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The computerized treatment planning system plays a major role in radiation therapy in delivering correct radiation dose to the patients within ±5% as recommended by the ICRU. To evaluate the dosimetric performance of the Treatment Planning system (TPS) with three-dimensional dose calculation algorithm using the basic beam data measured for 6 MV X-rays. Eleven numbers of test cases were created according to the Technical Report Series-430 (TRS 430) and are used to evaluate the TPS in a homogeneous water phantom. These cases involve simple field arrangements as well as the presence of a low-density material in the beam to resemble an air in-homogeneity. Absolute dose measurements were performed for the each case with the MU calculation given by the TPS, and the measured dose is compared with the corresponding TPS calculated dose values. The result yields a percentage difference maximum of 2.38% for all simple test cases. For complex test cases in the presence of in-homogeneity, beam modifiers or beam modifiers with asymmetric fields a maximum percentage difference of 5.94% was observed. This study ensures that the dosimetric calculations performed by the TPS are within the accuracy of ±5% which is very much warranted in patient dose delivery. The test procedures are simple, not only during the installation of TPS, but also repeated at periodic intervals.

Myofascial pain and myofascial pain syndromes are among some of the most common acute and chronic pain conditions. Many interventional procedures can be performed in both an acute and chronic pain setting to address myofascial pain syndromes. Trigger point injections can be performed with or without imaging guidance such as fluoroscopy and ultrasound; however, the use of imaging in years past has been recommended to improve patient outcome and safety. Injections can be performed using no injectate (dry needling), or can involve the administration of local anesthetics, botulinum toxin, or corticosteroids., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: The COVID-19 pandemic has caused unprecedented health, social, and economic unrest globally, particularly affecting resource-limited low-middle-income countries. The resultant curfew had made the access to and delivery of cancer care services an arduous task. We have reported the patterns of care and 1-year outcome of head and neck squamous cell carcinoma (HNSCC) treatment before and during COVID-19 lockdown at our institution., Materials and Methods: Patients who underwent radiation therapy (RT) for nonmetastatic HNSCC between March 1, 2020, and July 31, 2020, were included in the COVID-RT group, and those who were treated between October 1, 2019, and February 29, 2020, were included in the preCOVID-RT group., Results: A total of 25 patients were in the COVID-RT group, and 51 patients were in the preCOVID-RT group. An increase in the incidence of locally advanced cancers across all subsites was observed in the COVID-RT group. There was a steep increase in the median overall RT treatment duration (52 v 44) and median break days during RT (10 v 2) in the COVID-RT group. The median follow-up period of all patients was 18 months. The progression-free survival at 1 year in the COVID-RT group and preCOVID-RT group was 84% and 90%, respectively ( P = .08), and overall survival at 1 year was 86% and 96%, respectively ( P = .06)., Conclusion: Our study elucidates the adverse impact of the COVID-19 curfew on cancer care and has demonstrated safe delivery of RT for HNSCC without major acute adverse effects. Despite a significant increase in treatment breaks, early outcome data also suggest that 1-year progression-free survival and overall survival are comparable with that of the pre-COVID-19 times; however, longer follow-up is warranted.

Objective: To report our clinical experience and propose a biomechanical factor-based treatment strategy for improvement of genu recurvatum (GR) to reduce the need for knee-ankle-foot orthosis (KAFO) or surgical treatment., Design: Case series., Setting: Outpatient clinic of a Department of Physical Medicine and Rehabilitation in an academic medical center., Subjects and Interventions: Adult subjects (n = 22) with hemiparesis and GR who received botulinum injections alone or in combination with multiple types of orthotic interventions that included solid ankle-foot orthosis (AFO) ± heel lift, hinged AFO with an adjustable posterior stop ± heel lift, AFO with dual-channel ankle joint ± heel lift, or KAFO with offset knee joint. Biomechanical factors reviewed included muscle strength, modified Ashworth score for spasticity, presence of clonus, posterior capsule laxity, sensory deficits, and proprioception., Outcome Measurements: Outcome factors were improvement or elimination of GR based on subjective assessment before and after the interventions by the same experienced clinician., Results: More than one biomechanical factor contributed to GR in all patients. Botulinum toxin A injection was used in patients who had significant plantar flexor spasticity and/or clonus. Four types of orthotic interventions were used based on the biomechanical factor: solid AFO in patients with severe ankle dorsiflexion and plantar flexion weakness or clonus; hinged ankle joint with adjustable posterior stop in patients with less severe ankle dorsiflexion weakness in the absence of clonus; AFO with a dual-channel ankle joint for quadriceps weakness or severe proprioceptive deficits; and KAFO with offset knee joints in patients with Achilles tendon contracture or severe proprioceptive deficits. Adjunctive options included the addition of heel lifts and toeplate modifications. Combinatorial interventions of botulinum injection, modified AFOs, and heel lifts improved or eliminated GR and avoided the need for cumbersome orthotics or surgical interventions., Conclusions: GR in hemiparesis is multifactorial and can be successfully controlled by using a conservative biomechanical factor-based approach and combined medical and orthotic interventions. An algorithmic approach and a prospective study design is proposed to determine a combination of effective interventions to correct GR., (Copyright © 2015. Published by Elsevier Inc.)

Background: Fluoroscopic guided percutaneous interventional spine procedures are increasingly performed in recent years as they have been shown to be target specific and enhance patient safety. However, ionizing radiation has been associated with stochastic effects such as cancer and genetic defects as well as deterministic effects such as cataracts, erythema, epilation, and even death. These are dose related, and hence, measures should be taken to minimize radiation exposure to patients and health care personnel to reduce these adverse effects., Objective: A risk reduction project was completed with the goal of reducing effective doses to the staff and patients in a university-based spinal interventional practice. Effective dose reduction to the staff and patients was hypothesized to occur with technique and equipment changes in the procedure suite. The goal of this study was to quantify effective dose rates to staff before and after interventions., Study Design: Retrospective study comparing descriptive data of effective dose to the health care staff before and after implementation of a combination of technique and equipment changes., Methods: Technique changes from pre to post intervention period included continuous needle advancement under continuous fluoroscopic controlled by the interventional physician to intermittent needle advancement under pulsed fluoroscopic controlled by the radiology technician. Equipment changes included circumferential lead drape skirt around the procedure table and use of mobile transparent lead barriers on both sides of the procedure table.Effective dose exposure measured in Millirem (mrem) from the radiation dosimetry badges for pre-intervention (February 2009 through June 2009) and post-intervention (November 2009 through March 2010) periods were examined through monthly radiation dosimetry reports for the fluoroscopy suite staff., Results: A total of 685 interventional procedures were performed in the pre-intervention period and 385 in the post-intervention period. The median cumulative mrem (interquartile range) for all staff combined in the pre-intervention period was 71 (28,75) and post-intervention period was 1 (0,3). The median mrem per procedure was significantly higher in the pre-intervention group 0.46 (0.36, 0.54) compared to post-intervention 0.01 (0.0.03); P < 0.01. The percentage reduction in overall effective dose per procedure to all staff was 97.3%., Limitations: Observational study, multiple radiation reduction interventions confound the individual effects of each intervention's effective dose, Conclusions: Spinal injection technique and equipment changes in the procedure suite significantly reduced the rate of effective dose to the clinical staff.

The 4 MV photon beam offers equal build-up region behavior like Co-60 beam and it plays a major role in head and neck and pediatric radiotherapy. In this study an attempt is made to study the head scatter factor (SC) for 4 MV photon beam using locally designed PMMA and Brass miniphantoms. The SC is measured in combination of PMMA miniphantom with 0.6 cc chamber and Brass miniphantom with 0.6 cc and 0.13 cc chambers. The measured SC is compared with the literature data and it agrees within ± 1.98%. The study reveals that either 0.13 cc or 0.6 cc chamber with PMMA or Brass phantom materials can be used for SC measurements in a 4 MV photon beam. The variation of SSD does not alter the head scatter factor. The collimator exchange effect is found to be within 1, and it is less than that of other linear accelerators. It is also found that the presence of internal wedge has significant contribution to head scatter factor. The Phantom scatter factor is also calculated and it agrees within ±1% with published data.

Objective: To investigate the relationship between oxidative stress and the underlying causes of infertility, preovulatory ovarian hormones, and ovarian response to gonadotropin stimulation in patients undergoing assisted reproductive techniques., Design: Prospective, cross-sectional study., Setting: Assisted conception unit, university hospital., Patient(s): One hundred thirty women presenting with infertility, of the following types: male factor (n = 56), unexplained (n = 36), tubal factor (n = 16), polycystic ovary syndrome (n = 15), and endometriosis (n = 7)., Intervention(s): Follicular fluid (FF) and peripheral blood samples were collected at oocyte retrieval., Main Outcome Measure(s): Blood and FF samples were analyzed for inhibin A, inhibin B, activin A, anti-Müllerian hormone, and E(2) by using ELISA. Total antioxidant capacity (TAC) was measured in plasma and FF by using a calorimetric microplate assay., Result(s): There was no significant relationship between plasma or FF TAC and the underlying etiology of infertility. There was a statistically significant positive association between FF E(2) levels and TAC (r = 0.26). Higher antral follicle count, delta E(2) (day 3 E(2) minus day 2 E(2)), preovulatory serum anti-Müllerian hormone, inhibin B, and E(2) were associated with good ovarian response, whereas higher FF E(2) was associated with a statistically significant poor response. No significant direct relationship was observed between TAC and ovarian response as well as between TAC or any of the parameters measured and pregnancy outcome., Conclusion(s): Oxidative stress has an impact on the production of granulosa cell steroid hormones, in particular E(2), which is an important predictor of ovarian response. The positive association between FF E(2) and total antioxidant capacity suggests that E(2) may play a role in the ovarian antioxidant-oxidant balance.