EBCTCG METAANALYSIS
INDICATION OF POST OP RADIOTHERAPY
Immobilization devices
Conventional planning
Alignment of the Tangential Beam with the Chest Wall Contour
Doses To Heart & Lung By Tangential Fields
EBCTCG METAANALYSIS
INDICATION OF POST OP RADIOTHERAPY
Immobilization devices
Conventional planning
Alignment of the Tangential Beam with the Chest Wall Contour
Doses To Heart & Lung By Tangential Fields
This is a made easy summary of ICRU 89 guidelines for gynecological brachytherapy. Extra practical questions for MD/DNB Radiotherapy exams are also attached.
A review of advances in Brachytherapy treatment planning and delivery in last decade or so, with main focus on brachytherapy for Prostate cancer, Breast cancer and Cervical cancer
Management of cacrinoma cervix: Techniques of radiotherapy (2D conventional, 3D Conformal radiotherapy (3DCRT) and IMRT with a review of various contouring guidelines.
This is a made easy summary of ICRU 89 guidelines for gynecological brachytherapy. Extra practical questions for MD/DNB Radiotherapy exams are also attached.
A review of advances in Brachytherapy treatment planning and delivery in last decade or so, with main focus on brachytherapy for Prostate cancer, Breast cancer and Cervical cancer
Management of cacrinoma cervix: Techniques of radiotherapy (2D conventional, 3D Conformal radiotherapy (3DCRT) and IMRT with a review of various contouring guidelines.
In the slides, i have described the work which i had done in the past year for working in library at national and international level.
I had organized several events for enhancing the environment of library; some of them are listed below:
1. Vanche Smt. S. R Patel engineering college abhiyan.
2. Taratu Pustak abhiyan
3. Green reading section - for the first time in the world
4. Book lovers day - for the first time in the world
5. Librarian day
6. World Book day
7. Women Day
8. GPSC and UPSC Seminar
9. Book talk competition
10. Book review competition
11. Web site review competition
12. Essay competition and many more...
by .Mahesh Solanki
+91 9879665119 ,+919879665119
dr.Mahesh Solanki
This is a topic from Radiotherapy under the section Internal Beam Radiation Therapy. The first count slides have some pictures which you will connect once you have read all the slides. Save it for later.
This is a presentation on total body irradiation. This presentation explains about various techniques. positions used for TBI. Advantages and disadvantages of TBI.
It also gives an idea on Dosage and side effects.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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2. rationale
• prostate adenocarcinoma has a low α/β-ratio
of 1.2–3.0 Gy
• Late reacting tiisues are more sensitive to
higher does per fraction
• It is a form of conformal radiotherapy that
avoids dose to normal structures
• Shorter duration of treatment
3. History of brachytherapy
1910 - Young used urethral radium for treatment of
prostate cancer
1930 - Flocks first injected radioactive gold liquid
into prostate
1970 -Whitmer et al. at MSKCC in New York first
performed prostate seed implants using iodine
seeds
1983 - Holm performed the first closed
implant,using needles and ultrasound guidance
6. TYPES
LDR(0.4-2Gy/hr)
LDR brachytherapy or ‘seed’ implant involves the
insertion of permanent radioactive sources
directly into the prostate.
HDR(>12Gy/hr)
HDR brachytherapy also involves radioactive
material being placed directly into the prostate
but, unlike LDR seeds, the placement of the
material is temporary and for shorter periods –
usually for a day or two at a time
7. TYPES OF PERMANENT IMPLANTS
Classic LDR
• 222Rn seeds, 198Au seeds
• Half-lives of a few days
• High-energy γ-rays emitted by
these sources
• Monoenergetic
• The patient must be confined to
the hospital until the source
strength decays to a safe level (two
to three half-lives or about 10 days)
Ultra LDR
• 103Pd, 125I and 131Cs
• Uses longer half life
• Low-energy photon emitters
• cascade of rays with different
energy
• The patient’s tissues or a thin
lead foil are sufficient to reduce
ambient exposure rates to
negligible levels, eliminating the
need to hospitalize
• Reduce radiation exposure to
operating room personnel
9. Loose seeds Vs stranded seeds
• Stranded seeds are fabricated with absorbable spacer
material,which fix the distance of 1 cm between the
centers of two serial seeds.
• capability of minimizing the risk for seed loss
• Loose seeds can migrate through the venous system to
the lungs, abdomen and pelvis or are excreted with
urine or ejaculated
• Most of the seeds get lost within 30days of PSI
• Loose seeds are used in centre to prevent higher dose
to urethra
• Stranded seeds can be used in cases where margin is
required around prostate
10. Factors predicting seed loss
• Number of needles
• Number of seeds
• Preoperative prostate volume
• Expertise of the brachytherapy team
• Surprisingly, overall seed loss was more frequent in the
patient group with stranded seeds, which might be biased
by low patient number (n = 40) or wrong technique.
Miyazawa et al. 2012; Kono et al. 2010
15. Ultrasound simulation and volume assesment
TRUS imaging is obtained before the planned
procedure to assess the prostate volume
Treatment planning
A computerized plan is generated from the transverse
ultrasound images, producing isodose distributions and
the ideal location of seeds within the gland to deliver
the prescription dose to the prostate.
16. THINGS TO ENSURE PRIOR TO THE
IMPLANT PROCEDURE
• Patient is admitted the night prior to the day of the
procedure
• Enema to clear bowel prior to the procedure
• Preanesthetic check up should be done
• Fasting for atleast 6hrs before the procedure
• Shaving the hair from the genital area
• Medication that need to stop before the procedure, e.g.
anticoagulants, anti-inflammatories, herbal or
complementary supplements
17. IMPLANT PROCESS
• Done under general anaesthetia or spinal anaesthesia
• Patient in lithotomy position
• Patient is catheterised
• Real time TRUS guided
• 60-100 small radioactive seeds are placed inside the
prostate
• Seeds are inserted using Needles or Mick applicator guided
by a template placed over the perineum according to the
coordinates determined by the preplan
22. POST IMPLANT DOSIMETRY
• Post implant CT scan is done and images transferred to TPS
• At first, the actual number of seeds in the target area is
detected.
• If there are missing seeds, a chest X-ray is recommended.
CONTOURING
– CTV-P (prostate)
– CTV-PM (prostate + 3mm margin)
– Rectum (“r”)
– intraprostatic urethra (“u”)
• The detection of the seeds in the CT / MRI images is
performed by the automatic seed finder feature of the
planning software
23. TARGET DELINEATION
• The clinical target volume (CTV) is defined as the whole
prostate as seen in rectal ultrasound
• The seminal vesicles are not usually included within the
clinical target volume.
• A margin of 2–3 mm is added to generate the planning
target volume (PTV).
• In high risk prostate cancer, the PTV may consist of the
prostate gland with a 5 mm margin (posteriorly 2 mm).
• The proximal 1 cm of the seminal vesicles should also be
included in the planning target volume in high risk
cases(Bittner et al. 2012)
• The whole plan is then correlated with the pre plan for
verification.
24. Does prescription
The dose constraints for the PTV (prostate plus margin) are:
– pD90 > 100 % of prescribed dose(PD)
– pV100 ≥95 %,
– pV150 ≤50 %
• Rectum
– rD2cc ≤ PD and rD0.1cc<200 Gy
• Prostatic urethra
– uD10 <150 % of PD
– uD30 <130 % of PD
The GTV should be encompassed by the 150 % isodose.
25. Post procedure
• Antibiotics to prevent infection.
• Stool softeners to avoid constipation
• Can resume eating and drinking once patient is
awake
• Barrier contraception is recommended for use for
the first two months after implantation
• Patient is advised to come after 1month for
follow up
• it is important to remember that………………. the
seeds are radioactive, you are not
26. Intraoperative Planning
• An ultrasound probe is positioned in the rectum and the prostate
and normal anatomies are identified.
• Needles are inserted through the perineal template
• The prostate is subsequently scanned from apex to base, and these
0.5-cm images are transferred to the treatment-planning system
• On the computer monitor, the prostate contours and the urethra
are digitized on each axial image.
• Needle positions are identified on each image, and their
coordinates are incorporated into a genetic algorithm optimization
program.
• After the optimization program identifies the optimal seed-loading
pattern and the dose calculations are completed
27. LDR
advantage
• Usually only requires one night
in hospital
• Less invasive procedure than
prostatectomy
• Repeated treatments not
required
• Lesser risk of long term effects
to normal tissues (rectum,
bladder, urethra)
• Probably better preservation
of erectile function
disadvantage
• Not available in all centres
• Urinary side effects may occur
which might last over several
weeks or months
• Anaesthetic and surgical
procedure required
• You will have minor temporary
changes to lifestyle as a result
of radioactive implant
• Costly
28. Rationale for HDR Brachytherapy
• Higher dose per fraction as carcinoma prostate behaves as
a late responding tissue
• Without unacceptable dosimetric changes caused by
source migration and tissue deformity as in LDR implants
• No intrafraction motions as in EBRT
• Temporary HDR BRT is not limited by positioning
uncertainties as the target is immobilized by the implanted
catheters and treated within very short treatment times.
• Since there is no permanent implant with HDR, no long-
term radiation protection issues exist as in the case of LDR
BRT
29.
30. Brachytherapy Techniques
• performed under spinal or general anesthesia
• Patient in lithotomy position
• Real-time TRUS-guided implantation
• Treatment planning after TRUS-guided
implantation is commonly performed using
either CT or TRUS imaging
• Perineal template to aid catheter placement
31. • For CT based planning, 3 mm slice thickness in
the axial plane is used
• Imaging should extend the prostate in the
craniocaudal extension and should include
sufficient normal anatomy for meaningful
normal tissue dosimetry
• PTV is defined as the entire prostate gland
without margins
32. • Based on the acquired 3D anatomy, the appropriate virtual
needle positions are generated, the needle source dwell
positions located within the PTV are activated, and the
radioactive source dwell times are calculated using an
intraoperative treatment planning system
• If the pre-planning dosimetry parameters fulfill the
dosimetric protocol, TRUSguided implantation of catheters
is performed at the previously determined positions
• After completion of implantation, a final 3D TRUS data set
is acquired for intraoperative real-time treatment planning.
• Real needle positions are reconstructed and dwell positions
located within the PTV are activated ensuring the 3D dose
distribution fulfills the dosimetric protocol
33.
34. • Irrespective of the imaging modality for
interventional guidance or treatment
planning, HDR is performed using a remote
afterloading system.
• Iridium 192 is the most commonly used
isotope with an average energy of 380 keV, a
half-life of 73.8 days and a half value layer of
2.5 mm of lead
35. DEMERITS OF CT BASED AND TRUS BASED PLANS
CT PLANNING
• The potential disadvantages of CT dosimetry are the need to move the patient and
the time it takes to go from one location to another to perform serial functions.
• There may occur changes in catheter positions during transfer
TRUS PLANNING
• The image distortions (“shadows”) produced by the posterior (dorsal) catheters
can obscure the view of more anterior (ventral) catheters during treatment
planning, and the catheters themselves can obscure the prostate contour
especially near the apex.
• Definition of contours of the rectum and to a lesser extent the bladder may be less
accurately rendered with real time TRUS planning than with CT-based planning.
• Newer 3D ultrasound probes will likely reduce some of these technical difficulties
36. D. Jeffrey Demanes, Michel I. Ghilezan
High-dose-rate brachytherapy as monotherapy for prostate cancer
Brachytherapy, Volume 13, Issue 6, 2014, 529–541
Fig. 1. CT-based dosimetry. Transverse, sagittal, coronal, and three-dimensional views.
37. D. Jeffrey Demanes, Michel I. Ghilezan
High-dose-rate brachytherapy as monotherapy for prostate cancer
Brachytherapy, Volume 13, Issue 6, 2014, 529–541
Fig. 2. Ultrasound-based dosimetry. Coronal, transverse, sagittal, and 3D views with 100% isodose lines and 3D cloud (red). 3D =
three-dimensional. (For interpretation of the references to color in this figure legend, the reader is referred to the web version ...
39. HDR
ADVANTAGES
• Shorter course of treatment
• Usually minimal side effects
are experienced around the
time of treatment
• Minimal post procedure
recovery time required
DISADVANTAGES
• Needs hospitalisation
• Not available in all centres
• Having to lie flat while the
implant catheters are in place,
sometimes overnight, which
can be uncomfortable.
• Side effects affecting bladder,
bowel and erectile function
can occur in the longer term
• Costly
41. URINARY TOXICITY
• Acute urinary retention
• urinary frequency
• Urgency
• occasional urge incontinence.
• Depending on the isotope used, these symptoms often peak at 1 to
3 months after the procedure and subsequently gradually decline
over the ensuing 3 to 6 months.
• Most patients benefit with the use of an α-blocker, which
ameliorates such symptoms in 60% to 70% of patients.
• Most urinary symptoms resolved within 12 months after the
procedure, and significant residual toxicity was unusual.
42. Multivariate analysis demonstrated that the
– use of androgen-deprivation therapy before
implantation
– High prostate volume
– higher baseline IPSS
– use of higher number of needles
was associated with increased rate of grade 2 acute
toxicity
43. RECTAL TOXICITY
• Symptoms manifest as rectal bleeding or
increased mucous discharge.
• The onset of symptoms often peaks at 8 to 12
months and is self-limited in nature
ERECTILE DYSFUNCTION
• Erectile dysfunction after brachytherapy has been
reported to occur in from 20% to 80% of patients.
• Excellent responses were observed with sildenafil
citrate