FMECA Application in Tomotherapy: Comparison between Classic and Fuzzy Methodologies

Accident analysis in radiotherapy highlighted the need to increase quality assurance (QA) programs by the identification of failures/errors with very low probability (rare event) but very severe consequences. In this field, a Failure Mode, Effects and Criticality Analysis (FMECA) technique, used in various industrial processes to rank critical events, has been met with much interest. The literature describes different FMECA methods; however, it is necessary to understand if these tools are incisive and effective in the healthcare sector. In this work, comparisons of FMECA methodologies in the risk assessment of patients undergoing treatments performed with helical tomotherapy are reported. Failure modes identified for the phases "treatment planning" and "treatment execution" are classified using the Risk Priority Number (RPN) index. Differences and similarities in the classification of failures/errors of the examined FMECA approaches are highlighted

Phenol compounds as new materials for Electron Paramagnetic Resonance dosimetry in clinical photon and electron beams,

In the last decades several research laboratories have shown an increasing interest aimed at extending the applicability of Electron Paramagnetic Resonance (EPR) dosimetry to radiotherapy with different types of radiation beams. EPR is a spectroscopic method for investigating the structure and dynamics of such paramagnetic species. Free radicals are known to be produced when a compound is irradiated with ionizing radiations. The concentration of radiation-induced free radicals is proportional to the energy released inside in the medium and this allows for dosimetric measurements through EPR technique. The use of alanine as a dosimetric material gave the possibility to apply EPR spectroscopy for high-dose standardization and dose control in radiation processing (Marrale 2016). The EPR dosimetric method has many advantages such as simple and rapid dose evaluation, the readout procedure is non-destructive, linear response of many organic and inorganic compounds. EPR detectors show a behavior that suggest possible applications for various kinds of beams used for radiation therapy. Nowadays, the most widely used organic compound as a dosimeter is the alanine. However, many researches are in progress with the aim at improving sensitivity of EPR dosimetry for doses much smaller than 1 Gy. More sensitive materials than alanine are needed to make the EPR dosimeter competitive with other dosimetry systems. Our research group has started an investigation of the EPR response of some phenols compounds for possible EPR dosimetric applications suitable features, such as high efficiency of radiation-matter energy transfer and radical stability at room temperature. Phenols are compounds possessing a benzene ring attached to a OH group. After irradiation the final product is a stable phenoxy radical. The stability of such radical can be improved by adding other alkyl chains which can be attached to the benzene ring. The phenol octadecyl-3-(3,5-di-tert.butyl-4-hydroxyphenyl)-propionate gave interesting results. Moreover, its high molecular weight, the low volatility and the compatibility with the dosimeter binding material (wax) are advantages with respect to lower molecular weight phenols. In this work we report the EPR investigation of phenols exposed to clinical photon and electron beams (Gallo, 2016). The dosimetric features of these EPR dosimeters (dependence on microwave power and modulation amplitude, their response after gamma and electron irradiations, dependence on beam type and energy, the detection limits for both beam typologies, signal stability after irradiation) were investigated and the results are reported

The impact of the COVID-19 pandemic on people with neurological disorders: an urgent need to enhance the health care system's preparedness

The major ethical issue posed by the COVID 19 pandemic are discussed with special reference to the impact on acute and chronic neurological disorder

Scenarios of Electromobility. Cross ferilisation and Dissemination of Best Practices and Researches within EU Policies Webinar proceedings

La pubblicazione riporta gli esiti del webinar incentrato sull'user center design dei veicoli elettrici, delle loro infrastrutture di ricarica e sulle sperimentazioni dei veicoli elettrici leggeri nei sistemi di trasporto urbano di Torino e Venaria Reale (IT), Villach (Austria) e Calvià (Spagna). La pubblicazione e il seminario sono parte del progetto STEVE, finanziato dal programma europeo Horizon2020, e incentrato sulla sperimentazione di modelli di mobilità elettrica leggera nelle aree urbane. Il progetto ha coinvolto città, piccole e medie imprese e università di sette paesi europei. Urban Lab ha collaborato con la Città di Torino a delineare le raccomandazioni rivolte ai decision makers in materia di pianificazione della mobilità urbana, emerse dai risultati dei tre anni di progetto

Review of retrospective dosimetry techniques for external ionising radiation exposures

The current focus on networking and mutual assistance in the management of radiation accidents or incidents has demonstrated the importance of a joined-up approach in physical and biological dosimetry. To this end, the European Radiation Dosimetry Working Group 10 on 'Retrospective Dosimetry' has been set up by individuals from a wide range of disciplines across Europe. Here, established and emerging dosimetry methods are reviewed, which can be used immediately and retrospectively following external ionising radiation exposure. Endpoints and assays include dicentrics, translocations, premature chromosome condensation, micronuclei, somatic mutations, gene expression, electron paramagnetic resonance, thermoluminescence, optically stimulated luminescence, neutron activation, haematology, protein biomarkers and analytical dose reconstruction. Individual characteristics of these techniques, their limitations and potential for further development are reviewed, and their usefulness in specific exposure scenarios is discussed. Whilst no single technique fulfils the criteria of an ideal dosemeter, an integrated approach using multiple techniques tailored to the exposure scenario can cover most requirements. © The Author 2010. Published by Oxford University Press. All rights reserved

PVA-GTA Fricke gel dosimeters exposed to clinical photons beams: Nuclear Magnetic Resonance Relaxometry and Imaging

Fricke Gel (FXGs) dosimetric system is based on the radiation induced oxidation of ferrous to ferric ions. The application of Fricke gels for ionizing radiation dosimetry is continuously increasing worldwide due to their many favorable properties. However, one of their shortcomings is that ferrous and ferric ions diffuse in the gel matrix. To maintain the spatial integrity of the dose distribution, Fricke gels must be undergoing measurement within a few hours of their irradiation, so that ferric ions remain close to their point of production. Thus, the spatial integrity of the dose distribution in the Fricke gel is maintained (Schreiner, 2015). The gel matrix also contributes to the oxidation of ferrous ions during irradiation, increasing the chemical yield of ferric ions in aqueous solution and increasing the sensitivity of the dosimeter. The oxidation of ferrous ions also causes a reduction of the longitudinal nuclear magnetic relaxation time T1 which can be measured by means of Nuclear Magnetic Resonance Relaxometry (NMR) and Magnetic Resonance Imaging (MRI) (Marrale, 2014). The results here presented are related to an experimental investigation conducted on Fricke Gels characterized by gelatinous matrix of Polyvinyl alcohol (PVA) cross-linked with a Glutaraldehyde (GTA) (Marini, 2016). The main dosimetric features of the NMR signal were investigated. The gels were irradiated in the clinical dose range between 0 and 20 Gy. In order to assess the photon sensitivity we analyzed the dependence of NMR relaxation times on radiation dose with varying ferrous ammonium sulfate content inside FXGs. Furthermore, signal stability was followed for several days after irradiation. These measurements were preliminary to MRI analysis which can permit 3D dose mapping. In order to maximize the MRI response a systematic study was performed to optimize acquisition sequences and parameters. In particular, we analyzed for inversion recovery sequences the dependence of MRI signal on the repetition time TR and on the inversion time TI. The dose calibration curves are reported and discussed from the point of view of the dosimeter use in clinical radiotherapy. This work has highlighted that the optimization of additives inside gel matrix is fundamental for maximizing photon sensitivity of these detectors. We can conclude that FXG dosimeters with optimal ferrous ammonium sulfate content can be regarded as a valuable dosimetric tool to achieve fast information on spatial dose distribution

Withdrawal of mechanical ventilation in amyotrophic lateral sclerosis patients: a multicenter Italian survey

Background: Law 219/2017 was approved in Italy in December 2017, after a years-long debate on the autonomy of healthcare choices. This Law, for the first time in Italian legislation, guarantees the patient's right to request for withdrawal of life-sustaining treatments, including mechanical ventilation (MV). Objective: To investigate the current status of MV withdrawal in amyotrophic lateral sclerosis (ALS) patients in Italy and to assess the impact of Law 219/2017 on this practice. Methods: We conducted a Web-based survey, addressed to Italian neurologists with expertise in ALS care, and members of the Motor Neuron Disease Study Group of the Italian Society of Neurology. Results: Out of 40 ALS Italian centers, 34 (85.0%) responded to the survey. Law 219/2017 was followed by an increasing trend in MV withdrawals, and a significant increase of neurologists involved in this procedure (p 0.004). However, variations across Italian ALS centers were observed, regarding the inconsistent involvement of community health services and palliative care (PC) services, and the intervention and composition of the multidisciplinary team. Conclusions: Law 219/2017 has had a positive impact on the practice of MV withdrawal in ALS patients in Italy. The recent growing public attention on end-of-life care choices, along with the cultural and social changes in Italy, requires further regulatory frameworks that strengthen tools for self-determination, increased investment of resources in community and PC health services, and practical recommendations and guidelines for health workers involved

Causes of death in women with breast cancer: a risks and rates study on a population-based cohort

IntroductionThe increasing survival of patients with breast cancer has prompted the assessment of mortality due to all causes of death in these patients. We estimated the absolute risks of death from different causes, useful for health-care planning and clinical prediction, as well as cause-specific hazards, useful for hypothesis generation on etiology and risk factors.Materials and methodsUsing data from population-based cancer registries we performed a retrospective study on a cohort of women diagnosed with primary breast cancer. We carried out a competing-cause analysis computing cumulative incidence functions (CIFs) and cause-specific hazards (CSHs) in the whole cohort, separately by age, stage and registry area.ResultsThe study cohort comprised 12,742 women followed up for six years. Breast cancer showed the highest CIF, 13.71%, and cardiovascular disease was the second leading cause of death with a CIF of 3.60%. The contribution of breast cancer deaths to the CIF for all causes varied widely by age class: 89.25% in women diagnosed at age <50 years, 72.94% in women diagnosed at age 50–69 and 48.25% in women diagnosed at age ≥70. Greater CIF variations were observed according to stage: the contribution of causes other than breast cancer to CIF for all causes was 73.4% in women with stage I disease, 42.9% in stage II–III and only 13.2% in stage IV. CSH computation revealed temporal variations: in women diagnosed at age ≥70 the CSH for breast cancer was equaled by that for cardiovascular disease and “other diseases” in the sixth year following diagnosis, and an early peak for breast cancer was identified in the first year following diagnosis. Among women aged 50–69 we identified an early peak for breast cancer followed by a further peak near the second year of follow-up. Comparison by geographic area highlighted conspicuous variations: the highest CIF for cardiovascular disease was more than 70% higher than the lowest, while for breast cancer the highest CIF doubled the lowest.ConclusionThe integrated interpretation of absolute risks and hazards suggests the need for multidisciplinary surveillance and prevention using community-based, holistic and well-coordinated survivorship care models

Characterization of phenolic solid state pellets for ESR dosimetry with radio-therapeutic photon and electron beams

IIntroduction Among the various dosimetric techniques used for characterizing the radiation beams used in radiation therapy, the electron spin resonance (ESR) arouses increasing interest for applications in various therapy procedures. In this work we report the ESR investigation of particular phenol compound (IRGANOX 1076) exposed to clinical photon and electron beams (Gallo et al., 2017). Methods Phenol (IRGANOX 1076 - Sigma Aldrich) pellets were produced also with paraffin (10% by weight). Phenol pellets were exposed to clinical photon and electron beams at various energies produced by a linear accelerator (LINAC) Siemens Primus (Siemens Medical Systems, CA, USA) installed at the Radiotherapy Department of A.R.N.A.S. \u2013 Hospital Civico-Di Cristina-Benfratelli (Palermo) with absorbed doses ranging between 0 and 13 Gy. ESR measurements were performed through a X band Spectrometer. Readout parameters were optimized to maximise the signal without excessive spectrum distortions. Results Basic dosimetric properties of phenolic dosimeters, such as reproducibility, dose-response, sensitivity,linearity and dose rate dependence were investigated. A satisfactory intra-batch reproducibility of the ESR signal of the manufactured dosimeters was obtained. The analysis of the ESR signal as function of absorbed dose highlights that the response of this material is linear in the dose range investigated (1-13 Gy) and is independent of the beam energy. The presence of an intrinsic background signal limits the minimum detectable dose to a value of approximately 0.6 Gy. Reliable and accurate assessment of the dose was achieved, independently of the dose rate. The dosimeters were tested by measuring the depth dose profile of a 6 MV photon beam. Conclusion Such characteristics, together with the fact that IRGANOX 1076\uae is almost tissue-equivalent, and the stability of the ESR signal, make these dosimeters promising materials for ESR dosimetric applications in radiotherapy