Low-risk Situations Research Articles

Italian survey about intraperitoneal drain use in distal pancreatectomy.

Intraperitoneal prophylactic drain (IPD) use in distal pancreatectomy (DP) is still controversial. A survey was carried out through the Italian community of pancreatic surgeons using institutional emails, Twitter, and Facebook accounts of the Italian Association for the Study of the Pancreas (AISP) and the Italian Association of Hepato-biliary-pancreatic Surgery (AICEP). The survey was structured to learn surgeons' practice in using IPD through questions and one clinical vignette. Respondents were asked to report their regrets for omission and commission regarding the IPD use for the clinical scenario, eliciting a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were built to identify respondents' attitudes. One hundred six surgeons completed the survey. Sixty-three (59.4%) respondents confirmed using at least 1 drain, while 43 (40.6%) placed 2 IPDs. Only 13 respondents (12.3%) declared a change in IPD strategy in patients at high risk of clinically relevant postoperative pancreatic fistula (CR-POPF), while 9 (9.4%) respondents changed their strategy in low-risk POPF situations. Thirty-five (35.5%) respondents declared they would remove the IPD within the third postoperative day (POD) in the absence of CR-POPF suspicion. The median omission regret, which proved to be the wrong decision, was 80 (50-100, IQR). The median regret due to the commission of IPD, which turned out to be useless, was 2.5 (1-20, IQR). The CR-POPF probability threshold at which drainage omission was the less regrettable choice was 7% (1-35, IQR). The threshold to perceive drain omission as the least regrettable choice was higher in female surgeons (P < 0.001), in surgeons who modulated the strategies based on the risk of CR-POPF, and in high volume centers (p = 0.039). The threshold was lower in surgeons who performed minimally invasive distal pancreatectomy (P < 0.001), adopted a closed system (P < 0.001), placed two IPDs (P < 0.001), or perceived the IPD as important to prevent reintervention (p = 0.047). Drain management after DP remains very heterogeneous among surgeons. The regret model suggested that IPD omission could be performed in low-risk patients (7% of CR-POPF), leading to low regret in the case of the wrong decision, making it an acceptable clinical decision.

Escalation and De-Escalation of Adjuvant Radiotherapy in Early Breast Cancer: Strategies for Risk-Adapted Optimization.

Postoperative radiotherapy (RT) is recommended after breast-conserving surgery and mastectomy (with risk factors). Consideration of pros and cons, including potential side effects, demands the optimization of adjuvant RT and a risk-adapted approach. There is clear de-escalation in fractionation-hypofractionation should be considered standard. For selected low-risk situations, PBI only or even the omission of RT might be appropriate. In contrast, tendencies toward escalating RT are obvious. Preoperative RT seems attractive for patients in whom breast reconstruction is planned or for defining the tumor location more precisely with the potential of giving ablative doses. Dose escalation by a (simultaneous integrated) boost or the combination with new compounds/systemic treatments may increase antitumor efficacy but also toxicity. Despite low evidence, RT for oligometastatic disease is becoming increasingly popular. The omission of axillary dissection in node-positive disease led to an escalation of regional RT. Studies are ongoing to test if any axillary treatment can be omitted and which oligometastatic patients do really benefit from RT. Besides technical improvements, the incorporation of molecular risk profiles and also the response to neoadjuvant systemic therapy have the potential to optimize the decision-making concerning if and how local and/or regional RT should be administered.

The influence of driver’s risk perception ability on driving decision-making: an ERP study

Driver’s risk perception ability is of great significance to traffic safety. Driver’s risk perception ability is reflected in the risk handling in traffic situation and has a great impact on driving decisions, especially speed decisions. However, the mechanism of the influence of risk perception on driving decisions under risk situations is still unclear. According to standardized risk perception test, we divided drivers into high risk perception ability (H-RPA) group and low risk perception ability (L-RPA) group. Participants were shown traffic pictures with different levels of risk and asked to make decisions about whether to slow down, while their electrical brain responses were recorded. All participants were interviewed after the experiment. The results showed that in the low-risk traffic situation, compared to the drivers with H-RPA, the drivers with L-RPA made less deceleration decisions and evoked larger N1 and smaller P1 amplitude. 93.75% of the drivers with L-RPA stated in interviews that they did not notice the traffic risks on the road. The results show that risk perception affects the allocation of attention to risks in traffic situations, leading to a decrease in the safety of driving decisions. Our research results provide a reference for the training of safe driving skills for drivers.

The behavioral strategies of multiple stakeholders in the NIMBY facility public-private partnership project: a tripartite evolutionary game analysis based on prospect theory

In this study, evolutionary game method, prospect theory, and system dynamics (SD) method are combined to analyze the key stakeholders’ behaviors in the public-private partnership project of not-in-my-back-yard facility. First, the interaction behavior of the public sector, the private sector, and the public and their equilibrium state was analyzed based on the evolutionary game method and prospect theory. Then, the SD method was used to simulate and analyze the impact of different variables on the behavior of the three stakeholders. The results show that the greater the perceived cost difference between the active and negative behavior among the three stakeholders, the more likely they are to take negative behavior. The private sector tends to act opportunistically under low-risk loss situations. Dynamic rewards are more likely to incentivize the public to supervise than high rewards. Some recommendations to promote active behavioral interactions and cooperation among stakeholders were presented accordingly.

The attentional guidance and facilitating effects of group behavioral cues on individual college pedestrians’ jaywalking decisions

Objective Jaywalking is an important cause of pedestrian-related automobile accidents. Exploring the factors that influence jaywalking behavior and suggesting appropriate improvement measures are critical for reducing automobile accidents involving pedestrians. Methods This study divided traffic situations into high-risk and low-risk situations. Each situation contained three visual attention cues: vehicle, traffic light, and group behavior. Based on this, the role of visual cues in guiding pedestrians’ attention and influencing their decisions during jaywalking was examined. Sixty participants, with an average age of 19, were recruited. They were shown 84 crosswalk videos randomly while their crossing decisions and eye movement data were recorded. Results In low-risk situations, pedestrians spent more attention on group behavioral cues when making jaywalking decisions. The rate of jaywalking increased with the number of other jaywalking pedestrians. In high-risk situations, the pedestrians’ total fixation duration at vehicle hazard cues was longer when making jaywalking decisions, and the jaywalking rate decreased. Conclusions The results indicate that pedestrians’ jaywalking decisions were based on other pedestrians’ illegal crossing cues and automatic associative processes in low-risk situations. The higher the number of people crossing the street, the higher the number of pedestrians illegally crossing the road. In high-risk situations, pedestrians paid more attention to vehicle hazard cues before making jaywalking decisions, and fewer illegal crossings. The jaywalking decisions were based on a risk assessment, a controlled analytical process. The results verify the effect of visual cues on pedestrians’ attentional guidance and decision-making in different traffic situations, as well as the effectiveness of visual attention in predicting decision intention. The findings provide a theoretical basis and data reference for pedestrian safety education and constructing an intelligent driving pedestrian trajectory prediction model.

Development and validation of a work-related risk score for upper-extremity musculoskeletal disorders in a French working population.

The aim was to develop an easy-to-use risk score based on occupational factors and to validate its performance to identify workers either having (diagnostic setting) or developing (prognostic setting) upper-extremity musculoskeletal disorders (UEMSD). This study relied on data from the Cosali prospective cohort conducted in a French working population. Diagnostic status for six UEMSD at inclusion and at follow-up was assessed by a standardized clinical examination. Data on occupational factors were collected through a self-administered questionnaire completed before the clinical examination at inclusion. The risk score was derived from a prediction model developed on data of 2,468 workers included in 2002-2003, and the validation sample is composed of 1,051 workers included later in 2004-2005. The prognostic performance of the risk score was assessed in workers without UEMSD at baseline. A total of 13% and 12% of workers had a UEMSD at inclusion in the development and validation sample. The developed risk score includes physical, organizational and psychosocial factors at work. In the validation sample, this score had acceptable performance for identifying workers having or not UEMSD at baseline (AUC: 0.60 [95% CI 0.57 to 0.63]), in particular the negative predictive value was high (89%-90%). The baseline risk score showed similar performance for predicting incident UEMSD at follow-up examination. This score can be useful as a first-line risk assessment tool, especially for excluding the low-risk work situations from further intervention by an ergonomist. Further validation studies are needed to determine its performance among various working populations.

Pre-operative gastric ultrasound in patients at risk of pulmonary aspiration: a prospective observational cohort study.

Point-of-care gastric sonography offers an objective approach to assessing individual pulmonary aspiration risk before induction of general anaesthesia. We aimed to evaluate the potential impact of routine pre-operative gastric ultrasound on peri-operative management in a cohort of adult patients undergoing elective or emergency surgery at a single centre. According to pre-operative gastric ultrasound results, patients were classified as low risk (empty, gastric fluid volume ≤ 1.5 ml.kg-1 body weight) or high risk (solid, mixed or gastric fluid volume > 1.5 ml.kg-1 body weight) of aspiration. After sonography, examiners were asked to indicate changes in aspiration risk management (none; more conservative; more liberal) to their pre-defined anaesthetic plan and to adapt it if patient safety was at risk. We included 2003 patients, 1246 (62%) of which underwent elective and 757 (38%) emergency surgery. Among patients who underwent elective surgery, 1046/1246 (84%) had a low-risk and 178/1246 (14%) a high-risk stomach, with this being 587/757 (78%) vs. 158/757 (21%) among patients undergoing emergency surgery, respectively. Routine pre-operative gastric sonography enabled changes in anaesthetic management in 379/2003 (19%) of patients, with these being a more liberal approach in 303/2003 (15%). In patients undergoing elective surgery, pre-operative gastric sonography would have allowed a more liberal approach in 170/1246 (14%) and made a more conservative approach indicated in 52/1246 (4%), whereas in patients undergoing emergency surgery, 133/757 (18%) would have been managed more liberally and 24/757 (3%) more conservatively. We showed that pre-operative gastric ultrasound helps to identify high- and low-risk situations in patients at risk of aspiration and adds useful information to peri-operative management. Our data suggest that routine use of pre-operative gastric ultrasound may improve individualised care and potentially impact patient safety.

Adjuvant radiation therapy for breast cancer

Adjuvant radiotherapy is an integral part of multimodal therapy for early breast cancer. It contributes to the reduction of local recurrences across all disease stages. (Moderate) hypofractionated whole-breast irradiation is the standard of care. In low-risk situations, partial breast irradiation can be an option. The indication for adjuvant radiotherapy after mastectomy or additional irradiation of regional lymph nodes depends on the patient's individual risk profile. Long-term results of treatment and further development of irradiation techniques now allow shorter, individualized and well-tolerated treatments with the aim of therapy de-escalation.

A Practical Tool for Risk-Based In-use Compatibility Assessments

In drug development, in-use compatibility studies are crucial steps to ensure that the critical quality attributes of the drug product are maintained when in contact with administration components. But once the drug is in clinical trials, unanticipated variations in these components can stretch limited resources and lengthen timelines to market, as these changes must be assessed and approved to ensure continued patient safety. It's desirable to use a science-based risk evaluation to determine the extent of data and testing needed in these situations, but there is no standard for how such evaluations are done. We have developed an Excel™-based semi-quantitative risk assessment tool to determine whether in-use testing is needed when drug delivery sites or components are changed during a clinical trial. We developed the tool based on our multi-company experience with compatibility studies for many types of drug products targeted for various geographic regions. We have employed the tool as a means to expedite decision-making and, if appropriate, reduce testing in low-risk situations. The tool can save significant time and effort (our estimate is approximately at least 6-9 months off the development cycle) and can minimize pitfalls in clinical administration. While we have designed the tool for our drug products and for use with parenteral dosing regimens, the tool can be adapted for other situations as needed. It will be especially useful for companies with more limited resources.

A Multi-Topic Bystander Intervention Program for Upper-Level Undergraduate Students: Outcomes in Sexual Violence, Racism, and High-Risk Alcohol Situations.

Few bystander intervention trainings programs have evaluated behavioral outcomes in previously trained upper-level undergraduate students. Rigorous study designs are necessary to understand how multi-topic programs influence student outcomes to intervene against sexual violence, racism, and high-risk alcohol situations. A single-session bystander training for emphasizing communication strategies was developed for juniors and seniors on a private, Midwestern college campus. The training addressed sexual violence, racism, and high-risk alcohol situations and was evaluated using a randomized waitlist-control design in student-housing units. Online Qualtrics surveys were completed by 101 student participants (57 in the intervention group and 44 in the control group). Students responded to nine harm scenarios involving sexual violence, racism, and high-risk alcohol situations at baseline and 7 weeks follow-up. Between-group changes in scores were compared to determine the effect of the program on students' (a) readiness to intervene; (b) confidence to intervene; (c) bystander behaviors among students who witnessed actual or potentially harmful events; and (d) bystander reports of their experiences. Qualitative analysis assessed how the program influenced the use of positive verbal communication strategies. Program effects increased positive bystander experiences when helping someone who had too much to drink and needed assistance. Over time both groups reported increased confidence levels to intervene when someone intoxicated was being isolated with sexual intent. There were no further significant findings in readiness, confidence, behaviors, or other experiences, though some positive nonsignificant trends emerged. The program demonstrated little efficacy. Results suggest opportunities to improve bystander outcomes in low-risk primary prevention situations and racist scenarios, suggesting that targeted intervention of these outcomes may be useful when developing programming with previously-trained students. As universities expand prevention work beyond the first year, lessons learned may help inform multi-year programming across health topics to prevent harm and create healthier college campuses.

Systematic Review of College-based Bystander Interventions to Reduce Sexual Violence

Objective: Up to 20% of female students experience some form of sexual violence while attending college. Bystander intervention programs to reduce sexual violence among university students are increasingly common, yet their effectiveness is not well understood. The purpose of this study was to conduct a systematic review of literature on issues of sexual violence on college campuses, as well as the role of bystander intervention programs and bystander behavior. Methods: Using PRISMA guidelines, database and reference list reviews generated a total of 530 resources from 1972 to 2020. Results: Screenings resulted in a total of 106 resources including peer-reviewed articles, governmental reports, and other scholarly references. Conclusions: Research into campus-based sexual violence has documented the increasing popularity of bystander intervention programs. Although these bystander programs are popular, literature highlights their limited effectiveness in reducing campusbased sexual violence. Future research should explore methods to increase understanding of how bystander intervention programs impact immediate and long-term behavior. Research also should explore motivations to intervene during lower risk situations on the sexual violence continuum which could help explain motivations to intervene during higher-risk situations.

Digital Antibiotic Allergy Decision Support Tool Improves Management of β-Lactam Allergies

Frontline providers frequently make time-sensitive antibiotic choices, but many feel poorly equipped to handle antibiotic allergies. We hypothesized that a digital decision support tool could improve antibiotic selection and confidence when managing β-lactam allergies. A digital decision support tool was designed to guide non-allergist providers in managing patients with β-lactam allergy labels. Non-allergists were asked to make decisions in clinical test cases without the tool, and then with it. These decisions were compared using paired t tests. Users also completed surveys assessing their confidence in managing antibiotic allergies. The tool's algorithm was validated by confirming its recommendations aligned with that of five allergists. Non-allergist providers (n= 102) made antibiotic management decisions in test cases, both with and without the tool. Use of the tool increased the proportion of correct decisions from 0.41 to 0.67, a difference of 0.26 (95% CI, 0.22-0.30; P < .001). Users were more likely to give full-dose antibiotics in low-risk situations, give challenge doses in medium-risk situations, and avoid the antibiotic and/or consult allergy departments in high-risk situations. A total of 98 users (96%) said the tool would increase their confidence when choosing antibiotics for patients with allergies. A point-of-care clinical decision tool provides allergist-designed guidance for non-allergists and is a scalable system for addressing antibiotic allergies, irrespective of allergist availability. This tool encouraged appropriate antibiotic use in low- and medium-risk situations and increased caution in high-risk situations. A digital support tool should be considered in quality improvement and antibiotic stewardship efforts.

Effects of Conformity Bias Caused by Evacuation Order on Risk Evaluation

We have found that various cognitive biases would interfere with evacuation behavior during a disaster, and this have caused many casualties. In this study, we focused on the conformity bias, one of the cognitive biases, which is introduced by evacuation order sentences with information about other residences’ behavior, to facilitate evacuation behavior. In the experiment, we presented the evacuation order sentences, and pictures which depict the scene of disaster, or normal situation. Participants evaluated the degree of risk for the picture, and degree of necessity of evacuation from the scene. Our results demonstrated that the conformity bias would facilitate evacuation especially for the low-risk situation. In addition, we found that judgments of the need for evacuation can be predicted by the rating of the degree of danger, disaster experience, sense of crisis about disasters, and the other-personality-orientations of the participants.

Corporate social responsibility and firm market performance: the role of product market competition and firm life cycle

PurposeThis study empirically investigates the role of product market competition and mature-stage firm life cycle on the relation between corporate social responsibility (CSR) and market performance in an emerging market context – Malaysia.Design/methodology/approachThe authors construct a comprehensive CSR index toward the economy, environment and society (EES) and apply both Ordinary Least Squares (OLS) and Two-Stage Least Squares (2SLS) instrumental variables (IV) approaches to test the hypotheses of the study.FindingsThe authors find that EES-based CSR generally enhances firms' market performance; however, the level of product market competition undermines the market performance of socially and economically responsible firms. In addition, the study results indicate that mature-stage firm life cycle with more involvement in CSR activities shows better market performance. However, the endogeneity check of CSR suggests that both CSR and mature-stage firms are mutually exclusive in influencing market performance. The study findings are robust to alternative measures and different identifications of high and low default risk situations of sample firms.Practical implicationsThis study carries practical policy implications for the listed firms, regulators and stakeholders in general. For example, regulatory bodies may promote greater involvement in CSR activities by listed companies in the Malaysian stock market. Investors and other market participants should be aware of factors influencing socially responsible firms' market performance such as the corporate life cycle and the level of competition in product markets.Originality/valueThis research work responds to the call of regulatory bodies in Malaysia at a time when the Malaysian economy is under threat of environmental distraction practices by the palm oil industry and import ban by the largest export market, i.e. the European Union by 2030. The study also contributes to the theoretical literature by refining the moderating role of product market competition and mature-stage life cycle on the relationship between CSR and market performance from the perspectives of resource-based and stakeholder theories in emerging economy settings.

High Level Bioaerosol Protection against Infective Aerosols: How Medical Face Masks Compare against Respirators.

Face masks and respirators are commonly used to prevent the transmission of infectious diseases that spread by respiratory droplets and aerosols. However, there is still uncertainty about the protective effect of the different types of masks against virus containing aerosols. To determine the as-worn bioaerosol protection efficacy of different face coverings and estimate the possible protective function against airborne diseases, we challenged different respirators and medical masks on a standardized dummy head with a bioaerosol containing MS2 bacteriophages as virus surrogates. In our experiments, FFP2 respirators showed the highest filtration efficacy 94 ± 4 (SD) % followed by medical masks 93 ± 3 (SD) % and KN95 respirators 90 ± 7 (SD) %. Nevertheless, we found no statistically significant difference between respirators and medical masks in terms of provided protection against infective aerosols. Our findings indicate that both respirators and medical masks provide a high as-worn bioaerosol protection efficacy against virus containing aerosols, and therefore, a very high protection against airborne diseases. Considering the higher comfort, better availability, and lower price of medical masks in contrast to respirators, it is recommendable to use medical face masks especially in low risk situations and in general public.

Adaptive locomotion during subtle environmental changes in younger and older adults

For older adults especially, to perform everyday activities safely, adaptive locomotion that adjusts basic locomotion pattern according to the environmental features is critical. It is unknown, however, whether their locomotor patterns can be modified when there are subtle environmental changes. We examined adaptive limb movements, focusing on obstacle avoidance and age-related changes during such situations. Younger (102, with a mean age of 27.5 years) and older (101, with a mean age of 78.3 years) participants walked across one obstacle (150 mm height) four different times. The obstacles were then covertly raised or lowered by 10% of the baseline obstacle height (i.e., 165 mm for ascending and 135 mm for descending conditions), and participants were asked to repeat the activity. We measured leading and trailing foot clearances, the vertical distances between toe tips and the upper edge of the obstacle. In the ascending condition, both groups adjusted and raised their limb clearance according to the obstacle height change. Alternatively, foot clearance of the leading limb for the lowered obstacle did not change among the older adults, whereas it changed in the young adults (lowered their clearance). No changes were observed in the trailing foot clearance for the descending conditions in either age group. Our results suggest that when facing environmental changes that compromise safe mobility, individuals can adapt leading limb movement based on subtle environmental changes, irrespective of age. In case of other changes (i.e., in low-risk situations), however, the ability of adaptive locomotion may be affected by aging.

Home Visiting as an Equitable Intervention for Perinatal Depression: A Scoping Review.

ObjectiveMaternal mental health disorders are a leading complication of childbirth. While few systems are adequately able to identify and treat depression, people experiencing perinatal depression may benefit from the intervention of home visiting. The intent of home visiting interventions is to alleviate stressors of parenthood for people facing additional risk factors. The aim of this scoping review is to investigate the effect of home visiting on perinatal depression grounded in published studies.MethodsWe conducted a scoping review of the existing literature of studies relevant to perinatal depression and home visiting. We entered keywords in five search databases: MEDLINE, PsycInfo, CINAHL, Social Work s, and Google Scholar. All relevant literature published between January 1999–December 2019 was reviewed. Duplicates, books, and errata were excluded from the study. As a scoping review, we included all studies published in English describing the inclusion of maternal depression in home visits. We hypothesize birthing people with perinatal depression will benefit from home visiting interventions.ResultsThe results from the scoping review and describe the use of home visiting to improve perinatal mental health. An initial 12,652 records were identified in the search. After duplicates were removed, the titles of 2,140 articles were assessed for applicability, however 29 identified for full-text eligibility and were included in this analysis. The majority of the studies included in this review were quantitative (n = 23), followed by qualitative (n = 3), and mixed methods (n = 3). Nearly all studies (n = 28) using validated instruments such as the Edinburgh Postnatal Depression Scale to determine depressive symptoms.DiscussionThis review offers preliminary qualitative insights on the efficacy of home visiting for administrating perinatal depression care. Studies show that home visiting programs can provide treatment for perinatal depression and reduce the effects of depression for birthing people. Our review suggests that the efficacy of home visiting programs beginning in the postpartum period are less predictable than prenatal home visiting intervention among various populations, including people experiencing both high-risk and low-risk situations.

Impact of COVID-19 on Radiology Trainee Safety, Education, and Wellness: Challenges Experienced and Proposed Solutions for the Future.

Impact of COVID-19 on Radiology Trainee Safety, Education, and Wellness: Challenges Experienced and Proposed Solutions for the Future.

Addressing inequal risk exposure in the development of automated vehicles

Automated vehicles (AVs) are expected to operate on public roads, together with non-automated vehicles and other road users such as pedestrians or bicycles. Recent ethical reports and guidelines raise worries that AVs will introduce injustice or reinforce existing social inequalities in road traffic. One major injustice concern in today’s traffic is that different types of road users are exposed differently to risks of corporal harm. In the first part of the paper, we discuss the responsibility of AV developers to address existing injustice concerns regarding risk exposure as well as approaches on how to fulfill the responsibility for a fairer distribution of risk. In contrast to popular approaches on the ethics of risk distribution in unavoidable accident cases, we focus on low and moderate risk situations, referred to as routine driving. For routine driving, the obligation to distribute risks fairly must be discussed in the context of risk-taking and risk-acceptance, balancing safety objectives of occupants and other road users with driving utility. In the second part of the paper, we present a typical architecture for decentralized automated driving which contains a dedicated module for real-time risk estimation and management. We examine how risk estimation modules can be adjusted and parameterized to redress some inequalities.

Smarter Medicine in Radiation Oncology - current and proven treatment concepts offering the greatest possible benefit to cancer patients in clinical practice

Smarter Medicine in Radiation Oncology - current and proven treatment concepts offering the greatest possible benefit to cancer patients in clinical practice Abstract. Modern procedures in radiation therapy with respect to indication, therapy planning and implementation of shorter treatment regimens result in high local tumor control and excellent quality of life in frequent and clinically relevant disease entities including breast and prostate cancer as well as bone metastases. In the adjuvant therapy for early breast cancer, a careful comparative analysis of the use of endocrine adjuvant treatment over five years versus postoperative radiation therapy over less than four weeks may result in omission of radiation treatment in a selected patient population. Partial breast irradiation, while treating the tumor bed only in low risk situations, and hypofractionated whole breast radiotherapy for patients with a higher risk profile for local recurrence, halved treatment time compared to 10 years ago, making adjuvant radiotherapy for patients with breast cancer more convenient. In patients with localized prostate cancer, the introduction of hypofractionated treatment regimens halved the number of daily fractions and current developments point towards a one-week outpatient therapy for locally limited disease using high precision stereotactic techniques and accurate therapy planning based on multifunctional imaging. Patients with bone metastases are more and more treated with a single fraction, high precision stereotactic radiotherapy (radiosurgery) with high analgesic potential and achieving long lasting local tumor control. These modern, often significantly shorter, radiotherapy treatment regimens not only result in an excellent treatment response and better quality of life for patients, but also include a better utilization of radiotherapy resources needing less treatment machines and thus helping to reduce costs in the Swiss healthcare system.