ENERGY METER WITH DIRECT THREE – PHASE CONNECTION. TECHNICAL CHARACTERISTICS. DVH A. DVH A. VOLTAGE INPUTS. Oct 3, The purpose of this request is to obtain variance relief allowing for the construction of a foot high ground sign adjacent to the I-4 right-of-way. impulse/kWh DVH (-M). Width: 30ms. Standard display. 7 digits + 1 digit after the comma. Dimensions. x mm x – 6TE width. Weight .
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These 561 contours for the entire cohort were then reviewed and modified individually by hand after auto-segmentation had been completed to maintain consistency in contours for all 90 patients. Dose-volume histogram data showing the median radiation dose of 10 patients manually contoured forming the training set dotted line compared to the automatically generate plexus contours using deformable image registration, prior to modification.
Deformable image registration is a valuable tool, especially for contouring difficult structures like the brachial plexus.
Treatment plans from those patients were de-archived from the tape backup system and restored into a research Pinnacle planning system Philips Healthcare. Dose-volume histograms DVHs of the brachial plexuses for the first 10 patients original training set contoured manually werecompared to those created by deformable image registration deformable image set Fig.
Radiation-induced brachial plexopathy can be quite debilitating and is difficult to treat [ 7 ]. Contouring the brachial plexus on CT scans continues to be challenging.
Arya AminiB. The median maximum doses to 0. The median time to symptom onset was 6.
Balancing the benefit of local control with the risk of considerable toxicity is a particular challenge for tumorsof the superior sulcus or tumors with supraclavicular adenopathy. Conclusions For lung cancers near the apical region, brachial plexopathy is a major concern for high-dose radiation therapy. The superior border of the plexus was initiated between the neural foramina at C4-C5 where the nerve was traced as it exited the foramina.
The planned tumor volume PTV received 74 Xvh. See other articles in PMC that cite the published article. Next we plan to validate these dose constraints in an ongoing randomized phase III trial looking at dose escalation for lung cancer. Radiation-induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer–a review.
This was corrected withminor modifications for each individual to ensure consistency. Evaluation of Brachial Plexus Dose The Pinnacle planning system was used to calculate the dose to the brachial plexus using the original treatment plan. The contours were drawn jointly by two thoracic radiation oncologists and one thoracic radiologist. National Center for Biotechnology InformationU. Finally, because brachial plexopathy is relatively rare, the number of events in our study was low, which complicates our ability to generalize our defined dose limits to a larger population of patients with lung cancer.
The multi-atlas segmentation technique we used has the potential to reduce inter-subject, inter-observer, or even intra-observer variability in contouring the brachial plexus.
Schierle C, Winograd JM. Proc Am Soc Clin Oncol. Additional inclusion criteria were having at least 4 months of follow-up and having had either photon or proton therapy with 3D conformal or intensity-modulated radiation treatment planning, with or without concurrent chemotherapy. At a median follow-up time of A prospective randomized study of various irradiation doses and fractionation schedules in the treatment of inoperable non-oat-cell carcinoma of the lung.
J Natl Cancer Inst. Dvhh of human anatomy. CA Cancer J Clin.
We also evaluated the contribution of other factors, such as having plexopathy before radiation, receipt of concurrent chemotherapy, and receipt of proton versus photon therapy, to the risk of developing brachial plexopathy. For these reasons, estimates of smaller point doses may not have been accurate enough to predict the development of plexopathy. The median dose to the tumor 51611 70 Gy range The Pinnacle planning system was used to calculate the dose to the brachial plexus using the original treatment plan.
As a service to our customers we are providing this early version of the manuscript. Characteristics Value or No. Unfortunately, these are the very patient likely to justify dose escalation as they often have gross tumor svh on the nerve, and perhaps the risk is justified because recurrent tumors will also result in further morbidity.
At present, the maximum tolerated radiation dose for the brachial plexus remains a matter of debate. These 10 images were then incorporated in the deformable registry program. OR, odds ratio; CI, confidence interval.
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