of a marginal donor is only justified in situations when the risk of patient death due to heart disease is greater than that offered by the donor. These recommendations sought to expand the supply of donors, consequently increasing the transplant rate. We selected articles based on robust evidence to provide a substratum to develop recommendations for donors who exceed the traditional acceptance criteria. Recipient survival in the immediate postoperative period is intimately linked to allograft quality. Primary allograft failure is responsible for 38% to 40% of immediate deaths after heart transplantation: therefore; marginal donor selection must be more rigorous to not increase the surgical risk. The main donor risk factors with the respective evidence levels are: cancer in the donor (B), female donor (B), donor death due to hemorrhagic stroke (B), donor age above 50 years (relative risk [RR] = 1.5) (B), weight mismatch between donor and recipient 240 minutes (RR = 1.2) (B), left ventricular dysfunction with ejection fraction below 45% (B), and use of high doses of vasoactive drugs (dopamine > 15 mg/kg·min) (B). Factors that impact recipient mortality are: age over 50 years (RR = 1.5); allograft harvest at a distance; adult recipient weighing more than 20% of the donor; high doses of vasoactive drugs (dopamine greater than 15 mg/kg·min) and ischemic time >4 hours. The use of a marginal donor is only justified when it is able to increase life expectancy compared with clinical treatment, albeit the outcomes are interior to those using an ideal donor. Copyright © 2011 Elsevier Inc. All rights reserved.

High Center Volume Does Not Mitigate Risk Associated with Using High Donor Risk Organs in Liver Transplantation.

Science.gov (United States)

Beal, Eliza W; Black, Sylvester M; Mumtaz, Khalid; Hayes, Don; El-Hinnawi, Ashraf; Washburn, Kenneth; Tumin, Dmitry

2017-09-01

High-risk donor allografts increase access to liver transplant, but potentially reduce patient and graft survival. It is unclear whether the risk associated with using marginal donor livers is mitigated by increasing center experience. The United Network for Organ Sharing registry was queried for adult first-time liver transplant recipients between 2/2002 and 12/2015. High donor risk was defined as donor risk index >1.9, and 1-year patient and graft survival were compared according to donor risk index in small and large centers. Multivariable Cox regression estimated the hazard ratio (HR) associated with using high-risk donor organs, according to a continuous measure of annual center volume. The analysis included 51,770 patients. In 67 small and 67 large centers, high donor risk index predicted increased mortality (p = 0.001). In multivariable analysis, high-donor risk index allografts predicted greater mortality hazard at centers performing 20 liver transplants per year (HR 1.35; 95% CI 1.22, 1.49; p donor risk index and center volume was not statistically significant (p = 0.747), confirming that the risk associated with using marginal donor livers was comparable between smaller and larger centers. Results were consistent when examining graft loss. At both small and large centers, high-risk donor allografts were associated with reduced patient and graft survival after liver transplant. Specific strategies to mitigate the risk of liver transplant involving high-risk donors are needed, in addition to accumulation of center expertise.

Treatment of Passive Component Reliability in Risk-Informed Safety Margin Characterization FY 2010 Report

Energy Technology Data Exchange (ETDEWEB)

Robert W Youngblood

2010-09-01

The Risk-Informed Safety Margin Characterization (RISMC) pathway is a set of activities defined under the U.S. Department of Energy (DOE) Light Water Reactor Sustainability Program. The overarching objective of RISMC is to support plant life-extension decision-making by providing a state-of-knowledge characterization of safety margins in key systems, structures, and components (SSCs). A technical challenge at the core of this effort is to establish the conceptual and technical feasibility of analyzing safety margin in a risk-informed way, which, unlike conventionally defined deterministic margin analysis, is founded on probabilistic characterizations of SSC performance.

Retroperitoneal Sarcoma Target Volume and Organ at Risk Contour Delineation Agreement Among NRG Sarcoma Radiation Oncologists

Energy Technology Data Exchange (ETDEWEB)

Baldini, Elizabeth H., E-mail: ebaldini@partners.org [Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Abrams, Ross A. [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); Bosch, Walter [Department of Radiation Oncology, Washington University, St. Louis, Missouri (United States); Roberge, David [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, Quebec (Canada); Haas, Rick L.M. [Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam (Netherlands); Catton, Charles N. [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Indelicato, Daniel J. [Department of Radiation Oncology, University of Florida Medical Center, Jacksonville, Florida (United States); Olsen, Jeffrey R. [Department of Radiation Oncology, Washington University, St. Louis, Missouri (United States); Deville, Curtiland [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Chen, Yen-Lin [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Finkelstein, Steven E. [Translational Research Consortium, 21st Century Oncology, Scottsdale, Arizona (United States); DeLaney, Thomas F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Wang, Dian [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States)

2015-08-01

Purpose: The purpose of this study was to evaluate the variability in target volume and organ at risk (OAR) contour delineation for retroperitoneal sarcoma (RPS) among 12 sarcoma radiation oncologists. Methods and Materials: Radiation planning computed tomography (CT) scans for 2 cases of RPS were distributed among 12 sarcoma radiation oncologists with instructions for contouring gross tumor volume (GTV), clinical target volume (CTV), high-risk CTV (HR CTV: area judged to be at high risk of resulting in positive margins after resection), and OARs: bowel bag, small bowel, colon, stomach, and duodenum. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. Results: Ten radiation oncologists contoured both RPS cases, 1 contoured only RPS1, and 1 contoured only RPS2 such that each case was contoured by 11 radiation oncologists. The first case (RPS 1) was a patient with a de-differentiated (DD) liposarcoma (LPS) with a predominant well-differentiated (WD) component, and the second case (RPS 2) was a patient with DD LPS made up almost entirely of a DD component. Contouring agreement for GTV and CTV contours was high. However, the agreement for HR CTVs was only moderate. For OARs, agreement for stomach, bowel bag, small bowel, and colon was high, but agreement for duodenum (distorted by tumor in one of these cases) was fair to moderate. Conclusions: For preoperative treatment of RPS, sarcoma radiation oncologists contoured GTV, CTV, and most OARs with a high level of agreement. HR CTV contours were more variable. Further clarification of this volume with the help of sarcoma surgical oncologists is necessary to reach consensus. More attention to delineation of the duodenum is also needed.

Retroperitoneal Sarcoma Target Volume and Organ at Risk Contour Delineation Agreement Among NRG Sarcoma Radiation Oncologists

International Nuclear Information System (INIS)

Baldini, Elizabeth H.; Abrams, Ross A.; Bosch, Walter; Roberge, David; Haas, Rick L.M.; Catton, Charles N.; Indelicato, Daniel J.; Olsen, Jeffrey R.; Deville, Curtiland; Chen, Yen-Lin; Finkelstein, Steven E.; DeLaney, Thomas F.; Wang, Dian

2015-01-01

Purpose: The purpose of this study was to evaluate the variability in target volume and organ at risk (OAR) contour delineation for retroperitoneal sarcoma (RPS) among 12 sarcoma radiation oncologists. Methods and Materials: Radiation planning computed tomography (CT) scans for 2 cases of RPS were distributed among 12 sarcoma radiation oncologists with instructions for contouring gross tumor volume (GTV), clinical target volume (CTV), high-risk CTV (HR CTV: area judged to be at high risk of resulting in positive margins after resection), and OARs: bowel bag, small bowel, colon, stomach, and duodenum. Analysis of contour agreement was performed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. Results: Ten radiation oncologists contoured both RPS cases, 1 contoured only RPS1, and 1 contoured only RPS2 such that each case was contoured by 11 radiation oncologists. The first case (RPS 1) was a patient with a de-differentiated (DD) liposarcoma (LPS) with a predominant well-differentiated (WD) component, and the second case (RPS 2) was a patient with DD LPS made up almost entirely of a DD component. Contouring agreement for GTV and CTV contours was high. However, the agreement for HR CTVs was only moderate. For OARs, agreement for stomach, bowel bag, small bowel, and colon was high, but agreement for duodenum (distorted by tumor in one of these cases) was fair to moderate. Conclusions: For preoperative treatment of RPS, sarcoma radiation oncologists contoured GTV, CTV, and most OARs with a high level of agreement. HR CTV contours were more variable. Further clarification of this volume with the help of sarcoma surgical oncologists is necessary to reach consensus. More attention to delineation of the duodenum is also needed

Risk management and contingency planning for year 2000 - key business decisions for the success of an organization

International Nuclear Information System (INIS)

McNeil, J.L.

1998-01-01

Factors that transformed Y2K, initially considered as primarily a computer problem, into a business problem are outlined. For example, many organizations have prioritized their inventory of information technology (IT) systems, but few have prioritized their suppliers or customers, or have even thought of what will happen if they cannot get products, or cannot get paid by their customers. Estimates at this time reveal that approximately 30 per cent of businesses will not be operational. This presents a significant risk to any organisation's bottom line. Add to this the status of the world as a whole, where other than about 12 major countries, the majority has not even began to remediate their Y2K problems, and we begin to get a true picture of the potential of major communications problems with subsidiaries, partners or suppliers. Consideration of these factors make it easy to see how Y2K is potentially a major business problem. Because of these risks, it is strongly urged that organizations perform risk management and contingency planning. An example of a risk management approach is presented

Cities at risk: status of Italian planning system in reducing seismic and hydrogeological risks

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Grazia Di Giovanni

2016-03-01

Full Text Available Italy and its urban systems are under high seismic and hydrogeological risks. The awareness about the role of human activities in the genesis of disasters is achieved in the scientific debate, as well as the role of urban and regional planning in reducing risks. The paper reviews the state of Italian major cities referred to hydrogeological and seismic risk by: 1 extrapolating data and maps about seismic hazard and landslide risk concerning cities with more than 50.000 inhabitants and metropolitan contexts, and 2 outlining how risk reduction is framed in Italian planning system (at national and regional levels. The analyses of available data and the review of the normative framework highlight the existing gaps in addressing risk reduction: nevertheless a wide knowledge about natural risks afflicting Italian territory and an articulated regulatory framework, the available data about risks are not exhaustive, and risk reduction policies and multidisciplinary pro-active approaches are only partially fostered and applied.

Radiotherapy for stomach cancer: the dosimetric consequences of physiological movement of organs at risk

International Nuclear Information System (INIS)

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

2003-01-01

To assess the impact of movement of the liver and kidneys (organs at risk) on the dose volume histogram (DVH) when treating stomach cancer with radiation therapy. Immediate serial CT non-contrast and contrast scans are obtained as part of the planning process for treating stomach cancer with radiation in the neo-adjuvant and adjuvant setting at our institution. In a series of five patients the liver and right and left kidneys were contoured on both sets of scans. The maximal translational movement in three planes and volume changes of each structure was measured. The maximum, minimum and mean dose was calculated and compared for each organ at risk in both scans. To assess the change in the DVH, the following dose volume parameters were analysed: V50Gy, V35Gy, V30Gy, and V10GY for liver; V50Gy, V30Gy, V23Gy and V15Gy for both kidneys. A complete analysis of results will be presented

Informing practice regarding marginalization: the application of the Koci Marginality Index.

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Koci, Anne Floyd; McFarlane, Judith; Nava, Angeles; Gilroy, Heidi; Maddoux, John

2012-12-01

The 49th World Health Assembly of the World Health Organization (WHO) declared violence as the leading worldwide public health problem with a focus on the increase in the incidence of injuries to women. Violence against women is an international epidemic with specific instruments required to measure the impact on women's functioning. This article describes the application of the Koci Marginality Index (KMI), a 5-item scale to measure marginality, to the baseline data of a seven-year prospective study of 300 abused women: 150 first time users of a shelter and 150 first time applicants for a protection order from the justice system. Validity and reliability of the Koci Marginality Index and its usefulness for best clinical practice and for policy decisions for abused women's health are discussed. The 49th World Health Assembly of the World Health Organization (WHO) declared violence as the leading worldwide public health problem and focused on the increase in the incidence of injuries to women (Krug et al., 2002 ). Violence against women in the form of intimate partner violence (IPV) is costly in terms of dollars and health. In the United States in 2003, estimated costs of IPV approached $8.3 billion (Centers for Disease Control and Prevention [CDC], 2011). Outcomes related to severity of IPV vary but in 2003 victims suffering severe IPV lost nearly 8 million days of paid work, and greater than 5 million days of household productivity annually (CDC, 2011). Besides the evident financial cost of IPV, research confirms that exposure to IPV impacts a woman's health immediately and in the long-term (Breiding, Black, & Ryan, 2008 ; Campbell, 2002 ; CDC, 2011). Such sequela adversely affect the health of women and may increase their marginalization, a concept akin to isolation that may further increase negative effects on health outcomes. Immigrant women are at high risk for IPV (Erez, 2002 ) and those without documentation are at higher risk for marginalization (Montalvo

Evaluation of the setup margins for cone beam computed tomography–guided cranial radiosurgery: A phantom study

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Calvo Ortega, Juan Francisco, E-mail: jfcdrr@yahoo.es [Department of Radiation Oncology, Hospital Quirón, Barcelona (Spain); Wunderink, Wouter [Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam (Netherlands); Delgado, David; Moragues, Sandra; Pozo, Miquel; Casals, Joan [Department of Radiation Oncology, Hospital Quirón, Barcelona (Spain)

2016-10-01

The aim of this study is to evaluate the setup margins from the clinical target volume (CTV) to planning target volume (PTV) for cranial stereotactic radiosurgery (SRS) treatments guided by cone beam computed tomography (CBCT). We designed an end-to-end (E2E) test using a skull phantom with an embedded 6mm tungsten ball (target). A noncoplanar plan was computed (E2E plan) to irradiate the target. The CBCT-guided positioning of the skull phantom on the linac was performed. Megavoltage portal images were acquired after 15 independent deliveries of the E2E plan. The displacement 2-dimensional (2D) vector between the centers of the square field and the ball target on each portal image was used to quantify the isocenter accuracy. Geometrical margins on each patient's direction (left-right or LR, anterior-posterior or AP, superior-inferior or SI) were calculated. Dosimetric validation of the margins was performed in 5 real SRS cases: 3-dimesional (3D) isocenter deviations were mimicked, and changes in CTV dose coverage and organs-at-risk (OARs) dosage were analyzed. The CTV-PTV margins of 1.1 mm in LR direction, and 0.7 mm in AP and SI directions were derived from the E2E tests. The dosimetric analysis revealed that a 1-mm uniform margin was sufficient to ensure the CTV dose coverage, without compromising the OAR dose tolerances. The effect of isocenter uncertainty has been estimated to be 1 mm in our CBCT-guided SRS approach.

Integration of second cancer risk calculations in a radiotherapy treatment planning system

International Nuclear Information System (INIS)

Hartmann, M; Schneider, U

2014-01-01

Second cancer risk in patients, in particular in children, who were treated with radiotherapy is an important side effect. It should be minimized by selecting an appropriate treatment plan for the patient. The objectives of this study were to integrate a risk model for radiation induced cancer into a treatment planning system which allows to judge different treatment plans with regard to second cancer induction and to quantify the potential reduction in predicted risk. A model for radiation induced cancer including fractionation effects which is valid for doses in the radiotherapy range was integrated into a treatment planning system. From the three-dimensional (3D) dose distribution the 3D-risk equivalent dose (RED) was calculated on an organ specific basis. In addition to RED further risk coefficients like OED (organ equivalent dose), EAR (excess absolute risk) and LAR (lifetime attributable risk) are computed. A risk model for radiation induced cancer was successfully integrated in a treatment planning system. Several risk coefficients can be viewed and used to obtain critical situations were a plan can be optimised. Risk-volume-histograms and organ specific risks were calculated for different treatment plans and were used in combination with NTCP estimates for plan evaluation. It is concluded that the integration of second cancer risk estimates in a commercial treatment planning system is feasible. It can be used in addition to NTCP modelling for optimising treatment plans which result in the lowest possible second cancer risk for a patient.

Sensitivity of postplanning target and OAR coverage estimates to dosimetric margin distribution sampling parameters.

Science.gov (United States)

Xu, Huijun; Gordon, J James; Siebers, Jeffrey V

2011-02-01

A dosimetric margin (DM) is the margin in a specified direction between a structure and a specified isodose surface, corresponding to a prescription or tolerance dose. The dosimetric margin distribution (DMD) is the distribution of DMs over all directions. Given a geometric uncertainty model, representing inter- or intrafraction setup uncertainties or internal organ motion, the DMD can be used to calculate coverage Q, which is the probability that a realized target or organ-at-risk (OAR) dose metric D, exceeds the corresponding prescription or tolerance dose. Postplanning coverage evaluation quantifies the percentage of uncertainties for which target and OAR structures meet their intended dose constraints. The goal of the present work is to evaluate coverage probabilities for 28 prostate treatment plans to determine DMD sampling parameters that ensure adequate accuracy for postplanning coverage estimates. Normally distributed interfraction setup uncertainties were applied to 28 plans for localized prostate cancer, with prescribed dose of 79.2 Gy and 10 mm clinical target volume to planning target volume (CTV-to-PTV) margins. Using angular or isotropic sampling techniques, dosimetric margins were determined for the CTV, bladder and rectum, assuming shift invariance of the dose distribution. For angular sampling, DMDs were sampled at fixed angular intervals w (e.g., w = 1 degree, 2 degrees, 5 degrees, 10 degrees, 20 degrees). Isotropic samples were uniformly distributed on the unit sphere resulting in variable angular increments, but were calculated for the same number of sampling directions as angular DMDs, and accordingly characterized by the effective angular increment omega eff. In each direction, the DM was calculated by moving the structure in radial steps of size delta (=0.1, 0.2, 0.5, 1 mm) until the specified isodose was crossed. Coverage estimation accuracy deltaQ was quantified as a function of the sampling parameters omega or omega eff and delta. The

Margins for uncertainties in Hydro-Quebec's short-term operations planning

International Nuclear Information System (INIS)

Beaumont, M.; Raymond, M.P.

1995-01-01

A method developed by Hydro-Quebec for establishing the short-term capacity margin requirements for dealing with uncertainties from 1 to 24 hours in advance, was presented. Hydro-Quebec's generating system and characterization of the problems associated with meeting load requirements were discussed. Factors accounted for included those concerning internal load forecast, unit forced outages, risks of not meeting firm load, risks of not meeting real-time reserves requirements, costs, time delays, and operating constraints of non-hydraulic resources. Each of these were described in detail, and methods for combining mathematical uncertainties were presented. Procedures used for selecting an appropriate risk level and building a margin policy were described. Improvements for more accurate modelling were discussed. 5 refs., 2 tabs., 5 figs

PlanJury: probabilistic plan evaluation revisited

Science.gov (United States)

Witte, M.; Sonke, J.-J.; van Herk, M.

2014-03-01

Purpose: Over a decade ago, the 'Van Herk margin recipe paper' introduced plan evaluation through DVH statistics based on population distributions of systematic and random errors. We extended this work for structures with correlated uncertainties (e.g. lymph nodes or parotid glands), and considered treatment plans containing multiple (overlapping) dose distributions (e.g. conventional lymph node and hypo-fractionated tumor doses) for which different image guidance protocols may lead to correlated errors. Methods: A command-line software tool 'PlanJury' was developed which reads 3D dose and structure data exported from a treatment planning system. Uncertainties are specified by standard deviations and correlation coefficients. Parameters control the DVH statistics to be computed: e.g. the probability of reaching a DVH constraint, or the dose absorbed at given confidence in a (combined) volume. Code was written in C++ and parallelized using OpenMP. Testing geometries were constructed using idealized spherical volumes and dose distributions. Results: Negligible stochastic noise could be attained within two minutes computation time for a single target. The confidence to properly cover both of two targets was 90% for two synchronously moving targets, but decreased by 7% if the targets moved independently. For two partially covered organs at risk the confidence of at least one organ below the mean dose threshold was 40% for synchronous motion, 36% for uncorrelated motion, but only 20% for either of the organs separately. Two abutting dose distributions ensuring 91% confidence of proper target dose for correlated motions led to 28% lower confidence for uncorrelated motions as relative displacements between the doses resulted in cold spots near the target. Conclusions: Probabilistic plan evaluation can efficiently be performed for complicated treatment planning situations, thus providing important plan quality information unavailable in conventional PTV based evaluations.

Optimising risk reduction: An expected utility approach for marginal risk reduction during regulatory decision making

International Nuclear Information System (INIS)

Li Jiawei; Pollard, Simon; Kendall, Graham; Soane, Emma; Davies, Gareth

2009-01-01

In practice, risk and uncertainty are essentially unavoidable in many regulation processes. Regulators frequently face a risk-benefit trade-off since zero risk is neither practicable nor affordable. Although it is accepted that cost-benefit analysis is important in many scenarios of risk management, what role it should play in a decision process is still controversial. One criticism of cost-benefit analysis is that decision makers should consider marginal benefits and costs, not present ones, in their decision making. In this paper, we investigate the problem of regulatory decision making under risk by applying expected utility theory and present a new approach of cost-benefit analysis. Directly taking into consideration the reduction of the risks, this approach achieves marginal cost-benefit analysis. By applying this approach, the optimal regulatory decision that maximizes the marginal benefit of risk reduction can be considered. This provides a transparent and reasonable criterion for stakeholders involved in the regulatory activity. An example of evaluating seismic retrofitting alternatives is provided to demonstrate the potential of the proposed approach.

Planning issues for IMRT

International Nuclear Information System (INIS)

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

2001-01-01

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

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

Science.gov (United States)

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

2016-02-01

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

Segmentation of organs at risk in CT volumes of head, thorax, abdomen, and pelvis

Science.gov (United States)

Han, Miaofei; Ma, Jinfeng; Li, Yan; Li, Meiling; Song, Yanli; Li, Qiang

2015-03-01

Accurate segmentation of organs at risk (OARs) is a key step in treatment planning system (TPS) of image guided radiation therapy. We are developing three classes of methods to segment 17 organs at risk throughout the whole body, including brain, brain stem, eyes, mandible, temporomandibular joints, parotid glands, spinal cord, lungs, trachea, heart, livers, kidneys, spleen, prostate, rectum, femoral heads, and skin. The three classes of segmentation methods include (1) threshold-based methods for organs of large contrast with adjacent structures such as lungs, trachea, and skin; (2) context-driven Generalized Hough Transform-based methods combined with graph cut algorithm for robust localization and segmentation of liver, kidneys and spleen; and (3) atlas and registration-based methods for segmentation of heart and all organs in CT volumes of head and pelvis. The segmentation accuracy for the seventeen organs was subjectively evaluated by two medical experts in three levels of score: 0, poor (unusable in clinical practice); 1, acceptable (minor revision needed); and 2, good (nearly no revision needed). A database was collected from Ruijin Hospital, Huashan Hospital, and Xuhui Central Hospital in Shanghai, China, including 127 head scans, 203 thoracic scans, 154 abdominal scans, and 73 pelvic scans. The percentages of "good" segmentation results were 97.6%, 92.9%, 81.1%, 87.4%, 85.0%, 78.7%, 94.1%, 91.1%, 81.3%, 86.7%, 82.5%, 86.4%, 79.9%, 72.6%, 68.5%, 93.2%, 96.9% for brain, brain stem, eyes, mandible, temporomandibular joints, parotid glands, spinal cord, lungs, trachea, heart, livers, kidneys, spleen, prostate, rectum, femoral heads, and skin, respectively. Various organs at risk can be reliably segmented from CT scans by use of the three classes of segmentation methods.

Strategic planning in healthcare organizations.

Science.gov (United States)

Rodríguez Perera, Francisco de Paula; Peiró, Manel

2012-08-01

Strategic planning is a completely valid and useful tool for guiding all types of organizations, including healthcare organizations. The organizational level at which the strategic planning process is relevant depends on the unit's size, its complexity, and the differentiation of the service provided. A cardiology department, a hemodynamic unit, or an electrophysiology unit can be an appropriate level, as long as their plans align with other plans at higher levels. The leader of each unit is the person responsible for promoting the planning process, a core and essential part of his or her role. The process of strategic planning is programmable, systematic, rational, and holistic and integrates the short, medium, and long term, allowing the healthcare organization to focus on relevant and lasting transformations for the future. Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Risk of Local Failure in Breast Cancer Patients With Lobular Carcinoma In Situ at the Final Surgical Margins: Is Re-excision Necessary?

Energy Technology Data Exchange (ETDEWEB)

Sadek, Betro T.; Shenouda, Mina N.; Abi Raad, Rita F. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Statistics Section, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Keruakous, Amany R. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Goldberg, Saveli I. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Statistics Section, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)

2013-11-15

Purpose: To compare the outcome of patients with invasive breast cancer both with and without lobular carcinoma in situ (LCIS)-positive/close surgical margins after breast-conserving treatment. Methods and Materials: We retrospectively studied 2358 patients with T1-T2 invasive breast cancer treated with lumpectomy and radiation therapy from January 1980 to December 2009. Median age was 57 years (range, 24-91 years). There were 82 patients (3.5%) with positive/close LCIS margins (<0.2 cm) and 2232 patients (95.7%) with negative margins. A total of 1789 patients (76%) had negative lymph nodes. Patients who received neoadjuvant chemotherapy were excluded. A total of 1783 patients (76%) received adjuvant systemic therapy. Multivariable analysis (MVA) was performed using Cox's proportional hazards model. Results: The 5-year cumulative incidence of locoregional recurrence (LRR) was 3.2% (95% confidence interval [CI] 2.5%-4.1%) for the 2232 patients with LCIS-negative surgical margins (median follow-up 104 months) and 2.8% (95% CI 0.7%-10.8%) for the 82 patients with LCIS-positive/close surgical margins (median follow-up 90 months). This was not statistically significant (P=.5). On MVA, LCIS-positive margins after the final surgery were not associated with increased risk of LRR (hazard ratio [HR] 3.4, 95% CI 0.5-24.5, P=.2). Statistically significant prognostic variables on Cox's MVA for risk of LRR included systemic therapy (HR 0.5, 95% CI 0.33-0.75, P=.001), number of positive lymph nodes (HR 1.11, 95% CI 1.05-1.18, P=.001), menopausal status (HR 0.96, 95% CI 0.95-0.98, P=.001), and histopathologic grade (grade 3 vs grade 1/2) (HR 2.6, 95% CI 1.4-4.7, P=.003). Conclusion: Our results suggest that the presence of LCIS at the surgical margin after lumpectomy does not increase the risk of LRR or the final outcome. These findings suggest that re-excision or mastectomy in patients with LCIS-positive/close final surgical margins is unnecessary.

An IGRT margin concept for pelvic lymph nodes in high-risk prostate cancer

International Nuclear Information System (INIS)

Groher, M.; Kopp, P.; Deutschmann, H.; Sedlmayer, F.; Wolf, Frank; Drerup, M.

2017-01-01

Gold-marker-based image-guided radiation therapy (IGRT) of the prostate allows to correct for inter- and intrafraction motion and therefore to safely reduce margins for the prostate planning target volume (PTV). However, pelvic PTVs, when coadministered in a single plan (registered to gold markers [GM]), require reassessment of the margin concept since prostate movement is independent from the pelvic bony anatomy to which the lymphatics are usually referenced to. We have therefore revisited prostate translational movement relative to the bony anatomy to obtain adequate margins for the pelvic PTVs compensating mismatch resulting from referencing pelvic target volumes to GMs in the prostate. Prostate movement was analyzed in a set of 28 patients (25 fractions each, totaling in 684 fractions) and the required margins calculated for the pelvic PTVs according to Van Herk's margin formula M = 2.5 Σ + 1.64 (σ ' -σ p ). The overall mean prostate movement relative to bony anatomy was 0.9 ± 3.1, 0.6 ± 3.4, and 0.0 ± 0.7 mm in anterior/posterior (A/P), inferior/superior (I/S) and left/right (L/R) direction, respectively. Calculated margins to compensate for the resulting mismatch to bony anatomy were 9/9/2 mm in A/P, I/S, and L/R direction and 10/11/6 mm if an additional residual error of 2 mm was assumed. GM-based IGRT for pelvic PTVs is feasible if margins are adapted accordingly. Margins could be reduced further if systematic errors which are introduced during the planning CT were eliminated. (orig.) [de

Cooperative organic mine avoidance path planning

Science.gov (United States)

McCubbin, Christopher B.; Piatko, Christine D.; Peterson, Adam V.; Donnald, Creighton R.; Cohen, David

2005-06-01

The JHU/APL Path Planning team has developed path planning techniques to look for paths that balance the utility and risk associated with different routes through a minefield. Extending on previous years' efforts, we investigated real-world Naval mine avoidance requirements and developed a tactical decision aid (TDA) that satisfies those requirements. APL has developed new mine path planning techniques using graph based and genetic algorithms which quickly produce near-minimum risk paths for complicated fitness functions incorporating risk, path length, ship kinematics, and naval doctrine. The TDA user interface, a Java Swing application that obtains data via Corba interfaces to path planning databases, allows the operator to explore a fusion of historic and in situ mine field data, control the path planner, and display the planning results. To provide a context for the minefield data, the user interface also renders data from the Digital Nautical Chart database, a database created by the National Geospatial-Intelligence Agency containing charts of the world's ports and coastal regions. This TDA has been developed in conjunction with the COMID (Cooperative Organic Mine Defense) system. This paper presents a description of the algorithms, architecture, and application produced.

Development of organ-specific donor risk indices.

Science.gov (United States)

Akkina, Sanjeev K; Asrani, Sumeet K; Peng, Yi; Stock, Peter; Kim, W Ray; Israni, Ajay K

2012-04-01

Because of the shortage of deceased donor organs, transplant centers accept organs from marginal deceased donors, including older donors. Organ-specific donor risk indices have been developed to predict graft survival with various combinations of donor and recipient characteristics. Here we review the kidney donor risk index (KDRI) and the liver donor risk index (LDRI) and compare and contrast their strengths, limitations, and potential uses. The KDRI has a potential role in developing new kidney allocation algorithms. The LDRI allows a greater appreciation of the importance of donor factors, particularly for hepatitis C virus-positive recipients; as the donor risk index increases, the rates of allograft and patient survival among these recipients decrease disproportionately. The use of livers with high donor risk indices is associated with increased hospital costs that are independent of recipient risk factors, and the transplantation of livers with high donor risk indices into patients with Model for End-Stage Liver Disease scores indices for liver transplantation, including donor-recipient matching and the retransplant donor risk index. Although substantial progress has been made in developing donor risk indices to objectively assess donor variables that affect transplant outcomes, continued efforts are warranted to improve these indices to enhance organ allocation policies and optimize allograft survival. Copyright © 2012 American Association for the Study of Liver Diseases.

Comparison of various online IGRT strategies: The benefits of online treatment plan re-optimization

International Nuclear Information System (INIS)

Schulze, Derek; Liang, Jian; Yan, Di; Zhang Tiezhi

2009-01-01

Purpose: To compare the dosimetric differences of various online IGRT strategies and to predict potential benefits of online re-optimization techniques in prostate cancer radiation treatments. Materials and methods: Nine prostate patients were recruited in this study. Each patient has one treatment planning CT images and 10-treatment day CT images. Five different online IGRT strategies were evaluated which include 3D conformal with bone alignment, 3D conformal re-planning via aperture changes, intensity modulated radiation treatment (IMRT) with bone alignment, IMRT with target alignment and IMRT daily re-optimization. Treatment planning and virtual treatment delivery were performed. The delivered doses were obtained using in-house deformable dose mapping software. The results were analyzed using equivalent uniform dose (EUD). Results: With the same margin, rectum and bladder doses in IMRT plans were about 10% and 5% less than those in CRT plans, respectively. Rectum and bladder doses were reduced as much as 20% if motion margin is reduced by 1 cm. IMRT is more sensitive to organ motion. Large discrepancies of bladder and rectum doses were observed compared to the actual delivered dose with treatment plan predication. The therapeutic ratio can be improved by 14% and 25% for rectum and bladder, respectively, if IMRT online re-planning is employed compared to the IMRT bone alignment approach. The improvement of target alignment approach is similar with 11% and 21% dose reduction to rectum and bladder, respectively. However, underdosing in seminal vesicles was observed on certain patients. Conclusions: Online treatment plan re-optimization may significantly improve therapeutic ratio in prostate cancer treatments mostly due to the reduction of PTV margin. However, for low risk patient with only prostate involved, online target alignment IMRT treatment would achieve similar results as online re-planning. For all IGRT approaches, the delivered organ-at-risk doses may be

Development of Organ-Specific Donor Risk Indices

Science.gov (United States)

Akkina, Sanjeev K.; Asrani, Sumeet K.; Peng, Yi; Stock, Peter; Kim, Ray; Israni, Ajay K.

2012-01-01

Due to the shortage of deceased donor organs, transplant centers accept organs from marginal deceased donors, including older donors. Organ-specific donor risk indices have been developed to predict graft survival using various combinations of donor and recipient characteristics. We will review the kidney donor risk index (KDRI) and liver donor risk index (LDRI) and compare and contrast their strengths, limitations, and potential uses. The Kidney Donor Risk Index has a potential role in developing new kidney allocation algorithms. The Liver Donor Risk Index allows for greater appreciation of the importance of donor factors, particularly for hepatitis C-positive recipients; as the donor risk index increases, rates of allograft and patient survival among these recipients decrease disproportionately. Use of livers with high donor risk index is associated with increased hospital costs independent of recipient risk factors, and transplanting livers with high donor risk index into patients with Model for End-Stage Liver Disease scores Donor Risk Index has limited this practice. Significant regional variation in donor quality, as measured by the Liver Donor Risk Index, remains in the United States. We also review other potential indices for liver transplant, including donor-recipient matching and the retransplant donor risk index. While substantial progress has been made in developing donor risk indices to objectively assess donor variables that affect transplant outcomes, continued efforts are warranted to improve these indices to enhance organ allocation policies and optimize allograft survival. PMID:22287036

Seismic Safety Margins Research Program: Phase II program plan (FY 83-FY 84)

International Nuclear Information System (INIS)

Bohn, M.P.; Bernreuter, D.L.; Cover, L.E.; Johnson, J.J.; Shieh, L.C.; Shukla, S.N.; Wells, J.E.

1982-01-01

The Seismic Safety Margins Research Program (SSMRP) is an NRC-funded, multiyear program conducted by Lawrence Livermore National Laboratory (LLNL). Its goal is to develop a complete, fully coupled analysis procedure (including methods and computer codes) for estimating the risk of an earthquake-caused radioactive release from a commercial nuclear power plant. The analysis procedure is based upon a state-of-the-art evaluation of the current seismic analysis and design process and explicitly includes the uncertainties inherent in such a process. The results will be used to improve seismic licensing requirements for nuclear power plants. As currently planned, the SSMRP will be completed in September, 1984. This document presents the program plan for work to be done during the remainder of the program. In Phase I of the SSMRP, the necessary tools (both computer codes and data bases) for performing a detailed seismic risk analysis were identified and developed. Demonstration calculations were performed on the Zion Nuclear Power Plant. In the remainder of the program (Phase II) work will be concentrated on developing a simplified SSMRP methodology for routine probabilistic risk assessments, quantitative validation of the tools developed and application of the simplified methodology to a Boiling Water Reactor. (The Zion plant is a pressurized water reactor.) In addition, considerable effort will be devoted to making the codes and data bases easily accessible to the public

Intensity Modulated Proton Therapy for Craniospinal Irradiation: Organ-at-Risk Exposure and a Low-Gradient Junctioning Technique

International Nuclear Information System (INIS)

Stoker, Joshua B.; Grant, Jonathan; Zhu, X. Ronald; Pidikiti, Rajesh; Mahajan, Anita; Grosshans, David R.

2014-01-01

Purpose: To compare field junction robustness and sparing of organs at risk (OARs) during craniospinal irradiation (CSI) using intensity modulated proton therapy (IMPT) to conventional passively scattered proton therapy (PSPT). Methods and Materials: Ten patients, 5 adult and 5 pediatric patients, previously treated with PSPT-based CSI were selected for comparison. Anterior oblique cranial fields, using a superior couch rotation, and posterior spinal fields were used for IMPT planning. To facilitate low-gradient field junctioning along the spine, the inverse-planning IMPT technique was divided into 3 stages. Dose indices describing target coverage and normal tissue dose, in silico error modeling, and film dosimetry were used to assess plan quality. Results: Field junction robustness along the spine was improved using the staged IMPT planning technique, reducing the worst case impact of a 4-mm setup error from 25% in PSPT to <5% of prescription dose. This was verified by film dosimetry for clinical delivery. Exclusive of thyroid dose in adult patients, IMPT plans demonstrated sparing of organs at risk as good or better than PSPT. Coverage of the cribriform plate for pediatric (V95% [percentage of volume of the target receiving at least 95% of the prescribed dose]; 87 ± 11 vs 92 ± 7) and adult (V95%; 94 ± 7 vs 100 ± 1) patients and the clinical target in pediatric (V95%; 98 ± 2 vs 100 ± 1) and adult (V95%; 100 ± 1 vs 100 ± 1) patients for PSPT and IMPT plans, respectively, were comparable or improved. For adult patients, IMPT target dose inhomogeneity was increased, as determined by heterogeneity index (HI) and inhomogeneity coefficient (IC). IMPT lowered maximum spinal cord dose, improved spinal dose homogeneity, and reduced exposure to other OARs. Conclusions: IMPT has the potential to improve CSI plan quality and the homogeneity of intrafractional dose at match lines. The IMPT approach developed may also simplify treatments and reduce

Risk insights from seismic margin reviews

International Nuclear Information System (INIS)

Budnitz, R.J.

1990-01-01

This paper discusses the information that has been derived from the three seismic-margin reviews conducted so far, and the information that is potentially available from using the seismic-margin method more generally. There are two different methodologies for conducting seismic margin reviews of nuclear power plants, one developed under NRC sponsorship and one developed under sponsorship of the Electric Power Research Institute. Both methodologies will be covered in this paper. The paper begins with a summary of the steps necessary to complete a margin review, and will then outline the key technical difficulties that need to be addressed. After this introduction, the paper covers the safety and operational insights derived from the three seismic-margin reviews already completed: the NRC-sponsored review at Maine Yankee; the EPRI-sponsored review at Catawba; and the joint EPRI/NRC/utility effort at Hatch. The emphasis is on engineering insights, with attention to the aspects of the reviews that are easiest to perform and that provide the most readily available insights

Developing Probabilistic Safety Performance Margins for Unknown and Underappreciated Risks

Science.gov (United States)

Benjamin, Allan; Dezfuli, Homayoon; Everett, Chris

2015-01-01

Probabilistic safety requirements currently formulated or proposed for space systems, nuclear reactor systems, nuclear weapon systems, and other types of systems that have a low-probability potential for high-consequence accidents depend on showing that the probability of such accidents is below a specified safety threshold or goal. Verification of compliance depends heavily upon synthetic modeling techniques such as PRA. To determine whether or not a system meets its probabilistic requirements, it is necessary to consider whether there are significant risks that are not fully considered in the PRA either because they are not known at the time or because their importance is not fully understood. The ultimate objective is to establish a reasonable margin to account for the difference between known risks and actual risks in attempting to validate compliance with a probabilistic safety threshold or goal. In this paper, we examine data accumulated over the past 60 years from the space program, from nuclear reactor experience, from aircraft systems, and from human reliability experience to formulate guidelines for estimating probabilistic margins to account for risks that are initially unknown or underappreciated. The formulation includes a review of the safety literature to identify the principal causes of such risks.

Gaining control room habitability margin at the Palisades Plant

International Nuclear Information System (INIS)

Harden, P.A.

1993-01-01

The bounding design-basis accident for control room habitability is the loss-of-coolant accident (LOCA). At Palisades, very little margin existed between the calculated control room operator thyroid dose and the 0.3-Sv (30-rem) limit of Standard Review Plan (SRP) 6.4. Also, a low rate of unfiltered air leakage into the control room during the emergency mode of operation, 5.5 x 10 -3 m 3 /s (11.6 ft 3 /min), was accounted for in the control room habitability analysis. The control room heating, ventilating and air-conditioning system at Palisades has louvered isolation dampers for the normal air intake that are exposed to a negative pressure. Considering the small margin to the thyroid dose limits and the leakage characteristics of louvered dampers, a low allowable rate of unfiltered air in-leakage raised some concern. A significant effort has been initiated to alleviate control room habitability concerns at Palisades. The first step in this effort was to evaluate the calculational models for control room habitability and gain margin through updated analytical methods. To accomplish this, a new radiological consequence analysis for the LOCA was completed

Recommendations for CTV margins in radiotherapy planning for non melanoma skin cancer.

Science.gov (United States)

Khan, Luluel; Choo, Richard; Breen, Dale; Assaad, Dalal; Fialkov, Jefferey; Antonyshyn, Oleh; McKenzie, David; Woo, Tony; Zhang, Liying; Barnes, Elizabeth

2012-08-01

To provide practice guidelines for delineating clinical target volume (CTV) for radiotherapy planning of non melanoma (NMSC) skin cancers. A prospective, single arm, study. Preoperatively, a radiation oncologist outlined the boundary of a gross lesion, and drew 5-mm incremental marks in four directions from the delineated border. Under local anesthesia, the lesion was excised, and resection margins were assessed microscopically by frozen section. Once resection margins were clear, the microscopic tumor extent was calculated using the presurgical incremental markings as references. A potential relationship between the distance of microscopic tumor extension and other variables was analyzed. A total of 159 lesions in 150 consecutive patients, selected for surgical excision with frozen section assisted assessment of resection margins, were accrued. The distance of microscopic tumor extension beyond a gross lesion varied from 1mm to 15 mm, with a mean of 5.3mm. The microscopic tumor extent was positively correlated with the size of gross lesion, histology and number of surgical attempts required to obtain a clear margin. To provide a 95% or greater chance of covering microscopic disease we make the following recommendations for CTV margins; 10mm for BCC less than 2 cm, 13 mm for BCC greater than 2 cm, 11 mm for SCC less than 2 cm, and 14 mm for SCC greater than 2 cm. Tumors greater than 2 cm and SCC histology required larger margins to adequately cover the microscopic extent of disease. This information is crucial in radiation planning of NMSC. Clinicians should be cautioned, as these guidelines may not offer optimum treatment for patients with extremely large or small lesions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Recommendations for CTV margins in radiotherapy planning for non melanoma skin cancer

International Nuclear Information System (INIS)

Khan, Luluel; Choo, Richard; Breen, Dale; Assaad, Dalal; Fialkov, Jefferey; Antonyshyn, Oleh; McKenzie, David; Woo, Tony; Zhang Liying; Barnes, Elizabeth

2012-01-01

Purpose: To provide practice guidelines for delineating clinical target volume (CTV) for radiotherapy planning of non melanoma (NMSC) skin cancers. Methods and materials: A prospective, single arm, study. Preoperatively, a radiation oncologist outlined the boundary of a gross lesion, and drew 5-mm incremental marks in four directions from the delineated border. Under local anesthesia, the lesion was excised, and resection margins were assessed microscopically by frozen section. Once resection margins were clear, the microscopic tumor extent was calculated using the presurgical incremental markings as references. A potential relationship between the distance of microscopic tumor extension and other variables was analyzed. Results: A total of 159 lesions in 150 consecutive patients, selected for surgical excision with frozen section assisted assessment of resection margins, were accrued. The distance of microscopic tumor extension beyond a gross lesion varied from 1 mm to 15 mm, with a mean of 5.3 mm. The microscopic tumor extent was positively correlated with the size of gross lesion, histology and number of surgical attempts required to obtain a clear margin. To provide a 95% or greater chance of covering microscopic disease we make the following recommendations for CTV margins; 10 mm for BCC less than 2 cm, 13 mm for BCC greater than 2 cm, 11 mm for SCC less than 2 cm, and 14 mm for SCC greater than 2 cm. Conclusions: Tumors greater than 2 cm and SCC histology required larger margins to adequately cover the microscopic extent of disease. This information is crucial in radiation planning of NMSC. Clinicians should be cautioned, as these guidelines may not offer optimum treatment for patients with extremely large or small lesions.

Planned home versus planned hospital births in women at low-risk pregnancy: A systematic review with meta-analysis.

Science.gov (United States)

Rossi, A Cristina; Prefumo, Federico

2018-03-01

New interest in home birth have recently arisen in women at low risk pregnancy. Maternal and neonatal morbidity of women planning delivery at home has yet to be comprehensively quantified. We aimed to quantify pregnancy outcomes following planned home (PHB) versus planned hospital birth (PHos). We did a systematic review of maternal and neonatal morbidity following planned home (PHB) versus planned hospital birth (PHos). We included prospective, retrospective, cohort and case-control studies of low risk pregnancy outcomes according to planning place of birth, identified from January 2000 to June 2017. We excluded studies in which high-risk pregnancy and composite morbidity were included. Outcomes of interest were: maternal and neonatal morbidity/mortality, medical interventions, and delivery mode. We pooled estimates of the association between outcomes and planning place of birth using meta-analyses. The study protocol is registered with PROSPERO, protocol number CRD42017058016. We included 8 studies of the 4294 records identified, consisting in 14,637 (32.6%) in PHB and 30,177 (67.4%) in PHos group. Spontaneous delivery was significantly higher in PHB than PHos group (OR: 2.075; 95%CI:1.654-2.063) group. Women in PHB group were less likely to undergo cesarean section compared with women in PHos (OR:0.607; 95%CI:0.553-0.667) group. PHB group was less likely to receive medical interventions than PHos group. The risk of fetal dystocia was lower in PHB than PHos group (OR:0.287; 95%CI:0.133-0.618). The risk of post-partum hemorrhage was lower in PHB than PHos group (OR:0.692; 95% CI.0.634-0.755). The two groups were similar with regard to neonatal morbidity and mortality. Births assisted at hospital are more likely to receive medical interventions, fetal monitoring and prompt delivery in case of obstetrical complications. Further studies are needed in order to clarify whether home births are as safe as hospital births. Copyright © 2018 Elsevier B.V. All rights

Protection planning and risk management at Lawrence Livermore National Laboratory

International Nuclear Information System (INIS)

Hunt, J.S.; Altman, W.D.; Hockert, J.W.

1988-01-01

Effective safeguards and security management begins with comprehensive strategic planning that synthesizes protection objectives, threat information, existing protection capabilities, consequences of protection failure, and the costs and impacts of safeguards changes into cost effective protection strategies that adequately address credible threats. Lawrence Livermore National Laboratory (LLNL) has developed a structured risk management approach to safeguards and security planning that is designed to lead to protection strategies that are cost effective, meet the intent of Department of Energy (DOE) orders, balance protection needs with programmatic priorities, and acknowledge a level of residual risks that is not cost effective to eliminate. This risk management approach to safeguards decision making was used to develop the first DOE-approved Master Safeguards and Security Agreement (MSSA) that addresses all security interests at a major facility including: special nuclear material, classified information and materials, computer and communication security, and other DOE property. This risk management approach also provides the strategic basis for day-to-day management of the LLNL security program as well as the integration of safeguards program upgrades

Hippocampal sparing radiotherapy for pediatric medulloblastoma: impact of treatment margins and treatment technique.

Science.gov (United States)

Brodin, N Patrik; Munck af Rosenschöld, Per; Blomstrand, Malin; Kiil-Berthlesen, Anne; Hollensen, Christian; Vogelius, Ivan R; Lannering, Birgitta; Bentzen, Søren M; Björk-Eriksson, Thomas

2014-04-01

We investigated how varying the treatment margin and applying hippocampal sparing and proton therapy impact the risk of neurocognitive impairment in pediatric medulloblastoma patients compared with current standard 3D conformal radiotherapy. We included 17 pediatric medulloblastoma patients to represent the variability in tumor location relative to the hippocampal region. Treatment plans were generated using 3D conformal radiotherapy, hippocampal sparing intensity-modulated radiotherapy, and spot-scanned proton therapy, using 3 different treatment margins for the conformal tumor boost. Neurocognitive impairment risk was estimated based on dose-response models from pediatric CNS malignancy survivors and compared among different margins and treatment techniques. Mean hippocampal dose and corresponding risk of cognitive impairment were decreased with decreasing treatment margins (P < .05). The largest risk reduction, however, was seen when applying hippocampal sparing proton therapy-the estimated risk of impaired task efficiency (95% confidence interval) was 92% (66%-98%), 81% (51%-95%), and 50% (30%-70%) for 3D conformal radiotherapy, intensity-modulated radiotherapy, and proton therapy, respectively, for the smallest boost margin and 98% (78%-100%), 90% (60%-98%), and 70% (39%-90%) if boosting the whole posterior fossa. Also, the distance between the closest point of the planning target volume and the center of the hippocampus can be used to predict mean hippocampal dose for a given treatment technique. We estimate a considerable clinical benefit of hippocampal sparing radiotherapy. In choosing treatment margins, the tradeoff between margin size and risk of neurocognitive impairment quantified here should be considered.

Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy

International Nuclear Information System (INIS)

Gage, Irene; Nixon, Asa J.; Schnitt, Stuart J.; Recht, Abram; Gelman, Rebecca; Silver, Barbara; Connolly, James L.; Harris, Jay R.

1995-01-01

PURPOSE: To assess the relationship between microscopic margin status and recurrence after breast-conserving therapy for tumors with or without an extensive intraductal component (EIC). MATERIALS AND METHODS: During the years 1968 to 1986, 1865 women with unilateral clinical stage I or II breast cancer were treated with radiation therapy for breast conservation. Of these, 340 received ≥60 Gy to the tumor bed and had margins that were evaluable on review of their pathologic slides; these constitute the study population. The median follow-up was 109 months. All available slides were reviewed by one of the study pathologists (SS, JC). Final radial margins of excision were classified as negative >1 mm (no invasive or ductal carcinoma in-situ within 1 mm of the inked margin), negative ≤1 mm (any carcinoma ≤1 mm of the inked margin but not at ink) or positive (any carcinoma at the inked margin). A focally positive margin was defined as any invasive or in-situ carcinoma at the margin in ≤3 LPF. The extent of positivity was not evaluable in 2 patients and the distance of the tumor from the margin was not evaluable in 48 patients with a negative margin. Thirty-nine percent of EIC-negative and 46% of EIC-positive patients underwent a re-excision and, for these, the final margin analyzed was from the re-excised specimen. The median dose to the tumor bed was 63 Gy for patients with positive margins and 62 Gy for patients with negative margins. Recurrent disease was classified as ipsilateral breast recurrence (IBR) or distant metastasis/regional nodal failure (DM/RNF). RESULTS: Five year crude rates for the first site of recurrence were calculated for 340 patients evaluable at 5 years. Results were tabulated separately for all patients, EIC-negative and EIC-positive. All p-values tested for differences in the distribution of sites of first failure. CONCLUSIONS: The risk of ipsilateral breast recurrence is equally low for patients with close (≤1 mm) or negative (>1 mm

Surgical Margins and the Risk of Local-Regional Recurrence After Mastectomy Without Radiation Therapy

International Nuclear Information System (INIS)

Childs, Stephanie K.; Chen Yuhui; Duggan, Margaret M.; Golshan, Mehra; Pochebit, Stephen; Wong, Julia S.; Bellon, Jennifer R.

2012-01-01

Purpose: Although positive surgical margins are generally associated with a higher risk of local-regional recurrence (LRR) for most solid tumors, their significance after mastectomy remains unclear. We sought to clarify the influence of the mastectomy margin on the risk of LRR. Methods and Materials: The retrospective cohort consisted of 397 women who underwent mastectomy and no radiation for newly diagnosed invasive breast cancer from 1998-2005. Time to isolated LRR and time to distant metastasis (DM) were evaluated by use of cumulative-incidence analysis and competing-risks regression analysis. DM was considered a competing event for analysis of isolated LRR. Results: The median follow-up was 6.7 years (range, 0.5-12.8 years). The superficial margin was positive in 41 patients (10%) and close (≤2 mm) in 56 (14%). The deep margin was positive in 23 patients (6%) and close in 34 (9%). The 5-year LRR and DM rates for all patients were 2.4% (95% confidence interval, 0.9-4.0) and 3.5% (95% confidence interval, 1.6-5.3) respectively. Fourteen patients had an LRR. Margin status was significantly associated with time to isolated LRR (P=.04); patients with positive margins had a 5-year LRR of 6.2%, whereas patients with close margins and negative margins had 5-year LRRs of 1.5% and 1.9%, respectively. On univariate analysis, positive margins, positive nodes, lymphovascular invasion, grade 3 histology, and triple-negative subtype were associated with significantly higher rates of LRR. When these factors were included in a multivariate analysis, only positive margins and triple-negative subtype were associated with the risk of LRR. Conclusions: Patients with positive mastectomy margins had a significantly higher rate of LRR than those with a close or negative margin. However, the absolute risk of LRR in patients with a positive surgical margin in this series was low, and therefore the benefit of postmastectomy radiation in this population with otherwise favorable features

Risk of biochemical recurrence and positive surgical margins in patients with pT2 prostate cancer undergoing radical prostatectomy

DEFF Research Database (Denmark)

Røder, Martin Andreas; Thomsen, Frederik Birkebæk; Berg, Kasper Drimer

2014-01-01

BACKGROUND AND OBJECTIVE: To investigate risk factors associated with positive surgical margins (PSM) and biochemical recurrence (BR) in organ confined tumors (pT2) after radical prostatectomy (RP) for localized prostate cancer (PCa). METHODS: Between 1995 and 2011, 1,649 patients underwent RP...

SU-E-J-88: Margin Reduction of Level II/III Planning Target Volume for Image-Guided Simultaneous Integrated Boost Head-And-Neck Treatment

International Nuclear Information System (INIS)

Can, S; Neylon, J; Qi, S; Santhanam, A; Low, D

2014-01-01

Purpose: To investigate the feasibility of improved normal tissue sparing for head-and-neck (H'N) image-guided radiotherapy (IGRT) by employing tighter CTV-to-PTV margins for target level II/III though a GPU-based deformable image registration and dose accumulation framework. Methods: Ten H'N simultaneous integrated boost cases treated on TomoTherapy were retrospectively analyzed. Weekly kVCT scans in addition to daily MVCT scans were acquired for each patient. Reduced margin plans were generated with 0- mm margin for level II and III PTV (while 3-5 mm margin for PTV1) and compared with the standard margin plan using 3-5mm margin to all CTV1-3 (reference plan). An in-house developed GPU-based 3D image deformation tool was used to register and deform the weekly KVCTs with the planning CT and determine the delivered mean/minimum/maximum dose, dose volume histograms (DVHs), etc. Results: Compared with the reference plans, the averaged cord maximum, the right and left parotid doses reduced by 22.7 %, 16.5 %, and 9 % respectively in the reduced margin plans. The V95 for PTV2 and PTV3 were found within 2 and 5% between the reference and tighter margin plans. For the reduced margin plans, the averaged cumulative mean doses were consistent with the planned dose for PTV1, PTV2 and PTV3 within 1.5%, 1.7% and 1.4%. Similar dose variations of the delivered dose were seen for the reference and tighter margin plans. The delivered maximum and mean doses for the cord were 3.55 % and 2.37% higher than the planned doses; a 5 % higher cumulative mean dose for the parotids was also observed for the delivered dose than the planned doses in both plans. Conclusion: By imposing tighter CTV-to-PTV margins for level II and III targets for H'N irradiation, acceptable cumulative doses were achievable when coupled with weekly kVCT guidance while improving normal structure sparing

Production and planning organization at coal mines. Organizatsiya proizvodstva i planirovanie na ugol'nykh shakhtakh

Energy Technology Data Exchange (ETDEWEB)

Rybnikov, S E; Voloshin, A P

1981-01-01

A discussion is made of problems concerning the organization of production, labor, and planning at enterprises of the coal industry. Theoretical and methodological principles are given for production organization, standardization and renumeration of wages, production planning and the use of available capacity. Computations are given for optimal numbers of workers, the essential growth in productivity, material expenditures for coal recovery, lowering production costs, and increasing the profitability of enterprise operations. Particular attention is given to the operation of mines of production and associations, organizational and practical problems concerned with the technical retooling of coal mines, and improving management and planning. The teaching aid is intended for students at coal technical institutes specializing in planning at enterprises of the coal industry. 14 references, 26 figures, 14 tables.

Automatic Margin Computation for Risk-Limiting Audits

DEFF Research Database (Denmark)

Beckert, Bernhard; Kirsten, Michael; Klebanov, Vladimir

2017-01-01

A risk-limiting audit is a statistical method to create confidence in the correctness of an election result by checking samples of paper ballots. In order to perform an audit, one usually needs to know what the election margin is, i.e., the number of votes that would need to be changed in order...

ASME nuclear codes and standards risk management strategic planning

International Nuclear Information System (INIS)

Hill, Ralph S. III; Balkey, Kenneth R.; Erler, Bryan A.; Wesley Rowley, C.

2007-01-01

This paper is prepared in honor and in memory of the late Professor Emeritus Yasuhide Asada to recognize his contributions to ASME Nuclear Codes and Standards initiatives, particularly those related to risk-informed technology and System Based Code developments. For nearly two decades, numerous risk-informed initiatives have been completed or are under development within the ASME Nuclear Codes and Standards organization. In order to properly manage the numerous initiatives currently underway or planned for the future, the ASME Board on Nuclear Codes and Standards (BNCS) has an established Risk Management Strategic Plan (Plan) that is maintained and updated by the ASME BNCS Risk Management Task Group. This paper presents the latest approved version of the plan beginning with a background of applications completed to date, including the recent probabilistic risk assessment (PRA) standards developments for nuclear power plant applications. The paper discusses planned applications within ASME Nuclear Codes and Standards that will require expansion of the ASME PRA Standard to support new advanced light water reactor and next generation reactor developments, such as for high temperature gas-cooled reactors. Emerging regulatory developments related to risk-informed, performance- based approaches are summarized. A long-term vision for the potential development and evolution to a nuclear systems code that adopts a risk-informed approach across a facility life-cycle (design, construction, operation, maintenance, and closure) is also summarized. Finally, near term and long term actions are defined across the ASME Nuclear Codes and Standards organizations related to risk management, including related U.S. regulatory activities. (author)

Organic carbon burial in a mangrove forest, margin and intertidal mud flat

Science.gov (United States)

Sanders, Christian J.; Smoak, Joseph M.; Naidu, A. Sathy; Sanders, Luciana M.; Patchineelam, Sambasiva R.

2010-12-01

The flux of total organic carbon (TOC) to depositional facies (intertidal mud flat, margin and forest) was quantified for a tropical mangrove forest in Brazil. Results indicate that these mangrove margins and intertidal mudflats are sites of large TOC accumulation, almost four times greater than the global averages for mangrove forests. The TOC burial rates were determined from organic carbon content in sediment cores which were dated using 210Pb. Burial rates were calculated to be 1129, 949, and 353 (g m -2 yr -1), for the mud flat, margin and forest, respectively. Sediment accumulation rates (SAR) were estimated to be 7.3, 5.0 and 2.8 mm yr -1. Sediment characterization (δ 13C, δ 15N, TOC/TN and mud fraction) indicated a representative mangrove system with a record of consistent organic matter flux of up to 100 years. Because of substantial burial of organic carbon in mangrove ecosystems, their role in the global carbon budget must be considered. More importantly, as climate change influences temperature and sea level, mangrove ecosystems will respond to specific climatic conditions.

Cutting risk, boosting cash flow and developing marginal fields

International Nuclear Information System (INIS)

Baustad, T.; Courtin, G.; Davies, T.; Kenison, R.; Turnbull, J.; Gray, B.; Jalali, Y.; Remondet, J.C.; Hjelmsmark, L.; Oldfield, T.; Romano, C.; Saier, R.; Rannestad, G.

1996-01-01

To minimize financial risk and accelerate return on investment, oil companies are using low-cost, reusable production systems. The scope of these development options is illustrated by looking at three offshore case studies that range from extended well test to marginal field development. In each case, production systems technology has been deployed to provide superior data, early oil or both, thus reducing economic uncertainty and delivering accelerated cash flow. 10 figs., 23 refs

Providing Family Planning Services at Primary Care Organizations after the Exclusion of Planned Parenthood from Publicly Funded Programs in Texas: Early Qualitative Evidence.

Science.gov (United States)

White, Kari; Hopkins, Kristine; Grossman, Daniel; Potter, Joseph E

2017-10-20

To explore organizations' experiences providing family planning during the first year of an expanded primary care program in Texas. Between November 2014 and February 2015, in-depth interviews were conducted with program administrators at 30 organizations: 7 women's health organizations, 13 established primary care contractors (e.g., community health centers, public health departments), and 10 new primary care contractors. Interviews addressed organizational capacities to expand family planning and integrate services with primary care. Interview transcripts were analyzed using a theme-based approach. Themes were compared across the three types of organizations. Established and new primary care contractors identified several challenges expanding family planning services, which were uncommon among women's health organizations. Clinicians often lacked training to provide intrauterine devices and contraceptive implants. Organizations often recruited existing clients into family planning services, rather than expanding their patient base, and new contractors found family planning difficult to integrate because of clients' other health needs. Primary care contractors frequently described contraceptive provision protocols that were not evidence-based. Many primary care organizations in Texas initially lacked the capacity to provide evidence-based family planning services that women's health organizations already provided. © Health Research and Educational Trust.

Is There an Advantage in Designing Adapted, Patient-Specific PTV Margins in Intensity Modulated Proton Beam Therapy for Prostate Cancer?

International Nuclear Information System (INIS)

Góra, Joanna; Stock, Markus; Lütgendorf-Caucig, Carola; Georg, Dietmar

2013-01-01

Purpose: To investigate robust margin strategies in intensity modulated proton therapy to account for interfractional organ motion in prostate cancer. Methods and Materials: For 9 patients, one planning computed tomography (CT) scan and daily and weekly cone beam CTs (CBCTs) were acquired and coregistered. The following planning target volume (PTV) approaches were investigated: a clinical target volume (CTV) delineated on the planning CT (CTV ct ) plus 10-mm margin (PTV 10mm ); a reduced PTV (PTV Red ): CTV ct plus 5 mm in the left-right (LR) and anterior-posterior (AP) directions and 8 mm in the inferior-superior (IS) directions; and a PTV Hull method: the sum of CTV ct and CTVs from 5 CBCTs from the first week plus 3 mm in the LR and IS directions and 5 mm in the AP direction. For each approach, separate plans were calculated using a spot-scanning technique with 2 lateral fields. Results: Each approach achieved excellent target coverage. Differences were observed in volume receiving 98% of the prescribed dose (V 98% ) where PTV Hull and PTV Red results were superior to the PTV 10mm concept. The PTV Hull approach was more robust to organ motion. The V 98% for CTVs was 99.7%, whereas for PTV Red and PTV 10mm plans, V 98% was 98% and 96.1%, respectively. Doses to organs at risk were higher for PTV Hull and PTV 10mm plans than for PTV Red , but only differences between PTV 10mm and PTV Red were significant. Conclusions: In terms of organ sparing, the PTV 10mm method was inferior but not significantly different from the PTV Red and PTV Hull approaches. PTV Hull was most insensitive to target motion

Evaluation of a comprehensive employee wellness program at an organization with a consumer-directed health plan.

Science.gov (United States)

Burton, Wayne N; Chen, Chin-Yu; Li, Xingquan; Schultz, Alyssa B; Kasiarz, David; Edington, Dee W

2014-04-01

Consumer-directed health plans (CDHPs) are popular among employers in the United States. This study examined an employee wellness program and its association with employee health in an organization that recently initiated a CDHP. This retrospective observational analysis compared the health risks, employer-paid health care costs, and short-term disability absences of employees of a large financial services corporation from 2009 to 2010. The two-time health risk appraisal participants had a significant improvement in the percentage of employees in the overall low-risk category. The average annual employer-paid medical and pharmacy costs did not significantly change. For employees who improved their health risk category, there was a commensurate change in costs and absences. In a difficult economic climate, this organization began a health promotion program for employees as well as a new CDHP benefit structure. No short-term reduction in health care usage or overall health status was observed.

Risk Factors Associated With Circumferential Resection Margin Positivity in Rectal Cancer: A Binational Registry Study.

Science.gov (United States)

Warrier, Satish K; Kong, Joseph Cherng; Guerra, Glen R; Chittleborough, Timothy J; Naik, Arun; Ramsay, Robert G; Lynch, A Craig; Heriot, Alexander G

2018-04-01

Rectal cancer outcomes have improved with the adoption of a multidisciplinary model of care. However, there is a spectrum of quality when viewed from a national perspective, as highlighted by the Consortium for Optimizing the Treatment of Rectal Cancer data on rectal cancer care in the United States. The aim of this study was to assess and identify predictors of circumferential resection margin involvement for rectal cancer across Australasia. A retrospective study from a prospectively maintained binational colorectal cancer database was interrogated. This study is based on a binational colorectal cancer audit database. Clinical information on all consecutive resected rectal cancer cases recorded in the registry from 2007 to 2016 was retrieved, collated, and analyzed. The primary outcome measure was positive circumferential resection margin, measured as a resection margin ≤1 mm. A total of 3367 patients were included, with 261 (7.5%) having a positive circumferential resection margin. After adjusting for hospital and surgeon volume, hierarchical logistic regression analysis identified a 6-variable model encompassing the independent predictors, including urgent operation, abdominoperineal resection, open technique, low rectal cancer, T3 to T4, and N1 to N2. The accuracy of the model was 92.3%, with an receiver operating characteristic of 0.783 (p risk associated with circumferential resection margin positivity ranged from risk factors) to 43% (6 risk factors). This study was limited by the lack of recorded long-term outcomes associated with circumferential resection margin positivity. The rate of circumferential resection margin involvement in patients undergoing rectal cancer resection in Australasia is low and is influenced by a number of factors. Risk stratification of outcome is important with the increasing demand for publicly accessible quality data. See Video Abstract at http://links.lww.com/DCR/A512.

SU-F-T-505: A Novel Approach for Sparing Critical Organs at Risk for Cancer Patients Undergoing Radiation Oncology Treatments

Energy Technology Data Exchange (ETDEWEB)

Lavvafi, H; Pourriahi, M; Elahinia, H; Elahinia, M; Parsai, E [University of Toledo Medical Center, Toledo, OH (United States)

2016-06-15

Purpose: A major goal of an effective radiation treatment plan is to deliver the maximum dose to the tumor while minimizing radiation exposure to the surrounding normal structures. For example, due to the radiation exposure to neighboring critical structures during prostate cancer treatment, a significant increase in cancer risk was observed for the bladder (77%) and the rectum (105%) over the following decade. Consequently, an effective treatment plan necessitates limiting the exposure to such organs which can best be achieved by physically displacing the organ at-risk. The goal of this study is to present a prototype for an organ re-positioner device designed and fabricated to physically move the rectum away from the path of radiation beam during external beam and brachytherapy treatments. This device affords patient comfort and provides a fully controlled motion to safely relocate the rectum during treatment. Methods: The NiTi shape memory alloy was designed and optimized for manufacturing a rectal re-positioner device through cooling and heating the core alloy for its shaping. This has been achieved through a prototyped custom designed electronic circuit in order to induce the reversible austenitic transformation and was tested rigorously to ensure the integrity of the actuated motion in displacement of the target anatomy. Results: The desirable NiTi shape-setting was configured for easy insertion and based on anatomical constraint. When the final prototype was evaluated, accuracy and precision of the maximum displacement and temperature changes revealed that the device could safely be used within the target anatomy. Conclusion: The organ re-positioner device is a promising tool that can be implemented in clinical setting. It provides a controlled and safe displacement of the delicate organ(s) at risk. The location of the organ being treated could also be identified using conventional onboard imaging devices or MV imaging available on-board most modern clinical

Parotid gland sparing effect by computed tomography-based modified lower field margin in whole brain radiotherapy

International Nuclear Information System (INIS)

Cho, Oyeon; Chun, Mi Son; Oh, Young Taek; Kim, Mi Hwa; Park, Hae Jin; Nam, Sang Soo; Heo, Jae Sung; Noh, O Kyu; Park, Sung Ho

2013-01-01

Parotid gland can be considered as a risk organ in whole brain radiotherapy (WBRT). The purpose of this study is to evaluate the parotid gland sparing effect of computed tomography (CT)-based WBRT compared to 2-dimensional plan with conventional field margin. From January 2008 to April 2011, 53 patients underwent WBRT using CT-based simulation. Bilateral two-field arrangement was used and the prescribed dose was 30 Gy in 10 fractions. We compared the parotid dose between 2 radiotherapy plans using different lower field margins: conventional field to the lower level of the atlas (CF) and modified field fitted to the brain tissue (MF). Averages of mean parotid dose of the 2 protocols with CF and MF were 17.4 Gy and 8.7 Gy, respectively (p 98% of prescribed dose were 99.7% for CF and 99.5% for MF. Compared to WBRT with CF, CT-based lower field margin modification is a simple and effective technique for sparing the parotid gland, while providing similar dose coverage of the whole brain.

A method to dynamically balance intensity modulated radiotherapy dose between organs-at-risk

International Nuclear Information System (INIS)

Das, Shiva K.

2009-01-01

The IMRT treatment planning process typically follows a path that is based on the manner in which the planner interactively adjusts the target and organ-at-risk (OAR) constraints and priorities. The time-intensive nature of this process restricts the planner from fully understanding the dose trade-off between structures, making it unlikely that the resulting plan fully exploits the extent to which dose can be redistributed between anatomical structures. Multiobjective Pareto optimization has been used in the past to enable the planner to more thoroughly explore alternatives in dose trade-off by combining pre-generated Pareto optimal solutions in real time, thereby potentially tailoring a plan more exactly to requirements. However, generating the Pareto optimal solutions can be nonintuitive and computationally time intensive. The author presents an intuitive and fast non-Pareto approach for generating optimization sequences (prior to planning), which can then be rapidly combined by the planner in real time to yield a satisfactory plan. Each optimization sequence incrementally reduces dose to one OAR at a time, starting from the optimization solution where dose to all OARs are reduced with equal priority, until user-specified target coverage limits are violated. The sequences are computationally efficient to generate, since the optimization at each position along a sequence is initiated from the end result of the previous position in the sequence. The pre-generated optimization sequences require no user interaction. In real time, a planner can more or less instantaneously visualize a treatment plan by combining the dose distributions corresponding to user-selected positions along each of the optimization sequences (target coverage is intrinsically maintained in the combination). Interactively varying the selected positions along each of the sequences enables the planner to rapidly understand the nature of dose trade-off between structures and, thereby, arrive at a

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

Science.gov (United States)

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

2017-01-01

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

Difference in the Set-up Margin between 2D Conventional and 3D CT Based Planning in Patients with Early Breast Cancer

International Nuclear Information System (INIS)

Jo, Sun Mi; Chun, Mi Sun; Kim, Mi Hwa; Oh, Young Taek; Noh, O Kyu; Kang, Seung Hee

2010-01-01

Simulation using computed tomography (CT) is now widely available for radiation treatment planning for breast cancer. It is an important tool to help define the tumor target and normal tissue based on anatomical features of an individual patient. In Korea, most patients have small sized breasts and the purpose of this study was to review the margin of treatment field between conventional two-dimensional (2D) planning and CT based three-dimensional (3D) planning in patients with small breasts. Twenty-five consecutive patients with early breast cancer undergoing breast conservation therapy were selected. All patients underwent 3D CT based planning with a conventional breast tangential field design. In 2D planning, the treatment field margins were determined by palpation of the breast parenchyma (In general, the superior: base of the clavicle, medial: midline, lateral: mid - axillary line, and inferior margin: 2 m below the inflamammary fold). In 3D planning, the clinical target volume (CTV) ought to comprise all glandular breast tissue, and the PTV was obtained by adding a 3D margin of 1 cm around the CTV except in the skin direction. The difference in the treatment field margin and equivalent field size between 2D and 3D planning were evaluated. The association between radiation field margins and factors such as body mass index, menopause status, and bra size was determined. Lung volume and heart volume were examined on the basis of the prescribed breast radiation dose and 3D dose distribution. The margins of the treatment field were smaller in the 3D planning except for two patients. The superior margin was especially variable (average, 2.5 cm; range, -2.5 to 4.5 cm; SD, 1.85). The margin of these targets did not vary equally across BMI class, menopause status, or bra size. The average irradiated lung volume was significantly lower for 3D planning. The average irradiated heart volume did not decrease significantly. The use of 3D CT based planning reduced the

Difference in the Set-up Margin between 2D Conventional and 3D CT Based Planning in Patients with Early Breast Cancer

Energy Technology Data Exchange (ETDEWEB)

Jo, Sun Mi; Chun, Mi Sun; Kim, Mi Hwa; Oh, Young Taek; Noh, O Kyu [Ajou University School of Medicine, Seoul (Korea, Republic of); Kang, Seung Hee [Inje University, Ilsan Paik Hospital, Ilsan (Korea, Republic of)

2010-11-15

Simulation using computed tomography (CT) is now widely available for radiation treatment planning for breast cancer. It is an important tool to help define the tumor target and normal tissue based on anatomical features of an individual patient. In Korea, most patients have small sized breasts and the purpose of this study was to review the margin of treatment field between conventional two-dimensional (2D) planning and CT based three-dimensional (3D) planning in patients with small breasts. Twenty-five consecutive patients with early breast cancer undergoing breast conservation therapy were selected. All patients underwent 3D CT based planning with a conventional breast tangential field design. In 2D planning, the treatment field margins were determined by palpation of the breast parenchyma (In general, the superior: base of the clavicle, medial: midline, lateral: mid - axillary line, and inferior margin: 2 m below the inflamammary fold). In 3D planning, the clinical target volume (CTV) ought to comprise all glandular breast tissue, and the PTV was obtained by adding a 3D margin of 1 cm around the CTV except in the skin direction. The difference in the treatment field margin and equivalent field size between 2D and 3D planning were evaluated. The association between radiation field margins and factors such as body mass index, menopause status, and bra size was determined. Lung volume and heart volume were examined on the basis of the prescribed breast radiation dose and 3D dose distribution. The margins of the treatment field were smaller in the 3D planning except for two patients. The superior margin was especially variable (average, 2.5 cm; range, -2.5 to 4.5 cm; SD, 1.85). The margin of these targets did not vary equally across BMI class, menopause status, or bra size. The average irradiated lung volume was significantly lower for 3D planning. The average irradiated heart volume did not decrease significantly. The use of 3D CT based planning reduced the

Persistently better treatment planning results of intensity-modulated (IMRT) over conformal radiotherapy (3D-CRT) in prostate cancer patients with significant variation of clinical target volume and/or organs-at-risk

International Nuclear Information System (INIS)

Fenoglietto, Pascal; Laliberte, Benoit; Allaw, Ali; Ailleres, Norbert; Idri, Katia; Hay, Meng Huor; Moscardo, Carmen Llacer; Gourgou, Sophie; Dubois, Jean-Bernard; Azria, David

2008-01-01

Purpose: To compare the dose coverage of planning and clinical target volume (PTV, CTV), and organs-at-risk (OAR) between intensity-modulated (3D-IMRT) and conventional conformal radiotherapy (3D-CRT) before and after internal organ variation in prostate cancer. Methods and materials: We selected 10 patients with clinically significant interfraction volume changes. Patients were treated with 3D-IMRT to 80 Gy (minimum PTV dose of 76 Gy, excluding rectum). Fictitious, equivalent 3D-CRT plans (80 Gy at isocenter, with 95% isodose (76 Gy) coverage of PTV, with rectal blocking above 76 Gy) were generated using the same planning CT data set ('CT planning'). The plans were then also applied to a verification CT scan ('CT verify') obtained at a different moment. PTV, CTV, and OAR dose coverage were compared using non-parametric tests statistics for V95, V90 (% of the volume receiving ≥95 or 90% of the dose) and D50 (dose to 50% of the volume). Results: Mean V95 of the PTV for 'CT planning' was 94.3% (range, 88-99) vs 89.1% (range, 84-94.5) for 3D-IMRT and 3D-CRT (p = 0.005), respectively. Mean V95 of the CTV for 'CT verify' was 97% for both 3D-IMRT and 3D-CRT. Mean D50 of the rectum for 'CT planning' was 26.8 Gy (range, 22-35) vs 43.5 Gy (range, 33.5-50.5) for 3D-IMRT and 3D-CRT (p = 0.0002), respectively. For 'CT verify', this D50 was 31.1 Gy (range, 16.5-44) vs 44.2 Gy (range, 34-55) for 3D-IMRT and 3D-CRT (p = 0.006), respectively. V95 of the rectum was 0% for both plans for 'CT planning', and 2.3% (3D-IMRT) vs 2.1% (3D-CRT) for 'CT verify' (p = non-sig.). Conclusion: Dose coverage of the PTV and OAR was better with 3D-IMRT for each patient and remained so after internal volume changes

Bank Interest Margin and Default Risk under Basel III Capped Capital Adequacy Accord and Regulatory Deposit Insurance Fund Protection

OpenAIRE

Chuen-Ping Chang; Shi Chen

2015-01-01

We study the optimal bank interest margin and default risk under the capped ratio schedule of government capital instruments in the Basel III Capital Adequacy Accord and the Deposit Insurance Fund arrangement program. We show that an increase in the capped ratio (a decrease in the capped government capital injection) increases the default risk in the bank¡¯s equity return at a reduced interest margin. Regulatory deposit insurance fund protection reinforces the reduced bank interest margin and...

Safety margin evaluation concepts for plant Up rates and life extension. Results of the OECD/NEA/CSNI working group on Safety Margin Action Plan (SMAP)

International Nuclear Information System (INIS)

Belac, J

2006-01-01

This presentation summarizes results of the OECD/NEA/CSNI working group on Safety Margin Action Plan (SMAP) aimed to develop generalized safety margin concept and means of its quantification for the process of evaluating plant safety in the frame of plant life extension and power up rating activities to be used by OECD member countries. (author)

Toxicity risk of non-target organs at risk receiving low-dose radiation: case report

International Nuclear Information System (INIS)

Shueng, Pei-Wei; Lin, Shih-Chiang; Chang, Hou-Tai; Chong, Ngot-Swan; Chen, Yu-Jen; Wang, Li-Ying; Hsieh, Yen-Ping; Hsieh, Chen-Hsi

2009-01-01

The spine is the most common site for bone metastases. Radiation therapy is a common treatment for palliation of pain and for prevention or treatment of spinal cord compression. Helical tomotherapy (HT), a new image-guided intensity modulated radiotherapy (IMRT), delivers highly conformal dose distributions and provides an impressive ability to spare adjacent organs at risk, thus increasing the local control of spinal column metastases and decreasing the potential risk of critical organs under treatment. However, there are a lot of non-target organs at risk (OARs) occupied by low dose with underestimate in this modern rotational IMRT treatment. Herein, we report a case of a pathologic compression fracture of the T9 vertebra in a 55-year-old patient with cholangiocarcinoma. The patient underwent HT at a dose of 30 Gy/10 fractions delivered to T8-T10 for symptom relief. Two weeks after the radiotherapy had been completed, the first course of chemotherapy comprising gemcitabine, fluorouracil, and leucovorin was administered. After two weeks of chemotherapy, however, the patient developed progressive dyspnea. A computed tomography scan of the chest revealed an interstitial pattern with traction bronchiectasis, diffuse ground-glass opacities, and cystic change with fibrosis. Acute radiation pneumonitis was diagnosed. Oncologists should be alert to the potential risk of radiation toxicities caused by low dose off-targets and abscopal effects even with highly conformal radiotherapy

National Ignition Facility risk management plan, rev. 1

International Nuclear Information System (INIS)

Brereton, S J; Lane, M A

1998-01-01

The initial release of the National Ignition Facility (AUF) Risk Management Plan (LLNL, 1997a) was prepared in accordance with the DOE Life Cycle Asset Management Good Practice Guide (DOE, 1996a) and supported Critical Decision 3 (CD3), Approval to Initiate Construction (DOE, 1997a). The objectives of the plan were to: (1) Identify the risks to the completion of the Project in terms of meeting technical and regulatory requirements, cost, and schedule. (2) Assess the risks in terms of likelihood of occurrence and their impact potential relative to technical performance, ES and H (environmental, safety and health), costs, and schedule. (3) Address suitable risk mitigation measures for each identified risk. This revision of the Risk Management Plan considers project risks and vulnerabilities after CD3 (DOE, 1997a) was approved by the Secretary of Energy. During the one-year period since the initial release, the vulnerabilities of greatest concern have been the litigation of the Programmatic Environmental Impact Statement (PEIS) (DOE, 1996b) by a group of environmental organizations led by the Natural Resources Defense Council; the finding and successful clean-up of polychlorinated biphenyl (PCB)-filled electrical capacitors at the NIF site excavation; the FY98 congressional budget authorization and request for the FY99 budget authorization; funding for Inertial Confinement Fusion (ICF)/NIF programmatic activities (including French and other sources of funding); and finally, progress in the core science and technology, and optics program that form the basis for the NIF design

Heard and valued: the development of a model to meaningfully engage marginalized populations in health services planning.

Science.gov (United States)

Snow, M Elizabeth; Tweedie, Katherine; Pederson, Ann

2018-03-15

Recently, patient engagement has been identified as a promising strategy for supporting healthcare planning. However, the context and structure of universalistic, "one-size-fits-all" approaches often used for patient engagement may not enable diverse patients to participate in decision-making about programs intended to meet their needs. Specifically, standard patient engagement approaches are gender-blind and might not facilitate the engagement of those marginalized by, for example, substance use, low income, experiences of violence, homelessness, and/or mental health challenges-highly gendered health and social experiences. The project's purpose was to develop a heuristic model to assist planners to engage patients who are not traditionally included in healthcare planning. Using a qualitative research approach, we reviewed literature and conducted interviews with patients and healthcare planners regarding engaging marginalized populations in health services planning. From these inputs, we created a model and planning manual to assist healthcare planners to engage marginalized patients in health services planning, which we piloted in two clinical programs undergoing health services design. The findings from the pilots were used to refine the model. The analysis of the interviews and literature identified power and gender as barriers to participation, and generated suggestions to support diverse populations both to attend patient engagement events and to participate meaningfully. Engaging marginalized populations cannot be reduced to a single defined process, but instead needs to be understood as an iterative process of fitting engagement methods to a particular situation. Underlying this process are principles for meaningfully engaging marginalized people in healthcare planning. A one-size-fits-all approach to patient engagement is not appropriate given patients' diverse barriers to meaningful participation in healthcare planning. Instead, planners need a

TWRS safety and technical integration risk management plan

International Nuclear Information System (INIS)

Fordham, R.A.

1996-01-01

The objectives of the Tank Waste Remediation System (TWRS) Safety and Technical Integration (STI) programmatic risk management program are to assess, analyze, and handle risks associated with TWRS STI responsibilities and to communicate information about the actions being taken and the results to enable decision making. The objective of this TWRS STI Risk Management Plan is to communicate a consistent approach to risk management that will be used by the organization

Three independent one-dimensional margins for single-fraction frameless stereotactic radiosurgery brain cases using CBCT

International Nuclear Information System (INIS)

Zhang, Qinghui; Chan, Maria F.; Burman, Chandra; Song, Yulin; Zhang, Mutian

2013-01-01

Purpose: Setting a proper margin is crucial for not only delivering the required radiation dose to a target volume, but also reducing the unnecessary radiation to the adjacent organs at risk. This study investigated the independent one-dimensional symmetric and asymmetric margins between the clinical target volume (CTV) and the planning target volume (PTV) for linac-based single-fraction frameless stereotactic radiosurgery (SRS).Methods: The authors assumed a Dirac delta function for the systematic error of a specific machine and a Gaussian function for the residual setup errors. Margin formulas were then derived in details to arrive at a suitable CTV-to-PTV margin for single-fraction frameless SRS. Such a margin ensured that the CTV would receive the prescribed dose in 95% of the patients. To validate our margin formalism, the authors retrospectively analyzed nine patients who were previously treated with noncoplanar conformal beams. Cone-beam computed tomography (CBCT) was used in the patient setup. The isocenter shifts between the CBCT and linac were measured for a Varian Trilogy linear accelerator for three months. For each plan, the authors shifted the isocenter of the plan in each direction by ±3 mm simultaneously to simulate the worst setup scenario. Subsequently, the asymptotic behavior of the CTV V 80% for each patient was studied as the setup error approached the CTV-PTV margin.Results: The authors found that the proper margin for single-fraction frameless SRS cases with brain cancer was about 3 mm for the machine investigated in this study. The isocenter shifts between the CBCT and the linac remained almost constant over a period of three months for this specific machine. This confirmed our assumption that the machine systematic error distribution could be approximated as a delta function. This definition is especially relevant to a single-fraction treatment. The prescribed dose coverage for all the patients investigated was 96.1%± 5.5% with an extreme

Non-apical positive surgical margins after radical prostatectomy for pT2 prostate cancer is associated with the highest risk of recurrence

DEFF Research Database (Denmark)

Roder, Martin Andreas; Kawa, Sandra; Scheike, Thomas

2014-01-01

BACKGROUND AND OBJECTIVE: To investigate how location of positive surgical margins (PSM) in pT2 tumors affect the risk of biochemical recurrence (BR). METHODS: The study includes 1,133 consecutive patients from 1995 until end of 2011, who had organ-confined disease (pT2) following RP. The location...... a 3.1-fold increased risk of BR compared to margin negative patients. Patients with pT2 apical and non-apical PSM had a 5-year biochemical recurrence-free survival of 84.9% (95% CI: 77.6-92.2%) and 78.6% (95% CI: 71.3-85.9%), respectively. In multivariate analysis, pT2 apical and non-apical PSM...... was individually associated with a 2.2- and 3.8-fold increased risk of BR compared to margin negative patients. CONCLUSION: In our cohort the location of pT2 PSM was associated with time to BR, that is, patients with non-apical pT2 PSM endured the highest risk of BR compared to apical PSM. This may indicate...

Distinguishing Terrestrial Organic Carbon in Marginal Sediments of East China Sea and Northern South China Sea

Science.gov (United States)

Kandasamy, Selvaraj; Lin, Baozhi; Wang, Huawei; Liu, Qianqian; Liu, Zhifei; Lou, Jiann-Yuh; Chen, Chen-Tung Arthur; Mayer, Lawrence M.

2016-04-01

Knowledge about the sources, transport pathways and behavior of terrestrial organic carbon in continental margins adjoining to large rivers has improved in recent decades, but uncertainties and complications still exist with human-influenced coastal regions in densely populated wet tropics and subtropics. In these regions, the monsoon and other episodic weather events exert strong climatic control on mineral and particulate organic matter delivery to the marginal seas. Here we investigate elemental (TOC, TN and bromine-Br) and stable carbon isotopic (δ13C) compositions of organic matter (OM) in surface sediments and short cores collected from active (SW Taiwan) and passive margin (East China Sea) settings to understand the sources of OM that buried in these settings. We used sedimentary bromine to total organic carbon (Br/TOC) ratios to apportion terrigenous from marine organic matter, and find that Br/TOC may serve as an additional, reliable proxy for sedimentary provenance in both settings. Variations in Br/TOC are consistent with other provenance indicators in responding to short-lived terrigenous inputs. Because diagenetic alteration of Br is insignificant on shorter time scales, applying Br/TOC ratios as a proxy to identify organic matter source along with carbon isotope mixing models may provide additional constraints on the quantity and transformation of terrigenous organics in continental margins. We apply this combination of approaches to land-derived organic matter in different depositional environments of East Asian marginal seas.

Prevalence, risk factors and outcomes of velamentous and marginal cord insertions: a population-based study of 634,741 pregnancies.

Directory of Open Access Journals (Sweden)

Cathrine Ebbing

Full Text Available OBJECTIVES: To determine the prevalence of, and risk factors for anomalous insertions of the umbilical cord, and the risk for adverse outcomes of these pregnancies. DESIGN: Population-based registry study. SETTING: Medical Birth Registry of Norway 1999-2009. POPULATION: All births (gestational age >16 weeks to <45 weeks in Norway (623,478 singletons and 11,263 pairs of twins. METHODS: Descriptive statistics and odds ratios (ORs for risk factors and adverse outcomes based on logistic regressions adjusted for confounders. MAIN OUTCOME MEASURES: Velamentous or marginal cord insertion. Abruption of the placenta, placenta praevia, pre-eclampsia, preterm birth, operative delivery, low Apgar score, transferral to neonatal intensive care unit (NICU, malformations, birthweight, and perinatal death. RESULTS: The prevalence of abnormal cord insertion was 7.8% (1.5% velamentous, 6.3% marginal in singleton pregnancies and 16.9% (6% velamentous, 10.9% marginal in twins. The two conditions shared risk factors; twin gestation and pregnancies conceived with the aid of assisted reproductive technology were the most important, while bleeding in pregnancy, advanced maternal age, maternal chronic disease, female foetus and previous pregnancy with anomalous cord insertion were other risk factors. Velamentous and marginal insertion was associated with an increased risk of adverse outcomes such as placenta praevia (OR = 3.7, (95% CI = 3.1-4.6, and placental abruption (OR = 2.6, (95% CI = 2.1-3.2. The risk of pre-eclampsia, preterm birth and delivery by acute caesarean was doubled, as was the risk of low Apgar score, transferral to NICU, low birthweight and malformations. For velamentous insertion the risk of perinatal death at term was tripled, OR = 3.3 (95% CI = 2.5-4.3. CONCLUSION: The prevalence of velamentous and marginal insertions of the umbilical cord was 7.8% in singletons and 16.9% in twin gestations, with marginal insertion being more

ESTIMATION OF FLEXIBILITY OF AN ORGANIZATION ON THE GROUND OF THE CALCULATION OF PROFIT MARGIN RATE

Directory of Open Access Journals (Sweden)

Olga Gennadevna Rybakova

2016-12-01

Full Text Available The article deals with the problem of the flexibility of an organization as the ability to adapt effectively to the external environment. The authors have identified and investigated different approaches to estimating the flexibility of an organization on the ground of flexibility grading, calculation of the general index of flexibility as well as the calculation of flexibility’s ranking score. We have identified the advantages and disadvantages of these approaches. A new method of the estimation of an organization’s flexibility on the ground of the calculation of relative profit margin has been developed. This method is the multifunctional assessment tool of enterprise’s functionability in the current context of difficult and volatile economic environment. It allows in the early stage to identify negative trends in the production and financial figures and thus, it enables the organizational leadership to take steps in advance in order to avert a crisis in its activity. Keeping the profit margin at the same rate at the forced contraction of output, because of the negative impact of external factors, will confirm that the organization has adapted to the external environment and, therefore, it is flexible. The organization can be considered with margin rate beginning to low up to zero value as an organization with an insufficient level of flexibility that is at the “zone of crisis” and it is characterized by the depletion of reserved funds and reduction of current assets. Loss-maker is nonflexible and the presence of loss means that the organization has an evident sign of crisis and it can be bankrupt.

Improved Safety Margin Characterization of Risk from Loss of Offsite Power

Energy Technology Data Exchange (ETDEWEB)

Nelson, Paul [Texas A & M Univ., College Station, TX (United States)

2017-11-07

Original intent: The original intent of this task was “support of the Risk-Informed Safety Margin Characteristic (RISMC) methodology in order” “to address … efficiency of computation so that more accurate and cost-effective techniques can be used to address safety margin characterizations” (S. M. Hess et al., “Risk-Informed Safety Margin Characterization,” Procs. ICONE17, Brussels, July 2009, CD format). It was intended that “in Task 1 itself this improvement will be directed toward upon the very important issue of Loss of Offsite Power (LOOP) events,” more specifically toward the challenge of efficient computation of the multidimensional nonrecovery integral that has been discussed by many previous contributors to the theory of nuclear safety. It was further envisioned that “three different computational approaches will be explored,” corresponding to the three subtasks listed below; deliverables were tied to the individual subtasks.

Quantifying Safety Margin Using the Risk-Informed Safety Margin Characterization (RISMC)

Energy Technology Data Exchange (ETDEWEB)

Grabaskas, David; Bucknor, Matthew; Brunett, Acacia; Nakayama, Marvin

2015-04-26

The Risk-Informed Safety Margin Characterization (RISMC), developed by Idaho National Laboratory as part of the Light-Water Reactor Sustainability Project, utilizes a probabilistic safety margin comparison between a load and capacity distribution, rather than a deterministic comparison between two values, as is usually done in best-estimate plus uncertainty analyses. The goal is to determine the failure probability, or in other words, the probability of the system load equaling or exceeding the system capacity. While this method has been used in pilot studies, there has been little work conducted investigating the statistical significance of the resulting failure probability. In particular, it is difficult to determine how many simulations are necessary to properly characterize the failure probability. This work uses classical (frequentist) statistics and confidence intervals to examine the impact in statistical accuracy when the number of simulations is varied. Two methods are proposed to establish confidence intervals related to the failure probability established using a RISMC analysis. The confidence interval provides information about the statistical accuracy of the method utilized to explore the uncertainty space, and offers a quantitative method to gauge the increase in statistical accuracy due to performing additional simulations.

What margins should be added to the clinical target volume in radiotherapy treatment planning of lung cancer?

International Nuclear Information System (INIS)

Ekberg, L.; Wittgren, L.; Holmberg, O.

1995-01-01

When defining the planning target volume (PTV) in radiotherapy treatment planning, it is vital to add geometrical margins of normal tissue around the clinical target volume (CTV). This is to ensure that the whole CTV will receive the planned absorbed dose taking into account both set-up deviations and target movements as well as other geometrical variations in the treatment chain. The problem is our limited knowledge of how large these margins should be. To assess the size of needed margins around the CTV in conformal radiotherapy of lung cancer, electronic portal imaging was employed in 232 irradiation field set-ups of 14 patients. This was done in order to quantify the uncertainty in the execution of treatment considering patient movement and set-up displacements. For an estimation of the added geometrical variation from target movement during irradiation, fluoroscopy was used at the simulation of the irradiation fields. The set-up study showed an average systematic deviation for all individual fields of 3.1 mm and an average maximal systematic deviation (in either transversal or craniocaudal direction) of 4.8 mm. The random errors can be described by an average standard deviation of 2.8 mm for all fields in either direction. Major gradual displacements as a function of time was also detected in one of the patients. CTV-movements of several millimetres during respiration could be observed. It was also seen that heartbeats could add to CTV-movements during irradiation with an equal magnitude. The combined effect of these factors are considered when making an overall estimation of margins that should be added to the CTV

Is ad-hoc plan adaptation based on 2-Step IMRT feasible?

International Nuclear Information System (INIS)

Bratengeier, Klaus; Polat, Buelent; Gainey, Mark; Grewenig, Patricia; Meyer, Juergen; Flentje, Michael

2009-01-01

Background: The ability of a geometry-based method to expeditiously adapt a '2-Step' step and shoot IMRT plan was explored. Both changes of the geometry of target and organ at risk have to be balanced. A retrospective prostate planning study was performed to investigate the relative benefits of beam segment adaptation to the changes in target and organ at risk coverage. Methods: Four patients with six planning cases with extraordinarily large deformations of rectum and prostate were chosen for the study. A 9-field IMRT plan (A) using 2-Step IMRT segments was planned on an initial CT study. The plan had to fulfil all the requirements of a conventional high-quality step and shoot IMRT plan. To adapt to changes of the anatomy in a further CT data set, three approaches were considered: the original plan with optimized isocentre position (B), a newly optimized plan (C) and the original plan, adapted using the 2-Step IMRT optimization rules (D). DVH parameters were utilized for quantification of plan quality: D 99 for the CTV and the central planning target volume (PTV), D 95 for an outer PTV, V 95 , V 80 and V 50 for rectum and bladder. Results: The adapted plan (D) achieved almost the same target coverage as the newly optimized plan (C). Target coverage for plan B was poor and for the organs at risk, the rectum V 80 was slightly increased. The volume with more than 95% of the target dose (V 95 ) was 1.5 ± 1.5 cm 3 for the newly optimized plan (C), compared to 2.2 ± 1.3 cm 3 for the original plan (A) and 7.2 ± 4.8 cm 3 (B) on the first and the second CT, respectively. The adapted plan resulted in 4.3 ± 2.1 cm 3 (D), an intermediate dose load to the rectum. All other parameters were comparable for the newly optimized and the adapted plan. Conclusions: The first results for adaptation of interfractional changes using the 2-Step IMRT algorithm are encouraging. The plans were superior to plans with optimized isocentre position and only marginally inferior to a newly

Monitoring plan for routine organic air emissions at the Radioactive Waste Management Complex Waste Storage Facilities

International Nuclear Information System (INIS)

Galloway, K.J.; Jolley, J.G.

1994-06-01

This monitoring plan provides the information necessary to perform routine organic air emissions monitoring at the Waste Storage Facilities located at the Transuranic Storage Area of the Radioactive Waste Management Complex at the Idaho National Engineering Laboratory. The Waste Storage Facilities include both the Type I and II Waste Storage Modules. The plan implements a dual method approach where two dissimilar analytical methodologies, Open-Path Fourier Transform Infrared Spectroscopy (OP-FTIR) and ancillary SUMMA reg-sign canister sampling, following the US Environmental Protection Agency (EPA) analytical method TO-14, will be used to provide qualitative and quantitative volatile organic concentration data. The Open-Path Fourier Transform Infrared Spectroscopy will provide in situ, real time monitoring of volatile organic compound concentrations in the ambient air of the Waste Storage Facilities. To supplement the OP-FTIR data, air samples will be collected using SUMMA reg-sign, passivated, stainless steel canisters, following the EPA Method TO-14. These samples will be analyzed for volatile organic compounds with gas chromatograph/mass spectrometry analysis. The sampling strategy, procedures, and schedules are included in this monitoring plan. The development of this monitoring plan is driven by regulatory compliance to the Resource Conservation and Recovery Act, State of Idaho Toxic Air Pollutant increments, Occupational Safety and Health Administration. The various state and federal regulations address the characterization of the volatile organic compounds and the resultant ambient air emissions that may originate from facilities involved in industrial production and/or waste management activities

Risk Management and Viability of Public Organizations. Development of a Risk Measurement Tool: The Case of Greece

Directory of Open Access Journals (Sweden)

Iordanis Eleftheriadis

2017-03-01

Full Text Available Purpose: This paper provides an important contribution towards the development of a valid, reliable and cost-effective instrument that reduces operational and economic risk levels in public sector organizations. Design/methodology/approach: A quantitative methodology based on the collection of primary data via a questionnaire has been adopted in this research. Findings: The research results showed that the measurement tool selected, applied, presented and proposed is comprised of three (3 scales. The reliability analysis proved that all three scales are reliable; therefore, they are suitable for use as a risk measurement instrument. Research limitations/implications: The study's academic contribution is the application and testing of the aforementioned measurement instruments, which can now be utilised by researchers in the field of risk management, to further advance the study of risk management in public organizations in Greece. On the empirical level, the implementation of these three measurement instruments can assist public organizations in Greece via an easy and fast assessment of economic and operational risks. Originality/value: This tool can help public organizations gain insight into the level of risk they face at any given point in time in order plan their actions accordingly. At the same time, central state administration will have the necessary tools to monitor and support the organizations it evaluates.

Validation of mathematical models for the prediction of organs-at-risk dosimetric metrics in high-dose-rate gynecologic interstitial brachytherapy

Energy Technology Data Exchange (ETDEWEB)

Damato, Antonio L.; Viswanathan, Akila N.; Cormack, Robert A. [Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Boston, Massachusetts 02115 (United States)

2013-10-15

Purpose: Given the complicated nature of an interstitial gynecologic brachytherapy treatment plan, the use of a quantitative tool to evaluate the quality of the achieved metrics compared to clinical practice would be advantageous. For this purpose, predictive mathematical models to predict the D{sub 2cc} of rectum and bladder in interstitial gynecologic brachytherapy are discussed and validated.Methods: Previous plans were used to establish the relationship between D2cc and the overlapping volume of the organ at risk with the targeted area (C0) or a 1-cm expansion of the target area (C1). Three mathematical models were evaluated: D{sub 2cc}=α*C{sub 1}+β (LIN); D{sub 2cc}=α– exp(–β*C{sub 0}) (EXP); and a mixed approach (MIX), where both C{sub 0} and C{sub 1} were inputs of the model. The parameters of the models were optimized on a training set of patient data, and the predictive error of each model (predicted D{sub 2cc}− real D{sub 2cc}) was calculated on a validation set of patient data. The data of 20 patients were used to perform a K-fold cross validation analysis, with K = 2, 4, 6, 8, 10, and 20.Results: MIX was associated with the smallest mean prediction error <6.4% for an 18-patient training set; LIN had an error <8.5%; EXP had an error <8.3%. Best case scenario analysis shows that an error ≤5% can be achieved for a ten-patient training set with MIX, an error ≤7.4% for LIN, and an error ≤6.9% for EXP. The error decreases with the increase in training set size, with the most marked decrease observed for MIX.Conclusions: The MIX model can predict the D{sub 2cc} of the organs at risk with an error lower than 5% with a training set of ten patients or greater. The model can be used in the development of quality assurance tools to identify treatment plans with suboptimal sparing of the organs at risk. It can also be used to improve preplanning and in the development of real-time intraoperative planning tools.

Significance and management of positive surgical margins at the time of radical prostatectomy.

Science.gov (United States)

Silberstein, Jonathan L; Eastham, James A

2014-10-01

Positive surgical margins (PSM) at the time of radical prostatectomy (RP) result in an increased risk of biochemical recurrence (BCR) and secondary treatment. We review current literature with a focus on stratifying the characteristics of the PSM that may define its significance, the impact of modern imaging and surgical approaches in avoidance of PSM, and management strategies when PSM do occur. We performed a review of the available literature to identify factors associated with PSM and their management. PSM have been repeatedly demonstrated to be associated with an increased risk of BCR following RP. The specific characteristics (size, number, location, Gleason score at the margin) of the PSM may influence the risk of recurrence. Novel imaging and surgical approaches are being investigated and may allow for reductions of PSM in the future. The use of adjuvant treatment for a PSM remains controversial and should be decided on an individual basis after a discussion about the risks and benefits. The goal of RP is complete resection of the tumor. PSM are associated with increased risk of BCR and secondary treatments. Of the risk factors associated with BCR after RP, a PSM is directly influenced by surgical technique.

Significance and management of positive surgical margins at the time of radical prostatectomy

Directory of Open Access Journals (Sweden)

Jonathan L. Silberstein

2014-01-01

Full Text Available Positive surgical margins (PSM at the time of radical prostatectomy (RP result in an increased risk of biochemical recurrence (BCR and secondary treatment. We review current literature with a focus on stratifying the characteristics of the PSM that may define its significance, the impact of modern imaging and surgical approaches in avoidance of PSM, and management strategies when PSM do occur. We performed a review of the available literature to identify factors associated with PSM and their management. PSM have been repeatedly demonstrated to be associated with an increased risk of BCR following RP. The specific characteristics (size, number, location, Gleason score at the margin of the PSM may influence the risk of recurrence. Novel imaging and surgical approaches are being investigated and may allow for reductions of PSM in the future. The use of adjuvant treatment for a PSM remains controversial and should be decided on an individual basis after a discussion about the risks and benefits. The goal of RP is complete resection of the tumor. PSM are associated with increased risk of BCR and secondary treatments. Of the risk factors associated with BCR after RP, a PSM is directly influenced by surgical technique.

Improved Safety Margin Characterization of Risk from Loss of Offsite Power

International Nuclear Information System (INIS)

Nelson, Paul

2017-01-01

Original intent: The original intent of this task was ''support of the Risk-Informed Safety Margin Characteristic (RISMC) methodology in order'' ''to address ... efficiency of computation so that more accurate and cost-effective techniques can be used to address safety margin characterizations'' (S. M. Hess et al., ''Risk-Informed Safety Margin Characterization,'' Procs. ICONE17, Brussels, July 2009, CD format). It was intended that ''in Task 1 itself this improvement will be directed toward upon the very important issue of Loss of Offsite Power (LOOP) events,'' more specifically toward the challenge of efficient computation of the multidimensional nonrecovery integral that has been discussed by many previous contributors to the theory of nuclear safety. It was further envisioned that ''three different computational approaches will be explored,'' corresponding to the three subtasks listed below; deliverables were tied to the individual subtasks.

Dosimetric Comparison of Intensity-Modulated Radiotherapy Plans, With or Without Anterior Myocardial Territory and Left Ventricle as Organs at Risk, in Early-Stage Left-Sided Breast Cancer Patients

International Nuclear Information System (INIS)

Tan Wenyong; Wang Xiaohong; Qiu Dasheng; Liu Dong; Jia Shaohui; Zeng Fanyu; Chen Zhengwang; Li Beihui; Xu Jiaozhen; Wei Lai; Hu Desheng

2011-01-01

Purpose: We evaluated heart sparing using an intensity-modulated radiotherapy (IMRT) plan with the left ventricle (LV) and/or the anterior myocardial territory (AMT) as additional organs at risk (OARs). Methods and Materials: A total of 10 patients with left-sided breast cancer were selected for dosimetric planning. Both lungs, the right breast, heart, LV, and AMT were defined as OARs. We generated one tangential field plan and four IMRT plans for each patient. We examined the dose–volume histogram parameters of the planning target volume and OARs. Results: Compared with the tangential field plan, the mean dose to the heart in the IMRT plans did not show significant differences; however, the dose to the AMT and LV decreased by 18.7–45.4% and 10.8–37.4%, respectively. The maximal dose to the heart decreased by 18.6–35.3%, to the AMT by 22.0–45.1%, and to the LV by 23.5–45.0%, And the relative volumes of the heart (V ≥12 ), AMT (V >11 ) and LV (V >10 ) decreased significantly with different levels, respectively. The volume of the heart, AMT, LV, both lungs, and right breast receiving ≥5 Gy showed a significant increase. Compared with the IMRT (H) plan, the mean dose to the heart, AMT, and LV decreased by 17.5–21.5%, 25.2–29.8%, and 22.8–29.8% and the maximal dose by 13.6–20.6%, 23.1–29.6%, and 17.3–29.1%, respectively. The IMRT plans for both lungs and the right breast showed no significant differences. Conclusions: The IMRT plans with the addition of the AMT and/or LV as OARs considerably increased heart sparing. We recommend including the LV as an additional OAR in such plans.

TH-CD-202-08: Feasibility Study of Planning Phase Optimization Using Patient Geometry-Driven Information for Better Dose Sparing of Organ at Risks

Energy Technology Data Exchange (ETDEWEB)

Kang, S; Kim, D; Kim, T; Park, S; Shin, D; Kim, K; Cho, M; Suh, T [Department of Biomedical Engineering and Research Institute of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Kim, S [Virginia Commonwealth University, Richmond, VA (United States)

2016-06-15

Purpose: To propose a simple and effective cost value function to search optimal planning phase (gating window) and demonstrated its feasibility for respiratory correlated radiation therapy. Methods: We acquired 4DCT of 10 phases for 10 lung patients who have tumor located near OARs such as esophagus, heart, and spinal cord (i.e., central lung cancer patients). A simplified mathematical optimization function was established by using overlap volume histogram (OVH) between the target and organ at risk (OAR) at each phase and the tolerance dose of selected OARs to achieve surrounding OARs dose-sparing. For all patients and all phases, delineation of the target volume and selected OARs (esophagus, heart, and spinal cord) was performed (by one observer to avoid inter-observer variation), then cost values were calculated for all phases. After the breathing phases were ranked according to cost value function, the relationship between score and dose distribution at highest and lowest cost value phases were evaluated by comparing the mean/max dose. Results: A simplified mathematical cost value function showed noticeable difference from phase to phase, implying it is possible to find optimal phases for gating window. The lowest cost value which may result in lower mean/max dose to OARs was distributed at various phases for all patients. The mean doses of the OARs significantly decreased about 10% with statistical significance for all 3 OARs at the phase with the lowest cost value. Also, the max doses of the OARs were decreased about 2∼5% at the phase with the lowest cost value compared to the phase with the highest cost value. Conclusion: It is demonstrated that optimal phases (in dose distribution perspective) for gating window could exist differently through each patient and the proposed cost value function can be a useful tool for determining such phases without performing dose optimization calculations. This research was supported by the Mid-career Researcher Program

Assessing the relationship between child sexual abuse and marginal living conditions on HIV/AIDS-related risk behavior among women prisoners.

Science.gov (United States)

Mullings, J L; Marquart, J W; Brewer, V E

2000-05-01

There were two aims in this research. First, to examine the relationships between childhood sexual abuse and HIV drug and sexual risk taking behaviors among female prisoners, and second, to examine the relationship between a marginal adult living context and HIV drug and sexual risk taking behavior among female prisoners. The data were collected through face-to-face interviews with a random sample of 500 women at admission to prison in 1994. Differences between women who were sexually abused while growing up (n = 130) were compared to women who reported no sexual abuse (n = 370) along various demographic, and HIV drug and sexual risk taking dimensions. A history of sexual abuse while growing up was associated with increased sexual risk taking behaviors in adulthood. A marginal adult living situation also emerged as an important factor increasing the risk for HIV infection. Examining the co-occurrence of both childhood sexual abuse and adult marginal living context revealed a strong relationship between these two factors and HIV risk taking activities. The findings indicate that childhood sexual abuse may be a predictor for HIV sexual risk taking behaviors among incarcerated women. The marginal and chaotic adult living style of these women was also associated the extent of their HIV drug and sexual risk taking behaviors. Our research suggests that the co-occurrence of sexual victimization and marginality is a stronger predictor of HIV risk than each variable alone.

Differences in absorbed doses at risk organs and target tumoral of planning(PTV) in lung treatments using two algorithms of different calculations

International Nuclear Information System (INIS)

Uruena Llinares, A.; Santos Rubio, A.; Luis Simon, F. J.; Sanchez Carmona, G.; Herrador Cordoba, M.

2006-01-01

The objective of this paper is to compare, in thirty treatments for lung cancer,the absorbed doses at risk organs and target volumes obtained between the two used algorithms of calculation of our treatment planning system Oncentra Masterplan, that is, Pencil Beams vs Collapsed Cone. For it we use a set of measured indicators (D1 and D99 of tumor volume, V20 of lung, homogeneity index defined as (D5-D95)/D prescribed, and others). Analysing the dta, making a descriptor analysis of the results, and applying the non parametric test of the ranks with sign of Wilcoxon we find that the use of Pencil Beam algorithm underestimates the dose in the zone of the PTV including regions of low density as well as the values of maximum dose in spine cord. So, we conclude that in those treatments in which the spine dose is near the maximum permissible limit or those in which the PTV it includes a zone with pulmonary tissue must be used the Collapse Cone algorithm systematically and in any case an analysis must become to choose between time and precision in the calculation for both algorithms. (Authors)

Risk management at the level of agricultural organizations

Directory of Open Access Journals (Sweden)

Genoveva Buzamat

2014-10-01

Full Text Available In agriculture, as in other production branches of the economy, there businesses which have two main objectives: on short term – achieve profit and on long term – the viability of the company (economic growth and stability. Even if the risk management practice can vary from one company to another, some elements are common for the risk management programs. These are: mission identification, risk assessment and of the risk control uncertainty, risk financing, risk administration. In this study we identify the risk categories and we establish methods to prevent them. The studied organization has as activity object the cereals and technical plants culture.

ASME nuclear codes and standards risk management strategic plan

International Nuclear Information System (INIS)

Balkey, Kenneth R.

2003-01-01

Over the past 15 years, several risk-informed initiatives have been completed or are under development within the ASME Nuclear Codes and Standards organization. In order to better manage the numerous initiatives in the future, the ASME Board on Nuclear Codes and Standards has recently developed and approved a Risk Management Strategic Plan. This paper presents the latest approved version of the plan beginning with a background of applications completed to date, including the recent issuance of the ASME Standard for Probabilistic Risk Assessment (PRA) for Nuclear Power Plant Applications. The paper discusses potential applications within ASME Nuclear Codes and Standards that may require expansion of the PRA Standard, such as for new generation reactors, or the development of new PRA Standards. A long-term vision for the potential development and evolution to a nuclear systems code that adopts a risk-informed approach across a facility life-cycle (design, construction, operation, maintenance, and closure) is summarized. Finally, near term and long term actions are defined across the ASME Nuclear Codes and Standards organizations related to risk management, and related U.S. regulatory activities are also summarized. (author)

The marginal band system in nymphalid butterfly wings.

Science.gov (United States)

Taira, Wataru; Kinjo, Seira; Otaki, Joji M

2015-01-01

Butterfly wing color patterns are highly complex and diverse, but they are believed to be derived from the nymphalid groundplan, which is composed of several color pattern systems. Among these pattern systems, the marginal band system, including marginal and submarginal bands, has rarely been studied. Here, we examined the color pattern diversity of the marginal band system among nymphalid butterflies. Marginal and submarginal bands are usually expressed as a pair of linear bands aligned with the wing margin. However, a submarginal band can be expressed as a broken band, an elongated oval, or a single dot. The marginal focus, usually a white dot at the middle of a wing compartment along the wing edge, corresponds to the pupal edge spot, one of the pupal cuticle spots that signify the locations of color pattern organizing centers. A marginal band can be expressed as a semicircle, an elongated oval, or a pair of eyespot-like structures, which suggest the organizing activity of the marginal focus. Physical damage at the pupal edge spot leads to distal dislocation of the submarginal band in Junonia almana and in Vanessa indica, suggesting that the marginal focus functions as an organizing center for the marginal band system. Taken together, we conclude that the marginal band system is developmentally equivalent to other symmetry systems. Additionally, the marginal band is likely a core element and the submarginal band a paracore element of the marginal band system, and both bands are primarily specified by the marginal focus organizing center.

Involved Node, Site, Field and Residual Volume Radiotherapy for Lymphoma: A Comparison of Organ at Risk Dosimetry and Second Malignancy Risks.

Science.gov (United States)

Murray, L; Sethugavalar, B; Robertshaw, H; Bayman, E; Thomas, E; Gilson, D; Prestwich, R J D

2015-07-01

Recent radiotherapy guidelines for lymphoma have included involved site radiotherapy (ISRT), involved node radiotherapy (INRT) and irradiation of residual volume after full-course chemotherapy. In the absence of late toxicity data, we aim to compare organ at risk (OAR) dose-metrics and calculated second malignancy risks. Fifteen consecutive patients who had received mediastinal radiotherapy were included. Four radiotherapy plans were generated for each patient using a parallel pair photon technique: (i) involved field radiotherapy (IFRT), (ii) ISRT, (iii) INRT, (iv) residual post-chemotherapy volume. The radiotherapy dose was 30 Gy in 15 fractions. The OARs evaluated were: breasts, lungs, thyroid, heart, oesophagus. Relative and absolute second malignancy rates were estimated using the concept of organ equivalent dose. Significance was defined as P risks of second cancers were significantly higher with IFRT compared with ISRT for lung, breast and thyroid; INRT and residual volume resulted in significantly lower relative risks compared with ISRT for lung, breast and thyroid. The median excess absolute risks of second cancers were consistently lowest for the residual technique and highest for IFRT in terms of thyroid, lung and breast cancers. The risk of oesophageal cancer was similar for all four techniques. Overall, the absolute risk of second cancers was very similar for ISRT and INRT. Decreasing treatment volumes from IFRT to ISRT, INRT or residual volume reduces radiation exposure to OARs. Second malignancy modelling suggests that this reduction in treatment volumes will lead to a reduction in absolute excess second malignancy. Little difference was observed in second malignancy risks between ISRT and INRT, supporting the use of ISRT in the absence of a pre-chemotherapy positron emission tomography scan in the radiotherapy treatment position. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Australasian Gastrointestinal Trials Group (AGITG) Contouring Atlas and Planning Guidelines for Intensity-Modulated Radiotherapy in Anal Cancer

International Nuclear Information System (INIS)

Ng, Michael; Leong, Trevor; Chander, Sarat; Chu, Julie; Kneebone, Andrew; Carroll, Susan; Wiltshire, Kirsty; Ngan, Samuel; Kachnic, Lisa

2012-01-01

Purpose: To develop a high-resolution target volume atlas with intensity-modulated radiotherapy (IMRT) planning guidelines for the conformal treatment of anal cancer. Methods and Materials: A draft contouring atlas and planning guidelines for anal cancer IMRT were prepared at the Australasian Gastrointestinal Trials Group (AGITG) annual meeting in September 2010. An expert panel of radiation oncologists contoured an anal cancer case to generate discussion on recommendations regarding target definition for gross disease, elective nodal volumes, and organs at risk (OARs). Clinical target volume (CTV) and planning target volume (PTV) margins, dose fractionation, and other IMRT-specific issues were also addressed. A steering committee produced the final consensus guidelines. Results: Detailed contouring and planning guidelines and a high-resolution atlas are provided. Gross tumor and elective target volumes are described and pictorially depicted. All elective regions should be routinely contoured for all disease stages, with the possible exception of the inguinal and high pelvic nodes for select, early-stage T1N0. A 20-mm CTV margin for the primary, 10- to 20-mm CTV margin for involved nodes and a 7-mm CTV margin for the elective pelvic nodal groups are recommended, while respecting anatomical boundaries. A 5- to 10-mm PTV margin is suggested. When using a simultaneous integrated boost technique, a dose of 54 Gy in 30 fractions to gross disease and 45 Gy to elective nodes with chemotherapy is appropriate. Guidelines are provided for OAR delineation. Conclusion: These consensus planning guidelines and high-resolution atlas complement the existing Radiation Therapy Oncology Group (RTOG) elective nodal ano-rectal atlas and provide additional anatomic, clinical, and technical instructions to guide radiation oncologists in the planning and delivery of IMRT for anal cancer.

Evaluating risk management strategies in resource planning

International Nuclear Information System (INIS)

Andrews, C.J.

1995-01-01

This paper discusses the evaluation of risk management strategies as a part of integrated resource planning. Value- and scope-related uncertainties can be addressed during the process of planning, but uncertainties in the operating environment require technical analysis within planning models. Flexibility and robustness are two key classes of strategies for managing the risk posed by these uncertainties. This paper reviews standard capacity expansion planning models and shows that they are poorly equipped to compare risk management strategies. Those that acknowledge uncertainty are better at evaluating robustness than flexibility, which implies a bias against flexible options. Techniques are available to overcome this bias

Pattern of Failure After Limited Margin Radiotherapy and Temozolomide for Glioblastoma

International Nuclear Information System (INIS)

McDonald, Mark W.; Shu, Hui-Kuo G.; Curran, Walter J.; Crocker, Ian R.

2011-01-01

Purpose: To evaluate the pattern of failure after limited margin radiotherapy for glioblastoma. Methods and Materials: We analyzed 62 consecutive patients with newly diagnosed glioblastoma treated between 2006 and 2008 with standard fractionation to a total dose of 60Gy with concurrent temozolomide (97%) or arsenic trioxide (3%). The initial clinical target volume included postoperative T2 abnormality with a median margin of 0.7cm. The boost clinical target volume included residual T1-enhancing tumor and resection cavity with a median margin of 0.5cm. Planning target volumes added a 0.3- or 0.5-cm margin to clinical target volumes. The total boost planning target volume (PTV boost ) margin was 1cm or less in 92% of patients. The volume of recurrent tumor (new T1 enhancement) was categorized by the percent within the 60-Gy isodose line as central (>95%), infield (81-95%), marginal (20-80%), or distant ( boost with a 2.5-cm margin were created for each patient. Results: With a median follow-up of 12 months, radiographic tumor progression developed in 43 of 62 patients. Imaging was available for analysis in 41: 38 (93%) had central or infield failure, 2 (5%) had marginal failure, and 1 (2%) had distant failure relative to the 60-Gy isodose line. The treated PTV boost (median, 140cm 3 ) was, on average, 70% less than the PTV boost with a 2.5-cm margin (median, 477cm 3 ) (p boost margin of 1cm or less did not appear to increase the risk of marginal and/or distant tumor failures compared with other published series. With careful radiation planning and delivery, it appears that treatment margins for glioblastoma can be reduced.

Set-up errors analyses in IMRT treatments for nasopharyngeal carcinoma to evaluate time trends, PTV and PRV margins

Energy Technology Data Exchange (ETDEWEB)

Mongioj, Valeria (Dept. of Medical Physics, Fondazione IRCCS Istituto Nazionale Tumori, Milan (Italy)), e-mail: valeria.mongioj@istitutotumori.mi.it; Orlandi, Ester (Dept. of Radiotherapy, Fondazione IRCCS Istituto Nazionale Tumori, Milan (Italy)); Palazzi, Mauro (Dept. of Radiotherapy, A.O. Niguarda Ca' Granda, Milan (Italy)) (and others)

2011-01-15

Introduction. The aims of this study were to analyze the systematic and random interfractional set-up errors during Intensity Modulated Radiation Therapy (IMRT) in 20 consecutive nasopharyngeal carcinoma (NPC) patients by means of Electronic Portal Images Device (EPID), to define appropriate Planning Target Volume (PTV) and Planning Risk Volume (PRV) margins, as well as to investigate set-up displacement trend as a function of time during fractionated RT course. Material and methods. Before EPID clinical implementation, an anthropomorphic phantom was shifted intentionally 5 mm to all directions and the EPIs were compared with the digitally reconstructed radiographs (DRRs) to test the system's capability to recognize displacements observed in clinical studies. Then, 578 clinical images were analyzed with a mean of 29 images for each patient. Results. Phantom data showed that the system was able to correct shifts with an accuracy of 1 mm. As regards clinical data, the estimated population systematic errors were 1.3 mm for left-right (L-R), 1 mm for superior-inferior (S-I) and 1.1 mm for anterior-posterior (A-P) directions, respectively. Population random errors were 1.3 mm, 1.5 mm and 1.3 mm for L-R, S-I and A-P directions, respectively. PTV margin was at least 3.4, 3 and 3.2 mm for L-R, S-I and A-P direction, respectively. PRV margins for brainstem and spinal cord were 2.3, 2 and 2.1 mm and 3.8, 3.5 and 3.2 mm for L-R, A-P and S-I directions, respectively. Set-up error displacements showed no significant changes as the therapy progressed (p>0.05), although displacements >3 mm were found more frequently when severe weight loss or tumor nodal shrinkage occurred. Discussion. These results enable us to choose margins that guarantee with sufficient accuracy the coverage of PTVs and organs at risk sparing. Collected data confirmed the need for a strict check of patient position reproducibility in case of anatomical changes

The marginal social cost of headway for a scheduled service

DEFF Research Database (Denmark)

Fosgerau, Mogens

2009-01-01

waiting time costs as well as schedule delay costs measured relative to their desired time of arrival at the destination. They may either arrive at the station to choose just the next departure or they may plan for a specific departure in which case they incur also a planning cost. Then planning......This brief paper derives the marginal social cost of headway for a scheduled service, i.e. the cost for users of marginal increases to the time interval between departures. In brief we may call it the value of headway in analogy with the value of travel time and the value of reliability. Users have...... for a specific departure is costly but becomes more attractive at longer headways. Simple expressions for the user cost result. In particular, the marginal cost of headway is large at short headways and smaller at long headways. The difference in marginal costs is the value of time multiplied by half the headway....

Preferred Provider Organization (PPO) Plans

Science.gov (United States)

... Find & compare doctors, hospitals, & other providers Preferred Provider Organization (PPO) Plans How PPO Plans Work A Medicare ... extra for these benefits. Related Resources Health Maintenance Organization (HMO) Private Fee-for-Service (PFFS) Special Needs ...

Health Maintenance Organization (HMO) Plan

Science.gov (United States)

... Find & compare doctors, hospitals, & other providers Health Maintenance Organization (HMO) Plan In most HMO Plans, you generally ... certain service when needed. Related Resources Preferred Provider Organization (PPO) Private Fee-for-Service (PFFS) Special Needs ...

Riverine transport of terrestrial organic matter to the North Catalan margin, NW Mediterranean Sea

Science.gov (United States)

Sanchez-Vidal, Anna; Higueras, Marina; Martí, Eugènia; Liquete, Camino; Calafat, Antoni; Kerhervé, Philippe; Canals, Miquel

2013-11-01

Rivers are the primary pathway for organic matter transport from the terrestrial to the marine environment and, thus, river fluxes are critical in regulating the quantity of terrestrial organic matter that reaches the coastal ecosystems. Hydrodynamic processes typical of the coastal zone can lead to the transport of terrestrial organic matter across the continental shelf and beyond. Such organic matter can eventually reach the deep margin and basin ecosystems. Riverine inputs of organic matter to the sea can be a significant food source to marine ecosystems contributing to carbon cycling in these ecosystems. In order to assess the marine carbon cycle it is essential to know the biogeochemical characteristics and temporal dynamics of the fluvial organic matter input discharged by rivers to the coastal zone. In this study we present a one and a half year long (November 2008 to May 2010) assessment on organic carbon (OC) and nitrogen (N) inputs from the three main rivers discharging into the North Catalan margin (Tordera, Ter and Fluvià, from south to north). Furthermore, we investigate the characteristics of the particulate organic matter discharged by these rivers by means of stable isotopic (δ13C and δ15N) and grain size analyses. We found that the hydrological regime of the rivers is a relevant factor in regulating the quantity and mediating the quality of organic matter inputs to the North Catalan margin. Overall, the three main rivers discharging into the study area deliver 1266 and 159 tonnes of terrestrial OC and N per year, respectively, to the coastal zone. Most of the OC and N load is transported during floods, which indicates that the Mediterranean climate of the area, with a strong seasonal contrast in precipitation, determines the timing of the main inputs of OC and N to the sea. Therefore, the annual OC and N load experiences a high temporal variability associated to the number and magnitude of floods with in each hydrological year. In addition, we

Risk communications and the Chemical Stockpile Emergency-Planning Program

Energy Technology Data Exchange (ETDEWEB)

Vogt, B.M.; Sorensen, J.H.

1994-09-01

The CSEPP (Chemical Stockpile Emergency Preparedness Program) was created to improve emergency planning and response capabilities at the eight sites around the country that store chemical weapons. These weapons are scheduled to be destroyed in the near future. In preparation of the Draft Programmatic Environmental Impact Statement (DPEIS) for the Chemical Stockpile Disposal Program (CSDP), it was proposed that the Army mitigate accidents through an enhanced community emergency preparedness program at the eight storage sites. In 1986, the Army initiated the development of an Emergency Response Concept Plan (ERCP) for the CSDP, one of 12 technical support studies conducted during preparation of the Final Programmatic Environmental Impact Statement (FPEIS). The purpose of this document is to provide a fairly comprehensive source book on risk, risk management, risk communication research and recommended risk communication practices. It does not merely summarize each publication in the risk communication literature, but attempts to synthesize them along the lines of a set of organizing principles. Furthermore, it is not intended to duplicate other guidance manuals (such as Covello et al.`s manual on risk comparison). The source book was developed for the CSEPP in support of the training module on risk communications. Although the examples provided are specific to CSEPP, its use goes beyond that of CSEPP as the findings apply to a broad spectrum of risk communication topics. While the emphasis is on communication in emergency preparedness and response specific to the CSEPP, the materials cover other non-emergency communication settings. 329 refs.

An IGRT margin concept for pelvic lymph nodes in high-risk prostate cancer

Energy Technology Data Exchange (ETDEWEB)

Groher, M.; Kopp, P.; Deutschmann, H.; Sedlmayer, F.; Wolf, Frank [Paracelsus Medical University of Salzburg, Department of Radiation Oncology, St. Johanns-Spital, Salzburg (Austria); Drerup, M. [Paracelsus Medical University of Salzburg, Department of Urology, St. Johanns-Spital, Salzburg (Austria)

2017-09-15

Gold-marker-based image-guided radiation therapy (IGRT) of the prostate allows to correct for inter- and intrafraction motion and therefore to safely reduce margins for the prostate planning target volume (PTV). However, pelvic PTVs, when coadministered in a single plan (registered to gold markers [GM]), require reassessment of the margin concept since prostate movement is independent from the pelvic bony anatomy to which the lymphatics are usually referenced to. We have therefore revisited prostate translational movement relative to the bony anatomy to obtain adequate margins for the pelvic PTVs compensating mismatch resulting from referencing pelvic target volumes to GMs in the prostate. Prostate movement was analyzed in a set of 28 patients (25 fractions each, totaling in 684 fractions) and the required margins calculated for the pelvic PTVs according to Van Herk's margin formula M = 2.5 Σ + 1.64 (σ{sup '}-σ{sub p}). The overall mean prostate movement relative to bony anatomy was 0.9 ± 3.1, 0.6 ± 3.4, and 0.0 ± 0.7 mm in anterior/posterior (A/P), inferior/superior (I/S) and left/right (L/R) direction, respectively. Calculated margins to compensate for the resulting mismatch to bony anatomy were 9/9/2 mm in A/P, I/S, and L/R direction and 10/11/6 mm if an additional residual error of 2 mm was assumed. GM-based IGRT for pelvic PTVs is feasible if margins are adapted accordingly. Margins could be reduced further if systematic errors which are introduced during the planning CT were eliminated. (orig.) [German] Eine Goldmarker-(GM-)basierte, bildgefuehrte Radiotherapie der Prostata ermoeglicht inter- und intrafraktionelle Bewegungen auszugleichen und somit Sicherheitsraender der Planungszielvolumina (PTV) zu minimieren. Dies gilt jedoch nicht fuer Zielvolumina des pelvinen Lymphabflusses, wenn diese im Rahmen eines simultan integrierten Boost-Konzepts im selben Plan verabreicht werden. Da Bewegungen der Prostata und des Lymphabflusses unabhaengig

Individualized margins in 3D conformal radiotherapy planning for lung cancer: analysis of physiological movements and their dosimetric impacts.

Science.gov (United States)

Germain, François; Beaulieu, Luc; Fortin, André

2008-01-01

In conformal radiotherapy planning for lung cancer, respiratory movements are not taken into account when a single computed tomography (CT) scan is performed. This study examines tumor movements to design individualized margins to account for these movements and evaluates their dosimetric impacts on planning volume. Fifteen patients undergoing CT-based planning for radical radiotherapy for localized lung cancer formed the study cohort. A reference plan was constructed based on reference gross, clinical, and planning target volumes (rGTV, rCTV, and rPTV, respectively). The reference plans were compared with individualized plans using individualized margins obtained by using 5 serial CT scans to generate individualized target volumes (iGTV, iCTV, and iPTV). Three-dimensional conformal radiation therapy was used for plan generation using 6- and 23-MV photon beams. Ten plans for each patient were generated and dose-volume histograms (DVHs) were calculated. Comparisons of volumetric and dosimetric parameters were performed using paired Student t-tests. Relative to the rGTV, the total volume occupied by the superimposed GTVs increased progressively with each additional CT scans. With the use of all 5 scans, the average increase in GTV was 52.1%. For the plans with closest dosimetric coverage, target volume was smaller (iPTV/rPTV ratio 0.808) but lung irradiation was only slightly decreased. Reduction in the proportion of lung tissue that received 20 Gy or more outside the PTV (V20) was observed both for 6-MV plans (-0.73%) and 23-MV plans (-0.65%), with p = 0.02 and p = 0.04, respectively. In conformal RT planning for the treatment of lung cancer, the use of serial CT scans to evaluate respiratory motion and to generate individualized margins to account for these motions produced only a limited lung sparing advantage.

Individualized Margins in 3D Conformal Radiotherapy Planning for Lung Cancer: Analysis of Physiological Movements and Their Dosimetric Impacts

International Nuclear Information System (INIS)

Germain, Francois; Beaulieu, Luc; Fortin, Andre

2008-01-01

In conformal radiotherapy planning for lung cancer, respiratory movements are not taken into account when a single computed tomography (CT) scan is performed. This study examines tumor movements to design individualized margins to account for these movements and evaluates their dosimetric impacts on planning volume. Fifteen patients undergoing CT-based planning for radical radiotherapy for localized lung cancer formed the study cohort. A reference plan was constructed based on reference gross, clinical, and planning target volumes (rGTV, rCTV, and rPTV, respectively). The reference plans were compared with individualized plans using individualized margins obtained by using 5 serial CT scans to generate individualized target volumes (iGTV, iCTV, and iPTV). Three-dimensional conformal radiation therapy was used for plan generation using 6- and 23-MV photon beams. Ten plans for each patient were generated and dose-volume histograms (DVHs) were calculated. Comparisons of volumetric and dosimetric parameters were performed using paired Student t-tests. Relative to the rGTV, the total volume occupied by the superimposed GTVs increased progressively with each additional CT scans. With the use of all 5 scans, the average increase in GTV was 52.1%. For the plans with closest dosimetric coverage, target volume was smaller (iPTV/rPTV ratio 0.808) but lung irradiation was only slightly decreased. Reduction in the proportion of lung tissue that received 20 Gy or more outside the PTV (V20) was observed both for 6-MV plans (-0.73%) and 23-MV plans (-0.65%), with p = 0.02 and p = 0.04, respectively. In conformal RT planning for the treatment of lung cancer, the use of serial CT scans to evaluate respiratory motion and to generate individualized margins to account for these motions produced only a limited lung sparing advantage

Extraction of data from margin calculations in prostate radiotherapy from a commercial record and verify system

International Nuclear Information System (INIS)

Fox, C.; Kron, T.; Fisher, R.; Tai, K.H.; Thompson, A.; Owen, R.

2008-01-01

Full text: Radiation therapy is a widely prescribed and effective modality for the treatment of prostate cancer.1 3 Radiation therapy relies on precise targeting of the treatment site to deliver the required dose to the tumour while sparing critical organs nearby. To achieve this, it is necessary to allow for the effects of organ and patient motion, both during and between treatment fractions. In the treatment planning process, a margin is added to the clinical target volume (CTV) to create the planning target volume (PTV) to allow for targeting uncertainties which Iare dominated by these movements.4 5 Deciding the appropriate margin size is important since an excessively large margin will result in increased damage to adjacent normal tissues while an undersized margin will leave parts of the target underdosed. With the marked improvement in technology available with new treatment machines, remote online setup correction using high quality kilovoltage images has become straightforward and widely available. Used together with implanted radio-opaque markers, remote online setup correction allows direct targeting of the prostate organ, and significant reduction in the effects of interfraction motion.6 1 1 The introduction of this technology into a therapy department makes a reduction of CTV to PTV margin size possible. There are many published works dealing with margin size calculation for prostate treatment planning. The best known and most widely cited work is that of van Herk which modelled the prostate using simple geometry to calculate a minimum dose coverage probability.13 The outcome of this modelling was a simple and easily understood formula with just the patient group random and systematic setup errors used to calculate margin size. To apply such margin recipes, the patient group's random and systematic error performance must be well known, which requires the collection of a substantial quantity of data. The aim of the project described here was to collect

Optimal Patient Positioning (Prone Versus Supine) for VMAT in Gynecologic Cancer: A Dosimetric Study on the Effect of Different Margins

Energy Technology Data Exchange (ETDEWEB)

Heijkoop, Sabrina T., E-mail: s.heijkoop@erasmusmc.nl [Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Westerveld, Henrike; Bijker, Nina [Department of Radiation Oncology, Academic Medical Center, Amsterdam (Netherlands); Feije, Raphael; Sharfo, Abdul W. [Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Wieringen, Niek van [Department of Radiation Oncology, Academic Medical Center, Amsterdam (Netherlands); Mens, Jan Willem M. [Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Stalpers, Lukas J.A. [Department of Radiation Oncology, Academic Medical Center, Amsterdam (Netherlands); Hoogeman, Mischa S. [Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands)

2016-10-01

Purpose/Objective: It is unknown whether the historically found dosimetric advantages of treating gynecologic cancer with the patient in a prone position with use of a small-bowel displacement device (belly-board) remain when volumetric arc therapy (VMAT) is used and whether these advantages depend on the necessary margin between clinical target volume (CTV) and planning target volume (PTV). The aim of this study is to determine the best patient position (prone or supine) in terms of sparing organs at risk (OAR) for various CTV-to-PTV margins and VMAT dose delivery. Methods and Materials: In an institutional review board—approved study, 26 patients with gynecologic cancer scheduled for primary (9) or postoperative (17) radiation therapy were scanned in a prone position on a belly-board and in a supine position on the same day. The primary tumor CTV, nodal CTV, bladder, bowel, and rectum were delineated on both scans. The PTVs were created each with a different margin for the primary tumor and nodal CTV. The VMAT plans were generated with our in-house system for automated treatment planning. For all margin combinations, the supine and prone plans were compared with consideration of all OAR dose-volume parameters but with highest priority given to bowel cavity V{sub 45Gy} (cm{sup 3}). Results: For both groups, the prone position reduced the bowel cavity V{sub 45Gy}, in particular for nodal margins ≥10 mm (ΔV{sub 45Gy} = 23.9 ± 10.6 cm{sup 3}). However, for smaller margins, the advantage was much less pronounced (ΔV{sub 45Gy} = 6.5 ± 3.0 cm{sup 3}) and did not reach statistical significance. The rectum mean dose (D{sub mean}) was significantly lower (ΔD{sub mean} = 2.5 ± 0.3 Gy) in the prone position for both patient groups and for all margins, and the bladder D{sub mean} was significantly lower in the supine position (ΔD{sub mean} = 2.6 ± 0.4 Gy) only for the postoperative group. The advantage of the prone position was not present if it

The Danish Organic Action Plan 2020

DEFF Research Database (Denmark)

Sørensen, Nina Nørgaard; Lassen, Anne Dahl; Løje, Hanne

2015-01-01

Objective With political support from the Danish Organic Action Plan 2020, organic public procurement in Denmark is expected to increase. In order to evaluate changes in organic food procurement in Danish public kitchens, reliable methods are needed. The present study aimed to compare organic food...... procurement measurements by two methods and to collect and discuss baseline organic food procurement measurements from public kitchens participating in the Danish Organic Action Plan 2020. Design Comparison study measuring organic food procurement by applying two different methods, one based on the use...... organic food conversion projects funded by the Danish Organic Action Plan 2020 during 2012 and 2013. Subjects Twenty-six public kitchens (comparison study) and 345 public kitchens (baseline organic food procurement status). Results A high significant correlation coefficient was found between the two...

Conceptions of Marketing Management and Strategic Planning at the Market of Cellular Communication Services

Directory of Open Access Journals (Sweden)

Marina Vladimirovna Perevoznikova

2015-12-01

Full Text Available The article is devoted to the study and analysis of marketing management and strategic planning of the companies working in the field of cellular communication services. The article represented the concept of marketing management and strategic planning, and their importance in the business development. Objectives and tasks of marketing management in the telecommunications are considered. Тhe conceptions of marketing management and the advisability of their use in the market of cellular communication are described. Relationship of marketing management and strategic planning at activities of the organization are determined. The stages of strategic planning and types of global and corporate development strategies of companies in the telecommunication market are analyzed. The application features of the marketing management concepts and development strategies in the telecommunications sector are considered. The evaluation criteria and mobile operators performance indicators (data are formed. The conclusions about the role of the effective marketing management and strategic planning in the activities of mobile operators are formulated, that allows keeping marginality and high level of business profitability, creating competitive advantages in the conditions of highly competitive market, forming effective purchasing, sales activities and promotional activities, determining the correct tactics of behavior at the market.

Tank waste remediation system risk management plan

International Nuclear Information System (INIS)

Zimmerman, B.D.

1998-01-01

The purpose of the Tank Waste Remediation System (TWRS) Risk Management Plan is to describe a consistent approach to risk management such that TWRS Project risks are identified and managed to achieve TWRS Project success. The Risk Management Plan implements the requirements of the Tank Waste Remediation System Systems Engineering Management Plan in the area of risk management. Figure ES-1 shows the relationship of the TWRS Risk Management Plan to other major TWRS Project documents. As the figure indicates, the Risk Management Plan is a tool used to develop and control TWRS Project work. It provides guidance on how TWRS Project risks will be assessed, analyzed, and handled, and it specifies format and content for the risk management lists, which are a primary product of the risk management process. In many instances, the Risk Management Plan references the TWRS Risk Management Procedure, which provides more detailed discussion of many risk management activities. The TWRS Risk Management Plan describes an ongoing program within the TWRS Project. The Risk Management Plan also provides guidance in support of the TWRS Readiness To-Proceed (RTP) assessment package

Estimation of marginal costs at existing waste treatment facilities.

Science.gov (United States)

Martinez-Sanchez, Veronica; Hulgaard, Tore; Hindsgaul, Claus; Riber, Christian; Kamuk, Bettina; Astrup, Thomas F

2016-04-01

This investigation aims at providing an improved basis for assessing economic consequences of alternative Solid Waste Management (SWM) strategies for existing waste facilities. A bottom-up methodology was developed to determine marginal costs in existing facilities due to changes in the SWM system, based on the determination of average costs in such waste facilities as function of key facility and waste compositional parameters. The applicability of the method was demonstrated through a case study including two existing Waste-to-Energy (WtE) facilities, one with co-generation of heat and power (CHP) and another with only power generation (Power), affected by diversion strategies of five waste fractions (fibres, plastic, metals, organics and glass), named "target fractions". The study assumed three possible responses to waste diversion in the WtE facilities: (i) biomass was added to maintain a constant thermal load, (ii) Refused-Derived-Fuel (RDF) was included to maintain a constant thermal load, or (iii) no reaction occurred resulting in a reduced waste throughput without full utilization of the facility capacity. Results demonstrated that marginal costs of diversion from WtE were up to eleven times larger than average costs and dependent on the response in the WtE plant. Marginal cost of diversion were between 39 and 287 € Mg(-1) target fraction when biomass was added in a CHP (from 34 to 303 € Mg(-1) target fraction in the only Power case), between -2 and 300 € Mg(-1) target fraction when RDF was added in a CHP (from -2 to 294 € Mg(-1) target fraction in the only Power case) and between 40 and 303 € Mg(-1) target fraction when no reaction happened in a CHP (from 35 to 296 € Mg(-1) target fraction in the only Power case). Although average costs at WtE facilities were highly influenced by energy selling prices, marginal costs were not (provided a response was initiated at the WtE to keep constant the utilized thermal capacity). Failing to systematically

Implementing of action plans for risk communication on the uranium mining sites remedy at Ningyo-Toge Environmental Engineering Center

International Nuclear Information System (INIS)

Yabuta, Naohiro; Kawai, Jun; Hikawa, Tamae

2005-02-01

On the closure of uranium production facilities, settled at Ningyo-Toge Environmental Engineering Center and other area in Okayama and Tottori prefectures, action plans for risk communication with residence and local governments were developed and implemented. With the direction of the action plans for risk communication, 'Imaging plan for developing the local area around Ningyo-Toge' were drawn. Furthermore, practical program called Ethnography by High School Students' were developed, which draw the outlines of past and future around Ningyo-Toge with the insights of high school students, and conducted. As the fundamental materials required to conduct the program above, the topography of northern part of Okayama prefecture, the history and cultures of Kamisaibara village, the history of the uranium mining sites at Ningyo-Toge and Japanese nuclear energy development were clarified. Furthermore, Emergency management plans during pursuing of risk communication plans were also developed. (author)

It's lonely at the top: Biodiversity at risk to loss from climate change

Science.gov (United States)

John L. Koprowski; Sandra L. Doumas; Melissa J. Merrick; Brittany Oleson; Erin E. Posthumus; Timothy G. Jessen; R. Nathan Gwinn

2013-01-01

Climate change is a serious immediate and long-term threat to wildlife species. State and federal agencies are working with universities and non-government organizations to predict, plan for, and mitigate such uncertainties in the future. Endemic species may be particularly at-risk as climate-induced changes impact their limited geographic ranges. The Madrean...

Studying media at The Margins: learning from the field

Directory of Open Access Journals (Sweden)

Clemencia Rodríguez

2016-07-01

Full Text Available This article, informed by ethnographic research on media at the margins, proposes a shift in perspective at several different levels: 1 instead of focusing on individual technologies, our research should examine how grassroots communicators operating at the margins exist in a media ecology that offers different potentialities in each historical situation; 2 instead of trying to determine if the media technologies used at the margin are old or new, digital or not digital, we need to explore how embedded community communicators detect local information or communication needs and use available technologies to address these needs; 3 our research on media at the margins should shed light on how grassroots communicators re-invent, hybridize, converge, and bridge technologies from one platform to another. In sum, understanding media at the margins is about embracing complexity, maintaining the notion of media ecologies, and understanding how grassroots communicators, deeply embedded in local contexts, wedge media technologies into everyday life.

The Role of Seminal Vesicle Motion in Target Margin Assessment for Online Image-Guided Radiotherapy for Prostate Cancer

International Nuclear Information System (INIS)

Liang Jian; Wu Qiuwen; Yan Di

2009-01-01

Purpose: For patients with intermediate- and high-risk prostate cancer, the seminal vesicles (SVs) are included in the clinical target volume (CTV). The purposes of this study are to investigate interfraction motion characteristics of the SVs and determine proper margins for online computed tomography image guidance. Methods and Materials: Twenty-four patients, each with 16 daily helical computed tomography scans, were included in this study. A binary image mask was used for image registration to determine daily organ motion. Two online image-guided radiotherapy strategies (prostate only and prostate + SVs) were simulated in a hypofractionated scheme. Three margin designs were studied for both three-dimensional conformal radiotherapy and intensity-modulated radiotherapy (IMRT). In prostate-only guidance, Margin A was uniformly applied to the whole CTV, and Margin B was applied to the SVs with a fixed 3-mm prostate margin. In prostate plus SV guidance, Margin C was uniformly applied to the CTV. The minimum margins were sought to satisfy the criterion that minimum cumulative CTV dose be more than those of the planning target volume in the plan for greater than 95% of patients. Results: The prostate and SVs move significantly more in the anterior-posterior and superior-inferior than right-left directions. The anterior-posterior motion of the prostate and SVs correlated (R 2 = 0.7). The SVs move significantly more than the prostate. The minimum margins found were 2.5 mm for three-dimensional conformal radiotherapy and 4.5, 4.5, and 3.0 mm for Margins A, B, and C for IMRT, respectively. Margins for IMRT were larger, but the irradiated volume and doses to critical structures were smaller. Minimum margins of 4.5 mm to the SVs and 3 mm to the prostate are recommended for IMRT with prostate-only guidance. Conclusions: The SVs move independently from the prostate gland, and additional margins are necessary for image-guided radiotherapy

Addressing Cultural Aspects of Organizations in Industries at Risk

International Nuclear Information System (INIS)

Gisquet, Elsa; Jeffroy, Francois; Levy, Emmanuelle

2016-01-01

The Safety Culture concept is a key element of many approaches to improving safety in nuclear facilities. In particular, since the Chernobyl accident IAEA has considered this notion as the core of its strategy for dealing with Human and Organizational Factors aspects of safety. IRSN has developed a Human and Organizational Factors assessment approach based on theoretical concepts developed by Ergonomics and Organizational Sociology. This approach allowed IRSN to draw strong conclusions but it seems necessary to better integrate the cultural aspects, because they can have an impact on the safety management. Cultural dimensions play a role when assessing organizational measures designed to foster cooperation between different professions (maintenance and operation, operation and decommissioning, operation and research activities, etc.), between Project organization and daily organization, between companies (ordering institution and subcontractors). IRSN has therefore realized a study aimed at providing guidelines concerning the use of the concept of 'Safety Culture' in safety assessments of nuclear facilities. In the first section of this report, outcomes and limits of the concept are identified, which result in rereading the main research on culture, conducted in anthropology, sociology, management sciences and ergonomics. This research shows that taking into account cultural dimensions may reveal phenomena that other analytical frameworks of organizations are not able to identify. On this basis, four analysis plans are proposed to split up the overall 'culture' topic: organizational cultures, professional cultures, cultures and social relations, national cultures. In the fourth part of the document, such analysis plans are used to revisit safety assessments that were carried out in the past. In doing so, the relationship between cultural dimensions and safety is defined more precisely and the interest of taking them into account is confirmed

A Discussion of a Risk-Sharing Pension Plan

Directory of Open Access Journals (Sweden)

Catherine Donnelly

2017-02-01

Full Text Available I show that risk-sharing pension plans can reduce some of the shortcomings of defined benefit and defined contributions plans. The risk-sharing pension plan presented aims to improve the stability of benefits paid to generations of members, while allowing them to enjoy the expected advantages of a risky investment strategy. The plan does this by adjusting the investment strategy and benefits in response to a changing funding level, motivated by the with-profits contract proposed by Goecke (2013. He suggests a mean-reverting log reserve (or funding ratio, where mean reversion occurs through adjustments to the investment strategy and declared bonuses. To measure the robustness of the plan to human factors, I introduce a measurement of disappointment, where disappointment is high when there are many consecutive years over which benefit payments are declining. Another measure introduced is devastation, where devastation occurs when benefit payments are zero. The motivation is that members of a pension plan who are easily disappointed or likely to get no benefit, are more likely to exit the plan. I find that the risk-sharing plan offers more disappointment than a defined contribution plan, but it eliminates the devastation possible in a plan that tries to accumulate contributions at a steadily increasing rate. The proposed risk-sharing plan can give a narrower range of benefits than in a defined contribution plan. Thus it can offer a stable benefit to members without the risk of running out of money.

Inverse planning for interstitial gynecologic template brachytherapy: truly anatomy-based planning

International Nuclear Information System (INIS)

Lessard, Etienne; Hsu, I-Chou; Pouliot, Jean

2002-01-01

Purpose: Commercially available optimization schemes generally result in an undesirable dose distribution, because of the particular shapes of tumors extending laterally from the tandem. Dose distribution is therefore manually obtained by adjusting relative dwell time values until an acceptable solution is found. The objective of this work is to present the clinical application of an inverse planning dose optimization tool for the automatic determination of source dwell time values in the treatment of interstitial gynecologic templates. Methods and Materials: In cases where the tumor extends beyond the range of the tandem-ovoid applicator, catheters as well as the tandem are inserted into the paravaginal and parametrial region in an attempt to cover the tumor volume. CT scans of these patients are then used for CT-based dose planning. Dose distribution is obtained manually by varying the relative dwell times until adequate dose coverage is achieved. This manual planning is performed by an experienced physician. In parallel, our in-house inverse planning based on simulated annealing is used to automatically determine which of all possible dwell positions will become active and to calculate the dwell time values needed to fulfill dose constraints applied to the tumor volume and to each organ at risk. To compare the results of these planning methods, dose-volume histograms and isodose distributions were generated for the target and each organ at risk. Results: This procedure has been applied for the dose planning of 12 consecutive interstitial gynecologic templates cases. For all cases, once the anatomy was contoured, the routine of inverse planning based on simulated annealing found the solution to the dose constraints within 1 min of CPU time. In comparison, manual planning took more than 45 min. The inverse planning-generated plans showed improved protection to organs at risk for the same coverage compared to manual planning. Conclusion: This inverse planning tool

Quantifying motion for pancreatic radiotherapy margin calculation

International Nuclear Information System (INIS)

Whitfield, Gillian; Jain, Pooja; Green, Melanie; Watkins, Gillian; Henry, Ann; Stratford, Julie; Amer, Ali; Marchant, Thomas; Moore, Christopher; Price, Patricia

2012-01-01

Background and purpose: Pancreatic radiotherapy (RT) is limited by uncertain target motion. We quantified 3D patient/organ motion during pancreatic RT and calculated required treatment margins. Materials and methods: Cone-beam computed tomography (CBCT) and orthogonal fluoroscopy images were acquired post-RT delivery from 13 patients with locally advanced pancreatic cancer. Bony setup errors were calculated from CBCT. Inter- and intra-fraction fiducial (clip/seed/stent) motion was determined from CBCT projections and orthogonal fluoroscopy. Results: Using an off-line CBCT correction protocol, systematic (random) setup errors were 2.4 (3.2), 2.0 (1.7) and 3.2 (3.6) mm laterally (left–right), vertically (anterior–posterior) and longitudinally (cranio-caudal), respectively. Fiducial motion varied substantially. Random inter-fractional changes in mean fiducial position were 2.0, 1.6 and 2.6 mm; 95% of intra-fractional peak-to-peak fiducial motion was up to 6.7, 10.1 and 20.6 mm, respectively. Calculated clinical to planning target volume (CTV–PTV) margins were 1.4 cm laterally, 1.4 cm vertically and 3.0 cm longitudinally for 3D conformal RT, reduced to 0.9, 1.0 and 1.8 cm, respectively, if using 4D planning and online setup correction. Conclusions: Commonly used CTV–PTV margins may inadequately account for target motion during pancreatic RT. Our results indicate better immobilisation, individualised allowance for respiratory motion, online setup error correction and 4D planning would improve targeting.

User Interaction in Semi-Automatic Segmentation of Organs at Risk: a Case Study in Radiotherapy.

Science.gov (United States)

Ramkumar, Anjana; Dolz, Jose; Kirisli, Hortense A; Adebahr, Sonja; Schimek-Jasch, Tanja; Nestle, Ursula; Massoptier, Laurent; Varga, Edit; Stappers, Pieter Jan; Niessen, Wiro J; Song, Yu

2016-04-01

Accurate segmentation of organs at risk is an important step in radiotherapy planning. Manual segmentation being a tedious procedure and prone to inter- and intra-observer variability, there is a growing interest in automated segmentation methods. However, automatic methods frequently fail to provide satisfactory result, and post-processing corrections are often needed. Semi-automatic segmentation methods are designed to overcome these problems by combining physicians' expertise and computers' potential. This study evaluates two semi-automatic segmentation methods with different types of user interactions, named the "strokes" and the "contour", to provide insights into the role and impact of human-computer interaction. Two physicians participated in the experiment. In total, 42 case studies were carried out on five different types of organs at risk. For each case study, both the human-computer interaction process and quality of the segmentation results were measured subjectively and objectively. Furthermore, different measures of the process and the results were correlated. A total of 36 quantifiable and ten non-quantifiable correlations were identified for each type of interaction. Among those pairs of measures, 20 of the contour method and 22 of the strokes method were strongly or moderately correlated, either directly or inversely. Based on those correlated measures, it is concluded that: (1) in the design of semi-automatic segmentation methods, user interactions need to be less cognitively challenging; (2) based on the observed workflows and preferences of physicians, there is a need for flexibility in the interface design; (3) the correlated measures provide insights that can be used in improving user interaction design.

Tank waste remediation system programmatic risk management plan

International Nuclear Information System (INIS)

Seaver, D.A.

1995-01-01

This risk management plan defines the approach to be taken to managing risks in the Tank Waste Remediation System (TWRS) program. It defines the actions to be taken at the overall program level, and the risk management requirements for lower-level projects and other activities. The primary focus of this plan is on ''programmatic'' risks, i.e., risks with respect to the cost, schedule, and technical performance of the program. The plan defines an approach providing managers with the flexibility to manage risks according to their specific needs, yet creates. The consistency needed for effectiveness across the program. The basic risk management approach uses a risk management list for the program, each project, and additional lower-level activities. The risk management list will be regularly reviewed and updated by appropriate level of management. Each list defines key risks, their likelihood and consequences, risk management actions to be taken, responsible individuals, and other management information

Classification of risks in the process of financial planning

Directory of Open Access Journals (Sweden)

A.V. Overchuk

2017-12-01

Full Text Available The essence of the concept «risk» in the process of financial planning is studied. The classification of risks was conducted. The article provides the full enough and detailed system of classification of risks in the process of financial planning. The author researches and provides the factors, which directly influence upon the size of risks, which accompany the process of financial planning. A complete set of isolated independent features was determined for each risk type. It was found out that a part of features depends only on the risk type and the other part is determined by the character of a risky situation. The article substantiates the presence of indeterminacy typical for dynamic and non-stationary environment and the risks of different nature and strength of influence on the efficiency of financial planning, which cause the necessity to develop and implement the effective system of financial planning at an enterprise.

Study to Determine Adequate Margins in Radiotherapy Planning for Esophageal Carcinoma by Detailing Patterns of Recurrence After Definitive Chemoradiotherapy

International Nuclear Information System (INIS)

Button, Michael R.; Morgan, Carys A.; Croydon, Elizabeth S.; Roberts, S. Ashley; Crosby, Thomas D.L.

2009-01-01

Purpose: To ascertain the adequacy of radiotherapy (RT) margins by studying the relapse patterns after definitive chemoradiotherapy for carcinoma of the esophagus. Methods and Materials: We performed a retrospective study assessing the first site of disease relapse after definitive chemoradiotherapy that included four 3-weekly cycles of cisplatin and continuous infusion 5-fluorouracil, with conformal RT (50 Gy in 25 fractions) concurrent with Cycles 3 and 4. The RT planning target volume was the endoscopic ultrasonography/computed tomography-defined gross tumor volume with 1.5-cm lateral and 3-cm superoinferior margins. Results: A total of 145 patients were included. Their average age was 65.4 years, 45% had adenocarcinoma, 61% had lower third esophageal tumors, and 75% had Stage III-IVA disease. After RT, of 142 patients, 85 (60%) had evidence of relapse at a median follow-up of 18 months. The relapse was local (within the RT field) in 55; distant (metastatic) in 13, and a combination of local and distant in 14. The local relapse rates were not influenced by tumor stage, lymph node status, or disease length. Three patients developed a relapse in regions adjacent to the RT fields; however, it is unlikely that larger field margins would have been clinically acceptable or effective in these cases. The median overall survival was 15 months. Conclusion: The gross tumor volume-planning target volume margins in this study appeared adequate. Future efforts to improve outcomes using definitive chemoradiotherapy should be directed toward reducing the high rates of in-field and distant relapses

Light Water Reactor Sustainability Program Technical Basis Guide Describing How to Perform Safety Margin Configuration Risk Management

Energy Technology Data Exchange (ETDEWEB)

Curtis Smith; James Knudsen; Bentley Harwood

2013-08-01

The INL has carried out a demonstration of the RISMC approach for the purpose of configuration risk management. We have shown how improved accuracy and realism can be achieved by simulating changes in risk – as a function of different configurations – in order to determine safety margins as the plant is modified. We described the various technical issues that play a role in these configuration-based calculations with the intent that future applications can take advantage of the analysis benefits while avoiding some of the technical pitfalls that are found for these types of calculations. Specific recommendations have been provided on a variety of topics aimed at improving the safety margin analysis and strengthening the technical basis behind the analysis process.

Risk-oriented approach application at planning and orginizing antiepidemic provision of mass events

Directory of Open Access Journals (Sweden)

D.V. Efremenko

2017-03-01

for Sochi was accomplished taking the completed assessment into account. The positive experience obtained through risk-oriented organization of certain activities aimed at providing anti-epidemic safety of mass international events on the Russian Federation territory allows us to be optimistic about prospects of wider implementation of the approach described above and other similar approaches based on health risk analysis principles.

The use of active breathing control (ABC) to reduce margin for breathing motion

International Nuclear Information System (INIS)

Wong, John W.; Sharpe, Michael B.; Jaffray, David A.; Kini, Vijay R.; Robertson, John M.; Stromberg, Jannifer S.; Martinez, Alavro A.

1999-01-01

Purpose: For tumors in the thorax and abdomen, reducing the treatment margin for organ motion due to breathing reduces the volume of normal tissues that will be irradiated. A higher dose can be delivered to the target, provided that the risk of marginal misses is not increased. To ensure safe margin reduction, we investigated the feasibility of using active breathing control (ABC) to temporarily immobilize the patient's breathing. Treatment planning and delivery can then be performed at identical ABC conditions with minimal margin for breathing motion. Methods and Materials: An ABC apparatus is constructed consisting of 2 pairs of flow monitor and scissor valve, 1 each to control the inspiration and expiration paths to the patient. The patient breathes through a mouth-piece connected to the ABC apparatus. The respiratory signal is processed continuously, using a personal computer that displays the changing lung volume in real-time. After the patient's breathing pattern becomes stable, the operator activates ABC at a preselected phase in the breathing cycle. Both valves are then closed to immobilize breathing motion. Breathing motion of 12 patients were held with ABC to examine their acceptance of the procedure. The feasibility of applying ABC for treatment was tested in 5 patients by acquiring volumetric scans with a spiral computed tomography (CT) scanner during active breath-hold. Two patients had Hodgkin's disease, 2 had metastatic liver cancer, and 1 had lung cancer. Two intrafraction ABC scans were acquired at the same respiratory phase near the end of normal or deep inspiration. An additional ABC scan near the end of normal expiration was acquired for 2 patients. The ABC scans were also repeated 1 week later for a Hodgkin's patient. In 1 liver patient, ABC scans were acquired at 7 different phases of the breathing cycle to facilitate examination of the liver motion associated with ventilation. Contours of the lungs and livers were outlined when applicable

ENTERPRISE OPERATION PLANNING IN THE CONDITIONS OF RISK AND UNCERTAINTY IN THE EXTERNAL AND INTERNAL ENVIRONMENT

Directory of Open Access Journals (Sweden)

Titov V. V.

2017-09-01

Full Text Available Optimization of the enterprise activity planning taking into account the risk and uncertainty of the external and internal environment is a complex scientific and methodological problem. Its solution is important for the planning practice. Therefore, the relevance of this research topic is beyond doubt. Planning is based on the use of a multilevel system of models. At the top level, the achievement of key strategic indicators is ensured by the development and implementation of innovations, mainly related to the planning of the release of new high-tech products. However, it is at this level that the risks and uncertainties have the greatest impact on the planning processes for the development, production and marketing of new products. In the scientific literature it is proposed to use the stochastic graphs with returns for this purpose. This idea is also supported in this work. However, the implementation of such an idea requires additional methodological developments and quantitative calculations. The coordination of strategic decisions with tactical plans is based on the idea of eliminating the economic and other risks associated with the economic activity of the enterprise in tactical planning, by creating the stochastic reserves based on the implementation of additional innovations that ensure the receipt of above-target sales volumes, profits and other indicators of the strategic plan. The organization of operational management of production is represented by an iterative, sliding process (reducing risks in production, which is realized taking into account the limitations of tactical control.

Risk-based flood protection planning under climate change and modeling uncertainty: a pre-alpine case study

Directory of Open Access Journals (Sweden)

B. Dittes

2018-05-01

Full Text Available Planning authorities are faced with a range of questions when planning flood protection measures: is the existing protection adequate for current and future demands or should it be extended? How will flood patterns change in the future? How should the uncertainty pertaining to this influence the planning decision, e.g., for delaying planning or including a safety margin? Is it sufficient to follow a protection criterion (e.g., to protect from the 100-year flood or should the planning be conducted in a risk-based way? How important is it for flood protection planning to accurately estimate flood frequency (changes, costs and damage? These are questions that we address for a medium-sized pre-alpine catchment in southern Germany, using a sequential Bayesian decision making framework that quantitatively addresses the full spectrum of uncertainty. We evaluate different flood protection systems considered by local agencies in a test study catchment. Despite large uncertainties in damage, cost and climate, the recommendation is robust for the most conservative approach. This demonstrates the feasibility of making robust decisions under large uncertainty. Furthermore, by comparison to a previous study, it highlights the benefits of risk-based planning over the planning of flood protection to a prescribed return period.

Risk-based flood protection planning under climate change and modeling uncertainty: a pre-alpine case study

Science.gov (United States)

Dittes, Beatrice; Kaiser, Maria; Špačková, Olga; Rieger, Wolfgang; Disse, Markus; Straub, Daniel

2018-05-01

Planning authorities are faced with a range of questions when planning flood protection measures: is the existing protection adequate for current and future demands or should it be extended? How will flood patterns change in the future? How should the uncertainty pertaining to this influence the planning decision, e.g., for delaying planning or including a safety margin? Is it sufficient to follow a protection criterion (e.g., to protect from the 100-year flood) or should the planning be conducted in a risk-based way? How important is it for flood protection planning to accurately estimate flood frequency (changes), costs and damage? These are questions that we address for a medium-sized pre-alpine catchment in southern Germany, using a sequential Bayesian decision making framework that quantitatively addresses the full spectrum of uncertainty. We evaluate different flood protection systems considered by local agencies in a test study catchment. Despite large uncertainties in damage, cost and climate, the recommendation is robust for the most conservative approach. This demonstrates the feasibility of making robust decisions under large uncertainty. Furthermore, by comparison to a previous study, it highlights the benefits of risk-based planning over the planning of flood protection to a prescribed return period.

Computing Services Planning, Downsizing, and Organization at the University of Alberta.

Science.gov (United States)

Beltrametti, Monica

1993-01-01

In a six-month period, the University of Alberta (Canada) campus computing services department formulated a strategic plan, and downsized and reorganized to meet financial constraints and respond to changing technology, especially distributed computing. The new department is organized to react more effectively to trends in technology and user…

Reliability and risk analysis methods research plan

International Nuclear Information System (INIS)

1984-10-01

This document presents a plan for reliability and risk analysis methods research to be performed mainly by the Reactor Risk Branch (RRB), Division of Risk Analysis and Operations (DRAO), Office of Nuclear Regulatory Research. It includes those activities of other DRAO branches which are very closely related to those of the RRB. Related or interfacing programs of other divisions, offices and organizations are merely indicated. The primary use of this document is envisioned as an NRC working document, covering about a 3-year period, to foster better coordination in reliability and risk analysis methods development between the offices of Nuclear Regulatory Research and Nuclear Reactor Regulation. It will also serve as an information source for contractors and others to more clearly understand the objectives, needs, programmatic activities and interfaces together with the overall logical structure of the program

Comparison of Safety Margin Generation Concepts in Image Guided Radiotherapy to Account for Daily Head and Neck Pose Variations.

Science.gov (United States)

Stoll, Markus; Stoiber, Eva Maria; Grimm, Sarah; Debus, Jürgen; Bendl, Rolf; Giske, Kristina

2016-01-01

Intensity modulated radiation therapy (IMRT) of head and neck tumors allows a precise conformation of the high-dose region to clinical target volumes (CTVs) while respecting dose limits to organs a risk (OARs). Accurate patient setup reduces translational and rotational deviations between therapy planning and therapy delivery days. However, uncertainties in the shape of the CTV and OARs due to e.g. small pose variations in the highly deformable anatomy of the head and neck region can still compromise the dose conformation. Routinely applied safety margins around the CTV cause higher dose deposition in adjacent healthy tissue and should be kept as small as possible. In this work we evaluate and compare three approaches for margin generation 1) a clinically used approach with a constant isotropic 3 mm margin, 2) a previously proposed approach adopting a spatial model of the patient and 3) a newly developed approach adopting a biomechanical model of the patient. All approaches are retrospectively evaluated using a large patient cohort of over 500 fraction control CT images with heterogeneous pose changes. Automatic methods for finding landmark positions in the control CT images are combined with a patient specific biomechanical finite element model to evaluate the CTV deformation. The applied methods for deformation modeling show that the pose changes cause deformations in the target region with a mean motion magnitude of 1.80 mm. We found that the CTV size can be reduced by both variable margin approaches by 15.6% and 13.3% respectively, while maintaining the CTV coverage. With approach 3 an increase of target coverage was obtained. Variable margins increase target coverage, reduce risk to OARs and improve healthy tissue sparing at the same time.

Information security risk management and incompatible parts of organization

Energy Technology Data Exchange (ETDEWEB)

Talabeigi, E.; Naeeini, S.G.J.

2016-07-01

Purpose: we prepared a questionnaire to evaluate Incompatible parts and also risk management in University of Science and Technology E-Learning Center and studying the Incompatible parts impacts on utility of organization. Design/methodology/approach: By using coalitional game theory we present a new model to recognize the degrees of incompatibility among independent divisions of an organization with dependent security assets. Based on positive and negative interdependencies in the parts, the model provides how the organization can decrease the security risks through non-cooperation rather than cooperation. we implement the proposed model of this paper by analyzing the data which have been provided by questionnaires from different three managers' ideas of Iran University of Science and Technology E-Learning Center located in Iran University of Science and Technology, Tehran, Iran. Findings: In general, by collecting data and analyzing them, the survey showed that Incompatible parts of organizations have negative impacts on utility of organization risk management process. Furthermore, it adds values to other organizations and provides the best practices in planning, developing, implementing and monitoring risk management in organizations. Research limitations/implications: Since Information security and also Risk Management are still areas which need to improve in some Iranian universities, we couldn’t consider them in our analysis. On the other hand, due to questionnaire limitation, the study’s sample size is 1. This size may be considered large for our statistical analysis. Originality/value: The main contribution of this paper is to propose a model for non-cooperation among a number of divisions in a organization and using risk management factors.

Information security risk management and incompatible parts of organization

International Nuclear Information System (INIS)

Talabeigi, E.; Naeeini, S.G.J.

2016-01-01

Purpose: we prepared a questionnaire to evaluate Incompatible parts and also risk management in University of Science and Technology E-Learning Center and studying the Incompatible parts impacts on utility of organization. Design/methodology/approach: By using coalitional game theory we present a new model to recognize the degrees of incompatibility among independent divisions of an organization with dependent security assets. Based on positive and negative interdependencies in the parts, the model provides how the organization can decrease the security risks through non-cooperation rather than cooperation. we implement the proposed model of this paper by analyzing the data which have been provided by questionnaires from different three managers' ideas of Iran University of Science and Technology E-Learning Center located in Iran University of Science and Technology, Tehran, Iran. Findings: In general, by collecting data and analyzing them, the survey showed that Incompatible parts of organizations have negative impacts on utility of organization risk management process. Furthermore, it adds values to other organizations and provides the best practices in planning, developing, implementing and monitoring risk management in organizations. Research limitations/implications: Since Information security and also Risk Management are still areas which need to improve in some Iranian universities, we couldn’t consider them in our analysis. On the other hand, due to questionnaire limitation, the study’s sample size is 1. This size may be considered large for our statistical analysis. Originality/value: The main contribution of this paper is to propose a model for non-cooperation among a number of divisions in a organization and using risk management factors.

Role of regional planning organizations in transportation planning across boundaries

Science.gov (United States)

2014-06-11

The Volpe Center conducted research for the Federal Highway Administration Office of Planning that explores the implications of Regional Planning Organizations (RPO) engaging in transportation planning partnerships and projects of megaregions signifi...

Dose evaluation and risk estimation for secondary cancer in contralateral breast and a study of correlation between thorax shape and dose to organs at risk following tangentially breast irradiation during deep inspiration breath-hold and free breathing

International Nuclear Information System (INIS)

Johansen, Safora; Vikstroem, Johan; Blihovde Hjelstuen, Mari Helene; Mjaaland, Ingvil; Dybvik, Kjell Ivar; Olsen, Dag Rune

2011-01-01

Purpose: To assess the impact of using breathing adapted radiotherapy on contralateral breast (CB) dose, to relate the thorax shape with the dose to the organs at risk (OARs) and to predict the risk for induced malignancies in CB using linear and non-linear models, following tangential irradiation of breast. Material and methods. Sixteen patients with stage I-II breast cancer treatment planned with tangential fields using deep inspiration breath hold (DIBH) and free breathing (FB) techniques were included in this analysis. The dose results mainly based on DVH analysis were compared. Four parameters were defined to describe thoracic shape. Excess relative risk (ERR) for cancer induction in CB, employing linear and non-linear models was calculated. Results. Average CB volumes exposed to a dose of 1 Gy is 1.3 times higher in DIBH plans than in FB plans. No significant difference in average V3Gy and V5Gy for DIBH and FB plans is observed. The average mean CB dose for DIBH and FB plans is 0.33 and 0.28 Gy, respectively. No correlation between thorax shape parameters and mean OARs dose is observed. The estimated average mean ERR with linear model is lower in FB plans (0.12) than for the DIBH plans (0.14). The estimated ERR with non-linear model is 0.14 for DIBH plans and 0.15 for FB plans. Conclusion. No significant difference in CB dose between DIBH and FB plans is observed. The four thorax shape parameters defined in this study can not be related to the dose at OARs using DIBH and FB radiation techniques. The ERR estimates for secondary CB cancer are nearly the same for FB and DIBH planning when using a linear and non-linear risk prediction models

Robust Proton Pencil Beam Scanning Treatment Planning for Rectal Cancer Radiation Therapy

International Nuclear Information System (INIS)

Blanco Kiely, Janid Patricia; White, Benjamin M.

2016-01-01

Purpose: To investigate, in a treatment plan design and robustness study, whether proton pencil beam scanning (PBS) has the potential to offer advantages, relative to interfraction uncertainties, over photon volumetric modulated arc therapy (VMAT) in a locally advanced rectal cancer patient population. Methods and Materials: Ten patients received a planning CT scan, followed by an average of 4 weekly offline CT verification CT scans, which were rigidly co-registered to the planning CT. Clinical PBS plans were generated on the planning CT, using a single-field uniform-dose technique with single-posterior and parallel-opposed (LAT) fields geometries. The VMAT plans were generated on the planning CT using 2 6-MV, 220° coplanar arcs. Clinical plans were forward-calculated on verification CTs to assess robustness relative to anatomic changes. Setup errors were assessed by forward-calculating clinical plans with a ±5-mm (left–right, anterior–posterior, superior–inferior) isocenter shift on the planning CT. Differences in clinical target volume and organ at risk dose–volume histogram (DHV) indicators between plans were tested for significance using an appropriate Wilcoxon test (P<.05). Results: Dosimetrically, PBS plans were statistically different from VMAT plans, showing greater organ at risk sparing. However, the bladder was statistically identical among LAT and VMAT plans. The clinical target volume coverage was statistically identical among all plans. The robustness test found that all DVH indicators for PBS and VMAT plans were robust, except the LAT's genitalia (V5, V35). The verification CT plans showed that all DVH indicators were robust. Conclusions: Pencil beam scanning plans were found to be as robust as VMAT plans relative to interfractional changes during treatment when posterior beam angles and appropriate range margins are used. Pencil beam scanning dosimetric gains in the bowel (V15, V20) over VMAT suggest that using PBS to treat rectal cancer

Robust Proton Pencil Beam Scanning Treatment Planning for Rectal Cancer Radiation Therapy

Energy Technology Data Exchange (ETDEWEB)

Blanco Kiely, Janid Patricia, E-mail: jkiely@sas.upenn.edu; White, Benjamin M.

2016-05-01

Purpose: To investigate, in a treatment plan design and robustness study, whether proton pencil beam scanning (PBS) has the potential to offer advantages, relative to interfraction uncertainties, over photon volumetric modulated arc therapy (VMAT) in a locally advanced rectal cancer patient population. Methods and Materials: Ten patients received a planning CT scan, followed by an average of 4 weekly offline CT verification CT scans, which were rigidly co-registered to the planning CT. Clinical PBS plans were generated on the planning CT, using a single-field uniform-dose technique with single-posterior and parallel-opposed (LAT) fields geometries. The VMAT plans were generated on the planning CT using 2 6-MV, 220° coplanar arcs. Clinical plans were forward-calculated on verification CTs to assess robustness relative to anatomic changes. Setup errors were assessed by forward-calculating clinical plans with a ±5-mm (left–right, anterior–posterior, superior–inferior) isocenter shift on the planning CT. Differences in clinical target volume and organ at risk dose–volume histogram (DHV) indicators between plans were tested for significance using an appropriate Wilcoxon test (P<.05). Results: Dosimetrically, PBS plans were statistically different from VMAT plans, showing greater organ at risk sparing. However, the bladder was statistically identical among LAT and VMAT plans. The clinical target volume coverage was statistically identical among all plans. The robustness test found that all DVH indicators for PBS and VMAT plans were robust, except the LAT's genitalia (V5, V35). The verification CT plans showed that all DVH indicators were robust. Conclusions: Pencil beam scanning plans were found to be as robust as VMAT plans relative to interfractional changes during treatment when posterior beam angles and appropriate range margins are used. Pencil beam scanning dosimetric gains in the bowel (V15, V20) over VMAT suggest that using PBS to treat rectal

The relationship between the bladder volume and optimal treatment planning in definitive radiotherapy for localized prostate cancer

International Nuclear Information System (INIS)

Nakamura, Naoki; Sekiguchi, Kenji; Akahane, Keiko; Shikama, Naoto; Takahashi, Osamu; Hama, Yukihiro; Nakagawa, Keiichi

2012-01-01

Background and purpose: There is no current consensus regarding the optimal bladder volumes in definitive radiotherapy for localized prostate cancer. The aim of this study was to clarify the relationship between the bladder volume and optimal treatment planning in radiotherapy for localized prostate cancer. Material and methods: Two hundred and forty-three patients underwent definitive radiotherapy with helical tomotherapy for intermediate- and high-risk localized prostate cancer. The prescribed dose defined as 95 % of the planning target volume (PTV) receiving 100 % of the prescription dose was 76 Gy in 38 fractions. The clinical target volume (CTV) was defined as the prostate with a 5-mm margin and 2 cm of the proximal seminal vesicle. The PTV was defined as the CTV with a 5-mm margin. Treatment plans were optimized to satisfy the dose constraints defined by in-house protocols for PTV and organs at risk (rectum wall, bladder wall, sigmoid colon and small intestine). If all dose constraints were satisfied, the plan was defined as an optimal plan (OP). Results: An OP was achieved with 203 patients (84%). Mean bladder volume (± 1 SD) was 266 ml (± 130 ml) among those with an OP and 214 ml (±130 ml) among those without an OP (p = 0.02). Logistic regression analysis also showed that bladder volumes below 150 ml decreased the possibility of achieving an OP. However, the percentage of patients with an OP showed a plateau effect at bladder volumes above 150 ml. Conclusions. Bladder volume is a significant factor affecting OP rates. However, our results suggest that bladder volumes exceeding 150 ml may not help meet planning dose constraints

Risk management plans as a tool for proactive pharmacovigilance

DEFF Research Database (Denmark)

Vermeer, N S; Duijnhoven, R G; Straus, S M J M

2014-01-01

Risk Management Plans (RMPs) have become a cornerstone in the pharmacovigilance of new drugs in Europe. The RMP was introduced in 2005 to support a proactive approach in gaining knowledge on safety concerns through early planning of pharmacovigilance activities. However, the rate at which...... of uncertainties, suggests that opportunities for optimization exist while ensuring feasible and risk-proportionate pharmacovigilance planning....

Overview of the Hanford risk management plan

International Nuclear Information System (INIS)

Halverson, T.G.

1998-01-01

The Project Hanford Management Contract called for the enhancement of site-wide decision processes, and development of a Hanford Risk Management Plan to adopt or develop a risk management system for the Hanford Site. This Plan provides a consistent foundation for Site issues and addresses site-wide management of risks of all types. It supports the Department of Energy planning and sitewide decision making policy. Added to this requirement is a risk performance report to characterize the risk management accomplishments. This paper presents the development of risk management within the context of work planning and performance. Also discussed are four risk elements which add value to the context

Experimental validation of the van Herk margin formula for lung radiation therapy

International Nuclear Information System (INIS)

Ecclestone, Gillian; Heath, Emily; Bissonnette, Jean-Pierre

2013-01-01

Purpose: To validate the van Herk margin formula for lung radiation therapy using realistic dose calculation algorithms and respiratory motion modeling. The robustness of the margin formula against variations in lesion size, peak-to-peak motion amplitude, tissue density, treatment technique, and plan conformity was assessed, along with the margin formula assumption of a homogeneous dose distribution with perfect plan conformity.Methods: 3DCRT and IMRT lung treatment plans were generated within the ORBIT treatment planning platform (RaySearch Laboratories, Sweden) on 4DCT datasets of virtual phantoms. Random and systematic respiratory motion induced errors were simulated using deformable registration and dose accumulation tools available within ORBIT for simulated cases of varying lesion sizes, peak-to-peak motion amplitudes, tissue densities, and plan conformities. A detailed comparison between the margin formula dose profile model, the planned dose profiles, and penumbra widths was also conducted to test the assumptions of the margin formula. Finally, a correction to account for imperfect plan conformity was tested as well as a novel application of the margin formula that accounts for the patient-specific motion trajectory.Results: The van Herk margin formula ensured full clinical target volume coverage for all 3DCRT and IMRT plans of all conformities with the exception of small lesions in soft tissue. No dosimetric trends with respect to plan technique or lesion size were observed for the systematic and random error simulations. However, accumulated plans showed that plan conformity decreased with increasing tumor motion amplitude. When comparing dose profiles assumed in the margin formula model to the treatment plans, discrepancies in the low dose regions were observed for the random and systematic error simulations. However, the margin formula respected, in all experiments, the 95% dose coverage required for planning target volume (PTV) margin derivation, as

Risk impact of planned maintenance configuration at South Texas Project Electric Generating Station

International Nuclear Information System (INIS)

Loh, W.T.; Fleming, K.N.; Grantom, C.R.

2004-01-01

This paper is based on a study done for the Houston Lighting and Power Company. The purpose of this study is to estimate the risk impact of planned maintenance configurations at South Texas Project Electric Generating Station (STPEGS). To date, the focus of the STP probabilistic safety assessment (PSA) program has been to analyze risk in terms of estimates of accident frequencies that are expressed on a time-averaged basis. Thus, estimates of quantities such as severe core damage frequency have been made such that the temporal variations of this frequency with changing plant configurations are averaged out over time. The only condition that has been imposed on these estimates is that the plant is initially operating at full power when potential initiating events might occur. (author)

Assessing the Financial Condition of Provider-Sponsored Health Plans.

Science.gov (United States)

McCue, Michael J

2015-06-01

The aim of this study was to assess the performance of health plans sponsored by provider organizations, with respect to plans generating strong positive cash flow relative to plans generating weaker cash flow. A secondary aim was to assess their capital adequacy. The study identified 24 provider-sponsored health plans (PSHPs) with an average positive cash flow margin from 2011 through 2013 at or above the top 75th percentile, defined as "strong cash flow PSHPs:" This group was compared with 72 PSHPs below the 75th percentile, defined as "weak cash flow PSHPs:" Atlantic Information Services Directory of Health Plans was used to identify the PSHPs. Financial ratios were computed from 2013 National Association of Insurance Commissioners Financial Filings. The study conducted a t test mean comparison between strong and weak cash flow PSHPs across an array of financial performance and capital adequacy measures. In 2013, the strong cash flow PSHPs averaged a cash-flow margin ratio of 6.6%. Weak cash flow PSHPs averaged a cash-flow margin of -0.4%. The net worth capital position of both groups was more than 4.5 times authorized capital. The operational analysis shows that strong cash-flow margin PSHPs are managing their medical costs to achieve this position. Although their medical loss ratio increased by almost 300 basis points from 2011 to 2013, it was still statistically significantly lower than the weaker cash flow PSHP group (P<.001). In terms of capital adequacy, both strong and weak cash-flow margin PSHP groups possessed sufficient capital to ensure the viability of these plans.

Light Water Reactor Sustainability Program: Risk-Informed Safety Margins Characterization (RISMC) Pathway Technical Program Plan

International Nuclear Information System (INIS)

Smith, Curtis; Rabiti, Cristian; Martineau, Richard; Szilard, Ronaldo

2016-01-01

Safety is central to the design, licensing, operation, and economics of Nuclear Power Plants (NPPs). As the current Light Water Reactor (LWR) NPPs age beyond 60 years, there are possibilities for increased frequency of Systems, Structures, and Components (SSCs) degradations or failures that initiate safety-significant events, reduce existing accident mitigation capabilities, or create new failure modes. Plant designers commonly ''over-design'' portions of NPPs and provide robustness in the form of redundant and diverse engineered safety features to ensure that, even in the case of well-beyond design basis scenarios, public health and safety will be protected with a very high degree of assurance. This form of defense-in-depth is a reasoned response to uncertainties and is often referred to generically as ''safety margin.'' Historically, specific safety margin provisions have been formulated, primarily based on ''engineering judgment.''

Unforeseen risk and planning perspectives

International Nuclear Information System (INIS)

Kobayashi, Kiyoshi

2013-01-01

In traditional methodologies of engineering and risk analysis, it is the widely accepted presumption to delineate the scope of consideration by excluding uncertain events with extremely low probabilities, and to seek the rational means to maneuver the presumed risks in rational ways. But we learned these conventional wisdoms are no longer valid from the last earthquake in the Eastern Japan to cope with the unexpected huge disaster. In this article, I still wish to accept a paradigm at the first place that any kinds of analytical investigation for planning cannot stand without presumed comprehension of the world, but to acknowledge its insufficiency. I am motivated to seek the plausible philosophical foundations for risk management which could partly mitigate the methodological limitation driven by cognitive capacities of human beings. The article tries to contemplate the basic issues which may exist in risk communications between professionals and nonprofessional. The paper is concluded by illustrating some basic problems related to practices and researches in infrastructure planning and perspectives for human betterment. (author)

Information security risk management and incompatible parts of organization

Directory of Open Access Journals (Sweden)

Elham Talabeigi

2016-11-01

Full Text Available Purpose: we prepared a questionnaire to evaluate Incompatible parts and also risk management in University of Science and Technology E-Learning Center and studying the Incompatible parts impacts on utility of organization. Design/methodology/approach: By using coalitional game theory we present a new model to recognize the degrees of incompatibility among independent divisions of an organization with dependent security assets. Based on positive and negative interdependencies in the parts, the model provides how the organization can decrease the security risks through non-cooperation rather than cooperation. we implement the proposed model of this paper by analyzing the data which have been provided by questionnaires from different three managers' ideas of Iran University of Science and Technology E-Learning Center located in Iran University of Science and Technology, Tehran, Iran. Findings: In general, by collecting data and analyzing them, the survey showed that Incompatible parts of organizations have negative impacts on utility of organization risk management process. Furthermore, it adds values to other organizations and provides the best practices in planning, developing, implementing and monitoring risk management in organizations. Research limitations/implications: Since Information security and also Risk Management are still areas which need to improve in some Iranian universities, we couldn’t consider them in our analysis. On the other hand, due to questionnaire limitation, the study’s sample size is 1. This size may be considered large for our statistical analysis. Originality/value:  The main contribution of this paper is to propose a model for non-cooperation among a number of divisions in a organization and using risk management factors.

Recommendations for the delineation of organs at risk in ENT radiotherapy

International Nuclear Information System (INIS)

Ali, D.; Halimi, P.; Berges, O.; Deberne, M.; Botti, M.; Giraud, P.; Servagi-Vernat, S.

2011-01-01

Based on a literature survey, the authors propose recommendations for the delineation of the pharyngeal constrictor muscles, inner ear, larynx, buccal cavity, and temporomandibular joint. These recommendations of delineation of organs at risk are related to the functional anatomy of the considered structures, and correspond to volumes used in published surveys on dose-volume toxicity. They are simple and reproducible. Short communication

Light Water Reactor Sustainability Program Risk-Informed Safety Margins Characterization (RISMC) PathwayTechnical Program Plan

Energy Technology Data Exchange (ETDEWEB)

Curtis Smith; Cristian Rabiti; Richard Martineau

2012-11-01

Safety is central to the design, licensing, operation, and economics of Nuclear Power Plants (NPPs). As the current Light Water Reactor (LWR) NPPs age beyond 60 years, there are possibilities for increased frequency of Systems, Structures, and Components (SSCs) degradations or failures that initiate safety-significant events, reduce existing accident mitigation capabilities, or create new failure modes. Plant designers commonly “over-design” portions of NPPs and provide robustness in the form of redundant and diverse engineered safety features to ensure that, even in the case of well-beyond design basis scenarios, public health and safety will be protected with a very high degree of assurance. This form of defense-in-depth is a reasoned response to uncertainties and is often referred to generically as “safety margin.” Historically, specific safety margin provisions have been formulated, primarily based on “engineering judgment.”

Light Water Reactor Sustainability Program: Risk-Informed Safety Margins Characterization (RISMC) Pathway Technical Program Plan

Energy Technology Data Exchange (ETDEWEB)

Smith, Curtis [Idaho National Lab. (INL), Idaho Falls, ID (United States); Rabiti, Cristian [Idaho National Lab. (INL), Idaho Falls, ID (United States); Martineau, Richard [Idaho National Lab. (INL), Idaho Falls, ID (United States); Szilard, Ronaldo [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2016-09-01

Safety is central to the design, licensing, operation, and economics of Nuclear Power Plants (NPPs). As the current Light Water Reactor (LWR) NPPs age beyond 60 years, there are possibilities for increased frequency of Systems, Structures, and Components (SSCs) degradations or failures that initiate safety-significant events, reduce existing accident mitigation capabilities, or create new failure modes. Plant designers commonly “over-design” portions of NPPs and provide robustness in the form of redundant and diverse engineered safety features to ensure that, even in the case of well-beyond design basis scenarios, public health and safety will be protected with a very high degree of assurance. This form of defense-in-depth is a reasoned response to uncertainties and is often referred to generically as “safety margin.” Historically, specific safety margin provisions have been formulated, primarily based on “engineering judgment.”

Robust Production Planning in Fashion Apparel Industry under Demand Uncertainty via Conditional Value at Risk

Directory of Open Access Journals (Sweden)

Abderrahim Ait-Alla

2014-01-01

Full Text Available This paper presents a mathematical model for robust production planning. The model helps fashion apparel suppliers in making decisions concerning allocation of production orders to different production plants characterized by different lead times and production costs, and in proper time scheduling and sequencing of these production orders. The model aims at optimizing these decisions concerning objectives of minimal production costs and minimal tardiness. It considers several factors such as the stochastic nature of customer demand, differences in production and transport costs and transport times between production plants in different regions. Finally, the model is applied to a case study. The results of numerical computations are presented. The implications of the model results on different fashion related product types and delivery strategies, as well as the model’s limitations and potentials for expansion, are discussed. Results indicate that the production planning model using conditional value at risk (CVaR as the risk measure performs robustly and provides flexibility in decision analysis between different scenarios.

Risk perception in planning

Energy Technology Data Exchange (ETDEWEB)

Roh, S K

1987-01-01

The general public's perception of the risks involved with hazardous industries is increasing, especially in countries that high environmental amenity characteristics. This increased public awareness of risk may be an important factor in the future of countries who produce a large quantity of petroleum and chemical products. However, existing decision-making processes for determining safety controls do not take sufficient account of the community perception of risk. Identification of perceived risk levels could contribute to the determination of safe land-use planning policies and practices. The objective of land-use planning for hazardous industries is to reduce the gap between the calculated or technical assessment of risk and the risk as perceived by the community. This also facilitates a balanced approach in the decision making process between meeting industry requirements and community concerns. The comprehensive analysis presented in this study, based on a questionnaire given to residents in each of the three study areas (Australia, Japan and Korea), focused on identifying and measuring the respondent's understanding of the risk posed by nearby hazardous industrial developments.

SU-F-T-429: Craniospinal Irradiation by VMAT Technique: Impact of FFF Beam and High Resolution MLC On Plan Quality

Energy Technology Data Exchange (ETDEWEB)

Ganesh, T; Sarkar, B; Munshi, A; Mohanti, B [Fortis Memorial Research Institute, Gurgaon, Haryana (India)

2016-06-15

Purpose: Objective of this study was to evaluate the impact of using flattening filter free (FFF) beam with 0.5 cm multileaf collimator (MLC) leaves over conventional flattened beam with 1 cm leaf width MLC on the treatment plan quality in cranio-spinal irradiation (CSI). Methods: For five medulloblastoma cases (3 males and 2 females), who were previously treated by volumetric modulated arc therapy (VMAT) technique using conventional flattened beam shaped by 1 cm width MLC leaves, four test plans were generated and compared against the delivered plan. These retrospective plans consisted of four different combinations of flattened and FFF beams from Elekta’s Agility treatment head with 0.5 cm width MLC leaves. Sparing of organs at risks (OAR) in terms of dose to 5%, 50%, 75% and 90% volumes, mean and maximum dose were evaluated. Results: All plans satisfied the planning objective of covering 95% of PTV by at least 95% of prescription dose. Marginal variation of dose spillage was observed between different VMAT plans at very low dose range (1–5 Gy). Variation in dose statistics for PTVs and OARs were within 1% or 1 Gy. Amongst the five plans, the plan with flattened beam with 1 cm MLC had the highest number of MUs, 2.13 times higher than the plan with Agility MLC with FFF beam that had the least number of MUs. No statistically significant difference (p≥0.05) was observed between the reference plan and the retrospectively generated plans in terms of PTV coverage, cold spot, hot spot and organ at risk doses. Conclusion: In the treatment of CSI cases by VMAT technique, FFF beams and/or finer width MLC did not exhibit advantage over the flattened beams or wider MLC in terms of plan quality except for reduction in MUs.

Integration of oncologic margins in three-dimensional virtual planning for head and neck surgery, including a validation of the software pathway

NARCIS (Netherlands)

Kraeima, Joep; Schepers, Rutger H.; van Ooijen, Peter M. A.; Steenbakkers, Roel J. H. M.; Roodenburg, Jan L. N.; Witjes, Max J. H.

2015-01-01

Purpose: Three-dimensional (3D) virtual planning of reconstructive surgery, after resection, is a frequently used method for improving accuracy and predictability. However, when applied to malignant cases, the planning of the oncologic resection margins is difficult due to visualisation of tumours

Organs at risk in the brain and their dose-constraints in adults and in children: A radiation oncologist’s guide for delineation in everyday practice

International Nuclear Information System (INIS)

Scoccianti, Silvia; Detti, Beatrice; Gadda, Davide; Greto, Daniela; Furfaro, Ilaria; Meacci, Fiammetta; Simontacchi, Gabriele; Di Brina, Lucia; Bonomo, Pierluigi; Giacomelli, Irene; Meattini, Icro; Mangoni, Monica; Cappelli, Sabrina; Cassani, Sara; Talamonti, Cinzia; Bordi, Lorenzo; Livi, Lorenzo

2015-01-01

Purpose: Accurate organs at risk definition is essential for radiation treatment of brain tumors. The aim of this study is to provide a stepwise and simplified contouring guide to delineate the OARs in the brain as it would be done in the everyday practice of planning radiotherapy for brain cancer treatment. Methods: Anatomical descriptions and neuroimaging atlases of the brain were studied. The dosimetric constraints used in literature were reviewed. Results: A Computed Tomography and Magnetic Resonance Imaging based detailed atlas was developed jointly by radiation oncologists, a neuroradiologist and a neurosurgeon. For each organ brief anatomical notion, main radiological reference points and useful considerations are provided. Recommended dose-constraints both for adult and pediatric patients were also provided. Conclusions: This report provides guidelines for OARs delineation and their dose-constraints for the treatment planning of patients with brain tumors

Doses to organs at cerebral risks: optimization by robotized stereotaxic radiotherapy and automatic segmentation atlas versus three dimensional conformal radiotherapy

International Nuclear Information System (INIS)

Bondiau, P.Y.; Thariat, J.; Benezery, K.; Herault, J.; Dalmasso, C.; Marcie, S.; Malandain, G.

2007-01-01

The stereotaxic radiotherapy robotized by 'Cyberknife fourth generation' allows a dosimetric optimization with a high conformity index on the tumor and radiation doses limited on organs at risk. A cerebral automatic anatomic segmentation atlas of organs at risk are used in routine in three dimensions. This study evaluated the superiority of the stereotaxic radiotherapy in comparison with the three dimensional conformal radiotherapy on the preservation of organs at risk in regard of the delivered dose to tumors justifying an accelerated hypo fractionation and a dose escalation. This automatic segmentation atlas should allow to establish correlations between anatomy and cerebral dosimetry; This atlas allows to underline the dosimetry optimization by stereotaxic radiotherapy robotized for organs at risk. (N.C.)

Design of planning target volume margin using an active breathing control and Varian image-guided radiotherapy (IGRT) system in unresectable liver tumor

International Nuclear Information System (INIS)

Yue Jinbo; Yu Jinming; Liu Jing; Liu Tonghai; Yin Yong; Shi Xuetao; Song Jinlong

2007-01-01

Objective: To define the planning target volume(PTV) margin with an active breathing control (ABC) and the Varian image-guided radiotherapy (IGRT) system. Methods: Thirteen patients with liver cancer were treated with radiotherapy from May 2006 to September 2006. Prior to radiotherapy, all patients had undergone transarterial chemoembolization (TACE) by infusing a mixture of iodized oil contrast medium and chemotherapeutic agents, kV fluoroscopy was used to measure the potential motion of lipiodol spot positions during ABC breath-holds. ABC was used for planning CT scan and radiation delivery, with the breath held at the same phase of the respiratory cycle (near end-exhalation). Cone beam CT (CBCT) was taken using Varian IGRT system, which was then compared online with planning CT using a 3 D-3 D matching tool. Analysis relied on lipiodol spots on planning CT and CBCT manually. The treatment table was moved to produce acceptable setup before treatment delivery. Repeated CBCT image and another analysis were obtained after irradiation. Results: No motion of the intrahepatic tumor was observed on fluoroscopy during ABC breath-holds. The estimated required PTV margins, calculated according to the Stroom formula, were 4.4 mm, 5.3 mm and 7.8 mm in the x, y and z axis directions before radiotherapy. The corresponding parameters were 2.5m, 2.6 mm and 3.9 mm after radiotherapy. Conclusions: We have adopted a PTV margin of 5 mm, 6 mm and 8 mm in the x, y and z axis directions with ABC, and 3,3 and 4 mm with ABC and on-line kilovoltage CBCT. (authors)

Negotiating autonomy at the margins of the state

DEFF Research Database (Denmark)

Eilenberg, Michael

2009-01-01

Recent processes of decentralization have dramatically changed local political configurations and access to resources throughout Indonesia. In particular, the resource-rich regions at the margins of the state have, in the name of regional autonomy, experienced new spaces for manoeuvre in their cl......Recent processes of decentralization have dramatically changed local political configurations and access to resources throughout Indonesia. In particular, the resource-rich regions at the margins of the state have, in the name of regional autonomy, experienced new spaces for manoeuvre...

Risk factors for positive margins in conservative surgery for breast cancer after neoadjuvant chemotherapy.

Science.gov (United States)

Bouzón, Alberto; Acea, Benigno; García, Alejandra; Iglesias, Ángela; Mosquera, Joaquín; Santiago, Paz; Seoane, Teresa

2016-01-01

Breast conservative surgery after neoadjuvant chemotherapy intends to remove any residual tumor with negative margins. The purpose of this study was to analyze the preoperative clinical-pathological factors influencing the margin status after conservative surgery in breast cancer patients receiving neoadjuvant chemotherapy. A retrospective study of 91 breast cancer patients undergoing neoadjuvant chemotherapy (92 breast lesions) during the period 2006 to 2013. A Cox regression analysis to identify baseline tumor characteristics associated with positive margins after breast conservative surgery was performed. Of all cases, 71 tumors were initially treated with conservative surgery after neoadjuvant chemotherapy. Pathologic exam revealed positive margins in 16 of the 71 cases (22.5%). The incidence of positive margins was significantly higher in cancers with initial size >5cm (P=.021), in cancers with low tumor grade (P=.031), and in patients with hormone receptor-positive cancer (P=.006). After a median follow-up of 45.2 months, 7 patients of the 71 treated with conservative surgery had disease recurrence (9.8%). There was no significant difference in terms of disease-free survival according to the margin status (P=.596). A baseline tumor size >5cm, low tumor grade and hormone receptor-positive status increase the risk for surgical margin involvement in breast conservative surgery after neoadjuvant chemotherapy. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Organic carbon source and salinity shape sediment bacterial composition in two China marginal seas and their major tributaries.

Science.gov (United States)

Wang, Kai; Zou, Li; Lu, Xinxin; Mou, Xiaozhen

2018-08-15

Marginal sea sediments receive organic substrates of different origins, but whether and to what extent sediment microbial communities are reflective of the different sources of organic substrates remain unclear. To address these questions, sediment samples were collected in two connected China marginal seas, i.e., Bohai Sea and Yellow Sea, and their two major tributaries (Yellow River and Liao River). Sediment bacterial community composition (BCC) was examined using 16S rRNA gene pyrosequencing. In addition, physicochemical variables that describe environmental conditions and sediment features were measured. Our results revealed that BCCs changed with salinity and organic carbon (OC) content. Members of Gaiellaceae and Comamonadaceae showed a rapid decrease as salinity and phytoplankton-derived OC increased, while Piscirickettsiaceae and Desulfobulbaceae exhibited an opposite distribution pattern. Differences of riverine vs. marginal sea sediment BCCs could be mostly explained by salinity. However, within the marginal seas, sediment BCC variations were mainly explained by OC-related variables, including terrestrial-derived fatty acids (Terr_FA), phytoplankton-derived polyunsaturated fatty acids (Phyto_PUFA), stable carbon isotopes (δ 13 C), and carbon to nitrogen ratio (C/N). In addition to environmental variables, network analysis suggested that interactions among individual bacterial taxa might be important in shaping sediment BCCs in the studied areas. Copyright © 2018 Elsevier B.V. All rights reserved.

Dopamine reward prediction error responses reflect marginal utility.

Science.gov (United States)

Stauffer, William R; Lak, Armin; Schultz, Wolfram

2014-11-03

Optimal choices require an accurate neuronal representation of economic value. In economics, utility functions are mathematical representations of subjective value that can be constructed from choices under risk. Utility usually exhibits a nonlinear relationship to physical reward value that corresponds to risk attitudes and reflects the increasing or decreasing marginal utility obtained with each additional unit of reward. Accordingly, neuronal reward responses coding utility should robustly reflect this nonlinearity. In two monkeys, we measured utility as a function of physical reward value from meaningful choices under risk (that adhered to first- and second-order stochastic dominance). The resulting nonlinear utility functions predicted the certainty equivalents for new gambles, indicating that the functions' shapes were meaningful. The monkeys were risk seeking (convex utility function) for low reward and risk avoiding (concave utility function) with higher amounts. Critically, the dopamine prediction error responses at the time of reward itself reflected the nonlinear utility functions measured at the time of choices. In particular, the reward response magnitude depended on the first derivative of the utility function and thus reflected the marginal utility. Furthermore, dopamine responses recorded outside of the task reflected the marginal utility of unpredicted reward. Accordingly, these responses were sufficient to train reinforcement learning models to predict the behaviorally defined expected utility of gambles. These data suggest a neuronal manifestation of marginal utility in dopamine neurons and indicate a common neuronal basis for fundamental explanatory constructs in animal learning theory (prediction error) and economic decision theory (marginal utility). Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Masculinity at the margins

DEFF Research Database (Denmark)

Jensen, Sune Qvotrup

2010-01-01

and other types of material. Taking the concepts of othering, intersectionality and marginality as point of departure the article analyses how these young men experience othering and how they react to it. One type of reaction, described as stylization, relies on accentuating the latently positive symbolic...... of critique although in a masculinist way. These reactions to othering represent a challenge to researchers interested in intersectionality and gender, because gender is reproduced as a hierarchical form of social differentiation at the same time as racism is both reproduced and resisted....

Electric energy deficit marginal cost: historic, evaluation and proposition of a new method; Custo marginal do deficit de energia eletrica: historico, avaliacao e proposta de uma nova metodologia

Energy Technology Data Exchange (ETDEWEB)

Loureiro, Paulo Gerson Cayres

2009-05-15

The optimization model actually used to the energy operation planning of the National Interconnected System - NIS has as objective function the minimization of expected total cost operation. To achieve this goal the model provides optimal allocation of hydrothermal resources during the study horizon, employing aggregated subsystems. The deficit marginal cost is a parameter which is explicitly informed to the model, and does a part in the operation total cost calculation being a predominant factor in the service conditions evaluation of national electric energy market, affecting the energy costs and the risk of deficit on NIS. In this work is realized an integral study about the electric energy deficit marginal cost, starting with a historical review, followed by a actualization of your actual value and a propose of a new method for the calculation of deficit marginal cost value. The studies shows the impact of the values found over service conditions to the electric energy market in the energy operation planning, focusing on some usual indicators adopted in studies of the electrical sector. (author)

Risk management at GPU Nuclear

International Nuclear Information System (INIS)

Long, R.L.

1991-01-01

This paper reports on GPU Nuclear. Among other goals, it established the independence of key safety functions as highlighted by the lessons learned from the accident. In particular, an independent Nuclear Assurance Division was established which include Quality Assurance, Training and Education, Emergency Preparedness, and Nuclear Safety Assessment. The latter consisted of corporate and site independent-safety-review groups. As the GPU Nuclear organization matured, a mid-1987 reorganization created an even more focused Planning and Nuclear Safety Division bringing together Nuclear Safety Assessment with Licensing and Regulatory Affairs and Risk Management. The Risk Management Group (RMG), which began its work in fall 1987, was formed to develop a framework for proactive identification, evaluation, and cost-effective reduction and management of risks of all types. The RMG set out to learn as much as possible about risks and their management in nuclear and other high-technology industries. This began with a thorough literature search. It progressed to interviews with individuals and organizations which have demonstrated innovative ideas, experience, and reputations for safe and reliable operation

Strategic Planning: Contextual Factors that Facilitated and/or Challenged the Implementation of Strategic Planning in Two Nonprofit Organizations

Science.gov (United States)

Masilamony, Davadhasan

2010-01-01

As the nonprofit sector continues to grow in size and importance in American society, successful organizations proactively initiate strategic planning so they can be more responsive to changing circumstances, underlying trends, and shifting demands. At times, however, organizations develop elaborate plans that are never implemented. Unfortunately,…

Improving in organization of in-site planning for NPP

International Nuclear Information System (INIS)

Gitel'man, L.D.; Khanin, V.V.; Trunov, V.M.; Khanin, R.V.

1986-01-01

The organization of NPP section activity planning is considered. With regard to the structure of in-site plans by time and content, their distribution in organization control structure, order of plan development, stimulation, accounting and estimation of plan fulfillment, plan indices for each shop and plan-assignment form are developed

Assessment of improved organ at risk sparing for advanced cervix carcinoma utilizing precision radiotherapy techniques

Energy Technology Data Exchange (ETDEWEB)

Georg, D.; Georg, P.; Hillbrand, M.; Poetter, R.; Mock, U. [Dept. of Radiotherapy, Medical Univ. AKH, Vienna (Austria)

2008-11-15

Purpose: to evaluate the potential benefit of proton therapy and photon based intensity-modulated radiotherapy in comparison to 3-D conformal photon radiotherapy (3D-CRT) in locally advanced cervix cancer. Patients and methods: in five patients with advanced cervix cancer 3D-CRT (four-field box) was compared with intensity modulated photon (IMXT) and proton therapy (IMPT) as well as proton beam therapy (PT) based on passive scattering. Planning target volumes (PTVs) included primary tumor and pelvic and para-aortic lymph nodes. Dose-volume histograms (DVHs) were analyzed for the PTV and various organs at risk (OARs) (rectal wall, bladder, small bowel, colon, femoral heads, and kidneys). In addition dose conformity, dose inhomogeneity and overall volumes of 50% isodoses were assessed. Results: all plans were comparable concerning PTV parameters. Large differences between photon and proton techniques were seen in volumes of the 50% isodoses and conformity indices. DVH for colon and small bowel were significantly improved with PT and IMPT compared to IMXT, with D{sub mean} reductions of 50-80%. Doses to kidneys and femoral heads could also be substantially reduced with PT and IMPT. Sparing of rectum and bladder was superior with protons as well but less pronounced. Conclusion: proton beam RT has significant potential to improve treatment related side effects in the bowel compared to photon beam RT in patients with advanced cervix carcinoma. (orig.)

Assessment of improved organ at risk sparing for advanced cervix carcinoma utilizing precision radiotherapy techniques

International Nuclear Information System (INIS)

Georg, D.; Georg, P.; Hillbrand, M.; Poetter, R.; Mock, U.

2008-01-01

Purpose: to evaluate the potential benefit of proton therapy and photon based intensity-modulated radiotherapy in comparison to 3-D conformal photon radiotherapy (3D-CRT) in locally advanced cervix cancer. Patients and methods: in five patients with advanced cervix cancer 3D-CRT (four-field box) was compared with intensity modulated photon (IMXT) and proton therapy (IMPT) as well as proton beam therapy (PT) based on passive scattering. Planning target volumes (PTVs) included primary tumor and pelvic and para-aortic lymph nodes. Dose-volume histograms (DVHs) were analyzed for the PTV and various organs at risk (OARs) (rectal wall, bladder, small bowel, colon, femoral heads, and kidneys). In addition dose conformity, dose inhomogeneity and overall volumes of 50% isodoses were assessed. Results: all plans were comparable concerning PTV parameters. Large differences between photon and proton techniques were seen in volumes of the 50% isodoses and conformity indices. DVH for colon and small bowel were significantly improved with PT and IMPT compared to IMXT, with D mean reductions of 50-80%. Doses to kidneys and femoral heads could also be substantially reduced with PT and IMPT. Sparing of rectum and bladder was superior with protons as well but less pronounced. Conclusion: proton beam RT has significant potential to improve treatment related side effects in the bowel compared to photon beam RT in patients with advanced cervix carcinoma. (orig.)

Organ-specific radiation-induced cancer risk estimates due to radiotherapy for benign pigmented villonodular synovitis

Science.gov (United States)

Mazonakis, Michalis; Tzedakis, Antonis; Lyraraki, Efrossyni; Damilakis, John

2016-09-01

Pigmented villonodular synovitis (PVNS) is a benign disease affecting synovial membranes of young and middle-aged adults. The aggressive treatment of this disorder often involves external-beam irradiation. This study was motivated by the lack of data relating to the radiation exposure of healthy tissues and radiotherapy-induced cancer risk. Monte Carlo methodology was employed to simulate a patient’s irradiation for PVNS in the knee and hip joints with a 6 MV photon beam. The average radiation dose received by twenty-two out-of-field critical organs of the human body was calculated. These calculations were combined with the appropriate organ-, age- and gender-specific risk coefficients of the BEIR-VII model to estimate the lifetime probability of cancer development. The risk for carcinogenesis to colon, which was partly included in the treatment fields used for hip irradiation, was determined with a non-linear mechanistic model and differential dose-volume histograms obtained by CT-based 3D radiotherapy planning. Risk assessments were compared with the nominal lifetime intrinsic risk (LIR) values. Knee irradiation to 36 Gy resulted in out-of-field organ doses of 0.2-24.6 mGy. The corresponding range from hip radiotherapy was 1.2-455.1 mGy whereas the organ equivalent dose for the colon was up to 654.9 mGy. The organ-specific cancer risks from knee irradiation for PVNS were found to be inconsequential since they were at least 161.5 times lower than the LIRs irrespective of the patient’s age and gender. The bladder and colon cancer risk from radiotherapy in the hip joint was up to 3.2 and 6.6 times smaller than the LIR, respectively. These cancer risks may slightly elevate the nominal incidence rates and they should not be ignored during the patient’s treatment planning and follow-up. The probabilities for developing any other solid tumor were more than 20 times lower than the LIRs and, therefore, they may be considered as small.

The need for rotational margins in intensity-modulated radiotherapy and a new method for planning target volume design

International Nuclear Information System (INIS)

Langer, Mark Peter; Papiez, Lech; Spirydovich, Siarhei; Thai, Van

2005-01-01

Purpose: The effect of rotational errors on the coverage of clinical target volumes (CTVs) is examined. A new planning target volume (PTV) construction that considers the individual paths traced by movements of the target boundary points is developed. Methods and Materials: A standard uniform margin expansion was compared with a PTV constructed from the space swept out by a concave moving target. A new method formed the PTV by aggregating the separate convex hulls taken of the positions of the individual target boundary points in a sampling of CTV displacements. Results: A 0.5-cm uniform margin adequate for translations was inadequate given CTV rotation about a fixed off-center axis. A PTV formed of the target's swept-out area was 22% smaller than needed for coverage by a uniform margin, but computationally is not readily extended to translations combined with rotations about a shifting axis. Forming instead the union of convex hulls of the boundary points in a sampling of CTV displacements represented these movements in the PTV design and retained the target's concave shape. Conclusions: Planning target volumes should accommodate target rotation. The union of convex hulls of the boundary point positions in a sampling of displacements can effectively represent multiple sources of deviations while preserving target concavities

No difference in dose distribution in organs at risk in postmastectomy radiotherapy with or without breast implant reconstruction

International Nuclear Information System (INIS)

Liljegren, Annelie; Unukovych, Dmytro; Gagliardi, Giovanna; Bjöhle, Judith; Wickman, Marie; Johansson, Hemming; Sandelin, Kerstin

2014-01-01

The aim of this study was to quantify the variation in doses to organs at risk (ipsilateral lung and heart) and the clinical target volume (CTV) in the presence of breast implants. In this retrospective cohort study, patients were identified through the National Breast Cancer Register. Consecutive breast cancer patients undergoing mastectomy between 2009 and 2011 and completing a full course of postmastectomy radiotherapy (PMRT) were eligible. All included patients (n = 818) were identified in the ARIA© oncology information system and further stratified for immediate breast reconstruction (IBR+, n = 162) and no immediate breast reconstruction (IBR-, n = 656). Dose statistics for ipsilateral lung, heart and CTV were retrieved from the system. Radiation plans for patients with chest wall (CW) only (n = 242) and CW plus lymph nodes (n = 576) irradiation were studied separately. The outcome variables were dichotomized as follows: lung, V 20Gy ≤ 30% vs. V 20Gy > 30%; heart, D mean ≤ 5 Gy vs. D mean > 5 Gy; CTV, V 95% ≥ median vs. V 95% < median. In the univariate and multivariate regression models no correlation between potential confounders (i.e. breast reconstruction, side of PMRT, CW index) and the outcome variables was found. Multivariate analysis of CW plus lymph nodes radiation plans, for example, showed no association of breast reconstruction with dosimetric outcomes in neither lung nor heart- lung V 20Gy (odds ratio [OR]: 0.6, 95%CI, 0.4 to 1.0, p = 0.07) or heart D mean (OR: 1.2, 95%CI, 0.5 to 3.1, p = 0.72), respectively. CTV was statistically significantly larger in the IBR+ group (i.e. included breast implant), but no correlation between the implant type and dosimetric characteristics of the organs at risk was revealed. In the current study, the presence of breast implants during postmastectomy radiotherapy was not associated with increased doses to ipsilateral lung and heart, but CTV definition and its dosimetric characteristics urge further

Realistic respiratory motion margins for external beam partial breast irradiation

Energy Technology Data Exchange (ETDEWEB)

Conroy, Leigh; Quirk, Sarah [Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta T2N 4N2 (Canada); Department of Physics and Astronomy, University of Calgary, Calgary, Alberta T2N 1N4 (Canada); Smith, Wendy L., E-mail: wendy.smith@albertahealthservices.ca [Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta T2N 4N2 (Canada); Department of Physics and Astronomy, University of Calgary, Calgary, Alberta T2N 1N4 (Canada); Department of Oncology, University of Calgary, Calgary, Alberta T2N 1N4 (Canada)

2015-09-15

Purpose: Respiratory margins for partial breast irradiation (PBI) have been largely based on geometric observations, which may overestimate the margin required for dosimetric coverage. In this study, dosimetric population-based respiratory margins and margin formulas for external beam partial breast irradiation are determined. Methods: Volunteer respiratory data and anterior–posterior (AP) dose profiles from clinical treatment plans of 28 3D conformal radiotherapy (3DCRT) PBI patient plans were used to determine population-based respiratory margins. The peak-to-peak amplitudes (A) of realistic respiratory motion data from healthy volunteers were scaled from A = 1 to 10 mm to create respiratory motion probability density functions. Dose profiles were convolved with the respiratory probability density functions to produce blurred dose profiles accounting for respiratory motion. The required margins were found by measuring the distance between the simulated treatment and original dose profiles at the 95% isodose level. Results: The symmetric dosimetric respiratory margins to cover 90%, 95%, and 100% of the simulated treatment population were 1.5, 2, and 4 mm, respectively. With patient set up at end exhale, the required margins were larger in the anterior direction than the posterior. For respiratory amplitudes less than 5 mm, the population-based margins can be expressed as a fraction of the extent of respiratory motion. The derived formulas in the anterior/posterior directions for 90%, 95%, and 100% simulated population coverage were 0.45A/0.25A, 0.50A/0.30A, and 0.70A/0.40A. The differences in formulas for different population coverage criteria demonstrate that respiratory trace shape and baseline drift characteristics affect individual respiratory margins even for the same average peak-to-peak amplitude. Conclusions: A methodology for determining population-based respiratory margins using real respiratory motion patterns and dose profiles in the AP direction was

Realistic respiratory motion margins for external beam partial breast irradiation

International Nuclear Information System (INIS)

Conroy, Leigh; Quirk, Sarah; Smith, Wendy L.

2015-01-01

Purpose: Respiratory margins for partial breast irradiation (PBI) have been largely based on geometric observations, which may overestimate the margin required for dosimetric coverage. In this study, dosimetric population-based respiratory margins and margin formulas for external beam partial breast irradiation are determined. Methods: Volunteer respiratory data and anterior–posterior (AP) dose profiles from clinical treatment plans of 28 3D conformal radiotherapy (3DCRT) PBI patient plans were used to determine population-based respiratory margins. The peak-to-peak amplitudes (A) of realistic respiratory motion data from healthy volunteers were scaled from A = 1 to 10 mm to create respiratory motion probability density functions. Dose profiles were convolved with the respiratory probability density functions to produce blurred dose profiles accounting for respiratory motion. The required margins were found by measuring the distance between the simulated treatment and original dose profiles at the 95% isodose level. Results: The symmetric dosimetric respiratory margins to cover 90%, 95%, and 100% of the simulated treatment population were 1.5, 2, and 4 mm, respectively. With patient set up at end exhale, the required margins were larger in the anterior direction than the posterior. For respiratory amplitudes less than 5 mm, the population-based margins can be expressed as a fraction of the extent of respiratory motion. The derived formulas in the anterior/posterior directions for 90%, 95%, and 100% simulated population coverage were 0.45A/0.25A, 0.50A/0.30A, and 0.70A/0.40A. The differences in formulas for different population coverage criteria demonstrate that respiratory trace shape and baseline drift characteristics affect individual respiratory margins even for the same average peak-to-peak amplitude. Conclusions: A methodology for determining population-based respiratory margins using real respiratory motion patterns and dose profiles in the AP direction was

Collaborative multi-stakeholder approach to drafting flood risk management plans in Wallonia, Belgium

Science.gov (United States)

Maroy, Edith; Javaux, Mathieu; Vandermosten, Pierre; Englebert, Benjamin

2015-04-01

The Flood Directive 2007/60/CE establishes a common framework within the European Union for assessing and reducing risks posed by floods on human health, the environment, economic activity and cultural heritage. For that purpose, Member States had to establish flood areas and flood risk maps, and subsequently, flood risk management plans (due December 2015). According to the Directive, special attention is to be paid to international coordination for transboundary water courses, integrated management approaches at the catchment scale, cost-effectiveness of measures and public involvement. Management measures must focus on reducing the probability of flooding and the potential consequences of flooding. They must cover prevention, protection and preparedness and must take into account relevant aspects, such as water management, soil management, spatial planning, land use and nature conservation. Floods in Wallonia mostly originate from overflowing of both little sloped rivers and highly reactive rivers but also, from concentrated runoff in the intensely cultivated and erosion-prone region north of the Sambre-Meuse axis. Consequently, walloon flood area maps not only show flood areas based on hydraulic modelling and observations but also runoff concentration axis in agricultural areas. Now released to the public, this information can be used to assess the risk of damage for land planning and erosion control strategies. Incidentally, some 166 km2 were mapped as flood hazard area with a return period of 25 years, 28.8 of which are urbanized or destined to urbanisation and counting of number of approximatively 39.000 people living in those areas. Flood area and flood risk maps should be the starting point of elaborating flood risk management plans. In order to involve the diversity of water managers and stakeholders in the drafting of a management plan for hydrographic districts in Wallonia, responsible authorities decided to mandate scientists and engineers to organize

Risk evaluation method for faults by engineering approach. (2) Application concept of margin analysis utilizing accident sequences

International Nuclear Information System (INIS)

Kamiya, Masanobu; Kanaida, Syuuji; Kamiya, Kouichi; Sato, Kunihiko; Kuroiwa, Katsuya

2016-01-01

The influence of the fault displacement on the facility should to be evaluated not only by the activity of the fault but also by obtaining risk information by considering scenarios including such as the frequency and the degree of the hazard, which should be an appropriate approach for nuclear safety. An applicable concept of margin analysis utilizing accident sequences for evaluating the influence of the fault displacement is proposed. By use of this analysis, we can evaluate of the safety functions and margin for core damage, verify the efficiency of equipment of portable type and make a decision to take additional measures to reduce the risk by using obtained risk information. (author)

Technical challenges of sparing infrahyoid swallowing organs at risk in oropharynx squamous cell cancer treated with IMRT

International Nuclear Information System (INIS)

Morley, Lyndon; Tsang, Shirley W.S.; Breen, Stephen L.; Waldron, John N.; Maganti, Manjula; Pintilie, Melania; Dawson, Laura A.; Ringash, Jolie; Huang, Shao Hui; Kim, John

2014-01-01

This study reports clinical performance in the sparing of infrahyoid swallowing organs at risk (SWOARs) in oropharynx cancer intensity-modulated radiation therapy (IMRT) plans. Rates of meeting dose-volume planning goals are reported and compared with geometry-based estimates of what is achievable. This study also develops 3 measures of target-SWOAR geometry and tests their usefulness in providing geometry-based dose-volume planning goals. A total of 50 oropharynx cancer IMRT plans were reviewed. Success rates in meeting institutional dose-volume goals were determined for the glottic larynx (G), postcricoid pharynx (P), and esophagus (E). The following 3 measures of target-SWOAR geometry were investigated as methods of identifying geometry-based planning goals: presence of gross disease in neck levels 3 to 4, target-SWOAR overlap, and a 3-dimensional (3D) measure of target-SWOAR geometry. Locally advanced disease was predominant in this patient population with target volumes overlapping SWOARs in 68% to 98% of cases. Clinical rates of success in meeting dose-volume goals varied by SWOAR (16% to 82%) but compared well with estimated potentially achievable rates in most cases (14% average difference between clinical and potential). Cases grouped by the presence of levels 3 to 4 neck nodes or target-SWOAR overlap did not have significantly different SWOAR doses. Cases grouped using a 3D measure of target-SWOAR geometry differed significantly, providing useful geometry-based planning goals (e.g., mean Glottis dose <45 Gy was achieved 19%, 44%, or 81% of the time in each of 3 groups). This study describes the technical challenge of sparing SWOARs and investigates several potential methods for grouping cases to assist with treatment plan evaluation. Quantifying the 3-D relationship between the targets and SWOARs is a promising way of approaching this complex problem. Data presented in this paper may be useful to evaluate treatment plans using objective geometry

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

Relationship of Imaging Frequency and Planning Margin to Account for Intrafraction Prostate Motion: Analysis Based on Real-Time Monitoring Data

International Nuclear Information System (INIS)

Curtis, William; Khan, Mohammad; Magnelli, Anthony; Stephans, Kevin; Tendulkar, Rahul; Xia, Ping

2013-01-01

Purpose: Correction for intrafraction prostate motion becomes important for hypofraction treatment of prostate cancer. The purpose of this study was to estimate an ideal planning margin to account for intrafraction prostate motion as a function of imaging and repositioning frequency in the absence of continuous prostate motion monitoring. Methods and Materials: For 31 patients receiving intensity modulated radiation therapy treatment, prostate positions sampled at 10 Hz during treatment using the Calypso system were analyzed. Using these data, we simulated multiple, less frequent imaging protocols, including intervals of every 10, 15, 20, 30, 45, 60, 90, 120, 180, and 240 seconds. For each imaging protocol, the prostate displacement at the imaging time was corrected by subtracting prostate shifts from the subsequent displacements in that fraction. Furthermore, we conducted a principal component analysis to quantify the direction of prostate motion. Results: Averaging histograms of every 240 and 60 seconds for all patients, vector displacements of the prostate were, respectively, within 3 and 2 mm for 95% of the treatment time. A vector margin of 1 mm achieved 91.2% coverage of the prostate with 30 second imaging. The principal component analysis for all fractions showed the largest variance in prostate position in the midsagittal plane at 54° from the anterior direction, indicating that anterosuperior to inferoposterior is the direction of greatest motion. The smallest prostate motion is in the left-right direction. Conclusions: The magnitudes of intrafraction prostate motion along the superior-inferior and anterior-posterior directions are comparable, and the smallest motion is in the left-right direction. In the absence of continuous prostate motion monitoring, and under ideal circumstances, 1-, 2-, and 3-mm vector planning margins require a respective imaging frequency of every 15, 60, and 240 to account for intrafraction prostate motion while achieving

Economic Sustainability of Organic Aloe Vera Farming in Greece under Risk and Uncertainty

Directory of Open Access Journals (Sweden)

Angelos Liontakis

2016-04-01

Full Text Available During the last decade, an encouraging environment for the restructuring and modernization of the agricultural sector has formed in Greece. The diversification into higher-value crops can be a promising option for small and average-sized farms, particularly during the current economic crisis. One of the most promising alternative crops that have been recently established in Greece is the organic Aloe vera crop. The main advantage of this crop is that it can utilize poor farmlands and, therefore, can facilitate rural development in marginal areas. This study explores the economic sustainability of the Aloe vera crop, considering the embedded risk and uncertainty. The results indicate that organic aloe farming is a promising alternative to “traditional” crops in Greece, particularly for family farms in rural areas. In contrast, this activity is not advisable to the most entrepreneurial type of farmers, unless their crop size allows economies of scales. Finally, the Stochastic Efficiency with Respect to a Function (SERF analysis associates farmers’ risk attitude with their willingness to be involved in organic Aloe vera farming. SERF analysis highlights the crucial role of farmers’ risk aversion and concludes that, above a certain level of risk aversion, farmers have no incentive to adopt this economic activity.

Containment safety margins

International Nuclear Information System (INIS)

Von Riesemann, W.A.

1980-01-01

Objective of the Containment Safety Margins program is the development and verification of methodologies which are capable of reliably predicting the ultimate load-carrying capability of light water reactor containment structures under accident and severe environments. The program was initiated in June 1980 at Sandia and this paper addresses the first phase of the program which is essentially a planning effort. Brief comments are made about the second phase, which will involve testing of containment models

Assessment of improved organ at risk sparing for meningioma: Light ion beam therapy as boost versus sole treatment option

International Nuclear Information System (INIS)

Mock, Ulrike; Georg, Dietmar; Sölkner, Lukas; Suppan, Christian; Vatnitsky, Stanislav M.; Flechl, Birgit; Mayer, Ramona; Dieckmann, Karin; Knäusl, Barbara

2014-01-01

Purpose: To compare photons, protons and carbon ions and their combinations for treatment of atypical and anaplastical skull base meningioma. Material and methods: Two planning target volumes (PTV initial /PTV boost ) were delineated for 10 patients (prescribed doses 50 Gy(RBE) and 10 Gy(RBE)). Plans for intensity modulated photon (IMXT), proton (IMPT) and carbon ion therapy ( 12 C) were generated assuming a non-gantry scenario for particles. The following combinations were compared: IMXT + IMXT/IMPT/ 12 C; IMPT + IMPT/ 12 C; and 12 C + 12 C. Plan quality was evaluated by target conformity and homogeneity (CI, HI), V 95% , D 2% and D 50% and dose-volume-histogram (DVH) parameters for organs-at-risk (OAR). If dose escalation was possible, it was performed until OAR tolerance levels were reached. Results: CI was worst for IMXT. HI < 0.05 ± 0.01 for 12 C was significantly better than for IMXT. For all treatment options dose escalation above 60 Gy(RBE) was possible for four patients, but impossible for six patients. Compared to IMXT + IMXT, ion beam therapy showed an improved sparing for most OARs, e.g. using protons and carbon ions D 50% was reduced by more than 50% for the ipsilateral eye and the brainstem. Conclusion: Highly conformal IMPT and 12 C plans could be generated with a non-gantry scenario. Improved OAR sparing favors both sole 12 C and/or IMPT plans

Margins in breast conserving surgery: The financial cost & potential savings associated with the new margin guidelines.

Science.gov (United States)

Singer, Lauren; Brown, Eric; Lanni, Thomas

2016-08-01

In this study, we compare the indications for re-excision, the findings of additional tumor in the re-excision specimen as they relate to margin status, and costs associated with re-excision based on recent new consensus statements. A retrospective analysis was performed on 462 patients with invasive breast carcinoma who underwent at least one lumpectomy between January 2011 and December 2013. Postoperative data was analyzed based on where additional disease was found, as it relates to the margin status of the initial lumpectomy and the additional direct costs associated with additional procedures. Of the 462 patients sampled, 149 underwent a re-excision surgery (32.2%). Four patients underwent mastectomy as their second operation. In the 40 patients with additional disease found on re-excision, 36 (90.0%) of them had a positive margin on their initial lumpectomy. None of the four mastectomy patients had residual disease. The mean cost of the initial lumpectomy for all 462 patients was $2118.01 plus an additional $1801.92 for those who underwent re-excision. A positive margin was most predictive of finding residual tumor on re-excision as would be expected. Using old criteria only 0.07% (4/61) of patients who had undergone re-excision with a 'clear' margin, had additional tumor found, at a total cost of $106,354.11. Thus, the new consensus guidelines will lead to less overall cost, at no clinical risk to patients while reducing a patient's surgical risk and essentially eliminating delays in adjuvant care. Copyright © 2016 Elsevier Ltd. All rights reserved.

Seismic safety margins research program overview

International Nuclear Information System (INIS)

Tokarz, F.J.; Smith, P.D.

1978-01-01

A multiyear seismic research program has been initiated at the Lawrence Livermore Laboratory. This program, the Seismic Safety Margins Research Program (SSMRP) is funded by the U.S. Nuclear Regulatory Commission, Office of Nuclear Regulatory Research. The program is designed to develop a probabilistic systems methodology for determining the seismic safety margins of nuclear power plants. Phase I, extending some 22 months, began in July 1978 at a funding level of approximately $4.3 million. Here we present an overview of the SSMRP. Included are discussions on the program objective, the approach to meet the program goal and objectives, end products, the probabilistic systems methodology, and planned activities for Phase I

Incorporating organ movements in IMRT treatment planning for prostate cancer: Minimizing uncertainties in the inverse planning process

International Nuclear Information System (INIS)

Unkelbach, Jan; Oelfke, Uwe

2005-01-01

We investigate an off-line strategy to incorporate inter fraction organ movements in IMRT treatment planning. Nowadays, imaging modalities located in the treatment room allow for several CT scans of a patient during the course of treatment. These multiple CT scans can be used to estimate a probability distribution of possible patient geometries. This probability distribution can subsequently be used to calculate the expectation value of the delivered dose distribution. In order to incorporate organ movements into the treatment planning process, it was suggested that inverse planning could be based on that probability distribution of patient geometries instead of a single snapshot. However, it was shown that a straightforward optimization of the expectation value of the dose may be insufficient since the expected dose distribution is related to several uncertainties: first, this probability distribution has to be estimated from only a few images. And second, the distribution is only sparsely sampled over the treatment course due to a finite number of fractions. In order to obtain a robust treatment plan these uncertainties should be considered and minimized in the inverse planning process. In the current paper, we calculate a 3D variance distribution in addition to the expectation value of the dose distribution which are simultaniously optimized. The variance is used as a surrogate to quantify the associated risks of a treatment plan. The feasibility of this approach is demonstrated for clinical data of prostate patients. Different scenarios of dose expectation values and corresponding variances are discussed

A guide to understanding and implementing risk evaluation and mitigation strategies in organ transplantation.

Science.gov (United States)

Gabardi, Steven; Tichy, Eric M

2013-03-01

To review the components of the Congressional mandate for risk evaluation and mitigation strategies (REMS) managed by the Food and Drug Administration and assess their impact on health care providers practicing within the organ transplant arena. A non-date-limited search of MEDLINE and EMBASE (January 2007-June 2012) was conducted by using the following search terms: risk evaluation and mitigation strategies, REMS, and organ transplant, including a query of the individual organs. Information from the Federal Register and the Food and Drug Administration was also evaluated. REMS are strategies implemented to manage known or potential risks associated with medications and to ensure ongoing pharmacovigilance throughout the life of a pharmaceutical product. Elements of REMS programs may consist of 3 levels: a medication guide, communication plan, and elements to assure safe use. A medication guide is used to help prevent serious adverse events, aid in patients' decision making, and enhance medication adherence. Communication plans help educate health care providers and encourage adherence with REMS. The elements to assure safe use is a restrictive process implemented when it is deemed necessary to ensure safe access for patients to products with known serious risks. In transplant medicine, REMS currently exist for belatacept (medication guide and communication plan) and the mycophenolic acid derivatives (medication guide and elements to assure safe use). REMS are another step in the evolution of the development and marketing of pharmaceutical agents. Use of REMS in solid-organ transplant is becoming common. Transplant clinicians must provide required patient education and become involved with other aspects of REMS implementation to reduce the serious risks of pharmaceuticals and to improve patients' outcomes.

Geophysical constraints on geodynamical processes at convergent margins

DEFF Research Database (Denmark)

Artemieva, Irina; Thybo, Hans; Shulgin, Alexey

2016-01-01

Convergent margins, being the boundaries between colliding lithospheric plates, form the most disastrous areas in the world due to intensive, strong seismicity and volcanism. We review global geophysical data in order to illustrate the effects of the plate tectonic processes at convergent margins......, at least, one of the plates is oceanic. However, the oldest oceanic plate in the Pacific ocean has the smallest convergence rate. (2) The presence of an oceanic plate is, in general, required for generation of high-magnitude (M>8.0) earthquakes and for generating intermediate and deep seismicity along...... to shallow mantle levels....

SU-E-J-208: Fast and Accurate Auto-Segmentation of Abdominal Organs at Risk for Online Adaptive Radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Gupta, V; Wang, Y; Romero, A; Heijmen, B; Hoogeman, M [Erasmus MC Cancer Institute, Rotterdam (Netherlands); Myronenko, A; Jordan, P [Accuray Incorporated, Sunnyvale, United States. (United States)

2014-06-01

Purpose: Various studies have demonstrated that online adaptive radiotherapy by real-time re-optimization of the treatment plan can improve organs-at-risk (OARs) sparing in the abdominal region. Its clinical implementation, however, requires fast and accurate auto-segmentation of OARs in CT scans acquired just before each treatment fraction. Autosegmentation is particularly challenging in the abdominal region due to the frequently observed large deformations. We present a clinical validation of a new auto-segmentation method that uses fully automated non-rigid registration for propagating abdominal OAR contours from planning to daily treatment CT scans. Methods: OARs were manually contoured by an expert panel to obtain ground truth contours for repeat CT scans (3 per patient) of 10 patients. For the non-rigid alignment, we used a new non-rigid registration method that estimates the deformation field by optimizing local normalized correlation coefficient with smoothness regularization. This field was used to propagate planning contours to repeat CTs. To quantify the performance of the auto-segmentation, we compared the propagated and ground truth contours using two widely used metrics- Dice coefficient (Dc) and Hausdorff distance (Hd). The proposed method was benchmarked against translation and rigid alignment based auto-segmentation. Results: For all organs, the auto-segmentation performed better than the baseline (translation) with an average processing time of 15 s per fraction CT. The overall improvements ranged from 2% (heart) to 32% (pancreas) in Dc, and 27% (heart) to 62% (spinal cord) in Hd. For liver, kidneys, gall bladder, stomach, spinal cord and heart, Dc above 0.85 was achieved. Duodenum and pancreas were the most challenging organs with both showing relatively larger spreads and medians of 0.79 and 2.1 mm for Dc and Hd, respectively. Conclusion: Based on the achieved accuracy and computational time we conclude that the investigated auto

SU-E-J-208: Fast and Accurate Auto-Segmentation of Abdominal Organs at Risk for Online Adaptive Radiotherapy

International Nuclear Information System (INIS)

Gupta, V; Wang, Y; Romero, A; Heijmen, B; Hoogeman, M; Myronenko, A; Jordan, P

2014-01-01

Purpose: Various studies have demonstrated that online adaptive radiotherapy by real-time re-optimization of the treatment plan can improve organs-at-risk (OARs) sparing in the abdominal region. Its clinical implementation, however, requires fast and accurate auto-segmentation of OARs in CT scans acquired just before each treatment fraction. Autosegmentation is particularly challenging in the abdominal region due to the frequently observed large deformations. We present a clinical validation of a new auto-segmentation method that uses fully automated non-rigid registration for propagating abdominal OAR contours from planning to daily treatment CT scans. Methods: OARs were manually contoured by an expert panel to obtain ground truth contours for repeat CT scans (3 per patient) of 10 patients. For the non-rigid alignment, we used a new non-rigid registration method that estimates the deformation field by optimizing local normalized correlation coefficient with smoothness regularization. This field was used to propagate planning contours to repeat CTs. To quantify the performance of the auto-segmentation, we compared the propagated and ground truth contours using two widely used metrics- Dice coefficient (Dc) and Hausdorff distance (Hd). The proposed method was benchmarked against translation and rigid alignment based auto-segmentation. Results: For all organs, the auto-segmentation performed better than the baseline (translation) with an average processing time of 15 s per fraction CT. The overall improvements ranged from 2% (heart) to 32% (pancreas) in Dc, and 27% (heart) to 62% (spinal cord) in Hd. For liver, kidneys, gall bladder, stomach, spinal cord and heart, Dc above 0.85 was achieved. Duodenum and pancreas were the most challenging organs with both showing relatively larger spreads and medians of 0.79 and 2.1 mm for Dc and Hd, respectively. Conclusion: Based on the achieved accuracy and computational time we conclude that the investigated auto

Planning Target Margin Calculations for Prostate Radiotherapy Based on Intrafraction and Interfraction Motion Using Four Localization Methods

International Nuclear Information System (INIS)

Beltran, Chris; Herman, Michael G.; Davis, Brian J.

2008-01-01

Purpose: To determine planning target volume (PTV) margins for prostate radiotherapy based on the internal margin (IM) (intrafractional motion) and the setup margin (SM) (interfractional motion) for four daily localization methods: skin marks (tattoo), pelvic bony anatomy (bone), intraprostatic gold seeds using a 5-mm action threshold, and using no threshold. Methods and Materials: Forty prostate cancer patients were treated with external radiotherapy according to an online localization protocol using four intraprostatic gold seeds and electronic portal images (EPIs). Daily localization and treatment EPIs were obtained. These data allowed inter- and intrafractional analysis of prostate motion. The SM for the four daily localization methods and the IM were determined. Results: A total of 1532 fractions were analyzed. Tattoo localization requires a SM of 6.8 mm left-right (LR), 7.2 mm inferior-superior (IS), and 9.8 mm anterior-posterior (AP). Bone localization requires 3.1, 8.9, and 10.7 mm, respectively. The 5-mm threshold localization requires 4.0, 3.9, and 3.7 mm. No threshold localization requires 3.4, 3.2, and 3.2 mm. The intrafractional prostate motion requires an IM of 2.4 mm LR, 3.4 mm IS and AP. The PTV margin using the 5-mm threshold, including interobserver uncertainty, IM, and SM, is 4.8 mm LR, 5.4 mm IS, and 5.2 mm AP. Conclusions: Localization based on EPI with implanted gold seeds allows a large PTV margin reduction when compared with tattoo localization. Except for the LR direction, bony anatomy localization does not decrease the margins compared with tattoo localization. Intrafractional prostate motion is a limiting factor on margin reduction

Origins of saline fluids at convergent margins

Science.gov (United States)

Martin, Jonathan B.; Kastner, Miriam; Egeberg, Per Kr.

The compositions of pore and venting fluids at convergent margins differ from seawater values, reflecting mixing and diagenesis. Most significantly, the concentration of Cl-, assumed to be a conservative ion, differs from its seawater value. Chloride concentrations could be elevated by four processes, although two, the formation of gas hydrate and ion filtration by clay membranes, are insignificant in forming saline fluids at convergent margins. During the formation of gas hydrate, the resulting Cl--rich fluids, estimated to contain an average excess of ˜140 mM Cl- over seawater value, probably would be flushed from the sediment when the pore fluids vent to seawater. Ion filtration by clay membranes requires compaction pressures typical of >2 km burial depths. Even at these depths, the efficiency of ion filtration will be negligible because (1) fluids will flow through fractures, thereby bypassing clay membranes, (2) concentrations of clay minerals are diluted by other phases, and (3) during burial, smectite converts to illite, which has little capacity for ion filtration. A third process, mixing with subaerially evaporated seawater, elevates Cl- concentrations to 1043 mM in forearc basins along the Peru margin. Evaporation of seawater, however, will be important only in limited geographic regions that are characterized by enclosed basins, arid climates, and permeable sediments. At the New Hebrides and Izu-Bonin margins, Cl- concentrations are elevated to a maximum of 1241 mM. The process responsible for this increase is the alteration of volcanic ash to hydrous clay and zeolite minerals. Mass balance calculations, based on the decrease in δ18O values to -9.5‰ (SMOW), suggest that the Cl- concentrations could increase solely from the formation of smectite in a closed system. The diagenesis of volcanic ash also alters the concentrations of most dissolved species in addition to Cl-. Depending on the volume of this altered fluid, it could influence seawater

Is there any advantage of CT based 3-dimensional conformal planning over conventional orthogonal x-ray based planning in HDR brachytherapy in breast cancer

International Nuclear Information System (INIS)

Biswal, B.M.; Idris, N.R.; Zakaria, A.B.; Khairul, N.

2003-01-01

The conventional brachytherapy dose calculation is based on a particular brachytherapy rule or individual dosimetry based on the reconstruction of the sources from the orthogonal films. In the recent years many centers are using CT based 3D conformal brachytherapy in order to improve the dosimetric outcome of a given plan. Here we would like to present our experience on the use of both techniques to deliver HDR interstitial brachytherapy as boost in early breast cancer. From January 2001 to January 2003, we treated 4 breast cancer patients using conventional orthogonal x-rays and CT scan in 3 cases for the treatment plan. All patients received an external beam radiotherapy dose of 46 Gy in 23 fractions over 4.5 weeks to the whole breast using 6 MV photon beam. Subsequently the primary lesion was supplimented with HDR brachytherapy to a dose of 2.5 Gy BID for 3 consecutive days using a (192)Ir microSelectronHDR. The dose prescription was individualized to encompass the tumor volume with a 10 mm margin. The differences of the dosimetric outcome were compared. All patients completed above schedule of radiotherapy. The primary was implanted with single plane in 3 patients and multiplane implant in 4 patients. Orthogonal x-ray based localization was performed in 4 patients and CT scan based localization in 3 cases. Three patients were implanted single plane and 4 patients with multiplane implants with a median catheter number of 9 (range 6-14). The 3D conformal dose optimization was performed using Nucletron planning system (Plato). The mean 100% and 150% isodose volume was 67.3 cm 3 and 31.25cm 3 respectively. The identification of primary tumor volume, organ at risk, and identification of afterloading catheters were superior in CT based plan than conventional planning. CT scan based 3D conformal brachytherapy planning give better identification of tumor volume and its curvature, decrease the time to identify the sources and evaluate the radiation dose to organs at

A margin model to account for respiration-induced tumour motion and its variability

International Nuclear Information System (INIS)

Coolens, Catherine; Webb, Steve; Evans, Phil M; Shirato, H; Nishioka, K

2008-01-01

In order to reduce the sensitivity of radiotherapy treatments to organ motion, compensation methods are being investigated such as gating of treatment delivery, tracking of tumour position, 4D scanning and planning of the treatment, etc. An outstanding problem that would occur with all these methods is the assumption that breathing motion is reproducible throughout the planning and delivery process of treatment. This is obviously not a realistic assumption and is one that will introduce errors. A dynamic internal margin model (DIM) is presented that is designed to follow the tumour trajectory and account for the variability in respiratory motion. The model statistically describes the variation of the breathing cycle over time, i.e. the uncertainty in motion amplitude and phase reproducibility, in a polar coordinate system from which margins can be derived. This allows accounting for an additional gating window parameter for gated treatment delivery as well as minimizing the area of normal tissue irradiated. The model was illustrated with abdominal motion for a patient with liver cancer and tested with internal 3D lung tumour trajectories. The results confirm that the respiratory phases around exhale are most reproducible and have the smallest variation in motion amplitude and phase (approximately 2 mm). More importantly, the margin area covering normal tissue is significantly reduced by using trajectory-specific margins (as opposed to conventional margins) as the angular component is by far the largest contributor to the margin area. The statistical approach to margin calculation, in addition, offers the possibility for advanced online verification and updating of breathing variation as more data become available

Acute Radiation Risk and BRYNTRN Organ Dose Projection Graphical User Interface

Science.gov (United States)

Cucinotta, Francis A.; Hu, Shaowen; Nounu, Hateni N.; Kim, Myung-Hee

2011-01-01

The integration of human space applications risk projection models of organ dose and acute radiation risk has been a key problem. NASA has developed an organ dose projection model using the BRYNTRN with SUM DOSE computer codes, and a probabilistic model of Acute Radiation Risk (ARR). The codes BRYNTRN and SUM DOSE are a Baryon transport code and an output data processing code, respectively. The risk projection models of organ doses and ARR take the output from BRYNTRN as an input to their calculations. With a graphical user interface (GUI) to handle input and output for BRYNTRN, the response models can be connected easily and correctly to BRYNTRN. A GUI for the ARR and BRYNTRN Organ Dose (ARRBOD) projection code provides seamless integration of input and output manipulations, which are required for operations of the ARRBOD modules. The ARRBOD GUI is intended for mission planners, radiation shield designers, space operations in the mission operations directorate (MOD), and space biophysics researchers. BRYNTRN code operation requires extensive input preparation. Only a graphical user interface (GUI) can handle input and output for BRYNTRN to the response models easily and correctly. The purpose of the GUI development for ARRBOD is to provide seamless integration of input and output manipulations for the operations of projection modules (BRYNTRN, SLMDOSE, and the ARR probabilistic response model) in assessing the acute risk and the organ doses of significant Solar Particle Events (SPEs). The assessment of astronauts radiation risk from SPE is in support of mission design and operational planning to manage radiation risks in future space missions. The ARRBOD GUI can identify the proper shielding solutions using the gender-specific organ dose assessments in order to avoid ARR symptoms, and to stay within the current NASA short-term dose limits. The quantified evaluation of ARR severities based on any given shielding configuration and a specified EVA or other mission

Ecological and evolutionary processes at expanding range margins

OpenAIRE

Thomas, C.D.; Bodsworth, E.J.; Wilson, R.J.; Simmons, A.D.; Davies, Z.G.; Musche, M.; Conradt, L.

2001-01-01

Many animals are regarded as relatively sedentary and specialized in marginal parts of their geographical distributions. They are expected to be slow at colonizing new habitats. Despite this, the cool margins of many species' distributions have expanded\\ud rapidly in association with recent climate warming3±10. We examined four insect species that have expanded their geographical\\ud ranges in Britain over the past 20 years. Here we report that two butterfly species have increased the variety ...

7 CFR 407.17 - Group risk plan for wheat.

Science.gov (United States)

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Group risk plan for wheat. 407.17 Section 407.17..., DEPARTMENT OF AGRICULTURE GROUP RISK PLAN OF INSURANCE REGULATIONS § 407.17 Group risk plan for wheat. The provisions of the Group Risk Plan for Wheat for the 2000 and succeeding crop years are as follows: 1...

7 CFR 407.11 - Group risk plan for corn.

Science.gov (United States)

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Group risk plan for corn. 407.11 Section 407.11..., DEPARTMENT OF AGRICULTURE GROUP RISK PLAN OF INSURANCE REGULATIONS § 407.11 Group risk plan for corn. The provisions of the Group Risk Plan for Corn for the 2000 and succeeding crop years are as follows: 1...

Analysing the external supply chain risk driver competitiveness: a risk mitigation framework and business continuity plan.

Science.gov (United States)

Blos, Mauricio F; Wee, Hui-Ming; Yang, Joshua

2010-11-01

Innovation challenges for handling supply chain risks have become one of the most important drivers in business competitiveness and differentiation. This study analyses competitiveness at the external supply chain level as a driver of risks and provides a framework for mitigating these risks. The mitigation framework, also called the supply chain continuity framework, provides insight into six stages of the business continuity planning (BCP) process life cycle (risk mitigation management, business impact analysis, supply continuity strategy development, supply continuity plan development, supply continuity plan testing and supply continuity plan maintenance), together with the operational constructs: customer service, inventory management, flexibility, time to market, ordering cycle time and quality. The purpose of the BCP process life cycle and operational constructs working together is to emphasise the way in which a supply chain can deal with disruption risks and, consequently, bring competitive advantage. Future research will consider the new risk scenarios and analyse the consequences to promote the improvement of supply chain resilience.

Risk management plan for the National Ignition Facility

International Nuclear Information System (INIS)

Brereton, S.; Lane, M.; Smith, C.; Yatabe, J.

1998-01-01

The National Ignition Facility (NIF) is a U.S. Department of Energy inertial confinement laser fusion facility, currently under construction at the Lawrence Livermore National Laboratory (LLNL). NIF is a critical tool for the Department of Energy (DOE) science- based Stockpile Stewardship and Management Program. In addition, it represents a major step towards realizing inertial confinement fusion as a source of energy. The NIF will focus 192 laser beams onto spherical targets containing a mixture of deuterium and tritium, causing them to implode. This will create the high temperatures and pressures necessary for these targets to undergo fusion. The plan is for NIF to achieve ignition (i.e., self-heating of the fuel) and energy gain (i.e., more fusion energy produced than laser energy deposited) in the laboratory for the first time. A Risk Management Plan was prepared for the NIF design and construction Project. The plan was prepared in accordance with the DOE Life Cycle Asset Management Good Practice Guide. The objectives of the plan were to: (1) identify the risks to the completion of the Project in terms of meeting technical and regulatory requirements, cost, and schedule, (2) assess the risks in terms of likelihood of occurrence and their impact potential relative to technical performance, ES ampersand H (environment, safety and health), costs, and schedule, and (3) address each risk in terms of suitable risk management measures. Major risk elements were identified for the NIF Project. A risk assessment methodology was developed, which was utilized to rank the Project risks with respect to one another. Those elements presenting greater risk were readily identified by this process. This paper describes that methodology and the results

Pan-Arctic Distribution of Bioavailable Dissolved Organic Matter and Linkages With Productivity in Ocean Margins

Science.gov (United States)

Shen, Yuan; Benner, Ronald; Kaiser, Karl; Fichot, Cédric G.; Whitledge, Terry E.

2018-02-01

Rapid environmental changes in the Arctic Ocean affect plankton productivity and the bioavailability of dissolved organic matter (DOM) that supports microbial food webs. We report concentrations of dissolved organic carbon (DOC) and yields of amino acids (indicators of labile DOM) in surface waters across major Arctic margins. Concentrations of DOC and bioavailability of DOM showed large pan-Arctic variability that corresponded to varying hydrological conditions and ecosystem productivity, respectively. Widespread hot spots of labile DOM were observed over productive inflow shelves (Chukchi and Barents Seas), in contrast to oligotrophic interior margins (Kara, Laptev, East Siberian, and Beaufort Seas). Amino acid yields in outflow gateways (Canadian Archipelago and Baffin Bay) indicated the prevalence of semilabile DOM in sea ice covered regions and sporadic production of labile DOM in ice-free waters. Comparing these observations with surface circulation patterns indicated varying shelf subsidies of bioavailable DOM to Arctic deep basins.

Quantitative risk analysis as a basis for emergency planning

Energy Technology Data Exchange (ETDEWEB)

Yogui, Regiane Tiemi Teruya [Bureau Veritas do Brasil, Rio de Janeiro, RJ (Brazil); Macedo, Eduardo Soares de [Instituto de Pesquisas Tecnologicas (IPT), Sao Paulo, SP (Brazil)

2009-07-01

Several environmental accidents happened in Brazil and in the world during the 70's and 80's. This strongly motivated the preparation for emergencies in the chemical and petrochemical industries. Environmental accidents affect the environment and the communities that are neighbor to the industrial facilities. The present study aims at subsidizing and providing orientation to develop Emergency Planning from the data obtained on Quantitative Risk Analysis, elaborated according to the Technical Standard P4.261/03 from CETESB (Sao Paulo Environmental Agency). It was observed, during the development of the research, that the data generated on these studies need a complementation and a deeper analysis, so that it is possible to use them on the Emergency Plans. The main issues that were analyzed and discussed on this study were the reevaluation of hazard identification for the emergency plans, the consequences and vulnerability analysis for the response planning, the risk communication, and the preparation to respond to the emergencies of the communities exposed to manageable risks. As a result, the study intends to improve the interpretation and use of the data deriving from the Quantitative Risk Analysis to develop the emergency plans. (author)

Transformations and Fates of Terrigenous Dissolved Organic Matter in River-influenced Ocean Margins

Science.gov (United States)

Fichot, Cedric G.

Rivers contribute about 0.25 Pg of terrigenous dissolved organic carbon (tDOC) to the ocean each year. The fate and transformations of this material have important ramifications for the metabolic state of the ocean, air-sea CO2 exchange, and the global carbon cycle. Stable isotopic compositions and terrestrial biomarkers suggest tDOC must be efficiently mineralized in ocean margins. Nonetheless, the extent of tDOC mineralization in these environments remains unknown, as no quantitative estimate is available. The complex interplay of biogeochemical and physical processes in these systems compounded by the limited practicality of chemical proxies (organic biomarkers, isotopic compositions) make the quantification of tDOC mineralization in these dynamic systems particularly challenging. In this dissertation, new optical proxies were developed (Chapters 1 and 2) and facilitated the first quantitative assessment of tDOC mineralization in a dynamic river-influenced ocean margin (Chapter 3) and the monitoring of continental runoff distributions in the coastal ocean using remote sensing (Chapter 4). The optical properties of chromophoric dissolved organic matter (CDOM) were used as optical proxies for dissolved organic carbon concentration ([DOC]) and %tDOC. In both proxies, the CDOM spectral slope coefficient ( S275-295) was exploited for its informative properties on the chemical nature and composition of dissolved organic matter. In the first proxy, a strong relationship between S275-295 and the ratio of CDOM absorption to [DOC] facilitated accurate retrieval (+/- 4%) of [DOC] from CDOM. In the second proxy, the existence of a strong relationship between S275-295 and the DOC-normalized lignin yield facilitated the estimation of the %tDOC from S 275-295. Using the proxies, the tDOC concentration can be retrieved solely from CDOM absorption coefficients (lambda = 275-295 nm) in river-influenced ocean margins. The practicality of optical proxies facilitated the calculation

Computed tomography-based treatment planning for high-dose-rate brachytherapy using the tandem and ring applicator: influence of applicator choice on organ dose and inter-fraction adaptive planning

Directory of Open Access Journals (Sweden)

Vishruta A. Dumane

2017-06-01

Full Text Available Three dimensional planning for high-dose-rate (HDR brachytherapy in cervical cancer has been highly recommended by consensus guidelines such as the American Brachytherapy Society (ABS and the Groupe Européen de Curiethérapie – European Society for Radiotherapy and Oncology (GEC-ESTRO. In this document, we describe our experience with computed tomography (CT-based planning using the tandem/ring applicator. We discuss the influence of applicator geometry on doses to organs at risk (OARs, namely the bladder, rectum, and sigmoid. Through example cases with dose prescribed to point A, we demonstrate how adaptive planning can help achieve constraints to the OARs as per guidelines.

Effect of Maternal and Pregnancy Risk Factors on Early Neonatal Death in Planned Home Births Delivering at Home.

Science.gov (United States)

Bachilova, Sophia; Czuzoj-Shulman, Nicholas; Abenhaim, Haim Arie

2018-05-01

The prevalence of home birth in the United States is increasing, although its safety is undetermined. The objective of this study was to investigate the effects of obstetrical risk factors on early neonatal death in planned home births delivering at home. The authors conducted a retrospective 3-year cohort study consisting of planned home births that delivered at home in the United States between 2011 and 2013. The study excluded infants with congenital and chromosomal anomalies and infants born at ≤34 weeks' gestation. Multivariate logistic regression models were used to estimate the adjusted effects of individual obstetrical variables on early neonatal deaths within 7 days of delivery. During the study period, there were 71 704 planned and delivered home births. The overall early neonatal death rate was 1.5 deaths per 1000 planned home births. The risks of early neonatal death were significantly higher in nulliparous births (OR 2.71; 95% CI 1.71-4.31), women with a previous CS (OR 2.62, 95% CI 1.25-5.52), non-vertex presentations (OR 4.27; 95% CI 1.33-13.75), plural births (OR 9.79; 95% CI 4.25-22.57), preterm births (OR 4.68; 95% CI 2.30-9.51), and births at ≥41 weeks of gestation (OR 1.76; 95% CI 1.09-2.84). Early neonatal deaths occur more commonly in certain obstetrical contexts. Patient selection may reduce adverse neonatal outcomes among planned home births. Copyright © 2018 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

Planning of development strategy for establishment of advanced simulation of nuclear system

International Nuclear Information System (INIS)

Chung, Bubdong; Ko, Wonil; Kwon Junhyun

2013-12-01

In this product, the long term development plan in each technical area has been prosed with the plan of coupled code system. The consolidated code system for safety analysis has been proposing for future needs. The computing hardware needed for te advanced simulation is also proposing. The best approach for future safety analysis simulation capabilities may be a dual-path program. i. e. the development programs for an integrated analysis tool and multi-scale/multi-physic analysis tools, where the former aims at reducing uncertainty and the latter at enhancing accuracy. Integrated analysis tool with risk informed safety margin quantification It requires a significant extension of the phenomenological and geometric capabilities of existing reactor safety analysis software, capable of detailed simulations that reduce the uncertainties. Multi-scale, multi-physics analysis tools. Simplifications of complex phenomenological models and dependencies have been made in current safety analyses to accommodate computer hardware limitations. With the advent of modern computer hardware, these limitations may be removed to permit greater accuracy in representation of physical behavior of materials in design basis and beyond design basis conditions, and hence more accurate assessment of the true safety margins based on first principle methodology. The proposals can be utilized to develop the advanced simulation project and formulation of organization and establishment of high performance computing system in KAERI

Risk factors of circumferential resection margin involvement in the patients with extraperitoneal rectal cancer.

Science.gov (United States)

Oh, Sung Jin; Shin, Jin Yong

2012-03-01

Currently, circumferential resection margins (CRM) are used as a clinical endpoint in studies on the prognosis of rectal cancer. Although the concept of a circumferential resection margin in extraperitoneal rectal cancer differs from that in intraperitoneal rectal cancer due to differences in anatomical and biologic behaviors, previous reports have provided information on CRM involvement in all types of rectal cancer including intraperitoneal lesions. Therefore, the aim of this study was to analyze risk factors of CRM involvement in extraperitoneal rectal cancer. From January 2005 to December 2008, 306 patients with extraperitoneal rectal cancer were enrolled in a prospectively collected database. Multivariate logistic regression analysis was used to identify predictors of CRM involvement. The overall rate of CRM involvement was found to be 16.0%. Multivariate analysis showed that male sex, larger tumor size (≥4 cm), stage higher than T3, nodal metastasis, tumor perforation and non-sphincter preserving proctectomy (NSPP) were risk factors for CRM involvement. Male sex, larger tumor size (≥4 cm), advanced T stage, nodal metastasis, tumor perforation, and NSPP are significant risk factors of CRM involvement in extraperitoneal rectal cancer. Given that postoperative chemoradiotherapy is recommended for patients with a positive CRM, further oncologic studies are warranted to ascertain which patients with these risk factors would require adjuvant therapy.

Defense against terroristic hazards and risk by building planning law

International Nuclear Information System (INIS)

Hopkins, Richard

2012-01-01

The book on defense against terroristic hazards and risk by building planning law includes the following issues: Introduction: civil engineering and safety. Risk, hazards and urban planning: historical and actual examples for the constructional danger prevention, terroristic threat and urban planning. Risk, hazards and terrorism: sociology and risk, law and risk, terrorism - risk or hazard? Answer to uncertainty - risk prevention, catastrophe law as link. Risk, hazard, terrorism and the public building and regional planning law: regional planning law as point of origin, building law and terrorism, possibility of control by the legal building regulations.

Risk of persistent high-grade squamous intraepithelial lesion after electrosurgical excisional treatment with positive margins: a meta-analysis

Directory of Open Access Journals (Sweden)

Caroline Alves de Oliveira

Full Text Available CONTEXT AND OBJECTIVE: Even if precursor lesions of cervical cancer are properly treated, there is a risk of persistence or recurrence. The aim here was to quantify the risks of persistence of high-grade intraepithelial squamous lesions, one and two years after cervical electrosurgical excisional treatment with positive margins. DESIGN AND SETTING: Systematic review of the literature and meta-analysis at Instituto Fernandes Figueira. METHODS: This meta-analysis was on studies published between January 1989 and July 2009 that were identified in Medline, Scopus, Embase, Cochrane, SciELO, Lilacs, Adolec, Medcarib, Paho, Wholis, Popline, ISI Web of Science and Sigle. Articles were selected if they were cohort studies on electrosurgical excisional treatment of high-grade squamous intraepithelial lesions with a minimum follow-up of one year, a histopathological outcome of persistence of these lesions and a small risk of bias. RESULTS: The search identified 7,066 articles and another 21 in the reference lists of these papers. After applying the selection and exclusion criteria, only four articles were found to have extractable data. The risk of persistence of high-grade intraepithelial lesions after one year was 11.36 times greater (95% confidence interval, CI: 5.529-23.379, P < 0.0001 in patients with positive margins and after two years, was four times greater (95% CI: 0.996-16.164, although without statistical significance. CONCLUSION: This meta-analysis confirms the importance of positive margins as an indicator of incomplete treatment after the first year of follow-up and highlights the need for appropriately chosen electrosurgical techniques based on disease location and extent, with close surveillance of these patients.

World Health Organization cardiovascular risk stratification and target organ damage.

Science.gov (United States)

Piskorz, D; Bongarzoni, L; Citta, L; Citta, N; Citta, P; Keller, L; Mata, L; Tommasi, A

2016-01-01

Prediction charts allow treatment to be targeted according to simple markers of cardiovascular risk; many algorithms do not recommend screening asymptomatic target organ damage which could change dramatically the assessment. To demonstrate that target organ damage is present in low cardiovascular risk hypertensive patients and it is more frequent and severe as global cardiovascular risk increases. Consecutive hypertensive patients treated at a single Latin American center. Cardiovascular risk stratified according to 2013 WHO/ISH risk prediction chart America B. Left ventricular mass assessed by Devereux method, left ventricular hypertrophy considered >95g/m(2) in women and >115g/m(2) in men. Transmitral diastolic peak early flow velocity to average septal/lateral peak early diastolic relaxation velocity (E/e' ratio) measured cut off value >13. Systolic function assessed by tissue Doppler average interventricular septum/lateral wall mitral annulus rate systolic excursion (s wave). A total of 292 patients were included of whom 159 patients (54.5%) had cardiovascular risk of 20%. Left ventricular hypertrophy was detected in 17.6% low risk patients, 27.8% in medium risk and 23.3% in high risk (p<0.05), abnormal E/e' ratio was found in 13.8%, 31.1% and 27.9%, respectively (p<0.05). Mean s wave was 8.03+8, 8.1+9 and 8.7+1cm/s for low, intermediate and high risk patients, respectively (p<0.025). Target organ damage is more frequent and severe in high risk; one over four subjects was misclassified due to the presence of asymptomatic target organ damage. Copyright © 2015 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.

RISMC Toolkit and Methodology Research and Development Plan for External Hazards Analysis

Energy Technology Data Exchange (ETDEWEB)

Coleman, Justin Leigh [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2016-03-01

This report includes the description and development plan for a Risk Informed Safety Margins Characterization (RISMC) toolkit and methodology that will evaluate multihazard risk in an integrated manner to support the operating nuclear fleet.

RISMC Toolkit and Methodology Research and Development Plan for External Hazards Analysis

International Nuclear Information System (INIS)

Coleman, Justin Leigh

2016-01-01

This report includes the description and development plan for a Risk Informed Safety Margins Characterization (RISMC) toolkit and methodology that will evaluate multihazard risk in an integrated manner to support the operating nuclear fleet.

Pickering seismic safety margin

International Nuclear Information System (INIS)

Ghobarah, A.; Heidebrecht, A.C.; Tso, W.K.

1992-06-01

A study was conducted to recommend a methodology for the seismic safety margin review of existing Canadian CANDU nuclear generating stations such as Pickering A. The purpose of the seismic safety margin review is to determine whether the nuclear plant has sufficient seismic safety margin over its design basis to assure plant safety. In this review process, it is possible to identify the weak links which might limit the seismic performance of critical structures, systems and components. The proposed methodology is a modification the EPRI (Electric Power Research Institute) approach. The methodology includes: the characterization of the site margin earthquake, the definition of the performance criteria for the elements of a success path, and the determination of the seismic withstand capacity. It is proposed that the margin earthquake be established on the basis of using historical records and the regional seismo-tectonic and site specific evaluations. The ability of the components and systems to withstand the margin earthquake is determined by database comparisons, inspection, analysis or testing. An implementation plan for the application of the methodology to the Pickering A NGS is prepared

Marginalization and School Nursing

Science.gov (United States)

Smith, Julia Ann

2004-01-01

The concept of marginalization was first analyzed by nursing researchers Hall, Stevens, and Meleis. Although nursing literature frequently refers to this concept when addressing "at risk" groups such as the homeless, gays and lesbians, and those infected with HIV/AIDS, the concept can also be applied to nursing. Analysis of current school nursing…

PLAN FOR PERFORMANCE ADMINISTRATION IN PYRAMIDAL STRUCTURE ORGANIZATIONS

Directory of Open Access Journals (Sweden)

Domingo Alarcón Ortiz

2013-11-01

Full Text Available Performance administration has become a current strategy in evaluating management within organizations, but its implementation often lacks an action plan, resulting from the valuation of climate and leadership styles embedded in the culture of the organization. This paper proposes a model action plan for performance management, which has been implemented, executed and evaluated in pyramidal organizational structure organizations where a diagnosis of the cultural climate and leadership styles recurring in the organization have been previously made.

Financial planning considerations at retirement.

Science.gov (United States)

Cole, R J

1998-03-01

The process of retirement planning is a difficult one for a physician. The Planning process should address the areas of Investment Planning, Estate Planning, and Risk Management. This article examines each of these dimensions with special emphasis on Modern Portfolio Theory as the basis for investment planning.

The Impact of Colleague Peer Review on the Radiotherapy Treatment Planning Process in the Radical Treatment of Lung Cancer.

Science.gov (United States)

Rooney, K P; McAleese, J; Crockett, C; Harney, J; Eakin, R L; Young, V A L; Dunn, M A; Johnston, R E; Hanna, G G

2015-09-01

Modern radiotherapy uses techniques to reliably identify tumour and reduce target volume margins. However, this can potentially lead to an increased risk of geographic miss. One source of error is the accuracy of target volume delineation (TVD). Colleague peer review (CPR) of all curative-intent lung cancer plans has been mandatory in our institution since May 2013. At least two clinical oncologists review plans, checking treatment paradigm, TVD, prescription dose tumour and critical organ tolerances. We report the impact of CPR in our institution. Radiotherapy treatment plans of all patients receiving radical radiotherapy were presented at weekly CPR meetings after their target volumes were reviewed and signed off by the treating consultant. All cases and any resultant change to TVD (including organs at risk) or treatment intent were recorded in our prospective CPR database. The impact of CPR over a 13 month period from May 2013 to June 2014 is reported. One hundred and twenty-two patients (63% non-small cell lung carcinoma, 17% small cell lung carcinoma and 20% 'clinical diagnosis') were analysed. On average, 3.2 cases were discussed per meeting (range 1-8). CPR resulted in a change in treatment paradigm in 3% (one patient proceeded to induction chemotherapy, two patients had high-dose palliative radiotherapy). Twenty-one (17%) had a change in TVD and one (1%) patient had a change in dose prescription. In total, 6% of patients had plan adjustment after review of dose volume histogram. The introduction of CPR in our centre has resulted in a change in a component of the treatment plan for 27% of patients receiving curative-intent lung radiotherapy. We recommend CPR as a mandatory quality assurance step in the planning process of all radical lung plans. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Integrating ALARA into work planning and organization

International Nuclear Information System (INIS)

Croft, J.R.; Robb, J.D.

1993-01-01

This paper presents various organizational structures and systematic approaches that can be of benefit in integrating ALARA into work planning and organization. It is possible to have elegant policy statements, procedures and organizations and yet fail to implement ALARA effectively. The real key to success in ALARA work management is to recognize that ALARA is primarily a way of thinking and to secure the commitment of individuals at all levels within the organization, from senior management to workers carrying out specific tasks. The authors explain that the recommendations of ICRP Publication 60 will have an impact and will maintain the downward pressure on individual doses. 6 figs

Geophysical constraints on geodynamic processes at convergent margins: A global perspective

Science.gov (United States)

Artemieva, Irina; Thybo, Hans; Shulgin, Alexey

2016-04-01

Convergent margins, being the boundaries between colliding lithospheric plates, form the most disastrous areas in the world due to intensive, strong seismicity and volcanism. We review global geophysical data in order to illustrate the effects of the plate tectonic processes at convergent margins on the crustal and upper mantle structure, seismicity, and geometry of subducting slab. We present global maps of free-air and Bouguer gravity anomalies, heat flow, seismicity, seismic Vs anomalies in the upper mantle, and plate convergence rate, as well as 20 profiles across different convergent margins. A global analysis of these data for three types of convergent margins, formed by ocean-ocean, ocean-continent, and continent-continent collisions, allows us to recognize the following patterns. (1) Plate convergence rate depends on the type of convergent margins and it is significantly larger when, at least, one of the plates is oceanic. However, the oldest oceanic plate in the Pacific ocean has the smallest convergence rate. (2) The presence of an oceanic plate is, in general, required for generation of high-magnitude (M N 8.0) earthquakes and for generating intermediate and deep seismicity along the convergent margins. When oceanic slabs subduct beneath a continent, a gap in the seismogenic zone exists at depths between ca. 250 km and 500 km. Given that the seismogenic zone terminates at ca. 200 km depth in case of continent-continent collision, we propose oceanic origin of subducting slabs beneath the Zagros, the Pamir, and the Vrancea zone. (3) Dip angle of the subducting slab in continent-ocean collision does not correlate neither with the age of subducting oceanic slab, nor with the convergence rate. For ocean-ocean subduction, clear trends are recognized: steeply dipping slabs are characteristic of young subducting plates and of oceanic plates with high convergence rate, with slab rotation towards a near-vertical dip angle at depths below ca. 500 km at very high

Integration and test planning patterns in different organizations

NARCIS (Netherlands)

Jong, de I.S.M.; Boumen, R.; Mortel - Fronczak, van de J.M.; Rooda, J.E.; Tretmans, J.

2007-01-01

Planning an integration and test phase is often done by experts in the visited organizations. These experts have a thorough knowledge about the system, integration and testing and the business drivers of an organization. An integration and test plan developedfor an airplane is different than the

Patterns of failure for glioblastoma multiforme following limited-margin radiation and concurrent temozolomide

International Nuclear Information System (INIS)

Gebhardt, Brian J; Dobelbower, Michael C; Ennis, William H; Bag, Asim K; Markert, James M; Fiveash, John B

2014-01-01

To analyze patterns of failure in patients with glioblastoma multiforme (GBM) treated with limited-margin radiation therapy and concurrent temozolomide. We hypothesize that patients treated with margins in accordance with Adult Brain Tumor Consortium guidelines (ABTC) will demonstrate patterns of failure consistent with previous series of patients treated with 2–3 cm margins. A retrospective review was performed of patients treated at the University of Alabama at Birmingham for GBM between 2000 and 2011. Ninety-five patients with biopsy-proven disease and documented disease progression after treatment were analyzed. The initial planning target volume includes the T1-enhancing tumor and surrounding edema plus a 1 cm margin. The boost planning target volume includes the T1-enhancing tumor plus a 1 cm margin. The tumors were classified as in-field, marginal, or distant if greater than 80%, 20-80%, or less than 20% of the recurrent volume fell within the 95% isodose line, respectively. The median progression-free survival from the time of diagnosis to documented failure was 8 months (range 3–46). Of the 95 documented recurrences, 77 patients (81%) had an in-field component of treatment failure, 6 (6%) had a marginal component, and 27 (28%) had a distant component. Sixty-three patients (66%) demonstrated in-field only recurrence. The low rate of marginal recurrence suggests that wider margins would have little impact on the pattern of failure, validating the use of limited margins in accordance ABTC guidelines

Factors associated with high risk of marginal hyperthermia in elderly patients living in an institution.

Science.gov (United States)

Vassallo, M.; Gera, K. N.; Allen, S.

1995-01-01

The elderly, the very young, and the sick are known to be adversely affected by high environmental temperatures. In a retrospective open case-note review of 872 patients in a large institution during a hot summer we identified characteristics in the elderly that increase the risk of marginal hyperthermia. Women were more likely to be affected than men (25.6% vs 16.9%). We found an age-related increase in marginal hyperthermia, 15.7% of those below 60 years developed a hyperthermia compared to 18.9% in those between 70-79 years (non-significant), 28.3% in those between 80-89 years (p = 0.01) and 50% in those above 90 years (p bedridden group, p < 0.01, and 20.4% of the semi-dependent, p < 0.01, compared to 11.1% of the mobile group). These factors were more significant as predictors of risk than the diagnosis. Identifying high risk patients early and taking appropriate measures to avoid hyperthermia and dehydration is important to try to decrease mortality during heatwaves. PMID:7784280

Employee Perceptions of Their Organization's Level of Emergency Preparedness Following a Brief Workplace Emergency Planning Educational Presentation.

Science.gov (United States)

Renschler, Lauren A; Terrigino, Elizabeth A; Azim, Sabiya; Snider, Elsa; Rhodes, Darson L; Cox, Carol C

2016-06-01

A brief emergency planning educational presentation was taught during work hours to a convenience sample of employees of various workplaces in Northern Missouri, USA. Participants were familiarized with details about how an emergency plan is prepared by management and implemented by management-employee crisis management teams - focusing on both employee and management roles. They then applied the presentation information to assess their own organization's emergency preparedness level. Participants possessed significantly (p employees to become more involved in their organization's emergency planning and response. Educational strategies that involve management-employee collaboration in activities tailored to each workplace's operations and risk level for emergencies should be implemented.

A positive risk approach when clients choose to live at risk: a palliative case discussion.

Science.gov (United States)

De Bono, Christopher E; Henry, Blair

2016-09-01

The article discusses recent approaches in the literature about clients who chose to live at risk in their homes. It argues for a positive risk-based approach and a tool to help manage risk in the home, and applies these to a hypothetical end-of-life scenario. Historically, safety plans to consider risk management involved a culture of risk aversion supported by sometimes paternalistic motives intended to protect vulnerable clients. New findings in the literature engage in a process that respects the ethical principles underlying harm reduction philosophies. The literature also argues for a perspective that moves away from viewing risk as only harmful, to one that supports a positive understanding of risk as part of a client's informed choice. A risk support management plan, based on a positive approach, can provide a way to both support a client's choice to live at risk, anticipate for expected complications, and inform the creation of a contingency plan to address concerns as they may arise. The added value of a structured approach like the one proposed here for risk support management plans is that it provides adequate due diligence and informed decision-making when planning for risk-taking in complex situations.

Deceased Organ Donors and PHS Risk Identification: Impact on Organ Usage and Outcomes.

Science.gov (United States)

Pruett, Timothy L; Clark, Marissa A; Taranto, Sarah E

2017-07-01

In 2013, the public health service (PHS) changed the criteria intended to identify organ donors that put the associated organ recipients at increased risk for acquiring human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). The changing donor demographics, organ utilization, and outcomes associated with this change are not known. A review of the Organ Procurement and Transplantation Network database was performed to assess the impact of PHS donor designation on organ utilization and outcomes. After the 2013 modification, over 20% of all deceased organ donors in the United States were identified as PHS increased risk. Compared with the standard risk deceased organ donor, the PHS donor was younger, male, died from anoxia, more likely to be HCV and antibody reacting to hepatitis B core antigen+, and less likely to have diabetes or hypertension. Organs from the 18- to 34-year-old deceased donors with PHS risks (but relatively few medical comorbidities) and tested negative for HCV were less frequently transplanted compared with the standard risk donors (3.9 vs 4.2 organs transplanted per donor). However, the transplant patient and graft survival as well as risk of unexpected transmission of HIV, HBV, and HCV were equivalent, irrespective of PHS donor status. The rationale of using PHS donor designation that negatively impacts utilization of high-quality organs without the benefit of identifying the subset of organs with demonstrable proclivity to transmit HIV, HBV, or HCV needs to be reexamined.

Risk-informed analysis of the large break loss of coolant accident and PCT margin evaluation with the RISMC methodology

International Nuclear Information System (INIS)

Liang, T.H.; Liang, K.S.; Cheng, C.K.; Pei, B.S.; Patelli, E.

2016-01-01

Highlights: • With RISMC methodology, both aleatory and epistemic uncertainties have been considered. • 14 probabilistically significant sequences have been identified and quantified. • A load spectrum for LBLOCA has been conducted with CPCT and SP of each dominant sequence. • Comparing to deterministic methodologies, the risk-informed PCT margin can be greater by 44–62 K. • The SP of the referred sequence to cover 99% in the load spectrum is only 5.07 * 10 −3 . • The occurrence probability of the deterministic licensing sequence is 5.46 * 10 −5 . - Abstract: For general design basis accidents, such as SBLOCA and LBLOCA, the traditional deterministic safety analysis methodologies are always applied to analyze events based on a so called surrogate or licensing sequence, without considering how low this sequence occurrence probability is. In the to-be-issued 10 CFR 50.46a, the LBLOCA will be categorized as accidents beyond design basis and the PCT margin shall be evaluated in a risk-informed manner. According to the risk-informed safety margin characterization (RISMC) methodology, a process has been suggested to evaluate the risk-informed PCT margin. Following the RISMC methodology, a load spectrum of PCT for LBLOCA has been generated for the Taiwan’s Maanshan Nuclear Power plant and 14 probabilistic significant sequences have been identified. It was observed in the load spectrum that the conditional PCT generally ascends with the descending sequence occurrence probability. With the load spectrum covering both aleatory and epistemic uncertainties, the risk-informed PCT margin can be evaluated by either expecting value estimation method or sequence probability coverage method. It was found that by comparing with the traditional deterministic methodology, the PCT margin evaluated by the RISMC methodology can be greater by 44–62 K. Besides, to have a cumulated occurrence probability over 99% in the load spectrum, the occurrence probability of the

Risk-informed analysis of the large break loss of coolant accident and PCT margin evaluation with the RISMC methodology

Energy Technology Data Exchange (ETDEWEB)

Liang, T.H. [Institute of Nuclear Engineering and Science, National Tsing Hua University, 101 Sec. 2, Kuang-Fu Road, Hsinchu 30013, Taiwan (China); Liang, K.S., E-mail: ksliang@alum.mit.edu [Institute of Nuclear Engineering and Science, National Tsing Hua University, 101 Sec. 2, Kuang-Fu Road, Hsinchu 30013, Taiwan (China); Cheng, C.K.; Pei, B.S. [Institute of Nuclear Engineering and Science, National Tsing Hua University, 101 Sec. 2, Kuang-Fu Road, Hsinchu 30013, Taiwan (China); Patelli, E. [Institute of Risk and Uncertainty, University of Liverpool, Room 610, Brodie Tower, L69 3GQ (United Kingdom)

2016-11-15

Highlights: • With RISMC methodology, both aleatory and epistemic uncertainties have been considered. • 14 probabilistically significant sequences have been identified and quantified. • A load spectrum for LBLOCA has been conducted with CPCT and SP of each dominant sequence. • Comparing to deterministic methodologies, the risk-informed PCT margin can be greater by 44–62 K. • The SP of the referred sequence to cover 99% in the load spectrum is only 5.07 * 10{sup −3}. • The occurrence probability of the deterministic licensing sequence is 5.46 * 10{sup −5}. - Abstract: For general design basis accidents, such as SBLOCA and LBLOCA, the traditional deterministic safety analysis methodologies are always applied to analyze events based on a so called surrogate or licensing sequence, without considering how low this sequence occurrence probability is. In the to-be-issued 10 CFR 50.46a, the LBLOCA will be categorized as accidents beyond design basis and the PCT margin shall be evaluated in a risk-informed manner. According to the risk-informed safety margin characterization (RISMC) methodology, a process has been suggested to evaluate the risk-informed PCT margin. Following the RISMC methodology, a load spectrum of PCT for LBLOCA has been generated for the Taiwan’s Maanshan Nuclear Power plant and 14 probabilistic significant sequences have been identified. It was observed in the load spectrum that the conditional PCT generally ascends with the descending sequence occurrence probability. With the load spectrum covering both aleatory and epistemic uncertainties, the risk-informed PCT margin can be evaluated by either expecting value estimation method or sequence probability coverage method. It was found that by comparing with the traditional deterministic methodology, the PCT margin evaluated by the RISMC methodology can be greater by 44–62 K. Besides, to have a cumulated occurrence probability over 99% in the load spectrum, the occurrence probability

Understanding risk evaluation and mitigation strategies in organ transplantation.

Science.gov (United States)

Gabardi, Steven

2011-07-01

The United States Food and Drug Administration (FDA) Amendments Act of 2007 mandated that Risk Evaluation and Mitigation Strategies (REMS) be required of manufacturers. These REMS are strategies implemented to manage known or potential risks associated with drugs and to ensure ongoing pharmacovigilance throughout the life of a pharmaceutical product, including once the product becomes available as generic. The elements of an individual REMS program consist of three levels: medication guide or patient package insert, communication plan, and elements to assure safe use (ETASU). A medication guide or patient package insert is used to help prevent serious adverse events, aid in patient decision making, and enhance drug adherence. Communication plans are used to educate health care providers and to encourage their compliance with REMS. The ETASU is a restrictive process that is implemented when it is deemed necessary to ensure that patients have safe access to products with known serious risks that would otherwise be unavailable. To review the components of REMS and specifically assess their impact on health care providers practicing within the organ transplantation arena, a literature search of the MEDLINE database (January 2007-December 2010) was performed, and published materials from the FDA and its Web site were also reviewed. In transplantation, REMS programs exist for both everolimus (medication guide and communication plan) and sirolimus (medication guide). The FDA has stated that all mycophenolic acid derivatives will be subject to a proposed REMS that has not yet been approved; however, both branded mycophenolic acid agents already have approved medication guides. The REMS are a permanent fixture in the development and marketing of pharmaceutical agents, and their further implementation in solid organ transplantation is inevitable. Transplantation providers should take a proactive role in patient education and implementation of REMS within the therapeutic area

Hanford Mission Plan risk-based prioritization methodologies

International Nuclear Information System (INIS)

Hesser, W.A.; Madden, M.S.; Pyron, N.M.; Butcher, J.L.

1994-08-01

Sites across the US Department (DOE) complex recognize the critical need for a systematic method for prioritizing among their work scope activities. Here at the Hanford Site, Pacific Northwest Laboratory and Westinghouse Hanford Company (WHC) conducted preliminary research into techniques to meet this need and assist managers in making financial resource allocation decisions. This research is a subtask of the risk management task of the Hanford Mission Plan as described in the WHC Integrated Planning Work Breakdown Structure 1.8.2 Fiscal Year 1994 Work Plan. The research team investigated prioritization techniques used at other DOE sites and compared them with the Priority Planning Grid (PPG), a tool used at Hanford. The authors concluded that the PPG could be used for prioritization of resource allocation, but it needed to be revised to better reflect the Site's priorities and objectives. The revised PPG was tested with three Hanford programs, the PPG was modified, and updated procedures were prepared

Intentions to Participate in Counselling among Front-Line, At-Risk Irish Government Employees: An Application of the Theory of Planned Behaviour

Science.gov (United States)

Hyland, Philip E.; McLaughlin, Christopher G.; Boduszek, Daniel; Prentice, Garry R.

2012-01-01

The study set out to examine intentions to engage in counselling among at-risk Irish government employees and the differential utility of two alternative theory of planned behaviour (TPB) models of behaviour to explain intentions to participate in counselling. Individuals (N = 259) employed in a front-line, at-risk occupation for the Irish…

Subjective risk assessment for planning conservation projects

International Nuclear Information System (INIS)

Game, Edward T; Fitzsimons, James A; Lipsett-Moore, Geoff; McDonald-Madden, Eve

2013-01-01

Conservation projects occur under many types of uncertainty. Where this uncertainty can affect achievement of a project’s objectives, there is risk. Understanding risks to project success should influence a range of strategic and tactical decisions in conservation, and yet, formal risk assessment rarely features in the guidance or practice of conservation planning. We describe how subjective risk analysis tools can be framed to facilitate the rapid identification and assessment of risks to conservation projects, and how this information should influence conservation planning. Our approach is illustrated with an assessment of risks to conservation success as part of a conservation plan for the work of The Nature Conservancy in northern Australia. Risks can be both internal and external to a project, and occur across environmental, social, economic and political systems. Based on the relative importance of a risk and the level of certainty in its assessment we propose a series of appropriate, project level responses including research, monitoring, and active amelioration. Explicit identification, prioritization, and where possible, management of risks are important elements of using conservation resources in an informed and accountable manner. (letter)

Perforated marginal ulcers after laparoscopic gastric bypass.

Science.gov (United States)

Felix, Edward L; Kettelle, John; Mobley, Elijah; Swartz, Daniel

2008-10-01

Perforated marginal ulcer (PMU) after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a serious complication, but its incidence and etiology have rarely been investigated. Therefore, a retrospective review of all patients undergoing LRYGB at the authors' center was conducted to determine the incidence of PMU and whether any causative factors were present. A prospectively kept database of all patients at the authors' bariatric center was retrospectively reviewed. The complete records of patients with a PMU were examined individually for accuracy and analyzed for treatment, outcome, and possible underlying causes of the marginal perforation. Between April 1999 and August 2007, 1% of the patients (35/3,430) undergoing laparoscopic gastric bypass experienced one or more perforated marginal ulcers 3 to 70 months (median, 18 months) after LRYGB. The patients with and without perforation were not significantly different in terms of mean age (37 vs 41 years), weight (286 vs 287 lb), body mass index (BMI) (46 vs 47), or female gender (89% vs 83%). Of the patients with perforations, 2 (6%) were taking steroids, 10 (29%) were receiving nonsteroidal antiinflammatory drugs (NSAIDs) at the time of the perforation, 18 (51%) were actively smoking, and 6 of the smokers also were taking NSAIDs. Eleven of the patients (31%) who perforated did not have at least one of these possible risk factors, but 4 (36%) of the 11 patients in this group had been treated after bypass for a marginal ulcer. Only 7 (20%) of the 35 patients who had laparoscopic bypass, or 7 (0.2%) in the entire group of 3,430 patients, perforated without any warning. There were no deaths, but three patients reperforated. The incidence of a marginal ulcer perforating after LRYGB was significant (>1%) and appeared to be related to smoking or the use of NSAIDs or steroids. Because only 0.2% of all patients acutely perforated without some risk factor or warning, long-term ulcer prophylaxis or treatment may be necessary

Risk management of knowledge loss in nuclear industry organizations

International Nuclear Information System (INIS)

2006-07-01

Maintaining nuclear competencies in the nuclear industry and nuclear regulatory authorities will be one of the most critical challenges in the near future. As many nuclear experts around the world are retiring, they are taking with them a substantial amount of knowledge and corporate memory. The loss of such employees who hold knowledge critical to either operations or safety poses a clear internal threat to the safe and reliable operation of nuclear facilities. This publication is intended for senior and middle level managers of nuclear industry operating organizations and provides practical information on knowledge loss risk management. The information provided in this it is based upon the actual experiences of Member State operating organizations and is intended to increase awareness of the need to: develop a strategic approach and action plans to address the potential loss of critical knowledge and skills; provide processes and in conducting risk assessments to determine the potential for loss of critical knowledge caused by the loss of experienced workers; and enable nuclear organizations to utilize this knowledge to improve the skill and competence of new and existing workers In 2004, the IAEA published a report entitled The Nuclear Power Industry's Ageing Workforce: Transfer of Knowledge to the Next Generation (IAEA-TECDOC-1399). That report highlighted some of the knowledge management issues in Member States resulting from the large number of retiring nuclear power plant personnel who had been involved with the commissioning and initial operation of nuclear power plants. This publication complements that report by providing a practical methodology on knowledge loss risk management as one element of an overall strategic approach to workforce management which includes work force planning, recruitment, training, leadership development and knowledge retention

Global Production Planning Process considering the Supply Risk of Overseas Manufacturing Sites

Directory of Open Access Journals (Sweden)

Hosang Jung

2015-01-01

Full Text Available Although global manufacturers can produce most of their final products in local plants, they need to source components or parts from desirable overseas manufacturing partners at low cost in order to fulfill customer orders. In this global manufacturing environment, capacity information for planning is usually imprecise owing to the various risks of overseas plants (e.g., foreign governments’ policies and labor stability. It is therefore not easy for decision-makers to generate a global production plan showing the production amounts at local plants and overseas manufacturing facilities operated by manufacturing partners. In this paper, we present a new global production planning process considering the supply risk of overseas manufacturing sites. First, local experts estimate the supply capacity of an overseas plant using their judgment to determine when the risk could occur and how large the risk impact would be. Next, we run a global production planning model with the estimated supply capacities. The proposed process systematically adopts the qualitative judgments of local experts in the global production planning process and thus can provide companies with a realistic global production plan. We demonstrate the applicability of the proposed process with a real world case.

Long Term Planning at IQ Metal

DEFF Research Database (Denmark)

2017-01-01

This is a Danish version. This case about long term planning at the owner-managed manufacturing firm IQ Metal shows how the future management and ownership may be organized to utilize owner assets and minimize roadblocks. Initially, the owner-manager Bo Fischer Larsen explains how he acquired...... a stake in 2007 in the company which at that time was named Braendstrup Maskinfabrik. He furthermore expalins how he has developed the company based on a strategic plan focusing on professionalization and outsourcing. Next, the video shows how to type Bo Fischer Larsen's replies to the questions...... in The Owner Strategy Map into the questionnaire available on www.ejerstrategi-kortet.dk. Lastly, the Owner Strategy Map's recommendation of how to organize the future management and ownership of IQ Metal is explained....

Overall Survival Benefit From Postoperative Radiation Therapy for Organ-Confined, Margin-Positive Prostate Cancer

International Nuclear Information System (INIS)

Dillman, Robert O.; Hafer, Russell; Cox, Craig; McClure, Stephanie E.

2011-01-01

Purpose: Radical prostatectomy for invasive prostate cancer is associated with positive margin rates in 10% to 50% of resected specimens. Postoperative radiation therapy may benefit patients who have organ-confined prostate cancer with positive margins. Methods and Materials: We performed a retrospective analysis to examine whether adjunctive radiation therapy enhanced long-term survival for prostate cancer patients who underwent prostatectomy for localized prostate cancer but with positive margins. We used the Hoag Cancer Center database to identify patients diagnosed with invasive prostate cancer. Relative and overall survival rates were calculated. Results: Among 1,474 patients diagnosed with localized invasive prostate cancer during the years 1990 to 2006 and undergoing prostatectomy, 113 (7.7%) were identified who had positive margins and did not have local extension of disease, positive lymph nodes, or distant metastases. A total of 17 patients received adjunctive radiation therapy (Group A), whereas 96 did not (Group B; 3 received hormonal therapy). Both groups had a median age of 64 years and median follow-up of 7.5 years. In Group A, no patients have died as of last follow-up, but in Group B, 18 have died. Estimated 10-year and 15-year overall survival rates were both 100% for Group A compared with 85% and 57% respectively for Group B (p 2 = 0.050, log rank). Relative 10- and 15 year survival rates were both 100% for Group A compared with 100% and 79% respectively for Group B. Conclusions: This retrospective analysis suggests that prostate cancer patients with localized disease but positive margins do derive a survival benefit from adjuvant radiation therapy.

Estimation of marginal costs at existing waste treatment facilities

DEFF Research Database (Denmark)

Martinez Sanchez, Veronica; Hulgaard, Tore; Hindsgaul, Claus

2016-01-01

, marginal costs were not (provided a response was initiated at the WtE to keep constant the utilized thermal capacity). Failing to systematically address and include costs in existing waste facilities in decision-making may unintendedly lead to higher overall costs at societal level. To avoid misleading...... a constant thermal load, (ii) Refused-Derived-Fuel (RDF) was included to maintain a constant thermal load, or (iii) no reaction occurred resulting in a reduced waste throughput without full utilization of the facility capacity. Results demonstrated that marginal costs of diversion from WtE were up to eleven...

Perinatal risks of planned home births in the United States.

Science.gov (United States)

Grünebaum, Amos; McCullough, Laurence B; Brent, Robert L; Arabin, Birgit; Levene, Malcolm I; Chervenak, Frank A

2015-03-01

We analyzed the perinatal risks of midwife-attended planned home births in the United States from 2010 through 2012 and compared them with recommendations from the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) for planned home births. Data from the US Centers for Disease Control and Prevention's National Center for Health Statistics birth certificate data files from 2010 through 2012 were utilized to analyze the frequency of certain perinatal risk factors that were associated with planned midwife-attended home births in the United States and compare them with deliveries performed in the hospital by certified nurse midwives. Home birth deliveries attended by others were excluded; only planned home births attended by midwives were included. Hospital deliveries attended by certified nurse midwives served as the reference. Perinatal risk factors were those established by ACOG and AAP. Midwife-attended planned home births in the United States had the following risk factors: breech presentation, 0.74% (odds ratio [OR], 3.19; 95% confidence interval [CI], 2.87-3.56); prior cesarean delivery, 4.4% (OR, 2.08; 95% CI, 2.0-2.17); twins, 0.64% (OR, 2.06; 95% CI, 1.84-2.31); and gestational age 41 weeks or longer, 28.19% (OR, 1.71; 95% CI, 1.68-1.74). All 4 perinatal risk factors were significantly higher among midwife-attended planned home births when compared with certified nurse midwives-attended hospital births, and 3 of 4 perinatal risk factors were significantly higher in planned home births attended by non-American Midwifery Certification Board (AMCB)-certified midwives (other midwives) when compared with home births attended by certified nurse midwives. Among midwife-attended planned home births, 65.7% of midwives did not meet the ACOG and AAP recommendations for certification by the American Midwifery Certification Board. At least 30% of midwife-attended planned home births are not low risk and not within

[Post-marketing drug safety-risk management plan(RMP)].

Science.gov (United States)

Ezaki, Asami; Hori, Akiko

2013-03-01

The Guidance for Risk Management Plan(RMP)was released by the Ministry of Health, Labour and Welfare in April 2012. The RMP consists of safety specifications, pharmacovigilance plans and risk minimization action plans. In this paper, we outline post-marketing drug safety operations in PMDA and the RMP, with examples of some anticancer drugs.

Margins of safety provided by COSHH Essentials and the ILO Chemical Control Toolkit.

Science.gov (United States)

Jones, Rachael M; Nicas, Mark

2006-03-01

COSHH Essentials, developed by the UK Health and Safety Executive, and the Chemical Control Toolkit (Toolkit) proposed by the International Labor Organization, are 'control banding' approaches to workplace risk management intended for use by proprietors of small and medium-sized businesses. Both systems group chemical substances into hazard bands based on toxicological endpoint and potency. COSSH Essentials uses the European Union's Risk-phrases (R-phrases), whereas the Toolkit uses R-phrases and the Globally Harmonized System (GHS) of Classification and Labeling of Chemicals. Each hazard band is associated with a range of airborne concentrations, termed exposure bands, which are to be attained by the implementation of recommended control technologies. Here we analyze the margin of safety afforded by the systems and, for each hazard band, define the minimal margin as the ratio of the minimum airborne concentration that produced the toxicological endpoint of interest in experimental animals to the maximum concentration in workplace air permitted by the exposure band. We found that the minimal margins were always occupational exposure limits, we argue that the minimal margins are better indicators of health protection. Further, given the small margins observed, we feel it is important that revisions of these systems provide the exposure bands to users, so as to permit evaluation of control technology capture efficiency.

Role of initial depth at basin margins in sequence architecture: field examples and computer models

Czech Academy of Sciences Publication Activity Database

Uličný, David; Nichols, G.; Waltham, D.

2002-01-01

Roč. 14, č. 3 (2002), s. 347-360 ISSN 0950-091X R&D Projects: GA ČR GA205/01/0629 Institutional research plan: CEZ:AV0Z3012916 Keywords : basin margin * initial depth * sedimentation * depositional sequences Subject RIV: DB - Geology ; Mineralogy Impact factor: 2.022, year: 2002

Risk Management Plan Rule

Science.gov (United States)

RMP implements Section 112(r) of the 1990 Clean Air Act amendments, and requires facilities that use extremely hazardous substances to develop a Risk Management Plan and revise/resubmit every five years. Find guidance, factsheets, training, and assistance.

A phase-I trial of pre‐operative, margin intensive, stereotactic body radiation therapy for pancreatic cancer: the ‘SPARC’ trial protocol

International Nuclear Information System (INIS)

Holyoake, Daniel L. P.; Ward, Elizabeth; Grose, Derek; McIntosh, David; Sebag-Montefiore, David; Radhakrishna, Ganesh; Patel, Neel; Silva, Michael; Mukherjee, Somnath; Strauss, Victoria Y.; Odondi, Lang’o; Fokas, Emmanouil; Melcher, Alan; Hawkins, Maria A.

2016-01-01

analyses of the cytological and humoral immunological responses to stereotactic radiotherapy in pancreatic cancer. Radiotherapy quality assurance of target definition and radiotherapy planning is enforced with pre-trial test cases and on-trial review. Recruitment began in April 2015. This prospective multi-centre study aims to establish the maximum tolerated dose of pre-operative margin-intensified stereotactic radiotherapy in pancreatic cancer at high risk of positive resection margins with a view to subsequent definitive comparison with other neoadjuvant treatment options

Planned home compared with planned hospital births in the Netherlands: intrapartum and early neonatal death in low-risk pregnancies.

Science.gov (United States)

van der Kooy, Jacoba; Poeran, Jashvant; de Graaf, Johanna P; Birnie, Erwin; Denktasş, Semiha; Steegers, Eric A P; Bonsel, Gouke J

2011-11-01

The purpose of our study was to compare the intrapartum and early neonatal mortality rate of planned home birth with planned hospital birth in community midwife-led deliveries after case mix adjustment. The perinatal outcome of 679,952 low-risk women was obtained from the Netherlands Perinatal Registry (2000-2007). This group represents all women who had a choice between home and hospital birth. Two different analyses were performed: natural prospective approach (intention-to-treat-like analysis) and perfect guideline approach (per-protocol-like analysis). Unadjusted and adjusted odds ratios (ORs) were calculated. Case mix was based on the presence of at least one of the following: congenital abnormalities, small for gestational age, preterm birth, or low Apgar score. We also investigated the potential risk role of intended place of birth. Multivariate stepwise logistic regression was used to investigate the potential risk role of intended place of birth. Intrapartum and neonatal death at 0-7 days was observed in 0.15% of planned home compared with 0.18% in planned hospital births (crude relative risk 0.80, 95% confidence interval [CI] 0.71-0.91). After case mix adjustment, the relation is reversed, showing nonsignificant increased mortality risk of home birth (OR 1.05, 95% CI 0.91-1.21). In certain subgroups, additional mortality may arise at home if risk conditions emerge at birth (up to 20% increase). Home birth, under routine conditions, is generally not associated with increased intrapartum and early neonatal death, yet in subgroups, additional risk cannot be excluded.

Program strategies for maintenance management, organization and planning

International Nuclear Information System (INIS)

Czegeny, J.I.

2003-01-01

In this paper we look respectively at three specific examples showing program strategies for maintenance management, organization and planning. Starting with preventive maintenance optimization, we will look at one Bruce B Predefined task on the Reactor Regulating System to illustrate reduced maintenance requirement, a maintenance management strategy. Next discussed is the organizational strategy at Darlington to have an engineering program meet the jurisdictional requirements for maintaining certification for TSSA registered pressure vessels. The last look-see will show the earned value of the planning for the first Pickering A unit to be returned to service. Finally all the above is tied together in a compare and contrast of what works and what could be improved upon. (author)

A case study of IMRT planning (Plan B) subsequent to a previously treated IMRT plan (Plan A)

International Nuclear Information System (INIS)

2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" data-affiliation=" (Department of Medical Physics and 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" >Cao, F; 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" data-affiliation=" (Department of Medical Physics and 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" >Leong, C; 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" data-affiliation=" (Department of Medical Physics and 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" >Schroeder, J; 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" data-affiliation=" (Department of Medical Physics and 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" >Lee, B

2014-01-01

Background and purpose: Treatment of the contralateral neck after previous ipsilateral intensity modulated radiation therapy (IMRT) for head and neck cancer is a challenging problem. We have developed a technique that limits the cumulative dose to the spinal cord and brainstem while maximizing coverage of a planning target volume (PTV) in the contralateral neck. Our case involves a patient with right tonsil carcinoma who was given ipsilateral IMRT with 70Gy in 35 fractions (Plan A). A left neck recurrence was detected 14 months later. The patient underwent a neck dissection followed by postoperative left neck radiation to a dose of 66 Gy in 33 fractions (Plan B). Materials and Methods: The spinal cord-brainstem margin (SCBM) was defined as the spinal cord and brainstem with a 1.0 cm margin. Plan A was recalculated on the postoperative CT scan but the fluence outside of SCBM was deleted. A further modification of Plan A resulted in a base plan that was summed with Plan B to evaluate the cumulative dose received by the spinal cord and brainstem. Plan B alone was used to evaluate for coverage of the contralateral neck PTV. Results: The maximum cumulative doses to the spinal cord with 0.5cm margin and brainstem with 0.5cm margin were 51.96 Gy and 45.60 Gy respectively. For Plan B, 100% of the prescribed dose covered 95% of PTVb1. Conclusion: The use of a modified ipsilateral IMRT plan as a base plan is an effective way to limit the cumulative dose to the spinal cord and brainstem while enabling coverage of a PTV in the contralateral neck.

Influence of marginal highs on the accumulation of organic carbon along the continental slope off western India

Digital Repository Service at National Institute of Oceanography (India)

Rao, B.R.; Veerayya, M.

and 743E (after De Sousa, unpublished data). by the gasometric method using the &karbonate-bombe’ (Muller and Gastner, 1971) and organic carbon by the wet oxidation method (El Wakeel and Riley, 1957). Some samples from the upper continental slope, marginal...

Increased Risk of Biochemical and Clinical Failure for Prostate Patients with a Large Rectum at Radiotherapy Planning: Results from the Dutch Trial of 68 GY Versus 78 Gy

International Nuclear Information System (INIS)

Heemsbergen, Wilma D.; Hoogeman, Mischa S.; Witte, Marnix G.; Peeters, Stephanie T.H.; Incrocci, Luca; Lebesque, Joos V.

2007-01-01

Purpose: To investigate whether a large rectum filling visible on the planning CT scan was associated with a decrease in freedom from any failure (FFF) and freedom from clinical failure (FFCF) for prostate cancer patients. Methods and Materials: Patients from the Dutch trial (78 Gy vs. 68 Gy) with available acute toxicity data were analyzed (n = 549). A 10-mm margin was applied for the first 68 Gy and 0-5 mm for the 10-Gy boost. The dose in the seminal vesicles (SVs) was prescribed within four treatment groups according to the estimated risk of SV involvement. Two potential risk factors (RFs) for a geometric miss were defined: (1) an anorectal volume ≥ 90 cm 3 and ≥ 25% of treatment-time diarrhea (RF1); and (2) the mean cross-sectional area of the anorectum (RF2). We tested whether these were significant predictors for FFF and FFCF within each treatment group. Results: Significant results were observed only for patients with a risk of SV involvement > 25% (dose of 68-78 Gy to the SVs, n = 349). We found a decrease in FFF (p = 0.001) and FFCF (p = 0.01) for the 87 patients with RF1 (for RF2, p = 0.02 and p = 0.01, respectively). The estimated decrease in the FFCF rate at 5 years was 15%. Conclusion: Tumor control was significantly decreased in patients with a risk of SV involvement > 25% and at risk of geometric miss. Current image guidance techniques offer several solutions to geometrically optimize the treatment. Additional research is needed to evaluate whether geometric misses can be prevented using these techniques

Tax planning: organization features at enterprise

Directory of Open Access Journals (Sweden)

Grabchuk I.L.

2017-08-01

Full Text Available The research determines the need for studying the «cloud» technologies as the method of saving company’s resources and increasing the efficiency of processing accounting data. The study defines the concept of the «cloud», the types of clouds and the main advantages and disadvantages of each one for a particular purposes of a company. The possibility of wide popularization of cloud technologies was defined among small and medium enterprises as medium enterprises mainly use the basic version of accounting software and are more loyal in terms of data security unlike large enterprises, for which these actions are risky and cause very powerful changes in financial and human resources because information systems of large enterprises have individual software solutions, contain commercial secrets etc. The article defines the following paramount issues during the transition in the «cloud»: data security in the cloud; compliance of software for a transferring data base; enterprise’s possibility for a return data base at the enterprise if there are poor conditions; flexible platform in the «cloud»; possibility to develop software solutions for enterprises depending on the type of business; staff training for a work in the cloud. As a result, the study identifies the barriers of transferring of accounting data for Ukrainian entrepreneurs and positive results of the transition to the «cloud». The research introduces the model of distribution of resources between the enterprise and service provider depending on the type of cloud computing, and as a result, it is determined that the company’s management chooses the cloud model and the type of cloud computing depending on the amount of resources (human resources: wages to employees of Information Technology; material resources: equipment workplaces, construction of Data Centers; intangible resources: purchase licensed software taking into consideration currently existing risks of the

The effect of price and production risks on optimal farm plans in Swiss dairy production considering 2 different milk quota systems.

Science.gov (United States)

Briner, S; Finger, R

2013-04-01

The amount of milk produced on Swiss dairy farms is restricted by contracts between the farmers and their marketing agent. In the past, these contracts have been calculated on a yearly base. Due to a switch in agricultural policy, these yearly contracts are currently more and more replaced by contracts calculated on a monthly base. These new contracts are assumed to restrict the flexibility of farmers to react on changes in milk price as well as on changes in fodder availability. Thus, the contract design is expected to influence farmers' ability to cope with risks and, thus, to influence the farm's gross margin variability. Applying a bioeconomic whole-farm model, the effects of price and weather risk as well as different risk-management strategies on the gross margin and the variability of the gross margin in Swiss dairy production are assessed under the 2 contract designs. We consider both risk-neutral and risk-averse behavior of farmers in our study. Results show that gross margin is slightly higher under the yearly than under the monthly contract. Variability of gross margin is also higher under the yearly than under the monthly contract. If the farmer is assumed to be risk averse, under both contracts he can reduce the coefficient of variation of the gross margin by almost 20% at opportunity costs below 1% of the gross margin. To reduce variability of gross margin under both contracts the size of the feedstock needs to be increased. This increase, however, must be considerably higher under the monthly contract than under the yearly contract. An additional risk-management strategy under a monthly contract is an increase in the area used as intensive pasture to ensure fodder availability in years with unfavorable weather. Under the yearly contract, an increase in the area used as extensive pasture is shown to be more favorable because it increases the amount of direct payments the farmer will receive. Additional restrictions in farm management due to a monthly

Hormesis: from marginalization to mainstream A case for hormesis as the default dose-response model in risk assessment

International Nuclear Information System (INIS)

Calabrese, Edward J.

2004-01-01

The paper provides an account of how the hormetic dose response has emerged in recent years as a serious dose-response model in toxicology and risk assessment after decades of extreme marginalization. In addition to providing the toxicological basis of this dose-response revival, the paper reexamines the concept of a default dose model in toxicology and risk assessment and makes the argument that the hormetic model satisfies criteria (e.g., generalizability, frequency, application to risk assessment endpoints, false positive/negative potential, requirements for hazard assessment, reliability of estimating risks, capacity for validation of risk estimates, public health implications of risk estimates) for such a default model better than its chief competitors, the threshold and linear at low dose models. The selection of the hormetic model as the default model in risk assessment for noncarcinogens and specifically for carcinogens would have a profound impact on the practice of risk assessment and its societal implications

Identifying Gaps in the Performance of Pediatric Trainees Who Receive Marginal/Unsatisfactory Ratings.

Science.gov (United States)

Li, Su-Ting T; Tancredi, Daniel J; Schwartz, Alan; Guillot, Ann; Burke, Ann; Trimm, R Franklin; Guralnick, Susan; Mahan, John D; Gifford, Kimberly A

2018-01-01

To perform a derivation study to determine in which subcompetencies marginal/unsatisfactory pediatric residents had the greatest deficits compared with their satisfactorily performing peers and which subcompetencies best discriminated between marginal/unsatisfactory and satisfactorily performing residents. Multi-institutional cohort study of all 21 milestones (rated on four or five levels) reported to the Accreditation Council for Graduate Medical Education, and global marginal/unsatisfactory versus satisfactory performance reported to the American Board of Pediatrics. Data were gathered in 2013-2014. For each level of training (postgraduate year [PGY] 1, 2, and 3), mean differences between milestone levels of residents with marginal/unsatisfactory and satisfactory performance adjusted for clustering by program and C-statistics (area under receiver operating characteristic curve) were calculated. A Bonferroni-corrected significance threshold of .0007963 was used to account for multiple comparisons. Milestone and overall performance evaluations for 1,704 pediatric residents in 41 programs were obtained. For PGY1s, two subcompetencies had almost a one-point difference in milestone levels between marginal/unsatisfactory and satisfactory trainees and outstanding discrimination (≥ 0.90): organize/prioritize (0.93; C-statistic: 0.91) and transfer of care (0.97; C-statistic: 0.90). The largest difference between marginal/unsatisfactory and satisfactory PGY2s was trustworthiness (0.78). The largest differences between marginal/unsatisfactory and satisfactory PGY3s were ethical behavior (1.17), incorporating feedback (1.03), and professionalization (0.96). For PGY2s and PGY3s, no subcompetencies had outstanding discrimination. Marginal/unsatisfactory pediatric residents had different subcompetency gaps at different training levels. While PGY1s may have global deficits, senior residents may have different performance deficiencies requiring individualized counseling and

An effective deep-inspiration breath-hold radiotherapy technique for left-breast cancer: impact of post-mastectomy treatment, nodal coverage, and dose schedule on organs at risk

Directory of Open Access Journals (Sweden)

Rice L

2017-06-01

Full Text Available Lynsey Rice,1,2 Christy Goldsmith,1,2 Melanie ML Green,2 Susan Cleator,1,2 Patricia M Price1,2 1Department of Radiation Oncology, The Harley Street Clinic, 2Department of Surgery and Cancer, Imperial College London, London, UK Background: We developed, applied, and prospectively evaluated a novel deep-inspiration breath-hold (DIBH screening and delivery technique to optimize cardiac sparing in left-breast radiotherapy (RT at our clinic. The impact of set-up and dose variables upon organs at risk (OAR dose in DIBH RT was investigated.Methods and materials: All patients with left-breast cancer referred between 2011 and 2014 – of all disease stages, set-up variations, and dose prescriptions – were included. Radiographers used simple screening criteria at CT simulation, to systematically assess patients for obvious DIBH benefit and capability. Selected patients received forward-planned intensity-modulated RT (IMRT based on a DIBH CT scan. A 3D-surface monitoring system with visual feedback assured reproducible DIBH positioning during gated radiation delivery. Patient, target set-up, and OAR dose information were collected at treatment.Results: Of 272 patients who were screened, 4 withdrew, 56 showed no obvious advantage, and 56 showed benefit but had suitability issues; 156 patients were selected and successfully completed DIBH treatment. The technique was compatible with complex set-up and optimal target coverage was maintained. Comparison of free-breathing (FB and DIBH treatment plans in the first five patients enrolled confirmed DIBH reduced heart radiation by ~80% (p = 0.032. Low OAR doses were achieved overall: the mean (95% confidence interval [CI] heart dose was 1.17 (1.12–1.22 Gy, and the mean ipsilateral lung dose was 5.26 (5.01–5.52 Gy. Patients who underwent a standard radiation schedule (40 Gy/15# after breast-conserving surgery had the lowest OAR doses: post-mastectomy treatment, simultaneous supraclavicular (SCV node

Dual kidney transplants from adult marginal donors successfully expand the limited deceased donor organ pool.

Science.gov (United States)

Stratta, Robert J; Farney, Alan C; Orlando, Giuseppe; Farooq, Umar; Al-Shraideh, Yousef; Palanisamy, Amudha; Reeves-Daniel, Amber; Doares, William; Kaczmorski, Scott; Gautreaux, Michael D; Iskandar, Samy S; Hairston, Gloria; Brim, Elizabeth; Mangus, Margaret; El-Hennawy, Hany; Khan, Muhammad; Rogers, Jeffrey

2016-04-01

The need to expand the organ donor pool remains a formidable challenge in kidney transplantation (KT). The use of expanded criteria donors (ECDs) represents one approach, but kidney discard rates are high because of concerns regarding overall quality. Dual KT (DKT) may reduce organ discard and optimize the use of kidneys from marginal donors. We conducted a single-center retrospective review of outcomes in adult recipients of DKTs from adult marginal deceased donors (DD) defined by limited renal functional capacity. If the calculated creatinine clearance in an adult DD was DKT. Over 11.5 yr, 72 DKTS were performed including 45 from ECDs, 17 from donation after cardiac death (DCD) donors, and 10 from standard criteria donors (SCD). Mean adult DD and recipient ages were both 60 yr, including 29 DDs and 26 recipients ≥65 yr of age. Mean pre-DKT waiting and dialysis vintage times were 12 months and 25 months, respectively. Actual patient and graft survival rates were 84.7% and 70.8%, respectively, with a mean follow-up of 58 months. One yr and death-censored graft survival rates were 90% and 80%, respectively. Outcomes did not differ by DD category, recipient age, or presence of delayed graft function (DGF). Eleven patients died at a mean of 32 months post-DKT (eight with functioning grafts) and 13 other patients experienced graft losses at a mean of 33 months. The incidence of DGF was 25%; there were two cases (2.8%) of primary non-function. Mean length of initial hospital stay was 7.2 d. Mean serum creatinine and glomerular filtration rate levels at 12 and 24 months were 1.5 and 53 and 1.5 mg/dL and 51 mL/min/1.73 m(2) , respectively. DKT graft survival and function were superior to concurrent single ECD and similar to concurrent SCD KTs. Two patients underwent successful kidney retransplantation, so the dialysis-free rate in surviving patients was 87%. The proportion of total renal function transplanted from adult DD to DKT recipients was 77% compared to 56% for

Risk Informed Safety Margin Characterization Case Study: Selection of Electrical Equipment To Be Subjected to Environmental Qualification

Energy Technology Data Exchange (ETDEWEB)

D. Blanchard; R. Youngblood

2012-04-01

In general, the margins-based safety case helps the decision-maker manage plant margins most effectively. It tells the plant decision-maker such things as what margin is present (at the plant level, at the functional level, at the barrier level, at the component level), and where margin is thin or perhaps just degrading. If the plant is safe, it tells the decision-maker why the plant is safe and where margin needs to be maintained, and perhaps where the plant can afford to relax.

HISTOPATHOLOGY OF MARGINAL SUPERFICIAL PERIODONTIUM AT MENOPAUSE

Directory of Open Access Journals (Sweden)

A. Georgescu

2012-03-01

Full Text Available Premises: Sexual hormones may affect the general health condition of women, as early as puberty, continuing during pregnancy and also after menopause. Variations of the hormonal levels may cause different – either local or general – pathological modifications. Sexual hormones may also affect periodontal status, favourizing gingival inflammations and reducing periodontal resistance to the action of the bacterial plaque. Scope: Establishment of the correlations between the debut or the manifestation of menopause and the modifications produced in the superficial periodontium. Materials and method: Clinical and paraclinical investigations were performed on female patients with ages between 45 and 66 years, involving macroscopic, microscopic and radiological recording of the aspect of the superificial periodontium (gingiva. Results: Analysis of the histological sections evidenced atrophic and involutive modifications in the marginal superficial periodontium of female patients at menopause. Conclusions: Sexual hormones intervene in the histological equilibrium of the marginal superficial periodontium, influencing the periodontal health status, which explains the correlation between the subjective symptomatology specific to menopause and the histopatological aspect at epithelial level.

Analyzing systemic risk using non-linear marginal expected shortfall and its minimum spanning tree

Science.gov (United States)

Song, Jae Wook; Ko, Bonggyun; Chang, Woojin

2018-02-01

The aim of this paper is to propose a new theoretical framework for analyzing the systemic risk using the marginal expected shortfall (MES) and its correlation-based minimum spanning tree (MST). At first, we develop two parametric models of MES with their closed-form solutions based on the Capital Asset Pricing Model. Our models are derived from the non-symmetric quadratic form, which allows them to consolidate the non-linear relationship between the stock and market returns. Secondly, we discover the evidences related to the utility of our models and the possible association in between the non-linear relationship and the emergence of severe systemic risk by considering the US financial system as a benchmark. In this context, the evolution of MES also can be regarded as a reasonable proxy of systemic risk. Lastly, we analyze the structural properties of the systemic risk using the MST based on the computed series of MES. The topology of MST conveys the presence of sectoral clustering and strong co-movements of systemic risk leaded by few hubs during the crisis. Specifically, we discover that the Depositories are the majority sector leading the connections during the Non-Crisis period, whereas the Broker-Dealers are majority during the Crisis period.

Systems considerations in seismic margin evaluations

International Nuclear Information System (INIS)

Buttermer, D.R.

1987-01-01

Increasing knowledge in the geoscience field has led to the understanding that, although highly unlikely, it is possible for a nuclear power plant to be subjected to earthquake ground motion greater than that for which the plant was designed. While it is recognized that there are conservatisms inherent in current design practices, interest has developed in evaluating the seismic risk of operating plants. Several plant-specific seismic probabilistic risk assessments (SPRA) have been completed to address questions related to the seismic risk of a plant. The results from such SPRAs are quite informative, but such studies may entail a considerable amount of expensive analysis of large portions of the plant. As an alternative to an SPRA, it may be more practical to select an earthquake level above the design basis for which plant survivability is to be demonstrated. The principal question to be addressed in a seismic margin evaluation is: At what ground motion levels does one have a high confidence that the probability of seismically induced core damage is sufficiently low? In a seismic margin evaluation, an earthquake level is selected (based on site-specific geoscience considerations) for which a stable, long-term safe shutdown condition is to be demonstrated. This prespecified earthquake level is commonly referred to as the seismic margin earthquake (SME). The Electric Power Research Institute is currently supporting a research project to develop procedures for use by the utilities to allow them to perform nuclear plant seismic margin evaluations. This paper describes the systems-related aspects of these procedures

Migration and risk: net migration in marginal ecosystems and hazardous areas

International Nuclear Information System (INIS)

De Sherbinin, Alex; Levy, Marc; Adamo, Susana; MacManus, Kytt; Yetman, Greg; Mara, Valentina; Razafindrazay, Liana; Aichele, Cody; Pistolesi, Linda; Goodrich, Benjamin; Srebotnjak, Tanja

2012-01-01

The potential for altered ecosystems and extreme weather events in the context of climate change has raised questions concerning the role that migration plays in either increasing or reducing risks to society. Using modeled data on net migration over three decades from 1970 to 2000, we identify sensitive ecosystems and regions at high risk of climate hazards that have seen high levels of net in-migration and out-migration over the time period. This paper provides a literature review on migration related to ecosystems, briefly describes the methodology used to develop the estimates of net migration, then uses those data to describe the patterns of net migration for various ecosystems and high risk regions. The study finds that negative net migration generally occurs over large areas, reflecting its largely rural character, whereas areas of positive net migration are typically smaller, reflecting its largely urban character. The countries with largest population such as China and India tend to drive global results for all the ecosystems found in those countries. Results suggest that from 1970 to 2000, migrants in developing countries have tended to move out of marginal dryland and mountain ecosystems and out of drought-prone areas, and have moved towards coastal ecosystems and areas that are prone to floods and cyclones. For North America results are reversed for dryland and mountain ecosystems, which saw large net influxes of population in the period of record. Uncertainties and potential sources of error in these estimates are addressed. (letter)

Risk evaluation system for facility safeguards and security planning

International Nuclear Information System (INIS)

Udell, C.J.; Carlson, R.L.

1987-01-01

The Risk Evaluation System (RES) is an integrated approach to determining safeguards and security effectiveness and risk. RES combines the planning and technical analysis into a format that promotes an orderly development of protection strategies, planning assumptions, facility targets, vulnerability and risk determination, enhancement planning, and implementation. In addition, the RES computer database program enhances the capability of the analyst to perform a risk evaluation of the facility. The computer database is menu driven using data input screens and contains an algorithm for determining the probability of adversary defeat and risk. Also, base case and adjusted risk data records can be maintained and accessed easily

TU-AB-BRB-02: Stochastic Programming Methods for Handling Uncertainty and Motion in IMRT Planning

Energy Technology Data Exchange (ETDEWEB)

Unkelbach, J. [Massachusetts General Hospital (United States)

2015-06-15

The accepted clinical method to accommodate targeting uncertainties inherent in fractionated external beam radiation therapy is to utilize GTV-to-CTV and CTV-to-PTV margins during the planning process to design a PTV-conformal static dose distribution on the planning image set. Ideally, margins are selected to ensure a high (e.g. >95%) target coverage probability (CP) in spite of inherent inter- and intra-fractional positional variations, tissue motions, and initial contouring uncertainties. Robust optimization techniques, also known as probabilistic treatment planning techniques, explicitly incorporate the dosimetric consequences of targeting uncertainties by including CP evaluation into the planning optimization process along with coverage-based planning objectives. The treatment planner no longer needs to use PTV and/or PRV margins; instead robust optimization utilizes probability distributions of the underlying uncertainties in conjunction with CP-evaluation for the underlying CTVs and OARs to design an optimal treated volume. This symposium will describe CP-evaluation methods as well as various robust planning techniques including use of probability-weighted dose distributions, probability-weighted objective functions, and coverage optimized planning. Methods to compute and display the effect of uncertainties on dose distributions will be presented. The use of robust planning to accommodate inter-fractional setup uncertainties, organ deformation, and contouring uncertainties will be examined as will its use to accommodate intra-fractional organ motion. Clinical examples will be used to inter-compare robust and margin-based planning, highlighting advantages of robust-plans in terms of target and normal tissue coverage. Robust-planning limitations as uncertainties approach zero and as the number of treatment fractions becomes small will be presented, as well as the factors limiting clinical implementation of robust planning. Learning Objectives: To understand

Perinatal and maternal outcomes in planned home and obstetric unit births in women at 'higher risk' of complications: secondary analysis of the Birthplace national prospective cohort study.

Science.gov (United States)

Li, Y; Townend, J; Rowe, R; Brocklehurst, P; Knight, M; Linsell, L; Macfarlane, A; McCourt, C; Newburn, M; Marlow, N; Pasupathy, D; Redshaw, M; Sandall, J; Silverton, L; Hollowell, J

2015-04-01

To explore and compare perinatal and maternal outcomes in women at 'higher risk' of complications planning home versus obstetric unit (OU) birth. Prospective cohort study. OUs and planned home births in England. 8180 'higher risk' women in the Birthplace cohort. We used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures. Composite perinatal outcome measure encompassing 'intrapartum related mortality and morbidity' (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth. The risk of 'intrapartum related mortality and morbidity' or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31-0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure 'intrapartum related mortality and morbidity' (RR adjusted for parity 1.92, 95% CI 0.97-3.80). Maternal interventions were lower in planned home births. The babies of 'higher risk' women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between the groups. © 2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John

Reconceptualising risk: Perceptions of risk in rural and remote maternity service planning.

Science.gov (United States)

Barclay, Lesley; Kornelsen, Jude; Longman, Jo; Robin, Sarah; Kruske, Sue; Kildea, Sue; Pilcher, Jennifer; Martin, Tanya; Grzybowski, Stefan; Donoghue, Deborah; Rolfe, Margaret; Morgan, Geoff

2016-07-01

to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services. data collection in this qualitative component of a mixed methods study included 88 semi-structured individual and group interviews (n=102), three focus groups (n=22) and one group information session (n=17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category. fieldwork was conducted in four jurisdictions at nine sites in rural (n=3) and remote (n=6) Australia. 117 health service employees and 24 consumers. examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services. our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning. a comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health services. Formal risk analyses should consider the risks associated with failure to provide birthing services in rural and remote communities as well as the risks of maintaining services. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

A predictive model to guide management of the overlap region between target volume and organs at risk in prostate cancer volumetric modulated arc therapy

International Nuclear Information System (INIS)

Mattes, Malcolm D.; Lee, Jennifer C.; Einaiem, Sara; Guirguis, Adel; Ikoro, N. C.; Ashamalla Hani

2013-01-01

The goal of this study is to determine whether the magnitude of overlap between planning target volume (PTV) and rectum (Rectum overlap ) or PTV and bladder (Bladder overlap ) in prostate cancer volumetric-modulated arc therapy (VMAT) is predictive of the dose-volume relationships achieved after optimization, and to identify predictive equations and cutoff values using these overlap volumes beyond which the Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) dose-volume constraints are unlikely to be met. Fifty-seven patients with prostate cancer underwent VMAT planning using identical optimization conditions and normalization. The PTV (for the 50.4 Gy primary plan and 30.6 Gy boost plan) included 5 to 10 mm margins around the prostate and seminal vesicles. Pearson correlations, linear regression analyses, and receiver operating characteristic (ROC) curves were used to correlate the percentage overlap with dose-volume parameters. The percentage Rectum overlap and Bladder overlap correlated with sparing of that organ but minimally impacted other dose-volume parameters, predicted the primary plan rectum V 45 and bladder V 50 with R 2 = 0.78 and R 2 = 0.83, respectively, and predicted the boost plan rectum V 30 and bladder V 30 with R 2 = 0.53 and R 2 = 0.81, respectively. The optimal cutoff value of boost Rectumoverlap to predict rectum V75 >15% was 3.5% (sensitivity 100%, specificity 94%, p overlap to predict bladder V 80 >10% was 5.0% (sensitivity 83%, specificity 100%, p < 0.01). The degree of overlap between PTV and bladder or rectum can be used to accurately guide physicians on the use of interventions to limit the extent of the overlap region prior to optimization.

Integrated Waste Treatment Unit GFSI Risk Management Plan

International Nuclear Information System (INIS)

W. A. Owca

2007-01-01

This GFSI Risk Management Plan (RMP) describes the strategy for assessing and managing project risks for the Integrated Waste Treatment Unit (IWTU) that are specifically within the control and purview of the U.S. Department of Energy (DOE), and identifies the risks that formed the basis for the DOE contingency included in the performance baseline. DOE-held contingency is required to cover cost and schedule impacts of DOE activities. Prior to approval of the performance baseline (Critical Decision-2) project cost contingency was evaluated during a joint meeting of the Contractor Management Team and the Integrated Project Team for both contractor and DOE risks to schedule and cost. At that time, the contractor cost and schedule risk value was $41.3M and the DOE cost and schedule risk contingency value is $39.0M. The contractor cost and schedule risk value of $41.3M was retained in the performance baseline as the contractor's management reserve for risk contingency. The DOE cost and schedule risk value of $39.0M has been retained in the performance baseline as the DOE Contingency. The performance baseline for the project was approved in December 2006 (Garman 2006). The project will continue to manage to the performance baseline and change control thresholds identified in PLN-1963, ''Idaho Cleanup Project Sodium-Bearing Waste Treatment Project Execution Plan'' (PEP)

Adoption of Building Information Modelling in project planning risk management

Science.gov (United States)

Mering, M. M.; Aminudin, E.; Chai, C. S.; Zakaria, R.; Tan, C. S.; Lee, Y. Y.; Redzuan, A. A.

2017-11-01

An efficient and effective risk management required a systematic and proper methodology besides knowledge and experience. However, if the risk management is not discussed from the starting of the project, this duty is notably complicated and no longer efficient. This paper presents the adoption of Building Information Modelling (BIM) in project planning risk management. The objectives is to identify the traditional risk management practices and its function, besides, determine the best function of BIM in risk management and investigating the efficiency of adopting BIM-based risk management during the project planning phase. In order to obtain data, a quantitative approach is adopted in this research. Based on data analysis, the lack of compliance with project requirements and failure to recognise risk and develop responses to opportunity are the risks occurred when traditional risk management is implemented. When using BIM in project planning, it works as the tracking of cost control and cash flow give impact on the project cycle to be completed on time. 5D cost estimation or cash flow modeling benefit risk management in planning, controlling and managing budget and cost reasonably. There were two factors that mostly benefit a BIM-based technology which were formwork plan with integrated fall plan and design for safety model check. By adopting risk management, potential risks linked with a project and acknowledging to those risks can be identified to reduce them to an acceptable extent. This means recognizing potential risks and avoiding threat by reducing their negative effects. The BIM-based risk management can enhance the planning process of construction projects. It benefits the construction players in various aspects. It is important to know the application of BIM-based risk management as it can be a lesson learnt to others to implement BIM and increase the quality of the project.

Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization.

Science.gov (United States)

Brennan, Julia; Kuhns, Lisa M; Johnson, Amy K; Belzer, Marvin; Wilson, Erin C; Garofalo, Robert

2012-09-01

We assessed whether multiple psychosocial factors are additive in their relationship to sexual risk behavior and self-reported HIV status (i.e., can be characterized as a syndemic) among young transgender women and the relationship of indicators of social marginalization to psychosocial factors. Participants (n = 151) were aged 15 to 24 years and lived in Chicago or Los Angeles. We collected data on psychosocial factors (low self-esteem, polysubstance use, victimization related to transgender identity, and intimate partner violence) and social marginalization indicators (history of commercial sex work, homelessness, and incarceration) through an interviewer-administered survey. Syndemic factors were positively and additively related to sexual risk behavior and self-reported HIV infection. In addition, our syndemic index was significantly related to 2 indicators of social marginalization: a history of sex work and previous incarceration. These findings provide evidence for a syndemic of co-occurring psychosocial and health problems in young transgender women, taking place in a context of social marginalization.

Contemporary approaches to reducing the risks of central counterparties based on the use of marginal contributions

Directory of Open Access Journals (Sweden)

Utkin Viktor Sergeyevich

2012-07-01

Full Text Available To protect their own interests central counterparties has developed a number of procedures, including payment of guarantee margin by trading members as a means to ensure their positions. This article discusses a number of approaches, which attempt to simulate the risks of the Central Committee, as well as calculating the amount of margin and other resources in the event of insolvency. These approaches are based on the simulation of the three main types: (a statistical modeling; (b optimization modeling, and (c model of option pricing. The author incorporates the basic provisions of models.

Planning and Evaluation by Canadian Civil Society Organizations ...

International Development Research Centre (IDRC) Digital Library (Canada)

Planning and Evaluation by Canadian Civil Society Organizations : Bridging Gaps ... Specifically, the research team will assess the various planning, monitoring ... International Water Resources Association, in close collaboration with IDRC, ...

Quantifying Unnecessary Normal Tissue Complication Risks due to Suboptimal Planning: A Secondary Study of RTOG 0126

International Nuclear Information System (INIS)

Moore, Kevin L.; Schmidt, Rachel; Moiseenko, Vitali; Olsen, Lindsey A.; Tan, Jun; Xiao, Ying; Galvin, James; Pugh, Stephanie; Seider, Michael J.; Dicker, Adam P.; Bosch, Walter; Michalski, Jeff; Mutic, Sasa

2015-01-01

Purpose: The purpose of this study was to quantify the frequency and clinical severity of quality deficiencies in intensity modulated radiation therapy (IMRT) planning in the Radiation Therapy Oncology Group 0126 protocol. Methods and Materials: A total of 219 IMRT patients from the high-dose arm (79.2 Gy) of RTOG 0126 were analyzed. To quantify plan quality, we used established knowledge-based methods for patient-specific dose-volume histogram (DVH) prediction of organs at risk and a Lyman-Kutcher-Burman (LKB) model for grade ≥2 rectal complications to convert DVHs into normal tissue complication probabilities (NTCPs). The LKB model was validated by fitting dose-response parameters relative to observed toxicities. The 90th percentile (22 of 219) of plans with the lowest excess risk (difference between clinical and model-predicted NTCP) were used to create a model for the presumed best practices in the protocol (pDVH 0126,top10% ). Applying the resultant model to the entire sample enabled comparisons between DVHs that patients could have received to DVHs they actually received. Excess risk quantified the clinical impact of suboptimal planning. Accuracy of pDVH predictions was validated by replanning 30 of 219 patients (13.7%), including equal numbers of presumed “high-quality,” “low-quality,” and randomly sampled plans. NTCP-predicted toxicities were compared to adverse events on protocol. Results: Existing models showed that bladder-sparing variations were less prevalent than rectum quality variations and that increased rectal sparing was not correlated with target metrics (dose received by 98% and 2% of the PTV, respectively). Observed toxicities were consistent with current LKB parameters. Converting DVH and pDVH 0126,top10% to rectal NTCPs, we observed 94 of 219 patients (42.9%) with ≥5% excess risk, 20 of 219 patients (9.1%) with ≥10% excess risk, and 2 of 219 patients (0.9%) with ≥15% excess risk. Replanning demonstrated the predicted NTCP

Quantifying Unnecessary Normal Tissue Complication Risks due to Suboptimal Planning: A Secondary Study of RTOG 0126.

Science.gov (United States)

Moore, Kevin L; Schmidt, Rachel; Moiseenko, Vitali; Olsen, Lindsey A; Tan, Jun; Xiao, Ying; Galvin, James; Pugh, Stephanie; Seider, Michael J; Dicker, Adam P; Bosch, Walter; Michalski, Jeff; Mutic, Sasa

2015-06-01

The purpose of this study was to quantify the frequency and clinical severity of quality deficiencies in intensity modulated radiation therapy (IMRT) planning in the Radiation Therapy Oncology Group 0126 protocol. A total of 219 IMRT patients from the high-dose arm (79.2 Gy) of RTOG 0126 were analyzed. To quantify plan quality, we used established knowledge-based methods for patient-specific dose-volume histogram (DVH) prediction of organs at risk and a Lyman-Kutcher-Burman (LKB) model for grade ≥2 rectal complications to convert DVHs into normal tissue complication probabilities (NTCPs). The LKB model was validated by fitting dose-response parameters relative to observed toxicities. The 90th percentile (22 of 219) of plans with the lowest excess risk (difference between clinical and model-predicted NTCP) were used to create a model for the presumed best practices in the protocol (pDVH0126,top10%). Applying the resultant model to the entire sample enabled comparisons between DVHs that patients could have received to DVHs they actually received. Excess risk quantified the clinical impact of suboptimal planning. Accuracy of pDVH predictions was validated by replanning 30 of 219 patients (13.7%), including equal numbers of presumed "high-quality," "low-quality," and randomly sampled plans. NTCP-predicted toxicities were compared to adverse events on protocol. Existing models showed that bladder-sparing variations were less prevalent than rectum quality variations and that increased rectal sparing was not correlated with target metrics (dose received by 98% and 2% of the PTV, respectively). Observed toxicities were consistent with current LKB parameters. Converting DVH and pDVH0126,top10% to rectal NTCPs, we observed 94 of 219 patients (42.9%) with ≥5% excess risk, 20 of 219 patients (9.1%) with ≥10% excess risk, and 2 of 219 patients (0.9%) with ≥15% excess risk. Replanning demonstrated the predicted NTCP reductions while maintaining the volume of the PTV

Planning and Organizing Programmes in Adult Education.

Science.gov (United States)

Durston, Berry H., Ed.

These papers cover planning, organization, and administration of programs conducted by the Department of University Extension of the University of New England (New South Wales); they are concerned primarily with rural extension. The first paper reviews elements of program planning and program implementation in general. The second evaluates an…

Impact of margin on tumour and normal tissue dosimetry in patients treated with IMRT using an endorectal balloon for prostate immobilization

International Nuclear Information System (INIS)

Ahmad, S.

2004-01-01

Full text: In treatment of prostate cancer with IMRT (Intensity Modulated Radiation Therapy), clinical target volume margin is determined by organ motion and set-up error. However, the margin width that achieves the desired dose escalation while minimizing normal tissue exposure is dependent upon the patient immobilization and/or organ localization techniques. In this study, we compare the impact of margin width on the dosimetry of tumour and normal tissues using the endorectal balloon for prostate immobilization. IMRT plans were generated for ten patients using margin widths of 0, 3, 5, 8 and 10 mm. Patients had a planning CT scan in the prone position with an endorectal balloon filled with 100 cc of air for prostate immobilization. The Corvus version 3.0.11 was used for treatment planning. The dose for the prostate and seminal vesicles was 70 Gy in 2 Gy per fractions, prescribed at the 83% isodose line. Dose restrictions to normal tissues were as follows: 33% of bladder was allowed to receive above 65 Gy, 15% of rectum above 68 Gy and 10% of femurs above 45 Gy. Analysis of Variance was used to compare the target and normal tissue doses. Tumour control probability and normal tissue complication probability calculations are currently being performed and will be presented. The mean doses ranged from 73.93 to 75.31 Gy for the prostate and from 73.71 to 75.31 Gy for the seminal vesicles. A 10 mm margin produced significantly lower mean doses compared to 0 or 5 mm for both targets (prostate p 0.062). For bladder and rectum the mean doses ranged from 18.49 to 22.30 Gy (p=0.605) and from 29.34 to 31.33 Gy (p=0.135), respectively, while the percent rectal volumes above 68 Gy were significantly higher for margins of 5, 8 and 10 mm (p<0.006) ranging from 10.72% to 15.81%. Mean doses to the femurs and pelvis were significantly higher for 8 and 10 mm margins, ranging from 20.9 to 29.39 Gy for femurs (p<0.015) and from 15.05 to 19.98 Gy for pelvis (p<0.0005). Also the percent

Comparison of 3D CRT and IMRT Tratment Plans

Science.gov (United States)

Bakiu, Erjona; Telhaj, Ervis; Kozma, Elvisa; Ruçi, Ferdinand; Malkaj, Partizan

2013-01-01

Plans of patients with prostate tumor have been studied. These patients have been scanned in the CT simulator and the images have been sent to the Focal, the system where the doctor delineates the tumor and the organs at risk. After that in the treatment planning system XiO there are created for the same patients three dimensional conformal and intensity modulated radiotherapy treatment plans. The planes are compared according to the dose volume histograms. It is observed that the plans with IMRT technique conform better the isodoses to the planning target volume and protect more the organs at risk, but the time needed to create such plans and to control it is higher than 3D CRT. So it necessary to decide in which patients to do one or the other technique depending on the full dose given to PTV and time consuming in genereral. PMID:24167395

Remedial investigation work plan for the Groundwater Operable Unit at Oak Ridge National Laboratory, Oak Ridge, Tennessee

Energy Technology Data Exchange (ETDEWEB)

1994-03-01

This Remedial Investigation (RI) Work Plan has been developed as part of the US Department of Energy`s (DOE`s) investigation of the Groundwater Operable Unit (GWOU) at Oak Ridge National Laboratory (ORNL) located near Oak Ridge, Tennessee. The first iteration of the GWOU RI Work Plan is intended to serve as a strategy document to guide the ORNL GWOU RI. The Work Plan provides a rationale and organization for groundwater data acquisition, monitoring, and remedial actions to be performed during implementation of environmental restoration activities associated with the ORNL GWOU. It Is important to note that the RI Work Plan for the ORNL GWOU is not a prototypical work plan. The RI will be conducted using annual work plans to manage the work activities, and task reports will be used to document the results of the investigations. Sampling and analysis results will be compiled and reported annually with a review of data relative to risk (screening level risk assessment review) for groundwater. This Work Plan outlines the overall strategy for the RI and defines tasks which are to be conducted during the initial phase of investigation. This plan is presented with the understanding that more specific addenda to the plan will follow.

Remedial investigation work plan for the Groundwater Operable Unit at Oak Ridge National Laboratory, Oak Ridge, Tennessee

International Nuclear Information System (INIS)

1994-03-01

This Remedial Investigation (RI) Work Plan has been developed as part of the US Department of Energy's (DOE's) investigation of the Groundwater Operable Unit (GWOU) at Oak Ridge National Laboratory (ORNL) located near Oak Ridge, Tennessee. The first iteration of the GWOU RI Work Plan is intended to serve as a strategy document to guide the ORNL GWOU RI. The Work Plan provides a rationale and organization for groundwater data acquisition, monitoring, and remedial actions to be performed during implementation of environmental restoration activities associated with the ORNL GWOU. It Is important to note that the RI Work Plan for the ORNL GWOU is not a prototypical work plan. The RI will be conducted using annual work plans to manage the work activities, and task reports will be used to document the results of the investigations. Sampling and analysis results will be compiled and reported annually with a review of data relative to risk (screening level risk assessment review) for groundwater. This Work Plan outlines the overall strategy for the RI and defines tasks which are to be conducted during the initial phase of investigation. This plan is presented with the understanding that more specific addenda to the plan will follow

The Female Executive’s Perspective on Career Planning and Advancement in Organizations

Directory of Open Access Journals (Sweden)

Dasie J. Schulz

2014-11-01

Full Text Available Gender bias continues to play a role in the gender discrepancy at executive levels in organizations across the United States, although women hold 51% of all middle management positions. Female middle managers may be overlooked for advancement to executive positions because of a lack of synergy between individual career planning and organizational development and advancement practices. This may have significant implications for organizations as they struggle to recruit and hire qualified senior leadership to close the widening leadership gap created as baby boomers leave the workforce in record numbers over the next decade. One way to retain talented, knowledgeable, female middle managers is to incorporate career planning and advancement programs, which increase visibility for both the individual and organizational leaders into potential advancement opportunities. This descriptive phenomenological study was designed to investigate and describe the lived experiences of female executives with career planning and advancement in organizations. Data collected from 16 female executives employed in organizations in Nashville, Tennessee, revealed that although individuals must make a commitment to career planning and take responsibility for executing the plan, successful career planning and advancement are dependent on others beyond the individual seeking advancement. The findings of this study are important for women who desire advancement to executive levels and to organizational leaders who want to hire and promote the right person for the job regardless of gender.

The scenario-based generalization of radiation therapy margins

International Nuclear Information System (INIS)

Fredriksson, Albin; Bokrantz, Rasmus

2016-01-01

We give a scenario-based treatment plan optimization formulation that is equivalent to planning with geometric margins if the scenario doses are calculated using the static dose cloud approximation. If the scenario doses are instead calculated more accurately, then our formulation provides a novel robust planning method that overcomes many of the difficulties associated with previous scenario-based robust planning methods. In particular, our method protects only against uncertainties that can occur in practice, it gives a sharp dose fall-off outside high dose regions, and it avoids underdosage of the target in ‘easy’ scenarios. The method shares the benefits of the previous scenario-based robust planning methods over geometric margins for applications where the static dose cloud approximation is inaccurate, such as irradiation with few fields and irradiation with ion beams. These properties are demonstrated on a suite of phantom cases planned for treatment with scanned proton beams subject to systematic setup uncertainty. (paper)

Preparedness and planning for nuclear accidents at national level

International Nuclear Information System (INIS)

Shiukshta, A.

1998-01-01

National plan for the protection of population in the case in nuclear accident at Ignalina NPP is presented. The plan was elaborated and approved in 1995, tested in a number of training and practical operations and positively evaluated by experts. The plan provides for measures of protection, their scope, schedule, executive officers and organizations and procedure of implementation

Imaging dose in breast radiotherapy: does breast size affect the dose to the organs at risk and the risk of secondary cancer to the contralateral breast?

International Nuclear Information System (INIS)

Batumalai, Vikneswary; Quinn, Alexandra; Jameson, Michael; Delaney, Geoff; Holloway, Lois

2015-01-01

Correct target positioning is crucial for accurate dose delivery in breast radiotherapy resulting in utilisation of daily imaging. However, the radiation dose from daily imaging is associated with increased probability of secondary induced cancer. The aim of this study was to quantify doses associated with three imaging modalities and investigate the correlation of dose and varying breast size in breast radiotherapy. Planning computed tomography (CT) data sets of 30 breast cancer patients were utilised to simulate the dose received by various organs from a megavoltage computed tomography (MV-CT), megavoltage electronic portal image (MV-EPI) and megavoltage cone-beam computed tomography (MV-CBCT). The mean dose to organs adjacent to the target volume (contralateral breast, lungs, spinal cord and heart) were analysed. Pearson correlation analysis was performed to determine the relationship between imaging dose and primary breast volume and the lifetime attributable risk (LAR) of induced secondary cancer was calculated for the contralateral breast. The highest contralateral breast mean dose was from the MV-CBCT (1.79 Gy), followed by MV-EPI (0.22 Gy) and MV-CT (0.11 Gy). A similar trend was found for all organs at risk (OAR) analysed. The primary breast volume inversely correlated with the contralateral breast dose for all three imaging modalities. As the primary breast volume increases, the likelihood of a patient developing a radiation-induced secondary cancer to the contralateral breast decreases. MV-CBCT showed a stronger relationship between breast size and LAR of developing a radiation-induced contralateral breast cancer in comparison with the MV-CT and MV-EPI. For breast patients, imaging dose to OAR depends on imaging modality and treated breast size. When considering the use of imaging during breast radiotherapy, the patient's breast size and contralateral breast dose should be taken into account

Single-Center Experience Using Marginal Liver Grafts in Korea.

Science.gov (United States)

Park, P-J; Yu, Y-D; Yoon, Y-I; Kim, S-R; Kim, D-S

2018-05-01

Liver transplantation (LT) is an established therapeutic modality for patients with end-stage liver disease. The use of marginal donors has become more common worldwide due to the sharp increase in recipients, with a consequent shortage of suitable organs. We analyzed our single-center experience over the last 8 years in LT to evaluate the outcomes of using so-called "marginal donors." We retrospectively analyzed the database of all LTs performed at our institution from 2009 to 2017. Only patients undergoing deceased-donor LTs were analyzed. Marginal grafts were defined as livers from donors >60 years of age, livers from donors with serum sodium levels >155 mEq, graft steatosis >30%, livers with cold ischemia time ≥12 hours, livers from donors who were hepatitis B or C virus positive, livers recovered from donation after cardiac death, and livers split between 2 recipients. Patients receiving marginal grafts (marginal group) were compared with patients receiving standard grafts (standard group). A total of 106 patients underwent deceased-donor LT. There were 55 patients in the standard group and 51 patients in the marginal group. There were no significant differences in terms of age, sex, Model for End-Stage Liver Disease score, underlying liver disease, presence of hepatocellular carcinoma, and hospital stay between the 2 groups. Although the incidence of acute cellular rejection, cytomegalovirus infection, and postoperative complications was similar between the 2 groups, the incidence of early allograft dysfunction was higher in the marginal group. With a median follow-up of 26 months, the 1-, 3-, and 5-year overall and graft (death-censored) survivals in the marginal group were 85.5%, 75%, and 69.2% and 85.9%, 83.6%, and 77.2%, respectively. Patient overall survival and graft survival (death-censored) were significantly lower in the marginal group (P = .023 and P = .048, respectively). On multivariate analysis, receiving a marginal graft (hazard ratio [HR

Market modeling for assessment of demand side programs using the marginal cost

International Nuclear Information System (INIS)

Papastamatiou, Panagiotis; Psarras, John

2000-01-01

Demand side management is nowadays considered as a functional step in the energy planning process. The criteria proposed for the assessment of the demand side programs (DSPs) are usually based on the balance between the marginal supply cost and the mean DSP cost. These criteria could not support the allotting of the invested capital to incentives for the consumers and advertising. This paper presents a methodology to support the utility planning at this point with more reliability. It proposes the expansion of the assessment criteria with the use of the marginal cost of the DSP. For the calculation of the DSP marginal cost, a dynamic model is developed and it is used for the simulation of the penetration of a DS Program. Using the 'least-cost' criterion as the decision rule for the simulation, the planner has a distribution of the available investment capital throughout the whole planning period. The use of the 'most-value' criterion supports the separation of the invested capital between incentives for the consumers and supportive expenses, e.g. advertising, marketing cost, etc. (Author)

Impact of delineation uncertainties on dose to organs at risk in CT-guided intracavitary brachytherapy.

LENUS (Irish Health Repository)

Duane, Frances K

2014-08-07

This study quantifies the inter- and intraobserver variations in contouring the organs at risk (OARs) in CT-guided brachytherapy (BT) for the treatment of cervical carcinoma. The dosimetric consequences are reported in accordance with the current Gynecological Groupe Européen de Curiethérapie\\/European Society for Therapeutic Radiology and Oncology guidelines.

Organic amendments for risk mitigation of organochlorine pesticide residues in old orchard soils

International Nuclear Information System (INIS)

Centofanti, Tiziana; McConnell, Laura L.; Chaney, Rufus L.; Beyer, W. Nelson; Andrade, Natasha A.; Hapeman, Cathleen J.; Torrents, Alba; Nguyen, Anh; Anderson, Marya O.; Novak, Jeffrey M.

2016-01-01

Performance of compost and biochar amendments for in situ risk mitigation of aged DDT, DDE and dieldrin residues in an old orchard soil was examined. The change in bioavailability of pesticide residues to Lumbricus terrestris L. relative to the unamended control soil was assessed using 4-L soil microcosms with and without plant cover in a 48-day experiment. The use of aged dairy manure compost and biosolids compost was found to be effective, especially in the planted treatments, at lowering the bioavailability factor (BAF) by 18–39%; however, BAF results for DDT in the unplanted soil treatments were unaffected or increased. The pine chip biochar utilized in this experiment was ineffective at lower the BAF of pesticides in the soil. The US EPA Soil Screening Level approach was used with our measured values. Addition of 10% of the aged dairy manure compost reduced the average hazard quotient values to below 1.0 for DDT + DDE and dieldrin. Results indicate this sustainable approach is appropriate to minimize risks to wildlife in areas of marginal organochlorine pesticide contamination. Application of this remediation approach has potential for use internationally in areas where historical pesticide contamination of soils remains a threat to wildlife populations. - Highlights: • Historical applications of organochlorine pesticides are a risk to local ecosystems. • Low cost and sustainable mitigation measures are needed to reduce risks. • Organic matter rich amendments were added to contaminated soil. • Earthworms microcosms were used to measure bioaccumulation factors. • Aged composts were most effective at mitigating risks to ecosystems. - Incorporation of aged dairy manure and biosolids compost amendments is an effective, low cost approach to mitigate risks to terrestrial wildlife from organochlorine pesticides in soils.

The planning target volume margins detected by cone-beam CT in head and neck cancer patients treated by image-guided intensity modulated radiotherapy

International Nuclear Information System (INIS)

Liu Jun; Chen Hong; Zhang Guoqiao; Chen Fei; Zhang Li

2011-01-01

Objective: To determine the planning target volume margins of head and neck cancers treated by image guided radiotherapy (IGRT). Methods: 464 sets cone beam computed tomography (CBCT) images before setup correction and 126 sets CBCT images after correction were obtained from 51 head and neck cancer patients treated by IGRT in our department. The systematic and random errors were evaluated by either online or offline correction through registering the CBCT images to the planning CT. The data was divided into 3 groups according to the online correction times. Results: The isocenter shift were 0.37 mm ± 2.37 mm, -0.43 mm ± 2.30 mm and 0.47 mm ± 2.65 mm in right-left (RL), anterior-posterior (AP) and superior-inferior (SI) directions respectively before correction, and it reduced to 0.08 mm ± 0.68 mm, -0.03 mm ± 0.74 mm and 0.03 mm ± 0.80 mm when evaluated by 126 sets corrected CBCT images. The planning target volume (PTV) margin from clinical target volume (CTV) before correction were: 6.41 mm, 6.15 mm and 7.10 mm based on two parameter model, and it reduced to 1.78 mm, 1.80 mm and 1.97 mm after correction. The PTV margins were 3.8 mm, 3.8 mm, 4.0 mm; 4.0 mm, 4.0 mm, 5.0 mm and 5.4 mm, 5.2 mm, 6.1 mm in RL, AP and SI respectively when online-correction times were more than 15 times, 11-15 times, 5-10 times. Conclusions: CBCT-based on online correction reduce the PTV margin for head and neck cancers treated by IGRT and ensure more precise dose delivery and less normal tissue complications. (authors)

Light Reflectance Spectroscopy to Detect Positive Surgical Margins on Prostate Cancer Specimens.

Science.gov (United States)

Morgan, Monica S C; Lay, Aaron H; Wang, Xinlong; Kapur, Payal; Ozayar, Asim; Sayah, Maryam; Zeng, Li; Liu, Hanli; Roehrborn, Claus G; Cadeddu, Jeffrey A

2016-02-01

Intraoperative frozen section analysis is not routinely performed to determine positive surgical margins at radical prostatectomy due to time requirements and unproven clinical usefulness. Light reflectance spectroscopy, which measures light intensity reflected or backscattered from tissues, can be applied to differentiate malignant from benign tissue. We used a novel light reflectance spectroscopy probe to evaluate positive surgical margins on ex vivo radical prostatectomy specimens and correlate its findings with pathological examination. Patients with intermediate to high risk disease undergoing radical prostatectomy were enrolled. Light reflectance spectroscopy was performed on suspected malignant and benign prostate capsule immediately following organ extraction. Each light reflectance spectroscopy at 530 to 830 nm was analyzed and correlated with pathological results. A regression model and forward sequential selection algorithm were developed for optimal feature selection. Eighty percent of light reflectance spectroscopy data were selected to train a logistic regression model, which was evaluated by the remaining 20% data. This was repeated 5 times to calculate averaged sensitivity, specificity and accuracy. Light reflectance spectroscopy analysis was performed on 17 ex vivo prostate specimens, on which a total of 11 histologically positive and 22 negative surgical margins were measured. Two select features from 700 to 830 nm were identified as unique to malignant tissue. Cross-validation when performing the predictive model showed that the optical probe predicted positive surgical margins with 85% sensitivity, 86% specificity, 86% accuracy and an AUC of 0.95. Light reflectance spectroscopy can identify positive surgical margins accurately in fresh ex vivo radical prostatectomy specimens. Further study is required to determine whether such analysis may be used in real time to improve surgical decision making and decrease positive surgical margin rates

Strategic planning in media organizations of Iran

Directory of Open Access Journals (Sweden)

Ali Akbar Farhangi

2012-04-01

Full Text Available Organizations with activities of all kinds are influenced by environmental conditions, and external environment is in fact the beginning point of the strategy. Strategic management is an approach resulting from fast changing age and can consider it as a view and a technique for flexible planning to fast changes, and balanced score card is regarded as one of the strong instruments in this zone. Balanced score card can truly plays an important role in all stages of strategic management and the efficiency of this model is considerably regarded in management performance evaluation in different organizations. However, strong instrument such as balance score card is hardly used because of long term dominance of political approaches in the management of Iran media organizations. This paper conceptualizes administrational trend of strategic planning by implementing balanced score card and we draw strategy map and determine performance indexes in a written media organization (Hamshahri Newspaper.

Effect of Margin Designs on the Marginal Adaptation of Zirconia Copings.

Science.gov (United States)

Habib, Syed Rashid; Al Ajmi, Mohammed Ginan; Al Dhafyan, Mohammed; Jomah, Abdulrehman; Abualsaud, Haytham; Almashali, Mazen

2017-09-01

The aim of this in vitro study was to investigate the effect of Shoulder versus Chamfer margin design on the marginal adaptation of zirconia (Zr) copings. 40 extracted molar teeth were mounted in resin and prepared for zirconia crowns with two margin preparation designs (20=Shoulder and 20=Chamfer). The copings were manufactured by Cercon® (DeguDent GmbH, Germany) using the CAD/CAM system for each tooth. They were tried on each tooth, cemented, thermocycled, re-embedded in resin and were subsequently cross sectioned centrally into two equal mesial and distal halves. They were examined under electron microscope at 200 X magnification and the measurements were recorded at 5 predetermined points in micrometers (µm). The o verall mean marginal gap for the two groups was found to be 206.98+42.78µm with Shoulder margin design (Marginal Gap=199.50+40.72µm) having better adaptation compared to Chamfer (Marginal Gap=214.46+44.85µm). The independent-samples t-test showed a statistically non-significant difference (p=.113) between the means of marginal gap for Shoulder and Chamfer margin designs and the measurements were recorded at 5 predetermined points for the two groups. The Chamfer margin design appeared to offer the same adaptation results as the Shoulder margin design.

The generalized model of organization and planning of regional gas supply monitoring

Directory of Open Access Journals (Sweden)

Maria V. Shevchenko

2015-12-01

Full Text Available At the moment, gas is one of the most promising types of fuel in Ukraine. In this regard, the problems associated with its transportation in the regional system of gas supply are relevant. Now it is not completely solved and needs detailed study the problem of monitoring the regional gas supply system. Aim: The aim of the study is to improve the efficiency of the regional gas supply system at the expense of the organization and planning of gas transport monitoring and, in the future, the synthesis of the monitoring system of regional gas supply. Materials and Methods: The generalized model of organization and planning of monitoring regional gas suppliers were developed to achieve this goal. It allows making decisions on the organization of the monitoring system. In addition, this model makes it possible to plan under conditions of multicriteriality and uncertainty of the source data. Results: The basic criteria and constraints for solving the problem of organizing and planning the monitoring system of regional gas supply are proposed in this work. The corresponding computations were made to confirm the assumptions. The calculations were carried out in context of uncertainty of input data using a set of methods for the analysis of hierarchies, exhaustive search, as well as the methods of decision making in context of uncertainty.

Observations at convergent margins concerning sediment subduction, subduction erosion, and the growth of continental crust

Science.gov (United States)

von Huene, Roland E.; Scholl, D. W.

1991-01-01

At ocean margins where two plates converge, the oceanic plate sinks or is subducted beneath an upper one topped by a layer of terrestrial crust. This crust is constructed of continental or island arc material. The subduction process either builds juvenile masses of terrestrial crust through arc volcanism or new areas of crust through the piling up of accretionary masses (prisms) of sedimentary deposits and fragments of thicker crustal bodies scraped off the subducting lower plate. At convergent margins, terrestrial material can also bypass the accretionary prism as a result of sediment subduction, and terrestrial matter can be removed from the upper plate by processes of subduction erosion. Sediment subduction occurs where sediment remains attached to the subducting oceanic plate and underthrusts the seaward position of the upper plate's resistive buttress (backstop) of consolidated sediment and rock. Sediment subduction occurs at two types of convergent margins: type 1 margins where accretionary prisms form and type 2 margins where little net accretion takes place. At type 2 margins (???19,000 km in global length), effectively all incoming sediment is subducted beneath the massif of basement or framework rocks forming the landward trench slope. At accreting or type 1 margins, sediment subduction begins at the seaward position of an active buttress of consolidated accretionary material that accumulated in front of a starting or core buttress of framework rocks. Where small-to-mediumsized prisms have formed (???16,300 km), approximately 20% of the incoming sediment is skimmed off a detachment surface or decollement and frontally accreted to the active buttress. The remaining 80% subducts beneath the buttress and may either underplate older parts of the frontal body or bypass the prism entirely and underthrust the leading edge of the margin's rock framework. At margins bordered by large prisms (???8,200 km), roughly 70% of the incoming trench floor section is

A patient-specific planning target volume used in 'plan of the day' adaptation for interfractional motion mitigation

International Nuclear Information System (INIS)

Chen, Wenjing; Gemmel, Alexander; Rietzel, Eike

2013-01-01

We propose a patient-specific planning target volume (PTV) to deal with interfractional variations, and test its feasibility in a retrospective treatment-planning study. Instead of using one planning image only, multiple scans are taken on different days. The target and organs at risk (OARs) are delineated on each images. The proposed PTV is generated from a union of those target contours on the planning images, excluding voxels of the OARs, and is denoted the PTV 'GP-OAR' (global prostate-organs at risk). The study is performed using 'plan of the day' adaptive workflow, which selects a daily plan from a library of plans based on a similarity comparison between the daily scan and planning images. The daily plans optimized for GP-OAR volumes are compared with those optimized for PTVs generated from a single prostate contour (PTV SP). Four CT serials of prostate cancer patient datasets are included in the test, and in total 28 fractions are simulated. The results show that the daily chosen GP-OAR plans provide excellent target coverage, with V95 values of the prostate mostly >95%. In addition, dose delivered to the OARs as calculated from applying daily chosen GP-OAR plans is slightly increased but comparable to that calculated from applying daily SP plans. In general, the PTV GP-OARs are able to cover possible target variations while keeping dose delivered to the OARs at a similar level to that of the PTV SPs. (author)

Methodology for identifying patients at high risk for osteoporotic fracture.

Science.gov (United States)

Westfall, G; Littlefield, R; Heaton, A; Martin, S

2001-09-01

Osteoporotic fractures are associated with significant morbidity, mortality, and health care costs. The purpose of this paper is to present and validate a mathematical model that managed care organizations can apply to administrative claims data to help locate members at risk for osteoporotic fracture and estimate future fracture rates. Using known risk factors from previous clinical studies, 92,000 members of a large Midwest health plan were placed in 1 of 4 risk categories based on historical claims markers: demographic/lifestyle (age, sex, smoking, alcoholism); steroid use; medical history (previous osteoporotic fracture, ordinary bone fracture, osteoporosis diagnosis, bone mineral density test); or steroid use with medical history. Logistic regression was used to assign a probability of fracture for the 4 groups over the next 2 years. These predictions were compared with actual fracture rates, and refined models were produced. The models were then validated by applying them to current data and comparing the predicted fracture rate for each group to known results. The model predicted that 1.26% of the study members would experience osteoporotic fracture over the next 2 years; the actual result was 1.27%. Within the 4 risk groups, the predicted fracture rates were lower than the actual rates for the demographic risk group (0.87% predicted vs 0.97% actual) and higher than the actual rates for the steroid use (1.78% predicted vs 1.58% actual), medical history (5.90% predicted vs 4.94% actual), and the steroid use with medical history groups (7.80% predicted vs 6.42% actual). The application of this risk model to an administrative claims database successfully identified plan members at risk for osteoporotic fracture.