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1.

Aim

In this study, at different fields, energies and gantry angles, treatment couch and rails dose absorption ratio and treatment couch effect on surface and build-up region doses were examined.

Background

It is assumed that radiation attenuation is minimal because the carbon fiber couches have low density and it is not generally accounted for during treatment planning. Consequently, it leads to a major dosimetric mistake.

Materials and methods

Solid water phantom was used for relative dose measurement. The measurements were done using a Farmer ion chamber with 0.6 cc volume and a parallel plane ion chamber starting from surface with 1 mm depth intervals at 10 × 10 cm2 field, SSD 100 cm. Measurements were taken for situations where the beams intersect the couch and couch rails.

Results

Dose absorption ratio of carbon fiber couch obtained at gantry angle of 180° was 1.52%, 0.69%, 0.33% and 0.25% at different field sizes for 6 MV. For 15 MV, this ratio was 0.95%, 0.27%, 0.20% and 0.05%. The absorption ratio is between 3.4% and 1.22% when the beams intersect with couch rails. The couch effect increased surface dose from 14% to 70% for 6 MV and from 11.34% to 53.03% for 15 MV.

Conclusions

The results showed that the carbon fiber couch increased surface dose during posterior irradiation. Therefore, the skin-sparing effect of the high energy beams was decreased. If the effect of couch is not considered, it may cause significant differences at dose which reaches the patient and may cause tissue problems such as erythema.  相似文献   

2.

Aim

This study aims at examining absolute dose verification of step-and-shoot intensity modulated radiation treatment (IMRT) of prostate and brain patients by use of ion chambers of two different volumes and thermoluminescent detectors (TLD).

Background

The volume of the ion chamber (IC) is very important for absolute dose verification of IMRT plans since the IC has a volume average effect. With TLD detectors absolute dose verification can be done measuring the dose of multiple points simultaneously.

Materials and methods

Ion chambers FC65-P of volume 0.65 cc and semiflex of volume 0.125 cc as well as TLDs were used to measure the central axis absolute dose of IMRT quality assurance (QA) plans. The results were compared with doses calculated by a treatment planning system (TPS). The absolute doses of off axis points located 2 cm and 4 cm away from the isocenter were measured with TLDs.

Results

The measurements of the 0.125 cc ion chamber were found to be closer to TPS calculations compared to the 0.65 cc ion chamber, for both patient groups. For both groups the root mean square (RMS) differences between doses of the TPS and the TLD detectors are within 3.0% for the central axis and points 2 cm away from the isocenter of each axis. Larger deviations were found at the field edges, which have steep dose gradient.

Conclusions

The 0.125 cc ion chamber measures the absolute dose of the isocenter more accurately compared to the 0.65 cc chamber. TLDs have good accuracy (within 3.0%) for absolute dose measurements of in-field points.  相似文献   

3.

Purpose

The purpose of this study was to verify whether the dynamic tumor tracking (DTT) feature of a Vero4DRT system performs with 10-mm-long and 0.28 mm diameter gold anchor markers.

Methods

Gold anchor markers with a length of 10 mm and a diameter of 0.28 mm were used. Gold anchor markers were injected with short and long types into bolus material. These markers were sandwiched by a Tough Water (TW) phantom in the bolus material. For the investigation of 4-dimensional (4D) modeling feasibility under various phantom thicknesses, the TW phantom was added at 2 cm intervals (in upper and lower each by 1 cm). A programmable respiratory motion table was used to simulate breathing-induced organ motion, with an amplitude of 30 mm and a breathing cycle of 3 s. X-ray imaging parameters of 80 kV and 125 kV (320 mA and 5 ms) were used. The least detection error of the fiducial marker was defined as the 4D-modeling limitation.

Results

The 4D modeling process was attempted using short and long marker types and its limitation with the short and long types was with phantom thicknesses of 6 and 10 cm at 80 kV and 125 kV, respectively. However, the loss in detectability of the gold anchor because of 4D-modeling errors was found to be approximately 6% (2/31) with a phantom thickness of 2 cm under 125 kV. 4D-modeling could be performed except under the described conditions.

Conclusions

This work showed that a 10-mm-long gold anchor marker in short and long types can be used with DTT for short water equivalent path length site, such as lung cancer patients, in the Vero4DRT system.  相似文献   

4.

Aim

The aim of the study is to evaluate the differences in dosimetry between tandem-ovoid and tandem-ring gynaecologic brachytherapy applicators in image based brachytherapy.

Background

Traditionally, tandem ovoid applicators were used to deliver dose to tumor in intracavitary brachytherapy. Tandem-ring, tandem-cylinder and hybrid intracavitary, interstitial applicators are also used nowadays in cervical cancer brachytherapy.

Methods and materials

100 CT datasets of cervical cancer patients (stage IB2 – IIIB) receiving HDR application (50 tandem-ovoid and 50 tandem-ring) were studied. Brachytherapy was delivered using a CT-MRI compatible tandem-ovoid (50 patients) and a tandem-ring applicator (50 patients). DVHs were calculated and D2cc was recorded for the bladder and rectum and compared with the corresponding ICRU point doses. The point B dose, the treated volume, high dose volume and the treatment time were recorded and compared for the two applicators.

Results

The mean D2cc of the bladder with TR applicator was 6.746 Gy. TO applicator delivered a mean D2cc of 7.160 Gy to the bladder. The mean ICRU bladder points were 5.60 and 5.63 Gy for TR and TO applicator, respectively. The mean D2cc of the rectum was 4.04 Gy and 4.79 Gy for TR and TO applicators, respectively. The corresponding ICRU point doses were 5.10 Gy and 5.66 Gy, respectively.

Conclusions

The results indicate that the OAR doses assessed by DVH criteria were higher than ICRU point doses for the bladder with both tandem-ovoid and tandem-ring applicators whereas DVH based dose was lower than ICRU dose for the rectum. The point B dose, the treated volume and high dose volume was found to be slightly higher with the tandem-ovoid applicator. The mean D2cc dose for the bladder and rectum was lower with tandem-ring applicators. The clinical implication of the above dosimetric differences needs to be evaluated further.  相似文献   

5.

Aim

To identify the most reproducible technique of patient positioning and immobilization during pelvic radiotherapy.

Background

Radiotherapy plays an important role in the treatment of pelvic malignancies. Errors in positioning of patient are an integral component of treatment. The present study compares two methods of immobilization with no immobilization with an aim of identifying the most reproducible method.

Materials and methods

65 consecutive patients receiving pelvic external beam radiotherapy were retrospectively analyzed. 30, 21 and 14 patients were treated with no-immobilization with a leg separator, whole body vacuum bag cushion (VBC) and six point aquaplast immobilization system, respectively. The systematic error, random error and the planning target volume (PTV) margins were calculated for all the three techniques and statistically analyzed.

Results

The systematic errors were the highest in the VBC and random errors were the highest in the aquaplast group. Both systematic and random errors were the lowest in patients treated with no-immobilization. 3D Systematic error (mm, mean ± 1SD) was 4.31 ± 3.84, 3.39 ± 1.71 and 2.42 ± 0.97 for VBC, aquaplast and no-immobilization, respectively. 3D random error (mm, 1SD) was 2.96, 3.59 and 1.39 for VBC, aquaplast and no-immobilization, respectively. The differences were statistically significant between all the three groups. The calculated PTV margins were the smallest for the no-immobilization technique with 4.56, 4.69 and 4.59 mm, respectively, in x, y and z axes, respectively.

Conclusions

Among the three techniques, no-immobilization technique with leg separator was the most reproducible technique with the smallest PTV margins. For obvious reasons, this technique is the least time consuming and most economically viable in developing countries.  相似文献   

6.

Aim

To identifying depth dose differences between the two versions of the algorithms using AIP CT of a 4D dataset.

Background

Motion due to respiration may challenge dose prediction of dose calculation algorithms during treatment planning.

Materials and methods

The two versions of depth dose calculation algorithms, namely, Anisotropic Analytical Algorithm (AAA) version 10.0 (AAAv10.0), AAA version 13.6 (AAAv13.6) and Acuros XB dose calculation (AXB) algorithm version 10.0 (AXBv10.0), AXB version 13.6 (AXBv13.6), were compared against a full MC simulated 6X photon beam using QUASAR respiratory motion phantom with a moving chest wall. To simulate the moving chest wall, a 4 cm thick wax mould was attached to the lung insert of the phantom. Depth doses along the central axis were compared in the anterior and lateral beam direction for field sizes 2 × 2 cm2, 4 × 4 cm2 and 10 × 10 cm2.

Results

For the lateral beam direction, the moving chest wall highlighted differences of up to 105% for AAAv10.0 and 40% for AXBv10.0 from MC calculations in the surface and buildup doses. AAAv13.6 and AXBv13.6 agrees with MC predictions to within 10% at similar depth. For anterior beam doses, dose differences predicted for both versions of AAA and AXB algorithm were within 7% and results were consistent with static heterogeneous studies.

Conclusions

The presence of the moving chest wall was capable of identifying depth dose differences between the two versions of the algorithms. These differences could not be identified in the static chest wall as shown in the anterior beam depth dose calculations.  相似文献   

7.

Objective

To determine the frequency of successful aging (SA) and its relationship with frailty in an elderly population.

Material and methods

An analytical cross-sectional study of subjects ≥60 years of age seen as outpatients in a general hospital. Successful aging was defined as scores of ≥ 90 in the Barthel index and ≤ 2 in the Pfeiffer test. Frailty was determined using the Fried criteria.

Results

The study included 400 subjects (272 women and 128 men), with a mean age of 71.6 ± 8.2 years. The SA frequency was 40.4%. frail status was statistically higher in non-successful aging subjects than in SA subjects (161.7 versus 7.9%; P<.001). Women were more frequently frail, while being a pensioner/retired and married were associated less frequently with frailty.

Conclusions

Successful aging is associated with a lower level of frailty.  相似文献   

8.

Background

Candida parapsilosis may acquire resistance to echinocandins, a fact that prompts the search for new therapeutic options.

Aims

The present study aimed to evaluate the in vitro activity of antifungal agents, alone and in combination, against four groups of C. parapsilosis strains: (1) echinocandin-susceptible (ES) clinical isolates (MIC ≤ 2 μg/ml), (2) anidulafungin-resistant strains (MIC ≥ 8 μg/ml), (3) caspofungin-resistant strains (MIC ≥ 8 μg/ml), and (4) micafungin-resistant strains (MIC ≥ 8 μg/ml).

Methods

Antifungal interactions were evaluated by a checkerboard micro-dilution method. The determination of the MIC to each drug for every isolate according to the Clinical and Laboratory Standards Institute documents M27 (2017) and M60 (2017) was also done.

Results

The echinocandins-resistant (ER) strains showed higher MICs to the tested antifungals than the ES strains, except for amphotericin B, for which the ER groups remained susceptible.

Conclusions

Most combinations showed indifferent interactions. The use of monotherapy still seems to be the best option. As resistance to echinocandins is an emergent phenomenon, further studies are required to provide clearer information on the susceptibility differences between strains to these antifungal agents.  相似文献   

9.

Aim

To define the optimal margin on MRI scans in the re-radiation planning of recurrent glioblastoma using methionine positron emission tomography (MET-PET).

Background

It would be very useful if the optimal margin on MRI to cover the uptake area on MET-PET is known.

Materials and Methods

CT, MRI, and MET-PET were performed separately over the course of 2 weeks. Among the MRI scans, we used the contrast-enhanced T1-weighted images (Gd-MRI) and T2-weighted images (T2-MRI). The Gd-MRI-based clinical target volume (CTV) (CTV-Gd) and the T2-MRI-based CTV (CTV-T2) were defined as the contrast-enhanced area on Gd-MRI and the high intensity area on T2-MRI, respectively. We defined CTV x mm (x = 5, 10, 15, 20) as x mm outside the CTV. MET-PET-based CTV (CTV-MPET) was defined as the area of accumulation of MET-PET. We calculated the sensitivity and specificity of CTV-Gd and CTV-T2 following comparison with CTV-MPET, which served as the gold standard in this study.

Results

The sensitivity of CTV-T2 5 mm (98%) was significantly higher than CTV-T2 (87%), and there was no significant difference in the sensitivity between CTV-T2 5 mm and CTV T2 10, 15, or 20 mm. The sensitivity of CTV-Gd 20 mm (97%) was lower than that of CTV-T2 5 mm (98%).

Conclusions

A margin of at least 5 mm around the high intensity area on T2-MRI is necessary in the target volume delineation of recurrent glioblastoma for the coverage of MET-PET findings in re-radiation therapy planning.  相似文献   

10.

Background

Handgrip strength (HS) and peak oxygen consumption (Vo2peak) are powerful predictors of cardiovascular risk, although it is unknown which of the two variables is the better predictor.

Aim

The objective of the following study was to relate HS and Vo2peak to cardiovascular risk markers in older Chilean women.

Methods

Physically active adult women (n = 51; age, 69 ± 4.7 years) participated in this study. The HS and Vo2peak were evaluated and related to the anthropometric variables of body mass, body mass index (BMI), waist circumference (WC), hip circumference (HC), waist ratio (WR), and waist height ratio (WHR), as well as with the cardiovascular variables systolic (SBP) and diastolic (DBP) and cardiac recovery in one minute (RHR1). A multilinear regression model was used for the analysis of the associated variables (P < .05).

Results

The cardiovascular risk markers associated (P < .05) with the handgrip strength of the dominant limb (HSDL) were body mass, BMI, WR, and WHR. The handgrip strength of the non-dominant limb (HSNDL) was associated with body mass. Vo2peak was associated with body mass, BMI, HC and RHR1. The multilinear regression model showed a value of r = 0.43 in HSDL, r = 0.39 in HSNDL and r = 0.69 in peak Vo2.

Conclusion

Although HS and Vo2peak were related to cardiovascular risk markers, Vo2peak offers greater associative power with these cardiovascular risk factors.  相似文献   

11.

Aim

In this study, we intend to compare two different setup procedures for female breast cancer patients.

Background

Imaging in radiotherapy provides a precise localization of the tumour, increasing the accuracy of the treatment delivery in breast cancer.

Materials and methods

Twenty breast cancer patients who underwent whole breast radiotherapy (WBRT) were selected for this study. Patients were divided into two groups of ten. Group one (G1) was positioned by tattoos and then the patient positioning was adjusted with the aid of AlignRT (Vision RT, London, UK). In group two (G2), patients were positioned only by tattoos. For both groups, the first 15 fractions were analyzed, a daily kilovoltage (kV) cone beam computed tomography (CBCT) image was made and then the rotational and translational displacements and, posteriorly, the systematic (Σ) and random (σ) errors were analyzed.

Results

The comparison of CBCT displacements for the two groups showed a statistically significant difference in the translational left–right (LR) direction (ρ = 0.03), considering that the procedure with AlignRT system has smaller lateral displacements. The results of systematic (Σ) and random (σ) errors showed that for translational displacements the group positioned only by tattoos (G2) demonstrated higher values of errors when compared with the group positioned with the aid of AlignRT (G1).

Conclusions

AlignRT could help the positioning of breast cancer patients; however, it should be used with another imaging method.  相似文献   

12.
13.

Introduction

Physical activity and physical inactivity patterns can affect health status. In the elderly people, their study is relevant given the importance that they have on the morbidity and mortality.

Objective

To present preliminary data on activity and inactivity patterns of a sub-sample of older adults from the IMPACT65+ Study.

Material and methods

The sample included the first 84 participants (57% women) over 65 years (age 70.7±4.7). Time spent in activity and inactivity patterns was obtained from an Intelligent Device for Energy Expenditure and Activity monitor over a continuous period of 24 hours. The patterns analysed were: standing, lying down, sitting or reclining, and the transition between them. The physical activity patterns analysed were; walking, step up or step down, running, and jumping.

Results

Time spent in inactivity patterns like reclining, lying down, and sitting was 16.1±1.9 hours (67% day), while the amount of time spent in activity patterns was 2.4±1.9 hours (10% day). Differences were observed between men and women in the amount of hours sitting (9.7±3 men vs. 7.5±2.7 women) and standing (4.5±1.4 men vs. 5.6±2.7 women). These differences were greater in the older participants.

Conclusions

Preliminary results show that older adults spend a great part of day in inactivity patterns like sitting, and that gender is the only factor analysed that affects the time spent in the activity patterns analysed.  相似文献   

14.
15.

Background

Candida can be implicated in the pathology of chronic periodontitis.

Aims

To analyze the oral Candida carriage in patients suffering from chronic periodontitis (CP) and its correlation with the severity of this condition.

Methods

Microbiological samples were taken from 155 patients using the oral rinse (OR) technique and by using paper points in the periodontal pockets (GPP). These patients were divided into 3 groups: 89 patients without CP (control), 47 with moderate CP, and 19 with severe CP. Samples were cultured in a Candida chromogenic agar for Candida. Species were identified by microbiological and molecular methods.

Results

Candida was isolated in the OR of 45 (50.6%), 21 (44.7%), and 11 (57.9%) patients, respectively, and in the GPP of 32 (36%), 14 (29.2%), and 10 (42.6%) patients from the control, moderate CP and severe CP groups, respectively. Candida was isolated more frequently and in a greater burden in OR than in GPP (p < 0.01). Candida albicans was the most prevalent species. GPP of patients with CP had poor fungal biodiversity (p < 0.01).

Conclusions

Colonization by Candida was present in the samples of patients without CP, and with both moderate and severe CP. Nonetheless, patients with severe CP had a higher rate of Candida colonization, especially by C. albicans.  相似文献   

16.

Introduction

The prevention and management of neurocognitive disorders (NCD) among older adults can be improved by early identification of risk factors such as walking speed. The objective of the study is to assess the association between gait speed and NCD onset in a population of Peruvian older adults.

Material and methods

Cohort conducted in older adults who attended the geriatrics service of Naval Medical Center (Callao, Peru). During the baseline assessment, participants’ gait speed was recorded. Subsequently, participants were followed-up annually for 5 years, with a mean of 21 months. NCD onset was defined as the occurrence of a score ≤ 24 points on the Mini Mental State Examination (screening test) during follow-up. The hazard ratios (HR) and their 95% confidence intervals (95% CI) were calculated using Cox regression.

Results

The study included 657 participants, with a mean age of 73.4 ± 9.2 (SD) years, of whom 47.0% were male, 47.8% had a gait speed < 0.8 m/s, and 20.1% developed NCD during the follow up. It was found that older adults who had gait speed < 0.8 m/s at baseline were more likely to develop NCD than those who had a gait speed ≥ 0.8 m/s (adjusted HR = 1.41, 95% CI = 1.34-1.47).

Conclusion

A longitudinal association was found between decreased gait speed and NCD onset, suggesting that gait speed could be useful to identify patients at risk of NCD onset.  相似文献   

17.

Introduction

The search for biomarkers that can lead to the early diagnosis and thus, early treatment of frailty, has become one of the main challenges facing the geriatric scientific community. The aim of the present study was to identify single nucleotide polymorphisms (SNPs) related to frailty.

Material and methods

The study was conducted on 152 subjects from the Toledo Study for Healthy Aging (65 to 95 years of age), and classified as frail (n=78), and non-frail (n=74), according to Fried's criteria. After blood collection, DNA was isolated and amplified for the analysis of SNPs using AxiomTM Genotyping technology (Affymetrix). Statistical analyses were performed using the Plink program and library SNPassoc.

Results

The results of the study showed 15 SNPs with a P < .001. Those SNPs involved in processes related to frailty, such as energy metabolism, regulation of biological processes, cell motility and integrity, and cognition are highlighted.

Conclusions

These results suggest that the genetic variations identified in frail individuals that are involved in biological processes related to frailty may be considered as biomarkers for the early detection of frailty.  相似文献   

18.

Aim

This study aimed to evaluate the treatment result of intensity-modulated radiation therapy (IMRT) in a large number of Japanese patients with prostate cancer.

Background

A total of 1091 patients with localized prostate cancer were recruited between March 2006 and July 2014. The patients were stratified into low- (n = 205 [18.8%]), intermediate- (n = 450 [41.2%]), high- (n = 345 [31.6%]), and very high-risk (n = 91 [8.3%]) groups according to the National Comprehensive Cancer Network classification. All patients were irradiated via IMRT at a dose of 74–78 Gy with or without androgen-deprivation therapy. The mean follow-up period was 50 months (range, 2–120 months).

Results

The biochemical failure-free rate (BFFR), the clinical failure-free rate, and the overall survival rate at the 5-year follow-up for all patients was 91.3%, 96.2%, and 99.1%, respectively. In univariate analysis, the prostate-specific antigen (PSA) levels (≤20 vs. >20 ng/ml) were significantly correlated with BFFR. A trend toward higher BFFR was noted in patients with a Gleason score (GS) of ≤7 than in patients with GS ≥8. In multivariate analysis, only PSA (≤20 vs. >20 ng/ml) was significantly correlated with BFFR. The cumulative incidence rate of gastrointestinal and genitourinary toxicity (≥grade 2) at the 5-year follow-up was 11.4% and 4.3%, respectively.

Conclusions

The findings of this study indicate that IMRT is well tolerated and is associated with both good long-term tumor control and excellent outcomes in patients with localized prostate cancer.  相似文献   

19.

Aim

The aim of this study is to evaluate the accuracy of the inverse square law (ISL) method for determining location of virtual electron source (SVir) in Siemens Primus linac.

Background

So far, different experimental methods have presented for determining virtual and effective electron source location such as Full Width at Half Maximum (FWHM), Multiple Coulomb Scattering (MCS), and Multi Pinhole Camera (MPC) and Inverse Square Law (ISL) methods. Among these methods, Inverse Square Law is the most common used method.

Materials and methods

Firstly, Siemens Primus linac was simulated using MCNPX Monte Carlo code. Then, by using dose profiles obtained from the Monte Carlo simulations, the location of SVir was calculated for 5, 7, 8, 10, 12 and 14 MeV electron energies and 10 cm × 10 cm, 15 cm × 15 cm, 20 cm × 20 cm and 25 cm × 25 cm field sizes. Additionally, the location of SVir was obtained by the ISL method for the mentioned electron energies and field sizes. Finally, the values obtained by the ISL method were compared to the values resulted from Monte Carlo simulation.

Results

The findings indicate that the calculated SVir values depend on beam energy and field size. For a specific energy, with increase of field size, the distance of SVir increases for most cases. Furthermore, for a special applicator, with increase of electron energy, the distance of SVir increases for most cases. The variation of SVir values versus change of field size in a certain energy is more than the variation of SVir values versus change of electron energy in a certain field size.

Conclusion

According to the results, it is concluded that the ISL method can be considered as a good method for calculation of SVir location in higher electron energies (14 MeV).  相似文献   

20.

Introduction

There are no previous studies evaluating the effect of intravenous iron therapy on functional and cognitive status of patients with hip fracture (HF).

Material and methods

A single-centre randomised, placebo-controlled, double-blind and parallel treatment, clinical trial has been designed to assess the efficacy of intravenous iron therapy during the peri-operative period in elderly patients suffering from a HF. Blinding will be ensured by the packaging of the drug infusion system. On days 1, 3, and 5 from admission, the intervention group will receive 200 mg Venofer® (iron sucrose) diluted in 100 ml saline, and the control group 100 ml saline, also on days 1, 3 and 5. Patients will received conventional treatment in ortho-geriatric unit of the Hospital Infanta Sofia. Functional variables (activities of daily living and walking), cognitive (cognitive status and delirium), surgical, demographic and clinical characteristics will be collected during admission in order to assess the impact of treatment. A safety analysis of the treatment will also performed. Patients will be followed-up at 3, 6, and 12 months.

Results

The study will attempt to provide evidence on the impact of the intravenous iron administration on functional recovery. It will be determined whether iron therapy negatively affects the incidence of post-operative delirium. Finally, report will be presented on the safety data of intravenous iron in elderly HF patients, as well as the impact on allogenic blood transfusion savings.

Conclusions

The inclusion of elderly HF patients admitted to an ortho-geriatric unit, in a clinical trial, will help to improve the knowledge of the treatment impact on a usual scenario, and provide useful data for use in other units.  相似文献   

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