PURPOSE: To determine the optimal radiotherapy technique for gastric mucosa-associated lymphoid tissue lymphoma (MALToma), we compared the dosimetric parameters and the risk of solid secondary cancer from scattered doses among anterior-posterior/posterior-anterior parallel-opposed fields (AP/PA), anterior, posterior, right, and left lateral fields (4_field), 3-dimensional conformal radiotherapy (3D-CRT) using noncoplanar beams, and intensity-modulated radiotherapy composed of 7 coplanar beams (IMRT_co) and 7 coplanar and noncoplanar beams (IMRT_non). MATERIALS AND METHODS: We retrospectively generated 5 planning techniques for 5 patients with gastric MALToma. Homogeneity index (HI), conformity index (CI), and mean doses of the kidney and liver were calculated from the dose-volume histograms. Applied the Biological Effects of Ionizing Radiation VII report to scattered doses, the lifetime attributable risk (LAR) was calculated to estimate the risk of solid secondary cancer. RESULTS: The best value of CI was obtained with IMRT, although the HI varied among patients. The mean kidney dose was the highest with AP/PA, followed by 4_field, 3D-CRT, IMRT_co, and IMRT_non. On the other hand, the mean liver dose was the highest with 4_field and the lowest with AP/PA. Compared with 4_field, the LAR for 3D-CRT decreased except the lungs, and the LAR for IMRT_co and IMRT_non increased except the lungs. However, the absolute differences were much lower than <1%. CONCLUSION: Tailored RT techniques seem to be beneficial because it could achieve adjacent organ sparing with very small and clinically irrelevant increase of secondary solid cancer risk compared to the conventional techniques.
Hand ; Humans ; Kidney ; Liver ; Lung ; Lymphoma, B-Cell, Marginal Zone* ; Planning Techniques ; Radiation, Ionizing ; Radiotherapy* ; Radiotherapy, Conformal ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Risk Assessment* ; Stomach

As medical computer-aided design (CAD) has improved, virtual 3-dimensional medical images have been gaining more easily without any special practice. These images can be applied to various clinical fields. This article illustrates virtual preoperative simulation for excision of spinal tumors using medical CAD software. The software was used directly by the surgeon. The process of virtual preoperative simulation for spinal tumor surgery was found to be not inordinately complicated. And, virtual simulation was helpful in determining surgical steps as well as understanding the surgical anatomy.
Computer-Aided Design* ; Imaging, Three-Dimensional ; Planning Techniques ; Spinal Cord Neoplasms

As advance care planning is taking center stage in the field of end-of-life care, various tools have been developed to aid in the often emotional and difficult decision-making process. Video decision support tools are one of the most promising means of assistance, of which the modus operandi is to provide more comprehensive and precise information of medical procedures to patients and their families, allowing them to make better informed decisions. Despite such value, some are concerned about its potential negative impact. For example, video footages of some procedures may be shocking and unpalatable to non-medical professionals, and patients and families may refuse the procedures. One approach to soften the sometimes unpleasant visual of medical procedures is to show less aggressive or more relaxing scenes. Yet another potential issue is that the objectivity of video decision support tools might be vulnerable to the very stakeholders who were involved in the development. Some might argue that having multiple stakeholders may function as checks and balances and provide collective wisdom, but we should provide more systematic guarantee on the objectivity of the visual decision aids. Because the decision of the modality of an individual's death is the last and most significant choice in one's life, no party should exert their influence on such a delicate decision. With carefully designed video decision support tools, our patients will live the last moments of their lives with dignity, as they deserve.
Advance Care Planning* ; Decision Making ; Decision Support Systems, Clinical ; Decision Support Techniques ; Hope* ; Humans ; Lifting* ; Nimodipine ; Palliative Care ; Shock ; Terminal Care ; Videotape Recording

PURPOSE: The purpose was to compare the accuracy of Miniaci method using picture archiving and communication system (PACS) with a cable method in high tibial osteotomy (HTO). MATERIALS AND METHODS: This study analyzed 47 patients (52 knees) with varus deformity and medial osteoarthritis. From 2007 to 2013, patients underwent HTO using either a cable method (20 knees) or Miniaci method based on a PACS image (32 knees). In the cable method, the 62.5% point of the mediolateral tibial plateau width was located using an electrocautery cord under fluoroscopy (cable group). The Miniaci method used preoperative radiographs to shift the weight bearing axis (PACS group). Full-length lower limb radiographs obtained preoperatively and at the sixth postoperative week were used to compare the percentage of crossing point of the weight bearing line on the tibial plateau with respect to the medial border. RESULTS: The weight bearing line on the tibial plateau was corrected from a preoperative 11.0±7.0% to a postoperative 47.2±7.4% in the cable group and from 12.7±4.9% to 59.5±5.3% in the PACS group. The mechanical femorotibial angle was corrected from varus 8.9±3.7° to valgus 0.3±4.0° in the cable group and from varus 9.0±3.3° to valgus 2.9±2.6° in the PACS group. CONCLUSIONS: In HTO, correction based on the Miniaci method using a PACS was more accurate than correction using the cable method.
Congenital Abnormalities ; Electrocoagulation ; Fluoroscopy ; Humans ; Knee ; Lower Extremity ; Methods ; Osteoarthritis ; Osteotomy ; Planning Techniques ; Weight-Bearing

BACKGROUND: This anthropometric planning is devised for surgeons who assess the esthetic perspectives in Asian rhinoplasty and to provide an easy clinical method using two dimensional photograph. And specific planning in Asian secondary rhinoplasty are also depicted accordingly. METHOD AND DISCUSSION: In order to use a 2-dimensional digital photograph as a tool for the soft tissue cephalometric analysis (STCA) the surgeon can subjectively rotate the photograph to decide the ideal landmarks. Once this is done, consultation and planning begins. Complicated concepts can be simplified and adaptive ideal points needed in rhinoplasty can be determined according to the Asian concepts of beauty so that it will be used under a clinical setting. Initiation of planning starts by identifying the ideal Sellion and Subnasale, thus, determining the length of the nose. Determination of these two points is the foremost important step in planning. Thereafter, an ideal Tip forms naturally from the nasofrontal angle and the columellar-labial angle. Even with the well performed preoperative planning, the shortcomings in secondary Asian rhinoplasty, such as unexpected scar, may be totally different pitfalls to overcome. CONCLUSIONS: With two-dimensional digital photograph and simplified planning in STCA, planning ideal points will bring clarity to a relatively different planning process from western rhinoplasty for surgeons undertaking primary or secondary Asian rhinoplasty.
Asian Continental Ancestry Group* ; Beauty ; Cicatrix ; Humans ; Mortuary Practice ; Nose ; Planning Techniques ; Rhinoplasty*

Outcome mapping (OM) is a participant-oriented new method for project planning,monitoring and evaluation.It is based on continuous learning and focuses on changes in behavior,relationship and activities of persons,groups and organizations.The use of OM can help to clarify the roles and assignments of the government,managers,health workers,and other relevant personnel,making full use of the limited social resources and improving the efficiency and quality of health services.We introduce the principle and operation steps of OM with case simulation in health resource integration,to show its application in decision-making.
Decision Making ; Outcome and Process Assessment (Health Care) ; methods ; Planning Techniques

OBJECTIVE: It is to find the optimum beam angle by comparing the proper directional beam angle with various methods at time of treatment plan of stereotactic spinal radiation therapy. Also, it is to increase the therapy efficiency of spinal stereotactic body radiation therapy (SBRT) by providing the optimal target coverage through the therapy plan establishing various kinds of direction of beams and by decreasing the integral dose. METHODS: The object patients of treatment plan in this study have targeted 10 persons of thoracic spine bone metastasis patients. The treatment plan of prescription dose with 3 fraction of each 8 Gy has been established, it has been normalized so that it may be D95=2,400 cGy. Total 4 groups of treatment plan: the physical factor has been compared for the part for the target and the critical organ by establishing the treatment plan respectively in intensity-modulated radiation therapy (IMRT) and RapidArc therapy in (1) 1 group of IMRT (9 pieces of beam at 40 degrees equispaced angle intervals), (2) 2 groups of IMRT (9 pieces of half beam of non-equispaced angle), (3) arc 1 group (full arc), (4) arc 2 groups (half 2 arc) and eclipse planning (ver. 8.9). The physical factor for the target has been analyzed for the target coverage, maximum dose, minimum dose, maximum dose/prescribed dose (MD/PD). The maximum dose, mean dose, dose by each volume, and therapy time have been compared and analyzed for the spinal cord and esophagus adjacent to the target. RESULTS: The maximum dose of patients group of IMRT 1 group has appeared lower by 15% compared with the full arc and half arc plan as the analysis result of therapy plan for the object patients of thoracic spine. There has been no big difference in maximum dose of IMRT 1 group and 2 group. The full arc plan of conformity index showed the best result with the average 1.06, half arc plan of conformity index showed the highest result value with the average 1.15. Half arc plan of MD/PD showed the best value with the average 1.12. The half IMRT in D1 of planning target volumes showed the lowest value with the average 2,605 cGy; it showed the difference from the average from as small as 1% to as big as 11% as the comparison result with other groups. The plan of IMRT group of non-equispaced angle in D99 (cGy) showed the best value with the average 2,287.56 cGy. The IMRT of non-equispaced angle in Dmax of spinal cord showed the lowest with the average 1,779.9 cGy, D0.1cc and D1cc as well showed the lowest value with the average 1,605.19 cGy and 1,272.63 cGy. The IMRT plan of non-equispaced angle in throat showed the lowest value. The full arc (2 arc) of equispaced angle in therapy time was the shortest with 3.54 minutes, full IMRT of equispaced angle showed the longest time with the average 8.08 minutes. CONCLUSION: The treatment plan for IMRT of non-equispaced angle showed all good value in the target and critical organ as the analysis result of proper beam angle according to the respective therapy technique at time of treatment plan of spinal SBRT. It could find that the good therapy plan satisfactory to all target and critical organ at time of using the beam between 80 degrees and 280 degrees.
Esophagus ; Humans ; Neoplasm Metastasis ; Pharynx ; Planning Techniques* ; Prescriptions ; Spinal Cord ; Spine

When you are planning an event to accomplish a specific purpose for a diabetic patient motivating to management their glucose and life style, you must review all of the elements that affect an event, such as the time, place, and participants, the goals, and the schedule of activities of the event. After reviewing such elements, you need to identify the needs of the patients who will be participating in the event. Then you must try to meet both the goals of the event and the needs of the participants in the event. Events can be successful only when they have been planned and operated following the needs and desires of the participants. If the diabetes educator gives good events that have the all above things, the diabetic patients can find a way to control their glucose and life style more easily.
Appointments and Schedules ; Benchmarking ; Glucose ; Health Services Needs and Demand ; Humans ; Hypogonadism ; Life Style ; Mitochondrial Diseases ; Ophthalmoplegia ; Planning Techniques

In order to analyze the image noise effect on the results of Gamma knife dosimetry parameter test, we tested the dosimetry parameters of the Gamma knives according to GBZ 168-2005. Radiological protection standards of X (gamma)-ray stereotactic radiosurgery for head treatment. Dose analysis software was applied to examine the testing film before and after image denoising, and SPSS 11.0 software was used for statistical analysis. The results showed that there was a significant difference in the results of the maximum deviation between radiation field size and its nominal value (t = 7.600, P < 0.01) and the radiation field's penumbra region width of collimators also had significantly different sizes (t = 5.334, P < 0.01) before and after image denoising. This study indicated that the image noise could influence the results of testing Gamma knife dosimetry parameters, so as to cause deviations.
Algorithms ; Artifacts ; Gamma Rays ; Head ; surgery ; Humans ; Radiometry ; instrumentation ; Radiosurgery ; instrumentation ; Radiotherapy Planning, Computer-Assisted ; methods ; Stereotaxic Techniques

OBJECTIVETo explore the influence of intrafraction and interfraction target displacement on the dose distribution in the target of forward whole-breast intensity-modulated radiotherapy (IMRT) assisted by active breathing control (ABC).

METHODSEach of the selected patient who had received breast conserving surgery was immobilized and received the primary CT simulation assisted by ABC device to get five sets of CT images in three different breathing status, including free breathing (FB) (one set), moderate deep inspiration breathing hold (mDIBH)(two sets) and deep expiration breathing hold (DEBH) (2 sets). After 10 to 15 fractions of radiation, the repeated CT simulation was completed and the same five sets of CT images were obtained at FB, mDIBH, and DEBH, respectively. In the Pinnacle3 treatment planning system, the forward IMRT planning was completed on the first set of mDIBH CT images from the primary CT simulation, and the planning was separately copied by the special system order to the second set of CT images from the primary CT simulation and to the first set of CT images from the repeated CT simulation, keeping the primary angle, direction, size and shape of the MLC field and prescribed dose un-changed. the volumes covered by selected high dose area in the selected segment were compared.

RESULTSIn the planning based on the first set of mDIBH CT images from the primary CT simulation, the volume irradiated by equal and more than 103% of prescribed dose in the segment was (1.16 +/- 0.39) cm3, and the volumes were (3.88 +/- 1.07) cm3 and (51.66 +/- 8.68) cm3 in the plannings copied from the first set of mDIBH CT images from the primary CT simulation respectively to the second set of CT images from the primary CT simulation and first set of CT images from the repeat CT simulation, the difference of the volume in the two plannings based on the two set mDIBH CT image from the primary CT simulation was not statistically significant (t = -1.672, P = 0.103). The difference of the volume in the two plannings based on the two sets of mDIBH CT images respectively from the primary and repeat CT simulations had a significant difference (t = -5.728, P < 0.01).

CONCLUSIONIf the same threshold of mDIBH is maintained during IMRT after breast conserving surgery, the influence of the intrafraction target displacement on the dose distribution is not significant. However, if set-up error is not adjusted, the interfraction change of position of the segment given to cover the high dose area in the IMRT planning will be significant, resulting in a significant change of dose distribution in the breast.

Breast Neoplasms ; diagnostic imaging ; radiotherapy ; surgery ; Carcinoma, Ductal, Breast ; diagnostic imaging ; radiotherapy ; surgery ; Carcinoma, Lobular ; diagnostic imaging ; radiotherapy ; surgery ; Dose Fractionation ; Female ; Humans ; Mastectomy, Segmental ; Postoperative Period ; Radiography ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Intensity-Modulated ; methods ; Respiration ; Respiratory-Gated Imaging Techniques ; methods