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At least 163 records · Page 9Linked to original sources
PubMed2005

Hybrid IMRT plans--concurrently treating conventional and IMRT beams for improved breast irradiation and reduced planning time.

PURPOSE: To evaluate a hybrid intensity modulated radiation therapy (IMRT) technique as a class solution for treatment of the intact breast. METHODS AND MATERIALS: The following five plan techniques were compared for 10 breast patients using dose-volume histogram analysis: conventional wedged-field tangents (Tangents), forward-planned field-within-a-field tangents (FIF), IMRT-only tangents (IMRT tangents), conventional open plus IMRT tangents (4-field hybrid), and conventional open plus IMRT tangents with 2 anterior oblique IMRT beams (6-field hybrid). RESULTS: The 4-field hybrid and FIF achieved dose distributions better than Tangents and IMRT tangents. The volume of tissue outside the planning target volume receiving > or =110% of prescribed dose was largest for IMRT tangents (average 158 cc) and least for 6-field hybrid (average 1 cc); the FIF and 4-field hybrid were comparable (average 15 cc). Heart volume > or =30 Gy averaged 13 cc for all techniques, except Tangents, for which it was 32 cc. Average total lung volume > or =20 Gy was 7% for all. Contralateral breast doses were < 3% for all. Planning time for hybrid techniques was significantly less than for conventional FIF technique. CONCLUSIONS: The 4-field hybrid technique is a viable class solution. The 6-field hybrid technique creates the most conformal dose distribution at the expense of more normal tissue receiving low dose.

Breast Neoplasms↗
PubMed1997

Treatment planning for enhanced dynamic wedge with the CMS focus/Modulex treatment planning system.

The current versions of the CMS treatment planning systems, the FOCUS system for three dimensional planning, and Modulex for two dimensional planning, both require modeling dynamic wedges as filters. In this paper we describe methods for generating dynamic wedge filters for treatment planning. In our previous work with dynamic wedge we used measured data to back project the filter that would have delivered the wedge shaped isodoses. With the current version of Enhanced Dynamic Wedge, we use the segmented treatment table (STT) to create filters. For each wedge angle we created a 30 cm filter, for which the field is truncated by blocks according to the dynamic jaw settings. We found the filters provided isodoses that were within 2 degrees of the measured angles. Central axis dose was within 1% due to the fact the system does not account for beam hardening. Although an undesirable solution to model dynamic wedging, we found the filter method to be workable.

Radiotherapy Planning, Computer-Assisted↗
PubMedDate not supplied

Optimal electron-beam treatment planning for retinoblastoma using a new three-dimensional Monte Carlo-based treatment planning system.

Electron-beam treatment planning for retinoblastoma was investigated and an optimal treatment plan was devised for a particular case using a new three-dimensional Monte Carlo-based treatment planning system known to be capable of correctly predicting dose perturbations caused by body surface obliquities and tissue heterogeneities. Computed tomography (CT) data files were used to construct a three-dimensional eye phantom representing the anatomy of a child's orbit. Dose distributions in sagittal, transverse, and coronal planes were predicted with 1-mm resolution. Study of these distributions led to an optimal treatment plan consisting of an anterior-lateral pair, with the anterior field being a 10-MeV, 30-mm-diam circular field, centrally blocked by a 10-mm-diam lucite lens shield and the lateral field being a 16-MeV, 30 x 25-mm D-shaped field. The anterior field delivers a therapeutic dose to the ora serrata, but it underdoses the posterior retinal surface behind the lens shield; the lateral field provides the necessary boost dose to the posterior retinal surface. An equally weighted combination of the two fields produces a dose distribution in which the entire retinal surface receives a therapeutic dose, with less than 10% of that dose being delivered to the lens, brain, and the contralateral orbit.

Electrons↗
PubMed2006

Dosimetric comparison of intensity-modulated, conformal, and four-field pelvic radiotherapy boost plans for gynecologic cancer: a retrospective planning study.

PURPOSE: To evaluate intensity-modulated radiation therapy (IMRT) as an alternative to conformal radiotherapy (CRT) or 4-field box boost (4FB) in women with gynecologic malignancies who are unsuitable for brachytherapy for technical or medical reasons. METHODS: Dosimetric and toxicity information was analyzed for 12 patients with cervical (8), endometrial (2) or vaginal (2) cancer previously treated with external beam pelvic radiotherapy and a CRT boost. Optimized IMRT boost treatment plans were then developed for each of the 12 patients and compared to CRT and 4FB plans. The plans were compared in terms of dose conformality and critical normal tissue avoidance. RESULTS: The median planning target volume (PTV) was 151 cm(3) (range 58-512 cm(3)). The median overlap of the contoured rectum with the PTV was 15 (1-56) %, and 11 (4-35) % for the bladder. Two of the 12 patients, both with large PTVs and large overlap of the contoured rectum and PTV, developed grade 3 rectal bleeding. The dose conformity was significantly improved with IMRT over CRT and 4FB (p < or = 0.001 for both). IMRT also yielded an overall improvement in the rectal and bladder dose-volume distributions relative to CRT and 4FB. The volume of rectum that received the highest doses (>66% of the prescription) was reduced by 22% (p < 0.001) with IMRT relative to 4FB, and the bladder volume was reduced by 19% (p < 0.001). This was at the expense of an increase in the volume of these organs receiving doses in the lowest range (<33%). CONCLUSION: These results indicate that IMRT can improve target coverage and reduce dose to critical structures in gynecologic patients receiving an external beam radiotherapy boost. This dosimetric advantage will be integrated with other patient and treatment-specific factors, particularly internal tumor movement during fractionated radiotherapy, in the context of a future image-guided radiation therapy study.

Dose Fractionation, Radiation↗
PubMed2006

What is the optimum breast plan: a study based on the START trial plans.

Each year thousands of women within the UK are treated with radiotherapy for breast cancer. The majority of these women are treated using a medial and lateral tangential field. This study evaluates the plans submitted to the quality assurance (QA) team of the START trial and investigates some of the differences between departments. Throughout the START trial, hardcopies of the radiotherapy dose distribution on the central slice for one in three women were submitted to the QA team for analysis. The QA team measured physical parameters including breast size and lung depth as well as noting parameters used for the radiotherapy delivery including beam energy, field size and wedge angle. Over 1400 plans from 36 centres were analysed. The mean patient separation was 19.7 cm (SD 2.7 cm) with a mean lung depth of 1.5 cm (SD 0.7 cm). The modal beam energy was 6 MV and the mean wedge angle was 23 degrees . Significant differences in the choice of wedge angle between departments were noted; however, in 90% of cases the resultant plan complied with the maximum dose gradient of 10% on the central axis specified by the trial protocol. Less than 3% (37 plans) had dose gradients of greater than 12%. This resulted in a mean dose gradient for all patients on the central axis of 5.7% (SD 2.9%).

Analysis of Variance↗
PubMed2005

Creating a bridge between data collection and program planning: a technical assistance model to maximize the use of HIV/AIDS surveillance and service utilization data for planning purposes.

Over time, improvements in HIV/AIDS surveillance and service utilization data have increased their usefulness for planning programs, targeting resources, and otherwise informing HIV/AIDS policy. However, community planning groups, service providers, and health department staff often have difficulty in interpreting and applying the wide array of data now available. We describe the development of the Bridging Model, a technical assistance model for overcoming barriers to the use of data for program planning. Through the use of an iterative feedback loop in the model, HIV/AIDS data products constantly are evolving to better inform the decision-making tasks of their multiple users. Implementation of this model has led to improved data quality and data products and to a greater willingness and ability among stakeholders to use the data for planning purposes.

Data Collection↗
PubMed2000

Biological and chemical terrorism: strategic plan for preparedness and response. Recommendations of the CDC Strategic Planning Workgroup.

The U.S. national civilian vulnerability to the deliberate use of biological and chemical agents has been highlighted by recognition of substantial biological weapons development programs and arsenals in foreign countries, attempts to acquire or possess biological agents by militants, and high-profile terrorist attacks. Evaluation of this vulnerability has focused on the role public health will have detecting and managing the probable covert biological terrorist incident with the realization that the U.S. local, state, and federal infrastructure is already strained as a result of other important public health problems. In partnership with representatives for local and state health departments, other federal agencies, and medical and public health professional associations, CDC has developed a strategic plan to address the deliberate dissemination of biological or chemical agents. The plan contains recommendations to reduce U.S. vulnerability to biological and chemical terrorism--preparedness planning, detection and surveillance, laboratory analysis, emergency response, and communication systems. Training and research are integral components for achieving these recommendations. Success of the plan hinges on strengthening the relationships between medical and public health professionals and on building new partnerships with emergency management, the military, and law enforcement professionals.

Biological Warfare↗
PubMed2003

A review of dental plans: PPOs and referral plans to dominate future.

This important benefit has changed greatly in the last 20 years. Double-digit health care cost increases in the late 1980s caused indemnity plans to evolve into network plans, such as dental HMOs and PPOs. PPOs and referral or access plans now seem to be the plans of choice.

Cost Savings↗
PubMed1991

Employer health care plan design and its effect on plan costs.

This study uses claims data from employers in the Houston Area Health Care Coalition (HAHCC) for 1985 through the first half of 1987 to examine the effect of health care plan attributes on health care costs. Plan attributes affect the site of care and the costs of care. Utilization review clearly was effective in reducing the demand for inpatient services, but that reduction was in large measure matched by increases in care in the outpatient setting. Restrictions on mental health benefits also shifted the site of care. In contrast, neither premium sharing nor the plan's deductible had a significant impact on total plan charges. The study results demonstrate the need to have a comprehensive cost management strategy.

Adolescent↗
PubMedDate not supplied

Development of a state medical surge plan, Part II: Components of a medical surge plan.

In 2003, the Utah State Department of Health received funding from the Health Resources and Services Administration to develop a medical surge plan to increase the number of available hospital beds in the state by 1250 beds, including 125 beds for burn or critical trauma patients. A prior article discussed the planning procedures and process. This article describes the major components of the plan, including analysis of threats, direction and control, activation and system response; communications; and critical issues.

Accidents↗
PubMed1996

Strategy and planning for chemopreventive drug development: clinical development plans II.

This is the second publication of Clinical Development Plans from the National Cancer Institute, Division of Cancer Prevention and Control, Chemoprevention Branch and Agent Development Committee. The Clinical Development Plans summarize the status of promising chemopreventive agents regarding evidence for safety and chemopreventive efficacy in preclinical and clinical studies. They also contain the strategy for further development of these drugs, addressing pharmacodynamics, drug effect measurements, intermediate biomarkers for monitoring efficacy, toxicity, supply and formulation, regulatory approval, and proposed clinical trials. Sixteen new Clinical Development Plans are presented here: curcumin, dehydroepiandrosterone, folic acid, genistein, indole-3-carbinol, perillyl alcohol, phenethyl isothiocyanate, 9-cis-retinoic acid, 13-cis-retinoic acid, l-selenomethionine and 1, 4-phenylenebis(methylene)selenocyanate, sulindac sulfone, tea, ursodiol, vitamin A, and (+)-vorozole. The objective of publishing these plans is to stimulate interest and thinking among the scientific community on the prospects for developing these and future generations of chemopreventive drugs.

Animals↗
PubMed1995

Multisectional planning for external beam radiotherapy: a "poor person's" alternative to three-dimensional treatment planning.

Recent technical advances in the field of computers have led to the use of three-dimensional dose computation for optimizing a radiation therapy plan. However, in centers which lack such a state-of-the-art technology, one could explore the use of multisectional planning to obtain information about the dose profiles all along the target volume. This article highlights the utility of multisectional planning as an alternative to three-dimensional treatment planning systems for external beam radiation therapy.

Esophageal Neoplasms↗
PubMed2004

Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: the International Randomized Term Breech Trial.

OBJECTIVE: The purpose of this study was to determine whether planned cesarean delivery for the singleton fetus in breech presentation at term reduces the risk of death or neurodevelopmental delay at 2 years of age. STUDY DESIGN: In selected centers in the Term Breech Trial, children were screened for abnormalities at > or =2 years of age with the Ages and Stages Questionnaire, followed by a neurodevelopmental assessment if the Ages and Stages Questionnaire score was abnormal. RESULTS: A total of 923 of 1159 children (79.6%) from 85 centers were followed to 2 years of age. The risk of death or neurodevelopmental delay was no different for the planned cesarean than for the planned vaginal birth groups (14 children [3.1%] vs 13 children [2.8%]; relative risk, 1.09; 95% CI, 0.52- 2.30; P = .85; risk difference, +0.3%; 95% CI, -1.9%, +2.4%). CONCLUSION: Planned cesarean delivery is not associated with a reduction in risk of death or neurodevelopmental delay in children at 2 years of age.

Breech Presentation↗
PubMed2005

Translating a plan into action: a Public Health Action Plan to Prevent Heart Disease and Stroke.

A Public Health Action Plan to Prevent Heart Disease and Stroke charts a course for the Centers for Disease Control and Prevention (CDC) and collaborating public health agencies, with all interested partners and the public at large, to help in promoting achievement of national goals for preventing heart disease and stroke over the next 2 decades--through 2020 and beyond. The Action Plan was released in April 2003 and includes 24 recommendations and 69 proposed action steps to be implemented now and in the years ahead. To set priorities for action and to define a limited set of concrete tasks for immediate implementation, a process was undertaken that included CDC and lead partners, the American Heart Association/American Stroke Association and Association of State and Territorial Health Officials, as well as the Action Plan Working Group and other members of the National Forum for Heart Disease and Stroke Prevention. This report presents details of the methods used and discussion of this process and its outcome. The process was facilitated by Concept Systems, Inc. and began with refinement of proposed action steps to yield a final list of 75 items. Next, the Action Plan Working Group and the full National Forum membership were invited to rate each proposed action step as to its relation to the mission and capacity of the organization represented by each respondent. This process, with review and discussion of results by the Working Group in January 2004, identified a subset of 22 priority action steps. The National Forum then met in April 2004 to discuss these priorities and ultimately adopted eight concrete tasks for immediate implementation.

Centers for Disease Control and Prevention, U.S.↗
PubMed2005

Effects of radiotherapy planning with a dedicated combined PET-CT-simulator of patients with non-small cell lung cancer on dose limiting normal tissues and radiation dose-escalation: a planning study.

BACKGROUND AND PURPOSE: To investigate the effect of radiotherapy planning with a dedicated combined PET-CT simulator of patients with locally advanced non-small cell lung cancer. PATIENTS AND METHODS: Twenty-one patients underwent a pre-treatment simulation on a dedicated hybrid PET-CT-simulator. For each patient, two 3D conformal treatment plans were made: one with a CT based PTV and one with a PET-CT based PTV, both to deliver 60Gy in 30 fractions. The maximum tolerable prescribed radiation dose for CT versus PET-CT PTV was calculated based on constraints for the lung, the oesophagus, and the spinal cord, and the Tumour Control Probability (TCP) was estimated. RESULTS: For the same toxicity levels of the lung, oesophagus and spinal cord, the dose could be increased from 55.2+/-2.0Gy with CT planning to 68.9+/-3.3Gy with the use of PET-CT (P=0.002), with corresponding TCP's of 6.3+/-1.5% for CT and 24.0+/-5.6% for PET-CT planning (P=0.01). CONCLUSIONS: The use of a combined dedicated PET-CT-simulator reduced radiation exposure of the oesophagus and the lung, and thus allowed significant radiation dose escalation whilst respecting all relevant normal tissue constraints.

Carcinoma, Non-Small-Cell Lung↗
PubMed2005

Endurance training adherence in elite junior netball athletes: a test of the theory of planned behaviour and a revised theory of planned behaviour.

This study examined the utility of Ajzen's (1985) theory of planned behaviour and Maddux's (1993) revised theory of planned behaviour to predict endurance training intentions and adherence of elite junior netball athletes. One hundred and fifteen athletes from the England Netball World Class Start Programme were assessed on constructs central to the predictions of the two theories. Adherence to a recommended endurance training programme was recorded in self-report diaries across a 9-week period. Validity for the diaries was supported by significant correlations (P < 0.001) with recalls across 7 days and 9 weeks. Adherence was moderate and variable between athletes (mean = 66.05, s = 25.75%). Two separate path analyses were conducted to examine the predictions of the theories. Goodness-of-fit indices suggested acceptable fit of the data to the models. Analyses showed that attitude towards the new behaviour, subjective norms and perceived behavioural control predicted training intentions. The relationship between intention and adherence was weak. The present results suggest that the constructs of the theory of planned behaviour offer some insight into the explanation of intentions to follow an endurance training programme. Constructs unique to the revised theory of planned behaviour did not significantly predict training intentions or behaviour. Implications for practitioners working with team sport performers are provided.

Adolescent↗
PubMed2001

[Neonatal outcome after a planned vaginal breech birth: no association with parity or birth weight, but more birth injuries than in planned cesarean section].

OBJECTIVE: To investigate if in a planned vaginal breech delivery parity or birthweight is associated with neonatal outcome. DESIGN: Retrospective analysis of local data from the National Obstetric Registration of the Netherlands. METHOD: The study concerned outcomes of 516 births of singletons with breech presentation after pregnancies > 37 weeks in the period 1 January 1995 to 31 December 1999 at the Medical Centre Leeuwarden, the Netherlands; there were 448 planned vaginal breech deliveries. Nulliparous and multiparous were separately studied in four birthweight groups (< 3000 g, 3000-3499 g, 3500-3999 g and > or = 4000 g). RESULTS: None of the neonates born by primary caesarean experienced birth trauma. In the group with planned vaginal breech delivery 2% of the neonates of nulliparous and 3% of multiparous mothers experienced neonatal morbidity. There was one case of perinatal mortality due to birth trauma (0.2%). The total perinatal morbidity was 6% with no differences between nulliparae and multiparae and between the birthweight groups. In nulliparous, the percentage of emergency caesarean sections rose from 20% in the < 3000 g birthweight group to 62% in the > or = 4000 g birthweight group. CONCLUSION: Following a planned vaginal breech delivery, no differences were observed in neonatal outcome between nulliparous and multiparous women and between the four birthweight groups. The extent to which the figures were influenced by the selection for primary caesarean section is not clear.

Birth Injuries↗
PubMed1990

Case two. Development of a strategic plan and the planning process at a medical center.

In 1983, the medical center had no strategic planning process and no individual or department with an identified responsibility for planning to meet the needs of the organization and its service community. There were limited resources to apply to this endeavor and a prevailing attitude among current leadership that any planning done should be focused solely on facilities development. While the process pursued in this case is similar to that in Case One, unlike Case One, conditions within the organization are less than ideal for the implementation of any process, formal or informal, for the formulation of strategy. Read alone, the case is instructive. Considered in combination with Case One, it provides grist for a good discussion of the differences between organizations which have the capacity to be strategically managed and those which have learning to do.

Chief Executive Officers, Hospital↗