IMRT patients but remained within the dose TD 5/5 and Quantec constraints6. For the contralateral parotid, the mean dose for the IMRT was 1707 cGy compared to the wedged pair dose of 294cGy. The Quantec mean dose for unilateral parotid is 2000cGy and the TD 5/5 is 3200 cGy. Both are within limits to prevent xerostomia. The submandibular is another area that can cause dry mouth if the dose is over the TD 5/5 of 3900 cGy. For the IMRT the mean dose for the contralateral submandibular was 1788 cGy and for the wedged pair 444 cGy. So again, the dose is within the constraint for complicated side effects. The contralateral parotid and submandibular are important to prevent xerostomia and improve quality of life. Curative patients have long …show more content…
The mean PTV of the IMRT plan 6347 cGy and the wedge pair mean is 6414 cGy. The total mean dose that is trying to be achieved is 6167 cGy. The PTV had a sharper dose fall off to the PTV after the prescription dose was achieved than the wedged pair did. Discussion By just looking at the mean dose of the OAR, the wedge pair is a better option in planning. However, after evaluating the DVH and isodose distribution, the assessment becomes more complex. The conformality of IMRT is much better planning method to navigate the complex contour of the neck and the OARs that must have dose constraints to reduce side effect and increase quality. In the head and neck region, there are other considerations for dose constraint and accurate treatment of the tumor volume. Anatomical and set-up error can cause an increased dose of OARs and reduced tumor dose9. Changes in anatomy over the over the course of treatment such as tumor and lymph node shrinkage and weight loss can change the dosimetry.9 This is important in planning. With IMRT, daily imaging is often incorporated and includes IGRT. IGRT method can reduce the error in set-up and help to treat the tumor volume more accurately. Another methods treatment to consider is proton therapy. A pencil beam proton therapy can guide the beam to cover the PTV. There is a sharp fall off with proton therapy which makes it possible for the target volume to be covered and the OARs to give little or no dose.
This is a federal law that was established to protect the rights of individuals with disabilities in programs and activities that receive Federal funding from the United States Department of Education. This section explains the Rehabilitation Act of 1973 by referencing that an individual with a disability cannot and should not be excluded from participating in the activities of his/her interests that are funded by the Federal government. If an organization receiving federal funding does deny an individual with a disability(ies), he/she may file a complaint against the organization stating that the organization is discriminating according to Section 504 of the Rehabilitation Act of 1973. A school district can be reported as operating out
Labor unions have been instrumental in the lives of workers throughout American history, and have led to important advances in the American workforce. Throughout history there have been patterns of exploitation of immigrant workers by businesses in order to increase profits; the Mexican migrant workers of southern California are the most recent historical group to fall into this pattern of exploitation mostly from their lack of organization. Cesar Chavez, a great organizer, and leader in fighting for farm workers’ rights was head of the United Farm Workers Union. As a Mexican-American, he would become a noticeable union leader and labor organizer who was toughened by his early years as a migrant worker who founded the National Farm Workers
1. Discuss the five (5) major components of information management/information technology (IM/IT) governance with a focus on how they will collectively improve the quality of health care.
The total challenge dose is calculated as 0.15 to 0.3 g protein/kg body weight, not to exceed 3 g protein or 10 g whole food. In patients with a previous history of severe reactions, a lower starting dose of 0.06 g protein/ kg body weight is recommended. If the patient remains asymptomatic for 4 hours, a second dose is given, generally an appropriate single-serving amount followed by 2 to 3 hours of
The Postbellum period in America from 1865 to the 1920s was characterized by a transformation of the American economy and unprecedented growth. Some of the largest companies founded in this time period are still around and thriving today including the Ford Motor Company, J.P. Morgan Chase, and General Electric. In addition to economic growth, there was also rapid urbanization and population growth from 31 million people in 1860 to 91 million in 1910. A shift in the market from agriculture to manufacturing partially propelled this growth. Despite the decrease in agricultural market share, the output increased threefold. By 1910, America increased its share in world manufacturing to 38.8% from 23.3% in 1870. Some economic historians such as Beard and Hacker propose that this growth is due to the Civil War. In general, there were three main spheres of influence spurring economic growth in this time period including technological advances, economic advantages and big business, and institutional changes.
MIP allows patients to undergo focus parathyroidectom, and it has the benefit of a smaller incision, shorter operations, a decreased length of stay, and fewer complications (67). Importantly, it has been shown to be cost-effective when compared with standard 4-gland exploration (68). A small incision is usually made ipsilateral to the preoperative localized adenoma. MIP surgery can be performed through central or lateral neck incisions (50, 67), and it has a 97% success rate with minimal morbidity and no procedure-specific complications. Preoperative localization is critical in this situation because most of the neck is not explored given the focused nature of the procedure (17,50, 66, 67).
Each CT scan, covering the neck,, thorax, chest and abdomen is associated with an effective dose of approximately 20-25 mSv.
Although the types of toxicities are comparable to prior research, there has been minimal data reported regarding the specific nature and severity of these toxicities experienced during XRT. In the current study, maximal incidence of Grade 2 severity across the toxicities monitored in this study ranged from 12-68%. This data supports that XRT induced toxicities in this clinical group were mostly mild and the majority of the patients did not require SLP intervention to manage symptoms, including dysphagia, while undergoing treatment. The low level of severe toxicities experienced by patients in our current study was similar to that found in the few studies to date which examined early toxicities following PGC management. Oliver et al. (2004) found that only 23% of their study population of 25 patients who underwent XRT experienced Grade 2 mucositis, which is directly comparable to the incidence of oral mucositis (24%) and pharyngeal mucositis (28%) in the current cohort. In comparison, Chung et al. (2011) and Patel et al. (2014) reported only 3-5% of their study population experienced Grade 2 mucositis. Chung et al. also reported low incidence of Grade 2 xerostomia (5%), while Patel et al. reported only Grade 1 xerostomia and dysgeusia in 5%. These maximal incidence rates for early toxicities are much lower than the current study data. However different rating scales (Radiation Therapy Oncology Group
The author of this article talks about the use of SPECT/CT in many different ways relating to thyroid cancer staging and assessment of risk. Some of these areas include “problem solving, diagnostic preablation, and lesional dosimetry” (Avram, 2014 pp175, 177). Avarm starts with the advantages of using SPECT/CT in association with diagnosis and treatment of thyroid cancer. The first and major advantage of using SPECT/CT discussed by Avarm is “accurate anatomic localization and characterization of radioiodine foci as benign or malignant” (Avram, 2014 pp172). The author explains how this is such as huge advantage over planar imaging because it allows for a more accurate diagnosis. A study the author references shows “SPECT/CT accurately characterized 85% of foci considered inconclusive on planar
Radiation to the head and neck includes oral problems including mucositis, taste loss, loss of
Another search in Medline/Pubmed was performed via PICO. The search was done as follows. Patient/Problem: neoplasm, Intervention: Diffusion weighted imaging , Compare to: fdg, Outcome: accuracy. This gave a total of 26 results. From these 26 articles 5 were included into this review (2) (3) (4) (5) (6). Exclusion of articles was based on: the absence of statistical numbers, not being a clinical trial, and the participation of less than 25 patients.
For oropharyngeal cancers requiring bilateral neck irradiation, IMRT or VMAT is the ideal treatment delivery option, as this removes the need for the anterior neck beam matching, and reduces the risk of xerostomia and dysphagia (Barrett et al., 2009, 141).
The authors begin defending their stance by providing several reasons for the recent surge of CT procedures: rapid technological advances, convenience to the patient and cost effectiveness (David & Hall, 2007). The calculated dose a patient receives from a CT procedure is only an estimated exposure dose. To date, a patient’s
After complete follow-up, patients were divided into two groups based on the final diagnosis of LR or non-LR groups. LR group defined as positive malignancy from the pathological report. The criteria for the non-LR group including (a) negative malignancy from the pathological report or (b) no suspicious foci of tumor recurrence from serial ENT examination or conventional CT follow-up (table1). The perfusion CT parameters were analyzed and compared between these two
These scores tell me the way I think and how I tend to make decisions. From the scores above my two strong suits are Intuitive (38%) and Judging (38%) whereas; my weaknesses are Introvert (9%) and Thinking (9%). This also means that I am classified as an INTJ( Introverted, Intuitive, Thnking, Judging) which is also known as a Mastermind. INTJ’s are self-confident and tend to excel in careers such as sciences and engineering. Currently, I am a Micro Computer Support Assistant for LAUSD and being an INTJ type has allowed me to excel in this position because I am able to use my problem solving skills to try and figure out a certain problem even if I may not know the exact solution. But it is not always a good thing because INTJ’s tend to take