Small Instrument Research Articles

A qualitative evaluation of scalpel skill teaching of podiatry students

BackgroundDegrees in health disciplines need a balance of theoretical knowledge and sufficient clinical practice to meet registration requirements, in particular those requiring specialist skills such as the use of scalpels and other small instruments, such as podiatry. However, despite this requirement there is a scarcity of literature and research to inform teaching of these particular manual clinical skills. Therefore, the aims of this study were to determine the current approaches being used to teach manual skills, in particular scalpel skills, in university podiatry programs in Australia and New Zealand, and to explore what issues, challenges and innovations exist.MethodsA qualitative study, consisting of semi-structured interviews with staff at eight university podiatry programs in Australia and New Zealand was undertaken to determine how these skills are taught and evaluated, and how poor performers are managed. A conventional content analysis technique was used to analyse and code interview data, with the resultant categories reported.ResultsApproaches to teaching manual clinical skills, in particular scalpel skills, appear to be consistent between university programs in Australia and New Zealand in utilising didactic-style content, demonstration, physical practice on inanimate objects and real skin, and often the use of supplementary audio-visual material. The main reported differences between programs were in methods and processes of practice, with controversy regarding the use of inanimate objects versus real skin for practice.ConclusionsDespite a lack of research and literature surrounding this topic, the approach to teaching is relatively consistent between programs with greatest disparity being the structure and duration of practice. Key issues for teaching staff in teaching manual skills were students’ clinical exposure, motivation, levels of anxiety and dexterity.

Cooperation between humans and robots in fine assembly

The development of ever smaller components in manufacturing processes require handling, assembling and testing of miniature similar components. The human eye meets its optical limits with ongoing miniaturization of parts, due to the fact that it is not able to detect particles with a size smaller than 0.11 mm or register distances below 0.07 mm - like separating gaps. After several hours of labour, workers cannot accurately differentiate colour nuances as well as constant quality of work cannot be guaranteed. Assembly is usually done with tools, such as microscopes, magnifiers or digital measuring devices. Due to the enormous mental concentration, quickly a fatigue process sets in. This requires breaks or change of task and reduces productivity. Dealing with handling devices such as grippers, guide units and actuators for component assembling, requires a time consuming training process. Often productivity increase is first achieved after years of daily training. Miniaturizations are ubiquitously needed, for instance in the surgery. Very small add-on instruments must be provided. In measurement, e.g. it is a technological must and a competitive advantage, to determine required data with a small-as-possible, highest-possible-resolution sensor. Solution: The realization of a flexible universal workstation, using standard robotic systems and image processing devices in cooperation with humans, where workers are largely freed up from highly strenuous physical and fine motoric work, so that they can do productive work monitoring and adjusting the machine assisted production process.

Application of Portable Near-Infrared Spectrometer for Analysis of Organic Carbon in Marine Sediments

The performance of a portable near-infrared (NIR) spectrometer to determine organic carbon (OC) in marine sediments was evaluated. The NIR reflection spectra of 180 samples in the range 950 - 1650 nm were acquired using an ultra-compact spectrometer. NIR spectroscopy combined with the partial least squares (PLS) regression and Savitzky-Golay (SG) smoothing was successfully applied to rapid and reagent-free determination of OC. Using the PLS-SG model with 1nd order derivative, 2th polynomial and eleven smoothing points, the root-mean-square errors (RMSEPM) and correlation coefficients (RP,M) of prediction for modeling were 0.073% and 0.894, respectively, the root-mean-square errors (RMSEPV) and correlation coefficients (RP,V) of prediction for validation were 0.075% and 0.883, respectively. Results showed that the small portable NIR instrument achieved well prediction effect for the analysis of OC in marine sediments, which had advantages of rapid, easy to carry and operate suitable for large-scale applications to analyze marine sediments.

Evaluation of new technique of sterilization using biological indicator.

Background:A novel technique of sterilization of endodontic files is introduced in this article.Aims:Newly introduced sterilization unit, named “SteriFast” is compared with autoclave and glass bead sterilizer using biological indicator.Materials and Methods:Spore strips of Bacillus pumilus were cultured in nutrient broth. This cultured media was used to contaminate the experimental samples of endodontic files. These contaminated files were sterilized using three different techniques. The sterilized files were transferred into nutrient medium under aseptic condition. The results were observed after 24 h, 48 h, and 7 days.Results:The results showed that autoclave and new sterilization device (SteriFast) showed complete sterilization. The files sterilized using glass bead sterilizer showed bacterial growth (80%).Conclusions:Thus, it proves that autoclave and SteriFast are ideal techniques of sterilization of endodontic files. Glass bead sterilizer does not completely sterilize the files. The article also compares SteriFast and autoclave in other aspects such as its design, basic principle, advantages, and disadvantages. The article also describes features and design of SteriFast, used for all kind of small dental instruments.

Techno-economic analysis of blanking punch life improvement by environment friendly cryogenic treatment

Cryogenic treatment is an environment friendly supplementary process to conventional heat treatment used to improve wear resistance of tool and die steels. The potential of cryogenic treatment on AISI D2 die steel under laboratory conditions is well researched and documented. However to ensure the sustainable use of this technology in real life manufacturing, techno-economical analysis is required to be undertaken. Hence, a small scale production unit manufacturing medical instruments was identified and impact of cryogenic treatment on AISI D2 steel blanking punch was evaluated in terms of tool life, part quality and pecuniary gain. The cryogenically treated punches were inserted into the die and subjected to blanking of medical grade stainless steel sheets under real life manufacturing conditions. The improved wear resistance of cryogenically treated punch resulted in approximately 60% production rise and savings of 3.5% of annual turnover. Punch life was studied and correlated to part quality in term of burr size to divulge wear behavior of blanking punch. The AISI D2 steel samples were also prepared and subjected to laboratory tests comprising of metallographic observations and hardness. It was found that laboratory tests were not reliable enough to predict improvements in mechanical properties. The mechanism responsible for augmented wear resistance by cryogenic treatment was identified to be conversion of retained austenite in to martensite and precipitation of fine secondary carbides.

Guidance for Efficient Small Animal Imaging Quality Control

Routine quality control is a critical aspect of properly maintaining high-performance small animal imaging instrumentation. A robust quality control program helps produce more reliable data both for academic purposes and as proof of system performance for contract imaging work. For preclinical imaging laboratories, the combination of costs and available resources often limits their ability to produce efficient and effective quality control programs. This work presents a series of simplified quality control procedures that are accessible to a wide range of preclinical imaging laboratories. Our intent is to provide minimum guidelines for routine quality control that can assist preclinical imaging specialists in setting up an appropriate quality control program for their facility.

Examination of the Quality of the Manual Pre-Sterilization Processing of Dental Instruments Using Benzidine Test

Summary The risk of infections in dental practices has been attracting for decades the interest of researchers from all over the world. A serious problem related to the transmission of blood-borne viruses is the thorough removal of organic matter, and mainly blood, from dental instruments when performing manual pre-sterilization decontamination. Application of benzidine test to prove the presence of blood traces on large and small dental instruments prepared for sterilization for the purpose of assessing the quality of the manual pre-sterilization decontamination. A total of 485 benzidine tests had been performed on selected 205 large and 280 small dental instruments visibly contaminated with blood. Of the total of 485 tested samples, blood traces were found in 63 (12.99 ± 1.53%). In the group of large instruments, positive benzidine test was obtained in 7.80% compared to 16.78% in the small instruments with the difference being statistically significant (p = 0.003). All 63 positive samples were additionally processed using ultrasound. Blood traces were found in 8 instruments with all of the positive samples being obtained from the barbed broaches. The manual cleaning does not guarantee decontamination of the dental instruments unlike the ultrasonic cleaning where any blood traces are being completely removed from the large instruments. In terms of the small instruments, there are still blood traces present after the ultrasonic cleaning which requires for it to be combined with a suitable enzyme cleaner, and the barbed broaches, as a requirement, should be used on a disposable basis.

Percutaneous nephrolithotomy in children with pediatric and adult-sized instruments

Pediatric stone disease is a significant health issue which has increased in incidence because of lifestyle changes, dietary habits, and obesity. The incidence of urolithiasis among pediatric age groups varies according to region and is high in Turkey. The management of stone disease in children has improved dramatically over the last two decades. The high success rate of percutaneous nephrolithotomy (PNL) have led modern researchers to suggest that it be used as a first-line treatment of kidney stones greater than 2cm in size. This study compared the outcomes, including morbidity and success rates, of different groups of pediatric patients who underwent PNL via pediatric- and adult-sized instruments. Percutaneous nephrolithotomy was performed in 194 children in a clinical setting between the years 2000 and 2015. Patients were categorized into 2 groups (group 1: pediatric-sized devices used, n=90 [46.4%]; group 2: adult-sized devices used, n=104 [53.6%]). The children in group 2 were further divided into subgroups: a 24F nephroscope was used for group 2a (n=84 [43.3%]) and a 26F nephroscope was used for group 2b (n=20 [10.3%]) (Figure). For this study, a total of 194 pediatric patients (99 boys and 95 girls ranging from 8 months to 17 years of age, with a mean age of 9.43 years) underwent PNL for the removal of kidney stones in a clinical setting. Between the examined groups, there were no significant differences in patient height or weight, stone site or localization, pre- and post-operative creatinine levels, duration of nephrostomy, or hospitalization time. There was also no significant variation in minor complications such as fever or urinary infection. However, the stone burden was notably smaller in the group wherein pediatric-sized nephroscopes were used. Additionally, the incidence of hemorrhage was markedly lower in groups where a 17F nephroscope was used than in groups where treatment was administered via 24 and 26F nephroscopes. Stone disease is considered to be relatively rare in childhood, but recent studies have indicated that it presents a considerable health problem. According to some researchers, a decrease in instrument size has not meaningfully reduced complication rates. In contrast, some studies have reported that the use of smaller sized nephroscopes may reduce rates of morbidity and mortality. In this study, success rates of PNL were similar across all groups, regardless of nephroscope size. However, the use of a 17F nephroscope significantly decreased the rate of hematocrit level reduction (p<0.001). While instrument size does not affect the success of PNL, smaller instruments can be used to reduce various complications such as bleeding.

Abstract 4249: Quantification of murine lung tumor pH in vivo by acidoCEST MRI

Abstract Introduction: Our objective was to accurately measure the extracellular pH (pHe) of lung tumors in vivo using an innovative, non-invasive imaging method known as acidoCEST MRI, to potentially improve the early detection of lung tumors via molecular imaging. Methods: A spontaneous murine lung tumor model was initiated through orthotopic injections of urethane in seven A/J mice to induce formation of lung adenocarcinomas. Starting at 8 weeks post injection, we performed coronal anatomical scans to monitor tumor growth with Bruker BioSpin 7T small animal MRI instrument. AcidoCEST MRI was then performed when tumors reached a diameter of 1 mm in one dimension at approximately 17 weeks post injection, followed by additional scans each month. For all MRI scans, mice were anesthetized with 2.0% isofluorane, the respiration rate was monitored, and body temperature was maintained at 37 °C. Respiration-triggering (gating) was used in all imaging sequences to compensate for motion artifacts in the lung. For optimal gating, the mouse's respiration rate was maintained at &amp;lt; 40 breaths per minute. Each mouse was scanned with acidoCEST MRI using 370 mg/mL iopamidol (200 μL IV bolus, 400 μL/hr IV infusion), using a 6 sec saturation period at 3.5 μT power, 300 ms acquisition time, with 468×468 μm spatial resolution, updated with improved respiration gating. Parametric maps of pixel-wise pHe values of the tumor were produced by fitting the Bloch-McConnell equations in Matlab 2014a. The average tumor pHe and concentration of iopamidol agent in the tumor tissue were recorded. Results: AcidoCEST MRI was successfully applied to the in vivo imaging of murine lung tumors. Our innovative, respiration-gated pulse sequence and Bloch-McConnell fitting method were essential to overcome the noise created by motion artifacts inherent in lung imaging. Lung tumors demonstrated successful uptake of the iopamidol contrast agent, with an average concentration of approximately 40 mM. The pH values in the tumor ranged from 6.5 to 7.0 with an average value of 6.64, demonstrating tumor acidosis. Anatomical MRI was used to monitor tumor growth from 1 mm diameter at 17 weeks post injection, to 4 mm diameter at 36 weeks post-injection. Conclusion: Our study has established that acidoCEST MRI can be used to quantify the pH of murine lung tumors in vivo, showing that this method is promising for improved early detection of lung tumors. These pHe measurements can be compared with tumor growth rates to determine how tumor acidosis correlates with aggressive phenotype. Tumor pHe measurements can also be related to concentration of the agent as a biomarker of vascular perfusion. Furthermore, the spatial heterogeneity of lung tumor pHe can be assessed with this noninvasive imaging method. Further pre-clinical studies are also warranted to determine if the acidoCEST MRI method is suitable for early therapy response monitoring. Citation Format: Leila R. Lindeman, Edward A. Randtke, Christine M. Howison, Kyle M. Jones, Mark D. Pagel. Quantification of murine lung tumor pH in vivo by acidoCEST MRI. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 4249.

Additive Manufacturing Design and Fabrication of Ceramic Cylindrical Ion Trap Mass Analyzer Chips for Miniaturized Mass Spectrometer Smart-Device (Internet of Things) Applications

The current computing power and network capabilities of handheld smart devices is helping to drive the development of new sensors, enabling the Internet of things. A chip-based mass spectrometer technology promises to offer a smart-device autonomous microsystem chemical analysis capability for sample determination and process monitoring for multiple applications in a small low-power instrument package. This project focuses on the development of cylindrical ion trap (CIT) mass analyzer chips fabricated using three-dimensional (3-D) additive manufacturing (AM) and planar low temperature cofired ceramic thick film processes for a chip-based mass spectrometer microsystem. The CIT is a mass analyzer composed of planar electrodes and operates by trapping and ejecting sample ions based on their mass in a radiofrequency field. Because of its simplicity, CITs may be easily miniaturized and connected in tandem to achieve multiplexing. AM materials and methods enable enhanced trap miniaturization through micromachining and electrode patterning methods, fast and cost-effective prototyping, batch fabrication, and material formulation flexibility. The current design incorporates three parallel ceramic plate metalized electrodes making up a singular trap geometry in a 10-mm2 ceramic chip, forming a mass analyzer of reduced size, mass, and power, with enhanced material robustness for extended range use and in harsh environments. Unique processes have been developed to produce these devices which include conformal metallization layers, adhesion layers, ceramic paste formulations, sacrificial supporting materials, and cofiring methods. Additionally, 3-D printing brings a unique design and fabrication capability enabling novel structures, material blending, and heterogeneous integration. With true digital control, the designs are easily scalable and shape agnostic.

변수변화에 따른 가변강성 메커니즘의 강성변화 경향성에 관한 연구

일반적으로 시스템을 강성체로 설계할 경우 시스템의 구조적 안정성을 확보할 수 있으나 유리잔을 잡거나 작은 수술용 도구로 사용하는 등의 사용용도에 따라 활용성이 제한될 수 있다. 이러한 문제를 해결하기 위하여 유연한 재질을 사용하여 강성조절이 가능한 메커니즘에 대한 연구가 다양하게 이루어져 왔다. 기존에 연구했던 강성체와 연성체의 연속구조로 이루어진 모델에 텐던을 삽입한 구조를 이용한 가변강성 메커니즘을 통하여 가변강성 구조체에 대한 가능성을 확인하였다. 그러나 필요로 하는 가변강성을 충족하기 위한 구조체의 설계 변수에 대한 연구가 필요하였다. 따라서 본 연구에서는 가변강성 메커니즘의 다양한 변수 변화에 따른 강성변화 실험을 통해 강성의 경향성을 파악하고자 하였다. 실험 결과 지름이 클수록 강성은 증가하며 강성의 증가폭 또한 늘어난다. 또한 연성체 길이가 짧을수록 강성이 증가하며 텐던을 당겨 연성체를 압착할 경우 강성값은 비선형적으로 증가하였다. 동일 조건에서 연성체 길이변화에 따른 강성 증가폭과 강성체의 길이 변화에 따른 강성 증가폭을 비교하였을 때 연성체 길이 변화가 강성체 길이 변화 보다 강성값 변화에 영향을 미친다는 것을 확인하였다. 또한, 해석값이 실험값에 비하여 정확성은 낮지만, 가변강성의 경향성을 확인하기 위하여 해석적인 방법을 통한 강성을 예측해보았다. 이러한 변수변화 실험 결과는 필요로 하는 강성값을 충족하는 가변강성 메커니즘 설계에 활용할 수 있을 것이다. In general, a system can be stable when it is designed with a rigid material. However, the use of a rigid system can be limited, such as grasping a glass or using a small surgical instrument. To resolve this limitation, a variable stiffness mechanism was developed using a flexible material. Previous research verified the variable stiffness mechanism where flexible segments and rigid segments were connected alternately in series. However, research into the design parameters of the variable stiffness structure is needed to satisfy the desired stiffness. Therefore, a variable stiffness structure was tested by varying the design parameters to confirm the trend of the stiffness variation. When the radius of the structure becomes larger, the stiffness increases. The stiffness increased with decreasing length of the flexible segments. Under the same design parameters, the length of the flexible segments had a greater effect on the stiffness than the length of the rigid segments. In addition, the stiffness was estimated using the pseudo rigid body model and was compared with the experimental results. This parametric study can be used as a design guideline for designing the variable stiffness mechanism to satisfy the desired stiffness.

TH‐EF‐204‐00: AAPM‐AMPR (Russia)‐SEFM (Spain) Joint Course On Challenges and Advantages of Small Field Radiation Treatment Techniques

Joanna E. Cygler, Jan Seuntjens, J. Daniel Bourland, M. Saiful Huq, Josep Puxeu Vaque, Daniel Zucca Aparicio, Tatiana Krylova, Yuri Kirpichev, Eric Ford, Caridad BorrasStereotactic Radiation Therapy (SRT) utilizes small static and dynamic (IMRT) fields, to successfully treat malignant and benign diseases using techniques such as Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT). SRT is characterized by sharp dose gradients for individual fields and their resultant dose distributions. For appropriate targets, small field radiotherapy offers improved treatment quality by allowing better sparing of organs at risk while delivering the prescribed target dose. Specialized small field treatment delivery systems, such as robotic‐controlled linear accelerators, gamma radiosurgery units, and dynamic arc linear accelerators may utilize rigid fixation, image guidance, and tumor tracking, to insure precise dose delivery to static or moving targets. However, in addition to great advantages, small field delivery techniques present special technical challenges for dose calibration due to unique geometries and small field sizes not covered by existing reference dosimetry protocols such as AAPM TG‐51 or IAEA TRS 398. In recent years extensive research has been performed to understand small field dosimetry and measurement instrumentation. AAPM, IAEA and ICRU task groups are expected to provide soon recommendations on the dosimetry of small radiation fields. In this symposium we will: 1] discuss the physics, instrumentation, methodologies and challenges for small field radiation dose measurements; 2] review IAEA and ICRU recommendations on prescribing, recording and reporting of small field radiation therapy; 3] discuss selected clinical applications and technical aspects for specialized image‐guided, small field, linear accelerator based treatment techniques such as IMRT and SBRT. Learning Objectives: To learn the physics of small fields in contrast to dosimetry of conventional fields To learn about detectors suitable for small fields To learn about the role of Monte Carlo simulations in determination of small field output factors To provide an overview of the IAEA small field dosimetry recommendations To provide an overview of the content of the ICRU report on Prescribing, Reporting and Recording of Small Field Radiation Therapy. To learn about special technical considerations in delivering IMRT and SBRT treatments To appreciate specific challenges of IMRT implementationJ. Seuntjens, Natural Sciences and Engineering Research Council; Canadian Institutes of Health Research

TH‐EF‐204‐04: Experience of IMRT and Other Conformal Techniques in Russia

Joanna E. Cygler, Jan Seuntjens, J. Daniel Bourland, M. Saiful Huq, Josep Puxeu Vaque, Daniel Zucca Aparicio, Tatiana Krylova, Yuri Kirpichev, Eric Ford, Caridad BorrasStereotactic Radiation Therapy (SRT) utilizes small static and dynamic (IMRT) fields, to successfully treat malignant and benign diseases using techniques such as Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT). SRT is characterized by sharp dose gradients for individual fields and their resultant dose distributions. For appropriate targets, small field radiotherapy offers improved treatment quality by allowing better sparing of organs at risk while delivering the prescribed target dose. Specialized small field treatment delivery systems, such as robotic‐controlled linear accelerators, gamma radiosurgery units, and dynamic arc linear accelerators may utilize rigid fixation, image guidance, and tumor tracking, to insure precise dose delivery to static or moving targets. However, in addition to great advantages, small field delivery techniques present special technical challenges for dose calibration due to unique geometries and small field sizes not covered by existing reference dosimetry protocols such as AAPM TG‐51 or IAEA TRS 398. In recent years extensive research has been performed to understand small field dosimetry and measurement instrumentation. AAPM, IAEA and ICRU task groups are expected to provide soon recommendations on the dosimetry of small radiation fields. In this symposium we will: 1] discuss the physics, instrumentation, methodologies and challenges for small field radiation dose measurements; 2] review IAEA and ICRU recommendations on prescribing, recording and reporting of small field radiation therapy; 3] discuss selected clinical applications and technical aspects for specialized image‐guided, small field, linear accelerator based treatment techniques such as IMRT and SBRT. Learning Objectives: To learn the physics of small fields in contrast to dosimetry of conventional fields To learn about detectors suitable for small fields To learn about the role of Monte Carlo simulations in determination of small field output factors To provide an overview of the IAEA small field dosimetry recommendations To provide an overview of the content of the ICRU report on Prescribing, Reporting and Recording of Small Field Radiation Therapy. To learn about special technical considerations in delivering IMRT and SBRT treatments To appreciate specific challenges of IMRT implementationJ. Seuntjens, Natural Sciences and Engineering Research Council; Canadian Institutes of Health Research

TH‐EF‐204‐05: Application of Small‐Field Treatment: The Promises and Pitfalls of SBRT

Joanna E. Cygler, Jan Seuntjens, J. Daniel Bourland, M. Saiful Huq, Josep Puxeu Vaque, Daniel Zucca Aparicio, Tatiana Krylova, Yuri Kirpichev, Eric Ford, Caridad BorrasStereotactic Radiation Therapy (SRT) utilizes small static and dynamic (IMRT) fields, to successfully treat malignant and benign diseases using techniques such as Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT). SRT is characterized by sharp dose gradients for individual fields and their resultant dose distributions. For appropriate targets, small field radiotherapy offers improved treatment quality by allowing better sparing of organs at risk while delivering the prescribed target dose. Specialized small field treatment delivery systems, such as robotic‐controlled linear accelerators, gamma radiosurgery units, and dynamic arc linear accelerators may utilize rigid fixation, image guidance, and tumor tracking, to insure precise dose delivery to static or moving targets. However, in addition to great advantages, small field delivery techniques present special technical challenges for dose calibration due to unique geometries and small field sizes not covered by existing reference dosimetry protocols such as AAPM TG‐51 or IAEA TRS 398. In recent years extensive research has been performed to understand small field dosimetry and measurement instrumentation. AAPM, IAEA and ICRU task groups are expected to provide soon recommendations on the dosimetry of small radiation fields. In this symposium we will: 1] discuss the physics, instrumentation, methodologies and challenges for small field radiation dose measurements; 2] review IAEA and ICRU recommendations on prescribing, recording and reporting of small field radiation therapy; 3] discuss selected clinical applications and technical aspects for specialized image‐guided, small field, linear accelerator based treatment techniques such as IMRT and SBRT. Learning Objectives: To learn the physics of small fields in contrast to dosimetry of conventional fields To learn about detectors suitable for small fields To learn about the role of Monte Carlo simulations in determination of small field output factors To provide an overview of the IAEA small field dosimetry recommendations To provide an overview of the content of the ICRU report on Prescribing, Reporting and Recording of Small Field Radiation Therapy. To learn about special technical considerations in delivering IMRT and SBRT treatments To appreciate specific challenges of IMRT implementationJ. Seuntjens, Natural Sciences and Engineering Research Council; Canadian Institutes of Health Research

TH‐EF‐204‐01: Introduction

Joanna E. Cygler, Jan Seuntjens, J. Daniel Bourland, M. Saiful Huq, Josep Puxeu Vaque, Daniel Zucca Aparicio, Tatiana Krylova, Yuri Kirpichev, Eric Ford, Caridad BorrasStereotactic Radiation Therapy (SRT) utilizes small static and dynamic (IMRT) fields, to successfully treat malignant and benign diseases using techniques such as Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT). SRT is characterized by sharp dose gradients for individual fields and their resultant dose distributions. For appropriate targets, small field radiotherapy offers improved treatment quality by allowing better sparing of organs at risk while delivering the prescribed target dose. Specialized small field treatment delivery systems, such as robotic‐controlled linear accelerators, gamma radiosurgery units, and dynamic arc linear accelerators may utilize rigid fixation, image guidance, and tumor tracking, to insure precise dose delivery to static or moving targets. However, in addition to great advantages, small field delivery techniques present special technical challenges for dose calibration due to unique geometries and small field sizes not covered by existing reference dosimetry protocols such as AAPM TG‐51 or IAEA TRS 398. In recent years extensive research has been performed to understand small field dosimetry and measurement instrumentation. AAPM, IAEA and ICRU task groups are expected to provide soon recommendations on the dosimetry of small radiation fields. In this symposium we will: 1] discuss the physics, instrumentation, methodologies and challenges for small field radiation dose measurements; 2] review IAEA and ICRU recommendations on prescribing, recording and reporting of small field radiation therapy; 3] discuss selected clinical applications and technical aspects for specialized image‐guided, small field, linear accelerator based treatment techniques such as IMRT and SBRT. Learning Objectives: To learn the physics of small fields in contrast to dosimetry of conventional fields To learn about detectors suitable for small fields To learn about the role of Monte Carlo simulations in determination of small field output factors To provide an overview of the IAEA small field dosimetry recommendations To provide an overview of the content of the ICRU report on Prescribing, Reporting and Recording of Small Field Radiation Therapy. To learn about special technical considerations in delivering IMRT and SBRT treatments To appreciate specific challenges of IMRT implementationJ. Seuntjens, Natural Sciences and Engineering Research Council; Canadian Institutes of Health Research

TH‐EF‐204‐02: Small Field Radiation Therapy: Physics and Recent Recommendations From IAEA and ICRU

Joanna E. Cygler, Jan Seuntjens, J. Daniel Bourland, M. Saiful Huq, Josep Puxeu Vaque, Daniel Zucca Aparicio, Tatiana Krylova, Yuri Kirpichev, Eric Ford, Caridad BorrasStereotactic Radiation Therapy (SRT) utilizes small static and dynamic (IMRT) fields, to successfully treat malignant and benign diseases using techniques such as Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT). SRT is characterized by sharp dose gradients for individual fields and their resultant dose distributions. For appropriate targets, small field radiotherapy offers improved treatment quality by allowing better sparing of organs at risk while delivering the prescribed target dose. Specialized small field treatment delivery systems, such as robotic‐controlled linear accelerators, gamma radiosurgery units, and dynamic arc linear accelerators may utilize rigid fixation, image guidance, and tumor tracking, to insure precise dose delivery to static or moving targets. However, in addition to great advantages, small field delivery techniques present special technical challenges for dose calibration due to unique geometries and small field sizes not covered by existing reference dosimetry protocols such as AAPM TG‐51 or IAEA TRS 398. In recent years extensive research has been performed to understand small field dosimetry and measurement instrumentation. AAPM, IAEA and ICRU task groups are expected to provide soon recommendations on the dosimetry of small radiation fields. In this symposium we will: 1] discuss the physics, instrumentation, methodologies and challenges for small field radiation dose measurements; 2] review IAEA and ICRU recommendations on prescribing, recording and reporting of small field radiation therapy; 3] discuss selected clinical applications and technical aspects for specialized image‐guided, small field, linear accelerator based treatment techniques such as IMRT and SBRT. Learning Objectives: To learn the physics of small fields in contrast to dosimetry of conventional fields To learn about detectors suitable for small fields To learn about the role of Monte Carlo simulations in determination of small field output factors To provide an overview of the IAEA small field dosimetry recommendations To provide an overview of the content of the ICRU report on Prescribing, Reporting and Recording of Small Field Radiation Therapy. To learn about special technical considerations in delivering IMRT and SBRT treatments To appreciate specific challenges of IMRT implementationJ. Seuntjens, Natural Sciences and Engineering Research Council; Canadian Institutes of Health Research

TH‐EF‐204‐03: Determination of Small Field Output Factors, Advantages and Limitations of Monte Carlo Simulation

Joanna E. Cygler, Jan Seuntjens, J. Daniel Bourland, M. Saiful Huq, Josep Puxeu Vaque, Daniel Zucca Aparicio, Tatiana Krylova, Yuri Kirpichev, Eric Ford, Caridad BorrasStereotactic Radiation Therapy (SRT) utilizes small static and dynamic (IMRT) fields, to successfully treat malignant and benign diseases using techniques such as Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT). SRT is characterized by sharp dose gradients for individual fields and their resultant dose distributions. For appropriate targets, small field radiotherapy offers improved treatment quality by allowing better sparing of organs at risk while delivering the prescribed target dose. Specialized small field treatment delivery systems, such as robotic‐controlled linear accelerators, gamma radiosurgery units, and dynamic arc linear accelerators may utilize rigid fixation, image guidance, and tumor tracking, to insure precise dose delivery to static or moving targets. However, in addition to great advantages, small field delivery techniques present special technical challenges for dose calibration due to unique geometries and small field sizes not covered by existing reference dosimetry protocols such as AAPM TG‐51 or IAEA TRS 398. In recent years extensive research has been performed to understand small field dosimetry and measurement instrumentation. AAPM, IAEA and ICRU task groups are expected to provide soon recommendations on the dosimetry of small radiation fields. In this symposium we will: 1] discuss the physics, instrumentation, methodologies and challenges for small field radiation dose measurements; 2] review IAEA and ICRU recommendations on prescribing, recording and reporting of small field radiation therapy; 3] discuss selected clinical applications and technical aspects for specialized image‐guided, small field, linear accelerator based treatment techniques such as IMRT and SBRT. Learning Objectives: To learn the physics of small fields in contrast to dosimetry of conventional fields To learn about detectors suitable for small fields To learn about the role of Monte Carlo simulations in determination of small field output factors To provide an overview of the IAEA small field dosimetry recommendations To provide an overview of the content of the ICRU report on Prescribing, Reporting and Recording of Small Field Radiation Therapy. To learn about special technical considerations in delivering IMRT and SBRT treatments To appreciate specific challenges of IMRT implementationJ. Seuntjens, Natural Sciences and Engineering Research Council; Canadian Institutes of Health Research

TH‐EF‐204‐06: Closing

Joanna E. Cygler, Jan Seuntjens, J. Daniel Bourland, M. Saiful Huq, Josep Puxeu Vaque, Daniel Zucca Aparicio, Tatiana Krylova, Yuri Kirpichev, Eric Ford, Caridad BorrasStereotactic Radiation Therapy (SRT) utilizes small static and dynamic (IMRT) fields, to successfully treat malignant and benign diseases using techniques such as Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT). SRT is characterized by sharp dose gradients for individual fields and their resultant dose distributions. For appropriate targets, small field radiotherapy offers improved treatment quality by allowing better sparing of organs at risk while delivering the prescribed target dose. Specialized small field treatment delivery systems, such as robotic‐controlled linear accelerators, gamma radiosurgery units, and dynamic arc linear accelerators may utilize rigid fixation, image guidance, and tumor tracking, to insure precise dose delivery to static or moving targets. However, in addition to great advantages, small field delivery techniques present special technical challenges for dose calibration due to unique geometries and small field sizes not covered by existing reference dosimetry protocols such as AAPM TG‐51 or IAEA TRS 398. In recent years extensive research has been performed to understand small field dosimetry and measurement instrumentation. AAPM, IAEA and ICRU task groups are expected to provide soon recommendations on the dosimetry of small radiation fields. In this symposium we will: 1] discuss the physics, instrumentation, methodologies and challenges for small field radiation dose measurements; 2] review IAEA and ICRU recommendations on prescribing, recording and reporting of small field radiation therapy; 3] discuss selected clinical applications and technical aspects for specialized image‐guided, small field, linear accelerator based treatment techniques such as IMRT and SBRT. Learning Objectives: To learn the physics of small fields in contrast to dosimetry of conventional fields To learn about detectors suitable for small fields To learn about the role of Monte Carlo simulations in determination of small field output factors To provide an overview of the IAEA small field dosimetry recommendations To provide an overview of the content of the ICRU report on Prescribing, Reporting and Recording of Small Field Radiation Therapy. To learn about special technical considerations in delivering IMRT and SBRT treatments To appreciate specific challenges of IMRT implementationJ. Seuntjens, Natural Sciences and Engineering Research Council; Canadian Institutes of Health Research

Quality assessment of solar UV irradiance measured with array spectroradiometers

Abstract. The reliable quantification of ultraviolet (UV) radiation at the earth's surface requires accurate measurements of spectral global solar UV irradiance in order to determine the UV exposure to human skin and to understand long-term trends in this parameter. Array spectroradiometers (ASRMs) are small, light, robust and cost-effective instruments, and are increasingly used for spectral irradiance measurements. Within the European EMRP ENV03 project “Solar UV”, new devices, guidelines and characterization methods have been developed to improve solar UV measurements with ASRMs, and support to the end user community has been provided. In order to assess the quality of 14 end user ASRMs, a solar UV intercomparison was held on the measurement platform of the World Radiation Center (PMOD/WRC) in Davos, Switzerland, from 10 to 17 July 2014. The results of the blind intercomparison revealed that ASRMs, currently used for solar UV measurements, show a large variation in the quality of their solar UV measurements. Most of the instruments overestimate the erythema-weighted UV index – in particular at large solar zenith angles – due to stray light contribution in the UV-B range. The spectral analysis of global solar UV irradiance further supported the finding that the uncertainties in the UV-B range are very large due to stray light contribution in this wavelength range. In summary, the UV index may be detected by some commercially available ASRMs within 5 % compared to the world reference spectroradiometer, if well characterized and calibrated, but only for a limited range of solar zenith angles. Generally, the tested instruments are not yet suitable for solar UV measurements for the entire range between 290 and 400 nm under all atmospheric conditions.

Ex vivo evaluation of four final irrigation protocols on the removal of hard-tissue debris from the mesial root canal system of mandibular first molars.

To evaluate the efficacy of four final irrigation protocols on the reduction of hard-tissue debris accumulated within the mesial root canal system of mandibular first molars using micro-CT analysis. Forty mesial roots of mandibular molars with a single and continuous isthmus connecting the mesiobuccal and mesiolingual canals (Vertucci's Type I configuration) were selected and scanned at a resolution of 8.6μm. Canals were enlarged sequentially using WaveOne Small and Primary instruments activated in reciprocating motion without intracanal irrigation to allow debris to accumulate within the mesial root canal system. Then, specimens were anatomically matched and distributed into four groups (n=10), according to the final irrigation protocol: apical positive pressure (APP), passive ultrasonic irrigation (PUI), Self-adjusting File (SAF) and XP-endo Finisher (XPF). The final irrigation procedures were performed over 2min using a total of 5.5mL of 2.5% NaOCl per canal. Reconstructed data sets were coregistered, and the mean percentage reduction of accumulated hard-tissue debris after the final irrigation procedures was compared statistically between groups using the anovapost hoc Tukey test with a significance level set at 5%. Reduction of accumulated hard-tissue debris was observed in all groups after the final irrigation protocol. Overall, PUI and XPF groups had higher mean percentage reductions of accumulated hard-tissue debris (94.1% and 89.7%, respectively) than APP and SAF groups (45.7% and 41.3%, respectively) (P<0.05). No significant differences were found when comparing the results of PUI and XPF groups (P>0.05) or APP and SAF groups (P>0.05). The PUI technique and XP-endo Finisher instrument were associated with significantly lower levels of AHTD compared with conventional irrigation and the modified SAF system protocol in mesial root canals of mandibular molars.