The first patients treated with MR-CBCT soft-tissue matching in a MR-only prostate radiotherapy pathway

INTRODUCTION

Magnetic Resonance (MR)-only radiotherapy for prostate cancer has previously been reported using fiducial markers for on-treatment verification. MR-Cone Beam Computed Tomography (CBCT) soft-tissue matching does not require invasive fiducial markers and enables MR-only treatments to other pelvic cancers. This study evaluated the first clinical implementation of MR-only prostate radiotherapy using MR-CBCT soft-tissue matching.

METHODS

Twenty prostate patients were treated with MR-only radiotherapy using a synthetic (s)CT-optimised plan with MR-CBCT soft-tissue matching. Two MR sequences were acquired: small Field Of View (FOV) for target delineation and large FOV for organs at risk delineation, sCT generation and on-treatment verification. Patients also received a CT for validation. The prostate was independently contoured on the small FOV MR, copied to the registered CT and modified if there were MR-CT soft-tissue alignment differences (MR-CT volume). This was compared to the MR-only volume with a paired t-test. The treatment plan was recalculated on CT and the doses compared. Independent offline CT-CBCT matches for 5/20 fractions were performed by three therapeutic radiographers using the MR-only contours and compared to the online MR-CBCT matches using two one-sided paired t-tests for equivalence within ±1 mm.

RESULTS

The MR-only volumes were significantly smaller than MR-CT (p = 0.003), with a volume ratio 0.92 ± 0.02 (mean ± standard error). The sCT isocentre dose difference to CT was 0.2 ± 0.1%. MR-CBCT soft-tissue matching was equivalent to CT-CBCT (p < 0.001), with differences of 0.1 ± 0.2 mm (vertical), -0.1 ± 0.2 mm (longitudinal) and 0.0 ± 0.1 mm (lateral).

CONCLUSIONS

MR-only radiotherapy with soft-tissue matching has been successfully clinically implemented. It produced significantly smaller target volumes with high dosimetric and on-treatment matching accuracy.

IMPLICATIONS FOR PRACTICE

MR-only prostate radiotherapy can be safely delivered without using invasive fiducial markers. This enables MR-only radiotherapy to be extended to other pelvic cancers where fiducial markers cannot be used.

A-35 On-Field Dizziness and Timing of Referral to Vestibular Therapy Following Adolescent Sports-Related Concussion: Initial Findings

Objective

To examine if adolescent patients who experienced on-field dizziness immediately following sports-related concussion (SRC) and were referred to vestibular therapy (VT) in 7–9 days returned to play faster when compared to referrals made &gt; 10 days.

Method

Registry data for an outpatient clinic specializing in adolescent SRC was analyzed. Of the 85 adolescent patients included, 67 (79%) experienced dizziness immediately following injury; 36 (54%) of which were referred to VT. Mean age at time of injury was 15.3 years; 61.1% were male (n = 22); most were injured while participating in football (38.9%), soccer (16.7%), or wrestling (13.9%). Days to initial VT evaluation from time of injury and days from VT to clearance from concussion protocol were analyzed using a Poisson regression model; age and sex were controlled.

Results

Patients referred to VT 7–9 days post-injury returned to play 16 ± 13.4 days earlier (20.7 ± 18.6 days; p &lt; .0001) than patients who received VT 10–20 days post SRC (36.7 days±32). While non-significant, individuals referred to VT &gt; 21 days post-injury returned to play 6 days later than those referred &lt; 10 days (26.3 ± 32.9; p = .14).

Conclusions

Appropriate and timely referrals to VT following the presence of on-field dizziness after SRC may play an integral role in recovery, although more research in this area is needed. Initial findings suggest that when determining optimal time frame for referral to VT, 7–9 days post-injury may be most beneficial for adolescents following SRC.

Examining the relationship between obesity and mental health outcomes among individuals admitted to a level I trauma centre

The increased incidence of obesity in the general population translates into clinicians caring for an increased number of trauma patients with obesity. Previous research has documented the unique anatomical and physiological challenges that clinicians face when caring for trauma patients with obesity; however, little is known about psychological challenges that trauma patients with obesity may also experience in the months following injury. The aim of this study is to determine the relationship between obesity and (i) mental health, (ii) demographic and injury-related variables and (iii) quality-of-life outcomes among trauma patients between hospitalization and 3-months post-injury. This is a prospective, longitudinal study conducted between March 2012 and May 2014 at a single, level I trauma centre in the southwest United States. Inclusion criteria for this convenience sample consisted of patients who were admitted to the trauma or orthopaedic trauma service ≥24 h, medically stable, spoke English or Spanish and ≥18 years of age. In total, 455 eligible patients were consented and enrolled; 343 (70.87%) completed 3-month follow-up. The objective of this study is to investigate the relationship between obesity and mental health among trauma patients in the months following injury. Demographic and injury-related data were also collected; patients' height and weight were used to determine body mass index. Health outcomes were assessed during initial hospitalization and at 3-month follow-up and included depression, post-traumatic stress symptoms, pain and return to work. Prior to data collection, it was hypothesized that obesity would have a negative effect on mental health outcomes among patients 3 months post-injury. The final sample consisted of 343 participants; average age was 46.4 ± 17.3 years; majority male (n = 213, 63%) and Caucasian (n = 231, 69%). Patients with obesity had higher odds of screening positive for depression (odds ratio [OR] = 2.36, P = 0.02) and overweight patients had lower odds of returning to work (OR = 0.31, P = 0.01) 3 months post-injury compared to patients of normal weight (65% vs. 40%). No other significant differences were found. Results of the current study are novel in that they identify psychological challenges that overweight and trauma patients with obesity may experience. These results demonstrate the need for mental health professionals to be involved in follow-up care to extending in the months following injury.

Qualitative evaluation of a physical activity health promotion programme for people with intellectual disabilities in a group home setting

BACKGROUND

There is a lack of health promotion programming designed to change the physical activity environment of the group home setting. The Menu-Choice programme assists staff in creating physical activity goals alongside residents with intellectual disabilities and provides strategies to incorporate activity into the group home schedule. The purpose of this study was to complete a process evaluation of Menu-Choice utilizing qualitative methods.

METHODS

Twelve participants, who completed a 10-week pilot intervention (n = 7 staff, mean age 42; n = 5 residents, mean age 52), participated in face-to-face interviews. Participants represented five group home sites involved in the intervention.

RESULTS

Meta-themes included: (i) Programme training, (ii) Programme implementation, (iii) Programme physical activity, (iv) Programme barriers, (v) Programme facilitators and (vi) Programme feedback.

CONCLUSIONS

Changes in programme training and simplified programme materials are needed to accommodate identified barriers for implementation. The importance of obtaining increased agency support and policy change is highlighted.

DESCRIBING LYMPHEDEMA IN FEMALES WITH TURNER SYNDROME

Turner syndrome (TS) is a chromosomal condition affecting an estimated 1 in 2,500 girls where the second X chromosome is missing, or partially formed. This abnormality affects multiple body systems and can lead to short stature, cardiac, neural, and renal abnormalities. Due to the chronic, non-life threatening nature of lymphedema in comparison to other symptoms of TS, it is often ignored by girls and women with TS and their physicians. Consequently, little is known about how lymphedema affects girls and women with TS across the lifespan. Therefore, the objective of the study was to deliver an online survey for females with TS and caregivers in the US, UK, and Canada to provide a worldwide perspective on their current experience with lymphedema within the spectrum of TS. There were 219 participants who completed the survey, and we were able to identify incidence and characteristics of lymphedema across the lifespan. In addition, we found that females with 45,X karyotyping were more likely to report lymphedema symptoms. Lymphedema is not the most significant concern of females with TS, but education, physician evaluation, and assistance with referrals for treatment and management would improve the ease of managing lymphedema in girls and women with TS.

Social support and the physical activity behaviours of people with a brain injury

PRIMARY OBJECTIVE

To examine the influence of social support on the physical activity behaviours of individual's with a traumatic brain injury.

MAIN OUTCOMES AND RESULTS

The paper defines social support as a multi-dimensional construct and reviews relevant literature describing how the type and source of social support changes post-brain injury. These findings are then applied to a physical activity domain with the use of a conceptual framework. Discussion finally focuses on research applications and appropriate measures of social support within a physical activity environment.

CONCLUSIONS

This paper will provide physical activity programmers with an understanding of how social support influences physical activity participation, a conceptual framework to guide programming and appropriate measures of social support for research purposes.

Regulation of vascular endothelial growth factor-dependent retinal neovascularization by insulin-like growth factor-1 receptor

Although insulin-like growth factor 1 (IGF-1) has been associated with retinopathy, proof of a direct relationship has been lacking. Here we show that an IGF-1 receptor antagonist suppresses retinal neovascularization in vivo, and infer that interactions between IGF-1 and the IGF-1 receptor are necessary for induction of maximal neovascularization by vascular endothelial growth factor (VEGF). IGF-1 receptor regulation of VEGF action is mediated at least in part through control of VEGF activation of p44/42 mitogen-activated protein kinase, establishing a hierarchical relationship between IGF-1 and VEGF receptors. These findings establish an essential role for IGF-1 in angiogenesis and demonstrate a new target for control of retinopathy. They also explain why diabetic retinopathy initially increases with the onset of insulin treatment. IGF-1 levels, low in untreated diabetes, rise with insulin therapy, permitting VEGF-induced retinopathy.

The partnership for long-term care: who are the partnership policy purchasers?

Policymakers are increasingly looking toward expanding the role of private insurance in the financing of long-term care. One effort to blend public and private insurance is the Partnership for Long-Term Care sponsored by the Robert Wood Johnson Foundation. This article examines the characteristics of individuals who purchased long-term care insurance through the Partnership for Long-Term Care, as well as their motivation for purchase. Partnership purchasers are found to be a healthier, higher educated, and wealthier group than a comparison group of 55- to 75-year-olds. Partnership purchasers are also more active financial planners, have more self-reliant attitudes, and are more knowledgeable about long-term care. Findings also suggest that the Partnership for Long-Term Care attracts a substantial number of beneficiaries who would not have purchased long-term care insurance in the absence of the Partnership program.