Risk factors of unmet needs among women with breast cancer in the post-treatment phase

OBJECTIVE: Unmet health care needs require additional care resources to achieve optimal patient well-being. In this nationwide study we examined associations between a number of risk factors and unmet needs after treatment among women with breast cancer, while taking into account their health care practices. We expected that more care use would be associated with lower levels of unmet needs. METHODS: A multicenter, prospective, observational design was employed. Women with primary breast cancer completed questionnaires 6 and 15 months post-diagnosis. Medical data were retrieved from medical records. Direct and indirect associations between sociodemographic and clinical risk factors, distress, care use, and unmet needs were investigated with structural equation modeling. RESULTS: Seven hundred forty-six participants completed both questionnaires (response rate 73.7%). The care services received were not negatively associated with the reported levels of unmet needs after treatment. Comorbidity was associated with higher physical and daily living needs. Higher age was associated with higher health system-related and informational needs. Having had chemotherapy and a mastectomy were associated with higher sexuality needs and breast cancer-specific issues, respectively. A higher level of distress was associated with higher levels of unmet need in all domains. CONCLUSIONS: Clinicians may use these results to timely identify which women are at risk of developing specific unmet needs after treatment. Evidence-based, cost-effective (online) interventions that target distress, the most influential risk factor, should be further implemented and disseminated among patients and clinicians

Upgrade of the AGOR Cyclotron Control System at UMCG-PARTREC

The AGOR cyclotron began development in the late 1980s and was commissioned in 1997. In 2020, when the facility was transferred from the University of Groningen to the University Medical Center Groningen, it marked the start of an upgrade process aimed at ensuring reliable operation. Recent, current and upcoming upgrades and additions encompass the following: Firstly, the current OT network uses custom IO modules based on the outdated Bitbus fieldbus. A pilot study was conducted to evaluate the use of NI CompactRIO-based subracks for analog and digital IO. Also, a similar PLC-based solution is currently under investigation. Secondly, the current control system is based on Vsystem/Vista and alternatives are being investigated. Thirdly, PLCs are upgraded to a newer generation. Fourthly, the current harp electronics and beam current readout electronics both use components that are hard to procure and use a Bitbus interface. New, in-house designs constructed as generic I-V converters eliminate this fieldbus dependency. Fifthly, the present RF slow control employs feedback loops to regulate the RF power and phase. Our new design incorporates functional improvements and condenses several discrete modules into a single cassette, resulting in fewer expected issues with faulty cables and connectors, and enabling us to maintain a larger stock of spares. Finally, the UMCG Radiotherapy department is constructing a new beamline with support from the technical staff at UMCG-PARTREC. The control will be based on NI CompactRIO

Feasibility and accuracy of tissue characterization with dual source computed tomography

PURPOSE: To evaluate the feasibility and accuracy of a model for tissue characterization with dual source computed tomography (DSCT). METHODS AND MATERIALS: A model for tissue characterization in CT was used with a parameterization of linear attenuation coefficients. Sixteen chemical substances with effective atomic numbers between 5.21 and 13.08 and electron densities between 2.20 and 4.12 x10(23) electrons/cm(3) were scanned at energies of 80 and 140 kV on a DSCT. From the reconstructed dual energy data sets, effective atomic numbers and electron densities of the substances were calculated. RESULTS: Our presented model using DSCT approximated the effective atomic numbers and effective electron densities of 16 substances very well. The measured effective atomic numbers deviated 3.4 ± 6.8% (R(2) = 0.994) from theoretical effective atomic numbers. In addition, measured effective electron densities deviated -0.6 ± 2.2% (R(2) = 0.999) from theoretical effective electron densities. CONCLUSION: Effective atomic numbers and effective electron densities can be determined with a high accuracy with DSCT. Therefore the model can be of potential benefit for clinical applications of quantitative tissue characterization with DSCT

High accuracy proton relative stopping power measurement

Proton therapy is a fast growing treatment modality for cancer and is in selected cases preferred over conventional radiotherapy with photons because of the highly conformal dose distribution that can be achieved with protons due to their steep dose gradients. However, these steep gradients also make proton therapy sensitive to range uncertainties. Proton ranges are calculated from proton stopping powers relative to that in water (Relative Stopping Power, RSP). The RSPs needed for a treatment plan can be estimated from CT (Computed Tomography) data of a patient. High accuracy reference values of RSPs are required to assess the accuracy of these CT based estimates. In this paper we present a water phantom that enables accurate measurement of depth dose profiles in water. Experimental RSPs with a relative standard uncertainty smaller than 0.4% (1 sigma) for samples with a water equivalent thickness of about 2 cm can be derived from the measured depth dose distributions. Most CT based RSP estimates use an approximate RSP model based on the Bethe-Bloch formula without the shell, density, Barkas and Bloch correction. In the Geant4 Monte Carlo code these corrections are included and RSP calculations with this code are expected to be more accurate. In this work, a set of 32 well defined (composition and density), mostly clinically relevant materials is used to assess the correspondence between RSPs that were measured, that were estimated from the approximate RSP model and that were calculated from Monte Carlo simulations. With the measured RSPs we provide a ground-truth bench mark to test the validity of RSPs derived from CT imaging and Monte Carlo simulations

Working Together to Make Sense of the Past: Mothers\u27 and Children\u27s Use of Internal States Language in Conversations about Traumatic and Nontraumatic Events

Mother-child conversations about a devastating tornado and about 2 nontraumatic events were examined to determine whether there were (a) differences in use of internal states language when talking about traumatic and nontraumatic events and (b) similarities in mothers\u27 and children\u27s use of internal states language. At Session 1, which took place 4 months after the tornado, with conversational length controlled, there was no evidence of differential use of internal states language as a function of event for mothers or children. At Session 2, which took place 6 months later (10 months after the tornado), older children\u27s narratives about the tornado were more saturated with internal states language, relative to their narratives about nontornado events. For both the traumatic and the nontraumatic events, there were cross-lagged correlations between maternal use of emotion language at Session 1 and children\u27s use of emotion language at Session 2. The pattern of findings is consistent with the suggestion that mother-child conversations are one context for the socialization of language about emotional experiences

Relative electron density determination using a physics based parameterization of photon interactions in medical DECT

Radiotherapy and particle therapy treatment planning require accurate knowledge of the electron density and elemental composition of the tissues in the beam path to predict the local dose deposition. We describe a method for the analysis of dual energy computed tomography (DECT) images that provides the electron densities and effective atomic numbers of tissues. The CT measurement process is modelled by system weighting functions, which apply an energy dependent weighting to the parameterization of the total cross section for photon interactions with matter. This detailed parameterization is based on the theoretical analysis of Jackson and Hawkes and deviates, at most, 0.3% from the tabulated NIST values for the elements H to Zn. To account for beam hardening in the object as present in the CT image we implemented an iterative process employing a local weighting function, derived from the method proposed by Heismann and Balda. With this method effective atomic numbers between 1 and 30 can be determined. The method has been experimentally validated on a commercially available tissue characterization phantom with 16 inserts made of tissue substitutes and aluminium that has been scanned on a dual source CT system with tube potentials of 100 kV and 140 kV using a clinical scan protocol. Relative electron densities of all tissue substitutes have been determined with accuracy better than 1%. The presented DECT analysis method thus provides high accuracy electron densities and effective atomic numbers for radiotherapy and especially particle therapy treatment planning