Measuring Pacemaker Dose: A Clinical Perspective

Purpose: The number of patients presenting with pacemakers in our clinic has increased recently. Following AAPM recommendations, a treatment plan is developed that minimizes the dose to the pacemaker. The most efficient way to measure in vivo dose during treatment is to use MOSFETs or diodes which offer a simple but inaccurate (up to 25% error) method of recording. In this abstract, we analyze the dose measured by these different devices in an attempt to assess pacemaker dose. American Association of Physicists in Medicine (AAPM) 52nd Annual Meeting July 18-22, Philadelphia, P

Effects of aging on the relationship between cognitive demand and step variability during dual-task walking

A U-shaped relationship between cognitive demand and gait control may exist in dual-task situations, reflecting opposing effects of external focus of attention and attentional resource competition. The purpose of the study was twofold: to examine whether gait control, as evaluated from step-to-step variability, is related to cognitive task difficulty in a U-shaped manner and to determine whether age modifies this relationship. Young and older adults walked on a treadmill without attentional requirement and while performing a dichotic listening task under three attention conditions: non-forced (NF), forced-right (FR), and forced-left (FL). The conditions increased in their attentional demand and requirement for inhibitory control. Gait control was evaluated by the variability of step parameters related to balance control (step width) and rhythmic stepping pattern (step length and step time). A U-shaped relationship was found for step width variability in both young and older adults and for step time variability in older adults only. Cognitive performance during dual tasking was maintained in both young and older adults. The U-shaped relationship, which presumably results from a trade-off between an external focus of attention and competition for attentional resources, implies that higher-level cognitive processes are involved in walking in young and older adults. Specifically, while these processes are initially involved only in the control of (lateral) balance during gait, they become necessary for the control of (fore-aft) rhythmic stepping pattern in older adults, suggesting that attentional resources turn out to be needed in all facets of walking with aging. Finally, despite the cognitive resources required by walking, both young and older adults spontaneously adopted a “posture second” strategy, prioritizing the cognitive task over the gait task

Too much or too little step width variability is associated with a fall history in older persons who walk at or near normal gait speed

BACKGROUND: Decreased gait speed and increased stride time, stride length, double support time, and stance time variability have consistently been associated with falling whereas step width variability has not been strongly related to falls. The purpose was to examine the linear and nonlinear associations between gait variability and fall history in older persons and to examine the influence of gait speed. METHODS: Gait characteristics and fall history were obtained in 503 older adults (mean age = 79; 61% female) participating in the Cardiovascular Health Study who could ambulate independently. Gait characteristics were recorded from two trials on a 4 meter computerized walkway at the subject's self-selected walking speed. Gait variability was calculated as the coefficient of variation. The presence of a fall in the past 12 months was determined by interview. The nonlinear association between gait variability and fall history was examined using a simple three level classification derived from the distribution of the data and from literature based cut-points. Multivariate logistic regression was used to examine the association between step width variability (extreme or moderate) and fall history stratifying by gait speed (1.0 m/s) and controlling for age and gender. RESULTS: Step length, stance time, and step time variability did not differ with respect to fall history (p > .33). Individuals with extreme step width variability (either low or high step width variability) were more likely to report a fall in the past year than individuals with moderate step width variability. In individuals who walked ≥ 1.0 m/s (n = 281), after controlling for age, gender, and gait speed, compared to individuals with moderate step width variability individuals with either low or high step width variability were more likely to have fallen in the past year (OR and 95% CI 4.38 [1.79–10.72]). The association between step width variability and fall history was not significant in individuals who walked < 1.0 m/s (n = 224). CONCLUSION: Extreme (either too little or too much) step width variability is associated with falls in the past year in older persons who walk at or near normal gait speed and not in older persons who walk slowly (<1.0 m/s)

IMRT for Craniospinal Irradiation: A Dosimetric Comparison

Purpose: This work tests the possibility of using IMRT to promote organ sparing for the treatment of CSI. The traditional CSI technique uses opposed lateral fields to treat the brain and posterior fields to treat the spine. Published manuscripts focusing on the possibility of IMRT for CSI have only looked at pediatric cases. Here, we will plan IMRT for CSI on adult patients to quantify the dosimetric gains when compared to traditional techniques. American Association of Physicists in Medicine (AAPM) 52nd Annual Meeting July 18-22, Philadelphia, P

Uncertainty and Margin Study for IMRT, VMAT, and Proton Beam Therapy for Treatment After Radical Prostatectomy

Purpose/Objective(s): To compare the uncertainties of 3D dose distributions, caused by the geometrical uncertainty of patient setup, in IMRT, VMAT, and proton plans for post-prostatectomy treatment. To test the effectiveness of a common margin recipe in these three types of treatment plans. American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, C

Dosimetric Comparison of VMAT, IMRT and Proton Therapy for Post- Prostatectomy Radiation Therapy for Prostate Cancer

Purpose/Objectives: Radiation therapy (RT) for the treatment of prostate cancer after radical prostatectomy (RP) is widely accepted. With technological advances, radiation treatment technique and dosimetry may vary. The purpose of this study is to quantify dosimetric difference of proton therapy versus VMAT and IMRT focusing on bladder and rectal dose sparing and target coverage. American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, C

IGRT After Prostatectomy: Evaluation of Corrective Shifts and Toxicity Using Online Cone Beam CT vs. Weekly Port Films for Target Localization

Purpose/Objective(s): Image guidance (IG) may permit higher radiotherapy (RT) doses (\u3e65 Gy) after radical prostatectomy (RP) without increased toxicity, with improved accuracy and smaller margins. Conebeam (CBCT) allows IGRT with volumetric images. This study evaluated CBCT shifts and toxicity after conformal IGRT, compared to RT with port films. American Society for Therapeutic Radiation Oncology (ASTRO) 52nd Annual Meeting October 31 - November 4, San Diego, C

Bioavailable testosterone linearly declines over a wide age spectrum in men and women from the Baltimore longitudinal study of aging

Background: Age-related changes in testosterone levels in older persons and especially in women have not been fully explored. The objective of this study was to describe age-related trajectories of total testosterone (TT), ammonium sulfate precipitation-measured bioavailable testosterone (mBT), and sex hormone-binding glycoprotein (SHBG) in men and women from the Baltimore Longitudinal Study of Aging, with special focus on the oldest adults. Methods: Participants included 788 White men and women aged 30-96 years with excellent representation of old and oldest old, who reported not taking medications known to interfere with testosterone. Longitudinal data were included when available. TT, mBT, and SHBG were assayed. Age-related trajectories of mBT were compared with those obtained using calculated bioavailable testosterone (cBT). Generalized least square models were performed to describe age-related trajectories of TT, mBT, and SHBG in men and women. Results: mBT linearly declines over the life span and even at older ages in both sexes. In men, TT remains quite stable until the age of 70 years and then declines at older ages, whereas in women TT progressively declines in premenopausal years and slightly increases at older ages. Differences in age-related trajectories between total and bioavailable testosterone are only partially explained by age changes in SHBG, whose levels increases at accelerated rates in old persons. Noteworthy, although mBT and cBT highly correlated with one another, mBT is a much stronger correlate of chronological age than cBT. Conclusion: In both men and women, mBT linearly declines over the life span and even at old ages. Its relationship with age-related phenotypes should be further investigated

Extra‐nigral pathological conditions are common in Parkinson's disease with freezing of gait: An in vivo positron emission tomography study

Cholinergic denervation has been associated with falls and slower gait speed and β‐amyloid deposition with greater severity of axial motor impairments in Parkinson disease (PD). However, little is known about the association between the presence of extra‐nigral pathological conditions and freezing of gait (FoG). Patients with PD (n = 143; age, 65.5 ± 7.4 years, Hoehn and Yahr stage, 2.4 ± 0.6; Montreal Cognitive Assessment score, 25.9 ± 2.6) underwent [ 11 C]methyl‐4‐piperidinyl propionate acetylcholinesterase and [ 11 C]dihydrotetrabenazine dopaminergic PET imaging, and clinical, including FoG, assessment in the dopaminergic “off” state. A subset of subjects (n = 61) underwent [ 11 C]Pittsburgh compound‐B β‐amyloid positron emission tomography (PET) imaging. Normative data were used to dichotomize abnormal β‐amyloid uptake or cholinergic deficits. Freezing of gait was present in 20 patients (14.0%). Freezers had longer duration of disease ( P  = 0.009), more severe motor disease ( P  < 0.0001), and lower striatal dopaminergic activity ( P  = 0.013) compared with non‐freezers. Freezing of gait was more common in patients with diminished neocortical cholinergic innervation (23.9%, χ 2  = 5.56, P  = 0.018), but not in the thalamic cholinergic denervation group (17.4%, χ 2  = 0.26, P  = 0.61). Subgroup analysis showed higher frequency of FoG with increased neocortical β‐amyloid deposition (30.4%, Fisher Exact test: P  = 0.032). Frequency of FoG was lowest with absence of both pathological conditions (4.8%), intermediate in subjects with single extra‐nigral pathological condition (14.3%), and highest with combined neocortical cholinopathy and amyloidopathy (41.7%; Cochran‐Armitage trend test, Z  = 2.63, P  = 0.015). Within the group of freezers, 90% had at least one of the two extra‐nigral pathological conditions studied. Extra‐nigral pathological conditions, in particular the combined presence of cortical cholinopathy and amyloidopathy, are common in PD with FoG and may contribute to its pathophysiology. © 2014 International Parkinson and Movement Disorder SocietyPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108363/1/mds25929.pd

Lower mitochondrial energy production of the thigh muscles in patients with low-normal ankle-brachial index

Background--Lower muscle mitochondrial energy production may contribute to impaired walking endurance in patients with peripheral arterial disease. A borderline ankle-brachial index (ABI) of 0.91 to 1.10 is associated with poorer walking endurance compared with higher ABI. We hypothesized that in the absence of peripheral arterial disease, lower ABI is associated with lower mitochondrial energy production. Methods and Results--We examined 363 men and women participating in the Baltimore Longitudinal Study of Aging with an ABI between 0.90 and 1.40. Muscle mitochondrial energy production was assessed by post-exercise phosphocreatine recovery rate constant (kPCr) measured by phosphorus magnetic resonance spectroscopy of the left thigh. A lower post-exercise phosphocreatine recovery rate constant reflects decreased mitochondria energy production.The mean age of the participants was 71\uc2\ub112 years. A total of 18.4% had diabetes mellitus and 4% were current and 40% were former smokers. Compared with participants with an ABI of 1.11 to 1.40, those with an ABI of 0.90 to 1.10 had significantly lower post-exercise phosphocreatine recovery rate constant (19.3 versus 20.8 ms-1, P=0.015). This difference remained significant after adjusting for age, sex, race, smoking status, diabetes mellitus, body mass index, and cholesterol levels (P=0.028). Similarly, post-exercise phosphocreatine recovery rate constant was linearly associated with ABI as a continuous variable, both in the ABI ranges of 0.90 to 1.40 (standardized coefficient=0.15, P=0.003) and 1.1 to 1.4 (standardized coefficient=0.12, P=0.0405). Conclusions--An ABI of 0.90 to 1.10 is associated with lower mitochondrial energy production compared with an ABI of 1.11 to 1.40. These data demonstrate adverse associations of lower ABI values with impaired mitochondrial activity even within the range of a clinically accepted definition of a normal ABI. Further study is needed to determine whether interventions in persons with ABIs of 0.90 to 1.10 can prevent subsequent functional decline