Treatment & challenges of uh breast radiotherapy
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Simulation, Treatment & challenges faced to Radiation Therapist During CoVID 19 Pandamic By Mr Sunil Maurya, Radiation Therapist, Sir HN RELIANCE HOSPITAL and Research center, Mumbai
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Immobilization and setup for Prone Breast Radiotherapy- A Therapist approach
Immobilization and daily treatment setup for Prone Breast Radiotherapy is always challenging for radiation therapist team. This presentation will highlights the possibilities of the different immobilization and setup approaches in therapist perspective.
Motion Management in Radiation Therapy
Motion management strategies in radiation therapy aim to account for tumor movement during treatment. Key strategies include gating methods that deliver radiation only during specific respiratory phases, breath hold methods that immobilize tumors during deep inhalation or exhalation, tracking methods that follow tumor motion in real-time and adjust beam targeting accordingly, and encompassing methods that define larger target volumes to cover full respiratory excursion. No single approach is clearly superior, as appropriate management depends on tumor location, motion extent, and available technology. The goal of all motion management is to safely escalate dose to tumors while reducing dose to surrounding healthy tissues.
Hst motion inradiotherapy
Motion in radiotherapy can negatively impact treatment by causing a mismatch between the intended and actual radiation dose delivered to the target and surrounding tissues. There are several sources of motion, including patient setup errors, breathing/coughing, and target deformation. Systematic errors are generally more detrimental than random errors as they consistently underdose parts of the target. Motion management techniques aim to limit motion and its effects. These include patient immobilization, multiple CT scans, robust treatment planning, gating radiotherapy to specific breathing phases, and asking patients to briefly hold their breath.
Total body irradiation
This document provides information about total body irradiation (TBI). It discusses that TBI uses megavoltage photon beams to destroy the recipient's bone marrow and tumor cells prior to bone marrow transplantation. It is used to treat various diseases like leukemia, lymphoma, and multiple myeloma. TBI can be delivered at high or low doses, to half the body, or total nodes. Techniques include parallel opposed beams from linear accelerators or cobalt-60 machines. Dosimetry and in vivo dosimetry are important due to the large fields and difficulty achieving uniform dose. Complications can include sterility, secondary cancers, and growth issues.
Respiratory Gating with IMRT
Respiratory gating with intensity-modulated radiation therapy (IMRT) allows for higher doses to be delivered to the tumor target while reducing side effects to normal tissues. It works by synchronizing beam delivery to specific phases of the respiratory cycle using external markers or internal fiducials implanted in or near the tumor. This leads to smaller planning target volumes and sharper dose gradients compared to conventional radiation therapy that does not account for tumor motion. Respiratory gating requires consistent breathing patterns from patients and continuous monitoring during treatment. It is effective for tumors in organs that move significantly during respiration like lung, liver and pancreas.
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Motion management in Radiation Oncology - 2020
This document discusses various sources of uncertainty and errors in radiation therapy delivery due to patient and target motion. It describes advances in imaging guidance and motion management techniques like 4D imaging, respiratory gating, abdominal compression, and deep inspiration breath hold to minimize the effects of respiratory motion. Real-time tracking methods like RPM and ExacTrac systems are highlighted which allow continuous monitoring of tumor position throughout treatment. Managing respiratory motion remains an important area of focus to ensure accurate radiation delivery.
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Motion management strategies in radiation therapy aim to account for tumor movement during treatment. Key strategies include gating methods that deliver radiation only during specific respiratory phases, breath hold methods that immobilize tumors during deep inhalation or exhalation, tracking methods that follow tumor motion in real-time and adjust beam targeting accordingly, and encompassing methods that define larger target volumes to cover full respiratory excursion. No single approach is clearly superior, as appropriate management depends on tumor location, motion extent, and available technology. The goal of all motion management is to safely escalate dose to tumors while reducing dose to surrounding healthy tissues.
Hst motion inradiotherapy
Motion in radiotherapy can negatively impact treatment by causing a mismatch between the intended and actual radiation dose delivered to the target and surrounding tissues. There are several sources of motion, including patient setup errors, breathing/coughing, and target deformation. Systematic errors are generally more detrimental than random errors as they consistently underdose parts of the target. Motion management techniques aim to limit motion and its effects. These include patient immobilization, multiple CT scans, robust treatment planning, gating radiotherapy to specific breathing phases, and asking patients to briefly hold their breath.
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This document provides information about total body irradiation (TBI). It discusses that TBI uses megavoltage photon beams to destroy the recipient's bone marrow and tumor cells prior to bone marrow transplantation. It is used to treat various diseases like leukemia, lymphoma, and multiple myeloma. TBI can be delivered at high or low doses, to half the body, or total nodes. Techniques include parallel opposed beams from linear accelerators or cobalt-60 machines. Dosimetry and in vivo dosimetry are important due to the large fields and difficulty achieving uniform dose. Complications can include sterility, secondary cancers, and growth issues.
Respiratory Gating with IMRT
Respiratory gating with intensity-modulated radiation therapy (IMRT) allows for higher doses to be delivered to the tumor target while reducing side effects to normal tissues. It works by synchronizing beam delivery to specific phases of the respiratory cycle using external markers or internal fiducials implanted in or near the tumor. This leads to smaller planning target volumes and sharper dose gradients compared to conventional radiation therapy that does not account for tumor motion. Respiratory gating requires consistent breathing patterns from patients and continuous monitoring during treatment. It is effective for tumors in organs that move significantly during respiration like lung, liver and pancreas.
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Motion management in Radiation Oncology - 2020
This document discusses various sources of uncertainty and errors in radiation therapy delivery due to patient and target motion. It describes advances in imaging guidance and motion management techniques like 4D imaging, respiratory gating, abdominal compression, and deep inspiration breath hold to minimize the effects of respiratory motion. Real-time tracking methods like RPM and ExacTrac systems are highlighted which allow continuous monitoring of tumor position throughout treatment. Managing respiratory motion remains an important area of focus to ensure accurate radiation delivery.
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This document discusses radiotherapy planning and techniques for breast cancer treatment. It describes the iterative process of developing a treatment plan, which involves initial beam arrangement based on clinical experience, reviewing dose distributions, and modifying the plan based on parameters like isodose lines and dose-volume histograms. It also covers challenges like respiratory motion and setup uncertainties, and techniques to address these like deep inspiratory breath hold and respiratory gating. The goal is to deliver the prescribed radiation dose to the target while sparing surrounding healthy tissues as much as possible.4D Scan and Respiratory Gating
1.Aim of Radiotherapy
The goal of radiotherapy is to deliver a prescribed dose of radiation to the Target while sparing surrounding Healthy tissues to the largest extent possible
2.Organ Motion
Intra-fraction motion
during the fraction
Heartbeat
Swallowing
Coughing
Eye movement
Inter-fraction motion
- in between the fractions
Tumour change
Weight gain/loss
Positioning deviation
Breathing
Bowel and rectal filling
Bladder filling
Muscle relaxation/tension
3. Respiratory motion affects:
Respiratory motion affects all tumour sites in the thorax, abdomen and Pelvis. Tumours in the Lung, Liver, Pancreas, Oesophagus, Breast, Kidneys, prostate
Tumour displacement varies depending on the site and organ Location
Lung tumours can move several cm in any direction during irradiation
It is most prevalent and prominent in Lung cancers
4. Problems associated with respiratory motion during RT
Image acquisition limitations
Treatment planning limitations
Radiation delivery limitations
5. Methods to Account for Respiratory Motion
1. Motion encompassing methods
2. Respiratory gating methods
3. Breath hold methods
4. Forced shallow breathing with abdominal compression
5. Real-time tumor tracking methods
Summary:
The management of respiratory motion in radiation oncology is an evolving field
IGRT provides a solution for combating organ motion in radiotherapy
Delivering higher dose to tumor and less dose to normal tissue.
Limited clinical studies, needs to be studied further
IGRT – the future of radiotherapy
Motion Management in Lung Cancer Radiotherapy
This document discusses motion management techniques for lung cancer radiotherapy. It begins by explaining why motion management is important, as standard CT scans do not fully capture lung tumor motion. It then describes 4DCT and other methods for assessing tumor motion, as well as techniques like ITV, gating, tracking and breath-holding to control for motion. Specific examples of tracking systems like ExacTrac and Cyberknife are provided. Overall, the document provides an overview of the challenges of lung tumor motion and different strategies used to manage it in radiation treatment planning and delivery.
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IMAGE GUIDED BARCHYTHERAPY
AMERICAN BRACHYTHERAPY GUIDELINES
GEC-ESTRO GUIDELINES
LIMITATIONS OF (2 D)RADIOGRAPHIC IMAGING
VOLUMETRIC IMAGING
ADVANCES
MR recommendations gec-estro
The document summarizes recommendations from the GYN GEC-ESTRO Working Group regarding MRI use for image-based adaptive brachytherapy in cervical cancer treatment. It recommends performing pelvic MRI before radiotherapy (pre-RT) and at the time of brachytherapy (BT MRI) using the same MRI machine. T2-weighted multiplanar MRI with a pelvic surface coil provides optimal visualization of the tumor and organs at risk. Patient preparation and MRI protocols should be tailored to the needs of BT. Following these recommendations can help optimize target definition and dose distribution during treatment.
Cyberknife
The CyberKnife is a frameless robotic radiosurgery system used to treat both benign and malignant tumors. It was invented in the 1990s and is manufactured by Accuray. It uses a compact linear accelerator mounted on a robotic arm to deliver radiation from many angles and can track tumor motion using X-ray imaging and respiratory tracking sensors. Treatment planning involves defining target volumes and constructing a correspondence model between internal fiducial markers and external sensors to track tumor position in real-time during delivery. The CyberKnife provides an alternative to frame-based radiosurgery and can fractionate treatment over multiple days.
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Immobilization devices
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Alignment of the Tangential Beam with the Chest Wall Contour
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Modern Radiotherapy
This document discusses modern radiotherapy techniques including conformal radiotherapy and intensity-modulated radiation therapy (IMRT). It describes the planning steps which involve CT scanning of the patient, delineating the tumor and organ-at-risk volumes, dose analysis, and treatment delivery with quality assurance and patient positioning. IMRT allows for improved target conformality and reduced radiation exposure to surrounding healthy tissues compared to traditional radiotherapy through inverse planning optimization of multiple modulated radiation beams. Image-guided radiotherapy (IGRT) further improves treatment accuracy by accounting for organ motion and setup variations using frequent imaging.
3 d crt
Three-dimensional conformal radiation therapy (3D-CRT) uses 3D imaging to plan radiation doses that conform to the shape of the tumor target and minimizes doses to surrounding healthy tissues. The process involves imaging the patient, delineating tumor and organ contours, planning beam angles and shapes, and verifying the planned dose distribution before treatment. 3D-CRT aims to maximize tumor control while minimizing normal tissue side effects.
Immobilization in radiotherapy
Immobilization devices are crucial for accurate radiation therapy by reducing setup errors and patient movement. Proper immobilization allows higher radiation doses to be delivered safely to the target volume while sparing surrounding healthy tissues. For the head and neck, aquaplast masks and thermoplastic shells molded to the patient are commonly used. Indexing bars and shoulder straps further improve reproducibility. For the thorax and breast, vacuum cushions and breast boards are utilized, while pelvic regions employ partial body casts or vacuum cushions extending from the lower thorax to mid-thighs. Advances in immobilization now enable smaller treatment volumes and higher controlled doses for improved patient outcomes.
Summary of embrace protocol
The EMBRACE protocol involves a prospective multicenter study evaluating image-guided radiotherapy for cervical cancer, with a focus on improving outcomes. Key aspects of the protocol include:
1. Retrospective studies identified the benefits of MRI-based adaptive brachytherapy and established guidelines for parameters to evaluate.
2. The prospective EMBRACE I study involved over 1400 patients treated with chemoradiation followed by MRI-guided brachytherapy at 23 centers. Early results showed high local control rates and the benefits of combined intracavitary/interstitial brachytherapy in reducing morbidity.
3. The ongoing EMBRACE II study aims to further improve outcomes through
4D Radiotherapy
4D radiotherapy aims to account for tumor motion during radiation therapy by acquiring CT images over multiple phases of the breathing cycle (4D CT imaging) and using this information for treatment planning and delivery. It allows for more accurate targeting of tumors in organs affected by respiratory motion like the lungs. While 4D radiotherapy provides advantages over existing motion management techniques, there are still technological challenges and limitations like complexity, treatment time, and residual motion. Future work includes addressing these issues and further integrating 4D techniques with other advances in radiation oncology.
Intraoperative Radiotherapy (IORT)
IORT uses a high single dose of radiation delivered during surgery to treat cancer remnants after tumor removal. It has two objectives: increase local tumor control and increase the ratio of tumor control to damage of nearby healthy tissues. IORT can be delivered via two methods - IOERT uses electron beams from a LINAC and IOHDR uses radioactive sources. Treatment planning requires a multidisciplinary team to determine applicator positioning and appropriate dose to maximize tumor coverage while minimizing radiation to other organs. IORT provides local tumor control comparable to conventional fractionated radiotherapy but with faster treatment time and less damage to surrounding tissues.
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1645 ainsworth
This document discusses predicting patient risk of acquiring Klebsiella pneumoniae carbapenemase producing organisms (KCPO) and linking environmental exposure to patient acquisition. It describes developing a patient risk model using a case-control approach and clinical and demographic data. A naïve Bayesian model was built and validated, showing an AUC of 0.746. It then analyzes the impact of positive room environments on patient infection using a treatment effects model, controlling for patient risk and length of stay. The results show room positivity is significantly associated with acquisition of infection, with an odds ratio of 22.25. Ultimately, interventions like hopper covers and heater traps reduced environmental transmission.
Using POCT for Influenza
This document discusses using point-of-care testing (POCT) for influenza to improve patient care and hospital efficiency. It evaluates using the Liat system for influenza testing in the accident and emergency department during the 2017/2018 flu season. Key results included a 14% reduction in influenza admissions and a 7.5% reduction in upper respiratory tract infection admissions, avoiding 45 total admissions. Length of stay was also reduced for influenza patients. Estimated financial savings from avoided admissions and bed days was over £142,000 for a typical flu season. Challenges included funding, staffing, and ensuring all appropriate areas use the POCT. Overall benefits included improved patient experience, more efficient use of isolation rooms, and financial savings.
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Stereotactic body radiation therapy (SBRT) uses advanced technology to deliver high ablative doses of radiation to tumors in a precise manner. SBRT has been shown to be effective in treating various tumor types with acceptable toxicity. However, long term toxicity requires further study. New techniques aim to reduce treatment margins and account for organ motion to minimize dose to surrounding healthy tissues while ensuring accurate dose delivery to the tumor. SBRT shows promise but further prospective clinical trials are needed to fully evaluate efficacy and safety.
Breast Cancer Radiation Therapy: RT Plan evaluation & Recent Advances - 4DCT ...
Breast Cancer Radiation Therapy: RT Plan evaluation & Recent Advances - 4DCT ...Kidwai Memorial Institute of Oncology, Bangalore
This document discusses radiotherapy planning and techniques for breast cancer treatment. It describes the iterative process of developing a treatment plan, which involves initial beam arrangement based on clinical experience, reviewing dose distributions, and modifying the plan based on parameters like isodose lines and dose-volume histograms. It also covers challenges like respiratory motion and setup uncertainties, and techniques to address these like deep inspiratory breath hold and respiratory gating. The goal is to deliver the prescribed radiation dose to the target while sparing surrounding healthy tissues as much as possible.4D Scan and Respiratory Gating
1.Aim of Radiotherapy
The goal of radiotherapy is to deliver a prescribed dose of radiation to the Target while sparing surrounding Healthy tissues to the largest extent possible
2.Organ Motion
Intra-fraction motion
during the fraction
Heartbeat
Swallowing
Coughing
Eye movement
Inter-fraction motion
- in between the fractions
Tumour change
Weight gain/loss
Positioning deviation
Breathing
Bowel and rectal filling
Bladder filling
Muscle relaxation/tension
3. Respiratory motion affects:
Respiratory motion affects all tumour sites in the thorax, abdomen and Pelvis. Tumours in the Lung, Liver, Pancreas, Oesophagus, Breast, Kidneys, prostate
Tumour displacement varies depending on the site and organ Location
Lung tumours can move several cm in any direction during irradiation
It is most prevalent and prominent in Lung cancers
4. Problems associated with respiratory motion during RT
Image acquisition limitations
Treatment planning limitations
Radiation delivery limitations
5. Methods to Account for Respiratory Motion
1. Motion encompassing methods
2. Respiratory gating methods
3. Breath hold methods
4. Forced shallow breathing with abdominal compression
5. Real-time tumor tracking methods
Summary:
The management of respiratory motion in radiation oncology is an evolving field
IGRT provides a solution for combating organ motion in radiotherapy
Delivering higher dose to tumor and less dose to normal tissue.
Limited clinical studies, needs to be studied further
IGRT – the future of radiotherapy
Motion Management in Lung Cancer Radiotherapy
This document discusses motion management techniques for lung cancer radiotherapy. It begins by explaining why motion management is important, as standard CT scans do not fully capture lung tumor motion. It then describes 4DCT and other methods for assessing tumor motion, as well as techniques like ITV, gating, tracking and breath-holding to control for motion. Specific examples of tracking systems like ExacTrac and Cyberknife are provided. Overall, the document provides an overview of the challenges of lung tumor motion and different strategies used to manage it in radiation treatment planning and delivery.
Modern Radiation Treatment
This document summarizes modern advances in radiation treatment for cancer. It discusses how radiation oncology aims to maximize radiation targeting of tumors while sparing surrounding healthy tissues. Key advances discussed include improved dose delivery techniques like IMRT and IMAT, more precise target definition using anatomical and functional imaging, and better target localization using image-guided radiation therapy and on-board imaging. The document also outlines potential future directions like dose escalation techniques like focal boosting, use of charged particle therapy, and stereotactic body radiotherapy.
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Sharing about “A typical day in the life as Radiation Therapy Technologist (RTT)” includes their roles, responsibilities, duties, working protocols, management, working stress, daily challenges in this modern radiotherapy era. As well as a bit information about how to become a RTT in India.
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This document defines stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) as using precise 3D mapping to guide high dose, conformal radiation treatment in a single session for SRS or multiple fractions for SRT. It describes several techniques for SRS including Gamma Knife, LINAC, proton beam, and tomotherapy. Key requirements for stereotactic irradiation include accuracy of patient positioning and beam targeting. The document discusses radiobiology principles, normal tissue tolerances, and quality assurance needs for safe SRS/SRT delivery. It provides examples of clinical applications including brain and spinal metastases, AVMs, and benign tumors.
Forward imrt in breast radiotherapy
This document discusses the forward intensity-modulated radiation therapy (IMRT) technique known as field-in-field (FIF) for whole breast radiotherapy. It begins by explaining how FIF uses multiple subfields in addition to the main tangential fields to improve dose homogeneity throughout the breast. Studies show improved homogeneity decreases skin toxicities. The document then evaluates three FIF techniques - single pair of subfields, multiple pairs of subfields, and alternate subfields. It finds the alternate subfields technique provides the best dose distribution and target coverage while being less time-consuming than other techniques. Finally, the document discusses how FIF with lung blocks further reduces lung dose compared to physical wedges.
image guided brachytherapy carcinoma cervix
IMAGE GUIDED BARCHYTHERAPY
AMERICAN BRACHYTHERAPY GUIDELINES
GEC-ESTRO GUIDELINES
LIMITATIONS OF (2 D)RADIOGRAPHIC IMAGING
VOLUMETRIC IMAGING
ADVANCES
MR recommendations gec-estro
The document summarizes recommendations from the GYN GEC-ESTRO Working Group regarding MRI use for image-based adaptive brachytherapy in cervical cancer treatment. It recommends performing pelvic MRI before radiotherapy (pre-RT) and at the time of brachytherapy (BT MRI) using the same MRI machine. T2-weighted multiplanar MRI with a pelvic surface coil provides optimal visualization of the tumor and organs at risk. Patient preparation and MRI protocols should be tailored to the needs of BT. Following these recommendations can help optimize target definition and dose distribution during treatment.
Cyberknife
The CyberKnife is a frameless robotic radiosurgery system used to treat both benign and malignant tumors. It was invented in the 1990s and is manufactured by Accuray. It uses a compact linear accelerator mounted on a robotic arm to deliver radiation from many angles and can track tumor motion using X-ray imaging and respiratory tracking sensors. Treatment planning involves defining target volumes and constructing a correspondence model between internal fiducial markers and external sensors to track tumor position in real-time during delivery. The CyberKnife provides an alternative to frame-based radiosurgery and can fractionate treatment over multiple days.
radiation therapy in ca breast
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
Modern Radiotherapy
This document discusses modern radiotherapy techniques including conformal radiotherapy and intensity-modulated radiation therapy (IMRT). It describes the planning steps which involve CT scanning of the patient, delineating the tumor and organ-at-risk volumes, dose analysis, and treatment delivery with quality assurance and patient positioning. IMRT allows for improved target conformality and reduced radiation exposure to surrounding healthy tissues compared to traditional radiotherapy through inverse planning optimization of multiple modulated radiation beams. Image-guided radiotherapy (IGRT) further improves treatment accuracy by accounting for organ motion and setup variations using frequent imaging.
3 d crt
Three-dimensional conformal radiation therapy (3D-CRT) uses 3D imaging to plan radiation doses that conform to the shape of the tumor target and minimizes doses to surrounding healthy tissues. The process involves imaging the patient, delineating tumor and organ contours, planning beam angles and shapes, and verifying the planned dose distribution before treatment. 3D-CRT aims to maximize tumor control while minimizing normal tissue side effects.
Immobilization in radiotherapy
Immobilization devices are crucial for accurate radiation therapy by reducing setup errors and patient movement. Proper immobilization allows higher radiation doses to be delivered safely to the target volume while sparing surrounding healthy tissues. For the head and neck, aquaplast masks and thermoplastic shells molded to the patient are commonly used. Indexing bars and shoulder straps further improve reproducibility. For the thorax and breast, vacuum cushions and breast boards are utilized, while pelvic regions employ partial body casts or vacuum cushions extending from the lower thorax to mid-thighs. Advances in immobilization now enable smaller treatment volumes and higher controlled doses for improved patient outcomes.
Summary of embrace protocol
The EMBRACE protocol involves a prospective multicenter study evaluating image-guided radiotherapy for cervical cancer, with a focus on improving outcomes. Key aspects of the protocol include:
1. Retrospective studies identified the benefits of MRI-based adaptive brachytherapy and established guidelines for parameters to evaluate.
2. The prospective EMBRACE I study involved over 1400 patients treated with chemoradiation followed by MRI-guided brachytherapy at 23 centers. Early results showed high local control rates and the benefits of combined intracavitary/interstitial brachytherapy in reducing morbidity.
3. The ongoing EMBRACE II study aims to further improve outcomes through
4D Radiotherapy
4D radiotherapy aims to account for tumor motion during radiation therapy by acquiring CT images over multiple phases of the breathing cycle (4D CT imaging) and using this information for treatment planning and delivery. It allows for more accurate targeting of tumors in organs affected by respiratory motion like the lungs. While 4D radiotherapy provides advantages over existing motion management techniques, there are still technological challenges and limitations like complexity, treatment time, and residual motion. Future work includes addressing these issues and further integrating 4D techniques with other advances in radiation oncology.
Intraoperative Radiotherapy (IORT)
IORT uses a high single dose of radiation delivered during surgery to treat cancer remnants after tumor removal. It has two objectives: increase local tumor control and increase the ratio of tumor control to damage of nearby healthy tissues. IORT can be delivered via two methods - IOERT uses electron beams from a LINAC and IOHDR uses radioactive sources. Treatment planning requires a multidisciplinary team to determine applicator positioning and appropriate dose to maximize tumor coverage while minimizing radiation to other organs. IORT provides local tumor control comparable to conventional fractionated radiotherapy but with faster treatment time and less damage to surrounding tissues.
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Similar to Treatment & challenges of uh breast radiotherapy
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This document discusses predicting patient risk of acquiring Klebsiella pneumoniae carbapenemase producing organisms (KCPO) and linking environmental exposure to patient acquisition. It describes developing a patient risk model using a case-control approach and clinical and demographic data. A naïve Bayesian model was created and validated, showing an AUC of 0.746. It then analyzes the impact of positive room environments on patient infection using a treatment effects model, controlling for patient risk and length of stay. The results show room positivity is significantly associated with acquisition of infection, with an odds ratio of 22.25. Ultimately, interventions like hopper covers and heater traps reduced environmental transmission.
1645 ainsworth
This document discusses predicting patient risk of acquiring Klebsiella pneumoniae carbapenemase producing organisms (KCPO) and linking environmental exposure to patient acquisition. It describes developing a patient risk model using a case-control approach and clinical and demographic data. A naïve Bayesian model was built and validated, showing an AUC of 0.746. It then analyzes the impact of positive room environments on patient infection using a treatment effects model, controlling for patient risk and length of stay. The results show room positivity is significantly associated with acquisition of infection, with an odds ratio of 22.25. Ultimately, interventions like hopper covers and heater traps reduced environmental transmission.
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Part 1 discusses patient positioning, immobilization, localization, target volume definition, and errors that can occur.
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The document provides detailed information on simulation procedures such as patient history taking, immobilization device selection, patient counseling, scanning specifics, and data transfer. It also covers contouring guidelines for gross tumor volume, clinical target volume, planning target volume, and organs at risk according to ICRU recommendations.
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1. The document discusses peri-operative care, which refers to care before, during, and after surgery. It covers pre-operative, intra-operative, and post-operative care.
2. Pre-operative care involves assessing patient history, fitness for surgery, providing information consent, correcting health deficiencies, and instituting measures to prevent complications.
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Presentationversino41520162halfpastmidnightfinalversion
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CHC15 - EHR adoption in a european environment and public management hospital...
SOURCE:
Invited speaker for CERNER HEALTH CONFERENCE, Educational Session, held during Oct 11-14 in Kansas City (MO) - US.
ABSTRACT:
After 13 years under private management, Hospital Prof. Fernando da Fonseca (HFF) committed to invest a solid EHR strategic approach aligned with best practices, due to management shift as public management hospital within the NHS network. HFF focused on creating a Clinical Commission for information that could support and lead the change on workflow and mindset of the hospital culture. This team combines the knowledge and experience of multidisciplinary roles, designing a EHR model that fully responds to the needs. Thus ensuring a successful phased implementation which started in the emergency department and was then deployed throughout the rest of the hospital. After three years of project, the hospital has achieved a high level (superior to 85%) of EHR adoption and has proven outcomes in the delivery of quality of care and Social ROI (e.g. direct data interoperability with medical emergency before hospital admission, algorithm implementation to improve organ donor and collection, integration with private clinics for outsourcing auxiliary services, including Lab and radiology prescriptions and results/reports). HFF continues to strongly work on this project and are dedicated to implementing their roadmap with the short term aim of achieving HIMSS Stage 6.
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Here i present about how to manage patient who under going DVR surgery
In this i included some topics like
INTRODUCTION TO HEART VALVULAR DISEASES
CAUSE OF HEART DISEASES & PREVENTION
DIAGNOSIS & TREATMENT
OPERATION THEATER PARAMETER
OPERATION THEATER TEAM MEMBERS
OPERATION THEATER SETUP
TYPES OF VALVE
VALVULAR SETUP
PREPARATION ROOM
INTRA OPERATIVE PROCESS
IMPORTANCE OF OT DOCUMENTS
RECOVERY ROOM
DISCHARGE INSTRUCTION
SUMMARY
Managment DVR Surgery
Here, I going to upload about basics Managemnt of DVR surgery, IT present about details about INTRODUCTION TO HEART DISEASES
CAUSE OF HEART DISEASES & PREVENTION
DIAGNOSIS & TREATMENT
OPERATION THEATER PARAMETER
OPERATION THEATER TEAM MEMBERS
OPERATION THEATER SETUP
TYPES OF VALVE
VALVULAR SETUP
PREPARATION ROOM
INTRA OPERATIVE PROCESS
IMPORTANCE OF OT DOCUMENTS
RECOVERY ROOM
DISCHARGE INSTRUCTION
SUMMARY
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Operational Planning of Hospitals towards COVID 19 Pandemic- Indian Perspective
Operational Planning of Hospitals towards COVID 19 Pandemic- Indian Perspective
Simulation - treatment_clinical points(BSc Radiotherapy )
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Presentationversino41520162halfpastmidnightfinalversion
Presentationversino41520162halfpastmidnightfinalversion
CHC15 - EHR adoption in a european environment and public management hospital...
CHC15 - EHR adoption in a european environment and public management hospital...
STANDARD OPERATING PROCEDURE FOR RADIOTHERAPY IN COVID-19
STANDARD OPERATING PROCEDURE FOR RADIOTHERAPY IN COVID-19
Laparoscopic management of acute abdominal trauma - Dr Keyur Bhatt
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Treatment & challenges of uh breast radiotherapy
- 1. SIMULATION,TREATMENT & CHALLENGES OF BREAST CANCER PATIENTS Sunil M Maurya Radiation Therapist Sir H N Reliance Foundation Hospital & Research center Mumbai
- 2. • Simulation • Planning • Treatment
- 3. SIMULATION PROCESS: Identification & Diagnosis Verification of Document’s Explaining entire Simulation Process Collection of Required Documents Allotment of Treatment appointment slot
- 4. SIMULATION FOR ULTRA HYPO-FRACTIONATION BREAST CANCER Intact breast Chest wall e~ boost marking
- 5. E~BOOST CT SIMULATION: Why: to give Radiation dose to tumor bed How: Alignment of patient done in Civco Breast Board / Orfit AIO B/P with blue breast board setup Positioning (flat surface) Marking of treatment area (mammography scans) CT scan 1mm Defining surgical clips Appropriate field size and energy is defined by the clinical reference by the doctor during simulation
- 6. PLANNING………
- 7. TREATMENT
- 8. TREATMENT Verification ofTreatment Approval (treatment approvals ofT1 &T2) OSMS data import (import structure) Patient preparation for treatment (explaining procedure ) Plan implementation (Delta shifts) Plan verification & approval (orthogonal images) Plan execution
- 10. OSMS DATA IMPORT 1 Selection of patient 2 Site & Diagnosis 3 Appropriate ROI 4 Maximum clearance for OSMS coverage.
- 12. PATIENT PREPARATION FORTREATMENT Explaining treatment process Machine movements and OSMS Immobilization devices
- 14. PLAN IMPLEMENTATION (DELTA SHIFTS)
- 16. PLAN IMPLEMENTATION (OSMS GUIDED)
- 17. PLANVERIFICATION & APPROVAL (ORTHOGONAL IMAGES)
- 19. PLAN EXECUTION
- 20. CHALLENGES FORTHE PATIENTS • CoViD -19 pandemic • Loneliness in hospital waiting area • Loss of human connection (PPE ALIEN) • Extended time for day 1 • Anxiety of short course of treatment • Covid RT-PCR weekly tests • Continuation of treatment without gaps
- 21. CHALLENGESTOTHERAPIST • CoViD -19 pandemic • PPE (long hours) • Loneliness in department • Shifts &Travelling to hospital due to lockdown • Chances of CoViD -19 infection (to family) • Communication • Covid RT-PCR weekly tests • Quarantine during Covid-19 infection
- 22. COVID -19 PANDEMIC – CHALLENGES Battles faced by Patients Emotional, Physical, financial, social, problems of Family & most importantly CoViD-19 situation. Role of Radiation Therapist Emotional support Explaining procedure in detail Allow patients to express emotion Respond in an empathetic manner Improve patients satisfaction , reduces distress & anxiety, better treatment environment.
- 23. THANKYOU
Editor's Notes
- Reference image – CT body Map of ~20,000 points of patient’s external anatomy Multiple ROIs ROI size can be optimised for maximum performance Only the region of interest is monitored during treatment Deformable tissue can be ignored if necessary Areas of movement (e.g. eyelids in SRS patients) can be excluded from the ROI to give higher targeting accuracy