Shorter Delivery Time Research Articles

Volumetric-modulated arc therapy and intensity-modulated radiation therapy treatment planning for prostate cancer with flattened beam and flattening filter free linear accelerators.

This study on patients with localized prostate cancer was set up to investigate valuable differences using flattened beam (FB) and flattening filter free (FFF) mode in the application of intensity‐modulated radiotherapy (IMRT) and volumetric‐modulated arc therapy (VMAT). For ten patients, four different plans were calculated with Oncentra planning system of Elekta, using Synergy machines: IMRT and VMAT, with and without flattening filter. Homogeneity and conformity indexes, dose to the organs at risk, and measurements of peripheral dose and dosimetric plan verification including record of the delivery times were analyzed and statistically evaluated. The indexes for homogeneity and conformity (CTV and PTV) are either advantageous or not significantly different for FFF compared to FB with one minor exception. Regarding the doses to the organs at risk and the measured peripheral dose, equivalent or lower doses were delivered for FFF than with FB. Furthermore, the delivery times were significantly shorter for FFF. VMAT compared to IMRT reveals benefits or at least equivalent values. VMAT‐FFF combines the most advantageous plan quality parameters with the shortest delivery times and reduced peripheral dose and is therefore recommended for the given equipment and cancer localization.

Fewer beams and segments result in a shorter delivery time and a better quality intensity-modulated radiotherapy plan in gastric cancer

Fewer beams and segments result in a shorter delivery time and a better quality intensity-modulated radiotherapy plan in gastric cancer

Trajectory optimization in radiotherapy using sectioning (TORUS).

A challenging problem in trajectory optimization for radiotherapy is properly handling the synchronization of the medical accelerators dynamic delivery. The initial coarse sampling of control points implemented in a Progressive Resolution Optimization type approach (VMAT) routinely results in MLC aperture forming contention issues as the sampling resolution increases. This work presents an approach to optimize continuous, beam-on radiation trajectories through exploration of the anatomical topology present in the patient and formation of a novel dual-metric graph optimization problem. This work presents a new perspective on trajectory optimization in radiotherapy using the concept of sectioning (TORUS). TORUS avoids degradation of 3D dose optimization quality by mapping the connectedness of target regions from the BEV perspective throughout the space of deliverable coordinates. This connectedness information is then incorporated into a graph optimization problem to define ideal trajectories. The unique usage of two distance functions in this graph optimization permits the TORUS algorithm to generate efficient dynamic trajectories for delivery while maximizing the angular flux through all PTV voxels. 3D dose optimization is performed for trajectories using a commercial TPS progressive resolution optimizer. The TORUS algorithm is applied to three example treatments: chest wall, scalp, and the TG-119 C-shape phantom. When static collimator coplanar trajectories are generated for the chest wall and scalp cases, the TORUS trajectories are found to outperform both 7 field IMRT and 2 arc VMAT plans in delivery time, organ at risk sparing, conformality, and homogeneity. For the TG-119 phantom, when static couch and collimator non-coplanar trajectories are optimized, TORUS trajectories have superior sparing of the central core avoidance with shorter delivery times, with similar dose conformality and homogeneity. The TORUS algorithm is able to automatically generate trajectories having improved plan quality and delivery time over standard IMRT and VMAT treatments. TORUS offers an exciting and promising avenue forward toward increasing dynamic capabilities in radiation delivery.

2103 CCPM法によるソフトウェア開発プロジェクトの短納期化実現に関する研究(一般セッション)

2103 CCPM法によるソフトウェア開発プロジェクトの短納期化実現に関する研究(一般セッション)

Effects of low back massage on perceived birth pain and satisfaction

AimThe aim of the study was to evaluate the effect of low back massage on perceived birth pain and delivery. MethodThis study was designed as a study-control experimental type. The study sample consisted of 62 pregnant women (massage group = 31, control group = 31).Massage was applied to the study group in three phases during intrapartum period. The massages were done at the end of latent, active and transition phases (at cervical dilatation 3–4 cm, 5–7 cm, 8–10 cm) correspondingly. The VAS scores were evaluated three times during all phases. ResultsThe first mean VAS score was 5.2 ± 0.9 and 7.3 ± 1.3 for massage and control groups, respectively. Second VAS score was found as 6.6 ± 1.6 in massage group and 8.8 ± 1.0 in control group. The third VAS score was significantly higher in the control group than massage group during third evaluation (9.2 ± 2.4 vs 6.7 ± 2.7) (p < 0.05). The mean duration of second stage was 24.6 ± 12.7 min in massage group and 31.7 ± 20.9 min in control group (p > 0.05). The mean scores of satisfaction about delivery were found as 8.8 ± 0.7 in massage group and 6.9 ± 0.8 in control group (p < 0.05). ConclusionIt was determined in the study that lower back massage has a significant impact on reducing labor pain and increasing the satisfaction with birth. Health professionals, who work in the delivery unit, can use massage intervention for decreasing pain, shortening delivery time and increasing satisfaction with birth experience.

Research on Distribution Route of Electricity Supplier Logistics Based on the Customer's Hidden Cost

The rise of e-commerce makes green logistics increasingly important role. Combined with the characteristics of logistics distribution under the new e-commerce, the distribution route choice model was established. Based on lowering the total distribution cost and shortening delivery time, the paper proposes the idea to improve customer satisfaction. In calculating the total cost of the process, while taking the vehicle startup cost and vehicle cost into account, the concept of hidden cost was proposed, that is a kind of penalty cost due to customer dissatisfaction. In solving the model, determine the weight of each objective function by maximizing deviations, transfer the multi-objective functions into a single objective function which is relatively simple. Finally, take use of specific examples to drawn weights.

Treatment outcome and lung toxicities of volumetric modulated arc therapy in the treatment of inoperable non-small-cell lung cancer patients.

e20046 Background: Volumetric-modulated arc therapy (VMAT) has demonstrated the ability to deliver radiation dose precisely and accurately with a shorter delivery time and less MU compared to conventional intensity-modulated fixed-field treatment (IMRT) in the treatment of inoperable non–small-cell lung cancer (NSCLC). However, published data on clinical outcome and lung toxicities of VMAT in the treatment of NSCLC are scarce. Methods: The clinical outcome, acute and late pulmonary toxicities of 134 consecutive inoperable NSCLC patients treated by VMAT with or without concurrent chemotherapy were retrospectively reviewed. Univariate and multivariate analysis on the dosimetric and characteristic factors associated with acute radiation pnuemonitis (RP) and pulmonary fibrosis were evaluated. Results: The average prescriptions dose to these patients were 5736.38±649.11 cGy (range from 5200 to 6400 cGy) with a median follow-up of 18.6 months (range, 2–45 months) for the enrolled 134 patients. The two-year progression-free survival (PFS) and overall survival (OS) for all patients was 18.2% and 38.4% with a median PFS and OS of 7.6 months and 18.6 months, respectively. There were 14 and 12 out of 134 patients experienced grade III/higher RP (10.45%) and pulmonary fibrosis (8.95%), respectively. Age, chemotherapy exposure, dose prescription, V10, V13, V20 and V30 were significantly associated with acute RP. Dose prescription was related to pulmonary fibrosis. Only V13 (p = 0.02) and age (p = 0.02) were independently associated with acute RP according to multivariate analysis. Based on regression analysis, the threshold for lung dosimetric metrics V10,V13,V20 andV30 were 50%,40%,28% and 18% in VMAT treatment of NSCLC to limit the RP rate &lt; 10%. Conclusions: VMAT can be delivered safely with acceptable acute and late toxicities for NSCLC. Lung dosimetric metrics were valuable in predicting acute RP. A threshold of 40% of Lung V13 in VMAT treatment of NSCLC was helpful to limit the RP rate &lt; 10%.

Concepts, methods and tools for individualized production

The main objective of the paper is to give an overview of prerequisites and enablers for individualized production from the perspective of flexible, agile and sustainable production of customized and personalized products. Increasing volatility in the global and local markets, shortening innovation and product life cycles, as well as a tremendously increasing number of variants, call for production facilities and networks and operations management which comply with these changing demands. The paper presents a set of developed concepts, methods and tools based on the recognized needs of manufacturing companies. The observed manufacturing domain is characterized with highly customized and personalized products produced in competitively in a high-cost country with short delivery times and high quality requirements. Micro and desktop factories can be seen as one type of solution to point-of-need manufacturing of customized and personalized products, such as hand-held consumer electronics or medical implants. The LeanMES concept and associated solution blocks aim for more efficient operation via digital tools. The Competitive Sustainable Manufacturing Hotel (CSM-Hotel) concept of a platform targeted for SMEs collaborating under same factory roof or in the same area. The A-NET vision offers a new holistic framework for industrial supply networks to manage development more agilely and for deeper strategic cooperation.

P237 Modulating executive functions and working memory performance on clinical neuropsychological tasks with theta burst transcranial magnetic stimulation

Introduction Theta burst stimulation (TBS) protocols hold high promise in neuropsychological rehabilitation thanks to its ability to induce lasting effects on cortical excitability following a short delivery time. Nevertheless, its ability to inhibit (continuous protocol, cTBS) or facilitate (intermittent, iTBS) brain function from cortical areas other than the motor cortex remains to be fully established. The behavioral effects of TBS over the dorsolateral prefrontal cortex (DLPFC) are particularly interesting given its involvement in working memory and executive processing, often impaired after brain injury, and also due to its role of hub of frontal areas, for which it is frequently chosen as a target for treatment and rehabilitation. Objective To explore the ability of cTBS and iTBS to modulate working memory and executive functions assessed with clinical neuropsychological tasks. Materials and methods 36 healthy participants performed 3 clinical neuropsychological tasks: Digits Backward, Stroop test and Tower of Hanoi (Fig. 1). Subjects were assessed twice, first at baseline 1 week prior to stimulation and immediately following a single session of either active cTBS, active iTBS or sham TBS, delivered to the left DLPFC. Results Following sham TBS participants’ performance improved in the Stroop test, with higher scores in Color and Color-Word conditions, as well as lower interference scores (Fig. 2), likely caused by practice effects. Both, iTBS and cTBS, yielded improvements in the Digits Backward task and the Word score of the Stroop test. Moreover, similarly to the sham group, following iTBS participants showed lower Interference scores. In contrast, expected improvements in color score were not induced. Finally, cTBS decreased the number of movements necessary to complete the Tower of Hanoi. Nonetheless, at difference with the sham group, no improvements were observed in the Interference score of Stroop test. Conclusions TBS over DLPFC modulates working memory performance and executive processes. Both protocols resulted in similar working memory and information processing speed outcomes, whereas their effect on executive functions differed: cTBS impaired inhibitory control but improved planning abilities in a spatial task, meanwhile, no specific effects were observed following iTBS. Download : Download high-res image (431KB) Download : Download full-size image Download : Download high-res image (217KB) Download : Download full-size image

A Study to Assess the Effectiveness of Acupressure during Labour pain among Primigravida Mothers in Selected Hospitals, Puducherry

Acupressure has been used frequently to improve labour, manage labour pain, and shorten delivery time. However, there has been little research-based evidence to support the positive effects of acupressure in the obstetric area and obstetric nursing. The aim of this study was to evaluate the effects of SP6 acupressure on labour pain and delivery time in primigravida women in labour. The study was conducted at selected Hospitals in Puducherry. Its design was a randomized controlled clinical trial study using a single-blinded method. One hundred (100) primigravida women in labour were randomly assigned to either the SP6 acupressure (n = 50) or control group (n = 50). Acupressure was practiced 35 times in total on the SP6 point of both legs in the SP6 acupressure group; 15 times (during contraction) when cervical dilation was 2-3 cm, 10 times when cervical dilation was 5-6 cm and 10 times at 9-10 cm dilation, while the women in the control group received standard care. Labour pain was measured five times using a structured questionnaire of a subjective labour pain scale (visual analogue scale-VAS) when dilation was 2-3 cm (VAS 2), 5-6 cm (VAS 3) and 8-9 cm (VAS 4) before and after acupressure was applied to the SP6 point (VAS 1), and finally at the early postpartum period (VAS 5). The duration of labour in both groups was measured with a parto-graph and the length of delivery time was calculated in two stages: from 3 cm cervical dilation to full cervical dilation, and from full cervical dilation to delivery. There were significant differences between the groups in subjective labour pain scores (except VAS 4) (P < 0.001). The duration of the Phase one (3 cm dilatation to full dilatation) and Phase two (full dilatation to birth) in the acupressure group was shorter than the control group (Phase one, 225 min and 320 min, respectively; Phase two, 15 min and 20 min, respectively; both P < 0.001). It was determined that SP6 acupressure was effective in decreasing pain and duration of labour.

Priority Rule-based Planning Approaches for Regeneration Processes

Regeneration comprises the maintenance, repair and overhaul (MRO) of complex capital goods such as jet engines, wind turbines and stationary gas turbines. Service providers of such regeneration processes face many challenges, including the variability of regeneration paths due to the availability of different repair procedures. In addition, conditions for regeneration processes are defined by the high requirements for logistical performance, e.g., short delivery times and strong adherence to delivery dates set by customers. To meet these requirements, it is essential to efficiently plan regeneration processes. If constraints are not met, regeneration service providers risk heavy penalties and a loss of customers. In this paper, we present methods that, with the aid of priority rules, provide support in planning regeneration processes. These priority rules can be applied to different steps within the planning process: on a higher planning level, priority rules can be implemented to sequence orders and thus to optimize logistical performance. On a more detailed planning level, priority rules can be used to decide on the regeneration path and to schedule the particular regeneration steps. Both successive planning approaches take into account customer requirements as well as targets set by the service provider.

Ant Colony Optimization Algorithms to Enable Dynamic Milkrun Logistics

Flexibility in combination with high capacities are the main reasons for milkruns being one of the most popular intralogistics solutions. In most cases they are only used for static routes to always deliver the same material to the same stations. However, in the context of Industry 4.0, milkrun logistic also has become very popular for use cases where different materials have to be delivered to different stations in little time, so routes cannot be planned in advance anymore. As loading and unloading the milkrun requires a significant amount of time, beside the routing problem itself, both driving and loading times have to be taken into account. Especially in scenarios where high flexibility is required those times will vary significantly and thus are a crucial factor for obtaining the optimal solution. Although containing stochastic components, those times can be predicted by considering the optimal point of time for delivery. In consequence, the best tradeoff between short routes and optimal delivery times is in favor of the shortest route. To solve this optimization problem a biology-inspired method – the ant colony optimization algorithm – has been enhanced to obtain the best solution regarding the above-mentioned aspects. A manufacturing scenario was used to prove the ability of the algorithm in real world problems. It also demonstrates the ability to adapt to changes in manufacturing systems very quickly by dynamically modelling and simulating the processes in intralogistics. The paper describes the ant colony optimization algorithm with the necessary extensions to enable it for milkrun logistic problems. Additionally the implemented software environment to apply the algorithm in practice is explained.

A comparison of production control systems in a flexible flow shop

Production control in make-to-order must address the companies’ need for short delivery times and on-time deliveries. Several production control systems may be used to meet these needs. This paper presents a simulation study to evaluate the delivery performance of the TKS, GKS and POLCA production control systems, in the context of a make-to-order flexible flow shop. Since TKS is used for make-to-stock manufacturing, an adaptation of it is made to use in make-to-order. Results of a simulation study show that the adapted TKS outperforms POLCA, but performs worse than GKS. The study is a contribution for the alignment of production control theory to the industrial practice.

Analyzing the Effect of Express Orders on Supply Chain Costs and Delivery Times

Delivery time differentiation is a supply chain concept that has been implemented in various industries, but not yet in the automotive industry. One reason is that the effects of delivery time differentiation on the supply chain are not well understood. The BMW Group, for instance, has considered offering an express order option, where express orders bypass standard orders in the supply chain processes to achieve short delivery times. Express orders distort planning processes, increase operations cost, and increase the delivery times of standard orders, however the effects have not been quantified yet. This study analyzes the impact of express orders on the supply chain, when express orders are built‐to‐order. To understand the supply chain consequences of express orders better, we analyzed the relevant supply chain processes at BMW Group. We determine the effect that built‐to‐order express orders have on delivery times and on component demand. To analyze the effect of introducing express orders on expected delivery times and expected cost, we use queuing theory and derive expressions for the transient behavior of a discrete time batch queue. Our analyses indicate that many supply chain processes are only marginally affected. However, the orders to the suppliers become considerably more uncertain, which must be compensated by additional safety stock. Our results indicate that express orders can be an attractive option for BMW and other automotive companies. If the fraction of express orders stays at a reasonable level, express orders can be delivered within about two weeks.

Designing Capacity Synchronization within the Regeneration of Complex Capital Goods

Regeneration service providers who are conducting maintenance, repair and overhaul (MRO) tasks in the field of complex capital goods face strong market-based requests like short delivery times and a high schedule reliability. Further they have to deal with uncertain workload information and high load fluctuations caused by different damages. In order to cope with these demanding challenges a holistic planning and control performance that includes all different regeneration processes is necessary. A main lever for planning and controlling internal supply chains is represented by the tasks of capacity synchronization. There are several so called design options available for synchronizing capacities. These design option influence the logistic performance and will help the service provider to reach their goals in terms of customer satisfaction.

DVH comparison beween forward IMRT, inverse IMRT & RapidArc® for patients with left sided breast cancer after lumpectomy

Introduction When patients with left sided breast cancer are treated with adjuvant radiotherapy after lumpectomy, a significant volume of the heart and the left descending coronary artery (LDCA) receive enough radiation to result in serious late cardiac morbidity. This study dosimetrically compares the following three delivery techniques: forward intensity-modulated therapy (F-IMRT), inverse intensity-modulated therapy (I-IMRT), and volumetric-modulated arc therapy (RapidArc® in terms avoiding the heart and the LDCA. Other DVH parameters were also studied. Purpose The primary aim of this study is a feasibility check for the use of RapidArc®technique for breast radiotherapy to our department, as well as the identification of the potential advantages of RapidArc®into clinical routine. A secondary aim is a non inferiority check of RapidArc® versus conventional IMRT. Materials and methods Twenty patients with T1-2N0M0 breast cancer of the left breast who were treated with I-IMRT after lumpectomy were re-planned with F-IMRT and RapidArc® using Eclipse™ Treatment Planning System form Varian medical systems. Comparative endpoints were consider to be the doses to the surrounding structures, Conformity Index (CI), Homogeneity Index (HI), number of monitor units (MUs) and treatment delivery time. Statistical program SPSS was used in order to investigate the null hypothesis of this study: “No difference exists in distribution of various dosimetric scores between the three techniques”. Results RapidArc® significantly reduced the dose received from the 50% volume of the LDCA compared with I-IMRT and F-IMRT. RapidArc® and I-IMRT had better CI compared with F-IMRT but F-IMRT achieved better HI compared with I-IMRT and RapidArc®. RapidArc® reduced the number of MUs by 47% and the treatment time by 70% compared with I-IMRT. Conclusion RapidArc® achived better sparing of LDCA, with fewer MUs and shorter delivery time than F-IMRT and I-IMRT. Conformity significantly higher with RapidArc® and I-IMRT compared to F-IMRT. Disclosure No conflict of interest, financial or other, exists.

Rapid Prototyping in Humanitarian Aid To Manufacture Last Mile Vehicles Spare Parts: An Implementation Plan

AbstractThis research examines the use of rapid prototyping technologies in the supply chain of spare parts. Spare parts are manufactured in small production lots and distributed in wide areas, eventually requiring short delivery times. The focus of this research is the use of rapid prototyping in humanitarian logistics. The demand of humanitarian aid is large, but it is very difficult to predict and also to supply. The use of rapid prototyping to produce spare parts can greatly increase the availability of scarce resources. In this paper, it is demonstrated that rapid prototyping of spare parts for last mile vehicles can help achieve a cost‐effective solution to increase vehicle availability. Also, a detailed implementation plan is developed to serve as a guideline for any organization to successfully introduce the equipment in their operations.

Establishing a maturity model for design automation in sales-delivery processes of ETO products

Short delivery times are considered a competitive advantage in the engineer-to-order (ETO) sector. Design-related tasks contribute to a substantial amount of delivery times and costs since ETO products have to be either fully developed or adapted to customer specifications within tendering or order fulfillment. Approaches aiming at a computerised automation of tasks related to the design process, often termed design automation or knowledge-based engineering, are generally regarded as an effective means to achieve lead time and cost reductions while maintaining, or even improving product quality. In this study we propose a maturity model as a framework for analyzing and improving such activities in ETO companies. We contribute to the literature in being the first to investigate design automation in the ETO sector from a maturity perspective. Beyond that, we extend the extant literature on design automation, which is of a highly technical nature, by providing a framework considering organizational and managerial aspects. The findings indicate that five different levels of maturity can be achieved across the dimensions strategies, processes, systems, and people. Empirical cases give insight into these different levels. Our investigation draws from extant literature and a comparative case study involving four companies over two years.

SU‐F‐T‐21: A Novel Beam‐Light View, Collimating Applicator for HDR Ocular Conjunctiva Brachytherapy‐Treatments

Purpose:We propose the use of a HDR X‐ray source collimator to apply a conformal, relatively small, radiation suitable for a single fraction with short delivery time. In addition, this technique can be applied using a radioactive source.Methods:We have built a stainless steel 1.5 mm thick applicator, to accommodate the needle applicator of the Intra‐Beam X‐ray source. Additional cavity is created in the applicator to allow the hosting/nesting/positioning of a LED diode. This LED is allowing a pre‐irradiation beam marking on the tissue. The visible light emitted from the opening of the collimated applicator will delineate/verify the aperture of the kV beam to be applied, as well as serve as distance indicator and will assist in the determination of dose to be delivered. For the evaluation of the collimated spatial dose distribution we have performed water tank measurements using (IBA Dosimetry) with a 0.4 cc ion chamber (IBA Dosimetry). We have scanned a two dimensional array with 1mm pitch in depth and 0.3 mm step size laterally. Additional verifications were conducted using Gaf‐Chromic film for PDD measurements and Optical Stimulated Luminescence Dosimetry (OSLD, Landauer inc.) for absolute dosimetry.Results:The collimated applicator enables a conformal irradiated cross‐section of about 3 mm square at the applicator surface was used in this study. A 180 seconds of 50 kVp delivery yielded 29 Gy, 20.6 Gy and 14.5 Gy at 5, 10 and 15 mm depths respectively. These results are in good agreement with the needle applicator depth dose curve published data.Conclusion:We have demonstrated the feasibility of focal HDR brachytherapy for conjunctival and ocular tumors, using the Intra‐Beam needle applicator with in‐house developed collimator. The delivery time was found to be several minutes‐ suitable for an intra‐operative procedure and will allow dose fractionation deliveries.

SU‐F‐T‐391: Comparative Study of Treatment Planning Between IMRT and IMAT for Malignant Pleural Mesothelioma

Purpose:The purpose of this study was to compare the dosimetric differences between intensitymodulated radiation therapy (IMRT) and intensity modulated arc therapy (IMAT) for malignant pleural mesothelioma (MPM) patients with regard to the sparing effect on organs at risk (OARs), plan quality, and delivery efficiency.Methods:Ten MPM patients were recruited in this study. To avoid the inter‐operator variability, IMRT and IMAT plans for each patient were performed by one experienced dosimetrist. The treatment planning optimization process was carried out using the Eclipse 13.0 software. For a fair comparison, the planning target volume (PTV) coverage of the two plans was normalized to the same level. The treatment plans were evaluated on the following dosimetric variables: conformity index (CI) and homogeneity index (HI) for PTV, OARs dose, and the delivery efficiency for each plan.Results:All plans satisfied clinical requirements. The IMAT plans gained better CI and HI. The IMRT plans performed better sparing for heart and lung. Less MUs and control points were found in the IMAT plans. IMAT shortened delivery time compared with IMRT.Conclusion:For MPM, IMAT gains better conformity and homogeneity for PTV with IMRT, but increases the irradiation dose for OARs. IMAT shows an advantage in delivery efficiency.