Radiotherapie dichterbij?

Er dreigt een landelijk overschot aan bestralingsfaciliteiten te ontstaan als naast protonenfaciliteiten en ruimer gebruik van hypofractionering ook alle plannen voor dependances uitgevoerd gaan worden en als de door demissionair minister Klink beoogde marktwerking leidt tot nieuwe centra zoals voorzien in Boxmeer. Naar onze mening is er alleen plaats voor dependances als die de potentie hebben te kunnen uitgroeien tot een zelfstandig centrum met tenminste 4 versnellers. Het is bizar om te moeten vaststellen dat in de Verenigde Staten gekozen is voor een gezondheidszorgsysteem dat veel lijkt op het tot voor kort vigerend systeem in Nederland. Het Amerikaanse systeem van marktwerking in de zorg heeft duidelijk laten zien dat daardoor de kosten alleen maar stijgen, terwijl de kwaliteit van de zorg niet toeneemt. Het is niet te hopen dat, net als in de VS, de urologen in Nederland ‘integrated prostate cancer centers’ inclusief versnellers gaan opzetten. Want, zoals Falit et al schrijven: “The UroRad model is not an isolated problem, but rather a symptom of a systemic illness that plagues US health care. Fee-for-service reimbursement encourages physicians to overuse health care resources regardless of their source of referrals.“ In dit opzicht kan ik het demissionaire kabinet en speciaal minister Klink aanraden het interview met Simons in Nefarma te lezen, waarin hij pleit voor een moratorium, een periode van bezinning. Wij zien dan graag dat na de verkiezingen van morgen een nieuwe regering verdere marktwerking een halt toeroept en radiotherapie laat onder de Wet Bijzondere Medische Verrichtingen

Positionering van de radiotherapie binnen de oncologie

Contains fulltext : 24677___.PDF (publisher's version ) (Open Access

Loco-regional conformal radiotherapy of the breast: delineation of the regional lymph node clinical target volumes in treatment position.

Contains fulltext : 57546.pdf (publisher's version ) (Closed access)BACKGROUND AND PURPOSE: As the location of the regional lymph nodes (LNs) of the breast varies largely between patients and may be dependant on the position of the arm, adequate localization of these nodes is mandatory in order to fully take advantage of optimized conformal radiotherapy. For this purpose, the anatomical boundaries of the regional lymph node (LN) clinical target volumes (CTVs) for delineation on transverse CT-slices, made in treatment position, were established. PATIENTS AND METHODS: Anatomical and surgical descriptions of the regional LNs of the breast, as well as a shoulder dissection, were studied. Axial slices of a human cadaver with one arm in abduction and the other in adduction were investigated, to assess the displacement of LNs by abduction of the arm into treatment position. Based on these findings, we defined the anatomical boundaries of the regional LN CTVs visible on transverse CT-slices. RESULTS: Standard anatomical and surgical descriptions appeared to be inadequate for determination of the boundaries of the regional LN CTVs in treatment position. With abduction of the arm, a change in position of all regional LNs, except for the medial supraclavicular LNs and internal mammary LNs, was observed in the anatomical cross-sections. This was also taken into account in our delineation protocol proposal. CONCLUSIONS: Anatomically based guidelines for delineation of the regional LN CTVs for loco-regional irradiation of the breast on transverse CT-slices, made in treatment position, have been developed in this study. These could be used as a basis for conformal radiotherapy

Dose uniformity in MECS interstitial hyperthermia: the impact of longitudinal control in model anatomies

The quality of temperature distributions that can be generated with the multi-electrode current source (MECS) interstitial hyperthermia system, which allows 3D control of the spatial SAR distribution, has been investigated. For the investigations, computer models of idealized anatomies were used. These anatomical models did not contain discrete vessels. Binary-media anatomies, containing media interfaces oriented parallel, perpendicular or oblique with respect to the long axis of the implant, represent simple anatomies which can be encountered in the clinic. The implant volume was about . A seven-catheter hexagonal implant geometry with a nearest-neighbour distance of 15 mm was used. In each interstitial probe between one and four electrodes with a diameter of 2.1 mm were placed along an `active section' with a length of 50 mm. The electrode segments had lengths of 50, 20, 12 and 9 mm. This study shows that even with high contrasts in electrical and thermal conductivity in the implant it remains possible to obtain satisfactory temperature distributions with the MECS system. Due to its 3D spatial control the temperature homogeneity in the implant can be made quite satisfactory, with of the order of 2 - 3 K. Treatment planning must ensure that the placement of the current source electrodes is compatible with the media configuration