This study evaluated the impact of using individualized target volumes (PTVInd) compared to population-based volumes (PTV0236) for stereotactic body radiotherapy (SBRT) treatment planning in 6 lung cancer patients. PTVInd volumes were on average larger than PTV0236. Treatment plans covering PTVInd achieved similar or better lung sparing compared to PTV0236, with average decreases in irradiated lung volume of 11cc. Non-overlapped regions of PTVInd experienced cold spots with up to 54% reduction in prescription dose coverage. Using individualized volumes captured motion and setup uncertainties while minimizing increases in normal tissue dose compared to population-based volumes.
1) The study assesses the impact of individualized target volumes from multimodality imaging compared to population-based volumes for lung SBRT planning.
2) Individualized target volumes (ITVInd) derived from combining 4DCT, PET, and multiple CT scans better accounted for patient-specific motion and setup uncertainty than population-based volumes (PTV0236).
3) The use of abdominal compression and individualized volumes correlated well with recommended population margins, but individualized volumes are especially important when compression cannot be used since population margins may underestimate needed coverage.
This document compares the kinetics of thallium-201 clearance from peripheral blood between an immediate reinjection procedure and a standard reinjection procedure in patients undergoing thallium-201 scintigraphy. In the immediate procedure, 37 MBq of thallium-201 was reinjected immediately after exercise imaging, while in the standard procedure it was reinjected after 3-hour redistribution imaging. The study found no significant differences between the procedures in peak thallium-201 blood activity after exercise or reinjection, in the relative increase in blood activity after reinjection, or in thallium-201 clearance rates from blood. Both procedures resulted in over a 50% relative increase in the initial peak blood activity and amount of thallium
This document provides guidelines for myocardial perfusion imaging (MPI), including:
1. MPI utilizes radiopharmaceuticals and imaging techniques to identify areas of reduced blood flow in the heart associated with ischemia or scar.
2. Common indications for MPI are to assess for presence, location, and severity of perfusion abnormalities; determine significance of angiographic findings; and detect viable ischemic myocardium.
3. Common clinical settings are for known or suspected coronary artery disease, follow-up of patients with known CAD, and evaluation of congestive heart failure.
Subthalamic Deep Brain Stimulation in Patients with a Previous PallidotomyYavuz Silay
STN DBS patients with a previous unilateral pallidotomy had less improvement in motor function compared to other STN DBS patients, despite good outcomes after pallidotomy. Specifically, the post-pallidotomy STN DBS patients' mean "off" motor UPDRS scores improved by 16.6% compared to 40.2% for controls. Improvement in dyskinesia was similar. Adverse events like worse dysarthria and balance were reported. The authors hypothesize this may be due to patient selection bias or altered neurophysiology from the prior pallidotomy impacting DBS placement/outcomes. Overall results are mixed regarding efficacy of STN DBS after pallidotomy.
Gamma Knife radiosurgery provides a highly effective treatment for brain metastases, allowing for reliable local tumor control with a minimally invasive approach. It provides equivalent or superior outcomes to other standard treatments like surgical resection and fractionated radiotherapy. Studies show median survival times of 10-12 months for patients treated with radiosurgery alone or in combination with whole brain radiation. The risk of adverse side effects is low when established dose and volume criteria are followed for tumors under 30mm in diameter. Whole brain radiation does not seem to improve local control or survival when added to radiosurgery treatment.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
This document summarizes nonoperative treatment options for carpal tunnel syndrome (CTS). It discusses how CTS is a common compression neuropathy that can be costly and cause lost work time. Conservative treatments include medications like NSAIDs and steroids, splinting, modalities like ultrasound and iontophoresis, and addressing ergonomic risk factors. Studies show these approaches can provide relief for mild-moderate CTS and potentially avoid surgery, though outcomes vary. Nonoperative treatment is a viable first-line option when symptoms are early and mild.
1) The study assesses the impact of individualized target volumes from multimodality imaging compared to population-based volumes for lung SBRT planning.
2) Individualized target volumes (ITVInd) derived from combining 4DCT, PET, and multiple CT scans better accounted for patient-specific motion and setup uncertainty than population-based volumes (PTV0236).
3) The use of abdominal compression and individualized volumes correlated well with recommended population margins, but individualized volumes are especially important when compression cannot be used since population margins may underestimate needed coverage.
This document compares the kinetics of thallium-201 clearance from peripheral blood between an immediate reinjection procedure and a standard reinjection procedure in patients undergoing thallium-201 scintigraphy. In the immediate procedure, 37 MBq of thallium-201 was reinjected immediately after exercise imaging, while in the standard procedure it was reinjected after 3-hour redistribution imaging. The study found no significant differences between the procedures in peak thallium-201 blood activity after exercise or reinjection, in the relative increase in blood activity after reinjection, or in thallium-201 clearance rates from blood. Both procedures resulted in over a 50% relative increase in the initial peak blood activity and amount of thallium
This document provides guidelines for myocardial perfusion imaging (MPI), including:
1. MPI utilizes radiopharmaceuticals and imaging techniques to identify areas of reduced blood flow in the heart associated with ischemia or scar.
2. Common indications for MPI are to assess for presence, location, and severity of perfusion abnormalities; determine significance of angiographic findings; and detect viable ischemic myocardium.
3. Common clinical settings are for known or suspected coronary artery disease, follow-up of patients with known CAD, and evaluation of congestive heart failure.
Subthalamic Deep Brain Stimulation in Patients with a Previous PallidotomyYavuz Silay
STN DBS patients with a previous unilateral pallidotomy had less improvement in motor function compared to other STN DBS patients, despite good outcomes after pallidotomy. Specifically, the post-pallidotomy STN DBS patients' mean "off" motor UPDRS scores improved by 16.6% compared to 40.2% for controls. Improvement in dyskinesia was similar. Adverse events like worse dysarthria and balance were reported. The authors hypothesize this may be due to patient selection bias or altered neurophysiology from the prior pallidotomy impacting DBS placement/outcomes. Overall results are mixed regarding efficacy of STN DBS after pallidotomy.
Gamma Knife radiosurgery provides a highly effective treatment for brain metastases, allowing for reliable local tumor control with a minimally invasive approach. It provides equivalent or superior outcomes to other standard treatments like surgical resection and fractionated radiotherapy. Studies show median survival times of 10-12 months for patients treated with radiosurgery alone or in combination with whole brain radiation. The risk of adverse side effects is low when established dose and volume criteria are followed for tumors under 30mm in diameter. Whole brain radiation does not seem to improve local control or survival when added to radiosurgery treatment.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
This document summarizes nonoperative treatment options for carpal tunnel syndrome (CTS). It discusses how CTS is a common compression neuropathy that can be costly and cause lost work time. Conservative treatments include medications like NSAIDs and steroids, splinting, modalities like ultrasound and iontophoresis, and addressing ergonomic risk factors. Studies show these approaches can provide relief for mild-moderate CTS and potentially avoid surgery, though outcomes vary. Nonoperative treatment is a viable first-line option when symptoms are early and mild.
This randomized controlled trial compared vertebroplasty to conservative treatment for acute osteoporotic vertebral compression fractures. 202 patients with persistent pain were randomly assigned to vertebroplasty (101 patients) or conservative treatment (101 patients). Vertebroplasty provided significantly greater pain relief than conservative treatment at both 1 month and 1 year, with differences in mean pain scores of 2.6 and 2.0 respectively. No serious complications were reported. Vertebroplasty was found to be an effective and safe treatment for acute osteoporotic vertebral compression fractures with persistent pain.
Heparin dvt prophylaxis and intracranial surgery dec 2011MQ_Library
Pharmacological VTE prophylaxis such as heparin is commonly used in patients undergoing intracranial surgery to reduce the risk of VTE events like DVT and PE. However, there is also a risk of intracranial hemorrhage from the anticoagulation. A meta-analysis of 6 RCTs found that heparin reduced the relative risk of VTE by 42% but increased the risk of ICH, though not significantly. While heparin prevents symptomatic VTE in about 9-18 in 1000 patients, it could cause ICH in about 7 in 1000. The risk-benefit ratio is close to 1:1, so the decision to use heparin must be individual
This document discusses clinical issues related to IMRT planning for head and neck cancer. It summarizes guidelines for delineating the gross tumor volume (GTV) using PET, CT, and MRI imaging as well as clinical examination. It also provides recommendations for outlining nodal GTVs and clinical target volumes (CTVs). Additionally, it addresses dose escalation strategies and techniques for sparing organs at risk like the larynx when treating the low neck region.
This study evaluated patient controlled sedation (PCS) using propofol and alfentanil for dressing changes in 11 burn patients with over 10% total burn surface area. PCS was compared to sedation provided by an anesthesiologist. Patients preferred PCS due to greater control and less discomfort during recovery. No adverse respiratory or cardiovascular events occurred with PCS. Procedural pain was higher with PCS but lower after the procedure. The study concluded that PCS is an effective and safe alternative to anesthesiologist-provided sedation for burn dressing changes, but noted the small sample size limited the strength of this conclusion and further studies are warranted.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: La prescrizione della dose nei trattamenti stereo-RT e radiochirurgici: dall’ICRU a ROSEL ed altro
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
21 marzo 2014: Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida internazionali
This document discusses guidelines for evaluating radiotherapy treatment plans for primary brain tumors. It provides indications for radiotherapy based on tumor type and extent of resection. Key factors in treatment planning include: contouring target volumes and organs at risk, optimizing dose distribution to cover the target while sparing organs at risk, and quantitatively evaluating plans using tools like isodose distributions, dose volume histograms and indices like coverage, conformity and homogeneity. Plan evaluation ensures the target receives adequate and uniform dose while respecting organ at risk tolerances.
This document summarizes a new computer-aided detection method for intracranial aneurysms that enhances 3D images and highlights potential aneurysms. The method segments arteries from MRI images, determines artery centerlines, and assigns voxels to centerlines. It then colors the anatomical surface from cool to hot based on the change in distance from the centerline, signaling potential aneurysms. An evaluation of 8 subjects found the method detected all 9 true aneurysms with 3.875 false positives per subject on average. The structural information provided by the enhancements could help radiologists better diagnose and plan treatment for aneurysms.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
La costante tentazione dei trattamenti ipofrazionati: breve cronistoria dei modelli biologici e degli effetti clinici
This case report describes a rehabilitation protocol using a video game-based exercise tool to improve dynamic short-sitting balance for three patients with chronic spinal cord injuries or traumatic brain injuries. The tool tracks the center of pressure to control games requiring weight shifting. All three patients showed increased motivation to exercise and dynamic balance control after using the game-based tool. The findings suggest game-based exercises can positively impact rehabilitation by enhancing patient engagement.
Inestabilidad congenita de_hombro_opciones_de_ev_y_ttoIsrael Kine Cortes
This clinical commentary discusses the assessment and treatment of congenital instability of the shoulder joint, also known as multidirectional instability (MDI). MDI is difficult to diagnose due to a lack of understanding of its pathogenesis. It is believed to be caused by excessive joint laxity present from birth rather than trauma. Physical examination focuses on measuring translation beyond normal limits in two or more directions using tests like the sulcus sign and load-and-shift test to identify MDI. Current preferred treatment is extensive physical rehabilitation to strengthen dynamic restraints, though surgery may be needed for recalcitrant cases to restore stability.
AHA 2010 research highlights: A slideshow presentation theheart.org
http://www.theheart.org/editorial-program/1156073.do
The American Heart Association (AHA) 2010 Scientific Sessions took place in Chicago. Key trials presented at the sessions include: ADVANCE,RAFT,QRS EMPHASIS-HF,ASCEND HF,ROCKET AF,CLOSURE I,GRAVITAS,P-OM3,BASKET-PROVE,DEFINE,SYMPLICITY HTN,ASCOT CRP and ACT.
Narejo AS, et al. Comparison of large antecubital vein versus small vein on d...ABDULSATTARNAREJO
This study compared the effectiveness of injecting a propofol-lidocaine mixture through either a large antecubital vein or a small vein on the dorsum of the hand for preventing pain during propofol injection. The study found that injecting the mixture through the large antecubital vein resulted in significantly less moderate to severe pain (20%) compared to injecting through the small hand vein (71%). Injecting through the large antecubital vein also resulted in less reported pain overall and smaller increases in heart rate after injection compared to the small hand vein. The study concludes that using a large antecubital vein is markedly more effective at reducing pain from propofol injection than a small hand vein
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
Trattamenti ipofrazionati ed ipofrazionati-accelerati: effetti sul controllo tumorale e sulla tossicità (inclusa consequential late-toxicity)
TCT 2012 research highlights: A slideshow presentationtheheart.org
TCT 2012 took place in Miami, FL, on October 22-26. Key trials and presentations at the sessions included: PFO Closure, RESPECT, PC Trial, FAME II, ADVANCE, TAVR, TRILOGY-ACS, Live cases, DESSOLVE I and II, SES PARTNER B, MASTER, Career Achievement Award, ADAPT-DES, STEMI-RADIAL and POST
This document discusses frozen shoulder, also known as adhesive capsulitis. It begins by describing frozen shoulder and its prevalence, then discusses its classification. The etiology is unclear but patients typically show characteristic histories and presentations. The document proposes two classification systems, one based on primary versus secondary causes, and another based on patient irritability levels. Non-operative treatments discussed include corticosteroid injections, exercise, and joint mobilization. Corticosteroid injections, in particular glenohumeral intra-articular injections, provide improved short and long term outcomes compared to other treatments. Manipulation or surgery may be considered for recalcitrant cases.
The document discusses guidelines from the International Commission on Radiation Units and Measurements (ICRU) for prescribing, recording, and reporting intensity-modulated radiation therapy (IMRT). It describes the different target volumes and organs at risk that must be delineated for treatment planning according to ICRU reports 50, 62, and 83. These include the gross tumor volume, clinical target volume, planning target volume, internal target volume, treated volume, and irradiated volume. Factors such as margins for internal motion and patient setup must be considered when defining volumes. Dose specifications, dose-volume histograms, conformity, and homogeneity are also discussed. Proper delineation of volumes and standardization of dose reporting are emphasized.
The document discusses standards for precision in radiation oncology, including definitions of target volumes and dose reporting levels according to International Commission on Radiation Units and Measurements (ICRU) reports. It notes unresolved issues for 3D conformal radiation therapy and intensity-modulated radiation therapy, such as margins between gross tumor and clinical target volumes. The document recommends that a new ICRU report is needed to address these modern radiotherapy techniques and provide common guidelines.
1. ICRU Report 83 provides guidelines for prescribing, recording, and reporting intensity-modulated radiation therapy (IMRT). It emphasizes using dose-volume histograms and statistics like median dose to describe dose distributions.
2. The report outlines three levels of prescribing and reporting with increasing complexity. Level 1 involves basic 2D dose distributions while Level 3 incorporates more advanced metrics like tumor control probability.
3. Key volumes discussed include gross tumor volume, clinical target volume, planning target volume, and organs at risk. The report standardized how to account for uncertainties and patient motion when defining these volumes.
The document discusses intensity-modulated radiation therapy (IMRT) for head and neck cancers. It describes how IMRT improves target coverage and sparing of organs-at-risk like the parotid glands compared to conventional radiation therapy. Studies show IMRT reduces the risk of xerostomia and improves quality of life outcomes for patients.
The document discusses recommendations from ICRU reports 50 and 62 regarding prescribing, recording, and reporting photon beam radiation therapy. ICRU Report 50 from 1993 establishes definitions for key volumes used in treatment planning like gross tumor volume, clinical target volume, planning target volume, treated volume, and irradiated volume. ICRU Report 62 from 1999 supplements Report 50 by providing more details on margins needed to account for anatomical variations and uncertainties. It also defines volumes like internal target volume, internal margin, and planning organ at risk volume. The reports aim to standardize terminology and parameters for comparing treatment outcomes across institutions.
This randomized controlled trial compared vertebroplasty to conservative treatment for acute osteoporotic vertebral compression fractures. 202 patients with persistent pain were randomly assigned to vertebroplasty (101 patients) or conservative treatment (101 patients). Vertebroplasty provided significantly greater pain relief than conservative treatment at both 1 month and 1 year, with differences in mean pain scores of 2.6 and 2.0 respectively. No serious complications were reported. Vertebroplasty was found to be an effective and safe treatment for acute osteoporotic vertebral compression fractures with persistent pain.
Heparin dvt prophylaxis and intracranial surgery dec 2011MQ_Library
Pharmacological VTE prophylaxis such as heparin is commonly used in patients undergoing intracranial surgery to reduce the risk of VTE events like DVT and PE. However, there is also a risk of intracranial hemorrhage from the anticoagulation. A meta-analysis of 6 RCTs found that heparin reduced the relative risk of VTE by 42% but increased the risk of ICH, though not significantly. While heparin prevents symptomatic VTE in about 9-18 in 1000 patients, it could cause ICH in about 7 in 1000. The risk-benefit ratio is close to 1:1, so the decision to use heparin must be individual
This document discusses clinical issues related to IMRT planning for head and neck cancer. It summarizes guidelines for delineating the gross tumor volume (GTV) using PET, CT, and MRI imaging as well as clinical examination. It also provides recommendations for outlining nodal GTVs and clinical target volumes (CTVs). Additionally, it addresses dose escalation strategies and techniques for sparing organs at risk like the larynx when treating the low neck region.
This study evaluated patient controlled sedation (PCS) using propofol and alfentanil for dressing changes in 11 burn patients with over 10% total burn surface area. PCS was compared to sedation provided by an anesthesiologist. Patients preferred PCS due to greater control and less discomfort during recovery. No adverse respiratory or cardiovascular events occurred with PCS. Procedural pain was higher with PCS but lower after the procedure. The study concluded that PCS is an effective and safe alternative to anesthesiologist-provided sedation for burn dressing changes, but noted the small sample size limited the strength of this conclusion and further studies are warranted.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: La prescrizione della dose nei trattamenti stereo-RT e radiochirurgici: dall’ICRU a ROSEL ed altro
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
21 marzo 2014: Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida internazionali
This document discusses guidelines for evaluating radiotherapy treatment plans for primary brain tumors. It provides indications for radiotherapy based on tumor type and extent of resection. Key factors in treatment planning include: contouring target volumes and organs at risk, optimizing dose distribution to cover the target while sparing organs at risk, and quantitatively evaluating plans using tools like isodose distributions, dose volume histograms and indices like coverage, conformity and homogeneity. Plan evaluation ensures the target receives adequate and uniform dose while respecting organ at risk tolerances.
This document summarizes a new computer-aided detection method for intracranial aneurysms that enhances 3D images and highlights potential aneurysms. The method segments arteries from MRI images, determines artery centerlines, and assigns voxels to centerlines. It then colors the anatomical surface from cool to hot based on the change in distance from the centerline, signaling potential aneurysms. An evaluation of 8 subjects found the method detected all 9 true aneurysms with 3.875 false positives per subject on average. The structural information provided by the enhancements could help radiologists better diagnose and plan treatment for aneurysms.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
La costante tentazione dei trattamenti ipofrazionati: breve cronistoria dei modelli biologici e degli effetti clinici
This case report describes a rehabilitation protocol using a video game-based exercise tool to improve dynamic short-sitting balance for three patients with chronic spinal cord injuries or traumatic brain injuries. The tool tracks the center of pressure to control games requiring weight shifting. All three patients showed increased motivation to exercise and dynamic balance control after using the game-based tool. The findings suggest game-based exercises can positively impact rehabilitation by enhancing patient engagement.
Inestabilidad congenita de_hombro_opciones_de_ev_y_ttoIsrael Kine Cortes
This clinical commentary discusses the assessment and treatment of congenital instability of the shoulder joint, also known as multidirectional instability (MDI). MDI is difficult to diagnose due to a lack of understanding of its pathogenesis. It is believed to be caused by excessive joint laxity present from birth rather than trauma. Physical examination focuses on measuring translation beyond normal limits in two or more directions using tests like the sulcus sign and load-and-shift test to identify MDI. Current preferred treatment is extensive physical rehabilitation to strengthen dynamic restraints, though surgery may be needed for recalcitrant cases to restore stability.
AHA 2010 research highlights: A slideshow presentation theheart.org
http://www.theheart.org/editorial-program/1156073.do
The American Heart Association (AHA) 2010 Scientific Sessions took place in Chicago. Key trials presented at the sessions include: ADVANCE,RAFT,QRS EMPHASIS-HF,ASCEND HF,ROCKET AF,CLOSURE I,GRAVITAS,P-OM3,BASKET-PROVE,DEFINE,SYMPLICITY HTN,ASCOT CRP and ACT.
Narejo AS, et al. Comparison of large antecubital vein versus small vein on d...ABDULSATTARNAREJO
This study compared the effectiveness of injecting a propofol-lidocaine mixture through either a large antecubital vein or a small vein on the dorsum of the hand for preventing pain during propofol injection. The study found that injecting the mixture through the large antecubital vein resulted in significantly less moderate to severe pain (20%) compared to injecting through the small hand vein (71%). Injecting through the large antecubital vein also resulted in less reported pain overall and smaller increases in heart rate after injection compared to the small hand vein. The study concludes that using a large antecubital vein is markedly more effective at reducing pain from propofol injection than a small hand vein
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
Trattamenti ipofrazionati ed ipofrazionati-accelerati: effetti sul controllo tumorale e sulla tossicità (inclusa consequential late-toxicity)
TCT 2012 research highlights: A slideshow presentationtheheart.org
TCT 2012 took place in Miami, FL, on October 22-26. Key trials and presentations at the sessions included: PFO Closure, RESPECT, PC Trial, FAME II, ADVANCE, TAVR, TRILOGY-ACS, Live cases, DESSOLVE I and II, SES PARTNER B, MASTER, Career Achievement Award, ADAPT-DES, STEMI-RADIAL and POST
This document discusses frozen shoulder, also known as adhesive capsulitis. It begins by describing frozen shoulder and its prevalence, then discusses its classification. The etiology is unclear but patients typically show characteristic histories and presentations. The document proposes two classification systems, one based on primary versus secondary causes, and another based on patient irritability levels. Non-operative treatments discussed include corticosteroid injections, exercise, and joint mobilization. Corticosteroid injections, in particular glenohumeral intra-articular injections, provide improved short and long term outcomes compared to other treatments. Manipulation or surgery may be considered for recalcitrant cases.
The document discusses guidelines from the International Commission on Radiation Units and Measurements (ICRU) for prescribing, recording, and reporting intensity-modulated radiation therapy (IMRT). It describes the different target volumes and organs at risk that must be delineated for treatment planning according to ICRU reports 50, 62, and 83. These include the gross tumor volume, clinical target volume, planning target volume, internal target volume, treated volume, and irradiated volume. Factors such as margins for internal motion and patient setup must be considered when defining volumes. Dose specifications, dose-volume histograms, conformity, and homogeneity are also discussed. Proper delineation of volumes and standardization of dose reporting are emphasized.
The document discusses standards for precision in radiation oncology, including definitions of target volumes and dose reporting levels according to International Commission on Radiation Units and Measurements (ICRU) reports. It notes unresolved issues for 3D conformal radiation therapy and intensity-modulated radiation therapy, such as margins between gross tumor and clinical target volumes. The document recommends that a new ICRU report is needed to address these modern radiotherapy techniques and provide common guidelines.
1. ICRU Report 83 provides guidelines for prescribing, recording, and reporting intensity-modulated radiation therapy (IMRT). It emphasizes using dose-volume histograms and statistics like median dose to describe dose distributions.
2. The report outlines three levels of prescribing and reporting with increasing complexity. Level 1 involves basic 2D dose distributions while Level 3 incorporates more advanced metrics like tumor control probability.
3. Key volumes discussed include gross tumor volume, clinical target volume, planning target volume, and organs at risk. The report standardized how to account for uncertainties and patient motion when defining these volumes.
The document discusses intensity-modulated radiation therapy (IMRT) for head and neck cancers. It describes how IMRT improves target coverage and sparing of organs-at-risk like the parotid glands compared to conventional radiation therapy. Studies show IMRT reduces the risk of xerostomia and improves quality of life outcomes for patients.
The document discusses recommendations from ICRU reports 50 and 62 regarding prescribing, recording, and reporting photon beam radiation therapy. ICRU Report 50 from 1993 establishes definitions for key volumes used in treatment planning like gross tumor volume, clinical target volume, planning target volume, treated volume, and irradiated volume. ICRU Report 62 from 1999 supplements Report 50 by providing more details on margins needed to account for anatomical variations and uncertainties. It also defines volumes like internal target volume, internal margin, and planning organ at risk volume. The reports aim to standardize terminology and parameters for comparing treatment outcomes across institutions.
Final ICRU 62 ( International commission on radiation units and measurements)DrAyush Garg
The document discusses recommendations from reports by the International Commission on Radiation Units and Measurements (ICRU) for defining volumes used in radiation therapy planning and reporting. ICRU Report 62 provides additional details on volumes such as the internal target volume (ITV) and planning organ at risk volume (PRV), and introduces metrics like the conformity index. It also further classifies organs at risk as serial, parallel or serial-parallel based on their radiosensitivity.
The document discusses intensity-modulated radiation therapy (IMRT), including its advantages over conventional radiation therapy in delivering higher and more uniform radiation doses to tumor volumes while minimizing doses to surrounding healthy tissues. It explains that IMRT uses computer-optimized inverse planning to calculate non-uniform radiation beam intensities that target the tumor from several angles. This allows complex tumor shapes to be more conformally treated with lower toxicity risks compared to conventional techniques.
This document describes a study applying intensity modulated radiation therapy (IMRT) using independent jaws rather than a multi-leaf collimator for cancer patients in Dongnai General Hospital in Vietnam. IMRT plans were generated for a nasopharynx patient case using both conventional 3D conformal radiation therapy and jaw-only IMRT (JO-IMRT) techniques. The JO-IMRT plan provided better sparing of critical structures like the parotid glands and spinal cord compared to 3D-CRT. Measurement of the JO-IMRT plan delivery showed differences from calculated doses of less than 2.5%. The study aims to introduce JO-IMRT as a more economical and practical IMRT option for facilities
The document discusses using a Tomotherapy unit to perform total body irradiation (TTBI) treatments. It finds TTBI with Tomotherapy is a feasible technique that offers advantages over conventional TBI, but also has some limitations. Specifically, TTBI treatments can cover the target volume well while sparing organs at risk, but planning and delivery times are long and further dosimetric validation is needed before clinical use.
This document summarizes key aspects of the International Commission on Radiation Units and Measurements (ICRU) Report 83 from 2010 on prescribing, recording, and reporting photon beam intensity-modulated radiation therapy (IMRT). The ICRU Report 50 from 1993 and Report 62 from 1999 established guidelines for defining target volumes like gross tumor volume, clinical target volume, and planning target volume. ICRU Report 83 aimed to update these guidelines for IMRT, which uses non-uniform fluence and dose distributions compared to earlier conformal radiation techniques. Key changes included separating the planning target volume into internal and setup margins, classifying organs at risk, and defining new metrics like the planning organ at risk volume and conformity index for evaluating IM
The document discusses key concepts in radiobiology relevant for radiotherapy. It defines important treatment volumes including the gross tumour volume (GTV), clinical target volume (CTV), planning target volume (PTV), treated volume (TV), irradiated volume (IV), and organs at risk (OARs). It also describes biological factors that influence radiation effects on tissues, known as the "5 Rs": repair, repopulation, reoxygenation, redistribution, and radiosensitivity. Fractionated radiotherapy takes advantage of these factors to maximize tumor cell kill while minimizing damage to normal tissues.
Implementing an End-to-End SGRT Workflow for Breath-Hold SABRSGRT Community
SGRT Europe 2022
Ellen Dear
Senior Regional Therapeutic Radiographer
Genesis Care
Chelsea Carnall
Senior Regional Therapeutic Radiographer
Genesis Care
This document summarizes guidelines for radiotherapy planning for lung cancer. It discusses:
- Defining the gross tumor volume (GTV) based on imaging like PET which can help reduce margins.
- Adding margins to the GTV to create the clinical target volume (CTV) accounting for microscopic spread. There is debate around elective nodal irradiation.
- Further expanding the CTV to create the planning target volume (PTV) accounting for set-up uncertainty and tumor motion. Techniques like gating can help reduce this.
- Contouring the lungs as organs at risk and calculating dosimetric parameters like V20 and V5 to quantify lung dose and risk of toxicity. Dose needs to
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.
CT is one of the highest contributor for medical radiation exposure to patients. Some common CT dose descriptors and dose optimizations methods are briefly described in this presentation.
This document summarizes the use of radiotherapy in early breast cancer treatment. It discusses how breast-conserving therapy with radiotherapy is as effective as mastectomy, and how radiotherapy reduces local recurrence when used as part of breast-conserving surgery for ductal carcinoma in situ. It also describes different radiotherapy techniques for early invasive breast cancer including whole breast irradiation, tumor bed boosts, and accelerated partial breast irradiation.
Radiotherapy contouring guideline for non-hodgkin lymphomaketan kalariya
This document provides guidelines for modern radiation therapy for nodal non-Hodgkin lymphoma. It outlines a new concept of involved-site radiation therapy using reduced treatment volumes based on imaging to define target volumes. Guidelines are provided for radiation therapy as primary treatment, as part of combined modality treatment, and for recurrent or refractory disease. Recommended doses and techniques such as IMRT are discussed depending on the clinical situation and disease stage. The goal is to restrict radiation therapy to limited involved sites to reduce normal tissue exposure while maintaining local tumor control.
This document discusses the use of external beam radiotherapy (EBRT) and chemotherapy in the treatment of cervical cancer. It outlines the indications for EBRT in definitive, adjuvant, and palliative settings. It describes various EBRT techniques including conventional, 3D-CRT, IMRT and discusses steps like simulation, planning, dose and fractionation. The role of concurrent chemoradiation using cisplatin is discussed based on evidence from large randomized trials showing improved survival. Adjuvant chemotherapy with cisplatin and mitomycin C is also addressed.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
1. Impact of individualized target volumes on stereotactic body radiotherapy
(SBRT) treatment planning: Dosimetric analysis
CJ Hampton, WT Kearns, JJ Urbanic, KP McMullen, AW Blackstock, WH Hinson
Department of Radiation Oncology • Wake Forest University School of Medicine • Winston-Salem, North Carolina
Introduction either in the absence of (patients 1-3), or as a complement to the only one patient (patient #4, Figure 2a). The worst case indicated
compression apparatus (patients 4-6). Our SBRT treatment planning underdosing of PTVInd by 14% (patient #1). The portion of PTVInd not
Multimodality and 4D imaging provide temporal, anatomic and protocol introduces a hybrid internal target volume, ITVInd, defined by the overlapped by PTV0236 was on average covered by a mean dose of 96% of
physiological information that help reduce treatment planning combination of the 4DCT-derived MIP with gross tumor volumes (GTV1 & the prescription isodose. PTVInd, however, contained “cold” areas where
uncertainties. Our institution has performed over 200 CT or PET/CT SBRT
GTV2) contoured from the registered helical CT acquisitions and GTVPET the prescription dose was reduced by as much as 54% (Patient 6, Figure
simulations since 2003 using the commercially available Elekta
when available. Isotropic margins of 5mm were added to ITVInd as a 2b). When treatment plans created using PTV0236 and PTVInd as targets are
Stereotactic Body Frame (Elekta, Inc., Norcross, GA). While the
“safety margin" creating PTVInd(Figure 1). 3D treatment plans were compared, the impact of individualized margins on irradiated lung volumes
bodyframe employs stereotactic principles to immobilize patients for
calculated with heterogeneity corrections delivering D95%= Rx isodose for is exhibited by the ability to achieve dose coverage for the larger PTVInd
reproducible setup, a small amount of setup uncertainty can be quantified
by analyzing registered initial and repositioning CT scans. The bodyframe PTVInd, and minimal dose to normal tissues, especially the normal lung volume without sacrificing minimization of the irradiated lung volume
includes an abdominal compression apparatus which is used to force (V20<10%). For comparison, treatment plans were also created for a (Table 2). In fact, for all patients, V13 and V20 differ by no greater than 2%
shallow breathing by the patient, thereby minimizing physiological tumor for the two plans even when no abdominal compression is available and
second PTV (PTV0236) based on the expansion of GTV2 with population-
motion. A subpopulation of eligible patients, however, is unable to the PTVInd is largest (Patient 1). All treatment plans were able to achieve
based margins of 5mm (10mm S/I) as recommended by RTOG 0236.
Patient
tolerate the abdominal compression or, limited by anatomy, is unable to Abdominal Volume (cc) Dmax (%) V20 less than 10% as targeted by the protocol. When individualized margins
avoid collisions with the device. 4DCT, has emerged as a viable means of Compression? PTV0236 PTVIND
PTV0236 PTVIND are used for planning along with abdominal compression, the mean lung
creating patient-specific target volumes (PSTV) capturing a sample of 125 150 dose is decreased by an average of 11 cc with patient 4 achieving the
1 No 18.2 28.4
intrafraction motion. This work assesses the impact of individualized 125 122 largest reduction (-27cc).
2 No 23.8 30.2
target volumes derived from multimodality simulation scans on treatment
3 No 28.3 35.1 128 130
plans for 6 lung SBRT patients. The dosimetric impact of individualized Irradiated Lung Volume (% of total)
Patient
146 154 MeanLD (cc)
4 Yes 11.1 9.9 V13 V20
target volumes on target and normal tissues is contrasted with patient
5 Yes 52.1 56.9 120 132 PTV0236 PTVIND PTV0236 PTVIND PTV0236 PTVIND
population-based target volumes recommended by the recently closed
RTOG 0236 phase II clinical trial which investigated SBRT in the treatment 6 Yes 89.3 98.2 129 133
1 8 9 4 5 343 362
of medically inoperable stage I/II non-small cell lung cancer. (a) (b) 2 12 12 5 5 403 437
Table 1 – A comparison of target volumes (a) and Dmax (b) for plans 3 7 7 3 4 344 356
covering D95% of PTVInd and PTV0236 with the prescription isodose surface. 4 4 3 2 1 180 153
5 10 9 6 6 371 352
(a) (b) 6 17 17 8 10 565 579
Deviation (% of DRx)
Table 2 – A comparison on the impact of target coverage for PTVInd and
Cold Spot (% of DRx)
PTV0236 on the irradiated lung volume
Figure 1 – Individualized target volumes: the combination of GTV1 Conclusions
(orange), GTV2 (green), GTVPET (khaki), and MIP (yellow) plus margin • DVH analysis of comparative plans indicates that a reduction in
form PTVInd (light blue). PTV0236 (navy blue) is an expansion of GTV2. Patient Patient dosimetric coverage of the individualized planning target volume by
14% of the prescription dose may occur for some patients.
Figure 2 – (a) Deviation in coverage for PTVInd for a treatment plan
• Due to steep falloff gradients, non-overlapped regions of PTVInd
targeting PTV0236. (b) Cold spot (Dmin) as a percentage of DRx resulting
Methods and Materials from deviation in target coverage
contained “cold” spots with a 54% reduction in the prescription dose
coverage.
Three of the six SBRT patients met the criteria for the use of abdominal Results
• Coverage of the larger PTVInd can be achieved mostly by increasing
compression. Our SBRT simulation protocol involved the acquisition of 3-4 heterogeneity within the tumor volume with minimal increases in
The volume of PTVInd was greater than PTV0236 for 5 of 6 patients (Table
imaging studies per patient using a GE Discovery PET/CT scanner (GE irradiated lung volume.
1a). Separate treatment plans providing the desired coverage of PTV0236
Healthcare, Waukesha, WI), interfaced with the Varian Real-time • Individualized planning target volume margins taking into account data
Positioning (RPM) system (Varian Medical Systems, Palo Alto, CA): 2 and PTVInd were successfully created. For the group, the average increase
quantifying setup uncertainties and physiological tumor motion may be
sequential helical CT scans interspaced by patient repositioning, a non- in Dmax as a consequence of covering PTVInd was 8% (Table 1b). DVH used for stereotactic body radiotherapy without increasing irradiated
gated PET scan (optional) and a cine CT scan which was retrospectively analysis of target coverage demonstrates the potential risk of underdosing lung volumes beyond accepted values.
gated to produce a 4DCT dataset. 4DCT, was used for all patients to when population-based models are used. When the plan providing • The volumetric impact of individualized target volumes on SBRT was
create patient-specific maximum intensity projections (MIP) coverage of PTV0236 was spatially overlaid on top of PTVInd, target coverage the subject of a related investigation, the results of which are discussed
in ASTRO poster presentation # 2998 (CJ Hampton et al.)
was on average reduced by 8.3% with coverage maintained for
Presentation #3016