Towards the production of radiotherapy treatment shells on 3D printers using data derived from DICOM CT and MRI: preclinical feasibility studies

Background: Immobilisation for patients undergoing brain or head and neck radiotherapy is achieved using perspex or thermoplastic devices that require direct moulding to patient anatomy. The mould room visit can be distressing for patients and the shells do not always fit perfectly. In addition the mould room process can be time consuming. With recent developments in three-dimensional (3D) printing technologies comes the potential to generate a treatment shell directly from a computer model of a patient. Typically, a patient requiring radiotherapy treatment will have had a computed tomography (CT) scan and if a computer model of a shell could be obtained directly from the CT data it would reduce patient distress, reduce visits, obtain a close fitting shell and possibly enable the patient to start their radiotherapy treatment more quickly. Purpose: This paper focuses on the first stage of generating the front part of the shell and investigates the dosimetric properties of the materials to show the feasibility of 3D printer materials for the production of a radiotherapy treatment shell. Materials and methods: Computer algorithms are used to segment the surface of the patient’s head from CT and MRI datasets. After segmentation approaches are used to construct a 3D model suitable for printing on a 3D printer. To ensure that 3D printing is feasible the properties of a set of 3D printing materials are tested. Conclusions: The majority of the possible candidate 3D printing materials tested result in very similar attenuation of a therapeutic radiotherapy beam as the Orfit soft-drape masks currently in use in many UK radiotherapy centres. The costs involved in 3D printing are reducing and the applications to medicine are becoming more widely adopted. In this paper we show that 3D printing of bespoke radiotherapy masks is feasible and warrants further investigation

Year in review in Intensive Care Medicine 2009: I. Pneumonia and infections, sepsis, outcome, acute renal failure and acid base, nutrition and glycaemic control

Journal ArticleReviewSCOPUS: re.jinfo:eu-repo/semantics/publishe

The impact of COVID-19 critical illness on new disability, functional outcomes and return to work at 6 months: a prospective cohort study

BackgroundThere are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months.MethodsIn a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM.ResultsOf 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51–70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06–13.77]; p TM utility score (MD, − 0.19 [− 0.28 to − 0.10]; p ConclusionsAt six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning

Globalization and conflict : national security in a new strategic era/ Edit. : Robert G. Patman

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Changes in triceps surae muscle length and stiffness during intensive care admission: an observational study

This prospective descriptive study aimed to determine if changes in triceps surae muscle length and stiffness occur in ICU following acquired brain injury (ABI). Adult patients admitted to ICU for invasive ventilation and sedation for greater than 48 hours were studied. Twelve subjects met inclusion criteria over the six-week audit, five with ABI and seven with other diagnoses. Muscle stiffness was quantified by measuring ankle joint angles achieved from the application of three standardised torques (5, 10 and 15 Nm) via a modified Lidcombe template. Maximum dorsiflexion was used to indicate muscle length changes. Measurements were performed in knee flexion and extension to selectively bias soleus and gastrocnemius. Serial measurements were undertaken three times per week from admission to ICU until subjects were able to actively achieve ankle dorsiflexion, or were discharged from ICU. Subject comparisons were made between first and final day measurements, with comparison also made between subjects with ABI and those with other diagnoses. No significant differences were found between groups and neither group showed a significant change between admission and pre discharge measures. Analyses of all subjects showed a significant decrease in one of the measures of muscle stiffness. One subject developed extensor tone as sedation was withdrawn, which was reflected in all measures as decreased ankle dorsiflexion. Changes associated with contracture were evident only in one subject, and were related to the presence of extensor muscle tone. Some subjects exhibited increased ankle extensibility. The trend towards increased extensibility may have been related to muscle atrophy. Nielsen, G., Gardner, P., & Patman, S. (2006). Changes in triceps surae muscle length and stiffness during intensive care admission: an observational study. Australian Journal of Physiotherapy, 52(1), S22. ISSN: 0004-951