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  • ISSN: 2333-7095
    Volume 5, Issue 1
    Research Article
    Qurat-ul-ain Shamsi*, Maria Atiq, Atia Atiq, Saeed Ahmad Buzdar and Khalid Iqbal
    To characterize the radiation dose distribution in the target volume, various dosimetric indices are required which assist in making a choice of an optimum treatment plan. This study is primarily aimed at the analysis of various radiation dose indices essential for the evaluation of therapeutic plans by employing Intensity Modulated Radiotherapy (IMRT) on head and neck cancer patients. A group of 20 head and neck cancer patients, who were irradiated with 6MV beam form DHX Varianlinac, were brought into consideration. Their radiotherapy plans were designed using eclipse treatment planning software. Dosimetric indices like homogeneity, mDHI, rDHI, CI of the planning target volumes, were analyzed from the DVH of each patient. All the indices came within the limits as specified by RTOG; 1993 and OLIVER; 2007 except in few cases which might be due to complex geometry, extent of tumor volume and low radiation doses. This exploration can be extended to the calculation of other indices by using beams of higher energy and other treatment techniques on different target volumes of small extent and simple geometry.
    Gebre Mesay Geletu*, Fikru Abiko, and Shamble Sahlu
    Diagnostic imaging procedure using ionizing radiation has been growing due to its enormous benefits. However, using ionizing radiation is also associated with harmful biological effects. Therefore it is important to take consideration on harmful effects of ionizing radiation and have adequate awareness on the area, in order to protect people without limiting the benefits. In Ethiopia, the status of radiation protection practices have not been studied previously, which remain nearly unknown especially around the study area. Thus, in filing this gap the present study initiated to assess status of implementation of radiation protection system. General observation, questionnaire and dose rate measurements were used to get all necessary data for the study. The dose rate measurements at control room (CR), waiting room (WR) and inside X-ray room (XR) were carried out using well calibrated Thermo FH 40 G-L10 survey meter. The results of the general observation and the questionnaire showed poor practice of radiation protection system. The dose rate recordings from CR and WR, when the X-ray machine being switched on or off are within permissible allowed value at all hospitals. XR machine off measurements at two locations are also within the range allowed value. However, XR machine on recordings shows a high level of radiation. This causes very high level unnecessary exposure situation for helper as a result of poor practices of radiation protection system which intern extremely increases the population dose. Therefore there is a great need of radiation protection agency activity at all Hospitals. Considering this scenario we suggest continuous training programs for radiographers; all Hospitals must full fill more modern radiation protection monitoring equipment and should have radiation protection advisers to monitor the radiation protection practices.
    Rashmi Singh*, Sheh Rawat, and Manindra Bhushan
    Introduction: To compare double arc (DA), Sliding window (SW) & Step and shoot (SS) IMRT in Head & neck cancer (HNC) by different dosimetric parameters.
    Materials and methods: 25 cases of HNC were planned for DA, SW & SS IMRT by Treatment Planning System-Eclipse (version 10.0) between September 2012 to February 2013. Primary end points were target coverage and doses to organs at risk (OARs). The secondary end points were the treatment time (TT) and the monitor units (MUs). Statistical analysis was done using K independent sample test and paired t test.
    Results: The coverage for target volumes were similar by all the three techniques (p>0.05). There were also no difference in Homogenity Index (HI) and Conformity Index (CI) (p>0.05). Dmean to OARs were maximum with DA followed by SW and SS IMRT. Ipsilateral parotids, contralateral parotids and dysphagia aspiration risk structures (DARS) received higher mean dose by DA than by SW and SS IMRT (p<0.05). The Dmax for Brain stem and 1% volume of spinal cord was least by SS IMRT (p<0.05). The difference in Dmean between SW and SS IMRT for oral cavity was 0.5 ± 0.10Gy (p<0.05). However, DA had the advantage of requiring minimum number of MUs (p<0.05) and TT (p<0.05) in comparison to SW and SS IMRT.
    Conclusion: DA gave the advantage of minimum number of monitor units and least total treatment time over SS and SW IMRT. However, it was indifferent for target coverage, homogeneity and OAR sparing.
    Short Communication
    Ryuji Nakamura*, Koyo Kikuchi, Satoshi Yamaguchi, Hisao Kakuhara, Jun Sugawara, Hirobumi Oikawa, and Hisanori Ariga
    Purpose: To disclose effectiveness of substitution of conformal radiotherapy (CRT) with intensity-modulated radiotherapy (IMRT) in combined with 125I permanent seed brachytherapy(BT) in reducing a rectal dose-volume parameter recently proven to be correlated with late rectal bleeding after the combined radiotherapy.
    Materials/Methods: A CT image set obtained a month after BT was used for CRT and tentative IMRT planning as well as dosimetry of BT (post plan). Physical dose of each DICOM-RT was converted to biologically effective dose under α/β of 3(Gy3) for three dimensional summation of rectal volume exposed to 150 Gy3 (rV150 (3)). Alteration of the value along BT, BT combined with CRT (BT+CRT), and BT combined with IMRT (BT+IMRT) was traced individually, and the mean value were statistically compared between the modalities.
    Results: The elevation rate of rV150 (3) from BT to BT+CRT is proportional to their rV150 (3) of BT. All rV150 (3) was decreased from BT+CRT to BT+IMRT except 3 cases with smaller rV150 (3) at BT+CRT. The mean rV150 (3) values of BT, BT+CRT, and BT+IMRT were 0.06 ± 0.09 cc, 1.41 ± 0.88, and 1.18 ± 0.75 cc, respectively, showing significant differences between all values.
    Conclusions: The substitution of CRT with IMRT in conjunction with seed implant brachytherapy reduces the rectal dose predisposing bleeding. Avoiding rectal exposure to high doses during BT is important even in BT+IMRT.
    Case Report
    Wong Ting*, Cheng Lik Fai, and Ma Ka Fai Johnny
    Intracardiac stent migration is a rare but potentially fatal complication of endovascular stenting. A patient was referred for right brachiocephalic vein stenting for dialysis access venous stenosis. The stent migrated to right atrium upon deployment. Stent extraction was attempted with gooseneck snares but failed. Two endovascular biopsy forceps were then introduced and fractured the stent into two parts for removal. The patient was stable during the procedure and was subsequently discharged. No adverse cardiovascular event occurred. This case report demonstrates the usefulness of the strong gripping capability of endovascular forceps to retrieve a migrated stent that could not be approached by snare technique.
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