Implante de Marcapaso Doble Cámara en un Paciente con Vena Cava Superior Izquierda

La persistencia de la vena cava superior izquierda se observa en el 0.5% de la población. La mayor experiencia de los equipos implantadores, asicomo la mejor tecnologia de los electrodos, permite el implante endocavitario de los sistemas de estimulación tanto unicamerales, como bicamerales, aún en aquellos pacientes con ausencia de vena cava superior derecha, como el caso que relatamos

Implante de Marcapaso Doble Cámara en un Paciente con Vena Cava Superior Izquierda

La persistencia de la vena cava superior izquierda se observa en el 0.5% de la población. La mayor experiencia de los equipos implantadores, asicomo la mejor tecnologia de los electrodos, permite el implante endocavitario de los sistemas de estimulación tanto unicamerales, como bicamerales, aún en aquellos pacientes con ausencia de vena cava superior derecha, como el caso que relatamos

Variability of clinical target volume delineation for rectal cancer patients planned for neoadjuvant radiotherapy with the aid of the platform Anatom-e

Objective: Delineation of treatment volumes is a major source of uncertainties in radiotherapy (RT). This is also true for rectal cancer patients undergoing neoadjuvant RT, with a potential impact on treatment quality. We investigated the role of the digital platform Anatom-e (Anatom-e Information Sytems Ltd., Houston, Texas) in increasing the compliance to follow a specific treatment protocol in a multicentric setting. Materials and methods: Two clinical cases of locally advanced rectal cancer were chosen. Participants were instructed to follow the 2009 Radiation Therapy Oncology Group consensus atlas and asked to manually segment clinical target volumes (CTVs), for both patient 1 and 2, on day 1 with and without the use of Anatom-e. After one week (day 2), the same radiation oncologist contoured again, with and without Anatom-e, the same CT series. Intraobserver (Intra-OV) and interobserver (Inter-OV) variability were evaluated with the Dice similarity coefficient (DSC), the Hausdorff distance (HD) and mean distance to agreement (MDA). Results: For clinical case 1, no significant difference was found for Intra-OV and Inter-OV. For clinical case 2, no significant difference was found for Intra-OV but a statistically significant difference was found for Inter-OV in DSC when using or not the platform. Mean DCS was 0.65 (SD: ±0.64; range: 0.58–0.79) for day 1 vs reference volume without Anatom-e and 0.72 (SD: ±0.39; range: 0.67–0.77) (p = 0.03) with it. Mean MDA was lower with Anatom-e (3.61; SD: ±1.33; range: 2.85–4.78) than without (4.14; SD: ±2.97; range: 2.18–5.21), with no statistical significance (p = 0.21) The use of Anatom-e decreased the SD from 2.97 to 1.33. Mean HD was lower with Anatom-e (26.06; SD: ±2.05; range: 24.08–32.62), with no statistical significance (p = 0.14) compared to that without (31.39; SD: ±1.31; range: 26.14–48.72). Conclusions: The use of Anatom-e decreased the Inter-OV in the CTV delineation process for locally advanced rectal cancer with complex disease presentation planned for neoadjuvant RT. This system may be potentially helpful in increasing the compliance to follow shared guidelines and protocols

Small field correction factors determination for several active detectors using a Monte Carlo method in the Elekta Axesse linac equipped with circular cones

A Monte Carlo (MC) method was used to determine small field output correction factors for several active detectors (Exradin A16, Exradin A26, PTW microLion, PTW microDiamond, Exradin W1 and IBA RAZOR) for an Elekta Axesse linac equipped with circular cones. MC model of the linac was built with the GamBet software, using the Penelope code system. The dose-to-water simulation for each cone, ranging from 5 to 30 mm of diameter size, was used to calculate field factors and the results were validated together with Gafchromic EBT3 film. Output factors (OFs) were measured with the active detectors and correction factors were determined using the MC results. The MC simulations agreed with films within 1.2%. OFs measured with Exradin W1 scintillator were in agreement within 0.8% with MC simulations. The Exradin A16 and A26 microchambers under-responded for small fields relative to the MC (-13.1% and  -4.6%, respectively). PTW microLion, IBA RAZOR and PTW microDiamond overestimated the output factor for the smallest field (+3.9%, +5.4 and  +7.1%, respectively). The present study pointed out that it is crucial to apply the appropriate correction factors in order to provide accurate measurements in small beams geometry. The results showed that the Exradin W1 can be used for very small field dosimetry without correction factors, which shall be contrariwise employed for other detectors