Purpose: This study aims to evaluate the impact of smaller gantry arc increment (GAI) values on the plan quality and deliverability of volumetric modulated arc therapy (VMAT) for head and neck (HN) and prostate cancer cases using the Monaco treatment planning system. The study investigates whether a smaller GAI can enhance organ at risk (OAR) sparing without compromising target coverage or significantly increasing plan complexity. Methods: VMAT plans were created for 20 patients (10 HN and 10 prostate cancer) using GAI values of 15° and 30°. Dose-volumetric parameters, such as conformity number, homogeneity and gradient indices, were assessed alongside plan complexity metrics like the modulation complexityscore for VMAT (MCS v ) and monitor unit (MU). Statistical significance was determined using the Wilcoxon signed-rank test. Results: For HN cases, a 15° increment significantly reduced the D0.03cc for the spinal cord and the Dmean for both parotid glands compared to a 30° increment, improving OAR sparing. However, no significant differences were observed in the OAR doses for prostate cases. The 15° increment resulted in higher plan complexity, reflected by a lower MCS v , but the MU difference was not significant. Conclusions Smaller GAI values, such as 15°, can significantly reduce OAR doses in HN VMAT plans, offering potential clinical benefits despite increased plan complexity. However, no substantial advantages were observed in prostate cases. These findings suggest that smaller GAI values may be particularly beneficial for cases requiring high modulation.

Purpose: This study aims to evaluate the impact of smaller gantry arc increment (GAI) values on the plan quality and deliverability of volumetric modulated arc therapy (VMAT) for head and neck (HN) and prostate cancer cases using the Monaco treatment planning system. The study investigates whether a smaller GAI can enhance organ at risk (OAR) sparing without compromising target coverage or significantly increasing plan complexity. Methods: VMAT plans were created for 20 patients (10 HN and 10 prostate cancer) using GAI values of 15° and 30°. Dose-volumetric parameters, such as conformity number, homogeneity and gradient indices, were assessed alongside plan complexity metrics like the modulation complexityscore for VMAT (MCS v ) and monitor unit (MU). Statistical significance was determined using the Wilcoxon signed-rank test. Results: For HN cases, a 15° increment significantly reduced the D0.03cc for the spinal cord and the Dmean for both parotid glands compared to a 30° increment, improving OAR sparing. However, no significant differences were observed in the OAR doses for prostate cases. The 15° increment resulted in higher plan complexity, reflected by a lower MCS v , but the MU difference was not significant. Conclusions Smaller GAI values, such as 15°, can significantly reduce OAR doses in HN VMAT plans, offering potential clinical benefits despite increased plan complexity. However, no substantial advantages were observed in prostate cases. These findings suggest that smaller GAI values may be particularly beneficial for cases requiring high modulation.

Purpose: This study aims to evaluate the impact of smaller gantry arc increment (GAI) values on the plan quality and deliverability of volumetric modulated arc therapy (VMAT) for head and neck (HN) and prostate cancer cases using the Monaco treatment planning system. The study investigates whether a smaller GAI can enhance organ at risk (OAR) sparing without compromising target coverage or significantly increasing plan complexity. Methods: VMAT plans were created for 20 patients (10 HN and 10 prostate cancer) using GAI values of 15° and 30°. Dose-volumetric parameters, such as conformity number, homogeneity and gradient indices, were assessed alongside plan complexity metrics like the modulation complexityscore for VMAT (MCS v ) and monitor unit (MU). Statistical significance was determined using the Wilcoxon signed-rank test. Results: For HN cases, a 15° increment significantly reduced the D0.03cc for the spinal cord and the Dmean for both parotid glands compared to a 30° increment, improving OAR sparing. However, no significant differences were observed in the OAR doses for prostate cases. The 15° increment resulted in higher plan complexity, reflected by a lower MCS v , but the MU difference was not significant. Conclusions Smaller GAI values, such as 15°, can significantly reduce OAR doses in HN VMAT plans, offering potential clinical benefits despite increased plan complexity. However, no substantial advantages were observed in prostate cases. These findings suggest that smaller GAI values may be particularly beneficial for cases requiring high modulation.

Purpose: This study aims to evaluate the impact of smaller gantry arc increment (GAI) values on the plan quality and deliverability of volumetric modulated arc therapy (VMAT) for head and neck (HN) and prostate cancer cases using the Monaco treatment planning system. The study investigates whether a smaller GAI can enhance organ at risk (OAR) sparing without compromising target coverage or significantly increasing plan complexity. Methods: VMAT plans were created for 20 patients (10 HN and 10 prostate cancer) using GAI values of 15° and 30°. Dose-volumetric parameters, such as conformity number, homogeneity and gradient indices, were assessed alongside plan complexity metrics like the modulation complexityscore for VMAT (MCS v ) and monitor unit (MU). Statistical significance was determined using the Wilcoxon signed-rank test. Results: For HN cases, a 15° increment significantly reduced the D0.03cc for the spinal cord and the Dmean for both parotid glands compared to a 30° increment, improving OAR sparing. However, no significant differences were observed in the OAR doses for prostate cases. The 15° increment resulted in higher plan complexity, reflected by a lower MCS v , but the MU difference was not significant. Conclusions Smaller GAI values, such as 15°, can significantly reduce OAR doses in HN VMAT plans, offering potential clinical benefits despite increased plan complexity. However, no substantial advantages were observed in prostate cases. These findings suggest that smaller GAI values may be particularly beneficial for cases requiring high modulation.

Purpose: This study aims to evaluate the impact of smaller gantry arc increment (GAI) values on the plan quality and deliverability of volumetric modulated arc therapy (VMAT) for head and neck (HN) and prostate cancer cases using the Monaco treatment planning system. The study investigates whether a smaller GAI can enhance organ at risk (OAR) sparing without compromising target coverage or significantly increasing plan complexity. Methods: VMAT plans were created for 20 patients (10 HN and 10 prostate cancer) using GAI values of 15° and 30°. Dose-volumetric parameters, such as conformity number, homogeneity and gradient indices, were assessed alongside plan complexity metrics like the modulation complexityscore for VMAT (MCS v ) and monitor unit (MU). Statistical significance was determined using the Wilcoxon signed-rank test. Results: For HN cases, a 15° increment significantly reduced the D0.03cc for the spinal cord and the Dmean for both parotid glands compared to a 30° increment, improving OAR sparing. However, no significant differences were observed in the OAR doses for prostate cases. The 15° increment resulted in higher plan complexity, reflected by a lower MCS v , but the MU difference was not significant. Conclusions Smaller GAI values, such as 15°, can significantly reduce OAR doses in HN VMAT plans, offering potential clinical benefits despite increased plan complexity. However, no substantial advantages were observed in prostate cases. These findings suggest that smaller GAI values may be particularly beneficial for cases requiring high modulation.

Endotracheal intubation is the gold standard for airway management in general anesthesia. However, airway patency is not guaranteed by keeping the endotracheal tube (ETT) in place. Sometimes, the ETT itself may become a cause of airway obstruction; there are some reports on airway obstruction related to reinforced tube malfunction. We report a rare case with an obstruction of reinforced endotracheal tubes caused by dissection of the internal wall. Recognition of the possibility of airway obstruction due to a rare cause and monitoring patients vigilantly during anesthesia is very important for patient safety.
Airway Management ; Airway Obstruction* ; Anesthesia ; Anesthesia, General ; Humans ; Intubation, Intratracheal ; Patient Safety

Endotracheal intubation is the gold standard for airway management in general anesthesia. However, airway patency is not guaranteed by keeping the endotracheal tube (ETT) in place. Sometimes, the ETT itself may become a cause of airway obstruction; there are some reports on airway obstruction related to reinforced tube malfunction. We report a rare case with an obstruction of reinforced endotracheal tubes caused by dissection of the internal wall. Recognition of the possibility of airway obstruction due to a rare cause and monitoring patients vigilantly during anesthesia is very important for patient safety.
Airway Management ; Airway Obstruction* ; Anesthesia ; Anesthesia, General ; Humans ; Intubation, Intratracheal ; Patient Safety

A congenital cystic adenoid malformation of the lung(CCAM) is characterized by an anomalous fetal development of the terminal respiratory structures, resulting in the adenomatoid proliferation of the bronchiolar elements and cystic formation. CCAM has been detected on the fetus, premature babies and stillborn as well as infants and children. An adult presentation of CCAM is extremely rare. When cystic lesions occur with a repeated infection, an evaluation of the cystic lesions requires a differential diagnosis of CCAM, sequestration, a lung abscess, a pneumatocele and a bronchogenic cyst. The definite treatment of CCAM is the surgical removal of the involved lobe. We report a case of a CCAM in a 24-year-old female with a brief review of the relevant literature.
Adenoids ; Adult* ; Bronchogenic Cyst ; Child ; Diagnosis, Differential ; Female ; Fetal Development ; Fetus ; Humans ; Infant ; Lung Abscess ; Lung* ; Young Adult

The vast majority of malignant tumors involving the vagina are secondary spread from primary malignant lesion of the cervix uteri, the sigmoid colon, the bladder and the vulva. Primary invasive carcinoma of the vagina remains among the rare gynecologic malignant tumor. The diagnosis of primary carcinoma of the vagina requires that the cervix and the vulva be intact and no clinical evidence of other primary tumors exist. Greater than 80-90% of all vaginal tumors are squamous cell type. We experienced two cases of primary vaginal cancer of 68 years old woman without any other gynecologic disease and 67 years old woman after hysterectomy for benign desease. We presented these cases with a brief review of related literatures.
Aged ; Cervix Uteri ; Colon, Sigmoid ; Diagnosis ; Female ; Genital Diseases, Female ; Humans ; Hysterectomy ; Neoplasms, Squamous Cell ; Urinary Bladder ; Vagina ; Vaginal Neoplasms* ; Vulva

Uterine leiomyomas are the most common benign uterine tumors. They are estimated to be present in at least 20% of all women of reproductive age and may be asymptomatic in 40-50% of women older than 40 years of age. They may be subserosal, intramural, or submucosal in location within the uterus or located in the cervix, in the broad ligament, or on a pedicle. But it seems to be rare to experience a intraligamentary huge leiomyoma in the broad ligament.Recently we have experienced a case of intraligamentary huge leiomyoma with its weight of 3146 gm in 45 year-old primiparous woman. We present this case with a brief review of the literature.
Broad Ligament ; Cervix Uteri ; Female ; Humans ; Leiomyoma* ; Middle Aged ; Uterus