Risk Management in Magnetic Resonance: Failure Mode, Effects, and Criticality Analysis

The aim of the study was to perform a risk management procedure in "Magnetic Resonance Examination" process in order to identify the critical phases and sources of radiological errors and to identify potential improvement projects including procedures, tests, and checks to reduce the error occurrence risk. In this study we used the proactive analysis "Failure Mode Effects Criticality Analysis," a qualitative and quantitative risk management procedure; has calculated Priority Risk Index (PRI) for each activity of the process; have identified, on the PRI basis, the most critical activities and, for them, have defined improvement projects; and have recalculated the PRI after implementation of improvement projects for each activity. Time stop and audits are performed in order to control the new procedures. The results showed that the most critical tasks of "Magnetic Resonance Examination" process were the reception of the patient, the patient schedule drafting, the closing examination, and the organization of activities. Four improvement projects have been defined and executed. PRI evaluation after improvement projects implementation has shown that the risk decreased significantly following the implementation of procedures and controls defined in improvement projects, resulting in a reduction of the PRI between 43% and 100%

Phase II study of sequential hormonal therapy with anastrozole/exemestane in advanced and metastatic breast cancer

Hormonal therapy is the preferred systemic treatment for recurrent or metastatic, post-menopausal hormone-receptor-positive breast cancer. Previous studies have shown that there is no cross-resistance between exemestane and reversible aromatase inhibitors. Exposure to hormonal therapy does not hamper later response to chemotherapy. Patients with locally advanced or metastatic, hormonal receptor positive or unknown, breast cancer were treated with oral anastrozole, until disease progression, followed by oral exemestane until new evidence of disease progression. The primary end point of the study was clinical benefit, defined as the sum of complete responses (CR), partial responses (PR) and > 24 weeks stable disease (SD). In all, 100 patients were enrolled in the study. Anastrozole produced eight CR and 19 PR for an overall response rate of 27% (95% CI: 18.6-36.8%). An additional 46 patients had long-term (> 24 weeks) SD for an overall clinical benefit of 73% (95% CI: 63.2-81.4). Median time to progression (TTP) was 11 months (95% CI: 10-12). A total of 50 patients were evaluated for the second-line treatment: exemestane produced one CR and three PR; 25 patients had SD which lasted ≥ 6 months in 18 patients. Median TTP was 5 months. Toxicity of treatment was low. Our study confirms that treatment with sequential hormonal agents can extend the period of time during which endocrine therapy can be used, thereby deferring the decision to use chemotherapy. © 2005 Cancer Research UK

First observation of rotational structures in Re 168

The first rotational sequences have been assigned to the odd-odd nucleus Re168. Coincidence relationships of these structures with rhenium x rays confirm the isotopic assignment, while arguments based on the γ-ray multiplicity (K-fold) distributions observed with the new bands lead to the mass assignment. Configurations for the two bands were determined through analysis of the rotational alignments of the structures and a comparison of the experimental B(M1)/B(E2) ratios with theory. Tentative spin assignments are proposed for the πh11/2νi13/2 band, based on energy level systematics for other known sequences in neighboring odd-odd rhenium nuclei, as well as on systematics seen for the signature inversion feature that is well known in this region. The spin assignment for the πh11/2ν(h9/2/f7/2) structure provides additional validation of the proposed spins and configurations for isomers in the Au176 → Ir172→Re168 α-decay chain

Multiple band structures in 169,170Re: Search for the wobbling mode in 169Re, and residual-interaction analysis of structures in 170Re

Although the observation of wobbling was once thought to be possibly confined to lutetium isotopes in N≈94 nuclei, the identification of this exotic collective mode in 167Ta has raised the question of the role of the proton Fermi surface with regard to this phenomenon. To investigate this issue, an experiment was performed to populate high-spin states in the N=94 nucleus 169Re. The heavy-ion reaction 55Mn+118Sn was used in conjunction with Gammasphere to detect the emitted γ rays. More than 130 new transitions were added to the 169Re level scheme, including the first identification of the πi13/2 rotational sequence in this nucleus. This configuration is the structure on which all known wobbling sequences are based, but no wobbling band was observed, likely owing to the fact that the πi13/2 sequence is located at a relatively high energy in comparison with the other structures found in 169Re. Nine decay sequences are now established in this nucleus and are described within the context of the cranked shell model. In addition, significant extension of the level scheme of the odd-odd 170Re nucleus was possible and a discussion of the residual interactions for the πh 9/2νi13/2 and πi13/2νi13/2 configurations in this region is given as well

High-spin structure of odd-odd Re 172

A significant extension of the level scheme for the odd-odd nucleus Re172 was accomplished through the use of the Gammasphere spectrometer. States up to a tentative spin assignment of 39 were observed and two new structures were identified. Configuration assignments are proposed based on alignment properties and observed band crossings

Possible deformation evolution in the πi13/2 structure of 171Re

The phenomenon of wobbling can only occur for a nuclear shape with stable triaxial deformation. To date, only a few examples of this exotic collective mode have been observed in lutetium and tantalum isotopes. A search for a wobbling sequence was performed in 171Re to determine if this feature can be observed in Z>73 nuclei. No evidence was found for wobbling; however, an interaction between the πi13/2 sequence and another positive-parity band may give an indication on why wobbling may not occur in this nucleus. The level scheme for 171Re was significantly extended and interpretations for the decay sequences are proposed within the context of the cranked shell model

Tamoxifen in treatment of hepatocellular carcinoma: a randomised controlled trial

Background Results from small randomised trials on tamoxifen in the treatment of hepatocellular carcinoma (HCC) are conflicting, We studied whether the addition of tamoxifen to best supportive care prolongs survival of patients with HCC. Methods Patients with any stage of HCC were eligible, irrespective of locoregional treatment. Randomisation was centralised, with a minimisation procedure accounting for centre, evidence of disease, and time from diagnosis. Patients were randomly allocated best supportive care alone or in addition to tamoxifen, Tamoxifen was given orally, 40 mg per day, from randomisation until death. Results 496 patients from 30 institutions were randomly allocated treatment from January, 1995, to January, 1997. Information was available for 477 patients. By Sept 15, 1997, 119 (50%) of 240 and 130 (55%) of 237 patients had died in the control and tamoxifen arms, respectively. Median survival was 16 months and 15 months (p=0.54), respectively, No differences were found within subgroups defined by prognostic variables. Relative hazard of death for patients receiving tamoxifen was 1.07 (95% CI 0.83-1.39). Interpretation Our findings show that tamoxifen is not effective in prolonging survival of patients with HCC

Backbending, seniority, and Pauli blocking of pairing correlations at high rotational frequencies in rapidly rotating nuclei

Garrett et al. systematically investigated band-crossing frequencies resulting from the rotational alignment of the first pair of i13/2 neutrons (AB) in rare-earth nuclei. In that study, evidence was found for an odd-even neutron number dependence attributed to changes in the strength of neutron pairing correlations. The present paper carries out a similar investigation at higher rotational frequencies for the second pair of aligning i13/2 neutrons (BC). Again, a systematic difference in band-crossing frequencies is observed between odd-N and even-N Er, Yb, Hf, and W nuclei, but in the BC case, it is opposite to the AB neutron-number dependence. These results are discussed in terms of a reduction of neutron pairing correlations at high rotational frequencies and of the effects of Pauli blocking on the pairing field by higher-seniority configurations. Also playing a significant role are the changes in deformation with proton and neutron numbers, the changes in location of single-particle orbitals as a function of quadrupole deformation, and the position of the Fermi surface with regard to the various ω components of the neutron i13/2 shell