The impact of a dedicated training program for oral examiners at a medical school in Germany: a survey among participants from operative and non-operative disciplines

BACKGROUND: Oral examinations have been a crucial format in ancient and modern assessment to evaluate and guarantee quality of medical education and thereby to secure patient safety. To achieve a high level of quality in the oral part of the final examination of medical students, a training program for oral examiners at the Medical Faculty of Ulm (Germany) has been established since 2007. However, little is known about the attitude of the examiners in regard to the impact of this training program and of oral examinations as instruments to ensure patient safety. METHODS: All 367 academic clinicians from operative and non-operative disciplines, attending the one-day examiner training program at the University of Ulm between 2007 and 2012 have been asked to answer an online survey (EvaSys 5.0). Focus of the survey was to find out in which respect the examiners profited from the trainings, if the training effects were discipline-dependent, and to which degree the oral examinations could contribute to patient safety. Statistical analysis was performed using the t-test for independent samples. Results were considered statistically significant when p < 0.05. RESULTS: A total of 63 participants answered the survey, but in 4 cases the questionnaire was not fully completed (with single items missing). More than half of the study participants (n = 34/59; 58%) have experienced (at least sometimes or rarely) candidates that they deemed incompetent and perhaps even dangerous to the patients’ health who nevertheless passed the oral exam successfully. The majority of participants were convinced that oral examinations using concrete clinical cases could significantly contribute to patient safety, if grading is based on clear criteria and if examinations as well as grading are performed more critically. The impact of the training program was rated significantly stronger by surgeons than by non-surgeons in several categories. These categories included “strengths and weaknesses of oral examinations”, “reliability”, “validity”, “competence in grading”, “critical grading”, and “departmental improvements” concerning oral examinations. CONCLUSIONS: In respect to patient safety, it seems crucial to prevent incompetent candidates from passing the oral examination. The present study indicates the importance to continue and to develop our examiner trainings, with main emphasis on concrete clinical problems and a criteria-based critical grading system for oral examinations. Since the impact of the training was particularly high for colleagues from the operative disciplines, the training program should be offered especially in surgical departments

Dosimetric comparison of different radiation techniques (IMRT vs. 3-dimensional) of the “true” (deep) ano-inguinal lymphatic drainage of anal cancer patients

Introduction: The ano-inguinal lymphatic drainage (AILD) is located in the subcutaneous adipose tissue of the proximal medial thigh. Currently, there are no recommendations for an inclusion of the ‘true’ AILD in the clinical target volume (CTV) of definitive chemoradiation for anal cancer patients. To estimate the relevance of inguinal recurrence, we compared the incidental dose to the AILD in anal cancer (AC) patients who were treated either with Volumetric Arc Therapy – Intensity Modulated Radiation Therapy (VMAT-IMRT) or conventional 3D-radiation technique. Methods: One VMAT-IMRT-plans and one 3D-plans were calculated on the same target volumes and identical dose prescription in ten patients. We defined the volume of the AILD on the planning CT-scans based on the information of new fluorescence methods. Furthermore, we defined several anatomical subvolumes of interest inside the AILD. We examined and compared absolute and relative dosimetric parameters of the AILD and different anatomical subunits. Results: The Dmean of the AILD was 40 Gy in the 3D-group and 38 Gy in the IMRT-group. Dmean and Dmedian as well as the V30Gy of the AILD and all subvolumes of the caudal AILD were significant higher using 3D-RT compared to IMRT. Even though the absolute differences were small, in the caudal aspect of the ano-inguinal lymphatic drainage the V30Gy could be more than 10% less with VMAT-IMRT. Conclusions: 3D-RT was slightly superior to IMRT in terms of dose coverage of the AILD. However, the absolute differences were very small. Some relevant caudal parts of the AILD received an insufficient dose for treating potential micrometastases. Particularly in high-risk situations, this may lead to inguinal recurrence and therefore the true deep AILD should be included into the target volume in high risk patients

Morphological and functional ¹H magnetic resonance tomography of the human lung at 0.2 and 1.5 tesla

Das Ziel dieser Arbeit war es, Methoden und Techniken für die morphologische und funktionelle Bildgebung der menschlichen Lunge mittels Kernspintomographie bei Feldstärken von 0,2 Tesla und 1,5 Tesla zu entwickeln und zu optimieren. Bei 0,2 Tesla wurde mittels der gemessenen Relaxationszeiten T1 und T2* eine 2D und eine 3D FLASH Sequenz zur Untersuchung der Lungenmorphologie optimiert. Sauerstoffgestützte Messungen der Relaxationszeiten T1 und T2* sowie eine SpinLabeling Sequenz liefern funktionelle Informationen über den Sauerstofftransfer und die Perfusion der Lungen. Bei 1,5 Tesla wurde die Lungenperfusion mittels MR-Kontrastmittel mit einer 2D und einer 3D Sequenz unter Verwendung der Präbolus Technik quantifiziert. Zudem wurden zwei MR-Navigationstechniken entwickelt, die es ermöglichen Lungenuntersuchungen unter freier Atmung durchzuführen und aus den Daten artefaktfreie Bilder zu rekonstruieren. Diese Techniken können in verschiedenste Sequenzen für die Lungenbildgebung implementiert werden, ohne dass die Messzeit dadurch signifikant verlängert wird.The purpose of this thesis was to make a contribution to the development of lung MRI. While we developed and implemented new sequences and procedures both in the area of low-field MRI (0.2 Tesla) and 1.5 Tesla, we also took existing technologies into account by modifying and optimizing them for the working conditions at hand. In the process, we focused on techniques for both morphological and functional examination of the lung. Lung scans using an open 0.2 Tesla tomograph were an important component of this. Our first objective was to develop various methods for morphological and functional lung MRI, adapt them to altered conditions and further optimize them. The second objective was to contribute more in-depth research of contrast agent-based quantification of lung perfusion for the clinical standard of 1.5 Tesla. Additionally, we developed navigation methods which allow for scans of the lung under conditions of free breathing and without the use of external measurement devices

Balm Paints at the GMH power house, Elizabeth, South Australia, 1961 [picture] /

Condition: good.; Title from verso.; Sievers number: AC-3111-KA.; Title devised by cataloguer from information on verso.; Also available in an electronic version via the Internet at: http://nla.gov.au/nla.pic-vn3966012

Remarks on reporting and recording consistent with the ICRU Reference Dose

<p>Abstract</p> <p>Background</p> <p>ICRU 50/62 provides a framework to facilitate the reporting of external beam radiotherapy treatments from different institutions. A predominant role is played by points that represent "the PTV dose". However, for new techniques like Intensity Modulated Radiotherapy (IMRT) - especially step and shoot IMRT - it is difficult to define a point whose dose can be called "characteristic" of the PTV dose distribution. Therefore different volume based methods of reporting of the prescribed dose are in use worldwide. Several of them were compared regarding their usability for IMRT and compatibility with the ICRU Reference Point dose for conformal radiotherapy (CRT) in this study.</p> <p>Methods</p> <p>The dose distributions of 45 arbitrarily chosen volumes treated by CRT plans and 57 volumes treated by IMRT plans were used for comparison. Some of the IMRT methods distinguish the planning target volume (PTV) and its central part PTV_x(PTV minus a margin region of × mm). The reporting of dose prescriptions based on mean and median doses together with the dose to 95% of the considered volume (D₉₅) were compared with each other and in respect of a prescription report with the aid of one or several possible ICRU Reference Points. The correlation between all methods was determined using the standard deviation of the ratio of all possible pairs of prescription reports. In addition the effects of boluses and the characteristics of simultaneous integrated boosts (SIB) were examined.</p> <p>Results</p> <p>Two types of methods result in a high degree of consistency with the hitherto valid ICRU dose reporting concept: the median dose of the PTV and the mean dose to the central part of the PTV (PTV_x). The latter is similar to the CTV, if no nested PTVs are used and no patient model surfaces are involved. A reporting of dose prescription using the CTV mean dose tends to overestimate the plateau doses of the lower dose plateaus of SIB plans. PTV_xprovides the possibility to approach biological effects using the standard deviation of the dose within this volume.</p> <p>Conclusion</p> <p>The authors advocate reporting the PTV median dose or preferably the mean dose of the central dose plateau PTV_xas a potential replacement or successor of the ICRU Reference Dose - both usable for CRT and IMRT.</p

Long-term survival in metastasized leiomyosarcoma: a case report and review of the literature

BACKGROUND: Leiomyosarcoma of the mesosigma is a very rare entity, with low 5-year survival rates. Treatment consists of resection of the primary tumor and, if applicable, of synchronous or metachronous metastases. Local treatment options for metastatic disease should be exploited as long as possible, as response to chemotherapy is reportedly disappointing. Stereotactic radiotherapy is a fairly new locally effective treatment option which has been well established in stereotactic radiotherapy of lung tumors. Whether repeated stereotactic radiotherapy sessions for treatment of lung metastases can be safely and successfully performed over a long time period is not yet well documented. CASE REPORT: We present the case of a 71-year-old female patient who had a primary diagnosis of lung metastases 12 years ago. Atypical resections of 4 lung metastases were performed in 2001 and 2002. Between 2004 and 2011, 7 sessions of stereotactic body irradiation of lung metastases were performed. All stereotactic treatment were tolerated well (no radiation pneumonitis, FEV1 was 1.3 L [67.8%] in 2004 and 0.99 L [56.3%] in 2011). CONCLUSIONS: The present case could demonstrate that a repetitive treatment of lung metastases with multiple stereotactic radiotherapy sessions can lead to long-term survival with a good quality of life

Report on planning comparison of VMAT, IMRT and helical tomotherapy for the ESCALOX-trial pre-study

Background: The ESCALOX trial was designed as a multicenter, randomized prospective dose escalation study for head and neck cancer. Therefore, feasibility of treatment planning via diferent treatment planning systems (TPS) and radiotherapy (RT) techniques is essential. We hypothesized the comparability of dose distributions for simultaneous integrated boost (SIB) volumes respecting the constraints by diferent TPS and RT techniques. Methods: CT data sets of the frst six patients (all male, mean age: 61.3 years) of the pre-study (up to 77 Gy) were used for comparison of IMRT, VMAT, and helical tomotherapy (HT). Oropharynx was the primary tumor location. Normalization of the three step SIB (77 Gy, 70 Gy, 56 Gy) was D95%=77 Gy. Coverage (CVF), healthy tissue conformity index (HTCI), conformation number (CN), and dose homogeneity (HI) were compared for PTVs and conformation index (COIN) for parotids. Results: All RT techniques achieved good coverage. For SIB77Gy, CVF was best for IMRT and VMAT, HT achieved highest CN followed by VMAT and IMRT. HT reached good HTCI value, and HI compared to both other techniques. For SIB70Gy, CVF was best by IMRT. HTCI favored HT, consequently CN as well. HI was slightly better for HT. For SIB56Gy, CVF resulted comparably. Conformity favors VMAT as seen by HTCI and CN. Dmean of ipsilateral and contralateral parotids favor HT. Conclusion: Diferent TPS for dose escalation reliably achieved high plan quality. Despite the very good results of HT planning for coverage, conformity, and homogeneity, the TPS also achieved acceptable results for IMRT and VMAT