1
|
Huynh MA, Conway L, Physic M, Czerminska M, Spektor A, Killoran JH, Friesen S, Bredfeldt JS. Prospective Evaluation of Implementation of a Tattoo-less Workflow for Non-Spine Bone SBRT. Int J Radiat Oncol Biol Phys 2023; 117:e110. [PMID: 37784647 DOI: 10.1016/j.ijrobp.2023.06.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Oligometastatic disease has expanded the clinical indications for non-spine bone (NSB) SBRT. Optical surface monitoring systems (OSMS) may reduce treatment time if it represents an effective surrogate for bone intrafraction motion monitoring. We aimed to identify whether OSMS could substitute for 2D-3D mid-imaging and enable a tattoo-less set up in NSB SBRT. MATERIALS/METHODS Beginning 11/2019, OSMS was incorporated in parallel with an existing workflow using CBCT and mid 2D-3D kV/kV imaging for pre- and mid-imaging for NSB SBRT. The ability of OSMS to detect both observed out-of-tolerance (>2mm/>2deg) shifts and manual couch shifts was analyzed. A workflow incorporating OSMS reference captures, CBCT for pre-treatment verification and OSMS/triggered imaging (TI) for intrafraction monitoring was developed and deployed for rib/sternum SBRT beginning 11/2021 and all NSB SBRT beginning 2/2022. All NSB SBRT treatment appointments were analyzed through statistical process control (SPC) with use of an XmR chart of average set up and total treatment time per quarter from 2/2019 to 2/2023. Special cause rules were based on IHI rules and conduced with spreadsheet software. RESULTS From 2/2019 to 2/2023, 1962 NSB SBRT fractions were delivered, including 337 rib, 150 sternum, 197 femur, 266 ilium, 222 multi-site. Over 104 femur and 87 ilium images, there were no over tolerance intra-fraction events detected with 2D-3D or OSMS. Over 20 manual shifts, OSMS could detect 2mm shifts to within 0.4mm 67% of the time and 0.8mm 95% of time. There was no difference in treatment set up time following adoption of an OSMS/TI workflow as a replacement for 2D-3D mid-imaging. A reduction in rib SBRT delivery and multi-site treatment set-up times was significantly associated with the adoption of OSMS/TI and OSMS, respectively, as assessed based on special cause variation with 8 consecutive points below the mean. CONCLUSION Integration of OSMS and triggered imaging has enabled the transition to a completely tattoo-less workflow, thus sparing patients the need for permanent tattoos whilst also allowing more continuous motion monitoring and reduced radiation exposure related to unnecessary 2D-3D or CBCT mid-imaging. Treatment times were significantly reduced for patients receiving rib SBRT or multi-site NSB SBRT with this workflow.
Collapse
Affiliation(s)
- M A Huynh
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - L Conway
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - M Physic
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - M Czerminska
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - A Spektor
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - J H Killoran
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - S Friesen
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - J S Bredfeldt
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| |
Collapse
|
2
|
Kehayias CE, Bontempi D, Quirk S, Friesen S, Bredfeldt JS, Huynh MA, Aerts H, Mak RH, Guthier CV. Deep Learning-Based Automated Quality Assurance for Palliative Spinal Treatment Planning in Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:S50. [PMID: 37784515 DOI: 10.1016/j.ijrobp.2023.06.332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Robustquality assurance (QA) for palliative spine radiation therapy (RT) remains critical due to the risk of wrong anatomic level treatment on account of human error in enumerating vertebral bodies accurately based on morphology with incomplete imaging of the spine and prevalence of anatomic variants (10%). We propose a rapid, fully automated deep learning-based QA (DL-QA) tool for segmenting and enumerating vertebral structures from image data, capable of identifying misalignment based on discrepancies in calculated dose coverage. MATERIALS/METHODS Ina retrospective cohort of 514 patients who received palliative spine radiation treatment at a single institution for spinal metastases, vertebral volumes for each individual spine level were automatically segmented on RT planning computed tomography scans using a publicly available deep learning algorithm, Total Segmentator (TS) deployed in the treatment planning system (Wasserthal et al, 2022). Departmental policy requires that the prescription/plan name include all spinal levels that receive a prescribed dosimetric threshold of V50% > 50%. By comparing the intended spine level target in the prescription and plan name against the TS volumes, the DL-QA flagged all cases for which any target vertebrae did not receive this threshold dose and/or any non-targeted vertebrae that received V50% > 50%. To detect spine anomalies, cases were also flagged if any vertebrae volume was not within ±1σ of the entire population of vertebrae volumes. Flagged cases were either categorized as: (1) wrong spine level RT error; (2) documentation error, in which treatment was correct but the prescription/plan name did not follow Departmental policy; or (3) potential spinal geometric error. All flagged cases were verified manually by checking the original images and treatment planning data. RESULTS Outof 514 patients, 29 cases were flagged as potential errors. Manual review revealed that one of these was a previously discovered true treatment error (due to anatomic variant with 4 lumbar bodies) while 10 were treated as intended but showed documentation errors due to variants in the number of vertebral bodies, kyphosis of the spine causing non-targeted vertebrae to appear in the treatment field, or improper observation of the Departmental plan naming policy. The remaining 18 cases were associated with flagged vertebrae volumes. Reviewing those patients, we identified spinal anomalies where TS attempted to account for extra or missing vertebrae (N = 9) and cases where TS made segmentation errors (N = 9). CONCLUSION Theproposed automated DL-QA system successfully identified patients with spine anomalies, flagged documentation errors, verified the correct target levels of spine RT treatments, and detected a known misadministration. The next phase will involve prospective testing of the system in a clinical setting upstream of treatment delivery.
Collapse
Affiliation(s)
- C E Kehayias
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - D Bontempi
- Brigham and Women's Hospital, Boston, MA
| | - S Quirk
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - S Friesen
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - J S Bredfeldt
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - M A Huynh
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - H Aerts
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - R H Mak
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - C V Guthier
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| |
Collapse
|
3
|
Elliott MJ, Ravani P, Quinn RR, Oliver MJ, Love S, MacRae J, Hiremath S, Friesen S, James MT, King-Shier KM. Patient and Clinician Perspectives on Shared Decision Making in Vascular Access Selection: A Qualitative Study. Am J Kidney Dis 2023; 81:48-58.e1. [PMID: 35870570 DOI: 10.1053/j.ajkd.2022.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE & OBJECTIVE Collaborative approaches to vascular access selection are being increasingly encouraged to elicit patients' preferences and priorities where no unequivocally superior choice exists. We explored how patients, their caregivers, and clinicians integrate principles of shared decision making when engaging in vascular access discussions. STUDY DESIGN Qualitative description. SETTING & PARTICIPANTS Semistructured interviews with a purposive sample of patients, their caregivers, and clinicians from outpatient hemodialysis programs in Alberta, Canada. ANALYTICAL APPROACH We used a thematic analysis approach to inductively code transcripts and generate themes to capture key concepts related to vascular access shared decision making across participant roles. RESULTS 42 individuals (19 patients, 2 caregivers, 21 clinicians) participated in this study. Participants identified how access-related decisions follow a series of major decisions about kidney replacement therapy and care goals that influence vascular access preferences and choice. Vascular access shared decision making was strengthened through integration of vascular access selection with dialysis-related decisions and timely, tailored, and balanced exchange of information between patients and their care team. Participants described how opportunities to revisit the vascular access decision before and after dialysis initiation helped prepare patients for their access and encouraged ongoing alignment between patients' care priorities and treatment plans. Where shared decision making was undermined, hemodialysis via a catheter ensued as the most readily available vascular access option. LIMITATIONS Our study was limited to patients and clinicians from hemodialysis care settings and included few caregiver participants. CONCLUSIONS Findings suggest that earlier, or upstream, decisions about kidney replacement therapies influence how and when vascular access decisions are made. Repeated vascular access discussions that are integrated with other higher-level decisions are needed to promote vascular access shared decision making and preparedness.
Collapse
Affiliation(s)
- Meghan J Elliott
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Pietro Ravani
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Robert R Quinn
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Matthew J Oliver
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shannan Love
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer MacRae
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Swapnil Hiremath
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Friesen
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn M King-Shier
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
4
|
Bredfeldt J, Johnson T, Friesen S, Hu Y, Hacker F, Cagney D, Spektor A, Balboni T, Huynh M. Optical Surface Monitoring for Non-Spine Bone SBRT Patients. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
5
|
Wagar M, Friesen S, Lyatskaya Y, O'Farrell D, Bhagwat M. SU-F-T-464: Development of a Secondary Check Procedure to Evaluated Flatness and Symmetry Discrepancies Detected During Daily Morning QA. Med Phys 2016. [DOI: 10.1118/1.4956649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
6
|
Buzurovic I, Devlin P, Hansen J, O'Farrell D, Bhagwat M, Friesen S, Damato A, Harris T, Cormack R. SU-G-201-04: Can the Dynamic Library of Flap Applicators Replace Treatment Planning in Surface Brachytherapy? Med Phys 2016. [DOI: 10.1118/1.4956877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
7
|
Liu Y, Alexander B, Chen Y, Horvath M, Aizer A, Claus E, Dunn I, Golby A, Johnson M, Friesen S, Mannarino E, Wagar M, Hacker F, Arvold N. Need for Salvage Whole-Brain Radiation Therapy or Stereotactic Radiosurgery in Patients With 1-4 Brain Metastases Receiving Upfront Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
8
|
Wagar M, Bhagwat M, O'Farrell D, Friesen S, Buzurovic I, Damato A, Devlin P, Cormack R. SU-E-T-413: Examining Acquisition Rate for Using MatriXX Ion Chamber Array to Measure HDR Brachytherapy Treatments. Med Phys 2015. [DOI: 10.1118/1.4924774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
9
|
Han Z, Yip S, Lewis J, Mannarino E, Friesen S, Wagar M, Hacker F. SU-E-J-34: Setup Accuracy in Spine SBRT Using CBCT 6D Image Guidance in Comparison with 6D ExacTrac. Med Phys 2015. [DOI: 10.1118/1.4924121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
10
|
Bhagwat M, O'Farrell D, Wagar M, Buzurovic I, Friesen S, Damato A, Devlin P, Cormack R. SU-E-T-783: Using Matrixx to Determine Transit Dose Contribution Over Clinically Useful Limits of HDR Source Activity. Med Phys 2015. [DOI: 10.1118/1.4925147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
11
|
Buzurovic I, Hansen J, Bhagwat M, O'Farrell D, Damato A, Friesen S, Devlin P, Cormack R. SU-E-T-165: Characterization of Dose Distributions in High-Dose-Rate Surface Brachytherapy. Med Phys 2015. [DOI: 10.1118/1.4924527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
12
|
Damato A, Molodowitch C, Bhagwat M, Buzurovic I, Devlin P, Friesen S, Hansen J, Lee L, Nguyen P, O'Farrell D, Viswanathan A, Williams C, Cormack R, Killoran J. Review of High-Dose-Rate (HDR) Brachytherapy Plan Errors: Effect of Software-Aided Verification on Effectiveness and Efficiency of the Physics Plan Quality Assurance (QA) Process. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
13
|
Wagar M, Friesen S, Mannarino E, Hacker F. SU-E-T-106: Development of a Collision Prediction Algorithm for Determining Problematic Geometry for SBRT Treatments Using a Stereotactic Body Frame. Med Phys 2014. [DOI: 10.1118/1.4888436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
14
|
Buzurovic I, Devlin P, Hansen J, O' Farrell D, Bhagwat M, Friesen S, Damato A, Lewis J, Cormack R. SU-E-T-362: Automatic Catheter Reconstruction of Flap Applicators in HDR Surface Brachytherapy. Med Phys 2014. [DOI: 10.1118/1.4888695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
15
|
Damato AL, Bhagwat MS, Buzurovic I, Devlin PM, Friesen S, Hansen JL, Kapur T, Lee LJ, Mehrtash A, Nguyen PL, O' Farrell D, Wang W, Viswanathan AN, Cormack RA. WE-A-17A-03: Catheter Digitization in High-Dose-Rate Brachytherapy with the Assistance of An Electromagnetic (EM) Tracking System. Med Phys 2014. [DOI: 10.1118/1.4889373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
16
|
Rajakesari S, Arvold N, Christianson L, Jimenez R, Friesen S, Mannarino E, Wagar M, Hacker F, Weiss S, Alexander B. Hypofractionated Stereotactic Radiation Therapy for Brain Metastases. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
17
|
Hacker F, Friesen S, Mannarino E, Wagar M, Lewis J, Lyatskaya Y. SU-E-T-135: A Total Imaging Test Sequence to Determine the Isocenter Coordinates of Multi-Modality Imaging Systems On a Stereotactic Linac Relative to the Radiation Isocenter. Med Phys 2013. [DOI: 10.1118/1.4814570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
18
|
Hacker F, Bondeson J, Lewis J, Mannarino E, Friesen S, Balboni T, Alexander B, Sher D. SU-E-T-401: Evaluation of Initial Setup Accuracy and Intra-Fraction Motion for Spine SBRT Using Stereotactic Body Frames. Med Phys 2012; 39:3796. [DOI: 10.1118/1.4735490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
19
|
Wagar M, Mannarino E, Friesen S, Hacker F, Lewis J. SU-E-J-148: Fabrication of an Anatomically Realistic Dynamic Respiratory Phantom. Med Phys 2012; 39:3686-3687. [DOI: 10.1118/1.4734985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
20
|
Friesen S, Rottmann J, Berbeco R, Hacker F, Lewis J. The Improved Accuracy of Adaptive Gating and Effect on Treatment Time as Compared to External Surrogate-Based Gating. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
21
|
Lewis J, Friesen S, Rottmann J, Nishioka S, Shirato H, Berbeco R, Hacker F. TH-C-BRC-01: The Effects of Adaptive Gating on Treatment Accuracy and Delivery Time. Med Phys 2011. [DOI: 10.1118/1.3613518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
22
|
Hacker F, Rosca F, Friesen S, Zygmanski P, Ramakrishna N. SU-FF-T-75: Accuracy Assessment of a Non-Invasive Image Guided System for Intra-Cranial Linac Based Stereotactic Radiosurgery. Med Phys 2006. [DOI: 10.1118/1.2241001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
23
|
Lockhart WL, Stern GA, Low G, Hendzel M, Boila G, Roach P, Evans MS, Billeck BN, DeLaronde J, Friesen S, Kidd K, Atkins S, Muir DCG, Stoddart M, Stephens G, Stephenson S, Harbicht S, Snowshoe N, Grey B, Thompson S, DeGraff N. A history of total mercury in edible muscle of fish from lakes in northern Canada. Sci Total Environ 2005; 351-352:427-63. [PMID: 16169059 DOI: 10.1016/j.scitotenv.2004.11.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Revised: 06/05/2004] [Accepted: 11/27/2004] [Indexed: 05/04/2023]
Abstract
Subsistence fishing has been an important source of food for Native People in northern Canada since prehistoric time. Measurements of the levels of mercury in edible muscle of northern fish have been undertaken for over three decades in efforts to evaluate the risks of consuming northern fish. This report summarizes the data obtained from 7974 fish of 25 species from sites distributed from the Yukon to Labrador. The most abundant species were lake trout, lake whitefish, arctic char, walleye, northern pike and burbot. The question being asked was essentially "Are the fish safe to eat?" The results were used to support decisions on fishing and consumption of fish. They were sorted in several ways, into concentration ranges corresponding to human consumption guidelines, into political jurisdictions and into types of bedrock geology. Overall walleye, northern pike and lake trout, usually exceeded the subsistence consumption guideline of 0.2 microg g-1 total mercury and often exceeded the higher guideline of 0.5 microg g-1 total mercury for commercial sales of fish. Mercury in burbot, another facultative predator, was often lower but several still exceeding a guideline. Arctic char collections were mostly from anadromous populations and these had very low levels of mercury, presumably reflecting marine food sources. Lake whitefish were among the cleanest fish examined with 69 of 81 collections falling in the lowest range. Most collections were from sites in sedimentary rock. However a few sites were in metamorphic, intrusive or volcanic rocks and these, taken together, tended to have a higher proportion of sites in the higher ranges of mercury. These results indicate a widespread problem with mercury in subsistence fisheries for predator species of fish with the problem being most problematic for Nunavut.
Collapse
Affiliation(s)
- W L Lockhart
- North-South Consultants Inc., 833 Harstone Road, Winnipeg, Manitoba, Canada R3R 1E1
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Rosca F, Zygmanski P, Lorenz F, Hacker F, Chin L, Friesen S, Petsuksiri J, Shanmugham L, Ramakrishna N. SU-FF-T-390: A New Linac QA Procedure for the Characterization of Radiation Isocenter and Room Lasers Position. Med Phys 2005. [DOI: 10.1118/1.1998147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
25
|
Rosca F, Zygmanski P, Lorenz F, Hacker F, Chin L, Friesen S, Petsuksiri J, Shanmugham L, Ramakrishna N. SU-FF-T-175: A New Linac QA Procedure for the Characterization of Gantry Radiation Isocenter. Med Phys 2005. [DOI: 10.1118/1.1997846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
26
|
Abstract
We studied survival and prognostic factors in all cases of hepatocellular carcinoma seen at a Midwestern teaching hospital from 1947 through 1986. Of the 70 cases, 56 were diagnosed during life and 14 at autopsy. There were 47 males and 23 females with age at diagnosis ranging from 14 to 88. Median survival for the 56 patients diagnosed during life was 106 days. Only 11 patients lived longer than one year. Two patients were long survivors and presumed cured, one living 27 years after diagnosis and surgical treatment and the other 19 years. Cox regression model showed young age at diagnosis and low stage of disease at diagnosis to be significant predictors of long survival. White patients survived nearly twice as long as black patients but the difference was not significant. Gender and year of diagnosis did not appear to be important determinants of survival. Pathologic material was still available for one of the two long survivors and the histology was that of fibrolamellar carcinoma of young adults.
Collapse
Affiliation(s)
- G Zhao
- Department of Surgery, University of Kansas Medical Center, Kansas City 66103
| | | | | | | | | |
Collapse
|
27
|
Tomita T, Visser P, Friesen S, Doull V. Cortisone-induced islet cell hyperplasia in hamsters. Virchows Arch B Cell Pathol Incl Mol Pathol 1984; 45:85-95. [PMID: 6142561 DOI: 10.1007/bf02889855] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Pancreatic islet cell hyperplasia was studied in hamsters during one to eight weeks of cortisone treatment. Measurement of serum glucose and insulin; pancreatic insulin, glucagon, somatostatin, pancreatic polypeptide as well as islet tissue morphometry were performed. Serum glucose was highest at week 2, followed by mild to moderate hyperglycemia. Serum insulin was increasingly higher from week 1 to week 8. Pancreatic insulin was maximal at week 5 then declined through week 8 in the presence of beta cell neurosis in markedly hyperplastic islets. Pancreatic concentration of somatostatin and pancreatic polypeptide moderately increased more than the control levels; however, compared with the controls, glucagon was reduced by cortisone treatment. Effect of cortisone in the four types of islet cells is discussed, particularly on beta cell hyperplasia, which appears to be a response to decreased insulin binding to the target organs with no changes in receptor concentration.
Collapse
|
28
|
Swan H, Nelson AW, Friesen S. Experimental hemorrhage: absolute predictability of survival; a tool for evaluation of therapy. Bull Soc Int Chir 1972; 31:365-9. [PMID: 4656318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
29
|
Abstract
Thirty specimens of stomach, duodenum, and jejunum, removed at operation, were examined by optical microscopical, cytochemical, and electron microscopical techniques. The overall distribution of four types of endocrine polypeptide cell in the stomach, and three in the intestine, was determined. The seven cell types are described by names and letters belonging to a scheme for nomenclature agreed upon at the 1969 Wiesbaden conference on gastrointestinal hormones. The gastrin-secreting G cell was the only cell for which firm identification with a known hormone was possible. Although there was wide variation in the distribution of the various cells, from one case to another, striking differences were nevertheless observable, with respect to the G cell, between antra from carcinoma and from ulcer cases.
Collapse
|