40 CFR 265.118 - Post-closure plan; amendment of plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... the current post-closure plan (e.g., leachate or ground-water monitoring results, characteristics of... and the environment (e.g., leachate or ground-water monitoring results indicate a potential for...

40 CFR 265.118 - Post-closure plan; amendment of plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the current post-closure plan (e.g., leachate or ground-water monitoring results, characteristics of... and the environment (e.g., leachate or ground-water monitoring results indicate a potential for...

Strategic planning for post-disaster temporary housing.

PubMed

Johnson, Cassidy

2007-12-01

Temporary housing programmes suffer from excessively high cost, late delivery, poor location, improper unit designs and other inherent issues. These issues can be attributed in part to a prevalence of ad hoc tactical planning, rather than pre-disaster strategic planning, for reconstruction undertaken by governments and non-governmental organisations (NGOs) in the chaotic post-disaster environment. An analysis of the process and outcomes from six case studies of temporary housing programmes after disasters in Turkey and Colombia in 1999, Japan in 1995, Greece in 1986, Mexico in 1985, and Italy in 1976 yields information about the extent to which strategic planning is employed in temporary housing programmes, as well as common issues in temporary housing. Based on an understanding of these common issues, this paper proposes a framework for strategic planning for temporary housing that identifies organisational designs and available resources for temporary housing before the disaster, but allows modifications to fit the specific post-disaster situation.

SU-E-T-504: Intensity-Modulated Radiosurgery Treatments Derived by Optimizing Delivery of Sphere Packing Treatment Plans

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

Hermansen, M; Bova, F; John, T St.

2015-06-15

Purpose To minimize the number of monitor units required to deliver a sphere packing stereotactic radiosurgery (SRS) plan by eliminating overlaps of individual beam projections. Methods An algorithm was written in C{sup ++} to calculate SRS treatment doses using sphere packing. Three fixed beams were used to approximate each arc in a typical SRS treatment plan. For cases involving multiple isocenters, at each gantry and table angle position beams directed to individual spheres overlap to produce regions of high dose, resulting in intensity modulated beams. These high dose regions were dampened by post-processing of the combined beam profile. The post-processmore » dampening involves removing the excess overlapping fluence from all but the highest contributing beam. The dampened beam profiles at each table and gantry angle position were then summed to produce the new total dose distribution. Results Delivery times for even the most complex multiple sphere plans can be reduced to consistent times of about 20 to 30 minutes. The total MUs required to deliver the plan can also be reduced by as much as 85% of the original plan’s MUs. Conclusion Regions of high dose are removed. Dampening overlapping radiation fluence can produce the new beam profiles that have more uniform dose distributions using less MUs. This results in a treatment that requires significantly fewer intensity values than traditional IMRT or VAMT planning.« less

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.

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

PubMed

Ezaki, Asami; Hori, Akiko

2013-03-01

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

9 CFR 54.8 - Requirements for flock plans and post-exposure management and monitoring plans.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Requirements for flock plans and post... and post-exposure management and monitoring plans. (a) The owner of the flock or his or her agent must...: Utilization of a live-animal screening test; restrictions on the animals that may be moved from the flock...

9 CFR 54.8 - Requirements for flock plans and post-exposure management and monitoring plans.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Requirements for flock plans and post... and post-exposure management and monitoring plans. (a) The owner of the flock or his or her agent must...: Utilization of a live-animal screening test; restrictions on the animals that may be moved from the flock...

9 CFR 54.8 - Requirements for flock plans and post-exposure management and monitoring plans.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Requirements for flock plans and post... and post-exposure management and monitoring plans. (a) The owner of the flock or his or her agent must...: Utilization of a live-animal screening test; restrictions on the animals that may be moved from the flock...

9 CFR 54.8 - Requirements for flock plans and post-exposure management and monitoring plans.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Requirements for flock plans and post... and post-exposure management and monitoring plans. (a) The owner of the flock or his or her agent must...: Utilization of a live-animal screening test; restrictions on the animals that may be moved from the flock...

9 CFR 54.8 - Requirements for flock plans and post-exposure management and monitoring plans.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Requirements for flock plans and post... and post-exposure management and monitoring plans. (a) The owner of the flock or his or her agent must...: Utilization of a live-animal screening test; restrictions on the animals that may be moved from the flock...

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.

SU-E-T-628: Predicted Risk of Post-Irradiation Cerebral Necrosis in Pediatric Brain Cancer Patients: A Treatment Planning Comparison of Proton Vs. Photon Therapy

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

Freund, D; Zhang, R; Sanders, M

Purpose: Post-irradiation cerebral necrosis (PICN) is a severe late effect that can Result from brain cancers treatment using radiation therapy. The purpose of this study was to compare the treatment plans and predicted risk of PICN after volumetric modulated arc therapy (VMAT) to the risk after passively scattered proton therapy (PSPT) and intensity modulated proton therapy (IMPT) in a cohort of pediatric patients. Methods: Thirteen pediatric patients with varying age and sex were selected for this study. A clinical treatment volume (CTV) was constructed for 8 glioma patients and 5 ependymoma patients. Prescribed dose was 54 Gy over 30 fractionsmore » to the planning volume. Dosimetric endpoints were compared between VMAT and proton plans. The normal tissue complication probability (NTCP) following VMAT and proton therapy planning was also calculated using PICN as the biological endpoint. Sensitivity tests were performed to determine if predicted risk of PICN was sensitive to positional errors, proton range errors and selection of risk models. Results: Both PSPT and IMPT plans resulted in a significant increase in the maximum dose and reduction in the total brain volume irradiated to low doses compared with the VMAT plans. The average ratios of NTCP between PSPT and VMAT were 0.56 and 0.38 for glioma and ependymoma patients respectively and the average ratios of NTCP between IMPT and VMAT were 0.67 and 0.68 for glioma and ependymoma plans respectively. Sensitivity test revealed that predicted ratios of risk were insensitive to range and positional errors but varied with risk model selection. Conclusion: Both PSPT and IMPT plans resulted in a decrease in the predictive risk of necrosis for the pediatric plans studied in this work. Sensitivity analysis upheld the qualitative findings of the risk models used in this study, however more accurate models that take into account dose and volume are needed.« less

POST Traumatic Stress Disorder in Emergency Workers: Risk Factors and Treatment

NASA Astrophysics Data System (ADS)

Argentero, Piergiorgio; Dell'Olivo, Bianca; Setti, Ilaria

Post traumatic stress disorder (PTSD) are emergent phenomena resulting from exposure to a traumatic event that causes actual or threatened death or injury and produces intense fear, helplessness, or horror. In order to assess the role of different factors contributing to this kind of emergent phenomenon prevalence rates across gender, cultures, and samples exposed to different traumas are examined. Risk factors for PTSD, including pre-existing individual-based factors, features of the traumatic event, and post-trauma interventions are examined as well. Several characteristics of the trauma, related to cognitions, post-trauma social support and therapeutic interventions for PTSD are also considered. Further work is needed in order to analyze the inter-relationships among these factors and underlying mechanisms. The chaotic nature of traumatic processes, the multiple and interactive impacts on traumatic events require a comprehensive perspective aimed at planning effective interventions. Treatment outcome studies recommended the combined use of training and therapies as first-line treatment for PTSD.

Pre- and Post-Planned Evaluation: Which Is Preferable?

ERIC Educational Resources Information Center

Strasser, Stephen; Deniston, O. Lynn

1978-01-01

Factors involved in pre-planned and post-planned evaluation of program effectiveness are compared: (1) reliability and cost of data; (2) internal and external validity; (3) obtrusiveness and threat; (4) goal displacement and program direction. A model to help program administrators decide which approach is more appropriate is presented. (Author/MH)

An accountable fistula management treatment plan.

PubMed

Thompson, Mary Jo; Epanomeritakis, Emanuel

An accountable fistula management treatment plan focuses on combining effective medical and nursing treatment with effective and efficient pouching technique and equipment to ensure patient comfort. Small bowel fistula following abdominal surgery can provide challenges in patients' medical and nursing management. This article describes a case study of the successful medical and nursing management of a patient post-abdominal surgery. Within days of surgery a small bowel fistula formed within an abdominal wound. Medical management involved the use of total parenteral nutrition, electrolyte balance management, nil orally and Sandostatin medication. The nursing interventions comprised accurate intake and output measurement, effective and efficient pouching systems and appropriate psychological care. The medical and nursing interventions provided during the healing process are outlined together with the assessment and evaluation of a new innovative wound management pouch. This system proved invaluable in the successful containment of a high small bowel effluent and skin preservation. In an attempt to share best practice a pictorial guide is provided to demonstrate the correct application of the pouching system and technique. This article provides details of an accountable fistula management treatment plan which resulted in the successful spontaneous closure of the small bowel fistula coupled with excellent cost-effectiveness and patient comfort.

Electron Density Calibration for Radiotherapy Treatment Planning

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

Herrera-Martinez, F.; Rodriguez-Villafuerte, M.; Martinez-Davalos, A.

2006-09-08

Computed tomography (CT) images are used as basic input data for most modern radiosurgery treatment planning systems (TPS). CT data not only provide anatomic information to delineate target volumes, but also allow the introduction of corrections for tissue inhomogeneities into dose calculations during the treatment planning procedure. These corrections involve the determination of a relationship between tissue electron density ({rho}e) and their corresponding Hounsfield Units (HU). In this work, an elemental analysis of different commercial tissue equivalent materials using Scanning Electron Microscopy was carried out to characterize their chemical composition. The tissue equivalent materials were chosen to ensure a largemore » range of {rho}e to be included in the CT scanner calibration. A phantom was designed and constructed with these materials to simulate the size of a human head.« less

Radiobiological characterization of post-lumpectomy focal brachytherapy with lipid nanoparticle-carried radionuclides

NASA Astrophysics Data System (ADS)

Hrycushko, Brian A.; Gutierrez, Alonso N.; Goins, Beth; Yan, Weiqiang; Phillips, William T.; Otto, Pamela M.; Bao, Ande

2011-02-01

Post-operative radiotherapy has commonly been used for early stage breast cancer to treat residual disease. The primary objective of this work was to characterize, through dosimetric and radiobiological modeling, a novel focal brachytherapy technique which uses direct intracavitary infusion of β-emitting radionuclides (186Re/188Re) carried by lipid nanoparticles (liposomes). Absorbed dose calculations were performed for a spherical lumpectomy cavity with a uniformly injected activity distribution using a dose point kernel convolution technique. Radiobiological indices were used to relate predicted therapy outcome and normal tissue complication of this technique with equivalent external beam radiotherapy treatment regimens. Modeled stromal damage was used as a measure of the inhibition of the stimulatory effect on tumor growth driven by the wound healing response. A sample treatment plan delivering 50 Gy at a therapeutic range of 2.0 mm for 186Re-liposomes and 5.0 mm for 188Re-liposomes takes advantage of the dose delivery characteristics of the β-emissions, providing significant EUD (58.2 Gy and 72.5 Gy for 186Re and 188Re, respectively) with a minimal NTCP (0.046%) of the healthy ipsilateral breast. Modeling of kidney BED and ipsilateral breast NTCP showed that large injected activity concentrations of both radionuclides could be safely administered without significant complications.

Generalized Tumor Dose for Treatment Planning Decision Support

NASA Astrophysics Data System (ADS)

Zuniga, Areli A.

Modern radiation therapy techniques allow for improved target conformity and normal tissue sparing. These highly conformal treatment plans have allowed dose escalation techniques increasing the probability of tumor control. At the same time this conformation has introduced inhomogeneous dose distributions, making delivered dose characterizations more difficult. The concept of equivalent uniform dose (EUD) characterizes a heterogeneous dose distribution within irradiated structures as a single value and has been used in biologically based treatment planning (BBTP); however, there are no substantial validation studies on clinical outcome data supporting EUD's use and therefore has not been widely adopted as decision-making support. These highly conformal treatment plans have also introduced the need for safety margins around the target volume. These margins are designed to minimize geometrical misses, and to compensate for dosimetric and treatment delivery uncertainties. The margin's purpose is to reduce the chance of tumor recurrence. This dissertation introduces a new EUD formulation designed especially for tumor volumes, called generalized Tumor Dose (gTD). It also investigates, as a second objective, margins extensions for potential improvements in local control while maintaining or minimizing toxicity. The suitability of gTD to rank LC was assessed by means of retrospective studies in a head and neck (HN) squamous cell carcinoma (SCC) and non-small cell lung cancer (NSCLC) cohorts. The formulation was optimized based on two datasets (one of each type) and then, model validation was assessed on independent cohorts. The second objective of this dissertation was investigated by ranking the probability of LC of the primary disease adding different margin sizes. In order to do so, an already published EUD formula was used retrospectively in a HN and a NSCLC datasets. Finally, recommendations for the viability to implement this new formulation into a routine treatment

Final closure plan for the high-explosives open burn treatment facility at Lawrence Livermore National Laboratory Experimental Test Site 300

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

Mathews, S.

This document addresses the interim status closure of the HE Open Bum Treatment Facility, as detailed by Title 22, Division 4.5, Chapter 15, Article 7 of the Califonia Code of Regulations (CCR) and by Title 40, Code of Federal Regulations (CFR) Part 265, Subpart G, ``Closure and Post Closure.`` The Closure Plan (Chapter 1) and the Post- Closure Plan (Chapter 2) address the concept of long-term hazard elimination. The Closure Plan provides for capping and grading the HE Open Bum Treatment Facility and revegetating the immediate area in accordance with applicable requirements. The Closure Plan also reflects careful consideration ofmore » site location and topography, geologic and hydrologic factors, climate, cover characteristics, type and amount of wastes, and the potential for contaminant migration. The Post-Closure Plan is designed to allow LLNL to monitor the movement, if any, of pollutants from the treatment area. In addition, quarterly inspections will ensure that all surfaces of the closed facility, including the cover and diversion ditches, remain in good repair, thus precluding the potential for contaminant migration.« less

Post-fire treatment effectiveness for hillslope stabilization

Treesearch

Peter R. Robichaud; Louise E. Ashmun; Bruce D. Sims

2010-01-01

This synthesis of post-fire treatment effectiveness reviews the past decade of research, monitoring, and product development related to post-fire hillslope emergency stabilization treatments, including erosion barriers, mulching, chemical soil treatments, and combinations of these treatments. In the past ten years, erosion barrier treatments (contour-felled logs and...

Draft Site Treatment Plan (DSTP), Volumes I and II

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

D`Amelio, J.

1994-08-30

Site Treatment Plans (STP) are required for facilities at which the DOE generates or stores mixed waste. This Draft Site Treatment Plan (DSTP) the second step in a three-phase process, identifies the currently preferred options for treating mixed waste at the Savannah River Site (SRS) or for developing treatment technologies where technologies do not exist or need modification. The DSTP reflects site-specific preferred options, developed with the state`s input and based on existing available information. To the extent possible, the DSTP identifies specific treatment facilities for treating the mixed waste and proposes schedules. Where the selection of specific treatment facilitiesmore » is not possible, schedules for alternative activities such as waste characterization and technology assessment are provided. All schedule and cost information presented is preliminary and is subject to change. The DSTP is comprised of two volumes: this Compliance Plan Volume and the Background Volume. This Compliance Plan Volume proposes overall schedules with target dates for achieving compliance with the land disposal restrictions (LDR) of RCRA and procedures for converting the target dates into milestones to be enforced under the Order. The more detailed discussion of the options contained in the Background Volume is provided for informational purposes only.« less

3D treatment planning systems.

PubMed

Saw, Cheng B; Li, Sicong

2018-01-01

Three-dimensional (3D) treatment planning systems have evolved and become crucial components of modern radiation therapy. The systems are computer-aided designing or planning softwares that speed up the treatment planning processes to arrive at the best dose plans for the patients undergoing radiation therapy. Furthermore, the systems provide new technology to solve problems that would not have been considered without the use of computers such as conformal radiation therapy (CRT), intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). The 3D treatment planning systems vary amongst the vendors and also the dose delivery systems they are designed to support. As such these systems have different planning tools to generate the treatment plans and convert the treatment plans into executable instructions that can be implemented by the dose delivery systems. The rapid advancements in computer technology and accelerators have facilitated constant upgrades and the introduction of different and unique dose delivery systems than the traditional C-arm type medical linear accelerators. The focus of this special issue is to gather relevant 3D treatment planning systems for the radiation oncology community to keep abreast of technology advancement by assess the planning tools available as well as those unique "tricks or tips" used to support the different dose delivery systems. Copyright © 2018 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

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

[Review of pre- and post-treatment multidetector computed tomography findings in abdominal aortic aneurysms].

PubMed

Casula, E; Lonjedo, E; Cerverón, M J; Ruiz, A; Gómez, J

2014-01-01

The increase in the frequency of abdominal aortic aneurysms (AAA) and the widely accepted use of endovascular aneurysm repair (EVAR) as a first-line treatment or as an alternative to conventional surgery make it necessary for radiologists to have thorough knowledge of the pre- and post-treatment findings. The high image quality provided by multidetector computed tomography (MDCT) enables CT angiography to play a fundamental role in the study of AAA and in planning treatment. The objective of this article is to review the cases of AAA in which CT angiography was the main imaging technique, so that radiologists will be able to detect the signs related to this disease, to diagnose it, to plan treatment, and to detect complications in the postoperative period. Copyright © 2012 SERAM. Published by Elsevier Espana. All rights reserved.

Pre- and post-remediation characterization of acid-generating fluvial tailings material

USGS Publications Warehouse

Smith, Kathleen S.; Walton-Day, Katherine; Hoal, Karin O.; Driscoll, Rhonda L.; Pietersen, K.

2012-01-01

The upper Arkansas River south of Leadville, Colorado, USA, contains deposits of fluvial tailings from historical mining operations in the Leadville area. These deposits are potential non-point sources of acid and metal contamination to surface- and groundwater systems. We are investigating a site that recently underwent in situ remediation treatment with lime, fertilizer, and compost. Pre- and post-remediation fluvial tailings material was collected from a variety of depths to examine changes in mineralogy, acid generation, and extractable nutrients. Results indicate sufficient nutrient availability in the post-remediation near-surface material, but pyrite and acid generation persist below the depth of lime and fertilizer addition. Mineralogical characterization performed using semi-quantitative X-ray diffraction and quantitative SEM-based micro-mineralogy (Mineral Liberation Analysis, MLA) reveal formation of gypsum, jarosite, and complex coatings surrounding mineral grains in post-remediation samples.

Apipuncture treatment for central post-stroke pain.

PubMed

Yun, Sang Pil; Sun, Bong Chul

2010-02-01

The objective of this study was to assess the effectiveness of apipuncture treatment for central post-stroke pain. Two (2) female subjects with central post-stroke pain were treated with apipuncture. Both patients experienced a reduction in the intensity of pain after receiving apipuncture treatment without adverse effects. Apipuncture is an effective and safe intervention to treat central post-stroke pain.

30 CFR 71.301 - Respirable dust control plan; approval by District Manager and posting.

Code of Federal Regulations, 2010 CFR

2010-07-01

... District Manager and posting. 71.301 Section 71.301 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... plan; approval by District Manager and posting. (a) The District Manager will approve respirable dust control plans on a mine-by-mine basis. When approving respirable dust control plans, the District Manager...

Post-Treatment Lyme Disease Syndrome

MedlinePlus

... is CDC concerned about Lyme disease? Post-Treatment Lyme Disease Syndrome Recommend on Facebook Tweet Share Compartir Resources ... Dangers of long-term or alternative treatments for Lyme disease Studies funded by the National Institutes of Health ( ...

Incorporating deliverable monitor unit constraints into spot intensity optimization in intensity modulated proton therapy treatment planning

PubMed Central

Cao, Wenhua; Lim, Gino; Li, Xiaoqiang; Li, Yupeng; Zhu, X. Ronald; Zhang, Xiaodong

2014-01-01

The purpose of this study is to investigate the feasibility and impact of incorporating deliverable monitor unit (MU) constraints into spot intensity optimization in intensity modulated proton therapy (IMPT) treatment planning. The current treatment planning system (TPS) for IMPT disregards deliverable MU constraints in the spot intensity optimization (SIO) routine. It performs a post-processing procedure on an optimized plan to enforce deliverable MU values that are required by the spot scanning proton delivery system. This procedure can create a significant dose distribution deviation between the optimized and post-processed deliverable plans, especially when small spot spacings are used. In this study, we introduce a two-stage linear programming (LP) approach to optimize spot intensities and constrain deliverable MU values simultaneously, i.e., a deliverable spot intensity optimization (DSIO) model. Thus, the post-processing procedure is eliminated and the associated optimized plan deterioration can be avoided. Four prostate cancer cases at our institution were selected for study and two parallel opposed beam angles were planned for all cases. A quadratic programming (QP) based model without MU constraints, i.e., a conventional spot intensity optimization (CSIO) model, was also implemented to emulate the commercial TPS. Plans optimized by both the DSIO and CSIO models were evaluated for five different settings of spot spacing from 3 mm to 7 mm. For all spot spacings, the DSIO-optimized plans yielded better uniformity for the target dose coverage and critical structure sparing than did the CSIO-optimized plans. With reduced spot spacings, more significant improvements in target dose uniformity and critical structure sparing were observed in the DSIO- than in the CSIO-optimized plans. Additionally, better sparing of the rectum and bladder was achieved when reduced spacings were used for the DSIO-optimized plans. The proposed DSIO approach ensures the

SU-F-J-105: Towards a Novel Treatment Planning Pipeline Delivering Pareto- Optimal Plans While Enabling Inter- and Intrafraction Plan Adaptation

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

Kontaxis, C; Bol, G; Lagendijk, J

2016-06-15

Purpose: To develop a new IMRT treatment planning methodology suitable for the new generation of MR-linear accelerator machines. The pipeline is able to deliver Pareto-optimal plans and can be utilized for conventional treatments as well as for inter- and intrafraction plan adaptation based on real-time MR-data. Methods: A Pareto-optimal plan is generated using the automated multicriterial optimization approach Erasmus-iCycle. The resulting dose distribution is used as input to the second part of the pipeline, an iterative process which generates deliverable segments that target the latest anatomical state and gradually converges to the prescribed dose. This process continues until a certainmore » percentage of the dose has been delivered. Under a conventional treatment, a Segment Weight Optimization (SWO) is then performed to ensure convergence to the prescribed dose. In the case of inter- and intrafraction adaptation, post-processing steps like SWO cannot be employed due to the changing anatomy. This is instead addressed by transferring the missing/excess dose to the input of the subsequent fraction. In this work, the resulting plans were delivered on a Delta4 phantom as a final Quality Assurance test. Results: A conventional static SWO IMRT plan was generated for two prostate cases. The sequencer faithfully reproduced the input dose for all volumes of interest. For the two cases the mean relative dose difference of the PTV between the ideal input and sequenced dose was 0.1% and −0.02% respectively. Both plans were delivered on a Delta4 phantom and passed the clinical Quality Assurance procedures by achieving 100% pass rate at a 3%/3mm gamma analysis. Conclusion: We have developed a new sequencing methodology capable of online plan adaptation. In this work, we extended the pipeline to support Pareto-optimal input and clinically validated that it can accurately achieve these ideal distributions, while its flexible design enables inter- and intrafraction plan

The Advantages of Using Planned Comparisons over Post Hoc Tests.

ERIC Educational Resources Information Center

Kuehne, Carolyn C.

There are advantages to using a priori or planned comparisons rather than omnibus multivariate analysis of variance (MANOVA) tests followed by post hoc or a posteriori testing. A small heuristic data set is used to illustrate these advantages. An omnibus MANOVA test was performed on the data followed by a post hoc test (discriminant analysis). A…

10 CFR 60.16 - Site characterization plan required.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Site characterization plan required. 60.16 Section 60.16 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN GEOLOGIC REPOSITORIES Licenses Preapplication Review § 60.16 Site characterization plan required. Before proceeding to...

Post-Graduation Plans of International Science and Engineering Doctoral Students Attending U.S. Universities

ERIC Educational Resources Information Center

Ugwu, Dorothy N.; Adamuti-Trache, Maria

2017-01-01

This study examines the post-graduation plans of international science and engineering doctoral students at a public research-intensive university, and the extent to which graduate school experiences influence post-graduation plans. The study is grounded in Tinto's Integration Model as well as Berry's Acculturation Model. Study findings highlight…

MO-D-BRB-02: SBRT Treatment Planning and Delivery

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

Yang, Y.

2016-06-15

Increased use of SBRT and hypofractionation in radiation oncology practice has posted a number of challenges to medical physicist, ranging from planning, image-guided patient setup and on-treatment monitoring, to quality assurance (QA) and dose delivery. This symposium is designed to provide current knowledge necessary for the safe and efficient implementation of SBRT in various linac platforms, including the emerging digital linacs equipped with high dose rate FFF beams. Issues related to 4D CT, PET and MRI simulations, 3D/4D CBCT guided patient setup, real-time image guidance during SBRT dose delivery using gated/un-gated VMAT/IMRT, and technical advancements in QA of SBRT (inmore » particular, strategies dealing with high dose rate FFF beams) will be addressed. The symposium will help the attendees to gain a comprehensive understanding of the SBRT workflow and facilitate their clinical implementation of the state-of-art imaging and planning techniques. Learning Objectives: Present background knowledge of SBRT, describe essential requirements for safe implementation of SBRT, and discuss issues specific to SBRT treatment planning and QA. Update on the use of multi-dimensional and multi-modality imaging for reliable guidance of SBRT. Discuss treatment planning and QA issues specific to SBRT. Provide a comprehensive overview of emerging digital linacs and summarize the key geometric and dosimetric features of the new generation of linacs for substantially improved SBRT. NIH/NCI; Varian Medical Systems; F. Yin, Duke University has a research agreement with Varian Medical Systems. In addition to research grant, I had a technology license agreement with Varian Medical Systems.« less

High Resolution PET Imaging Probe for the Detection, Molecular Characterization and Treatment Monitoring of Prostate Cancer

DTIC Science & Technology

2010-07-01

W81XWH-09-1-0420 TITLE: High Resolution PET Imaging Probe for the Detection, Molecular Characterization and Treatment Monitoring of Prostate Cancer...4. TITLE AND SUBTITLE High-Resolution PET Imaging Probe for the Detection, Molecular Characterization and Treatment of Prostate Cancer... molecular imaging for diagnosis as well as treatment planning and monitoring in prostate cancer. This investigation hypothesizes that a dedicated

Automated construction of an intraoperative high-dose-rate treatment plan library for the Varian brachytherapy treatment planning system.

PubMed

Deufel, Christopher L; Furutani, Keith M; Dahl, Robert A; Haddock, Michael G

2016-01-01

The ability to create treatment plans for intraoperative high-dose-rate (IOHDR) brachytherapy is limited by lack of imaging and time constraints. An automated method for creation of a library of high-dose-rate brachytherapy plans that can be used with standard planar applicators in the intraoperative setting is highly desirable. Nonnegative least squares algebraic methods were used to identify dwell time values for flat, rectangular planar applicators. The planar applicators ranged in length and width from 2 cm to 25 cm. Plans were optimized to deliver an absorbed dose of 10 Gy to three different depths from the patient surface: 0 cm, 0.5 cm, and 1.0 cm. Software was written to calculate the optimized dwell times and insert dwell times and positions into a .XML plan template that can be imported into the Varian brachytherapy treatment planning system. The user may import the .XML template into the treatment planning system in the intraoperative setting to match the patient applicator size and prescribed treatment depth. A total of 1587 library plans were created for IOHDR brachytherapy. Median plan generation time was approximately 1 minute per plan. Plan dose was typically 100% ± 1% (mean, standard deviation) of the prescribed dose over the entire length and width of the applicator. Plan uniformity was best for prescription depths of 0 cm and 0.5 cm from the patient surface. An IOHDR plan library may be created using automated methods. Thousands of plan templates may be optimized and prepared in a few hours to accommodate different applicator sizes and treatment depths and reduce treatment planning time. The automated method also enforces dwell time symmetry for symmetrical applicator geometries, which simplifies quality assurance. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Automatic liver contouring for radiotherapy treatment planning

NASA Astrophysics Data System (ADS)

Li, Dengwang; Liu, Li; Kapp, Daniel S.; Xing, Lei

2015-09-01

To develop automatic and efficient liver contouring software for planning 3D-CT and four-dimensional computed tomography (4D-CT) for application in clinical radiation therapy treatment planning systems. The algorithm comprises three steps for overcoming the challenge of similar intensities between the liver region and its surrounding tissues. First, the total variation model with the L1 norm (TV-L1), which has the characteristic of multi-scale decomposition and an edge-preserving property, is used for removing the surrounding muscles and tissues. Second, an improved level set model that contains both global and local energy functions is utilized to extract liver contour information sequentially. In the global energy function, the local correlation coefficient (LCC) is constructed based on the gray level co-occurrence matrix both of the initial liver region and the background region. The LCC can calculate the correlation of a pixel with the foreground and background regions, respectively. The LCC is combined with intensity distribution models to classify pixels during the evolutionary process of the level set based method. The obtained liver contour is used as the candidate liver region for the following step. In the third step, voxel-based texture characterization is employed for refining the liver region and obtaining the final liver contours. The proposed method was validated based on the planning CT images of a group of 25 patients undergoing radiation therapy treatment planning. These included ten lung cancer patients with normal appearing livers and ten patients with hepatocellular carcinoma or liver metastases. The method was also tested on abdominal 4D-CT images of a group of five patients with hepatocellular carcinoma or liver metastases. The false positive volume percentage, the false negative volume percentage, and the dice similarity coefficient between liver contours obtained by a developed algorithm and a current standard delineated by the expert group

Strengths and Limitations of Ontario Post-Secondary Education Accessibility Plans: A Review of One University Accessibility Plan

ERIC Educational Resources Information Center

Opini, Bathseba M.

2008-01-01

This paper examines the strengths and limitations of the Ontarians with Disabilities Act (ODA) accessibility plan prepared by one post-secondary education institution in Ontario, Canada, during the 2004/05 academic year. The paper focuses on ways the intersectionality between disability and gender is not voiced in the plan and its implications for…

Dental consultation in patients planned for/undergoing/post radiation therapy for head and neck cancers: a questionnaire-based survey.

PubMed

Mainali, Apeksha; Sumanth, K N; Ongole, Ravikiran; Denny, Ceena

2011-01-01

Mouth and pharyngeal cancers account for approximately 6% of cancers worldwide. Radiotherapy is one of the means of treatment of head and neck cancer. Consultation with a dental team experienced in caring for patients undergoing treatment for head and neck cancer will improve the quality of life of such patients. To evaluate the attitude of oncologists toward dental consultation to patients planning for/prior to/undergoing/post radiation therapy for head and neck cancers and to evaluate the number of radiation oncologists who encounter oral complaints and consider worth referring to a dentist. A questionnaire-based study was carried out following mailing of covering letter and self-administered questionnaire comprising 11 items, to 25 radiation oncology centers selected in India based on convenient sampling. Out of the 25 centers, we received response from 20 centers with 60 completely filled questionnaires. Five centers did not respond for further correspondences. The study indicated a need for awareness and education among radiation oncologists regarding dental consultation in patients planned/undergoing /post radiation therapy for head and neck cancer.

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

Training Psychotherapists in Hierarchical Treatment Planning

PubMed Central

MAKOVER, RICHARD B.

1992-01-01

Treatment planning is a central and persistent challenge in psychotherapy. This paper outlines a four-level planning hierarchy that encourages the therapist to conceptualize a desired overall outcome (the "aim") that can be realized through subsidiary objectives (the "goals"). The "strategies" by which goals are pursued and the "tactics" that carry out those strategies are subordinate and instrumental elements of the treatment process. Greater emphasis on this type of treatment planning in the training and supervision of psychotherapists should make therapy more effective, improve treatment outcomes, and allow more efficient use of therapy resources. PMID:22700115

The dissociative post-traumatic stress disorder (PTSD) subtype: A treatment outcome cohort study in veterans with PTSD.

PubMed

Haagen, Joris F G; van Rijn, Allison; Knipscheer, Jeroen W; van der Aa, Niels; Kleber, Rolf J

2018-06-01

Dissociation is a prevalent phenomenon among veterans with post-traumatic stress disorder (PTSD) that may interfere with the effectiveness of treatment. This study aimed to replicate findings of a dissociative PTSD subtype, to identify corresponding patterns in coping style, symptom type, and symptom severity, and to investigate its impact on post-traumatic symptom improvement. Latent profile analysis (LPA) was applied to baseline data from 330 predominantly (97%) male treatment-seeking veterans (mean age 39.5 years) with a probable PTSD. Multinomial logistic models were used to identify predictors of dissociative PTSD. Eighty veterans with PTSD that commenced with psychotherapy were invited for a follow-up measure after 6 months. The majority (n = 64, 80% response rate) completed the follow-up measure. Changes in post-traumatic stress between baseline and follow-up were explored as a continuous distal outcome. Latent profile analysis revealed four distinct patient profiles: 'low' (12.9%), 'moderate' (33.2%), 'severe' (45.1%), and 'dissociative' (8.8%) PTSD. The dissociative PTSD profile was characterized by more severe pathology levels, though not post-traumatic reactions symptom severity. Veterans with dissociative PTSD benefitted equally from PTSD treatment as veterans with non-dissociative PTSD with similar symptom severity. Within a sample of veterans with PTSD, a subsample of severely dissociative veterans was identified, characterized by elevated severity levels on pathology dimensions. The dissociative PTSD subtype did not negatively impact PTSD treatment. The present findings confirmed the existence of a distinct subgroup veterans that fit the description of dissociative PTSD. Patients with dissociative PTSD subtype symptoms uniquely differed from patients with non-dissociative PTSD in the severity of several psychopathology dimensions. Dissociative and non-dissociative PTSD patients with similar post-traumatic severity levels showed similar levels of

Post-traumatic growth among the UK veterans following treatment for post-traumatic stress disorder.

PubMed

Murphy, Dominic; Palmer, E; Lock, R; Busuttil, W

2017-04-01

The aim of this paper was to examine levels of post-traumatic growth (PTG) in a sample of the UK veterans who had received treatment for post-traumatic stress disorder (PTSD). The study followed-up 149 UK veterans after they had completed standardised treatment for PTSD provided by Combat Stress. Data had previously been collected on a range of mental health outcomes before treatment, and then repeated 6 months after the end of treatment. For the current study, participants completed the post-traumatic growth inventory (PTGI) measure. Analysis was conducted to explore levels of PTG and whether there were any relationships between pretreatment and post-treatment ratings of mental health and PTG. The mean score on the PTGI was 32.6. Evidence of a treatment effect on levels of PTG was observed. There appeared to be a relationship between improvements in symptoms of PTSD and depression and higher levels of PTG. This study observed the presence of PTG following exposure to traumatic events within a sample of the UK veterans following their treatment for PTSD. PTG scores were moderately low in comparison to similar studies in the USA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Water Vapor Adsorption on Biomass Based Carbons under Post-Combustion CO2 Capture Conditions: Effect of Post-Treatment

PubMed Central

Querejeta, Nausika; Plaza, Marta G.; Rubiera, Fernando; Pevida, Covadonga

2016-01-01

The effect of post-treatment upon the H2O adsorption performance of biomass-based carbons was studied under post-combustion CO2 capture conditions. Oxygen surface functionalities were partially replaced through heat treatment, acid washing, and wet impregnation with amines. The surface chemistry of the final carbon is strongly affected by the type of post-treatment: acid treatment introduces a greater amount of oxygen whereas it is substantially reduced after thermal treatment. The porous texture of the carbons is also influenced by post-treatment: the wider pore volume is somewhat reduced, while narrow microporosity remains unaltered only after acid treatment. Despite heat treatment leading to a reduction in the number of oxygen surface groups, water vapor adsorption was enhanced in the higher pressure range. On the other hand acid treatment and wet impregnation with amines reduce the total water vapor uptake thus being more suitable for post-combustion CO2 capture applications. PMID:28773488

From Tragedy To Strategy: Assessing The FDNY’s Post 9/11 Strategic Planning Process

DTIC Science & Technology

2016-12-01

STRATEGY: ASSESSING THE FDNY’S POST -9/11 STRATEGIC PLANNING PROCESS by Jonathan P. Pistilli December 2016 Thesis Advisor: Rodrigo Nieto...December 2016 3. REPORT TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE FROM TRAGEDY TO STRATEGY: ASSESSING THE FDNY’S POST -9/11...the city of New York (FDNY) strategic plans have been formulated using the same process, implemented in the post -9/11 environment. The process must

Fate of oestrogens during anaerobic blackwater treatment with micro-aerobic post-treatment.

PubMed

de Mes, T Z D; Kujawa-Roeleveld, K; Zeeman, G; Lettinga, G

2007-01-01

The fate of oestrone (E1), 17beta-oestradiol (E2) and 17alpha-ethynyloestradiol (EE2) was investigated in a concentrated blackwater treatment system consisting of an UASB septic tank, with micro-aerobic post-treatment. In UASB septic tank effluent a (natural) total concentration of 4.02 microg/L E1 and 18.69 microg/L E2, comprising the sum of conjugated (>70% for E1 and >80% for E2) and unconjugated forms, was measured. During post-treatment the unconjugated oestrogens were removed to below 1 microg/L. A percentage of 77% of the measured unconjugated E1 and 82% of E2 was associated with particles >1.2 microm in the final effluent implying high sorption affinity of both compounds. When spiking the UASB septic tank effluent with E1, E2, EE2 and the sulphate conjugate of E2, removal in the micro-aerobic post-treatment was >99% for both E2 and EE2 and 83% for E1. The lower removal value for E1 was a result of (slow) deconjugation during the treatment, and in the final effluent still 40% of E1 and 99% of E2 was present in conjugated form. The latter was the result of incomplete deconjugation of the spiked E2(3S) in the post-treatment system.

Pre-Treatment with Metformin in Comparison with Post-Treatment Reduces Cerebral Ischemia Reperfusion Induced Injuries in Rats.

PubMed

Karimipour, Mojtaba; Shojaei Zarghani, Sara; Mohajer Milani, Majid; Soraya, Hamid

2018-04-01

To explore the effects of pre versus post ischemic treatment with metformin after global cerebral ischemia in rats. Male Wister rats underwent forebrain ischemia by bilateral common carotid artery occlusion for 17 min. Metformin (200 mg/kg) or vehicle was given orally by gavage for 7-14 days. Rats were divided into: control, metformin pre-treatment, metformin post-treatment and metformin pre and post continuous treatment groups. Cerebral infarct size, histopathology, myeloperoxidase and serum malondialdehyde were measured 7 days after ischemia. Histopathological analysis showed that metformin pre-treatment significantly decreased leukocyte infiltration, myeloperoxidase activity and also malondialdehyde level. Metformin pre-treatment and metformin post-treatment reduced infarct size compared with the control group, but it was not significant in the pre and post continuous treatment group. Our findings suggest that pre-treatment with metformin in comparison with post-treatment in experimental stroke can reduce the extent of brain damage and is more neuroprotective at least in part by inhibiting oxidative stress and inflammation.

Post-ritual Circumcision Bleeding-Characteristics and Treatment Outcome.

PubMed

Mano, Roy; Nevo, Amihay; Sivan, Bezalel; Morag, Roy; Ben-Meir, David

2017-07-01

To report the characteristics, treatment, and short-term outcome of neonatal post-circumcision bleeding, and to identify predictors of surgical treatment. The medical records of 90 consecutive neonates who presented to the emergency room with post-circumcision bleeding between 2009 and 2014 were reviewed. Circumcisions were performed using the traditional Mogen shield device. The study end point was surgical intervention for hemostasis. Predictors of surgical treatment were evaluated. An estimated total of 28,383 circumcisions were performed during the study period; thus, the post-circumcision bleeding rate was 0.32%. Initial treatment included compressive dressing in 15 infants (17%) and hemostatic dressing in 47 infants (52%); 28 infants (31%) did not require treatment upon arrival to the emergency room. Two infants (2%) received blood transfusion. Surgical treatment was required in 11 infants (12%); 10 of 43 infants (23%) with active bleeding on arrival to the emergency room required surgery compared to 1 of 47 infants (2%) without active bleeding (P = .003). Similarly, 3 of 7 infants (43%) referred from other hospitals required surgery compared to 8 of 83 infants (10%) referred from the community (P = .037). Abnormal blood tests at presentation were not associated with surgical treatment. At 1 month of follow-up, 2 infants were admitted for recurrent bleeding. Coagulation abnormalities were found in 4 infants. Surgical treatment was required in 12% of infants presenting to the emergency room with post-circumcision bleeding. The rate of surgical intervention was significantly higher in infants with active bleeding at presentation and in those referred from other hospitals. Physicians should consider admitting infants presenting with active post-circumcision bleeding, whereas infants without active bleeding may be observed and discharged. Copyright © 2017 Elsevier Inc. All rights reserved.

WE-B-304-03: Biological Treatment Planning

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

Orton, C.

The ultimate goal of radiotherapy treatment planning is to find a treatment that will yield a high tumor control probability (TCP) with an acceptable normal tissue complication probability (NTCP). Yet most treatment planning today is not based upon optimization of TCPs and NTCPs, but rather upon meeting physical dose and volume constraints defined by the planner. It has been suggested that treatment planning evaluation and optimization would be more effective if they were biologically and not dose/volume based, and this is the claim debated in this month’s Point/Counterpoint. After a brief overview of biologically and DVH based treatment planning bymore » the Moderator Colin Orton, Joseph Deasy (for biological planning) and Charles Mayo (against biological planning) will begin the debate. Some of the arguments in support of biological planning include: this will result in more effective dose distributions for many patients DVH-based measures of plan quality are known to have little predictive value there is little evidence that either D95 or D98 of the PTV is a good predictor of tumor control sufficient validated outcome prediction models are now becoming available and should be used to drive planning and optimization Some of the arguments against biological planning include: several decades of experience with DVH-based planning should not be discarded we do not know enough about the reliability and errors associated with biological models the radiotherapy community in general has little direct experience with side by side comparisons of DVH vs biological metrics and outcomes it is unlikely that a clinician would accept extremely cold regions in a CTV or hot regions in a PTV, despite having acceptable TCP values Learning Objectives: To understand dose/volume based treatment planning and its potential limitations To understand biological metrics such as EUD, TCP, and NTCP To understand biologically based treatment planning and its potential limitations.« less

Pre- and Post-Processing Tools to Create and Characterize Particle-Based Composite Model Structures

DTIC Science & Technology

2017-11-01

ARL-TR-8213 ● NOV 2017 US Army Research Laboratory Pre- and Post -Processing Tools to Create and Characterize Particle-Based...ARL-TR-8213 ● NOV 2017 US Army Research Laboratory Pre- and Post -Processing Tools to Create and Characterize Particle-Based Composite...AND SUBTITLE Pre- and Post -Processing Tools to Create and Characterize Particle-Based Composite Model Structures 5a. CONTRACT NUMBER 5b. GRANT

Clinical knowledge-based inverse treatment planning

NASA Astrophysics Data System (ADS)

Yang, Yong; Xing, Lei

2004-11-01

Clinical IMRT treatment plans are currently made using dose-based optimization algorithms, which do not consider the nonlinear dose-volume effects for tumours and normal structures. The choice of structure specific importance factors represents an additional degree of freedom of the system and makes rigorous optimization intractable. The purpose of this work is to circumvent the two problems by developing a biologically more sensible yet clinically practical inverse planning framework. To implement this, the dose-volume status of a structure was characterized by using the effective volume in the voxel domain. A new objective function was constructed with the incorporation of the volumetric information of the system so that the figure of merit of a given IMRT plan depends not only on the dose deviation from the desired distribution but also the dose-volume status of the involved organs. The conventional importance factor of an organ was written into a product of two components: (i) a generic importance that parametrizes the relative importance of the organs in the ideal situation when the goals for all the organs are met; (ii) a dose-dependent factor that quantifies our level of clinical/dosimetric satisfaction for a given plan. The generic importance can be determined a priori, and in most circumstances, does not need adjustment, whereas the second one, which is responsible for the intractable behaviour of the trade-off seen in conventional inverse planning, was determined automatically. An inverse planning module based on the proposed formalism was implemented and applied to a prostate case and a head-neck case. A comparison with the conventional inverse planning technique indicated that, for the same target dose coverage, the critical structure sparing was substantially improved for both cases. The incorporation of clinical knowledge allows us to obtain better IMRT plans and makes it possible to auto-select the importance factors, greatly facilitating the inverse

Improving treatment plan evaluation with automation.

PubMed

Covington, Elizabeth L; Chen, Xiaoping; Younge, Kelly C; Lee, Choonik; Matuszak, Martha M; Kessler, Marc L; Keranen, Wayne; Acosta, Eduardo; Dougherty, Ashley M; Filpansick, Stephanie E; Moran, Jean M

2016-11-08

The goal of this work is to evaluate the effectiveness of Plan-Checker Tool (PCT) which was created to improve first-time plan quality, reduce patient delays, increase the efficiency of our electronic workflow, and standardize and automate the phys-ics plan review in the treatment planning system (TPS). PCT uses an application programming interface to check and compare data from the TPS and treatment management system (TMS). PCT includes a comprehensive checklist of automated and manual checks that are documented when performed by the user as part of a plan readiness check for treatment. Prior to and during PCT development, errors identified during the physics review and causes of patient treatment start delays were tracked to prioritize which checks should be automated. Nineteen of 33checklist items were automated, with data extracted with PCT. There was a 60% reduction in the number of patient delays in the six months after PCT release. PCT was suc-cessfully implemented for use on all external beam treatment plans in our clinic. While the number of errors found during the physics check did not decrease, automation of checks increased visibility of errors during the physics check, which led to decreased patient delays. The methods used here can be applied to any TMS and TPS that allows queries of the database. © 2016 The Authors.

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

PEG spacer gel and adaptive planning vs single plan in external prostate radiotherapy—clinical dosimetry evaluation

PubMed Central

2015-01-01

Objective: Spacer gel is used to reduce the rectal dose in prostate radiotherapy. It is injected to increase the distance between the prostate and rectum. During the course of external radiotherapy treatment, physiological changes in rectal volume exist. When using polyethylene glycol material, such as DuraSeal® (Covidien, Mansfield, MA), gel resorption also occurs. Together, these factors alter the original dose plan distribution. Methods: External dose planning and calculations were simulated using images acquired from 10 patients who were treated with brachytherapy and gel. The CT series was taken relative to gel injection: pre 1 day, post 1 day, post 1 month and post 2 months. Adaptive planning was compared with a single plan. Results: Adaptive planning shows better results compared with the single plan used in the total treatment course; however, the effect is minor. Conclusion: Gel usage is clearly favourable to rectal DVH. Using adaptive planning with gel improves rectal DVH but is not necessary according to this study. Advances in knowledge: Spacer gel is used in prostate radiotherapy to increase distance between the prostate and the rectum, thus reducing the rectal doses. During the treatment course, gel resorption exists which affects the rectal doses. The usefulness of adaptive planning to compensate this resorption effect has not been studied before. PMID:26370300

[The problem of post-marketing surveillance planning on drugs for infectious disease].

PubMed

Sato, J

2001-12-01

In principle, a new drug is approved via the assessments of safety and efficacy by the Ministry of Health, Labor and Welfare (MHLW). After approval, conduct of post-marketing surveillance is requested by law in order to assess the safety and efficacy of the drug in a large number of patients. Before initiating a surveillance, submission to MHLW of a document on the plan of survey is necessary in the purpose of inspection if it includes any ethical or regulatory problem or not. Through the inspections of the plans submitted during the period of April 1998 and March 2000, many problems have been pointed out. In this report, the author introduces some of the concrete problems noted in the plans on drugs for infectious diseases and shows some of the guidance made by the authority how to improve them. It is expected that such practical analyses of cases may be useful for future planning of post-marketing surveillance on drugs for infectious diseases.

Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients.

PubMed

Wojnar, Marcin; Ilgen, Mark A; Jakubczyk, Andrzej; Wnorowska, Anna; Klimkiewicz, Anna; Brower, Kirk J

2008-10-01

The present study was designed to examine the influence of suicidality on relapse in alcohol-dependent patients. Specifically, a lifetime suicide attempt at baseline was used to predict relapse in the year after treatment. Also, the unique contribution of impulsive suicide attempts was examined. A total of 154 patients with alcohol dependence, consecutively admitted to four addiction treatment facilities in Warsaw, Poland participated in the study. Of the 154 eligible patients, 118 (76.6%) completed a standardized follow-up assessment at 12 months. Previous suicide attempts were common in adults treated for alcohol dependence with 43% patients in the present sample reporting an attempt at some point during their lifetime. Additionally, more than 62% of those with a lifetime suicide attempt reported making an impulsive attempt. Lifetime suicide attempts were not associated with post-treatment relapse (chi-square=2.37, d.f.=1, p=0.124). However, impulsive suicide attempts strongly predicted relapse (OR=2.81, 95% CI=1.13-6.95, p=0.026) and time to relapse (OR=2.10, 95% CI=1.18-3.74, p=0.012) even after adjusting for other measures of baseline psychopathology, depression, impulsivity, hopelessness and alcohol use severity. This study is the first to document the relationship between pre-treatment impulsive suicide attempts and higher likelihood of post-treatment relapse in alcohol-dependent patents. Clinicians should routinely conduct an assessment for previous suicide attempts in patients with alcohol use disorders, and when impulsive suicidality is reported, they should recognize the increased risk for relapse and formulate their patients' treatment plans accordingly with the goals of reducing both alcoholic relapse and suicide rates.

Ask Pete, software planning and estimation through project characterization

NASA Technical Reports Server (NTRS)

Kurtz, T.

2001-01-01

Ask Pete, was developed by NASA to provide a tool for integrating the estimation and planning activities for a software development effort. It incorporates COCOMO II estimating with NASA's software development practices and IV&V criteria to characterize a project. This characterization is then used to generate estimates and tailored planning documents.

SU-E-T-502: Initial Results of a Comparison of Treatment Plans Produced From Automated Prioritized Planning Method and a Commercial Treatment Planning System

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

Tiwari, P; Chen, Y; Hong, L

2015-06-15

Purpose We developed an automated treatment planning system based on a hierarchical goal programming approach. To demonstrate the feasibility of our method, we report the comparison of prostate treatment plans produced from the automated treatment planning system with those produced by a commercial treatment planning system. Methods In our approach, we prioritized the goals of the optimization, and solved one goal at a time. The purpose of prioritization is to ensure that higher priority dose-volume planning goals are not sacrificed to improve lower priority goals. The algorithm has four steps. The first step optimizes dose to the target structures, whilemore » sparing key sensitive organs from radiation. In the second step, the algorithm finds the best beamlet weight to reduce toxicity risks to normal tissue while holding the objective function achieved in the first step as a constraint, with a small amount of allowed slip. Likewise, the third and fourth steps introduce lower priority normal tissue goals and beam smoothing. We compared with prostate treatment plans from Memorial Sloan Kettering Cancer Center developed using Eclipse, with a prescription dose of 72 Gy. A combination of liear, quadratic, and gEUD objective functions were used with a modified open source solver code (IPOPT). Results Initial plan results on 3 different cases show that the automated planning system is capable of competing or improving on expert-driven eclipse plans. Compared to the Eclipse planning system, the automated system produced up to 26% less mean dose to rectum and 24% less mean dose to bladder while having the same D95 (after matching) to the target. Conclusion We have demonstrated that Pareto optimal treatment plans can be generated automatically without a trial-and-error process. The solver finds an optimal plan for the given patient, as opposed to database-driven approaches that set parameters based on geometry and population modeling.« less

Planning for Retirement: Longitudinal Effect on Retirement Resources and Post-retirement Well-being

PubMed Central

Yeung, Dannii Y.; Zhou, Xiaoyu

2017-01-01

Retirement is a major life event, and a positive adjustment to retirement is essential for maintaining physical and psychological well-being in later life. Previous research demonstrates that pre-retirement planning predicts post-retirement well-being. This study further explores the underlying mechanism between planning activities and post-retirement well-being. By applying the resource-based dynamic model (Wang et al., 2011), the present longitudinal study examines whether pre-retirement planning activities can increase the total resources of retirees, including tangible, mental and social resources, and consequently contribute to better psychological and physical well-being 1 year after actual retirement. A total of 118 Hong Kong Chinese retirees completed three assessments: Time 1 assessment was conducted 6 months before retirement, and Times 2 and 3 assessments were carried out 6 and 12 months, respectively, after retirement. Latent growth models were employed to examine changes in retirement resources and post-retirement well-being over time. Consistent with the proposition of the resource-based dynamic model, positive changes in well-being were observed in the retirees with increases in retirement resources between pre- and post-retirement phases. The results of the latent growth mediation models also support our prediction: retirees with more preparatory activities before retirement acquire greater resources at the initial stage, which contribute to positive changes in post-retirement well-being over time. PMID:28798716

Planning for Retirement: Longitudinal Effect on Retirement Resources and Post-retirement Well-being.

PubMed

Yeung, Dannii Y; Zhou, Xiaoyu

2017-01-01

Retirement is a major life event, and a positive adjustment to retirement is essential for maintaining physical and psychological well-being in later life. Previous research demonstrates that pre-retirement planning predicts post-retirement well-being. This study further explores the underlying mechanism between planning activities and post-retirement well-being. By applying the resource-based dynamic model (Wang et al., 2011), the present longitudinal study examines whether pre-retirement planning activities can increase the total resources of retirees, including tangible, mental and social resources, and consequently contribute to better psychological and physical well-being 1 year after actual retirement. A total of 118 Hong Kong Chinese retirees completed three assessments: Time 1 assessment was conducted 6 months before retirement, and Times 2 and 3 assessments were carried out 6 and 12 months, respectively, after retirement. Latent growth models were employed to examine changes in retirement resources and post-retirement well-being over time. Consistent with the proposition of the resource-based dynamic model, positive changes in well-being were observed in the retirees with increases in retirement resources between pre- and post-retirement phases. The results of the latent growth mediation models also support our prediction: retirees with more preparatory activities before retirement acquire greater resources at the initial stage, which contribute to positive changes in post-retirement well-being over time.

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

Feasibility of using glass-bead thermoluminescent dosimeters for radiotherapy treatment plan verification.

PubMed

Jafari, Shakardokht M; Jordan, Tom J; Distefano, Gail; Bradley, David A; Spyrou, Nicholas M; Nisbet, Andrew; Clark, Catharine H

2015-01-01

To investigate the feasibility of using glass beads as novel thermoluminescent dosemeters (TLDs) for radiotherapy treatment plan verification. Commercially available glass beads with a size of 1-mm thickness and 2-mm diameter were characterized as TLDs. Five clinical treatment plans including a conventional larynx, a conformal prostate, an intensity-modulated radiotherapy (IMRT) prostate and two stereotactic body radiation therapy (SBRT) lung plans were transferred onto a CT scan of a water-equivalent phantom (Solid Water(®), Gammex, Middleton, WI) and the dose distribution recalculated. The number of monitor units was maintained from the clinical plan and delivered accordingly. The doses determined by the glass beads were compared with those measured by a graphite-walled ionization chamber, and the respective expected doses were determined by the treatment-planning system (TPS) calculation. The mean percentage difference between measured dose with the glass beads and TPS was found to be 0.3%, -0.1%, 0.4%, 1.8% and 1.7% for the conventional larynx, conformal prostate, IMRT prostate and each of the SBRT delivery techniques, respectively. The percentage difference between measured dose with the ionization chamber and glass bead was found to be -1.2%, -1.4%, -0.1%, -0.9% and 2.4% for the above-mentioned plans, respectively. The results of measured doses with the glass beads and ionization chamber in comparison with expected doses from the TPS were analysed using a two-sided paired t-test, and there was no significant difference at p < 0.05. It is feasible to use glass-bead TLDs as dosemeters in a range of clinical plan verifications. Commercial glass beads are utilized as low-cost novel TLDs for treatment-plan verification.

Phase 2 Site-Specific Fumigant Management Plans and Post-Application Summaries

EPA Pesticide Factsheets

New soil fumigant pesticide requirements protect handlers and other workers from exposure risks. FMP elements include application block information, tarp plan, buffer zone and sign posting requirements, air monitoring, and hazard communication.

Experimental characterization and numerical modeling of tissue electrical conductivity during pulsed electric fields for irreversible electroporation treatment planning.

PubMed

Neal, Robert E; Garcia, Paulo A; Robertson, John L; Davalos, Rafael V

2012-04-01

Irreversible electroporation is a new technique to kill cells in targeted tissue, such as tumors, through a nonthermal mechanism using electric pulses to irrecoverably disrupt the cell membrane. Treatment effects relate to the tissue electric field distribution, which can be predicted with numerical modeling for therapy planning. Pulse effects will change the cell and tissue properties through thermal and electroporation (EP)-based processes. This investigation characterizes these changes by measuring the electrical conductivity and temperature of ex vivo renal porcine tissue within a single pulse and for a 200 pulse protocol. These changes are incorporated into an equivalent circuit model for cells and tissue with a variable EP-based resistance, providing a potential method to estimate conductivity as a function of electric field and pulse length for other tissues. Finally, a numerical model using a human kidney volumetric mesh evaluated how treatment predictions vary when EP- and temperature-based electrical conductivity changes are incorporated. We conclude that significant changes in predicted outcomes will occur when the experimental results are applied to the numerical model, where the direction and degree of change varies with the electric field considered.

SU-E-J-97: Pretreatment Test and Post-Treatment Evaluation for Iso-NTCP Dose Guided Adapive Radiotherapy (DGART), Experience with Prostate Cancer Patients Treated with Rectal Balloons

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

Yu, J; Thomas Jefferson UniversityHospital, Philadelphia, PA; Hardcastle, N

Purpose: To explore the feasibility of pretreatment test for iso-NTCP DGART and to compare the pretreatment test results with post-treatment evaluations. Methods: NTCP here refers to late rectal wall toxicity only and is calculated with the ring rectal wall DVH. Simulation for one time iso- NTCP DGART starts after half of the total dose was done for 10 patients to investigate if TCP gains could be achieved. Six patients were treated using a 12-fraction 4.3Gy technique and four using 16-fraction 3.63Gy technique. For each of the 12-fraction cases a VMAT plan was generated in Pinnacle3™ using the daily CT obtainedmore » prior to the 6th fraction. A pretreatment simulation was performed using only the first 6 daily CTs. The idea is to add the 6 original plan delivered doses with 6 DGART plan delivered doses by deformable dose accumulation (DDA) on each of the first 6 CTs, resulting in 6 rectal wall doses (RWDs) and NTCPs. The 95% confidence interval (95%CI) for the 6 NTCPs were computed.The posttreatment evaluation was done by: a) copy the DGART plan to 6 CTs for fraction 7–12 and calculate the 6 actual DGART delivered fractional doses; b) sum the 6 actual DGART doses with the 6 original plan delivered doses by DDA on each of the 12 CTs resulting in 12 post-treatment RWDs and NTCPs; c) boxplot the 12 post-treatment NTCPs. Results: Target dose gain is 0.76–1.93 Gy. The 95%CI widths of the pretreatment tests NTCPs were 1.1–2.7%. For 5 patients, the planned NTCP fell within the 95%CI. For 4 patients, the planned NTCP was lower than the 95%CI lines. Post-treatment results show that for 7 patients, the upper quartile was within the 95%CI; for 2 patients, the upper quartile were higher than the 95%CI. Conclusion: The pretreatment test yields conservative prediction of the actual delivered NTCP.« less

Microstructure characterization and charpy toughness of P91 weldment for as-welded, post-weld heat treatment and normalizing & tempering heat treatment

NASA Astrophysics Data System (ADS)

Pandey, Chandan; Mahapatra, M. M.; Kumar, Pradeep; Giri, A.

2017-09-01

The effect of weld groove design and heat treatment on microstructure evolution and Charpy toughness of P91 pipe weldments was studied. The P91 pipe weldments were subjected to subcritical post weld heat treatment (760 °C-2 h) and normalizing/tempering conditions (normalized-1040 °C/40 min, air cooled; tempered 760 °C/2 h, air cooled) were employed. The influence of subsequent PWHT and N&T treatment on the microstructure of various zone of P91 pipe weldments were also investigated. The present investigation also described the effect of PWHT and N&T treatment on hardness, grain size, precipitate size, inter-particle spacing and fraction area of precipitates present in each zone of P91 pipe weldments. The result indicated great impact of heat treatment on the Charpy toughness and microstructure evolution of P91 weldments. The N&T treatment was found to be more effective heat treatment compared to subsequent PWHT. Charpy toughness value was found to be higher for narrow-groove design as compared to conventional V-groove design.

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

SU-F-T-453: Improved Head and Neck SBRT Treatment Planning Using PlanIQ

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

Wang, H; Wang, C; Phan, J

Purpose: Treatment planning for Head and Neck(HN) re-irradiation is a challenge because of ablative doses to target volume and strict critical structure constraints. PlanIQ(Sun Nuclear Corporation) can assess the feasibility of clinical goals and quantitatively measure plan quality. Here, we assess whether incorporation of PlanIQ in our SBRT treatment planning process can improve plan quality and planning efficiency. Methods: From 2013–2015, 35 patients (29 retrospective, 6 prospective) with recurrent HN tumors were treated with SBRT using VMAT treatment plans. The median prescription dose was 45 Gy in 5 fractions. We retrospectively reviewed the treatment plans and physician directives of ourmore » first 29 patients and generated score functions of the dosimetric goals used in our practice and obtained a baseline histogram. We then re-optimized 12 plans that had potential to further reduce organs-at-risk (OAR) doses according to PlanIQ feasibility DVH and plan quality analysis and compared them to the original plans. We applied our new PlanIQ-assisted planning process for our 6 most recently treated patients and evaluated the plan quality and planning efficiency. Results: The mean plan quality metric(PQM) and feasibility adjusted PQM(APQM) scores of our initial 29 treatment plans were 77.1±13.1 and 88.7±11.9, respectively (0–100 scale). The PQM and APQM scores for the 12 optimized plans improved from 75.9±11.0 and 85.1±10.2 to 80.7±9.3 and 90.2±8.0, respectively (p<0.005). Using our newly developed PlanIQ-assisted planning process, the PQM and APQM scores for the 6 most recently treated patients were 93.6±6.5 and 99.1±0.6, respectively. The planning goals were more straightforward to minimize OAR doses during optimization, thus less planning and revision time were used than before. Conclusion: PlanIQ has the potential to provide achievable planning goals and also improve plan quality and planning efficiency.« less

Mission Planning for Heterogeneous UxVs Operating in a Post-Disaster Urban Environment

DTIC Science & Technology

2017-09-01

FOR HETEROGENEOUS UxVs OPERATING IN A POST -DISASTER URBAN ENVIRONMENT by Choon Seng Leon Mark Tan September 2017 Thesis Advisor: Oleg...September 2017 3. REPORT TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE MISSION PLANNING FOR HETEROGENEOUS UxVs OPERATING IN A POST ...UxVs OPERATING IN A POST -DISASTER URBAN ENVIRONMENT Choon Seng Leon Mark Tan Civilian Engineer, ST Aerospace Ltd., Singapore B. Eng (Hons

Patterns of osteoporosis treatment change and treatment discontinuation among commercial and Medicare Advantage Prescription Drug members in a national health plan.

PubMed

Xu, Yihua; Viswanathan, Hema N; Ward, Melea A; Clay, Brad; Adams, John L; Stolshek, Bradley S; Kallich, Joel D; Fine, Shari; Saag, Kenneth G

2013-02-01

Multiple treatments are available for osteoporosis; however, little is known about treatment change patterns and associated factors. Osteoporosis treatment change patterns, discontinuation and factors associated with treatment change in members of a large national health plan were examined. A retrospective cohort study was conducted in 7315 commercial and 34 146 Medicare Advantage Prescription Drug (MAPD) members newly initiated on an osteoporosis medication between 2006 and 2008. Osteoporosis treatment change, discontinuation and re-initiation patterns were assessed. Multivariate logistic regression was used to examine factors associated with treatment change. Commercial and MAPD members were assessed separately because of differences in demographics and insurance benefits. Approximately 12% of members had a change in index therapy within 12 months. Almost 60% of members discontinued the index medication at least once, based on a 90-day refill gap. Over 40% of members discontinued all osteoporosis medications by the end of 12 months post-index. Among MAPD and commercial members, women and those with risedronate, ibandronate or calcitonin at index, index therapy in 2008 and an osteoporosis diagnosis were more likely to have a treatment change while members with health plans other than health maintenance organizations and generic alendronate at index were less likely to have a treatment change. Osteoporosis treatment change occurred in approximately 12% of members, while a greater proportion of members discontinued treatment completely within 12 months. Member characteristics may be used to predict therapy change for evaluation and quality initiatives within a health plan. © 2011 Blackwell Publishing Ltd.

The long-term health plan and disability cost benefit of obstructive sleep apnea treatment in a commercial motor vehicle driver population.

PubMed

Hoffman, Benjamin; Wingenbach, Dustin D; Kagey, Amy N; Schaneman, Justin L; Kasper, David

2010-05-01

To assess the impact on health plan and disability costs associated with continuous positive airway pressure or bi-level positive airway pressure treatment of obstructive sleep apnea in a commercial motor vehicle driver population. A retrospective, pre/post claims-based comparison analysis was performed. Health plan and disability costs, in addition to disability claimant rates and missed workdays were compared for the 12 months before treatment to the 24 months after treatment. Health plan costs were significantly lower in both the first and second years after treatment. Short-term disability metrics also exhibited favorable results, with approximately half as many using the benefit, lower costs, and fewer missed workdays in the postperiod. Effective treatment of obstructive sleep apnea in drivers is associated with lower health care and disability costs and fewer missed workdays.

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.

Breast cancer survivorship and South Asian women: understanding about the follow-up care plan and perspectives and preferences for information post treatment

PubMed Central

Singh–Carlson, S.; Wong, F.; Martin, L.; Nguyen, S.K.A.

2013-01-01

Background and Objectives As more treatment options become available and supportive care improves, a larger number of people will survive after treatment for breast cancer. In the present study, we explored the experiences and concerns of female South Asian (sa) breast cancer survivors (bcss) from various age groups after treatment to determine their understanding of follow-up care and to better understand their preferences for a survivorship care plan (scp). Methods Patients were identified by name recognition from BC Cancer Agency records for sa patients who were 3–60 months post treatment, had no evidence of recurrence, and had been discharged from the cancer centre to follow-up. Three focus groups and eleven face-to-face semistructured interviews were audio-recorded, transcribed verbatim, cross-checked for accuracy, and analyzed using thematic and content analysis. Participants were asked about their survivorship experiences and their preferences for the content and format of a scp. Results Fatigue, cognitive changes, fear of recurrence, and depression were the most universal effects after treatment. “Quiet acceptance” was the major theme unique to sa women, with a unique cross-influence between faith and acceptance. Emphasis on a generalized scp with individualized content echoed the wide variation in breast cancer impacts for sa women. Younger women preferred information on depression and peer support. Conclusions For sa bcss, many of the psychological and physical impacts of breast cancer diagnosis and treatment may be experienced in common with bcss of other ethnic backgrounds, but the present study also suggests the presence of unique cultural nuances such as spiritual and language-specific support resource needs. The results provide direction for designing key content and format of scps, and information about elements of care that can be customized to individual patient needs. PMID:23559888

Improving treatment plan evaluation with automation

PubMed Central

Covington, Elizabeth L.; Chen, Xiaoping; Younge, Kelly C.; Lee, Choonik; Matuszak, Martha M.; Kessler, Marc L.; Keranen, Wayne; Acosta, Eduardo; Dougherty, Ashley M.; Filpansick, Stephanie E.

2016-01-01

The goal of this work is to evaluate the effectiveness of Plan‐Checker Tool (PCT) which was created to improve first‐time plan quality, reduce patient delays, increase the efficiency of our electronic workflow, and standardize and automate the physics plan review in the treatment planning system (TPS). PCT uses an application programming interface to check and compare data from the TPS and treatment management system (TMS). PCT includes a comprehensive checklist of automated and manual checks that are documented when performed by the user as part of a plan readiness check for treatment. Prior to and during PCT development, errors identified during the physics review and causes of patient treatment start delays were tracked to prioritize which checks should be automated. Nineteen of 33 checklist items were automated, with data extracted with PCT. There was a 60% reduction in the number of patient delays in the six months after PCT release. PCT was successfully implemented for use on all external beam treatment plans in our clinic. While the number of errors found during the physics check did not decrease, automation of checks increased visibility of errors during the physics check, which led to decreased patient delays. The methods used here can be applied to any TMS and TPS that allows queries of the database. PACS number(s): 87.55.‐x, 87.55.N‐, 87.55.Qr, 87.55.tm, 89.20.Bb PMID:27929478

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

Modularized and Outcomes-Led Planning of Higher Education in Post-Apartheid South Africa.

ERIC Educational Resources Information Center

Ntshoe, I. M.

1999-01-01

Examines modularization and outcomes-based planning of higher education in South Africa as part of transforming higher education in a post-apartheid society. Discusses principles and assumptions of modularization and outcomes-based planning, identifies intended and unintended outcomes, and notes such issues as the origins of outcome-based…

Post-Flight Characterization of Samples for the MISSE-7 Spacesuit Fabric Exposure Experiment

NASA Technical Reports Server (NTRS)

Gaier, James R.; Waters, Deborah L.; Jaworski, Donald A.; McCue, Terry R.; Folz, Angela; Baldwin, Sammantha; Clark, Gregory W.; Batman, Brittany; Bruce, John

2012-01-01

Six samples of pristine and dust-abraded outer layer spacesuit fabrics were included in the Materials International Space Station Experiment-7, in which they were exposed to the wake side low Earth orbit environment (LEO) on the International Space Station (ISS) for 18 months in order to determine whether abrasion by lunar dust increases radiation degradation. The fabric samples were characterized using optical microscopy, field emission scanning electron microscopy, and tensile testing before and after exposure on the ISS. Comparison of pre- and post-flight characterizations showed that wake side LEO environment darkened and reddened all six fabrics, increasing their integrated solar absorptance by 7 to 38 percent. There was a decrease in the ultimate tensile strength and elongation to failure of lunar dust abraded Apollo spacesuit fibers by a factor of four and increased the elastic modulus by a factor of two. The severity of the degradation of the fabric samples over this short exposure time demonstrates the necessity to find ways to prevent or mitigate radiation damage to spacesuits when planning extended missions to the Moon.

Effect of post-space treatment on retention of fiber posts in different root regions using two self-etching systems.

PubMed

Zhang, Ling; Huang, Li; Xiong, Yu; Fang, Ming; Chen, Ji-Hua; Ferrari, Marco

2008-06-01

The effect of post-space treatment on the retention of fiber posts in different root regions was evaluated using two self-etching systems. Post spaces were prepared in extracted premolars and then the root canals were subjected to one of the following post-space treatments: (i) water irrigation (control); (ii) etching with 35% phosphoric acid for 30 s; (iii) irrigation with 17% EDTA followed by 5.25% sodium hypochlorite (NaOCl); and (iv) ultrasonic agitation associated with 17% EDTA and 5.25% NaOCl irrigating solutions. The dentin surfaces were examined under scanning electron microscopy (SEM) after different post-space treatments. Fiber posts were then luted in the treated roots using resin cement with either Clearfil SE Bond or Clearfil DC Bond, and the thin-slice push-out test was performed. Scanning electron microscopy showed that all the post-space treatments tested were effective in removal of the smear layer of debris, or sealer/gutta-percha remnants, on the root canal. The apical push-out strength was affected by post-space treatment. Both 35% phosphoric acid etching and ultrasonic agitation in combination with EDTA/NaOCl irrigation improved the apical push-out strength of the fiber post, regardless of the type of self-etching system. A solo irrigation with an EDTA/NaOCl solution resulted in a lower apical push-out strength compared with the other two experimental groups.

Post-treatment Stage of Change Predicts 12-month Outcome of Treatment for Alcohol Problems

PubMed Central

Heather, Nick; McCambridge, Jim

2013-01-01

Aims: To evaluate relationships between clients' self-reported ‘stage of change’ and outcomes after treatment for alcohol problems. Methods: Using data from the ‘United Kingdom Alcohol Treatment Trial’, clients who had received at least one session of treatment and who had complete data (n = 392) entered the analysis. Two continuous measures of drinking behaviour (% days abstinent (PDA) and drinks per drinking day (DDD)) and categorical outcomes at the 12-month follow-up were compared between clients in Pre-action and Action stages of change at either pre- or post-treatment assessment. Multiple and logistic regression analyses examined the relationships between stage of change and treatment outcomes, evaluating the strength of these relationships by controlling for likely confounders. Results: Pre-treatment stage of change did not predict outcome but post-treatment stage of change predicted PDA and DDD at the 12-month follow-up. In unadjusted and adjusted analyses, clients in Action at post-treatment were two to three times more likely to show a favourable categorical outcome, variously defined, than those in Pre-action. There were no differences between clients who had received Motivational Enhancement Therapy and those who had received Social Behaviour and Network Therapy in proportions maintaining or moving towards Action from before to after treatment. Conclusions: These findings confirm previous reports that motivational variables predict outcome of treatment but add that such a relationship is seen for post-treatment stage of change. For therapists, it would seem important to monitor the client's stage of change—which in good clinical practice often occurs in informal ways—and have strategies to deal with low motivation to change whenever it occurs throughout treatment. The findings are also consistent with a ‘common factors’ perspective on effective treatment for alcohol problems. PMID:23408241

Improved Therapeutic Regimens for Treatment of Post-Traumatic Ocular Infections

DTIC Science & Technology

2009-05-01

TITLE: Improved Therapeutic Regimens for Treatment of Post- Traumatic Ocular Infections PRINCIPAL INVESTIGATOR: Michelle C. Callegan, Ph.D...From - To) 15 APR 2008 - 14 APR 2009 4. TITLE AND SUBTITLE Improved Therapeutic Regimens for Treatment of Post-Traumatic 5a. CONTRACT NUMBER...delay between injury and adequate treatment . This proposal was designed to analyze the effectiveness of antibiotics, anti- inflammatory drugs, and non

Improved Therapeutic Regimens for Treatment of Post-Traumatic Ocular Infections

DTIC Science & Technology

2008-05-01

Treatment of Post-Traumatic Ocular Infections PRINCIPAL INVESTIGATOR: Michelle C. Callegan, Ph.D. CONTRACTING...NUMBER Improved Therapeutic Regimens for Treatment of Post-Traumatic Ocular Infections 5b. GRANT NUMBER W81XWH-07-1-0280 5c. PROGRAM ELEMENT NUMBER...in arid environments and the delay between time of injury and adequate treatment . This proposal was designed to analyze the effectiveness of

MO-B-BRC-00: Prostate HDR Treatment Planning - Considering Different Imaging Modalities

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

NONE

2016-06-15

Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR ismore » U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions.« less

Childhood Arthritis and Rheumatology Research Alliance Consensus Clinical Treatment Plans for Juvenile Dermatomyositis with Persistent Skin Rash.

PubMed

Huber, Adam M; Kim, Susan; Reed, Ann M; Carrasco, Ruy; Feldman, Brian M; Hong, Sandy D; Kahn, Philip; Rahimi, Homaira; Robinson, Angela Byun; Vehe, Richard K; Weiss, Jennifer E; Spencer, Charles

2017-01-01

Juvenile dermatomyositis (JDM) is the most common form of idiopathic inflammatory myopathy in children. While outcomes are generally thought to be good, persistence of skin rash is a common problem. The goal of this study was to describe the development of clinical treatment plans (CTP) for children with JDM characterized by persistent skin rash despite complete resolution of muscle involvement. The Childhood Arthritis and Rheumatology Research Alliance, a North American consortium of pediatric rheumatologists and other healthcare providers, used a combination of Delphi surveys and nominal group consensus meetings to develop CTP that reflected consensus on typical treatments for patients with JDM with persistent skin rash. Consensus was reached on patient characteristics and outcome assessment. Patients should have previously received corticosteroids and methotrexate (MTX). Three consensus treatment plans were developed. Plan A added intravenous immunoglobulin (IVIG) if it was not already being used. Plan B added mycophenolate mofetil, while Plan C added cyclosporine. Continuation of previous treatments, including corticosteroids, MTX, and IVIG, was permitted in plans B and C. Three consensus CTP were developed for use in children with JDM and persistent skin rash despite complete resolution of muscle disease. These CTP reflect typical treatment approaches and are not to be considered treatment recommendations or standard of care. Using prospective data collection and statistical methods to account for nonrandom treatment assignment, it is expected that these CTP will be used to allow treatment comparisons, and ultimately determine the best treatment for these patients.

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

Risk factors associated with short-term post-treatment outcomes of clinical mastitis.

PubMed

Pinzón-Sánchez, C; Ruegg, P L

2011-07-01

The objectives of this study were to characterize 60-d outcomes after treatment of mild (abnormal milk) and moderate (abnormal milk and abnormal udder) cases of clinical mastitis (CM) occurring in a single quarter of cows on Wisconsin farms (n=4) and to determine risk factors associated with those outcomes. Duplicate milk samples were collected from the affected quarter of each cow for microbiological analysis at the onset of CM (PRE) and 21 d later (POST). Cows were treated only in the affected quarter using an intramammary product containing 125 mg of ceftiofur. Bacteriological cure was defined as absence of pathogens in the POST sample obtained from the enrolled quarter. Recurrence was defined for the cow when CM occurred after the milk-withholding period for the enrolled case of CM. Retention in the herd was defined when a cow was retained within the herd for the 60-d follow-up period. Somatic cell count reduction (SCCR) was defined at the cow level as somatic cell count (SCC) below 200,000 cells/mL at the Dairy Herd Improvement Association test day occurring between 21 to 55 d post-treatment. The effects of farm, days in milk, parity, severity, microbiological diagnosis at PRE, previous milk yield, previous SCC, previous occurrence of CM and treatment duration on selected post-treatment outcomes were assessed using Chi-squared analysis and logistic regression. Microbiological results at PRE were distributed as: Escherichia coli (n=14), Klebsiella spp. (n=11), Enterobacter spp. (n=8), Serratia spp. (n=7), other gram-negative species (n=3), Streptococcus spp. (n=25), coagulase-negative staphylococci (n=4); Staphylococcus aureus (n=1); Streptococcus agalactiae (n=1), other gram-positive species (n=9), and culture negative (n=60). Treated quarters were more likely to experience bacteriological cure when the cow experienced CM for the first time in the lactation and when no pathogen was recovered from PRE milk samples obtained from the enrolled quarter. Parity and

Cost-Effective Fuel Treatment Planning

NASA Astrophysics Data System (ADS)

Kreitler, J.; Thompson, M.; Vaillant, N.

2014-12-01

The cost of fighting large wildland fires in the western United States has grown dramatically over the past decade. This trend will likely continue with growth of the WUI into fire prone ecosystems, dangerous fuel conditions from decades of fire suppression, and a potentially increasing effect from prolonged drought and climate change. Fuel treatments are often considered the primary pre-fire mechanism to reduce the exposure of values at risk to wildland fire, and a growing suite of fire models and tools are employed to prioritize where treatments could mitigate wildland fire damages. Assessments using the likelihood and consequence of fire are critical because funds are insufficient to reduce risk on all lands needing treatment, therefore prioritization is required to maximize the effectiveness of fuel treatment budgets. Cost-effectiveness, doing the most good per dollar, would seem to be an important fuel treatment metric, yet studies or plans that prioritize fuel treatments using costs or cost-effectiveness measures are absent from the literature. Therefore, to explore the effect of using costs in fuel treatment planning we test four prioritization algorithms designed to reduce risk in a case study examining fuel treatments on the Sisters Ranger District of central Oregon. For benefits we model sediment retention and standing biomass, and measure the effectiveness of each algorithm by comparing the differences among treatment and no treat alternative scenarios. Our objective is to maximize the averted loss of net benefits subject to a representative fuel treatment budget. We model costs across the study landscape using the My Fuel Treatment Planner software, tree list data, local mill prices, and GIS-measured site characteristics. We use fire simulations to generate burn probabilities, and estimate fire intensity as conditional flame length at each pixel. Two prioritization algorithms target treatments based on cost-effectiveness and show improvements over those

Implementing post-trial access plans for HIV prevention research.

PubMed

Paul, Amy; Merritt, Maria W; Sugarman, Jeremy

2018-05-01

Ethics guidance increasingly recognises that researchers and sponsors have obligations to consider provisions for post-trial access (PTA) to interventions that are found to be beneficial in research. Yet, there is little information regarding whether and how such plans can actually be implemented. Understanding practical experiences of developing and implementing these plans is critical to both optimising their implementation and informing conceptual work related to PTA. This viewpoint is informed by experiences with developing and implementing PTA plans for six large-scale multicentre HIV prevention trials supported by the HIV Prevention Trials Network. These experiences suggest that planning and implementing PTA often involve challenges of planning under uncertainty and confronting practical barriers to accessing healthcare systems. Even in relatively favourable circumstances where a tested intervention medication is approved and available in the local healthcare system, system-level barriers can threaten the viability of PTA plans. The aggregate experience across these HIV prevention trials suggests that simply referring participants to local healthcare systems for PTA will not necessarily result in continued access to beneficial interventions for trial participants. Serious commitments to PTA will require additional efforts to learn from future approaches, measuring the success of PTA plans with dedicated follow-up and further developing normative guidance to help research stakeholders navigate the complex practical challenges of realising PTA. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Projected 24-hour post-dose ocular itching scores post-treatment with olopatadine 0.7% versus 0.2.

PubMed

Fidler, Matthew L; Ogundele, Abayomi; Covert, David; Sarangapani, Ramesh

2018-04-21

Olopatadine is an antihistamine and mast cell stabilizer used for treating allergic conjunctivitis. Olopatadine 0.7% has been recently approved for daily dosing in the US, which supersedes the previously approved 0.2% strength. The objective of this analysis was to characterize patients who have better itching relief at 24 h when taking olopatadine 0.7% treatment instead of olopatadine 0.2% (in terms of proportions of responses) and relate this to the severity of baseline itching as an indirect metric of a patient's sensitivity to antihistamines. A differential odds model was developed using data from two conjunctival allergen challenge (CAC) studies to characterize individual-level and population-level response to ocular itching following olopatadine treatment and the data was analyzed retrospectively. This modeling analysis was designed to predict 24 h ocular itching scores and to quantify the differences in 24 h itching relief following treatment with olopatadine 0.2% versus 0.7% in patients with moderate-to-high baseline itching. A one-compartment kinetic-pharmacodynamic E max model was used to determine the effect of olopatadine. Impact of baseline itching severity, vehicle effect and the drug effect on the overall itching scores post-treatment were explicitly incorporated in the model. The model quantified trends observed in the clinical data with regards to both mean scores and the proportions of patients responding to olopatadine treatment. The model predicts a higher proportion of patients in the olopatadine 0.7% versus 0.2% group will experience relief within 24 h. This prediction was confirmed with retrospective clinical data analysis. The number of allergy patients relieved with olopatadine 0.7% increased with higher baseline itching severity scores, when compared to olopatadine 0.2%.

Rapid and Checkable Electrical Post-Treatment Method for Organic Photovoltaic Devices

PubMed Central

Park, Sangheon; Seo, Yu-Seong; Shin, Won Suk; Moon, Sang-Jin; Hwang, Jungseek

2016-01-01

Post-treatment processes improve the performance of organic photovoltaic devices by changing the microscopic morphology and configuration of the vertical phase separation in the active layer. Thermal annealing and solvent vapor (or chemical) treatment processes have been extensively used to improve the performance of bulk-heterojunction (BHJ) organic photovoltaic (OPV) devices. In this work we introduce a new post-treatment process which we apply only electrical voltage to the BHJ-OPV devices. We used the commercially available P3HT [Poly(3-hexylthiophene)] and PC61BM (Phenyl-C61-Butyric acid Methyl ester) photovoltaic materials as donor and acceptor, respectively. We monitored the voltage and current applied to the device to check for when the post-treatment process had been completed. This electrical treatment process is simpler and faster than other post-treatment methods, and the performance of the electrically treated solar cell is comparable to that of a reference (thermally annealed) device. Our results indicate that the proposed treatment process can be used efficiently to fabricate high-performance BHJ-OPV devices. PMID:26932767

PyCMSXiO: an external interface to script treatment plans for the Elekta® CMS XiO treatment planning system

NASA Astrophysics Data System (ADS)

Xing, Aitang; Arumugam, Sankar; Holloway, Lois; Goozee, Gary

2014-03-01

Scripting in radiotherapy treatment planning systems not only simplifies routine planning tasks but can also be used for clinical research. Treatment planning scripting can only be utilized in a system that has a built-in scripting interface. Among the commercially available treatment planning systems, Pinnacle (Philips) and Raystation (Raysearch Lab.) have inherent scripting functionality. CMS XiO (Elekta) is a widely used treatment planning system in radiotherapy centres around the world, but it does not have an interface that allows the user to script radiotherapy plans. In this study an external scripting interface, PyCMSXiO, was developed for XiO using the Python programming language. The interface was implemented as a python package/library using a modern object-oriented programming methodology. The package was organized as a hierarchy of different classes (objects). Each class (object) corresponds to a plan object such as the beam of a clinical radiotherapy plan. The interface of classes was implemented as object functions. Scripting in XiO using PyCMSXiO is comparable with Pinnacle scripting. This scripting package has been used in several research projects including commissioning of a beam model, independent three-dimensional dose verification for IMRT plans and a setup-uncertainty study. Ease of use and high-level functions provided in the package achieve a useful research tool. It was released as an open-source tool that may benefit the medical physics community.

Outcomes associated with a negotiated asthma treatment plan.

PubMed

Clark, Noreen M; Ko, Yi-An; Gong, Z Molly; Johnson, Timothy R

2012-08-01

Negotiated treatment plans are increasingly recommended in asthma clinical care. However, limited data are available to indicate whether this more patient-engaged process results in improved health outcomes. The aim of this study was to determine the associations between the presence of a negotiated treatment plan and the outcomes related to adherence to the medical regimen, symptom control, and health care use. The focus of the study was on women, the subgroup of adult patients, who are most vulnerable for negative asthma outcomes. Data were collected by telephone interview and medical record review from 808 women diagnosed with asthma at baseline, first year, and second year follow-up. Associations were examined between the presence of a negotiated treatment plan at baseline and subsequent asthma outcomes. Women with a negotiated treatment plan reported more adherent to prescribed asthma medicines (odds ratio (OR) = 2.41, 95% confidence interval (CI) = (1.82, 3.19)) and those with a plan and using oral steroids at baseline had less oral steroid use at follow-up (OR = 0.21, 95% CI = (0.05, 0.93)). Women with a negotiated plan also had more days (17%, 95% CI = (8, 27)) and nights (31%, 95% CI = (16, 48)) with symptoms than those without such a plan. No differences in hospitalizations, emergency department visits, or urgent physician office visits were noted between the groups. Patients with higher education levels were more likely to have a negotiated treatment plan. Negotiated treatment plans appear to have achieved greater adherence to prescribed asthma medicines and less need for oral steroids but were not related to fewer symptoms of asthma or reductions in urgent health care use. Additional strategies may be needed to reduce symptom and health services utilization outcomes.

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.

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

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

Influence of TiCl4 post-treatment condition on TiO2 electrode for enhancement photovoltaic efficiency of dye-sensitized solar cells.

PubMed

Eom, Tae Sung; Kim, Kyung Hwan; Bark, Chung Wung; Choi, Hyung Wook

2014-10-01

Titanium tetrachloride (TiCl4) treatment processed by chemical bath deposition is usually adopted as pre- and post-treatment for nanocrystalline titanium dioxide (TiO2) film deposition in the dye-sensitized solar cells (DSSCs) technology. TiCl4 post-treatment is a widely known method capable of improving the performance of dye-sensitized solar cells. In this work, the effect of TiCl4 post-treatment on the TiO2 electrode is proposed and compared to the untreated film. A TiO2 passivating layer was deposited on FTO glass by RF magnetron sputtering. The TiO2 sol prepared sol-gel method, nanoporous TiO2 upper layer was deposited by screen printing method on the passivating layer. TiCl4 post-treatment was deposited on the substrate by hydrolysis of TiCl4 aqueous solution. Crystalline structure was adjusted by various TiCl4 concentration and dipping time: 20 mM-150 mM and 30 min-120 min. The conversion efficiency was measured by solar simulator (100 mW/cm2). The dye-sensitized solar cell using TiCl4 post-treatment was measured the maximum conversion efficiency of 5.04% due to electron transport effectively. As a result, the DSSCs based on TiCl4 post-treatment showed better photovoltaic performance than cells made purely of TiO2 nanoparticles. The relative DSSCs devices are characterized in terms of short circuit current density, open circuit voltage, fill factor, conversion efficiency.

[Pre- and post-surgical orthodontic treatment of mandibular asymmetry and prognathism].

PubMed

Chen, Song; Chen, Yang-xi; Hu, Jing

2005-01-01

The purpose of this study was to analyze the pre- and post surgical orthodontic treatment of mandibular asymmetry and prognathism in our hospital, and to summarize some helpful experiences for future clinical work. The data were derived from 21 adults aged from 19 - 28 years who had severe mandibular asymmetry and prognathism. The ANB angle of all patients is from -3 degrees to -8 degrees. The value of wits of all patients is from -7 mm to -14 mm. The deviation of chin point of all patients is from 3 mm to 7 mm. The duration of pre- and post-surgical orthodontic treatment was 10-20 months (mean 18 months) and 5-10 months (mean 7.5 months), respectively. The keys in pre-surgical orthodontic treatment include (1) three dimensional dental decompensation; (2) arch form and transverse discrepancy correction; (3) model surgery and the splint making. The main objective of post surgical orthodontic treatment is to detail the occlusion. Pre- and post surgical orthodontic treatment is essential for the orthognathic treatment of patients with mandibular asymmetry and prognathism.

In vivo verification of proton beam path by using post-treatment PET/CT imaging.

PubMed

Hsi, Wen C; Indelicato, Daniel J; Vargas, Carlos; Duvvuri, Srividya; Li, Zuofeng; Palta, Jatinder

2009-09-01

The purpose of this study is to establish the in vivo verification of proton beam path by using proton-activated positron emission distributions. A total of 50 PET/CT imaging studies were performed on ten prostate cancer patients immediately after daily proton therapy treatment through a single lateral portal. The PET/CT and planning CT were registered by matching the pelvic bones, and the beam path of delivered protons was defined in vivo by the positron emission distribution seen only within the pelvic bones, referred to as the PET-defined beam path. Because of the patient position correction at each fraction, the marker-defined beam path, determined by the centroid of implanted markers seen in the posttreatment (post-Tx) CT, is used for the planned beam path. The angular variation and discordance between the PET- and marker-defined paths were derived to investigate the intrafraction prostate motion. For studies with large discordance, the relative location between the centroid and pelvic bones seen in the post-Tx CT was examined. The PET/CT studies are categorized for distinguishing the prostate motion that occurred before or after beam delivery. The post-PET CT was acquired after PET imaging to investigate prostate motion due to physiological changes during the extended PET acquisition. The less than 2 degrees of angular variation indicates that the patient roll was minimal within the immobilization device. Thirty of the 50 studies with small discordance, referred as good cases, show a consistent alignment between the field edges and the positron emission distributions from the entrance to the distal edge. For those good cases, average displacements are 0.6 and 1.3 mm along the anterior-posterior (D(AP)) and superior-inferior (D(SI)) directions, respectively, with 1.6 mm standard deviations in both directions. For the remaining 20 studies demonstrating a large discordance (more than 6 mm in either D(AP) or D(SI)), 13 studies, referred as motion-after-Tx cases

No filter: A characterization of #pharmacist posts on Instagram.

PubMed

Hindman, F Mark; Bukowitz, Alison E; Reed, Brent N; Mattingly, T Joseph

The primary objective was to characterize the underlying intent of Instagram posts using the hashtag metadata term "#pharmacist" over a 1-year period. The secondary objective was to determine whether statistically significant relationships existed between the categories and the 2 dichotomous variables tested, self-portrayed images, and relation to health care. Retrospective, cross-sectional, mixed methods, exploratory, descriptive study. A review of available Instagram posts using the hashtag metadata "#pharmacist" from November 4, 2014, to November 3, 2015. Data were collected using software provided by NEXT Analytics. A sample of 14 random days was selected. Six hundred sixty-one Instagram posts containing "#pharmacist" in the caption. Categorization of post (including both picture and primary caption), self-portrayed images (i.e., "selfie"), and health care-related images. One thousand three hundred thirty-eight posts were collected from the 14-day sample. Of the posts, 661 (49.4%) were analyzed; the remainder were excluded for being written in a non-English language or containing "#pharmacist" in the comments of the post, rather than the primary caption; 19.7% of all posts fell into the Celebration category, followed by Work Experience and Advertisement with 18.6% and 12.6%, respectively. The remainder of the categories contained 10% or fewer posts. Less than 25% of posts were self-portrayed images, and 88% of posts were deemed health care-related. Instagram is an emerging social media platform that can be used to expand patient education, professional advocacy, and public health outreach. In this study, the majority of #pharmacist posts were celebratory in nature, and the majority were determined to be related to health care. Posts containing #pharmacist may provide the opportunity to educate the public regarding the knowledge and capabilities of pharmacists. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Physical activity and post-treatment weight trajectory in anorexia nervosa

PubMed Central

Gianini, Loren M; Klein, Diane A; Call, Christine; Walsh, B. Timothy; Wang, Yuanjia; Wu, Peng; Attia, Evelyn

2015-01-01

Objective This study compared an objective measurement of physical activity (PA) in individuals with anorexia nervosa (AN) at low-weight, weight-restored, and post-treatment time points, and also compared PA in AN with that of healthy controls (HC). Method Sixty-one female inpatients with AN wore a novel accelerometer (the IDEEA) which measured PA at three time points: a) low-weight, b) weight-restored, and c) one month post-hospital discharge. Twenty-four HCs wore the IDEEA at one time point. Results Inpatients with AN became more physically active than they were at low-weight at weight restoration and following treatment discharge. Post-treatment patients with AN were more physically active than HCs during the day and less active at night, which was primarily accounted for by amount of time spent on feet, including standing and walking. Greater time spent on feet during the weight-restoration time point of inpatient treatment was associated with more rapid decrease in BMI over the 12 months following treatment discharge. Fidgeting did not differ between patients and controls, did not change with weight restoration, and did not predict post-treatment weight change. Discussion Use of a novel accelerometer demonstrated greater PA in AN than in healthy controls. PA following weight restoration in AN, particularly time spent in standing postures, may contribute to weight loss in the year following hospitalization. PMID:26712105

A Tough Transition: Cancer Survivorship Plans Slow to Take Hold

Cancer.gov

The Institute of Medicine recommends that all patients completing cancer treatment receive a survivorship care plan to help navigate post-treatment life. But the progress in refining and implementing these plans has been mixed.

Immediate titanium mesh cranioplasty for treatment of post-craniotomy infections

PubMed Central

Wind, Joshua J.; Ohaegbulam, Chima; Iwamoto, Fabio M.; Black, Peter McL.; Park, John K.

2011-01-01

OBJECTIVE Post craniotomy infections have generally been treated by debridement of infected tissues, disposal of the bone flap, and delayed cranioplasty several months later to repair the resulting skull defect. Debridement followed by retention of the bone flap has also been advocated. Here we propose an alternative operative strategy for the treatment of post craniotomy infections. METHODS Two patients presenting with clinical and radiographic signs and symptoms of post craniotomy infections were treated by debridement, bone flap disposal, and immediate titanium mesh cranioplasty. The patients were subsequently administered antibiotics and their clinical courses were followed. RESULTS The patients treated in this fashion did not have recurrence of their infections during three-year follow-up periods. CONCLUSIONS Surgical debridement, bone flap disposal and immediate titanium mesh cranioplasty may be a suitable option for the treatment of post craniotomy infections. This treatment strategy facilitates the eradication of infectious sources and obviates the risks and costs associated with a second surgical procedure. PMID:22120410

AutoLock: a semiautomated system for radiotherapy treatment plan quality control.

PubMed

Dewhurst, Joseph M; Lowe, Matthew; Hardy, Mark J; Boylan, Christopher J; Whitehurst, Philip; Rowbottom, Carl G

2015-05-08

A semiautomated system for radiotherapy treatment plan quality control (QC), named AutoLock, is presented. AutoLock is designed to augment treatment plan QC by automatically checking aspects of treatment plans that are well suited to computational evaluation, whilst summarizing more subjective aspects in the form of a checklist. The treatment plan must pass all automated checks and all checklist items must be acknowledged by the planner as correct before the plan is finalized. Thus AutoLock uniquely integrates automated treatment plan QC, an electronic checklist, and plan finalization. In addition to reducing the potential for the propagation of errors, the integration of AutoLock into the plan finalization workflow has improved efficiency at our center. Detailed audit data are presented, demonstrating that the treatment plan QC rejection rate fell by around a third following the clinical introduction of AutoLock.

Accessing specialty behavioral health treatment in private health plans.

PubMed

Merrick, Elizabeth L; Horgan, Constance M; Garnick, Deborah W; Reif, Sharon; Stewart, Maureen T

2009-10-01

Connecting people to mental health and substance abuse services is critical, given the extent of unmet need. The way health plans structure access to care can play a role. This study examined treatment entry procedures for specialty behavioral health care in private health plans and their relationship with behavioral health contracting arrangements, focusing primarily on initial entry into outpatient treatment. The data source was a nationally representative health plan survey on behavioral health services in 2003 (N = 368 plans with 767 managed care products; 83% response rate). Most health plan products initially authorized six or more outpatient visits if authorization was required, did not routinely conduct telephonic clinical assessment, had standards for timely access, and monitored wait time. Products with carve-outs differed on several treatment entry dimensions. Findings suggest that health plans focus on timely access and typically do not heavily manage initial entry into outpatient treatment.

Parents' and Students' Perspectives of Transition Planning and Post-Secondary Outcomes

ERIC Educational Resources Information Center

Morgan, Valda R. Beasley

2010-01-01

One of many responsibilities for public schools concerning students with mental retardation is to assist students with the development of their individual transition plans. The purpose of this study was to evaluate if post-secondary outcomes identified for students with mental retardation while in public school were the actual outcomes in which…

Post-Treatment Hemodynamics of a Basilar Aneurysm and Bifurcation

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

Ortega, J; Hartman, J; Rodriguez, J

2008-01-16

Aneurysm re-growth and rupture can sometimes unexpectedly occur following treatment procedures that were initially considered to be successful at the time of treatment and post-operative angiography. In some cases, this can be attributed to surgical clip slippage or endovascular coil compaction. However, there are other cases in which the treatment devices function properly. In these instances, the subsequent complications are due to other factors, perhaps one of which is the post-treatment hemodynamic stress. To investigate whether or not a treatment procedure can subject the parent artery to harmful hemodynamic stresses, computational fluid dynamics simulations are performed on a patient-specific basilarmore » aneurysm and bifurcation before and after a virtual endovascular treatment. The simulations demonstrate that the treatment procedure produces a substantial increase in the wall shear stress. Analysis of the post-treatment flow field indicates that the increase in wall shear stress is due to the impingement of the basilar artery flow upon the aneurysm filling material and to the close proximity of a vortex tube to the artery wall. Calculation of the time-averaged wall shear stress shows that there is a region of the artery exposed to a level of wall shear stress that can cause severe damage to endothelial cells. The results of this study demonstrate that it is possible for a treatment procedure, which successfully excludes the aneurysm from the vascular system and leaves no aneurysm neck remnant, to elevate the hemodynamic stresses to levels that are injurious to the immediately adjacent vessel wall.« less

Robustness of IPSA optimized high-dose-rate prostate brachytherapy treatment plans to catheter displacements

PubMed Central

Whitaker, May

2016-01-01

Purpose Inverse planning simulated annealing (IPSA) optimized brachytherapy treatment plans are characterized with large isolated dwell times at the first or last dwell position of each catheter. The potential of catheter shifts relative to the target and organs at risk in these plans may lead to a more significant change in delivered dose to the volumes of interest relative to plans with more uniform dwell times. Material and methods This study aims to determine if the Nucletron Oncentra dwell time deviation constraint (DTDC) parameter can be optimized to improve the robustness of high-dose-rate (HDR) prostate brachytherapy plans to catheter displacements. A set of 10 clinically acceptable prostate plans were re-optimized with a DTDC parameter of 0 and 0.4. For each plan, catheter displacements of 3, 7, and 14 mm were retrospectively applied and the change in dose volume histogram (DVH) indices and conformity indices analyzed. Results The robustness of clinically acceptable prostate plans to catheter displacements in the caudal direction was found to be dependent on the DTDC parameter. A DTDC value of 0 improves the robustness of planning target volume (PTV) coverage to catheter displacements, whereas a DTDC value of 0.4 improves the robustness of the plans to changes in hotspots. Conclusions The results indicate that if used in conjunction with a pre-treatment catheter displacement correction protocol and a tolerance of 3 mm, a DTDC value of 0.4 may produce clinically superior plans. However, the effect of the DTDC parameter in plan robustness was not observed to be as strong as initially suspected. PMID:27504129

Robustness of IPSA optimized high-dose-rate prostate brachytherapy treatment plans to catheter displacements.

PubMed

Poder, Joel; Whitaker, May

2016-06-01

Inverse planning simulated annealing (IPSA) optimized brachytherapy treatment plans are characterized with large isolated dwell times at the first or last dwell position of each catheter. The potential of catheter shifts relative to the target and organs at risk in these plans may lead to a more significant change in delivered dose to the volumes of interest relative to plans with more uniform dwell times. This study aims to determine if the Nucletron Oncentra dwell time deviation constraint (DTDC) parameter can be optimized to improve the robustness of high-dose-rate (HDR) prostate brachytherapy plans to catheter displacements. A set of 10 clinically acceptable prostate plans were re-optimized with a DTDC parameter of 0 and 0.4. For each plan, catheter displacements of 3, 7, and 14 mm were retrospectively applied and the change in dose volume histogram (DVH) indices and conformity indices analyzed. The robustness of clinically acceptable prostate plans to catheter displacements in the caudal direction was found to be dependent on the DTDC parameter. A DTDC value of 0 improves the robustness of planning target volume (PTV) coverage to catheter displacements, whereas a DTDC value of 0.4 improves the robustness of the plans to changes in hotspots. The results indicate that if used in conjunction with a pre-treatment catheter displacement correction protocol and a tolerance of 3 mm, a DTDC value of 0.4 may produce clinically superior plans. However, the effect of the DTDC parameter in plan robustness was not observed to be as strong as initially suspected.

AutoLock: a semiautomated system for radiotherapy treatment plan quality control

PubMed Central

Lowe, Matthew; Hardy, Mark J.; Boylan, Christopher J.; Whitehurst, Philip; Rowbottom, Carl G.

2015-01-01

A semiautomated system for radiotherapy treatment plan quality control (QC), named AutoLock, is presented. AutoLock is designed to augment treatment plan QC by automatically checking aspects of treatment plans that are well suited to computational evaluation, whilst summarizing more subjective aspects in the form of a checklist. The treatment plan must pass all automated checks and all checklist items must be acknowledged by the planner as correct before the plan is finalized. Thus AutoLock uniquely integrates automated treatment plan QC, an electronic checklist, and plan finalization. In addition to reducing the potential for the propagation of errors, the integration of AutoLock into the plan finalization workflow has improved efficiency at our center. Detailed audit data are presented, demonstrating that the treatment plan QC rejection rate fell by around a third following the clinical introduction of AutoLock. PACS number: 87.55.Qr PMID:26103498

Incorporating big data into treatment plan evaluation: Development of statistical DVH metrics and visualization dashboards.

PubMed

Mayo, Charles S; Yao, John; Eisbruch, Avraham; Balter, James M; Litzenberg, Dale W; Matuszak, Martha M; Kessler, Marc L; Weyburn, Grant; Anderson, Carlos J; Owen, Dawn; Jackson, William C; Haken, Randall Ten

2017-01-01

To develop statistical dose-volume histogram (DVH)-based metrics and a visualization method to quantify the comparison of treatment plans with historical experience and among different institutions. The descriptive statistical summary (ie, median, first and third quartiles, and 95% confidence intervals) of volume-normalized DVH curve sets of past experiences was visualized through the creation of statistical DVH plots. Detailed distribution parameters were calculated and stored in JavaScript Object Notation files to facilitate management, including transfer and potential multi-institutional comparisons. In the treatment plan evaluation, structure DVH curves were scored against computed statistical DVHs and weighted experience scores (WESs). Individual, clinically used, DVH-based metrics were integrated into a generalized evaluation metric (GEM) as a priority-weighted sum of normalized incomplete gamma functions. Historical treatment plans for 351 patients with head and neck cancer, 104 with prostate cancer who were treated with conventional fractionation, and 94 with liver cancer who were treated with stereotactic body radiation therapy were analyzed to demonstrate the usage of statistical DVH, WES, and GEM in a plan evaluation. A shareable dashboard plugin was created to display statistical DVHs and integrate GEM and WES scores into a clinical plan evaluation within the treatment planning system. Benchmarking with normal tissue complication probability scores was carried out to compare the behavior of GEM and WES scores. DVH curves from historical treatment plans were characterized and presented, with difficult-to-spare structures (ie, frequently compromised organs at risk) identified. Quantitative evaluations by GEM and/or WES compared favorably with the normal tissue complication probability Lyman-Kutcher-Burman model, transforming a set of discrete threshold-priority limits into a continuous model reflecting physician objectives and historical experience

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

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.

Beneficial Effect of Post-Deposition Treatment in High-Efficiency Cu(In,Ga)Se2 Solar Cells through Reduced Potential Fluctuations

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

Jensen, Soren A.; Glynn, Stephen; Kanevce, Ana

World-record power conversion efficiencies for Cu(In,Ga)Se2 (CIGS) solar cells have been achieved via a post-deposition treatment with alkaline metals, which increases the open-circuit voltage and fill factor. We explore the role of the potassium fluoride (KF) post-deposition treatment in CIGS by employing energy- and time-resolved photoluminescence spectroscopy and electrical characterization combined with numerical modeling. The bulk carrier lifetime is found to increase with post-deposition treatment from 255 ns to 388 ns, which is the longest charge carrier lifetime reported for CIGS, and within ~40% of the radiative limit. We find evidence that the post-deposition treatment causes a decrease in themore » electronic potential fluctuations. These potential fluctuations have previously been shown to reduce the open-circuit voltage and the device efficiency in CIGS. Additionally, numerical simulations based on the measured carrier lifetimes and mobilities show a diffusion length of ~10 um, which is ~4 times larger than the film thickness. Thus, carrier collection in the bulk is not a limiting factor for device efficiency. By considering differences in doping, bandgap, and potential fluctuations, we present a possible explanation for the voltage difference between KF-treated and untreated samples.« less

Effects of endodontic post surface treatment, dentin conditioning, and artificial aging on the retention of glass fiber-reinforced composite resin posts.

PubMed

Albashaireh, Zakereyya S; Ghazal, Muhamad; Kern, Matthias

2010-01-01

Several post surface treatments with or without the application of a bonding agent have been recommended to improve the bond strength of resin cements to posts. A regimen that produces the maximum bond strength of glass fiber-reinforced composite resin posts has not been verified. The purpose of this study was to evaluate the influence of post surface conditioning methods and artificial aging on the retention and microleakage of adhesively luted glass fiber-reinforced composite resin posts. Seventy-two endodontically treated single-rooted teeth were prepared for glass fiber-reinforced composite resin posts. The posts were submitted to 3 different surface treatments (n=24), including no treatment, etching with phosphoric acid, and airborne-particle abrasion. Subgroups of the posts (n=8) were then allocated for 3 different experimental conditions: no artificial aging, no bonding agent; no artificial aging, bonding agent; or artificial aging, bonding agent. The posts were luted with resin cement (Calibra). Post retention was measured in tension at a crosshead speed of 2 mm/min. The posts assigned for microleakage investigation were placed in fuchsin dye for 72 hours. The dislodged posts and the post spaces were examined microscopically to evaluate the mode of failure and explore the microleakage. Data were analyzed by 2-way ANOVA followed by Tukey HSD test (alpha=.05). The mean (SD) retention values for test groups ranged from 269 (63.8) to 349 (52.2) N. The retention values of the airborne-particle-abrasion group were significantly higher than those of the acidic-treatment and no-treatment groups. The application of bonding agent on the post surface produced no significant influence on retention. The mean retention values after artificial aging were significantly higher than without artificial aging. Microscopic evaluation demonstrated that the failure mode was primarily mixed. Treating the surface of the posts with phosphoric acid for 15 seconds before cementation

Modeling treatment couches in the Pinnacle treatment planning system: Especially important for arc therapy

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

Duggar, William Neil, E-mail: wduggar@umc.edu; Nguyen, Alex; Stanford, Jason

This study is to demonstrate the importance and a method of properly modeling the treatment couch for dose calculation in patient treatment using arc therapy. The 2 treatment couch tops—Aktina AK550 and Elekta iBEAM evo—of Elekta LINACs were scanned using Philips Brilliance Big Bore CT Simulator. Various parts of the couch tops were contoured, and their densities were measured and recorded on the Pinnacle treatment planning system (TPS) using the established computed tomography density table. These contours were saved as organ models to be placed beneath the patient during planning. Relative attenuation measurements were performed following procedures outlined by TG-176more » as well as absolute dose comparison of static fields of 10 × 10 cm{sup 2} that were delivered through the couch tops with that calculated in the TPS with the couch models. A total of 10 random arc therapy treatment plans (5 volumetric-modulated arc therapy [VMAT] and 5 stereotactic body radiation therapy [SBRT]), using 24 beams, were selected for this study. All selected plans were calculated with and without couch modeling. Each beam was evaluated using the Delta{sup 4} dosimetry system (Delta{sup 4}). The Student t-test was used to determine statistical significance. Independent reviews were exploited as per the Imaging and Radiation Oncology Core head and neck credentialing phantom. The selected plans were calculated on the actual patient anatomies with and without couch modeling to determine potential clinical effects. Large relative beam attenuations were noted dependent on which part of the couch top beams were passing through. Substantial improvements were also noted for static fields both calculated with the TPS and delivered physically when the couch models were included in the calculation. A statistically significant increase in agreement was noted for dose difference, distance to agreement, and γ-analysis with the Delta{sup 4} on VMAT and SBRT plans. A credentialing review

Tensile strength of glass fiber posts submitted to different surface treatments.

PubMed

Faria, Maria Isabel A; Gomes, Érica Alves; Messias, Danielle Cristine; Silva Filho, João Manoel; Souza Filho, Celso Bernardo; Paulino, Silvana Maria

2013-01-01

The aim of this in vitro study was to evaluate the tensile strength of glass fiber posts submitted to different surface treatments. Forty-eight maxillary canines had their crowns sectioned and root canals endodontically treated. The roots were embedded in acrylic resin and distributed into 3 groups according to the surface treatment: Group I: the posts were treated with silane agent for 30 s and adhesive; Group II: the posts were cleaned with alcohol before treatment with silane agent and adhesive; Group III: the posts were submitted to conditioning with 37% phosphoric acid for 30 s before treatment with silane agent and adhesive. Each group was divided into 2 subgroups for adhesive polymerization or not before insertion into the canal: A - adhesive was not light cured and B - adhesive was light cured. All posts were cemented with Panavia F and the samples were subjected to tensile strength test in a universal testing machine at crosshead speed of 1 mm/min. Data were submitted to one-way ANOVA and Tukey's test at 5% significance level. There was statistically significant difference (p<0.01) only between group GIII-B and groups GI-A and GI-B. No significant difference was found among the other groups (p>0.05). It was concluded that the products used for cleaning the posts influenced the retention regardless of adhesive light curing.

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.

Demystifying post-stroke pain: from etiology to treatment

PubMed Central

Treister, Andrew K.; Hatch, Maya N.; Cramer, Steven C.; Chang, Eric Y.

2016-01-01

Pain following stroke is commonly reported but often incompletely managed, which prevents optimal recovery. This is in part due to the esoteric nature of post-stroke pain and its limited presence in current discussions of stroke management. The major specific afflictions that affect patients with stroke who develop pain include central post-stroke pain (CPSP), complex regional pain syndrome (CRPS), and pain associated with spasticity and shoulder subluxation. Each disorder carries its own intricacies that require specific approaches to treatment and understanding. This review aims to present and clarify the major pain syndromes that affect patients who have suffered from stroke in order to aid in their diagnosis and treatment. PMID:27317916

SU-E-T-268: Differences in Treatment Plan Quality and Delivery Between Two Commercial Treatment Planning Systems for Volumetric Arc-Based Radiation Therapy

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

Chen, S; Zhang, H; Zhang, B

2015-06-15

Purpose: To clinically evaluate the differences in volumetric modulated arc therapy (VMAT) treatment plan and delivery between two commercial treatment planning systems. Methods: Two commercial VMAT treatment planning systems with different VMAT optimization algorithms and delivery approaches were evaluated. This study included 16 clinical VMAT plans performed with the first system: 2 spine, 4 head and neck (HN), 2 brain, 4 pancreas, and 4 pelvis plans. These 16 plans were then re-optimized with the same number of arcs using the second treatment planning system. Planning goals were invariant between the two systems. Gantry speed, dose rate modulation, MLC modulation, planmore » quality, number of monitor units (MUs), VMAT quality assurance (QA) results, and treatment delivery time were compared between the 2 systems. VMAT QA results were performed using Mapcheck2 and analyzed with gamma analysis (3mm/3% and 2mm/2%). Results: Similar plan quality was achieved with each VMAT optimization algorithm, and the difference in delivery time was minimal. Algorithm 1 achieved planning goals by highly modulating the MLC (total distance traveled by leaves (TL) = 193 cm average over control points per plan), while maintaining a relatively constant dose rate (dose-rate change <100 MU/min). Algorithm 2 involved less MLC modulation (TL = 143 cm per plan), but greater dose-rate modulation (range = 0-600 MU/min). The average number of MUs was 20% less for algorithm 2 (ratio of MUs for algorithms 2 and 1 ranged from 0.5-1). VMAT QA results were similar for all disease sites except HN plans. For HN plans, the average gamma passing rates were 88.5% (2mm/2%) and 96.9% (3mm/3%) for algorithm 1 and 97.9% (2mm/2%) and 99.6% (3mm/3%) for algorithm 2. Conclusion: Both VMAT optimization algorithms achieved comparable plan quality; however, fewer MUs were needed and QA results were more robust for Algorithm 2, which more highly modulated dose rate.« less

SU-F-T-403: Impact of Dose Reduction for Simulation CT On Radiation Therapy Treatment Planning

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

Liang, Q; Shah, P; Li, S

Purpose: To investigate the feasibility of applying ALARA principles to current treatment planning CT scans. The study aims to quantitatively verify lower dose scans does not alter treatment planning. Method: Gammex 467 tissue characterization phantom with inserts of 14 different materials was scanned at seven different mA levels (30∼300 mA). CT numbers of different inserts were measured. Auto contouring for bone and lung in treatment planning system (Pinnacle) was used to evaluate the effect of CT number accuracy from treatment planning aspect, on the 30 and 300 mA-scanned images. A head CT scan intended for a 3D whole brain radiationmore » treatment was evaluated. Dose calculations were performed on normal scanned images using clinical protocol (120 kVP, Smart mA, maximum 291 mA), and the images with added simulating noise mimicking a 70 mA scan. Plan parameters including isocenter, beam arrangements, block shapes, dose grid size and resolution, and prescriptions were kept the same for these two plans. The calculated monitor units (MUs) for these two plans were compared. Results: No significant degradation of CT number accuracy was found at lower dose levels from both the phantom scans, and the patient images with added noise. The CT numbers kept consistent when mA is higher than 60 mA. The auto contoured volumes for lung and cortical bone show 0.3% and 0.12% of differences between 30 mA and 300 mA respectively. The two forward plans created on regular and low dose images gave the same calculated MU, and 98.3% of points having <1% of dose difference. Conclusion: Both phantom and patient studies quantitatively verified low dose CT provides similar quality for treatment planning at 20–25% of regular scan dose. Therefore, there is the potential to optimize simulation CT scan protocol to fulfil the ALARA principle and limit unnecessary radiation exposure to non-targeted tissues.« less

Adverse event assessment and reporting in trials of newer treatments for post-operative pain.

PubMed

Hoffer, D; Smith, S M; Parlow, J; Allard, R; Gilron, I

2016-08-01

Assessment and reporting of adverse events (AEs) in studies of perioperative interventions is critical given the potential for unintended and preventable iatrogenic morbidity and mortality. This focused review evaluated the quality of AE assessment and reporting in acute post-operative pain treatment trials. Since older analgesics (e.g., opioids, NSAIDs) already have a well-characterized safety profile, we concentrated on trials of pregabalin and gabapentin as a representative sample of studies where the perioperative safety profile was relatively unknown. We reviewed primary reports of trials of pregabalin and gabapentin for treatment of acute post-operative pain for: (1) adherence to the 10 recommendations from the 'CONSORT Extension for Harms,' (2) AE assessment method, (3) timing of AE assessment and reporting, and (4) assessment and reporting of AE severity. We identified 31 trials of pregabalin and 59 of gabapentin. The median number of CONSORT harms recommendations that were satisfied was 7 of 10. The most common (41%) method of AE assessment was direct questioning about specific AEs by investigators. However, AE assessment method was not described in 18% of trials. AE assessments were reported for specified perioperative time points in only 24% of trials. Of greatest concern, no AE data were reported whatsoever in 8 of the included publications. Considerable widespread improvements are needed in AE reporting for post-operative pain treatment trials. In addition to heightened awareness among clinical investigators, mandatory journal editorial policies may further facilitate improvements in safety assessment and reporting. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Tools to aid post-wildfire assessment and erosion-mitigation treatment decisions

Treesearch

Peter R. Robichaud; Louise E. Ashmun

2013-01-01

A considerable investment in post-fire research over the past decade has improved our understanding of wildfire effects on soil, hydrology, erosion and erosion-mitigation treatment effectiveness. Using this new knowledge, we have developed several tools to assist land managers with post-wildfire assessment and treatment decisions, such as prediction models, research...

Predicting client attendance at further treatment following drug and alcohol detoxification: Theory of Planned Behaviour and Implementation Intentions.

PubMed

Kelly, Peter J; Leung, Joanne; Deane, Frank P; Lyons, Geoffrey C B

2016-11-01

Despite clinical recommendations that further treatment is critical for successful recovery following drug and alcohol detoxification, a large proportion of clients fail to attend treatment after detoxification. In this study, individual factors and constructs based on motivational and volitional models of health behaviour were examined as predictors of post-detoxification treatment attendance. The sample consisted of 220 substance-dependent individuals participating in short-term detoxification programs provided by The Australian Salvation Army. The Theory of Planned Behaviour and Implementation Intentions were used to predict attendance at subsequent treatment. Follow-up data were collected for 177 participants (81%), with 104 (80%) of those participants reporting that they had either attended further formal treatment (e.g. residential rehabilitation programs, outpatient counselling) or mutual support groups in the 2 weeks after leaving the detoxification program. Logistic regression examined the predictors of further treatment attendance. The full model accounted for 21% of the variance in treatment attendance, with attitude and Implementation Intentions contributing significantly to the prediction. Findings from the present study would suggest that assisting clients to develop a specific treatment plan, as well as helping clients to build positive perceptions about subsequent treatment, will promote greater attendance at further treatment following detoxification. [Kelly PJ, Leung J, Deane FP, Lyons GCB. Predicting client attendance at further treatment following drug and alcohol detoxification: Theory of Planned Behaviour and Implementation Intentions. Drug Alcohol Rev 2016;35:678-685]. © 2015 Australasian Professional Society on Alcohol and other Drugs.

A new plan-scoring method using normal tissue complication probability for personalized treatment plan decisions in prostate cancer

NASA Astrophysics Data System (ADS)

Kim, Kwang Hyeon; Lee, Suk; Shim, Jang Bo; Yang, Dae Sik; Yoon, Won Sup; Park, Young Je; Kim, Chul Yong; Cao, Yuan Jie; Chang, Kyung Hwan

2018-01-01

The aim of this study was to derive a new plan-scoring index using normal tissue complication probabilities to verify different plans in the selection of personalized treatment. Plans for 12 patients treated with tomotherapy were used to compare scoring for ranking. Dosimetric and biological indexes were analyzed for the plans for a clearly distinguishable group ( n = 7) and a similar group ( n = 12), using treatment plan verification software that we developed. The quality factor ( QF) of our support software for treatment decisions was consistent with the final treatment plan for the clearly distinguishable group (average QF = 1.202, 100% match rate, n = 7) and the similar group (average QF = 1.058, 33% match rate, n = 12). Therefore, we propose a normal tissue complication probability (NTCP) based on the plan scoring index for verification of different plans for personalized treatment-plan selection. Scoring using the new QF showed a 100% match rate (average NTCP QF = 1.0420). The NTCP-based new QF scoring method was adequate for obtaining biological verification quality and organ risk saving using the treatment-planning decision-support software we developed for prostate cancer.

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...

Prospective treatment plan-specific action limits for real-time intrafractional monitoring in surface image guided radiosurgery.

PubMed

Yock, Adam D; Pawlicki, Todd; Kim, Gwe-Ya

2016-07-01

In surface image guided radiosurgery, action limits are created to determine at what point intrafractional motion exhibited by the patient is large enough to warrant intervention. Action limit values remain constant across patients despite the fact that patient motion affects the target coverage of brain metastases differently depending on the planning technique and other treatment plan-specific factors. The purpose of this work was twofold. The first purpose was to characterize the sensitivity of single-met per iso and multimet per iso treatment plans to uncorrected patient motion. The second purpose was to describe a method to prospectively determine treatment plan-specific action limits considering this sensitivity. In their surface image guided radiosurgery technique, patient positioning is achieved with a thermoplastic mask that does not cover the patient's face. The patient's exposed face is imaged by a stereoscopic photogrammetry system. It is then compared to a reference surface and monitored throughout treatment. Seventy-two brain metastases (representing 29 patients) were used for this study. Twenty-five mets were treated individually ("single-met per iso plans"), and 47 were treated in a plan simultaneously with at least one other met ("multimet per iso plans"). For each met, the proportion of the gross tumor volume that remained within the 100% prescription isodose line was estimated under the influence of combinations of translations and rotations (0.0-3.0 mm and 0.0°-3.0°, respectively). The target volume and the prescription dose-volume were considered concentric spheres that each encompassed a volume determined from the treatment plan. Plan-specific contour plots and DVHs were created to illustrate the sensitivity of a specific lesion to uncorrected patient motion. Both single-met per iso and multimet per iso plans exhibited compromised target coverage under translations and rotations, though multimet per iso plans were considerably more sensitive

Consensus Treatment Plans for New-Onset Systemic Juvenile Idiopathic Arthritis

PubMed Central

DeWitt, Esi Morgan; Kimura, Yukiko; Beukelman, Timothy; Nigrovic, Peter A.; Onel, Karen; Prahalad, Sampath; Schneider, Rayfel; Stoll, Matthew L.; Angeles-Han, Sheila; Milojevic, Diana; Schikler, Kenneth N.; Vehe, Richard K.; Weiss, Jennifer E.; Weiss, Pamela; Ilowite, Norman T.; Wallace, Carol A.

2012-01-01

Objective There is wide variation in therapeutic approaches to systemic juvenile idiopathic arthritis (sJIA) among North American rheumatologists. Understanding the comparative effectiveness of the diverse therapeutic options available for treatment of sJIA can result in better health outcomes. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans and standardized assessment schedules for use in clinical practice to facilitate such studies. Methods Case-based surveys were administered to CARRA members to identify prevailing treatments for new-onset sJIA. A 2-day consensus conference in April 2010 employed modified nominal group technique to formulate preliminary treatment plans and determine important data elements for collection. Follow-up surveys were employed to refine the plans and assess clinical acceptability. Results The initial case-based survey identified significant variability among current treatment approaches for new onset sJIA, underscoring the utility of standardized plans to evaluate comparative effectiveness. We developed four consensus treatment plans for the first 9 months of therapy, as well as case definitions and clinical and laboratory monitoring schedules. The four treatment regimens included glucocorticoids only, or therapy with methotrexate, anakinra or tocilizumab, with or without glucocorticoids. This approach was approved by >78% of CARRA membership. Conclusion Four standardized treatment plans were developed for new-onset sJIA. Coupled with data collection at defined intervals, use of these treatment plans will create the opportunity to evaluate comparative effectiveness in an observational setting to optimize initial management of sJIA. PMID:22290637

Providing Post-Treatment Support in an Outpatient Alcohol and Other Drug Treatment Context: A Qualitative Study of Staff Opinion

ERIC Educational Resources Information Center

Pulford, Justin; Black, Stella; Wheeler, Amanda; Sheridan, Janie; Adams, Peter

2010-01-01

This paper examines the post-treatment support practices, attitudes and preferences of outpatient alcohol and other drug (AOD) treatment staff as well as perceived barriers to implementing a post-treatment support service in an outpatient AOD treatment context. Data were collected via semi-structured interview and group discussion (n = 23).…

Benefits of Using Planned Comparisons Rather Than Post Hoc Tests: A Brief Review with Examples.

ERIC Educational Resources Information Center

DuRapau, Theresa M.

The rationale behind analysis of variance (including analysis of covariance and multiple analyses of variance and covariance) methods is reviewed, and unplanned and planned methods of evaluating differences between means are briefly described. Two advantages of using planned or a priori tests over unplanned or post hoc tests are presented. In…

Post-Secondary Plans, Aspirations and Profile Characteristics of Grade Ten and Eleven Students in Manitoba, 1976-1977.

ERIC Educational Resources Information Center

Russell, C. Neil; And Others

This study was undertaken because of a sharp dip in the increase rate in post-secondary enrollments in Manitoba for Fall, 1970. Research was carried out to examine the process by which Manitoba's twelfth grade students make decisions concerning post-secondary enrollment. The research provides information on students' career plans, post-secondary…

Post-cure heat treatments for composites: properties and fractography.

PubMed

Ferracane, J L; Condon, J R

1992-09-01

Two commercial and four experimental composites were subjected to post-cure heat treatments of 10 min and 3 h duration immediately after light-curing. Fracture toughness, flexural modulus, microhardness and degree of conversion (FTIR) were evaluated 24 h later. The results showed that post-cure heat treatments at 120 degrees C of short or long duration can be used to produce significant improvements in the degree of cure and the mechanical properties of dental composites used as inlays. A 10 min heat treatment was as effective as a 3 h treatment in enhancing properties and degree of cure. In addition, a 3 h heat treatment carried out 7 days after the initial light-curing was capable of improving properties and cure to almost the same extent as the immediate heat treatments. The improvement in properties, in conjunction with the fractography, indicate a toughening of the filled resin matrix and possibly an improved filler/matrix adhesion in the microfills. The changes appear to be predominantly the result of an increase in degree of cure.

Spitzer Mission Operation System Planning for IRAC Warm-Instrument Characterization

NASA Technical Reports Server (NTRS)

Hunt, Joseph C., Jr.; Sarrel, Marc A.; Mahoney, William A.

2010-01-01

This paper will describe how the Spitzer Mission Operations System planned and executed the characterization phase between Spitzer's cryogenic mission and its warm mission. To the largest extend possible, the execution of this phase was done with existing processing and procedures. The modifications that were made were in response to the differences of the characterization phase compared to normal phases before and after. The primary two categories of difference are: unknown date of execution due to uncertainty of knowledge of the date of helium depletion, and the short cycle time for data analysis and re-planning during execution. In addition, all of the planning and design had to be done in parallel with normal operations, and we had to transition smoothly back to normal operations following the transition. This paper will also describe the re-planning we had to do following an anomaly discovered in the first days after helium depletion.

Beneficial effect of post-deposition treatment in high-efficiency Cu(In,Ga)Se{sub 2} solar cells through reduced potential fluctuations

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

Jensen, S. A., E-mail: Soren.Jensen@nrel.gov, E-mail: Darius.Kuciauskas@nrel.gov; Glynn, S.; Kanevce, A.

World-record power conversion efficiencies for Cu(In,Ga)Se{sub 2} (CIGS) solar cells have been achieved via a post-deposition treatment with alkaline metals, which increases the open-circuit voltage and fill factor. We explore the role of the potassium fluoride (KF) post-deposition treatment in CIGS by employing energy- and time-resolved photoluminescence spectroscopy and electrical characterization combined with numerical modeling. The bulk carrier lifetime is found to increase with post-deposition treatment from 255 ns to 388 ns, which is the longest charge carrier lifetime reported for CIGS, and within ∼40% of the radiative limit. We find evidence that the post-deposition treatment causes a decrease in the electronicmore » potential fluctuations. These potential fluctuations have previously been shown to reduce the open-circuit voltage and the device efficiency in CIGS. Additionally, numerical simulations based on the measured carrier lifetimes and mobilities show a diffusion length of ∼10 μm, which is ∼4 times larger than the film thickness. Thus, carrier collection in the bulk is not a limiting factor for device efficiency. By considering differences in doping, bandgap, and potential fluctuations, we present a possible explanation for the voltage difference between KF-treated and untreated samples.« less

45 CFR 146.180 - Treatment of non-Federal governmental plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Treatment of non-Federal governmental plans. 146... § 146.180 Treatment of non-Federal governmental plans. (a) Requirements subject to exemption—(1) Basic rule. A sponsor of a non-Federal governmental plan may elect to exempt its plan, to the extent that the...

45 CFR 146.180 - Treatment of non-Federal governmental plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Treatment of non-Federal governmental plans. 146... § 146.180 Treatment of non-Federal governmental plans. (a) Requirements subject to exemption—(1) Basic rule. A sponsor of a non-Federal governmental plan may elect to exempt its plan, to the extent that the...

Generating AN Optimum Treatment Plan for External Beam Radiation Therapy.

NASA Astrophysics Data System (ADS)

Kabus, Irwin

1990-01-01

The application of linear programming to the generation of an optimum external beam radiation treatment plan is investigated. MPSX, an IBM linear programming software package was used. All data originated from the CAT scan of an actual patient who was treated for a pancreatic malignant tumor before this study began. An examination of several alternatives for representing the cross section of the patient showed that it was sufficient to use a set of strategically placed points in the vital organs and tumor and a grid of points spaced about one half inch apart for the healthy tissue. Optimum treatment plans were generated from objective functions representing various treatment philosophies. The optimum plans were based on allowing for 216 external radiation beams which accounted for wedges of any size. A beam reduction scheme then reduced the number of beams in the optimum plan to a number of beams small enough for implementation. Regardless of the objective function, the linear programming treatment plan preserved about 95% of the patient's right kidney vs. 59% for the plan the hospital actually administered to the patient. The clinician, on the case, found most of the linear programming treatment plans to be superior to the hospital plan. An investigation was made, using parametric linear programming, concerning any possible benefits derived from generating treatment plans based on objective functions made up of convex combinations of two objective functions, however, this proved to have only limited value. This study also found, through dual variable analysis, that there was no benefit gained from relaxing some of the constraints on the healthy regions of the anatomy. This conclusion was supported by the clinician. Finally several schemes were found that, under certain conditions, can further reduce the number of beams in the final linear programming treatment plan.

EDITORIAL: International Workshop on Current Topics in Monte Carlo Treatment Planning

NASA Astrophysics Data System (ADS)

Verhaegen, Frank; Seuntjens, Jan

2005-03-01

The use of Monte Carlo particle transport simulations in radiotherapy was pioneered in the early nineteen-seventies, but it was not until the eighties that they gained recognition as an essential research tool for radiation dosimetry, health physics and later on for radiation therapy treatment planning. Since the mid-nineties, there has been a boom in the number of workers using MC techniques in radiotherapy, and the quantity of papers published on the subject. Research and applications of MC techniques in radiotherapy span a very wide range from fundamental studies of cross sections and development of particle transport algorithms, to clinical evaluation of treatment plans for a variety of radiotherapy modalities. The International Workshop on Current Topics in Monte Carlo Treatment Planning took place at Montreal General Hospital, which is part of McGill University, halfway up Mount Royal on Montreal Island. It was held from 3-5 May, 2004, right after the freezing winter has lost its grip on Canada. About 120 workers attended the Workshop, representing 18 countries. Most of the pioneers in the field were present but also a large group of young scientists. In a very full programme, 41 long papers were presented (of which 12 were invited) and 20 posters were on display during the whole meeting. The topics covered included the latest developments in MC algorithms, statistical issues, source modelling and MC treatment planning for photon, electron and proton treatments. The final day was entirely devoted to clinical implementation issues. Monte Carlo radiotherapy treatment planning has only now made a slow entrée in the clinical environment, taking considerably longer than envisaged ten years ago. Of the twenty-five papers in this dedicated special issue, about a quarter deal with this topic, with probably many more studies to follow in the near future. If anything, we hope the Workshop served as an accelerator for more clinical evaluation of MC applications. The

300 Area waste acid treatment system closure plan

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

LUKE, S.N.

1999-05-17

The Hanford Facility Dangerous Waste Permit Application is considered to be a single application organized into a General Information Portion (document number DOERL-91-28) and a Unit-Specific Portion. The scope of the Unit-Specific Portion includes closure plan documentation submitted for individual, treatment, storage, and/or disposal units undergoing closure, such as the 300 Area Waste Acid Treatment System. Documentation contained in the General Information Portion is broader in nature and could be used by multiple treatment, storage, and/or disposal units (e.g., the glossary provided in the General Information Portion). Whenever appropriate, 300 Area Waste Acid Treatment System documentation makes cross-reference to themore » General Information Portion, rather than duplicating text. This 300 Area Waste Acid Treatment System Closure Plan (Revision 2) includes a Hanford Facility Dangerous Waste Permit Application, Part A, Form 3. Information provided in this closure plan is current as of April 1999.« less

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.

Microbiome in the Apical Root Canal System of Teeth with Post-Treatment Apical Periodontitis

PubMed Central

Siqueira, José F.; Antunes, Henrique S.; Rôças, Isabela N.; Rachid, Caio T. C. C.

2016-01-01

Introduction Bacteria present in the apical root canal system are directly involved with the pathogenesis of post-treatment apical periodontitis. This study used a next-generation sequencing approach to identify the bacterial taxa occurring in cryopulverized apical root samples from root canal-treated teeth with post-treatment disease. Methods Apical root specimens obtained during periradicular surgery of ten adequately treated teeth with persistent apical periodontitis were cryogenically ground. DNA was extracted from the powder and the microbiome was characterized on the basis of the V4 hypervariable region of the 16S rRNA gene by using paired-end sequencing on Illumina MiSeq device. Results All samples were positive for the presence of bacterial DNA. Bacterial taxa were mapped to 11 phyla and 103 genera composed by 538 distinct operational taxonomic units (OTUs) at 3% of dissimilarity. Over 85% of the sequences belonged to 4 phyla: Proteobacteria, Firmicutes, Fusobacteria and Actinobacteria. In general, these 4 phyla accounted for approximately 80% of the distinct OTUs found in the apical root samples. Proteobacteria was the most abundant phylum in 6/10 samples. Fourteen genera had representatives identified in all cases. Overall, the genera Fusobacterium and Pseudomonas were the most dominant. Enterococcus was found in 4 cases, always in relatively low abundance. Conclusions This study showed a highly complex bacterial community in the apical root canal system of adequately treated teeth with persistent apical periodontitis. This suggests that this disease is characterized by multispecies bacterial communities and has a heterogeneous etiology, because the community composition largely varied from case to case. PMID:27689802

Microbiome in the Apical Root Canal System of Teeth with Post-Treatment Apical Periodontitis.

PubMed

Siqueira, José F; Antunes, Henrique S; Rôças, Isabela N; Rachid, Caio T C C; Alves, Flávio R F

Bacteria present in the apical root canal system are directly involved with the pathogenesis of post-treatment apical periodontitis. This study used a next-generation sequencing approach to identify the bacterial taxa occurring in cryopulverized apical root samples from root canal-treated teeth with post-treatment disease. Apical root specimens obtained during periradicular surgery of ten adequately treated teeth with persistent apical periodontitis were cryogenically ground. DNA was extracted from the powder and the microbiome was characterized on the basis of the V4 hypervariable region of the 16S rRNA gene by using paired-end sequencing on Illumina MiSeq device. All samples were positive for the presence of bacterial DNA. Bacterial taxa were mapped to 11 phyla and 103 genera composed by 538 distinct operational taxonomic units (OTUs) at 3% of dissimilarity. Over 85% of the sequences belonged to 4 phyla: Proteobacteria, Firmicutes, Fusobacteria and Actinobacteria. In general, these 4 phyla accounted for approximately 80% of the distinct OTUs found in the apical root samples. Proteobacteria was the most abundant phylum in 6/10 samples. Fourteen genera had representatives identified in all cases. Overall, the genera Fusobacterium and Pseudomonas were the most dominant. Enterococcus was found in 4 cases, always in relatively low abundance. This study showed a highly complex bacterial community in the apical root canal system of adequately treated teeth with persistent apical periodontitis. This suggests that this disease is characterized by multispecies bacterial communities and has a heterogeneous etiology, because the community composition largely varied from case to case.

[Pre- and post-surgical orthodontic treatment for skeletal open bite].

PubMed

Zhou, Y; Hu, W; Sun, Y

2001-05-01

To Study the principles and rules of pre- and post-surgical orthodontic treatment for skeletal open bite patients. Thirty-two surgically treated open bite cases were analyzed, of which 9 were males, and 23 were females, aged from 16 to 38. Open bite was from 1 to 8.5 mm, average was 4 mm. 31 patients were Class III malocclusion, while 1 patient was Class II malocclusion. 1. Totally 21 patients were treated with orthodontics before and after orthognathic surgery, while 8 patients had pre-surgical orthodontics only, and other 3 had post-surgical orthodontics only. The duration for pre-surgical orthodontics was from 4 to 33 months, average was 12 months. The duration for post-surgical orthodontics was from 3 to 17 months, average was 8.5 months. 2. Presurgical orthodontic treatment included: Alignment of arches, decompensation of incisors, avoiding extrusion of incisors, and slight expansion of arches for coordination of arches. 3. Post-surgical orthodontic treatment included: Closure of residual spaces in the arches, realignment of arches, vertical elastics and Class II or III intermaxillary elastics. Skeletal open bites require combined orthodontic-orthognathic surgery for optimal and esthetical pleasing results.

Prolonged morphine treatment alters δ opioid receptor post-internalization trafficking

PubMed Central

Ong, E W; Xue, L; Olmstead, M C; Cahill, C M

2015-01-01

BACKGROUND AND PURPOSE The δ opioid receptor (DOP receptor) undergoes internalization both constitutively and in response to agonists. Previous work has shown that DOP receptors traffic from intracellular compartments to neuronal cell membranes following prolonged morphine treatment. Here, we examined the effects of prolonged morphine treatment on the post-internalization trafficking of DOP receptors. EXPERIMENTAL APPROACH Using primary cultures of dorsal root ganglia neurons, we measured the co-localization of endogenous DOP receptors with post-endocytic compartments following both prolonged and acute agonist treatments. KEY RESULTS A departure from the constitutive trafficking pathway was observed following acute DOP receptor agonist-induced internalization by deltorphin II. That is, the DOP receptor underwent distinct agonist-induced post-endocytic sorting. Following prolonged morphine treatment, constitutive DOP receptor trafficking was augmented. SNC80 following prolonged morphine treatment also caused non-constitutive DOP receptor agonist-induced post-endocytic sorting. The μ opioid receptor (MOP receptor) agonist DAMGO induced DOP receptor internalization and trafficking following prolonged morphine treatment. Finally, all of the alterations to DOP receptor trafficking induced by both DOP and MOP receptor agonists were inhibited or absent when those agonists were co-administered with a DOP receptor antagonist, SDM-25N. CONCLUSIONS AND IMPLICATIONS The results support the hypothesis that prolonged morphine treatment induces the formation of MOP–DOP receptor interactions and subsequent augmentation of the available cell surface DOP receptors, at least some of which are in the form of a MOP/DOP receptor species. The pharmacology and trafficking of this species appear to be unique compared to those of its individual constituents. LINKED ARTICLES This article is part of a themed section on Opioids: New Pathways to Functional Selectivity. To view the other

Prolonged morphine treatment alters δ opioid receptor post-internalization trafficking.

PubMed

Ong, E W; Xue, L; Olmstead, M C; Cahill, C M

2015-01-01

The δ opioid receptor (DOP receptor) undergoes internalization both constitutively and in response to agonists. Previous work has shown that DOP receptors traffic from intracellular compartments to neuronal cell membranes following prolonged morphine treatment. Here, we examined the effects of prolonged morphine treatment on the post-internalization trafficking of DOP receptors. Using primary cultures of dorsal root ganglia neurons, we measured the co-localization of endogenous DOP receptors with post-endocytic compartments following both prolonged and acute agonist treatments. A departure from the constitutive trafficking pathway was observed following acute DOP receptor agonist-induced internalization by deltorphin II. That is, the DOP receptor underwent distinct agonist-induced post-endocytic sorting. Following prolonged morphine treatment, constitutive DOP receptor trafficking was augmented. SNC80 following prolonged morphine treatment also caused non-constitutive DOP receptor agonist-induced post-endocytic sorting. The μ opioid receptor (MOP receptor) agonist DAMGO induced DOP receptor internalization and trafficking following prolonged morphine treatment. Finally, all of the alterations to DOP receptor trafficking induced by both DOP and MOP receptor agonists were inhibited or absent when those agonists were co-administered with a DOP receptor antagonist, SDM-25N. The results support the hypothesis that prolonged morphine treatment induces the formation of MOP-DOP receptor interactions and subsequent augmentation of the available cell surface DOP receptors, at least some of which are in the form of a MOP/DOP receptor species. The pharmacology and trafficking of this species appear to be unique compared to those of its individual constituents. This article is part of a themed section on Opioids: New Pathways to Functional Selectivity. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2015.172.issue-2. © 2014 The Authors. British

Effect of surface treatments on the bond strength of CAD/CAM fiberglass posts.

PubMed

Garcia, Paula-Pontes; da Costa, Rogério-Goulart; Garcia, André-Vivan; Gonzaga, Carla-Castiglia; da Cunha, Leonardo-Fernandes; Rezende, Carlos-Eduardo-Edwards; Correr, Gisele-Maria

2018-06-01

There is no ideal protocol for the surface treatment of fiber posts, especially when using a computer-aided design/computer-aided manufacturing (CAD/CAM) experimental fiberglass block. The purpose of this study was to evaluate the bond strength of a CAD/CAM customized glass fiber post and core after applying different surface treatment techniques. Forty premolars were prepared to receive a customized CAD/CAM glass-fiber post and core obtained from an experimental block of glass fiber and epoxy resin. The specimens were randomly distributed in 4 groups (n=10) according to the post and core surface treatment: ETH - 70% ethanol; HP - 24% hydrogen peroxide for 1 minute; ETH/S - 70% ethanol + silane; HP/S - 24% hydrogen peroxide + silane. The universal adhesive containing silane was applied on the posts and prepared post spaces in all groups. The posts were cemented using dual cure resin cement. The specimens were stored in distilled water at 37°C for 24 h, cut (two slices of 1 mm for each root third - coronal, middle, and apical) and subjected to push-out test (0.5 mm/min). Data was subjected to two-way ANOVA (surface treatment and root third) and Tukey's test (α=0,05). There was no significant difference of bond strength values among groups, regardless the surface treatment ( p >0.05). There was significant difference on bond strength values for the different root thirds ( p <0.05) (coronal>middle=apical). The different surface treatment and application of additional silane in the CAD/CAM customized glass-fiber post and core does not interfere on bond strength values. The root dentin third interfered on the bond strength, with higher values for the coronal third. Key words: Post and core technique, cad/cam, shear strength, hydrogen peroxide.

Effect of surface treatments on the bond strength of CAD/CAM fiberglass posts

PubMed Central

Garcia, Paula-Pontes; da Costa, Rogério-Goulart; Garcia, André-Vivan; Gonzaga, Carla-Castiglia; da Cunha, Leonardo-Fernandes; Rezende, Carlos-Eduardo-Edwards

2018-01-01

Background There is no ideal protocol for the surface treatment of fiber posts, especially when using a computer-aided design/computer-aided manufacturing (CAD/CAM) experimental fiberglass block. The purpose of this study was to evaluate the bond strength of a CAD/CAM customized glass fiber post and core after applying different surface treatment techniques. Material and Methods Forty premolars were prepared to receive a customized CAD/CAM glass-fiber post and core obtained from an experimental block of glass fiber and epoxy resin. The specimens were randomly distributed in 4 groups (n=10) according to the post and core surface treatment: ETH - 70% ethanol; HP - 24% hydrogen peroxide for 1 minute; ETH/S - 70% ethanol + silane; HP/S - 24% hydrogen peroxide + silane. The universal adhesive containing silane was applied on the posts and prepared post spaces in all groups. The posts were cemented using dual cure resin cement. The specimens were stored in distilled water at 37°C for 24 h, cut (two slices of 1 mm for each root third - coronal, middle, and apical) and subjected to push-out test (0.5 mm/min). Data was subjected to two-way ANOVA (surface treatment and root third) and Tukey’s test (α=0,05). Results There was no significant difference of bond strength values among groups, regardless the surface treatment (p >0.05). There was significant difference on bond strength values for the different root thirds (p<0.05) (coronal>middle=apical). Conclusions The different surface treatment and application of additional silane in the CAD/CAM customized glass-fiber post and core does not interfere on bond strength values. The root dentin third interfered on the bond strength, with higher values for the coronal third. Key words:Post and core technique, cad/cam, shear strength, hydrogen peroxide. PMID:29930778

Treatment planning and dose analysis for interstitial photodynamic therapy of prostate cancer

NASA Astrophysics Data System (ADS)

Davidson, Sean R. H.; Weersink, Robert A.; Haider, Masoom A.; Gertner, Mark R.; Bogaards, Arjen; Giewercer, David; Scherz, Avigdor; Sherar, Michael D.; Elhilali, Mostafa; Chin, Joseph L.; Trachtenberg, John; Wilson, Brian C.

2009-04-01

With the development of new photosensitizers that are activated by light at longer wavelengths, interstitial photodynamic therapy (PDT) is emerging as a feasible alternative for the treatment of larger volumes of tissue. Described here is the application of PDT treatment planning software developed by our group to ensure complete coverage of larger, geometrically complex target volumes such as the prostate. In a phase II clinical trial of TOOKAD vascular targeted photodynamic therapy (VTP) for prostate cancer in patients who failed prior radiotherapy, the software was used to generate patient-specific treatment prescriptions for the number of treatment fibres, their lengths, their positions and the energy each delivered. The core of the software is a finite element solution to the light diffusion equation. Validation against in vivo light measurements indicated that the software could predict the location of an iso-fluence contour to within approximately ±2 mm. The same software was used to reconstruct the treatments that were actually delivered, thereby providing an analysis of the threshold light dose required for TOOKAD-VTP of the post-irradiated prostate. The threshold light dose for VTP-induced prostate damage, as measured one week post-treatment using contrast-enhanced MRI, was found to be highly heterogeneous, both within and between patients. The minimum light dose received by 90% of the prostate, D90, was determined from each patient's dose-volume histogram and compared to six-month sextant biopsy results. No patient with a D90 less than 23 J cm-2 had complete biopsy response, while 8/13 (62%) of patients with a D90 greater than 23 J cm-2 had negative biopsies at six months. The doses received by the urethra and the rectal wall were also investigated.

SU-D-BRD-01: Cloud-Based Radiation Treatment Planning: Performance Evaluation of Dose Calculation and Plan Optimization

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

Na, Y; Kapp, D; Kim, Y

2014-06-01

Purpose: To report the first experience on the development of a cloud-based treatment planning system and investigate the performance improvement of dose calculation and treatment plan optimization of the cloud computing platform. Methods: A cloud computing-based radiation treatment planning system (cc-TPS) was developed for clinical treatment planning. Three de-identified clinical head and neck, lung, and prostate cases were used to evaluate the cloud computing platform. The de-identified clinical data were encrypted with 256-bit Advanced Encryption Standard (AES) algorithm. VMAT and IMRT plans were generated for the three de-identified clinical cases to determine the quality of the treatment plans and computationalmore » efficiency. All plans generated from the cc-TPS were compared to those obtained with the PC-based TPS (pc-TPS). The performance evaluation of the cc-TPS was quantified as the speedup factors for Monte Carlo (MC) dose calculations and large-scale plan optimizations, as well as the performance ratios (PRs) of the amount of performance improvement compared to the pc-TPS. Results: Speedup factors were improved up to 14.0-fold dependent on the clinical cases and plan types. The computation times for VMAT and IMRT plans with the cc-TPS were reduced by 91.1% and 89.4%, respectively, on average of the clinical cases compared to those with pc-TPS. The PRs were mostly better for VMAT plans (1.0 ≤ PRs ≤ 10.6 for the head and neck case, 1.2 ≤ PRs ≤ 13.3 for lung case, and 1.0 ≤ PRs ≤ 10.3 for prostate cancer cases) than for IMRT plans. The isodose curves of plans on both cc-TPS and pc-TPS were identical for each of the clinical cases. Conclusion: A cloud-based treatment planning has been setup and our results demonstrate the computation efficiency of treatment planning with the cc-TPS can be dramatically improved while maintaining the same plan quality to that obtained with the pc-TPS. This work was supported in part by the National Cancer

Post-treatment skin reactions reported by cancer patients differ by race, not by treatment or expectations

PubMed Central

Ryan, J L; Bole, C; Hickok, J T; Figueroa-Moseley, C; Colman, L; Khanna, R C; Pentland, A P; Morrow, G R

2007-01-01

Cancer patients may experience skin problems while undergoing chemotherapy and radiation therapy. Frequency of skin reactions may be influenced by skin pigmentation and psychological factors. A Symptom Inventory completed by 656 cancer patients nationwide before and after chemotherapy, radiation therapy, or chemotherapy plus radiation therapy was analysed to determine if treatment type, race (Black vs White), and pretreatment expectations influenced post-treatment skin reactions. Subsequent analysis of a local Symptom Inventory completed weekly for 5 weeks by 308 patients receiving radiation therapy examined severity of reported skin reactions. Significantly more patients receiving radiation therapy had stronger expectations of skin problems (62%) than patients receiving chemotherapy (40%, P=0.001) or chemotherapy plus radiation therapy (45%, P=0.003). Overall, expectations did not correlate with patient reported post-treatment skin problems in white (r=0.014, P=0.781) or black (r=0.021, P=0.936) patients. Although no significant difference was found between black and white patients in their pretreatment expectations of skin problems (P=0.32), black patients (10 out of 18, 56%) reported more skin problems than white patients (90 out of 393, 23%, P=0.001). Similarly, the local study showed that significantly more black patients (1 out of 5, 20%) reported severe skin reactions at the treatment site than white patients (12 out of 161, 8%). A direct correlation was observed between severity of skin problems and pain at the treatment site (r=0.541, P<0.001). Total radiation exposure did not significantly correlate with the report of skin problems at the treatment site for white or black patients. Overall, black patients reported more severe post-treatment skin problems than white patients. Our results suggest that symptom management for post-treatment skin reactions in cancer patients receiving radiation treatment could differ depending on their racial background. PMID

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

The computer-generated treatment plan... Create the nucleus to successful systems.

PubMed

Bernhardt, Christene

2004-12-01

A well-managed, highly efficient practice relies on the comprehensive information provided through effective treatment planning. Computer-generated treatment plans are successful only if the 14 key points of information are included within the plan. Major systems such as scheduling, financial agreements, and insurance processing fail if adequate information is not provided through the treatment plan. Successful interactions with patients at the time of the consultation rely heavily on having adequate information at your fingertips. The treatment plan is truly the foundation to all communications that must occur during the patient's experience, and ensures that every team member has clear and easy access to the status of each patient as treatment unfolds.

Effect of surface treatments on the flexural properties and adhesion of glass fiber-reinforced composite post to self-adhesive luting agent and radicular dentin.

PubMed

Elnaghy, Amr M; Elsaka, Shaymaa E

2016-01-01

This study evaluated the effect of different surface treatments on the flexural properties and adhesion of glass fiber post to self-adhesive luting agent and radicular dentin. Seventy-five single-rooted human teeth were prepared to receive a glass fiber post (Reblida). The posts were divided into five groups according to the surface treatment: Gr C (control; no treatment), Gr S (silanization for 60 s), Gr AP (airborne-particle abrasion), Gr HF (etching with 9 % hydrofluoric acid for 1 min), and Gr M10 (etching with CH2Cl2 for 10 min). Dual-cure self-adhesive luting agent (Rely X Unicem) was applied to each group for testing the adhesion using micropush-out test. Failure types were examined with stereomicroscope and surface morphology of the posts was characterized using a scanning electron microscopy (SEM). Flexural properties of posts were assessed using a three-point bending test. Data were analyzed using ANOVA and Tukey's HSD test. Statistical significance was set at the 0.05 probability level. Groups treated with M10 showed significantly higher bond strength than those obtained with other surface treatments (P < 0.05). In general, improvements in bond strength (MPa) were found in the following order: M10 > C > S > AP > HF. Most failure modes were adhesive type of failures between dentin and luting agent (48.2%). SEM analysis revealed that the fiber post surfaces were modified after surface treatments. The surface treatments did not compromise the flexural properties of fiber posts. Application of M10 to the fiber post surfaces enhanced the adhesion to self-adhesive luting agent and radicular dentin.

Development of independent MU/treatment time verification algorithm for non-IMRT treatment planning: A clinical experience

NASA Astrophysics Data System (ADS)

Tatli, Hamza; Yucel, Derya; Yilmaz, Sercan; Fayda, Merdan

2018-02-01

The aim of this study is to develop an algorithm for independent MU/treatment time (TT) verification for non-IMRT treatment plans, as a part of QA program to ensure treatment delivery accuracy. Two radiotherapy delivery units and their treatment planning systems (TPS) were commissioned in Liv Hospital Radiation Medicine Center, Tbilisi, Georgia. Beam data were collected according to vendors' collection guidelines, and AAPM reports recommendations, and processed by Microsoft Excel during in-house algorithm development. The algorithm is designed and optimized for calculating SSD and SAD treatment plans, based on AAPM TG114 dose calculation recommendations, coded and embedded in MS Excel spreadsheet, as a preliminary verification algorithm (VA). Treatment verification plans were created by TPSs based on IAEA TRS 430 recommendations, also calculated by VA, and point measurements were collected by solid water phantom, and compared. Study showed that, in-house VA can be used for non-IMRT plans MU/TT verifications.

Automated radiotherapy treatment plan integrity verification

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

Yang Deshan; Moore, Kevin L.

2012-03-15

Purpose: In our clinic, physicists spend from 15 to 60 min to verify the physical and dosimetric integrity of radiotherapy plans before presentation to radiation oncology physicians for approval. The purpose of this study was to design and implement a framework to automate as many elements of this quality control (QC) step as possible. Methods: A comprehensive computer application was developed to carry out a majority of these verification tasks in the Philips PINNACLE treatment planning system (TPS). This QC tool functions based on both PINNACLE scripting elements and PERL sub-routines. The core of this technique is the method ofmore » dynamic scripting, which involves a PERL programming module that is flexible and powerful for treatment plan data handling. Run-time plan data are collected, saved into temporary files, and analyzed against standard values and predefined logical rules. The results were summarized in a hypertext markup language (HTML) report that is displayed to the user. Results: This tool has been in clinical use for over a year. The occurrence frequency of technical problems, which would cause delays and suboptimal plans, has been reduced since clinical implementation. Conclusions: In addition to drastically reducing the set of human-driven logical comparisons, this QC tool also accomplished some tasks that are otherwise either quite laborious or impractical for humans to verify, e.g., identifying conflicts amongst IMRT optimization objectives.« less

Development of Consensus Treatment Plans for Juvenile Localized Scleroderma

PubMed Central

Li, Suzanne C.; Torok, Kathryn S.; Pope, Elena; Dedeoglu, Fatma; Hong, Sandy; Jacobe, Heidi T.; Rabinovich, C. Egla; Laxer, Ronald M.; Higgins, Gloria C.; Ferguson, Polly J.; Lasky, Andrew; Baszis, Kevin; Becker, Mara; Campillo, Sarah; Cartwright, Victoria; Cidon, Michael; Inman, Christi J; Jerath, Rita; O'Neil, Kathleen M.; Vora, Sheetal; Zeft, Andrew; Wallace, Carol A.; Ilowite, Norman T.; Fuhlbrigge, Robert C

2013-01-01

Objective To develop standardized treatment plans, clinical assessments, and response criteria for active, moderate to high severity juvenile localized scleroderma (jLS). Background jLS is a chronic inflammatory skin disorder associated with substantial morbidity and disability. Although a wide range of therapeutic strategies have been reported in the literature, a lack of agreement on treatment specifics and accepted methods for clinical assessment of have made it difficult to compare approaches and identify optimal therapy. Methods A core group of pediatric rheumatologists, dermatologists and a lay advisor was engaged by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) to develop standardized treatment plans and assessment parameters for jLS using consensus methods/nominal group techniques. Recommendations were validated in two face-to-face conferences with a larger group of practitioners with expertise in jLS and with the full membership of CARRA, which encompasses the majority of pediatric rheumatologists in the U.S and Canada. Results Consensus was achieved on standardized treatment plans that reflect the prevailing treatment practices of CARRA members. Standardized clinical assessment methods and provisional treatment response criteria were also developed. Greater than 90% of pediatric rheumatologists responding to a survey (67% of CARRA membership) affirmed the final recommendations and agreed to utilize these consensus plans to treat patients with jLS. Conclusions Using consensus methodology, we have developed standardized treatment plans and assessment methods for jLS. The high level of support among pediatric rheumatologists will support future comparative effectiveness studies and enable the development of evidence-based guidelines for the treatment of jLS. PMID:22505322

Guaranteed epsilon-optimal treatment plans with the minimum number of beams for stereotactic body radiation therapy

NASA Astrophysics Data System (ADS)

Yarmand, Hamed; Winey, Brian; Craft, David

2013-09-01

Stereotactic body radiation therapy (SBRT) is characterized by delivering a high amount of dose in a short period of time. In SBRT the dose is delivered using open fields (e.g., beam’s-eye-view) known as ‘apertures’. Mathematical methods can be used for optimizing treatment planning for delivery of sufficient dose to the cancerous cells while keeping the dose to surrounding organs at risk (OARs) minimal. Two important elements of a treatment plan are quality and delivery time. Quality of a plan is measured based on the target coverage and dose to OARs. Delivery time heavily depends on the number of beams used in the plan as the setup times for different beam directions constitute a large portion of the delivery time. Therefore the ideal plan, in which all potential beams can be used, will be associated with a long impractical delivery time. We use the dose to OARs in the ideal plan to find the plan with the minimum number of beams which is guaranteed to be epsilon-optimal (i.e., a predetermined maximum deviation from the ideal plan is guaranteed). Since the treatment plan optimization is inherently a multi-criteria-optimization problem, the planner can navigate the ideal dose distribution Pareto surface and select a plan of desired target coverage versus OARs sparing, and then use the proposed technique to reduce the number of beams while guaranteeing epsilon-optimality. We use mixed integer programming (MIP) for optimization. To reduce the computation time for the resultant MIP, we use two heuristics: a beam elimination scheme and a family of heuristic cuts, known as ‘neighbor cuts’, based on the concept of ‘adjacent beams’. We show the effectiveness of the proposed technique on two clinical cases, a liver and a lung case. Based on our technique we propose an algorithm for fast generation of epsilon-optimal plans.

The Trimeric Model: A New Model of Periodontal Treatment Planning

PubMed Central

Tarakji, Bassel

2014-01-01

Treatment of periodontal disease is a complex and multidisciplinary procedure, requiring periodontal, surgical, restorative, and orthodontic treatment modalities. Several authors attempted to formulate models for periodontal treatment that orders the treatment steps in a logical and easy to remember manner. In this article, we discuss two models of periodontal treatment planning from two of the most well-known textbook in the specialty of periodontics internationally. Then modify them to arrive at a new model of periodontal treatment planning, The Trimeric Model. Adding restorative and orthodontic interrelationships with periodontal treatment allows us to expand this model into the Extended Trimeric Model of periodontal treatment planning. These models will provide a logical framework and a clear order of the treatment of periodontal disease for general practitioners and periodontists alike. PMID:25177662

A 'learning-by-doing' treatment planning tutorial for medical physicists.

PubMed

Meyer, J; Hartmann, B; Kalet, I

2009-06-01

A framework for a tutorial for treatment planning in radiation oncology physics was developed, based on the University of Washington treatment planning system Prism. The tutorial is aimed at students in Medical Physics to accompany the lectures on treatment planning to enhance their theoretical knowledge. A web-based layout was chosen to allow independent work of the students. The tutorial guides the students through three different learning modules, designed mainly to enhance their understanding of the processes involved in treatment planning but also to learn the specific features of a modern treatment planning system. Each of the modules contains four units, with the aim to introduce the relevant Prism features, practice skills in different tasks and finally check the learning outcomes with a challenge and a self-scoring quiz. A survey for students' feedback completes the tutorial. Various tools and learning methods help to create an interactive, appealing learning environment, in which the emphasis is shifted from teacher-centred to student-centred learning paradigms. In summary, Prism lends itself well for educational purposes. The tutorial covers all main aspects of treatment planning. In its current form the tutorial is self-contained but still adjustable and expandable. The tutorial can be made available upon request to the authors.

Treatment planning for radiotherapy with very high-energy electron beams and comparison of VHEE and VMAT plans

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

Bazalova-Carter, Magdalena; Qu, Bradley; Palma, Bianey

2015-05-15

Purpose: The aim of this work was to develop a treatment planning workflow for rapid radiotherapy delivered with very high-energy electron (VHEE) scanning pencil beams of 60–120 MeV and to study VHEE plans as a function of VHEE treatment parameters. Additionally, VHEE plans were compared to clinical state-of-the-art volumetric modulated arc therapy (VMAT) photon plans for three cases. Methods: VHEE radiotherapy treatment planning was performed by linking EGSnrc Monte Carlo (MC) dose calculations with inverse treatment planning in a research version of RayStation. In order to study the effect of VHEE treatment parameters on VHEE dose distributions, a MATLAB graphicalmore » user interface (GUI) for calculation of VHEE MC pencil beam doses was developed. Through the GUI, pediatric case MC simulations were run for a number of beam energies (60, 80, 100, and 120 MeV), number of beams (13, 17, and 36), pencil beam spot (0.1, 1.0, and 3.0 mm) and grid (2.0, 2.5, and 3.5 mm) sizes, and source-to-axis distance, SAD (40 and 50 cm). VHEE plans for the pediatric case calculated with the different treatment parameters were optimized and compared. Furthermore, 100 MeV VHEE plans for the pediatric case, a lung, and a prostate case were calculated and compared to the clinically delivered VMAT plans. All plans were normalized such that the 100% isodose line covered 95% of the target volume. Results: VHEE beam energy had the largest effect on the quality of dose distributions of the pediatric case. For the same target dose, the mean doses to organs at risk (OARs) decreased by 5%–16% when planned with 100 MeV compared to 60 MeV, but there was no further improvement in the 120 MeV plan. VHEE plans calculated with 36 beams outperformed plans calculated with 13 and 17 beams, but to a more modest degree (<8%). While pencil beam spacing and SAD had a small effect on VHEE dose distributions, 0.1–3 mm pencil beam sizes resulted in identical dose distributions. For the 100 MeV VHEE

Technical Note: Improving the VMERGE treatment planning algorithm for rotational radiotherapy

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

Gaddy, Melissa R., E-mail: mrgaddy@ncsu.edu; Papp,

2016-07-15

Purpose: The authors revisit the VMERGE treatment planning algorithm by Craft et al. [“Multicriteria VMAT optimization,” Med. Phys. 39, 686–696 (2012)] for arc therapy planning and propose two changes to the method that are aimed at improving the achieved trade-off between treatment time and plan quality at little additional planning time cost, while retaining other desirable properties of the original algorithm. Methods: The original VMERGE algorithm first computes an “ideal,” high quality but also highly time consuming treatment plan that irradiates the patient from all possible angles in a fine angular grid with a highly modulated beam and then makesmore » this plan deliverable within practical treatment time by an iterative fluence map merging and sequencing algorithm. We propose two changes to this method. First, we regularize the ideal plan obtained in the first step by adding an explicit constraint on treatment time. Second, we propose a different merging criterion that comprises of identifying and merging adjacent maps whose merging results in the least degradation of radiation dose. Results: The effect of both suggested modifications is evaluated individually and jointly on clinical prostate and paraspinal cases. Details of the two cases are reported. Conclusions: In the authors’ computational study they found that both proposed modifications, especially the regularization, yield noticeably improved treatment plans for the same treatment times than what can be obtained using the original VMERGE method. The resulting plans match the quality of 20-beam step-and-shoot IMRT plans with a delivery time of approximately 2 min.« less

Effect of Post-weld Heat Treatment on the Mechanical Properties of Supermartensitic Stainless Steel Deposit

NASA Astrophysics Data System (ADS)

Zappa, Sebastián; Svoboda, Hernán; Surian, Estela

2017-02-01

Supermartensitic stainless steels have good weldability and adequate tensile property, toughness and corrosion resistance. They have been developed as an alternative technology, mainly for oil and gas industries. The final properties of a supermartensitic stainless steel deposit depend on its chemical composition and microstructure: martensite, tempered martensite, ferrite, retained austenite and carbides and/or nitrides. In these steels, the post-weld heat treatments (PWHTs) are usually double tempering ones, to ensure both complete tempering of martensite and high austenite content, to increase toughness and decrease hardness. The aim of this work was to study the effect of post-weld heat treatments (solution treatment with single and double tempering) on the mechanical properties of a supermartensitic stainless steel deposit. An all-weld metal test coupon was welded according to standard ANSI/AWS A5.22-95 using a GMAW supermartensitic stainless steel metal cored wire, under gas shielding. PWHTs were carried out varying the temperature of the first tempering treatment with and without a second tempering one, after solution treatment. All-weld metal chemical composition analysis, metallurgical characterization, hardness and tensile property measurements and Charpy-V tests were carried out. There are several factors which can be affected by the PWHTs, among them austenite content is a significant one. Different austenite contents (0-42%) were found. Microhardness, tensile property and toughness were affected with up to 15% of austenite content, by martensite tempering and carbide precipitation. The second tempering treatment seemed not to have had an important effect on the mechanical properties measured in this work.

SU-E-T-201: Safety-Focused Customization of Treatment Plan Documentation.

PubMed

Schubert, L; Westerly, D; Stuhr, K; Miften, M

2012-06-01

Plan report documentation contains numerous details about the treatment plan, but critical information for patient safety is often presented without special emphasis. This can make it difficult to detect errors from treatment planning and data transfer during the initial chart review. The objective of this work is to improve safety measures in radiation therapy practice by customizing the treatment plan report to emphasize safety-critical information. Commands within the template file from a commercial planning system (Eclipse, Varian Medical Systems) that automatically generates the treatment plan report were reviewed and modified. Safety-critical plan parameters were identified from published risks known to be inherent in the treatment planning process. Risks having medium to high potential impact on patient safety included incorrect patient identifiers, erroneous use of the treatment prescription, and incorrect transfer of beam parameters or consideration of accessories. Specific examples of critical information in the treatment plan report that can be overlooked during a chart review included prescribed dose per fraction and number of fractions, wedge and open field monitor units, presence of beam accessories, and table shifts for patient setup. Critical information was streamlined and concentrated. Patient and plan identification, dose prescription details, and patient positioning couch shift instructions were placed on the first page. Plan information to verify the correct data transfer to the record and verify system was re-organized in an easy to review tabular format and placed in the second page of the customized printout. Placeholders were introduced to indicate both the presence and absence of beam modifiers. Font sizes and spacing were adjusted for clarity, and departmental standards and terminology were introduced to streamline data communication among staff members. Plan reporting documentation has been customized to concentrate and emphasize safety

To evaluate and compare the effect of different Post Surface treatments on the Tensile Bond Strength between Fiber Posts and Composite Resin.

PubMed

Shori, Deepa; Pandey, Swapnil; Kubde, Rajesh; Rathod, Yogesh; Atara, Rahul; Rathi, Shravan

2013-10-01

Fiber posts are widely used for restoration of mutilated teeth that lack adequate coronal tooth structure to retain a core for definitive restoration, bond between the fiber post and composite material depends upon the chemical reaction between the post surface and the resin material used for building up the core. In attempt to maximize the resin bonding with fiber post, different post surface conditioning is advocated. Therefore the purpose of the study is to examine the interfacial strength between fiber post and composite, as core build-up material after different surface treatments of fiber posts. Twenty fiber posts were split into four groups off five each according to different surface treatments viz. Group I-(Negative Control), Group II-Silanization (Positive control), Group III-(37% Phosphoric Acid & Silanization) ,Group IV- (10% Hydrogen Peroxide and Silanization). With the preformed plastic mould, a core of dual cure composite resin around the fiber post having the uniform thickness was created. Tensile bond strength of each specimen was measured under Universal Testing Machine (UTM) at the cross head speed of 3mm/min. The results achieved with 10% Hydrogen peroxide had a marked effect on micro tensile bond strength values between the tested materials. Immense enhancement in the silanization efficiency of quartz fiber phase was observed with different surface chemical treatment of the resin phase of fiber posts with the marked increase in the micro-tensile bond strength between fiber post and composite core. Shori D, Pandey S, Kubde R, Rathod Y, Atara R, Rathi S. To evaluate and compare the effect of different Post Surface treatments on the Tensile Bond Strength between Fiber Posts and Composite Resin. J Int Oral Health 2013; 5(5):27-32.

Orthodontics: computer-aided diagnosis and treatment planning

NASA Astrophysics Data System (ADS)

Yi, Yaxing; Li, Zhongke; Wei, Suyuan; Deng, Fanglin; Yao, Sen

2000-10-01

The purpose of this article is to introduce the outline of our newly developed computer-aided 3D dental cast analyzing system with laser scanning, and its preliminary clinical applications. The system is composed of a scanning device and a personal computer as a scanning controller and post processor. The scanning device is composed of a laser beam emitter, two sets of linear CCD cameras and a table which is rotatable by two-degree-of-freedom. The rotating is controlled precisely by a personal computer. The dental cast is projected and scanned with a laser beam. Triangulation is applied to determine the location of each point. Generation of 3D graphics of the dental cast takes approximately 40 minutes. About 170,000 sets of X,Y,Z coordinates are store for one dental cast. Besides the conventional linear and angular measurements of the dental cast, we are also able to demonstrate the size of the top surface area of each molar. The advantage of this system is that it facilitates the otherwise complicated and time- consuming mock surgery necessary for treatment planning in orthognathic surgery.

Computer-Based Script Training for Aphasia: Emerging Themes from Post-Treatment Interviews

ERIC Educational Resources Information Center

Cherney, Leora R.; Halper, Anita S.; Kaye, Rosalind C.

2011-01-01

This study presents results of post-treatment interviews following computer-based script training for persons with chronic aphasia. Each of the 23 participants received 9 weeks of AphasiaScripts training. Post-treatment interviews were conducted with the person with aphasia and/or a significant other person. The 23 interviews yielded 584 coded…

Effectiveness of three post-fire rehabilitation treatments in the Colorado Front Range

Treesearch

J. W. Wagenbrenner; L. H. MacDonald; D. Rough

2006-01-01

Post-fire rehabilitation treatments are commonly implemented after high-severity wildfires, but few data are available about the efficacy of these treatments. This study assessed post-fire erosion rates and the effectiveness of seeding, straw mulching, and contour felling in reducing erosion after a June 2000 wildfire northwest of Loveland, Colorado. Site...

[Rational Rehabilitation in the treatment of post-traumatic stress disorder (PTSD). A pilot study].

PubMed

Tomasoa, A T; Appelo, M T

2007-01-01

In a randomised controlled study, a type of cognitive behavior therapy known as Rational Rehabilitation proved effective in the treatment of patients with chronic mental symptoms. Post-traumatic stress disorder is a serious illness that occurs frequently and can last for many years. Rational Rehabilitation may also be an effective treatment for post-traumatic stress disorder. To investigate, via a pilot study, on the effect of Rational Rehabilitation in patients with post-traumatic stress disorder, whether a randomised controlled study is called for. Nineteen patients with post-traumatic stress disorder, who were awaiting regular treatment, opted to join the study. The effect of Rational Rehabilitation was studied in relation to: symptoms of post-traumatic stress disorder, degree of happiness experienced, autonomy, social support and need for further treatment. results Rational Rehabilitation seems to have a positive effect on all outcome measures, except flashbacks. A controlled study of the effect of Rational Rehabilitation in patients with post-traumatic stress disorder seems justified.

POST-TREATMENT REGRET AMONG YOUNG BREAST CANCER SURVIVORS

PubMed Central

Bloom, Joan R.

2010-01-01

Objective The study addresses: (1) what women regret about their breast cancer treatment five years later, and (2) what characteristics of disease and treatment predict post-treatment regret. Method Interviews were conducted with breast cancer survivors in the San Francisco Bay Area. Participants were interviewed following diagnosis. Five years later, women were asked whether they had any regrets about their cancer treatment (N=449). Qualitative analysis was used to identify regret content, and logistic regression was used to determine what characteristics of treatment predicted regret. Results 42.5% of women in the sample regretted some aspect of treatment. The most common regrets were primary surgery (24.1%), chemotherapy and/or radiation (21.5%), reconstruction (17.8%), and problems with providers (13.1%). In addition, women regretted inactions (59.2%) (actions that they did not take) more than actions that they did take (30.4%). This represents a novel finding in the study of post-treatment regret, which has largely focused on regrets over actions. Quantitative analysis revealed that women who were anxious about the future (OR=1.32; p=.03) or had problems communicating with physicians (OR=1.26; p=.02) during treatment were more likely to express regret 5 years later. In addition, women with new or recurrent cancers 5 years later were significantly more likely to regret some aspect of their primary treatment (OR=5.81; p<.001). Conclusion This research supports addressing the psychosocial aspects of cancer care and improving physician-patient communication. Evidence is also provided for addressing the unique emotional needs of women with recurrent cancers, who may experience an undue burden of regret. PMID:20878843

Using measurable dosimetric quantities to characterize the inter-structural tradeoff in inverse planning

NASA Astrophysics Data System (ADS)

Liu, Hongcheng; Dong, Peng; Xing, Lei

2017-08-01

Traditional inverse planning relies on the use of weighting factors to balance the conflicting requirements of different structures. Manual trial-and-error determination of weighting factors has long been recognized as a time-consuming part of treatment planning. The purpose of this work is to develop an inverse planning framework that parameterizes the dosimetric tradeoff among the structures with physically meaningful quantities to simplify the search for clinically sensible plans. In this formalism, instead of using weighting factors, the permissible variation range of the prescription dose or dose volume histogram (DVH) of the involved structures are used to characterize the ‘importance’ of the structures. The inverse planning is then formulated into a convex feasibility problem, called the dosimetric variation-controlled model (DVCM), whose goal is to generate plans with dosimetric or DVH variations of the structures consistent with the pre-specified values. For simplicity, the dosimetric variation range for a structure is extracted from a library of previous cases which possess similar anatomy and prescription. A two-phase procedure (TPP) is designed to solve the model. The first phase identifies a physically feasible plan to satisfy the prescribed dosimetric variation, and the second phase automatically improves the plan in case there is room for further improvement. The proposed technique is applied to plan two prostate cases and two head-and-neck cases and the results are compared with those obtained using a conventional CVaR approach and with a moment-based optimization scheme. Our results show that the strategy is able to generate clinically sensible plans with little trial and error. In all cases, the TPP generates a very competitive plan as compared to those obtained using the alternative approaches. Particularly, in the planning of one of the head-and-neck cases, the TPP leads to a non-trivial improvement in the resultant dose distribution�

Automatic treatment plan re-optimization for adaptive radiotherapy guided with the initial plan DVHs.

PubMed

Li, Nan; Zarepisheh, Masoud; Uribe-Sanchez, Andres; Moore, Kevin; Tian, Zhen; Zhen, Xin; Graves, Yan Jiang; Gautier, Quentin; Mell, Loren; Zhou, Linghong; Jia, Xun; Jiang, Steve

2013-12-21

Adaptive radiation therapy (ART) can reduce normal tissue toxicity and/or improve tumor control through treatment adaptations based on the current patient anatomy. Developing an efficient and effective re-planning algorithm is an important step toward the clinical realization of ART. For the re-planning process, manual trial-and-error approach to fine-tune planning parameters is time-consuming and is usually considered unpractical, especially for online ART. It is desirable to automate this step to yield a plan of acceptable quality with minimal interventions. In ART, prior information in the original plan is available, such as dose-volume histogram (DVH), which can be employed to facilitate the automatic re-planning process. The goal of this work is to develop an automatic re-planning algorithm to generate a plan with similar, or possibly better, DVH curves compared with the clinically delivered original plan. Specifically, our algorithm iterates the following two loops. An inner loop is the traditional fluence map optimization, in which we optimize a quadratic objective function penalizing the deviation of the dose received by each voxel from its prescribed or threshold dose with a set of fixed voxel weighting factors. In outer loop, the voxel weighting factors in the objective function are adjusted according to the deviation of the current DVH curves from those in the original plan. The process is repeated until the DVH curves are acceptable or maximum iteration step is reached. The whole algorithm is implemented on GPU for high efficiency. The feasibility of our algorithm has been demonstrated with three head-and-neck cancer IMRT cases, each having an initial planning CT scan and another treatment CT scan acquired in the middle of treatment course. Compared with the DVH curves in the original plan, the DVH curves in the resulting plan using our algorithm with 30 iterations are better for almost all structures. The re-optimization process takes about 30 s using

Automatic treatment plan re-optimization for adaptive radiotherapy guided with the initial plan DVHs

NASA Astrophysics Data System (ADS)

Li, Nan; Zarepisheh, Masoud; Uribe-Sanchez, Andres; Moore, Kevin; Tian, Zhen; Zhen, Xin; Jiang Graves, Yan; Gautier, Quentin; Mell, Loren; Zhou, Linghong; Jia, Xun; Jiang, Steve

2013-12-01

Adaptive radiation therapy (ART) can reduce normal tissue toxicity and/or improve tumor control through treatment adaptations based on the current patient anatomy. Developing an efficient and effective re-planning algorithm is an important step toward the clinical realization of ART. For the re-planning process, manual trial-and-error approach to fine-tune planning parameters is time-consuming and is usually considered unpractical, especially for online ART. It is desirable to automate this step to yield a plan of acceptable quality with minimal interventions. In ART, prior information in the original plan is available, such as dose-volume histogram (DVH), which can be employed to facilitate the automatic re-planning process. The goal of this work is to develop an automatic re-planning algorithm to generate a plan with similar, or possibly better, DVH curves compared with the clinically delivered original plan. Specifically, our algorithm iterates the following two loops. An inner loop is the traditional fluence map optimization, in which we optimize a quadratic objective function penalizing the deviation of the dose received by each voxel from its prescribed or threshold dose with a set of fixed voxel weighting factors. In outer loop, the voxel weighting factors in the objective function are adjusted according to the deviation of the current DVH curves from those in the original plan. The process is repeated until the DVH curves are acceptable or maximum iteration step is reached. The whole algorithm is implemented on GPU for high efficiency. The feasibility of our algorithm has been demonstrated with three head-and-neck cancer IMRT cases, each having an initial planning CT scan and another treatment CT scan acquired in the middle of treatment course. Compared with the DVH curves in the original plan, the DVH curves in the resulting plan using our algorithm with 30 iterations are better for almost all structures. The re-optimization process takes about 30 s using

"SABER": A new software tool for radiotherapy treatment plan evaluation.

PubMed

Zhao, Bo; Joiner, Michael C; Orton, Colin G; Burmeister, Jay

2010-11-01

Both spatial and biological information are necessary in order to perform true optimization of a treatment plan and for predicting clinical outcome. The goal of this work is to develop an enhanced treatment plan evaluation tool which incorporates biological parameters and retains spatial dose information. A software system is developed which provides biological plan evaluation with a novel combination of features. It incorporates hyper-radiosensitivity using the induced-repair model and applies the new concept of dose convolution filter (DCF) to simulate dose wash-out effects due to cell migration, bystander effect, and/or tissue motion during treatment. Further, the concept of spatial DVH (sDVH) is introduced to evaluate and potentially optimize the spatial dose distribution in the target volume. Finally, generalized equivalent uniform dose is derived from both the physical dose distribution (gEUD) and the distribution of equivalent dose in 2 Gy fractions (gEUD2) and the software provides three separate models for calculation of tumor control probability (TCP), normal tissue complication probability (NTCP), and probability of uncomplicated tumor control (P+). TCP, NTCP, and P+ are provided as a function of prescribed dose and multivariable TCP, NTCP, and P+ plots are provided to illustrate the dependence on individual parameters used to calculate these quantities. Ten plans from two clinical treatment sites are selected to test the three calculation models provided by this software. By retaining both spatial and biological information about the dose distribution, the software is able to distinguish features of radiotherapy treatment plans not discernible using commercial systems. Plans that have similar DVHs may have different spatial and biological characteristics and the application of novel tools such as sDVH and DCF within the software may substantially change the apparent plan quality or predicted plan metrics such as TCP and NTCP. For the cases examined

SU-F-T-442: Dose Distribution Comparison for Post-Laryngectomy Stoma Area Between Conventional AP and VMAT Plans with Or Without Bolus

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

Lee, B; Zhang, J; Cho-Lim, J

Purpose: To compare dose distributions of conventional AP vs. VMAT treatment plans with or without bolus around post-laryngectomy stoma. Methods: Radiation dose coverage for post-laryngectomy stoma was analyzed using a set of real-case CT-simulation images. After meticulous contouring of the catheter cuff, stoma lumen, peri-stoma skin and subclinical tumor bed at the larynx, the resulting dosimetry plans were analyzed with or without a 5 mm bolus placement. Wet gauze was used to minimize the effect of any air gap. Four plans were generated: AP superclavicular (SCV) plan with or without bolus, and VMAT plan with or without bolus. A dosemore » of 60Gy in 30 fractions was prescribed at 3 cm depth for AP SCV plan, and to 95% of the PTV volume for VMAT plan. Results: For the conventional AP SCV plan, the peri-stoma skin dose is sensitive to bolus placement as well as air gap compensation by wetted gauze (V95% of 20.7%, 33.0% and 94.8% for no bolus, bolus without and with air gap compensation, respectively). For stoma lumen, the dose drops off rapidly in depth. The catheter cuff may have certain dose-buildup effect, but air gap around it and under the bolus placed can pose a more serious problem. The dose distributions of the two VMAT plans are moderately different for peri-stoma skin (V95% of 95.0% with bolus and air gap compensation, and 82.3% without bolus), but nearly identical for stoma lumen (V95% of 91.5% and 92.0%, respectively). VMAT allows beamlets with different angles of incidence that helped achieve such dose distribution around the stoma even without bolus placement. Conclusion: Overall, the dose coverage around the stoma in the VMAT plan is better than the conventional AP SCV plan. To achieve optimal dose distribution, it is still recommended to place physical bolus and reduce the air gaps.« 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

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

SU-F-T-427: Utilization and Evaluation of Diagnostic CT Imaging with MAR Technique for Radiation Therapy Treatment Planning

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

Xu, M; Foster, R; Parks, H

Purpose: The objective was to utilize and evaluate diagnostic CT-MAR technique for radiation therapy treatment planning. Methods: A Toshiba-diagnostic-CT acquisition with SEMAR(Single-energy-MAR)-algorism was performed to make the metal-artifact-reduction (MAR) for patient treatment planning. CT-imaging datasets with and without SEMAR were taken on a Catphan-phantom. Two sets of CT-numbers were calibrated with the relative electron densities (RED). A tissue characterization phantom with Gammex various simulating material rods was used to establish the relationship between known REDs and corresponding CT-numbers. A GE-CT-sim acquisition was taken on the Catphan for comparison. A patient with bilateral hip arthroplasty was scanned in the radiotherapy CT-simmore » and the diagnostic SEMAR-CT on a flat panel. The derived SEMAR images were used as a primary CT dataset to create contours for the target, critical-structures, and for planning. A deformable registration was performed with VelocityAI to track voxel changes between SEMAR and CT-sim images. The SEMAR-CT images with minimal artifacts and high quality of geometrical and spatial integrity were employed for a treatment plan. Treatment-plans were evaluated based on deformable registration of SEMAR-CT and CT-sim dataset with assigned CT-numbers in the metal artifact regions in Eclipse v11 TPS. Results: The RED and CT-number relationships were consistent for the datasets in CT-sim and CT’s with and without SEMAR. SEMAR datasets with high image quality were used for PTV and organ delineation in the treatment planning process. For dose distribution to the PTV through the DVH analysis, the plan using CT-sim with the assigned CT-number showed a good agreement to those on deformable CT-SEMAR. Conclusion: A diagnostic-CT with MAR-algorithm can be utilized for radiotherapy treatment planning with CT-number calibrated to the RED. Treatment planning comparison and DVH shows a good agreement in the PTV and critical organs

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

NASA Astrophysics Data System (ADS)

Hartmann, M.; Schneider, U.

2014-03-01

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

12. "OBSERVATION POSTS, STRUCTURAL PLANS AND DETAILS." Specifications No. OC25572; ...

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

12. "OBSERVATION POSTS, STRUCTURAL PLANS AND DETAILS." Specifications No. OC2-55-72; Drawing No. 60-09-12; sheet 89 of 148; file no. 1321/40, Rev. A. Very faint stamp above note reads: RECORD DRAWING - AS CONSTRUCTED. Below stamp: Contract no. 4338, no change. - Edwards Air Force Base, Air Force Rocket Propulsion Laboratory, Observation Bunkers for Test Stand 1-A, Test Area 1-120, north end of Jupiter Boulevard, Boron, Kern County, CA

Effect of surface treatment on retention of glass-fiber endodontic posts.

PubMed

Balbosh, Ali; Kern, Matthias

2006-03-01

The effects of surface treatment on the retention of prefabricated fiber-reinforced epoxy resin posts are not well understood because most studies measure retention shortly after cementation, without artificial aging. The purpose of this study was to evaluate the effect of surface treatment on the retention of glass-fiber endodontic posts luted with resin cement and subjected to artificial aging. Thirty-two single-rooted teeth were selected, the coronal aspect of each tooth was removed, and the remaining root received endodontic therapy. Specimens were then divided into 4 groups (n = 8). Post spaces were prepared to a depth of 10 mm by using ISO 90 rotary instruments. The tapered posts received 1 of 4 surface treatments: cleaning with alcohol (Alc), cleaning with alcohol and conditioning with ED-Primer material (Alc-ED), airborne-particle abrasion (Air), or airborne-particle abrasion and conditioning with ED-Primer material (Air-ED). All posts were luted with a composite resin luting agent (Panavia F) after conditioning the canal dentin with autopolymerizing dentin primer (ED-Primer) and without acid etching of the canal dentin. After cementation, the specimens were stored in water at 37 degrees C for 30 days and subjected to simulated aging conditions consisting of 7500 thermal cycles (5 degrees C/55 degrees C) and 300,000 mechanical loading cycles with 30 N. Retention (N) of the posts was measured with a universal testing machine with a crosshead speed of 2 mm/min. The data were analyzed using 1-way ANOVA and the Tukey HSD test (alpha = .05). The dislodged posts were also examined microscopically at x8 and x20 magnification to evaluate the mode of failure. The mean retentive values (N) and SDs of the test groups were as follows: Alc, 375.9 +/- 85.0; Alc-ED, 421.2 +/- 46.8; Air, 534.8 +/- 65.8; and Air-ED, 555.8 +/- 86.9. Airborne-particle-abraded posts had significantly higher retention compared with nonabraded posts (P < .001). Treating the post's surface with

Stereotactic Arrhythmia Radioablation (STAR) of Ventricular Tachycardia: A Treatment Planning Study

PubMed Central

Fahimian, Benjamin; Soltys, Scott G; Zei, Paul; Lo, Anthony; Gardner, Edward A; Maguire, Patrick J; Loo Jr., Billy W

2016-01-01

Purpose The first stereotactic arrhythmia radioablation (STAR) of ventricular tachycardia (VT) was delivered at Stanford on a robotic radiosurgery system (CyberKnife® G4) in 2012. The results warranted further investigation of this treatment. Here we compare dosimetrically three possible treatment delivery platforms for STAR. Methods The anatomy and target volume of the first treated patient were used for this study. A dose of 25 Gy in one fraction was prescribed to the planning target volume (PTV). Treatment plans were created on three treatment platforms: CyberKnife® G4 system with Iris collimator (Multiplan, V. 4.6)(Plan #1), CyberKnife® M6 system with InCise 2TM multileaf collimator (Multiplan V. 5.3)(Plan #2) and Varian TrueBeamTM STx with HD 120TM MLC and 10MV flattening filter free (FFF) beam (Eclipse planning system, V.11) (Plan #3 coplanar and #4 noncoplanar VMAT plans). The four plans were compared by prescription isodose line, plan conformity index, dose gradient, as well as dose to the nearby critical structures. To assess the delivery efficiency, planned monitor units (MU) and estimated treatment time were evaluated. Results Plans #1-4 delivered 25 Gy to the PTV to the 75.0%, 83.0%, 84.3%, and 84.9% isodose lines and with conformity indices of 1.19, 1.16, 1.05, and 1.05, respectively. The dose gradients for plans #1-4 were 3.62, 3.42, 3.93, and 3.73 with the CyberKnife® MLC plan (Plan #2) the best, and the TrueBeamTM STx co-planar plan (Plan #3) the worst. The dose to nearby critical structures (lung, stomach, bowel, and esophagus) were all well within tolerance. The MUs for plans #1-4 were 27671, 16522, 6275, and 6004 for an estimated total-treatment-time/beam-delivery-time of 99/69, 65/35, 37/7, and 56/6 minutes, respectively, under the assumption of 30 minutes pretreatment setup time. For VMAT gated delivery, a 40% duty cycle, 2400MU/minute dose rate, and an extra 10 minutes per extra arc were assumed. Conclusion Clinically acceptable plans were

Treatment planning for SBRT using automated field delivery: A case study

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

Ritter, Timothy A., E-mail: timritte@med.umich.edu; Department of Radiation Oncology, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI; Owen, Dawn

Stereotactic body radiation therapy (SBRT) treatment planning and delivery can be accomplished using a variety of techniques that achieve highly conformal dose distributions. Herein, we describe a template-based automated treatment field approach that enables rapid delivery of more than 20 coplanar fields. A case study is presented to demonstrate how modest adaptations to traditional SBRT planning can be implemented to take clinical advantage of this technology. Treatment was planned for a left-sided lung lesion adjacent to the chest wall using 25 coplanar treatment fields spaced at 11° intervals. The plan spares the contralateral lung and is in compliance with themore » conformality standards set forth in Radiation Therapy and Oncology Group protocol 0915, and the dose tolerances found in the report of the American Association of Physicists in Medicine Task Group 101. Using a standard template, treatment planning was accomplished in less than 20 minutes, and each 10 Gy fraction was delivered in approximately 5.4 minutes. For those centers equipped with linear accelerators capable of automated treatment field delivery, the use of more than 20 coplanar fields is a viable SBRT planning approach and yields excellent conformality and quality combined with rapid planning and treatment delivery. Although the case study discusses a laterally located lung lesion, this technique can be applied to centrally located tumors with similar results.« less

Treatment planning for heavy ion radiotherapy: clinical implementation and application.

PubMed

Jäkel, O; Krämer, M; Karger, C P; Debus, J

2001-04-01

The clinical implementation and application of a novel treatment planning system (TPS) for scanned ion beams is described, which is in clinical use for carbon ion treatments at the German heavy ion facility (GSI). All treatment plans are evaluated on the basis of biologically effective dose distributions. For therapy control, in-beam positron emission tomography (PET) and an online monitoring system for the beam intensity and position are used. The absence of a gantry restricts the treatment plans to horizontal beams. Most of the treatment plans consist of two nearly opposing lateral fields or sometimes orthogonal fields. In only a very few cases a single beam was used. For patients with very complex target volumes lateral and even distal field patching techniques were applied. Additional improvements can be achieved when the patient's head is fixed in a tilted position, in order to achieve sparing of the organs at risk. In order to test the stability of dose distributions in the case of patient misalignments we routinely simulate the effects of misalignments for patients with critical structures next to the target volume. The uncertainties in the range calculation are taken into account by a margin around the target volume of typically 2-3 mm, which can, however, be extended if the simulation demonstrates larger deviations. The novel TPS developed for scanned ion beams was introduced into clinical routine in December 1997 and was used for the treatment planning of 63 patients with head and neck tumours until July 2000. Planning strategies and methods were developed for this tumour location that facilitate the treatment of a larger number of patients with the scanned heavy ion beam in a clinical setting. Further developments aim towards a simultaneous optimization of the treatment field intensities and more effective procedures for the patient set-up. The results demonstrate that ion beams can be integrated into a clinical environment for treatment planning and

Post-Polio Syndrome and the Late Effects of Poliomyelitis: Part 2. Treatment, Management and Prognosis.

PubMed

Lo, Julian K; Robinson, Lawrence R

2018-05-12

Post-Polio Syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years following the initial poliomyelitis illness. An individualized approach to rehabilitation management is critical. Interventions may include rehabilitation management strategies, adaptive equipment, orthotic equipment, gait/mobility aids and a variety of therapeutic exercises. The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis. Further research is required to determine the effectiveness of selected medical treatment. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

Online Adaptive Hyperthermia Treatment Planning During Locoregional Heating to Suppress Treatment-Limiting Hot Spots.

PubMed

Kok, H Petra; Korshuize-van Straten, Linda; Bakker, Akke; de Kroon-Oldenhof, Rianne; Geijsen, Elisabeth D; Stalpers, Lukas J A; Crezee, Johannes

2017-11-15

Adequate tumor temperatures during hyperthermia are essential for good clinical response, but excessive heating of normal tissue should be avoided. This makes locoregional heating using phased array systems technically challenging. Online application of hyperthermia treatment planning could help to improve the heating quality. The aim of this study was to evaluate the clinical benefit of online treatment planning during treatment of pelvic tumors heated with the AMC-8 locoregional hyperthermia system. For online adaptive hyperthermia treatment planning, a graphical user interface was developed. Electric fields were calculated in a preprocessing step using our in-house-developed finite-difference-based treatment planning system. This allows instant calculation of the temperature distribution for user-selected phase-amplitude settings during treatment and projection onto the patient's computed tomographic scan for online visualization. Online treatment planning was used for 14 treatment sessions in 8 patients to reduce the patients' reports of hot spots while maintaining the same level of tumor heating. The predicted decrease in hot spot temperature should be at least 0.5°C, and the tumor temperature should decrease less than 0.2°C. These predictions were compared with clinical data: patient feedback about the hot spot and temperature measurements in the tumor region. In total, 17 hot spot reports occurred during the 14 sessions, and the alternative settings predicted the hot spot temperature to decrease by at least 0.5°C, which was confirmed by the disappearance of all 17 hot spot reports. At the same time, the average tumor temperature was predicted to change on average -0.01°C (range, -0.19°C to 0.34°C). The measured tumor temperature change was on average only -0.02°C (range, -0.26°C to 0.31°C). In only 2 cases the temperature decrease was slightly larger than 0.2°C, but at most it was 0.26°C. Online application of hyperthermia treatment planning is

'Mafia Baroque': post-socialist architecture and urban planning in Bulgaria.

PubMed

Holleran, Max

2014-03-01

This paper traces the reception of the architectural style known as 'Mafia Baroque' within the professions of architecture and urban planning in Bulgaria. The debate within these professions was strongly linked to the general decline of power among former intellectual elites and the specific decline of architects and planners, who were sidelined as arbiters of 'good taste' and disempowered as regulators of urban growth. The reaction to this style also highlights the rise in public concern over corruption and organized crime and dissatisfaction with post-socialist urbanization. This paper chronicles the extent of changes in construction and regulation in Bulgaria during the 1990s and argues that planners and architects were challenged not only by their professional marginalization but also by a deeper embarrassment over cultural change. It then relates this debate to broader post-socialist anxieties over insufficient regulation of urbanization and fear of failing to meet Western European goals for economic and political change. © London School of Economics and Political Science 2014.

MO-C-BRF-01: Pediatric Treatment Planning I: Overview of Planning Strategies

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

Olch, A; Hua, C

Most Medical Physicists working in radiotherapy departments see few pediatric patients. This is because, fortunately, children get cancer at a rate nearly 100 times lower than adults. Children have not smoked, abused alcohol, or been exposed to environmental carcinogens for decades, and of course, have not fallen victim to the aging process. Children get very different cancers than adults. Breast or prostate cancers, typical in adults, are rarely seen in children but instead a variety of tumors occur in children that are rarely seen in adults; examples are germinomas, ependymomas and primitive neuroectodermal tumors, which require treatment of the child'smore » brain or neuroblastoma, requiring treatment in the abdomen. The treatment of children with cancer using radiation therapy is one of the most challenging planning and delivery problems facing the physicist. This is because bones, brain, breast tissue, and other organs are more sensitive to radiation in children than in adults. Because most therapy departments treat mostly adults, when the rare 8 year-old patient comes to the department for treatment, the physicist may not understand the clinical issues of his disease which drive the planning and delivery decisions. Additionally, children are more prone than adults to developing secondary cancers after radiation. This fact has important implications for the choice of delivery techniques, especially when considering IMRT. For bilateral retinoblastoma for example, an irradiated child has a 50% chance of developing a second cancer by age 50. In the first presentation, an overview of childhood cancers and their corresponding treatment techniques will be given. These can be some of the most complex treatments that are delivered in the radiation therapy department. These cancers include leukemia treated with total body irradiation, medulloblastoma, treated with craniospinal irradiation plus a conformal boost to the posterior fossa, neuroblastoma, requiring focal

Predicting post-traumatic stress disorder treatment response in refugees: Multilevel analysis.

PubMed

Haagen, Joris F G; Ter Heide, F Jackie June; Mooren, Trudy M; Knipscheer, Jeroen W; Kleber, Rolf J

2017-03-01

Given the recent peak in refugee numbers and refugees' high odds of developing post-traumatic stress disorder (PTSD), finding ways to alleviate PTSD in refugees is of vital importance. However, there are major differences in PTSD treatment response between refugees, the determinants of which are largely unknown. This study aimed at improving PTSD treatment for adult refugees by identifying PTSD treatment response predictors. A prospective longitudinal multilevel modelling design was used to predict PTSD severity scores over time. We analysed data from a randomized controlled trial with pre-, post-, and follow-up measurements of the safety and efficacy of eye movement desensitization and reprocessing and stabilization in asylum seekers and refugees suffering from PTSD. Lack of refugee status, comorbid depression, demographic, trauma-related and treatment-related variables were analysed as potential predictors of PTSD treatment outcome. Treatment outcome data from 72 participants were used. The presence (B = 6.5, p = .03) and severity (B = 6.3, p < .01) of a pre-treatment depressive disorder predicted poor treatment response and explained 39% of the variance between individuals. Refugee patients who suffer from PTSD and severe comorbid depression benefit less from treatment aimed at alleviating PTSD. Results highlight the need for treatment adaptations for PTSD and comorbid severe depression in traumatized refugees, including testing whether initial targeting of severe depressive symptoms increases PTSD treatment effectiveness. There are differences in post-traumatic stress disorder (PTSD) treatment response between traumatized refugees. Comorbid depressive disorder and depression severity predict poor PTSD response. Refugees with PTSD and severe depression may not benefit from PTSD treatment. Targeting comorbid severe depression before PTSD treatment is warranted. This study did not correct for multiple hypothesis testing. Comorbid depression may

Oncologists' perspectives on post-cancer treatment communication and care coordination with primary care physicians.

PubMed

Klabunde, C N; Haggstrom, D; Kahn, K L; Gray, S W; Kim, B; Liu, B; Eisenstein, J; Keating, N L

2017-07-01

Post-treatment cancer care is often fragmented and of suboptimal quality. We explored factors that may affect cancer survivors' post-treatment care coordination, including oncologists' use of electronic technologies such as e-mail and integrated electronic health records (EHRs) to communicate with primary care physicians (PCPs). We used data from a survey (357 respondents; participation rate 52.9%) conducted in 2012-2013 among medical oncologists caring for patients in a large US study of cancer care delivery and outcomes. Oncologists reported their frequency and mode of communication with PCPs, and role in providing post-treatment care. Seventy-five per cent said that they directly communicated with PCPs about post-treatment status and care recommendations for all/most patients. Among those directly communicating with PCPs, 70% always/usually used written correspondence, while 36% always/usually used integrated EHRs; telephone and e-mail were less used. Eighty per cent reported co-managing with PCPs at least one post-treatment general medical care need. In multivariate-adjusted analyses, neither communication mode nor intensity were associated with co-managing survivors' care. Oncologists' reliance on written correspondence to communicate with PCPs may be a barrier to care coordination. We discuss new research directions for enhancing communication and care coordination between oncologists and PCPs, and to better meet the needs of cancer survivors post-treatment. © 2017 John Wiley & Sons Ltd.

Effects of homogenization treatment on recrystallization behavior of 7150 aluminum sheet during post-rolling annealing

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

Guo, Zhanying; Department of Applied Science, University of Québec at Chicoutimi, Saguenay, QC G7H 2B1; Zhao, Gang

2016-04-15

The effects of two homogenization treatments applied to the direct chill (DC) cast billet on the recrystallization behavior in 7150 aluminum alloy during post-rolling annealing have been investigated using the electron backscatter diffraction (EBSD) technique. Following hot and cold rolling to the sheet, measured orientation maps, the recrystallization fraction and grain size, the misorientation angle and the subgrain size were used to characterize the recovery and recrystallization processes at different annealing temperatures. The results were compared between the conventional one-step homogenization and the new two-step homogenization, with the first step being pretreated at 250 °C. Al{sub 3}Zr dispersoids with highermore » densities and smaller sizes were obtained after the two-step homogenization, which strongly retarded subgrain/grain boundary mobility and inhibited recrystallization. Compared with the conventional one-step homogenized samples, a significantly lower recrystallized fraction and a smaller recrystallized grain size were obtained under all annealing conditions after cold rolling in the two-step homogenized samples. - Highlights: • Effects of two homogenization treatments on recrystallization in 7150 Al sheets • Quantitative study on the recrystallization evolution during post-rolling annealing • Al{sub 3}Zr dispersoids with higher densities and smaller sizes after two-step treatment • Higher recrystallization resistance of 7150 sheets with two-step homogenization.« less

Dosimetric comparison of stopping power calibration with dual-energy CT and single-energy CT in proton therapy treatment planning

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

Zhu, Jiahua; Penfold, Scott N., E-mail: scott.penfold@adelaide.edu.au

Purpose: The accuracy of proton dose calculation is dependent on the ability to correctly characterize patient tissues with medical imaging. The most common method is to correlate computed tomography (CT) numbers obtained via single-energy CT (SECT) with proton stopping power ratio (SPR). CT numbers, however, cannot discriminate between a change in mass density and change in chemical composition of patient tissues. This limitation can have consequences on SPR calibration accuracy. Dual-energy CT (DECT) is receiving increasing interest as an alternative imaging modality for proton therapy treatment planning due to its ability to discriminate between changes in patient density and chemicalmore » composition. In the current work we use a phantom of known composition to demonstrate the dosimetric advantages of proton therapy treatment planning with DECT over SECT. Methods: A phantom of known composition was scanned with a clinical SECT radiotherapy CT-simulator. The phantom was rescanned at a lower X-ray tube potential to generate a complimentary DECT image set. A set of reference materials similar in composition to the phantom was used to perform a stoichiometric calibration of SECT CT number to proton SPRs. The same set of reference materials was used to perform a DECT stoichiometric calibration based on effective atomic number. The known composition of the phantom was used to assess the accuracy of SPR calibration with SECT and DECT. Intensity modulated proton therapy (IMPT) treatment plans were generated with the SECT and DECT image sets to assess the dosimetric effect of the imaging modality. Isodose difference maps and root mean square (RMS) error calculations were used to assess dose calculation accuracy. Results: SPR calculation accuracy was found to be superior, on average, with DECT relative to SECT. Maximum errors of 12.8% and 2.2% were found for SECT and DECT, respectively. Qualitative examination of dose difference maps clearly showed the dosimetric

Alcohol expectancies pre-and post-alcohol use disorder treatment: Clinical implications.

PubMed

Coates, Jason M; Gullo, Matthew J; Feeney, Gerald F X; Young, Ross McD; Dingle, Genevieve A; Connor, Jason P

2018-05-01

Modification of elevated positive expectations of alcohol consumption (alcohol outcome expectancies; AOEs) is a key feature of Cognitive Behaviour Therapy (CBT) approaches to Alcohol Use Disorders (AUDs). Despite extensive research supporting the efficacy of CBT for AUD, few studies have examined AOE change. This study aimed to assess AOE change following completion of CBT for AUD and its association with drinking behaviour. One-hundred and seventy-five patients who completed a 12-week CBT program for AUD were administered the Drinking Expectancy Questionnaire (DEQ) at pre-treatment assessment and upon completion of treatment. Abstinence was achieved by 108 (61.7%) of completing patients. For patients who lapsed, the mean proportion of abstinent days was 93%. DEQ scales assessing expectations of positive alcohol effects on tension reduction, assertiveness, and cognitive enhancement were significantly lower post-treatment (p<0.001). Expectations of negative effects on mood were higher post-treatment (p<0.001). The largest AOE change occurred on the tension reduction scale. Greater percentage of abstinent days over treatment was associated with lower pre-and post-treatment tension reduction expectancy scores (p<0.05). Drinking during treatment was associated with smaller changes in expectations of negative effects of alcohol on mood (p<0.05). Individuals who completed CBT treatment for AUD showed significant AOE change. Tension reduction and affective change expectancies may be particularly important for abstinence and useful markers of lapse risk. Copyright © 2018 Elsevier Ltd. All rights reserved.

DEVELOPMENT OF A MULTIMODAL MONTE CARLO BASED TREATMENT PLANNING SYSTEM.

PubMed

Kumada, Hiroaki; Takada, Kenta; Sakurai, Yoshinori; Suzuki, Minoru; Takata, Takushi; Sakurai, Hideyuki; Matsumura, Akira; Sakae, Takeji

2017-10-26

To establish boron neutron capture therapy (BNCT), the University of Tsukuba is developing a treatment device and peripheral devices required in BNCT, such as a treatment planning system. We are developing a new multimodal Monte Carlo based treatment planning system (developing code: Tsukuba Plan). Tsukuba Plan allows for dose estimation in proton therapy, X-ray therapy and heavy ion therapy in addition to BNCT because the system employs PHITS as the Monte Carlo dose calculation engine. Regarding BNCT, several verifications of the system are being carried out for its practical usage. The verification results demonstrate that Tsukuba Plan allows for accurate estimation of thermal neutron flux and gamma-ray dose as fundamental radiations of dosimetry in BNCT. In addition to the practical use of Tsukuba Plan in BNCT, we are investigating its application to other radiation therapies. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Emergency Planning for Municipal Wastewater Treatment Facilities.

ERIC Educational Resources Information Center

Lemon, R. A.; And Others

This manual for the development of emergency operating plans for municipal wastewater treatment systems was compiled using information provided by over two hundred municipal treatment systems. It covers emergencies caused by natural disasters, civil disorders and strikes, faulty maintenance, negligent operation, and accidents. The effects of such…

[Endodontically treated teeth. Success--failure. Endorestorative treatment plan].

PubMed

Zabalegui, B

1990-01-01

More and more often the general dentist is finding the presence of endodontically treated teeth during his treatment planning procedure. He has to ask himself if the endo-treated tooth functions and will continue to function function successfully, when deciding which final endo-restorative procedure to apply. For this reason the dentist or the endodontist with whom he works should clinically evaluate these teeth, establish a diagnostic criteria of their success or failure and a treatment plan according to the prognosis. The purpose of this article is to offer an organized clinical view of the steps to follow when evaluating an endodontically treated tooth and how to establish a final endo-restorative plan.

A methodology for automatic intensity-modulated radiation treatment planning for lung cancer

NASA Astrophysics Data System (ADS)

Zhang, Xiaodong; Li, Xiaoqiang; Quan, Enzhuo M.; Pan, Xiaoning; Li, Yupeng

2011-07-01

In intensity-modulated radiotherapy (IMRT), the quality of the treatment plan, which is highly dependent upon the treatment planner's level of experience, greatly affects the potential benefits of the radiotherapy (RT). Furthermore, the planning process is complicated and requires a great deal of iteration, and is often the most time-consuming aspect of the RT process. In this paper, we describe a methodology to automate the IMRT planning process in lung cancer cases, the goal being to improve the quality and consistency of treatment planning. This methodology (1) automatically sets beam angles based on a beam angle automation algorithm, (2) judiciously designs the planning structures, which were shown to be effective for all the lung cancer cases we studied, and (3) automatically adjusts the objectives of the objective function based on a parameter automation algorithm. We compared treatment plans created in this system (mdaccAutoPlan) based on the overall methodology with plans from a clinical trial of IMRT for lung cancer run at our institution. The 'autoplans' were consistently better, or no worse, than the plans produced by experienced medical dosimetrists in terms of tumor coverage and normal tissue sparing. We conclude that the mdaccAutoPlan system can potentially improve the quality and consistency of treatment planning for lung cancer.

The influence of patients' decisions on treatment planning in restorative dentistry.

PubMed

Kalsi, Jagdip S; Hemmings, Kenneth

2013-11-01

As part of treatment planning, options are presented to patients by dentists. An informal discussion takes place involving a cost-benefit analysis and a treatment plan is agreed. Evidence-based dentistry takes into account the best available literature, clinical experience and patient factors to guide the dentist. Dentists exert considerable influence on which treatment modality is selected. This paper focuses on the importance of patient factors which lead to less than ideal, clinically acceptable, treatment plans that nevertheless give patient satisfaction over the long term. Though no universally accepted healthcare model exists for restorative dentistry, patients' decisions are most influenced by their relationship with their dentist over factors such as time, access and cost. Letters should be sent to patients clarifying the nature of all proposed options, including advantages and disadvantages, complications, success rates, biological and financial costs and what happens if no treatment is carried out. Many psychological and social determinants influence patients'values and decision-making when planning for restorative dentistry. These lead to a treatment plan agreed between the patient and the dentist. Often an element of compromise is considered acceptable to both parties when the evidence would suggest an alternative treatment to be preferable.

An Investigation of Engineering Students' Post-Graduation Plans inside or outside of Engineering

ERIC Educational Resources Information Center

Ro, Hyun Kyoung

2011-01-01

The question of students' post-graduation plans is a critical one for the field of engineering as both industry and higher education institutions seek to understand how to increase the production of highly-skilled individuals for the STEM workforce. Despite the concern, there are but a few empirical studies that examine how students' academic…

Recovery among Adolescents: Models for Post-Treatment Gains in Drug Abuse Treatments

PubMed Central

Joe, George W.; Knight, Danica Kalling; Becan, Jennifer E.; Flynn, Patrick M.

2013-01-01

Recovery among adolescents undergoing substance abuse treatment was modeled in terms of pre-treatment motivation, therapeutic relationships, psychological functioning, treatment retention, legal pressures, DSM diagnoses, and client demographics. To address between program differences, a within-covariance matrix, based on 547 youth, was used. Applicability of the results across treatment modalities was also examined. The data were from the NIDA-sponsored DATOS Adolescent study. Results from structural equation models (estimated using Mplus) indicated that higher pre-treatment motivation predicted stronger counselor and in-treatment peer relationships, better counselor relationships and retention predicted less illegal drug use at follow-up, and DSM diagnosis was important in the treatment process. Overall, illegal drug use at follow-up was associated with post-treatment alcohol consumption, cigarette use, condom nonuse, psychological distress, criminality, and school non-attendance. The results document the importance of motivation and therapeutic relationships on recovery, even when taking into account the relative effects of legal pressures, DSM diagnoses, and demographics. PMID:24238715

Methods to model and predict the ViewRay treatment deliveries to aid patient scheduling and treatment planning

PubMed Central

Liu, Shi; Wu, Yu; Wooten, H. Omar; Green, Olga; Archer, Brent; Li, Harold

2016-01-01

A software tool is developed, given a new treatment plan, to predict treatment delivery time for radiation therapy (RT) treatments of patients on ViewRay magnetic resonance image‐guided radiation therapy (MR‐IGRT) delivery system. This tool is necessary for managing patient treatment scheduling in our clinic. The predicted treatment delivery time and the assessment of plan complexities could also be useful to aid treatment planning. A patient's total treatment delivery time, not including time required for localization, is modeled as the sum of four components: 1) the treatment initialization time; 2) the total beam‐on time; 3) the gantry rotation time; and 4) the multileaf collimator (MLC) motion time. Each of the four components is predicted separately. The total beam‐on time can be calculated using both the planned beam‐on time and the decay‐corrected dose rate. To predict the remain‐ing components, we retrospectively analyzed the patient treatment delivery record files. The initialization time is demonstrated to be random since it depends on the final gantry angle of the previous treatment. Based on modeling the relationships between the gantry rotation angles and the corresponding rotation time, linear regression is applied to predict the gantry rotation time. The MLC motion time is calculated using the leaves delay modeling method and the leaf motion speed. A quantitative analysis was performed to understand the correlation between the total treatment time and the plan complexity. The proposed algorithm is able to predict the ViewRay treatment delivery time with the average prediction error 0.22 min or 1.82%, and the maximal prediction error 0.89 min or 7.88%. The analysis has shown the correlation between the plan modulation (PM) factor and the total treatment delivery time, as well as the treatment delivery duty cycle. A possibility has been identified to significantly reduce MLC motion time by optimizing the positions of closed MLC pairs. The

Methods to model and predict the ViewRay treatment deliveries to aid patient scheduling and treatment planning.

PubMed

Liu, Shi; Wu, Yu; Wooten, H Omar; Green, Olga; Archer, Brent; Li, Harold; Yang, Deshan

2016-03-08

A software tool is developed, given a new treatment plan, to predict treatment delivery time for radiation therapy (RT) treatments of patients on ViewRay magnetic resonance image-guided radiation therapy (MR-IGRT) delivery system. This tool is necessary for managing patient treatment scheduling in our clinic. The predicted treatment delivery time and the assessment of plan complexities could also be useful to aid treatment planning. A patient's total treatment delivery time, not including time required for localization, is modeled as the sum of four components: 1) the treatment initialization time; 2) the total beam-on time; 3) the gantry rotation time; and 4) the multileaf collimator (MLC) motion time. Each of the four components is predicted separately. The total beam-on time can be calculated using both the planned beam-on time and the decay-corrected dose rate. To predict the remain-ing components, we retrospectively analyzed the patient treatment delivery record files. The initialization time is demonstrated to be random since it depends on the final gantry angle of the previous treatment. Based on modeling the relationships between the gantry rotation angles and the corresponding rotation time, linear regression is applied to predict the gantry rotation time. The MLC motion time is calculated using the leaves delay modeling method and the leaf motion speed. A quantitative analysis was performed to understand the correlation between the total treatment time and the plan complexity. The proposed algorithm is able to predict the ViewRay treatment delivery time with the average prediction error 0.22min or 1.82%, and the maximal prediction error 0.89 min or 7.88%. The analysis has shown the correlation between the plan modulation (PM) factor and the total treatment delivery time, as well as the treatment delivery duty cycle. A possibility has been identified to significantly reduce MLC motion time by optimizing the positions of closed MLC pairs. The accuracy of

42 CFR 460.184 - Post-eligibility treatment of income.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Payment § 460.184 Post-eligibility treatment of income. (a) A State may provide...

Characterization and quality assessment of recycled post-consumption poly(ethylene terephthalate) (PET).

PubMed

Masmoudi, Fatma; Fenouillot, Françoise; Mehri, Afef; Jaziri, Mohamed; Ammar, Emna

2018-06-05

In the present study, the recycled post-consumption polyethylene terephthalate (PET) flakes were investigated as possible raw materials for the production of food packaging. After heating at 220 °C for 1 h, a steaming stage was conducted as a control test to assess the quality of the product. Different samples were characterized by 1 H-NMR, FT-IR, DSC/TGA analysis, viscosity index (VI), and trace metals analysis. The results showed that the recycled post-consumed PET flakes' properties were generally conform to the standard norms of PET except the color of some flakes turned to yellow. Subsequently, a complementary study was undertaken to assess whether the material could be possibly reused for food packaging. For this purpose, rheological, thermal, and mechanical characterizations were performed. The results of the comparative study between the virgin and the recycled PET flakes concluded that the PET recycling affected the rheological properties but did not have any significant effect on their thermal and mechanical characteristics. Hence, it was deduced that the post-consumed PET flakes could be reused as a packaging material except food products.

Correlation between CdSe QD Synthesis, Post-Synthetic Treatment, and BHJ Hybrid Solar Cell Performance

PubMed Central

Eck, Michael; Krueger, Michael

2016-01-01

In this publication we show that the procedure to synthesize nanocrystals and the post-synthetic nanocrystal ligand sphere treatment have a great influence not only on the immediate performance of hybrid bulk heterojunction solar cells, but also on their thermal, long-term, and air stability. We herein demonstrate this for the particular case of spherical CdSe nanocrystals, post-synthetically treated with a hexanoic acid based treatment. We observe an influence from the duration of this post-synthetic treatment on the nanocrystal ligand sphere size, and also on the solar cell performance. By tuning the post-synthetic treatment to a certain degree, optimal device performance can be achieved. Moreover, we show how to effectively adapt the post-synthetic nanocrystal treatment protocol to different nanocrystal synthesis batches, hence increasing the reproducibility of hybrid nanocrystal:polymer bulk-heterojunction solar cells, which usually suffers due to the fluctuations in nanocrystal quality of different synthesis batches and synthesis procedures. PMID:28335243

Use of diffusion-weighted MRI to modify radiosurgery planning in brain metastases may reduce local recurrence.

PubMed

Zakaria, Rasheed; Pomschar, Andreas; Jenkinson, Michael D; Tonn, Jörg-Christian; Belka, Claus; Ertl-Wagner, Birgit; Niyazi, Maximilian

2017-02-01

Stereotactic radiosurgery (SRS) is an effective and well tolerated treatment for selected brain metastases; however, local recurrence still occurs. We investigated the use of diffusion weighted MRI (DWI) as an adjunct for SRS treatment planning in brain metastases. Seventeen consecutive patients undergoing complete surgical resection of a solitary brain metastasis underwent image analysis retrospectively. SRS treatment plans were generated based on standard 3D post-contrast T1-weighted sequences at 1.5T and then separately using apparent diffusion coefficient (ADC) maps in a blinded fashion. Control scans immediately post operation confirmed complete tumour resection. Treatment plans were compared to one another and with volume of local recurrence at progression quantitatively and qualitatively by calculating the conformity index (CI), the overlapping volume as a proportion of the total combined volume, where 1 = identical plans and 0 = no conformation whatsoever. Gross tumour volumes (GTVs) using ADC and post-contrast T1-weighted sequences were quantitatively the same (related samples Wilcoxon signed rank test = -0.45, p = 0.653) but showed differing conformations (CI 0.53, p < 0.001). The diffusion treatment volume (DTV) obtained by combining the two target volumes was significantly greater than the treatment volume based on post contrast T1-weighted MRI alone, both quantitatively (median 13.65 vs. 9.52 cm 3 , related samples Wilcoxon signed rank test p < 0.001) and qualitatively (CI 0.74, p = 0.001). This DTV covered a greater volume of subsequent tumour recurrence than the standard plan (median 3.53 cm 3 vs. 3.84 cm 3 , p = 0.002). ADC maps may be a useful tool in addition to the standard post-contrast T1-weighted sequence used for SRS planning.

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

Glass transition temperature of hard chairside reline materials after post-polymerisation treatments.

PubMed

Urban, Vanessa M; Machado, Ana L; Alves, Marinês O; Maciel, Adeilton P; Vergani, Carlos E; Leite, Edson R

2010-09-01

This study evaluated the effect of post-polymerisation treatments on the glass transition temperature (T(g)) of five hard chairside reline materials (Duraliner II-D, Kooliner-K, New Truliner-N, Ufi Gel hard-U and Tokuso Rebase Fast-T). Specimens (10 x 10 x 1 mm) were made following the manufacturers' instructions and divided into three groups (n = 5). Control group specimens were left untreated. Specimens from the microwave group were irradiated with pre-determined power/time combinations, and specimens from the water-bath group were immersed in hot water at 55 degrees C for 10 min. Glass transition ( degrees C) was performed by differential scanning calorimetry. Data were analysed using anova, followed by post hoc Tukey's test (alpha = 0.05). Both post-polymerisation treatments promoted a significant (p < 0.05) increase in the T(g) of reline material K. Materials K, D and N showed the lowest T(g) (p < 0.05). No significant difference between T and U specimens was observed. Post-polymerisation treatments improved the glass transition of material Kooliner, with the effect being more pronounced for microwave irradiation.

MR Imaging Based Treatment Planning for Radiotherapy of Prostate Cancer

DTIC Science & Technology

2008-02-01

Radiotherapy, MR-based treatment planning, dosimetry, Monte Carlo dose verification, Prostate Cancer, MRI -based DRRs 16. SECURITY CLASSIFICATION...AcQPlan system Version 5 was used for the study , which is capable of performing dose calculation on both CT and MRI . A four field 3D conformal planning...prostate motion studies for 3DCRT and IMRT of prostate cancer; (2) to investigate and improve the accuracy of MRI -based treatment planning dose calculation

The European post-marketing observational sertindole study: an investigation of the safety of antipsychotic drug treatment.

PubMed

Kasper, Siegfried; Möller, Hans-Jürgen; Hale, Anthony

2010-02-01

The objective of the European Post-marketing Observational Serdolect((R)) (EPOS) Study was to compare the safety of treatment with Serdolect (sertindole) with that of usual treatment in patients with schizophrenia, in normal European clinical practice. The EPOS was a multicentre, multinational, referenced, cohort study. Patients were enrolled at 226 centres in ten European countries. The study was prematurely terminated in 1998 as a result of the temporary market suspension of sertindole. Termination of the study reduced the number of patients recruited from the planned 12,000 to 2,321. While the power of the study was weakened, it did provide useful mortality information, which may be useful for future long-term studies. Crude mortality in the sertindole and non-sertindole groups was 1.45 (95% confidence interval, CI 0.53-3.16) and 1.50 (CI 0.72-2.76) deaths/100 patient-years exposed, respectively. There were no more cardiac deaths in the sertindole group than in the non-sertindole group. QT interval prolongation did not translate into an increased risk of death. Sertindole was well tolerated and caused few extrapyramidal symptoms. Although CIs remained large, this post-marketing study does not provide any evidence against the use of sertindole under normal conditions. Sertindole was well tolerated and posed no significant safety problems.

Correlates of improvement in substance abuse among dually diagnosed veterans with post-traumatic stress disorder in specialized intensive VA treatment.

PubMed

Coker, Kendell L; Stefanovics, Elina; Rosenheck, Robert

2016-01-01

Substantial rates of substance use comorbidity have been observed among veterans with Post-Traumatic Stress Disorder (PTSD), highlighting the need to identify patient and program characteristics associated with improved outcomes for substance abuse. Data were drawn from 12,270 dually diagnosed veterans who sought treatment from specialized intensive Veterans Health Administration PTSD programs between 1993 and 2011. The magnitude of the improvement in Addiction Severity Index (ASI) alcohol and drug use composite scores from baseline was moderate, with effect sizes (ES) of -.269 and -.287, respectively. Multivariate analyses revealed that treatment in longer-term programs, being prescribed psychiatric medication, and planned participation in reunions were all associated with slightly improved outcomes. Reductions in substance use measures were associated with robust improvements in PTSD symptoms and violent behavior. These findings suggest not only synergistic treatment effects linking improvement in PTSD symptoms with substance use disorders among dually diagnosed veterans with PTSD, but also to reductions in violent behavior. Furthermore, the findings indicate that proper discharge planning in addition to intensity and duration of treatment for dually diagnosed veterans with severe PTSD may result in better outcomes. Further dissemination of evidence-based substance abuse treatment may benefit this population. (c) 2016 APA, all rights reserved).

[Calcium and bone metabolism across women's life stages. Pathophysiology, adiagnosis and treatment of post-pregnancy osteoporosis.

PubMed

Kurabayashi, Takumi

Post-pregnancy osteoporosis is a rare condition with little known pathophysiology. Most cases are diagnosed in the late stage of pregnancy or in the post-partum while breastfeeding, particularly in first pregnancy. Vertebral fractures are most commonly observed and characterized by prolonged severe pain and functional limitations. Measurements of bone mineral density(BMD)of the lumbar spine and proximal femur with dual energy X-ray absorptiometry(DXA)are the clinical methods most commonly used for no fracture women. Conventional radiography will confirm the fracture in most cases, and magnetic resonance(MR), which can be safely used during pregnancy, is effective in detecting vertebral fractures and bone marrow edema. Although the bone resorption increased at the end of pregnancy and lactation, the bone formation increases and the bone structure is almost recovered after cessation of lactating in postpartum. There is much uncertainty about whether pharmacological treatments should be used for osteoporosis that presents during pregnancy and lactation. This is partly because of the lack of a firm evidence base for treatment and also because there is a spontaneous recovery of bone mass and strength after pregnancy or weaning.

Effect of surface treatment of fiberglass posts on bond strength to root dentin.

PubMed

Valdivia, Andréa Dolores Correia Miranda; Novais, Veridiana Resende; Menezes, Murilo de Sousa; Roscoe, Marina Guimarães; Estrela, Carlos; Soares, Carlos José

2014-01-01

This study evaluated the influence of the surface treatments of fiberglass posts on bond strength to root dentin using push-out test. Forty bovine incisor roots were endodontically treated. The surface of the fiberglass posts (Exacto #2, Angelus) were treated using 4 different protocols (n=10): Control - 70% ethanol for 1 min; 37% phosphoric acid for 1 min; 10% hydrofluoric acid for 1 min; and 24% hydrogen peroxide for 1 min. After a silane coupling agent was applied for 1 min and all posts were cemented using self-adhesive resin cement (RelyX Unicem, 3M-ESPE). The roots were sectioned and two 1-mm-thick slices were obtained from each third: cervical, middle and apical. The specimens were subjected to the push-out test with a crosshead speed of 0.5 mm/min. Data were analyzed by repeated measures ANOVA followed by Tukey's HSD tests (=0.05). The surface treatment (p<0.001) and root third region (p=0.007) factors were significant. The retention to root canal was affected by surface treatment type. The post surface treatment with 24% hydrogen peroxide for 1 min yielded significantly higher bond strength when the fiberglass posts were cemented with RelyX Unicem.

SERA -- An advanced treatment planning system for neutron therapy and BNCT

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

Nigg, D.W.; Wemple, C.A.; Wessol, D.E.

1999-09-01

Detailed treatment planning calculations on a patient-specific basis are required for boron neutron capture therapy (BNCT). Two integrated treatment planning systems developed specifically for BNCT have been in clinical use in the United States over the past few years. The MacNCTPLAN BNCT treatment planning system is used in the clinical BNCT trials that are underway at the Massachusetts Institute of Technology. A second system, BNCT{_}rtpe (BNCT radiation therapy planning environment), developed independently by the Idaho national Engineering and Environmental Laboratory (INEEL) in collaboration with Montana State University (MSU), is used for treatment planning in the current series of BNCT clinicalmore » trials for glioblastoma at Brookhaven National Laboratory (BNL). This latter system is also licensed for use at several other BNCT research facilities worldwide. Although the currently available BNCT planning systems have served their purpose well, they suffer from somewhat long computation times (2 to 3 CPU-hours or more per field) relative to standard photon therapy planning software. This is largely due to the need for explicit three-dimensional solutions to the relevant transport equations. The simplifying approximations that work well for photon transport computations are not generally applicable to neutron transport computations. Greater computational speeds for BNCT treatment planning must therefore generally be achieved through the application of improved numerical techniques rather than by simplification of the governing equations. Recent efforts at INEEL and MSU have been directed toward this goal. This has resulted in a new paradigm for this type of calculation and the subsequent creation of the new simulation environment for radiotherapy applications (SERA) treatment planning system for BNCT. SERA is currently in initial clinical testing in connection with the trials at BNL, and it is expected to replace the present BNCT{_}rtpe system upon general

The Great East Japan Earthquake: a need to plan for post-disaster surveillance in developed countries

PubMed Central

Matsui, Tamano; Partridge, Jeffrey; Kasai, Takeshi

2011-01-01

After a devastating earthquake and tsunami struck north-eastern Japan in March 2011, the public health system, including the infectious disease surveillance system, was severely compromised. While models for post-disaster surveillance exist, they focus predominantly on developing countries during the early recovery phase. Such models do not necessarily apply to developed countries, which differ considerably in their baseline surveillance systems. Furthermore, there is a need to consider the process by which a surveillance system recovers post-disaster. The event in Japan has highlighted a need to address these concerns surrounding post-disaster surveillance in developed countries. In May 2011, the World Health Organization convened a meeting where post-disaster surveillance was discussed by experts and public health practitioners. In this paper, we describe a post-disaster surveillance approach that was discussed at the meeting, based on what had actually occurred and what may have been, or would be, ideal. Briefly, we describe the evolution of a surveillance system as it returns to the pre-existing system, starting from an event-based approach during the emergency relief phase, a syndromic approach during the early recovery phase, an enhanced sentinel approach during the late recovery phase and a return to baseline during the development phase. Our aim is not to recommend a specific model but to encourage other developed countries to initiate their own discussions on post-disaster surveillance and develop plans according to their needs and capacities. As natural disasters will continue to occur, we hope that developing such plans during the “inter-disaster” period will help mitigate the surveillance challenges that will arise post-disaster. PMID:23908893

Rutosides for treatment of post-thrombotic syndrome.

PubMed

Morling, Joanne R; Yeoh, Su Ern; Kolbach, Dinanda N

2015-09-16

Post-thrombotic syndrome (PTS) is a long-term complication of deep venous thrombosis (DVT) that is characterised by pain, swelling, and skin changes in the affected limb. One in three patients with DVT will develop post-thrombotic sequelae within five years. Rutosides are a group of compounds derived from horse chestnut (Aesculus hippocastanum), a traditional herbal remedy for treating oedema formation in chronic venous insufficiency (CVI). However, it is not known whether rutosides are effective and safe in the treatment of PTS. This is an update of the review first published in 2013. To determine the effectiveness (improvement or deterioration in symptoms) and safety of rutosides for treatment of post-thrombotic syndrome (PTS) in patients with DVT compared to placebo, no intervention, elastic compression stockings (ECS) or any other treatment. For this update the Cochrane Vascular Group Trials Search Co-ordinator searched the Specialised Register (last searched September 2015) and the Cochrane Register of Studies (CRS) (CENTRAL (2015, Issue 8)). Clinical trials databases were searched for details of ongoing and unpublished studies. Two review authors (JM and DNK) independently assessed studies for inclusion. Studies were included to allow the comparison of rutosides versus placebo or no treatment, rutosides versus ECS, and rutosides versus any other treatment. Two review authors (JM and SEY) extracted information from the trials. Disagreements were resolved by discussion. Data were extracted using designated data extraction forms. The Cochrane risk of bias tool was used for all included studies to assist in the assessment of quality. Primary outcome measures were the occurrence of leg ulceration over time (yes or no) and any improvement or deterioration of post-thrombotic syndrome (yes or no). Secondary outcomes included reduction of oedema, pain, recurrence of deep venous thrombosis or pulmonary embolism, compliance with therapy, and adverse effects. All of the

Monte Carlo treatment planning with modulated electron radiotherapy: framework development and application

NASA Astrophysics Data System (ADS)

Alexander, Andrew William

Within the field of medical physics, Monte Carlo radiation transport simulations are considered to be the most accurate method for the determination of dose distributions in patients. The McGill Monte Carlo treatment planning system (MMCTP), provides a flexible software environment to integrate Monte Carlo simulations with current and new treatment modalities. A developing treatment modality called energy and intensity modulated electron radiotherapy (MERT) is a promising modality, which has the fundamental capabilities to enhance the dosimetry of superficial targets. An objective of this work is to advance the research and development of MERT with the end goal of clinical use. To this end, we present the MMCTP system with an integrated toolkit for MERT planning and delivery of MERT fields. Delivery is achieved using an automated "few leaf electron collimator" (FLEC) and a controller. Aside from the MERT planning toolkit, the MMCTP system required numerous add-ons to perform the complex task of large-scale autonomous Monte Carlo simulations. The first was a DICOM import filter, followed by the implementation of DOSXYZnrc as a dose calculation engine and by logic methods for submitting and updating the status of Monte Carlo simulations. Within this work we validated the MMCTP system with a head and neck Monte Carlo recalculation study performed by a medical dosimetrist. The impact of MMCTP lies in the fact that it allows for systematic and platform independent large-scale Monte Carlo dose calculations for different treatment sites and treatment modalities. In addition to the MERT planning tools, various optimization algorithms were created external to MMCTP. The algorithms produced MERT treatment plans based on dose volume constraints that employ Monte Carlo pre-generated patient-specific kernels. The Monte Carlo kernels are generated from patient-specific Monte Carlo dose distributions within MMCTP. The structure of the MERT planning toolkit software and

Family Planning in Substance Use Disorder Treatment Centers: Opportunities and Challenges.

PubMed

Robinowitz, Natanya; Muqueeth, Sadiya; Scheibler, Jill; Salisbury-Afshar, Elizabeth; Terplan, Mishka

2016-09-18

Alcohol, tobacco, and drug use during pregnancy can cause a range of adverse birth outcomes. Promoting family planning among women with substance use disorders (SUD) can help reduce substance exposed pregnancies. We conducted qualitative research to determine the acceptability and feasibility of offering family planning education and services SUD treatment centers. Focus groups and in-depth interviews were conducted with clients, staff and medical providers at three treatment centers. Interviews were transcribed and data was analyzed using a flexible coding scheme. Clients reported being interested in family planning services while they were in treatment. Most preferred to receive these services onsite. Providers also felt that services should be received onsite, though cited several barriers to implementation, including time constraints and staff levels of comfort with the subject. Women in SUD treatment are open to the integration of family planning services into treatment. Treatment centers have the opportunity to serve as models of client-centered health homes that offer a variety of educational, preventive, and medical services for women in both treatment and recovery.

Microstructural inhomogeneity in plasma-sprayed hydroxyapatite coatings and effect of post-heat treatment

NASA Astrophysics Data System (ADS)

Lu, Yu-Peng; Xiao, Gui-Yong; Li, Shi-Tong; Sun, Rui-Xue; Li, Mu-Sen

2006-01-01

The microstructural inhomogeneity in the plasma-sprayed hydroxyapatite (HA) coatings was characterized by using electron probe microanalyser (EPMA). A simple and artful method was developed to detect the interface characteristics. All the samples for observation were ground and polished along the direction parallel to the coating surfaces. The BSE images directly and clearly showed the inhomogeneity in the as-sprayed coatings with the amorphous regions being bright gray and crystalline regions being dark gray. X-ray diffractometer (XRD) patterns indicated that after immersion in deionized water for 20 days, bone-like apatite and α-Ca 2P 2O 7 precipitated on the polished surfaces of the as-sprayed HA coatings. The post-heat treatment could eliminate the microstructural inhomogeneity in the coatings. Only β-Ca 2P 2O 7 precipitated on the surfaces of the heat-treated HA coatings. The immersed samples were re-polished till tiny substrate was bared to investigate the effect of immersion on interface. It was shown that the immersion decreased the cohesive strength of the as-sprayed coatings. There were more and broader cracks in the splats that came into contact with the substrate and amorphous phase increased toward the coating-substrate interface. Post-heat treatment was proved to reduce the peeling off of coating during re-polishing operation. It was proposed that the distributions of amorphous phase and cracks in as-sprayed coatings are detrimental to coating properties and should be modified through improving the plasma spraying processing.

MO-D-BRB-01: Pediatric Treatment Planning I: Overview of Planning Strategies and Challenges

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

Olch, A.

Most Medical Physicists working in radiotherapy departments see few pediatric patients. This is because, fortunately, children get cancer at a rate nearly 100 times lower than adults. Children have not smoked, abused alcohol, or been exposed to environmental carcinogens for decades, and of course, have not fallen victim to the aging process. Children get very different cancers than adults. Breast or prostate cancers, typical in adults, are rarely seen in children but instead a variety of tumors occur in children that are rarely seen in adults; examples are germinomas, ependymomas and primitive neuroectodermal tumors, which require treatment of the child’smore » brain or neuroblastoma, requiring treatment in the abdomen. The treatment of children with cancer using radiation therapy is one of the most challenging planning and delivery problems facing the physicist. This is because bones, brain, breast tissue, and other organs are more sensitive to radiation in children than in adults. Because most therapy departments treat mostly adults, when the rare 8 year-old patient comes to the department for treatment, the physicist may not understand the clinical issues of his disease which drive the planning and delivery decisions. Additionally, children are more prone than adults to developing secondary cancers after radiation. For bilateral retinoblastoma for example, an irradiated child has a 40% chance of developing a second cancer by age 50. The dosimetric tradeoffs made during the planning process are complex and require careful consideration for children treated with radiotherapy. In the first presentation, an overview of childhood cancers and their corresponding treatment techniques will be given. These can be some of the most complex treatments that are delivered in the radiation therapy department. These cancers include leukemia treated with total body irradiation, medulloblastoma, treated with craniospinal irradiation plus a conformal boost to the posterior

Personal network structure and substance use in women by 12 months post treatment intake

PubMed Central

Tracy, Elizabeth M.; Min, Meeyoung O.; Park, Hyunyong; Jun, MinKyoung; Brown, Suzanne; Francis, Meredith W.

2015-01-01

Introduction Women with substance use disorders enter treatment with limited personal network resources and reduced recovery support. This study examined the impact of personal networks on substance use by 12 months post treatment intake. Methods Data were collected from 284 women who received substance abuse treatment. At six month follow up, composition, support availability and structure of personal networks were examined. Substance use was measured by women’s report of any use of alcohol or drugs. Hierarchical multivariate logistic regression was conducted to examine the contribution of personal network characteristics on substance use by 12 months post treatment intake. Results Higher numbers of substance using alters (network members) and more densely connected networks at six month follow-up were associated with an increased likelihood of substance use by 12 months post treatment intake. A greater number of isolates in women’s networks was associated with decreased odds of substance use. Women who did not use substances by 12 months post treatment intake had more non-users among their isolates at six months compared to those who used substances. No association was found between support availability and likelihood of substance use. Conclusions Both network composition and structure could be relevant foci for network interventions e.g. helping women change network composition by reducing substance users as well as increasing network connections. Isolates who are not substance users may be a particular strength to help women cultivate within their network to promote sustained sobriety post treatment. PMID:26712040

WE-G-16A-01: Evolution of Radiation Treatment Planning

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

Rothenberg, L; Mohan, R; Van Dyk, J

Welcome and Introduction - Lawrence N. Rothenberg This symposium is one a continuing series of presentations at AAPM Annual Meetings on the historical aspects of medical physics, radiology, and radiation oncology that have been organized by the AAPM History Committee. Information on previous presentations including “Early Developments in Teletherapy” (Indianapolis 2013), “Historical Aspects of Cross-Sectional Imaging” (Charlotte 2012), “Historical Aspects of Brachytherapy” (Vancouver 2011), “50 Years of Women in Medical Physics” (Houston 2008), and “Roentgen's Early Investigations” (Minneapolis 2007) can be found in the Education Section of the AAPM Website. The Austin 2014 History Symposium will be on “Evolution ofmore » Radiation Treatment Planning.” Overview - Radhe Mohan Treatment planning is one of the most critical components in the chain of radiation therapy of cancers. Treatment plans of today contain a wide variety of sophisticated information conveying the potential clinical effectiveness of the designed treatment to practitioners. Examples of such information include dose distributions superimposed on three- or even four-dimensional anatomic images; dose volume histograms, dose, dose-volume and dose-response indices for anatomic structures of interest; etc. These data are used for evaluating treatment plans and for making treatment decisions. The current state-of-the-art has evolved from the 1940s era when the dose to the tumor and normal tissues was estimated approximately by manual means. However, the symposium will cover the history of the field from the late-1950's, when computers were first introduced for treatment planning, to the present state involving the use of high performance computing and advanced multi-dimensional anatomic, functional and biological imaging, focusing only on external beam treatment planning. The symposium will start with a general overview of the treatment planning process including imaging

Treatment plan comparison between helical tomotherapy and MLC-based IMRT using radiobiological measures

NASA Astrophysics Data System (ADS)

Mavroidis, Panayiotis; Costa Ferreira, Brigida; Shi, Chengyu; Lind, Bengt K.; Papanikolaou, Nikos

2007-07-01

The rapid implementation of advanced treatment planning and delivery technologies for radiation therapy has brought new challenges in evaluating the most effective treatment modality. Intensity-modulated radiotherapy (IMRT) using multi-leaf collimators (MLC) and helical tomotherapy (HT) are becoming popular modes of treatment delivery and their application and effectiveness continues to be investigated. Presently, there are several treatment planning systems (TPS) that can generate and optimize IMRT plans based on user-defined objective functions for the internal target volume (ITV) and organs at risk (OAR). However, the radiobiological parameters of the different tumours and normal tissues are typically not taken into account during dose prescription and optimization of a treatment plan or during plan evaluation. The suitability of a treatment plan is typically decided based on dosimetric criteria such as dose-volume histograms (DVH), maximum, minimum, mean and standard deviation of the dose distribution. For a more comprehensive treatment plan evaluation, the biologically effective uniform dose ({\\bar{\\bar{D}}}) is applied together with the complication-free tumour control probability (P+). Its utilization is demonstrated using three clinical cases that were planned with two different forms of IMRT. In this study, three different cancer types at different anatomical sites were investigated: head and neck, lung and prostate cancers. For each cancer type, a linac MLC-based step-and-shoot IMRT plan and a HT plan were developed. The MLC-based IMRT treatment plans were developed on the Philips treatment-planning platform, using the Pinnacle 7.6 software release. For the tomotherapy HiArt plans, the dedicated tomotherapy treatment planning station was used, running version 2.1.2. By using {\\bar{\\bar{D}}} as the common prescription point of the treatment plans and plotting the tissue response probabilities versus {\\bar{\\bar{D}}} for a range of prescription doses

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

PubMed Central

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

2016-01-01

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 mathematically 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 participants, 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

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

10 CFR 60.17 - Contents of site characterization plan.

Code of Federal Regulations, 2010 CFR

2010-01-01

... GEOLOGIC REPOSITORIES Licenses Preapplication Review § 60.17 Contents of site characterization plan. The... construction authorization for a geologic repository operations area; (4) Criteria, developed pursuant to... area for the location of a geologic repository; and (5) Any other information which the Commission, by...

"Before the war we had it all": Family planning among couples in a post-conflict setting.

PubMed

Warren, Nicole; Alvarez, Carmen; Makambo, Maphie Tosha; Johnson-Agbakwu, Crista; Glass, Nancy

2017-08-01

There is little evidence about family planning knowledge, attitudes, and use among couples in post-conflict Democratic Republic of the Congo. We used qualitative descriptions to analyze data from 75 participants. Intimate partner violence (IPV) was common among participants. They were aware of family planning methods; however, IPV and fears of side effects were barriers to use. Although participants were concerned about the cost of large families, had positive attitudes toward family planning, and intended to use it, actual use was uncommon. The need for family planning was acute because of war-related poverty. Couples negotiated, but men had strong influence over family planning decisions. Couples saw health workers as a valuable resource. Interventions in this setting should include a couple-based approach that addresses IPV as well as family planning content.

Comparing Pre- and Post-Operative Fontan Hemodynamic Simulations: Implications for the Reliability of Surgical Planning

PubMed Central

Haggerty, Christopher M.; de Zélicourt, Diane A.; Restrepo, Maria; Rossignac, Jarek; Spray, Thomas L.; Kanter, Kirk R.; Fogel, Mark A.; Yoganathan, Ajit P.

2012-01-01

Background Virtual modeling of cardiothoracic surgery is a new paradigm that allows for systematic exploration of various operative strategies and uses engineering principles to predict the optimal patient-specific plan. This study investigates the predictive accuracy of such methods for the surgical palliation of single ventricle heart defects. Methods Computational fluid dynamics (CFD)-based surgical planning was used to model the Fontan procedure for four patients prior to surgery. The objective for each was to identify the operative strategy that best distributed hepatic blood flow to the pulmonary arteries. Post-operative magnetic resonance data were acquired to compare (via CFD) the post-operative hemodynamics with predictions. Results Despite variations in physiologic boundary conditions (e.g., cardiac output, venous flows) and the exact geometry of the surgical baffle, sufficient agreement was observed with respect to hepatic flow distribution (90% confidence interval-14 ± 4.3% difference). There was also good agreement of flow-normalized energetic efficiency predictions (19 ± 4.8% error). Conclusions The hemodynamic outcomes of prospective patient-specific surgical planning of the Fontan procedure are described for the first time with good quantitative comparisons between preoperatively predicted and postoperative simulations. These results demonstrate that surgical planning can be a useful tool for single ventricle cardiothoracic surgery with the ability to deliver significant clinical impact. PMID:22777126

Draft Plan for Characterizing Commercial Data Products in Support of Earth Science Research

NASA Technical Reports Server (NTRS)

Ryan, Robert E.; Terrie, Greg; Berglund, Judith

2006-01-01

This presentation introduces a draft plan for characterizing commercial data products for Earth science research. The general approach to the commercial product verification and validation includes focused selection of a readily available commercial remote sensing products that support Earth science research. Ongoing product verification and characterization will question whether the product meets specifications and will examine its fundamental properties, potential and limitations. Validation will encourage product evaluation for specific science research and applications. Specific commercial products included in the characterization plan include high-spatial-resolution multispectral (HSMS) imagery and LIDAR data products. Future efforts in this process will include briefing NASA headquarters and modifying plans based on feedback, increased engagement with the science community and refinement of details, coordination with commercial vendors and The Joint Agency Commercial Imagery Evaluation (JACIE) for HSMS satellite acquisitions, acquiring waveform LIDAR data and performing verification and validation.

Statistical control process to compare and rank treatment plans in radiation oncology: impact of heterogeneity correction on treatment planning in lung cancer.

PubMed

Chaikh, Abdulhamid; Balosso, Jacques

2016-12-01

This study proposes a statistical process to compare different treatment plans issued from different irradiation techniques or different treatment phases. This approach aims to provide arguments for discussion about the impact on clinical results of any condition able to significantly alter dosimetric or ballistic related data. The principles of the statistical investigation are presented in the framework of a clinical example based on 40 fields of radiotherapy for lung cancers. Two treatment plans were generated for each patient making a change of dose distribution due to variation of lung density correction. The data from 2D gamma index (γ) including the pixels having γ≤1 were used to determine the capability index (Cp) and the acceptability index (Cpk) of the process. To measure the strength of the relationship between the γ passing rates and the Cp and Cpk indices, the Spearman's rank non-parametric test was used to calculate P values. The comparison between reference and tested plans showed that 95% of pixels have γ≤1 with criteria (6%, 6 mm). The values of the Cp and Cpk indices were lower than one showing a significant dose difference. The data showed a strong correlation between γ passing rates and the indices with P>0.8. The statistical analysis using Cp and Cpk, show the significance of dose differences resulting from two plans in radiotherapy. These indices can be used for adaptive radiotherapy to measure the difference between initial plan and daily delivered plan. The significant changes of dose distribution could raise the question about the continuity to treat the patient with the initial plan or the need for adjustments.

WE-A-BRD-01: Innovation in Radiation Therapy Planning I: Knowledge Guided Treatment Planning

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

Wu, Q; Olsen, L

2014-06-15

Intensity modulated radiation therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) offer the capability of normal tissues and organs sparing. However, the exact amount of sparing is often unknown until the plan is complete. This lack of prior guidance has led to the iterative, trial and-error approach in current planning practice. Even with this effort the search for patient-specific optimal organ sparing is still strongly influenced by planner's experience. While experience generally helps in maximizing the dosimetric advantages of IMRT/VMAT, there have been several reports showing unnecessarily high degree of plan quality variability at individual institutions and amongst different institutions,more » even with a large amount of experience and the best available tools. Further, when physician and physicist evaluate a plan, the dosimetric quality of the plan is often compared with a standard protocol that ignores individual patient anatomy and tumor characteristic variations. In recent years, developments of knowledge models for clinical IMRT/VMAT planning guidance have shown promising clinical potentials. These knowledge models extract past expert clinical experience into mathematical models that predict dose sparing references at patient-specific level. For physicians and planners, these references provide objective values that reflect best achievable dosimetric constraints. For quality assurance, applying patient-specific dosimetry requirements will enable more quantitative and objective assessment of protocol compliance for complex IMRT planning. Learning Objectives: Modeling and representation of knowledge for knowledge-guided treatment planning. Demonstrations of knowledge-guided treatment planning with a few clinical caanatomical sites. Validation and evaluation of knowledge models for cost and quality effective standardization of plan optimization.« less

Interobserver reliability of computed tomographic contouring of canine tonsils in radiation therapy treatment planning.

PubMed

Murakami, Keiko; Rancilio, Nicholas J; Plantenga, Jeannie Poulson; Moore, George E; Heng, Hock Gan; Lim, Chee Kin

2018-05-01

In radiation therapy (RT) treatment planning for canine head and neck cancer, the tonsils may be included as part of the treated volume. Delineation of tonsils on computed tomography (CT) scans is difficult. Error or uncertainty in the volume and location of contoured structures may result in treatment failure. The purpose of this prospective, observer agreement study was to assess the interobserver agreement of tonsillar contouring by two groups of trained observers. Thirty dogs undergoing pre- and post-contrast CT studies of the head were included. After the pre- and postcontrast CT scans, the tonsils were identified via direct visualization, barium paste was applied bilaterally to the visible tonsils, and a third CT scan was acquired. Data from each of the three CT scans were registered in an RT treatment planning system. Two groups of observers (one veterinary radiologist and one veterinary radiation oncologist in each group) contoured bilateral tonsils by consensus, obtaining three sets of contours. Tonsil volume and location data were obtained from both groups. The contour volumes and locations were compared between groups using mixed (fixed and random effect) linear models. There was no significant difference between each group's contours in terms of three-dimensional coordinates. However there was a significant difference between each group's contours in terms of the tonsillar volume (P < 0.0001). Pre- and postcontrast CT can be used to identify the location of canine tonsils with reasonable agreement between trained observers. Discrepancy in tonsillar volume between groups of trained observers may affect RT treatment outcome. © 2017 American College of Veterinary Radiology.

Effects of spot parameters in pencil beam scanning treatment planning.

PubMed

Kraan, Aafke Christine; Depauw, Nicolas; Clasie, Ben; Giunta, Marina; Madden, Tom; Kooy, Hanne M

2018-01-01

Spot size σ (in air at isocenter), interspot spacing d, and spot charge q influence dose delivery efficiency and plan quality in Intensity Modulated Proton Therapy (IMPT) treatment planning. The choice and range of parameters varies among different manufacturers. The goal of this work is to demonstrate the influence of the spot parameters on dose quality and delivery in IMPT treatment plans, to show their interdependence, and to make practitioners aware of the spot parameter values for a certain facility. Our study could help as a guideline to make the trade-off between treatment quality and time in existing PBS centers and in future systems. We created plans for seven patients and a phantom, with different tumor sites and volumes, and compared the effect of small-, medium-, and large-spot widths (σ = 2.5, 5, and 10 mm) and interspot distances (1σ, 1.5σ, and 1.75σ) on dose, spot charge, and treatment time. Moreover, we quantified how postplanning charge threshold cuts affect plan quality and the total number of spots to deliver, for different spot widths and interspot distances. We show the effect of a minimum charge (or MU) cutoff value for a given proton delivery system. Spot size had a strong influence on dose: larger spots resulted in more protons delivered outside the target region. We observed dose differences of 2-13 Gy (RBE) between 2.5 mm and 10 mm spots, where the amount of extra dose was due to dose penumbra around the target region. Interspot distance had little influence on dose quality for our patient group. Both parameters strongly influence spot charge in the plans and thus the possible impact of postplanning charge threshold cuts. If such charge thresholds are not included in the treatment planning system (TPS), it is important that the practitioner validates that a given combination of lower charge threshold, interspot spacing, and spot size does not result in a plan degradation. Low average spot charge occurs for small spots, small interspot

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

Poster — Thur Eve — 32: Stereotactic Body Radiation Therapy for Peripheral Lung Lesion: Treatment Planning and Quality Assurance

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

Wan, Shuying; Oliver, Michael; Wang, Xiaofang

2014-08-15

Stereotactic body radiation therapy (SBRT), due to its high precision for target localizing, has become widely used to treat tumours at various locations, including the lungs. Lung SBRT program was started at our institution a year ago. Eighteen patients with peripheral lesions up to 3 cm diameter have been treated with 48 Gy in 4 fractions. Based on four-dimensional computed tomography (4DCT) simulation, internal target volume (ITV) was delineated to encompass the respiratory motion of the lesion. A margin of 5 mm was then added to create the planning target volume (PTV) for setup uncertainties. There was no expansion frommore » gross tumour volume (GTV) to clinical target volume (CTV). Pinnacle 9.6 was used as the primary treatment planning system. Volumetric modulated arc therapy (VMAT) technique, with one or two coplanar arcs, generally worked well. For quality assurance (QA), each plan was exported to Eclipse 10 and dose calculation was repeated. Dose volume histograms (DVHs) of the targets and organs at risk (OARs) were then compared between the two treatment planning systems. Winston-Lutz tests were carried out as routine machine QA. Patient-specific QA included ArcCheck measurement with an insert, where an ionization chamber was placed at the centre to measure dose at the isocenter. For the first several patients, and subsequently for the plans with extremely strong modulation, Gafchromic film dosimetry was also employed. For each patient, a mock setup was scheduled prior to treatments. Daily pre- and post-CBCT were acquired for setup and assessment of intra-fractional motion, respectively.« less

Tongue acupuncture in treatment of post-stroke dysphagia

PubMed Central

Cai, Haiyan; Ma, Benxu; Gao, Xia; Gao, Huanmin

2015-01-01

Tongue acupuncture is a technique that treats illness through acupuncture applied to the tongue. This study was designed to assess its therapeutic effects in the treatment of post-stroke dysphagia. A clinical control study was conducted with randomly selected 180 patients with post-stroke dysphagia. The patients were assigned into 2 groups: 90 in the Tongue acupuncture group received tongue acupuncture on the basis of conventional medication, 90 in the conventional acupuncture group received acupuncture on the neck and wrist. Acupoints in the tongue are Juanquan (EX-HN10) (at the midpoint of dorsal raphe of the tongue) and Haiquan (EX-HN11) (Sublingual frenulum midpoint). Acupoits on the body are Fengchi (GB20) and Neiguan (PC6). The effective rate, the national institutes of health stroke scale (NIHSS), TV X-ray fluoroscopy swallowing function (VFSS), the incidence rate of pneumonia were used to evaluate the efficacy after 4 weeks treatment. The NIHSS and VFSS of tongue acupuncture group were improved significantly than that of the conventional group (P < 0.01, respectively). The incidence rate of pneumonia decreased (P < 0. 01). The effective rate of the tongue acupuncture group was higher than that of conventional group (96.67% vs. 66.67%, P < 0. 01). On the basis of the conventional medication, tongue acupuncture would effectively improve the swallow functions, decrease the neurological deficit and reduce the incidence of pneumonia in patients with post-stroke dysphagia. PMID:26550374

Screening, diagnosis, and treatment of post-traumatic stress disorder.

PubMed

Wisco, Blair E; Marx, Brian P; Keane, Terence M

2012-08-01

Post-traumatic stress disorder (PTSD) is a prevalent problem among military personnel and veterans. Identification of effective screening tools, diagnostic technologies, and treatments for PTSD is essential to ensure that all individuals in need of treatment are offered interventions with proven efficacy. Well-validated methods for screening and diagnosing PTSD are now available, and effective pharmacological and psychological treatments can be offered. Despite these advances, many military personnel and veterans do not receive evidence-based care. We review the literature on screening, diagnosis, and treatment of PTSD in military populations, and discuss the challenges to implementing the best evidence-based practices in clinical settings.

Recent Advances in Physical Post-Harvest Treatments for Shelf-Life Extension of Cereal Crops

PubMed Central

Schmidt, Marcus; Zannini, Emanuele; Arendt, Elke K.

2018-01-01

As a result of the rapidly growing global population and limited agricultural area, sufficient supply of cereals for food and animal feed has become increasingly challenging. Consequently, it is essential to reduce pre- and post-harvest crop losses. Extensive research, featuring several physical treatments, has been conducted to improve cereal post-harvest preservation, leading to increased food safety and sustainability. Various pests can lead to post-harvest losses and grain quality deterioration. Microbial spoilage due to filamentous fungi and bacteria is one of the main reasons for post-harvest crop losses and mycotoxins can induce additional consumer health hazards. In particular, physical treatments have gained popularity making chemical additives unnecessary. Therefore, this review focuses on recent advances in physical treatments with potential applications for microbial post-harvest decontamination of cereals. The treatments discussed in this article were evaluated for their ability to inhibit spoilage microorganisms and degrade mycotoxins without compromising the grain quality. All treatments evaluated in this review have the potential to inhibit grain spoilage microorganisms. However, each method has some drawbacks, making industrial application difficult. Even under optimal processing conditions, it is unlikely that cereals can be decontaminated of all naturally occurring spoilage organisms with a single treatment. Therefore, future research should aim for the development of a combination of treatments to harness their synergistic properties and avoid grain quality deterioration. For the degradation of mycotoxins the same conclusion can be drawn. In addition, future research must investigate the fate of degraded toxins, to assess the toxicity of their respective degradation products. PMID:29565832

3D geophysical imaging for site-specific characterization plan of an old landfill.

PubMed

Di Maio, R; Fais, S; Ligas, P; Piegari, E; Raga, R; Cossu, R

2018-06-01

As it is well-known, the characterization plan of an old landfill site is the first stage of the project for the treatment and reclamation of contaminated lands. It is a preliminary in-situ study, with collection of data related to pollution phenomena, and is aimed at defining the physical properties and the geometry of fill materials as well as the possible migration paths of pollutants to the surrounding environmental targets (subsoil and groundwater). To properly evaluate the extent and potential for subsoil contamination, waste volume and possible leachate emissions from the landfill have to be assessed. In such perspective, the integrated use of geophysical methods is an important tool as it allows a detailed 3D representation of the whole system, i.e. waste body and hosting environment (surrounding rocks). This paper presents a very accurate physical and structural characterization of an old landfill and encasing rocks obtained by an integrated analysis of data coming from a multi-methodological geophysical exploration. Moreover, drillings were carried out for waste sampling and characterization of the landfill body, as well as for calibration of the geophysical modeling. Copyright © 2018 Elsevier Ltd. All rights reserved.

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

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

SU-F-SPS-10: The Dosimetric Comparison of GammaKnife and Cyberknife Treatment Plans for Brain SRS Treatment

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

Sanli, E; Mabhouti, H; Cebe, M

Purpose: Brain stereotactic radiosurgery (SRS) involves the use of precisely directed, single session radiation to create a desired radiobiologic response within the brain target with acceptable minimal effects on surrounding structures or tissues. In this study, the dosimetric comparison of GammaKnife perfection and Cyberknife M6 treatment plans were made. Methods: Treatment plannings were done for GammaKnife perfection unit using Gammaplan treatment planning system (TPS) on the CT scan of head and neck randophantom simulating the treatment of sterotactic treatments for one brain metastasis. The dose distribution were calculated using TMR 10 algorithm. The treatment planning for the same target weremore » also done for Cyberknife M6 machine using Multiplan (TPS) with Monte Carlo algorithm. Using the same film batch, the net OD to dose calibration curve was obtained using both machine by delivering 0- 800 cGy. Films were scanned 48 hours after irradiation using an Epson 1000XL flatbed scanner. Dose distribution were measured using EBT3 film dosimeter. The measured and calculated doses were compared. Results: The dose distribution in the target and 2 cm beyond the target edge were calculated on TPSs and measured using EBT3 film. For cyberknife treatment plans, the gamma analysis passing rates between measured and calculated dose distributions were 99.2% and 96.7% for target and peripheral region of target respectively. For gammaknife treatment plans, the gamma analysis passing rates were 98.9% and 93.2% for target and peripheral region of target respectively. Conclusion: The study shows that dosimetrically comparable plans are achievable with Cyberknife and GammaKnife. Although TMR 10 algorithm predicts the target dose.« less

SU-F-J-94: Development of a Plug-in Based Image Analysis Tool for Integration Into Treatment Planning

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

Owen, D; Anderson, C; Mayo, C

Purpose: To extend the functionality of a commercial treatment planning system (TPS) to support (i) direct use of quantitative image-based metrics within treatment plan optimization and (ii) evaluation of dose-functional volume relationships to assist in functional image adaptive radiotherapy. Methods: A script was written that interfaces with a commercial TPS via an Application Programming Interface (API). The script executes a program that performs dose-functional volume analyses. Written in C#, the script reads the dose grid and correlates it with image data on a voxel-by-voxel basis through API extensions that can access registration transforms. A user interface was designed through WinFormsmore » to input parameters and display results. To test the performance of this program, image- and dose-based metrics computed from perfusion SPECT images aligned to the treatment planning CT were generated, validated, and compared. Results: The integration of image analysis information was successfully implemented as a plug-in to a commercial TPS. Perfusion SPECT images were used to validate the calculation and display of image-based metrics as well as dose-intensity metrics and histograms for defined structures on the treatment planning CT. Various biological dose correction models, custom image-based metrics, dose-intensity computations, and dose-intensity histograms were applied to analyze the image-dose profile. Conclusion: It is possible to add image analysis features to commercial TPSs through custom scripting applications. A tool was developed to enable the evaluation of image-intensity-based metrics in the context of functional targeting and avoidance. In addition to providing dose-intensity metrics and histograms that can be easily extracted from a plan database and correlated with outcomes, the system can also be extended to a plug-in optimization system, which can directly use the computed metrics for optimization of post-treatment tumor or normal tissue

78 FR 36571 - Extension of Post-Sale Evaluation Period for Central Gulf of Mexico Planning Area Lease Sale 227

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-18

... DEPARTMENT OF THE INTERIOR Bureau of Ocean Energy Management [MMAA104000] Extension of Post-Sale Evaluation Period for Central Gulf of Mexico Planning Area Lease Sale 227 AGENCY: Bureau of Ocean Energy Management (BOEM), Interior. ACTION: Notice to Extend Post-Sale Evaluation Period. SUMMARY: This notice...

Personal Development Planning in Initial Teacher Training: A Case Study from Post-Compulsory Education

ERIC Educational Resources Information Center

Thompson, Ron; Hallwood, Linda; Clements, Christine; Rivron, Helen

2009-01-01

This paper provides a case study of personal development planning (PDP) within an initial teacher training course for the post-compulsory sector, delivered through a large consortium in the north of England. The paper reviews conceptual and empirical studies of PDP in higher education and reports on the practice and perceptions of students and…

Treatment planning considerations for molar uprighting.

PubMed

Kaur, Harsimrat; Pavithra, U S; Shabeer, N N; Reji, Abraham

2014-01-01

Molar uprighting cases require individualized treatment planning depending upon condition of ridge, growth pattern of patient, periodontal condition, lower facial height, position of third molar and anchorage. Uprighting of molar was done in two cases--effectively using simple tip back spring in one case and implant in another.

9 CFR 430.4 - Control of Listeria monocytogenes in post-lethality exposed ready-to-eat products.

Code of Federal Regulations, 2011 CFR

2011-01-01

... products must control through its HACCP plan or prevent in the processing environment through a Sanitation...: (i) The post-lethality treatment must be included in the establishment's HACCP plan. The... the establishment's HACCP plan or its Sanitation SOP or other prerequisite program. (ii) The...

9 CFR 430.4 - Control of Listeria monocytogenes in post-lethality exposed ready-to-eat products.

Code of Federal Regulations, 2010 CFR

2010-01-01

... products must control through its HACCP plan or prevent in the processing environment through a Sanitation...: (i) The post-lethality treatment must be included in the establishment's HACCP plan. The... the establishment's HACCP plan or its Sanitation SOP or other prerequisite program. (ii) The...

Assessment to Guide Individualized Transition Plans from School to Post-School for Children Ages 14+ with Moderate Disabilities

ERIC Educational Resources Information Center

Skidmore, Kevin

2014-01-01

As a part of the Individualized Education Plan (IEP), special education teachers work along with their student with special needs and their parent(s)/guardian(s) to create and implement Individualized Transition Plans (ITP) to assist the student with their transition to the post-school environment. As mandated by Individuals with Disabilities…

SPIDERplan: A tool to support decision-making in radiation therapy treatment plan assessment.

PubMed

Ventura, Tiago; Lopes, Maria do Carmo; Ferreira, Brigida Costa; Khouri, Leila

2016-01-01

In this work, a graphical method for radiotherapy treatment plan assessment and comparison, named SPIDERplan, is proposed. It aims to support plan approval allowing independent and consistent comparisons of different treatment techniques, algorithms or treatment planning systems. Optimized plans from modern radiotherapy are not easy to evaluate and compare because of their inherent multicriterial nature. The clinical decision on the best treatment plan is mostly based on subjective options. SPIDERplan combines a graphical analysis with a scoring index. Customized radar plots based on the categorization of structures into groups and on the determination of individual structures scores are generated. To each group and structure, an angular amplitude is assigned expressing the clinical importance defined by the radiation oncologist. Completing the graphical evaluation, a global plan score, based on the structures score and their clinical weights, is determined. After a necessary clinical validation of the group weights, SPIDERplan efficacy, to compare and rank different plans, was tested through a planning exercise where plans had been generated for a nasal cavity case using different treatment planning systems. SPIDERplan method was applied to the dose metrics achieved by the nasal cavity test plans. The generated diagrams and scores successfully ranked the plans according to the prescribed dose objectives and constraints and the radiation oncologist priorities, after a necessary clinical validation process. SPIDERplan enables a fast and consistent evaluation of plan quality considering all targets and organs at risk.

Effects of post-harvest treatments on high-elevation forests in the North Cascade Range, Washington.

Treesearch

Ella Elman; David L. Peterson

2005-01-01

We studied the effects of post-harvest treatments on regeneration and forest composition 13-27 years following harvest in high-elevation forests of the North Cascade Range, Washington. Eighteen sites encompassing three common post-harvest treatments were examined at elevations ranging from 830 m to 1460 m. Treatments included: (1) sites broadcast burned and planted...

A Monte Carlo investigation of lung brachytherapy treatment planning

NASA Astrophysics Data System (ADS)

Sutherland, J. G. H.; Furutani, K. M.; Thomson, R. M.

2013-07-01

Iodine-125 (125I) and Caesium-131 (131Cs) brachytherapy have been used in conjunction with sublobar resection to reduce the local recurrence of stage I non-small cell lung cancer compared with resection alone. Treatment planning for this procedure is typically performed using only a seed activity nomogram or look-up table to determine seed strand spacing for the implanted mesh. Since the post-implant seed geometry is difficult to predict, the nomogram is calculated using the TG-43 formalism for seeds in a planar geometry. In this work, the EGSnrc user-code BrachyDose is used to recalculate nomograms using a variety of tissue models for 125I and 131Cs seeds. Calculated prescription doses are compared to those calculated using TG-43. Additionally, patient CT and contour data are used to generate virtual implants to study the effects that post-implant deformation and patient-specific tissue heterogeneity have on perturbing nomogram-derived dose distributions. Differences of up to 25% in calculated prescription dose are found between TG-43 and Monte Carlo calculations with the TG-43 formalism underestimating prescription doses in general. Differences between the TG-43 formalism and Monte Carlo calculated prescription doses are greater for 125I than for 131Cs seeds. Dose distributions are found to change significantly based on implant deformation and tissues surrounding implants for patient-specific virtual implants. Results suggest that accounting for seed grid deformation and the effects of non-water media, at least approximately, are likely required to reliably predict dose distributions in lung brachytherapy patients.

Benchmarking of a treatment planning system for spot scanning proton therapy: Comparison and analysis of robustness to setup errors of photon IMRT and proton SFUD treatment plans of base of skull meningioma

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

Harding, R., E-mail: ruth.harding2@wales.nhs.uk; Trnková, P.; Lomax, A. J.

Purpose: Base of skull meningioma can be treated with both intensity modulated radiation therapy (IMRT) and spot scanned proton therapy (PT). One of the main benefits of PT is better sparing of organs at risk, but due to the physical and dosimetric characteristics of protons, spot scanned PT can be more sensitive to the uncertainties encountered in the treatment process compared with photon treatment. Therefore, robustness analysis should be part of a comprehensive comparison between these two treatment methods in order to quantify and understand the sensitivity of the treatment techniques to uncertainties. The aim of this work was tomore » benchmark a spot scanning treatment planning system for planning of base of skull meningioma and to compare the created plans and analyze their robustness to setup errors against the IMRT technique. Methods: Plans were produced for three base of skull meningioma cases: IMRT planned with a commercial TPS [Monaco (Elekta AB, Sweden)]; single field uniform dose (SFUD) spot scanning PT produced with an in-house TPS (PSI-plan); and SFUD spot scanning PT plan created with a commercial TPS [XiO (Elekta AB, Sweden)]. A tool for evaluating robustness to random setup errors was created and, for each plan, both a dosimetric evaluation and a robustness analysis to setup errors were performed. Results: It was possible to create clinically acceptable treatment plans for spot scanning proton therapy of meningioma with a commercially available TPS. However, since each treatment planning system uses different methods, this comparison showed different dosimetric results as well as different sensitivities to setup uncertainties. The results confirmed the necessity of an analysis tool for assessing plan robustness to provide a fair comparison of photon and proton plans. Conclusions: Robustness analysis is a critical part of plan evaluation when comparing IMRT plans with spot scanned proton therapy plans.« less

3D Computer aided treatment planning in endodontics.

PubMed

van der Meer, Wicher J; Vissink, Arjan; Ng, Yuan Ling; Gulabivala, Kishor

2016-02-01

Obliteration of the root canal system due to accelerated dentinogenesis and dystrophic calcification can challenge the achievement of root canal treatment goals. This paper describes the application of 3D digital mapping technology for predictable navigation of obliterated canal systems during root canal treatment to avoid iatrogenic damage of the root. Digital endodontic treatment planning for anterior teeth with severely obliterated root canal systems was accomplished with the aid of computer software, based on cone beam computer tomography (CBCT) scans and intra-oral scans of the dentition. On the basis of these scans, endodontic guides were created for the planned treatment through digital designing and rapid prototyping fabrication. The custom-made guides allowed for an uncomplicated and predictable canal location and management. The method of digital designing and rapid prototyping of endodontic guides allows for reliable and predictable location of root canals of teeth with calcifically metamorphosed root canal systems. The endodontic directional guide facilitates difficult endodontic treatments at little additional cost. Copyright © 2016. Published by Elsevier Ltd.

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

High post-irradiation ductility thermomechanical treatment for precipitation strengthened austenitic alloys

DOEpatents

Laidler, James J.; Borisch, Ronald R.; Korenko, Michael K.

1982-01-01

A method for improving the post-irradiation ductility is described which prises a solution heat treatment following which the materials are cold worked. They are included to demonstrate the beneficial effect of this treatment on the swelling resistance and the ductility of these austenitic precipitation hardenable alloys.

Suicide Management Plan--Post Suicide Response.

ERIC Educational Resources Information Center

Imhoff, Robert; Royster, Sharon

This document contains a suicide management plan developed specifically for colleges. The suicide management plan described includes pre-planning, immediate response to the event, press releases, college staff jobs, college responses (such as memorials or scholarships), interaction with the family, and staff counseling. The plan is presented as a…

Rutosides for treatment of post-thrombotic syndrome.

PubMed

Morling, Joanne R; Yeoh, Su Ern; Kolbach, Dinanda N

2013-04-30

Post-thrombotic syndrome (PTS) is a long-term complication of deep venous thrombosis (DVT) that is characterised by pain, swelling, and skin changes in the affected limb. One in three patients with DVT will develop post-thrombotic sequelae within five years. Rutosides are a group of compounds derived from horse chestnut (Aesculus hippocastanum), a traditional herbal remedy for treating oedema formation in chronic venous insufficiency (CVI). However, it is not known whether rutosides are effective and safe in the treatment of PTS. To determine the effectiveness and safety of rutosides for treatment of PTS in patients with DVT compared to placebo, no intervention, elastic compression stockings (ECS) or any other treatment. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched October 2012) and CENTRAL (2012, Issue 9). Clinical trials databases were searched for details of ongoing and unpublished studies. Two authors (JM and DNK) independently assessed studies for inclusion. Studies were included to allow the comparison of rutosides versus placebo or no treatment, rutosides versus ECS, and rutosides versus any other treatment. Two authors (JM and SEY) extracted information from the trials. Disagreements were resolved by discussion. Data were extracted using designated data extraction forms. The Cochrane risk of bias tool was used for all included studies to assist in the assessment of quality. Primary outcome measures were the occurrence of leg ulceration over time (yes or no) and any improvement or deterioration of post-thrombotic syndrome (yes or no). Secondary outcomes included reduction of oedema, pain, recurrence of deep venous thrombosis or pulmonary embolism, compliance with therapy, and adverse effects. All of the outcome measures were analysed using Mantel-Haenzel fixed-effect model odds ratios. The unit of analysis was the number of patients. Ten reports of nine studies were identified

Peer Review of Radiotherapy Planning: Quantifying Outcomes and a Proposal for Prospective Data Collection.

PubMed

Mackenzie, J; Graham, G; Olivotto, I A

2016-12-01

The Canadian Partnership for Quality Radiotherapy quality assurance guidelines recommend that radiation oncologist peer review of curative radiotherapy plans takes place ideally before the first fraction of treatment is delivered. This study documented and evaluated the outcomes of weekly, disease site-specific, radiotherapy peer review, quality assurance rounds at the Tom Baker Cancer Centre in Calgary, Canada with a view to making recommendations about the optimal timing and documentation of peer review during the radiotherapy planning processes. Outcomes of each case reviewed at (i) breast, (ii) head and neck (including thyroid and cutaneous cases) and (iii) lung team quality assurance rounds from 6 January to 5 May 2015 were recorded prospectively. Each radiotherapy plan was assigned an outcome: A for plans with no suggested changes; B for satisfactory, but where issues were raised to consider for future patients; or C when a change was recommended before the first or next fraction. The B outcomes were further subdivided into B1 for a case-specific concern and B2 for a policy gap. Plans were assessed after contour definition and before the plan was formulated (post-contouring reviews) and/or assessed when the plan was complete (post-planning reviews). 209 radiotherapy plans prescribed by 20 radiation oncologists were peer reviewed at 43 quality assurance meetings. 93% were curative-intent and 7% were palliative. 83% of plans were reviewed before delivery of the first treatment fraction. There were a total of 257 case reviews: 60 at the post-contouring stage, 197 at the post-planning stage, including 46 patients reviewed at both time points. Overall rates of A, B1, B2 and C outcomes were 78%, 9%, 4% and 9%, respectively. The most common reason for a B or C outcome was related to target volume definition. Only 56% of C outcomes at the post-planning stage would have been detected at the post-contouring stage. Results varied between tumour site groups. 9% of

WE-D-BRB-02: Proton Treatment Planning and Beam Optimization

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

Pankuch, M.

2016-06-15

The goal of this session is to review the physics of proton therapy, treatment planning techniques, and the use of volumetric imaging in proton therapy. The course material covers the physics of proton interaction with matter and physical characteristics of clinical proton beams. It will provide information on proton delivery systems and beam delivery techniques for double scattering (DS), uniform scanning (US), and pencil beam scanning (PBS). The session covers the treatment planning strategies used in DS, US, and PBS for various anatomical sites, methods to address uncertainties in proton therapy and uncertainty mitigation to generate robust treatment plans. Itmore » introduces the audience to the current status of image guided proton therapy and clinical applications of CBCT for proton therapy. It outlines the importance of volumetric imaging in proton therapy. Learning Objectives: Gain knowledge in proton therapy physics, and treatment planning for proton therapy including intensity modulated proton therapy. The current state of volumetric image guidance equipment in proton therapy. Clinical applications of CBCT and its advantage over orthogonal imaging for proton therapy. B. Teo, B.K Teo had received travel funds from IBA in 2015.« less

SU-E-T-626: Accuracy of Dose Calculation Algorithms in MultiPlan Treatment Planning System in Presence of Heterogeneities

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

Moignier, C; Huet, C; Barraux, V

Purpose: Advanced stereotactic radiotherapy (SRT) treatments require accurate dose calculation for treatment planning especially for treatment sites involving heterogeneous patient anatomy. The purpose of this study was to evaluate the accuracy of dose calculation algorithms, Raytracing and Monte Carlo (MC), implemented in the MultiPlan treatment planning system (TPS) in presence of heterogeneities. Methods: First, the LINAC of a CyberKnife radiotherapy facility was modeled with the PENELOPE MC code. A protocol for the measurement of dose distributions with EBT3 films was established and validated thanks to comparison between experimental dose distributions and calculated dose distributions obtained with MultiPlan Raytracing and MCmore » algorithms as well as with the PENELOPE MC model for treatments planned with the homogenous Easycube phantom. Finally, bones and lungs inserts were used to set up a heterogeneous Easycube phantom. Treatment plans with the 10, 7.5 or the 5 mm field sizes were generated in Multiplan TPS with different tumor localizations (in the lung and at the lung/bone/soft tissue interface). Experimental dose distributions were compared to the PENELOPE MC and Multiplan calculations using the gamma index method. Results: Regarding the experiment in the homogenous phantom, 100% of the points passed for the 3%/3mm tolerance criteria. These criteria include the global error of the method (CT-scan resolution, EBT3 dosimetry, LINAC positionning …), and were used afterwards to estimate the accuracy of the MultiPlan algorithms in heterogeneous media. Comparison of the dose distributions obtained in the heterogeneous phantom is in progress. Conclusion: This work has led to the development of numerical and experimental dosimetric tools for small beam dosimetry. Raytracing and MC algorithms implemented in MultiPlan TPS were evaluated in heterogeneous media.« less

[Application of digital design of orthodontic-prosthodontic multidisciplinary treatment plan in esthetic rehabilitation of anterior teeth].

PubMed

Liu, Y S; Li, Z; Zhao, Y J; Ye, H Q; Zhou, Y Q; Hu, W J; Liu, Y S; Xun, C L; Zhou, Y S

2018-02-18

To develop a digital workflow of orthodontic-prosthodontic multidisciplinary treatment plan which can be applied in complicated anterior teeth esthetic rehabilitation, in order to enhance the efficiency of communication between dentists and patients, and improve the predictability of treatment outcome. Twenty patients with the potential needs of orthodontic-prosthodontic multidisciplinary treatment to solve their complicated esthetic problems in anterior teeth were recruited in this study. Digital models of patients' both dental arches and soft tissues were captured using intra oral scanner. Direct prosthodontic (DP) treatment plan and orthodontic-prosthodontic (OP) treatment plan were carried out for each patient. For DP treatment plans, digital wax-up models were directly designed on original digital models using prosthodontic design system. For OP treatment plans, virtual-setups were performed using orthodontic analyze system according to orthodontic and esthetic criteria and imported to prosthodontic design system to finalize the digital wax-up models. These two treatment plans were shown to the patients and demonstrated elaborately. Each patient rated two treatment plans using visual analogue scales and the medians of scores of two treatment plans were analyzed using signed Wilcoxon test. Having taken into consideration various related factors, including time, costs of treatment, each patient chose a specific treatment plan. For the patients chose DP treatment plans, digital wax-up models were exported and printed into resin diagnostic models which would be utilized in the prosthodontic treatment process. For the patients chose OP treatment plans, virtual-setups were used to fabricate aligners or indirect bonding templates and digital wax-up models were also exported and printed into resin diagnostic models for prosthodontic treatment after orthodontic treatment completed. The medians of scores of DP treatment plan and OP treatment plan were calculated and

Post-treatment control of HIV infection

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

Conway, Jessica M.; Perelson, Alan S.

Antiretroviral therapy (ART) for HIV is not a cure. However, recent studies suggest that ART, initiated early during primary infection, may induce post-treatment control (PTC) of HIV infection with HIV RNA maintained at <50 copies per mL. We investigate the hypothesis that ART initiated early during primary infection permits PTC by limiting the size of the latent reservoir, which, if small enough at treatment termination, may allow the adaptive immune response to prevent viral rebound (VR) and control infection. We use a mathematical model of within host HIV dynamics to capture interactions among target cells, productively infected cells, latently infectedmore » cells, virus, and cytotoxic T lymphocytes (CTLs). Analysis of our model reveals a range in CTL response strengths where a patient may show either VR or PTC, depending on the size of the latent reservoir at treatment termination. Below this range, patients will always rebound, whereas above this range, patients are predicted to behave like elite controllers. As a result, using data on latent reservoir sizes in patients treated during primary infection, we also predict population-level VR times for non-controllers consistent with observations.« less

Post-treatment control of HIV infection

DOE PAGES

Conway, Jessica M.; Perelson, Alan S.

2015-04-13

Antiretroviral therapy (ART) for HIV is not a cure. However, recent studies suggest that ART, initiated early during primary infection, may induce post-treatment control (PTC) of HIV infection with HIV RNA maintained at <50 copies per mL. We investigate the hypothesis that ART initiated early during primary infection permits PTC by limiting the size of the latent reservoir, which, if small enough at treatment termination, may allow the adaptive immune response to prevent viral rebound (VR) and control infection. We use a mathematical model of within host HIV dynamics to capture interactions among target cells, productively infected cells, latently infectedmore » cells, virus, and cytotoxic T lymphocytes (CTLs). Analysis of our model reveals a range in CTL response strengths where a patient may show either VR or PTC, depending on the size of the latent reservoir at treatment termination. Below this range, patients will always rebound, whereas above this range, patients are predicted to behave like elite controllers. As a result, using data on latent reservoir sizes in patients treated during primary infection, we also predict population-level VR times for non-controllers consistent with observations.« less

Effect of laser heat treatment on Pull-out bond strength of fiber posts treated with different silanes.

PubMed

Shafiei, Fereshteh; Saadat, Maryam; Jowkar, Zahra

2018-05-01

This study evaluated the effect of three different silanes and post-silanization treatments on the retentive strength of fiber posts luted with an etch-and-rinse resin cement. One hundred intact maxillary central incisors were randomly divided into 10 groups after endodontic treatment and post space preparation (n=10). The fiber posts were etched using 24% hydrogen peroxide. Posts of the control group did not receive silane. In nine experimental groups, each of the three silanes used, Scotchbond Universal adhesive, Bis-Silane and Porcelain Primer, was subjected to three treatments: air-drying at 25°C, warm air-drying and CO2 laser heat treatment. After cementation of the treated posts using One-Step Plus/Duo-Link cement, the specimens were stored for one weak and then subjected to pull-out bond strength (PBS) testing. The data in Newton (N) were analyzed using two-way ANOVA and Tukey tests (α=0.05). PBS was significantly affected by silane type and post-silanization treatment ( p <0.001). The interaction of the two factors was not statistically significant ( p =0.15). The effect of Porcelain Primer on PBS was significantly higher than those of universal adhesive ( p <0.001) and Bis-Silane ( p =0.01), with similar results for the two latter. Warm air-drying and laser treatment significantly increased PBS ( p <0.001). The lowest and highest PBS was obtained in the control (no silane) group (190.9±31) and laser-treated/ Porcelain Primer group (377.1±50), respectively. Warm air-drying and CO2 laser heat treatment had a significantly beneficial effect on retentive strength of fiber posts. Porcelain Primer was significantly more effective than universal adhesive and Bis-Silane. Key words: Laser heat treatment, Pull-out bond strength, fiber post.

42 CFR 485.916 - Condition of participation: Treatment team, person-centered active treatment plan, and...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Condition of participation: Treatment team, person... Health Centers (CMHCs) § 485.916 Condition of participation: Treatment team, person-centered active treatment plan, and coordination of services. The CMHC must designate an interdisciplinary treatment team...

The role of social support in post-treatment surveillance among African American colorectal cancer survivors

PubMed Central

Le, Daisy; Holt, Cheryl L.; Pisu, Maria; Brown-Galvan, Aquila; Fairley, Temeika L.; Smith, Judith Lee; White, Arica; Hall, Ingrid J.; Oster, Robert A.; Martin, Michelle Y.

2017-01-01

Objectives African Americans are less likely than other groups to receive appropriate surveillance after colorectal cancer (CRC) treatment. The objective of this study is to qualitatively explore the role of social support in post-CRC treatment surveillance and ultimately, inform interventions to promote surveillance in African American CRC survivors. Design Interviews were conducted with 60 African American CRC survivors recruited from the Cancer Care Outcomes Research and Surveillance (CanCORS) study and the Alabama Statewide Cancer Registry. Interviews were recorded and transcribed. Transcripts were reviewed and coded independently by the authors. The NVivo software package was used to facilitate coding and data management. Results Survivors were from 4 to 6 years post diagnosis, 57% female, 60% older than 65 years, 57% from rural Alabama, 30% with stage 1, 32% with stage 2, and 38% with stage 3 disease. Material and emotional social support from family and one’s faith community were cited as playing an important role in coping with the disease and post-treatment surveillance. Survivors who reported being adherent with post-treatment surveillance recommendations (according to stage of disease based on self-report of colonoscopy, CT scans, and blood work) reported more religious material and non-material social support, and support from other CRC survivors. Conclusion In these African American CRC survivors, support from family, other cancer survivors, and the faith community was perceived as being important for adherence to post-treatment surveillance. Interventions to increase post-treatment surveillance in this population may be enhanced by including components that emphasize familial, other cancer survivor, and religious support. PMID:24611486

Multi-centre audit of VMAT planning and pre-treatment verification.

PubMed

Jurado-Bruggeman, Diego; Hernández, Victor; Sáez, Jordi; Navarro, David; Pino, Francisco; Martínez, Tatiana; Alayrach, Maria-Elena; Ailleres, Norbert; Melero, Alejandro; Jornet, Núria

2017-08-01

We performed a multi-centre intercomparison of VMAT dose planning and pre-treatment verification. The aims were to analyse the dose plans in terms of dosimetric quality and deliverability, and to validate whether in-house pre-treatment verification results agreed with those of an external audit. The nine participating centres encompassed different machines, equipment, and methodologies. Two mock cases (prostate and head and neck) were planned using one and two arcs. A plan quality index was defined to compare the plans and different complexity indices were calculated to check their deliverability. We compared gamma index pass rates using the centre's equipment and methodology to those of an external audit (global 3D gamma, absolute dose differences, 10% of maximum dose threshold). Log-file analysis was performed to look for delivery errors. All centres fulfilled the dosimetric goals but plan quality and delivery complexity were heterogeneous and uncorrelated, depending on the manufacturer and the planner's methodology. Pre-treatment verifications results were within tolerance in all cases for gamma 3%-3mm evaluation. Nevertheless, differences between the external audit and in-house measurements arose due to different equipment or methodology, especially for 2%-2mm criteria with differences up to 20%. No correlation was found between complexity indices and verification results amongst centres. All plans fulfilled dosimetric constraints, but plan quality and complexity did not correlate and were strongly dependent on the planner and the vendor. In-house measurements cannot completely replace external audits for credentialing. Copyright © 2017 Elsevier B.V. All rights reserved.

Intricate Estimation and Assessment of Surface Conditioning of Posts to improve Interfacial Adhesion in Post-core Restorations: An in vitro Study.

PubMed

Gupta, Priyanka; Sharma, Amil; Pathak, Vivek K; Mankeliya, Saurabh; Bhardwaj, Shivanshu; Dhanare, Poorvasha

2017-12-01

Post and core restorations are routinely used for restoring grossly decayed tooth structures. Various chemical agents are known to affect the interfacial adhesions between the post and the core. Hence, we planned the present study to evaluate the effect of various post-surface treatments on the interfacial strength between the posts and composite materials that are used for building up the core portion. The present study included assessment of the effect of surface conditioning of posts on the interfacial adhesion in post-core restorations. A total of 80 clear post-tapers were included and were divided broadly into four study groups based on the type of chemical testing protocols used. Various chemical treatments included alkaline potassium permanganate, hydrogen peroxide, and phosphoric acid. The fourth group was the control group. The composite core material was used for building up the core. Testing of the tensile load was done on a universal testing machine. All the results were analyzed by the Statistical Package for the Social Sciences (SPSS) software. The highest bond strength was observed in the study group treated with alkaline potassium permanganate, while the lowest was observed in the control group followed by the hydrogen peroxide group. While comparing the mean bond strength in between various study groups, significant results were obtained. Chemical treatment protocol significantly alters the mean bond strength of the post and core restoration. Potassium permanganate significantly increases the bond strength between the fiber post and core restoration.

NOTE: MMCTP: a radiotherapy research environment for Monte Carlo and patient-specific treatment planning

NASA Astrophysics Data System (ADS)

Alexander, A.; DeBlois, F.; Stroian, G.; Al-Yahya, K.; Heath, E.; Seuntjens, J.

2007-07-01

Radiotherapy research lacks a flexible computational research environment for Monte Carlo (MC) and patient-specific treatment planning. The purpose of this study was to develop a flexible software package on low-cost hardware with the aim of integrating new patient-specific treatment planning with MC dose calculations suitable for large-scale prospective and retrospective treatment planning studies. We designed the software package 'McGill Monte Carlo treatment planning' (MMCTP) for the research development of MC and patient-specific treatment planning. The MMCTP design consists of a graphical user interface (GUI), which runs on a simple workstation connected through standard secure-shell protocol to a cluster for lengthy MC calculations. Treatment planning information (e.g., images, structures, beam geometry properties and dose distributions) is converted into a convenient MMCTP local file storage format designated, the McGill RT format. MMCTP features include (a) DICOM_RT, RTOG and CADPlan CART format imports; (b) 2D and 3D visualization views for images, structure contours, and dose distributions; (c) contouring tools; (d) DVH analysis, and dose matrix comparison tools; (e) external beam editing; (f) MC transport calculation from beam source to patient geometry for photon and electron beams. The MC input files, which are prepared from the beam geometry properties and patient information (e.g., images and structure contours), are uploaded and run on a cluster using shell commands controlled from the MMCTP GUI. The visualization, dose matrix operation and DVH tools offer extensive options for plan analysis and comparison between MC plans and plans imported from commercial treatment planning systems. The MMCTP GUI provides a flexible research platform for the development of patient-specific MC treatment planning for photon and electron external beam radiation therapy. The impact of this tool lies in the fact that it allows for systematic, platform

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-E-T-213: Comparison of Treatment Efficiency of Gamma Knife SRS Plans for Brain Metastases with Different Planning Methods

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

Feng, Y; Huang, Z; Lo, S

2015-06-15

Purpose: To improve Gamma Knife SRS treatment efficiency for brain metastases and compare the differences of treatment time and radiobiological effects between two different planning methods of automatic filling and manual placement of shots with inverse planning. Methods: T1-weighted MRI images with gadolinium contrast from five patients with a single brain metastatic-lesion were used in this retrospective study. Among them, two were from primary breast cancer, two from primary melanoma cancer and one from primary prostate cancer. For each patient, two plans were generated in Leksell GammaPlan10.1.1 for radiosurgical treatment with a Leksell GammaKnife Perfexion machine: one with automatic filling,more » automatic sector configuration and inverse optimization (Method1); and the other with manual placement of shots, manual setup of collimator sizes, manual setup of sector blocking and inverse optimization (Method2). Dosimetric quality of the plans was evaluated with parameters of Coverage, Selectivity, Gradient-Index and DVH. Beam-on Time, Number-of-Shots and Tumor Control Probability(TCP) were compared for the two plans while keeping their dosimetric quality very similar. Relative reduction of Beam-on Time and Number-of-Shots were calculated as the ratios among the two plans and used for quantitative analysis. Results: With very similar dosimetric and radiobiological plan quality, plans created with Method 2 had significantly reduced treatment time. Relative reduction of Beam-on Time ranged from 20% to 51 % (median:29%,p=0.001), and reduction of Number-of-Shots ranged from 5% to 67% (median:40%,p=0.0002), respectively. Time of plan creation for Method1 and Method2 was similar, approximately 20 minutes, excluding the time for tumor delineation. TCP calculated for the tumors from differential DVHs did not show significant difference between the two plans (p=0.35). Conclusion: The method of manual setup combined with inverse optimization in LGP for treatment of

Development of a foundation for a case definition of post-treatment Lyme disease syndrome.

PubMed

Aucott, John N; Crowder, Lauren A; Kortte, Kathleen B

2013-06-01

The study objective is to demonstrate the clinical and research utility of an operationalized definition of post-treatment Lyme disease syndrome (PTLDS), as proposed by the Infectious Diseases Society of America. Seventy-four patients with confirmed erythema migrans and 14 controls were enrolled. Patient-reported symptoms and health function (SF-36) were collected pre-treatment and at follow-up visits over 6 months post-treatment. Eight (11%) patients met our operationalized definition of PTLDS, which included self-reported symptoms of fatigue, widespread musculoskeletal pain or cognitive complaints, and functional impact as measured by a T score of <45 on the composite SF-36. No controls met the functional impact criteria. Forty-three (60% patients returned to their previous health status when measured at 6 months post-treatment. Twenty (28%) patients had either residual symptoms or functional impact, but not both, and did not meet criteria for PTLDS. This operationalized definition of PTLDS allows for identification of those patients who are treated for early Lyme disease and have significant post-treatment illness, as they have both residual symptoms and impact on daily life functioning. With further refinement and improvement of this operationalized definition, the true incidence of PTLDS can be determined and future studies can be designed to examine its pathophysiology and treatment. Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

The effectiveness of alternative planned durations of residential drug abuse treatment.

PubMed Central

McCusker, J; Vickers-Lahti, M; Stoddard, A; Hindin, R; Bigelow, C; Zorn, M; Garfield, F; Frost, R; Love, C; Lewis, B

1995-01-01

Randomized controlled trials were conducted at two residential drug abuse treatment facilities to compare programs that differed in planned duration. One trial compared a 6-month and a 12-month therapeutic community program (n = 184), and the second compared a 3-month and a 6-month relapse prevention program (n = 444). Retention rates over comparable time periods differed minimally by planned treatment duration, and the longer programs had lower completion rates. There was no effect in either trial of planned treatment duration on changes in psychosocial variables between admission and exit or on rates or patterns of drug use at follow-up between 2 and 6 months after exit. PMID:7573630

Improving proton therapy accessibility through seamless electronic integration of remote treatment planning sites.

PubMed

Belard, Arnaud; Dolney, Derek; Zelig, Tochner; McDonough, James; O'Connell, John

2011-06-01

Proton radiotherapy is a relatively scarce treatment modality in radiation oncology, with only nine centers currently operating in the United States. Funded by Public Law 107-248, the University of Pennsylvania and the Walter Reed Army Medical Center have developed a remote proton radiation therapy solution with the goals of improving access to proton radiation therapy for Department of Defense (DoD) beneficiaries while minimizing treatment delays and time spent away from home/work (time savings of up to 3 weeks per patient). To meet both Health Insurance Portability and Accountability Act guidelines and the more stringent security restrictions imposed by the DoD, our program developed a hybrid remote proton radiation therapy solution merging a CITRIX server with a JITIC-certified (Joint Interoperability Test Command) desktop videoconferencing unit. This conduit, thoroughly tested over a period of 6 months, integrates both institutions' radiation oncology treatment planning infrastructures into a single entity for DoD patients' treatment planning and delivery. This telemedicine solution enables DoD radiation oncologists and medical physicists the ability to (1) remotely access a proton therapy treatment planning platform, (2) transfer patient plans securely to the University of Pennsylvania patient database, and (3) initiate ad-hoc point-to-point and multipoint videoconferences to dynamically optimize and validate treatment plans. Our robust and secure remote treatment planning solution grants DoD patients not only access to a state-of-the-art treatment modality, but also participation in the treatment planning process by Walter Reed Army Medical Center radiation oncologists and medical physicists. This telemedicine system has the potential to lead to a greater integration of military treatment facilities and/or satellite clinics into regional proton therapy centers.

Non-target screening to trace ozonation transformation products in a wastewater treatment train including different post-treatments.

PubMed

Schollée, Jennifer E; Bourgin, Marc; von Gunten, Urs; McArdell, Christa S; Hollender, Juliane

2018-05-25

Ozonation and subsequent post-treatments are increasingly implemented in wastewater treatment plants (WWTPs) for enhanced micropollutant abatement. While this technology is effective, micropollutant oxidation leads to the formation of ozonation transformation products (OTPs). Target and suspect screening provide information about known parent compounds and known OTPs, but for a more comprehensive picture, non-target screening is needed. Here, sampling was conducted at a full-scale WWTP to investigate OTP formation at four ozone doses (2, 3, 4, and 5 mg/L, ranging from 0.3 to 1.0 gO 3 /gDOC) and subsequent changes during five post-treatment steps (i.e., sand filter, fixed bed bioreactor, moving bed bioreactor, and two granular activated carbon (GAC) filters, relatively fresh and pre-loaded). Samples were measured with online solid-phase extraction coupled to liquid chromatography high-resolution tandem mass spectrometry (LC-HRMS/MS) using electrospray ionization (ESI) in positive and negative modes. Existing non-target screening workflows were adapted to (1) examine the formation of potential OTPs at four ozone doses and (2) compare the removal of OTPs among five post-treatments. In (1), data processing included principal component analysis (PCA) and chemical knowledge on possible oxidation reactions to prioritize non-target features likely to be OTPs. Between 394 and 1328 unique potential OTPs were detected in positive ESI for the four ozone doses tested; between 12 and 324 unique potential OTPs were detected in negative ESI. At a specific ozone dose of 0.5 gO 3 /gDOC, 27 parent compounds were identified and were related to 69 non-target features selected as potential OTPs. Two OTPs were confirmed with reference standards (venlafaxine N-oxide and chlorothiazide); 34 other potential OTPs were in agreement with literature data and/or reaction mechanisms. In (2), hierarchical cluster analysis (HCA) was applied on profiles detected in positive ESI mode across the

Evaluation of a software module for adaptive treatment planning and re-irradiation.

PubMed

Richter, Anne; Weick, Stefan; Krieger, Thomas; Exner, Florian; Kellner, Sonja; Polat, Bülent; Flentje, Michael

2017-12-28

The aim of this work is to validate the Dynamic Planning Module in terms of usability and acceptance in the treatment planning workflow. The Dynamic Planning Module was used for decision making whether a plan adaptation was necessary within one course of radiation therapy. The Module was also used for patients scheduled for re-irradiation to estimate the dose in the pretreated region and calculate the accumulated dose to critical organs at risk. During one year, 370 patients were scheduled for plan adaptation or re-irradiation. All patient cases were classified according to their treated body region. For a sub-group of 20 patients treated with RT for lung cancer, the dosimetric effect of plan adaptation during the main treatment course was evaluated in detail. Changes in tumor volume, frequency of re-planning and the time interval between treatment start and plan adaptation were assessed. The Dynamic Planning Tool was used in 20% of treated patients per year for both approaches nearly equally (42% plan adaptation and 58% re-irradiation). Most cases were assessed for the thoracic body region (51%) followed by pelvis (21%) and head and neck cases (10%). The sub-group evaluation showed that unintended plan adaptation was performed in 38% of the scheduled cases. A median time span between first day of treatment and necessity of adaptation of 17 days (range 4-35 days) was observed. PTV changed by 12 ± 12% on average (maximum change 42%). PTV decreased in 18 of 20 cases due to tumor shrinkage and increased in 2 of 20 cases. Re-planning resulted in a reduction of the mean lung dose of the ipsilateral side in 15 of 20 cases. The experience of one year showed high acceptance of the Dynamic Planning Module in our department for both physicians and medical physicists. The re-planning can potentially reduce the accumulated dose to the organs at risk and ensure a better target volume coverage. In the re-irradiation situation, the Dynamic Planning Tool was used to

Effects of post-heat treatment on microstructure and properties of laser cladded composite coatings on titanium alloy substrate

NASA Astrophysics Data System (ADS)

Li, G. J.; Li, J.; Luo, X.

2015-01-01

The composite coatings were produced on the Ti6Al4V alloy substrate by laser cladding. Subsequently, the coatings were heated at 500 °C for 1 h and 2 h and then cooled in air. Effects of post-heat treatment on microstructure, microhardness and fracture toughness of the coatings were investigated by scanning electron microscopy (SEM), X-ray diffraction (XRD), energy dispersive spectroscopy (EDS), optical microscopy (OM). Wear resistance of the coatings was evaluated under the dry sliding reciprocating friction condition at room temperature. The results indicated that the coatings mainly consist of a certain amount of coarse white equiaxed WC particles surrounded by the white-bright W2C, a great deal of fine dark spherical TiC particles and the matrix composed of the α(Ti), Ti2Ni and TiNi phases. Effects of the post-heat treatment on phase constituents and microstructure of the coatings were almost negligible due to the low temperature. However, the post-heat treatment could decrease the residual stress and increase fracture toughness of the coatings, and fracture toughness of the coatings was improved from 2.77 MPa m1/2 to 3.80 MPa m1/2 and 4.43 MPa m1/2 with the heat treatment for 1 h and 2 h, respectively. The mutual role would contribute to the reduction in cracking susceptibility. Accompanied with the increase in fracture toughness, microhardness of the coatings was reduced slightly. The dominant wear mechanism for all the coatings was abrasive wear, characterized by micro-cutting or micro-plowing. The heat treatment could significantly decrease the average friction coefficient and reduce the fluctuation of the friction coefficient with the change in sliding time. The appropriate heat treatment time (approximately 1 h) had a minimal effect on wear mass loss and volume loss. Moreover, the improvement in fracture toughness will also be beneficial to wear resistance of the coatings under the long service.

MR Imaging Based Treatment Planning for Radiotherapy of Prostate Cancer

DTIC Science & Technology

2007-02-01

developed practical methods for heterogeneity correction for MRI - based dose calculations (Chen et al 2007). 6) We will use existing Monte Carlo ... Monte Carlo verification of IMRT dose distributions from a commercial treatment planning optimization system, Phys. Med. Biol., 45:2483-95 (2000) Ma...accuracy and consistency for MR based IMRT treatment planning for prostate cancer. A short paper entitled “ Monte Carlo dose verification of MR image based

Ion beams in radiotherapy - from tracks to treatment planning

NASA Astrophysics Data System (ADS)

Krämer, M.; Scifoni, E.; Wälzlein, C.; Durante, M.

2012-07-01

Several dozen clinical sites around the world apply beams of fast light ions for radiotherapeutical purposes. Thus there is a vested interest in the various physical and radiobiological processes governing the interaction of ion beams with matter, specifically living systems. We discuss the various modelling steps which lead from basic interactions to the application in actual patient treatment planning. The nano- and microscopic scale is covered by sample calculations with our TRAX code. On the macroscopic scale we feature the TRiP98 treatment planning system, which was clinically used in GSI's radiotherapy pilot project.

Automated high-dose rate brachytherapy treatment planning for a single-channel vaginal cylinder applicator

NASA Astrophysics Data System (ADS)

Zhou, Yuhong; Klages, Peter; Tan, Jun; Chi, Yujie; Stojadinovic, Strahinja; Yang, Ming; Hrycushko, Brian; Medin, Paul; Pompos, Arnold; Jiang, Steve; Albuquerque, Kevin; Jia, Xun

2017-06-01

High dose rate (HDR) brachytherapy treatment planning is conventionally performed manually and/or with aids of preplanned templates. In general, the standard of care would be elevated by conducting an automated process to improve treatment planning efficiency, eliminate human error, and reduce plan quality variations. Thus, our group is developing AutoBrachy, an automated HDR brachytherapy planning suite of modules used to augment a clinical treatment planning system. This paper describes our proof-of-concept module for vaginal cylinder HDR planning that has been fully developed. After a patient CT scan is acquired, the cylinder applicator is automatically segmented using image-processing techniques. The target CTV is generated based on physician-specified treatment depth and length. Locations of the dose calculation point, apex point and vaginal surface point, as well as the central applicator channel coordinates, and the corresponding dwell positions are determined according to their geometric relationship with the applicator and written to a structure file. Dwell times are computed through iterative quadratic optimization techniques. The planning information is then transferred to the treatment planning system through a DICOM-RT interface. The entire process was tested for nine patients. The AutoBrachy cylindrical applicator module was able to generate treatment plans for these cases with clinical grade quality. Computation times varied between 1 and 3 min on an Intel Xeon CPU E3-1226 v3 processor. All geometric components in the automated treatment plans were generated accurately. The applicator channel tip positions agreed with the manually identified positions with submillimeter deviations and the channel orientations between the plans agreed within less than 1 degree. The automatically generated plans obtained clinically acceptable quality.

The effectiveness of conization treatment for post-menopausal women with high-grade cervical intraepithelial neoplasia

PubMed Central

CHENG, XIAODONG; FENG, YAN; WANG, XINYU; WAN, XIAOYUN; XIE, XING; LU, WEIGUO

2013-01-01

The aim of this study was to evaluate the effectiveness of conization in the diagnosis and treatment of high-grade cervical intraepithelial neoplasia (CIN) in post-menopausal women. A total of 101 post-menopausal patients who were diagnosed with high-grade lesion CIN by biopsy and in whom conization was used as the primary treatment were examined and 202 pre-menopausal patients were studied as the controls. Clinical and pathological data including symptoms, cytological examination and HPV DNA test results before and after conization treatment were analyzed. Both the cytological abnormalities (57.9 vs. 58.5%, P=0.260) and the positive rate of the HPV DNA test (89.5 vs. 86.4%, P=0.812) did not show a significant difference between the post- and pre-menopausal group. The rate of satisfactory colposcopy was significantly lower in post-menopausal patients compared with pre-menosausal patients (23.2 vs. 68.9%, P<0.001). Post-menopausal patients presented a significantly lower diagnostic consistency between colpscopy-directed biopsy and conization (46.4 vs. 68.9%, P=0.004), and a significantly higher positive margin rate of conization (20.8 vs. 10.9%, P=0.020). A total of 10 of the 101 post-menopausal and 2 of the 202 pre-menopausal women were diagnosed with invasive cancer by conization and underwent further treatment. In conclusion, these data suggest that conization, as a conservative primary treatment, is not suitable for post-menopausal women with high-grade lesion CIN due to the lower rate of satisfactory colposcopy, lower consistency of diagnosis between colposcopy-directed biopsy and conization, and a higher positive margin of conization. PMID:23251264

Radiation treatment planning techniques for lymphoma of the stomach

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

Della Biancia, Cesar; Hunt, Margie; Furhang, Eli

2005-07-01

Purpose: Involved-field radiation therapy of the stomach is often used in the curative treatment of gastric lymphoma. Yet, the optimal technique to irradiate the stomach with minimal morbidity has not been well established. This study was designed to evaluate treatment planning alternatives for stomach irradiation, including intensity-modulated radiation therapy (IMRT), to determine which approach resulted in improved dose distribution and to identify patient-specific anatomic factors that might influence a treatment planning choice. Methods and Materials: Fifteen patients with lymphoma of the stomach (14 mucosa-associated lymphoid tissue lymphomas and 1 diffuse large B-cell lymphoma) were categorized into 3 types, depending onmore » the geometric relationship between the planning target volume (PTV) and kidneys. AP/PA and 3D conformal radiation therapy (3DCRT) plans were generated for each patient. IMRT was planned for 4 patients with challenging geometric relationship between the PTV and the kidneys to determine whether it was advantageous to use IMRT. Results: For type I patients (no overlap between PTV and kidneys), there was essentially no benefit from using 3DCRT over AP/PA. However, for patients with PTVs in close proximity to the kidneys (type II) or with high degree of overlap (type III), the 4-field 3DCRT plans were superior, reducing the kidney V {sub 15Gy} by approximately 90% for type II and 50% for type III patients. For type III, the use of a 3DCRT plan rather than an AP/PA plan decreased the V {sub 15Gy} by approximately 65% for the right kidney and 45% for the left kidney. In the selected cases, IMRT led to a further decrease in left kidney dose as well as in mean liver dose. Conclusions: The geometric relationship between the target and kidneys has a significant impact on the selection of the optimum beam arrangement. Using 4-field 3DCRT markedly decreases the kidney dose. The addition of IMRT led to further incremental improvements in the left

Considerations for using data envelopment analysis for the assessment of radiotherapy treatment plan quality.

PubMed

Simpson, John; Raith, Andrea; Rouse, Paul; Ehrgott, Matthias

2017-10-09

Purpose The operations research method of data envelopment analysis (DEA) shows promise for assessing radiotherapy treatment plan quality. The purpose of this paper is to consider the technical requirements for using DEA for plan assessment. Design/methodology/approach In total, 41 prostate treatment plans were retrospectively analysed using the DEA method. The authors investigate the impact of DEA weight restrictions with reference to the ability to differentiate plan performance at a level of clinical significance. Patient geometry influences plan quality and the authors compare differing approaches for managing patient geometry within the DEA method. Findings The input-oriented DEA method is the method of choice when performing plan analysis using the key undesirable plan metrics as the DEA inputs. When considering multiple inputs, it is necessary to constrain the DEA input weights in order to identify potential plan improvements at a level of clinical significance. All tested approaches for the consideration of patient geometry yielded consistent results. Research limitations/implications This work is based on prostate plans and individual recommendations would therefore need to be validated for other treatment sites. Notwithstanding, the method that requires both optimised DEA weights according to clinical significance and appropriate accounting for patient geometric factors is universally applicable. Practical implications DEA can potentially be used during treatment plan development to guide the planning process or alternatively used retrospectively for treatment plan quality audit. Social implications DEA is independent of the planning system platform and therefore has the potential to be used for multi-institutional quality audit. Originality/value To the authors' knowledge, this is the first published examination of the optimal approach in the use of DEA for radiotherapy treatment plan assessment.

Post-Secondary Plans, Aspirations and Profile Characteristics of Grade Twelve Students in Manitoba, 1977-78.

ERIC Educational Resources Information Center

Russell, C. Neil; And Others

This survey examines post-secondary plans, aspirations, and characteristics of twelfth grade students in order to develop a medium range enrollment forecasting model of postsecondary education and to develop a data base on high school student aspirations. The survey is the third year of a three-year project undertaken in Manitoba, Canada.…

Building on a national health information technology strategic plan for long-term and post-acute care: comments by the Long Term Post Acute Care Health Information Technology Collaborative.

PubMed

Alexander, Gregory L; Alwan, Majd; Batshon, Lynne; Bloom, Shawn M; Brennan, Richard D; Derr, John F; Dougherty, Michelle; Gruhn, Peter; Kirby, Annessa; Manard, Barbara; Raiford, Robin; Serio, Ingrid Johnson

2011-07-01

The LTPAC (Long Term Post Acute Care) Health Information Technology (HIT) Collaborative consists of an alliance of long-term services and post-acute care stakeholders. Members of the collaborative are actively promoting HIT innovations in long-term care settings because IT adoption for health care institutions in the United States has become a high priority. One method used to actively promote HIT is providing expert comments on important documents addressing HIT adoption. Recently, the Office of the National Coordinator for HIT released a draft of the Federal Health Information Technology Strategic Plan 2011-2015 for public comment. The following brief is intended to inform about recommendations and comments made by the Collaborative on the strategic plan. Copyright 2011, SLACK Incorporated.

Orthovoltage radiation therapy treatment planning using Monte Carlo simulation: treatment of neuroendocrine carcinoma of the maxillary sinus

NASA Astrophysics Data System (ADS)

Gao, Wanbao; Raeside, David E.

1997-12-01

Dose distributions that result from treating a patient with orthovoltage beams are best determined with a treatment planning system that uses the Monte Carlo method, and such systems are not readily available. In the present work, the Monte Carlo method was used to develop a computer code for determining absorbed dose distributions in orthovoltage radiation therapy. The code was used in planning treatment of a patient with a neuroendocrine carcinoma of the maxillary sinus. Two lateral high-energy photon beams supplemented by an anterior orthovoltage photon beam were utilized in the treatment plan. For the clinical case and radiation beams considered, a reasonably uniform dose distribution is achieved within the target volume, while the dose to the lens of each eye is 4 - 8% of the prescribed dose. Therefore, an orthovoltage photon beam, when properly filtered and optimally combined with megavoltage beams, can be effective in the treatment of cancers below the skin, providing that accurate treatment planning is carried out to establish with accuracy and precision the doses to critical structures.

Nightguard vital bleaching: side effects and patient satisfaction 10 to 17 years post-treatment.

PubMed

Boushell, Lee W; Ritter, André V; Garland, Glenn E; Tiwana, Karen K; Smith, Lynn R; Broome, Angela; Leonard, Ralph H

2012-06-01

  The long-term patient satisfaction and safety of nightguard vital bleaching (NGVB) requires further evaluation.   The purpose of this study was to evaluate patients' satisfaction and identify side effects of NGVB up to 17 years post-treatment.   Thirty-one participants who had completed previous NGVB studies using 10% carbamide peroxide were contacted at least 10 years post-treatment (range 10-17 years, average 12.3 years). Participants reported shade satisfaction (very satisfied [VS], partially satisfied [PS], or not satisfied [NS]) as well as potential complications. Participants had teeth # 6 to 11 examined for tooth vitality, gingival inflammation (Löe's Gingival Index [GI]), and radiographically for external cervical resorption (ECR).   All of the participants had successful lightening of their teeth. Sixty-one percent (19) had not retreated their teeth. Of those who had not retreated their teeth and who responded to the question of whitening satisfaction, 31% (4/13) were VS, 54% (7/13) were PS, and 15% (2/13) were NS with their current shade. Of those who had retreated their teeth, all were VS or PS. Ninety-one percent of the examined teeth had GI = 0 (normal), 7% had GI = 1 (mild inflammation), and 2% had GI = 2 (moderate inflammation). Sixty-nine percent of teeth tested responded to a cold stimulus. Radiographs did not detect ECR or apical lesions. No participant reported having a gingival biopsy post-treatment, and 87% would whiten again.   Patient satisfaction with NGVB may last as long as 12.3 years in average (range 10-17 years) post-treatment. GI and ECR findings were considered within the normal expectations for the sample studied, suggesting minimal clinical post-NGVB side effects up to 17 years. Nightguard vital bleaching provides patient satisfaction with minimal side effects up to 17 years post-treatment. © 2011 Wiley Periodicals, Inc.

Influence of calcium hydroxide on the post-treatment pain in Endodontics: A systematic review

PubMed Central

Anjaneyulu, K.; Nivedhitha, Malli Sureshbabu

2014-01-01

Introduction: Pain of endodontic origin has been a major concern to the patients and the clinicians for many years. Post-operative pain is associated with inflammation in the periradicular tissues caused by irritants egressing from root canal during treatment. It has been suggested that calcium hydroxide intra-canal medicament has pain-preventive properties because of its anti-microbial or tissue altering effects. Some dispute this and reasoned that calcium hydroxide may initiate or increase pain by inducing or increasing inflammation. Objective: To evaluate the effectiveness of calcium hydroxide in reducing the post-treatment pain when used as an intra-canal medicament Materials and Methods: The following databases were searched: PubMed CENTRAL (until July 2013), MEDLINE, and Cochrane Database of Systematic Reviews. Bibliographies of clinical studies and reviews identified in the electronic search were analyzed for studies published outside the electronically searched journals. The primary outcome measure was to evaluate the post-treatment pain reduction when calcium hydroxide is used as an intra-canal medicament in patients undergoing root canal therapy. Results: The reviews found some clinical evidence that calcium hydroxide is not very effective in reducing post-treatment pain when it is used alone, but its effectiveness can be increased when used in combination with other medicaments like chlorhexidine and camphorated monochlorophenol (CMCP). Conclusion: Even though calcium hydroxide is one of the most widely used intra-canal medicament due to its anti-microbial properties, there is no clear evidence of its effect on the post-treatment pain after the chemo-mechanical root canal preparation. PMID:24944439

A novel method for vaginal cylinder treatment planning: a seamless transition to 3D brachytherapy

PubMed Central

Wu, Vincent; Wang, Zhou; Patil, Sachin

2012-01-01

Purpose Standard treatment plan libraries are often used to ensure a quick turn-around time for vaginal cylinder treatments. Recently there is increasing interest in transitioning from conventional 2D radiograph based brachytherapy to 3D image based brachytherapy, which has resulted in a substantial increase in treatment planning time and decrease in patient through-put. We describe a novel technique that significantly reduces the treatment planning time for CT-based vaginal cylinder brachytherapy. Material and methods Oncentra MasterPlan TPS allows multiple sets of data points to be classified as applicator points which has been harnessed in this method. The method relies on two hard anchor points: the first dwell position in a catheter and an applicator configuration specific dwell position as the plan origin and a soft anchor point beyond the last active dwell position to define the axis of the catheter. The spatial location of various data points on the applicator's surface and at 5 mm depth are stored in an Excel file that can easily be transferred into a patient CT data set using window operations and then used for treatment planning. The remainder of the treatment planning process remains unaffected. Results The treatment plans generated on the Oncentra MasterPlan TPS using this novel method yielded results comparable to those generated on the Plato TPS using a standard treatment plan library in terms of treatment times, dwell weights and dwell times for a given optimization method and normalization points. Less than 2% difference was noticed between the treatment times generated between both systems. Using the above method, the entire planning process, including CT importing, catheter reconstruction, multiple data point definition, optimization and dose prescription, can be completed in ~5–10 minutes. Conclusion The proposed method allows a smooth and efficient transition to 3D CT based vaginal cylinder brachytherapy planning. PMID:23349650

In situ gas treatment technology demonstration test plan

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

Thornton, E.C.; Miller, R.D.

1996-02-16

This document defines the objectives and requirements associated with undertaking a field demonstration of an in situ gas treatment appoach to remediation chromate-contaminated soil. The major tasks presented in this plan include the design and development of the surface gas treatment system, performance of permitting activities, and completion of site preparation and field testing activities.

SU-E-T-161: Characterization and Validation of CT Simulator Hounsfield Units to Relative Stopping Power Values for Proton Treatment Planning

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

Schnell, E; Ahmad, S; De La Fuente Herman, T

2015-06-15

Purpose: To develop a calibration curve that includes and minimizes the variations of Hounsfield Unit (HU) from a CT scanner to Relative Stopping Power (RSP) of tissues along the proton beam path. The variations are due to scanner and proton energy, technique, phantom size and placement, and tissue arrangement. Methods: A CIRS 062 M phantom with 10 plugs of known relative electron density (RED) was scanned through a 16 slice GE Discovery CT Simulator scanner. Three setup combinations of plug distributions and techniques clinically implemented for five treatment regions were scanned with energies of 100, 120, and 140 kV. Volumetricmore » HU values were measured for each plug and scan. The RSP values derived through the Bethe-Bloch formula are currently being verified with parallel-plate ionization chamber measurements in water using 80, 150, and 225 MeV proton beam. Typical treatment plans for treatment regions of brain, head-&-neck, chest, abdomen, and pelvis are being planned and dose delivered will be compared with film and Optically Stimulated Luminescence (OSL) measurements. Results: Percentage variations were determined for each variable. For tissues close to water, variations were <1% from any given parameter. Tissues far from water equivalence (lung and bone) showed the greatest sensitivity to change (7.4% maximum) with scanner energy and up to 5.3% with positioning of the phantom. No major variations were observed for proton energies within the treatment range. Conclusion: When deriving a calibration curve, attention should be placed to low and high HU values. A thorough verification process of calculated vs. water-phantom measured RSP values at different proton energies, followed by dose validation of planned vs. measured doses in phantom with film and OSL detectors are currently being undertaken.« less

Optimization of tomotherapy treatment planning for patients with bilateral hip prostheses.

PubMed

Chapman, David; Smith, Shaun; Barnett, Rob; Bauman, Glenn; Yartsev, Slav

2014-02-04

To determine the effect of different imaging options and the most efficient imaging strategy for treatment planning of patients with hip prostheses. The planning kilovoltage CT (kVCT) and daily megavoltage CT (MVCT) studies for three prostate cancer patients with bilateral hip prostheses were used for creating hybrid kVCT/MVCT image sets. Treatment plans were created for kVCT images alone, hybrid kVCT/MVCT images, and MVCT images alone using the same dose prescription and planning parameters. The resulting dose volume histograms were compared. The orthopedic metal artifact reduction (O-MAR) reconstruction tool for kVCT images and different MVCT options were investigated with a water tank fit with double hip prostheses. Treatment plans were created for all imaging options and calculated dose was compared with the one measured by a pin-point ion chamber. On average for three patients, the D35% for the bladder was 8% higher in plans based on MVCT images and 7% higher in plans based on hybrid images, compared to the plans based on kVCT images alone. Likewise, the D35% for the rectum was 3% higher than the kVCT based plan for both hybrid and MVCT plans. The average difference in planned D99% in the PTV compared to kVCT plans was 0.9% and 0.1% for MVCT and hybrid plans, respectively. For the water tank with hip prostheses phantom, the kVCT plan with O-MAR correction applied showed better agreement between the measured and calculated dose than the original image set, with a difference of -1.9% compared to 3.3%. The measured doses for the MVCT plans were lower than the calculated dose due to image size limitations. The best agreement was for the kVCT/MVCT hybrid plans with the difference between calculated and measured dose around 1%. MVCT image provides better visualization of patient anatomy and hybrid kVCT/MVCT study enables more accurate calculations using updated MVCT relative electron density calibration.

[Treatment strategy and planning for pilon fractures].

PubMed

Mittlmeier, Thomas; Wichelhaus, Alice

2017-08-01

Pilon fractures are mainly severe and prognostically serious injuries with a high rate of relevant soft tissue involvement. The adequate decision making and choice of treatment in the early phase of trauma are of paramount importance for the final outcome. This essentially encompasses the management of the soft tissue damage, the surgical planning and the differentiated selection of procedures. Most concepts of staged treatment nowadays offer a wide range of options which are integrated into expert-based algorithms. The aim of the present analysis was to display the strategy variations for the treatment of pilon fractures taking into account the advantages and disadvantages of the corresponding treatment concepts. A staged procedure including primary closed reduction employing ligamentotaxis and fixation of the joints of the hindfoot via tibiocalcaneal metatarsal fixation offers a safe basis for consecutive imaging and the selection of specific approaches for definitive reconstruction. A simultaneous reconstruction and fixation of the fibula during the primary intervention are generally not recommended in order to avoid any limitations for subsequent reconstructive procedures. A time frame for definitive reconstruction covers a period of up to 3 weeks after trauma and allows a detailed planning considering the individual dynamics of the soft tissue situation and any logistic requirements. For the choice of the definitive treatment concept a wide range of procedures and implants are available. There are also valid concepts for primary treatment of defined fracture constellations while primary arthrodesis represents a solution in cases of major destruction of the joint surface. Knowledge of the multiple procedural variations for pilon fracture treatment creates the basis to optimize the treatment modalities and to take into account individual parameters of the fracture.

Application of Magnetic Resonance Imaging and Three-Dimensional Treatment Planning in the Treatment of Orbital Lymphoma

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

Rudoltz, Marc S.; Ayyangar, Komanduri; Mohiuddin, Mohammed

Radiotherapy for lymphoma of the orbit must be individualized for each patient and clinical setting. Most techniques focus on optimizing the dose to the tumor while sparing the lens. This study describes a technique utilizing magnetic resonance imaging (MRI) and three dimensional (3D) planning in the treatment of orbital lymphoma. A patient presented with an intermediate grade lymphoma of the right orbit. The prescribed tumor dose was 4050 cGy in 18 fractions. Three D planning was carried out and tumor volumes, retina, and lens were subsequently outlined. Dose calculations including dose volume histograms of the target, retina, and lens weremore » then performed. Part of the retina was outside of the treatment volume while 50% of the retina received 90% or more of the prescribed dose. The patient was clinically NED when last seen 2 years following therapy with no treatment-related morbidity. Patients with lymphomas of the orbit can be optimally treated using MRI based 3D treatment planning.« less

Post-exposure treatment of VX poisoned guinea pigs with the engineered phosphotriesterase mutant C23: a proof-of-concept study.

PubMed

Worek, Franz; Seeger, Thomas; Reiter, Georg; Goldsmith, Moshe; Ashani, Yacov; Leader, Haim; Sussman, Joel L; Aggarwal, Nidhi; Thiermann, Horst; Tawfik, Dan S

2014-11-18

The highly toxic organophosphorus (OP) nerve agent VX is characterized by a remarkable biological persistence which limits the effectiveness of standard treatment with atropine and oximes. Existing OP hydrolyzing enzymes show low activity against VX and hydrolyze preferentially the less toxic P(+)-VX enantiomer. Recently, a phosphotriesterase (PTE) mutant, C23, was engineered towards the hydrolysis of the toxic P(-) isomers of VX and other V-type agents with relatively high in vitro catalytic efficiency (kcat/KM=5×10(6)M(-1)min(-1)). To investigate the suitability of the PTE mutant C23 as a catalytic scavenger, an in vivo guinea pig model was established to determine the efficacy of post-exposure treatment with C23 alone against VX intoxication. Injection of C23 (5mgkg(-1) i.v.) 5min after s.c. challenge with VX (∼2LD50) prevented systemic toxicity. A lower C23 dose (2mgkg(-1)) reduced systemic toxicity and prevented mortality. Delayed treatment (i.e., 15min post VX) with 5mgkg(-1) C23 resulted in survival of all animals and only in moderate systemic toxicity. Although C23 did not prevent inhibition of erythrocyte acetylcholinesterase (AChE) activity, it partially preserved brain AChE activity. C23 therapy resulted in a rapid decrease of racemic VX blood concentration which was mainly due to the rate of degradation of the toxic P(-)-VX enantiomer that correlates with the C23 blood levels and its kcat/KM value. Although performed under anesthesia, this proof-of-concept study demonstrated for the first time the ability of a catalytic bioscavenger to prevent systemic VX toxicity when given alone as a single post-exposure treatment, and enables an initial assessment of a time window for this approach. In conclusion, the PTE mutant C23 may be considered as a promising starting point for the development of highly effective catalytic bioscavengers for post-exposure treatment of V-agents intoxication. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Amlodipine and the Successful Management of Post-Electroconvulsive Therapy Agitation.

PubMed

Shahriari, Ali; Khooshideh, Maryam; Sheikh, Mahdi

2016-01-01

Electroconvulsive therapy (ECT) is a highly effective nonpharmacologic treatment for the management of depression and some other psychiatric disorders. Post-ECT agitation occurs in up to 12% of ECT treatments and is characterized by motor restlessness, irritability, disorientation, and panic-like behaviors. The severity of post-ECT agitation ranges from mild and self-limited to serious and severe forms requiring prompt medical intervention to protect the patient and the medical staff. In severe agitation medical management may be necessary which consists of using sedative agents, either benzodiazepines or propofol. The side-effects of these sedative agents, especially in the elderly population, necessitate finding ways that could help the prevention of the occurrence of agitation after ECT treatments. We report a 68-year-old female with major depression who was referred for ECT. She experienced severe post-ECT agitation requiring medical intervention after all ECT treatments. Administering of oral amlodipine (5 mg) one hour before ECT treatment successfully prevented the occurrence of post-ECT agitation in this patient. We briefly discuss the possible underlying mechanisms and pathophysiology of amlodipine in the prevention of post-ECT agitation.

The Influence of Post Bleaching Treatments in Stain Absorption and Microhardness.

PubMed

Moosavi, Horieh; Darvishzadeh, Fatemeh

2016-01-01

This study investigated the effects of post bleaching treatments to prevent restaining and the change of enamel surface microhardness after dental bleaching in vitro. Sixty intact human incisor teeth were stained in tea solution and randomly assigned into four groups (n=15). Then samples were bleached for two weeks (8 hours daily) by 15% carbamide peroxide. Tooth color was determined both with a spectrophotometer and visually before bleaching (T1) and immediately after bleaching (T2). Next, it was applied in group 1 fluoride (Naf 2%) gel for 2 minutes, and in group 2 a fractional CO2 laser (10 mJ, 200 Hz, 10 s), and in group 3, nanohydroxyapatite gel for 2 minutes. The bleached teeth in group 4 remained untreated (control group). Then teeth placed in tea solution again. Color examinations were repeated after various post bleaching treatments (T3) and restaining with tea (T4) and color change values recorded. The microhardness was measured at the enamel surface of samples. Data was analyzed using ANOVA, Tukey HSD test and Dunnett T3 (α = 0.05). Directly after bleaching (ΔE T3-T2), the treatment with nanohydroxyapatite showed significantly the least color lapse in colorimetric evaluation. In experimental groups, the color change between T3 and T4 stages (ΔE T4-T3) was significantly lower than control group (P < 0.05). Different methods of enamel treatment caused a significant increase in surface microhardness compared to control group (P < 0.05). Application of fluoride, fractional CO2 laser and nanohydroxyapatite as post bleaching treatments are suggested for prevention of stain absorption and increasing the hardening of bleached enamel.

Characterizing the Biochemical Response to Schistosoma mansoni Infection and Treatment with Praziquantel in Preschool and School Aged Children.

PubMed

Panic, Gordana; Coulibaly, Jean T; Harvey, Nikita; Keiser, Jennifer; Swann, Jonathan

2018-05-21

Schistosomiasis is a widespread chronic neglected tropical disease prevalent mostly in children in under-resourced rural areas. Its pathological effects have been clinically characterized, yet the molecular-level effects are understudied. In this study, the biochemical effects of Schistosoma mansoni infection and praziquantel treatment were studied in 130 preschool aged and 159 school aged infected children and 11 noninfected children in Azaguié, Côte d'Ivoire. Urine samples were collected prior to receiving 20, 40, or 60 mg/kg of praziquantel or a placebo, as well as 24 h post-treatment, and at the 3-week follow up. Urinary metabolic phenotypes were measured using 1 H NMR spectroscopy, and metabolic variation associated with S. mansoni infection and praziquantel administration was identified using multivariate statistical techniques. Discriminatory metabolic signatures were detected between heavily infected and noninfected children at baseline as well as according to the dose of praziquantel administered 24 h post treatment. These signatures were primarily associated with the metabolic activity of the gut microbiota, gut health and growth biomarkers and energy and liver metabolism. These analyses provide insights into the metabolic phenotype of schistosomiasis and treatment with praziquantel in two important demographics.

The influence of four dual-cure resin cements and surface treatment selection to bond strength of fiber post

PubMed Central

Liu, Chang; Liu, Hong; Qian, Yue-Tong; Zhu, Song; Zhao, Su-Qian

2014-01-01

In this study, we evaluate the influence of post surface pre-treatments on the bond strength of four different cements to glass fiber posts. Eighty extracted human maxillary central incisors and canines were endodontically treated and standardized post spaces were prepared. Four post pre-treatments were tested: (i) no pre-treatment (NS, control), (ii) sandblasting (SA), (iii) silanization (SI) and (iv) sandblasting followed by silanization (SS). Per pre-treatment, four dual-cure resin cements were used for luting posts: DMG LUXACORE Smartmix Dual, Multilink Automix, RelyX Unicem and Panavia F2.0. All the specimens were subjected to micro push-out test. Two-way analysis of variance and Tukey post hoc tests were performed (α=0.05) to analyze the data. Bond strength was significantly affected by the type of resin cement, and bond strengths of RelyX Unicem and Panavia F2.0 to the fiber posts were significantly higher than the other cement groups. Sandblasting significantly increased the bond strength of DMG group to the fiber posts. PMID:24177170

Detection of Cases of Noncompliance to Drug Treatment in Patient Forum Posts: Topic Model Approach

PubMed Central

Foulquié, Pierre; Texier, Nathalie; Faviez, Carole; Burgun, Anita; Schück, Stéphane

2018-01-01

Background Medication nonadherence is a major impediment to the management of many health conditions. A better understanding of the factors underlying noncompliance to treatment may help health professionals to address it. Patients use peer-to-peer virtual communities and social media to share their experiences regarding their treatments and diseases. Using topic models makes it possible to model themes present in a collection of posts, thus to identify cases of noncompliance. Objective The aim of this study was to detect messages describing patients’ noncompliant behaviors associated with a drug of interest. Thus, the objective was the clustering of posts featuring a homogeneous vocabulary related to nonadherent attitudes. Methods We focused on escitalopram and aripiprazole used to treat depression and psychotic conditions, respectively. We implemented a probabilistic topic model to identify the topics that occurred in a corpus of messages mentioning these drugs, posted from 2004 to 2013 on three of the most popular French forums. Data were collected using a Web crawler designed by Kappa Santé as part of the Detec’t project to analyze social media for drug safety. Several topics were related to noncompliance to treatment. Results Starting from a corpus of 3650 posts related to an antidepressant drug (escitalopram) and 2164 posts related to an antipsychotic drug (aripiprazole), the use of latent Dirichlet allocation allowed us to model several themes, including interruptions of treatment and changes in dosage. The topic model approach detected cases of noncompliance behaviors with a recall of 98.5% (272/276) and a precision of 32.6% (272/844). Conclusions Topic models enabled us to explore patients’ discussions on community websites and to identify posts related with noncompliant behaviors. After a manual review of the messages in the noncompliance topics, we found that noncompliance to treatment was present in 6.17% (276/4469) of the posts. PMID:29540337

Multicentre analysis of treatment planning information: technical requirements, possible applications and a proposal.

PubMed

Ebert, M A; Blight, J; Price, S; Haworth, A; Hamilton, C; Cornes, D; Joseph, D J

2004-09-01

Digital data from 3-D treatment planning computers is generally used for patient planning and then never considered again. However, such data contains enormous quantities of information regarding patient geometries, tissue outlining, treatment approaches and dose distributions. Were such data accessible from planning systems from multiple manufacturers, there would be substantial opportunities for undertaking quality assurance of radiotherapy clinical trials, prospective assessment of trial outcomes and basic treatment planning research and development. The technicalities of data exchange between planning systems are outlined, and previous attempts at producing systems capable of viewing and/or manipulating imaging and radiotherapy digital data reviewed. Development of a software system for enhancing the quality of Australasian clinical trials is proposed.

Treatment planning optimisation in proton therapy

PubMed Central

McGowan, S E; Burnet, N G; Lomax, A J

2013-01-01

ABSTRACT. The goal of radiotherapy is to achieve uniform target coverage while sparing normal tissue. In proton therapy, the same sources of geometric uncertainty are present as in conventional radiotherapy. However, an important and fundamental difference in proton therapy is that protons have a finite range, highly dependent on the electron density of the material they are traversing, resulting in a steep dose gradient at the distal edge of the Bragg peak. Therefore, an accurate knowledge of the sources and magnitudes of the uncertainties affecting the proton range is essential for producing plans which are robust to these uncertainties. This review describes the current knowledge of the geometric uncertainties and discusses their impact on proton dose plans. The need for patient-specific validation is essential and in cases of complex intensity-modulated proton therapy plans the use of a planning target volume (PTV) may fail to ensure coverage of the target. In cases where a PTV cannot be used, other methods of quantifying plan quality have been investigated. A promising option is to incorporate uncertainties directly into the optimisation algorithm. A further development is the inclusion of robustness into a multicriteria optimisation framework, allowing a multi-objective Pareto optimisation function to balance robustness and conformity. The question remains as to whether adaptive therapy can become an integral part of a proton therapy, to allow re-optimisation during the course of a patient's treatment. The challenge of ensuring that plans are robust to range uncertainties in proton therapy remains, although these methods can provide practical solutions. PMID:23255545

Magnetic resonance spectroscopic imaging for improved treatment planning of prostate cancer

NASA Astrophysics Data System (ADS)

Venugopal, Niranjan

. Results from the in vivo study were verified with post-histopathological data. Lastly, 1H-MRSI data was incorporated into the radiation treatment planning software and used to assess tumour control by escalating the radiation to prostate lesions that were identified by 1H-MRSI. In summary, this thesis demonstrates the clinical feasibility of using advanced spectroscopic imaging techniques for improved diagnosis and treatment of prostate cancer.

Urban Stormwater Characterization, Control, and Treatment.

PubMed

Moore, Trisha L; Rodak, Carolyn M; Vogel, Jason R

2017-10-01

A summary of 246 studies published in 2016 on topics related to the characterization and management of urban stormwater runoff is presented in the following review. The review is structured along three major topical areas: (1) general characterization of stormwater quantity and quality; (2) engineered systems for stormwater control and treatment, including erosion and sediment control practices, constructed stormwater ponds and wetlands, bioretention, permeable pavement, greenroofs, and rainwater harvesting and (3) watershedscale application of stormwater treatment and control practices. Common research themes and needs highlighted throughout this review include efforts to better understand stormwater transport and treatment mechanisms and their representation in models, advancements to optimize the design of stormwater control measures to meet specific hydrologic and/or water quality targets, and increasing understanding of the biophysical and social factors that influence watershed-scale implementation of low impact development and other stormwater control measures.

MO-F-CAMPUS-T-05: SQL Database Queries to Determine Treatment Planning Resource Usage

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

Fox, C; Gladstone, D

2015-06-15

Purpose: A radiation oncology clinic’s treatment capacity is traditionally thought to be limited by the number of machines in the clinic. As the number of fractions per course decrease and the number of adaptive plans increase, the question of how many treatment plans a clinic can plan becomes increasingly important. This work seeks to lay the ground work for assessing treatment planning resource usage. Methods: Care path templates were created using the Aria 11 care path interface. Care path tasks included key steps in the treatment planning process from the completion of CT simulation through the first radiation treatment. SQLmore » Server Management Studio was used to run SQL queries to extract task completion time stamps along with care path template information and diagnosis codes from the Aria database. 6 months of planning cycles were evaluated. Elapsed time was evaluated in terms of work hours within Monday – Friday, 7am to 5pm. Results: For the 195 validated treatment planning cycles, the average time for planning and MD review was 22.8 hours. Of those cases 33 were categorized as urgent. The average planning time for urgent plans was 5 hours. A strong correlation between diagnosis code and range of elapsed planning time was as well as between elapsed time and select diagnosis codes was observed. It was also observed that tasks were more likely to be completed on the date due than the time that they were due. Follow-up confirmed that most users did not look at the due time. Conclusion: Evaluation of elapsed planning time and other tasks suggest that care paths should be adjusted to allow for different contouring and planning times for certain diagnosis codes and urgent cases. Additional clinic training around task due times vs dates or a structuring of care paths around due dates is also needed.« less

Epilepsy Treatment Simplified through Mobile Ketogenic Diet Planning.

PubMed

Li, Hanzhou; Jauregui, Jeffrey L; Fenton, Cagla; Chee, Claire M; Bergqvist, A G Christina

2014-07-01

The Ketogenic Diet (KD) is an effective, alternative treatment for refractory epilepsy. This high fat, low protein and carbohydrate diet mimics the metabolic and hormonal changes that are associated with fasting. To maximize the effectiveness of the KD, each meal is precisely planned, calculated, and weighed to within 0.1 gram for the average three-year duration of treatment. Managing the KD is time-consuming and may deter caretakers and patients from pursuing or continuing this treatment. Thus, we investigated methods of planning KD faster and making the process more portable through mobile applications. Nutritional data was gathered from the United States Department of Agriculture (USDA) Nutrient Database. User selected foods are converted into linear equations with n variables and three constraints: prescribed fat content, prescribed protein content, and prescribed carbohydrate content. Techniques are applied to derive the solutions to the underdetermined system depending on the number of foods chosen. The method was implemented on an iOS device and tested with varieties of foods and different number of foods selected. With each case, the application's constructed meal plan was within 95% precision of the KD requirements. In this study, we attempt to reduce the time needed to calculate a meal by automating the computation of the KD via a linear algebra model. We improve upon previous KD calculators by offering optimal suggestions and incorporating the USDA database. We believe this mobile application will help make the KD and other dietary treatment preparations less time consuming and more convenient.

Epilepsy Treatment Simplified through Mobile Ketogenic Diet Planning

PubMed Central

Li, Hanzhou; Jauregui, Jeffrey L.; Fenton, Cagla; Chee, Claire M.; Bergqvist, A.G. Christina

2017-01-01

Background The Ketogenic Diet (KD) is an effective, alternative treatment for refractory epilepsy. This high fat, low protein and carbohydrate diet mimics the metabolic and hormonal changes that are associated with fasting. Aims To maximize the effectiveness of the KD, each meal is precisely planned, calculated, and weighed to within 0.1 gram for the average three-year duration of treatment. Managing the KD is time-consuming and may deter caretakers and patients from pursuing or continuing this treatment. Thus, we investigated methods of planning KD faster and making the process more portable through mobile applications. Methods Nutritional data was gathered from the United States Department of Agriculture (USDA) Nutrient Database. User selected foods are converted into linear equations with n variables and three constraints: prescribed fat content, prescribed protein content, and prescribed carbohydrate content. Techniques are applied to derive the solutions to the underdetermined system depending on the number of foods chosen. Results The method was implemented on an iOS device and tested with varieties of foods and different number of foods selected. With each case, the application’s constructed meal plan was within 95% precision of the KD requirements. Conclusion In this study, we attempt to reduce the time needed to calculate a meal by automating the computation of the KD via a linear algebra model. We improve upon previous KD calculators by offering optimal suggestions and incorporating the USDA database. We believe this mobile application will help make the KD and other dietary treatment preparations less time consuming and more convenient. PMID:28794808

[Embolization as a treatment method in post-traumatic right hepatic artery pseudoaneurysm].

PubMed

Dobrowolska-Bak, Malgorzata; Brzegowy, Paweł; Urbanik, Andrzej

2012-01-01

A case of 42-year-old man with post-traumatic right hepatic artery pseudoaneurysm successfully treated by endovascular embolization with histoacrylate glue is presented. Despite coils are mostly used embolic material in pseudoaneurysm, embolization with histoacrylate glue can be highly effective and quick treatment modality for post-traumatic hepatic artery pseudoaneurysm, especially in cases when it is impossible to use standard materials.

Automated replication of cone beam CT-guided treatments in the Pinnacle(3) treatment planning system for adaptive radiotherapy.

PubMed

Hargrave, Catriona; Mason, Nicole; Guidi, Robyn; Miller, Julie-Anne; Becker, Jillian; Moores, Matthew; Mengersen, Kerrie; Poulsen, Michael; Harden, Fiona

2016-03-01

Time-consuming manual methods have been required to register cone-beam computed tomography (CBCT) images with plans in the Pinnacle(3) treatment planning system in order to replicate delivered treatments for adaptive radiotherapy. These methods rely on fiducial marker (FM) placement during CBCT acquisition or the image mid-point to localise the image isocentre. A quality assurance study was conducted to validate an automated CBCT-plan registration method utilising the Digital Imaging and Communications in Medicine (DICOM) Structure Set (RS) and Spatial Registration (RE) files created during online image-guided radiotherapy (IGRT). CBCTs of a phantom were acquired with FMs and predetermined setup errors using various online IGRT workflows. The CBCTs, DICOM RS and RE files were imported into Pinnacle(3) plans of the phantom and the resulting automated CBCT-plan registrations were compared to existing manual methods. A clinical protocol for the automated method was subsequently developed and tested retrospectively using CBCTs and plans for six bladder patients. The automated CBCT-plan registration method was successfully applied to thirty-four phantom CBCT images acquired with an online 0 mm action level workflow. Ten CBCTs acquired with other IGRT workflows required manual workarounds. This was addressed during the development and testing of the clinical protocol using twenty-eight patient CBCTs. The automated CBCT-plan registrations were instantaneous, replicating delivered treatments in Pinnacle(3) with errors of ±0.5 mm. These errors were comparable to mid-point-dependant manual registrations but superior to FM-dependant manual registrations. The automated CBCT-plan registration method quickly and reliably replicates delivered treatments in Pinnacle(3) for adaptive radiotherapy.

MO-D-BRB-02: Pediatric Treatment Planning II: Applications of Proton Beams for Pediatric Treatment

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

Hua, C.

Most Medical Physicists working in radiotherapy departments see few pediatric patients. This is because, fortunately, children get cancer at a rate nearly 100 times lower than adults. Children have not smoked, abused alcohol, or been exposed to environmental carcinogens for decades, and of course, have not fallen victim to the aging process. Children get very different cancers than adults. Breast or prostate cancers, typical in adults, are rarely seen in children but instead a variety of tumors occur in children that are rarely seen in adults; examples are germinomas, ependymomas and primitive neuroectodermal tumors, which require treatment of the child’smore » brain or neuroblastoma, requiring treatment in the abdomen. The treatment of children with cancer using radiation therapy is one of the most challenging planning and delivery problems facing the physicist. This is because bones, brain, breast tissue, and other organs are more sensitive to radiation in children than in adults. Because most therapy departments treat mostly adults, when the rare 8 year-old patient comes to the department for treatment, the physicist may not understand the clinical issues of his disease which drive the planning and delivery decisions. Additionally, children are more prone than adults to developing secondary cancers after radiation. For bilateral retinoblastoma for example, an irradiated child has a 40% chance of developing a second cancer by age 50. The dosimetric tradeoffs made during the planning process are complex and require careful consideration for children treated with radiotherapy. In the first presentation, an overview of childhood cancers and their corresponding treatment techniques will be given. These can be some of the most complex treatments that are delivered in the radiation therapy department. These cancers include leukemia treated with total body irradiation, medulloblastoma, treated with craniospinal irradiation plus a conformal boost to the posterior

Private and Public Sector Enterprise Resource Planning System Post-Implementation Practices: A Comparative Mixed Method Investigation

ERIC Educational Resources Information Center

Bachman, Charles A.

2010-01-01

While private sector organizations have implemented enterprise resource planning (ERP) systems since the mid 1990s, ERP implementations within the public sector lagged by several years. This research conducted a mixed method, comparative assessment of post "go-live" ERP implementations between public and private sector organization. Based on a…

Meal Plan in the Treatment of Anorexia Nervosa: A Way of Feeding the Disorder and Starving the Patient

PubMed Central

Padrão, Maria João; Barbosa, Maria Raquel; Coimbra, Joaquim Luís

2013-01-01

For the mainstream Psychology/Psychiatry, anorexia nervosa is considered an eating disorder characterized by the low body weight and by the restrictive eating pattern. The traditional psychiatric treatment consists in the establishment of a meal plan that must be scrupulously followed and, most frequently, in pharmacological treatment. We propose an alternative conceptualization of anorexia nervosa that envisages this disorder as pertaining to the control domain. In this sense, we formulate psychiatric intervention as a “pact with anorexia”, once it follows the very same logic, prohibitions and self-impositions of the disorder. Specifically, we envisage the meal plan as a way of maintaining anorexia, instead of suppressing it. As we could observe in our four year research project, in which we’ve followed several anorectic female patients, those who were more committed to their psychiatric treatment were precisely those who had more difficulty in recovering from anorexia – i.e., from renouncing the control from which the disorder lives. Finally, we suggest some fundamental underpinnings to an effective therapeutic approach, based in our conceptualization and understanding of the disorder. PMID:23283043

75 FR 19966 - Boulder Canyon Project-Post-2017 Application of the Energy Planning and Management Program Power...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-16

... DEPARTMENT OF ENERGY Western Area Power Administration Boulder Canyon Project--Post-2017 Application of the Energy Planning and Management Program Power Marketing Initiative AGENCY: Western Area... and Management Program (Program) Power Marketing Initiative (PMI) (10 CFR part 905) to the Boulder...

An Analysis of Image Segmentation Time in Beam’s-Eye-View Treatment Planning

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

Li, Chun; Spelbring, D.R.; Chen, George T.Y.

In this work we tabulate and histogram the image segmentation time for beam’s eye view (BEV) treatment planning in our center. The average time needed to generate contours on CT images delineating normal structures and treatment target volumes is calculated using a data base containing over 500 patients’ BEV plans. The average number of contours and total image segmentation time needed for BEV plans in three common treatment sites, namely, head/neck, lung/chest, and prostate, were estimated.

[Early versus delayed physiotherapy in the treatment of post-prostatectomy male urinary incontinence].

PubMed

Tarcía Kahihara, Carina; Ferreira, Ubirajora; Nardi Pedro, Renato; Matheus, Wagner Eduardo; Rodrigues Netto, Nelson

2006-10-01

To analyze the importance of the starting time for pelvic floor physiotherapy in patients with post radical prostatectomy urinary incontinence. Between May 2003 and February 2004 18 patients with the diagnosis of post radical prostatectomy urinary incontinence underwent physiotherapy of the pelvic floor. Each patient received 12 sessions using kinesotherapy and electric stimulation on a weekly basis. Patients were divided into two groups: Group 1 included eight patients that started therapy within the first six months after surgery; Group 2 included 10 patients starting therapy after the sixth post operative month. All patients were evaluated by the pad test and number of incontinence pads per day. Evaluating pad tests before and after treatment, six patients in group 1 had a reduction of the amount of urine leak in comparison to seven patients in group 2. The statistical analysis showed significant differences before and after treatment for both groups (group 1: p = 0.028; group 2: p = 0.018). The evaluation of the number of pads showed: Group 1: all eight patients using pods had a reduction in the number of pads. Group 2: 5 of the eight patients using pads had a reduction and the other three continued using the same number. Statistical analysis comparing the number of pads per day before and after treatment showed a significant difference in group 1 (p = 0.004). There was no statistically significant difference in the number of pads per day before and after physiotherapy in group 2, although half of the patients showed a diminishment in the number of pads required after treatment. Results demonstrate that early indication of physiotherapy for the treatment of post radical prostatectomy urinary incontinence is better than delayed treatment. New works may be developed in the future to confirm our results.

Three dimensional intensity modulated brachytherapy (IMBT): dosimetry algorithm and inverse treatment planning.

PubMed

Shi, Chengyu; Guo, Bingqi; Cheng, Chih-Yao; Esquivel, Carlos; Eng, Tony; Papanikolaou, Niko

2010-07-01

The feasibility of intensity modulated brachytherapy (IMBT) to improve dose conformity for irregularly shaped targets has been previously investigated by researchers by means of using partially shielded sources. However, partial shielding does not fully explore the potential of IMBT. The goal of this study is to introduce the concept of three dimensional (3D) intensity modulated brachytherapy and solve two fundamental issues regarding the application of 3D IMBT treatment planning: The dose calculation algorithm and the inverse treatment planning method. A 3D IMBT treatment planning system prototype was developed using the MATLAB platform. This system consists of three major components: (1) A comprehensive IMBT source calibration method with dosimetric inputs from Monte Carlo (EGSnrc) simulations; (2) a "modified TG-43" (mTG-43) dose calculation formalism for IMBT dosimetry; and (3) a physical constraint based inverse IMBT treatment planning platform utilizing a simulated annealing optimization algorithm. The model S700 Axxent electronic brachytherapy source developed by Xoft, Inc. (Fremont, CA), was simulated in this application. Ten intracavitary accelerated partial breast irradiation (APBI) cases were studied. For each case, an "isotropic plan" with only optimized source dwell time and a fully optimized IMBT plan were generated and compared to the original plan in various dosimetric aspects, such as the plan quality, planning, and delivery time. The issue of the mechanical complexity of the IMBT applicator is not addressed in this study. IMBT approaches showed superior plan quality compared to the original plans and tht isotropic plans to different extents in all studied cases. An extremely difficult case with a small breast and a small distance to the ribs and skin, the IMBT plan minimized the high dose volume V200 by 16.1% and 4.8%, respectively, compared to the original and the isotropic plans. The conformity index for the target was increased by 0.13 and 0

Blood pressure control with cilnidipine treatment in Japanese post-stroke hypertensive patients: The CA-ATTEND study.

PubMed

Aoki, Shiro; Hosomi, Naohisa; Nezu, Tomohisa; Teshima, Tsukasa; Sugii, Hitoshi; Nagahama, Shinobu; Kurose, Yoshiki; Maruyama, Hirofumi; Matsumoto, Masayasu

2017-01-01

Blood pressure control is important in post-stroke hypertensive patients and antihypertensive treatment is recommended for such patients. Ca-channel blockers are recommended as the medications of choice for the treatment of post-stroke patients. Here, we report the results of a large-scale prospective post-marketing surveillance study of post-stroke hypertensive patients (n = 2667, male 60.4%, 69.0 ± 10.9 years) treated with cilnidipine, with regard to blood pressure control and adverse reactions. Cilnidipine treatment caused a decrease in both clinic and home blood pressures 2 months after the beginning of treatment, and the decreased blood pressure was maintained until the end of 12 months' observation. The proportion of patients in whom clinic blood pressure was well controlled (<140/90 mmHg) increased from 21.5% to 65.3% in cilnidipine treatment, with no differences in effectiveness among the various clinical subtypes of stroke. In total, 346 adverse events occurred, with an overall incidence of 8.9% (238 of 2667 patients). In the elderly group, specifically, a fall and a hip fracture each occurred in 1 (0.1%) patient. These results indicate that cilnidipine was effective in treating uncontrolled blood pressure and was well tolerated in Japanese post-stroke hypertensive patients in a real-world clinical setting.