Statistical analysis of IMRT dosimetry quality assurance measurements for local delivery guideline

<p>Abstract</p> <p>Purpose</p> <p>To establish our institutional guideline for IMRT delivery, we statistically evaluated the results of dosimetry quality assurance (DQA) measurements and derived local confidence limits using the concept confidence limit of |mean|+1.96σ.</p> <p>Materials and methods</p> <p>From June 2006 to March 2009, 206 patients with head and neck cancer, prostate cancer, liver cancer, or brain tumor were treated using LINAC-based IMRT technique. In order to determine site specific DQA tolerances at a later stage, a hybrid plan with the same fluence maps as in the treatment plan was generated on CT images of a cylindrical phantom of acryl. Points of measurement using a 0.125 cm³ion-chamber were typically located in the region of high and uniform doses. The planar dose distributions perpendicular to the central axis were measured by using a diode array in solid water with all fields delivered, and assessed using gamma criteria of 3%/3 mm. The mean values and standard deviations were used to develop the local confidence and tolerance limits. The dose differences and gamma pass rates for the different treatment sites were also evaluated in terms of total monitor uints (MU), MU/cGy, and the number of PTV's pieces.</p> <p>Results</p> <p>The mean values and standard deviations of ion-chamber dosimetry differences between calculated and measured doses were -1.6 ± 1.2% for H&N cancer, -0.4 ± 1.2% for prostate and abdominal cancer, and -0.6 ± 1.5% for brain tumor. Most of measured doses (92.2%) agreed with the calculated doses within a tolerance limit of ±3% recommended in the literature. However, we found some systematic under-dosage for all treatment sites. The percentage of points passing the gamma criteria, averaged over all treatment sites was 97.3 ± 3.7%. The gamma pass rate and the agreement of ion-chamber dosimetry generally decreased with increasing the number of PTV's pieces, the degree of modulation (MU/cGy), and the total MU beyond 700. Our local confidence limits were comparable to those of AAPM TG 119 and ESTRO guidelines that were provided as a practical baseline for center-to-center commissioning comparison. Thus, our institutional confidence and action limits for IMRT delivery were set into the same levels of those guidelines.</p> <p>Discussion and Conclusions</p> <p>The systematic under-dosage were corrected by tuning up the MLC-related factors (dosimetric gap and transmission) in treatment planning system (TPS) and further by incorporating the tongue-and groove effect into TPS. Institutions that have performed IMRT DQA measurements over a certain period of time need to analyze their accrued DQA data. We confirmed the overall integrity of our IMRT system and established the IMRT delivery guideline during this procedure. Dosimetric corrections for the treatment plans outside of the action level can be suggested only with such rigorous DQA and statistical analysis.</p

Influence of welding passes on grain orientation - The example of a multi-pass V-weld

International audienceThe accurate modelling of grain orientations in a weld is important, when accurate ultrasonic test predictions of a welded assembly are needed. To achieve this objective, Electricité de France (EDF) and the Laboratoire de Caractérisation Non Destructive (LCND) have developed a dedicated code, which makes use of information recorded in the welding procedure. Among the welding parameters recorded, although the order in which the welding passes are made is of primary importance in the welding process, this information is not always well known or accurately described. In the present paper we analyse in greater detail the influence of the order of welding passes, using data obtained from the Centre for Advanced Non Destructive Evaluation (CANDE), derived from a dissimilar metal weld (DMW) with buttering. Comparisons are made using grain orientation measurements on a macrograph

Sammelrezension

1.) Hanft, Anke / Simmel, Annika (Hrsg.): Vermarktung von Hochschulweiterbildung. Waxmann Verlag: Münster, 2007. 192 S. ISBN 978-3-8309-1785-4. 2.) Bremer, Helmut: Soziale Milieus, Habitus und Lernen: Zur sozialen Selektivität des Bildungswesens am Beispiel der Weiterbildung. Juventa Verlag: Weinheim, 2007. 308 S. ISBN 978-37799-1585-0. 3.) Dust, Martin: 'Unser Ja zum neuen Deutschland': Katholische Erwachsenenbildung von der Weimarer Republik zur Nazi-Diktatur. Studien zur Bildungsreform, Bd. 49. Peter Lang: Frankfurt, 2007. 631 S. ISBN 978-3-631-55693-1. 4.) Gieseke, Wiltrud: Lebenslanges Lernen und Emotionen: Wirkungen von Emotionen auf Bildungsprozesse aus beziehungstheoretischer Perspektive. W. Bertelsmann Verlag: Bielefeld, 2007. 280 S. ISBN 978-3-7639-3331-0. 5.) Heuer, Ulrike / Siebers, Ruth: Weiterbildung am Beginn des 21. Jahrhunderts: Festschrift für Wiltrud Gieseke. Erwachsenenpädagogisches Institut Berlin e.V. Waxmann Verlag: Münster, 2007. 496 S. ISBN 978-3-8309-1811-0. 6.) Janetzko, Dietmar: Eigenlogik: Zur Rolle subjektiver Theorien bei der Bildungsmotivation. Waxmann Verlag: Münster, 2007. 188 S. ISBN 978-3-8309-1693-2. 7.) Kaiser, Arnim / Kaiser, Ruth / Hohmann, Reinhard (Hrsg.): Lernertypen - Lernumgebung - Lernerfolg: Erwachsene im Lernfeld. W. Bertelsmann Verlag: Bielefeld, 2007. 284 S. ISBN 978-3-7639-3560-4. 8.) Koerrenz, Ralf / Meilhammer, Elisabeth / Schneider, Käthe (Hrsg.): Wegweisende Werke zur Erwachsenenbildung. Verlag IKS Garamond: Jena, 2007. 613 S. ISBN 978-3-938203-51-4. 9.) Schiersmann, Christiane: Berufliche Weiterbildung: Lehrbuch. VS Verlag für Sozialwissenschaften: Wiesbaden, 2007. 272 S. ISBN 3-8100-3891-1. 10.) West, Linden / Alheit, Peter / Andersen, Anders Siig / Merill, Barbara (Hrsg.): Using Biographical and Life History Approaches in the Study of Adult and Lifelong Learning. European Perspectives European Studies in Lifelong Learning and Adult Learning Research, Vol. 2. Peter Lang Verlag: Frankfurt a. M., 2007. 310 S. ISBN 978-3-631-56286-4

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat