A dosimetric comparison of different treatment plans of palliative spinal bone irradiation: analysis of dose coverage with respect to ICRU 50 report

<p>Abstract</p> <p>Background</p> <p>This study aimed to analyze three-dimensional (3D) dosimetric data of conventional two-dimensional (2D) palliative spinal bone irradiation using different reference points and treatment plans with respect to the International Commission on Radiation Units and Measurements (ICRU) Report 50.</p> <p>Methods</p> <p>Forty-five simulation CT scans of 39 patients previously treated for thoraco-lumbar spinal bone metastases were used. Three different treatment plans were created: (1) single posterior field plans using the ICRU reference points (ICRUrps); (2) single posterior field plans using the International Bone Metastasis Consensus Working Party reference points (IBMCrps); (3) two opposed anterior-posterior (AP-PA) field plans using the ICRUrps. The intended dose range for planning target volume (PTV) was 90% to 110% of the prescribed dose for AP-PA field plans. Cumulative dose-volume histograms were generated for each plan, and minimum, maximum and mean doses to the PTV, medulla spinalis, esophagus and intestines were analyzed.</p> <p>Results</p> <p>The mean percentages of minimum, maximum and mean PTV doses ± standard deviation were, respectively, 91 ± 1.3%, 108.8 ± 1.3% and 99.7 ± 1.3% in AP-PA field plans; 77.3 ± 2.6%, 122.2 ± 4.3% and 99.8 ± 2.6% in ICRUrp single field plans; and 83.7 ± 3.3%, 133.9 ± 7.1% and 108.8 ± 3.3% in IBMCrp single field plans. Minimum doses of both single field plans were significantly lower (p < 0.001) while maximum doses were significantly higher (p < 0.001) than AP-PA field plans. Minimum, maximum and mean doses were higher in IBMCrp single field plans than in ICRUrp single field plans (p < 0.001). The mean medulla spinalis doses were lower in AP-PA field plans than single posterior field plans (p < 0.001). Maximum doses for medulla spinalis were higher than 120% of the prescribed dose in 22 of 45 (49%) IBMCrp single field plans. Mean esophagus and intestinal doses were higher (p < 0.001) in AP-PA field plans than single field plans, however, less than 95% of the prescribed dose.</p> <p>Conclusion</p> <p>In palliative spinal bone irradiation, 2D conventional single posterior field radiotherapy did not accomplish the ICRU Report 50 recommendations for PTV dose distribution, while the AP-PA field plans did achieve the intended dose ranges with a homogenous distribution and reasonable doses to the medulla spinalis, esophagus and intestines.</p

Evaluation of skin dose associated with different frequencies of bolus applications in post-mastectomy three-dimensional conformal radiotherapy

<p>Abstract</p> <p>Background</p> <p>The study aimed to calculate chest-wall skin dose associated with different frequencies of bolus applications in post-mastectomy three-dimensional conformal radiotherapy (3D-CRT) and to provide detailed information in the selection of an appropriate bolus regimen in this clinical setting.</p> <p>Methods</p> <p>CT-Simulation scans of 22 post-mastectomy patients were used. Chest wall for clinical target volume (CTV) and a volume including 2-mm surface thickness of the chest wall for skin structures were delineated. Precise PLAN 2.11 treatment planning system (TPS) was used for 3D-CRT planning. 50 Gy in 25 fractions were prescribed using tangential fields and 6-MV photons. Six different frequencies of bolus applications (0, 5, 10, 15, 20, and 25) were administered. Cumulative dose-volume histograms were generated for each bolus regimen. The minimum, maximum and mean skin doses associated with the bolus regimens were compared. To test the accuracy of TPS dose calculations, experimental measurements were performed using EBT gafchromic films.</p> <p>Results</p> <p>The mean, minimum and maximum skin doses were significantly increased with increasing days of bolus applications (p < 0.001). The minimum skin doses for 0, 5, 10, 15, 20, and 25 days of bolus applications were 73.0% ± 2.0%, 78.2% ± 2.0%, 83.3% ± 1.7%, 88.3% ± 1.6%, 92.2% ± 1.7%, and 93.8% ± 1.8%, respectively. The minimum skin dose increments between 20 and 25 (1.6% ± 1.0%), and 15 and 20 (4.0% ± 1.0%) days of bolus applications were significantly lower than the dose increments between 0 and 5 (5.2% ± 0.6%), 5 and 10 (5.1% ± 0.8%), and 10 and 15 (4.9% ± 0.8%) days of bolus applications (p < 0.001). The maximum skin doses for 0, 5, 10, 15, 20, and 25 days of bolus applications were 110.1% ± 1.1%, 110.3% ± 1.1%, 110.5% ± 1.2%, 110.8% ± 1.3%, 111.2% ± 1.5%, and 112.2% ± 1.7%, respectively. The maximum skin dose increments between 20 and 25 (1.0% ± 0.6%), and 15 and 20 (0.4% ± 0.3%) days of bolus applications were significantly higher than the dose increments between 0 and 5 (0.2% ± 0.2%), 5 and 10 (0.2% ± 0.2%), and 10 and 15 (0.2% ± 0.2%) days of bolus applications (p ≤ 0.003). The TPS overestimated the near-surface dose 10.8% at 2-mm below the skin surface.</p> <p>Conclusion</p> <p>In post-mastectomy 3D-CRT, using a 1-cm thick bolus in up to 15 of the total 25 fractions increased minimum skin doses with a tolerable increase in maximum doses.</p

A sample of paediatric residents' loneliness-anxiety-depression-burnout and job satisfaction with probable affecting factors

Objective: To assess levels of anxiety, depression, loneliness, burnout and job satisfaction among paediatric Residents, and how they influence each other. Methods: The cross-sectional study was conducted at Necmettin Erbakan University, Meram, and Konya Meram Education and Research Hospital, Turkey from January to June 2011, and comprised paediatric Residents and their counterparts from other departments who formed the control group. While maintaining confidentiality, a questionnaire was used to collect data that had elements of the University of California, Los Angeles, Loneliness Scale, Hospital Anxiety and Depression Scale, Maslach Burnout Inventory and Minnesota Job Satisfaction Questionnaire. SPSS version 13 was used for statistical analysis. Results: Overall there were 74 Residents in the study; 43(58%) working with the paediatrics department, and 31(42%) in the control group. Overall mean age was 27.60+/-2.25 years. Residents who were not satisfied with the city they were living in, with their professional career and who would not choose the same career given a second chance were feeling more lonely and had higher loneliness scores (p<0.05). In contrast, anxiety among female Residents who were unsatisfied with their professional career and working conditions was significantly high (p<0.05). Positive correlation was detected between the burnout levels of Residents and their anxiety, depression and loneliness scores (r=0.74; r=0.65; r=0.36). In terms of intrinsic, extrinsic and total job satisfaction, there was an obvious negative correlation (r=-0.57; r=-0.54; r=-0.61). Conclusion: Working conditions and professional liability were the main factors affecting the Residents. Informed decision and career willingness may help them feel better

Type Of Setting For The Inpatient Adolescent With An Eating Disorder: Are Specialized Inpatient Clinics A Must Or Will The Pediatric Ward Do?

There are a range of different services for treating adolescent eating disorders (ED) but there is no clinical consensus and a paucity of research indicating which type of treatment setting is the best. Although it would be ideal to have a specialized ward for these patients what happens when this is not possible? The aim of this study was to evaluate patients with ED hospitalized on a general pediatric ward. A retrospective chart review for 37 patients hospitalized for an ED and followed by a team consisting of an adolescent medicine specialist, a child and adolescent psychiatrist and a dietician on a pediatric ward were re-evaluated. Twenty-four (64.9%) patients were diagnosed with anorexia nervosa (AN) restricting type, 8 (21.6%) with anorexia nervosa binging purging type, 3 (8.1%) with bulimia nervosa (BN) and 2 (5.4%) with eating disorder otherwise not specified. The mean age at admission was 14.79 +/- 1.75 years and 7 (20%) were males. A majority were hospitalized due to medical instability. Mean period of time from admittance to medical stabilization was 6.04 +/- 4.79 days. The mean period of admittance was 26.4 +/- 11.9 days for AN and 23.7 +/- 15.03 days for BN patients. The mean calorie intake of the AN group was 607 +/- 333 kcal and 2,358 +/- 605 kcal at hospitalization and discharge, respectively. Hypophosphatemia occurred in 2 patients during refeeding. Mean total weight gained during the whole hospitalization period was 3,950 +/- 3,524grs. This study shows that although not ideal, EDs can successfully be followed on general pediatric wards and could have implications at centers with no specialized wards.WoSScopu

Syntheses, crystal structures, theoretical studies, and anticancer properties of an unsymmetrical Schiff base ligand N-2-(6- methylpyridyl)-2-hydroxy-1-naphthaldimine and its Ni(II) complex

In this work, syntheses of Schiff-base ligand, N-2-(6-methylpyridyl)-2-hydroxy-1-naphthaldimine (1) and its hitherto unknown chelate with a Ni(II) salt, bis[N-2-(6-methylpyridyl)-2-oxo-1-naphthaldimnato-k 3N^N^O] nickel(II) (2) have been reported and characterized by spectral techniques (IR, 1H NMR, Mass). Solid state structures and non-covalent interactions persisting in 1 and 2 are studied by Density Functional Theory (DFT) optimizations and Hirshfeld Surface (HS) analysis. X-ray diffraction (XRD) study shows zwitter ionic keto-amine tautomer form of planar Schiff base 1 that exists as dimer formed by C13 ̶ H13A···O1 i [(i) -x+1, -y, -z+1] hydrogen bonds and distorted octahedral geometry around Ni +2 center in chelate 2, where overall crystal structure stability may be attributed to weak C ̶ H···π, π···π stacking, van der Waals interactions, and C ̶ H···O type intermolecular hydrogen bonds. The HS study and 2D Finger Print (FP) plots corroborate well with XRD data and show prominent O···H/H···O spikes (2.2 Å < d e+d i < 2.3 Å) and C···H/H···C (2.5 Å < d e+d i < 2.6 Å) spikes that arise from C ̶ H···O type H-bonds and C ̶ H···π interactions respectively, along with significant C···C interactions (d e+d i ∼ 3.3 Å) due to π···π stacking (2). The anticancer activity has been investigated by using cytotoxicity measure (MTT assay), apoptosis assay, quantitative polymerase chain reaction (qPCR), and colony formation assays. The Ni(II) metal complex demonstrates dose-dependent cytotoxicity in vitro, killing A549 lung cancer cells via an apoptotic pathway