'Medicamenteuze interventies bij drugverslaving'; een advies van de Gezondheidsraad

Addiction is a relapsing brain disease with a tendency towards chronicity. Biological, psychological and socio-cultural factors play a role in the onset and course of this disease. The Health Council of the Netherlands has issued a report on pharmacotherapeutic interventions. The treatment of addiction should be regarded as a medical intervention. A growing number of effective pharmacotherapies are becoming available for the treatment of heroin addiction, although not all of those are available in the Netherlands. Currently, no effective pharmacotherapies are available for the treatment of cocaine addiction. In polydrug addicts, pharmacotherapeutic interventions should be directed at the various separate addictions. In the majority of cases pharmacotherapy is part of an integrated treatment approach in which supportive psychosocial interventions are also important. The long-term continuation of treatment is usually indicated. The Health Council recommends that addiction physicians be put in charge of the multidisciplinary treatment. Medical schools should pay attention to the practical aspects of the treatment and management of addicts. The organisation and workforce of addiction treatment services should comply with the demands that are placed upon healthcare services. Public information campaigns about addiction and the treatment options for addicts can contribute to the destigmatisation of this patient categor

Patient-specific CT calibration based on ion radiography for different detector configurations in 1H, 4He and 12C ion pencil beam scanning

The empirical conversion of the treatment planning x-ray computed tomography (CT) image to ion stopping power relative to water causes dose calculation inaccuracies in ion beam therapy. A patient-specific calibration of the CT image is enabled by the combination of an ion radiography (iRad) with the forward-projection of the empirically converted CT image along the estimated ion trajectories. This work investigated the patient-specific CT calibration for list-mode and integration-mode detector configurations, with reference to a ground truth ion CT (iCT) image. Analytical simulations of idealized carbon ion and proton trajectories in a numerical anthropomorphic phantom and realistic Monte Carlo simulations of proton, helium and carbon ion pencil beam scanning in a clinical CT image of a head-and-neck patient were considered. Controlled inaccuracy and noise levels were applied to the calibration curve and to the iRad, respectively. The impact of the selection of slices and angles of the iRads, as well as the choice of the optimization algorithm, were investigated. Accurate and robust CT calibration was obtained in analytical simulations of straight carbon ion trajectories. Analytical simulations of non-straight proton trajectories due to scattering suggested limitations for integration-mode but not for list-mode. To make the most of integration-mode, a dedicated objective function was proposed, demonstrating the desired accuracy for sufficiently high proton statistics in analytical simulations. In clinical data the inconsistencies between the iRad and the forward-projection of the ground truth iCT image were in the same order of magnitude as the applied inaccuracies (up to 5%). The accuracy of the CT calibration were within 2%-5% for integration-mode and 1%-3% for list-mode. The feasibility of successful patient-specific CT calibration depends on detector technologies and is primarily limited by these above mentioned inconsistencies that slightly penalize protons over helium and carbon ions due to larger scattering and beam spot size