Treatment Room Research Articles

The Usefulness of a Virtual Environment-Based Patient Setup Training System for Radiation Therapy.

In radiation therapy, patient setup is important for improving treatment accuracy. The six-axis couch semi-automatically adjusts the patient's position; however, adjusting the patient to twist is difficult. In this study, we developed and evaluated a virtual reality setup training tool for medical students to understand and improve their patient setup skills for radiation therapy. First, we set up a simulated patient in a virtual space to reproduce the radiation treatment room. A gyro sensor was attached to the patient phantom in real space, and the twist of the phantom was linked to the patient in the virtual space. Training was conducted for 24 students, and their operation records were analyzed and evaluated. The training's efficacy was also evaluated through questionnaires provided at the end of the training. The total time required for patient setup tests before and after training decreased significantly from 331.9 s to 146.2 s. As a result of the questionnaire regarding the usability of training to the trainee, most were highly evaluated. We found that training significantly improved students' understanding of the patient setup. With the proposed system, trainees can experience a simulated setup that can aid in deepening their understanding of radiation therapy treatments.

Rotatorlike gantry optics

Rotating gantries are commonly used in ion-therapy facilities to assist and support optimizing the dose distribution delivered to the patient. They are installed at the end of the beamlines and rotated mechanically in the treatment room. In synchrotron-based facilities, the gantries must be able to transport slowly extracted beams with essentially different emittance patterns in the two transverse planes. Such beams will be referred to as the asymmetric beams. A special device called rotator has been proposed as a possible solution. The worldwide first beamline with the rotator has been recently commissioned. The original rotator concept uses an “external” rotator that is a part (a module) of the beamline the gantry is connected to. In this paper, a novel gantry ion-optical concept integrating the rotator optics into the gantry optics is introduced. The first-order gantry transfer matrix satisfies the so-called sigma-matching ion-optical constraints, and—at the same time—it possesses the format of a rotator transfer matrix. The rotator-matching and the sigma-matching principles are combined in the gantry transfer matrix, which means that the sigma-matching gantry acts simultaneously as a rotator without the need for an extra rotator device. In addition, scattering in the gantry nozzle is used to balance the asymmetric beam emittances in the two transverse planes without an additional scattering foil. In this way, the presented ion-optical concept combines all three known matching techniques—the sigma matching, the rotator matching, and the scattering-foil matching—within the gantry beam transport system. Such a beam transport system provides the best matching result and full angular independence of the beam parameters at the gantry isocenter. It also makes it possible to optimize the beam parameters not only at the gantry isocenter but also at the beam monitors located in the gantry nozzle without increasing the number of gantry quadrupoles. There are two possible versions of such gantry optics: the point-to-point and the parallel-to-point optics. They both are presented in this paper. Theoretical calculations are supported by beam transport simulations performed with the in code. Feasibility of the newly proposed ion-optical concept is demonstrated on the MedAustron proton gantry. However, it can be applied to any rotating gantry at any ion-therapy facility. The presented design is the first rotatorlike gantry ion-optical concept worldwide. Published by the American Physical Society 2024

General Anestesi Intravena pada Tindakan Debridement dan Tangensial Eksisi Pasien Combustio 13.5% Grade Iia

It was reported that the patient, a 40 year old woman, weighing 53 kg, would undergo debridement and tangential excision. The patient said he had no history of previous illness. The patient also denied a history of allergies and dentures. The patient also does not currently have a cold, cough or fever. Therefore, the patient is classified as ASA I because he has no systemic abnormalities. In this operation, an intravenous general anesthesia technique was used because the duration of the surgery is not long, and it also avoids the effects of inhalation sedation. The patient did not use respiratory assistance and had strict intraoperative monitoring to maintain airway patency.The drugs used are midazolam and fentanyl as pre-medication, and propofol as an induction drug, which is then treated with propofol intermittently. After the operation is complete, the patient is immediately transferred to the recovery room, and his consciousness value is checked using the Aldrette score, which in this patient's score is 10, and therefore, the patient can be transferred to the treatment room.

Photoneutron production mechanisms, their characteristics, and shielding strategies in high-energy linac environment: A review

Radiotherapy, a mainstay cancer treatment for patients worldwide, utilizes medical linear accelerators (linacs) with photon energies ranging from 4 MV to 25 MV. However, concerns arise at higher energies (>6 MV, particularly >10 MV). These high-energy photons interact with high-atomic number materials in the linac head and collimation system, generating unwanted neutrons through (γ,n) reactions. This neutron contamination, present in both photon and electron beams, is a significant issue. Neutrons, with their high Linear Energy Transfer (LET), are more effective at causing clustered DNA damage (single and double-strand breaks). These neutrons not only impact shielding requirements in treatment rooms but also increase out-of-field radiation doses for patients receiving high-energy photon therapy. Therefore, for radiotherapy treatments exceeding 6 MV, additional precautions become crucial, including enhanced door shielding and optimized treatment planning. This review discusses in detail the multifaceted aspects of neutron production and shielding requirements during radiotherapy.

Degree-day models for predicting adult Delia platura (Diptera: Anthomyiidae) spring flight and first emergence in New York State.

The seedcorn maggot, Delia platura (Meigen), is a pest affecting many crops, including corn. The early spring emergence of adults and belowground seed damage by maggots leave no room for rescue treatments during the short growing season in New York State. Degree-day (DD) models play a crucial role in predicting insect emergence and adult peak activity and are essential for effective pest management. The current D. platura DD model was launched on the Network for Environment and Weather Applications (NEWA) in 2022, using existing scientific literature from other North American regions. The NEWA model predicted adult D. platura first emergence at an average of 471 (39°F) DD in 2022. To gain an accurate and precise understanding of D. platura adult spring emergence and activity, we used interpolated temperature data to calculate the DD for each specific location where adults were captured in the field. DD calculations were performed using the average method, setting a biofix on January 1st and a base temperature of 39°F. In 2023, overwintering adults emerged at an average of 68 DD, and in 2022, adult activity was registered at an average of 282 DD. Accurately predicting the emergence of D. platura could contribute to informing integrated pest management strategies that incorporate timing and cultural practices over chemical solutions to protect crops and the environment.

CARING NURSES IN THE PREVENTION OF FALL RISK PATIENTS IN THE INPATIENT ROOM

The inpatient treatment room is a room that has the potential to have a risk of falling in patients with heart, lung and nerve diseases such as strokes who experience decreased consciousness, muscle weakness and impaired mobility which are at risk of falling from bed or when going to the bathroom. Nurses who are not Caring for patients can result in the risk of falling for patients. The inability of nurses to carry out fall risk assessments will be detrimental to patients during hospitalization. The purpose of this study was to explore the description of caring for nurses in preventing patients at risk of falling in the inpatient room of Permata Medika Ngaliyan Hospital, Semarang City. The research method uses a qualitative research design with a phenomenological approach. Research informants are implementing nurses. Determination of the sample using purposive sampling. Collecting data by in-depth interviews with informants using a voice recorder. The results of the study identified several themes related to the research objectives, namely the caring behavior of nurses when providing nursing care to patients, the impact of caring for patients on patients, the implementation of patient fall risk assessments in hospitals, and the efforts of nurses to prevent the risk of falling in patients. Conclusion: Nurses' caring behavior is a dynamic approach, where nurses work to increase their concern for patients, especially patients at risk of falling as an effort to prevent unexpected events in maintaining the quality of nursing care services.

Sex differences in intestinal morphology and increase in diencephalic neuropeptide Y gene expression in female but not male Pekin ducks exposed to chronic heat stress.

The impact of heat stress (HS) on production is intricately linked with feed intake. We investigated the effects of HS on intestines and diencephalic genes in Pekin ducks. One hundred and sixty adult ducks were allocated to two treatment rooms. The control room was maintained at 22°C and the HS room at 35°C for the first 10 h of the day then reduced to 29.5°C. After 3 weeks, 10 hens and 5 drakes were euthanized from each room and jejunum and ileum collected for histology. Brains were collected for gene expression analysis using qRT-PCR. Intestinal morphology data were analyzed with two-way ANOVA and diencephalic gene data were analyzed with Kruskal-Wallis test. There was an increase in villi width in the ileum (p = .0136) and jejunum (p = .0019) of HS hens compared to controls. HS drakes showed a higher crypt depth (CD) in the jejunum (p = .0198) compared to controls. There was an increase in crypt goblet cells (GC) count in the ileum (p = .0169) of HS drakes compared to HS hens. There was higher villi GC count (p = .07) in the jejunum of HS drakes compared to controls. There was an increase in the crypt GC density (p = .0054) in the ileum, not jejunum, of HS drakes compared to HS hens. Further, there were no differences in the proopiomelanocortin gene expression in either sex but there was an increase in the expression of neuropeptide Y (NPY) gene in HS hens (p = .031) only and a decrease in the corticotropin releasing hormone gene in the HS drakes (p = .037) compared to controls. These data show that there are sex differences in the effect of HS on gut morphology while the upregulation in NPY gene may suggest a role in mediating response to chronic HS.

Sensitivity Response Analysis of Optical Surface Monitoring Systems Using the Fitzpatrick Scale: A Phantom Study

PurposeOptical Surface Monitoring systems (OSMS) have gained substantial attention in modern radiotherapy, specifically in the context of Surface Guided Radiation Therapy (SGRT) which offers real-time patient surface monitoring, ensuring accurate and effective radiotherapy treatments. The aim of this paper is to evaluate the OSMS camera sensitivity towards different skin tones, categorized according to the Fitzpatrick scale, a universal classification of human skin tones, using a phantom. Methods and MaterialThe study utilized Catalyst and SentinelTM OSMS systems (C-Rad, Uppsala, Sweden). The Alderson RANDO Female Pelvis phantom, located at the isocenter in CT simulation and treatment rooms, served as an experimental subject. Eighteen skin tone matching cotton cloths, selected based on Von Luschan's chromatic and Fitzpatrick scales, were wrapped around the phantom for sensitivity evaluation. Camera sensitivity was optimized by adjusting threshold/gain (100-600%) and integration time during individual scans in both rooms. Temporal response analysis spanned two months, with sixteen measurements for each OSMS taken in varying light conditions. ResultsThe OSMS systems successfully detected the surface of cloth-covered phantoms with varying mean (standard deviation) integration times: 550 (34) to 950 (43) μs for the Sentinel system and 2300 (71) to12000 (400) μs for the Catalyst system. The sensitivity parameters differed for each skin tone, with lighter skin requiring shorter integration times and gain/threshold values. Darker skin tones necessitated higher parameters for optimal surface images. The reliability of the systems declined with excessive parameters, leading to noise and compromised accuracy in patient positioning. ConclusionsOptimized sensitivity parameters tailored to individual skin tones are crucial for effective real-time patient surface monitoring in radiation therapy, as variations in skin colour can affect the accuracy of measurements. The precision of skin colour measurements in OSMS relies on carefully adjusting camera sensitivity parameters. However, careful consideration is essential, as larger values are required for darker skin tones, compromising reliability. This suggests the need for exploring alternative image guidance methods for patients with darker skin tones.

Ворохобова Департамента здравоохранения города Москвы.

To reduce the workload of nursing staff, it is necessary to develop new approaches to the organization of work, new methods and forms of managing these personnel. Purpose of the study is to develop a system for the distribution of duties of non-medical personnel in order to improve the efficiency of medical organization functioning, basing on the example of the Vorohobov’s City Clinical Hospital № 67. The system will significantly reduce the workload of medical personnel, increase staff motivation and improve the quality of medical services provided. Material and methods. The features of the the Vorohobov’s City Clinical Hospital № 67 functioning, as well as the personnel reform carried out, contributing to the optimization of the activities of medical personnel, are considered. A quantitative analysis of the costs and structure of the nurses working time in the Vorohobov’s City Clinical Hospital № 67 was carried out on the basis of statistical accounting methods: an inventory of tasks and a survey of nurses in a separate building of the medical organization were performed. Results. It was revealed that the greatest time costs for performing labor operations that do not require medical qualifications during the working day fall on the nurses of treatment (procedure) room and dressing examination (bandaging room). Specific job responsibilities that can be delegated to non-medical staff have been identified. According to the results of a quantitative study, the modernization of labor organization principles in medical organizations on the example of the Vorohobov’s City Clinical Hospital № 67 consists in delegating labor operations, such as document handling and working with electronic resources, to non-medical personnel. Findings. The results of the study can be used by the management of medical organizations in the organization of labor and the distribution of the workload of medical and non-medical personnel to improve the quality of medical services provided.

New concept for neutron dosimetry in ion beam radiotherapy: Feasibility study

In ion beam radiotherapy (IBRT), the secondary neutrons contribute to whole-body exposure, potentially increasing the risk of radiation-induced cancer. The energy range of neutrons generated in the IBRT treatment room spreads from thermal to a few hundred MeV, with those between 0.1 and a few hundred MeV playing a crucial role in the ambient dose equivalent. This study introduces a novel approach for measuring the ambient dose equivalent that focuses on the neutron energy spectrum in the IBRT treatment room. Distinguished by the use of a hydrogen-filled proportional counter and a single moderator, this new method overcomes the weakness of the traditional Bonner Sphere Spectrometer by reducing the complexity and time required for measurements. By deriving the neutron energy spectrum, the neutron ambient dose equivalent can be accurately calculated. Our validation demonstrated that the neutron ambient dose equivalents derived using our method closely agree with the actual values, with discrepancies within 4%, underscoring the feasibility of this innovative approach to neutron dosimetry in the IBRT treatment room.

The safety and prognostic evaluation of subsequent aortic surgery after thoracic endovascular aortic repair: a retrospective cohort study.

Thoracic endovascular aortic repair (TEVAR) is a widely employed clinical procedure for treating various aortic pathologies. However, some patients require subsequent surgical interventions post-TEVAR, particularly due to life-threatening complications such as aortic dissection. This study aimed to evaluate the safety and prognosis associated with additional aortic surgeries following TEVAR. A retrospective analysis was conducted on 21 patients who underwent aortic surgery after TEVAR at Guangdong Provincial People's Hospital between September 2016 and August 2020. By compiling and reviewing perioperative data, we assessed surgical-related complications and survival rates. Among the 21 patients, 95.2% were male, with an average age of 53 years. Preoperative comorbidities included hypertension in 15 individuals, abdominal aortic aneurysm in one patient, and coronary heart disease in two patients. The primary complications of TEVAR were stent leakage and retrograde aortic dissection, with the latter being the predominant type in subsequent aortic surgeries. The mean duration of aortic clamping during surgery was 130.0 minutes, with a deep hypothermic circulatory arrest time of 8.5 minutes. Postoperatively, two patients suffered in-hospital mortality, one developed renal dysfunction, four required re-entry into the operating room for further treatment, and the average length of hospital stay was 20 days. Following discharge, 14.3% of patients experienced complications, with central nervous system symptoms being the most prevalent. Kaplan-Meier survival analysis indicated a 5-year survival rate of 85.7%. Aortic surgical intervention following TEVAR is a safe therapeutic approach that can improve patient prognosis. However, meticulous management of the perioperative period is crucial for reducing the risk of complications and improving survival rates. This study provides valuable insights into aortic surgery post-TEVAR, but large-scale research is needed to validate these findings.

Setting up the endoscopy room for benign prostatic hypertrophy treatment: Nursing expertise relevance

Setting up the endoscopy room for benign prostatic hypertrophy treatment: Nursing expertise relevance

Using ANN for thermal neutron shield designing for BNCT treatment room

Occupational radiation protection should be applied to the design of treatment rooms for various radiation therapy techniques, including BNCT, where escaping particles from the beam port of the beam shaping assembly (BSA) may reach the walls or penetrate through the entrance door. The focus of the present study is to design an alternative shielding material, other than the conventional material of lead, that can be considered as the material used in the door and be able to effectively absorb the BSA neutrons which have slowed down to the thermal energy range of <1\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$< 1$$\\end{document} eV after passing through the walls and the maze of the room. To this aim, a thermal neutron shield, composed of polymer composite and polyethylene, has been simulated using the Geant4 Monte Carlo code. The neutron flux and dose values were predicted using an artificial neural network (ANN), eliminating the need for time-consuming Monte Carlo simulations in all possible suggestions. Additionally, this technique enables simultaneous optimization of the parameters involved, which is more effective than the traditional sequential and separate optimization process. The results indicated that the optimized shielding material, chosen through ANN calculations that determined the appropriate thickness and weight percent of its compositions, can decrease the dose behind the door to lower than the allowable limit for occupational exposure. The stability of ANN was tested by considering uncertainties with the Gaussian distributions of random numbers to the testing data. The results are promising as they indicate that ANNs could be used as a reliable tool for accurately predicting the dosimetric results, providing a drastically powerful alternative approach to the time-consuming Monte Carlo simulations.

A review on 4D cone-beam CT (4D-CBCT) in radiation therapy: Technical advances and clinical applications.

Cone-beam CT (CBCT) is the most commonly used onboard imaging technique for target localization in radiation therapy. Conventional 3D CBCT acquires x-ray cone-beam projections at multiple angles around the patient to reconstruct 3D images of the patient in the treatment room. However, despite its wide usage, 3D CBCT is limited in imaging disease sites affected by respiratory motions or other dynamic changes within the body, as it lacks time-resolved information. To overcome this limitation, 4D-CBCT was developed to incorporate a time dimension in the imaging to account for the patient's motion during the acquisitions. For example, respiration-correlated 4D-CBCT divides the breathing cycles into different phase bins and reconstructs 3D images for each phase bin, ultimately generating a complete set of 4D images. 4D-CBCT is valuable for localizing tumors in the thoracic and abdominal regions where the localization accuracy is affected by respiratory motions. This is especially important for hypofractionated stereotactic body radiation therapy (SBRT), which delivers much higher fractional doses in fewer fractions than conventional fractionated treatments. Nonetheless, 4D-CBCT does face certain limitations, including long scanning times, high imaging doses, and compromised image quality due to the necessity of acquiring sufficient x-ray projections for each respiratory phase. In order to address these challenges, numerous methods have been developed to achieve fast, low-dose, and high-quality 4D-CBCT. This paper aims to review the technical developments surrounding 4D-CBCT comprehensively. It will explore conventional algorithms and recent deep learning-based approaches, delving into their capabilities and limitations. Additionally, the paper will discuss the potential clinical applications of 4D-CBCT and outline a future roadmap, highlighting areas for further research and development. Through this exploration, the readers will better understand 4D-CBCT's capabilities and potential to enhance radiation therapy.

Dose equivalent consideration from neutron contamination in modified radiotherapy vault: a Monte Carlo study

Laminated barriers incorporating metal sheets provide effective protection for space-restricted radiotherapy centers. This study aimed to assess photoneutron contamination in smaller vaults protected by different compositions of multilayer barriers during simulated pelvic radiotherapy with 18 MV photon beams. Monte Carlo Simulations of 18 MV LINAC (Varian 2100 C/D) and Medical Internal Radiation Dose (MIRD) phantom were used to assess photoneutron contamination within reconstructed vaults incorporating different combinations of metal sheet and borated polyethylene (BPE) during pelvic radiotherapy. The findings highlight a 3.27 and 2.91 times increase in ambient neutron dose Hn* (10) along the maze of reconstructed vaults that use lead and steel sheets, respectively, compared to concrete. The Hn* (10) outside the treatment room increased after incorporating a metal sheet, but it remained within the permissible limit of 20 μSv/week for uncontrolled areas adjacent to the LINAC bunker, even with a workload of 1000Gy/week. Neutron equivalent doses in the patient’s organs ranged from 0.22 to 0.96 mSv Gy−1. There is no notable distinction in the organ’s neutron equivalent dose, fatal cancer risk, secondary radiation-induced cancer risk, and cancer mortality for various laminated barrier compositions. Furthermore, the use of metal sheets for vault wall reconstruction keeps the variation in cancer risk induced by photoneutrons below 6%, while risks of fatal cancer and cancer mortality vary less than 11%. While the metal portion of the laminated barrier raises the neutron dose, the addition of a BPE plate reduces concerns of increased effective dose and secondary malignancy risk.

Medication Safety Sebagai Upaya Pencegahan Medication Error dalam Kebidanan

Patient safety is defined as an effort to prevent things that endanger patients in the process of administering drugs. Overall patient safety or prevention and reduction of errors of various risks resulting from such errors. During the process of health services, especially in the treatment of patients, mistakes can be made by health workers. The incidence of Drug Error is a measure of patient safety achievement. The purpose of this study was to analyze the implementation factors of medication safety in an effort to prevent drug errors in obstetrics. The research design chosen is qualitative . This research will be carried out at RSIA Aisyiyah on midwives who work in the inpatient room. Data collection techniques in this study conducted in-depth interviews with 10 informants consisting of midwives in the treatment room. Data analysis is carried out to process qualitative data. Some factors that influence the application of patient safety principles in hospital X include leadership factors, namely lack of supervision from the leadership, lack of human resources for health servants both nurses and pharmacy personnel, workplace environmental factors that are less conducive, unavailability of SPO drug administration with principle 7 correct, socialization that is not carried out consistently and continuously and does not run training or training programs. Some suggestions that may be considered by hospital X in order to provide safe services and in accordance with patient safety principles in drug administration.

An outbreak of Pseudomonas aeruginosa urinary tract infections following cystoscopy traceable to a malfunctioning drying cabinet

Pseudomonas aeruginosa is an important bacterial pathogen, particularly as a cause of nosocomial infections in hospitalized patients. Only few reports exist in which cystoscopes were implicated as an outbreak source. We describe an investigation into the cause of a sudden increase in the number of urinary tract infections (UTI) with P. aeruginosa in patients after cystoscopy. In addition, we share the lessons learned and measures taken to reduce the risk of similar infections in the future. Over a period of two weeks the urology outpatient department noticed a UTI in four patients following cystoscopy. An investigation was started for a common source of the outbreak in the urological treatment room. Additional screening of patients revealed a total of eleven males with P.aeruginosa UTI following cystoscopy. The infections were found to be due to a defective drying cabinet, which lacked an alarm signaling in case of loss of airflow. Amplified fragment length polymorphism (AFLP) analysis revealed that P.aeruginosa isolates from three patients and six isolates from environmental cultures (including cystoscopes from the drying cabinet) genotypically belonged to one strain. The AFLP results suggest that contaminated cystoscopes caused P.aeruginosa UTI in 11 patients, with the drying cabinet as site of transfer of the infective strain. To our knowledge, this is the first report describing a malfunctioning drying cabinet as source of an outbreak following cystoscopy. In case of concomitant P.aeruginosa infections, cystoscopes and drying cabinets should be suspected as a potential source. Molecular techniques are helpful in investigating the epidemiology of an outbreak.

Stress Coping Strategies Among Nurses at Hasanuddin University Hospital Indonesia

Introduction: Nurses have a major contribution in determining the quality of hospital services, but the heavy workload carried by nurses makes them vulnerable to work stress. Work stress that is if not handled properly can result in a decrease in the quality of services provided to the effect on hospital productivity, therefore it is necessary to do a coping strategy so that nurses can deal with and neutralize or overcomereduce the work stress experienced. Objective: This study aims to describe stress coping strategies for nurses in the Inpatient Installation of the Hasanuddin University Hospital Makassar. Method: This research was using quantitative approach. It was conducted at the Hasanuddin University Hospital in July 2022. The population in this study were all nurses who served in the Inpatient Room of Hasanuddin University Hospital with a total sample of 54 nurses. Collecting research data using The Brief COPE Questionnaire. The data were analyzed by using univariate analysis test. Result: The results describe nurses' stress coping strategies based on problem focused coping, that all indicators included in the high category, there are active coping (6.42), followed by planning (6.29) and use of instrumental support (6.02). Then the Nnurse's stress coping strategy based on emotional focused coping, there are 3 indicators that are included in the high category, there are religion (7.39), positive reframing (6.31), and acceptance (6.07), use of emotional support (4 .83) is an indicator that included in the medium category and denial (3.14) is an indicator that included in the low category. While Nnurses' stress coping strategies based on dysfunctional coping, self-distraction (6,16) is the only indicators that included in the high category, then there are 4 indicators that were included in the moderate category, there were namely venting (4,87), humor (4,50), self blame (4.50), and behavioral disengagement (3.24), as well as substance use (2.66) are indicators that are included in the low category. Conclusion: Majority of nurses at Hasanuddin University Hospital applied high problem focused coping and emotional focused coping. Therefore, the management of the Hasanuddin University Hospital may consider opening or holding a communication forum between nurses in each treatment room to discuss problems at work and provide psychological guidance and support in order to overcome the work stress that nurses experienced.

A scattering-foil free electron beam to increase dose rate for total skin electron therapy (TSET).

Electron beams are used at extended distances ranging between 300 to 700cm to uniformly cover the entirety of the patient's skin for total skin electron therapy (TSET). Even with electron beams utilizing the high dose rate total skin electron (HDTSe) mode from the Varian 23iX or TrueBeam accelerators, the dose rate is only 2500 cGy/min at source-to-surface distance (SSD)=100cm. At extended distances, the decrease in dose rate leads to long beam delivery times that can limit or even prevent the use of the treatment for patients who, in their weakened condition, may be unable to stand on their own for extended periods of time. Previously, to increase dose rate, a customized 6 MeV electron beam was created by removing the x-ray target, flattening filter, beam monitor chamber, and so forth. from the beam path (Chen, et at IJROBP 59, 2004) for TSET. Using this scattering-foil free (SFF) electron beam requires the treatment distance be extended to 700cm to achieve dose uniformity from the single beam. This room size requirement has limited the widespread use of the 6 MeV-SFF beam. This study explores an application of a dual-field technique with a 6 MeV-SFF beam to provide broad and uniform electron fields to reduce the treatment distances in order to overcome treatment room size limitations. The EGSnrc system was used to generate incident beams. Gantry angles between 6 MeV-SFF dual-fields were optimized to achieve the similar patient skin dose distribution resulting from a standard 6 MeV-HDTSe dual-field configuration. The patient skin dose comparisons were performed based on the patient treatment setup geometries using dose-volume-histograms. Similar dose coverage can be achieved between 6 MeV-SFF and 6 MeV-HDTSe beams by reducing gantry angles between dual-field geometries by 8° and 7° at treatment distances of 400 and 500cm, respectively. To achieve 95% mean dose to the first 5mm of skin depth in the torso area, the mean dose to depths of 5-10mm and 10-15mm below the skin surface was 74% (74%) and 49% (50%) of the prescribed dose when using 6 MeV-SFF (6 MeV-HDTSe) beam, respectively. The 6 MeV-SFF electron beam is feasible to provide similar TSET skin dose coverage at SSD ≥ 400cm using a dual-field technique. The dose rate of the 6 MeV-SFF beam is about 4 times that of current available 6 MeV-HDTSe beams at treatment distances of 400-500cm, which significantly shortens the treatment beam-on time and makes TSET available to patients in weakened conditions.

Statistical and cross-sectional analysis of factors effecting the prevalence of pressure ulcer in hospital admitted stroke patients

Every year, millions of people around the world are disabled by stroke, it is well recognized that complications aftera stroke extend hospital stays and pressure ulcers, a stroke consequence, which can be prevented by educating the caregiver. The primary focus of this research is not only to investigate the prevalence of pressure ulcers (PU) among stroke patients, but this study also introduced a variety of factors which influence the formation of PU, such as restricted mobility, gender, duration of stroke, hypertension, diabetes, hygiene, type of mattress, malnutrition, awareness, etc. In addition, this research provides a comparative and statistical analysis, a cause of the catastrophic disabilities influenced by a variety of factors. Moreover, the proposed research also provides a room for the pertinent treatment of stroke patient to curtail the formation of pressure ulcer. In this research, a total of 120 stroke patients were initially included to monitor the frequency of pressure ulcers at incipient stage. Out of the total patients, the number of patients with ischemic stroke were 78.5 % while 8.3 % were of haemorrhagic type. In the results, the demographic characteristics and the factors which influence the formation of PU of the patients were examined with their cross-sectional impact on each other through comparative and statistical analysis. It was discovered that among all the stroke patients, 8.3 % were found with a PUs and the most frequent localization was sacrum and no new PU was observed for the participants under the observation.