Using Shipping Containers to Provide Temporary Housing in Post-disaster Recovery: Social Case Studies

AbstractHousing that makes use of the ubiquitous general purpose shipping container is becoming more commonly seen as a useful way of reusing the empty vessels as valuable accommodation. In particular, the application of shipping container temporary housing is suited to post-disaster situations, design examples of which can be found in the literature. However, ensuring the success of implementing such projects in a post-disaster setting requires investigation into the social considerations of temporary housing. This research takes a qualitative approach, focusing particularly on case studies of temporary housing experiences following the Hurricane Katrina in 2005, the Christchurch Earthquake in 2011 and a field study of 2009 Black Saturday bushfire-affected communities in Victoria, Australia. Key social factors found to be significant to the success of shipping container temporary housing projects relate to flexibility in ownership, reuse and siting arrangement, in addition to robust pre-disaster planning by authorities, taking into account the varying characteristics of different types of disasters

SHOULD PATIENT SETUP IN LUNG CANCER BE BASED ON THE PRIMARY TUMOR? AN ANALYSIS OF TUMOR COVERAGE AND NORMAL TISSUE DOSE USING REPEATED POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY IMAGING

PURPOSE: Evaluation of the dose distribution for lung cancer patients using a patient set-up procedure based on the bony anatomy or the primary tumor. METHODS AND MATERIALS: For 39 (non-)small cell lung cancer patients the planning FDG-PET/CT scan was registered to a repeated FDG-PET/CT scan made in the second week of treatment. Two patient set-up methods were analyzed: bony anatomy or primary tumor set-up. The original treatment plan was copied to the repeated scan, and target and normal tissue structures were delineated. Dose distributions were analyzed using dose-volume histograms for the primary tumor, lymph nodes, lungs and spinal cord. RESULTS: One patient showed decreased dose coverage of the primary tumor due to progressive disease and required re-planning to achieve adequate coverage. For the other patients, the minimum dose to the primary tumor did not significantly deviate from the planned dose: −0.2±1.7% (p=0.71) and −0.1±1.7% (p=0.85) for the bony anatomy and primary tumor set-up, respectively. For patients (N=31) with nodal involvement, 10% showed a decrease in minimum dose larger than 5% for the bony-anatomy set-up and 13% for the primary tumor based set-up. Mean lung dose exceeded the maximum allowed 20 Gy in 21% of the patients for the bony-anatomy and in 13% for the primary tumor set-up, whereas for the spinal cord this occurred in 10% and 13% of the patients, respectively. CONCLUSIONS: In 10% and 13% of patients with nodal involvement, set-up based on bony anatomy or primary tumor, respectively, lead to important dose deviations in nodal target volumes. Overdosage of critical structures occurred in 10-20% of the patients. In case of progressive disease, repeated imaging revealed underdosage of the primary tumor. Development of practical ways for set-up procedures based on repeated high-quality imaging of all tumor sites during radiotherapy should therefore be an important research focus

Assessment of bias in scoring of AI-based radiotherapy segmentation and planning studies using modified TRIPOD and PROBAST guidelines as an example

BACKGROUND AND PURPOSE Studies investigating the application of Artificial Intelligence (AI) in the field of radiotherapy exhibit substantial variations in terms of quality. The goal of this study was to assess the amount of transparency and bias in scoring articles with a specific focus on AI based segmentation and treatment planning, using modified PROBAST and TRIPOD checklists, in order to provide recommendations for future guideline developers and reviewers. MATERIALS AND METHODS The TRIPOD and PROBAST checklist items were discussed and modified using a Delphi process. After consensus was reached, 2 groups of 3 co-authors scored 2 articles to evaluate usability and further optimize the adapted checklists. Finally, 10 articles were scored by all co-authors. Fleiss' kappa was calculated to assess the reliability of agreement between observers. RESULTS Three of the 37 TRIPOD items and 5 of the 32 PROBAST items were deemed irrelevant. General terminology in the items (e.g., multivariable prediction model, predictors) was modified to align with AI-specific terms. After the first scoring round, further improvements of the items were formulated, e.g., by preventing the use of sub-questions or subjective words and adding clarifications on how to score an item. Using the final consensus list to score the 10 articles, only 2 out of the 61 items resulted in a statistically significant kappa of 0.4 or more demonstrating substantial agreement. For 41 items no statistically significant kappa was obtained indicating that the level of agreement among multiple observers is due to chance alone. CONCLUSION Our study showed low reliability scores with the adapted TRIPOD and PROBAST checklists. Although such checklists have shown great value during development and reporting, this raises concerns about the applicability of such checklists to objectively score scientific articles for AI applications. When developing or revising guidelines, it is essential to consider their applicability to score articles without introducing bias

Evaluating Tumor Response of Non-Small Cell Lung Cancer Patients With F-18-Fludeoxyglucose Positron Emission Tomography: Potential for Treatment Individualization

Objective: To assess early tumor responsiveness and the corresponding effective radiosensitivity for individual patients with non-small cell lung cancer (NSCLC) based on 2 successive F-18-fludeoxyglucose positron emission tomography (FDG-PET) scans. Methods and Materials: Twenty-six NSCLC patients treated in Maastricht were included in the study. Fifteen patients underwent sequential chemoradiation therapy, and 11 patients received concomitant chemoradiation therapy. All patients were imaged with FDG before the start and during the second week of radiation therapy. The sequential images were analyzed in relation to the dose delivered until the second image. An operational quantity, effective radiosensitivity, alpha(eff), was determined at the voxel level. Correlations were sought between the average aeff or the fraction of negative aeff values and the overall survival at 2 years. Separate analyses were performed for the primary gross target volume (GTV), the lymph node GTV, and the clinical target volumes (CTVs). Results: Patients receiving sequential treatment could be divided into responders and nonresponders, using a threshold for the average alpha(eff) of 0.003 Gy(-1) in the primary GTV, with a sensitivity of 75% and a specificity of 100% (

PET-based dose painting in non-small cell lung cancer: Comparing uniform dose escalation with boosting hypoxic and metabolically active sub-volumes.

BACKGROUND AND PURPOSE: We compared two imaging biomarkers for dose-escalation in patients with advanced non-small cell lung cancer (NSCLC). Treatment plans boosting metabolically active sub-volumes defined by FDG-PET or hypoxic sub-volumes defined by HX4-PET were compared with boosting the entire tumour.MATERIALS AND METHODS: Ten NSCLC patients underwent FDG- and HX4-PET/CT scans prior to radiotherapy. Three isotoxic dose-escalation plans were compared per patient: plan A, boosting the primary tumour (PTVprim); plan B, boosting sub-volume with FDG >50% SUVmax (PTVFDG); plan C, boosting..