Soft Bolus Research Articles

Analisis Penggunaan Bolus Lunak terhadap Distribusi Dosis pada Penyinaran Karsinoma Sel Skuamosa Facial dengan Teknik IMRT di Departemen Radioterapi MRCCC Siloam Hospital Semanggi

Background: Diagnostically, Facial Squamous Cell Carcinoma develops in the areas of the face that are uneven in nature on the surface of the skin. For that reason, irradiation in this area can cause any inhomogeneous dose distribution and increase the potential for the emergence of new cancer due to radiation exposure to the surrounding healthy tissue; therefore, it is necessary to use a soft bolus which is combined with IMRT radiation technique to make the dose distribution more optimal. Methods: This research applies descriptive qualitative method with one sample taken from secondary data of the patients with Facial Squamous Cell Carcinoma cases using a soft bolus with IMRT technique. As for the research methods, they include among the other things literature study, observation, interviews, and documentation. Meanwhile, this research was conducted starting from February up to May 2024 executed at Radiotherapy Department of MRCCC Siloam Hospital Semanggi. Results: IMRT technique is used with the use of MLC and irradiation from several angles combined with the use of a soft bolus made from plasticine to increase the surface dose and optimize the dose distribution. Apparently, the planning result suggests that the distribution of doses in the organ at risk against the tolerated dose shows that the right eye is above tolerance; however, the other organs at risk such as brainstem, chiasm, eye left, lens left, lens right, optic nerve left, and optic nerve right are below the tolerance. Conclusions: The planning results highlight that the use of IMRT technique combined with a soft bolus increases surface dose and optimizes dose distribution in Facial Squamous Cell Carcinoma irradiation, while ensuring most organs at risk remain within tolerance levels except for the right eye.

Functional treatment of bilateral posterior crossbite improves mandibular kinematics during chewing.

To evaluate the effects of treatment of bilateral posterior crossbite (BPXB) on mandibular kinematics by the percentage of reverse chewing cycles (RCCs) during soft and hard bolus chewing before and after the correction of the malocclusion with function-generating bite (FGB). This prospective study included 71 subjects: 19 patients with occlusally symmetric BPXB (M = 9; F = 10; mean age 9.3 ± 2.2[yr.mo]), 32 patients with occlusally asymmetric BPXB (19 with more teeth in crossbite on the right side (right prevalent side), M = 7; F = 12; mean age 8.2 ± 1.6 [yr.mo] and 13 on the left side, M = 7; F = 6; mean age 9.6 ± 1.9 [yr.mo]) and 20 controls without malocclusion (M = 8; F = 12; mean age 10.2 ± 1.7 [yr.mo]). Masticatory patterns were recorded before (T0) and after (T1) the correction of the malocclusion with FGB, with the K7-I® kinesiograph using standardized soft and hard boluses. BPXB was corrected in all included patients. At T0, the percentage of RCCs in BPXB was significantly increased compared to controls (P < .0001); symmetric BPXB showed no difference in RCCs between the sides, whereas asymmetric BPXB showed significantly more RCCs on the side with more teeth in crossbite (prevalent side). After treatment with FGB (T1), the percentage of RCCs was significantly reduced in both symmetric BPXB patients (soft bolus, P = .003; hard bolus, P < .001) and asymmetric BPXB patients (prevalent side: soft and hard bolus, P < .00001; non-prevalent side: soft bolus, P = .01 and hard bolus, P = .0002). Functional correction of BPXB with FGB significantly improved mandibular kinematics during chewing.

Conformity between modified Swallowing Outcome After Laryngectomy questionnaire and Flexible Endoscopic Evaluation of Swallowing in laryngeal carcinoma patients after total laryngectomy

Background:One of the impacts in anatomic laryngeal and phariyngeal changes after total laryngectomy (TL) is oropharyngeal dysphagia (OPD). The detection of neopharyngeal residue as a sign of OPD can be performed by videofluoroscopy (VFS) and flexible endoscopic evaluation of swallowing (FEES). The availability of these tools in rural areas is still limited, thus the treatment of OPD is not maximal. There is a need for a more practical tool, including the modified swallowing outcomes after laryngectomy (SOAL) questionnaire.Methods:This was an analytic observational diagnostic study with a cross-sectional approach. Samples were obtained in Otorhinolaryngology Oncology Clinic and Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, who filled SOAL modified questionnaire followed by FEES. Samples were obtained within 3 months from 10 May to 10 August 2021. The number of samples obtained through simple random sampling was 16 post-TL patients from a total population of 17 patients who met the inclusion and exclusion criteria. The conformity test between modified SOAL questionnaire and FEES was analyzed using McNemar comparison test and Kappa association test.Results:McNemar test showed no significant difference between both assessment tools (p > 0.05), and the Kappa test showed an association between both tools (p < 0.05). The results of this study stated that there was conformity between modified SOAL questionnaire and FEES in patients after TL in all types of food bolus had Kappa score of >0.81, showing a reliable association between these tools. Kappa test also showed that out of all three types of boluses, the soft bolus had the highest conformity with a Kappa score of 0.875, followed by thick bolus with 0.839, and watery bolus with 0.818.Conclusion:There was a conformity between the results of the modified SOAL questionnaire and FEES in head and neck surgery patients after TL.

Spinal disorders and mastication: The potential relationship between adolescent idiopathic scoliosis and alterations of the chewing patterns.

To evaluate mastication in a group of patients with adolescent idiopathic scoliosis (AIS) with a control group, by means of the prevalence of reverse chewing cycles (RCCs). This study included a group of patients (N=32; F=24; M=8; mean age ± SD=14 ± 3 years) with a confirmed diagnosis of AIS and a group of control subjects (N=32; F=24; M=8; mean age ± SD=13 ± 6 years) without spinal disorders. Mastication was recorded with both a hard and a soft bolus, following a standardized protocol, and the prevalence of RCCs was compared between the groups. The prevalence of RCCs was significantly higher in the AIS group, with both a soft and a hard bolus, compared to the control group (P < .001). The results of this study indicate that the presence of AIS influences mastication, one of the main functions of the stomatognathic system. A multidisciplinary approach to these patients may be relevant in providing the best possible treatment outcomes.

Correlation of Pharyngeal Residue with PenetrationAspiration in Post-Radiotherapy Nasopharyngeal Carcinoma Patients with Oropharyngeal Dysphagia

Background: Nasopharyngeal carcinoma (NPC) ranks first for head and neck malignancies, and radiotherapyis a recommended treatment. Most post-radiotherapy NPC patients experience oropharyngeal dysphagia thatresults in pharyngeal residue. Pharyngeal residue is thought to be a risk factor for aspiration-penetration.Objective: Examining the correlation between pharyngeal residue and penetration-aspiration in postradiotherapy NPC patients.Method: Participants have been identified since 2018 to find out the total number of NPC patients. Inthe period January-October 2019, identification of NPC patients was performed according to participantcriteria. Participants were examined for fiberoptic endoscopic evaluation of swallowing (FEES), pharyngealresidue using the Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS), and penetration-aspirationusing Penetration-Aspiration Scale (PAS). Statistical tests were used Spearman correlation test with p&lt;0.05.Results: The highest participant’s pharyngeal residue appeared in vallecula when given soft bolus (96.55%),and in pyriform sinus when given thick liquid bolus (72.41%). Most participants with soft bolus had thehighest negative penetration (72.59%) and positive penetration in thick liquid bolus (51.72%), while mosthad negative aspirations with the lowest value (89.66%). There is aspiration in 10.34% of patients whengiven a dilute liquid. There was a significant correlation between pharyngeal residue in vallecula andpyriform sinus with penetration-aspiration (p&lt;0.05). There was a positive association with the use of softbolus (r=0.623), thick liquid bolus (r=0.631), and dilute liquid bolus (r=0.891).Conclusions: There is a significant association between pharyngeal residue and penetration-aspiration inpost-radiotherapy NPC patients.

Retrospective chart review: seasonal variation in incidence of bolus impaction is maintained and statistically significant in subgroups with atopy and eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition with eosinophilic infiltration of the esophageal mucosa. The most prominent symptom is dysphagia, which may result in esophageal bolus impaction in need of surgical extraction. To investigate whether an earlier reported seasonal variation in esophageal bolus impaction present only in a subgroup of patients with EoE and atopic disorders could be confirmed in this larger study. A single center retrospective chart review of patients who were diagnosed with esophageal bolus impaction between January 2004 and December 2017 was performed. Clinical, epidemiological and histologic data were collected. A total of 755 cases with esophageal bolus impaction were reviewed. A significantly higher occurrence of soft bolus impaction in summer and fall was shown in cases with confirmed EoE and in cases with atopy but not in the nonatopic group or in the group with a negative biopsy result. EoE was found in 48% of biopsied patients. A significant seasonal variation in cases with esophageal bolus impaction and concomitant atopy and EoE is confirmed, but the study design does not allow a causative role of allergens to be established.

Lost and found: missing denture in an amnesic elderly man

A 74-year-old man with Alzheimer’s disease was brought to the emergency department for aphagia of 1 day duration. He was noticed to be drooling saliva with otherwise stable vital signs....

Three-dimensional printer-aided casting of soft, custom silicone boluses (SCSBs) for head and neck radiation therapy

PurposeCustom tissue compensators provide dosimetric advantages for treating superficial or complex anatomy, but currently available fabrication technology is expensive or impractical for most clinical operations and yields compensators that are difficult for patients to tolerate. We aimed to develop an inexpensive, clinically feasible workflow for generating patient-specific, soft, custom silicone boluses (SCSBs) for head-and-neck (HN) radiation therapy. Methods and materialsWe developed a method using 3-dimensional printed parts for generating SCSBs for the treatment of HN cancers. The clinical workflow for generation of SCSBs was characterized inclusive of patient simulation to treatment in terms of resource time and cost. Dosimetric properties such as percentage depth dose and dose profiles were measured for SCSBs using GaF films. Comprehensive measurements were also conducted on an HN phantom. SCSBs were generated and used for electron or photon based radiation treatments of 7 HN patients with lesions at nose, cheek, eye, or ears. In vivo dose measurements with optically simulated luminescence dosimeters were performed. ResultsTotal design and fabrication time from patient simulation to radiation treatment start required approximately 1 week, with fabrication constituting 1 to 2 working days depending on bolus surface area, volume, and complexity. Computed tomography and dosimetric properties of the soft bolus were similar to water. In vivo dose measurements on 7 treated patients confirmed that the dose deposition conformed to planned doses. Material costs were lower than currently available hard plastic boluses generated with 3-dimensional printing technology. All treated patients tolerated SCSBs for the duration of therapy. ConclusionsGeneration and use of SCSBs for clinical use is feasible and effective for the treatment of HN cancers.

Effects of therapy on masseter activity and chewing kinematics in patients with unilateral posterior crossbite

ObjectiveTo describe the effects of therapy on masseter activity and chewing kinematic in patients with unilateral posterior crossbite (UPC). DesignFifty children (age: mean±SD: 9.1±2.3years) with UPC (34 on the right side, 16 on the left side) and twenty children (age: 9.5±2.6years) with normal occlusion were selected for the study. The mandibular motion and the muscular activity during chewing soft and hard boli were simultaneously recorded, before and after correction with function generating bite, after a mean treatment time of 7.3±2.4months plus the retention time of 5–6 months. The percentage of reverse cycles and the percent difference between ipsilateral and contralateral peaks of the masseter electromyography envelopes were computed. ResultsBefore therapy, the percentage of reverse cycles during chewing on the crossbite side was greater in patients than in controls (P<0.001) and significantly reduced after therapy (P<0.001) towards the reference normal value (soft bolus; pre: 57±30%, post:12±17%; hard bolus; pre: 65±34%, post: 12±13%; reference value: soft bolus 4±2%, hard bolus 5±3%). Before therapy the percent difference between electromyography envelope peaks in patients was lower than in controls (P<0.01) and significantly increased after therapy (P<0.05) becoming similar to the reference normal value. ConclusionsThe correction induced a normal-like coordination of masseter muscles activity together with a significant reduction of the reverse chewing patterns. The previous altered muscular activation corresponded to the altered kinematics of reverse chewing cycles that might be considered a useful indicator of the severity of the masticatory function involvement.

SU‐C‐213‐03: Custom 3D Printed Boluses for Radiation Therapy

Purpose:To develop a clinical workflow and to commission the process of creating custom 3d printed boluses for radiation therapy.Methods:We designed a workflow to create custom boluses using a commercial 3D printer. Contours of several patients were deformably mapped to phantoms where the test bolus contours were designed. Treatment plans were created on the phantoms following our institutional planning guideline. The DICOM file of the bolus contours were then converted to stereoLithography (stl) file for the 3d printer. The boluses were printed on a commercial 3D printer using polylactic acid (PLA) material. Custom printing parameters were optimized in order to meet the requirement of bolus composition. The workflow was tested on multiple anatomical sites such as skull, nose and chest wall. The size of boluses varies from 6×9cm2 to 12×25cm2. To commission the process, basic CT and dose properties of the printing materials were measured in photon and electron beams and compared against water and soft superflab bolus. Phantoms were then scanned to confirm the placement of custom boluses. Finally dose distributions with rescanned CTs were compared with those computer‐generated boluses.Results:The relative electron density(1.08±0.006) of the printed boluses resemble those of liquid tap water(1.04±0.004). The dosimetric properties resemble those of liquid tap water(1.04±0.004). The dosimetric properties were measured at dmax with an ion chamber in electron and photon open beams. Compared with solid water and soft bolus, the output difference was within 1% for the 3D printer material. The printed boluses fit well to the phantom surfaces on CT scans. The dose distribution and DVH based on the printed boluses match well with those based on TPS generated boluses.Conclusion:3d printing provides a cost effective and convenient solution for patient‐specific boluses in radiation therapy.

Pharmacological Management of Esophageal Food Bolus Impaction

Background. Soft esophageal bolus impaction is an emergency that requires skilled endoscopic removal if persistent obstructive symptoms do not resolve spontaneously after careful observation. Expedited care of these patients is crucial to avoid respiratory and mechanical complications. Other possible options for management include medical agents used to manage it prior to performing endoscopy if access to endoscopy was not available or declined by the patient. Aim. To review the available pharmacological and other nonmedicinal options and their mechanism of relief for soft esophageal impaction. Method. Pubmed, Medline and Ovid were used for search of MESH terms pertinent including “foreign body, esophageal, esophageal bolus and medical” for pharmacological and non medicinial agents used for management of esophageal soft bolus impaction as well as manual review of the cross-references. Results. Several agents were identified including Buscopan, Glucagon, nitrates, calcium channel blockers, and papaveretum. Non medicinal agents are water, effervescent agents, and papain. No evidence was found to suggest preference or effectiveness of use of a certain pharmacological agent compared to others. Buscopan, Glucagon, benzodiazepines, and nitrates were studied extensively and may be used in selected patients with caution. Use of papain is obsolete in management of soft bolus impaction.

Muscular activation during reverse and non‐reverse chewing cycles in unilateral posterior crossbite

The aim of this study was to characterize the kinematics and masseter muscle activation in unilateral posterior crossbite. Eighty-two children (8.6 +/- 1.3 yr of age) with unilateral posterior crossbite and 12 children (8.9 +/- 0.6 yr of age) with normal occlusion were selected for the study. Electromyography (EMG) and kinematics were concurrently recorded during mastication of a soft bolus and a hard bolus. The percentage of reverse cycles in the group of patients was 59.0 +/- 33.1% (soft bolus) and 69.7 +/- 29.7% (hard bolus) when chewing on the crossbite side. When chewing on the non-affected side, the number of reverse cycles was 16.7 +/- 24.5% (soft bolus) and 16.7 +/- 22.3% (hard bolus). The reverse cycles on the crossbite side were narrower with respect to the cycles on the non-affected side. Although both types of cycles in patients resulted in lower EMG activity of the masseter of the crossbite side than of the contralateral masseter, the activity of the non-affected side was larger for reverse than for non-reverse cycles. It was concluded that when chewing on the crossbite side, the masseter activity is reduced on the mastication side (crossbite) and is unaltered (non-reverse cycles) or increased (reverse) on the non-affected side.

Effect of bolus hardness on the chewing pattern and activation of masticatory muscles in subjects with normal dental occlusion

The aim of the study was to evaluate the effect of bolus hardness on the kinematic of mastication and jaw-elevator muscle activity in subjects with normal dental occlusion and function. The mandibular motion and the surface EMG envelope of the masseter and temporalis anterior muscles were assessed in twelve subjects during mastication of a soft and hard bolus of the same size. When chewing the hard bolus, the chewing pattern in the frontal plane was significantly higher and wider, with smaller closure angle and higher peak velocity than when chewing the soft bolus. EMG peak amplitude of both the masseter and anterior temporalis muscles was higher for the side of the bolus but the contralateral side increased its activity significantly more than the ipsilateral side when the hardness of the bolus increased (for the masseter, mean ± SD: 130.4 ± 108.1% increase for the contralateral side and 29.6 ± 26.9% for the ipsilateral side). Moreover, the peak EMG activity for both muscles occurred more distant from the closure point with hard bolus. The increased activity of the contralateral side may help maintaining the mandibular equilibrium, with indirect participation to the power stroke generated by the chewing-side masseter. The results provide kinematic and EMG adaptations to bolus hardness in healthy subjects and can be used as normative data in the development of methods for early diagnosis of impaired chewing function.

Dose measurements near a non-radioactive gold seed using radiographic film

The dose distribution near a non-radioactive gold seed under a 6 MV photon beam was measured using radiographic film, water equivalent bolus and solid water slabs. This type of small seed is typically used as a marker in target positional verification using a portal imager for conformal prostate treatment such as intensity modulated radiation therapy. A stack of three films was placed on top of the seed located on a soft bolus. Solid water slabs were then placed on top of the film. The films were exposed using a small 1 × 1 cm2 field. Then, using a similar experimental set-up and exposure, another stack of three films was placed under the seed, which was then covered by the soft bolus and solid water slabs. The cross-plane axial beam profiles at different depths, depending on the thickness of the film package, were measured. From the group of beam profiles above and below the seed, the dose distribution along a selected vertical line within the profiles was easily plotted. Compared to the dose with no seed at the isocentre and 5 cm of solid water, there was about a 21% increase in dose at 0.35 mm above the seed. On the other hand, there was about a 22% decrease in dose at the same distance below the seed. The dosimetry of the calibrated film was verified with a MOSFET detector. The change in dose due to the seed by varying the incident beam angles was also measured for this note.

Food and Foreign Body Impaction In Upper GI Tract

Background: Ingestion of foreign bodies and food impaction are the most common cause of esophageal obstruction, which is considered as acute emergency, this obstruction can be caused by soft, blunt, and sharp objects. Endoscopy is considered as the main therapeutic procedure, surgical intervention is rarely needed. Methods: a retrospective study of all patients' records with acute esophageal obstruction or presence of radio-opaque foreign body in esophagus or stomach. Urgent EGD used to be done in outpatient clinic, or elective, if the patient has the foreign body days in the stomach. XQ10, XV10, and Q20 Olympus gastroscopes were used, retrieval was carried out by snare or tetrapode grasper, over tube was used once indicated. Conscious sedation, by using titrated doses of Medazolam, or GA if sedation was not enough. Patients were classified according to esophageal pathology, and type of obstructing object. Results: All records of 77patients from 1992-Nov 2003 presented with either esophageal obstruction, or a radio-opaque shadow were reviewed, mean age 28.2 years ( 1-80 years), total events 81, M:F 38:39, total number of EGD in that period 4522. Cause of obstruction, and management were as follows:- (Insert table) * Soft, ** Blunt, **Sharp Four patients with gastric bezoars 3 were removed, and one trichobezoar was fragmented and pushed completely on 3rd sessions. Three pins, in 3 patients were embedded in full stomach and could not be seen, passed with stool. The blade was removed by snare with over tube protection. And in 3 patients negative EGD. Conclusion: foreign bodies and impacted food can be successfully managed by gastroscopy in most cases, (93%). Failure is due to embedded bones in upper esophagus, and surgery is the treatment. Either extracting or pushing techniques are effective. Coins and coins like impaction occurred in normal esophagus, mainly in children, while soft bolus impaction occurred in an abnormally narrowed esophagus.

The diagnosis of anal sacculitis in the dog

ABSTRACTA new approach to diagnosis is described based on behavioural signs of which some twenty are listed. Fixation licking, starting at the rump and asymmetrical sitting are among signs added to the existing commonly accepted ones such as ‘scooting’. Normal anal sac fluid is defined as almost clear, slightly yellow in colour, and abnormal material is described in varying forms of coloured pus. Predisposing factors are suggested such as diarrhoea and diets leading to soft bolus. The bacterial flora involved is defined consisting of micrococci, diphtheroids, Escherichia colt, Salmonella, Streptococcus faecalis, Clostridium welchii, Staphylococcus, Pseudomonas and Proteus. Moreover, it is suggested that some unresponsive skin conditions are prolonged through a secondary effect of anal sacculitis.

Foreign bodies impacted in the œsophagus: A record of some unusual cases

Summary This paper deals with the unsuspected foreign body in the œsophagus and how it may produce prolonged dysphagia or pass through the œsophageal wall and be hidden in the prevertebral space. The importance of anterior and lateral straight X-ray after the barium swallow is emphasised. Cases are described of impaction by a soft bolus and of impaction of a small foreign body at a malignant stricture.