A case study of radiotherapy treatment for Dupuytren's contracture and Ledderhose disease

Dupuytren's contracture (DC) and Ledderhose disease (LD) are benign conditions of the fascia in the hands and feet respectively, which result in contracture of the digits. Radiation therapy has been proven effective in treating early-stage DC and LD; however, the problem is that there is a paucity of literature regarding radiation therapy treatment set-up for Dupuytren's and Ledderhose patients. The purpose of this case study was to demonstrate treatment set-up considerations of 6 and 9 MeV for DC and LD cases in radiotherapy (RT). Two patients were selected from the same cancer center, each diagnosed with DC and LD. Treatment plans were established utilizing a clinical set-up, electron dose tables, bolus, and target volumes delineated by the radiation oncologist. For each patient, the radiation oncologist prescribed 2 treatment courses of 300 cGy in 5 fractions per treatment site. The radiation oncologist determined the desired depth of treatment, through the palpation of the nodules, and used electron depth dose tables to determine the energy, isodose lines, and bolus thickness necessary to treat the lesions to the appropriate depth. Doses delivered were verified with metal oxide semiconductor field effect transistors (MOS-FET) in vivo on the first day of treatment for each course. In this case study, researchers demonstrated clinical set-up for 2 patients treated for both DC and LD. The clinical set-up considerations resulted in successful treatment delivery with minor, but acceptable, variations during treatment.

Microstructure and properties of additively manufactured Al-Ce-Mg alloys

Additive manufacturing of aluminum alloys is largely dominated by a near-eutectic Al-Si compositions, which are highly weldable, but have mechanical properties that are not competitive with conventional wrought Al alloys. In addition, there is a need for new Al alloys with improved high temperature properties and thermal stability for applications in the automotive and aerospace fields. In this work, we considered laser powder bed fusion additive manufacturing of two alloys in the Al–Ce–Mg system, designed as near-eutectic (Al–11Ce–7Mg) and hyper-eutectic (Al–15Ce–9Mg) compositions with respect to the binary L → Al + Al₁₁Ce eutectic reaction. The addition of magnesium is used to promote solid solution strengthening. A custom laser scan pattern was used to reduce the formation of keyhole porosity, which was caused by excessive vaporization due to the high vapor pressure of magnesium. The microstructure and tensile mechanical properties of the alloys were characterized in the as-fabricated condition and following hot isostatic pressing. The two alloys exhibit significant variations in solidification structure morphology. These variations in non-equilibrium solidification structure were rationalized using a combination of thermodynamic and thermal modeling. Both alloys showed higher yield strength than AM Al-10Si-Mg for temperatures up to 350 °C and better strength retention at elevated temperatures than additively manufactured Scalmaloy.

Implementation and operation of incident learning across a newly-created health system

PURPOSE

The purpose of this work is to describe our experience launching an expanded incident learning system for patient safety and quality that takes into account aspects beyond therapeutic dose delivery, specifically imaging/simulation incidents, medical care incidents, and operational issues.

METHODS

Our ILS was designed for a newly created health system comprised of a midsized academic hospital and two smaller community hospitals. The main design goal was to create a highly sensitive system to capture as much information throughout the department as possible. Reports were classified according to incidents and near misses involving therapeutic radiation, imaging/simulation, and patient care (not involving radiation), unsafe conditions, operational issues, and accolades/suggestions. Reports were analyzed according to impact on various steps in the process of care. Actions made in response to reports were assessed and characterized by intervention reliability.

RESULTS

A total of 1125 reports were submitted in the first 23 months. For all three departments, therapeutic radiation incidents and near misses consisted of less than one-third of all reports submitted. For the midsized academic department, operational issues and unsafe conditions comprised the largest percentage of reports (70%). Although the majority of reports impacted steps related to the technical aspects of treatment (simulation, planning, and treatment delivery), 20% impacted other steps such as scheduling or clinic visits. More than 160 actions were performed in response to reports. Of these actions, 63 were quality improvement interventions to improve practices, while 97 were learning actions for raising awareness.

CONCLUSIONS

We have developed an ILS that identifies issues related to the entire process of care delivery in radiation oncology, as evidenced by frequent and varied reported events. By identifying a broad spectrum of issues in a department, opportunities for improvement can be identified.

Intake of individual macronutrients following IP injections of BBS and CCK in rats

The effects of injections of either bombesin (BBS) or cholecystokinin octapeptide (CCK-8) on patterns of food intake of macronutrients were examined in adult male rats, and compared to the effects following saline injections. The animals were food deprived for 18 hours and then offered one of three isocaloric dietary components (protein, carbohydrate or fat). During the first 30 minutes following injections of BBS, protein intake was decreased. Suppression of carbohydrate intake, significant between 30 and 60 minutes, was sustained up to two hours following injections. During the first 30 minutes following injections of CCK, animals reduced their intake of each macronutrient. Reductions in the consumption of fat and protein were sustained up to one and six hours, respectively. The availability of particular macronutrients is proposed as a possible factor accounting for differences among studies with respect to self-selection profiles and duration effects.