This document summarizes the case of a 47-year-old male patient with brain metastases from lung cancer. He underwent surgery to remove a left occipital lobe tumor. Following surgery, the patient was planned for stereotactic radiosurgery to treat a residual cavity. The treatment plan delivered 30Gy over 5 fractions to the planning target volume surrounding the cavity. Dosimetry parameters and organ-at-risk constraints were evaluated to ensure safe and accurate delivery of the prescribed dose.
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
This is a made easy summary of ICRU 89 guidelines for gynecological brachytherapy. Extra practical questions for MD/DNB Radiotherapy exams are also attached.
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
This is a made easy summary of ICRU 89 guidelines for gynecological brachytherapy. Extra practical questions for MD/DNB Radiotherapy exams are also attached.
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 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.
Management of cacrinoma cervix: Techniques of radiotherapy (2D conventional, 3D Conformal radiotherapy (3DCRT) and IMRT with a review of various contouring guidelines.
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 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.
Management of cacrinoma cervix: Techniques of radiotherapy (2D conventional, 3D Conformal radiotherapy (3DCRT) and IMRT with a review of various contouring guidelines.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
2. HISTORY
• 47year male
• Nonsmoker
• ECOG-1
• One episode of GTCS in the month of march 12 2020.
• Duration of the episode is for 3 to 4 min, followed by aura.
• Post ictal confusion for a duration of 15 to 20 min
• No headache and vomiting
• No history of involuntary urination or defecation.
• Another episode of GTCS in the month of June 15th 2020.
• Duration of the episode is for 2 to 3 min, followed by aura.
• Post ictal confusion for a duration of 25 to 30 min
• No headache and vomiting’s.
• No history of involuntary urination or defecation
3. • Left occipital lobe and inferior
temporal lobe.
• Lesion of size 3.2*3.2 cm
• Hypointense on T1 .
• Heterogenous on T2 .
• Brilliantly heterogenous
enhancement
• Perilesional edema present
• Occipital horn of left lateral
ventricle dilated.
• MR spectroscopy shows
increased choline and
decreased NAA.
• Possibilities :? Ganglioglioma
PRE OP MRI
7. • Left temporo-occipital region
lesion
• Post surgical defect of size
3.2*3.0cm
• Thick walled minimal irregular
outline cavity
• Central cystic
• Hypointense on T1
• Hyperintense on T2
• Bloom on wall cavity s/o
hemorrhagic products
• No perilesional edema is seen.
• Hyperintense on diffusion images
along the peripheral wall of
lesion.
POST OP MRI
8. • Brain : surgical defect in the
left parieto-occipital region
• Size 3.2*2.4cm
• Lung : spiculated lesion in the
upper lobe of right lung .
• Size 2.6*2.1 (SUV max 3.5)
• Innumerable sub centimeter
nodules in both the lungs. s/o
met
• Right paratracheal lymph node
size 1.1*1.6 (SUV max 3).
• Hypermetabolic lymph nodes
in the right paratracheal and
subcarinal region.
PET SCAN WHOLE BODY
9. • CA Right lung with brain
metastasis
• Post operative case of
the brain metastasis
• TNM staging :
cT4N2M1b
Final Diagnosis
10. Tumor board decision
• After group discussion with neurosurgeon,
radiation oncologist and medical oncologist
board decided to plan for stereotactic
radiotherapy followed by chemotherapy
• Patient was explained about complications
and outcome of the procedure
12. Patient discussion
• Discussed about the procedure
• Discussed about imaging and follow up
• Discussed about tumor response
• Discussed about need of radiotherapy in
future[WBRT/SRS]
• Discussed about post radiotherapy raised ICT
16. Time interval to address cavity dynamics
Caution must be taken when treating cavities in the early(<21 days) interval after
surgery as it may lead to irradiating more normal tissue especially in small tumors
18. Give adequate DREAM protocol before
planning image to decrease edema
Drug Dosage
D Inj. /tab DEXA 8mg Thrice a day after food 5days
R Inj. /tab Ranitidine Twice a day before food 5days
E Inj. /tab Emset 8mg Thrice a day before food 5days
A ANTIEPILEPTICS SOS
M Inj. Mannitol
Syp. Glycerol
Thrice a day infusion over 20 min
20 ml Thrice a day in apple juice
19. • Surgery date -23rd JUNE 2020
• MRI planning 17th JULY 2020 - 24th day post op
• CT planning – 21st JULY 2020 - 28th day post op
Time interval to address cavity dynamics
20. • 1mm slice
• Contrast
• Vertex to neck
• With Fraxion
• CT plan done at end
of 28th day of surgery
keeping the cavity
remodeling in mind
Planning CT
21. MRI protocol
• T1/T2/FLAIR sequence- Usual
sequence
• 3D FSPGR contrast- Normal
anatomy
• 512x 512 matrix
• 1mm slice
• No gap
• No tilt
• Neutral neck
• FOV should include
• body contour nose, eye and skull
22. Pattern of recurrence in cavity
• Cavity
• LMD-leptomeningeal spread
– Nodular pattern
– Sugarcoat pattern
• Surgical tract
• Based on histology
23.
24. • Breast cancer histology,
• Piecemeal resection of BM
• Posterior fossa location
• Multiple BM
• And hemorrhagic or cystic features
• It is thought that this increased risk is due to
tumor spillage into the cerebrospinal fluid
(CSF) at the time of surgical resection
Risk factors for LMD
25. • Nodular LMD (nLMD) was defined as new focal
extra-axial distinct nodular enhancing lesions
located on the leptomeninges or ependyma.
• Classical LMD (cLMD) was akin to “sugarcoating”
enhancement and was defined as new linear or
curvilinear enhancement of the leptomeninges
involving the sulci of the cerebral hemispheres,
cranial nerves, brainstem, cerebellar folia, or
ependyma
Types of recurrence
44. SL NO PARAMETER VALUE
1 D MAX 36.43Gy
2 D95% 31.01Gy
3 D100% 28.23Gy
4 V95% 99.99%
5 V30 Gy[V100%] 99.56%
6 V110% 44.45%
7 V120% 0.03%
8 V130% 0%
1. Prescription Isodose level is usually not 100% PD covering 100% PTV
2. Often 95% PD covering 95% PTV or higher
3. Or 100% PD covering 95% PTV or higher.
Michael Torrens,/J Neurosurg (Suppl 2)/2014
PTV coverage index
45. • FORMULA
• VOLUME OF PRESCRIPTION ISODOSE/PTV VOLUME
• 43.798/37.491=1.17
• DESIRABLE=1
[Sonja Petkovska
Proceedings of the Second
Conference on Medical Physics and
Biomedical Engineering]
RTOG conformity index
46. • FORMULA
(VOLUME OF PRESCRIPTION ISODOSE IN AREA OF INTEREST)2
PTV VOLUME X VOLUME OF PRESCRIPTION ISODOSE
• =39.764 x 39.764 /37.494 x43.798 =0.96
• IDEAL= > 0.85. AND <1
Michael Torrens,/J Neurosurg (Suppl 2)/2014
Paddick conformity index
47. • FORMULA
• MAXIMUM DOSE/PRESCRIPTION DOSE
• 36.43Gy/30Gy=1.21
• DESIRABLE = 1.1-1.3
HOMOGENITY index
48. • Dose fall off observation is very much needed in this
evaluation under headings
• Gradient index
• Difference between various isodose lines
• e.g between 80% and 60%- ideal- <2mm
• Between 80% and 40%- ideal- < 8mm
• For that reason we have to calculate equivalent
radius
Dose fall off
49. • To evaluate dose gradient we have to find out
difference between radius of various isodose line
• But none is iso spherical
• We have to find out equivalent radius from formula
• First find out the specified isodose volume
• Then calculate the radius
• V=4/3 πr3
• r= (3V/4π)1/3
Equivalent radius
51. • FORMULA
– Difference of equivalent radius of prescription
isodose and equivalent radius of 50% isodose
• 2.19mm-3.15mm=0.96mm
• It should be between 0.3 to 0.9
Gradient index
52. • BETWEEN 80% AND 60%- IDEAL-<2mm
– HERE- 0. 4mm
• BETWEEN 80% AND 40%- IDEAL- <8mm
– HERE- 1mm
EORTC-22952-26001
Distance between various isodose lines
58. SL NO ORGAN DESIRABLE ACHIEVED
1 RT. EYE MAX <22.5Gy 1.97Gy
2 LT. EYE MAX <22.5Gy 4.4Gy
3 RT. OPTIC NERVE MAX <22.5Gy 2.3Gy
4 LT. OPTIC NERVE MAX <22.5Gy 5.5Gy
5 OPTIC CHIASM MAX <22.5Gy 7.5Gy
8 BRAIN STEM MAX 23-31Gy 10.01Gy
9 RT. COCHLEA MEAN <25Gy <1Gy
10 LT. COCHLEA MEAN <25Gy <1Gy
GG HANNA/CLINICAL ONCOLOGY/2016
OAR coverage
59. • MECHANICAL ISOCENTER CHECK
– WINSTON LUTZ TEST
• POINT DOSE VERIFICATION
• TOLERANCE-1MM
Travis R. Denton/JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS/2015
QA part
63. PREMEDICATION
• TAB. DEXAMETHASONE 8MG THRICE DAILY
STARTING DAY BEFORE
• TAB. ONDANSETRON 8MG THRICE DAILY
STARTING DAY BEFORE
• TAB. PAN 4O ONCE DAILY STARTING DAY
BEFORE
• DIABETES CARE IF
Pre medication-optional
64. • TAPER THE STEROID OVER A WEEK
• ANTI EMETICS
• PPI
Post medication-optional
66. DOCTORS
• DR P S BHATTACHARYA
• DR C R KUNDU
• DR V K REDDY
• DR P MADHURI
PHYSICISTS
• MR A C PRABU
• MR A SRINU
• MR Prasad
• DR ANIL KUMAR
TECHNOLOGIST TEAM
Acknowledgments