29 CFR 4006.5 - Exemptions and special rules.

Code of Federal Regulations, 2013 CFR

2013-07-01

... the last day of the prior plan year. (d) Participant count date; new and newly-covered plans. The participant count date of a new plan or a newly-covered plan for a plan year is the first day of the plan year. For this purpose, a new plan's first plan year begins on the plan's effective date. (e) Participant...

29 CFR 4006.5 - Exemptions and special rules.

Code of Federal Regulations, 2012 CFR

2012-07-01

... the last day of the prior plan year. (d) Participant count date; new and newly-covered plans. The participant count date of a new plan or a newly-covered plan for a plan year is the first day of the plan year. For this purpose, a new plan's first plan year begins on the plan's effective date. (e) Participant...

29 CFR 4006.5 - Exemptions and special rules.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the last day of the prior plan year. (d) Participant count date; new and newly-covered plans. The participant count date of a new plan or a newly-covered plan for a plan year is the first day of the plan year. For this purpose, a new plan's first plan year begins on the plan's effective date. (e) Participant...

29 CFR 4006.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... single-employer plan. In addition, for purposes of this part: New plan means a plan that did not exist... that meets this definition is considered to be a new plan even if the plan constitutes a successor plan within the meaning of section 4021(a) of ERISA. Newly-covered plan means a plan that is not a new plan...

29 CFR 4006.5 - Exemptions and special rules.

Code of Federal Regulations, 2011 CFR

2011-07-01

... the last day of the prior plan year. (d) Participant count date; new and newly-covered plans. The participant count date of a new plan or a newly-covered plan for a plan year is the first day of the plan year. For this purpose, a new plan's first plan year begins on the plan's effective date. (e) Participant...

29 CFR 4006.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... single-employer plan. In addition, for purposes of this part: New plan means a plan that did not exist... that meets this definition is considered to be a new plan even if the plan constitutes a successor plan within the meaning of section 4021(a) of ERISA. Newly-covered plan means a plan that is not a new plan...

Evaluation of a commercial automatic treatment planning system for liver stereotactic body radiation therapy treatments.

PubMed

Gallio, Elena; Giglioli, Francesca Romana; Girardi, Andrea; Guarneri, Alessia; Ricardi, Umberto; Ropolo, Roberto; Ragona, Riccardo; Fiandra, Christian

2018-02-01

Automated treatment planning is a new frontier in radiotherapy. The Auto-Planning module of the Pinnacle 3 treatment planning system (TPS) was evaluated for liver stereotactic body radiation therapy treatments. Ten cases were included in the study. Six plans were generated for each case by four medical physics experts. The first two planned with Pinnacle TPS, both with manual module (MP) and Auto-Planning one (AP). The other two physicists generated two plans with Monaco TPS (VM). Treatment plan comparisons were then carried on the various dosimetric parameters of target and organs at risk, monitor units, number of segments, plan complexity metrics and human resource planning time. The user dependency of Auto-Planning was also tested and the plans were evaluated by a trained physician. Statistically significant differences (Anova test) were observed for spinal cord doses, plan average beam irregularity, number of segments, monitor units and human planning time. The Fisher-Hayter test applied to these parameters showed significant statistical differences between AP e MP for spinal cord doses and human planning time; between MP and VM for monitor units, number of segments and plan irregularity; for all those between AP and VM. The two plans created by different planners with AP were similar to each other. The plans created with Auto-Planning were comparable to the manually generated plans. The time saved in planning enables the planner to commit more resources to more complex cases. The independence of the planner enables to standardize plan quality. Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

40 CFR 62.5100 - Identification of plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS Maryland Plan for Control... plan. (a) Identification of plan. Maryland Plan for Control Designated Pollutants from Existing Facilities (Section 111(d) plan). (b) The plan was officially submitted as follows: (1) Control of sulfuric...

40 CFR 62.10100 - Identification of plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS South Carolina... Identification of plan. (a) Identification of plan. South Carolina Designated Facility Plan (Section 111(d) Plan). (b) The plan was officially submitted as follows: (1) Implementation Plan for Control of Designated...

14 CFR 77.75 - Establishment of antenna farm areas.

Code of Federal Regulations, 2011 CFR

2011-01-01

... indicated on an FAA planning document or military service military airport planning document. Planned or...; any other FAA planning document, or military service military airport planning document. Public use... layout plan, a military service approved military airport layout plan, or by any planning document...

11. Strategic planning.

PubMed

2014-05-01

There are several types of planning processes and plans, including strategic, operational, tactical, and contingency. For this document, operational planning includes tactical planning. This chapter examines the strategic planning process and includes an introduction into disaster response plans. "A strategic plan is an outline of steps designed with the goals of the entire organisation as a whole in mind, rather than with the goals of specific divisions or departments". Strategic planning includes all measures taken to provide a broad picture of what must be achieved and in which order, including how to organise a system capable of achieving the overall goals. Strategic planning often is done pre-event, based on previous experience and expertise. The strategic planning for disasters converts needs into a strategic plan of action. Strategic plans detail the goals that must be achieved. The process of converting needs into plans has been deconstructed into its components and includes consideration of: (1) disaster response plans; (2) interventions underway or planned; (3) available resources; (4) current status vs. pre-event status; (5) history and experience of the planners; and (6) access to the affected population. These factors are tempered by the local: (a) geography; (b) climate; (c) culture; (d) safety; and (e) practicality. The planning process consumes resources (costs). All plans must be adapted to the actual conditions--things never happen exactly as planned.

40 CFR 62.8350 - Identification of plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS North Carolina Plan for... Identification of plan. (a) Identification of plan. North Carolina Designated Facility Plan (Section 111(d) Plan). (b) The plan was officially submitted as follows: (1) Control of sulfuric acid mist emissions from...

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, J; Hu, W; Chen, X

Purpose: The aim of this study is to investigate the feasibility of using RapidPlan for breast cancer radiotherapy and to evaluate its performance for planners with different planning experiences. Methods: A training database was collected with 80 expert plan datasets from patients previously received left breast conserving surgery and IMRT-simultaneously integrated boost radiotherapy. The models were created on the RapidPlan. Five patients from the training database and 5 external patients were used for internal and external validation, respectively. Three planners with different planning experiences (beginner, junior, senior) designed manual and RapidPlan based plans for additional ten patients. The plan qualitiesmore » were compared with manual and RapidPlan based ones. Results: For the internal and external validations, there were no significant dose differences on target coverage for plans from RapidPlan and manual. Also, no difference was found in the mean doses to contralateral breast and lung. The RapidPlan improved the heart (V5, V10, V20, V30, and mead dose) and ipsilateral lung (V5, V10, V20, V30, and mean dose) sparing for the beginner and junior planners. Compare to the plans from senior planner, 6 out of 16 clinically checked parameters were improved in RapidPlan, and the left parameters were similar. Conclusion: It is feasible to generate clinical acceptable plans using RapidPlan for breast cancer radiotherapy. The RapidPlan helps to systematically improve the quality of IMRT plans against the benchmark of clinically accepted plans. The RapidPlan shows promise for homogenizing plan quality by transferring planning expertise from more experienced to less experienced planners.« less

30 CFR 784.23 - Operation plan: Maps and plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Operation plan: Maps and plans. 784.23 Section... PLAN § 784.23 Operation plan: Maps and plans. Each application shall contain maps and plans as follows... INTERIOR SURFACE COAL MINING AND RECLAMATION OPERATIONS PERMITS AND COAL EXPLORATION SYSTEMS UNDER...

31 CFR 29.402 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Judges Plan, Police and Firefighters Plan, or Teachers Plan, who is or may become entitled to a benefit... Judges Plan, Police and Firefighters Plan, or Teachers Plan. Department means the Secretary of the... under the Police and Firefighters Plan or the Teachers Plan based on credit for service accrued as of...

31 CFR 29.402 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Judges Plan, Police and Firefighters Plan, or Teachers Plan, who is or may become entitled to a benefit... Judges Plan, Police and Firefighters Plan, or Teachers Plan. Department means the Secretary of the... under the Police and Firefighters Plan or the Teachers Plan based on credit for service accrued as of...

31 CFR 29.402 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Judges Plan, Police and Firefighters Plan, or Teachers Plan, who is or may become entitled to a benefit... Judges Plan, Police and Firefighters Plan, or Teachers Plan. Department means the Secretary of the... under the Police and Firefighters Plan or the Teachers Plan based on credit for service accrued as of...

31 CFR 29.402 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Judges Plan, Police and Firefighters Plan, or Teachers Plan, who is or may become entitled to a benefit... Judges Plan, Police and Firefighters Plan, or Teachers Plan. Department means the Secretary of the... under the Police and Firefighters Plan or the Teachers Plan based on credit for service accrued as of...

42 CFR 423.4 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... MA plan has the meaning given the term in § 422.2 of this chapter. MA-PD plan means an MA plan that... plan) means a prescription drug plan, an MA-PD plan, a PACE Plan offering qualified prescription drug... sponsor refers to a PDP sponsor, MA organization offering a MA-PD plan, a PACE organization offering a...

42 CFR 423.4 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... MA plan has the meaning given the term in § 422.2 of this chapter. MA-PD plan means an MA plan that... plan) means a prescription drug plan, an MA-PD plan, a PACE Plan offering qualified prescription drug... sponsor refers to a PDP sponsor, MA organization offering a MA-PD plan, a PACE organization offering a...

42 CFR 423.4 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... MA plan has the meaning given the term in § 422.2 of this chapter. MA-PD plan means an MA plan that... plan) means a prescription drug plan, an MA-PD plan, a PACE Plan offering qualified prescription drug... sponsor refers to a PDP sponsor, MA organization offering a MA-PD plan, a PACE organization offering a...

40 CFR 264.118 - Post-closure plan; amendment of plan.

Code of Federal Regulations, 2014 CFR

2014-07-01

... days after an unexpected event has occurred which has affected the post-closure plan. An owner or... 40 Protection of Environment 26 2014-07-01 2014-07-01 false Post-closure plan; amendment of plan... FACILITIES Closure and Post-Closure § 264.118 Post-closure plan; amendment of plan. (a) Written Plan. The...

40 CFR 264.118 - Post-closure plan; amendment of plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

... days after an unexpected event has occurred which has affected the post-closure plan. An owner or... 40 Protection of Environment 26 2011-07-01 2011-07-01 false Post-closure plan; amendment of plan... FACILITIES Closure and Post-Closure § 264.118 Post-closure plan; amendment of plan. (a) Written Plan. The...

40 CFR 264.118 - Post-closure plan; amendment of plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... days after an unexpected event has occurred which has affected the post-closure plan. An owner or... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Post-closure plan; amendment of plan... FACILITIES Closure and Post-Closure § 264.118 Post-closure plan; amendment of plan. (a) Written Plan. The...

40 CFR 264.118 - Post-closure plan; amendment of plan.

Code of Federal Regulations, 2013 CFR

2013-07-01

... days after an unexpected event has occurred which has affected the post-closure plan. An owner or... 40 Protection of Environment 27 2013-07-01 2013-07-01 false Post-closure plan; amendment of plan... FACILITIES Closure and Post-Closure § 264.118 Post-closure plan; amendment of plan. (a) Written Plan. The...

40 CFR 264.118 - Post-closure plan; amendment of plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... days after an unexpected event has occurred which has affected the post-closure plan. An owner or... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Post-closure plan; amendment of plan... FACILITIES Closure and Post-Closure § 264.118 Post-closure plan; amendment of plan. (a) Written Plan. The...

DEFINED CONTRIBUTION PLANS, DEFINED BENEFIT PLANS, AND THE ACCUMULATION OF RETIREMENT WEALTH

PubMed Central

Poterba, James; Rauh, Joshua; Venti, Steven; Wise, David

2010-01-01

The private pension structure in the United States, once dominated by defined benefit (DB) plans, is currently divided between defined contribution (DC) and DB plans. Wealth accumulation in DC plans depends on the participant's contribution behavior and on financial market returns, while accumulation in DB plans is sensitive to a participant's labor market experience and to plan parameters. This paper simulates the distribution of retirement wealth under representative DB and DC plans. It uses data from the Health and Retirement Study (HRS) to explore how asset returns, earnings histories, and retirement plan characteristics contribute to the variation in retirement wealth outcomes. We simulate DC plan accumulation by randomly assigning individuals a share of wages that they and their employer contribute to the plan. We consider several possible asset allocation strategies, with asset returns drawn from the historical return distribution. Our DB plan simulations draw earnings histories from the HRS, and randomly assign each individual a pension plan drawn from a sample of large private and public defined benefit plans. The simulations yield distributions of both DC and DB wealth at retirement. Average retirement wealth accruals under current DC plans exceed average accruals under private sector DB plans, although DC plans are also more likely to generate very low retirement wealth outcomes. The comparison of current DC plans with more generous public sector DB plans is less definitive, because public sector DB plans are more generous on average than their private sector counterparts. PMID:21057597

SU-E-T-173: Clinical Comparison of Treatment Plans and Fallback Plans for Machine Downtime

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cruz, W; Cancer Therapy and Research Center, San Antonio, TX; Papanikolaou, P

2015-06-15

Purpose: The purpose of this study was to determine the clinical effectiveness and dosimetric quality of fallback planning in relation to machine downtime. Methods: Plans for a Varian Novalis TX were mimicked, and fallback plans using an Elekta VersaHD machine were generated using a dual arc template. Plans for thirty (n=30) patients of various treatment sites optimized and calculated using RayStation treatment planning system. For each plan, a fall back plan was created and compared to the original plan. A dosimetric evaluation was conducted using the homogeneity index, conformity index, as well as DVH analysis to determine the quality ofmore » the fallback plan on a different treatment machine. Fallback plans were optimized for 60 iterations using the imported dose constraints from the original plan DVH to give fallback plans enough opportunity to achieve the dose objectives. Results: The average conformity index and homogeneity index for the NovalisTX plans were 0.76 and 10.3, respectively, while fallback plan values were 0.73 and 11.4. (Homogeneity =1 and conformity=0 for ideal plan) The values to various organs at risk were lower in the fallback plans as compared to the imported plans across most organs at risk. Isodose difference comparisons between plans were also compared and the average dose difference across all plans was 0.12%. Conclusion: The clinical impact of fallback planning is an important aspect to effective treatment of patients. With the complexity of LINACS increasing every year, an option to continue treating during machine downtime remains an essential tool in streamlined treatment execution. Fallback planning allows the clinic to continue to run efficiently should a treatment machine become offline due to maintenance or repair without degrading the quality of the plan all while reducing strain on members of the radiation oncology team.« less

ISS Payload Operations: The Need for and Benefit of Responsive Planning

NASA Technical Reports Server (NTRS)

Nahay, Ed; Boster, Mandee

2000-01-01

International Space Station (ISS) payload operations are controlled through implementation of a payload operations plan. This plan, which represents the defined approach to payload operations in general, can vary in terms of level of definition. The detailed plan provides the specific sequence and timing of each component of a payload's operations. Such an approach to planning was implemented in the Spacelab program. The responsive plan provides a flexible approach to payload operations through generalization. A responsive approach to planning was implemented in the NASA/Mir Phase 1 program, and was identified as a need during the Skylab program. The current approach to ISS payload operations planning and control tends toward detailed planning, rather than responsive planning. The use of detailed plans provides for the efficient use of limited resources onboard the ISS. It restricts flexibility in payload operations, which is inconsistent with the dynamic nature of the ISS science program, and it restricts crew desires for flexibility and autonomy. Also, detailed planning is manpower intensive. The development and implementation of a responsive plan provides for a more dynamic, more accommodating, and less manpower intensive approach to planning. The science program becomes more dynamic and responsive as the plan provides flexibility to accommodate real-time science accomplishments. Communications limitations and the crew desire for flexibility and autonomy in plan implementation are readily accommodated with responsive planning. Manpower efficiencies are accomplished through a reduction in requirements collection and coordination, plan development, and maintenance. Through examples and assessments, this paper identifies the need to transition from detailed to responsive plans for ISS payload operations. Examples depict specific characteristics of the plans. Assessments identify the following: the means by which responsive plans accommodate the dynamic nature of science programs and the crew desire for flexibility; the means by which responsive plans readily accommodate ISS communications constraints; manpower efficiencies to be achieved through use of responsive plans; and the implications of responsive planning relative to resource utilization efficiency.

Assessment of PlanIQ Feasibility DVH for head and neck treatment planning.

PubMed

Fried, David V; Chera, Bhishamjit S; Das, Shiva K

2017-09-01

Designing a radiation plan that optimally delivers both target coverage and normal tissue sparing is challenging. There are limited tools to determine what is dosimetrically achievable and frequently the experience of the planner/physician is relied upon to make these determinations. PlanIQ software provides a tool that uses target and organ at risk (OAR) geometry to indicate the difficulty of achieving different points for organ dose-volume histograms (DVH). We hypothesized that PlanIQ Feasibility DVH may aid planners in reducing dose to OARs. Clinically delivered head and neck treatments (clinical plan) were re-planned (re-plan) putting high emphasis on maximally sparing the contralateral parotid gland, contralateral submandibular gland, and larynx while maintaining routine clinical dosimetric objectives. The planner was blinded to the results of the clinically delivered plan as well as the Feasibility DVHs from PlanIQ. The re-plan treatments were designed using 3-arc VMAT in Raystation (RaySearch Laboratories, Sweden). The planner was then given the results from the PlanIQ Feasibility DVH analysis and developed an additional plan incorporating this information using 4-arc VMAT (IQ plan). The DVHs across the three treatment plans were compared with what was deemed "impossible" by PlanIQ's Feasibility DVH (Impossible DVH). The impossible DVH (red) is defined as the DVH generated using the minimal dose that any voxel outside the targets must receive given 100% target coverage. The re-plans performed blinded to PlanIQ Feasibilty DVH achieved superior sparing of aforementioned OARs compared to the clinically delivered plans and resulted in discrepancies from the impossible DVHs by an average of 200-700 cGy. Using the PlanIQ Feasibility DVH led to additionalOAR sparing compared to both the re-plans and clinical plans and reduced the discrepancies from the impossible DVHs to an average of approximately 100 cGy. The dose reduction from clinical to re-plan and re-plan to IQ plan were significantly different even when taking into account multiple hypothesis testing for both the contralateral parotid and the larynx (P < 0.004 for all comparisons). No significant differences were observed between the three plans for the contralateral parotid when considering multiple hypothesis testing. Clinical treatment plans and blinded re-plans were found to suboptimally spare OARs. PlanIQ could aid planners in generating treatment plans that push the limits of OAR sparing while maintaining routine clinical target coverage goals. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Meaning and Problems of Planning

ERIC Educational Resources Information Center

Brieve, Fred J.; Johnston, A. P.

1973-01-01

Examines the educational planning process. Discusses what planning is, how methodological planning can work in education, misunderstandings about planning, and difficulties in applying the planning methodology. (DN)

7 CFR 1210.303 - Plan.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Plan. 1210.303 Section 1210.303 Agriculture... PLAN Watermelon Research and Promotion Plan Definitions § 1210.303 Plan. Plan means this watermelon research and promotion Plan issued by the Secretary pursuant to the Act. ...

36 CFR 219.3 - Overview.

Code of Federal Regulations, 2011 CFR

2011-07-01

... System Land and Resource Management Planning The Framework for Planning § 219.3 Overview. (a) The planning framework. Land and resource management planning is a flexible process for fitting solutions to... responsible for national planning. National planning includes the Forest Service national strategic plan...

33 CFR 385.34 - Changes to the Plan.

Code of Federal Regulations, 2014 CFR

2014-07-01

... the Plan; (2) The estimated cost of the Plan, including any approved changes to the Plan; (3) A water... 33 Navigation and Navigable Waters 3 2014-07-01 2014-07-01 false Changes to the Plan. 385.34... Information Into the Plan § 385.34 Changes to the Plan. (a) The Plan shall be updated to incorporate approved...

33 CFR 385.34 - Changes to the Plan.

Code of Federal Regulations, 2013 CFR

2013-07-01

... the Plan; (2) The estimated cost of the Plan, including any approved changes to the Plan; (3) A water... 33 Navigation and Navigable Waters 3 2013-07-01 2013-07-01 false Changes to the Plan. 385.34... Information Into the Plan § 385.34 Changes to the Plan. (a) The Plan shall be updated to incorporate approved...

33 CFR 385.34 - Changes to the Plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... the Plan; (2) The estimated cost of the Plan, including any approved changes to the Plan; (3) A water... 33 Navigation and Navigable Waters 3 2012-07-01 2012-07-01 false Changes to the Plan. 385.34... Information Into the Plan § 385.34 Changes to the Plan. (a) The Plan shall be updated to incorporate approved...

33 CFR 385.34 - Changes to the Plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the Plan; (2) The estimated cost of the Plan, including any approved changes to the Plan; (3) A water... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Changes to the Plan. 385.34... Information Into the Plan § 385.34 Changes to the Plan. (a) The Plan shall be updated to incorporate approved...

33 CFR 385.34 - Changes to the Plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

... the Plan; (2) The estimated cost of the Plan, including any approved changes to the Plan; (3) A water... 33 Navigation and Navigable Waters 3 2011-07-01 2011-07-01 false Changes to the Plan. 385.34... Information Into the Plan § 385.34 Changes to the Plan. (a) The Plan shall be updated to incorporate approved...

29 CFR 2510.3-102 - Definition of “plan assets”-participant contributions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... in cash. (c) Maximum time period for welfare benefit plans. With respect to an employee welfare...) of this section shall apply to such plan as if such plan were an employee welfare benefit plan. (i...) of this section shall apply to such plan as if such plan were an employee welfare benefit plan. [61...

43 CFR 3931.50 - Exploration plan and plan of development modifications.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Exploration plan and plan of development... EXPLORATION AND LEASES Plans of Development and Exploration Plans § 3931.50 Exploration plan and plan of development modifications. (a) The operator or lessee may apply in writing to the BLM for modification of the...

43 CFR 3931.50 - Exploration plan and plan of development modifications.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Exploration plan and plan of development... EXPLORATION AND LEASES Plans of Development and Exploration Plans § 3931.50 Exploration plan and plan of development modifications. (a) The operator or lessee may apply in writing to the BLM for modification of the...

43 CFR 3931.50 - Exploration plan and plan of development modifications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Exploration plan and plan of development... EXPLORATION AND LEASES Plans of Development and Exploration Plans § 3931.50 Exploration plan and plan of development modifications. (a) The operator or lessee may apply in writing to the BLM for modification of the...

43 CFR 3931.50 - Exploration plan and plan of development modifications.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Exploration plan and plan of development... EXPLORATION AND LEASES Plans of Development and Exploration Plans § 3931.50 Exploration plan and plan of development modifications. (a) The operator or lessee may apply in writing to the BLM for modification of the...

Administrator's Guide to Technology: Planning, Funding & Implementation.

ERIC Educational Resources Information Center

Aspen Education Development Group, Gaithersburg, MD.

This document provides guidelines for administrators related to instructional technology and planning. Chapter 1 discusses planning, including developing a technology plan, facility assessment, e-rate planning, formation of a technology committee, budget planning, and hardware/software replacement plan and costs. Chapter 2 addresses…

Noncoplanar VMAT for nasopharyngeal tumors: Plan quality versus treatment time.

PubMed

Wild, Esther; Bangert, Mark; Nill, Simeon; Oelfke, Uwe

2015-05-01

The authors investigated the potential of optimized noncoplanar irradiation trajectories for volumetric modulated arc therapy (VMAT) treatments of nasopharyngeal patients and studied the trade-off between treatment plan quality and delivery time in radiation therapy. For three nasopharyngeal patients, the authors generated treatment plans for nine different delivery scenarios using dedicated optimization methods. They compared these scenarios according to dose characteristics, number of beam directions, and estimated delivery times. In particular, the authors generated the following treatment plans: (1) a 4π plan, which is a not sequenced, fluence optimized plan that uses beam directions from approximately 1400 noncoplanar directions and marks a theoretical upper limit of the treatment plan quality, (2) a coplanar 2π plan with 72 coplanar beam directions as pendant to the noncoplanar 4π plan, (3) a coplanar VMAT plan, (4) a coplanar step and shoot (SnS) plan, (5) a beam angle optimized (BAO) coplanar SnS IMRT plan, (6) a noncoplanar BAO SnS plan, (7) a VMAT plan with rotated treatment couch, (8) a noncoplanar VMAT plan with an optimized great circle around the patient, and (9) a noncoplanar BAO VMAT plan with an arbitrary trajectory around the patient. VMAT using optimized noncoplanar irradiation trajectories reduced the mean and maximum doses in organs at risk compared to coplanar VMAT plans by 19% on average while the target coverage remains constant. A coplanar BAO SnS plan was superior to coplanar SnS or VMAT; however, noncoplanar plans like a noncoplanar BAO SnS plan or noncoplanar VMAT yielded a better plan quality than the best coplanar 2π plan. The treatment plan quality of VMAT plans depended on the length of the trajectory. The delivery times of noncoplanar VMAT plans were estimated to be 6.5 min in average; 1.6 min longer than a coplanar plan but on average 2.8 min faster than a noncoplanar SnS plan with comparable treatment plan quality. The authors' study reconfirms the dosimetric benefits of noncoplanar irradiation of nasopharyngeal tumors. Both SnS using optimized noncoplanar beam ensembles and VMAT using an optimized, arbitrary, noncoplanar trajectory enabled dose reductions in organs at risk compared to coplanar SnS and VMAT. Using great circles or simple couch rotations to implement noncoplanar VMAT, however, was not sufficient to yield meaningful improvements in treatment plan quality. The authors estimate that noncoplanar VMAT using arbitrary optimized irradiation trajectories comes at an increased delivery time compared to coplanar VMAT yet at a decreased delivery time compared to noncoplanar SnS IMRT.

Helical tomotherapy to LINAC plan conversion utilizing RayStation Fallback planning.

PubMed

Zhang, Xin; Penagaricano, Jose; Narayanasamy, Ganesh; Corry, Peter; Liu, TianXiao; Sanjay, Maraboyina; Paudel, Nava; Morrill, Steven

2017-01-01

RaySearch RayStation Fallback (FB) planning module can generate an equivalent backup radiotherapy treatment plan facilitating treatment on other linear accelerators. FB plans were generated from the RayStation FB module by simulating the original plan target and organ at risk (OAR) dose distribution and delivered in various backup linear accelerators. In this study, helical tomotherapy (HT) backup plans used in Varian TrueBeam linear accelerator were generated with the RayStation FB module. About 30 patients, 10 with lung cancer, 10 with head and neck (HN) cancer, and 10 with prostate cancer, who were treated with HT, were included in this study. Intensity-modulated radiotherapy Fallback plans (FB-IMRT) were generated for all patients, and three-dimensional conformal radiotherapy Fallback plans (FB-3D) were only generated for lung cancer patients. Dosimetric comparison study evaluated FB plans based on dose coverage to 95% of the PTV volume (R 95 ), PTV mean dose (D mean ), Paddick's conformity index (CI), and dose homogeneity index (HI). The evaluation results showed that all IMRT plans were statistically comparable between HT and FB-IMRT plans except that PTV HI was worse in prostate, and PTV R 95 and HI were worse in HN multitarget plans for FB-IMRT plans. For 3D lung cancer plans, only the PTV R 95 was statistically comparable between HT and FB-3D plans, PTV D mean was higher, and CI and HI were worse compared to HT plans. The FB plans using a TrueBeam linear accelerator generally offer better OAR sparing compared to HT plans for all the patients. In this study, all cases of FB-IMRT plans and 9/10 cases of FB-3D plans were clinically acceptable without further modification and optimization once the FB plans were generated. However, the statistical differences between HT and FB-IMRT/3D plans might not be of any clinically significant. One FB-3D plan failed to simulate the original plan without further optimization. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

A knowledge-based approach to improving and homogenizing intensity modulated radiation therapy planning quality among treatment centers: an example application to prostate cancer planning.

PubMed

Good, David; Lo, Joseph; Lee, W Robert; Wu, Q Jackie; Yin, Fang-Fang; Das, Shiva K

2013-09-01

Intensity modulated radiation therapy (IMRT) treatment planning can have wide variation among different treatment centers. We propose a system to leverage the IMRT planning experience of larger institutions to automatically create high-quality plans for outside clinics. We explore feasibility by generating plans for patient datasets from an outside institution by adapting plans from our institution. A knowledge database was created from 132 IMRT treatment plans for prostate cancer at our institution. The outside institution, a community hospital, provided the datasets for 55 prostate cancer cases, including their original treatment plans. For each "query" case from the outside institution, a similar "match" case was identified in the knowledge database, and the match case's plan parameters were then adapted and optimized to the query case by use of a semiautomated approach that required no expert planning knowledge. The plans generated with this knowledge-based approach were compared with the original treatment plans at several dose cutpoints. Compared with the original plan, the knowledge-based plan had a significantly more homogeneous dose to the planning target volume and a significantly lower maximum dose. The volumes of the rectum, bladder, and femoral heads above all cutpoints were nominally lower for the knowledge-based plan; the reductions were significantly lower for the rectum. In 40% of cases, the knowledge-based plan had overall superior (lower) dose-volume histograms for rectum and bladder; in 54% of cases, the comparison was equivocal; in 6% of cases, the knowledge-based plan was inferior for both bladder and rectum. Knowledge-based planning was superior or equivalent to the original plan in 95% of cases. The knowledge-based approach shows promise for homogenizing plan quality by transferring planning expertise from more experienced to less experienced institutions. Copyright © 2013 Elsevier Inc. All rights reserved.

Evaluation of a commercial automatic treatment planning system for prostate cancers.

PubMed

Nawa, Kanabu; Haga, Akihiro; Nomoto, Akihiro; Sarmiento, Raniel A; Shiraishi, Kenshiro; Yamashita, Hideomi; Nakagawa, Keiichi

2017-01-01

Recent developments in Radiation Oncology treatment planning have led to the development of software packages that facilitate automated intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) planning. Such solutions include site-specific modules, plan library methods, and algorithm-based methods. In this study, the plan quality for prostate cancer generated by the Auto-Planning module of the Pinnacle 3 radiation therapy treatment planning system (v9.10, Fitchburg, WI) is retrospectively evaluated. The Auto-Planning module of Pinnacle 3 uses a progressive optimization algorithm. Twenty-three prostate cancer cases, which had previously been planned and treated without lymph node irradiation, were replanned using the Auto-Planning module. Dose distributions were statistically compared with those of manual planning by the paired t-test at 5% significance level. Auto-Planning was performed without any manual intervention. Planning target volume (PTV) dose and dose to rectum were comparable between Auto-Planning and manual planning. The former, however, significantly reduced the dose to the bladder and femurs. Regression analysis was performed to examine the correlation between volume overlap between bladder and PTV divided by the total bladder volume and resultant V70. The findings showed that manual planning typically exhibits a logistic way for dose constraint, whereas Auto-Planning shows a more linear tendency. By calculating the Akaike information criterion (AIC) to validate the statistical model, a reduction of interoperator variation in Auto-Planning was shown. We showed that, for prostate cancer, the Auto-Planning module provided plans that are better than or comparable with those of manual planning. By comparing our results with those previously reported for head and neck cancer treatment, we recommend the homogeneous plan quality generated by the Auto-Planning module, which exhibits less dependence on anatomic complexity. Copyright © 2017 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Comparison of composite prostate radiotherapy plan doses with dependent and independent boost phases.

PubMed

Narayanasamy, Ganesh; Avila, Gabrielle; Mavroidis, Panayiotis; Papanikolaou, Niko; Gutierrez, Alonso; Baacke, Diana; Shi, Zheng; Stathakis, Sotirios

2016-09-01

Prostate cases commonly consist of dual phase planning with a primary plan followed by a boost. Traditionally, the boost phase is planned independently from the primary plan with the risk of generating hot or cold spots in the composite plan. Alternatively, boost phase can be planned taking into account the primary dose. The aim of this study was to compare the composite plans from independently and dependently planned boosts using dosimetric and radiobiological metrics. Ten consecutive prostate patients previously treated at our institution were used to conduct this study on the Raystation™ 4.0 treatment planning system. For each patient, two composite plans were developed: a primary plan with an independently planned boost and a primary plan with a dependently planned boost phase. The primary plan was prescribed to 54 Gy in 30 fractions to the primary planning target volume (PTV1) which includes prostate and seminal vesicles, while the boost phases were prescribed to 24 Gy in 12 fractions to the boost planning target volume (PTV2) that targets only the prostate. PTV coverage, max dose, median dose, target conformity, dose homogeneity, dose to OARs, and probabilities of benefit, injury, and complication-free tumor control (P+) were compared. Statistical significance was tested using either a 2-tailed Student's t-test or Wilcoxon signed-rank test. Dosimetrically, the composite plan with dependent boost phase exhibited smaller hotspots, lower maximum dose to the target without any significant change to normal tissue dose. Radiobiologically, for all but one patient, the percent difference in the P+ values between the two methods was not significant. A large percent difference in P+ value could be attributed to an inferior primary plan. The benefits of considering the dose in primary plan while planning the boost is not significant unless a poor primary plan was achieved.

Marine spatial planning in practice

NASA Astrophysics Data System (ADS)

Collie, Jeremy S.; (Vic) Adamowicz, W. L.; Beck, Michael W.; Craig, Bethany; Essington, Timothy E.; Fluharty, David; Rice, Jake; Sanchirico, James N.

2013-01-01

Multiple competing uses of continental-shelf environments have led to a proliferation of marine spatial planning initiatives, together with expert guidance on marine spatial planning. This study provides an empirical review of marine spatial plans, their attributes, and the extent to which the expert guidance is actually being followed. We performed a structured review of 16 existing marine spatial plans and created an idealized marine spatial plan from the steps included in recent expert papers. A cluster analysis of the yes/no answers to 28 questions was used to ordinate the 16 marine spatial plans and to compare them with the idealized plan. All the plans that have been implemented have a high-level government mandate and the authority to implement spatial planning vested in existing institutions. Almost all the plans used data with clear criteria for data inclusion. Stakeholders were included in almost all the plans; they did not participate in all stages of the planning process but their roles were generally clearly defined. Decision-support tools were applied inconsistently across plans and were seldom used dynamically over time. Most spatial planning processes did not select specific outcomes, such as preferred use scenarios. Success is defined inconsistently across plans; in half the cases there are no metrics of success with reference benchmarks. Although monitoring is included in the majority of plans, only in some cases do monitoring results feed back into management decisions. The process of marine spatial planning had advanced in that some of the more recent plans were developed more quickly and contain more desirable attributes than earlier plans. Even so, existing marine spatial plans are heterogeneous—there are essential ingredients, but no single recipe for success.

Inverse planning in three-dimensional conformal and intensity-modulated radiotherapy of mid-thoracic oesophageal cancer.

PubMed

Wu, V W C; Sham, J S T; Kwong, D L W

2004-07-01

The aim of this study is to demonstrate the use of inverse planning in three-dimensional conformal radiation therapy (3DCRT) of oesophageal cancer patients and to evaluate its dosimetric results by comparing them with forward planning of 3DCRT and inverse planning of intensity-modulated radiotherapy (IMRT). For each of the 15 oesophageal cancer patients in this study, the forward 3DCRT, inverse 3DCRT and inverse IMRT plans were produced using the FOCUS treatment planning system. The dosimetric results and the planner's time associated with each of the treatment plans were recorded for comparison. The inverse 3DCRT plans showed similar dosimetric results to the forward plans in the planning target volume (PTV) and organs at risk (OARs). However, they were inferior to that of the IMRT plans in terms of tumour control probability and target dose conformity. Furthermore, the inverse 3DCRT plans were less effective in reducing the percentage lung volume receiving a dose below 25 Gy when compared with the IMRT plans. The inverse 3DCRT plans delivered a similar heart dose as in the forward plans, but higher dose than the IMRT plans. The inverse 3DCRT plans significantly reduced the operator's time by 2.5 fold relative to the forward plans. In conclusion, inverse planning for 3DCRT is a reasonable alternative to the forward planning for oesophageal cancer patients with reduction of the operator's time. However, IMRT has the better potential to allow further dose escalation and improvement of tumour control.

Mission planning for autonomous systems

NASA Technical Reports Server (NTRS)

Pearson, G.

1987-01-01

Planning is a necessary task for intelligent, adaptive systems operating independently of human controllers. A mission planning system that performs task planning by decomposing a high-level mission objective into subtasks and synthesizing a plan for those tasks at varying levels of abstraction is discussed. Researchers use a blackboard architecture to partition the search space and direct the focus of attention of the planner. Using advanced planning techniques, they can control plan synthesis for the complex planning tasks involved in mission planning.

Patient-specific dosimetric endpoints based treatment plan quality control in radiotherapy.

PubMed

Song, Ting; Staub, David; Chen, Mingli; Lu, Weiguo; Tian, Zhen; Jia, Xun; Li, Yongbao; Zhou, Linghong; Jiang, Steve B; Gu, Xuejun

2015-11-07

In intensity modulated radiotherapy (IMRT), the optimal plan for each patient is specific due to unique patient anatomy. To achieve such a plan, patient-specific dosimetric goals reflecting each patient's unique anatomy should be defined and adopted in the treatment planning procedure for plan quality control. This study is to develop such a personalized treatment plan quality control tool by predicting patient-specific dosimetric endpoints (DEs). The incorporation of patient specific DEs is realized by a multi-OAR geometry-dosimetry model, capable of predicting optimal DEs based on the individual patient's geometry. The overall quality of a treatment plan is then judged with a numerical treatment plan quality indicator and characterized as optimal or suboptimal. Taking advantage of clinically available prostate volumetric modulated arc therapy (VMAT) treatment plans, we built and evaluated our proposed plan quality control tool. Using our developed tool, six of twenty evaluated plans were identified as sub-optimal plans. After plan re-optimization, these suboptimal plans achieved better OAR dose sparing without sacrificing the PTV coverage, and the dosimetric endpoints of the re-optimized plans agreed well with the model predicted values, which validate the predictability of the proposed tool. In conclusion, the developed tool is able to accurately predict optimally achievable DEs of multiple OARs, identify suboptimal plans, and guide plan optimization. It is a useful tool for achieving patient-specific treatment plan quality control.

42 CFR 430.20 - Effective dates of State plans and plan amendments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Effective dates of State plans and plan amendments... State Plans § 430.20 Effective dates of State plans and plan amendments. For purposes of FFP, the... first day of the quarter in which an approvable plan is submitted to the regional office; and (2) With...

42 CFR 430.20 - Effective dates of State plans and plan amendments.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Effective dates of State plans and plan amendments... State Plans § 430.20 Effective dates of State plans and plan amendments. For purposes of FFP, the... first day of the quarter in which an approvable plan is submitted to the regional office; and (2) With...

42 CFR 430.20 - Effective dates of State plans and plan amendments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Effective dates of State plans and plan amendments... State Plans § 430.20 Effective dates of State plans and plan amendments. For purposes of FFP, the... first day of the quarter in which an approvable plan is submitted to the regional office; and (2) With...

42 CFR 430.20 - Effective dates of State plans and plan amendments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Effective dates of State plans and plan amendments... State Plans § 430.20 Effective dates of State plans and plan amendments. For purposes of FFP, the... first day of the quarter in which an approvable plan is submitted to the regional office; and (2) With...

42 CFR 430.20 - Effective dates of State plans and plan amendments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Effective dates of State plans and plan amendments... State Plans § 430.20 Effective dates of State plans and plan amendments. For purposes of FFP, the... first day of the quarter in which an approvable plan is submitted to the regional office; and (2) With...

The Best Laid Plans: An Examination of School Plan Quality and Implementation in a School Improvement Initiative

ERIC Educational Resources Information Center

Strunk, Katharine O.; Marsh, Julie A.; Bush-Mecenas, Susan C.; Duque, Matthew R.

2016-01-01

Purpose: A common strategy used in school improvement efforts is a mandated process of formal planning, yet little is known about the quality of plans or the relationship between plan quality and implementation. This mixed-methods article investigates plan quality, factors associated with plan quality, and the relationship between plan quality and…

Planning to Serve: Using Backwards Planning to Design Service-Learning Lesson Plans in the Preservice Curriculum

ERIC Educational Resources Information Center

Stiler, Gary

2009-01-01

The author describes how the Understanding by Design (backwards planning) lesson plan format was used by his preservice K-12 students to develop service-learning lesson plans. Preservice teachers in a multicultural education course were given an assignment to develop service-learning lesson plans using the Understanding by Design planning process.…

Iowa in motion : transit system plan : implementing Iowa's state transportation plan

DOT National Transportation Integrated Search

1999-09-14

The Iowa Transit System Plan was developed as a result of the on-going long-range transportation planning process known as Iowa In Motion This planning document, the 1999 Iowa Transit System Plan, is the result of this continuing planning process and...

Planning Resource Guide.

ERIC Educational Resources Information Center

RP Group of California Community Colleges, Santa Ana.

The Planning Resource Guide by the RP Group of California Community Colleges was created to provide practical planning assistance. It contains four sections, including: (1) a basic conceptual framework for planning; (2) common planning definitions for colleges; (3) planning steps and samples of planning structures; and (4) suggestions for linking…

Medicare Part D Beneficiaries' Plan Switching Decisions and Information Processing.

PubMed

Han, Jayoung; Urmie, Julie

2017-03-01

Medicare Part D beneficiaries tend not to switch plans despite the government's efforts to engage beneficiaries in the plan switching process. Understanding current and alternative plan features is a necessary step to make informed plan switching decisions. This study explored beneficiaries' plan switching using a mixed-methods approach, with a focus on the concept of information processing. We found large variation in beneficiary comprehension of plan information among both switchers and nonswitchers. Knowledge about alternative plans was especially poor, with only about half of switchers and 2 in 10 nonswitchers being well informed about plans other than their current plan. We also found that helpers had a prominent role in plan decision making-nearly twice as many switchers as nonswitchers worked with helpers for their plan selection. Our study suggests that easier access to helpers as well as helpers' extensive involvement in the decision-making process promote informed plan switching decisions.

Planning in the Continuous Operations Environment of the International Space Station

NASA Technical Reports Server (NTRS)

Maxwell, Theresa; Hagopian, Jeff

1996-01-01

The continuous operation planning approach developed for the operations planning of the International Space Station (ISS) is reported on. The approach was designed to be a robust and cost-effective method. It separates ISS planning into two planning functions: long-range planning for a fixed length planning horizon which continually moves forward as ISS operations progress, and short-range planning which takes a small segment of the long-range plan and develops a detailed operations schedule. The continuous approach is compared with the incremental approach, the short and long-range planning functions are described, and the benefits and challenges of implementing a continuous operations planning approach for the ISS are summarized.

Automating Space Station operations planning

NASA Technical Reports Server (NTRS)

Ziemer, Kathleen A.

1989-01-01

The development and implementation of the operations planning processes for the Space Station are discussed. A three level planning process, consisting of strategic, tactical, and execution level planning, is being developed. The integration of the planning procedures into a tactical planning system is examined and the planning phases are illustrated.

14 CFR 77.2 - Definition of terms.

Code of Federal Regulations, 2011 CFR

2011-01-01

... approach system is planned and is so indicated by an FAA approved airport layout plan; a military service approved military airport layout plan; any other FAA planning document, or military service military... layout plan, a military service approved military airport layout plan, or by any planning document...

Yavapai College Integrated Master Plan.

ERIC Educational Resources Information Center

Yavapai Coll., Prescott, AZ.

This integrated master plan for Yavapai College (Arizona) includes the following six key components: (1) district services overview; (2) educational services plan; (3) human resources plan; (4) information technology services; (5) facilities plan; and (6) financial plan. The master plan was developed as a result of discussions and meetings with…

A Retrospective on Educational Planning in Comparative Education.

ERIC Educational Resources Information Center

Farrell, Joseph P.

1997-01-01

Defines and broadly traces the history of educational planning in both developing and industrialized capitalist nations. Discusses general approaches to educational planning (technical versus political planning, top-down versus bottom-up planning, and various theoretical bases); the contingency view of planning; case examples of planned,…

Do more specific plans help you lose weight? Examining the relationship between plan specificity, weight loss goals, and plan content in the context of a weight management programme.

PubMed

Dombrowski, Stephan U; Endevelt, Ronit; Steinberg, David M; Benyamini, Yael

2016-11-01

The conditions under which planning for behaviour change is most effective are not fully understood. In the context of a weight management programme, we examined the interrelationship between plan specificity, type of behaviour planned (diet vs. exercise), and weight loss goals. Prospective design and content analysis of plans formed by participants of a 10-week weight management programme. Participants (n = 239) formulated two plans, for dietary and exercise behaviours, respectively. Plans were rated for specificity by examining the number of plan components. Weight loss goals were assessed by asking how much weight participants intend to lose. Weight was measured objectively each of the 10 weeks. Changes in body mass index (BMI) over time and the interactions between plan specificity and weight loss goals, for all plans and separately for diet and exercise, were estimated using linear mixed models. Plan specificity was unrelated to weight loss, but interacted with weight loss goals in predicting linear change in BMI (t = -2.48): More specific plans were associated with higher decreases in weight in participants with high weight loss goals. Separate interaction tests for plans formulated for diet and exercise change showed that more specific dietary plans, but not exercise plans, were associated with higher decreases in weight in participants with high weight loss goals (t = -2.21). Within a population that is highly motivated to lose weight, the combination of high weight loss goals and formulating detailed plans for changing dietary behaviours may be most effective in supporting weight loss. Statement of contribution What is already known on this subject? More specific plans are associated with increased performance of health-related behaviours. More motivated individuals form more specific plans. The interrelationship between plan specificity, plan content and behaviour-related goals in relation intervention effectiveness has not been explored to date. What does this study add? The effectiveness of forming specific plans may depend on the strength of behaviour-related goals as well as the behaviour selected for change. More detailed plans, in particular dietary plans, were related to greater weight loss, but only for participants with higher initial weight loss goals. Detailed exercise plans were not associated with weight loss, regardless of initial weight loss goals. © 2016 The British Psychological Society.

40 CFR 62.7325 - Identification of plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS New Hampshire Plan for... Identification of plan. (a) Identification of plan. New Hampshire Plan for the Control of Designated Pollutants...

40 CFR 62.7325 - Identification of plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS New Hampshire Plan for... Identification of plan. (a) Identification of plan. New Hampshire Plan for the Control of Designated Pollutants...

40 CFR 62.7325 - Identification of plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS New Hampshire Plan for... Identification of plan. (a) Identification of plan. New Hampshire Plan for the Control of Designated Pollutants...

40 CFR 62.7325 - Identification of plan.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS New Hampshire Plan for... Identification of plan. (a) Identification of plan. New Hampshire Plan for the Control of Designated Pollutants...

40 CFR 62.7325 - Identification of plan.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS New Hampshire Plan for... Identification of plan. (a) Identification of plan. New Hampshire Plan for the Control of Designated Pollutants...

45 CFR 309.35 - What are the procedures for review of a Tribal IV-D program application, plan or plan amendment?

Code of Federal Regulations, 2014 CFR

2014-10-01

...) The effective date of a plan or plan amendment may not be earlier than the first day of the fiscal... program application, plan or plan amendment? 309.35 Section 309.35 Public Welfare Regulations Relating to... of a Tribal IV-D program application, plan or plan amendment? (a) The Secretary will promptly review...

SU-F-T-421: Dosimetry Change During Radiotherapy and Dosimetry Difference for Rigid and Deformed Registration in the Mid-Thoracic Esophageal Carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tao, C; Liu, T; Chen, J

Purpose: This study aimed to analyze dosimetry changes during radiotherapy for the mid-thoracic esophageal carcinoma, and investigate dosimetry difference between rigid and deformed registration. Methods: Twelve patients with primary middle thoracic esophageal carcinoma were selected randomly. Based on first CT scanning of each patient, plans-o were generated by experience physicists. After 20 fractions treatment, the corresponding plans-re were created with second CT scanning. And then, these two CT images were rigid and deformed registration respectively, and the dose was accumulated plan-o with plan-re. The dosimetry variation of these plans (plan-o: with 30 fractions, plan-rig: the accumulated dose with rigid registrationmore » and plan-def: the accumulated dose with deformed registration) were evaluated by paired T-test. Results: The V20 value of total lung were 32.68%, 30.3% and 29.71% for plan-o, plan-rig and plan-def respectively. The mean dose of total lung was 17.19 Gy, 16.67 Gy and 16.51 Gy for plan-o plan-rig and plan-def respectively. There were significant differences between plan-o and plan-rig or plan-def for both V20 and mean dose of total lung (with p= 0.003, p= 0.000 for V20 and p=0.008, p= 0.000 for mean dose respectively). There was no significant difference between plan-rig and plan-def (with p=0.118 for V20 and p=0.384 for mean dose). The max dose of spinal-cord was 41.95 Gy, 41.48 Gy and 41.4 Gy for plan-o, plan-rig and plan-def respectively. There were no significant differences for the max dose of spinal-cord between these plans. Conclusion: The target volume changes and anatomic position displacement of mid-thoracic esophageal carcinoma should not be neglected in clinics. These changes would cause overdose in normal tissue. Therefore, it is necessary to have another CT scanning and re-plan during the mid-thoracic esophageal carcinoma radiotherapy. And the dosimetry difference between rigid and deformed fusions was not found in this study.« less

Is it possible for knowledge-based planning to improve intensity modulated radiation therapy plan quality for planners with different planning experiences in left-sided breast cancer patients?

PubMed

Wang, Juanqi; Hu, Weigang; Yang, Zhaozhi; Chen, Xiaohui; Wu, Zhiqiang; Yu, Xiaoli; Guo, Xiaomao; Lu, Saiquan; Li, Kaixuan; Yu, Gongyi

2017-05-22

Knowledge-based planning (KBP) is a promising technique that can improve plan quality and increase planning efficiency. However, no attempts have been made to extend the domain of KBP for planners with different planning experiences so far. The purpose of this study was to quantify the potential gains for planners with different planning experiences after implementing KBP in intensity modulated radiation therapy (IMRT) plans for left-sided breast cancer patients. The model libraries were populated with 80 expert clinical plans from treated patients who previously received left-sided breast-conserving surgery and IMRT with simultaneously integrated boost. The libraries were created on the RapidPlan TM . 6 planners with different planning experiences (2 beginner planners, 2 junior planners and 2 senior planners) generated manual and KBP optimized plans for additional 10 patients, similar to those included in the model libraries. The plan qualities were compared between manual and KBP plans. All plans were capable of achieving the prescription requirement. There were almost no statistically significant differences in terms of the planning target volume (PTV) coverage and dose conformality. It was demonstrated that the doses for most of organs-at-risk (OARs) were on average lower or equal in KBP plans compared to manual plans except for the senior planners, where the very small differences were not statistically significant. KBP data showed a systematic trend to have superior dose sparing at most parameters for the heart and ipsilateral lung. The observed decrease in the doses to these OARs could be achieved, particularly for the beginner and junior planners. Many differences were statistically significant. It is feasible to generate acceptable IMRT plans after implementing KBP for left-sided breast cancer. KBP helps to effectively improve the quality of IMRT plans against the benchmark of manual plans for less experienced planners without any manual intervention. KBP showed promise for homogenizing the plan quality by transferring planning expertise from more experienced to less experienced planners.

Evaluation of a Machine-Learning Algorithm for Treatment Planning in Prostate Low-Dose-Rate Brachytherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nicolae, Alexandru; Department of Medical Physics, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario; Morton, Gerard

Purpose: This work presents the application of a machine learning (ML) algorithm to automatically generate high-quality, prostate low-dose-rate (LDR) brachytherapy treatment plans. The ML algorithm can mimic characteristics of preoperative treatment plans deemed clinically acceptable by brachytherapists. The planning efficiency, dosimetry, and quality (as assessed by experts) of preoperative plans generated with an ML planning approach was retrospectively evaluated in this study. Methods and Materials: Preimplantation and postimplantation treatment plans were extracted from 100 high-quality LDR treatments and stored within a training database. The ML training algorithm matches similar features from a new LDR case to those within the trainingmore » database to rapidly obtain an initial seed distribution; plans were then further fine-tuned using stochastic optimization. Preimplantation treatment plans generated by the ML algorithm were compared with brachytherapist (BT) treatment plans in terms of planning time (Wilcoxon rank sum, α = 0.05) and dosimetry (1-way analysis of variance, α = 0.05). Qualitative preimplantation plan quality was evaluated by expert LDR radiation oncologists using a Likert scale questionnaire. Results: The average planning time for the ML approach was 0.84 ± 0.57 minutes, compared with 17.88 ± 8.76 minutes for the expert planner (P=.020). Preimplantation plans were dosimetrically equivalent to the BT plans; the average prostate V150% was 4% lower for ML plans (P=.002), although the difference was not clinically significant. Respondents ranked the ML-generated plans as equivalent to expert BT treatment plans in terms of target coverage, normal tissue avoidance, implant confidence, and the need for plan modifications. Respondents had difficulty differentiating between plans generated by a human or those generated by the ML algorithm. Conclusions: Prostate LDR preimplantation treatment plans that have equivalent quality to plans created by brachytherapists can be rapidly generated using ML. The adoption of ML in the brachytherapy workflow is expected to improve LDR treatment plan uniformity while reducing planning time and resources.« less

Clinical implementation of a knowledge based planning tool for prostate VMAT.

PubMed

Powis, Richard; Bird, Andrew; Brennan, Matthew; Hinks, Susan; Newman, Hannah; Reed, Katie; Sage, John; Webster, Gareth

2017-05-08

A knowledge based planning tool has been developed and implemented for prostate VMAT radiotherapy plans providing a target average rectum dose value based on previously achievable values for similar rectum/PTV overlap. The purpose of this planning tool is to highlight sub-optimal clinical plans and to improve plan quality and consistency. A historical cohort of 97 VMAT prostate plans was interrogated using a RayStation script and used to develop a local model for predicting optimum average rectum dose based on individual anatomy. A preliminary validation study was performed whereby historical plans identified as "optimal" and "sub-optimal" by the local model were replanned in a blinded study by four experienced planners and compared to the original clinical plan to assess whether any improvement in rectum dose was observed. The predictive model was then incorporated into a RayStation script and used as part of the clinical planning process. Planners were asked to use the script during planning to provide a patient specific prediction for optimum average rectum dose and to optimise the plan accordingly. Plans identified as "sub-optimal" in the validation study observed a statistically significant improvement in average rectum dose compared to the clinical plan when replanned whereas plans that were identified as "optimal" observed no improvement when replanned. This provided confidence that the local model can identify plans that were suboptimal in terms of rectal sparing. Clinical implementation of the knowledge based planning tool reduced the population-averaged mean rectum dose by 5.6Gy. There was a small but statistically significant increase in total MU and femoral head dose and a reduction in conformity index. These did not affect the clinical acceptability of the plans and no significant changes to other plan quality metrics were observed. The knowledge-based planning tool has enabled substantial reductions in population-averaged mean rectum dose for prostate VMAT patients. This suggests plans are improved when planners receive quantitative feedback on plan quality against historical data.

SU-E-T-97: An Analysis of Knowledge Based Planning for Stereotactic Body Radiation Therapy of the Spine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Foy, J; Marsh, R; Owen, D

2015-06-15

Purpose: Creating high quality SBRT treatment plans for the spine is often tedious and time consuming. In addition, the quality of treatment plans can vary greatly between treatment facilities due to inconsistencies in planning methods. This study investigates the performance of knowledge-based planning (KBP) for spine SBRT. Methods: Treatment plans were created for 28 spine SBRT patients. Each case was planned to meet strict dose objectives and guidelines. After physician and physicist approval, the plans were added to a custom model in a KBP system (RapidPlan, Varian Eclipse v13.5). The model was then trained to be able to predict estimatedmore » DVHs and provide starting objective functions for future patients based on both generated and manual objectives. To validate the model, ten additional spine SBRT cases were planned manually as well as using the model objectives. Plans were compared based on planning time and quality (ability to meet the plan objectives, including dose metrics and conformity). Results: The average dose to the spinal cord and the cord PRV differed between the validation and control plans by <0.25% demonstrating iso-toxicity. Six out of 10 validation plans met all dose objectives without the need for modifications, and overall, target dose coverage was increased by about 4.8%. If the validation plans did not meet the dose requirements initially, only 1–2 iterations of modifying the planning parameters were required before an acceptable plan was achieved. While manually created plans usually required 30 minutes to 3 hours to create, KBP can be used to create similar quality plans in 15–20 minutes. Conclusion: KBP for spinal tumors has shown to greatly decrease the amount of time required to achieve high quality treatment plans with minimal human intervention and could feasibly be used to standardize plan quality between institutions. Supported by Varian Medical Systems.« less

SU-G-201-09: Evaluation of a Novel Machine-Learning Algorithm for Permanent Prostate Brachytherapy Treatment Planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nicolae, A; Department of Physics, Ryerson University, Toronto, ON; Lu, L

Purpose: A novel, automated, algorithm for permanent prostate brachytherapy (PPB) treatment planning has been developed. The novel approach uses machine-learning (ML), a form of artificial intelligence, to substantially decrease planning time while simultaneously retaining the clinical intuition of plans created by radiation oncologists. This study seeks to compare the ML algorithm against expert-planned PPB plans to evaluate the equivalency of dosimetric and clinical plan quality. Methods: Plan features were computed from historical high-quality PPB treatments (N = 100) and stored in a relational database (RDB). The ML algorithm matched new PPB features to a highly similar case in the RDB;more » this initial plan configuration was then further optimized using a stochastic search algorithm. PPB pre-plans (N = 30) generated using the ML algorithm were compared to plan variants created by an expert dosimetrist (RT), and radiation oncologist (MD). Planning time and pre-plan dosimetry were evaluated using a one-way Student’s t-test and ANOVA, respectively (significance level = 0.05). Clinical implant quality was evaluated by expert PPB radiation oncologists as part of a qualitative study. Results: Average planning time was 0.44 ± 0.42 min compared to 17.88 ± 8.76 min for the ML algorithm and RT, respectively, a significant advantage [t(9), p = 0.01]. A post-hoc ANOVA [F(2,87) = 6.59, p = 0.002] using Tukey-Kramer criteria showed a significantly lower mean prostate V150% for the ML plans (52.9%) compared to the RT (57.3%), and MD (56.2%) plans. Preliminary qualitative study results indicate comparable clinical implant quality between RT and ML plans with a trend towards preference for ML plans. Conclusion: PPB pre-treatment plans highly comparable to those of an expert radiation oncologist can be created using a novel ML planning model. The use of an ML-based planning approach is expected to translate into improved PPB accessibility and plan uniformity.« less

PLANNERS AND PLANNING, A REPORT FROM THE COMMUNITY COLLEGE PLANNING CENTER ON COMMUNITY COLLEGE FACILITIES.

ERIC Educational Resources Information Center

MAYHEW, LEWIS B.

GROWTH OF STUDENT POPULATIONS AND THE KNOWLEDGE EXPANSION NECESSITATE CAREFUL PLANNING IN THE COMMUNITY COLLEGE. PLANT PLANNING DEPENDS ON INSTRUCTIONAL PROGRAM PLANNING, STAFF EMPLOYMENT AND ORGANIZATION, STUDENT PLANNING, FUNDING AND COMMUNITY RELATIONSHIPS. PLANNING SHOULD INVOLVE THE ADMINISTRATIVE STAFF, LIBRARIAN, FACULTY, OTHER STAFF,…

40 CFR 62.1100 - Identification of plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS California Plan for the... of plan. (a) State of California Designated Facility Plan (Section 111(d) Plan). (b) The plan was... Pollution Control District Regulation 1; Rule 130—Definitions, Rule 240—Permit to Operate, Rule 450—Sulfide...

40 CFR 62.1100 - Identification of plan.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS California Plan for the... of plan. (a) State of California Designated Facility Plan (Section 111(d) Plan). (b) The plan was... Pollution Control District Regulation 1; Rule 130—Definitions, Rule 240—Permit to Operate, Rule 450—Sulfide...

40 CFR 62.1100 - Identification of plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS California Plan for the... of plan. (a) State of California Designated Facility Plan (Section 111(d) Plan). (b) The plan was... Pollution Control District Regulation 1; Rule 130—Definitions, Rule 240—Permit to Operate, Rule 450—Sulfide...

40 CFR 62.1100 - Identification of plan.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS California Plan for the... of plan. (a) State of California Designated Facility Plan (Section 111(d) Plan). (b) The plan was... Pollution Control District Regulation 1; Rule 130—Definitions, Rule 240—Permit to Operate, Rule 450—Sulfide...

40 CFR 62.1100 - Identification of plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS California Plan for the... of plan. (a) State of California Designated Facility Plan (Section 111(d) Plan). (b) The plan was... Pollution Control District Regulation 1; Rule 130—Definitions, Rule 240—Permit to Operate, Rule 450—Sulfide...

76 FR 58020 - Prescription Drug User Fee Act IV Information Technology Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-19

...] Prescription Drug User Fee Act IV Information Technology Plan AGENCY: Food and Drug Administration, HHS. ACTION... information technology (IT) plan entitled ``PDUFA IV Information Technology Plan'' (updated plan) to achieve... Information Technology Plan.'' This plan will meet one of the performance goals agreed to under the 2007...

46 CFR 127.110 - Plans and specifications required for new construction.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) General Arrangement Plans. (3) Safety Plan (Fire-Control Plan), for OCMI review and approval. (b) Hull... 46 Shipping 4 2014-10-01 2014-10-01 false Plans and specifications required for new construction... SUPPLY VESSELS CONSTRUCTION AND ARRANGEMENTS Plan Approval § 127.110 Plans and specifications required...

46 CFR 127.110 - Plans and specifications required for new construction.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) General Arrangement Plans. (3) Safety Plan (Fire-Control Plan), for OCMI review and approval. (b) Hull... 46 Shipping 4 2012-10-01 2012-10-01 false Plans and specifications required for new construction... SUPPLY VESSELS CONSTRUCTION AND ARRANGEMENTS Plan Approval § 127.110 Plans and specifications required...

46 CFR 127.110 - Plans and specifications required for new construction.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) General Arrangement Plans. (3) Safety Plan (Fire-Control Plan), for OCMI review and approval. (b) Hull... 46 Shipping 4 2013-10-01 2013-10-01 false Plans and specifications required for new construction... SUPPLY VESSELS CONSTRUCTION AND ARRANGEMENTS Plan Approval § 127.110 Plans and specifications required...

7 CFR 622.31 - Basic planning efforts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Basic planning efforts. 622.31 Section 622.31..., DEPARTMENT OF AGRICULTURE WATER RESOURCES WATERSHED PROJECTS Planning § 622.31 Basic planning efforts. Upon... the need for planning effort. Once planning is authorized by the Chief of NRCS, a watershed plan...

A new plan quality index for nasopharyngeal cancer SIB IMRT.

PubMed

Jin, X; Yi, J; Zhou, Y; Yan, H; Han, C; Xie, C

2014-02-01

A new plan quality index integrating dosimetric and radiobiological indices was proposed to facilitate the evaluation and comparison of simultaneous integrated boost (SIB) intensity modulated radiotherapy (IMRT) plans for nasopharyngeal cancer (NPC) patients. Ten NPC patients treated by SIB-IMRT were enrolled in the study. Custom software was developed to read dose-volume histogram (DVH) curves from the treatment planning system (TPS). A plan filtering matrix was introduced to filter plans that fail to satisfy treatment protocol. Target plan quality indices and organ at risk (OAR) plan quality indices were calculated for qualified plans. A unique composite plan quality index (CPQI) was proposed based on the relative weight of these indices to evaluate and compare competing plans. Plan ranking results were compared with detailed statistical analysis, radiation oncology quality system (ROQS) scoring results and physician's evaluation results to verify the accuracy of this new plan quality index. The average CPQI values for plans with OAR priority of low, normal, high, and PTV only were 0.22 ± 0.08, 0.49 ± 0.077, 0.71 ± 0.062, and -0.21 ± 0.16, respectively. There were significant differences among these plan quality indices (One-way ANOVA test, p < 0.01). This was consistent with statistical analysis, ROQS results and physician's ranking results in which 90% OAR high plans were selected. Plan filtering matrix was able to speed up the plan evaluation process. The new matrix plan quality index CPQI showed good consistence with physician ranking results. It is a promising index for NPC SIB-IMRT plan evaluation. Copyright © 2013 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Automation of radiation treatment planning : Evaluation of head and neck cancer patient plans created by the Pinnacle3 scripting and Auto-Planning functions.

PubMed

Speer, Stefan; Klein, Andreas; Kober, Lukas; Weiss, Alexander; Yohannes, Indra; Bert, Christoph

2017-08-01

Intensity-modulated radiotherapy (IMRT) techniques are now standard practice. IMRT or volumetric-modulated arc therapy (VMAT) allow treatment of the tumor while simultaneously sparing organs at risk. Nevertheless, treatment plan quality still depends on the physicist's individual skills, experiences, and personal preferences. It would therefore be advantageous to automate the planning process. This possibility is offered by the Pinnacle 3 treatment planning system (Philips Healthcare, Hamburg, Germany) via its scripting language or Auto-Planning (AP) module. AP module results were compared to in-house scripts and manually optimized treatment plans for standard head and neck cancer plans. Multiple treatment parameters were scored to judge plan quality (100 points = optimum plan). Patients were initially planned manually by different physicists and re-planned using scripts or AP. Script-based head and neck plans achieved a mean of 67.0 points and were, on average, superior to manually created (59.1 points) and AP plans (62.3 points). Moreover, they are characterized by reproducibility and lower standard deviation of treatment parameters. Even less experienced staff are able to create at least a good starting point for further optimization in a short time. However, for particular plans, experienced planners perform even better than scripts or AP. Experienced-user input is needed when setting up scripts or AP templates for the first time. Moreover, some minor drawbacks exist, such as the increase of monitor units (+35.5% for scripted plans). On average, automatically created plans are superior to manually created treatment plans. For particular plans, experienced physicists were able to perform better than scripts or AP; thus, the benefit is greatest when time is short or staff inexperienced.

Automatic treatment planning facilitates fast generation of high-quality treatment plans for esophageal cancer.

PubMed

Hansen, Christian Rønn; Nielsen, Morten; Bertelsen, Anders Smedegaard; Hazell, Irene; Holtved, Eva; Zukauskaite, Ruta; Bjerregaard, Jon Kroll; Brink, Carsten; Bernchou, Uffe

2017-11-01

The quality of radiotherapy planning has improved substantially in the last decade with the introduction of intensity modulated radiotherapy. The purpose of this study was to analyze the plan quality and efficacy of automatically (AU) generated VMAT plans for inoperable esophageal cancer patients. Thirty-two consecutive inoperable patients with esophageal cancer originally treated with manually (MA) generated volumetric modulated arc therapy (VMAT) plans were retrospectively replanned using an auto-planning engine. All plans were optimized with one full 6MV VMAT arc giving 60 Gy to the primary target and 50 Gy to the elective target. The planning techniques were blinded before clinical evaluation by three specialized oncologists. To supplement the clinical evaluation, the optimization time for the AU plan was recorded along with DVH parameters for all plans. Upon clinical evaluation, the AU plan was preferred for 31/32 patients, and for one patient, there was no difference in the plans. In terms of DVH parameters, similar target coverage was obtained between the two planning methods. The mean dose for the spinal cord increased by 1.8 Gy using AU (p = .002), whereas the mean lung dose decreased by 1.9 Gy (p < .001). The AU plans were more modulated as seen by the increase of 12% in mean MUs (p = .001). The median optimization time for AU plans was 117 min. The AU plans were in general preferred and showed a lower mean dose to the lungs. The automation of the planning process generated esophageal cancer treatment plans quickly and with high quality.

Coordination of Individual and Organizational Planning for Natural Hazards (Invited)

NASA Astrophysics Data System (ADS)

Krantz, D. H.

2013-12-01

Decision making consists of constructing or selecting a plan. This is true at many levels of decision making: individuals or households, small groups, larger organizations, and governments. In each case, plans are constructed or selected taking account of the decision maker's prioritized set of active goals and the decision maker's beliefs about the probability or the extent to which each goal will be attained through a given plan. Planning for mitigation of or response to natural hazards can be improved if the plans of the many decision makers at multiple levels are coordinated. Government planning should ideally be informed by knowledge about the plans of businesses and non-profit organizations as well as knowledge about individual, household, and neighborhood plans. Similarly, plans at the individual and organizational levels should be informed by knowledge of others' plans at the same and at higher and lower levels of aggregation. Coordination can be impaired by differences in goals, differences in beliefs about the instrumentality of plans toward given goals, and also by ignorance of others' goals and plans. Good coordination requires incentives that promote sharing of plans, horizontally and vertically, and that alleviate conflicts in goals and conflicts in beliefs that will inevitably surface once plans are shared. Thus, four different kinds of decision aids are needed to improve natural hazard planning: mechanisms that support horizontal dissemination of plans, mechanisms that support vertical dissemination, mechanisms for examining goal conflicts and reducing these through plans that take others' goals into account, and mechanisms for examining belief conflicts.

Noncoplanar VMAT for nasopharyngeal tumors: Plan quality versus treatment time

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wild, Esther, E-mail: e.wild@dkfz.de; Bangert, Mark; Nill, Simeon

Purpose: The authors investigated the potential of optimized noncoplanar irradiation trajectories for volumetric modulated arc therapy (VMAT) treatments of nasopharyngeal patients and studied the trade-off between treatment plan quality and delivery time in radiation therapy. Methods: For three nasopharyngeal patients, the authors generated treatment plans for nine different delivery scenarios using dedicated optimization methods. They compared these scenarios according to dose characteristics, number of beam directions, and estimated delivery times. In particular, the authors generated the following treatment plans: (1) a 4π plan, which is a not sequenced, fluence optimized plan that uses beam directions from approximately 1400 noncoplanar directionsmore » and marks a theoretical upper limit of the treatment plan quality, (2) a coplanar 2π plan with 72 coplanar beam directions as pendant to the noncoplanar 4π plan, (3) a coplanar VMAT plan, (4) a coplanar step and shoot (SnS) plan, (5) a beam angle optimized (BAO) coplanar SnS IMRT plan, (6) a noncoplanar BAO SnS plan, (7) a VMAT plan with rotated treatment couch, (8) a noncoplanar VMAT plan with an optimized great circle around the patient, and (9) a noncoplanar BAO VMAT plan with an arbitrary trajectory around the patient. Results: VMAT using optimized noncoplanar irradiation trajectories reduced the mean and maximum doses in organs at risk compared to coplanar VMAT plans by 19% on average while the target coverage remains constant. A coplanar BAO SnS plan was superior to coplanar SnS or VMAT; however, noncoplanar plans like a noncoplanar BAO SnS plan or noncoplanar VMAT yielded a better plan quality than the best coplanar 2π plan. The treatment plan quality of VMAT plans depended on the length of the trajectory. The delivery times of noncoplanar VMAT plans were estimated to be 6.5 min in average; 1.6 min longer than a coplanar plan but on average 2.8 min faster than a noncoplanar SnS plan with comparable treatment plan quality. Conclusions: The authors’ study reconfirms the dosimetric benefits of noncoplanar irradiation of nasopharyngeal tumors. Both SnS using optimized noncoplanar beam ensembles and VMAT using an optimized, arbitrary, noncoplanar trajectory enabled dose reductions in organs at risk compared to coplanar SnS and VMAT. Using great circles or simple couch rotations to implement noncoplanar VMAT, however, was not sufficient to yield meaningful improvements in treatment plan quality. The authors estimate that noncoplanar VMAT using arbitrary optimized irradiation trajectories comes at an increased delivery time compared to coplanar VMAT yet at a decreased delivery time compared to noncoplanar SnS IMRT.« less

Better sorry than safe: Making a Plan B reduces effectiveness of implementation intentions in healthy eating goals.

PubMed

Vinkers, Charlotte D W; Adriaanse, Marieke A; Kroese, Floor M; de Ridder, Denise T D

2015-01-01

Implementation intentions (if-then plans) are helpful to health behaviour change. As these plans specify only one goal-directed behaviour for one specific situation, however, their effectiveness may be limited when a planned behaviour is impossible to execute in situ. The present research examines whether and how planning more than one goal-directed response for the same situation ('making a Plan B') affects successful self-regulation of eating behaviour. In Study 1, participants formulated either one or two plans, after which a lexical decision task was administered to assess association strength between the if-part and the then-part(s). In Study 2, the effect of making one, two or no plan(s) was assessed on actual eating behaviour, after which a Stroop task measured cognitive load as an additional explanatory mechanism. Study 1 revealed that making a Plan B disrupts the creation of strong if-then associations during plan formation. Study 2 showed that making a Plan B yields increased unhealthy food intake compared to making one or no plan, and induces greater cognitive load during plan enactment. Making a Plan B interferes with essential cognitive processes during different stages of planning, leading to an increased likelihood of self-regulatory failure.

Development and clinical introduction of automated radiotherapy treatment planning for prostate cancer

NASA Astrophysics Data System (ADS)

Winkel, D.; Bol, G. H.; van Asselen, B.; Hes, J.; Scholten, V.; Kerkmeijer, L. G. W.; Raaymakers, B. W.

2016-12-01

To develop an automated radiotherapy treatment planning and optimization workflow to efficiently create patient specifically optimized clinical grade treatment plans for prostate cancer and to implement it in clinical practice. A two-phased planning and optimization workflow was developed to automatically generate 77Gy 5-field simultaneously integrated boost intensity modulated radiation therapy (SIB-IMRT) plans for prostate cancer treatment. A retrospective planning study (n  =  100) was performed in which automatically and manually generated treatment plans were compared. A clinical pilot (n  =  21) was performed to investigate the usability of our method. Operator time for the planning process was reduced to  <5 min. The retrospective planning study showed that 98 plans met all clinical constraints. Significant improvements were made in the volume receiving 72Gy (V72Gy) for the bladder and rectum and the mean dose of the bladder and the body. A reduced plan variance was observed. During the clinical pilot 20 automatically generated plans met all constraints and 17 plans were selected for treatment. The automated radiotherapy treatment planning and optimization workflow is capable of efficiently generating patient specifically optimized and improved clinical grade plans. It has now been adopted as the current standard workflow in our clinic to generate treatment plans for prostate cancer.

Radiation Planning Assistant - A Streamlined, Fully Automated Radiotherapy Treatment Planning System

PubMed Central

Court, Laurence E.; Kisling, Kelly; McCarroll, Rachel; Zhang, Lifei; Yang, Jinzhong; Simonds, Hannah; du Toit, Monique; Trauernicht, Chris; Burger, Hester; Parkes, Jeannette; Mejia, Mike; Bojador, Maureen; Balter, Peter; Branco, Daniela; Steinmann, Angela; Baltz, Garrett; Gay, Skylar; Anderson, Brian; Cardenas, Carlos; Jhingran, Anuja; Shaitelman, Simona; Bogler, Oliver; Schmeller, Kathleen; Followill, David; Howell, Rebecca; Nelson, Christopher; Peterson, Christine; Beadle, Beth

2018-01-01

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated arc therapy (VMAT) plans for patients with head/neck cancer and 4-field box plans for patients with cervical cancer. It is a combination of specially developed in-house software that uses an application programming interface to communicate with a commercial radiotherapy treatment planning system. It also interfaces with a commercial secondary dose verification software. The necessary inputs to the system are a Treatment Plan Order, approved by the radiation oncologist, and a simulation computed tomography (CT) image, approved by the radiographer. The RPA then generates a complete radiotherapy treatment plan. For the cervical cancer treatment plans, no additional user intervention is necessary until the plan is complete. For head/neck treatment plans, after the normal tissue and some of the target structures are automatically delineated on the CT image, the radiation oncologist must review the contours, making edits if necessary. They also delineate the gross tumor volume. The RPA then completes the treatment planning process, creating a VMAT plan. Finally, the completed plan must be reviewed by qualified clinical staff. PMID:29708544

Inverse-optimized 3D conformal planning: Minimizing complexity while achieving equivalence with beamlet IMRT in multiple clinical sites

PubMed Central

Fraass, Benedick A.; Steers, Jennifer M.; Matuszak, Martha M.; McShan, Daniel L.

2012-01-01

Purpose: Inverse planned intensity modulated radiation therapy (IMRT) has helped many centers implement highly conformal treatment planning with beamlet-based techniques. The many comparisons between IMRT and 3D conformal (3DCRT) plans, however, have been limited because most 3DCRT plans are forward-planned while IMRT plans utilize inverse planning, meaning both optimization and delivery techniques are different. This work avoids that problem by comparing 3D plans generated with a unique inverse planning method for 3DCRT called inverse-optimized 3D (IO-3D) conformal planning. Since IO-3D and the beamlet IMRT to which it is compared use the same optimization techniques, cost functions, and plan evaluation tools, direct comparisons between IMRT and simple, optimized IO-3D plans are possible. Though IO-3D has some similarity to direct aperture optimization (DAO), since it directly optimizes the apertures used, IO-3D is specifically designed for 3DCRT fields (i.e., 1–2 apertures per beam) rather than starting with IMRT-like modulation and then optimizing aperture shapes. The two algorithms are very different in design, implementation, and use. The goals of this work include using IO-3D to evaluate how close simple but optimized IO-3D plans come to nonconstrained beamlet IMRT, showing that optimization, rather than modulation, may be the most important aspect of IMRT (for some sites). Methods: The IO-3D dose calculation and optimization functionality is integrated in the in-house 3D planning/optimization system. New features include random point dose calculation distributions, costlet and cost function capabilities, fast dose volume histogram (DVH) and plan evaluation tools, optimization search strategies designed for IO-3D, and an improved, reimplemented edge/octree calculation algorithm. The IO-3D optimization, in distinction to DAO, is designed to optimize 3D conformal plans (one to two segments per beam) and optimizes MLC segment shapes and weights with various user-controllable search strategies which optimize plans without beamlet or pencil beam approximations. IO-3D allows comparisons of beamlet, multisegment, and conformal plans optimized using the same cost functions, dose points, and plan evaluation metrics, so quantitative comparisons are straightforward. Here, comparisons of IO-3D and beamlet IMRT techniques are presented for breast, brain, liver, and lung plans. Results: IO-3D achieves high quality results comparable to beamlet IMRT, for many situations. Though the IO-3D plans have many fewer degrees of freedom for the optimization, this work finds that IO-3D plans with only one to two segments per beam are dosimetrically equivalent (or nearly so) to the beamlet IMRT plans, for several sites. IO-3D also reduces plan complexity significantly. Here, monitor units per fraction (MU/Fx) for IO-3D plans were 22%–68% less than that for the 1 cm × 1 cm beamlet IMRT plans and 72%–84% than the 0.5 cm × 0.5 cm beamlet IMRT plans. Conclusions: The unique IO-3D algorithm illustrates that inverse planning can achieve high quality 3D conformal plans equivalent (or nearly so) to unconstrained beamlet IMRT plans, for many sites. IO-3D thus provides the potential to optimize flat or few-segment 3DCRT plans, creating less complex optimized plans which are efficient and simple to deliver. The less complex IO-3D plans have operational advantages for scenarios including adaptive replanning, cases with interfraction and intrafraction motion, and pediatric patients. PMID:22755717

Trestle Reflected Framing Plan, Trestle Deck Plan, Trestle Framing Plan ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Trestle Reflected Framing Plan, Trestle Deck Plan, Trestle Framing Plan - Denver & Rio Grande Railroad, San Juan Extension, Wolf Creek Trestle, Crossing Wolf Creek at Milepost 339.78, Chama, Rio Arriba County, NM

Planning in Higher Education: A Model from Chaos Theory.

ERIC Educational Resources Information Center

Cutright, Marc

This paper proposes a metaphoric perspective based on chaos theory for strategic planning by institutions of higher education. It offers 10 propositions for planning: (1) the ideal outcome of planning is planning, not a plan; (2) planning begins with a distillation of the institution's key values and purposes; (3) the widest possible universe of…

42 CFR 423.4 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the term in § 422.2 of this chapter. MA-PD plan means an MA plan that provides qualified prescription... prescription drug plan, an MA-PD plan, a PACE Plan offering qualified prescription drug coverage, or a cost... PDP sponsor, MA organization offering a MA-PD plan, a PACE organization offering a PACE plan including...

24 CFR 203.205 - Plan coverage.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Plan coverage. 203.205 Section 203... Protection Plans (plan) § 203.205 Plan coverage. (a) Plan coverage must take effect at closing or settlement following the initial sale of the property to the homeowner. (b) During the first year of coverage, a Plan...

24 CFR 984.201 - Action Plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Action Plan. 984.201 Section 984... § 984.201 Action Plan. (a) Requirement for Action Plan. A PHA must have a HUD-approved Action Plan that... program is a mandatory or voluntary program. (b) Development of Action Plan. The Action Plan shall be...

24 CFR 984.201 - Action Plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Action Plan. 984.201 Section 984... § 984.201 Action Plan. (a) Requirement for Action Plan. A PHA must have a HUD-approved Action Plan that... program is a mandatory or voluntary program. (b) Development of Action Plan. The Action Plan shall be...

Special event planning for the emergency manager.

PubMed

Gaynor, Peter T

2009-11-01

In the domain of emergency management and homeland security there is a lack of a formal planning process at the local level when it comes to special event planning. The unique nature of special event planning demands an understanding of the planning process for both traditional and non-traditional planning partners. This understanding will make certain that local governments apply due diligence when planning for the safety of the public. This paper offers a practical roadmap for planning at the local level. It will address those 'special events' that are beyond routine local events but not of a sufficient scale to be granted National Special Security Event status. Due to the infrequency of 'special events' in most communities, it is imperative that deliberate planning takes place. Upon conclusion, the reader will be able to construct a planning process tailored to the needs of their community, guide both traditional and non-traditional planning partners through the planning process, determine priorities, explore alternatives, plan for contingencies, conduct a confirmation brief, facilitate operations and assemble an after-action report and improvement plan.

Knowledge-based treatment planning and its potential role in the transition between treatment planning systems.

PubMed

Masi, Kathryn; Archer, Paul; Jackson, William; Sun, Yilun; Schipper, Matthew; Hamstra, Daniel; Matuszak, Martha

2017-11-22

Commissioning a new treatment planning system (TPS) involves many time-consuming tasks. We investigated the role that knowledge-based planning (KBP) can play in aiding a clinic's transition to a new TPS. Sixty clinically treated prostate/prostate bed intensity-modulated radiation therapy (IMRT) plans were exported from an in-house TPS and were used to create a KBP model in a newly implemented commercial application. To determine the benefit that KBP may have in a TPS transition, the model was tested on 2 groups of patients. Group 1 consisted of the first 10 prostate/prostate bed patients treated in the commercial TPS after the transition from the in-house TPS. Group 2 consisted of 10 patients planned in the commercial TPS after 8 months of clinical use. The KBP-generated plan was compared with the clinically used plan in terms of plan quality (ability to meet planning objectives and overall dose metrics) and planning efficiency (time required to generate clinically acceptable plans). The KBP-generated plans provided a significantly improved target coverage (p = 0.01) compared with the clinically used plans for Group 1, but yielded plans of comparable target coverage to the clinically used plans for Group 2. For the organs at risk, the KBP-generated plans produced lower doses, on average, for every normal-tissue objective except for the maximum dose to 0.1 cc of rectum. The time needed for the KBP-generated plans ranged from 6 to 15 minutes compared to 30 to 150 and 15 to 60 minutes for manual planning in Groups 1 and 2, respectively. KBP is a promising tool to aid in the transition to a new TPS. Our study indicates that high-quality treatment plans could have been generated in the newly implemented TPS more efficiently compared with not using KBP. Even after 8 months of the clinical use, KBP still showed an increase in plan quality and planning efficiency compared with manual planning. Copyright © 2017 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

SU-F-T-435: Helical Tomotherapy for Craniospinal Irradiation: What We Have Learned from a Multi-Institutional Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Du, D; Kaprealian, T; Low, D

Purpose: To report cranio-spinal irradiation (CSI) planning experience, compare dosimetric quality and delivery efficiency with Tomotherapy from different institutions, and to investigate effect of planning parameters on plan quality and treatment time. Methods: Clinical helical tomotherapy IMRT plans for thirty-nine CSI cases from three academic institutions were retrospectively evaluated. The planning parameters: field width (FW), pitch, modulation factor (MF), and achieved dosimetric endpoints were cross-compared. A fraction-dose-delivery-timing index (FDTI), defined as treatment time per fraction dose per PTV length, was utilized to evaluate plan delivery efficiency. A lower FDTI indicates higher delivery efficiency. We studied the correlation between planning quality,more » treatment time and planning parameters by grouping the plans under specific planning parameters. Additionally, we created new plans using 5cm jaw for a subset of plans that used 2.5cm jaw to exam if treatment efficiency can be improved without sacrificing plan quality. Results: There were significant dosimetric differences for organ at risks (OARs) among different institutions (A,B,C). Using the lowest average MF (1.9±0.4) and 5cm field width, C had the highest lung, heart, kidney, liver mean doses and maximum doses for lens. Using the same field width of 5cm, but higher MF (2.6±0.6), B had lower doses to the OARs in the thorax and abdomen area. Most of A’s plans were planned with 2.5cm jaw, the plans yielded better PTV coverage, higher OAR doses and slightly shorter FDTI compared to institution B. The replanned 5cm jaw plans achieved comparable PTV coverage and OARs sparing, while saving up to 44.7% treatment time. Conclusion: Plan quality and delivery efficiency could vary significantly in CSI planning on Tomotheapy due to choice of different planning parameters. CSI plans using a 5cm jaw, with proper selection of pitch and MF, can achieve comparable/ better plan quality with shorter delivery time compared to 2.5cm jaw plans.« less

SU-F-P-46: Comparative Study Between Two Normalization Prescriptions for Accelerated Partial Breast Irradiation: A Dosimetric Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Agarwal, P; Sharma, D; Gandhi, A

2016-06-15

Purpose: To compare the Accelerated Partial Breast Irradiation (APBI) plan with the normalized basal dose points and 5mm box prescription. Methods: Five patients of APBI were planned twice in Oncentra Master planning TPS (Version 4.3) using TG-43 algorithm. The number of catheters for all the patients was 10 to 16 and implant plane 2 to 3. For planning all catheters were reconstructed. Source loading was done as per HR-CTV contoured. The HR-CTV volume range was from 75cc to 182cc. Plans were normalized in two methods. First all plans were normalized on Basal dose points (PlanA) and second all the planmore » were normalized on 5mm box (PlanB). The prescription dose (PD) was 35Gy in 10 fractions. All the plans were completely based on normalization and without optimization. Plan evaluation was based on certain parameters coverage Index (CI), dose homogeneity index (DHI), conformity index (COIN), over dose volume index (OI). Results: The average and median of CI for planA was 0.835 and 0.8154, for planB 0.82 and 0.799 respectively. The median and average of DHI for planA was 0.66 and 0.6062, for planB 0.67 and 0.62 respectively. The range of COIN for planA and planB was from 0.58 to 0.65 respectively. The range of OI was from 0.083 to 0.169 for planA and planB. The treatment time in planA was in average 1.13 times more than planB as V150% of HR-CTV in planA was 4–6% more. The ipsilateral lung was getting 30% of PD which was 0.6% to 3.5%. Conclusion: Treatment Planning should be individualized based on implants characteristics. Planning with prescription to basal dose points should be preferred to 5mm box prescription, in order to achieve better DHI and less treatment time.« less

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Robertson, SP; Moore, JA; Hui, X

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

MO-B-BRB-01: Optimize Treatment Planning Process in Clinical Environment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Feng, W.

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequentialmore » events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.« less

MO-B-BRB-00: Optimizing the Treatment Planning Process

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequentialmore » events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.« less

MO-B-BRB-03: Systems Engineering Tools for Treatment Planning Process Optimization in Radiation Medicine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kapur, A.

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequentialmore » events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.« less

MO-B-BRB-02: Maintain the Quality of Treatment Planning for Time-Constraint Cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chang, J.

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequentialmore » events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.« less

Validation of Fully Automated VMAT Plan Generation for Library-Based Plan-of-the-Day Cervical Cancer Radiotherapy.

PubMed

Sharfo, Abdul Wahab M; Breedveld, Sebastiaan; Voet, Peter W J; Heijkoop, Sabrina T; Mens, Jan-Willem M; Hoogeman, Mischa S; Heijmen, Ben J M

2016-01-01

To develop and validate fully automated generation of VMAT plan-libraries for plan-of-the-day adaptive radiotherapy in locally-advanced cervical cancer. Our framework for fully automated treatment plan generation (Erasmus-iCycle) was adapted to create dual-arc VMAT treatment plan libraries for cervical cancer patients. For each of 34 patients, automatically generated VMAT plans (autoVMAT) were compared to manually generated, clinically delivered 9-beam IMRT plans (CLINICAL), and to dual-arc VMAT plans generated manually by an expert planner (manVMAT). Furthermore, all plans were benchmarked against 20-beam equi-angular IMRT plans (autoIMRT). For all plans, a PTV coverage of 99.5% by at least 95% of the prescribed dose (46 Gy) had the highest planning priority, followed by minimization of V45Gy for small bowel (SB). Other OARs considered were bladder, rectum, and sigmoid. All plans had a highly similar PTV coverage, within the clinical constraints (above). After plan normalizations for exactly equal median PTV doses in corresponding plans, all evaluated OAR parameters in autoVMAT plans were on average lower than in the CLINICAL plans with an average reduction in SB V45Gy of 34.6% (p<0.001). For 41/44 autoVMAT plans, SB V45Gy was lower than for manVMAT (p<0.001, average reduction 30.3%), while SB V15Gy increased by 2.3% (p = 0.011). AutoIMRT reduced SB V45Gy by another 2.7% compared to autoVMAT, while also resulting in a 9.0% reduction in SB V15Gy (p<0.001), but with a prolonged delivery time. Differences between manVMAT and autoVMAT in bladder, rectal and sigmoid doses were ≤ 1%. Improvements in SB dose delivery with autoVMAT instead of manVMAT were higher for empty bladder PTVs compared to full bladder PTVs, due to differences in concavity of the PTVs. Quality of automatically generated VMAT plans was superior to manually generated plans. Automatic VMAT plan generation for cervical cancer has been implemented in our clinical routine. Due to the achieved workload reduction, extension of plan libraries has become feasible.

A planning language for activity scheduling

NASA Technical Reports Server (NTRS)

Zoch, David R.; Lavallee, David; Weinstein, Stuart; Tong, G. Michael

1991-01-01

Mission planning and scheduling of spacecraft operations are becoming more complex at NASA. Described here are a mission planning process; a robust, flexible planning language for spacecraft and payload operations; and a software scheduling system that generates schedules based on planning language inputs. The mission planning process often involves many people and organizations. Consequently, a planning language is needed to facilitate communication, to provide a standard interface, and to represent flexible requirements. The software scheduling system interprets the planning language and uses the resource, time duration, constraint, and alternative plan flexibilities to resolve scheduling conflicts.

Writing a group practice business plan.

PubMed

Reiboldt, J M

1999-07-01

A business plan offers group practices a blueprint to accomplish a variety of goals, such as securing capital, marketing the practice's services, recruiting new employees, developing a strategic plan or a budget, or planning for growth. A business plan should be informative, specific, and visionary. Elements that every business plan should address are a mission statement, strategy, planning, management information, and action scheme. A business plan should include certain information in a prescribed order. By writing a realistic business plan, group practices can work more efficiently and minimize the risk of not meeting their financial projections.

Changes in Consumer Cost-Sharing for Health Plans Sold in the ACA's Insurance Marketplaces, 2015 to 2016.

PubMed

Gabel, Jon; Green, Matthew; Call, Adrienne; Whitmore, Heidi; Stromberg, Sam; Oran, Rebecca

2016-05-01

This brief examines changes in consumer health plan cost-sharing--deductibles, copayments, coinsurance, and out-of-pocket limits--for coverage offered in the Affordable Care Act's marketplaces between 2015 and 2016. Three of seven measures studied rose moderately in 2016, an increase attributable in part to a shift in the mix of plans offered in the marketplaces, from plans with higher actuarial value (platinum and gold plans) to those that have less generous coverage (bronze and silver plans). Nearly 60 percent of enrollees in marketplace plans receive cost-sharing reductions as part of income-based assistance. For enrollees without cost-sharing reductions, average copayments, deductibles, and out-of-pocket limits remain considerably higher under bronze and silver plans than under employer-based plans; cost-sharing is similar in gold plans and employer plans. Marketplace plans are more likely than employer-based plans to impose a deductible for prescription drugs but no less likely to do so for primary care visits.

Strategic planning: the first step in the planning process.

PubMed

Gelinas, Marc A

2003-01-01

Strategic planning is a systematic process through which an organization builds commitment among key stakeholders to goals and priorities which are essential to its mission and vision, and responsive to the operating environment. Strategic planning is the first step in a comprehensive planning process that also includes business planning and implementation planning. If all three steps are carried out in sequence, strategic planning can be a very effective means of educating the stakeholders about where the cancer program is and where it is going, gaining support and commitment for the direction that the cancer program will take, and assuring that everyone's expectations can be managed effectively. Unfortunately, some organizations and cancer program leaders misunderstand the process. Too often, strategic planning is used as a stand-alone activity. This article will describe what strategic planning is, how it should smoothly lead into business planning and implementation planning, and how to avoid the pitfalls that sometimes arise during the strategic planning effort.

Automated IMRT planning in Pinnacle : A study in head-and-neck cancer.

PubMed

Kusters, J M A M; Bzdusek, K; Kumar, P; van Kollenburg, P G M; Kunze-Busch, M C; Wendling, M; Dijkema, T; Kaanders, J H A M

2017-12-01

This study evaluates the performance and planning efficacy of the Auto-Planning (AP) module in the clinical version of Pinnacle 9.10 (Philips Radiation Oncology Systems, Fitchburg, WI, USA). Twenty automated intensity-modulated radiotherapy (IMRT) plans were compared with the original manually planned clinical IMRT plans from patients with oropharyngeal cancer. Auto-Planning with IMRT offers similar coverage of the planning target volume as the original manually planned clinical plans, as well as better sparing of the contralateral parotid gland, contralateral submandibular gland, larynx, mandible, and brainstem. The mean dose of the contralateral parotid gland and contralateral submandibular gland could be reduced by 2.5 Gy and 1.7 Gy on average. The number of monitor units was reduced with an average of 143.9 (18%). Hands-on planning time was reduced from 1.5-3 h to less than 1 h. The Auto-Planning module was able to produce clinically acceptable head and neck IMRT plans with consistent quality.

Identifying Executable Plans

NASA Technical Reports Server (NTRS)

Bedrax-Weiss, Tania; Jonsson, Ari K.; Frank, Jeremy D.; McGann, Conor

2003-01-01

Generating plans for execution imposes a different set of requirements on the planning process than those imposed by planning alone. In highly unpredictable execution environments, a fully-grounded plan may become inconsistent frequently when the world fails to behave as expected. Intelligent execution permits making decisions when the most up-to-date information is available, ensuring fewer failures. Planning should acknowledge the capabilities of the execution system, both to ensure robust execution in the face of uncertainty, which also relieves the planner of the burden of making premature commitments. We present Plan Identification Functions (PIFs), which formalize what it means for a plan to be executable, md are used in conjunction with a complete model of system behavior to halt the planning process when an executable plan is found. We describe the implementation of plan identification functions for a temporal, constraint-based planner. This particular implementation allows the description of many different plan identification functions. characteristics crf the xectieonfvii rnm-enft,h e best plan to hand to the execution system will contain more or less commitment and information.

Can persuasive messages encourage individuals to create action plans for physical activity?

PubMed

Sweet, Shane N; Brawley, Lawrence R; Hatchell, Alexandra; Gainforth, Heather L; Latimer-Cheung, Amy E

2014-08-01

Given the positive influence of action planning on physical activity, persuasive messages could be designed to promote action planning. The purpose of this paper was to test action planning messages in two studies. Participants were allocated to one of two message groups, reading either a physical activity only or physical activity plus action planning message (Study 1) and either a gain-framed or loss-framed action planning message (Study 2). The percent of individuals who created an action plan and the quality of the plans were evaluated. In Study 1, individuals in the physical activity plus action planning group created as many action plans as the physical activity only group, but their plans were higher quality. In Study 2, Week 2 differences between the gain- and loss-framed message groups were found for action planning. To our knowledge, these studies were the first to investigate message-induced action planning as a behavior. More research is needed to optimize these messages.

SU-F-T-94: Plan2pdf - a Software Tool for Automatic Plan Report for Philips Pinnacle TPS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, C

Purpose: To implement an automatic electronic PDF plan reporting tool for Philips Pinnacle treatment planning system (TPS) Methods: An electronic treatment plan reporting software is developed by us to enable fully automatic PDF report from Pinnacle TPS to external EMR programs such as MOSAIQ. The tool is named “plan2pdf”. plan2pdf is implemented using Pinnacle scripts, Java and UNIX shell scripts, without any external program needed. plan2pdf supports full auto-mode and manual mode reporting. In full auto-mode, with a single mouse click, plan2pdf will generate a detailed Pinnacle plan report in PDF format, which includes customizable cover page, Pinnacle plan summary,more » orthogonal views through each plan POI and maximum dose point, DRR for each beam, serial transverse views captured throughout the dose grid at a user specified interval, DVH and scorecard windows. The final PDF report is also automatically bookmarked for each section above for convenient plan review. The final PDF report can either be saved on a user specified folder on Pinnacle, or it can be automatically exported to an EMR import folder via a user configured FTP service. In manual capture mode, plan2pdf allows users to capture any Pinnacle plan by full screen, individual window or rectangular ROI drawn on screen. Furthermore, to avoid possible patients’ plan mix-up during auto-mode reporting, a user conflict check feature is included in plan2pdf: it prompts user to wait if another patient is being exported by plan2pdf by another user. Results: plan2pdf is tested extensively and successfully at our institution consists of 5 centers, 15 dosimetrists and 10 physicists, running Pinnacle version 9.10 on Enterprise servers. Conclusion: plan2pdf provides a highly efficient, user friendly and clinical proven platform for all Philips Pinnacle users, to generate a detailed plan report in PDF format for external EMR systems.« less

SU-F-T-312: Identifying Distinct Radiation Therapy Plan Classes Through Multi-Dimensional Analysis of Plan Complexity Metrics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Desai, V; Labby, Z; Culberson, W

Purpose: To determine whether body site-specific treatment plans form unique “plan class” clusters in a multi-dimensional analysis of plan complexity metrics such that a single beam quality correction determined for a representative plan could be universally applied within the “plan class”, thereby increasing the dosimetric accuracy of a detector’s response within a subset of similarly modulated nonstandard deliveries. Methods: We collected 95 clinical volumetric modulated arc therapy (VMAT) plans from four body sites (brain, lung, prostate, and spine). The lung data was further subdivided into SBRT and non-SBRT data for a total of five plan classes. For each control pointmore » in each plan, a variety of aperture-based complexity metrics were calculated and stored as unique characteristics of each patient plan. A multiple comparison of means analysis was performed such that every plan class was compared to every other plan class for every complexity metric in order to determine which groups could be considered different from one another. Statistical significance was assessed after correcting for multiple hypothesis testing. Results: Six out of a possible 10 pairwise plan class comparisons were uniquely distinguished based on at least nine out of 14 of the proposed metrics (Brain/Lung, Brain/SBRT lung, Lung/Prostate, Lung/SBRT Lung, Lung/Spine, Prostate/SBRT Lung). Eight out of 14 of the complexity metrics could distinguish at least six out of the possible 10 pairwise plan class comparisons. Conclusion: Aperture-based complexity metrics could prove to be useful tools to quantitatively describe a distinct class of treatment plans. Certain plan-averaged complexity metrics could be considered unique characteristics of a particular plan. A new approach to generating plan-class specific reference (pcsr) fields could be established through a targeted preservation of select complexity metrics or a clustering algorithm that identifies plans exhibiting similar modulation characteristics. Measurements and simulations will better elucidate potential plan-class specific dosimetry correction factors.« less

A comprehensive comparison of IMRT and VMAT plan quality for prostate cancer treatment

PubMed Central

QUAN, ENZHUO M.; LI, XIAOQIANG; LI, YUPENG; WANG, XIAOCHUN; KUDCHADKER, RAJAT J.; JOHNSON, JENNIFER L.; KUBAN, DEBORAH A.; LEE, ANDREW K.; ZHANG, XIAODONG

2013-01-01

Purpose We performed a comprehensive comparative study of the plan quality between volumetric modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) for the treatment of prostate cancer. Methods and Materials Eleven patients with prostate cancer treated at our institution were randomly selected for this study. For each patient, a VMAT plan and a series of IMRT plans using an increasing number of beams (8, 12, 16, 20, and 24 beams) were examined. All plans were generated using our in-house-developed automatic inverse planning (AIP) algorithm. An existing 8-beam clinical IMRT plan, which was used to treat the patient, was used as the reference plan. For each patient, all AIP-generated plans were optimized to achieve the same level of planning target volume (PTV) coverage as the reference plan. Plan quality was evaluated by measuring mean dose to and dose-volume statistics of the organs-at-risk, especially the rectum, from each type of plan. Results For the same PTV coverage, the AIP-generated VMAT plans had significantly better plan quality in terms of rectum sparing than the 8-beam clinical and AIP-generated IMRT plans (p < 0.0001). However, the differences between the IMRT and VMAT plans in all the dosimetric indices decreased as the number of beams used in IMRT increased. IMRT plan quality was similar or superior to that of VMAT when the number of beams in IMRT was increased to a certain number, which ranged from 12 to 24 for the set of patients studied. The superior VMAT plan quality resulted in approximately 30% more monitor units than the 8-beam IMRT plans, but the delivery time was still less than 3 minutes. Conclusions Considering the superior plan quality as well as the delivery efficiency of VMAT compared with that of IMRT, VMAT may be the preferred modality for treating prostate cancer. PMID:22704703

SU-F-T-337: Accounting for Patient Motion During Volumetric Modulated Ac Therapy (VMAT) Planning for Post Mastectomy Chest Wall Irradiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hernandez, M; Fontenot, J; Heins, D

2016-06-15

Purpose: To evaluate two dose optimization strategies for maintaining target volume coverage of inversely-planned post mastectomy radiotherapy (PMRT) plans during patient motion. Methods: Five patients previously treated with VMAT for PMRT at our clinical were randomly selected for this study. For each patient, two plan optimization strategies were compared. Plan 1 was optimized to a volume that included the physician’s planning target volume (PTV) plus an expansion up to 0.3 cm from the bolus surface. Plan 2 was optimized to the PTV plus an expansion up to 0.3 cm from the patient surface (i.e., not extending into the bolus). VMATmore » plans were optimized to deliver 95% of the prescription to 95% of the PTV while sparing organs at risk based on clinical dose limits. PTV coverage was then evaluated following the simulation of patient shifts by 1.0 cm in the anterior and posterior directions using the treatment planning system. Results: Posterior patient shifts produced a difference in D95% of around 11% in both planning approaches from the non-shifted dose distributions. Coverage of the medial and lateral borders of the evaluation volume was reduced in both the posteriorly shifted plans (Plan 1 and Plan 2). Anterior patient shifts affected Plan 2 more than Plan 1 with a difference in D95% of 1% for Plan 1 versus 6% for Plan 2 from the non-shifted dose distributions. The least variation in PTV dose homogeneity for both shifts was obtained with Plan 1. However, all posteriorly shifted plans failed to deliver 95% of the prescription to 95% of the PTV. Whereas, only a few anteriorly shifted plans failed this criteria. Conclusion: The results of this study suggest both planning volume methods are sensitive to patient motion, but that a PTV extended into a bolus volume is slightly more robust for anterior patient shifts.« less

SU-G-TeP1-05: Development and Clinical Introduction of Automated Radiotherapy Treatment Planning for Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Winkel, D; Bol, GH; Asselen, B van

Purpose: To develop an automated radiotherapy treatment planning and optimization workflow for prostate cancer in order to generate clinical treatment plans. Methods: A fully automated radiotherapy treatment planning and optimization workflow was developed based on the treatment planning system Monaco (Elekta AB, Stockholm, Sweden). To evaluate our method, a retrospective planning study (n=100) was performed on patients treated for prostate cancer with 5 field intensity modulated radiotherapy, receiving a dose of 35×2Gy to the prostate and vesicles and a simultaneous integrated boost of 35×0.2Gy to the prostate only. A comparison was made between the dosimetric values of the automatically andmore » manually generated plans. Operator time to generate a plan and plan efficiency was measured. Results: A comparison of the dosimetric values show that automatically generated plans yield more beneficial dosimetric values. In automatic plans reductions of 43% in the V72Gy of the rectum and 13% in the V72Gy of the bladder are observed when compared to the manually generated plans. Smaller variance in dosimetric values is seen, i.e. the intra- and interplanner variability is decreased. For 97% of the automatically generated plans and 86% of the clinical plans all criteria for target coverage and organs at risk constraints are met. The amount of plan segments and monitor units is reduced by 13% and 9% respectively. Automated planning requires less than one minute of operator time compared to over an hour for manual planning. Conclusion: The automatically generated plans are highly suitable for clinical use. The plans have less variance and a large gain in time efficiency has been achieved. Currently, a pilot study is performed, comparing the preference of the clinician and clinical physicist for the automatic versus manual plan. Future work will include expanding our automated treatment planning method to other tumor sites and develop other automated radiotherapy workflows.« less

Personal Financial Planning: Failure to Plan Properly May Have Dire Consequences.

ERIC Educational Resources Information Center

Rosenbloom, Jerry

1988-01-01

Effective personal financial planning results in sound decisions in the areas of insurance, accumulating capital, retirement planning, and tax planning. Appropriate financial planning concerns everyone--regardless of his or her stage in life. (MLW)

Transforming the Department of State: Adapting Operational Capacities and Capabilities to the Post-9/11 Reality, Evolving Interagency Responsibilities, and the Challenges of the 21st Century

DTIC Science & Technology

2006-04-14

combination of the Strategic Plan, MPPs, and BPPs goals, along with performance, and accountability plans. Three other documents are inherently important...DOS Strategic Plan, Mission Performance Plan (MPP), Bureau Performance Plan ( BPP ). NSC representation, POLADs, Embassy Country Teams, and...the world. DOS Strategic Plan, Mission Performance Plan (MPP), Bureau Performance Plan ( BPP ). NSC representation, POLADs, Exchange

Relative Effects of Forward and Backward Planning on Goal Pursuit.

PubMed

Park, Jooyoung; Lu, Fang-Chi; Hedgcock, William M

2017-11-01

Considerable research has shown that planning plays an important role in goal pursuit. But how does the way people plan affect goal pursuit? Research on this question is scarce. In the current research, we examined how planning the steps required for goal attainment in chronological order (i.e., forward planning) and reverse chronological order (i.e., backward planning) influences individuals' motivation for and perceptions of goal pursuit. Compared with forward planning, backward planning not only led to greater motivation, higher goal expectancy, and less time pressure but also resulted in better goal-relevant performance. We further demonstrated that this motivational effect occurred because backward planning allowed people to think of tasks required to reach their goals more clearly, especially when goals were complex to plan. These findings suggest that the way people plan matters just as much as whether or not they plan.

Understanding what asthma plans mean: a linguistic analysis of terminology used in published texts.

PubMed

Ring, Nicola; Pinnock, Hilary; Wilson, Caroline; Hoskins, Gaylor; Jepson, Ruth; Wyke, Sally; Sheikh, Aziz

2011-06-01

To identify from the literature what terms are used for 'asthma plans', with what meaning, and in what context(s). Linguistic analysis of a selected body of asthma literature from 1989-2009. A wide range of asthma plan terminology was evident, with terms such as 'action plans', 'self-management plans' and 'treatment plans' being applied inconsistently and synonymously. For individual patients the term 'asthma plan' can describe a clinically-determined list of prescribed medication, an agreed plan to guide self-management of changing symptoms, or a more holistic 'living with asthma' plan. In some contexts the term 'asthma plan' was also used to describe an organisational system of care, which causes further ambiguity. Within the literature, a plethora of terms is used inconsistently and with varied meaning. This is a potential, but previously unrecognised, barrier to asthma plan implementation. A taxonomy of asthma plans and a standardised definitions of terms is required.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barbee, D; McCarthy, A; Galavis, P

Purpose: Errors found during initial physics plan checks frequently require replanning and reprinting, resulting decreased departmental efficiency. Additionally, errors may be missed during physics checks, resulting in potential treatment errors or interruption. This work presents a process control created using the Eclipse Scripting API (ESAPI) enabling dosimetrists and physicists to detect potential errors in the Eclipse treatment planning system prior to performing any plan approvals or printing. Methods: Potential failure modes for five categories were generated based on available ESAPI (v11) patient object properties: Images, Contours, Plans, Beams, and Dose. An Eclipse script plugin (PlanCheck) was written in C# tomore » check errors most frequently observed clinically in each of the categories. The PlanCheck algorithms were devised to check technical aspects of plans, such as deliverability (e.g. minimum EDW MUs), in addition to ensuring that policy and procedures relating to planning were being followed. The effect on clinical workflow efficiency was measured by tracking the plan document error rate and plan revision/retirement rates in the Aria database over monthly intervals. Results: The number of potential failure modes the PlanCheck script is currently capable of checking for in the following categories: Images (6), Contours (7), Plans (8), Beams (17), and Dose (4). Prior to implementation of the PlanCheck plugin, the observed error rates in errored plan documents and revised/retired plans in the Aria database was 20% and 22%, respectively. Error rates were seen to decrease gradually over time as adoption of the script improved. Conclusion: A process control created using the Eclipse scripting API enabled plan checks to occur within the planning system, resulting in reduction in error rates and improved efficiency. Future work includes: initiating full FMEA for planning workflow, extending categories to include additional checks outside of ESAPI via Aria database queries, and eventual automated plan checks.« less

Care plans and care planning in long-term conditions: a conceptual model.

PubMed

Burt, Jenni; Rick, Jo; Blakeman, Thomas; Protheroe, Joanne; Roland, Martin; Bower, Pete

2014-10-01

The prevalence and impact of long-term conditions continues to rise. Care planning for people with long-term conditions has been a policy priority for chronic disease management in a number of health-care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between 'care planning' (the process by which health-care professionals and patients discuss, agree and review an action plan to achieve the goals or behaviour change of most relevance and concern to the patient) and a 'care plan' (a written document recording the outcome of a care planning process). We propose a typology of care planning and care plans with three core dimensions: perspective (patient or professional), scope (a focus on goals or on behaviours) and networks (confined to the professional-patient dyad or extending to the entire care network). In addition, we draw on psychological models of mediation and moderation to outline potential mechanisms through which care planning and care plans may lead to improved outcomes for both patients and the wider health-care system. The proposed typology of care planning and care plans offered here, along with the model of the process by which care planning may influence outcomes, provide a useful framework for future policy developments and evaluations. Empirical work is required to explore the degree to which current care planning approaches and care plans can be described according to these dimensions, and the factors that determine which types of patients and professionals use which type of care plans.

[CT guidance 125I seed implantation for pelvic recurrent rectal cancer assisted by 3D printing individual non-coplanar template].

PubMed

Wang, H; Wang, J J; Jiang, Y L; Tian, S Q; Ji, Z; Guo, F X; Sun, H T; Fan, J H; Xu, Y P

2016-12-20

Objective: To analyze the difference of dosimetric parameters between pre-plan and post-plan of 125 I radioactive seed implantation assisted by 3D printing individual non-coplanar template (3D printing template) for locally recurrent rectal cancer (LRRC). Methods: From February 2016 to April 2016, a total of 10 patients with locally recurrent rectal cancer received 125 I seeds implantation under CT guidance assisted by 3D printing template in Department of Radiation Oncology, Peking University Third Hospital.Each patient underwent CT simulation, three-dimentional treatment planning pre-implantation, 3D printing template design, radioactive seed implantation assisted by 3D printing template and dosimetric verification post implantation. The median activity of seed was 0.63 mCi (0.58 to 0.7 mCi) (2.15- 2.59×10 7 Bq), and the median number of seeds was 80 (19 to 192). D 90 , D 100 , V 100 , V 150 , CI, EI, HI, D 5cc , D 2cc of bladder and bowel of pre-plan and post-plan were calculated, respectively.Paired t test was used to evaluate the difference of dosimetric parameters between pre-plan and post-plan. Results: The median D 90 of pre-plan and post-plan were 13 761.0 and 12 798.8 cGy, respectively.The median D 100 of pre-plan and post-plan were 5 293.6 and 5 397.9 cGy, respectively.The median V 100 of pre-plan and post-plan were 90.0% and 90.0%, respectively.The median V 150 of pre-plan and post-plan were 63.8% and 62.4%, respectively.The median CI of pre-plan and post-plan were 0.73 and 0.67.The median EI of pre-plan and post-plan were 0.22 and 0.30, respectively. The median HI of pre-plan and post-plan were 0.29 and 0.31.The median bladder D 2cc of pre-plan and post-plan were 3 088.8 and 4 240.4 cGy, respectively.The median bowel D 2cc of pre-plan and post-plan were 7 051.6 and 7 903.9 cGy, respectively. Conclusions: 3D printing template might be helpful for locally recurrent rectal cancer patients who received 125 I radioactive seed implantation assisted by 3D printing individual template.Seed implantation might have more chances to achieve prescription dose and dose limitation of organs at risk of pre-plan, which is important for precise implantation and quality control.

10 CFR 436.107 - Review of plan.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Operations Plans § 436.107 Review of plan. (a) Each plan or revision of a plan shall be submitted to DOE and... general operations plan under the guidelines will be evaluated with respect to: (1) Adequacy of... 10 Energy 3 2010-01-01 2010-01-01 false Review of plan. 436.107 Section 436.107 Energy DEPARTMENT...

Planning Skills and Negotiator Goal Accomplishment: The Relationship between Self-Monitoring and Plan Generation, Plan Enactment, and Plan Consequences.

ERIC Educational Resources Information Center

Jordan, Jerry Monroe; Roloff, Michael E.

1997-01-01

Focuses on skills necessary for effective negotiation planning. Argues that the information processing tendencies of high self-monitors make them adept at negotiation planning. Extends existing work by relating self-monitoring to plan generation, enactment, and consequences. Indicates that self-monitoring is related to prenegotiation goal…

Sample-Based Motion Planning in High-Dimensional and Differentially-Constrained Systems

DTIC Science & Technology

2010-02-01

Reachable Set . . . 88 6-1 LittleDog Robot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 6-2 Dog bounding up stairs ...planning algorithm implemented on LittleDog, a quadruped robot . The motion planning algorithm successfully planned bounding trajectories over extremely...a motion planning algorithm implemented on LittleDog, a quadruped robot . The motion planning algorithm successfully planned bounding trajectories

Guidelines for Analysis of Health Facilities Planning in Developing Countries. Volume 5: Health Facilities Planning. International Health Planning Methods Series.

ERIC Educational Resources Information Center

Porter, Dennis R.; And Others

Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this fifth of ten manuals in the International Health Planning Methods Series deals with health facilities planning in developing countries. While several specific…

29 CFR 4006.5 - Exemptions and special rules.

Code of Federal Regulations, 2014 CFR

2014-07-01

... year. (4) Certain small new and newly covered plans. A plan is described in this paragraph if— (i) It is a small plan other than a continuation plan, and (ii) It is a new plan or a newly covered plan. (b... the plan year preceding the premium payment year. (d) Participant count date; new and newly covered...

Guidelines for Analysis of Health Manpower Planning. Volume 3: Health Manpower Planning. International Health Planning Methods Series.

ERIC Educational Resources Information Center

Staff, Robert J.; Porter, Dennis R.

Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this third of ten manuals in the International Health Planning Methods Series deals with health manpower planning and assessment. It provides a conceptual and…

Preliminary logging analysis system (PLANS): overview.

Treesearch

R.H. Twito; S.E. Reutebuch; R.J. McGaughey; C.N. Mann

1987-01-01

The paper previews a computer-aided design system, PLANS, that is useful for developing timber harvest and road network plans on large-scale topographic maps. Earlier planning techniques are reviewed, and the advantages are explained of using advanced planning systems like PLANS. There is a brief summary of the input, output, and function of each program in the PLANS...

10 CFR 52.79 - Contents of applications; technical information in final safety analysis report.

Code of Federal Regulations, 2012 CFR

2012-01-01

... B to 10 CFR part 73. (iii) A cyber security plan in accordance with the criteria set forth in § 73..., training and qualification plan, and cyber security plan; and (v) Each applicant who prepares a physical security plan, a safeguards contingency plan, a training and qualification plan, or a cyber security plan...

10 CFR 52.79 - Contents of applications; technical information in final safety analysis report.

Code of Federal Regulations, 2013 CFR

2013-01-01

... B to 10 CFR part 73. (iii) A cyber security plan in accordance with the criteria set forth in § 73..., training and qualification plan, and cyber security plan; and (v) Each applicant who prepares a physical security plan, a safeguards contingency plan, a training and qualification plan, or a cyber security plan...

10 CFR 52.79 - Contents of applications; technical information in final safety analysis report.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) A cyber security plan in accordance with the criteria set forth in § 73.54 of this chapter; (iv) A... cyber security plan; and (v) Each applicant who prepares a physical security plan, a safeguards contingency plan, a training and qualification plan, or a cyber security plan, shall protect the plans and...

10 CFR 52.79 - Contents of applications; technical information in final safety analysis report.

Code of Federal Regulations, 2014 CFR

2014-01-01

... B to 10 CFR part 73. (iii) A cyber security plan in accordance with the criteria set forth in § 73..., training and qualification plan, and cyber security plan; and (v) Each applicant who prepares a physical security plan, a safeguards contingency plan, a training and qualification plan, or a cyber security plan...

40 CFR Appendix F to Part 112 - Facility-Specific Response Plan

Code of Federal Regulations, 2011 CFR

2011-07-01

... of Contents 1.0Model Facility-Specific Response Plan 1.1Emergency Response Action Plan 1.2Facility.... EC01MR92.015 1.1Emergency Response Action Plan Several sections of the response plan shall be co-located... sections shall be called the Emergency Response Action Plan. The Agency intends that the Action Plan...

SouthWest Elevation, Plan Showing Deck Framing, Deck Plan, Plan of ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

South-West Elevation, Plan Showing Deck Framing, Deck Plan, Plan of Collar Beams, Etc., Typical Framing Details, End Elevations, Elevation of Scarf Top Chord, Joint Details - Perrine's Bridge, Spanning Wallkill River, Rifton, Ulster County, NY

SU-E-T-618: Dosimetric Comparison of Manual and Beam Angle Optimization of Gantry Angles in IMRT for Cervical Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lin, X; Sun, T; Liu, T

2014-06-01

Purpose: To evaluate the dosimetric characteristics of intensity-modulated radiotherapy (IMRT) treatment plan with beam angle optimization. Methods: Ten post-operation patients with cervical cancer were included in this analysis. Two IMRT plans using seven beams were designed in each patient. A standard coplanar equi-space beam angles were used in the first plan (plan 1), whereas the selection of beam angle was optimized by beam angle optimization algorithm in Varian Eclipse treatment planning system for the same number of beams in the second plan (plan 2). Two plans were designed for each patient with the same dose-volume constraints and prescription dose. Allmore » plans were normalized to the mean dose to PTV. The dose distribution in the target, the dose to the organs at risk and total MU were compared. Results: For conformity and homogeneity in PTV, no statistically differences were observed in the two plans. For the mean dose in bladder, plan 2 were significantly lower than plan 1(p<0.05). No statistically significant differences were observed between two plans for the mean doses in rectum, left and right femur heads. Compared with plan1, the average monitor units reduced 16% in plan 2. Conclusion: The IMRT plan based on beam angle optimization for cervical cancer could reduce the dose delivered to bladder and also reduce MU. Therefore there were some dosimetric advantages in the IMRT plan with beam angle optimization for cervical cancer.« less

Strategic Petroleum Reserve Plan. Distribution Plan for the Strategic Petroleum Reserve. Amendment No. 3. Energy Action DOE No. 5

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

Purpose of this Strategic Petroleum Reserve (SPR) Plan Amendment is to provide a Distribution Plan, setting forth the method of drawdown and distribution of the Reserve. Chapter VII of the SPR Plan contained a Distribution Plan which identified and discussed the major objectives, criteria and other factors that will be considered in developing the detailed plan. This Amendment replaces Chapter VII of the SPR Plan in its entirety.

Do consumer reports of health plan quality affect health plan selection?

PubMed Central

Spranca, M; Kanouse, D E; Elliott, M; Short, P F; Farley, D O; Hays, R D

2000-01-01

OBJECTIVE: To learn whether consumer reports of health plan quality can affect health plan selection. DATA SOURCES: A sample of 311 privately insured adults from Los Angeles County. STUDY DESIGN: The design was a fractional factorial experiment. Consumers reviewed materials on four hypothetical health plans and selected one. The health plans varied as to cost, coverage, type of plan, ability to keep one's doctor, and quality, as measured by the Consumer Assessment of Health Plans Study (CAHPS) survey. DATA ANALYSIS: We used multinomial logistic regression to model each consumer's choice among health plans. PRINCIPAL FINDINGS: In the absence of CAHPS information, 86 percent of consumers preferred plans that covered more services, even though they cost more. When CAHPS information was provided, consumers shifted to less expensive plans covering fewer services if CAHPS ratings identified those plans as higher quality (59 percent of consumers preferred plans covering more services). Consumer choices were unaffected when CAHPS ratings identified the more expensive plans covering more services as higher quality (89 percent of consumers preferred plans covering more services). CONCLUSIONS: This study establishes that, under certain realistic conditions, CAHPS ratings could affect consumer selection of health plans and ultimately contain costs. Other studies are needed to learn how to enhance exposure and use of CAHPS information in the real world as well as to identify other conditions in which CAHPS ratings could make a difference. PMID:11130805

Effective protection of open space: does planning matter?

PubMed

Steelman, Toddi A; Hess, George R

2009-07-01

High quality plans are considered a crucial part of good land use planning and often used as a proxy measure for success in plan implementation and goal attainment. We explored the relationship of open space plan quality to the implementation of open space plans and attainment of open space protection goals in Research Triangle, North Carolina, USA. To measure plan quality, we used a standard plan evaluation matrix that we modified to focus on open space plans. We evaluated all open space plans in the region that contained a natural resource protection element. To measure plan implementation and open space protection, we developed an online survey and administered it to open space planners charged with implementing the plans. The survey elicited each planner's perspective on aspects of open space protection in his or her organization. The empirical results (1) indicate that success in implementation and attaining goals are not related to plan quality, (2) highlight the importance of when and how stakeholders are involved in planning and implementation processes, and (3) raise questions about the relationship of planning to implementation. These results suggest that a technically excellent plan does not guarantee the long-term relationships among local land owners, political and appointed officials, and other organizations that are crucial to meeting land protection goals. A greater balance of attention to the entire decision process and building relationships might lead to more success in protecting open space.

Explicit optimization of plan quality measures in intensity-modulated radiation therapy treatment planning.

PubMed

Engberg, Lovisa; Forsgren, Anders; Eriksson, Kjell; Hårdemark, Björn

2017-06-01

To formulate convex planning objectives of treatment plan multicriteria optimization with explicit relationships to the dose-volume histogram (DVH) statistics used in plan quality evaluation. Conventional planning objectives are designed to minimize the violation of DVH statistics thresholds using penalty functions. Although successful in guiding the DVH curve towards these thresholds, conventional planning objectives offer limited control of the individual points on the DVH curve (doses-at-volume) used to evaluate plan quality. In this study, we abandon the usual penalty-function framework and propose planning objectives that more closely relate to DVH statistics. The proposed planning objectives are based on mean-tail-dose, resulting in convex optimization. We also demonstrate how to adapt a standard optimization method to the proposed formulation in order to obtain a substantial reduction in computational cost. We investigated the potential of the proposed planning objectives as tools for optimizing DVH statistics through juxtaposition with the conventional planning objectives on two patient cases. Sets of treatment plans with differently balanced planning objectives were generated using either the proposed or the conventional approach. Dominance in the sense of better distributed doses-at-volume was observed in plans optimized within the proposed framework. The initial computational study indicates that the DVH statistics are better optimized and more efficiently balanced using the proposed planning objectives than using the conventional approach. © 2017 American Association of Physicists in Medicine.

Plan averaging for multicriteria navigation of sliding window IMRT and VMAT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Craft, David, E-mail: dcraft@partners.org; Papp, Dávid; Unkelbach, Jan

2014-02-15

Purpose: To describe a method for combining sliding window plans [intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT)] for use in treatment plan averaging, which is needed for Pareto surface navigation based multicriteria treatment planning. Methods: The authors show that by taking an appropriately defined average of leaf trajectories of sliding window plans, the authors obtain a sliding window plan whose fluence map is the exact average of the fluence maps corresponding to the initial plans. In the case of static-beam IMRT, this also implies that the dose distribution of the averaged plan is the exact dosimetricmore » average of the initial plans. In VMAT delivery, the dose distribution of the averaged plan is a close approximation of the dosimetric average of the initial plans. Results: The authors demonstrate the method on three Pareto optimal VMAT plans created for a demanding paraspinal case, where the tumor surrounds the spinal cord. The results show that the leaf averaged plans yield dose distributions that approximate the dosimetric averages of the precomputed Pareto optimal plans well. Conclusions: The proposed method enables the navigation of deliverable Pareto optimal plans directly, i.e., interactive multicriteria exploration of deliverable sliding window IMRT and VMAT plans, eliminating the need for a sequencing step after navigation and hence the dose degradation that is caused by such a sequencing step.« less

Intensity modulated neutron radiotherapy optimization by photon proxy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Snyder, Michael; Hammoud, Ahmad; Bossenberger, Todd

2012-08-15

Purpose: Introducing intensity modulation into neutron radiotherapy (IMNRT) planning has the potential to mitigate some normal tissue complications seen in past neutron trials. While the hardware to deliver IMNRT plans has been in use for several years, until recently the IMNRT planning process has been cumbersome and of lower fidelity than conventional photon plans. Our in-house planning system used to calculate neutron therapy plans allows beam weight optimization of forward planned segments, but does not provide inverse optimization capabilities. Commercial treatment planning systems provide inverse optimization capabilities, but currently cannot model our neutron beam. Methods: We have developed a methodologymore » and software suite to make use of the robust optimization in our commercial planning system while still using our in-house planning system to calculate final neutron dose distributions. Optimized multileaf collimator (MLC) leaf positions for segments designed in the commercial system using a 4 MV photon proxy beam are translated into static neutron ports that can be represented within our in-house treatment planning system. The true neutron dose distribution is calculated in the in-house system and then exported back through the MATLAB software into the commercial treatment planning system for evaluation. Results: The planning process produces optimized IMNRT plans that reduce dose to normal tissue structures as compared to 3D conformal plans using static MLC apertures. The process involves standard planning techniques using a commercially available treatment planning system, and is not significantly more complex than conventional IMRT planning. Using a photon proxy in a commercial optimization algorithm produces IMNRT plans that are more conformal than those previously designed at our center and take much less time to create. Conclusions: The planning process presented here allows for the optimization of IMNRT plans by a commercial treatment planning optimization algorithm, potentially allowing IMNRT to achieve similar conformality in treatment as photon IMRT. The only remaining requirements for the delivery of very highly modulated neutron treatments are incremental improvements upon already implemented hardware systems that should be readily achievable.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, X; Wang, J; Hu, W

Purpose: The Varian RapidPlan™ is a commercial knowledge-based optimization process which uses a set of clinically used treatment plans to train a model that can predict individualized dose-volume objectives. The purpose of this study is to evaluate the performance of RapidPlan to generate intensity modulated radiation therapy (IMRT) plans for cervical cancer. Methods: Totally 70 IMRT plans for cervical cancer with varying clinical and physiological indications were enrolled in this study. These patients were all previously treated in our institution. There were two prescription levels usually used in our institution: 45Gy/25 fractions and 50.4Gy/28 fractions. 50 of these plans weremore » selected to train the RapidPlan model for predicting dose-volume constraints. After model training, this model was validated with 10 plans from training pool(internal validation) and additional other 20 new plans(external validation). All plans used for the validation were re-optimized with the original beam configuration and the generated priorities from RapidPlan were manually adjusted to ensure that re-optimized DVH located in the range of the model prediction. DVH quantitative analysis was performed to compare the RapidPlan generated and the original manual optimized plans. Results: For all the validation cases, RapidPlan based plans (RapidPlan) showed similar or superior results compared to the manual optimized ones. RapidPlan increased the result of D98% and homogeneity in both two validations. For organs at risk, the RapidPlan decreased mean doses of bladder by 1.25Gy/1.13Gy (internal/external validation) on average, with p=0.12/p<0.01. The mean dose of rectum and bowel were also decreased by an average of 2.64Gy/0.83Gy and 0.66Gy/1.05Gy,with p<0.01/ p<0.01and p=0.04/<0.01 for the internal/external validation, respectively. Conclusion: The RapidPlan model based cervical cancer plans shows ability to systematically improve the IMRT plan quality. It suggests that RapidPlan has great potential to make the treatment planning process more efficient.« less

SU-F-T-358: Is Auto-Planning Useful for Volumetric-Modulated Arc Therapy Planning in Rectal Cancer Radiotherapy?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, K; Chang, X; Wang, J

Purpose: To evaluate whether Auto-Planning based volumetric-modulated radiotherapy (auto-VMAT) can reduce manual interaction time during treatment planning and improve plan quality for rectal cancer radiotherapy. Methods: Ten rectal cancer patients (stage II and III) after radical resection using Dixon surgery were enrolled. All patients were treated with VMAT technique. The manual VMAT plans (man-VMAT) were designed in the Pinnacle treatment planning system (Version 9.10) following the standard treatment planning procedure developed in our department. Clinical plans were manually designed by our experienced dosimetrists. Additionally, an auto-VMAT plan was created for each patient using Auto-Planning module. However, manual interaction was stillmore » applied to meet the clinical requirements. The treatment planning time and plan quality surrogated by the DVH parameters were compared between manual and automated plans. Results: The total planning time and manual interaction time were 50.38 and 4.47 min for the auto-VMAT and 36.81 and 16.94 min for the man-VMAT (t=60.14,−23.86; p=0.000, 0.000). In terms of plan quality, both plans meet the clinical requirements. The PTV homogeneity index (HI) and conformity index (CI) were 0.054 and 0.822 for the auto-VMAT and 0.059 and 0.815 for the man-VMAT (t=−1.72, 0.36;p=0.119,0.730).Compared to the man-VMAT, the auto-VMAT showed reduction of 11.9% and 0.7% in V40 and V50 of the bladder, respectively.The V30 and D mean were reduced by 14.0% and 5.1Gy in the left femur and 12.2% and 3.8Gy in the right femur. Conclusion: The Auto-Planning based VMAT plans not only shows similar or superior plan quality to the manual ones in the rectal cancer radiotherapy, but also improve the planning efficiency significantly. However, manual interactions are still required to achieve a clinically acceptable plan based on our experiences.« less

The role of action planning and plan enactment for smoking cessation

PubMed Central

2013-01-01

Background Several studies have reemphasized the role of action planning. Yet, little attention has been paid to the role of plan enactment. This study assesses the determinants and the effects of action planning and plan enactment on smoking cessation. Methods One thousand and five participants completed questionnaires at baseline and at follow-ups after one and six months. Factors queried were part of the I-Change model. Descriptive analyses were used to assess which plans were enacted the most. Multivariate linear regression analyses were used to assess whether the intention to quit smoking predicted action planning and plan enactment, and to assess which factors would predict quitting behavior. Subsequently, both multivariate and univariate regression analyses were used to assess which particular action plans would be most effective in predicting quitting behavior. Similar analyses were performed among a subsample of smokers prepared to quit within one month. Results Smokers who intended to quit smoking within the next month had higher levels of action planning than those intending to quit within a year. Additional predictors of action planning were being older, being female, having relatively low levels of cigarette dependence, perceiving more positive and negative consequences of quitting, and having high self-efficacy toward quitting. Plan enactment was predicted by baseline intention to quit and levels of action planning. Regression analysis revealed that smoking cessation after six months was predicted by low levels of depression, having a non-smoking partner, the intention to quit within the next month, and plan enactment. Only 29% of the smokers who executed relatively few plans had quit smoking versus 59% of the smokers who executed many plans. The most effective preparatory plans for smoking cessation were removing all tobacco products from the house and choosing a specific date to quit. Conclusion Making preparatory plans to quit smoking is important because it also predicts plan enactment, which is predictive of smoking cessation. Not all action plans were found to be predictive of smoking cessation. The effects of planning were not very much different between the total sample and smokers prepared to quit within one month. PMID:23622256

Optimism in Enrollment Management

ERIC Educational Resources Information Center

Buster-Williams, Kimberley

2016-01-01

Enrollment managers, like most managers, have goals that must be focused on with precision, excitement, and vigor. Enrollment managers must excel at enrollment planning. Typically, enrollment planning unites undergraduate and graduate recruitment plans, out-of-state recruitment plans, marketing plans, retention plans, international enrollment…

Strategic Planning for Independent Schools.

ERIC Educational Resources Information Center

Stone, Susan C.

This manual is intended to serve independent schools beginning strategic planning methods. Chapter 1, "The Case for Strategic Planning," suggests replacing the term "long range planning" with the term "strategic planning," which emphasizes change. The strategic planning and policy development process begins with…

Journey to 2030 : transportation plan of the Boston region metropolitan planning organization.

DOT National Transportation Integrated Search

2007-06-28

JOURNEY to 2030, the Transportation Plan of the Boston Region Metropolitan Planning Organization (referred to as the Plan), is the long-range, comprehensive transportation planning document for the Boston region. The region encompasses 101 cities and...

Drug Plan Coverage Rules

MedlinePlus

... the first time Filling a prescription without your new plan card Costs for Medicare drug coverage Joining a health or drug plan How Part D works with other insurance Find health & drug plans Drug plan coverage rules Note Call your Medicare drug plan to find ...

48 CFR 806.570 - Planning requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Planning requirements. 806... AND ACQUISITION PLANNING COMPETITION REQUIREMENTS Competition Advocates 806.570 Planning requirements... planning that is required. (3) A description of how to integrate the Competition Plan into advance...

Analysis of The Planning Education in the Light of the Contemporary Trends in Planning

NASA Astrophysics Data System (ADS)

Husar, Milan; Ceren Varis, Sila; Ondrejicka, Vladimir

2017-12-01

This paper examines the way the planning education is taught and examines the recent trends in the curricula of planning education institutions. The introduction of changing economic systems and planning in the field of education is discussed against these changes. Additionally, the evolution in the planner’s role and how it affects the planning education is discussed. The paper is addressing trends and challenges the countries and their planning changes are facing in 21st century. The trends such as increasing globalization, fuzziness of spatial structures and their borders, complexity and uncertainty and the growing interconnectedness of the world are discussed. Another aim is to prepare a common ground, a platform at the university level for scientific cooperation in the field of planning. This study aims at examining the situation of planning in the contemporary world. The identified challenges include the need for more flexibility in planning and planning education, the emergence of innovations and creativity in planners and planning projects, the necessity of promoting soft skills while keeping the existing technical nature of planning and lastly, the need for more interdisciplinary work. The final part of the paper is discussing the future planning education and recommendations on how the schools of planning should reflect these changes.

Strategic planning processes and hospital financial performance.

PubMed

Kaissi, Amer A; Begun, James W

2008-01-01

Many common management practices in healthcare organizations, including the practice of strategic planning, have not been subject to widespread assessment through empirical research. If management practice is to be evidence-based, evaluations of such common practices need to be undertaken. The purpose of this research is to provide evidence on the extent of strategic planning practices and the association between hospital strategic planning processes and financial performance. In 2006, we surveyed a sample of 138 chief executive officers (CEOs) of hospitals in the state of Texas about strategic planning in their organizations and collected financial information on the hospitals for 2003. Among the sample hospitals, 87 percent reported having a strategic plan, and most reported that they followed a variety of common practices recommended for strategic planning-having a comprehensive plan, involving physicians, involving the board, and implementing the plan. About one-half of the hospitals assigned responsibility for the plan to the CEO. We tested the association between these planning characteristics in 2006 and two measures of financial performance for 2003. Three dimensions of the strategic planning process--having a strategic plan, assigning the CEO responsibility for the plan, and involving the board--are positively associated with earlier financial performance. Further longitudinal studies are needed to evaluate the cause-and-effect relationship between planning and performance.

Automation and Intensity Modulated Radiation Therapy for Individualized High-Quality Tangent Breast Treatment Plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Purdie, Thomas G., E-mail: Tom.Purdie@rmp.uhn.on.ca; Department of Radiation Oncology, University of Toronto, Toronto, Ontario; Techna Institute, University Health Network, Toronto, Ontario

Purpose: To demonstrate the large-scale clinical implementation and performance of an automated treatment planning methodology for tangential breast intensity modulated radiation therapy (IMRT). Methods and Materials: Automated planning was used to prospectively plan tangential breast IMRT treatment for 1661 patients between June 2009 and November 2012. The automated planning method emulates the manual steps performed by the user during treatment planning, including anatomical segmentation, beam placement, optimization, dose calculation, and plan documentation. The user specifies clinical requirements of the plan to be generated through a user interface embedded in the planning system. The automated method uses heuristic algorithms to definemore » and simplify the technical aspects of the treatment planning process. Results: Automated planning was used in 1661 of 1708 patients receiving tangential breast IMRT during the time interval studied. Therefore, automated planning was applicable in greater than 97% of cases. The time for treatment planning using the automated process is routinely 5 to 6 minutes on standard commercially available planning hardware. We have shown a consistent reduction in plan rejections from plan reviews through the standard quality control process or weekly quality review multidisciplinary breast rounds as we have automated the planning process for tangential breast IMRT. Clinical plan acceptance increased from 97.3% using our previous semiautomated inverse method to 98.9% using the fully automated method. Conclusions: Automation has become the routine standard method for treatment planning of tangential breast IMRT at our institution and is clinically feasible on a large scale. The method has wide clinical applicability and can add tremendous efficiency, standardization, and quality to the current treatment planning process. The use of automated methods can allow centers to more rapidly adopt IMRT and enhance access to the documented improvements in care for breast cancer patients, using technologies that are widely available and already in clinical use.« less

Automation and intensity modulated radiation therapy for individualized high-quality tangent breast treatment plans.

PubMed

Purdie, Thomas G; Dinniwell, Robert E; Fyles, Anthony; Sharpe, Michael B

2014-11-01

To demonstrate the large-scale clinical implementation and performance of an automated treatment planning methodology for tangential breast intensity modulated radiation therapy (IMRT). Automated planning was used to prospectively plan tangential breast IMRT treatment for 1661 patients between June 2009 and November 2012. The automated planning method emulates the manual steps performed by the user during treatment planning, including anatomical segmentation, beam placement, optimization, dose calculation, and plan documentation. The user specifies clinical requirements of the plan to be generated through a user interface embedded in the planning system. The automated method uses heuristic algorithms to define and simplify the technical aspects of the treatment planning process. Automated planning was used in 1661 of 1708 patients receiving tangential breast IMRT during the time interval studied. Therefore, automated planning was applicable in greater than 97% of cases. The time for treatment planning using the automated process is routinely 5 to 6 minutes on standard commercially available planning hardware. We have shown a consistent reduction in plan rejections from plan reviews through the standard quality control process or weekly quality review multidisciplinary breast rounds as we have automated the planning process for tangential breast IMRT. Clinical plan acceptance increased from 97.3% using our previous semiautomated inverse method to 98.9% using the fully automated method. Automation has become the routine standard method for treatment planning of tangential breast IMRT at our institution and is clinically feasible on a large scale. The method has wide clinical applicability and can add tremendous efficiency, standardization, and quality to the current treatment planning process. The use of automated methods can allow centers to more rapidly adopt IMRT and enhance access to the documented improvements in care for breast cancer patients, using technologies that are widely available and already in clinical use. Copyright © 2014 Elsevier Inc. All rights reserved.

Inverse optimization of objective function weights for treatment planning using clinical dose-volume histograms.

PubMed

Babier, Aaron; Boutilier, Justin J; Sharpe, Michael B; McNiven, Andrea L; Chan, Timothy C Y

2018-05-10

We developed and evaluated a novel inverse optimization (IO) model to estimate objective function weights from clinical dose-volume histograms (DVHs). These weights were used to solve a treatment planning problem to generate 'inverse plans' that had similar DVHs to the original clinical DVHs. Our methodology was applied to 217 clinical head and neck cancer treatment plans that were previously delivered at Princess Margaret Cancer Centre in Canada. Inverse plan DVHs were compared to the clinical DVHs using objective function values, dose-volume differences, and frequency of clinical planning criteria satisfaction. Median differences between the clinical and inverse DVHs were within 1.1 Gy. For most structures, the difference in clinical planning criteria satisfaction between the clinical and inverse plans was at most 1.4%. For structures where the two plans differed by more than 1.4% in planning criteria satisfaction, the difference in average criterion violation was less than 0.5 Gy. Overall, the inverse plans were very similar to the clinical plans. Compared with a previous inverse optimization method from the literature, our new inverse plans typically satisfied the same or more clinical criteria, and had consistently lower fluence heterogeneity. Overall, this paper demonstrates that DVHs, which are essentially summary statistics, provide sufficient information to estimate objective function weights that result in high quality treatment plans. However, as with any summary statistic that compresses three-dimensional dose information, care must be taken to avoid generating plans with undesirable features such as hotspots; our computational results suggest that such undesirable spatial features were uncommon. Our IO-based approach can be integrated into the current clinical planning paradigm to better initialize the planning process and improve planning efficiency. It could also be embedded in a knowledge-based planning or adaptive radiation therapy framework to automatically generate a new plan given a predicted or updated target DVH, respectively.

Planning the Breast Boost: Comparison of Three Techniques and Evolution of Tumor Bed During Treatment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hepel, Jaroslaw T.; Department of Radiation Oncology, Brown University, Rhode Island Hospital, Providence, RI; Evans, Suzanne B.

2009-06-01

Purpose: To evaluate the accuracy of two clinical techniques for electron boost planning compared with computed tomography (CT)-based planning. Additionally, we evaluated the tumor bed characteristics at whole breast planning and boost planning. Methods and Materials: A total of 30 women underwent tumor bed boost planning within 2 weeks of completing whole breast radiotherapy using three planning techniques: scar-based planning, palpation/clinical-based planning, and CT-based planning. The plans were analyzed for dosimetric coverage of the CT-delineated tumor bed. The cavity visualization score was used to define the CT-delineated tumor bed as well or poorly defined. Results: Scar-based planning resulted in inferiormore » tumor bed coverage compared with CT-based planning, with the minimal dose received by 90% of the target volume >90% in 53% and a geographic miss in 53%. The results of palpation/clinical-based planning were significantly better: 87% and 10% for the minimal dose received by 90% of the target volume >90% and geographic miss, respectively. Of the 30 tumor beds, 16 were poorly defined by the cavity visualization score. Of these 16, 8 were well demarcated by the surgical clips. The evaluation of the 22 well-defined tumor beds revealed similar results. A comparison of the tumor bed volume from the initial planning CT scan to the boost planning CT scan revealed a decrease in size in 77% of cases. The mean decrease in volume was 52%. Conclusion: The results of our study have shown that CT-based planning allows for optimal tumor bed coverage compared with clinical and scar-based approaches. However, in the setting of a poorly visualized cavity on CT without surgical clips, palpation/clinical-based planning can help delineate the appropriate target volumes and is superior to scar-based planning. CT simulation at boost planning could allow for a reduction in the boost volumes.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huh, S; Lee, S; Dagan, R

Purpose: To investigate the feasibility of utilizing Dynamic Arc (DA) and IMRT with 5mm MLC leaf of VERO treatment unit for SRS/FSRT brain cancer patients with non-invasive stereotactic treatments. The DA and IMRT plans using the VERO unit (BrainLab Inc, USA) are compared with cone-based planning and proton plans to evaluate their dosimetric advantages. Methods: The Vero treatment has unique features like no rotational or translational movements of the table during treatments, Dynamic Arc/IMRT, tracking of IR markers, limitation of Ring rotation. Accuracies of the image fusions using CBCT, orthogonal x-rays, and CT are evaluated less than ∼ 0.7mm withmore » a custom-made target phantom with 18 hidden targets. 1mm margin is given to GTV to determine PTV for planning constraints considering all the uncertainties of planning computer and mechanical uncertainties of the treatment unit. Also, double-scattering proton plans with 6F to 9F beams and typical clinical parameters, multiple isocenter plans with 6 to 21 isocenters, and DA/IMRT plans are evaluated to investigate the dosimetric advantages of the DA/IMRT for complex shape of targets. Results: 3 Groups of the patients are divided: (1) Group A (complex target shape), CI's are same for IMRT, and DGI of the proton plan are better by 9.5% than that of the IMRT, (2) Group B, CI of the DA plans (1.91+/−0.4) are better than cone-based plan, while DGI of the DA plan is 4.60+/−1.1 is better than cone-based plan (5.32+/−1.4), (3) Group C (small spherical targets), CI of the DA and cone-based plans are almost the same. Conclusion: For small spherical targets, cone-based plans are superior to other 2 plans: DS proton and DA plans. For complex or irregular plans, dynamic and IMRT plans are comparable to cone-based and proton plans for complex targets.« less

Dosimetric benefits of automation in the treatment of lower thoracic esophageal cancer: Is manual planning still an alternative option?

PubMed

Li, Xiadong; Wang, Lu; Wang, Jiahao; Han, Xu; Xia, Bing; Wu, Shixiu; Hu, Weigang

2017-01-01

This study aimed to design automated volumetric-modulated arc therapy (VMAT) plans in Pinnacle auto-planning and compare it with manual plans for patients with lower thoracic esophageal cancer (EC). Thirty patients with lower thoracic EC were randomly selected for replanning VMAT plans using auto-planning in Pinnacle treatment planning system (TPS) version 9.10. Historical plans of these patients were then compared. Dose-volume histogram (DVH) statistics, dose uniformity, and dose homogeneity were analyzed to evaluate treatment plans. Auto-planning was superior in terms of conformity index (CI) and homogeneity index (HI) for planning target volume (PTV), significantly improving 8.2% (p = 0.013) and 25% (p = 0.007) compared with manual planning, respectively, and decreasing dose of heart and liver irradiated by 20 to 40 Gy and 5 to 30 Gy, respectively (p < 0.05). Meanwhile, auto-planning further reduced the maximum dose (D max ) of spinal cord by 6.9 Gy compared with manual planning (p = 0.000). Additionally, manual planning showed the significantly lower low-dose volume (V 5 ) for the lung (p = 0.005). For auto-planning, the V 5 of the lung was significantly associated with the relative volume index (the volume ratio of PTV to the lung), and the correlation coefficient (R) and p-value were 0.994 and 0.000. Pinnacle auto-planning achieved superior target conformity and homogeneity and similar target coverage compared with historical manual planning. Most of organs at risk (OARs) sparing was significantly improved by auto-planning except for the V 5 of the lung, and the low dose distribution was highly associated with PTV volume and lung volume in auto-planning. Copyright © 2017 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Improvement of VMAT plan quality for head and neck cancer with high resolution fluences generated by couch shift between arcs.

PubMed

Park, Jong Min; Park, So-Yeon; Wu, Hong-Gyun; Kim, Jung-In

2018-02-01

To investigate the changes in quality of the volumetric modulated arc therapy (VMAT) plans with couch-shift between arcs by half of a multi-leaf collimator (MLC) leaf width. A total of 22 patients with head-and-neck cancer were retrospectively selected. Since the smallest MLC leaf width was 5 mm in this study, the couch was shifted by 2.5 mm in the longitudinal-direction between arcs to increase the resolution of fluence map. A total of three types of VMAT plans were generated for each patient; the three types of plans were a two-full-arc plan without couch-shift (NS plan), a two-half-arc-pair plan with couch-shift (HAS plan), and a two-full-arc pair plan with couch-shift (FAS plan). Changes in the dose-volumetric parameters were investigated. The FAS plan showed the best plan quality for the target volumes and organs at risk compared to the NS and HAS plans. However, the magnitudes of differences among the three types of plans were minimal, and every plan was clinically acceptable. The average integral doses of the NS, HAS, and FAS plans were 160,549 ± 37,600 Gy-cc, 147,828 ± 33,343 Gy-cc, and 156,030 ± 36,263 Gy-cc, respectively. The average monitor unit of the NS, HAS, and FAS plans were 717 ± 120 MU, 648 ± 100 MU, and 763 ± 158 MU, respectively. The HAS plan was better than the others in terms of normal tissue sparing and plan efficiency. By shifting the couch by half of the MLC leaf width in the longitudinal direction between arcs, the VMAT plan quality could be improved. Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

20 CFR 1002.171 - How does the continuation of health plan benefits apply to a multiemployer plan that provides...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false How does the continuation of health plan benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account... benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account...

20 CFR 1002.171 - How does the continuation of health plan benefits apply to a multiemployer plan that provides...

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false How does the continuation of health plan benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account... benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account...

20 CFR 1002.171 - How does the continuation of health plan benefits apply to a multiemployer plan that provides...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false How does the continuation of health plan benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account... benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account...

20 CFR 1002.171 - How does the continuation of health plan benefits apply to a multiemployer plan that provides...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false How does the continuation of health plan benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account... benefits apply to a multiemployer plan that provides health plan coverage through a health benefits account...

Guidelines for Analysis of Communicable Disease Control Planning in Developing Countries. Volume 1: Communicable Diseases Control Planning. International Health Planning Methods Series.

ERIC Educational Resources Information Center

Chin, James

Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this first of ten manuals in the International Health Planning Methods Series deals with planning and evaluation of communicable disease control programs. The first…

Defense.gov - Special Report: VOTE

Science.gov Websites

Voting Action Plan (pdf) 2013 USMC Voting Action Plan (pdf) 2013 Army Voting Action Plan (pdf) Air Force Voting Plan 2012-13 (pdf) Army Voting Action Plan 2012 (pdf) Marine Corps Voting Action Plan 2012 (pdf ) Navy Voting Action Plan (pdf) Overseas Vote Foundation Project Vote Smart Preparing for the 2012

Futures Research and the Strategic Planning Process: Implications for Long-Range Planning in Higher Education.

ERIC Educational Resources Information Center

Morrison, James L.; Renfro, William L.

The concepts of long-range planning and strategic planning are explained, and a planning model is proposed. Attention is directed to an environmental scanning model that is congruent with the concept of strategic planning and that emerges from one portion of the futures research community, issues management. A third planning model, the strategic…

Predicting Changes in Physical Activity among Adolescents: The Role of Self-Efficacy, Intention, Action Planning and Coping Planning

ERIC Educational Resources Information Center

Araujo-Soares, Vera; McIntyre, Teresa; Sniehotta, Falko F.

2009-01-01

This paper aims to test the direct predictors of the theory of planned behaviour (TPB), action planning and coping planning as predictors of changes in physical activity (PA) in 157 adolescents (mean age: 12). TPB measures, the Action Planning and Coping Planning Scales (APCPS) and the International Physical Activity Questionnaires were measured…

26 CFR 1.414(e)-1 - Definition of church plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... or more unrelated trades or businesses. (i) (A) A plan, other than a plan in existence on September 2... paragraphs (b) and (if applicable) (c) of this section. If at any time during its existence a plan is not a... become a church plan. (b) Unrelated businesses—(1) In general. A plan is not a church plan unless it is...

Guidelines for Analysis of Environmental Health Planning in Developing Countries. Volume 2: Environmental Health Planning. International Health Planning Methods Series.

ERIC Educational Resources Information Center

Fraser, Renee White; Shani, Hadasa

Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this second of ten manuals in the International Health Planning Methods Series deals with assessment, planning, and evaluation in the field of environmental health.…

Scripts and information units in future planning: Interactions between a past and a future planning task.

PubMed

Cordonnier, Aline; Barnier, Amanda J; Sutton, John

2016-01-01

Research on future thinking has emphasized how episodic details from memories are combined to create future thoughts, but has not yet examined the role of semantic scripts. In this study, participants recalled how they planned a past camping trip in Australia (past planning task) and imagined how they would plan a future camping trip (future planning task), set either in a familiar (Australia) or an unfamiliar (Antarctica) context. Transcripts were segmented into information units that were coded according to semantic category (e.g., where, when, transport, material, actions). Results revealed a strong interaction between tasks and their presentation order. Starting with the past planning task constrained the future planning task when the context was familiar. Participants generated no new information when the future camping trip was set in Australia and completed second (after the past planning task). Conversely, starting with the future planning task facilitated the past planning task. Participants recalled more information units of their past plan when the past planning task was completed second (after the future planning task). These results shed new light on the role of scripts in past and future thinking and on how past and future thinking processes interact.

Comparison of treatment plans: a retrospective study by the method of radiobiological evaluation

NASA Astrophysics Data System (ADS)

Puzhakkal, Niyas; Kallikuzhiyil Kochunny, Abdullah; Manthala Padannayil, Noufal; Singh, Navin; Elavan Chalil, Jumanath; Kulangarakath Umer, Jamshad

2016-09-01

There are many situations in radiotherapy where multiple treatment plans need to be compared for selection of an optimal plan. In this study we performed the radiobiological method of plan evaluation to verify the treatment plan comparison procedure of our clinical practice. We estimated and correlated various radiobiological dose indices with physical dose metrics for a total of 30 patients representing typical cases of head and neck, prostate and brain tumors. Three sets of plans along with a clinically approved plan (final plan) treated by either Intensity Modulated Radiation Therapy (IMRT) or Rapid Arc (RA) techniques were considered. The study yielded improved target coverage for final plans, however, no appreciable differences in doses and the complication probabilities of organs at risk were noticed. Even though all four plans showed adequate dose distributions, from dosimetric point of view, the final plan had more acceptable dose distribution. The estimated biological outcome and dose volume histogram data showed least differences between plans for IMRT when compared to RA. Our retrospective study based on 120 plans, validated the radiobiological method of plan evaluation. The tumor cure or normal tissue complication probabilities were found to be correlated with the corresponding physical dose indices.

Semiautomated head-and-neck IMRT planning using dose warping and scaling to robustly adapt plans in a knowledge database containing potentially suboptimal plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schmidt, Matthew, E-mail: matthew.schmidt@varian.com; Grzetic, Shelby; Lo, Joseph Y.

Purpose: Prior work by the authors and other groups has studied the creation of automated intensity modulated radiotherapy (IMRT) plans of equivalent quality to those in a patient database of manually created clinical plans; those database plans provided guidance on the achievable sparing to organs-at-risk (OARs). However, in certain sites, such as head-and-neck, the clinical plans may not be sufficiently optimized because of anatomical complexity and clinical time constraints. This could lead to automated plans that suboptimally exploit OAR sparing. This work investigates a novel dose warping and scaling scheme that attempts to reduce effects of suboptimal sparing in clinicalmore » database plans, thus improving the quality of semiautomated head-and-neck cancer (HNC) plans. Methods: Knowledge-based radiotherapy (KBRT) plans for each of ten “query” patients were semiautomatically generated by identifying the most similar “match” patient in a database of 103 clinical manually created patient plans. The match patient’s plans were adapted to the query case by: (1) deforming the match beam fluences to suit the query target volume and (2) warping the match primary/boost dose distribution to suit the query geometry and using the warped distribution to generate query primary/boost optimization dose-volume constraints. Item (2) included a distance scaling factor to improve query OAR dose sparing with respect to the possibly suboptimal clinical match plan. To further compensate for a component plan of the match case (primary/boost) not optimally sparing OARs, the query dose volume constraints were reduced using a dose scaling factor to be the minimum from either (a) the warped component plan (primary or boost) dose distribution or (b) the warped total plan dose distribution (primary + boost) scaled in proportion to the ratio of component prescription dose to total prescription dose. The dose-volume constraints were used to plan the query case with no human intervention to adjust constraints during plan optimization. Results: KBRT and original clinical plans were dosimetrically equivalent for parotid glands (mean/median doses), spinal cord, and brainstem (maximum doses). KBRT plans significantly reduced larynx median doses (21.5 ± 6.6 Gy to 17.9 ± 3.9 Gy), and oral cavity mean (32.3 ± 6.2 Gy to 28.9 ± 5.4 Gy) and median (28.7 ± 5.7 Gy to 23.2 ± 5.3 Gy) doses. Doses to ipsilateral parotid gland, larynx, oral cavity, and brainstem were lower or equivalent in the KBRT plans for the majority of cases. By contrast, KBRT plans generated without the dose warping and dose scaling steps were not significantly different from the clinical plans. Conclusions: Fast, semiautomatically generated HNC IMRT plans adapted from existing plans in a clinical database can be of equivalent or better quality than manually created plans. The reductions in OAR doses in the semiautomated plans, compared to the clinical plans, indicate that the proposed dose warping and scaling method shows promise in mitigating the impact of suboptimal clinical plans.« less

Teaching Treatment Planning.

ERIC Educational Resources Information Center

Seligman, Linda

1993-01-01

Describes approach to teaching treatment planning that author has used successfully in both seminars and graduate courses. Clarifies nature and importance of systematic treatment planning, then describes context in which treatment planning seems more effectively taught, and concludes with step-by-step plan for teaching treatment planning.…

40 CFR 300.205 - Planning and coordination structure.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 29 2013-07-01 2013-07-01 false Planning and coordination structure... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.205 Planning and coordination structure. (a... assure pre-planning of joint response efforts, including appropriate procedures for mechanical recovery...

40 CFR 300.205 - Planning and coordination structure.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 28 2014-07-01 2014-07-01 false Planning and coordination structure... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.205 Planning and coordination structure. (a... assure pre-planning of joint response efforts, including appropriate procedures for mechanical recovery...

40 CFR 300.205 - Planning and coordination structure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Planning and coordination structure... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.205 Planning and coordination structure. (a... assure pre-planning of joint response efforts, including appropriate procedures for mechanical recovery...

40 CFR 300.205 - Planning and coordination structure.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Planning and coordination structure... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.205 Planning and coordination structure. (a... assure pre-planning of joint response efforts, including appropriate procedures for mechanical recovery...

29 CFR 4231.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... several funding media used for a single plan (such as between trusts, between annuity contracts, or..., AND OTHER RULES APPLICABLE TO MULTIEMPLOYER PLANS MERGERS AND TRANSFERS BETWEEN MULTIEMPLOYER PLANS... market value, IRS, multiemployer plan, PBGC, plan, plan year, and PN. In addition, for purposes of this...

36 CFR 219.7 - Plan decisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Forest System Land and Resource Management Planning The Framework for Planning § 219.7 Plan decisions... the Forest Service national strategic plan to specific national forests and grasslands. While plan... management actions necessary for the achievement of desired conditions and objectives and compliance with...

36 CFR 219.7 - Plan decisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Forest System Land and Resource Management Planning The Framework for Planning § 219.7 Plan decisions... the Forest Service national strategic plan to specific national forests and grasslands. While plan... management actions necessary for the achievement of desired conditions and objectives and compliance with...

Making a successful transition to cash balance. Using employee choice and financial education.

PubMed

Scahill, P; Wiley, P

2000-01-01

As employee work patterns change, the need for flexible plan design has increased. Hybrid plans such as cash balance plans offer a plan design variation that incorporates elements of the traditional defined benefit plan as well as those of defined contribution plans. This article examines plan design trends and discusses both negative and positive reactions to those trends. Finally, the solution of offering choice to plan participants is suggested, and the issues that must be considered are discussed.

Computer Aided Process Planning (CAPP): The User Interface for the Fabrication Module of the Rapid Design System

DTIC Science & Technology

1991-01-01

plan. The Fabrication Planning Module automatically creates a plan using information from the Feature Based Design Environment (FBDE) of the RDS. It...llll By using the user Interface, the final process plan can be modified in many different ways. The translation of a design feature to a more...for the review and modification of a process plan. The Fabrication Planning Module automatically creates a plan using information from the Feature Based

Robustness via Run-Time Adaptation of Contingent Plans

NASA Technical Reports Server (NTRS)

Bresina, John L.; Washington, Richard; Norvig, Peter (Technical Monitor)

2000-01-01

In this paper, we discuss our approach to making the behavior of planetary rovers more robust for the purpose of increased productivity. Due to the inherent uncertainty in rover exploration, the traditional approach to rover control is conservative, limiting the autonomous operation of the rover and sacrificing performance for safety. Our objective is to increase the science productivity possible within a single uplink by allowing the rover's behavior to be specified with flexible, contingent plans and by employing dynamic plan adaptation during execution. We have deployed a system exhibiting flexible, contingent execution; this paper concentrates on our ongoing efforts on plan adaptation, Plans can be revised in two ways: plan steps may be deleted, with execution continuing with the plan suffix; and the current plan may be merged with an "alternate plan" from an on-board library. The plan revision action is chosen to maximize the expected utility of the plan. Plan merging and action deletion constitute a more conservative general-purpose planning system; in return, our approach is more efficient and more easily verified, two important criteria for deployed rovers.

An exploratory study of healthcare strategic planning in two metropolitan areas.

PubMed

Begun, James W; Kaissi, Amer A

2005-01-01

Little is known about empirical variation in the extent to which healthcare organizations conduct formal strategic planning or the extent to which strategic planning affects performance. Structural contingency and complexity science theory offer differing interpretations of the value of strategic planning. Structural contingency theory emphasizes adaptation to achieve organizational fit with a changing environment and views strategic planning as a way to chart the organization's path. Complexity science argues that planning is largely futile in changing environments. Interviews of leaders in 20 healthcare organizations in the metropolitan areas of Minneapolis/St. Paul, Minnesota, and San Antonio, Texas, reveal that strategic planning is a common and valued function in healthcare organizations. Respondents emphasized the need to continuously update strategic plans, involve physicians and the governing board, and integrate strategic plans with other organizational plans. Most leaders expressed that strategic planning contributes to organizational focus, fosters stakeholder participation and commitment, and leads to achievement of strategic goals. Because the widespread belief in strategic planning is based largely on experience, intuition, and faith, we present recommendations for developing an evidence base for healthcare strategic planning.

Preparing strategic information management plans for hospitals: a practical guideline SIM plans for hospitals: a guideline.

PubMed

Brigl, B; Ammenwerth, E; Dujat, C; Gräber, S; Grosse, A; Häber, A; Jostes, C; Winter, A

2005-01-01

Systematic information management in hospitals demands for a strategic information management plan (SIM plan). As preparing a SIM plan is a considerable challenge we provide a practical guideline that is directly applicable when a SIM plan is going to be prepared. The guideline recommends a detailed structure of a SIM plan and gives advice about its content and the preparation process. It may be used as template, which can be adapted to the individual demands of any hospital. The guideline was used in several hospitals preparing a SIM plan. Experiences showed that the SIM plans could be prepared very efficiently and timely using the guideline, that the proposed SIM plan structure suited well, that the guideline offers enough flexibility to meet the requirements of the individual hospitals and that the specific recommendations of the guideline were very helpful. Nevertheless, we must strive for a more comprehensive theory of strategic information management planning which -- in the sense of enterprise architecture planning -- represents the intrinsic correlations of the different parts of a SIM plan to a greater extent.

The Effect of Benefits, Premiums, and Health Risk on Health Plan Choice in the Medicare Program

PubMed Central

Atherly, Adam; Dowd, Bryan E; Feldman, Roger

2004-01-01

Objective To estimate the effect of Medicare+Choice (M+C) plan premiums and benefits and individual beneficiary characteristics on the probability of enrollment in a Medicare+Choice plan. Data Source Individual data from the Medicare Current Beneficiary Survey were combined with plan-level data from Medicare Compare. Study Design Health plan choices, including the Medicare+Choice/Fee-for-Service decision and the choice of plan within the M+C sector, were modeled using limited information maximum likelihood nested logit. Principal Findings Premiums have a significant effect on plan selection, with an estimated out-of-pocket premium elasticity of −0.134 and an insurer-perspective elasticity of −4.57. Beneficiaries are responsive to plan characteristics, with prescription drug benefits having the largest marginal effect. Sicker beneficiaries were more likely to choose plans with drug benefits and diabetics were more likely to pick plans with vision coverage. Conclusions Plan characteristics significantly impact beneficiaries' decisions to enroll in Medicare M+C plans and individuals sort themselves systematically into plans based on individual characteristics. PMID:15230931

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gopan, O; Yang, F; Ford, E

Purpose: The physics plan check verifies various aspects of a treatment plan after dosimetrists have finished creating the plan. Some errors in the plan which are caught by the physics check could be caught earlier in the departmental workflow. The purpose of this project was to evaluate a plan checking script that can be run within the treatment planning system (TPS) by the dosimetrists prior to plan approval and export to the record and verify system. Methods: A script was created in the Pinnacle TPS to automatically check 15 aspects of a plan for clinical practice conformity. The script outputsmore » a list of checks which the plan has passed and a list of checks which the plan has failed so that appropriate adjustments can be made. For this study, the script was run on a total of 108 plans: IMRT (46/108), VMAT (35/108) and SBRT (27/108). Results: Of the plans checked by the script, 77/108 (71%) failed at least one of the fifteen checks. IMRT plans resulted in more failed checks (91%) than VMAT (51%) or SBRT (63%), due to the high failure rate of an IMRT-specific check, which checks that no IMRT segment < 5 MU. The dose grid size and couch removal checks caught errors in 10% and 14% of all plans – errors that ultimately may have resulted in harm to the patient. Conclusion: Approximately three-fourths of the plans being examined contain errors that could be caught by dosimetrists running an automated script embedded in the TPS. The results of this study will improve the departmental workflow by cutting down on the number of plans that, due to these types of errors, necessitate re-planning and re-approval of plans, increase dosimetrist and physician workload and, in urgent cases, inconvenience patients by causing treatment delays.« less

Adaptive Planning: Understanding Organizational Workload to Capability/ Capacity through Modeling and Simulation

NASA Technical Reports Server (NTRS)

Hase, Chris

2010-01-01

In August 2003, the Secretary of Defense (SECDEF) established the Adaptive Planning (AP) initiative [1] with an objective of reducing the time necessary to develop and revise Combatant Commander (COCOM) contingency plans and increase SECDEF plan visibility. In addition to reducing the traditional plan development timeline from twenty-four months to less than twelve months (with a goal of six months)[2], AP increased plan visibility to Department of Defense (DoD) leadership through In-Progress Reviews (IPRs). The IPR process, as well as the increased number of campaign and contingency plans COCOMs had to develop, increased the workload while the number of planners remained fixed. Several efforts from collaborative planning tools to streamlined processes were initiated to compensate for the increased workload enabling COCOMS to better meet shorter planning timelines. This paper examines the Joint Strategic Capabilities Plan (JSCP) directed contingency planning and staffing requirements assigned to a combatant commander staff through the lens of modeling and simulation. The dynamics of developing a COCOM plan are captured with an ExtendSim [3] simulation. The resulting analysis provides a quantifiable means by which to measure a combatant commander staffs workload associated with development and staffing JSCP [4] directed contingency plans with COCOM capability/capacity. Modeling and simulation bring significant opportunities in measuring the sensitivity of key variables in the assessment of workload to capability/capacity analysis. Gaining an understanding of the relationship between plan complexity, number of plans, planning processes, and number of planners with time required for plan development provides valuable information to DoD leadership. Through modeling and simulation AP leadership can gain greater insight in making key decisions on knowing where to best allocate scarce resources in an effort to meet DoD planning objectives.

Evaluating Primary Care Providers' Views on Survivorship Care Plans Generated by an Electronic Health Record System

PubMed Central

Donohue, SarahMaria; Sesto, Mary E.; Hahn, David L.; Buhr, Kevin A.; Jacobs, Elizabeth A.; Sosman, James M.; Andreason, Molly J.; Wiegmann, Douglas A.; Tevaarwerk, Amye J.

2015-01-01

Purpose: Survivorship care plans for cancer survivors may facilitate provider-to-provider communication. Primary care provider (PCP) perspectives on care plan provision and use are limited, especially when care plans are generated by an electronic health record (EHR) system. We sought to examine PCPs' perspectives regarding EHR-generated care plans. Methods: PCPs (N = 160) who were members of the Wisconsin Research and Education Network listserv received a sample 10-page plan (WREN cohort). PCPs (n = 81) who had or were currently seeing survivors enrolled onto one of our survivorship clinical trials received a copy of the survivor's personalized care plan (University of Wisconsin [UW] cohort). Both cohorts received a survey after reviewing the plan. All plans were generated within an EHR. Results: Forty-six and 26 PCPs participated in the WREN and UW cohorts, respectively. PCPs regarded EHR-generated plans as useful in coordinating care (88%), understanding treatments (94%), understanding treatment adverse effects (89%), and supporting clinical decisions (82%). Few felt using EHR-generated plans would disrupt clinic workflow (14%) or take too much time (11%). Most (89%) preferred receiving the plan via EHR. PCPs reported consistent provision (81%) and standard location in the medical record (89%) as key factors facilitating their use of survivorship care plans. Important facilitators of care plan use included a more abbreviated plan, ideally one to three pages (32%), and/or a plan specifically tailored to PCP use (57%). Conclusion: Plans were viewed as useful for coordinating care and making clinical decisions. However, PCPs desired shorter, clinician-oriented plans, accessible within an EHR and delivered and located in a standardized manner. PMID:25804989

Validation of Fully Automated VMAT Plan Generation for Library-Based Plan-of-the-Day Cervical Cancer Radiotherapy

PubMed Central

Breedveld, Sebastiaan; Voet, Peter W. J.; Heijkoop, Sabrina T.; Mens, Jan-Willem M.; Hoogeman, Mischa S.; Heijmen, Ben J. M.

2016-01-01

Purpose To develop and validate fully automated generation of VMAT plan-libraries for plan-of-the-day adaptive radiotherapy in locally-advanced cervical cancer. Material and Methods Our framework for fully automated treatment plan generation (Erasmus-iCycle) was adapted to create dual-arc VMAT treatment plan libraries for cervical cancer patients. For each of 34 patients, automatically generated VMAT plans (autoVMAT) were compared to manually generated, clinically delivered 9-beam IMRT plans (CLINICAL), and to dual-arc VMAT plans generated manually by an expert planner (manVMAT). Furthermore, all plans were benchmarked against 20-beam equi-angular IMRT plans (autoIMRT). For all plans, a PTV coverage of 99.5% by at least 95% of the prescribed dose (46 Gy) had the highest planning priority, followed by minimization of V45Gy for small bowel (SB). Other OARs considered were bladder, rectum, and sigmoid. Results All plans had a highly similar PTV coverage, within the clinical constraints (above). After plan normalizations for exactly equal median PTV doses in corresponding plans, all evaluated OAR parameters in autoVMAT plans were on average lower than in the CLINICAL plans with an average reduction in SB V45Gy of 34.6% (p<0.001). For 41/44 autoVMAT plans, SB V45Gy was lower than for manVMAT (p<0.001, average reduction 30.3%), while SB V15Gy increased by 2.3% (p = 0.011). AutoIMRT reduced SB V45Gy by another 2.7% compared to autoVMAT, while also resulting in a 9.0% reduction in SB V15Gy (p<0.001), but with a prolonged delivery time. Differences between manVMAT and autoVMAT in bladder, rectal and sigmoid doses were ≤ 1%. Improvements in SB dose delivery with autoVMAT instead of manVMAT were higher for empty bladder PTVs compared to full bladder PTVs, due to differences in concavity of the PTVs. Conclusions Quality of automatically generated VMAT plans was superior to manually generated plans. Automatic VMAT plan generation for cervical cancer has been implemented in our clinical routine. Due to the achieved workload reduction, extension of plan libraries has become feasible. PMID:28033342

Small employers and the challenge of sponsoring a retirement plan: results of the 1998 Small Employer Retirement Survey.

PubMed

Yakoboski, P; Ostuw, P

1998-10-01

Forty-two million individuals work for small employers; 9 million are participating in an employment-based retirement plan, while 33 million are not participating in a plan. This Issue Brief examines the barriers that prevent small employers from sponsoring a retirement plan, their level of knowledge about plans, and changes that might lead to plan sponsorship. It also examines the motivations of small employers that sponsor retirement plans. Small employers identify three main reasons for not offering a plan: employees' preferences for wages and/or other benefits, administrative costs, and uncertain revenue that makes it difficult to commit to a plan. Small employers without plans report being familiar with 401(k) and profit-sharing plans, but little else. Forty-seven percent report never having heard of the savings incentive match plan for employees (SIMPLE), and 55 percent report never having heard of simplified employee pensions (SEPs). There is apparent misunderstanding about retirement plans among small employers that do not sponsor one, especially with regard to costs. For example, 35 percent do not know that a plan can be set up for less than $2,000. What changes would lead to serious consideration of retirement plan sponsorship? In order of reported importance: increased company profits (66 percent), a business tax credit (64 percent), reduced administrative requirements (50 percent), demand from employees (49 percent), allowing key executives to save more in the plan (49 percent), and easing, i.e., lengthening, of vesting requirements (40 percent). Many small employers that sponsor a retirement plan cite business reasons among their motivations. Sixty-eight percent cite a "positive effect on employee attitude and performance" as a major reason for offering a plan. Fifty-six percent cite a "competitive advantage in employee recruitment and retention" as a major reason. Small employers with a retirement plan report direct benefits from sponsorship, but many of those without plans appear unaware of these potential benefits. The 1998 SERS indicates that effective public policy must educate workers regarding the need to make retirement planning and saving a priority, in addition to addressing employer concerns about offering plans. Furthermore, there is a need to educate small employers about the options available to them and what these options entail. Finally, it appears that many employers need to be informed of the potential benefits from plan sponsorship.

Autobiographical Planning and the Brain: Activation and Its Modulation by Qualitative Features.

PubMed

Spreng, R Nathan; Gerlach, Kathy D; Turner, Gary R; Schacter, Daniel L

2015-11-01

To engage in purposeful behavior, it is important to make plans, which organize subsequent actions. Most studies of planning involve "look-ahead" puzzle tasks that are unrelated to personal goals. We developed a task to assess autobiographical planning, which involves the formulation of personal plans in response to real-world goals, and examined autobiographical planning in 63 adults during fMRI scanning. Autobiographical planning was found to engage the default network, including medial-temporal lobe and midline structures, and executive control regions in lateral pFC and parietal cortex and caudate. To examine how specific qualitative features of autobiographical plans modulate neural activity, we performed parametric modulation analyses. Ratings of plan detail, novelty, temporal distance, ease of plan formulation, difficulty in goal completion, and confidence in goal accomplishment were used as covariates in six hierarchical linear regression models. This modeling procedure removed shared variance among the ratings, allowing us to determine the independent relationship between ratings of interest and trial-wise BOLD signal. We found that specific autobiographical planning, describing a detailed, achievable, and actionable planning process for attaining a clearly envisioned future, recruited both default and frontoparietal brain regions. In contrast, abstract autobiographical planning, plans that were constructed from more generalized semantic or affective representations of a less tangible and distant future, involved interactions among default, sensory perceptual, and limbic brain structures. Specific qualities of autobiographical plans are important predictors of default and frontoparietal control network engagement during plan formation and reflect the contribution of mnemonic and executive control processes to autobiographical planning.

Cabrillo College Master Plan, 2001-2004.

ERIC Educational Resources Information Center

Cabrillo Coll., Aptos, CA. Office of Institutional Research.

This document presents Cabrillo College's (California) master plan for 2001 to 2004. Major steps in compiling the master plan included: conducting environmental scanning, making planning assumptions, establishing goals, identifying objectives, developing strategies, and evaluating the plan. The plan is based on six broad goals: (1) to enable…

Financial planning considerations at retirement.

PubMed

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.

7 CFR 4284.630 - Other considerations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 1940 of this title. Applications for technical assistance or planning projects are generally excluded... within their plans the important environmental factors within the planning area and the potential environmental impacts of the plan on the planning area, as well as the alternative planning strategies that were...

Role of Australian primary healthcare organisations (PHCOs) in primary healthcare (PHC) workforce planning: lessons from abroad.

PubMed

Naccarella, Lucio; Buchan, James; Newton, Bill; Brooks, Peter

2011-08-01

To review international experience in order to inform Australian PHC workforce policy on the role of primary healthcare organisations (PHCOs/Medicare Locals) in PHC workforce planning. A NZ and UK study tour was conducted by the lead author, involving 29 key informant interviews with regard to PHCOs roles and the effect on PHC workforce planning. Interviews were audio-taped with consent, transcribed and analysed thematically. Emerging themes included: workforce planning is a complex, dynamic, iterative process and key criteria exist for doing workforce planning well; PHCOs lacked a PHC workforce policy framework to do workforce planning; PHCOs lacked authority, power and appropriate funding to do workforce planning; there is a need to align workforce planning with service planning; and a PHC Workforce Planning and Development Benchmarking Database is essential for local planning and evaluating workforce reforms. With the Australian government promoting the role of PHCOs in health system reform, reflections from abroad highlight the key action within PHC and PHCOs required to optimise PHC workforce planning.

A Search Algorithm for Generating Alternative Process Plans in Flexible Manufacturing System

NASA Astrophysics Data System (ADS)

Tehrani, Hossein; Sugimura, Nobuhiro; Tanimizu, Yoshitaka; Iwamura, Koji

Capabilities and complexity of manufacturing systems are increasing and striving for an integrated manufacturing environment. Availability of alternative process plans is a key factor for integration of design, process planning and scheduling. This paper describes an algorithm for generation of alternative process plans by extending the existing framework of the process plan networks. A class diagram is introduced for generating process plans and process plan networks from the viewpoint of the integrated process planning and scheduling systems. An incomplete search algorithm is developed for generating and searching the process plan networks. The benefit of this algorithm is that the whole process plan network does not have to be generated before the search algorithm starts. This algorithm is applicable to large and enormous process plan networks and also to search wide areas of the network based on the user requirement. The algorithm can generate alternative process plans and to select a suitable one based on the objective functions.

Explanation-based generalization of partially ordered plans

NASA Technical Reports Server (NTRS)

Kambhampati, Subbarao; Kedar, Smadar

1991-01-01

Most previous work in analytic generalization of plans dealt with totally ordered plans. These methods cannot be directly applied to generalizing partially ordered plans, since they do not capture all interactions among plan operators for all total orders of such plans. We introduce a new method for generalizing partially ordered plans. This method is based on providing explanation-based generalization (EBG) with explanations which systematically capture the interactions among plan operators for all the total orders of a partially-ordered plan. The explanations are based on the Modal Truth Criterion which states the necessary and sufficient conditions for ensuring the truth of a proposition at any point in a plan, for a class of partially ordered plans. The generalizations obtained by this method guarantee successful and interaction-free execution of any total order of the generalized plan. In addition, the systematic derivation of the generalization algorithms from the Modal Truth Criterion obviates the need for carrying out a separate formal proof of correctness of the EBG algorithms.

Streamlining Collaborative Planning in Spacecraft Mission Architectures

NASA Technical Reports Server (NTRS)

Misra, Dhariti; Bopf, Michel; Fishman, Mark; Jones, Jeremy; Kerbel, Uri; Pell, Vince

2000-01-01

During the past two decades, the planning and scheduling community has substantially increased the capability and efficiency of individual planning and scheduling systems. Relatively recently, research work to streamline collaboration between planning systems is gaining attention. Spacecraft missions stand to benefit substantially from this work as they require the coordination of multiple planning organizations and planning systems. Up to the present time this coordination has demanded a great deal of human intervention and/or extensive custom software development efforts. This problem will become acute with increased requirements for cross-mission plan coordination and multi -spacecraft mission planning. The Advanced Architectures and Automation Branch of NASA's Goddard Space Flight Center is taking innovative steps to define collaborative planning architectures, and to identify coordinated planning tools for Cross-Mission Campaigns. Prototypes are being developed to validate these architectures and assess the usefulness of the coordination tools by the planning community. This presentation will focus on one such planning coordination too], named Visual Observation Layout Tool (VOLT), which is currently being developed to streamline the coordination between astronomical missions

Systematizing the production of environmental plans: an Australian example

NASA Astrophysics Data System (ADS)

Davis, J. Richard

1985-09-01

Environmental planning legislation in New South Wales now requires local government authorities to draw up statutory plans that take into account, among other concerns, both the biophysical and the social environmental issues within their jurisdictions. The SIRO-PLAN method of plan production provides a systematic mechanism for fulfilling this requirement. This article describes the application of the method by planning researchers over 18 months to the production of a Local Environmental Plan for a rural local government in New South Wales. The policy formulation, the purposive data collection, and the deliberate adjustment of plans in order to recognize interest group requirements were all found to be valuable features of the method, while the translation of the ultimately chosen land-use plan into the explicit regulatory controls available to the local government authority was found to require further refinement. The capacity of SIRO-PLAN to quantify the resolution of competing environmental concerns in the final plan, although of value to planning researchers, proved too arcane for traditionally trained planners.

7 CFR 1207.303 - Plan.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Definitions § 1207.303 Plan. Plan means this potato research and...

7 CFR 1207.303 - Plan.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Definitions § 1207.303 Plan. Plan means this potato research and...

7 CFR 1207.303 - Plan.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Definitions § 1207.303 Plan. Plan means this potato research and...

7 CFR 1207.303 - Plan.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Definitions § 1207.303 Plan. Plan means this potato research and...

7 CFR 1207.303 - Plan.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE POTATO RESEARCH AND PROMOTION PLAN Potato Research and Promotion Plan Definitions § 1207.303 Plan. Plan means this potato research and...

MO-FG-CAMPUS-TeP3-04: Deliverable Robust Optimization in IMPT Using Quadratic Objective Function

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shan, J; Liu, W; Bues, M

Purpose: To find and evaluate the way of applying deliverable MU constraints into robust spot intensity optimization in Intensity-Modulated- Proton-Therapy (IMPT) to prevent plan quality and robustness from degrading due to machine deliverable MU-constraints. Methods: Currently, the influence of the deliverable MU-constraints is retrospectively evaluated by post-processing immediately following optimization. In this study, we propose a new method based on the quasi-Newton-like L-BFGS-B algorithm with which we turn deliverable MU-constraints on and off alternatively during optimization. Seven patients with two different machine settings (small and large spot size) were planned with both conventional and new methods. For each patient, threemore » kinds of plans were generated — conventional non-deliverable plan (plan A), conventional deliverable plan with post-processing (plan B), and new deliverable plan (plan C). We performed this study with both realistic (small) and artificial (large) deliverable MU-constraints. Results: With small minimum MU-constraints considered, new method achieved a slightly better plan quality than conventional method (D95% CTV normalized to the prescription dose: 0.994[0.992∼0.996] (Plan C) vs 0.992[0.986∼0.996] (Plan B)). With large minimum MU constraints considered, results show that the new method maintains plan quality while plan quality from the conventional method is degraded greatly (D95% CTV normalized to the prescription dose: 0.987[0.978∼0.994] (Plan C) vs 0.797[0.641∼1.000] (Plan B)). Meanwhile, plan robustness of these two method’s results is comparable. (For all 7 patients, CTV DVH band gap at D95% normalized to the prescription dose: 0.015[0.005∼0.043] (Plan C) vs 0.012[0.006∼0.038] (Plan B) with small MU-constraints and 0.019[0.009∼0.039] (Plan C) vs 0.030[0.015∼0.041] (Plan B) with large MU-constraints) Conclusion: Positive correlation has been found between plan quality degeneration and magnitude of deliverable minimal MU. Compared to conventional post-processing method, our new method of incorporating deliverable minimal MU-constraints directly into plan optimization, can produce machine-deliverable plans with better plan qualities and non-compromised plan robustness. This research was supported by the National Cancer Institute Career Developmental Award K25CA168984, by the Fraternal Order of Eagles Cancer Research Fund Career Development Award, by The Lawrence W. and Marilyn W. Matteson Fund for Cancer Research, by Mayo Arizona State University Seed Grant and by The Kemper Marley Foundation.« less

26 CFR 1.401(a)(4)-5 - Plan amendments and plan terminations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 5 2013-04-01 2013-04-01 false Plan amendments and plan terminations. 1.401(a)(4)-5 Section 1.401(a)(4)-5 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Pension, Profit-Sharing, Stock Bonus Plans, Etc. § 1.401(a)(4)-5 Plan amendments and plan...

26 CFR 1.401(a)(4)-5 - Plan amendments and plan terminations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 5 2014-04-01 2014-04-01 false Plan amendments and plan terminations. 1.401(a)(4)-5 Section 1.401(a)(4)-5 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Pension, Profit-Sharing, Stock Bonus Plans, Etc. § 1.401(a)(4)-5 Plan amendments and plan...

26 CFR 1.401(a)(4)-5 - Plan amendments and plan terminations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 5 2012-04-01 2011-04-01 true Plan amendments and plan terminations. 1.401(a)(4)-5 Section 1.401(a)(4)-5 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Pension, Profit-Sharing, Stock Bonus Plans, Etc. § 1.401(a)(4)-5 Plan amendments and plan...

26 CFR 1.401(a)(4)-5 - Plan amendments and plan terminations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Plan amendments and plan terminations. 1.401(a)(4)-5 Section 1.401(a)(4)-5 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Pension, Profit-Sharing, Stock Bonus Plans, Etc. § 1.401(a)(4)-5 Plan amendments and plan terminations. ...

26 CFR 1.401(a)(4)-5 - Plan amendments and plan terminations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 5 2011-04-01 2011-04-01 false Plan amendments and plan terminations. 1.401(a)(4)-5 Section 1.401(a)(4)-5 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Pension, Profit-Sharing, Stock Bonus Plans, Etc. § 1.401(a)(4)-5 Plan amendments and plan...

Planning Systems for Distributed Operations

NASA Technical Reports Server (NTRS)

Maxwell, Theresa G.

2002-01-01

This viewgraph representation presents an overview of the mission planning process involving distributed operations (such as the International Space Station (ISS)) and the computer hardware and software systems needed to support such an effort. Topics considered include: evolution of distributed planning systems, ISS distributed planning, the Payload Planning System (PPS), future developments in distributed planning systems, Request Oriented Scheduling Engine (ROSE) and Next Generation distributed planning systems.

Automatic planning on hippocampal avoidance whole-brain radiotherapy.

PubMed

Wang, Shuo; Zheng, Dandan; Zhang, Chi; Ma, Rongtao; Bennion, Nathan R; Lei, Yu; Zhu, Xiaofeng; Enke, Charles A; Zhou, Sumin

2017-01-01

Mounting evidence suggests that radiation-induced damage to the hippocampus plays a role in neurocognitive decline for patients receiving whole-brain radiotherapy (WBRT). Hippocampal avoidance whole-brain radiotherapy (HA-WBRT) has been proposed to reduce the putative neurocognitive deficits by limiting the dose to the hippocampus. However, urgency of palliation for patients as well as the complexities of the treatment planning may be barriers to protocol enrollment to accumulate further clinical evidence. This warrants expedited quality planning of HA-WBRT. Pinnacle 3 Automatic treatment planning was designed to increase planning efficiency while maintaining or improving plan quality and consistency. The aim of the present study is to evaluate the performance of the Pinnacle 3 Auto-Planning on HA-WBRT treatment planning. Ten patients previously treated for brain metastases were selected. Hippocampal volumes were contoured on T1 magnetic resonance (MR) images, and planning target volumes (PTVs) were generated based on RTOG0933. The following 2 types of plans were generated by Pinnacle 3 Auto-Planning: the one with 2 coplanar volumetric modulated arc therapy (VMAT) arcs and the other with 9-field noncoplanar intensity-modulated radiation therapy (IMRT). D 2% and D 98% of PTV were used to calculate homogeneity index (HI). HI and Paddick Conformity index (CI) of PTV as well as D 100% and D max of the hippocampus were used to evaluate the plan quality. All the auto-plans met the dose coverage and constraint objectives based on RTOG0933. The auto-plans eliminated the necessity of generating pseudostructures by the planners, and it required little manual intervention which expedited the planning process. IMRT quality assurance (QA) results also suggest that all the auto-plans are practically acceptable on delivery. Pinnacle 3 Auto-Planning generates acceptable plans by RTOG0933 criteria without time-consuming planning process. The expedited quality planning achieved by Auto-Planning (AP) may facilitate protocol enrollment of patients to further investigate the hippocampal-sparing effect and be used to ensure timely start of palliative treatment in future clinical practice. Copyright © 2017 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Automatic planning on hippocampal avoidance whole-brain radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Shuo, E-mail: shuo0220@gmail.com; Zheng, Dandan; Zhang, Chi

Mounting evidence suggests that radiation-induced damage to the hippocampus plays a role in neurocognitive decline for patients receiving whole-brain radiotherapy (WBRT). Hippocampal avoidance whole-brain radiotherapy (HA-WBRT) has been proposed to reduce the putative neurocognitive deficits by limiting the dose to the hippocampus. However, urgency of palliation for patients as well as the complexities of the treatment planning may be barriers to protocol enrollment to accumulate further clinical evidence. This warrants expedited quality planning of HA-WBRT. Pinnacle{sup 3} Automatic treatment planning was designed to increase planning efficiency while maintaining or improving plan quality and consistency. The aim of the present studymore » is to evaluate the performance of the Pinnacle{sup 3} Auto-Planning on HA-WBRT treatment planning. Ten patients previously treated for brain metastases were selected. Hippocampal volumes were contoured on T1 magnetic resonance (MR) images, and planning target volumes (PTVs) were generated based on RTOG0933. The following 2 types of plans were generated by Pinnacle{sup 3} Auto-Planning: the one with 2 coplanar volumetric modulated arc therapy (VMAT) arcs and the other with 9-field noncoplanar intensity-modulated radiation therapy (IMRT). D{sub 2%} and D{sub 98%} of PTV were used to calculate homogeneity index (HI). HI and Paddick Conformity index (CI) of PTV as well as D{sub 100%} and D{sub max} of the hippocampus were used to evaluate the plan quality. All the auto-plans met the dose coverage and constraint objectives based on RTOG0933. The auto-plans eliminated the necessity of generating pseudostructures by the planners, and it required little manual intervention which expedited the planning process. IMRT quality assurance (QA) results also suggest that all the auto-plans are practically acceptable on delivery. Pinnacle{sup 3} Auto-Planning generates acceptable plans by RTOG0933 criteria without time-consuming planning process. The expedited quality planning achieved by Auto-Planning (AP) may facilitate protocol enrollment of patients to further investigate the hippocampal-sparing effect and be used to ensure timely start of palliative treatment in future clinical practice.« less

Nurse manager succession planning: a concept analysis.

PubMed

Titzer, Jennifer L; Shirey, Maria R

2013-01-01

The current nursing leadership pipeline is inadequate and demands strategic succession planning methods. This article provides concept clarification regarding nurse manager succession planning. Attributes common to succession planning include organizational commitment and resource allocation, proactive and visionary leadership approach, and a mentoring and coaching environment. Strategic planning, current and future leadership analysis, high-potential identification, and leadership development are succession planning antecedents. Consequences of succession planning are improved leadership and organizational culture continuity, and increased leadership bench strength. Health care has failed to strategically plan for future leadership. Developing a strong nursing leadership pipeline requires deliberate and strategic succession planning. © 2013 Wiley Periodicals, Inc.

Planning documents: a business planning strategy.

PubMed

Kaehrle, P A

2000-06-01

Strategic planning and business plan development are essential nursing management skills in today's competitive, fast paced, continually changing health care environment. Even in times of great uncertainty, nurse managers need to plan and forecast for the future. A well-written business plan allows nurse managers to communicate their expertise and proactively contribute to the programmatic decisions and changes occurring within their patient population or service area. This article presents the use of planning documents as a practical, strategic business planning strategy. Although the model addresses orthopedic services specifically, nurse managers can gain an understanding and working knowledge of planning concepts that can be applied to all patient populations.

Plan choice, health insurance cost and premium sharing.

PubMed

Kosteas, Vasilios D; Renna, Francesco

2014-05-01

We develop a model of premium sharing for firms that offer multiple insurance plans. We assume that firms offer one low quality plan and one high quality plan. Under the assumption of wage rigidities we found that the employee's contribution to each plan is an increasing function of that plan's premium. The effect of the other plan's premium is ambiguous. We test our hypothesis using data from the Employer Health Benefit Survey. Restricting the analysis to firms that offer both HMO and PPO plans, we measure the amount of the premium passed on to employees in response to a change in both premiums. We find evidence of large and positive effects of the increase in the plan's premium on the amount of the premium passed on to employees. The effect of the alternative plan's premium is negative but statistically significant only for the PPO plans. Copyright © 2014 Elsevier B.V. All rights reserved.

PEL and Corridor Planning: State of the Practice Review of Planning and Environment Linkages Implementation in Corridor Planning

DOT National Transportation Integrated Search

2014-07-01

The Federal Highway Administration (FHWA) commissioned a review of transportation corridor plans to determine the extent to which these plans have utilized FHWA's Planning and Environment Linkages (PEL) approach, as described in the FHWA Guidance on ...

40 CFR 62.10850 - Identification of Plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... from existing sulfuric acid production plants as adopted by the Texas Air Control Board (TACB) on May... (CONTINUED) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS Texas Plan for... Identification of Plan. (a) Identification of plan. Texas Plan for Control of Designated Pollutants from Existing...

36 CFR 219.2 - Levels of planning and responsible officials.

Code of Federal Regulations, 2012 CFR

2012-07-01

... AGRICULTURE PLANNING National Forest System Land Management Planning § 219.2 Levels of planning and... management plan. A land management plan provides a framework for integrated resource management and for... management policies, practices, and procedures that are in the Forest Service Directive System. (3) The...

40 CFR 62.1875 - Identification of plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... of Sources: The plan includes the following sulfuric acid plants: (1) Allied Chemical Company... Mist from Existing Sulfuric Acid Plants § 62.1875 Identification of plan. (a) Title of plan: State implementation plan for control of sulfuric acid mist from existing sulfuric acid plants. (b) The plan was...

40 CFR 62.1875 - Identification of plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

... of Sources: The plan includes the following sulfuric acid plants: (1) Allied Chemical Company... Mist from Existing Sulfuric Acid Plants § 62.1875 Identification of plan. (a) Title of plan: State implementation plan for control of sulfuric acid mist from existing sulfuric acid plants. (b) The plan was...

40 CFR 62.1875 - Identification of plan.

Code of Federal Regulations, 2013 CFR

2013-07-01

... of Sources: The plan includes the following sulfuric acid plants: (1) Allied Chemical Company... Mist from Existing Sulfuric Acid Plants § 62.1875 Identification of plan. (a) Title of plan: State implementation plan for control of sulfuric acid mist from existing sulfuric acid plants. (b) The plan was...

40 CFR 62.1875 - Identification of plan.

Code of Federal Regulations, 2014 CFR

2014-07-01

... of Sources: The plan includes the following sulfuric acid plants: (1) Allied Chemical Company... Mist from Existing Sulfuric Acid Plants § 62.1875 Identification of plan. (a) Title of plan: State implementation plan for control of sulfuric acid mist from existing sulfuric acid plants. (b) The plan was...

IPEM: An Integrated Planning, Effectiveness Model.

ERIC Educational Resources Information Center

Donsky, Aaron P.

While historically higher education has utilized many different planning paradigms and elements, two concepts (strategic planning and operational planning) can be presented as the major planning concepts into which the various paradigms can be placed. Starting in fall 1991, Seminole Community College developed a planning model which integrated…

78 FR 28776 - Approval and Promulgation of Implementation Plans; Georgia; State Implementation Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-16

... Section of this Federal Register, EPA is approving the State's implementation plan revision as a direct... Promulgation of Implementation Plans; Georgia; State Implementation Plan Miscellaneous Revisions AGENCY... State Implementation Plan (SIP) submitted by the Georgia Environmental Protection Division to EPA in...

Determinants of Medicare plan choices: are beneficiaries more influenced by premiums or benefits?

PubMed

Jacobs, Paul D; Buntin, Melinda B

2015-07-01

To evaluate the sensitivity of Medicare beneficiaries to premiums and benefits when selecting healthcare plans after the introduction of Part D. We matched respondents in the 2008 Medicare Current Beneficiary Survey to the Medicare Advantage (MA) plans available to them using the Bid Pricing Tool and previously unavailable data on beneficiaries' plan choices. We estimated a 2-stage nested logit model of Medicare plan choice decision making, including the decision to choose traditional fee-for-service (FFS) Medicare or an MA plan, and for those choosing MA, which specific plan they chose. Beneficiaries living in areas with higher average monthly rebates available from MA plans were more likely to choose MA rather than FFS. When choosing MA plans, beneficiaries are roughly 2 to 3 times more responsive to dollars spent to reduce cost sharing than reductions in their premium. We calculated an elasticity of plan choice with respect to the monthly MA premium of -0.20. Beneficiaries with lower incomes are more sensitive to plan premiums and cost sharing than higher-income beneficiaries. MA plans appear to have a limited incentive to aggressively price their products, and seem to compete primarily over reduced beneficiary cost sharing. Given the limitations of the current plan choice environment, policies designed to encourage the selection of lower-cost plans may require increasing premium differences between plans and providing the tools to enable beneficiaries to easily assess those differences.

A feasibility study using TomoDirect for craniospinal irradiation

PubMed Central

Molloy, Janelle A.; Gleason, John F.; Feddock, Jonathan M.

2013-01-01

The feasibility of delivering craniospinal irradiation (CSI) with TomoDirect is investigated. A method is proposed to generate TomoDirect plans using standard three‐dimensional (3D) beam arrangements on Tomotherapy with junctioning of these fields to minimize hot or cold spots at the cranial/spinal junction. These plans are evaluated and compared to a helical Tomotherapy and a three‐dimensional conformal therapy (3D CRT) plan delivered on a conventional linear accelerator (linac) for CSI. The comparison shows that a TomoDirect plan with an overlap between the cranial and spinal fields might be preferable over Tomotherapy plans because of decreased low dose to large volumes of normal tissues outside of the planning target volume (PTV). Although the TomoDirect plans were not dosimetrically superior to a 3D CRT linac plan, the patient can be easily treated in the supine position, which is often more comfortable and efficient from an anesthesia standpoint. TomoDirect plans also have only one setup position which obviates the need for matching of fields and feathering of junctions, two issues encountered with conventional 3D CRT plans. TomoDirect plans can be delivered with comparable treatment times to conventional 3D plans and in shorter times than a Tomotherapy plan. In this paper, a method is proposed for creating TomoDirect craniospinal plans, and the dosimetric consequences for choosing different planning parameters are discussed. PACS number: 87.55.D‐ PMID:24036863

29 CFR 4007.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... of this chapter: continuation plan, new plan, newly covered plan, participant, participant count, premium funding target, premium payment year short plan year, small plan, and UVB valuation date. [61 FR...

Inverse optimization of objective function weights for treatment planning using clinical dose-volume histograms

NASA Astrophysics Data System (ADS)

Babier, Aaron; Boutilier, Justin J.; Sharpe, Michael B.; McNiven, Andrea L.; Chan, Timothy C. Y.

2018-05-01

We developed and evaluated a novel inverse optimization (IO) model to estimate objective function weights from clinical dose-volume histograms (DVHs). These weights were used to solve a treatment planning problem to generate ‘inverse plans’ that had similar DVHs to the original clinical DVHs. Our methodology was applied to 217 clinical head and neck cancer treatment plans that were previously delivered at Princess Margaret Cancer Centre in Canada. Inverse plan DVHs were compared to the clinical DVHs using objective function values, dose-volume differences, and frequency of clinical planning criteria satisfaction. Median differences between the clinical and inverse DVHs were within 1.1 Gy. For most structures, the difference in clinical planning criteria satisfaction between the clinical and inverse plans was at most 1.4%. For structures where the two plans differed by more than 1.4% in planning criteria satisfaction, the difference in average criterion violation was less than 0.5 Gy. Overall, the inverse plans were very similar to the clinical plans. Compared with a previous inverse optimization method from the literature, our new inverse plans typically satisfied the same or more clinical criteria, and had consistently lower fluence heterogeneity. Overall, this paper demonstrates that DVHs, which are essentially summary statistics, provide sufficient information to estimate objective function weights that result in high quality treatment plans. However, as with any summary statistic that compresses three-dimensional dose information, care must be taken to avoid generating plans with undesirable features such as hotspots; our computational results suggest that such undesirable spatial features were uncommon. Our IO-based approach can be integrated into the current clinical planning paradigm to better initialize the planning process and improve planning efficiency. It could also be embedded in a knowledge-based planning or adaptive radiation therapy framework to automatically generate a new plan given a predicted or updated target DVH, respectively.

Knowledge-based IMRT treatment planning for prostate cancer.

PubMed

Chanyavanich, Vorakarn; Das, Shiva K; Lee, William R; Lo, Joseph Y

2011-05-01

To demonstrate the feasibility of using a knowledge base of prior treatment plans to generate new prostate intensity modulated radiation therapy (IMRT) plans. Each new case would be matched against others in the knowledge base. Once the best match is identified, that clinically approved plan is used to generate the new plan. A database of 100 prostate IMRT treatment plans was assembled into an information-theoretic system. An algorithm based on mutual information was implemented to identify similar patient cases by matching 2D beam's eye view projections of contours. Ten randomly selected query cases were each matched with the most similar case from the database of prior clinically approved plans. Treatment parameters from the matched case were used to develop new treatment plans. A comparison of the differences in the dose-volume histograms between the new and the original treatment plans were analyzed. On average, the new knowledge-based plan is capable of achieving very comparable planning target volume coverage as the original plan, to within 2% as evaluated for D98, D95, and D1. Similarly, the dose to the rectum and dose to the bladder are also comparable to the original plan. For the rectum, the mean and standard deviation of the dose percentage differences for D20, D30, and D50 are 1.8% +/- 8.5%, -2.5% +/- 13.9%, and -13.9% +/- 23.6%, respectively. For the bladder, the mean and standard deviation of the dose percentage differences for D20, D30, and D50 are -5.9% +/- 10.8%, -12.2% +/- 14.6%, and -24.9% +/- 21.2%, respectively. A negative percentage difference indicates that the new plan has greater dose sparing as compared to the original plan. The authors demonstrate a knowledge-based approach of using prior clinically approved treatment plans to generate clinically acceptable treatment plans of high quality. This semiautomated approach has the potential to improve the efficiency of the treatment planning process while ensuring that high quality plans are developed.

Automated planning of tangential breast intensity-modulated radiotherapy using heuristic optimization.

PubMed

Purdie, Thomas G; Dinniwell, Robert E; Letourneau, Daniel; Hill, Christine; Sharpe, Michael B

2011-10-01

To present an automated technique for two-field tangential breast intensity-modulated radiotherapy (IMRT) treatment planning. A total of 158 planned patients with Stage 0, I, and II breast cancer treated using whole-breast IMRT were retrospectively replanned using automated treatment planning tools. The tools developed are integrated into the existing clinical treatment planning system (Pinnacle(3)) and are designed to perform the manual volume delineation, beam placement, and IMRT treatment planning steps carried out by the treatment planning radiation therapist. The automated algorithm, using only the radio-opaque markers placed at CT simulation as inputs, optimizes the tangential beam parameters to geometrically minimize the amount of lung and heart treated while covering the whole-breast volume. The IMRT parameters are optimized according to the automatically delineated whole-breast volume. The mean time to generate a complete treatment plan was 6 min, 50 s ± 1 min 12 s. For the automated plans, 157 of 158 plans (99%) were deemed clinically acceptable, and 138 of 158 plans (87%) were deemed clinically improved or equal to the corresponding clinical plan when reviewed in a randomized, double-blinded study by one experienced breast radiation oncologist. In addition, overall the automated plans were dosimetrically equivalent to the clinical plans when scored for target coverage and lung and heart doses. We have developed robust and efficient automated tools for fully inversed planned tangential breast IMRT planning that can be readily integrated into clinical practice. The tools produce clinically acceptable plans using only the common anatomic landmarks from the CT simulation process as an input. We anticipate the tools will improve patient access to high-quality IMRT treatment by simplifying the planning process and will reduce the effort and cost of incorporating more advanced planning into clinical practice. Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.

Contingency plan implementation.

PubMed

Neurath, D; Cober, N; Owens, W; Giulivi, A

2012-06-01

Although the National blood system in Canada reduces the risk of inventory shortages the possibility of a blood supply shortage still exists. The Ontario Ministry of Health and Long-Term Care developed a provincial plan to manage blood transfusion needs and inventory in the event of a National blood shortage. The Ontario plan was developed to align with the National plan as well as other provincial plans in order to ensure consistency in blood management strategies across the country. The Ontario plan was released in 2008, along with a toolkit to aid hospitals in developing their facility specific plans. In the Champlain region of Ontario, a group of 16 hospitals worked collaboratively to develop a regional blood shortage plan. A provincial blood shortage simulation exercise was held in 2010 to test out these plans. The Director of Transfusion Medicine of the largest facility in the group of 16 hospitals (The Ottawa Hospital) took the lead in the development of the regional blood shortage management plan. Working groups from all 16 sites contributed to the plan development. The proposed plan was presented to the Medical Advisory Committee for approval. The plan consists of activities relating to the severity of the supply shortage as defined by Amber, Red, Recovery and Green phases. The plan includes a communication plan for notifying stakeholders including patients whose treatment may be affected. Inventory management and triage guidelines are provided to reduce the demand for blood and to conserve inventory for those patients whose need is prioritized as highest. The regional blood shortage management plan was tested successfully during the provincial simulation exercise. Where regional hospitals work together to provide healthcare, it is beneficial to develop a standardized plan to provide guidance to hospital personnel in response to a blood supply shortage. A consistent plan will ensure patient care is provided in a consistent manner across a health region. Mock or simulation exercises can aid in testing plans and raising the awareness of stakeholders. Copyright © 2012 Elsevier Ltd. All rights reserved.

Inverse treatment planning for spinal robotic radiosurgery: an international multi-institutional benchmark trial.

PubMed

Blanck, Oliver; Wang, Lei; Baus, Wolfgang; Grimm, Jimm; Lacornerie, Thomas; Nilsson, Joakim; Luchkovskyi, Sergii; Cano, Isabel Palazon; Shou, Zhenyu; Ayadi, Myriam; Treuer, Harald; Viard, Romain; Siebert, Frank-Andre; Chan, Mark K H; Hildebrandt, Guido; Dunst, Jürgen; Imhoff, Detlef; Wurster, Stefan; Wolff, Robert; Romanelli, Pantaleo; Lartigau, Eric; Semrau, Robert; Soltys, Scott G; Schweikard, Achim

2016-05-08

Stereotactic radiosurgery (SRS) is the accurate, conformal delivery of high-dose radiation to well-defined targets while minimizing normal structure doses via steep dose gradients. While inverse treatment planning (ITP) with computerized optimization algorithms are routine, many aspects of the planning process remain user-dependent. We performed an international, multi-institutional benchmark trial to study planning variability and to analyze preferable ITP practice for spinal robotic radiosurgery. 10 SRS treatment plans were generated for a complex-shaped spinal metastasis with 21 Gy in 3 fractions and tight constraints for spinal cord (V14Gy < 2 cc, V18Gy < 0.1 cc) and target (coverage > 95%). The resulting plans were rated on a scale from 1 to 4 (excellent-poor) in five categories (constraint compliance, optimization goals, low-dose regions, ITP complexity, and clinical acceptability) by a blinded review panel. Additionally, the plans were mathemati-cally rated based on plan indices (critical structure and target doses, conformity, monitor units, normal tissue complication probability, and treatment time) and compared to the human rankings. The treatment plans and the reviewers' rankings varied substantially among the participating centers. The average mean overall rank was 2.4 (1.2-4.0) and 8/10 plans were rated excellent in at least one category by at least one reviewer. The mathematical rankings agreed with the mean overall human rankings in 9/10 cases pointing toward the possibility for sole mathematical plan quality comparison. The final rankings revealed that a plan with a well-balanced trade-off among all planning objectives was preferred for treatment by most par-ticipants, reviewers, and the mathematical ranking system. Furthermore, this plan was generated with simple planning techniques. Our multi-institutional planning study found wide variability in ITP approaches for spinal robotic radiosurgery. The participants', reviewers', and mathematical match on preferable treatment plans and ITP techniques indicate that agreement on treatment planning and plan quality can be reached for spinal robotic radiosurgery.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

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 planningmore » 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 may reduce radiation treatment–related toxicity.« less

7 CFR 1415.12 - Modifications to easements and rental contracts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... modifications for restoration agreements and grazing management plans, or conservation plans where applicable... conservation plans, grazing management plans, and restoration plans, to facilitate the practical administration...

Transportation planning performance measures : appendices.

DOT National Transportation Integrated Search

2005-10-01

The article is the appendices for Transportation Planning Performance Measures. : Oregon transportation plans, including the statewide Oregon Transportation Plan, and current regional transportation plans for the Portland, Salem, Eugene, and Medford ...

76 FR 38672 - Order of Succession for the Office of Strategic Planning and Management

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-01

... Office of Strategic Planning and Management AGENCY: Office of Strategic Planning and Management, HUD... Planning and Management, designates the Order of Succession for the Office of Strategic Planning and..., 2011. FOR FURTHER INFORMATION CONTACT: Nina M. Coward, Office of Strategic Planning and Management...

The State of Strategic Planning: A Survey of Selected Research Universities.

ERIC Educational Resources Information Center

Tan, David L.

1995-01-01

Despite the complexity and elusiveness of strategic planning by research universities, factors correlated with satisfaction in planning include presence of president or chief executive, presence of centralization and decentralization elements in the planning process, presence of a permanent planning committee, linkage of planning to budgeting, use…

29 CFR 1910.38 - Emergency action plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Means of Egress § 1910.38 Emergency action plans. (a) Application. An... plans. An emergency action plan must be in writing, kept in the workplace, and available to employees... information about the plan or an explanation of their duties under the plan. (d) Employee alarm system. An...

5 CFR 720.304 - Agency plan.

Code of Federal Regulations, 2013 CFR

2013-01-01

... structure, and update the plan as necessary. Agency operating components and field installations required to... review and update of their plans. (2) Plans shall cover a time period of not less than one year and may... most recent plan was effective or was last amended. (e) Plan Content. Disabled veteran affirmative...

5 CFR 720.304 - Agency plan.

Code of Federal Regulations, 2011 CFR

2011-01-01

... structure, and update the plan as necessary. Agency operating components and field installations required to... review and update of their plans. (2) Plans shall cover a time period of not less than one year and may... most recent plan was effective or was last amended. (e) Plan Content. Disabled veteran affirmative...

5 CFR 720.304 - Agency plan.

Code of Federal Regulations, 2014 CFR

2014-01-01

... structure, and update the plan as necessary. Agency operating components and field installations required to... review and update of their plans. (2) Plans shall cover a time period of not less than one year and may... most recent plan was effective or was last amended. (e) Plan Content. Disabled veteran affirmative...

5 CFR 720.304 - Agency plan.

Code of Federal Regulations, 2010 CFR

2010-01-01

... structure, and update the plan as necessary. Agency operating components and field installations required to... review and update of their plans. (2) Plans shall cover a time period of not less than one year and may... most recent plan was effective or was last amended. (e) Plan Content. Disabled veteran affirmative...

30 CFR 780.13 - Operation plan: Blasting.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Operation plan: Blasting. 780.13 Section 780.13... SURFACE MINING PERMIT APPLICATIONS-MINIMUM REQUIREMENTS FOR RECLAMATION AND OPERATION PLAN § 780.13 Operation plan: Blasting. (a) Blasting plan. Each application shall contain a blasting plan for the proposed...

40 CFR 130.6 - Water quality management plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Water quality management plans. 130.6... QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM... and certified and approved updates to those plans. Continuing water quality planning shall be based...

7 CFR 1485.15 - Activity plan.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Activity plan. 1485.15 Section 1485.15 Agriculture... MARKETS FOR AGRICULTURAL COMMODITIES Market Access Program § 1485.15 Activity plan. (a) General. A participant shall develop a specific activity plan(s) based on its strategic plan and the allocation approval...

36 CFR 219.2 - Levels of planning and responsible officials.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... Planning occurs at three levels—national strategic planning, NFS unit planning, and project or activity... measures, and strategies for management of the NFS, as well as the other Forest Service mission areas... System unit planning. (1) NFS unit planning results in the development, amendment, or revision of a land...

36 CFR 219.2 - Levels of planning and responsible officials.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... Planning occurs at three levels—national strategic planning, NFS unit planning, and project or activity... measures, and strategies for management of the NFS, as well as the other Forest Service mission areas... System unit planning. (1) NFS unit planning results in the development, amendment, or revision of a land...

43 CFR 3482.2 - Action on plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Exploration and Resource Recovery and Protection Plans § 3482.2 Action on plans. (a)(1) Exploration plans. The.... The authorized officer may impose additional conditions to conform to the rules of this part. In... with the approval terms of the exploration plan. (2) Resource recovery and protection plans. No...

43 CFR 3482.2 - Action on plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Exploration and Resource Recovery and Protection Plans § 3482.2 Action on plans. (a)(1) Exploration plans. The.... The authorized officer may impose additional conditions to conform to the rules of this part. In... with the approval terms of the exploration plan. (2) Resource recovery and protection plans. No...

43 CFR 3482.2 - Action on plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Exploration and Resource Recovery and Protection Plans § 3482.2 Action on plans. (a)(1) Exploration plans. The.... The authorized officer may impose additional conditions to conform to the rules of this part. In... with the approval terms of the exploration plan. (2) Resource recovery and protection plans. No...

On Language Management in Multinational Companies in the Czech Republic

ERIC Educational Resources Information Center

Nekvapil, Jiri; Nekula, Marek

2006-01-01

In this paper, we demonstrate the dialectical relationship between micro and macro language planning: macro planning influences micro planning and yet macro planning results (or should result) from micro planning. The relation between the two planning perspectives is illustrated within the framework of Language Management Theory (Jernudd &…

20 CFR 668.720 - What information must these planning documents contain?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What information must these planning... 166 Planning/Funding Process § 668.720 What information must these planning documents contain? (a) The... planning instructions issued by the Department, the comprehensive services plan must describe in narrative...

49 CFR 272.101 - Content of a critical incident stress plan.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Content of a critical incident stress plan. 272... RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CRITICAL INCIDENT STRESS PLANS Plan Components and Approval Process § 272.101 Content of a critical incident stress plan. Each critical incident stress plan...

10 CFR 5.230 - Transition plans.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Transition plans. 5.230 Section 5.230 Energy NUCLEAR... FEDERAL FINANCIAL ASSISTANCE Coverage § 5.230 Transition plans. (a) Submission of plans. An institution to... either a single transition plan applicable to all such units, or a separate transition plan applicable to...

10 CFR 5.230 - Transition plans.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Transition plans. 5.230 Section 5.230 Energy NUCLEAR... FEDERAL FINANCIAL ASSISTANCE Coverage § 5.230 Transition plans. (a) Submission of plans. An institution to... either a single transition plan applicable to all such units, or a separate transition plan applicable to...

10 CFR 5.230 - Transition plans.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Transition plans. 5.230 Section 5.230 Energy NUCLEAR... FEDERAL FINANCIAL ASSISTANCE Coverage § 5.230 Transition plans. (a) Submission of plans. An institution to... either a single transition plan applicable to all such units, or a separate transition plan applicable to...

10 CFR 5.230 - Transition plans.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Transition plans. 5.230 Section 5.230 Energy NUCLEAR... FEDERAL FINANCIAL ASSISTANCE Coverage § 5.230 Transition plans. (a) Submission of plans. An institution to... either a single transition plan applicable to all such units, or a separate transition plan applicable to...

40 CFR 52.672 - Approval of plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Idaho § 52.672 Approval of plans. (a) Carbon Monoxide. (1) EPA approves as a revision to the Idaho State Implementation Plan, the Limited Maintenance Plan for.... [Reserved] (e) Particulate Matter. (1) EPA approves as a revision to the Idaho State Implementation Plan...

29 CFR 1910.38 - Emergency action plans.

Code of Federal Regulations, 2014 CFR

2014-07-01

... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Exit Routes and Emergency Planning § 1910.38 Emergency action plans. (a) Application. An employer must have an emergency action plan whenever an OSHA standard in this...) Written and oral emergency action plans. An emergency action plan must be in writing, kept in the...

29 CFR 1910.38 - Emergency action plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Exit Routes and Emergency Planning § 1910.38 Emergency action plans. (a) Application. An employer must have an emergency action plan whenever an OSHA standard in this...) Written and oral emergency action plans. An emergency action plan must be in writing, kept in the...

24 CFR 1003.205 - Eligible planning, urban environmental design and policy-planning-management-capacity building...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Eligible planning, urban environmental design and policy-planning-management-capacity building activities. 1003.205 Section 1003.205... planning, urban environmental design and policy-planning-management-capacity building activities. (a...

24 CFR 1003.205 - Eligible planning, urban environmental design and policy-planning-management-capacity building...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Eligible planning, urban environmental design and policy-planning-management-capacity building activities. 1003.205 Section 1003.205... planning, urban environmental design and policy-planning-management-capacity building activities. (a...

24 CFR 570.205 - Eligible planning, urban environmental design and policy-planning-management-capacity building...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 3 2011-04-01 2010-04-01 true Eligible planning, urban... ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT..., urban environmental design and policy-planning-management-capacity building activities. (a) Planning...

A Set of Planning Tools for School Leaders & Teams: Differentiated Planning.

ERIC Educational Resources Information Center

Miles, Bruce H.

This presentation outline with overheads demonstrates differentiated planning, a system with four separate planning methods designed to reduce confusion and increase staff commitment to planning efforts. Differentiated planning involves: (1) prioritization (used for single question issues, multiple question issues, and as a follow-up to the…

78 FR 67027 - Nontank Vessel Response Plans and Other Response Plan Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-08

...-1070] RIN 1625-AB27 Nontank Vessel Response Plans and Other Response Plan Requirements AGENCY: Coast... Guard amended regulations on response plans for nontank vessels. The amendment triggered information... facility response plans. This notice announces that the collection of information has been approved by the...

29 CFR 36.230 - Transition plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Transition plans. 36.230 Section 36.230 Labor Office of the... FEDERAL FINANCIAL ASSISTANCE Coverage § 36.230 Transition plans. (a) Submission of plans. An institution... submit either a single transition plan applicable to all such units, or a separate transition plan...

40 CFR 74.61 - Monitoring plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Monitoring plan. 74.61 Section 74.61... OPT-INS Monitoring Emissions: Combustion Sources § 74.61 Monitoring plan. (a) Monitoring plan. The... monitoring plan that includes the information required in a monitoring plan under § 75.53 of this chapter...

10 CFR 5.230 - Transition plans.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Transition plans. 5.230 Section 5.230 Energy NUCLEAR... FEDERAL FINANCIAL ASSISTANCE Coverage § 5.230 Transition plans. (a) Submission of plans. An institution to... either a single transition plan applicable to all such units, or a separate transition plan applicable to...

49 CFR 37.149 - Disapproved plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false Disapproved plans. 37.149 Section 37.149... DISABILITIES (ADA) Paratransit as a Complement to Fixed Route Service § 37.149 Disapproved plans. (a) If a plan... shall amend its plan consistent with this information and resubmit the plan to the appropriate FTA...

40 CFR 264.54 - Amendment of contingency plan.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 26 2014-07-01 2014-07-01 false Amendment of contingency plan. 264.54... Contingency Plan and Emergency Procedures § 264.54 Amendment of contingency plan. The contingency plan must be reviewed, and immediately amended, if necessary, whenever: (a) The facility permit is revised; (b) The plan...

40 CFR 264.54 - Amendment of contingency plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Amendment of contingency plan. 264.54... Contingency Plan and Emergency Procedures § 264.54 Amendment of contingency plan. The contingency plan must be reviewed, and immediately amended, if necessary, whenever: (a) The facility permit is revised; (b) The plan...

45 CFR 1386.31 - State Plan submittal and approval.

Code of Federal Regulations, 2010 CFR

2010-10-01

... State Plan to significant comments and suggestions. A summary of the Council's response to State Plan.... (c) Failure to submit an approvable State plan or amendment prior to the Federal fiscal years for... eligible for Federal financial participation. (d) The Commissioner must approve any State plan or plan...

40 CFR 300.215 - Title III local emergency response plans.

Code of Federal Regulations, 2014 CFR

2014-07-01

... should be closely coordinated with applicable federal ACPs and state emergency response plans. (b... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.215 Title III local emergency response plans... are codified at 40 CFR part 355. (a) Each LEPC is to prepare an emergency response plan in accordance...

49 CFR 194.119 - Submission and approval procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.119 Submission and approval procedures. (a) Each operator shall submit two copies of the response plan required by this part. Copies of the response plan...: Submission of plans in electronic format is preferred. (b) If PHMSA determines that a response plan requiring...

40 CFR 300.215 - Title III local emergency response plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... should be closely coordinated with applicable federal ACPs and state emergency response plans. (b... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.215 Title III local emergency response plans... are codified at 40 CFR part 355. (a) Each LEPC is to prepare an emergency response plan in accordance...

40 CFR 300.215 - Title III local emergency response plans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... should be closely coordinated with applicable federal ACPs and state emergency response plans. (b... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.215 Title III local emergency response plans... are codified at 40 CFR part 355. (a) Each LEPC is to prepare an emergency response plan in accordance...

45 CFR 1386.31 - State Plan submittal and approval.

Code of Federal Regulations, 2013 CFR

2013-10-01

... State Plan to significant comments and suggestions. A summary of the Council's response to State Plan.... (c) Failure to submit an approvable State plan or amendment prior to the Federal fiscal years for... eligible for Federal financial participation. (d) The Commissioner must approve any State plan or plan...

45 CFR 1386.31 - State Plan submittal and approval.

Code of Federal Regulations, 2014 CFR

2014-10-01

... State Plan to significant comments and suggestions. A summary of the Council's response to State Plan.... (c) Failure to submit an approvable State plan or amendment prior to the Federal fiscal years for... eligible for Federal financial participation. (d) The Commissioner must approve any State plan or plan...

49 CFR 194.119 - Submission and approval procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.119 Submission and approval procedures. (a) Each operator shall submit two copies of the response plan required by this part. Copies of the response plan...: Submission of plans in electronic format is preferred. (b) If PHMSA determines that a response plan requiring...

49 CFR 194.119 - Submission and approval procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.119 Submission and approval procedures. (a) Each operator shall submit two copies of the response plan required by this part. Copies of the response plan...: Submission of plans in electronic format is preferred. (b) If PHMSA determines that a response plan requiring...

49 CFR 194.119 - Submission and approval procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.119 Submission and approval procedures. (a) Each operator shall submit two copies of the response plan required by this part. Copies of the response plan...: Submission of plans in electronic format is preferred. (b) If PHMSA determines that a response plan requiring...

40 CFR 300.215 - Title III local emergency response plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... should be closely coordinated with applicable federal ACPs and state emergency response plans. (b... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.215 Title III local emergency response plans... are codified at 40 CFR part 355. (a) Each LEPC is to prepare an emergency response plan in accordance...

49 CFR 194.119 - Submission and approval procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.119 Submission and approval procedures. (a) Each operator shall submit two copies of the response plan required by this part. Copies of the response plan...: Submission of plans in electronic format is preferred. (b) If PHMSA determines that a response plan requiring...

45 CFR 1386.31 - State Plan submittal and approval.

Code of Federal Regulations, 2011 CFR

2011-10-01

... State Plan to significant comments and suggestions. A summary of the Council's response to State Plan.... (c) Failure to submit an approvable State plan or amendment prior to the Federal fiscal years for... eligible for Federal financial participation. (d) The Commissioner must approve any State plan or plan...

40 CFR 300.215 - Title III local emergency response plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... should be closely coordinated with applicable federal ACPs and state emergency response plans. (b... POLLUTION CONTINGENCY PLAN Planning and Preparedness § 300.215 Title III local emergency response plans... are codified at 40 CFR part 355. (a) Each LEPC is to prepare an emergency response plan in accordance...

45 CFR 1386.31 - State Plan submittal and approval.

Code of Federal Regulations, 2012 CFR

2012-10-01

... State Plan to significant comments and suggestions. A summary of the Council's response to State Plan.... (c) Failure to submit an approvable State plan or amendment prior to the Federal fiscal years for... eligible for Federal financial participation. (d) The Commissioner must approve any State plan or plan...

Roof Plans: Section "CC", Roof Plan; Roof Framing Plans: Section ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Roof Plans: Section "C-C", Roof Plan; Roof Framing Plans: Section "C-C", Section "D-D"; Roof Framing Sections: Cross Section "G-G", Cross Section "H-H" - Fort Washington, Fort Washington Light, Northeast side of Potomac River at Fort Washington Park, Fort Washington, Prince George's County, MD

The role of statewide planning goals in Oregon's system of coordination and planning and their effect on transportation planning.

DOT National Transportation Integrated Search

2008-01-01

The motivation for this study was the observation that the reactive approach to the coordination of land use and transportation planning, which treats transportation planning as the handmaiden of land use planning and which greatly limits the options...

14 CFR 152.105 - Sponsors and planning agencies: Airport planning.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Sponsors and planning agencies: Airport planning. 152.105 Section 152.105 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF....105 Sponsors and planning agencies: Airport planning. (a) To be eligible to apply for a project for...

30 CFR 254.21 - How must I format my response plan?

Code of Federal Regulations, 2011 CFR

2011-07-01

... plan. (v) In situ burning plan. (vi) Training and drills. ... response plan? (a) You must divide your response plan for OCS facilities into the sections specified in paragraph (b) and explained in the other sections of this subpart. The plan must have an easily found marker...

ACHP | Stragetic Sustainability Performance Plans

Science.gov Websites

Sustainability Performance Plan (SSPP). Click here to access these plans. The ACHP's SSPP addresses how the Strategic Sustainability Performance Plan 2012 (PDF) ACHP Strategic Sustainability Performance Plan 2011 (PDF) ACHP Strategic Sustainability Performance Plan 2010 (PDF) Updated August 5, 2013 Return to Top

Strategic Planning and Open Learning: Turkey Tails and Frogs.

ERIC Educational Resources Information Center

Pacey, Lucille

This paper discusses the principles of strategic planning and how they can be applied in open and distance learning for greater student success. The model selected for discussion is the Applied Strategic Planning Model which proposes nine important steps for strategic planning: planning to plan, values audit, mission formulation, strategic…

42 CFR 457.710 - State plan requirements: Strategic objectives and performance goals.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) ALLOTMENTS AND GRANTS TO STATES Strategic Planning, Reporting, and Evaluation § 457.710 State plan requirements: Strategic objectives and performance goals. (a) Plan description. A State plan must include a... 42 Public Health 4 2011-10-01 2011-10-01 false State plan requirements: Strategic objectives and...

40 CFR 264.53 - Copies of contingency plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Copies of contingency plan. 264.53... Contingency Plan and Emergency Procedures § 264.53 Copies of contingency plan. A copy of the contingency plan... called upon to provide emergency services. [Comment: The contingency plan must be submitted to the...

Payload crew activity planning integration. Task 2: Inflight operations and training for payloads

NASA Technical Reports Server (NTRS)

Hitz, F. R.

1976-01-01

The primary objectives of the Payload Crew Activity Planning Integration task were to: (1) Determine feasible, cost-effective payload crew activity planning integration methods. (2) Develop an implementation plan and guidelines for payload crew activity plan (CAP) integration between the JSC Orbiter planners and the Payload Centers. Subtask objectives and study activities were defined as: (1) Determine Crew Activity Planning Interfaces. (2) Determine Crew Activity Plan Type and Content. (3) Evaluate Automated Scheduling Tools. (4) Develop a draft Implementation Plan for Crew Activity Planning Integration. The basic guidelines were to develop a plan applicable to the Shuttle operations timeframe, utilize existing center resources and expertise as much as possible, and minimize unnecessary data exchange not directly productive in the development of the end-product timelines.

75 FR 61931 - Proposed Exemptions From Certain Prohibited Transaction Restrictions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-06

...This document contains notices of pendency before the Department of Labor (the Department) of proposed exemptions from certain of the prohibited transaction restrictions of the Employee Retirement Income Security Act of 1974 (ERISA or the Act) and/or the Internal Revenue Code of 1986 (the Code). This notice includes the following proposed exemptions: D-11576, Bank of America, NA et al.; D-11591, Citigroup Inc. and its affiliates (Citigroup), the Citigroup 401(k) Plan, the Citibuilder 401(k) Plan for Puerto Rico the (Citibuilder Plan) and collectively with the Citigroup 401(k) Plan, the Participant Directed Plans, the Citigroup Pension Plan (and collectively with the Participant Directed Plans, the Plans) (the Applicants); and D-11611, The West Coast Bancorp 401(k) Plan (the Plan); et al.

The Mission Operations Planning Assistant

NASA Technical Reports Server (NTRS)

Schuetzle, James G.

1987-01-01

The Mission Operations Planning Assistant (MOPA) is a knowledge-based system developed to support the planning and scheduling of instrument activities on the Upper Atmospheric Research Satellite (UARS). The MOPA system represents and maintains instrument plans at two levels of abstraction in order to keep plans comprehensible to both UARS Principal Investigators and Command Management personnel. The hierarchical representation of plans also allows MOPA to automatically create detailed instrument activity plans from which spacecraft command loads may be generated. The MOPA system was developed on a Symbolics 3640 computer using the ZetaLisp and ART languages. MOPA's features include a textual and graphical interface for plan inspection and modification, recognition of instrument operational constraint violations during the planning process, and consistency maintenance between the different planning levels. This paper describes the current MOPA system.

The mission operations planning assistant

NASA Technical Reports Server (NTRS)

Schuetzle, James G.

1987-01-01

The Mission Operations Planning Assistant (MOPA) is a knowledge-based system developed to support the planning and scheduling of instrument activities on the Upper Atmospheric Research Satellite (UARS). The MOPA system represents and maintains instrument plans at two levels of abstraction in order to keep plans comprehensible to both UARS Prinicpal Investigators and Command Management personnel. The hierarchical representation of plans also allows MOPA to automatically create detailed instrument activity plans from which spacecraft command loads may be generated. The MOPA system was developed on a Symbolics 3640 computer using the ZETALISP and ART languages. MOPA's features include a textual and graphical interface for plan inspection and modification, recognition of instrument operational constraint violations during the planning process, and consistency maintenance between the different planning levels. This paper describes the current MOPA system.

CRI planning and scheduling for space

NASA Technical Reports Server (NTRS)

Aarup, Mads

1994-01-01

Computer Resources International (CRI) has many years of experience in developing space planning and scheduling systems for the European Space Agency. Activities range from AIT/AIV planning over mission planning to research in on-board autonomy using advanced planning and scheduling technologies in conjunction with model based diagnostics. This article presents four projects carried out for ESA by CRI with various subcontractors: (1) DI, Distributed Intelligence for Ground/Space Systems is an on-going research project; (2) GMPT, Generic Mission Planning Toolset, a feasibility study concluded in 1993; (3) OPTIMUM-AIV, Open Planning Tool for AIV, development of a knowledge based AIV planning and scheduling tool ended in 1992; and (4) PlanERS-1, development of an AI and knowledge-based mission planning prototype for the ERS-1 earth observation spacecraft ended in 1991.

Hybrid Motion Planning with Multiple Destinations

NASA Technical Reports Server (NTRS)

Clouse, Jeffery

1998-01-01

In our initial proposal, we laid plans for developing a hybrid motion planning system that combines the concepts of visibility-based motion planning, artificial potential field based motion planning, evolutionary constrained optimization, and reinforcement learning. Our goal was, and still is, to produce a hybrid motion planning system that outperforms the best traditional motion planning systems on problems with dynamic environments. The proposed hybrid system will be in two parts the first is a global motion planning system and the second is a local motion planning system. The global system will take global information about the environment, such as the placement of the obstacles and goals, and produce feasible paths through those obstacles. We envision a system that combines the evolutionary-based optimization and visibility-based motion planning to achieve this end.

Planning for a Nondriving Future: Behaviors and Beliefs Among Middle-Aged and Older Drivers.

PubMed

Harmon, Annie C; Babulal, Ganesh; Vivoda, Jonathon M; Zikmund-Fisher, Brian J; Carr, David B

2018-01-01

Despite the reality of older adults living many years after driving cessation, few prepare for the eventuality; empirically, planning for a nondriving future has not been directly quantified or explored. The following study quantifies 1) the extent of current drivers' planning, 2) specific planning behaviors, 3) beliefs about benefits of planning, 4) drivers' intention to plan more for future transportation needs, and 5) group differences associated with planning. In a predominantly female, black, urban sample of current drivers ages 53-92, fewer than half (42.1%) had planned at all for a nondriving future, with correspondingly low levels of planning behaviors reported. However, over 80% believed planning would help them meet their needs post-cessation and transition emotionally to being a nondriver. Most (85%) intended to plan more in the future as well, indicating further potential openness to the topic. Drivers who planned were older, drove less frequently, limited their driving to nearby places, reported less difficulty believing they would become a nondriver, and expected to continue driving three years less than non-planners. These findings suggest that drivers' perceived nearness to driving cessation impacts planning for future transportation needs, and existing perceived benefits of planning may provide leverage to motivate action.

The mediating and moderating role of planning on mothers' decisions for early childhood dietary behaviours.

PubMed

Hamilton, Kyra; Kothe, Emily J; Mullan, Barbara; Spinks, Teagan

2017-12-01

Examine the roles of action and coping planning on the intention-behaviour relationship for mothers' decisions for their young children's dietary behaviours. Prospective design with two waves of data collection, one week apart. Mothers (N = 197, M age  = 34.39, SD = 5.65) of children aged 2-3 years completed a main questionnaire assessing planning constructs and intentions, and a one-week follow-up of the target behaviours - 'healthy eating' and 'discretionary choices'. Intention was the strongest predictor of behaviour for both dietary behaviours. For healthy eating, intention moderated the indirect relationship between intention-behaviour via planning; coping planning was less important when intention was strong. Further, intention was not a direct predictor of behaviour when intention was relatively low. Action planning was not a direct predictor of either behaviour after accounting for intention and coping planning; action planning on behaviour was mediated by coping planning (only for healthy eating). Intention was not a direct predictor of coping planning; intention on coping planning was mediated by action planning. Neither type of planning predicted discretionary choices. Current findings contribute novel information on the mechanisms underpinning the effect of action and coping planning on the intention-behaviour relationship.

Ten things to get right for marine conservation planning in the Coral Triangle.

PubMed

Weeks, Rebecca; Pressey, Robert L; Wilson, Joanne R; Knight, Maurice; Horigue, Vera; Abesamis, Rene A; Acosta, Renerio; Jompa, Jamaluddin

2014-01-01

Systematic conservation planning increasingly underpins the conservation and management of marine and coastal ecosystems worldwide. Amongst other benefits, conservation planning provides transparency in decision-making, efficiency in the use of limited resources, the ability to minimise conflict between diverse objectives, and to guide strategic expansion of local actions to maximise their cumulative impact. The Coral Triangle has long been recognised as a global marine conservation priority, and has been the subject of huge investment in conservation during the last five years through the Coral Triangle Initiative on Coral Reefs, Fisheries and Food Security. Yet conservation planning has had relatively little influence in this region. To explore why this is the case, we identify and discuss 10 challenges that must be resolved if conservation planning is to effectively inform management actions in the Coral Triangle. These are: making conservation planning accessible; integrating with other planning processes; building local capacity for conservation planning; institutionalising conservation planning within governments; integrating plans across governance levels; planning across governance boundaries; planning for multiple tools and objectives; understanding limitations of data; developing better measures of progress and effectiveness; and making a long term commitment. Most important is a conceptual shift from conservation planning undertaken as a project, to planning undertaken as a process, with dedicated financial and human resources committed to long-term engagement.

Use of plan quality degradation to evaluate tradeoffs in delivery efficiency and clinical plan metrics arising from IMRT optimizer and sequencer compromises

PubMed Central

Wilkie, Joel R.; Matuszak, Martha M.; Feng, Mary; Moran, Jean M.; Fraass, Benedick A.

2013-01-01

Purpose: Plan degradation resulting from compromises made to enhance delivery efficiency is an important consideration for intensity modulated radiation therapy (IMRT) treatment plans. IMRT optimization and/or multileaf collimator (MLC) sequencing schemes can be modified to generate more efficient treatment delivery, but the effect those modifications have on plan quality is often difficult to quantify. In this work, the authors present a method for quantitative assessment of overall plan quality degradation due to tradeoffs between delivery efficiency and treatment plan quality, illustrated using comparisons between plans developed allowing different numbers of intensity levels in IMRT optimization and/or MLC sequencing for static segmental MLC IMRT plans. Methods: A plan quality degradation method to evaluate delivery efficiency and plan quality tradeoffs was developed and used to assess planning for 14 prostate and 12 head and neck patients treated with static IMRT. Plan quality was evaluated using a physician's predetermined “quality degradation” factors for relevant clinical plan metrics associated with the plan optimization strategy. Delivery efficiency and plan quality were assessed for a range of optimization and sequencing limitations. The “optimal” (baseline) plan for each case was derived using a clinical cost function with an unlimited number of intensity levels. These plans were sequenced with a clinical MLC leaf sequencer which uses >100 segments, assuring delivered intensities to be within 1% of the optimized intensity pattern. Each patient's optimal plan was also sequenced limiting the number of intensity levels (20, 10, and 5), and then separately optimized with these same numbers of intensity levels. Delivery time was measured for all plans, and direct evaluation of the tradeoffs between delivery time and plan degradation was performed. Results: When considering tradeoffs, the optimal number of intensity levels depends on the treatment site and on the stage in the process at which the levels are limited. The cost of improved delivery efficiency, in terms of plan quality degradation, increased as the number of intensity levels in the sequencer or optimizer decreased. The degradation was more substantial for the head and neck cases relative to the prostate cases, particularly when fewer than 20 intensity levels were used. Plan quality degradation was less severe when the number of intensity levels was limited in the optimizer rather than the sequencer. Conclusions: Analysis of plan quality degradation allows for a quantitative assessment of the compromises in clinical plan quality as delivery efficiency is improved, in order to determine the optimal delivery settings. The technique is based on physician-determined quality degradation factors and can be extended to other clinical situations where investigation of various tradeoffs is warranted. PMID:23822412

The role of complexity metrics in a multi-institutional dosimetry audit of VMAT

PubMed Central

Agnew, Christina E; Hussein, Mohammad; Tsang, Yatman; McWilliam, Alan; Hounsell, Alan R; Clark, Catharine H

2016-01-01

Objective: To demonstrate the benefit of complexity metrics such as the modulation complexity score (MCS) and monitor units (MUs) in multi-institutional audits of volumetric-modulated arc therapy (VMAT) delivery. Methods: 39 VMAT treatment plans were analysed using MCS and MU. A virtual phantom planning exercise was planned and independently measured using the PTW Octavius® phantom and seven29® 2D array (PTW-Freiburg GmbH, Freiburg, Germany). MCS and MU were compared with the median gamma index pass rates (2%/2 and 3%/3 mm) and plan quality. The treatment planning systems (TPS) were grouped by VMAT modelling being specifically designed for the linear accelerator manufacturer's own treatment delivery system (Type 1) or independent of vendor for VMAT delivery (Type 2). Differences in plan complexity (MCS and MU) between TPS types were compared. Results: For Varian® linear accelerators (Varian® Medical Systems, Inc., Palo Alto, CA), MCS and MU were significantly correlated with gamma pass rates. Type 2 TPS created poorer quality, more complex plans with significantly higher MUs and MCS than Type 1 TPS. Plan quality was significantly correlated with MU for Type 2 plans. A statistically significant correlation was observed between MU and MCS for all plans (R = −0.84, p < 0.01). Conclusion: MU and MCS have a role in assessing plan complexity in audits along with plan quality metrics. Plan complexity metrics give some indication of plan deliverability but should be analysed with plan quality. Advances in knowledge: Complexity metrics were investigated for a national rotational audit involving 34 institutions and they showed value. The metrics found that more complex plans were created for planning systems which were independent of vendor for VMAT delivery. PMID:26511276

Spatial and temporal patterns of North Carolina pedestrian and bicycle plans.

PubMed

Aytur, Semra A; Rodriguez, Daniel A; Kerr, Zachary Y; Ji, Kai; Evenson, Kelly R

2013-01-01

Pedestrian and bicycle plans support community-level physical activity. In North Carolina, pedestrian/bicycle plans are becoming more prevalent. However, no studies have examined the spatial and temporal diffusion of pedestrian/bicycle plans. This study assessed (a) temporal trends associated with municipal pedestrian/bicycle planning from 1974 to 2011 and (b) spatial patterns associated with municipal plans, specifically, whether the publication of a pedestrian/bicycle plan in a given year was associated with the number of neighboring municipalities with plans. North Carolina from 1974 to 2011. The main outcome was date of publication of all North Carolina municipal pedestrian and bicycle plans (1974-2011). We calculated Euclidean distances from each municipality center to all other municipality centers to derive whether municipalities were within 20 and 50 miles of each other. Sociodemographic covariates (eg, education, grant funding status, poverty, urbanicity, racial composition, population size, population growth) were collected from the US Census of Population (1980-2010) and the American Community Survey (2006-2010). Time series models fitted by generalized estimating equations were used to assess relationships between plan presence and the temporal and spatial predictor variables. The number of pedestrian and bicycle plans significantly increased over time, especially after 2006 when a state grant funding program was initiated. Unadjusted models indicated that municipalities were significantly more likely to have a pedestrian plan if higher numbers of neighboring municipalities had pedestrian plans. After adjustment for sociodemographic covariates and funding source, this relationship was attenuated but remained statistically significant. For bicycle plans, no significant associations were observed between plan presence and the number of neighboring municipalities with bicycle plans in adjusted models. Findings from this study can be used to generate hypotheses to test theories about diffusion of innovation and social contagion processes in pedestrian/bicycle planning.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheung, Michael L M; Chan, Anthony T C; The Chinese University of Hong Kong

Purpose: To develop a formulation for 4D treatment planning for a tumour tracking volumetric modulated arc therapy treatment (VMAT) plan for lung cancer. Methods: A VMAT plan was optimized based on a reference phase of the 4DCT of a lung cancer patient. The PTV was generated from the GTV of the reference phase. The collimator angle was set to 90 degrees such that the MLC travels along superior-inferior direction which is the main component of movement of a lung tumour. Then, each control point of the VMAT plan was assigned to a particular phase of the 4DCT in chronological order.more » The MLC positions of each control point were shifted according to the position of the tumour centroid of its assigned phase to form a tumour tracking VMAT plan. The control points of the same phase were grouped to form a pseudo VMAT plan for that particular phase. Dose calculation was performed for each pseudo VMAT plan on the corresponding phase of the 4DCT. The CTs of all phases were registered to the reference phase CT according to the displacement of the tumour centroid. The individual dose distributions of the pseudo VMAT plans were summed up and displayed on the reference phase of the 4DCT. A control VMAT plan was optimized based on a PTV generated from the ITV of all phases and compared with the tumour tracking VMAT plan. Results: Both plans achieved >95% volume coverage at the prescription dose level (96% for the tumour tracking plan and 97% for the control plan). But the normal lung volume irradiated at the prescription dose level was 39% less for the tumour tracking plan than the control plan. Conclusion: A formulation of 4D treatment planning for tumour tracking VMAT plans for lung cancer was developed.« less

Dosimetric and efficiency comparison of high-dose radiotherapy for esophageal cancer: volumetric modulated arc therapy versus fixed-field intensity-modulated radiotherapy.

PubMed

Lin, C-Y; Huang, W-Y; Jen, Y-M; Chen, C-M; Su, Y-F; Chao, H-L; Lin, C-S

2014-08-01

The aim of this study was to compare high-dose volumetric modulated arc therapy (VMAT) and fixed-field intensity-modulated radiotherapy (ff-IMRT) plans for the treatment of patients with middle-thoracic esophageal cancer. Eight patients with cT2-3N0M0 middle-thoracic esophageal cancer were enrolled. The treatment planning system was the version 9 of the Pinnacle(3) with SmartArc (Philips Healthcare, Fitchburg, WI, USA). VMAT and ff-IMRT treatment plans were generated for each case, and both techniques were used to deliver 50 Gy to the planning target volume (PTV(50)) and then provided a 16-Gy boost (PTV(66)). The VMAT plans provided superior PTV(66) coverage compared with the ff-IMRT plans (P = 0.034), whereas the ff-IMRT plans provided more appropriate dose homogeneity to the PTV(50) (P = 0.017). In the lung, the V(5) and V(10) were lower for the ff-IMRT plans than for the VMAT plans, whereas the V(20) was lower for the VMAT plans. The delivery time was significantly shorter for the VMAT plans than for the ff-IMRT plans (P = 0.012). In addition, the VMAT plans delivered fewer monitor units. The VMAT technique required a shorter planning time than the ff-IMRT technique (3.8 ± 0.8 hours vs. 5.4 ± 0.6 hours, P = 0.011). The major advantages of VMAT plans are higher efficiency and an approximately 50% reduction in delivery time compared with the ff-IMRT plans, with comparable plan quality. Further clinical investigations to evaluate the use of high-dose VMAT for the treatment of esophageal cancer are warranted. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

SU-F-T-65: AutomaticTreatment Planning for High-Dose Rate (HDR) Brachytherapy with a VaginalCylinder Applicator

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhou, Y; Tan, J; Jiang, S

Purpose: High dose rate (HDR) brachytherapy treatment planning is conventionally performed in a manual fashion. Yet it is highly desirable to perform computerized automated planning to improve treatment planning efficiency, eliminate human errors, and reduce plan quality variation. The goal of this research is to develop an automatic treatment planning tool for HDR brachytherapy with a cylinder applicator for vaginal cancer. Methods: After inserting the cylinder applicator into the patient, a CT scan was acquired and was loaded to an in-house developed treatment planning software. The cylinder applicator was automatically segmented using image-processing techniques. CTV was generated based on user-specifiedmore » treatment depth and length. Locations of relevant points (apex point, prescription point, and vaginal surface point), central applicator channel coordinates, and dwell positions were determined according to their geometric relations with the applicator. Dwell time was computed through an inverse optimization process. The planning information was written into DICOM-RT plan and structure files to transfer the automatically generated plan to a commercial treatment planning system for plan verification and delivery. Results: We have tested the system retrospectively in nine patients treated with vaginal cylinder applicator. These cases were selected with different treatment prescriptions, lengths, depths, and cylinder diameters to represent a large patient population. Our system was able to generate treatment plans for these cases with clinically acceptable quality. Computation time varied from 3–6 min. Conclusion: We have developed a system to perform automated treatment planning for HDR brachytherapy with a cylinder applicator. Such a novel system has greatly improved treatment planning efficiency and reduced plan quality variation. It also served as a testbed to demonstrate the feasibility of automatic HDR treatment planning for more complicated cases.« less

The role of complexity metrics in a multi-institutional dosimetry audit of VMAT.

PubMed

McGarry, Conor K; Agnew, Christina E; Hussein, Mohammad; Tsang, Yatman; McWilliam, Alan; Hounsell, Alan R; Clark, Catharine H

2016-01-01

To demonstrate the benefit of complexity metrics such as the modulation complexity score (MCS) and monitor units (MUs) in multi-institutional audits of volumetric-modulated arc therapy (VMAT) delivery. 39 VMAT treatment plans were analysed using MCS and MU. A virtual phantom planning exercise was planned and independently measured using the PTW Octavius(®) phantom and seven29(®) 2D array (PTW-Freiburg GmbH, Freiburg, Germany). MCS and MU were compared with the median gamma index pass rates (2%/2 and 3%/3 mm) and plan quality. The treatment planning systems (TPS) were grouped by VMAT modelling being specifically designed for the linear accelerator manufacturer's own treatment delivery system (Type 1) or independent of vendor for VMAT delivery (Type 2). Differences in plan complexity (MCS and MU) between TPS types were compared. For Varian(®) linear accelerators (Varian(®) Medical Systems, Inc., Palo Alto, CA), MCS and MU were significantly correlated with gamma pass rates. Type 2 TPS created poorer quality, more complex plans with significantly higher MUs and MCS than Type 1 TPS. Plan quality was significantly correlated with MU for Type 2 plans. A statistically significant correlation was observed between MU and MCS for all plans (R = -0.84, p < 0.01). MU and MCS have a role in assessing plan complexity in audits along with plan quality metrics. Plan complexity metrics give some indication of plan deliverability but should be analysed with plan quality. Complexity metrics were investigated for a national rotational audit involving 34 institutions and they showed value. The metrics found that more complex plans were created for planning systems which were independent of vendor for VMAT delivery.

Care plans and care planning in long term conditions: a conceptual model

PubMed Central

Burt, J; Rick, J; Blakeman, T; Protheroe, J; Roland, M; Bower, P

2013-01-01

The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority for chronic disease management in a number of health care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between ‘care planning’ (the process by which health care professionals and patients discuss, agree and review an action plan to achieve the goals or behaviour change of most relevance and concern to the patient) and a ‘care plan’ (a written document recording the outcome of a care planning process). We propose a typology of care planning and care plans with three core dimensions: perspective (patient or professional), scope (a focus on goals or on behaviours) and networks (confined to the professional-patient dyad or extending to the entire care network). In addition, we draw on psychological models of mediation and moderation to outline potential mechanisms through which care planning and care plans may lead to improved outcomes for both patients and the wider health care system. The proposed typology of care planning and care plans offered here, along with the model of the process by which care planning may influence outcomes, provide a useful framework for future policy developments and evaluations. Empirical work is required to explore the degree to which current care planning approaches and care plans can be described according to these dimensions, and the factors that determine which types of patients and professionals use which type of care plans. PMID:23883621

Assessment of monitor unit limiting strategy using volumetric modulated arc therapy for cancer of hypopharynx.

PubMed

Ahamed, Shabbir; Singh, Navin; Gudipudi, Deleep; Mulinti, Suneetha; Talluri, Anil; Soubhagya, Bhudevi; Sresty, Madhusudhana

2017-03-01

To quantify relative merit of MU deprived plans against freely optimized plans in terms of plan quality and report changes induced by progressive resolution optimizer algorithm (PRO3) to the dynamic parameters of RapidArc. Ten cases of carcinoma hypopharynx were retrospectively planned in three phases without using MU tool. Replicas of these baseline plans were reoptimized using "Intermediate dose" feature and "MU tool" to reduce MUs by 20%, 35%, and 50%. Overall quality indices for target and OAR, integral dose, dose-volume spread were assessed. All plans were appraised for changes induced in RapidArc dynamic parameters and pre-treatment quality assurance (QA). With increasing MU reduction strength (MURS), MU/Gy values reduced, for all phases with an overall range of 8.6-34.7%; mean dose rate decreased among plans of each phase, phase3 plans recorded greater reductions. MURS20% showed good trade-off between MUs and plan quality. Dose-volume spread below 5Gy was higher for baseline plans while lower between 20 and 35Gy. Integral dose was lower for MURS0%, not exceeding 1.0%, compared against restrained plans. Mean leaf aperture and control point areas increased systematically, correlated negatively with increasing MURS. Absolute delta dose rate variations were least for MURS0%. MU deprived plans exhibited GAI (>93%), better than MURS0% plans. Baseline plans are superior to MU restrained plans. However, MURS20% offers equivalent and acceptable plan quality with mileage of MUs, improved GAI for complex cases. MU tool may be adopted to tailor treatment plans using PRO3. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

A fixed-jaw method to protect critical organs during intensity-modulated radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Jiayun; Chen, Xinyuan; Huang, Manni, E-mail: dai_jianrong@163.com

2014-01-01

Intensity-modulated radiotherapy (IMRT) plays an important role in cancer radiotherapy. For some patients being treated with IMRT, the extremely low tolerances of critical organs (such as lens, ovaries, and testicles) cannot be met during treatment planning. The aim of this article is to introduce a new planning method to overcome that problem. In current planning practice, jaw positions are automatically set to cover all target volumes by the planning system (e.g., Pinnacle{sup 3} system). Because of such settings, critical organs may be fully blocked by the multileaf collimator (MLC), but they still sit in the field that is shaped bymore » collimator jaws. These critical organs receive doses from the transmission and leakage of MLC leaves. We manually fixed jaw positions to block them to further reduce such doses. This method has been used for different treatment sites in our clinic, and it was thoroughly evaluated in patients with radical hysterectomy plus ovarian transposition after surgery. For each patient, 2 treatment plans were designed with the same optimization parameters: the original plan with automatically chosen jaw positions (called O-plan) and the plan with fixed-jaw positions (named F-plan). In the F-plan, the jaws were manually fixed to block the ovaries. For target coverage, the mean conformity index (CI) of the F-plan (1.28 ± 0.02) was remarkably lower than that of the O-plan (1.53 ± 0.09) (p < 0.05). The F-plan and the O-plan performed similarly in target dose homogeneity. Meanwhile, for the critical organ sparing, the mean dose of both ovaries were much lower in the F-plan than that in the O-plan (p < 0.05). The V{sub 20}, V{sub 30}, and V{sub 40} of bladder were also lower in the F-plan (93.57 ± 1.98, 73.99 ± 5.76, and 42.33 ± 3.7, respectively) than those in the O-plan (97.98 ± 1.11, 85.07 ± 4.04, and 49.71 ± 3.63, respectively) (p < 0.05). The maximum dose to the spinal cord planning organ at risk (OAR) volume (PRV) in the O-plan (3940.24 ± 102.8) was higher than that in the F-plan (3628.18 ± 131.45) with significant differences (p < 0.01). For other OARs, there were no significant differences in doses between these 2 plans except that the high-dose regions of the rectum were higher for V{sub 40} in the O-plan than that in the F-plan (p < 0.01). But the monitor units (MUs) in the F-plan were 1.4 times as much as that in the O-plan. Thus the treatment time could be longer by using the F-plan. As it results in more MUs in spite of better plan quality, it is recommended to be used only in situations in which clinical requirements to critical organs cannot be met with the regular method.« less

Financial performance of health plans in Medicaid managed care.

PubMed

McCue, Mike

2012-01-01

This study assesses the financial performance of health plans that enroll Medicaid members across the key plan traits, specifically Medicaid dominant, publicly traded, and provider-sponsored. National Association of Insurance Commissioners (NAIC) financial data, coupled with selected state financial data, were analyzed for 170 Medicaid health plans for 2009. A mean test compared the mean values for medical loss, administrative cost, and operating margin ratios across these plan traits. Medicaid dominant plans are plans with 75 percent of their total enrollment in the Medicaid line of business. Plans that are Medicaid dominant and publicly traded incurred a lower medical loss ratio and higher administrative cost ratio than multi-product and non-publicly traded plans. Medicaid dominant plans also earned a higher operating profit margin. Plans offering commercial and Medicare products are operating at a loss for their Medicaid line of business. Health plans that do not specialize in Medicaid are losing money. Higher medical cost rather than administrative cost is the underlying reason for this financial loss. Since Medicaid enrollees do not account for their primary book of business, these plans may not have invested in the medical management programs to reduce inappropriate emergency room use and avoid costly hospitalization.

Planning in context: A situated view of children's management of science projects

NASA Astrophysics Data System (ADS)

Marshall, Susan Katharine

This study investigated children's collaborative planning of a complex, long-term software design project. Using sociocultural methods, it examined over time the development of design teams' planning negotiations and tools to document the coconstruction of cultural frameworks to organize teams' shared understanding of what and how to plan. Results indicated that student teams developed frameworks to address a set of common planning functions that included design planning, project metaplanning (things such as division of labor or sharing of computer resources) and team collaboration management planning. There were also some between-team variations in planning frameworks, within a bandwidth of options. Teams engaged in opportunistic planning, which reflected shifts in strategies in response to new circumstances over time. Team members with past design project experience ("oldtimers") demonstrated the transfer of their planning framework to the current design task, and they supported the developing participation of "newcomers." Teams constructed physical tools (e.g. planning boards) that acted as visual representations of teams' planning frameworks, and inscriptions of team thinking. The assigned functions of the tools also shifted over time with changing project circumstances. The discussion reexamines current approaches to the study of planning and discusses their educational implications.

Do Medicare Advantage Plans Minimize Costs? Investigating the Relationship Between Benchmarks, Costs, and Rebates.

PubMed

Zuckerman, Stephen; Skopec, Laura; Guterman, Stuart

2017-12-01

Medicare Advantage (MA), the program that allows people to receive their Medicare benefits through private health plans, uses a benchmark-and-bidding system to induce plans to provide benefits at lower costs. However, prior research suggests medical costs, profits, and other plan costs are not as low under this system as they might otherwise be. To examine how well the current system encourages MA plans to bid their lowest cost by examining the relationship between costs and bonuses (rebates) and the benchmarks Medicare uses in determining plan payments. Regression analysis using 2015 data for HMO and local PPO plans. Costs and rebates are higher for MA plans in areas with higher benchmarks, and plan costs vary less than benchmarks do. A one-dollar increase in benchmarks is associated with 32-cent-higher plan costs and a 52-cent-higher rebate, even when controlling for market and plan factors that can affect costs. This suggests the current benchmark-and-bidding system allows plans to bid higher than local input prices and other market conditions would seem to warrant. To incentivize MA plans to maximize efficiency and minimize costs, Medicare could change the way benchmarks are set or used.

45 CFR 156.400 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., silver, gold, or platinum level of coverage is referred to as a standard bronze plan, a standard silver plan, a standard gold plan, and a standard platinum plan, respectively. Zero cost sharing plan...

SU-G-TeP4-14: Quality Control of Treatment Planning Using Knowledge-Based Planning Across a System of Radiation Oncology Practices

DOE Office of Scientific and Technical Information (OSTI.GOV)

Masi, K; Ditman, M; Marsh, R

Purpose: There is potentially a wide variation in plan quality for a certain disease site, even for clinics located in the same system of hospitals. We have used a prostate-specific knowledge-based planning (KBP) model as a quality control tool to investigate the variation in prostate treatment planning across a network of affiliated radiation oncology departments. Methods: A previously created KBP model was applied to 10 patients each from 4 community-based clinics (Clinics A, B, C, and D). The KBP model was developed using RapidPlan (Eclipse v13.5, Varian Medical Systems) from 60 prostate/prostate bed IMRT plans that were originally planned usingmore » an in-house treatment planning system at the central institution of the community-based clinics. The dosimetric plan quality (target coverage and normal-tissue sparing) of each model-generated plan was compared to the respective clinically-used plan. Each community-based clinic utilized the same planning goals to develop the clinically-used plans that were used at the main institution. Results: Across all 4 clinics, the model-generated plans decreased the mean dose to the rectum by varying amounts (on average, 12.5, 2.6, 4.5, and 2.7 Gy for Clinics A, B, C, and D, respectively). The mean dose to the bladder also decreased with the model-generated plans (5.4, 2.3, 3.0, and 4.1 Gy, respectively). The KBP model also identified that target coverage (D95%) improvements were possible for for Clinics A, B, and D (0.12, 1.65, and 2.75%) while target coverage decreased by 0.72% for Clinic C, demonstrating potentially different trade-offs made in clinical plans at different institutions. Conclusion: Quality control of dosimetric plan quality across a system of radiation oncology practices is possible with knowledge-based planning. By using a quality KBP model, smaller community-based clinics can potentially identify the areas of their treatment plans that may be improved, whether it be in normal-tissue sparing or improved target coverage. M. Matuszak has research funding for KBP from Varian Medical Systems.« less

A planning study investigating dual-gated volumetric arc stereotactic treatment of primary renal cell carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Devereux, Thomas, E-mail: thomas.devereux@petermac.org; Pham, Daniel; Kron, Tomas

2015-04-01

This is a planning study investigating the dosimetric advantages of gated volumetric-modulated arc therapy (VMAT) to the end-exhale and end-inhale breathing phases for patients undergoing stereotactic treatment of primary renal cell carcinoma. VMAT plans were developed from the end-inhale (VMATinh) and the end-exhale (VMATexh) phases of the breathing cycle as well as a VMAT plan and 3-dimensional conformal radiation therapy plan based on an internal target volume (ITV) (VMATitv). An additional VMAT plan was created by giving the respective gated VMAT plan a 50% weighting and summing the inhale and exhale plans together to create a summed gated plan. Dosemore » to organs at risk (OARs) as well as comparison of intermediate and low-dose conformity was evaluated. There was no difference in the volume of healthy tissue receiving the prescribed dose for the planned target volume (PTV) (CI100%) for all the VMAT plans; however, the mean volume of healthy tissue receiving 50% of the prescribed dose for the PTV (CI50%) values were 4.7 (± 0.2), 4.6 (± 0.2), and 4.7 (± 0.6) for the VMATitv, VMATinh, and VMATexh plans, respectively. The VMAT plans based on the exhale and inhale breathing phases showed a 4.8% and 2.4% reduction in dose to 30 cm{sup 3} of the small bowel, respectively, compared with that of the ITV-based VMAT plan. The summed gated VMAT plans showed a 6.2% reduction in dose to 30 cm{sup 3} of the small bowel compared with that of the VMAT plans based on the ITV. Additionally, when compared with the inhale and the exhale VMAT plans, a 4% and 1.5%, respectively, reduction was observed. Gating VMAT was able to reduce the amount of prescribed, intermediate, and integral dose to healthy tissue when compared with VMAT plans based on an ITV. When summing the inhale and exhale plans together, dose to healthy tissue and OARs was optimized. However, gating VMAT plans would take longer to treat and is a factor that needs to be considered.« less

Focal dose escalation for prostate cancer using 68Ga-HBED-CC PSMA PET/CT and MRI: a planning study based on histology reference.

PubMed

Zamboglou, Constantinos; Thomann, Benedikt; Koubar, Khodor; Bronsert, Peter; Krauss, Tobias; Rischke, Hans C; Sachpazidis, Ilias; Drendel, Vanessa; Salman, Nasr; Reichel, Kathrin; Jilg, Cordula A; Werner, Martin; Meyer, Philipp T; Bock, Michael; Baltas, Dimos; Grosu, Anca L

2018-05-02

Focal radiation therapy has gained of interest in treatment of patients with primary prostate cancer (PCa). The question of how to define the intraprostatic boost volume is still open. Previous studies showed that multiparametric MRI (mpMRI) or PSMA PET alone could be used for boost volume definition. However, other studies proposed that the combined usage of both has the highest sensitivity in detection of intraprostatic lesions. The aim of this study was to demonstrate the feasibility and to evaluate the tumour control probability (TCP) and normal tissue complication probability (NTCP) of radiation therapy dose painting using 68 Ga-HBED-CC PSMA PET/CT, mpMRI or the combination of both in primary PCa. Ten patients underwent PSMA PET/CT and mpMRI followed by prostatectomy. Three gross tumour volumes (GTVs) were created based on PET (GTV-PET), mpMRI (GTV-MRI) and the union of both (GTV-union). Two plans were generated for each GTV. Plan95 consisted of whole-prostate IMRT to 77 Gy in 35 fractions and a simultaneous boost to 95 Gy (Plan95 PET /Plan95 MRI /Plan95 union ). Plan80 consisted of whole-prostate IMRT to 76 Gy in 38 fractions and a simultaneous boost to 80 Gy (Plan80 PET /Plan80 MRI /Plan80 union ). TCPs were calculated for GTV-histo (TCP-histo), which was delineated based on PCa distribution in co-registered histology slices. NTCPs were assessed for bladder and rectum. Dose constraints of published protocols were reached in every treatment plan. Mean TCP-histo were 99.7% (range: 97%-100%) and 75.5% (range: 33%-95%) for Plan95 union and Plan80 union , respectively. Plan95 union had significantly higher TCP-histo values than Plan95 MRI (p = 0.008) and Plan95 PET (p = 0.008). Plan80 union had significantly higher TCP-histo values than Plan80 MRI (p = 0.012), but not than Plan80 PET (p = 0.472). Plan95 MRI had significantly lower NTCP-rectum than Plan95 union (p = 0.012). No significant differences in NTCP-rectum and NTCP-bladder were observed for all other plans (p > 0.05). IMRT dose escalation on GTVs based on mpMRI, PSMA PET/CT and the combination of both was feasible. Boosting GTV-union resulted in significantly higher TCP-histo with no or minimal increase of NTCPs compared to the other plans.

Impact of database quality in knowledge-based treatment planning for prostate cancer.

PubMed

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

2018-03-13

This article investigates dose-volume prediction improvements in a common knowledge-based planning (KBP) method using a Pareto plan database compared with using a conventional, clinical plan database. Two plan databases were created using retrospective, anonymized data of 124 volumetric modulated arc therapy (VMAT) prostate cancer patients. The clinical plan database (CPD) contained planning data from each patient's clinically treated VMAT plan, which were manually optimized by various planners. The multicriteria optimization database (MCOD) contained Pareto-optimal plan data from VMAT plans created using a standardized multicriteria optimization protocol. Overlap volume histograms, incorporating fractional organ at risk volumes only within the treatment fields, were computed for each patient and used to match new patient anatomy to similar database patients. For each database patient, CPD and MCOD KBP predictions were generated for D 10 , D 30 , D 50 , D 65 , and D 80 of the bladder and rectum in a leave-one-out manner. Prediction achievability was evaluated through a replanning study on a subset of 31 randomly selected database patients using the best KBP predictions, regardless of plan database origin, as planning goals. MCOD predictions were significantly lower than CPD predictions for all 5 bladder dose-volumes and rectum D 50 (P = .004) and D 65 (P < .001), whereas CPD predictions for rectum D 10 (P = .005) and D 30 (P < .001) were significantly less than MCOD predictions. KBP predictions were statistically achievable in the replans for all predicted dose-volumes, excluding D 10 of bladder (P = .03) and rectum (P = .04). Compared with clinical plans, replans showed significant average reductions in D mean for bladder (7.8 Gy; P < .001) and rectum (9.4 Gy; P < .001), while maintaining statistically similar planning target volume, femoral head, and penile bulb dose. KBP dose-volume predictions derived from Pareto plans were more optimal overall than those resulting from manually optimized clinical plans, which significantly improved KBP-assisted plan quality. This work investigates how the plan quality of knowledge databases affects the performance and achievability of dose-volume predictions from a common knowledge-based planning approach for prostate cancer. Bladder and rectum dose-volume predictions derived from a database of standardized Pareto-optimal plans were compared with those derived from clinical plans manually designed by various planners. Dose-volume predictions from the Pareto plan database were significantly lower overall than those from the clinical plan database, without compromising achievability. Copyright © 2018 Elsevier Inc. All rights reserved.

To Prosecute or Not? Enforcement of Federal Criminal Regulatory Statutes. Revised Edition. A Student's Lesson Plan [and] A Teacher's Lesson Plan [and] A Lawyer's Lesson Plan.

ERIC Educational Resources Information Center

Howard, Estelle; And Others

One of a series of secondary level teaching units presenting case studies with pro and con analyses of particular legal problems, the document consists of a student's lesson plan, a teacher's lesson plan, and a lawyer's lesson plan for a unit about the enforcement of federal criminal regulatory statutes. The lesson plan presents an analysis of the…

Strategic Planning for the Air Force. Leveraging Business Planning Insights to Create Future Value

DTIC Science & Technology

1998-01-01

Strategic Planning for the Air Force Leveraging Business Planning Insights to Create Future Value DEBORAH L. WESTPHAL, RICHARD SZAFRANSKI...SUBTITLE Strategic Planning for the Air Force. Leveraging Business Planning Insights to Create Future Value 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...can be so, unless leaders and planners are willing to think in the boundary between order and chaos. Long-Range Planning, Strategic Thinking, or

Wilderness fire management planning guide

Treesearch

William C. Fischer

1984-01-01

Outlines a procedure for fire management planning for parks; wilderness areas; and other wild, natural, or essentially undeveloped areas. Discusses background and philosophy of wilderness fire management, planning concepts, planning elements, and planning methods.

Advance Care Planning for Serious Illness

MedlinePlus

ADVANCE CARE PLANNING FOR SERIOUS ILLNESS Making plans for the health care you want during a serious illness is called “advance care planning.” Planning involves learning about your illness, understanding choices ...

Meta-analysis of landscape conservation plan evaluations

Treesearch

Michaela Foster; M. Nils Peterson; Frederick Cubbage; Gerard McMahon

2016-01-01

The number of studies evaluating the quality and content of many types of plans have grown in recent decades. Natural resource conservation plans have been included in some of these plan evaluation studies; however, no meta-analysis of natural resource planning literature has been conducted. This focus is needed because natural resource conservation planning differs...

49 CFR 194.121 - Response plan review and update procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 3 2011-10-01 2011-10-01 false Response plan review and update procedures. 194... SAFETY RESPONSE PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.121 Response plan review and update procedures. (a) Each operator shall update its response plan to address new or different operating conditions...

49 CFR 194.121 - Response plan review and update procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 3 2013-10-01 2013-10-01 false Response plan review and update procedures. 194... SAFETY RESPONSE PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.121 Response plan review and update procedures. (a) Each operator shall update its response plan to address new or different operating conditions...

49 CFR 194.121 - Response plan review and update procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 3 2014-10-01 2014-10-01 false Response plan review and update procedures. 194... SAFETY RESPONSE PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.121 Response plan review and update procedures. (a) Each operator shall update its response plan to address new or different operating conditions...

49 CFR 194.121 - Response plan review and update procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 3 2012-10-01 2012-10-01 false Response plan review and update procedures. 194... SAFETY RESPONSE PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.121 Response plan review and update procedures. (a) Each operator shall update its response plan to address new or different operating conditions...

49 CFR 194.121 - Response plan review and update procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 3 2010-10-01 2010-10-01 false Response plan review and update procedures. 194... SAFETY RESPONSE PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.121 Response plan review and update procedures. (a) Each operator shall update its response plan to address new or different operating conditions...

30 CFR 250.289 - What must the Conceptual Plan contain?

Code of Federal Regulations, 2010 CFR

2010-07-01

... GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Plans and Information Deepwater Operations Plans (dwop) § 250.289 What must the Conceptual Plan contain? In the Conceptual Plan, you must explain... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What must the Conceptual Plan contain? 250.289...

40 CFR 60.2899 - What is a waste management plan?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 6 2010-07-01 2010-07-01 false What is a waste management plan? 60.2899 Section 60.2899 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS... Management Plan § 60.2899 What is a waste management plan? A waste management plan is a written plan that...

75 FR 51831 - Request for Measures of Health Plan Efforts To Address Health Plan Members' Health Literacy Needs

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-23

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Request for Measures of Health Plan Efforts To Address Health Plan Members' Health Literacy Needs AGENCY: Agency for... well health plans and health providers address health plan enrollees' health literacy needs and how...

Down the Road...Long Range Planning for Automation.

ERIC Educational Resources Information Center

Texas State Library, Austin. Dept. of Library Development.

The materials in this manual/workbook were prepared to assist participants in a workshop on long-range planning for library automation. Chapters cover the following topics: (1) "What Is Long-Range Planning?" (2) "Why Plan?" (3) "Who Needs to Participate?" (4) "Planning to Plan"; (5) "Determining Needs"; (6) "Description and Introduction"; (7)…

Purdue Extended Campus: Transparency, Accountability, and Assessment in Strategic Planning

ERIC Educational Resources Information Center

Cunningham, Robin; Eddy, Michael; Pagano, Mark; Ncube, Lisa

2011-01-01

In 2002 President Martin Jischke initiated a new era in strategic planning at Purdue. Under his leadership, strategic planning became a centralized activity with unit plans aligned to the university plan. Strategic goals were designed to have maximum impact, which would be measurable through metrics. Strategic planning at Purdue would be an…

20 CFR 632.22 - Modification of a Comprehensive Annual Plan (CAP) and/or Master Plan.

Code of Federal Regulations, 2012 CFR

2012-04-01

... (CAP) and/or Master Plan. 632.22 Section 632.22 Employees' Benefits EMPLOYMENT AND TRAINING... Master Plan. (a) The requirements for modifying a Master Plan and/or CAP will be included in administrative instructions issued by the Grant Officer upon final implementation of the Master Plan/CAP system...

20 CFR 632.22 - Modification of a Comprehensive Annual Plan (CAP) and/or Master Plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

... (CAP) and/or Master Plan. 632.22 Section 632.22 Employees' Benefits EMPLOYMENT AND TRAINING... Master Plan. (a) The requirements for modifying a Master Plan and/or CAP will be included in administrative instructions issued by the Grant Officer upon final implementation of the Master Plan/CAP system...

43 CFR 10005.15 - Planning and management techniques applicable to the plan.

Code of Federal Regulations, 2011 CFR

2011-10-01

... applicable to the plan. 10005.15 Section 10005.15 Public Lands: Interior Regulations Relating to Public Lands... AND IMPLEMENTING THE COMMISSION'S MITIGATION AND CONSERVATION PLAN § 10005.15 Planning and management techniques applicable to the plan. The Commission recognizes that there are a wide range of techniques that...

20 CFR 632.22 - Modification of a Comprehensive Annual Plan (CAP) and/or Master Plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (CAP) and/or Master Plan. 632.22 Section 632.22 Employees' Benefits EMPLOYMENT AND TRAINING..., Application and Modification Procedures § 632.22 Modification of a Comprehensive Annual Plan (CAP) and/or Master Plan. (a) The requirements for modifying a Master Plan and/or CAP will be included in...

Concept for a Satellite-Based Advanced Air Traffic Management System : Volume 6. Development and Transition Plans.

DOT National Transportation Integrated Search

1974-02-01

The volume presents the plans for implementing the Satellite-Based Advanced Air Traffic Management System (SAATMS) described in Volumes II, III, and IV. Two plans are presented: an RDT&E plan and a transition plan. The RDT&E plan is presented as a se...

Young Adults' Attitudes toward Multiple Role Planning: The Influence of Gender, Career Traditionality, and Marriage Plans.

ERIC Educational Resources Information Center

Peake, Amy; Harris, Karen L.

2002-01-01

For 66 young adult couples, marriage plans were positively related to knowledge and certainty about multiple role planning. Men with more nontraditional career partners had more commitment to and involvement in multiple role planning. Women with marriage plans and nontraditional career expectations had substantially higher commitment and…

Teacher Performance Assessment Instruments: Plans for Practice Rating.

ERIC Educational Resources Information Center

Capie, William; And Others

This manual consists of lesson plans developed to train data collectors in the use of the Teacher Performance Assessment Instruments (TPAI). Each set of plans was designed for one of three purposes. Lesson plans developed for the Teaching Plans and Materials Instrument (TPM) simulate a portfolio prepared by the teacher. One-day plans developed for…

18 CFR 5.11 - Potential Applicant's proposed study plan and study plan meetings.

Code of Federal Regulations, 2010 CFR

2010-04-01

... proposed study plan and study plan meetings. 5.11 Section 5.11 Conservation of Power and Water Resources... INTEGRATED LICENSE APPLICATION PROCESS § 5.11 Potential Applicant's proposed study plan and study plan..., including information and study requests, the potential applicant must file with the Commission a proposed...

18 CFR 5.11 - Potential Applicant's proposed study plan and study plan meetings.

Code of Federal Regulations, 2011 CFR

2011-04-01

... proposed study plan and study plan meetings. 5.11 Section 5.11 Conservation of Power and Water Resources... INTEGRATED LICENSE APPLICATION PROCESS § 5.11 Potential Applicant's proposed study plan and study plan..., including information and study requests, the potential applicant must file with the Commission a proposed...

26 CFR 1.401(a)(26)-8 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... defined in § 1.410(b)-9. Section 401(k) plan. Section 401(k) plan means a plan consisting of elective....401(k)-1(a)(4)(i). Section 401(m) plan. Section 401(m) plan means a plan consisting of employee... unless otherwise provided. Collective bargaining agreement. Collective bargaining agreement means an...

7 CFR 1717.604 - Long-range engineering plans and construction work plans.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Long-range engineering plans and construction work... AND GUARANTEED ELECTRIC LOANS Operational Controls § 1717.604 Long-range engineering plans and construction work plans. (a) All borrowers are required to maintain up-to-date long-range engineering plans and...

7 CFR 1717.604 - Long-range engineering plans and construction work plans.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 11 2013-01-01 2013-01-01 false Long-range engineering plans and construction work... AND GUARANTEED ELECTRIC LOANS Operational Controls § 1717.604 Long-range engineering plans and construction work plans. (a) All borrowers are required to maintain up-to-date long-range engineering plans and...

7 CFR 1717.604 - Long-range engineering plans and construction work plans.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 11 2014-01-01 2014-01-01 false Long-range engineering plans and construction work... AND GUARANTEED ELECTRIC LOANS Operational Controls § 1717.604 Long-range engineering plans and construction work plans. (a) All borrowers are required to maintain up-to-date long-range engineering plans and...

7 CFR 1717.604 - Long-range engineering plans and construction work plans.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 11 2012-01-01 2012-01-01 false Long-range engineering plans and construction work... AND GUARANTEED ELECTRIC LOANS Operational Controls § 1717.604 Long-range engineering plans and construction work plans. (a) All borrowers are required to maintain up-to-date long-range engineering plans and...

7 CFR 1717.604 - Long-range engineering plans and construction work plans.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 11 2011-01-01 2011-01-01 false Long-range engineering plans and construction work... AND GUARANTEED ELECTRIC LOANS Operational Controls § 1717.604 Long-range engineering plans and construction work plans. (a) All borrowers are required to maintain up-to-date long-range engineering plans and...

40 CFR 60.2620 - What is a waste management plan?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 7 2012-07-01 2012-07-01 false What is a waste management plan? 60... Commercial and Industrial Solid Waste Incineration Units Model Rule-Waste Management Plan § 60.2620 What is a waste management plan? A waste management plan is a written plan that identifies both the feasibility...

40 CFR 60.2899 - What is a waste management plan?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 6 2011-07-01 2011-07-01 false What is a waste management plan? 60... (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Preconstruction Siting Analysis Waste Management Plan § 60.2899 What is a waste management plan? A waste management plan is a written plan that...

40 CFR 60.2899 - What is a waste management plan?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 7 2012-07-01 2012-07-01 false What is a waste management plan? 60... (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Preconstruction Siting Analysis Waste Management Plan § 60.2899 What is a waste management plan? A waste management plan is a written plan that...

Companion Guides for Lesson Planning: A Planning Template and the Lesson Plan Pro Forma

ERIC Educational Resources Information Center

Pang, May

2016-01-01

Jason Anderson's proposal, in "ELT Journal" (2015), for an affordance-based approach to lesson planning raises important issues in teacher education. However, his arguments against the role of planned outcomes in favour of an affordance-based focus using learning opportunities as units of planning fail to acknowledge the complexities…

Climate Action Planning Process | Climate Neutral Research Campuses | NREL

Science.gov Websites

Action Planning Process Climate Action Planning Process For research campuses, NREL has developed a five-step process to develop and implement climate action plans: Determine baseline energy consumption Analyze technology options Prepare a plan and set priorities Implement the climate action plan Measure and

28 CFR 70.25 - Revision of budget and program plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Revision of budget and program plans. 70... Revision of budget and program plans. (a) The budget plan is the financial expression of the project or... from budget and program plans, and request prior approvals for budget and program plan revisions, in...

45 CFR 2543.25 - Revision of budget and program plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Revision of budget and program plans. 2543.25... Revision of budget and program plans. (a) The budget plan is the financial expression of the project or... deviations from budget and program plans, and request prior approvals for budget and program plan revisions...

42 CFR 423.272 - Review and negotiation of bid and approval of plans submitted by potential Part D sponsors.

Code of Federal Regulations, 2012 CFR

2012-10-01

...-PD plans with the following exceptions: (1) Exemption from negotiations. These plans are exempt from... prescription drug coverage and actuarial determinations. (1) Application of revenue requirements standard. CMS... in benefits offered under the plan. (c) Limited risk plans. (1) Application of limited risk plans...

42 CFR 423.272 - Review and negotiation of bid and approval of plans submitted by potential Part D sponsors.

Code of Federal Regulations, 2014 CFR

2014-10-01

...-PD plans with the following exceptions: (1) Exemption from negotiations. These plans are exempt from... prescription drug coverage and actuarial determinations. (1) Application of revenue requirements standard. CMS... in benefits offered under the plan. (c) Limited risk plans. (1) Application of limited risk plans...

26 CFR 54.9815-1251T - Preservation of right to maintain existing coverage (temporary).

Code of Federal Regulations, 2011 CFR

2011-04-01

... grandfathered health plan. Example 4. (i) Facts. Same facts as Example 3, except the grandfathered health plan..., except on March 23, 2010, the grandfathered health plan has no copayment ($0) for office visits for... health plan coverage—(1) In general—(i) Grandfathered health plan coverage. Grandfathered health plan...

The Intermountain West Region Waterbird Plan

Treesearch

Gary Ivey

2005-01-01

The planning process for the Intermountain West Region component of the North American Waterbird Conservation Plan began in November 2001. This is one of several region-specific plans being developed as part of the Waterbird Conservation for the Americas initiative (Kushlan et al. 2002), as called for in the North American Waterbird Conservation Plan. The plan...

18 CFR 1317.230 - Transition plans.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Transition plans. 1317... Coverage § 1317.230 Transition plans. (a) Submission of plans. An institution to which § 1317.225 applies... transition plan applicable to all such units, or a separate transition plan applicable to each such unit. (b...

45 CFR 618.230 - Transition plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Transition plans. 618.230 Section 618.230 Public... Coverage § 618.230 Transition plans. (a) Submission of plans. An institution to which § 618.225 applies and... plan applicable to all such units, or a separate transition plan applicable to each such unit. (b...

34 CFR 106.17 - Transition plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Transition plans. 106.17 Section 106.17 Education... Coverage § 106.17 Transition plans. (a) Submission of plans. An institution to which § 106.16 applies and... plan applicable to all such units, or a separate transition plan applicable to each such unit. (b...

30 CFR 282.26 - Contingency Plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Contingency Plan. 282.26 Section 282.26 Mineral... § 282.26 Contingency Plan. (a) When required by the Director, a lessee shall include a Contingency Plan as part of its request for approval of a Delineation, Testing, or Mining Plan. The Contingency Plan...

FAQs about Facilities: Practical Tips for Planning Renovations and New School Library Media Centers.

ERIC Educational Resources Information Center

Lenk, Mary Anne

2002-01-01

Answers frequently asked questions (FAQs) related to planning for renovating or building school library media centers (SLMCs). Topics include the role of the school library media specialist, advance planning, importance of a written long-range plan, library consultants, courses on planning, design compromises, planning resources, professional…

Planning and Second Language Development in Task-Based Synchronous Computer-Mediated Communication

ERIC Educational Resources Information Center

Hsu, Hsiu-Chen

2012-01-01

This dissertation explored the effect of two planning conditions (the multiple planning condition with rehearsal and online planning time, and the single planning condition with online planning time only) on L2 production complexity and accuracy and the subsequent development of these two linguistic areas in the context of written synchronous…

40 CFR 264.53 - Copies of contingency plan.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 26 2014-07-01 2014-07-01 false Copies of contingency plan. 264.53... Contingency Plan and Emergency Procedures § 264.53 Copies of contingency plan. A copy of the contingency plan and all revisions to the plan must be: (a) Maintained at the facility; and (b) Submitted to all local...

40 CFR 265.53 - Copies of contingency plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 26 2011-07-01 2011-07-01 false Copies of contingency plan. 265.53... DISPOSAL FACILITIES Contingency Plan and Emergency Procedures § 265.53 Copies of contingency plan. A copy of the contingency plan and all revisions to the plan must be: (a) Maintained at the facility; and (b...

40 CFR 264.53 - Copies of contingency plan.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 27 2013-07-01 2013-07-01 false Copies of contingency plan. 264.53... Contingency Plan and Emergency Procedures § 264.53 Copies of contingency plan. A copy of the contingency plan and all revisions to the plan must be: (a) Maintained at the facility; and (b) Submitted to all local...

40 CFR 264.53 - Copies of contingency plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Copies of contingency plan. 264.53... Contingency Plan and Emergency Procedures § 264.53 Copies of contingency plan. A copy of the contingency plan and all revisions to the plan must be: (a) Maintained at the facility; and (b) Submitted to all local...

40 CFR 264.53 - Copies of contingency plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 26 2011-07-01 2011-07-01 false Copies of contingency plan. 264.53... Contingency Plan and Emergency Procedures § 264.53 Copies of contingency plan. A copy of the contingency plan and all revisions to the plan must be: (a) Maintained at the facility; and (b) Submitted to all local...

40 CFR 265.53 - Copies of contingency plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Copies of contingency plan. 265.53... DISPOSAL FACILITIES Contingency Plan and Emergency Procedures § 265.53 Copies of contingency plan. A copy of the contingency plan and all revisions to the plan must be: (a) Maintained at the facility; and (b...

40 CFR 265.53 - Copies of contingency plan.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 26 2014-07-01 2014-07-01 false Copies of contingency plan. 265.53... DISPOSAL FACILITIES Contingency Plan and Emergency Procedures § 265.53 Copies of contingency plan. A copy of the contingency plan and all revisions to the plan must be: (a) Maintained at the facility; and (b...

40 CFR 265.53 - Copies of contingency plan.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 27 2013-07-01 2013-07-01 false Copies of contingency plan. 265.53... DISPOSAL FACILITIES Contingency Plan and Emergency Procedures § 265.53 Copies of contingency plan. A copy of the contingency plan and all revisions to the plan must be: (a) Maintained at the facility; and (b...

40 CFR 77.4 - Administrator's action on proposed offset plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... representative. The Administrator will also give notice of any approval in the Federal Register. The plans will... response to public comments submitted on the draft offset plan or disapproval of a draft offset plan... offset plan. The Administrator will serve a copy of any approved offset plan and the response to comments...

40 CFR 77.4 - Administrator's action on proposed offset plans.

Code of Federal Regulations, 2014 CFR

2014-07-01

... representative. The Administrator will also give notice of any approval in the Federal Register. The plans will... response to public comments submitted on the draft offset plan or disapproval of a draft offset plan... offset plan. The Administrator will serve a copy of any approved offset plan and the response to comments...

40 CFR 77.4 - Administrator's action on proposed offset plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... representative. The Administrator will also give notice of any approval in the Federal Register. The plans will... response to public comments submitted on the draft offset plan or disapproval of a draft offset plan... offset plan. The Administrator will serve a copy of any approved offset plan and the response to comments...

40 CFR 77.4 - Administrator's action on proposed offset plans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... representative. The Administrator will also give notice of any approval in the Federal Register. The plans will... response to public comments submitted on the draft offset plan or disapproval of a draft offset plan... offset plan. The Administrator will serve a copy of any approved offset plan and the response to comments...

44 CFR 350.6 - Assistance in development of State and local plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... State and local plans. 350.6 Section 350.6 Emergency Management and Assistance FEDERAL EMERGENCY... radiological emergency response plans, and will review plans and observe exercises to evaluate the adequacy of... RADIOLOGICAL EMERGENCY PLANS AND PREPAREDNESS § 350.6 Assistance in development of State and local plans. (a...

Does Your Health Plan Measure Up? How Can You Tell?

ERIC Educational Resources Information Center

Edwards, Tom

1999-01-01

Describes the process behind health-plan selection for school district employees and offers suggestions on how managers might enhance their current healthcare plan purchasing process. Areas of health-plan review and critique are listed as are tips for measuring plan performance and advice on acquiring backup data on plan quality. (GR)

46 CFR 189.55-20 - Number of plans required.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 7 2012-10-01 2012-10-01 false Number of plans required. 189.55-20 Section 189.55-20... AND CERTIFICATION Plan Approval § 189.55-20 Number of plans required. (a) Three copies of each plan... additional approved plans, a suitable number should be submitted to permit the required distribution. [CGFR...

46 CFR 189.55-20 - Number of plans required.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 7 2014-10-01 2014-10-01 false Number of plans required. 189.55-20 Section 189.55-20... AND CERTIFICATION Plan Approval § 189.55-20 Number of plans required. (a) Three copies of each plan... additional approved plans, a suitable number should be submitted to permit the required distribution. [CGFR...

24 CFR 91.320 - Action plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Action plan. 91.320 Section 91.320... Consolidated Plan § 91.320 Action plan. The action plan must include the following: (a) Standard Form 424; (b... outcome measures for activities included in its action plan in accordance with guidance issued by HUD. For...

24 CFR 91.220 - Action plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Action plan. 91.220 Section 91.220... Consolidated Plan § 91.220 Action plan. The action plan must include the following: (a) Standard Form 424; (b... to be undertaken. The action plan must provide a description of the activities the jurisdiction will...

24 CFR 91.220 - Action plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Action plan. 91.220 Section 91.220... Consolidated Plan § 91.220 Action plan. The action plan must include the following: (a) Standard Form 424; (b... to be undertaken. The action plan must provide a description of the activities the jurisdiction will...

24 CFR 91.320 - Action plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Action plan. 91.320 Section 91.320... Consolidated Plan § 91.320 Action plan. The action plan must include the following: (a) Standard Form 424; (b... outcome measures for activities included in its action plan in accordance with guidance issued by HUD. For...

24 CFR 91.420 - Action plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Action plan. 91.420 Section 91.420... Plan § 91.420 Action plan. (a) Form application. The action plan for the consortium must include a...) Description of resources and activities. The action plan must describe the resources to be used and activities...

24 CFR 91.420 - Action plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Action plan. 91.420 Section 91.420... Plan § 91.420 Action plan. (a) Form application. The action plan for the consortium must include a...) Description of resources and activities. The action plan must describe the resources to be used and activities...

40 CFR 265.53 - Copies of contingency plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Copies of contingency plan. 265.53... DISPOSAL FACILITIES Contingency Plan and Emergency Procedures § 265.53 Copies of contingency plan. A copy of the contingency plan and all revisions to the plan must be: (a) Maintained at the facility; and (b...

Advance care treatment plan (ACT-Plan) for African American family caregivers: a pilot study.

PubMed

Bonner, Gloria J; Wang, Edward; Wilkie, Diana J; Ferrans, Carol E; Dancy, Barbara; Watkins, Yashika

2014-01-01

Research is limited on end-of-life treatment decisions made by African American family caregivers. In a pilot study, we examined the feasibility of implementing an advance care treatment plan (ACT-Plan), a group-based education intervention, with African American dementia caregivers. Theoretically based, the ACT-Plan included strategies to enhance knowledge, self-efficacy, and behavioral skills to make end-of-life treatment plans in advance. Cardiopulmonary resuscitation, mechanical ventilation, and tube feeding were end-of-life treatments discussed in the ACT-Plan. In a four-week pre/posttest two-group design at urban adult day care centers, 68 caregivers were assigned to the ACT-Plan or attention-control health promotion conditions. Findings strongly suggest that the ACT-Plan intervention is feasible and appropriate for African American caregivers. Self-efficacy and knowledge about dementia, cardiopulmonary resuscitation, mechanical ventilation, and tube feeding increased for ACT-Plan participants but not for the attention-control. More ACT-Plan than attention-control participants developed advance care plans for demented relatives. Findings warrant a randomized efficacy trial.

1. Statement of significance, site plan, plan, elevation, section, boxcar ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

1. Statement of significance, site plan, plan, elevation, section, boxcar spring details, and outhouse plan and elevation. - Woods Landing Dance Hall, 2731 State Highway 230, Woods Landing, Albany County, WY

31 CFR 29.301 - Purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-07-01

... employee's total retirement benefits under the Police and Firefighters Plan or the Teachers Plan. (2) This... Firefighters Plan or the Teachers Plan for individuals who have performed service creditable under these... Judges Plan. ...

31 CFR 29.301 - Purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-07-01

... employee's total retirement benefits under the Police and Firefighters Plan or the Teachers Plan. (2) This... Firefighters Plan or the Teachers Plan for individuals who have performed service creditable under these... Judges Plan. ...

Floor Plans Foundation Plan at Bedrock and Subgrade Level ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Floor Plans - Foundation Plan at Bedrock and Subgrade Level Plan - Marshall Space Flight Center, F-1 Engine Static Test Stand, On Route 565 between Huntsville and Decatur, Huntsville, Madison County, AL

14 CFR 431.39 - Mission rules, procedures, contingency plans, and checklists.

Code of Federal Regulations, 2012 CFR

2012-01-01

... mission rules, procedures, checklists, emergency plans, and contingency abort plans, if any, that ensure..., procedures, checklists, emergency plans, and contingency abort plans must be contained in a safety directive...

14 CFR 431.39 - Mission rules, procedures, contingency plans, and checklists.

Code of Federal Regulations, 2014 CFR

2014-01-01

... mission rules, procedures, checklists, emergency plans, and contingency abort plans, if any, that ensure..., procedures, checklists, emergency plans, and contingency abort plans must be contained in a safety directive...

14 CFR 431.39 - Mission rules, procedures, contingency plans, and checklists.

Code of Federal Regulations, 2013 CFR

2013-01-01

... mission rules, procedures, checklists, emergency plans, and contingency abort plans, if any, that ensure..., procedures, checklists, emergency plans, and contingency abort plans must be contained in a safety directive...

Iterative dataset optimization in automated planning: Implementation for breast and rectal cancer radiotherapy.

PubMed

Fan, Jiawei; Wang, Jiazhou; Zhang, Zhen; Hu, Weigang

2017-06-01

To develop a new automated treatment planning solution for breast and rectal cancer radiotherapy. The automated treatment planning solution developed in this study includes selection of the iterative optimized training dataset, dose volume histogram (DVH) prediction for the organs at risk (OARs), and automatic generation of clinically acceptable treatment plans. The iterative optimized training dataset is selected by an iterative optimization from 40 treatment plans for left-breast and rectal cancer patients who received radiation therapy. A two-dimensional kernel density estimation algorithm (noted as two parameters KDE) which incorporated two predictive features was implemented to produce the predicted DVHs. Finally, 10 additional new left-breast treatment plans are re-planned using the Pinnacle 3 Auto-Planning (AP) module (version 9.10, Philips Medical Systems) with the objective functions derived from the predicted DVH curves. Automatically generated re-optimized treatment plans are compared with the original manually optimized plans. By combining the iterative optimized training dataset methodology and two parameters KDE prediction algorithm, our proposed automated planning strategy improves the accuracy of the DVH prediction. The automatically generated treatment plans using the dose derived from the predicted DVHs can achieve better dose sparing for some OARs without compromising other metrics of plan quality. The proposed new automated treatment planning solution can be used to efficiently evaluate and improve the quality and consistency of the treatment plans for intensity-modulated breast and rectal cancer radiation therapy. © 2017 American Association of Physicists in Medicine.

State of emergency preparedness for US health insurance plans.

PubMed

Merchant, Raina M; Finne, Kristen; Lardy, Barbara; Veselovskiy, German; Korba, Caey; Margolis, Gregg S; Lurie, Nicole

2015-01-01

Health insurance plans serve a critical role in public health emergencies, yet little has been published about their collective emergency preparedness practices and policies. We evaluated, on a national scale, the state of health insurance plans' emergency preparedness and policies. A survey of health insurance plans. We queried members of America's Health Insurance Plans, the national trade association representing the health insurance industry, about issues related to emergency preparedness issues: infrastructure, adaptability, connectedness, and best practices. Of 137 health insurance plans queried, 63% responded, representing 190.6 million members and 81% of US plan enrollment. All respondents had emergency plans for business continuity, and most (85%) had infrastructure for emergency teams. Some health plans also have established benchmarks for preparedness (eg, response time). Regarding adaptability, 85% had protocols to extend claim filing time and 71% could temporarily suspend prior medical authorization rules. Regarding connectedness, many plans shared their contingency plans with health officials, but often cited challenges in identifying regulatory agency contacts. Some health insurance plans had specific policies for assisting individuals dependent on durable medical equipment or home healthcare. Many plans (60%) expressed interest in sharing best practices. Health insurance plans are prioritizing emergency preparedness. We identified 6 policy modifications that health insurance plans could undertake to potentially improve healthcare system preparedness: establishing metrics and benchmarks for emergency preparedness; identifying disaster-specific policy modifications, enhancing stakeholder connectedness, considering digital strategies to enhance communication, improving support and access for special-needs individuals, and developing regular forums for knowledge exchange about emergency preparedness.

A knowledge-based approach to automated planning for hepatocellular carcinoma.

PubMed

Zhang, Yujie; Li, Tingting; Xiao, Han; Ji, Weixing; Guo, Ming; Zeng, Zhaochong; Zhang, Jianying

2018-01-01

To build a knowledge-based model of liver cancer for Auto-Planning, a function in Pinnacle, which is used as an automated inverse intensity modulated radiation therapy (IMRT) planning system. Fifty Tomotherapy patients were enrolled to extract the dose-volume histograms (DVHs) information and construct the protocol for Auto-Planning model. Twenty more patients were chosen additionally to test the model. Manual planning and automatic planning were performed blindly for all twenty test patients with the same machine and treatment planning system. The dose distributions of target and organs at risks (OARs), along with the working time for planning, were evaluated. Statistically significant results showed that automated plans performed better in target conformity index (CI) while mean target dose was 0.5 Gy higher than manual plans. The differences between target homogeneity indexes (HI) of the two methods were not statistically significant. Additionally, the doses of normal liver, left kidney, and small bowel were significantly reduced with automated plan. Particularly, mean dose and V15 of normal liver were 1.4 Gy and 40.5 cc lower with automated plans respectively. Mean doses of left kidney and small bowel were reduced with automated plans by 1.2 Gy and 2.1 Gy respectively. In contrast, working time was also significantly reduced with automated planning. Auto-Planning shows availability and effectiveness in our knowledge-based model for liver cancer. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Multivariable normal tissue complication probability model-based treatment plan optimization for grade 2-4 dysphagia and tube feeding dependence in head and neck radiotherapy.

PubMed

Kierkels, Roel G J; Wopken, Kim; Visser, Ruurd; Korevaar, Erik W; van der Schaaf, Arjen; Bijl, Hendrik P; Langendijk, Johannes A

2016-12-01

Radiotherapy of the head and neck is challenged by the relatively large number of organs-at-risk close to the tumor. Biologically-oriented objective functions (OF) could optimally distribute the dose among the organs-at-risk. We aimed to explore OFs based on multivariable normal tissue complication probability (NTCP) models for grade 2-4 dysphagia (DYS) and tube feeding dependence (TFD). One hundred head and neck cancer patients were studied. Additional to the clinical plan, two more plans (an OF DYS and OF TFD -plan) were optimized per patient. The NTCP models included up to four dose-volume parameters and other non-dosimetric factors. A fully automatic plan optimization framework was used to optimize the OF NTCP -based plans. All OF NTCP -based plans were reviewed and classified as clinically acceptable. On average, the Δdose and ΔNTCP were small comparing the OF DYS -plan, OF TFD -plan, and clinical plan. For 5% of patients NTCP TFD reduced >5% using OF TFD -based planning compared to the OF DYS -plans. Plan optimization using NTCP DYS - and NTCP TFD -based objective functions resulted in clinically acceptable plans. For patients with considerable risk factors of TFD, the OF TFD steered the optimizer to dose distributions which directly led to slightly lower predicted NTCP TFD values as compared to the other studied plans. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Using multi-disciplinary strategic master facilities planning for organizations experiencing programmatic re-direction

DOE Office of Scientific and Technical Information (OSTI.GOV)

Heubach, J.G.; Weimer, W.C.; Bruce, W.A.

Facility master planning is critical to the future productivity of a laboratory and the quality of worklife for the laboratory staff. For organizations undergoing programmatic re-direction, a master facility planning approach linked to the organization`s strategic planning process is even more important. Major changes in an organization such as programmatic re-direction can significantly impact a broad range of variables which exceed the expertise of traditional planning teams, e.g., capacity variability, work team organization, organizational culture, and work process simplification. By expanding the diversity of the participants of the planning team, there is a greater likelihood that a research organization`s scientific,more » organizational, economic, and employees` needs can be meshed in the strategic plan and facility plan. Recent recommendations from facility planners suggest drawing from diverse fields in building multi-disciplinary planning teams: Architecture, engineering, natural science, social psychology, and strategic planning (Gibson,1993). For organizations undergoing significant operational or culture change, the master facility planning team should also include members with expertise in organizational effectiveness, industrial engineering, human resources, and environmental psychology. A recent planning and design project provides an example which illustrates the use of an expanded multi-disciplinary team engaged in planning laboratory renovations for a research organization undergoing programmatic re-direction. The purpose of the proposed poster session is to present a multi-disciplinary master facility planning process linked to an organization`s strategic planning process or organizational strategies.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zaks, D; Fletcher, R; Salamon, S

Purpose: To develop an online framework that tracks a patient’s plan from initial simulation to treatment and that helps automate elements of the physics plan checks usually performed in the record and verify (RV) system and treatment planning system. Methods: We have developed PlanTracker, an online plan tracking system that automatically imports new patients tasks and follows it through treatment planning, physics checks, therapy check, and chart rounds. A survey was designed to collect information about the amount of time spent by medical physicists in non-physics related tasks. We then assessed these non-physics tasks for automation. Using these surveys, wemore » directed our PlanTracker software development towards the automation of intra-plan physics review. We then conducted a systematic evaluation of PlanTracker’s accuracy by generating test plans in the RV system software designed to mimic real plans, in order to test its efficacy in catching errors both real and theoretical. Results: PlanTracker has proven to be an effective improvement to the clinical workflow in a radiotherapy clinic. We present data indicating that roughly 1/3 of the physics plan check can be automated, and the workflow optimized, and show the functionality of PlanTracker. When the full system is in clinical use we will present data on improvement of time use in comparison to survey data prior to PlanTracker implementation. Conclusion: We have developed a framework for plan tracking and automatic checks in radiation therapy. We anticipate using PlanTracker as a basis for further development in clinical/research software. We hope that by eliminating the most simple and time consuming checks, medical physicists may be able to spend their time on plan quality and other physics tasks rather than in arithmetic and logic checks. We see this development as part of a broader initiative to advance the clinical/research informatics infrastructure surrounding the radiotherapy clinic. This research project has been financially supported by Varian Medical Systems, Palo Alto, CA, through a Varian MRA.« less

Generalizable Class Solutions for Treatment Planning of Spinal Stereotactic Body Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Weksberg, David C.; Palmer, Matthew B.; Vu, Khoi N.

2012-11-01

Purpose: Spinal stereotactic body radiation therapy (SBRT) continues to emerge as an effective therapeutic approach to spinal metastases; however, treatment planning and delivery remain resource intensive at many centers, which may hamper efficient implementation in clinical practice. We sought to develop a generalizable class solution approach for spinal SBRT treatment planning that would allow confidence that a given plan provides optimal target coverage, reduce integral dose, and maximize planning efficiency. Methods and Materials: We examined 91 patients treated with spinal SBRT at our institution. Treatment plans were categorized by lesion location, clinical target volume (CTV) configuration, and dose fractionation scheme,more » and then analyzed to determine the technically achievable dose gradient. A radial cord expansion was subtracted from the CTV to yield a planning CTV (pCTV) construct for plan evaluation. We reviewed the treatment plans with respect to target coverage, dose gradient, integral dose, conformality, and maximum cord dose to select the best plans and develop a set of class solutions. Results: The class solution technique generated plans that maintained target coverage and improved conformality (1.2-fold increase in the 95% van't Riet Conformation Number describing the conformality of a reference dose to the target) while reducing normal tissue integral dose (1.3-fold decrease in the volume receiving 4 Gy (V{sub 4Gy}) and machine output (19% monitor unit (MU) reduction). In trials of planning efficiency, the class solution technique reduced treatment planning time by 30% to 60% and MUs required by {approx}20%: an effect independent of prior planning experience. Conclusions: We have developed a set of class solutions for spinal SBRT that incorporate a pCTV metric for plan evaluation while yielding dosimetrically superior treatment plans with increased planning efficiency. Our technique thus allows for efficient, reproducible, and high-quality spinal SBRT treatment planning.« less

Comparison of organ-at-risk sparing and plan robustness for spot-scanning proton therapy and volumetric modulated arc photon therapy in head-and-neck cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barten, Danique L. J., E-mail: d.barten@vumc.nl; Tol, Jim P.; Dahele, Max

Purpose: Proton radiotherapy for head-and-neck cancer (HNC) aims to improve organ-at-risk (OAR) sparing over photon radiotherapy. However, it may be less robust for setup and range uncertainties. The authors investigated OAR sparing and plan robustness for spot-scanning proton planning techniques and compared these with volumetric modulated arc therapy (VMAT) photon plans. Methods: Ten HNC patients were replanned using two arc VMAT (RapidArc) and spot-scanning proton techniques. OARs to be spared included the contra- and ipsilateral parotid and submandibular glands and individual swallowing muscles. Proton plans were made using Multifield Optimization (MFO, using three, five, and seven fields) and Single-field Optimizationmore » (SFO, using three fields). OAR sparing was evaluated using mean dose to composite salivary glands (Comp{sub Sal}) and composite swallowing muscles (Comp{sub Swal}). Plan robustness was determined for setup and range uncertainties (±3 mm for setup, ±3% HU) evaluating V95% and V107% for clinical target volumes. Results: Averaged over all patients Comp{sub Sal}/Comp{sub Swal} mean doses were lower for the three-field MFO plans (14.6/16.4 Gy) compared to the three-field SFO plans (20.0/23.7 Gy) and VMAT plans (23.0/25.3 Gy). Using more than three fields resulted in differences in OAR sparing of less than 1.5 Gy between plans. SFO plans were significantly more robust than MFO plans. VMAT plans were the most robust. Conclusions: MFO plans had improved OAR sparing but were less robust than SFO and VMAT plans, while SFO plans were more robust than MFO plans but resulted in less OAR sparing. Robustness of the MFO plans did not increase with more fields.« less

Dosimetric comparison of three intensity-modulated radiation therapies for left breast cancer after breast-conserving surgery.

PubMed

Zhang, Huai-Wen; Hu, Bo; Xie, Chen; Wang, Yun-Lai

2018-05-01

This study aimed to evaluate dosimetric differences of intensity-modulated radiation therapy (IMRT) in target and normal tissues after breast-conserving surgery. IMRT five-field plan I, IMRT six-field plan II, and field-in-field-direct machine parameter optimization-IMRT plan III were designed for each of the 50 patients. One-way analysis of variance was performed to compare differences, and P < 0.05 was considered statistically significant. Homogeneity index of plan III is lower than those of plans I and II. No difference was identified in conformity index of targets. Plan I exhibited difference in mean dose (D mean ) for the heart (P < 0.05). Plan I featured smaller irradiation dose volumes in V 5 , V 20 (P < 0.05) of the left lung than II. Plan I exhibited significantly higher V 5 in the right lung than plans II and III (P < 0.05). Under plan I, irradiation dose at V 5 in the right breast is higher than that in plans II and III. Patients in plan III presented less total monitor unit and total treatment time than those in plans I and II (P < 0.05). IMRT six-field plans II, and field-in-field-direct machine parameter optimization-IMRT plans III can reduce doses and volumes to the lungs and heart better while maintaining satisfying conformity index and homogeneity index of target. Nevertheless, plan II neglects target movements caused by respiration. In the same manner, plan III can substantially reduce MU and shorten patient treatment time. Therefore, plan III, which considers target movement caused by respiration, is a more practical radiation mode. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

SU-E-T-308: Dosimetric Comparison of SBRT VMAT Treatment Plans Generated for 6 MV, 6 MV FFF, and 10 MV FFF Photon Beams

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wilson, D; Wang, B; Dunlap, N

2015-06-15

Purpose: To assess differences in treatment plan quality between VMAT stereotactic body plans generated using the 6 MV, 6 MV FFF, and 10 MV FFF modalities available in our clinic. Plans for lung, spine, and other sites were compared to see if there is any advantage of one modality over the other. Methods: Treatment plans done for actual SBRT patients were selected. Groups of ten lung plans, five spine plans, and five plans from other sites were selected. New treatment plans were generated for each plan using the Varian Eclipse AAA algorithm. The constraints were kept the same as usedmore » in the actual plans, but the same version of software was used to generate plans for the three modalities. In addition, because there are natural variations in plans re-done with the same dose constraints, one of the lung plans was repeated ten times to assess those differences. Volumes of the 100%, 90%, 50%, 20% and 10% isodose surfaces were compared. Maximum dose two centimeters from the PTV were compared, as well as the volume of the 105% isodose surface outside of the PTV. In addition, the 20 Gray lung volume was compared for the lung plans. The values of these parameters were divided by the values for the 6 MV plans for comparison. Average and standard deviations were obtained for quantities in each group. The Student t test was done to determine if differences were seen at the 95% confidence level. Results: Comparison of the treatment plans showed no significant differences when assessing these volumes and doses. There were not any trends seen when comparing modalities as a function of PTV volume either. Conclusion: There is no obvious dosimetric advantage in selection of one modality over another for these types of SBRT plans.« less

MO-F-CAMPUS-T-03: Continuous Dose Delivery with Gamma Knife Perfexion

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ghobadi,; Li, W; Chung, C

2015-06-15

Purpose: We propose continuous dose delivery techniques for stereotactic treatments delivered by Gamma Knife Perfexion using inverse treatment planning system that can be applied to various tumour sites in the brain. We test the accuracy of the plans on Perfexion’s planning system (GammaPlan) to ensure the obtained plans are viable. This approach introduces continuous dose delivery for Perefxion, as opposed to the currently employed step-and-shoot approaches, for different tumour sites. Additionally, this is the first realization of automated inverse planning on GammaPlan. Methods: The inverse planning approach is divided into two steps of identifying a quality path inside the target,more » and finding the best collimator composition for the path. To find a path, we select strategic regions inside the target volume and find a path that visits each region exactly once. This path is then passed to a mathematical model which finds the best combination of collimators and their durations. The mathematical model minimizes the dose spillage to the surrounding tissues while ensuring the prescribed dose is delivered to the target(s). Organs-at-risk and their corresponding allowable doses can also be added to the model to protect adjacent organs. Results: We test this approach on various tumour sizes and sites. The quality of the obtained treatment plans are comparable or better than forward plans and inverse plans that use step- and-shoot technique. The conformity indices in the obtained continuous dose delivery plans are similar to those of forward plans while the beam-on time is improved on average (see Table 1 in supporting document). Conclusion: We employ inverse planning for continuous dose delivery in Perfexion for brain tumours. The quality of the obtained plans is similar to forward and inverse plans that use conventional step-and-shoot technique. We tested the inverse plans on GammaPlan to verify clinical relevance. This research was partially supported by Elekta, Sweden (vendor of Gamma Knife Perfexion)« less

Treatment planning for spinal radiosurgery : A competitive multiplatform benchmark challenge.

PubMed

Moustakis, Christos; Chan, Mark K H; Kim, Jinkoo; Nilsson, Joakim; Bergman, Alanah; Bichay, Tewfik J; Palazon Cano, Isabel; Cilla, Savino; Deodato, Francesco; Doro, Raffaela; Dunst, Jürgen; Eich, Hans Theodor; Fau, Pierre; Fong, Ming; Haverkamp, Uwe; Heinze, Simon; Hildebrandt, Guido; Imhoff, Detlef; de Klerck, Erik; Köhn, Janett; Lambrecht, Ulrike; Loutfi-Krauss, Britta; Ebrahimi, Fatemeh; Masi, Laura; Mayville, Alan H; Mestrovic, Ante; Milder, Maaike; Morganti, Alessio G; Rades, Dirk; Ramm, Ulla; Rödel, Claus; Siebert, Frank-Andre; den Toom, Wilhelm; Wang, Lei; Wurster, Stefan; Schweikard, Achim; Soltys, Scott G; Ryu, Samuel; Blanck, Oliver

2018-05-25

To investigate the quality of treatment plans of spinal radiosurgery derived from different planning and delivery systems. The comparisons include robotic delivery and intensity modulated arc therapy (IMAT) approaches. Multiple centers with equal systems were used to reduce a bias based on individual's planning abilities. The study used a series of three complex spine lesions to maximize the difference in plan quality among the various approaches. Internationally recognized experts in the field of treatment planning and spinal radiosurgery from 12 centers with various treatment planning systems participated. For a complex spinal lesion, the results were compared against a previously published benchmark plan derived for CyberKnife radiosurgery (CKRS) using circular cones only. For two additional cases, one with multiple small lesions infiltrating three vertebrae and a single vertebra lesion treated with integrated boost, the results were compared against a benchmark plan generated using a best practice guideline for CKRS. All plans were rated based on a previously established ranking system. All 12 centers could reach equality (n = 4) or outperform (n = 8) the benchmark plan. For the multiple lesions and the single vertebra lesion plan only 5 and 3 of the 12 centers, respectively, reached equality or outperformed the best practice benchmark plan. However, the absolute differences in target and critical structure dosimetry were small and strongly planner-dependent rather than system-dependent. Overall, gantry-based IMAT with simple planning techniques (two coplanar arcs) produced faster treatments and significantly outperformed static gantry intensity modulated radiation therapy (IMRT) and multileaf collimator (MLC) or non-MLC CKRS treatment plan quality regardless of the system (mean rank out of 4 was 1.2 vs. 3.1, p = 0.002). High plan quality for complex spinal radiosurgery was achieved among all systems and all participating centers in this planning challenge. This study concludes that simple IMAT techniques can generate significantly better plan quality compared to previous established CKRS benchmarks.

SU-E-J-78: Adaptive Planning Workflow in a Pencil Beam Scanning Proton Therapy Center

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blakey, M; Price, S; Robison, B

Purpose: The susceptibility of proton therapy to changes in patient setup and anatomy necessitates an adaptive planning process. With the right planning tools and clinical workflow, an adaptive plan can be created in a timely manner without adding significant workload to the treatment planning staff. Methods: In our center, a weekly QA CT is performed on most patients to assess setup, anatomy change, and tumor response. The QA CT is fused to the treatment planning CT, the contours are transferred via deformable registration, and the plan dose is recalculated on the QA CT. A physicist assesses the dose distribution, andmore » an adaptive plan is requested based on tumor coverage or OAR dose changes. After the physician confirms or alters the deformed contours, a dosimetrist develops an adaptive plan using our TPS adaptation module. The plan is assessed for robustness and is then reviewed by the physician. Patient QA is performed within three days following the first adapted treatment. Results: Of the patients who received QA CTs, 19% required at least one adaptive plan (18.5% H&N, 18.5% brain, 11.1% breast, 14.8% chestwall, 14.8% lung, 18.5% pelvis and 3.8% abdomen). Of these patients, 14% went on a break, while the remainder was treated with the previous plan during the re-planning process. Adaptive plans were performed based on tumor shrinkage, anatomy change or positioning uncertainties for 37.9%, 44.8%, and 17.3% of the patients, respectively. On average, 3 full days are required between the QA CT and the first adapted plan treatment. Conclusion: Adaptive planning is a crucial component of proton therapy and should be applied to any site when the QA CT shows significant deviation from the plan. With an efficient workflow, an adaptive plan can be applied without delaying patient treatment or burdening the dosimetry and medical physics team.« less

Using gEUD based plan analysis method to evaluate proton vs. photon plans for lung cancer radiation therapy.

PubMed

Xiao, Zhiyan; Zou, Wei J; Chen, Ting; Yue, Ning J; Jabbour, Salma K; Parikh, Rahul; Zhang, Miao

2018-03-01

The goal of this study was to exam the efficacy of current DVH based clinical guidelines draw from photon experience for lung cancer radiation therapy on proton therapy. Comparison proton plans and IMRT plans were generated for 10 lung patients treated in our proton facility. A gEUD based plan evaluation method was developed for plan evaluation. This evaluation method used normal lung gEUD(a) curve in which the model parameter "a" was sampled from the literature reported value. For all patients, the proton plans delivered lower normal lung V 5 Gy with similar V 20 Gy and similar target coverage. Based on current clinical guidelines, proton plans were ranked superior to IMRT plans for all 10 patients. However, the proton and IMRT normal lung gEUD(a) curves crossed for 8 patients within the tested range of "a", which means there was a possibility that proton plan would be worse than IMRT plan for lung sparing. A concept of deficiency index (DI) was introduced to quantify the probability of proton plans doing worse than IMRT plans. By applying threshold on DI, four patients' proton plan was ranked inferior to the IMRT plan. Meanwhile if a threshold to the location of curve crossing was applied, 6 patients' proton plan was ranked inferior to the IMRT plan. The contradictory ranking results between the current clinical guidelines and the gEUD(a) curve analysis demonstrated there is potential pitfalls by applying photon experience directly to the proton world. A comprehensive plan evaluation based on radio-biological models should be carried out to decide if a lung patient would really be benefit from proton therapy. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Sci-Fri PM: Radiation Therapy, Planning, Imaging, and Special Techniques - 02: Feasibility of using multileaf collimation for stereotactic radiosurgery of arteriovenous malformation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Young; Ruschin, Mark

SRS using linac and cones offers steep dose fall-off but a tradeoff exists between conformality and treatment time, which depends on the number of isocentres. Purpose of this study is to quantify planning metrics between cones- and MLC-based SRS for arteriovenous malformation(AVM). Seven AVM cases treated with cones were re-planned with MLC on Pinnacle treatment planning system. Planning target volume(PTV) was created with 1mm uniform margin to the AVM to account for MLC positional variation. Clinically-planned prescription dose(15–25Gy) was used. Four plans were generated per case:non-coplanar VMAT(ncV), single-arc VMAT(saV), non-coplanar IMRT(ncI), non-coplanar conformal(ncC). Plans were compared for conformity(CI), heterogeneity(HI) andmore » gradient(GI) indices and brain doses. Estimated treatment times and monitor units(MU) were compared. Cone-based plans required 2–6 isocentres. Though CI-RTOG was similar for plans(median=0.98), CI-Paddick was most favourable for ncV(median=0.86) and worst for cones(0.54). HI for MLC plans(median=1.19–1.27) were lower than cone-based plans(1.43). GI was similar for all plans. For 2/7 ncC had brainstem maximum dose>16.7Gy and therefore were clinically unacceptable. Brain V12Gy,V10Gy,V2Gy were lowest in the cones plan. ncV brain V12Gy,V10Gy,V2Gy were lowest of all MLC-based plans studied. Treatment MUs were similar for MLC-based plans and up to 70% lower than clinically delivered plans. ncV showed best conformality in this study. Of the MLC-based plans, ncV also showed lowest normal tissue dose with reasonable treatment time.« less

Quality assessment for VMAT prostate radiotherapy planning based on data envelopment analysis

NASA Astrophysics Data System (ADS)

Lin, Kuan-Min; Simpson, John; Sasso, Giuseppe; Raith, Andrea; Ehrgott, Matthias

2013-08-01

The majority of commercial radiotherapy treatment planning systems requires planners to iteratively adjust the plan parameters in order to find a satisfactory plan. This iterative trial-and-error nature of radiotherapy treatment planning results in an inefficient planning process and in order to reduce such inefficiency, plans can be accepted without achieving the best attainable quality. We propose a quality assessment method based on data envelopment analysis (DEA) to address this inefficiency. This method compares a plan of interest to a set of past delivered plans and searches for evidence of potential further improvement. With the assistance of DEA, planners will be able to make informed decisions on whether further planning is required and ensure that a plan is only accepted when the plan quality is close to the best attainable one. We apply the DEA method to 37 prostate plans using two assessment parameters: rectal generalized equivalent uniform dose (gEUD) as the input and D95 (the minimum dose that is received by 95% volume of a structure) of the planning target volume (PTV) as the output. The percentage volume of rectum overlapping PTV is used to account for anatomical variations between patients and is included in the model as a non-discretionary output variable. Five plans that are considered of lesser quality by DEA are re-optimized with the goal to further improve rectal sparing. After re-optimization, all five plans improve in rectal gEUD without clinically considerable deterioration of the PTV D95 value. For the five re-optimized plans, the rectal gEUD is reduced by an average of 1.84 Gray (Gy) with only an average reduction of 0.07 Gy in PTV D95. The results demonstrate that DEA can correctly identify plans with potential improvements in terms of the chosen input and outputs.

From action planning and plan enactment to fruit consumption: moderated mediation effects.

PubMed

Kasten, Stefanie; van Osch, Liesbeth; Eggers, Sander Matthijs; de Vries, Hein

2017-10-23

Sufficient fruit consumption is beneficial for a healthy live. While many Dutch adults intent to eat the recommended amount of fruit, only 5-10% of the population actually adheres to the recommendation. One mechanism that can help to narrow this gap between intention and actual fruit consumption is action planning. However, action planning is only assumed to be effective if plans are enacted. This study assessed which action plans are made and enacted, and further aimed to investigate two main hypotheses: 1. the effect of action planning (at T1) on fruit consumption (at T2) is mediated by plan enactment (at T3); 2. positive intentions (2a), high self-efficacy (2b) and a strong habit to eat fruit (2c) enhance the mediation of plan enactment, whereas a strong habit to eat snacks (2d) hinders the mediation of plan enactment. This study was a self-reported longitudinal online survey study. A total of 428 participants filled in a survey, measuring demographic factors (e.g. gender, age, education level), several socio-cognitive constructs (i.e. attitudes, self-efficacy, habit, action planning, plan enactment), and fruit consumption, at three points in time (baseline, after 1 month, and after 3 months). Mediation and moderated mediation analyses were used to investigate the planning-plan enactment- fruit consumption relationship. Up to 70% of the participants reported to have enacted their T1 action plans at T2. Action planning on fruit consumption was fully mediated by plan enactment (Hypothesis 1). All four proposed moderators (i.e. intention, self-efficacy, habit to consume fruit, and habit to consume snacks) significantly influenced the mediation (Hypotheses 2a-2d). Mediation of plan enactment was only present with high levels of intention, high levels of self-efficacy, strong habits to eat fruit, and weak habits to eat snacks. The study suggests the importance of plan enactment for fruit consumption. Furthermore, it emphasizes the necessity of facilitating factors. High levels of intention, self-efficacy and a strong habit to consume fruit clearly aid the enactment of action plans. This suggests that when these factors are moderately low, plan enactment may fail and thus an intervention may require first steps to foster these moderating factors.

Monitored execution of robot plans produced by STRIPS.

NASA Technical Reports Server (NTRS)

Fikes, R. E.

1972-01-01

We describe PLANEX1, a plan executor for the Stanford Research Institute robot system. The problem-solving program STRIPS creates a plan consisting of a sequence of actions, and PLANEX1 program carries out the plan by executing the actions. PLANEX1 is designed so that it executes only that portion of the plan necessary for completing the task, reexecutes any portion of the plan that has failed to achieve the desired results, and initiates replanning in situations where the plan can no longer be effective in completing the task. The scenario for an example plan execution is given.

Planning for strategic change? A participative planning approach for community hospitals.

PubMed

MacDonald, S K; Beange, J E; Blachford, P C

1992-01-01

Strategic planning is becoming to hospitals what business case analysis is to private corporations. In fact, this type of planning is becoming essential for the professional management of Ontario hospitals. The participative strategic planning process at Toronto East General Hospital (TEGH) is an example of how a professionally structured and implemented strategic planning process can be successfully developed and implemented in a community hospital. In this article, the environmental factors driving planning are reviewed and the critical success factors for the development and implementation of a strategic plan are examined in the context of TEGH's experience.

Program planning for the community teaching hospital medical library.

PubMed Central

McCorkel, J; Cook, V

1985-01-01

To respond to the increasing demand for information from medical educators and clinicians and to persuade administrators to purchase the newly available microcomputer library systems, medical librarians in community teaching hospitals may find it useful to engage in intermediate term (for example, five-year) program planning. To increase the probability that the plan which emerges will be implemented, the planning process should fit the organizational nexus. Planning involves needs assessment, prioritized program elements, a written plan, and facilities planning (if applicable), which lead to program implementation. Components of a model program plan are presented. PMID:4027443

Institutional plan. Fiscal year, 1997--2002

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1996-10-01

The Institutional Plan is the culmination of Argonne`s annual planning cycle. The document outlines what Argonne National Laboratory (ANL) regards as the optimal development of programs and resources in the context of national research and development needs, the missions of the Department of Energy and Argonne National Laboratory, and pertinent resource constraints. It is the product of ANL`s internal planning process and extensive discussions with DOE managers. Strategic planning is important for all of Argonne`s programs, and coordination of planning for the entire institution is crucial. This Institutional Plan will increasingly reflect the planning initiatives that have recently been implemented.

Agent independent task planning

NASA Technical Reports Server (NTRS)

Davis, William S.

1990-01-01

Agent-Independent Planning is a technique that allows the construction of activity plans without regard to the agent that will perform them. Once generated, a plan is then validated and translated into instructions for a particular agent, whether a robot, crewmember, or software-based control system. Because Space Station Freedom (SSF) is planned for orbital operations for approximately thirty years, it will almost certainly experience numerous enhancements and upgrades, including upgrades in robotic manipulators. Agent-Independent Planning provides the capability to construct plans for SSF operations, independent of specific robotic systems, by combining techniques of object oriented modeling, nonlinear planning and temporal logic. Since a plan is validated using the physical and functional models of a particular agent, new robotic systems can be developed and integrated with existing operations in a robust manner. This technique also provides the capability to generate plans for crewmembers with varying skill levels, and later apply these same plans to more sophisticated robotic manipulators made available by evolutions in technology.

Medicare Prescription Drug Plan Enrollees Report Less Positive Experiences Than Their Medicare Advantage Counterparts.

PubMed

Elliott, Marc N; Landon, Bruce E; Zaslavsky, Alan M; Edwards, Carol; Orr, Nathan; Beckett, Megan K; Mallett, Joshua; Cleary, Paul D

2016-03-01

Since 2006, Medicare beneficiaries have been able to obtain prescription drug coverage through standalone prescription drug plans or their Medicare Advantage (MA) health plan, options exercised in 2015 by 72 percent of beneficiaries. Using data from community-dwelling Medicare beneficiaries older than age sixty-four in 700 plans surveyed from 2007 to 2014, we compared beneficiaries' assessments of Medicare prescription drug coverage when provided by standalone plans or integrated into an MA plan. Beneficiaries in standalone plans consistently reported less positive experiences with prescription drug plans (ease of getting medications, getting coverage information, and getting cost information) than their MA counterparts. Because MA plans are responsible for overall health care costs, they might have more integrated systems and greater incentives than standalone prescription drug plans to provide enrollees medications and information effectively, including, since 2010, quality bonus payments to these MA plans under provisions of the Affordable Care Act. Project HOPE—The People-to-People Health Foundation, Inc.

Advancing the state of the art in healthcare strategic planning.

PubMed

Zuckerman, Alan M

2006-01-01

A recent survey of the state of strategic planning among healthcare organizations indicates that planners and executives believe that healthcare strategic planning practices are effective and provide the appropriate focus and direction for their organizations. When compared to strategic planning practices employed outside of the healthcare field, however, most healthcare strategic planning processes have not evolved to the more advanced, state-of-the-art levels of planning being used successfully outside of healthcare. While organizations that operate in stable markets may be able to survive using basic strategic planning practices, the volatile healthcare market demands that providers be nimble competitors with advanced, ongoing planning processes that drive growth and organizational effectiveness. What should healthcare organizations do to increase the rigor and sophistication of their strategic planning practices? This article identifies ten current healthcare strategic planning best practices and recommends five additional innovative approaches from pathbreaking companies outside of healthcare that have used advanced strategic planning practices to attain high levels of organizational success.

Coosa River Storage Annex, Talladega, Alabama Environmental Investigation, Final Management and Resources Utilization Plan

DTIC Science & Technology

1991-02-01

to adequately assess the health and environmental risks associated with the closure and transfer of the Annex forI other use; and 3) identification of...1990); Draft Final Technical Plan, Draft Final Sampling Design Plan and Draft Final Health and Safety Plan, USATHAMA, June 1990. 2.1.2 Draft Final...Final Technical Plan, Sampling Design Plan and Health and Safety Plan) supplied by USATHAMA. The estimate may be revised, with USATHAMA approval, as

The Devil is in the Concepts: Lessons Learned from World War II Planning Staffs for Transitioning from Conceptual to Detailed Planning

DTIC Science & Technology

2017-05-25

the planning process. Current US Army doctrine links conceptual planning to the Army Design Methodology and detailed planning to the Military...Decision Making Process. By associating conceptual and detailed planning with doctrinal methodologies , it is easy to regard the transition as a set period...plans into detailed directives resulting in changes to the operational environment. 15. SUBJECT TERMS Design; Army Design Methodology ; Conceptual

Aligning Strategic and Information Systems Planning: A Review of Navy Efforts

DTIC Science & Technology

1990-03-01

plans." [Ref. 11:p. 6] The results of the component level IR planning process are documented in Component Information Management Plans ( CIMP ). In mid...August, the CIMP’s are presented to the IR Planning Committee at the annual IR Planning Conference. Each CIMP is then distributed to all organizations...objectives promulgated in the CIMP or FASP will, if approved for development or acquisition, be further refined in project plans, which in turn, form the

In Second Year Of Marketplaces, New Entrants, ACA 'Co-Ops,' And Medicaid Plans Restrain Average Premium Growth Rates.

PubMed

Gabel, Jon R; Whitmore, Heidi; Green, Matthew; Stromberg, Sam T; Weinstein, Daniel S; Oran, Rebecca

2015-12-01

Premiums for health insurance plans offered through the federally facilitated and state-based Marketplaces remained steady or increased only modestly from 2014 to 2015. We used data from the Marketplaces, state insurance departments, and insurer websites to examine patterns of premium pricing and the factors behind these patterns. Our data came from 2,964 unique plans offered in 2014 and 4,153 unique plans offered in 2015 in forty-nine states and the District of Columbia. Using descriptive and multivariate analysis, we found that the addition of a carrier in a rating area lowered average premiums for the two lowest-cost silver plans and the lowest-cost bronze plan by 2.2 percent. When all plans in a rating area were included, an additional carrier was associated with an average decline in premiums of 1.4 percent. Plans in the Consumer Operated and Oriented Plan Program and Medicaid managed care plans had lower premiums and average premium increases than national commercial and Blue Cross and Blue Shield plans. On average, premiums fell by an appreciably larger amount for catastrophic and bronze plans than for gold plans, and premiums for platinum plans increased. This trend of low premium increases overall is unlikely to continue, however, as insurers are faced with mounting medical claims. Project HOPE—The People-to-People Health Foundation, Inc.

Consumer experiences in a consumer-driven health plan.

PubMed

Christianson, Jon B; Parente, Stephen T; Feldman, Roger

2004-08-01

To assess the experience of enrollees in a consumer-driven health plan (CDHP). Survey of University of Minnesota employees regarding their 2002 health benefits. Comparison of regression-adjusted mean values for CDHP and other plan enrollees: customer service, plan paperwork, overall satisfaction, and plan switching. For CDHP enrollees only, use of plan features, willingness to recommend the plan to others, and reports of particularly negative or positive experiences. There were significant differences in experiences of CDHP enrollees versus enrollees in other plans with customer service and paperwork, but similar levels of satisfaction (on a 10-point scale) with health plans. Eight percent of CDHP enrollees left their plan after one year, compared to 5 percent of enrollees leaving other plans. A minority of CDHP enrollees used online plan features, but enrollees generally were satisfied with the amount and quality of the information provided by the CDHP. Almost half reported a particularly positive experience, compared to a quarter reporting a particularly negative experience. Thirty percent said they would recommend the plan to others, while an additional 57 percent said they would recommend it depending on the situation. Much more work is needed to determine how consumer experience varies with the number and type of plan options available, the design of the CDHP, and the length of time in the CDHP. Research also is needed on the factors that affect consumer decisions to leave CDHPs.

Ten things to get right for marine conservation planning in the Coral Triangle

PubMed Central

Weeks, Rebecca; Pressey, Robert L.; Wilson, Joanne R.; Knight, Maurice; Horigue, Vera; Abesamis, Rene A.; Acosta, Renerio; Jompa, Jamaluddin

2015-01-01

Systematic conservation planning increasingly underpins the conservation and management of marine and coastal ecosystems worldwide. Amongst other benefits, conservation planning provides transparency in decision-making, efficiency in the use of limited resources, the ability to minimise conflict between diverse objectives, and to guide strategic expansion of local actions to maximise their cumulative impact. The Coral Triangle has long been recognised as a global marine conservation priority, and has been the subject of huge investment in conservation during the last five years through the Coral Triangle Initiative on Coral Reefs, Fisheries and Food Security. Yet conservation planning has had relatively little influence in this region. To explore why this is the case, we identify and discuss 10 challenges that must be resolved if conservation planning is to effectively inform management actions in the Coral Triangle. These are: making conservation planning accessible; integrating with other planning processes; building local capacity for conservation planning; institutionalising conservation planning within governments; integrating plans across governance levels; planning across governance boundaries; planning for multiple tools and objectives; understanding limitations of data; developing better measures of progress and effectiveness; and making a long term commitment. Most important is a conceptual shift from conservation planning undertaken as a project, to planning undertaken as a process, with dedicated financial and human resources committed to long-term engagement. PMID:25110579

Planning Targets for Phase II Watershed Implementation Plans

EPA Pesticide Factsheets

On August 1, 2011, EPA provided planning targets for nitrogen, phosphorus and sediment for the Phase II Watershed Implementation Plans (WIPs) of the Chesapeake Bay TMDL. This page provides the letters containing those planning targets.

Hampton Roads 2015 Regional Transportation Plan

DOT National Transportation Integrated Search

1995-05-01

The Hampton Roads Planning District Commission has developed a transportation plan which addresses a twenty year planning period (1990-2015). The Hampton Roads 2015 Regional Transportation Plan includes both long-range and short-range strategies/acti...

Role of regional planning organizations in transportation planning across boundaries

DOT National Transportation Integrated Search

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...

20 CFR 628.426 - Disapproval or revocation of the plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Disapproval or revocation of the plan. (a) If the Governor disapproves the SDA job training plan or plan... training plan or modification may be appealed by the PIC and chief elected official(s) of the SDA to the... and chief elected official(s) of the final disapproval of the SDA job training plan or modification...

75 FR 44265 - Office of the Assistant Secretary for Planning and Evaluation; Request for Comments on the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-28

... planning process is an opportunity for the Department to further refine and strengthen the strategic goal... for Planning and Evaluation; Request for Comments on the Departmental FY 2010-2015 Strategic Plan... and Human Services Draft FY 2010-2015 Strategic Plan is provided as part of the strategic planning...

Interdisciplinary Care Planning and the Written Care Plan in Nursing Homes: A Critical Review

ERIC Educational Resources Information Center

Dellefield, Mary Ellen

2006-01-01

Purpose: This article is a critical review of the history, research evidence, and state-of-the-art technology in interdisciplinary care planning and the written plan of care in American nursing homes. Design and Methods: We reviewed educational and empirical literature. Results: Interdisciplinary care planning and the written care plan are…

Strategic and tactiocal planning for managing national park resources

Treesearch

Daniel L. Schmoldt; David L. Peterson

2001-01-01

Each National Park Service unit in the United States produces a resource management plan (RMP) every four years or less. These plans constitute a strategic agenda for a park. Later, tactical plans commit budgets and personnel to specific projects over the planning horizon. Yet, neither planning stage incorporates much quantitative and analytical rigor and is devoid of...

42 CFR 422.4 - Types of MA plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Types of MA plans. 422.4 Section 422.4 Public...) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM General Provisions § 422.4 Types of MA plans. (a) General rule. An MA plan may be a coordinated care plan, a combination of an MA MSA plan and a contribution into an...

42 CFR 422.4 - Types of MA plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Types of MA plans. 422.4 Section 422.4 Public...) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM General Provisions § 422.4 Types of MA plans. (a) General rule. An MA plan may be a coordinated care plan, a combination of an MA MSA plan and a...

42 CFR 422.4 - Types of MA plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Types of MA plans. 422.4 Section 422.4 Public...) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM General Provisions § 422.4 Types of MA plans. (a) General rule. An MA plan may be a coordinated care plan, a combination of an MA MSA plan and a...

42 CFR 422.4 - Types of MA plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Types of MA plans. 422.4 Section 422.4 Public...) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM General Provisions § 422.4 Types of MA plans. (a) General rule. An MA plan may be a coordinated care plan, a combination of an MA MSA plan and a...

7 CFR 43.104 - Master table of single and double sampling plans.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Master table of single and double sampling plans. 43... STANDARD CONTAINER REGULATIONS STANDARDS FOR SAMPLING PLANS Sampling Plans § 43.104 Master table of single and double sampling plans. (a) In the master table, a sampling plan is selected by first determining...

7 CFR 43.104 - Master table of single and double sampling plans.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Master table of single and double sampling plans. 43... STANDARD CONTAINER REGULATIONS STANDARDS FOR SAMPLING PLANS Sampling Plans § 43.104 Master table of single and double sampling plans. (a) In the master table, a sampling plan is selected by first determining...

7 CFR 43.104 - Master table of single and double sampling plans.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Master table of single and double sampling plans. 43... STANDARD CONTAINER REGULATIONS STANDARDS FOR SAMPLING PLANS Sampling Plans § 43.104 Master table of single and double sampling plans. (a) In the master table, a sampling plan is selected by first determining...

7 CFR 43.104 - Master table of single and double sampling plans.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Master table of single and double sampling plans. 43... STANDARD CONTAINER REGULATIONS STANDARDS FOR SAMPLING PLANS Sampling Plans § 43.104 Master table of single and double sampling plans. (a) In the master table, a sampling plan is selected by first determining...

Strategic Planning, Management and Decision Making. AAHE-ERIC/Higher Education Research Report No. 9, 1981.

ERIC Educational Resources Information Center

Cope, Robert G.

Recent applications of the strategic planning approach in colleges and universities and techniques necessary for its application are reviewed. In addition, the intellectual roots of strategic planning are traced, and strategic planning is defined and contrasted with long-range planning. It is suggested that strategic planning addresses the total…

Research, Development & Dissemination in Educational Planning & Educational Facilities Planning. Project SIMU-School.

ERIC Educational Resources Information Center

Hunt, Lester W.; Burr, Donald F.

The Simu-School Program and the National Center for Educational Planning were conceived because of the need for (1) expertise in educational planning, (2) a system to collect and assemble the vast amount of knowledge concerning education, (3) community involvement in planning, and (4) a system to accurately interpret today's data in planning for…

26 CFR 1.410(b)-3 - Employees and former employees who benefit under a plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... under the section 401(a)(4) general test. (C) Defined contribution plans. A defined contribution plan is... the plan. Thus, for example, if the formula under a defined benefit plan takes into account only the... benefit previously accrued were disregarded. This could happen, for example, when the plan is applying the...

26 CFR 1.410(b)-7 - Definition of plan and rules governing plan disaggregation and aggregation.

Code of Federal Regulations, 2011 CFR

2011-04-01

... same plan year. (e) Determination of plans in testing group for average benefit percentage test—(1) In... qualifiedseparatelineofbu5ine55 basis. The plans in the testing group used to determine whether Plan F satisfies the average..., DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Pension, Profit...

18 CFR 5.13 - Revised study plan and study plan determination.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Revised study plan and study plan determination. 5.13 Section 5.13 Conservation of Power and Water Resources FEDERAL ENERGY... APPLICATION PROCESS § 5.13 Revised study plan and study plan determination. (a) Within 30 days following the...

18 CFR 5.13 - Revised study plan and study plan determination.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false Revised study plan and study plan determination. 5.13 Section 5.13 Conservation of Power and Water Resources FEDERAL ENERGY... APPLICATION PROCESS § 5.13 Revised study plan and study plan determination. (a) Within 30 days following the...

Linking human and natural systems in the planning process

Treesearch

Susan I. Stewart; Miranda H. Mockrin; Roger B. Hammer

2012-01-01

Planning links human and natural systems in the urban-rural interface by engaging people in consideration of the future of natural resources. We review evolving ideas about what planning entails, who it involves, and what its outcomes should be. Sense of place, collaboration, emergent planning, and other new developments in planning are discussed. Smaller plans,...

76 FR 58781 - Endangered and Threatened Species; Recovery Plans; Recovery Plan for the Kemp's Ridley Sea Turtle

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-22

... the threats to the species. Recovery of Kemp's ridleys has and will continue to be a long-term effort... and Threatened Species; Recovery Plans; Recovery Plan for the Kemp's Ridley Sea Turtle AGENCY... USFWS, announce the availability of the Bi- National Recovery Plan (Recovery Plan) for the Kemp's Ridley...

Guidelines for Planning in Colleges and Universities. Volume 3: Physical Plant Planning, Land Use, and Traffic.

ERIC Educational Resources Information Center

Pinnell, Charles; Wacholder, Michael

The third of five volumes concerned with higher educational planning is divided into two distinct sections--(1) land use planning, and (2) traffic planning. The first section commences with certain definitions and interpretations which are meant to overcome any misunderstandings. Actual land use planning process follows and can be identified by…

Science-based strategic planning for hazardous fuel treatment.

Treesearch

D.L. Peterson; M.C. Johnson

2007-01-01

A scientific foundation coupled with technical support is needed to develop long-term strategic plans for fuel and vegetation treatments on public lands. These plans are developed at several spatial scales and are typically a component of fire management plans and other types of resource management plans. Such plans need to be compatible with national, regional, and...

40 CFR 60.2055 - What is a waste management plan?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 6 2011-07-01 2011-07-01 false What is a waste management plan? 60... Which Modification or Reconstruction Is Commenced on or After June 1, 2001 Waste Management Plan § 60.2055 What is a waste management plan? A waste management plan is a written plan that identifies both...

40 CFR 62.14580 - What is a waste management plan?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 9 2014-07-01 2014-07-01 false What is a waste management plan? 62... Construction On or Before November 30, 1999 Waste Management Plan § 62.14580 What is a waste management plan? A waste management plan is a written plan that identifies both the feasibility and the methods used to...

40 CFR 60.2899 - What is a waste management plan?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 7 2013-07-01 2013-07-01 false What is a waste management plan? 60... Modification or Reconstruction is Commenced on or After June 16, 2006 Waste Management Plan § 60.2899 What is a waste management plan? A waste management plan is a written plan that identifies both the feasibility...

40 CFR 60.2055 - What is a waste management plan?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 7 2013-07-01 2013-07-01 false What is a waste management plan? 60... Industrial Solid Waste Incineration Units Waste Management Plan § 60.2055 What is a waste management plan? A waste management plan is a written plan that identifies both the feasibility and the methods used to...

40 CFR 60.2055 - What is a waste management plan?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 7 2012-07-01 2012-07-01 false What is a waste management plan? 60... Which Modification or Reconstruction Is Commenced on or After June 1, 2001 Waste Management Plan § 60.2055 What is a waste management plan? A waste management plan is a written plan that identifies both...

40 CFR 60.2899 - What is a waste management plan?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 7 2014-07-01 2014-07-01 false What is a waste management plan? 60... Modification or Reconstruction is Commenced on or After June 16, 2006 Waste Management Plan § 60.2899 What is a waste management plan? A waste management plan is a written plan that identifies both the feasibility...

40 CFR 62.14580 - What is a waste management plan?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 9 2012-07-01 2012-07-01 false What is a waste management plan? 62... Construction On or Before November 30, 1999 Waste Management Plan § 62.14580 What is a waste management plan? A waste management plan is a written plan that identifies both the feasibility and the methods used to...

40 CFR 60.2055 - What is a waste management plan?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 7 2014-07-01 2014-07-01 false What is a waste management plan? 60... Industrial Solid Waste Incineration Units Waste Management Plan § 60.2055 What is a waste management plan? A waste management plan is a written plan that identifies both the feasibility and the methods used to...

40 CFR 62.14580 - What is a waste management plan?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 9 2013-07-01 2013-07-01 false What is a waste management plan? 62... Construction On or Before November 30, 1999 Waste Management Plan § 62.14580 What is a waste management plan? A waste management plan is a written plan that identifies both the feasibility and the methods used to...

26 CFR 1.401(l)-4 - Special rules for railroad plans.

Code of Federal Regulations, 2010 CFR

2010-04-01

... paragraph (b)(2) or (b)(3) of this section for the plan year. (2) Single integration level method—(i) In general. A plan satisfies this paragraph (b)(2) if— (A) The plan specifies a single integration level for... percentage of such plan year compensation). (3) Two integration level method—(i) In general. A plan satisfies...