IMRT is an advanced form of radiation therapy that uses modulated beam intensities to more precisely target tumors while reducing radiation exposure to surrounding healthy tissues. It involves inverse planning where dose and volume constraints for the tumor and organs at risk are specified upfront. The treatment planning system then optimizes beam fluence maps through multiple iterations to achieve the desired dose distribution. Final treatment delivery involves either segmented or dynamic modulation of the multileaf collimator to sculpt the radiation beam according to the optimal fluence map calculated during planning.
The vmat vs other recent radiotherapy techniquesM'dee Phechudi
VMAT is a new type of intensity-modulated radiation therapy (IMRT) treatment technique that uses the same hardware (i.e. a digital linear accelerator) as used for IMRT or conformal treatment, but delivers the radiotherapy treatment using a rotational or arc geometry rather than several static beams.
This technique uses continuous modulation (i.e. moving the collimator leaves) of the multileaf collimator (MLC) fields, continuous change of the fluence rate (the intensity of the X rays) and gantry rotation speed across a single or multiple 360 degree rotations
Conformal Radiotherapy in Head and neck cancers is essential in terms of improving quality of life and local control in this era. This presentation aimed at giving an overview of conformal radiotherapy and its role in HNC to a 'general audience'.
The vmat vs other recent radiotherapy techniquesM'dee Phechudi
VMAT is a new type of intensity-modulated radiation therapy (IMRT) treatment technique that uses the same hardware (i.e. a digital linear accelerator) as used for IMRT or conformal treatment, but delivers the radiotherapy treatment using a rotational or arc geometry rather than several static beams.
This technique uses continuous modulation (i.e. moving the collimator leaves) of the multileaf collimator (MLC) fields, continuous change of the fluence rate (the intensity of the X rays) and gantry rotation speed across a single or multiple 360 degree rotations
Conformal Radiotherapy in Head and neck cancers is essential in terms of improving quality of life and local control in this era. This presentation aimed at giving an overview of conformal radiotherapy and its role in HNC to a 'general audience'.
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
This seminar is presented as a part of weekly journal club and seminar presented in Apollo Hospital,Kolkata Department of Radiation Oncology.This seminar is moderated by Dr Tanweer Shahid.
Conventional radiotherapy treatments are delivered with radiation beams that are of uniform intensity across the field (within the flatness specification limits). Wedges or compensators are used to modify the intensity profile to offset contour in irregularities and produce more uniform composite dose distributions such as in techniques using wedges. This process of changing beam intensity profile to meet the goals of a composite plan is called intensity modulation
IMRT refers to a radiation therapy technique in which nonuniform fluence is delivered to the patient from any given position of the treatment beam to optimize the composite dose distribution. The optimal fluence profiles for a given set of beam directions are determined through inverse planning. The fluence files thus generated are electronically transmitted to the linear accelerator, which is computer controlled, to deliver intensity modulated beams (IMBs) as calculated.
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
This seminar is presented as a part of weekly journal club and seminar presented in Apollo Hospital,Kolkata Department of Radiation Oncology.This seminar is moderated by Dr Tanweer Shahid.
Conventional radiotherapy treatments are delivered with radiation beams that are of uniform intensity across the field (within the flatness specification limits). Wedges or compensators are used to modify the intensity profile to offset contour in irregularities and produce more uniform composite dose distributions such as in techniques using wedges. This process of changing beam intensity profile to meet the goals of a composite plan is called intensity modulation
IMRT refers to a radiation therapy technique in which nonuniform fluence is delivered to the patient from any given position of the treatment beam to optimize the composite dose distribution. The optimal fluence profiles for a given set of beam directions are determined through inverse planning. The fluence files thus generated are electronically transmitted to the linear accelerator, which is computer controlled, to deliver intensity modulated beams (IMBs) as calculated.
A summary of recent innovations in radiation oncology focussing on the priniciples of different techniques and their application. An overview of clinical results has also been given
Intensity Modulated Radiation Therapy (IMRT) is an advanced mode of high-precision radiotherapy that uses computer-controlled linear accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor by reducing radiation dose to the nearby normal tissues.
Billing and Coding Guidelines for Intensity Modulated Radiation Therapy (IMRT)Jessica Parker
IMRT is a valuable tool in the treatment of certain cancers. Be sure to maintain appropriate and compliant documentation to support the processes that go into this type of therapy. Knowing the guidelines for billing and coding IMRT is critical to proper payment.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
3. Forward Planning
3D Conformal Therapy (not IMRT) is forward based
planning.
Planner chooses number and position of beams,
shape, weighting and wedging, calculates the
resulting distribution, & adjusts the beam
parameters as needed
Dose to structures is NOT specified
3
6. What is IMRT ?
Intensity Modulated Radiation Therapy (IMRT) is a
method of radiation delivery using beams of varying
intensities
Planner chooses
Number of beams
Energy
DVH
6
Sharp Dose Gradient
9. Inverse Planning
IMRT uses a different method of planning.
The final goal - in terms of Dose/Volume for each structure
is defined at the outset.
The DVHs- Dose volume Histograms are adjusted to
achieve the desired plan (rather than the beams)
9
19. Fluence
Levels of radiation intensity that the linac outputs
Optimal Fluence
The pattern of radiation intensity that delivers the
best plan - determined by the software during
optimization
19
20. Actual fluence
What the treatment unit is able to deliver –
considering physical parameters of the mlc (max.leaf
speed, leaf transmission etc.)
20
22. Priorities
The priority is specified for each dose constraint
points
It defines the importance of that point relative to all
other points for all structures
22
24. Iterations
The beam intensities are adjusted many times during
optimization, and many ‘plans’ calculated
Each adjustment is 1 iteration
24
25. Leaf Motion Calculator
MLC movement used during treatment is calculated by the Leaf
Motion Calculator – the output from this is the actual fluence
25
Optimal
Fluence
Leaf
Motion
Calculator
Actual
Fluence
Optimization
Plan
28. Delivery
2 main ways of delivering the treatment;
1. Segmented Delivery
Also described as Step and Shoot -
the beam is OFF as the MLCs
move to their next position
28
29. Delivery
2. Sliding Window (Dynamic Delivery).
The beam remains ON as MLCs
move automatically to their next position
29
30. Summary
Forward planning
IMRT
Dose volume histogram
Inverse planning
Optimization
Dose constraints
Priorities
Iterations
Cost functions and penalties
Fluence – actual and optimal
Leaf motion calculator
Segmented delivery
Step and shoot
30
Takehomemessage
I
M
R
T
is
a
ll
a
b
o
u
t
V
o
lu
m
e
s
Today I am going to talk about defining IMRT, explaining the terminology used in IMRT and new advances in IMRT. However the focus of my of my presentation is going to the terminology that is used in IMRT planning.
Before we get into IMRT terminology I want to explain what we do when planning 3d conformal radiation therapy. In 3d conformal planning for eg a ct based 3 fld rectum plan the beam parameters are inputted & manipulated to get a desired dose distribution.it is by manipulating the beam parameters for example wedges ,we get a dose distribution.
Beautiful B.C
This slide demonstrates what happens when a 3 fld pelvis is planned. beam parameters such as the wedges angles, etc are inputted into the comp system and the resultant output that is dose distribution is obtained.
In IMRT the beam is modulated by using different MLC patterns that the planning system produces after going through hundreds of calculations . These modulations correlate directly to the dose that is permitted to the determined volume of each structure specified by the planner...therefore if the planner says cord 50% of the cord can get 2500cGy for eg the system will try its best to achieve that. Of course the huge advantage of IMRT is the sparing of critical structures and as there are many structures that need sparing ,the planner must decide how to best give that information to the system to get the optimal plan.
Radiation pattern for a beam ,showing the intensity pattern formed by the MLCs
Dose Volume Histogram or DVH is defined as graph where each structure in the plan, can be viewed for the volume and dose that it is receiving. In IMRT by changing the DVH of particular structure the beam intensities are manipulated and the desired plan is acheived
Beam angle optimizn not used as the more modulated beams used, the less imp is their direction of incidence
No significant benefit, it’s a non-convex problem, trapped in local minima
The dose volume histogram is used in two steps in IMRT planning. 1 is when we interactively adjust the doses and priorities of structures during optimization as the graph shows, and the other is when we have the final plan where we are able check exactly the volume and dose a particular structure is receiving. Brainstem
The table on the left specifies the volume & dose to be received by each structure . On the right the software tries to match these criteria as set by the planer.
So just as when you want to go form vanc to Coquitlam you tell the comp that Coquitlam is the end product and it finds the most efficient route to get you there, in Inverse planning you tell the planning system what doses you will accept to all the different structures, and it tells you the best and most efficient way to get those.
So just as when you want to go form vanc to Coquitlam you tell the comp that Coquitlam is the end product and it finds the most efficient route to get you there, in Inverse planning you tell the planning system what doses you will accept to all the different structures, and it tells you the best and most efficient way to get there..
So just as when you want to go form vanc to Coquitlam you tell the comp that Coquitlam is the end product and it finds the most efficient route to get you there, in Inverse planning you tell the planning system what doses you will accept to all the different structures, and it tells you the best and most efficient way to get there..
So just as when you want to go form vanc to Coquitlam you tell the comp that Coquitlam is the end product and it finds the most efficient route to get you there, in Inverse planning you tell the planning system what doses you will accept to all the different structures, and it tells you the best and most efficient way to get those..
So while with forward planning the beam is modulated by wedges etc , with IMRT it is modulated by adjusting the dose constraints and priorities.
So hundreds of different mlc patterns and beam weights are tried by the computer to get to the specified dose goals that are set to the different structures by the planner.
This slide shows a fluence map in IMRT
Fluence is radiation intensity pattern & is calculated as the number of photons per given area .Optimal Fluence is what the planning system would like to deliver in a perfect world.
These are set to tell the planning system how important it is to cover the PTVs and the spare the critical structures also known as Organs At Risk OARs.
The priority is used as a weighting factor in the optimization process.For example the sparing of the Optic Chiasm could be more important than the spinal cord and therefore the Optic chiasm would have a higher priority. Only ptvs have upper & lower priorities. Upper for max dose & lower for minimum dose-all critical structures have upper only to limit dose.
The highest priority is most often set on the PTVs as it is essential that these are covered with the appropriate dose
The table on the left specifies the volume & dose to be received by each structure . On the right the software tries to match these criteria as set by the planer.
Plans are run with hundreds of iterations , so that lots of different options are tried.
This is what the Linac can actually deliver taking into account the MLC limitations ie leaf size, rounded edge, tongue & groove. etc.
DVH to show exactly the dose received to the volume of each structure that was used in the planning process.
For those working at the Vanc centre this method of delivery is used at the present time when treating nasopharynxs, tonsil etc with the mlc compensators.
This is done under the control of the MLC computer
So we have covered quite a lot of the terminology used in IMRT.