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7. Proton therapy technology evolution in the clinic: impact on radiation protection

Author

T Depuydt

Subjects
medicine.medical_specialty, Radiological and Ultrasound Technology, Computer science, business.industry, medicine.medical_treatment, Public Health, Environmental and Occupational Health, Technological evolution, 030218 nuclear medicine & medical imaging, Radiation therapy, 03 medical and health sciences, Radiation Protection, 0302 clinical medicine, Conventional radiotherapy, Treatment modality, 030220 oncology & carcinogenesis, Proton Therapy, medicine, Humans, Radiology, Nuclear Medicine and imaging, Medical physics, Radiation protection, Pencil-beam scanning, business, Image guidance, Proton therapy
Abstract

The use of proton therapy as a treatment modality is becoming more widespread in conventional radiation therapy practice. Commercialisation and introduction of compact systems has led to embedding of proton therapy facilities in existing hospital environments. In addition, technologically, proton therapy is currently undergoing an important evolution, moving from passive scattering delivery techniques to active pencil beam scanning, adopting image guidance techniques from conventional radiotherapy and introducing various range verification techniques in the clinic. An overview is given of today’s technological evolution of proton therapy in clinical environments, and its impact on aspects of radiation protection.

Published
2018
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9. Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study

Author

Pham, Tài, Serpa Neto, Ary, Pelosi, Paolo, Laffey, John Gerard, De Haro, Candelaria, Lorente, Jose Angel, Bellani, Giacomo, Fan, Eddy, Brochard, Laurent Jean, Pesenti, Antonio, Schultz, Marcus Josephu, Artigas, Antonio, Esteban, A., Gattinoni, L., Van, Haren, F., Larsson, A., Mcauley, D. F., Ranieri, M., Rubenfeld, G., Thompson, B. T., Wrigge, H., Slutsky, A. S., Rio, F., Sottiaux, T., Depuydt, P., Lora, F. S., Azevedo, L. C., Bugedo, G., Qiu, Montini, Luca, G, L. P., Bettini, L. R., Bisso, M. C., Osman, E. M., Setten, M. G., Lovazzano, P., Alvarez, J., Villar, V., Pozo, N. C., Grubissich, N., Plotnikow, G. A., Vasquez, D. N., Ilutovich, S., Tiribelli, N., Chena, A., Pellegrini, C. A., Saenz, M. G., Estenssoro, E., Brizuela, M., Gianinetto, H., Gomez, P. E., Cerrato, V. I., Bezzi, M. G., Borello, S. A., Loiacono, F. A., Fernandez, A. M., Knowles, S., Reynolds, C., Inskip, D. M., Miller, J. J., Kong, J., Whitehead, C., Bihari, S., Seven, A., Krstevski, A., Rodgers, H. J., Millar, R. T., Mckenna, T. E., Bailey, I. M., Hanlon, G. C., Aneman, A., Lynch, J. M., Azad, R., Neal, J., Woods, P. W., Roberts, B. L., Kol, M. R., Wong, H. S., Riss, K. C., Staudinger, T., Wittebole, X., Berghe, C., Bulpa, P. A., Dive, A. M., Verstraete, R., Lebbinck, H., Depuydt, P., Vermassen, J., Meersseman, P., Ceunen, H., Rosa, J. I., Beraldo, D. O., Piras, C., Rampinelli, A. M., Nassar, A. P., Mataloun, S., Moock, M., Thompson, M. M., Gonçalves, C. H., Antônio, Acp., Ascoli, A., Biondi, R. S., Fontenele, D. C., Nobrega, D., Sales, V. M., Bin Hj Abul, Wahab, A. Y., Ismail, M., Shindhe, S., Beloncle, F., Davie, K. G., Cirone, R., Manoharan, V., Ismail, M., Goligher, E. C., Jassal, M., Nishikawa, E., Javeed, A., Curley, G., Rittayamai, N., Parotto, M., Ferguson, N. D., Mehta, S., Knoll, J., Pronovost, A., Canestrini, S., Bruhn, A. R., Garcia, P. H., Aliaga, F. A., Faría, P. A., Yumha, J. S., Ortiz, C. A., Sala, J. E., Saez, A. A., Vega, L. D., Labarca, E. F., Martinez, F. T., Carreño, N. G., Lora, P., Liu, H., Qiu, H., Liu, L., Tang, R., Luo, X., An, Y., Zhao, H., Gao, Y., Zhai, Z., Ye, Z. L., Wang, W., Li, Q., Zheng, R., Yu, W., Shen, J., Li, X., Yu, T., Lu, W., Wu, Y. Q., Huang, X. B., He, Z., Lu, Y., Han, H., Zhang, F., Sun, R., Wang, H. X., Qin, S. H., Zhu, B. H., Zhao, J., Liu, B., Liu, J. L., Zhou, F. C., Li, Q. J., Zhang, X. Y., Li-Xin, Z., Xin-Hua, Q., Jiang, L., Gao, Y. N., Zhao, X. Y., Li, Y. Y., Li, X. L., Wang, C., Yao, Q., Yu, R., Chen, K., Shao, H., Qin, B., Huang, Q. Q., Zhu, W. H., Hang, A. Y., Hua, M. X., Li, Y., Xu, Y., Di, Y. D., Ling, L. L., Qin, T. H., Wang, S. H., Qin, J., Han, Y., Zhou, S., Varga, M., P., Silesky, Jimenez, J., I., González, Roja, M. A., Solis-Quesada, J. E., Ramirez-Alfaro, C. M., Máca, J., Sklienka, P., Gjedst, Zani, G., Fusari, M., Spadaro, S., Volta, C. A., Graziani, R., Brunettini, B., Palmese, S., Formenti, P., Umbrello, M., Lombardo, A., Pecci, E., Botteri, M., Savioli, M., Protti, A., Mattei, A., Schiavoni, L., Tinnirello, A., Todeschini, M., Giarratano, A., Cortegiani, A., Sher, S., Rossi, A., Antonelli, Massimo, Montini, L., Casalena, P., Scafetti, S., Panarello, G., Occhipinti, G., Patroniti, N., Pozzi, M., Biscione, R. R., Poli, M. M., Raimondi, F., Albiero, D., Crapelli, G., Beck, E., Pota, V., Schiavone, V., Molin, A., Tarantino, F., Monti, G., Frati, E., Mirabella, L., Cinnella, G., Fossali, T., Colombo, R., Pattarino, Pti., Mojoli, F., Braschi, A., Borotto, E. E., Cracchiolo, A. N., Palma, D. M., Raponi, F., Foti, G., Vascotto, E. R., Coppadoro, A., Brazzi, L., Floris, L., Iotti, G. A., Venti, Montini Luca (ORCID:0000-0003-4602-5134), Antonelli, M (ORCID:0000-0003-3007-1670), Pham, Tài, Serpa Neto, Ary, Pelosi, Paolo, Laffey, John Gerard, De Haro, Candelaria, Lorente, Jose Angel, Bellani, Giacomo, Fan, Eddy, Brochard, Laurent Jean, Pesenti, Antonio, Schultz, Marcus Josephu, Artigas, Antonio, Esteban, A., Gattinoni, L., Van, Haren, F., Larsson, A., Mcauley, D. F., Ranieri, M., Rubenfeld, G., Thompson, B. T., Wrigge, H., Slutsky, A. S., Rio, F., Sottiaux, T., Depuydt, P., Lora, F. S., Azevedo, L. C., Bugedo, G., Qiu, Montini, Luca, G, L. P., Bettini, L. R., Bisso, M. C., Osman, E. M., Setten, M. G., Lovazzano, P., Alvarez, J., Villar, V., Pozo, N. C., Grubissich, N., Plotnikow, G. A., Vasquez, D. N., Ilutovich, S., Tiribelli, N., Chena, A., Pellegrini, C. A., Saenz, M. G., Estenssoro, E., Brizuela, M., Gianinetto, H., Gomez, P. E., Cerrato, V. I., Bezzi, M. G., Borello, S. A., Loiacono, F. A., Fernandez, A. M., Knowles, S., Reynolds, C., Inskip, D. M., Miller, J. J., Kong, J., Whitehead, C., Bihari, S., Seven, A., Krstevski, A., Rodgers, H. J., Millar, R. T., Mckenna, T. E., Bailey, I. M., Hanlon, G. C., Aneman, A., Lynch, J. M., Azad, R., Neal, J., Woods, P. W., Roberts, B. L., Kol, M. R., Wong, H. S., Riss, K. C., Staudinger, T., Wittebole, X., Berghe, C., Bulpa, P. A., Dive, A. M., Verstraete, R., Lebbinck, H., Depuydt, P., Vermassen, J., Meersseman, P., Ceunen, H., Rosa, J. I., Beraldo, D. O., Piras, C., Rampinelli, A. M., Nassar, A. P., Mataloun, S., Moock, M., Thompson, M. M., Gonçalves, C. H., Antônio, Acp., Ascoli, A., Biondi, R. S., Fontenele, D. C., Nobrega, D., Sales, V. M., Bin Hj Abul, Wahab, A. Y., Ismail, M., Shindhe, S., Beloncle, F., Davie, K. G., Cirone, R., Manoharan, V., Ismail, M., Goligher, E. C., Jassal, M., Nishikawa, E., Javeed, A., Curley, G., Rittayamai, N., Parotto, M., Ferguson, N. D., Mehta, S., Knoll, J., Pronovost, A., Canestrini, S., Bruhn, A. R., Garcia, P. H., Aliaga, F. A., Faría, P. A., Yumha, J. S., Ortiz, C. A., Sala, J. E., Saez, A. A., Vega, L. D., Labarca, E. F., Martinez, F. T., Carreño, N. G., Lora, P., Liu, H., Qiu, H., Liu, L., Tang, R., Luo, X., An, Y., Zhao, H., Gao, Y., Zhai, Z., Ye, Z. L., Wang, W., Li, Q., Zheng, R., Yu, W., Shen, J., Li, X., Yu, T., Lu, W., Wu, Y. Q., Huang, X. B., He, Z., Lu, Y., Han, H., Zhang, F., Sun, R., Wang, H. X., Qin, S. H., Zhu, B. H., Zhao, J., Liu, B., Liu, J. L., Zhou, F. C., Li, Q. J., Zhang, X. Y., Li-Xin, Z., Xin-Hua, Q., Jiang, L., Gao, Y. N., Zhao, X. Y., Li, Y. Y., Li, X. L., Wang, C., Yao, Q., Yu, R., Chen, K., Shao, H., Qin, B., Huang, Q. Q., Zhu, W. H., Hang, A. Y., Hua, M. X., Li, Y., Xu, Y., Di, Y. D., Ling, L. L., Qin, T. H., Wang, S. H., Qin, J., Han, Y., Zhou, S., Varga, M., P., Silesky, Jimenez, J., I., González, Roja, M. A., Solis-Quesada, J. E., Ramirez-Alfaro, C. M., Máca, J., Sklienka, P., Gjedst, Zani, G., Fusari, M., Spadaro, S., Volta, C. A., Graziani, R., Brunettini, B., Palmese, S., Formenti, P., Umbrello, M., Lombardo, A., Pecci, E., Botteri, M., Savioli, M., Protti, A., Mattei, A., Schiavoni, L., Tinnirello, A., Todeschini, M., Giarratano, A., Cortegiani, A., Sher, S., Rossi, A., Antonelli, Massimo, Montini, L., Casalena, P., Scafetti, S., Panarello, G., Occhipinti, G., Patroniti, N., Pozzi, M., Biscione, R. R., Poli, M. M., Raimondi, F., Albiero, D., Crapelli, G., Beck, E., Pota, V., Schiavone, V., Molin, A., Tarantino, F., Monti, G., Frati, E., Mirabella, L., Cinnella, G., Fossali, T., Colombo, R., Pattarino, Pti., Mojoli, F., Braschi, A., Borotto, E. E., Cracchiolo, A. N., Palma, D. M., Raponi, F., Foti, G., Vascotto, E. R., Coppadoro, A., Brazzi, L., Floris, L., Iotti, G. A., Venti, Montini Luca (ORCID:0000-0003-4602-5134), and Antonelli, M (ORCID:0000-0003-3007-1670)

Abstract

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Hospital mortality in acute respiratory distress syndrome is approximately 40%, but mortality and trajectory in "mild" acute respiratory distress syndrome (classified only since 2012) are unknown, and many cases are not detected WHAT THIS ARTICLE TELLS US THAT IS NEW: Approximately 80% of cases of mild acute respiratory distress syndrome persist or worsen in the first week; in all cases, the mortality is substantial (30%) and is higher (37%) in those in whom the acute respiratory distress syndrome progresses BACKGROUND:: Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. METHODS: This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: "worsening" if moderate or severe acute respiratory distress syndrome criteria were met, "persisting" if mild acute respiratory distress syndrome criteria were the most severe category, and "improving" if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2. RESULTS: Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality

Published
2019

10. WE-G-213CD-03: A Dual Complementary Verification Method for Dynamic Tumor Tracking on Vero SBRT

Author

Kenneth Poels, Dirk Verellen, M. De Ridder, and T. Depuydt

Subjects
business.industry, Computer science, Medical imaging, Computer vision, General Medicine, Artificial intelligence, business, Tracking (particle physics), Rotation (mathematics), Image-guided radiation therapy
Abstract

Purpose: to use complementary cine EPID and gimbals log file analysis for in‐vivo tracking accuracy monitoring. Methods: A clinical prototype of dynamic tracking (DT) was installed on the Vero SBRTsystem. This prototype version allowed tumor tracking by gimballed linac rotations using an internal‐external correspondence model. The DT prototype software allowed the detailed logging of all applied gimbals rotations during tracking. The integration of an EPID on the vero system allowed the acquisition of cine EPIDimages during DT. We quantified the tracking error on cine EPID (E‐EPID) by subtracting the target center (fiducial marker detection) and the field centroid. Dynamic gimbals log file information was combined with orthogonal x‐ray verification images to calculate the in‐vivo tracking error (E‐kVLog). The correlation between E‐kVLog and E‐EPID was calculated for validation of the gimbals log file. Further, we investigated the sensitivity of the log file tracking error by introducing predefined systematic tracking errors. As an application we calculate gimbals log file tracking error for dynamic hidden target tests to investigate gravity effects and decoupled gimbals rotation from gantry rotation. Finally, calculating complementary cine EPID and log file tracking errors evaluated the clinical accuracy of dynamic tracking. Results: A strong correlation was found between log file and cine EPID tracking error distribution during concurrent measurements (R=0.98). We found sensitivity in the gimbals log files to detect a systematic tracking error up to 0.5 mm. Dynamic hidden target tests showed no gravity influence on tracking performance and high degree of decoupled gimbals and gantry rotation during dynamic arc dynamic tracking. A submillimetric agreement between clinical complementary tracking error measurements was found. Conclusions: Redundancy of the internal gimbals log file with x‐ray verification images with complementary independent cine EPIDimages was implemented to monitor the accuracy of gimballed tumor tracking on Vero SBRT. Research was financially supported by the Flemish government (FWO), Hercules Foundation and BrainLAB AG.

Published
2017

12. PO-0929: Dual-modality simultaneous orthogonal kV and portal MV imaging for verification of tumor tracking on SBRT patients

Author

Kenneth Poels, J. Dhont, T. Depuydt, M. Burghelea, Thierry Gevaert, Dirk Verellen, Benedikt Engels, M. De Ridder, and Christine Collen

Subjects
Oncology, Radiology Nuclear Medicine and imaging, business.industry, Tumor tracking, Medicine, Dual modality, Radiology, Nuclear Medicine and imaging, Hematology, business, Nuclear medicine
Published
2015
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13. PO-0972: Geometric verification of Dynamic Wave Arc using orthogonal X-ray fluoroscopic imaging

Author

Thierry Gevaert, Dirk Verellen, Masahiro Hiraoka, M. De Ridder, K Tournel, T. Depuydt, Viorica Simon, Kenneth Poels, and M. Burghelea

Subjects
Arc (geometry), Optics, Materials science, Oncology, Radiology Nuclear Medicine and imaging, business.industry, X-ray, Geometric verification, Radiology, Nuclear Medicine and imaging, Hematology, business, Fluoroscopic imaging
Published
2015
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15. PD-0046: Dose reconstruction of gimballed dynamic tumour tracking incorporating clinical intra-fraction tracking errors

Author

Dirk Verellen, M. De Ridder, Thierry Gevaert, Kenneth Poels, Christine Collen, Benedikt Engels, and T. Depuydt

Subjects
Oncology, Computer science, business.industry, Radiology Nuclear Medicine and imaging, Radiology, Nuclear Medicine and imaging, Fraction (mathematics), Hematology, Nuclear medicine, business, Tracking (particle physics), Biomedical engineering
Published
2013
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17. SU-E-T-140: Dynamic Wave Arc Trajectory Verification Using KV X-Ray Fluoroscopy

Author

Dirk Verellen, M. De Ridder, Kenneth Poels, K Tournel, M. Burghelea, and T. Depuydt

Subjects
Physics, Cone beam computed tomography, medicine.diagnostic_test, business.industry, Aperture, General Medicine, Kinematics, Iterative reconstruction, Linear interpolation, Rotation, Imaging phantom, Optics, medicine, Fluoroscopy, business
Abstract

Purpose: Purpose: This study investigates the geometric accuracy of simultaneous Gantry/Ring rotation during Dynamic Wave Arc (DWA) delivery. Methods: The Vero SBRT system consists of a 6MV LINAC mounted on an O-ring gantry that can rotate around the vertical axis (±60°), similar to couch rotation on C-arm gantries. To provide CBCT and fluoroscopy imaging functionalities, two orthogonal kV imaging units are attached to the O-ring at −45°/+45° from the beam axis.Dynamic Wave Arc maximizes Vero's motion capabilities by employing synchronized gantry and ring motion on a complex non-coplanar trajectory in combination with aperture based optimized MLC segments.Four wave arc trajectories (T1-4) were delivered using a cubic phantom with a configuration of five lead beads. O-ring gantry position information was retrieved through continuous dual-source kV X-ray image acquisition during DWA. An in-house algorithm read in the image set, extracted the projected marker positions and determined the angulation through reconstruction of the beam source position. The geometric error was quantified as the distance between the independently detected positions from kV-images and reference trajectory derived from the treatment plan in the Ring-Gantry space. Results: The average displacement between the 3D gantry/ring positions reconstructed from the fluoroscopy images and the reference trajectory was 0.346 mm (SD 0,171) for T1. A mean offset of 0.348 mm (SD 0,182) and 0.357 mm (SD 0.194) was observed for trajectory T2(2segmens) and T3(4segments), respectively. The saw shape T4 presented a mean geometric error of 0.363 (SD 0.156). The overall systematic error of 0.350 was caused by the difference between planned reference trajectory created by linear interpolation between CP, and the machine delivery following a spline curve. Conclusion: An independent geometric QA approach has been developed for DWA delivery verification, successfully applied on diverse trajectories and disclosed that the Vero system is capable of accurately follow complex trajectories.

Published
2014
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18. WE-G-BRF-02: Geometrical Verification of Real-Time Tumor Tracking Using Fast MV Fluoroscopy On a New Generation EPID: Investigating the Influence of Pulsing Artifacts and Artifact Suppression Techniques On Fiducial Marker and Marker-Less Soft-Tissue Detec

Author

Kenneth Poels, M. Burghelea, T. Depuydt, de vondel I Van, Dirk Verellen, and M. De Ridder

Subjects
Physics, Sine wave, medicine.diagnostic_test, Pulse (signal processing), medicine, Fluoroscopy, General Medicine, Frame rate, Fiducial marker, Imaging phantom, Linear particle accelerator, Image-guided radiation therapy, Biomedical engineering
Abstract

Purpose: to investigate the influence of megavolt (MV) pulse artifacts and pulsing artifact suppression techniques on fiducial marker and marker-less detection success for verification of real-time tumor tracking (RTTT) on a gimbaled linac system using fast MV fluoroscopy. Methods: Because frame rates on current clinical available EPIDs is limited to 7.5 Hz, a new generation EPID (XRD-1642 AP19) with a maximum frame rate of 30 Hz was evaluated for RTTT verification. Both 0.5 mm and 0.75 mm Visicoil™ markers were used for MV marker tracking with a frame rate of respectively 7.5 Hz, 15 Hz and 30 Hz. Additionally, marker-less tumor tracking was conducted and compared with the ground-truth fiducial marker motion. Static markers under influence of increasing phantom thickness and dynamic (sine and human irregular) motion was used to investigate performance of MV target detection.For each MV sequence, the free running (FR-nF) (ignoring MV pulsing during readout) acquisition mode was compared with two acquisition modes aiming to reduce MV pulsing artifacts, i.e. combined wavelet-FFT filtering (FR-wF) and a hardware synchronized (S-nF) readout with respect to the MV pulses. Results: For a 0.75 mm visicoil, deviations of sine wave motion were sub-millimeter (RMSE 3 mm, while for MV fluoroscopy in S-mode RMSE

Published
2014
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20. PD-0484 INITIAL CLINICAL ASSESSMENT OF A GIMBALED LINAC TUMOR TRACKING SYSTEM IN A PATIENT SIMULATION STUDY

Author

T. Depuydt, Frederik Vandenbroucke, Thierry Gevaert, Kenneth Poels, Dirk Verellen, M. De Ridder, Benedikt Engels, Nico Buls, G. Van Gompel, and C. Haverbeke

Subjects
medicine.medical_specialty, Oncology, Computer science, Tumor tracking, medicine, Radiology, Nuclear Medicine and imaging, Medical physics, Hematology, Gimbal, Patient simulation, Linear particle accelerator
Published
2012
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21. PO-0920 IMPLEMENTATION OF HYBRIDARC TREATMENT TECHNIQUE IN PREOPERATIVE RADIOTHERAPY OF RECTAL CANCER

Author

Dirk Verellen, Cristina Garibaldi, Benedikt Engels, Thierry Gevaert, T. Depuydt, M. Boussaer, M. Deridder, Michael Duchateau, T Reynders, and Peter Deconinck

Subjects
medicine.medical_specialty, Oncology, Preoperative radiotherapy, Colorectal cancer, business.industry, medicine, Radiology, Nuclear Medicine and imaging, Hematology, Radiology, medicine.disease, business
Published
2012
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23. OC-0504: Comparing a clinical protocol and fast intra-fraction update of a new motion prediction model for tumor tracking

Author

Thierry Gevaert, M. Boussaer, T. Depuydt, Femke Steenbeke, Benedikt Engels, Michael Duchateau, Kenneth Poels, Dirk Verellen, Christine Collen, and M. De Ridder

Subjects
Oncology, Computer science, Motion prediction, Tumor tracking, Radiology, Nuclear Medicine and imaging, Fraction (mathematics), Hematology, Protocol (object-oriented programming), Algorithm
Published
2014
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24. PD-0515: Phase II study of VERO SBRT for oligometastatic cancer: First clinical results

Author

Christine Collen, Thierry Gevaert, Dirk Verellen, T. de Vin, M. De Ridder, R. Van den Begin, Michael Duchateau, Benedikt Engels, Kenneth Poels, and T. Depuydt

Subjects
Oncology, medicine.medical_specialty, business.industry, Internal medicine, Medicine, Cancer, Phases of clinical research, Radiology, Nuclear Medicine and imaging, Hematology, business, medicine.disease
Published
2014
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25. OC-0500: A comparison of two clinical correlation models for dynamic tumor tracking with a focus on geometrical accuracy

Author

Kenneth Poels, M Buleteanu, J. Dhont, Dirk Verellen, T. Lacornerie, M. De Ridder, Benedikt Engels, Thierry Gevaert, T. Depuydt, and Christine Collen

Subjects
Oncology, business.industry, Tumor tracking, Medicine, Radiology, Nuclear Medicine and imaging, Computer vision, Hematology, Artificial intelligence, Clinical correlation, business, Focus (optics)
Published
2014
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27. WE-A-134-05: Comparison Between a Clinical Protocol and a Fast Automatic Update for Correlation Model Retraining During Gimballed Tumour Tracking: Impact On Margins and Target Dose Coverage

Author

Kenneth Poels, Dirk Verellen, T. Depuydt, and M. De Ridder

Subjects
medicine.diagnostic_test, business.industry, General Medicine, Tracking (particle physics), Target dose, Correlation, Planned Dose, Margin (machine learning), Treatment interruption, Medical imaging, Medicine, Fluoroscopy, business, Nuclear medicine
Abstract

Purpose: to evaluate the reduction of correlation errors for both the clinical user‐dependent and an automatic correlation model (CM) retraining procedure based on patient data acquired during real‐time tumour tracking (RTTT). Methods: During clinical RTTT, tumour positions were detected using 0.5 Hz orthogonal kV fluoroscopy. Correlation models were retrained by three scenarios: (1) the current clinical procedure with a treatment interruption and rebuild of the correlation model using 20s fluoroscopy, (2) a single CM for the entire treatment without retraining and (3) a continuous retrained CM using an input of 0.5 Hz orthogonal verification images acquired during RTTT. The correlation errors (CE) were calculated by the difference between predicted and detected target positions. For all three retraining procedures, PTV margins were calculated using margin recipes. With the dose reconstruction by convolution of a static planned dose (5 mm PTV‐margin) with a point spread function based on CE, the coverage of the CTV periphery was evaluated for RTTT with the different CM update approaches Results: The clinical CM update procedure showed a 0.9 mm margin reduction compared with omission of intra‐fraction retraining. An additional 0.9 mm margin reduction was achieved by on‐the‐fly CM updating. Without interruptions for correlation remodelling, the treatment time could be reduced by 20% (1−5 minutes). On average, RTTT treatments showed a reduction of 2.4±3.1% for CTV D99 when using a clinical update and was equal to reconstructed CTV D99 values for a single CM treatment (1.6±3.3%) and for continuous CM update (1.6±2.0%). For 2 patients with a larger dose‐loss (>5%) on the CTV periphery using the clinical RTTT routine, the continuous CM approach reduced the dose‐loss to 2%. Conclusion: A fast automatic update of the correlation model reduced PTV‐margins and maintained an adequate CTV dose coverage for a large variety of breathing motion during RTTT. Corporate funding by BrainLab AG and Hercules Funding by the Flemish Government.

Published
2013
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28. SU-E-J-166: Combining Dynamic Wave Arc and Tangential Arc for Breast Boost Irradiation with the Vero System

Author

Dirk Verellen, Kenneth Poels, Michael Duchateau, H. Van Parijs, Viorica Simon, Mark De Ridder, M Buleteanu, T Reynders, T. Depuydt, and Thierry Gevaert

Subjects
Physics, medicine.medical_specialty, Breast boost, business.industry, Low dose, General Medicine, Linear particle accelerator, Surgery, Conformity index, Arc (geometry), medicine, Irradiation, Radiation treatment planning, Previously treated, Nuclear medicine, business
Abstract

Purpose: To present two novel treatment planning techniques developed for breast boost irradiation on the Vero system and investigate possible dosimetric advantages. Methods: The Vero system consists of a 6MV LINAC mounted on an O‐ring gantry that rotates around the patients by +/− 185°. Unlike C‐arm gantries it can also rotate around the vertical axis (+/− 60°). A preliminary version iPlan RT (Brainlab AG, Feldkirchen, Germany) was used to plan, optimize and investigate two arc‐based approaches. The Dynamic Wave Arc (DWA) combines simultaneously gantry and ring rotation, offering additional range of treatment orientation without involving patient/couch motion. The Tangential Arc (TGA), static gantry position with continuous ring rotation makes the most of the tangential benefits within the non‐coplanar delivery. Ten patients previously treated for breast boost (7–10 non‐coplanar static beams on Vero) were selected for breast boost comparison. All patients were replanned using two TGA combined with a DWA to achieve a sculpted dose around the thorax wall. The dosimetric parameters were calculated to evaluate the plan quality. Results: The combination of 2TGA and DWA proved to be a feasible technique for breast boost irradiation. In contrast with 3D‐CRT, it presented a better low dose reduction for the V5% and V15% ipsilateral lung. For the left side localizations, the TGA&DWA significantly reduced the heart doses (0.19+/− 0.5 vs. 8.4+/−17.73), the V5% being outside the heart in all cases. A better conformity index was also achieved (0.74 +/−0.03 for TGA&DWA versus 0.67 +/−0.04 for 3D‐CRT). The mean total number of Monitor Units was comparable for both planning approaches. Conclusion: TGA and DWA are two promising techniques that highlight the advantages of the unique design of the Vero system. Combining TGA&DWA already presented good results for breast boost. The dosimetric and clinical gains are to be further investigated for other sites. M. Buleteanu is a PhD student financially supported by Brainlab AG (Feldkirchen, Germany) during the entire period of the doctoral thesis. The other authors have no conflict of interest.

Published
2013
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29. PO-0888 A VERIFICATION METHOD OF GIMBALED LINAC DYNAMIC TRACKING PATIENT QA ON THE VERO™ SBRT SYSTEM

Author

C. Haverbeke, T. Depuydt, Thierry Gevaert, S. Heinrich, Kenneth Poels, V. Schultheis, Dirk Verellen, Nicolas Christian, M. De Ridder, and Benedikt Engels

Subjects
Oncology, Computer science, business.industry, Radiology, Nuclear Medicine and imaging, Computer vision, Hematology, Artificial intelligence, Gimbal, business, Tracking (particle physics), Linear particle accelerator
Published
2012
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30. SU-E-T-457: Influence of Changing Magnetron and Injector Current on the Beam Characteristics of a Tomotherapy Hi-Art SYSTEM

Author

Kenneth Poels, K Leysen, M. Boussaer, T Reynders, Michael Duchateau, K Tournel, T. Depuydt, S Van Vaerenbergh, I. Van De Vondel, Dirk Verellen, and M. De Ridder

Subjects
Materials science, business.industry, medicine.medical_treatment, Dose profile, General Medicine, Injector, Tomotherapy, Imaging phantom, law.invention, Optics, law, Absorbed dose, Cavity magnetron, medicine, Current (fluid), business, Beam (structure)
Abstract

Purpose: This study investigates the influence of the magnetron and injector current on the beam characteristics of a Tomotherapy system. Methods: Treatment on tomotherapy is time‐based : the gantry rotates while the beam is on and all beam modulation is performed by the MLC. This implies that maintaining output stability is crucial. However, daily changes in output have been observed of up to 2.5% depending on external (pressure, temperature) or internal (component wear or instability). The output is tuned by adjusting the magnetron and injector current. This however, has an influence on both beam energy and profile but to which extent or magnitude has not been clear. Therefor, 144 measurements were performed by altering the magnetron current from 86,75A to 101,7A in 6 equal steps and by altering the injector current from 277,5mA to 612mA in 8 equal steps. Beam profile was measured using Tomodose (Sun Nuclear corp.). The Quality index was calculated using the absorbed dose ratio at depth 20cm and 10cm in rectangular slabs of solid water phantom with an SSD of 85cm. To estimate the influence on the cone profile the ratio between two volumes (on‐axis and off‐axis) was calculated. Results: With a magnetron current change of 14A the average quality index difference was 1.63%. Varying the injector current with 334.5mA causes the average quality index to change with 1.43%. Dose variation at 10cm from the central axis in lateral direction was 3% when changing the injector current by 334.5mA and 1.9% when changing the magnetron current by 14A Conclusions: Modifying magnetron and injector current does not have a major effect on the quality index. The lateral dose profile sagging is the most important finding since this will have an effect on off‐axis located targets. Injector current variation has more influence on the profile than magnetron current variation.

Published
2011
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31. Feasibility study of using the HybridArc treatment technique for preoperative irradiation for rectal cancer: comparison of dose patterns in lesion and organ at risk with the Tomotherapy

Author

Peter Deconinck, Michael Duchateau, Thierry Gevaert, Benedikt Engels, Kenneth Poels, M. Boussaer, T Reynders, K Tournel, T. Depuydt, Dirk Verellen, and M. De Ridder

Subjects
medicine.medical_specialty, business.industry, Colorectal cancer, medicine.medical_treatment, Biophysics, General Physics and Astronomy, General Medicine, medicine.disease, Tomotherapy, Lesion, Organ at risk, medicine, Radiology, Nuclear Medicine and imaging, Preoperative irradiation, Radiology, medicine.symptom, business
Published
2011
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32. SU-E-T-221: An In-House Developed Resettable MOSFET Dosimeter for Radiotherapy

Author

I. Van De Vondel, Kenneth Poels, Dirk Verellen, K. Heuninckx, Thierry Gevaert, M. De Ridder, T Reynders, K Tournel, S Van Vaerenbergh, T. Depuydt, Michael Duchateau, and K Leysen

Subjects
Materials science, Dosimeter, business.industry, Ionization chamber, Dosimetry, Biasing, General Medicine, Thermoluminescent dosimeter, Nuclear medicine, business, Sensitivity (electronics), Imaging phantom, Threshold voltage
Abstract

Purpose: To report the feasibility and clinical validation of an in‐house developed MOSFETdosimetry system and describe an integrated nondestructive reset procedure. Methods: Off‐the‐shelf MOSFETs are connected to a PC using an 18 bit/analogue‐input and 16 bit/output data acquisition card. A reading algorithm was developed defining the zero‐temperature‐coefficient point (ZTC) to determine the threshold voltage. The reset procedure consists of an internal circuit generating a local heating induced by an electrical current. Sensitivity has been investigated as a function of bias voltage (0—9 V) to the gate. Dosimetric properties have been evaluated for 6 MV and 15 MV clinical photon beams and in vivo benchmarking was performed against TLD for conventional treatments and total body irradiation (TBI). Results: Sensitivity of 0.08 mV cGy−1 can be obtained for 200 cGy irradiations at 5 V bias voltage. Ten consecutive measurements at 200 cGy yield a SD of 2.08 cGy (1.05%). Increasing the dose in steps from 5 cGy to 1000 cGy yields a 1.00 Pearson correlation coefficient and agreement within 2.0%. Dose rate dependence (160–800 cGy min−1) was within 2.5%, temperature dependence within 2.0% (25–37° C). Dose response is stable up to 50 Gy (saturation occurs at approximately 90 Gy), which is used as threshold dose before resetting the MOSFET. An average measured‐over‐calculateddose ratio within 1.05 (SD: 0.04) has been obtained in vivo. TBI midplane‐dose assessed by entrance and exit dosemeasurements agreed within 1.9% with ionization chamber in phantom, and within 1.0% with TLD in vivo. Conclusions: An in‐house developed resettable MOSFET‐based dosimetry system is proposed. The system has been validated and is currently used for in vivo entrance dosemeasurement in clinical routine for open field treatment configurations.

Published
2011
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33. SU-E-J-172: The Effect of MVCT Image Quality Parameters on Dose Recalculation for Tomotherapy

Author

Kenneth Poels, Thierry Gevaert, Dirk Verellen, Michael Duchateau, M. De Ridder, T Reynders, K Tournel, T. Depuydt, K Leysen, and M. Boussaer

Subjects
business.industry, Image quality, Gaussian, medicine.medical_treatment, General Medicine, Patient specific, Imaging phantom, Tomotherapy, symbols.namesake, Noise, Medical imaging, symbols, Medicine, Sensitivity (control systems), business, Nuclear medicine
Abstract

Purpose: The tomotherapy MVCT images should in theory allow offline adaptive treatment monitoring by recalculation of the dose on each day's image and summation over the entire treatment course. However, Instabilities in the MVCT‐beam can cause shifts in the calculated doses because of shifts in the HU‐calibration (Duchateau et al,2010 Phys. Med. Biol. 55). However, the significance of these shifts can only be established by performing the recalculation again using a newly acquired hu‐calibration curve using a density phantom or patient specific datapoints. This work aims in defining a clear threshold using simple image parameters such as mean HU shift and noise level on the image. This also allows to devise a strict QA program for the MVCT beam based on image quality, which can be accessed in a simple manner, as opposed to beam characteristics, which require service interventions. Methods: Simple spherical phantom‐images were created in dicom‐format with a mean HU‐value representing air, bone, fat, lung and muscle with no superposed noise (baseline set). This set was altered by a)shifting the mean HU and b)superimposing Gaussian noise‐levels of up to 30% (clinical observation). The dose was planned on the baseline set and recalculated on the other sets using the tomotherapy DQA‐ software. Results: Results show a deviation of 2% in dose for a 30HU‐shift in the water‐like region (fat, muscle) and a much lower sensitivity for the high and low densities(air,bone, lung) of about 0.5%. Noise levels had no influence on the center of the sphere when levels were below 20%. Conclusions: It is possible to predict changes in dose from the mean HU and noise level on MVCT images. To derive a clear threshold and a QA protocol, the measurements will be repeated using multiple HU‐images and finally on patients.

Published
2011
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34. SU-E-J-152: Improving 4D CBCT Image Quality by Using Tumor Trajectory Based Rebinning with Orthogonal Dual Source KV Imaging of the Novel VERO System

Author

Kenneth Poels, Thierry Gevaert, Dirk Verellen, T Reynders, M. De Ridder, Michael Duchateau, M. Boussaer, K Tournel, and T. Depuydt

Subjects
Cone beam computed tomography, business.industry, Image quality, Computer science, Point cloud, Cancer, General Medicine, Iterative reconstruction, Frame rate, medicine.disease, Imaging phantom, Tissue equivalent, Cyberknife, Medical imaging, medicine, Computer vision, Artificial intelligence, Nuclear medicine, business, Projection (set theory)
Abstract

Purpose: To improve image quality of 4D CBCT FDK reconstructions by rebinning using 3D tumor trajectories acquired with orthogonal dual source kV imaging. Methods: The Shepp‐Logan in‐silico phantom was used to generate artificial single and dual source projection images during 4D CBCT acquisition. The Shepp‐Logan phantom was modified by adding a 3 cm tissue equivalent sphere inside an air cavity. The sphere was moved inside the phantom by applying six minutes of tumormotion retrieved from a Cyberknife treatment. Images were generated with frame rates of 12 fps and an acquisition speed of 1 degree per second. Through detection of a marker inserted in the moving sphere, the 3D tumormotion trajectory was extracted from the projection data. The projection images were binned either based on the 1D marker motion in the cranial‐caudal direction for 8 phases or based on the 3D marker position using orthogonal images. The 1D rebinning technique was used for both the single and dual source acquisition. The dual source marker projections formed a 3D point cloud representing the tumor track. The track based rebinning used the 175 most proximal marker locations corresponding to 350 projections with minimal intra‐bin residual motion. Results: Differences between single and dual source CBCTimages were small, although dual source CBCT used less breathing cycles. The contrast‐to‐noise ratio for the track based reconstruction was significantly higher compared to 1D rebinned reconstructions. An intra‐bin motion of 2.0 ±1.4 mm was found for 1D rebinned dual source images and 1.2 ± 0.4 mm for track based rebinning. Maximum intra‐bin motion after track rebinning was found to be 2.2 ±0.8 mm. Conclusions: Using track‐based rebinning for 4D CBCT in dual source acquisition, intra‐bin residual motion is reduced and image quality was improved for reconstructions with projection images from irregular breathing.

Published
2011
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35. SU-E-J-171: The Possibility of Adaptive Breast Treatment on Tomotherapy Using a Patient-Specific Density Calibration

Author

Dirk Verellen, M. De Ridder, K Leysen, M. Boussaer, Kenneth Poels, Thierry Gevaert, K Tournel, T. Depuydt, P De Coninck, T Reynders, and Michael Duchateau

Subjects
business.industry, Calibration curve, medicine.medical_treatment, Significant difference, General Medicine, Breast treatment, Patient specific, Tomotherapy, Imaging phantom, medicine, Medical imaging, Calibration, business, Nuclear medicine
Abstract

Purpose: The tomotherapy MVCT images should in theory allow offline adaptive treatment monitoring by recalculation of the dose on each day's image and summation over the entire treatment course. However, Instabilities in the MVCT‐beam can cause shifts in the calculated doses because of shifts in the HU‐calibration (Duchateau et al,2010 Phys. Med. Biol. 55). This work presents an approach with a patient specific HU‐calibration for breast patients. Methods: For 20 Breast patients irradiated on tomotherapy (15×2.8Gy) the daily delivered dose was calculated and summed over the entire treatment using a) the standard HU‐calibration of the MVCT (taken biweekly), b) a generic curve per patient generated by measuring the HU of breast, muscle,lung, bone and fat tissue, resulting in 15 different calibration curves/patient and c)an average for each patient of all “daily” curves. The total dose was calculated on the breast, contralateral breast, long and hearttissue and compared. Results: The generated patient‐specific HUcalibration curves show a large inter‐patient variation with shifts of up to 50HU for the breast. Also noise levels varied up to 30%. Using the standard HU‐calibration showed shifts of dose that were on average 1.3–1.5 times higher for the breast region and 1.2x higher for the organs‐at‐risk as opposed to a patient specific curve. No significant difference could be found between methods (b) and (c). Conclusions: Using the MVCT images to calculate the actual delivered dose for breast patients on tomotherapy the HU‐calibration for the MVCT is crucial to interpret the results. Using the standard calibration method can introduce large errors, even on phantoms (Duchateau et al,2010 Phys. Med. Biol. 55) This study shows that using a patient specific curve generated out of the MVCT data can solve this problem without introducing extra calibrations on phantom

Published
2011
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36. SU-E-T-454: Feasibilty of Image-Guided Total Marrow Irradiation Using Helical TomoTherapy

Author

K Leysen, M. Boussaer, Dirk Verellen, M. De Ridder, Michael Duchateau, Thierry Gevaert, A. Gulyban, G.A. Storme, K Tournel, T. Depuydt, G. Soete, Kenneth Poels, and T Reynders

Subjects
Supine position, business.industry, medicine.medical_treatment, General Medicine, Total Marrow Irradiation, Tomotherapy, Transplantation, Homogeneous, medicine, Medical imaging, Dosimetry, Nuclear medicine, business, Conventional technique
Abstract

Purpose: Investigation of the technical feasibility and dosimetry of image‐ guided total marrow irradiation using helical TomoTherapy in the treatment of relapsed multiple myeloma patients. Irradiation is followed by a hematopietic stemcell transplantation. This study concentrates on planning and dosimetry Methods: Patients are simulated in supine position with H&N mask and pelvic cast. TomoTherapy plans for the upper body (head‐knees) were generated (pitch 0.45, modulation factor 2.0, field width 5cm). Dose prescription was 4x3Gy=12Gy. Dose verification is performed with the I'mRT MatriXX. Beam‐on‐time is +/−30min. TMI‐stability measurement was done with 2 ICs on different distances in 1.5m solid water equivalent blocks. Lower extremities were planned conventional and with TomoTherapy. Dose in the junction region between upper and lower body plans was verified with EDR2 film for both techniques. Results: It is possible to create clinically acceptable plans for the upper body with TomoTherapy. Verification shows acceptable results in the lung region (gamma 5%, 7mm). Measurement in pelvis region is less good as in lung region. TMI‐stability measurement shows differences in dose till 4% measured/calculated. During TMI a 2.5% dose drift was seen by the detectors. Plans for the extremities were more homogeneous in the junction region with TomoTherapy comparing with the conventional technique. Conclusions: TPS has difficulties to find a good ratio between couch and gantry speed. Differences seen at TMI‐stability measurements can be pointed to drift and stability of one rotation. Differences are depending on system stability (magnetron, target, …). Patient specific QA is necessary before treatment. Differences between the gamma index of the lungs and pelvis can be pointed to the fact that the planning is optimized very well for the lung region. Pitch and modulation factor are optimized for this region. For the junction region tomotherapy plans give a better homogeneity than 1 tomotherapy and 1 conventional plan.

Published
2011
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37. SU-E-T-863: Feasibility Study of Using the HybridArc Treatment Technique for Preoperative Irradiation of Rectal Cancer: Comparison of Dose Patterns in Lesion and Organ at Risk with the Tomotherapy

Author

Thierry Gevaert, Benedikt Engels, T Reynders, P De Coninck, Dirk Verellen, Michael Duchateau, M. De Ridder, K Tournel, and T. Depuydt

Subjects
Colorectal cancer, business.industry, medicine.medical_treatment, General Medicine, Intensity-modulated radiation therapy, medicine.disease, Tomotherapy, Homogeneous, Organ at risk, Dynamic conformal arc, medicine, Preoperative irradiation, business, Nuclear medicine, Preoperative treatment
Abstract

Purpose: HybridArc is a novel treatment technique blending aperture‐enhanced dynamic conformal arcs with discrete IMRT beams, allowing selection of dynamic arcs with a set of static IMRT beams at specified intervals along each arc. The aim was to evaluate the new technique with regard to achievable plan quality and treatment efficiency and to compare HybridArc against the well establish IMRTtreatment technique, Tomotherapy, for the preoperative treatment of rectal cancer. Methods: Twelve patients treated with Tomotherapy were considered and simulated with HybridArc. Treatment plans were designed to deliver in one process a homogeneous dose of 46.0Gy with an integrated boost of 55.2Gy. Planning objectives were to give at least 95% of the prescribed dose to 95% of the PTVs while keeping irradiated volumes of the organs‐at‐risk (small bowel and bladder) as low as possible. The gradient toward the boost region (GI) (ratio volume receiving 52.5Gy on PTV55.2Gy volume), the volumes receiving: 95% of the dose for PTV, 15Gy (V15) for small bowel and 21Gy (V21) for bladder were analyzed. Results: All plans achieved the objectives. Comparable GI was found 1.31 SD0.20 (HybridArc) and 1.32 SD0.16 (Tomotherapy). The 95% PTV coverage was 95.70% (SD1.16) and 97.80% (SD1.70) for PTV46Gy ; and 99.19% (SD1.60) and 99.29% (SD0.72) for PTV55.2Gy for HybridArc and Tomotherapy, respectively. In terms of organ at risk sparing, a small advantage for Tomotherapy was found. The V15 of the small bowel was 145,90cc (SD75,94cc) and 112,71cc (SD73,43cc), for HybridArc and Tomotherapy, respectively. The V21 for the bladder was 45.48% (SD10.19) and 39.68% (SD10.67), for HybridArc and Tomotherapy, respectively. Conclusions: HybridArc is clinically possible for the irradiation of preoperative rectal cancer. Furthermore, HybridArc, using one single enhanced dynamic conformal arc and 6 discrete IMRT beams, can achieve equivalent treatment plans (PTV coverage and organ at risk sparing) than the Tomotherapy.

Published
2011
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38. SU-E-J-136: Clinical Evaluation of a Robotic 6-Degree of Freedom Treatment Couch for Frameless Radiosurgery

Author

Thierry Gevaert, Michael Duchateau, K Tournel, M. Deridder, T. Depuydt, Kenneth Poels, M. Boussaer, Benedikt Engels, T Reynders, Dirk Verellen, and K. Heuninckx

Subjects
medicine.medical_specialty, business.industry, Frameless radiosurgery, medicine.medical_treatment, Isocenter, General Medicine, Radiosurgery, Surgery, Conformity index, Intrafraction motion, Existing Treatment, medicine, Intracranial lesions, business, Nuclear medicine, Clinical evaluation
Abstract

Purpose: To evaluate the added value of 6 degree‐of‐freedom (DOF) patient positioning with robotic couch compared to 4DOF positioning for intracranial lesions and to estimate the immobilization characteristics of the Brainlab frameless mask, more specifically the setup errors and the intrafraction motion. Methods: Forty patients with 66 brain metastases treated with frameless stereotactic radiosurgery and 6DOF robotic couch were enrolled. Patient positioning was performed with the Brainlab ExacTrac stereoscopic x‐ray system. Positioning results were collected before and after treatment to assess patient setup error and intrafraction motion. Existing treatment plannings were loaded and simulated for 4DOF positioning and compared to the 6DOF positioning. The clinical relevance was analyzed by means of the Paddick conformity index (CI) and the ratio of prescribed isodose volume covered with 4DOF to that obtained with the 6DOF positioning. Results: Results. The mean 3D setup error before 6DOF correction was 1.91 mm (SD1.25mm). The rotational errors were larger in the longitudinal (0.23° SD0.82°) direction compared to the lateral (−0.09° SD0.72°) and vertical (−0.10° SD1.03°) ones (p

Published
2011
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39. 69 speaker 3D DOSIMETRY SYSTEMS-GELS, EPIDS AND OTHERS

Author

Kenneth Poels, Dirk Verellen, Thierry Gevaert, K Leysen, M. De Ridder, M. Duchaleau, K Tournel, T. Depuydt, T Reynders, and A. Gulyban

Subjects
medicine.medical_specialty, Dosimeter, medicine.medical_treatment, Detector, Hematology, Tomotherapy, Imaging phantom, Oncology, Pyramid, Ionization chamber, Calibration, medicine, Dosimetry, Radiology, Nuclear Medicine and imaging, Medical physics
Abstract

Treatment modalities are becoming more and more complex in order to enable advanced patient treatments with a higher dose to the tumor while sparing the organs at risk. The last couple of years a lot of new treatment techniques and modalities became commercially available such as Intensity modulated radiotherapy (IMRT), Helical Tomotherapy, gated treatments, tumor tracking, VMAT, RapidArc, IMAT, dynamic delivery techniques (leafs, gantry and couch), flatness filter free (FFF) designs, etc.. Although the compliance rate for beam calibration is improving and near 98% for both photon and electron beams, increasing treatment complexity leads to more technically advanced components in the treatment chain, possibly inducing discrepancies. Credential audit results from the Radiological Physics Center (RPC) indicate that roughly 30% of the institutions failed to deliver an IMRT dose distribution to a head and neck phantom that agrees with their own treatment plan to within 7% or 4mm. So, even though the use of advanced dosimetry equipment for QA is wide spread, it seams that a lot of caveats are still present in the QA chain of advanced treatment techniques. The choice of a specific QA system depends on the number of treatment parameters to be verified and the extensiveness of the desired QA process. For this choice the use of the conceptual pyramid was proposed by De Wagter et al. In this conceptual pyramid the treatment chain is divided into 4 levels of specificity, all based on the stability of the underlying levels. On top of the pyramid (level 4) we can find the 3D dosimetry of the entire treatment delivery. Descending brings us to level 3 where we find the 1D-2D dosimetry of individual beam components. Level 2 is the planning system and data consistency QA level and at the ground level (level 1) we find the machine QA level.The best way to use the conceptual pyramid is the top down approach where a 3D dosimetry of the entire treatment is delivered to a phantom. When the results show discrepancies, lower levels of the pyramid should be sought to find answers. 3D dose distributions are QA’ed using different types of dosimeters such as; film (EDR2 and EBT2), diode arrays, ionization chamber arrays, EPID detectors, MVCT imaging detectors, etc... Is this talk we will try to give a general overview of dosimetry techniques used to QA 3D dose distributions and we will try to answer some questions: What techniques are used and are the QA tools keeping up with the rapid evolutions of the treatment machine manufacturers ? How are they applied in the different levels of the conceptual pyramid ? Is 3D really 3D ? Where do they stand compared to the ’ideal’ dosimeter ? What are the pros and cons of each group of dosimeters ? How do they fit in the workflow ?

Published
2011
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41. 250 oral LOW DOSE FLUOROSCOPY BASED DETECTION OF IMPLANTED MARKER POSITION ON THE VERO SYSTEM FOR REAL-TIME TUMOR TRACKING

Author

Dirk Verellen, T. Depuydt, M. De Ridder, Kenneth Poels, Nico Buls, and G. Van Gompel

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Low dose, Hematology, Position (obstetrics), Oncology, Tumor tracking, Medicine, Fluoroscopy, Radiology, Nuclear Medicine and imaging, Radiology, business, Nuclear medicine
Published
2011
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42. SU-GG-T-369: An In-House Developed MOSFET Dosimeter with Reset Capabilities

Author

N Linthout, T Reynders, Michael Duchateau, S Van Vaerenbergh, Dirk Verellen, Thierry Gevaert, G.A. Storme, I. Van De Vondel, Luc Coppens, K Tournel, and T. Depuydt

Subjects
Materials science, Dosimeter, Dose profile, Dosimetry, Biasing, General Medicine, Thermoluminescent dosimeter, Sensitivity (electronics), Imaging phantom, Biomedical engineering, Threshold voltage
Abstract

Background and purpose : To report the feasibility and clinical validation of an in‐house developed MOSFETdosimetry system and describing an integrated non‐destructive reset procedure. Material and Methods : Off‐the‐shelf MOSFETs are connected to a common PC using an 18bit/analogue‐input and 16bit/output data acquisition card. A reading algorithm was developed defining the Zero‐Temperature‐Coefficient point to determine the threshold voltage. A wireless interface was established for ease‐of‐use. The reset procedure consists of an internal circuit generating a local heating induced by an electrical current. Sensitivity has been investigated as a function of bias voltage (0V–9V) to the gate. Dosimetric properties have been evaluated for 6MV and 15MV clinical photon beams and in vivo benchmarking was performed against TLD for conventional treatments (2 groups of 10 patients for each energy) and TBI. Results : MOSFETS were pre‐irradiated with 20Gy. Sensitivity of 0.08mV/cGy can be obtained for 200cGy irradiations at 5V bias voltage. Ten consecutive measurements at 200cGy yield a SD of 2.08cGy (1.05%). Increasing dose in steps from 5cGy to 1000cGy yields a 1.00 Pearson correlation coefficient and agreement within 2.0%. Dose rate dependence (160–800cGy/min) was within 2.5%, temperature dependence within 2.0% (25–37°C). A strong angular dependence has been observed for gantry incidences exceeding ±30°. Dose response is stable up to 50Gy (saturation occurs at approximately 90Gy), which is used as threshold dose before resetting the MOSFET. An average measured‐over‐calculated dose ratio within 1.05 (SD: 0.04) has been obtained in vivo. TBI midplane‐dose assessed by entrance and exit dose measurements agreed within 1.9% with ionisation chamber in phantom, and within 1.0% with TLDin vivo. Conclusions : An in‐house developed resettable MOSFET‐based dosimetry system is proposed. The system has been validated and is currently used for in vivo entrance dose measurement in clinical routine for simple (open field) treatment configurations.

Published
2010
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43. WE-C-BRA-06: The VERO System, a Novel IGRT Device for Stereotactic Body Radiation Therapy: Commissioning and First Experience

Author

G.A. Storme, T. Depuydt, Dirk Verellen, M. De Ridder, Medical Imaging and Physical Sciences, and Translational Radiation Oncology and Physics

Subjects
medicine.diagnostic_test, business.industry, Computer science, Stereotactic body radiation therapy, medicine.medical_treatment, Computed tomography, General Medicine, Rotation, Linear particle accelerator, Radiation therapy, Optics, Tilt (optics), medicine, Medical imaging, Fluoroscopy, business, Nuclear medicine, Stereotactic body radiotherapy, Image-guided radiation therapy
Abstract

Purpose: Due to the recent introduction of the VERO system in the field, very little detailed information is available. An overview will be given of the experimental results acquired during commissioning. Methods and Materials: The VERO system, a novel radiation therapy platform developed for image guided stereotactic body radiotherapy(SBRT), has been installed and commissioned in our hospital. This device is a joint product of BrainLAB and MHI. A newly developed small 6 MV linac with attached MLC is mounted on an O‐ring gantry. The MLC consists of 60 5‐mm‐leafs and produces a maximum field size of 150×150mm. The gantry rotates 360° about the horizontal axis, similar to a C‐arm linac platform, but additionally allows rotation about the vertical axis, a so called “skew” of +/− 60°. Orthogonal gimbals hold the linac, which allows pan and tilt motions of the linac and the therapeutic beam. This mechanism offers the possibility to actively compensate for mechanical distortions during gantry rotation and to perform real‐time tracking of moving tumors. Beside an EPID for MV portal imaging, the system is equipped with a dual orthogonal kV Imaging systems attached to the O‐ring at 45° from the MV beam. This imaging system allows simultaneous acquisition of orthogonal X‐rays images and fluoroscopy. Also kV cone‐beam CTimaging is available. An automated infra‐red marker based patient‐positioning device is integrated. The treatment couch provides 5D positional correction (X,Y,Z,pitch,roll). The 6th degree of freedom, the yaw angle correction, is handled by the O‐ring skew. Results: We have conducted full commissioning of this novel SBRT platform, including full mechanical and dosimetric characterization, and report on the performance of this device installed in a clinical environment. Conclusion: Based on the experimental results, the systems characteristics were considered adequate for SBRT treatments. Conflict of Interest: Research sponsored by BrainLAB.

Published
2010
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46. Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Author

Boyle A. J., Madotto F., Laffey J. G., Bellani G., Pham T., Pesenti A., Thompson B. T., O'Kane C. M., Deane A. M., McAuley D. F, Rios F, Van Haren F, Faruq MO, Sottiaux T, Depuydt P, Lora FS, Azevedo LC, Fan E, Bugedo G, Qiu H, Gonzalez M, Silesky J, Cerny V, Nielsen J, Jibaja M, Pham T, Wrigge H, Matamis D, Ranero JL, Gomersall C, Amin P, Hashemian SM, Clarkson K, Bellani G, Kurahashi K, Koh Y, Villagomez A, Zeggwagh AA, Heunks LM, Laake JH, Kashif W, Synclair J, Palo JE, do Vale Fernandes A, Sandesc D, Arabi Y, Bumbasierevic V, Nin N, Lorente JA, Larsson A, Piquilloud L, Patjanasoontorn B, Abroug F, McAuley DF, McNamee L, Hurtado J, Bajwa E, Démpaire G, Francois GM, Rabboni F, Conti S, Sula H, Cani A, Zazu A, Dellera C, Alejandro RV, Daldin J, Fernandez RO, Cardonnet LP, Bettini LR, Bisso MC, Osman EM, Setten MG, Lovazzano P, Alvarez J, Villar V, Pozo NC, Grubissich N, Plotnikow GA, Vasquez DN, Ilutovich S, Tiribelli N, Chena A, Pellegrini CA, Saenz MG, Estenssoro E, Brizuela M, Gianinetto H, Gomez PE, Cerrato VI, Bezzi MG, Borello SA, Loiacono FA, Fernandez AM, Knowles S, Reynolds C, Inskip DM, Miller JJ, Kong J, Whitehead C, Bihari S, Seven A, Krstevski A, Rodgers HJ, Millar RT, Mckenna TE, Bailey IM, Hanlon GC, Aneman A, Lynch JM, Azad R, Neal J, Woods PW, Roberts BL, Kol MR, Wong HS, Riss KC, Staudinger T, Wittebole X, Bulpa PA, Dive AM, Verstraete R, Lebbinck H, Vermassen J, Philippe M, Ceunen H, Rosa JI, Beraldo DO, Piras C, Rampinelli AM, Nassar AP Jr, Mataloun S, Moock M, Thompson MM, Gonçalves CH, Antônio ACP, Ascoli A, Biondi RS, Fontenele DC, Nobrega D, Sales VM, Shindhe S, Pg Hj Ismail DMAB, Laffey J, Beloncle F, Davies KG, Cirone R, Manoharan V, Ismail M, Goligher EC, Jassal M, Ferguson ND, Nishikawa E, Javeed A, Curley G, Rittayamai N, Parotto M, Mehta S, Knoll J, Pronovost A, Bruhn SCAR, Garcia PH, Aliaga FA, Farías PA, Yumha JS, Ortiz CA, Salas JE, Saez AA, Vega LD, Labarca EF, Martinez FT, Carreño NG, Lora P, Liu H, Liu L, Tang R, Luo X, An Y, Zhao H, Gao Y, Zhai Z, Ye ZL, Wang W, Li W, Li Q, Zheng R, Yu W, Shen J, Li X, Yu T, Lu W, Wu YQ, Huang XB, He Z, Lu Y, Han H, Zhang F, Sun R, Wang HX, Qin SH, Zhu BH, Zhao J, Liu J, Li B, Liu JL, Zhou FC, Li QJ, Zhang XY, Li-Xin Z, Xin-Hua Q, Jiang L, Gao YN, Zhao XY, Li YY, Li XL, Wang C, Yao Q, Yu R, Chen K, Shao H, Qin B, Huang QQ, Zhu WH, Hang AY, Hua MX, Li Y, Xu Y, Di YD, Ling LL, Qin TH, Wang SH, Qin J, Han Y, Zhou S, Vargas MP, Silesky Jimenez JI, González Rojas MA, Solis-Quesada JE, Ramirez-Alfaro CM, Máca J, Sklienka P, Gjedsted J, Christiansen A, Rigshopitalet, Villamagua BG, Llano M, Burtin P, Buzancais G, Beuret P, Pelletier N, Mortaza S, Mercat A, Chelly J, Jochmans S, Terzi N, Daubin C, Carteaux G, de Prost N, Chiche JD, Daviaud F, Fartoukh M, Barberet G, Biehler J, Dellamonica J, Doyen D, Arnal JM, Briquet A, Klasen F, Papazian L, Follin A, Roux D, Messika J, Kalaitzis E, Dangers L, Combes A, Au SM, Béduneau G, Carpentier D, Zogheib EH, Dupont H, Ricome S, Santoli FL, Besset SL, Michel P, Gelée B, Danin PE, Goubaux B, Crova PJ, Phan NT, Berkelmans F, Badie JC, Tapponnier R, Gally J, Khebbeb S, Herbrecht JE, Schneider F, Declercq PM, Rigaud JP, Duranteau J, Harrois A, Chabanne R, Marin J, Constantin JM, Thibault S, Ghazi M, Boukhazna M, Zein SO, Richecoeur JR, Combaux DM, Grelon F, Le Moal C, Sauvadet EP, Robine A, Lemiale V, Reuter D, Dres M, Demoule A, Goldgran-Toledano D, Baboi L, Guérin C, Lohner R, Kraßler J, Schäfer S, Zacharowski KD, Meybohm P, Reske AW, Simon P, Hopf HF, Schuetz M, Baltus T, Papanikolaou MN, Papavasilopoulou TG, Zacharas GA, Ourailogloy V, Mouloudi EK, Massa EV, Nagy EO, Stamou EE, Kiourtzieva EV, Oikonomou MA, Avila LE, Cortez CA, Citalán JE, Jog SA, Sable SD, Shah B, Gurjar M, Baronia AK, Memon M, Muthuchellappan R, Ramesh VJ, Shenoy A, Unnikrishnan R, Dixit SB, Rhayakar RV, Ramakrishnan N, Bhardwaj VK, Mahto HL, Sagar SV, Palaniswamy V, Ganesan D, Jamaati H, Heidari F, Meaney EA, Nichol A, Knapman KM, O'Croinin D, Dunne ES, Breen DM, Clarkson KP, Jaafar RF, Dwyer R, Amir F, Ajetunmobi OO, O'Muircheartaigh AC, Black CS, Treanor N, Collins DV, Altaf W, Zani G, Fusari M, Spadaro S, Volta CA, Graziani R, Brunettini B, Palmese S, Formenti P, Umbrello M, Lombardo A, Pecci E, Botteri M, Savioli M, Protti A, Mattei A, Schiavoni L, Tinnirello A, Todeschini M, Giarratano A, Cortegiani A, Sher S, Rossi A, Antonelli MM, Montini LM, Casalena P, Scafetti S, Panarello G, Occhipinti G, Patroniti N, Pozzi M, Biscione RR, Poli MM, Raimondi F, Albiero D, Crapelli G, Beck E, Pota V, Schiavone V, Molin A, Tarantino F, Monti G, Frati E, Mirabella L, Cinnella G, Fossali T, Colombo R, Pattarino PTI, Mojoli F, Braschi A, Borotto EE, Cracchiolo AN, Palma DM, Raponi F, Foti G, Vascotto ER, Coppadoro A, Brazzi L, Floris L, Iotti GA, Venti A, Yamaguchi O, Takagi S, Maeyama HN, Watanabe E, Yamaji Y, Shimizu K, Shiozaki K, Futami S, Ryosuke S, Saito K, Kameyama Y, Ueno K, Izawa M, Okuda N, Suzuki H, Harasawa T, Nasu M, Takada T, Ito F, Nunomiya S, Koyama K, Abe T, Andoh K, Kusumoto K, Hirata A, Takaba A, Kimura H, Matsumoto S, Higashijima U, Honda H, Aoki N, Imai H, Ogino Y, Mizuguchi I, Ichikado K, Nitta K, Mochizuki K, Hashida T, Tanaka H, Nakamura T, Niimi D, Ueda T, Kashiwa Y, Uchiyama A, Sabelnikovs O, Oss P, Haddad Y, Liew KY, Ñamendys-Silva SA, Jarquin-Badiola YD, Sanchez-Hurtado LA, Gomez-Flores SS, Marin MC, Villagomez AJ, Lemus JS, Fierro JM, Cervantes MR, Mejia FJF, Dector D, Dector DM, Gonzalez DR, Estrella CR, Sanchez-Medina JR, Ramirez-Gutierrez A, George FG, Aguirre JS, Buensuseso JA, Poblano M, Dendane T, Balkhi H, Elkhayari M, Samkaoui N, Ezzouine H, Benslama A, Amor M, Maazouzi W, Cimic N, Beck O, Bruns MM, Schouten JA, Rinia M, Raaijmakers M, Van Wezel HM, Heines SJ, Strauch U, Buise MP, Simonis FD, Schultz MJ, Goodson JC, Browne TS, Navarra L, Hunt A, Hutchison RA, Bailey MB, Newby L, Mcarthur C, Kalkoff M, Mcleod A, Casement J, Hacking DJ, Andersen FH, Dolva MS, Barratt-Due A, Noremark KAL, Søreide E, Sjøbø BÅ, Guttormsen AB, Leon Yoshido HH, Aguilar RZ, Montes Oscanoa FA, Alisasis AU, Robles JB, Pasanting-Lim RAB, Tan BC, Andruszkiewicz P, Jakubowska K, Coxo CM, Alvarez AM, Oliveira BS, Montanha GM, Barros NC, Pereira CS, Messias AM, Monteiro JM, Araujo AM, Catorze NT, Marum SM, Bouw MJ, Gomes RM, Brito VA, Castro S, Estilita JM, Barros FM, Serra IM, Martinho AM, Tomescu DR, Marcu A, Bedreag OH, Papurica M, Corneci DE, Negoita SI, Grigoriev E, Gritsan AI, Gazenkampf AA, Almekhlafi G, Albarrak MM, Mustafa GM, Maghrabi KA, Salahuddin N, Aisa TM, Al Jabbary AS, Tabhan E, Arabi YM, Trinidad OA, Al Dorzi HM, Tabhan EE, Bolon S, Smith O, Mancebo J, Aguirre-Bermeo H, Lopez-Delgado JC, Esteve F, Rialp G, Forteza C, De Haro C, Artigas A, Albaiceta GM, De Cima-Iglesias S, Seoane-Quiroga L, Ceniceros-Barros A, Ruiz-Aguilar AL, Claraco-Vega LM, Soler JA, Del Carmen Lorente M, Hermosa C, Gordo F, Prieto-González M, López-Messa JB, Perez MP, Perez CP, Allue RM, Roche-Campo F, Ibañez-Santacruz M, Temprano S, Pintado MC, De Pablo R, Gómez PRA, Ruiz SR, Moles SI, Jurado MT, Arizmendi A, Piacentini EA, Franco N, Honrubia T, Cheng MP, Losada EP, Blanco J, Yuste LJ, Carbayo-Gorriz C, Cazorla-Barranquero FG, Alonso JG, Alda RS, Algaba Á, Navarro G, Cereijo E, Diaz-Rodriguez E, Marcos DP, Montero LA, Para LH, Sanchez RJ, Navalpotro MAB, Abad RD, González RM, Toribio DP, Castro AG, Artiga MJD, Penuelas O, Roser TP, Olga MF, Curto EG, Sánchez RM, Imma VP, Elisabet GM, Claverias L, Magret M, Pellicer AM, Rodriguez LL, Sánchez-Ballesteros J, González-Salamanca Á, Jimenez AG, Huerta FP, Llinares Moya DD, Tallet Alfonso AA, Luis PSE, Cesar PS, Rafael SI, Virgilio CG, Recio NN, Adamsson RO, Rylander CC, Holzgraefe B, Broman LM, Wessbergh J, Persson L, Schiöler F, Kedelv H, Tibblin AO, Appelberg H, Hedlund L, Helleberg J, Eriksson KE, Glietsch R, Larsson N, Nygren I, Nunes SL, Morin AK, Kander T, Adolfsson A, Zender HO, Leemann-Refondini C, Elatrous S, Bouchoucha S, Chouchene I, Ouanes I, Souissi AB, Kamoun S, Demirkiran O, Aker M, Erbabacan E, Ceylan I, Girgin NK, Ozcelik M, Ünal N, Meco BC, Akyol OO, Derman SS, Kennedy B, Parhar K, Srinivasa L, McAuley D, Hopkins P, Mellis C, Kakar V, Hadfield D, Vercueil A, Bhowmick K, Humphreys SK, Ferguson A, Mckee R, Raj AS, Fawkes DA, Watt P, Twohey L, JhaMatthew Thomas RR, Morton A, Kadaba V, Smith MJ, Hormis AP, Kannan SG, Namih M, Reschreiter H, Camsooksai J, Kumar A, Rugonfalvi S, Nutt C, Oneill O, Seasman C, Dempsey G, Scott CJ, Ellis HE, Mckechnie S, Hutton PJ, Di Tomasso NN, Vitale MN, Griffin RO, Dean MN, Cranshaw JH, Willett EL, Ioannou N, Gillis S, Csabi P, Macfadyen R, Dawson H, Preez PD, Williams AJ, Boyd O, De Gordoa LO, Bramall J, Symmonds S, Chau SK, Wenham T, Szakmany T, Toth-Tarsoly P, Mccalman KH, Alexander P, Stephenson L, Collyer T, Chapman R, Cooper R, Allan RM, Sim M, Wrathall DW, Irvine DA, Zantua KS, Adams JC, Burtenshaw AJ, Sellors GP, Welters ID, Williams KE, Hessell RJ, Oldroyd MG, Battle CE, Pillai S, Kajtor I, Sivashanmugavel M, Okane SC, Donnelly A, Frigyik AD, Careless JP, May MM, Stewart R, John Trinder T, Hagan SJ, Wise MP, Cole JM, MacFie CC, Dowling AT, Nuñez E, Pittini G, Rodriguez R, Imperio MC, Santos C, França AG, Ebeid A, Deicas A, Serra C, Uppalapati A, Kamel G, Banner-Goodspeed VM, Beitler JR, Mukkera SR, Kulkarni S, Lee J, Mesar T, Shinn Iii JO, Gomaa D, Tainter C, Yeatts DJ, Warren J, Lanspa MJ, Miller RR, Grissom CK, Brown SM, Bauer PR, Gosselin RJ, Kitch BT, Cohen JE, Beegle SH, Gueret RM, Tulaimat A, Choudry S, Stigler W, Batra H, Huff NG, Lamb KD, Oetting TW, Mohr NM, Judy C, Saito S, Kheir FM, Kheir F, Schlichting AB, Delsing A, Crouch DR, Elmasri M, Ismail D, Dreyer KR, Blakeman TC, Baron RM, Grijalba CQ, Hou PC, Seethala R, Aisiku I, Henderson G, Frendl G, Hou SK, Owens RL, Schomer A, Bumbasirevic V, Jovanovic B, Surbatovic M, Veljovic M., Boyle, A. J., Madotto, F., Laffey, J. G., Bellani, G., Pham, T., Pesenti, A., Thompson, B. T., O'Kane, C. M., Deane, A. M., Mcauley, D. F., Rios, F., Van Haren, F., Faruq, M. O., Sottiaux, T., Depuydt, P., Lora, F. S., Azevedo, L. C., Fan, E., Bugedo, G., Qiu, H., Gonzalez, M., Silesky, J., Cerny, V., Nielsen, J., Jibaja, M., Wrigge, H., Matamis, D., Ranero, J. L., Gomersall, C., Amin, P., Hashemian, S. M., Clarkson, K., Kurahashi, K., Koh, Y., Villagomez, A., Zeggwagh, A. A., Heunks, L. M., Laake, J. H., Kashif, W., Synclair, J., Palo, J. E., do Vale Fernandes, A., Sandesc, D., Arabi, Y., Bumbasierevic, V., Nin, N., Lorente, J. A., Larsson, A., Piquilloud, L., Patjanasoontorn, B., Abroug, F., Mcnamee, L., Hurtado, J., Bajwa, E., Dempaire, G., Francois, G. M., Rabboni, F., Conti, S., Sula, H., Cani, A., Zazu, A., Dellera, C., Alejandro, R. V., Daldin, J., Fernandez, R. O., Cardonnet, L. P., Bettini, L. R., Bisso, M. C., Osman, E. M., Setten, M. G., Lovazzano, P., Alvarez, J., Villar, V., Pozo, N. C., Grubissich, N., Plotnikow, G. A., Vasquez, D. N., Ilutovich, S., Tiribelli, N., Chena, A., Pellegrini, C. A., Saenz, M. G., Estenssoro, E., Brizuela, M., Gianinetto, H., Gomez, P. E., Cerrato, V. I., Bezzi, M. G., Borello, S. A., Loiacono, F. A., Fernandez, A. M., Knowles, S., Reynolds, C., Inskip, D. M., Miller, J. J., Kong, J., Whitehead, C., Bihari, S., Seven, A., Krstevski, A., Rodgers, H. J., Millar, R. T., Mckenna, T. E., Bailey, I. M., Hanlon, G. C., Aneman, A., Lynch, J. M., Azad, R., Neal, J., Woods, P. W., Roberts, B. L., Kol, M. R., Wong, H. S., Riss, K. C., Staudinger, T., Wittebole, X., Bulpa, P. A., Dive, A. M., Verstraete, R., Lebbinck, H., Vermassen, J., Philippe, M., Ceunen, H., Rosa, J. I., Beraldo, D. O., Piras, C., Rampinelli, A. M., Nassar, A. P., Mataloun, S., Moock, M., Thompson, M. M., Goncalves, C. H., Antonio, Acp., Ascoli, A., Biondi, R. S., Fontenele, D. C., Nobrega, D., Sales, V. M., Shindhe, S., Pg Hj Ismail, Dmab., Beloncle, F., Davies, K. G., Cirone, R., Manoharan, V., Ismail, M., Goligher, E. C., Jassal, M., Ferguson, N. D., Nishikawa, E., Javeed, A., Curley, G., Rittayamai, N., Parotto, M., Mehta, S., Knoll, J., Pronovost, A., Bruhn, Scar., Garcia, P. H., Aliaga, F. A., Farias, P. A., Yumha, J. S., Ortiz, C. A., Salas, J. E., Saez, A. A., Vega, L. D., Labarca, E. F., Martinez, F. T., Carreno, N. G., Lora, P., Liu, H., Liu, L., Tang, R., Luo, X., An, Y., Zhao, H., Gao, Y., Zhai, Z., Ye, Z. L., Wang, W., Li, W., Li, Q., Zheng, R., Yu, W., Shen, J., Li, X., Yu, T., Lu, W., Wu, Y. Q., Huang, X. B., He, Z., Lu, Y., Han, H., Zhang, F., Sun, R., Wang, H. X., Qin, S. H., Zhu, B. H., Zhao, J., Liu, J., Li, B., Liu, J. L., Zhou, F. C., Li, Q. J., Zhang, X. Y., Li-Xin, Z., Xin-Hua, Q., Jiang, L., Gao, Y. N., Zhao, X. Y., Li, Y. Y., Li, X. L., Wang, C., Yao, Q., Yu, R., Chen, K., Shao, H., Qin, B., Huang, Q. Q., Zhu, W. H., Hang, A. Y., Hua, M. X., Li, Y., Xu, Y., Di, Y. D., Ling, L. L., Qin, T. H., Wang, S. H., Qin, J., Han, Y., Zhou, S., Vargas, M. P., Silesky Jimenez, J. I., Gonzalez Rojas, M. A., Solis-Quesada, J. E., Ramirez-Alfaro, C. M., Maca, J., Sklienka, P., Gjedsted, J., Christiansen, A., Rigshopitalet, Villamagua, B. G., Llano, M., Burtin, P., Buzancais, G., Beuret, P., Pelletier, N., Mortaza, S., Mercat, A., Chelly, J., Jochmans, S., Terzi, N., Daubin, C., Carteaux, G., de Prost, N., Chiche, J. D., Daviaud, F., Fartoukh, M., Barberet, G., Biehler, J., Dellamonica, J., Doyen, D., Arnal, J. M., Briquet, A., Klasen, F., Papazian, L., Follin, A., Roux, D., Messika, J., Kalaitzis, E., Dangers, L., Combes, A., Au, S. M., Beduneau, G., Carpentier, D., Zogheib, E. H., Dupont, H., Ricome, S., Santoli, F. L., Besset, S. L., Michel, P., Gelee, B., Danin, P. E., Goubaux, B., Crova, P. J., Phan, N. T., Berkelmans, F., Badie, J. C., Tapponnier, R., Gally, J., Khebbeb, S., Herbrecht, J. E., Schneider, F., Declercq, P. M., Rigaud, J. P., Duranteau, J., Harrois, A., Chabanne, R., Marin, J., Constantin, J. M., Thibault, S., Ghazi, M., Boukhazna, M., Zein, S. O., Richecoeur, J. R., Combaux, D. M., Grelon, F., Le Moal, C., Sauvadet, E. P., Robine, A., Lemiale, V., Reuter, D., Dres, M., Demoule, A., Goldgran-Toledano, D., Baboi, L., Guerin, C., Lohner, R., Krassler, J., Schafer, S., Zacharowski, K. D., Meybohm, P., Reske, A. W., Simon, P., Hopf, H. F., Schuetz, M., Baltus, T., Papanikolaou, M. N., Papavasilopoulou, T. G., Zacharas, G. A., Ourailogloy, V., Mouloudi, E. K., Massa, E. V., Nagy, E. O., Stamou, E. E., Kiourtzieva, E. V., Oikonomou, M. A., Avila, L. E., Cortez, C. A., Citalan, J. E., Jog, S. A., Sable, S. D., Shah, B., Gurjar, M., Baronia, A. K., Memon, M., Muthuchellappan, R., Ramesh, V. J., Shenoy, A., Unnikrishnan, R., Dixit, S. B., Rhayakar, R. V., Ramakrishnan, N., Bhardwaj, V. K., Mahto, H. L., Sagar, S. V., Palaniswamy, V., Ganesan, D., Jamaati, H., Heidari, F., Meaney, E. A., Nichol, A., Knapman, K. M., O'Croinin, D., Dunne, E. S., Breen, D. M., Clarkson, K. P., Jaafar, R. F., Dwyer, R., Amir, F., Ajetunmobi, O. O., O'Muircheartaigh, A. C., Black, C. S., Treanor, N., Collins, D. V., Altaf, W., Zani, G., Fusari, M., Spadaro, S., Volta, C. A., Graziani, R., Brunettini, B., Palmese, S., Formenti, P., Umbrello, M., Lombardo, A., Pecci, E., Botteri, M., Savioli, M., Protti, A., Mattei, A., Schiavoni, L., Tinnirello, A., Todeschini, M., Giarratano, A., Cortegiani, A., Sher, S., Rossi, A., Antonelli, M. M., Montini, L. M., Casalena, P., Scafetti, S., Panarello, G., Occhipinti, G., Patroniti, N., Pozzi, M., Biscione, R. R., Poli, M. M., Raimondi, F., Albiero, D., Crapelli, G., Beck, E., Pota, V., Schiavone, V., Molin, A., Tarantino, F., Monti, G., Frati, E., Mirabella, L., Cinnella, G., Fossali, T., Colombo, R., Pattarino, Pti., Mojoli, F., Braschi, A., Borotto, E. E., Cracchiolo, A. N., Palma, D. M., Raponi, F., Foti, G., Vascotto, E. R., Coppadoro, A., Brazzi, L., Floris, L., Iotti, G. A., Venti, A., Yamaguchi, O., Takagi, S., Maeyama, H. N., Watanabe, E., Yamaji, Y., Shimizu, K., Shiozaki, K., Futami, S., Ryosuke, S., Saito, K., Kameyama, Y., Ueno, K., Izawa, M., Okuda, N., Suzuki, H., Harasawa, T., Nasu, M., Takada, T., Ito, F., Nunomiya, S., Koyama, K., Abe, T., Andoh, K., Kusumoto, K., Hirata, A., Takaba, A., Kimura, H., Matsumoto, S., Higashijima, U., Honda, H., Aoki, N., Imai, H., Ogino, Y., Mizuguchi, I., Ichikado, K., Nitta, K., Mochizuki, K., Hashida, T., Tanaka, H., Nakamura, T., Niimi, D., Ueda, T., Kashiwa, Y., Uchiyama, A., Sabelnikovs, O., Oss, P., Haddad, Y., Liew, K. Y., Namendys-Silva, S. A., Jarquin-Badiola, Y. D., Sanchez-Hurtado, L. A., Gomez-Flores, S. S., Marin, M. C., Villagomez, A. J., Lemus, J. S., Fierro, J. M., Cervantes, M. R., Mejia, Fjf., Dector, D., Dector, D. M., Gonzalez, D. R., Estrella, C. R., Sanchez-Medina, J. R., Ramirez-Gutierrez, A., George, F. G., Aguirre, J. S., Buensuseso, J. A., Poblano, M., Dendane, T., Balkhi, H., Elkhayari, M., Samkaoui, N., Ezzouine, H., Benslama, A., Amor, M., Maazouzi, W., Cimic, N., Beck, O., Bruns, M. M., Schouten, J. A., Rinia, M., Raaijmakers, M., Van Wezel, H. M., Heines, S. J., Strauch, U., Buise, M. P., Simonis, F. D., Schultz, M. J., Goodson, J. C., Browne, T. S., Navarra, L., Hunt, A., Hutchison, R. A., Bailey, M. B., Newby, L., Mcarthur, C., Kalkoff, M., Mcleod, A., Casement, J., Hacking, D. J., Andersen, F. H., Dolva, M. S., Barratt-Due, A., Noremark, Kal., Soreide, E., Sjobo, B. A., Guttormsen, A. B., Leon Yoshido, H. H., Aguilar, R. Z., Montes Oscanoa, F. A., Alisasis, A. U., Robles, J. B., Pasanting-Lim, Rab., Tan, B. C., Andruszkiewicz, P., Jakubowska, K., Coxo, C. M., Alvarez, A. M., Oliveira, B. S., Montanha, G. M., Barros, N. C., Pereira, C. S., Messias, A. M., Monteiro, J. M., Araujo, A. M., Catorze, N. T., Marum, S. M., Bouw, M. J., Gomes, R. M., Brito, V. A., Castro, S., Estilita, J. M., Barros, F. M., Serra, I. M., Martinho, A. M., Tomescu, D. R., Marcu, A., Bedreag, O. H., Papurica, M., Corneci, D. E., Negoita, S. I., Grigoriev, E., Gritsan, A. I., Gazenkampf, A. A., Almekhlafi, G., Albarrak, M. M., Mustafa, G. M., Maghrabi, K. A., Salahuddin, N., Aisa, T. M., Al Jabbary, A. S., Tabhan, E., Arabi, Y. M., Trinidad, O. A., Al Dorzi, H. M., Tabhan, E. E., Bolon, S., Smith, O., Mancebo, J., Aguirre-Bermeo, H., Lopez-Delgado, J. C., Esteve, F., Rialp, G., Forteza, C., De Haro, C., Artigas, A., Albaiceta, G. M., De Cima-Iglesias, S., Seoane-Quiroga, L., Ceniceros-Barros, A., Ruiz-Aguilar, A. L., Claraco-Vega, L. M., Soler, J. A., Del Carmen Lorente, M., Hermosa, C., Gordo, F., Prieto-Gonzalez, M., Lopez-Messa, J. B., Perez, M. P., Perez, C. P., Allue, R. M., Roche-Campo, F., Ibanez-Santacruz, M., Temprano, S., Pintado, M. C., De Pablo, R., Gomez, Pra., Ruiz, S. R., Moles, S. I., Jurado, M. T., Arizmendi, A., Piacentini, E. A., Franco, N., Honrubia, T., Cheng, M. 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AJ, Boyd O, De Gordoa LO, Bramall J, Symmonds S, Chau SK, Wenham T, Szakmany T, Toth-Tarsoly P, Mccalman KH, Alexander P, Stephenson L, Collyer T, Chapman R, Cooper R, Allan RM, Sim M, Wrathall DW, Irvine DA, Zantua KS, Adams JC, Burtenshaw AJ, Sellors GP, Welters ID, Williams KE, Hessell RJ, Oldroyd MG, Battle CE, Pillai S, Kajtor I, Sivashanmugavel M, Okane SC, Donnelly A, Frigyik AD, Careless JP, May MM, Stewart R, John Trinder T, Hagan SJ, Wise MP, Cole JM, MacFie CC, Dowling AT, Hurtado J, Nin N, Hurtado J, Nuñez E, Pittini G, Rodriguez R, Imperio MC, Santos C, França AG, Ebeid A, Deicas A, Serra C, Uppalapati A, Kamel G, Banner-Goodspeed VM, Beitler JR, Mukkera SR, Kulkarni S, Lee J, Mesar T, Shinn Iii JO, Gomaa D, Tainter C, Lee J, Mesar T, Lee J, Yeatts DJ, Warren J, Lanspa MJ, Miller RR, Grissom CK, Brown SM, Bauer PR, Gosselin RJ, Kitch BT, Cohen JE, Beegle SH, Gueret RM, Tulaimat A, Choudry S, Stigler W, Batra H, Huff NG, Lamb KD, Oetting TW, Mohr NM, Judy C, Saito S, Kheir FM, Kheir F, Schlichting AB, Delsing A, Crouch DR, Elmasri M, Crouch DR, Ismail D, Dreyer KR, Blakeman TC, Dreyer KR, Gomaa D, Baron RM, Grijalba CQ, Hou PC, Seethala R, Aisiku I, Henderson G, Frendl G, Hou SK, Owens RL, Schomer A, Bumbasirevic V, Jovanovic B, Surbatovic M, Veljovic M., UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (SLuc) Service de soins intensifs, and UCL - (MGD) Services des soins intensifs

Subjects
Adult, Male, Diabetes mellitu, LUNG SAFE, Organ Dysfunction Scores, humanos, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Socio-culturale, Organ Dysfunction Score, Diabetes Complications, Diabetes mellitus, puntuaciones de disfunción orgánica, Risk Factors, Diabetes Complication, estudios prospectivos, Humans, factores de riesgo, Prospective Studies, Hospital Mortality, Hypoxia, mediana edad, Acute hypoxemic respiratory failure, Aged, Respiratory Distress Syndrome, anciano, Acute respiratory distress syndrome, Research, Respiration, respiración, Respiratory Distress Syndrome, Adult, lcsh:Medical emergencies. Critical care. Intensive care. First aid, lcsh:RC86-88.9, Middle Aged, Respiration, Artificial, insuficiencia respiratoria, Prospective Studie, Artificial, Diabetes Mellitus, Female, Respiratory Insufficiency, mortalidad hospitalaria, complicaciones de la diabetes, Human
Abstract

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS., This work was supported by the European Society of Intensive Care Medicine (ESICM), Brussels, Belgium who funded the original LUNG SAFE study.

Published
2018
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47. Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Author

Abe T., Madotto F., Pham T., Nagata I., Uchida M., Tamiya N., Kurahashi K., Bellani G., Laffey J. G, Francois GM, Rabboni F, Madotto F, Conti S, Laffey JG, Bellani G, Pham T, Fan E, Pesenti A, Brochard L, Esteban A, Gattinoni L, van Haren F, Larsson A, McAuley DF, Ranieri M, Rubenfeld G, Thompson BT, Wrigge H, Slutsky AS, Rios F, Sottiaux T, Depuydt P, Lora FS, Azevedo LC, Bugedo G, Qiu H, Gonzalez M, Silesky J, Cerny V, Nielsen J, Jibaja M, Matamis D, Ranero JL, Amin P, Hashemian SM, Clarkson K, Kurahashi K, Villagomez A, Zeggwagh AA, Heunks LM, Laake JH, Palo JE, do Vale Fernandes A, Sandesc D, Arabi Y, Bumbasierevic V, Nin N, Lorente JA, Piquilloud L, Abroug F, McNamee L, Hurtado J, Bajwa E, Démpair G, Sula H, Nunci L, Cani A, Zazu A, Dellera C, Insaurralde CS, Alejandro RV, Daldin J, Vinzio M, Fernandez RO, Cardonnet LP, Bettini LR, Bisso MC, Osman EM, Setten MG, Lovazzano P, Alvarez J, Villar V, Milstein C, Pozo NC, Grubissich N, Plotnikow GA, Vasquez DN, Ilutovich S, Tiribelli N, Chena A, Pellegrini CA, Saenz MG, Estenssoro E, Brizuela M, Gianinetto H, Gomez PE, Cerrato VI, Bezzi MG, Borello SA, Loiacono FA, Fernandez AM, Knowles S, Reynolds C, Inskip DM, Miller JJ, Kong J, Whitehead C, Bihari S, Seven A, Krstevski A, Rodgers HJ, Millar RT, Mckenna TE, Bailey IM, Hanlon GC, Aneman A, Lynch JM, Azad R, Neal J, Woods PW, Roberts BL, Kol MR, Wong HS, Riss KC, Wittebole X, Berghe C, Bulpa PA, Dive AM, Verstraete R, Lebbinck H, Vermassen J, Meersseman P, Ceunen H, Rosa JI, Beraldo DO, Piras C, Rampinelli AM, Nassar AP Jr, Mataloun S, Moock M, Thompson MM, Gonçalves CH, Antônio ACP, Ascoli A, Biondi RS, Fontenele DC, Nobrega D, Sales VM, Shindhe S, Ismail DHMABPH, Laffey J, Beloncle F, Davies KG, Cirone R, Manoharan V, Ismail M, Goligher EC, Jassal M, Nishikawa E, Javeed A, Curley G, Rittayamai N, Parotto M, Ferguson ND, Mehta S, Knoll J, Pronovost A, Chile SC, Bruhn AR, Garcia PH, Aliaga FA, Farías PA, Yumha JS, Ortiz CA, Salas JE, Saez AA, Vega LD, Labarca EF, Martinez FT, Carreño NG, Lora P, Liu H, Liu L, Tang R, Luo X, An Y, Zhao H, Gao Y, Zhai Z, Ye ZL, Wang W, Li W, Li Q, Zheng R, Yu W, Shen J, Li X, Yu T, Lu W, Wu YQ, Huang XB, He Z, Lu Y, Han H, Zhang F, Sun R, Wang HX, Qin SH, Zhu BH, Zhao J, Liu J, Li B, Liu JL, Zhou FC, Li QJ, Zhang XY, Li-Xin Z, Xin-Hua Q, Jiang L, Gao YN, Zhao XY, Li YY, Li XL, Wang C, Yao Q, Yu R, Chen K, Shao H, Qin B, Huang QQ, Zhu WH, Hang AY, Hua MX, Li Y, Xu Y, Di YD, Ling LL, Qin TH, Wang SH, Qin J, Han Y, Vargas MP, Silesky Jimenez JI, González Rojas MA, Solis-Quesada JE, Ramirez-Alfaro CM, Máca J, Sklienka P, Gjedsted J, Villamagua BG, Llano M, Burtin P, Buzancais G, Beuret P, Pelletier N, Mortaza S, Mercat A, Chelly J, Jochmans S, Terzi N, Daubin C, Carteaux G, de Prost N, Chiche JD, Daviaud F, Fartoukh M, Barberet G, Biehler J, Dellamonica J, Doyen D, Arnal JM, Briquet A, Hraiech S, Papazian L, Roux D, Messika J, Kalaitzis E, Médicale R, Dangers L, Combes A, Au SM, Béduneau G, Carpentier D, Zogheib EH, Dupont H, Ricome S, Santoli FL, Besset SL, Michel P, Gelée B, Danin PE, Goubaux B, Crova PJ, Phan NT, Berkelmans F, Badie JC, Tapponnier R, Gally J, Khebbeb S, Herbrecht JE, Schneider F, Declercq PM, Rigaud JP, Duranteau J, Harrois A, Chabanne R, Marin J, Bigot C, Thibault S, Ghazi M, Boukhazna M, Zein SO, Richecoeur JR, Combaux DM, Grelon F, Le Moal C, Sauvadet EP, Robine A, Lemiale V, Reuter D, Dres M, Demoule A, Goldgran-Toledano D, Baboi L, Guérin C, Lohner R, Kraßler J, Schäfer S, Zacharowski KD, Meybohm P, Reske AW, Simon P, Hopf HF, Schuetz M, Baltus T, Papanikolaou MN, Papavasilopoulou TG, Zacharas GA, Ourailogloy V, Mouloudi EK, Massa EV, Nagy EO, Stamou EE, Kiourtzieva EV, Oikonomou MA, Avila LE, Cortez CA, Citalán JE, Jog SA, Sable SD, Shah B, Gurjar M, Baronia AK, Memon M, Muthuchellappan R, Ramesh VJ, Shenoy A, Unnikrishnan R, Dixit SB, Rhayakar RV, Ramakrishnan N, Bhardwaj VK, Mahto HL, Sagar SV, Palaniswamy V, Ganesan D, Jamaati H, Heidari F, Meaney EA, Nichol A, Knapman KM, O'Croinin D, Dunne ES, Breen DM, Clarkson KP, Jaafar RF, Dwyer R, Amir F, Ajetunmobi OO, O'Muircheartaigh AC, Black CS, Treanor N, Collins DV, Altaf W, Zani G, Fusari M, Spadaro S, Volta CA, Graziani R, Brunettini B, Palmese S, Formenti P, Umbrello M, Lombardo A, Pecci E, Botteri M, Savioli M, Protti A, Mattei A, Schiavoni L, Tinnirello A, Todeschini M, Giarratano A, Cortegiani A, Sher S, Rossi A, Antonelli MM, Montini LM, Casalena P, Scafetti S, Panarello G, Occhipinti G, Patroniti N, Pozzi M, Biscione RR, Poli MM, Raimondi F, Albiero D, Crapelli G, Beck E, Pota V, Schiavone V, Molin A, Tarantino F, Monti G, Frati E, Mirabella L, Cinnella G, Fossali T, Colombo R, Pattarino PTI, Mojoli F, Braschi A, Borotto EE, Cracchiolo AN, Palma DM, Raponi F, Foti G, Vascotto ER, Coppadoro A, Brazzi L, Floris L, Iotti GA, Venti A, Yamaguchi O, Takagi S, Maeyama HN, Watanabe E, Yamaji Y, Shimizu K, Shiozaki K, Futami S, Ryosuke S, Saito K, Kameyama Y, Ueno K, Izawa M, Okuda N, Suzuki H, Harasawa T, Nasu M, Takada T, Ito F, Nunomiya S, Koyama K, Abe T, Andoh K, Kusumoto K, Hirata A, Takaba A, Kimura H, Matsumoto S, Higashijima U, Honda H, Aoki N, Imai H, Ogino Y, Mizuguchi I, Ichikado K, Nitta K, Mochizuki K, Hashida T, Tanaka H, Nakamura T, Niimi D, Ueda T, Kashiwa Y, Uchiyama A, Sabelnikovs O, Lebanon PO, Haddad Y, Liew KY, Ñamendys-Silva SA, Jarquin-Badiola YD, Sanchez-Hurtado LA, Gomez-Flores SS, Marin MC, Villagomez AJ, General H, Lemus JS, Fierro JM, Cervantes MR, Mejia FJF, Dector D, Dector DM, Gonzalez DR, Estrella CR, Sanchez-Medina JR, Ramirez-Gutierrez A, George FG, Aguirre JS, Buensuseso JA, Poblano M, Dendane T, Balkhi H, Elkhayari M, Samkaoui N, Ezzouine H, Benslama A, Amor M, Maazouzi W, Cimic N, Beck O, Bruns MM, Schouten JA, Rinia M, Raaijmakers M, Van Wezel HM, Heines SJ, Strauch U, Buise MP, Simonis FD, Schultz MJ, Goodson JC, Browne TS, Navarra L, Hunt A, Hutchison RA, Bailey MB, Newby L, Mcarthur C, Kalkoff M, Mcleod A, Casement J, Hacking DJ, Andersen FH, Dolva MS, Barratt-Due A, Noremark KAL, Søreide E, Sjøbø BÅ, Guttormsen AB, Leon Yoshido HH, Aguilar RZ, Montes Oscanoa FA, Alisasis AU, Robles JB, Pasanting-Lim RAB, Tan Poland BC, Andruszkiewicz P, Jakubowska K, Coxo CM, Alvarez AM, Oliveira BS, Montanha GM, Barros NC, Pereira CS, Messias AM, Monteiro JM, Araujo AM, Catorze NT, Marum SM, Bouw MJ, Gomes RM, Brito VA, Castro S, Estilita JM, Barros FM, Serra IM, Romania A, Tomescu DR, Marcu A, Bedreag OH, Papurica M, Corneci DE, Negoita SI, Grigoriev E, Gritsan AI, Gazenkampf AA, Almekhlafi G, Albarrak MM, Mustafa GM, Maghrabi KA, Salahuddin N, Aisa TM, Al Jabbary AS, Tabhan E, Arabim YM, Arabi YM, Trinidad OA, Al Dorzi HM, Tabhan EE, Bolon S, Smith O, Mancebo J, Aguirre-Bermeo H, Lopez-Delgado JC, Esteve F, Rialp G, Forteza C, de Haro C, Artigas A, Albaiceta GM, de Cima-Iglesias S, Seoane-Quiroga L, Ceniceros-Barros A, Ruiz-Aguilar AL, Claraco-Vega LM, Soler JA, Del Carmen Lorente M, Hermosa C, Gordo F, Prieto-González M, López-Messa JB, Perez MP, Perez CP, Allue RM, Roche-Campo F, Ibañez-Santacruz M, Temprano S, Pintado MC, de Pablo R, Gómez PRA, Ruiz SR, Moles SI, Jurado MT, Arizmendi A, Piacentini EA, Franco N, Honrubia T, Cheng MP, Losada EP, Blanco J, Yuste LJ, Carbayo-Gorriz C, Cazorla-Barranquero FG, Alonso JG, Alda RS, Algaba Á, Navarro G, Cereijo E, Diaz-Rodriguez E, Marcos DP, Montero LA, Para LH, Sanchez RJ, Navalpotro MAB, Abad RD, González RM, Toribio DP, Castro AG, Artiga MJD, Penuelas O, Roser TP, Olga MF, Curto EG, Sánchez RM, Imma VP, Elisabet GM, Claverias L, Magret M, Pellicer AM, Rodriguez LL, Sánchez-Ballesteros J, González-Salamanca Á, Jimenez AG, Huerta FP, Sotillo Diaz JCJ, Lopez EB, Llinares Moya DD, Tallet Alfonso AA, Luis PSE, Cesar PS, Rafael SI, Virgilio CG, Recio NN, Adamsson RO, Rylander CC, Holzgraefe B, Broman LM, Wessbergh J, Persson L, Schiöler F, Kedelv H, Tibblin AO, Appelberg H, Hedlund L, Helleberg J, Eriksson KE, Glietsch R, Larsson N, Nygren I, Nunes SL, Morin AK, Kander T, Adolfsson A, Zender HO, Leemann-Refondini C, Elatrous S, Bouchoucha S, Chouchene I, Ouanes I, Souissi AB, Kamoun S, Demirkiran O, Aker M, Erbabacan E, Ceylan I, Girgin NK, Ozcelik M, Ünal N, Meco BC, Akyol OO, Derman SS, Kennedy B, Parhar K, Srinivasa L, McAuley D, Hopkins P, Mellis C, Kakar V, Hadfield D, Vercueil A, Bhowmick K, Humphreys SK, Ferguson A, Mckee R, Raj AS, Fawkes DA, Watt P, Twohey L, JhaMatthew Thomas RR, Morton A, Kadaba V, Smith MJ, Hormis AP, Kannan SG, Namih M, Reschreiter H, Camsooksai J, Kumar A, Rugonfalvi S, Nutt C, Oneill O, Seasman C, Dempsey G, Scott CJ, Ellis HE, Mckechnie S, Hutton PJ, Di Tomasso NN, Vitale MN, Griffin R, Dean MN, Cranshaw JH, Willett EL, Ioannou N, Gillis S, Csabi P, Macfadyen R, Dawson H, Preez PD, Williams AJ, Boyd O, de Gordoa LO, Bramall J, Symmonds S, Chau SK, Wenham T, Szakmany T, Toth-Tarsoly P, Mccalman KH, Alexander P, Stephenson L, Collyer T, Chapman R, Cooper R, Allan RM, Sim M, Wrathall DW, Irvine DA, Zantua KS, Adams JC, Burtenshaw AJ, Sellors GP, Welters ID, Williams KE, Hessell RJ, Oldroyd MG, Battle CE, Pillai S, Okane SC, Donnelly A, Frigyik AD, Careless JP, May MM, Stewart R, John Trinder T, Hagan SJ, Wise MP, Cole JM, MacFie CC, Dowling AT, Nuñez E, Pittini G, Rodriguez R, Imperio MC, Santos C, França AG, Ebeid A, Deicas A, Uppalapati A, Kamel G, Banner-Goodspeed VM, Beitler JR, Mukkera SR, Kulkarni S, Lee J, Mesar T, Shinn Iii JO, Gomaa D, Tainter C, Yeatts DJ, Warren J, Lanspa MJ, Miller RR, Grissom CK, Brown SM, Bauer PR, Gosselin RJ, Kitch BT, Cohen JE, Beegle SH, Gueret RM, Tulaimat A, Choudry S, Stigler W, Batra H, Huff NG, Lamb KD, Oetting TW, Mohr NM, Judy C, Saito S, Kheir FM, Kheir F, Schlichting AB, Delsing A, Crouch DR, Elmasri M, Ismail D, Dreyer KR, Blakeman TC, Baron RM, Grijalba CQ, Hou PC, Seethala R, Aisiku I, Henderson G, Frendl G, Hou SK, Owens RL, Schomer A, Bumbasirevic V, Jovanovic B, Surbatovic M, Veljovic M., UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - (SLuc) Service de soins intensifs, UCL - (MGD) Services des soins intensifs, Department of Medicine and Surgery [Monza, Italy] (Research Center on Public Health), Università degli Studi di Milano-Bicocca [Milano] (UNIMIB), Sorbonne Université (SU), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), ACS - Heart failure & arrhythmias, AII - Inflammatory diseases, Graduate School, Intensive Care Medicine, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, Abe, T, Madotto, F, Pham, T, Nagata, I, Uchida, M, Tamiya, N, Kurahashi, K, Bellani, G, Laffey, J, Abe, T., Madotto, F., Pham, T., Nagata, I., Uchida, M., Tamiya, N., Kurahashi, K., Bellani, G., Laffey, J. G., Francois, G. M., Rabboni, F., Conti, S., Fan, E., Pesenti, A., Brochard, L., Esteban, A., Gattinoni, L., van Haren, F., Larsson, A., Mcauley, D. F., Ranieri, M., Rubenfeld, G., Thompson, B. T., Wrigge, H., Slutsky, A. S., Rios, F., Sottiaux, T., Depuydt, P., Lora, F. S., Azevedo, L. C., Bugedo, G., Qiu, H., Gonzalez, M., Silesky, J., Cerny, V., Nielsen, J., Jibaja, M., Matamis, D., Ranero, J. L., Amin, P., Hashemian, S. M., Clarkson, K., Villagomez, A., Zeggwagh, A. A., Heunks, L. M., Laake, J. H., Palo, J. E., do Vale Fernandes, A., Sandesc, D., Arabi, Y., Bumbasierevic, V., Nin, N., Lorente, J. A., Piquilloud, L., Abroug, F., Mcnamee, L., Hurtado, J., Bajwa, E., Dempair, G., Sula, H., Nunci, L., Cani, A., Zazu, A., Dellera, C., Insaurralde, C. S., Alejandro, R. V., Daldin, J., Vinzio, M., Fernandez, R. O., Cardonnet, L. P., Bettini, L. R., Bisso, M. C., Osman, E. M., Setten, M. G., Lovazzano, P., Alvarez, J., Villar, V., Milstein, C., Pozo, N. C., Grubissich, N., Plotnikow, G. A., Vasquez, D. N., Ilutovich, S., Tiribelli, N., Chena, A., Pellegrini, C. A., Saenz, M. G., Estenssoro, E., Brizuela, M., Gianinetto, H., Gomez, P. E., Cerrato, V. I., Bezzi, M. G., Borello, S. A., Loiacono, F. A., Fernandez, A. M., Knowles, S., Reynolds, C., Inskip, D. M., Miller, J. J., Kong, J., Whitehead, C., Bihari, S., Seven, A., Krstevski, A., Rodgers, H. J., Millar, R. T., Mckenna, T. E., Bailey, I. M., Hanlon, G. C., Aneman, A., Lynch, J. M., Azad, R., Neal, J., Woods, P. W., Roberts, B. L., Kol, M. R., Wong, H. S., Riss, K. C., Wittebole, X., Berghe, C., Bulpa, P. A., Dive, A. M., Verstraete, R., Lebbinck, H., Vermassen, J., Meersseman, P., Ceunen, H., Rosa, J. I., Beraldo, D. O., Piras, C., Rampinelli, A. M., Nassar, A. P., Mataloun, S., Moock, M., Thompson, M. M., Goncalves, C. H., Antonio, Acp., Ascoli, A., Biondi, R. S., Fontenele, D. C., Nobrega, D., Sales, V. M., Shindhe, S., Ismail, Dhmabph., Beloncle, F., Davies, K. G., Cirone, R., Manoharan, V., Ismail, M., Goligher, E. C., Jassal, M., Nishikawa, E., Javeed, A., Curley, G., Rittayamai, N., Parotto, M., Ferguson, N. D., Mehta, S., Knoll, J., Pronovost, A., Chile, S. C., Bruhn, A. R., Garcia, P. H., Aliaga, F. A., Farias, P. A., Yumha, J. S., Ortiz, C. A., Salas, J. E., Saez, A. A., Vega, L. D., Labarca, E. F., Martinez, F. T., Carreno, N. G., Lora, P., Liu, H., Liu, L., Tang, R., Luo, X., An, Y., Zhao, H., Gao, Y., Zhai, Z., Ye, Z. L., Wang, W., Li, W., Li, Q., Zheng, R., Yu, W., Shen, J., Li, X., Yu, T., Lu, W., Wu, Y. Q., Huang, X. B., He, Z., Lu, Y., Han, H., Zhang, F., Sun, R., Wang, H. X., Qin, S. H., Zhu, B. H., Zhao, J., Liu, J., Li, B., Liu, J. L., Zhou, F. C., Li, Q. J., Zhang, X. Y., Li-Xin, Z., Xin-Hua, Q., Jiang, L., Gao, Y. N., Zhao, X. Y., Li, Y. Y., Li, X. L., Wang, C., Yao, Q., Yu, R., Chen, K., Shao, H., Qin, B., Huang, Q. Q., Zhu, W. H., Hang, A. Y., Hua, M. X., Li, Y., Xu, Y., Di, Y. D., Ling, L. L., Qin, T. H., Wang, S. H., Qin, J., Han, Y., Vargas, M. P., Silesky Jimenez, J. I., Gonzalez Rojas, M. A., Solis-Quesada, J. E., Ramirez-Alfaro, C. M., Maca, J., Sklienka, P., Gjedsted, J., Villamagua, B. G., Llano, M., Burtin, P., Buzancais, G., Beuret, P., Pelletier, N., Mortaza, S., Mercat, A., Chelly, J., Jochmans, S., Terzi, N., Daubin, C., Carteaux, G., de Prost, N., Chiche, J. D., Daviaud, F., Fartoukh, M., Barberet, G., Biehler, J., Dellamonica, J., Doyen, D., Arnal, J. M., Briquet, A., Hraiech, S., Papazian, L., Roux, D., Messika, J., Kalaitzis, E., Medicale, R., Dangers, L., Combes, A., Au, S. M., Beduneau, G., Carpentier, D., Zogheib, E. H., Dupont, H., Ricome, S., Santoli, F. L., Besset, S. L., Michel, P., Gelee, B., Danin, P. E., Goubaux, B., Crova, P. J., Phan, N. T., Berkelmans, F., Badie, J. C., Tapponnier, R., Gally, J., Khebbeb, S., Herbrecht, J. E., Schneider, F., Declercq, P. M., Rigaud, J. P., Duranteau, J., Harrois, A., Chabanne, R., Marin, J., Bigot, C., Thibault, S., Ghazi, M., Boukhazna, M., Zein, S. O., Richecoeur, J. R., Combaux, D. M., Grelon, F., Le Moal, C., Sauvadet, E. P., Robine, A., Lemiale, V., Reuter, D., Dres, M., Demoule, A., Goldgran-Toledano, D., Baboi, L., Guerin, C., Lohner, R., Krassler, J., Schafer, S., Zacharowski, K. D., Meybohm, P., Reske, A. W., Simon, P., Hopf, H. F., Schuetz, M., Baltus, T., Papanikolaou, M. N., Papavasilopoulou, T. G., Zacharas, G. A., Ourailogloy, V., Mouloudi, E. K., Massa, E. V., Nagy, E. O., Stamou, E. E., Kiourtzieva, E. V., Oikonomou, M. A., Avila, L. E., Cortez, C. A., Citalan, J. E., Jog, S. A., Sable, S. D., Shah, B., Gurjar, M., Baronia, A. K., Memon, M., Muthuchellappan, R., Ramesh, V. J., Shenoy, A., Unnikrishnan, R., Dixit, S. B., Rhayakar, R. V., Ramakrishnan, N., Bhardwaj, V. K., Mahto, H. L., Sagar, S. V., Palaniswamy, V., Ganesan, D., Jamaati, H., Heidari, F., Meaney, E. A., Nichol, A., Knapman, K. M., O'Croinin, D., Dunne, E. S., Breen, D. M., Clarkson, K. P., Jaafar, R. F., Dwyer, R., Amir, F., Ajetunmobi, O. O., O'Muircheartaigh, A. C., Black, C. S., Treanor, N., Collins, D. V., Altaf, W., Zani, G., Fusari, M., Spadaro, S., Volta, C. A., Graziani, R., Brunettini, B., Palmese, S., Formenti, P., Umbrello, M., Lombardo, A., Pecci, E., Botteri, M., Savioli, M., Protti, A., Mattei, A., Schiavoni, L., Tinnirello, A., Todeschini, M., Giarratano, A., Cortegiani, A., Sher, S., Rossi, A., Antonelli, M. M., Montini, L. M., Casalena, P., Scafetti, S., Panarello, G., Occhipinti, G., Patroniti, N., Pozzi, M., Biscione, R. R., Poli, M. M., Raimondi, F., Albiero, D., Crapelli, G., Beck, E., Pota, V., Schiavone, V., Molin, A., Tarantino, F., Monti, G., Frati, E., Mirabella, L., Cinnella, G., Fossali, T., Colombo, R., Pattarino, Pti., Mojoli, F., Braschi, A., Borotto, E. E., Cracchiolo, A. N., Palma, D. M., Raponi, F., Foti, G., Vascotto, E. R., Coppadoro, A., Brazzi, L., Floris, L., Iotti, G. 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G, Hou SK, Owens RL, Schomer A, Bumbasirevic V, Jovanovic B, Surbatovic M, Veljovic M.

Subjects
Male, ARDS, Internationality, [SDV]Life Sciences [q-bio], humanos, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], traqueostomía, Critical Care and Intensive Care Medicine, Severity of Illness Index, Cohort Studies, Propensity-matched analysi, 0302 clinical medicine, Tracheostomy, estudios prospectivos, Epidemiology, Acute respiratory distress syndrome (ARDS), 030212 general & internal medicine, Prospective Studies, puntuación de propensión, 10. No inequality, Prospective cohort study, estudios de cohortes, mediana edad, anciano, Respiratory Distress Syndrome, respiración, Respiration, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, 3. Good health, Intensive Care Units, Cohort, Artificial, Critical Illne, Female, ICU, Propensity-matched analysis, Ventilation, Aged, Critical Illness, Humans, Propensity Score, Respiration, Artificial, Respiratory Distress Syndrome, Adult, Cohort study, Human, Adult, medicine.medical_specialty, Intensive Care Unit, Socio-culturale, unidades de cuidados intensivos, enfermedad crítica, 03 medical and health sciences, Severity of illness, Settore MED/41 - ANESTESIOLOGIA, medicine, índice de gravedad de la enfermedad, business.industry, Research, internacionalidad, lcsh:RC86-88.9, medicine.disease, R1, Prospective Studie, 030228 respiratory system, Propensity score matching, Emergency medicine, Observational study, Cohort Studie, business
Abstract

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study. Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort. Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample. Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality., This work was funded and supported by the European Society of Intensive Care Medicine (ESICM), Brussels, Belgium, by St Michael's Hospital, Toronto, Canada, and by the University of Milan-Bicocca, Monza, Italy. This work was supported by JSPS KAKENHI JP 16 K15388, Japan.

Published
2018
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48. Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study

Author

Bellani, Giacomo, Laffey, John G., Pham, Tai, Madotto, Fabiana, Fan, Eddy, Brochard, Laurent, Esteban, Andres, Gattinoni, Luciano, Bumbasirevic, Vesna, Piquilloud, Lise, Van Haren, Frank, Larsson, Anders, McAuley, Daniel F., Bauer, Philippe R., Arabi, Yaseen M., Ranieri, Marco, Antonelli, Massimo, Rubenfeld, Gordon D., Taylor Thompson, B., Wrigge, Hermann, Slutsky, Arthur S., Pesenti, Antonio, Rios F, Van Haren F, Sottiaux T, Depuydt P, Lora FS, Azevedo LC, Fan E, Bugedo G, Qiu H, Gonzalez M, Silesky J, Cerny V, Nielsen J, Jibaja M, Pham T, Wrigge H, Matamis D, Ranero JL, Amin P, Hashemian SM, Clarkson K, Bellani G, Kurahashi K, Villagomez A, Zeggwagh AA, Heunks LM, Laake JH, Palo JE, do Vale Fernandes A, Sandesc D, Arabi Y, Bumbasierevic V, Nin N, Lorente JA, Larsson A, Piquilloud L, Abroug F, McAuley DF, McNamee L, Hurtado J, Bajwa E, Démpaire G, Francois GM, Sula H, Nunci L, Cani A, Zazu A, Dellera C, Insaurralde CS, Alejandro RV, Daldin J, Vinzio M, Fernandez RO, Cardonnet LP, Bettini LR, Bisso MC, Osman EM, Setten MG, Lovazzano P, Alvarez J, Villar V, Pozo NC, Grubissich N, Plotnikow GA, Vasquez DN, Ilutovich S, Tiribelli N, Chena A, Pellegrini CA, Saenz MG, Estenssoro E, Brizuela M, Gianinetto H, Gomez PE, Cerrato VI, Bezzi MG, Borello SA, Loiacono FA, Fernandez AM, Knowles S, Reynolds C, Inskip DM, Miller JJ, Kong J, Whitehead C, Bihari S, Seven A, Krstevski A, Rodgers HJ, Millar RT, Mckenna TE, Bailey IM, Hanlon GC, Aneman A, Lynch JM, Azad R, Neal J, Woods PW, Roberts BL, Kol MR, Wong HS, Riss KC, Staudinger T, Wittebole X, Berghe C, Bulpa PA, Dive AM, Verstraete R, Lebbinck H, Vermassen J, Meersseman P, Ceunen H, Rosa JI, Beraldo DO, Piras C, Rampinelli AM, Nassar Jr AP, Mataloun S, Moock M, Thompson MM, Gonçalves CH, Antônio AP, Ascoli A, Biondi RS, Fontenele DC, Nobrega D, Sales VM, Shindhe S, Aiman M, Laffey J, Beloncle F, Davies KG, Cirone R, Manoharan V, Ismail M, Goligher EC, Jassal M, Nishikawa E, Javeed A, Curley G, Rittayamai N, Parotto M, Ferguson ND, Mehta S, Knoll J, Pronovost A, Canestrini S, Bruhn AR, Garcia PH, Aliaga FA, Farías PA, Yumha JS, Ortiz CA, Salas JE, Saez AA, Vega LD, Labarca EF, Martinez FT, Carreño NG, Lora P, Liu H, Liu L, Tang R, Luo X, An Y, Zhao H, Gao Y, Zhai Z, Ye ZL, Wang W, Li W, Li Q, Zheng R, Yu W, Shen J, Li X, Yu T, Wu YQ, Huang XB, He Z, Lu Y, Han H, Zhang F, Sun R, Wang HX, Qin SH, Zhu BH, Zhao J, Liu J, Li B, Liu JL, Zhou FC, Li QJ, Zhang XY, Li-Xin Z, Xin-Hua Q, Jiang L, Gao YN, Zhao XY, Li YY, Li XL, Wang C, Yao Q, Yu R, Chen K, Shao H, Qin B, Huang QQ, Zhu WH, Hang AY, Hua MX, Li Y, Xu Y, Di YD, Ling LL, Qin TH, Wang SH, Qin J, Han Y, Zhou S, Vargas MP, Silesky Jimenez JI, González Rojas MA, Solis-Quesada JE, Ramirez-Alfaro CM, Máca J, Sklienka P, Gjedsted J, Christiansen A, Villamagua BG, Llano M, Burtin P, Buzancais G, Beuret P, Pelletier N, Mortaza S, Mercat A, Chelly J, Jochmans S, Terzi N, Daubin C, Carteaux G, de Prost N, Chiche JD, Daviaud F, Fartoukh M, Barberet G, Biehler J, Dellamonica J, Doyen D, Arnal JM, Briquet A, Hraiech S, Papazian L, Follin A, Roux D, Messika J, Kalaitzis E, Dangers L, Combes A, Au SM, Béduneau G, Carpentier D, Zogheib EH, Dupont H, Ricome S, Santoli FL, Besset SL, Michel P, Gelée B, Danin PE, Goubaux B, Crova PJ, Phan NT, Berkelmans F, Badie JC, Tapponnier R, Gally J, Khebbeb S, Herbrecht JE, Schneider F, Declercq PM, Rigaud JP, Duranteau J, Harrois A, Chabanne R, Marin J, Bigot C, Thibault S, Ghazi M, Boukhazna M, Zein SO, Richecoeur JR, Combaux DM, Grelon F, Le Moal C, Sauvadet EP, Robine A, Lemiale V, Reuter D, Dres M, Demoule A, Goldgran-Toledano D, Baboi L, Guérin C, Lohner R, Kraßler J, Schäfer S, Zacharowski KD, Meybohm P, Reske AW, Simon P, Hopf HF, Schuetz M, Baltus T, Papanikolaou MN, Papavasilopoulou TG, Zacharas GA, Ourailogloy V, Mouloudi EK, Massa EV, Nagy EO, Stamou EE, Kiourtzieva EV, Oikonomou MA, Avila LE, Cortez CA, Citalán JE, Jog SA, Sable SD, Shah B, Gurjar M, Baronia AK, Memon M, Muthuchellappan R, Ramesh VJ, Shenoy A, Unnikrishnan R, Dixit SB, Rhayakar RV, Ramakrishnan N, Bhardwaj VK, Mahto HL, Sagar SV, Palaniswamy V, Ganesan D, Jamaati H, Heidari F, Meaney EA, Nichol A, Knapman KM, O’Croinin D, Dunne ES, Breen DM, Clarkson KP, Jaafar RF, Dwyer R, Amir F, Ajetunmobi OO, O’Muircheartaigh AC, Black CS, Treanor N, Collins DV, Altaf W, Zani G, Fusari M, Spadaro S, Volta CA, Graziani R, Brunettini B, Palmese S, Formenti P, Umbrello M, Lombardo A, Pecci E, Botteri M, Savioli M, Protti A, Mattei A, Schiavoni L, Tinnirello A, Todeschini M, Giarratano A, Cortegiani A, Sher S, Rossi A, Antonelli MM, Montini LM, Casalena P, Scafetti S, Panarello G, Occhipinti G, Patroniti N, Pozzi M, Biscione RR, Poli MM, Raimondi F, Albiero D, Crapelli G, Beck E, Pota V, Schiavone V, Molin A, Tarantino F, Monti G, Frati E, Mirabella L, Cinnella G, Fossali T, Colombo R, Terragni P, Pattarino I, Mojoli F, Braschi A, Borotto EE, Cracchiolo AN, Palma DM, Raponi F, Foti G, Vascotto ER, Coppadoro A, Brazzi L, Floris L, Iotti GA, Venti A, Yamaguchi O, Takagi S, Maeyama HN, Watanabe E, Yamaji Y, Shimizu K, Shiozaki K, Futami S, Ryosuke S, Saito K, Kameyama Y, Ueno K, Izawa M, Okuda N, Suzuki H, Harasawa T, Nasu M, Takada T, Ito F, Nunomiya S, Koyama K, Abe T, Andoh K, Kusumoto K, Hirata A, Takaba A, Kimura H, Matsumoto S, Higashijima U, Honda H, Aoki N, Imai H, Ogino Y, Mizuguchi I, Ichikado K, Nitta K, Mochizuki K, Hashida T, Tanaka H, Nakamura T, Niimi D, Ueda T, Kashiwa Y, Uchiyama A, Sabelnikovs O, Oss P, Haddad Y, Liew KY, Ñamendys-Silva SA, Jarquin-Badiola YD, Sanchez-Hurtado LA, Gomez-Flores SS, Marin MC, Villagomez AJ, Lemus JS, Fierro JM, Cervantes MR, Flores Mejia FJ, Dector D, Dector DM, Gonzalez DR, Estrella CR, Sanchez-Medina JR, Ramirez-Gutierrez A, George FG, Aguirre JS, Buensuseso JA, Poblano M, Dendane T, Balkhi H, Elkhayari M, Samkaoui N, Ezzouine H, Benslama A, Amor M, Maazouzi W, Cimic N, Beck O, Bruns MM, Schouten JA, Rinia M, Raaijmakers M, Van Wezel HM, Heines SJ, Strauch U, Buise MP, Simonis FD, Schultz MJ, Goodson JC, Browne TS, Navarra L, Hunt A, Hutchison RA, Bailey MB, Newby L, Mcarthur C, Kalkoff M, Mcleod A, Casement J, Hacking DJ, Andersen FH, Dolva MS, Barratt-Due A, Noremark KL, Søreide E, Sjøbø BÅ, Guttormsen AB, Yoshido HL, Aguilar RZ, Oscanoa FM, Alisasis AU, Robles JB, Pasanting-Lim RB, Tan BC, Andruszkiewicz P, Jakubowska K, Coxo CM, Alvarez AM, Oliveira BS, Montanha GM, Barros NC, Pereira CS, Messias AM, Monteiro JM, Araujo AM, Catorze NT, Marum SM, Bouw MJ, Gomes RM, Brito VA, Castro S, Estilita JM, Barros FM, Serra IM, Martinho AM, Tomescu DR, Marcu A, Bedreag OH, Papurica M, Corneci DE, Negoita SI, Grigoriev E, Gritsan AI, Gazenkampf AA, Almekhlafi G, Albarrak MM, Mustafa GM, Maghrabi KA, Salahuddin N, Aisa TM, Al Jabbary AS, Tabhan E, Arabi YM, Trinidad OA, Al Dorzi HM, Tabhan EE, Bolon S, Smith O, Mancebo J, Lopez-Delgado JC, Esteve F, Rialp G, Forteza C, De Haro C, Artigas A, Albaiceta GM, De Cima-Iglesias S, Seoane-Quiroga L, Ruiz-Aguilar AL, Claraco-Vega LM, Soler JA, Lorente MC, Hermosa C, Gordo F, Prieto-González M, López-Messa JB, Perez MP, Perez CP, Allue RM, Roche-Campo F, Ibañez-Santacruz M, Temprano S, Pintado MC, De Pablo R, Gómez PA, Rodriguez Ruiz S, Iglesias Moles S, Jurado MT, Arizmendi A, Piacentini EA, Franco N, Honrubia T, Perez Cheng M, Perez Losada E, Blanco J, Yuste LJ, Carbayo-Gorriz C, Cazorla-Barranquero FG, Alonso JG, Alda RS, Algaba A, Navarro G, Cereijo E, Diaz-Rodriguez E, Pastor Marcos D, Alvarez Montero L, Herrera Para L, Jimenez Sanchez R, Blasco Navalpotro MA, Diaz Abad R, Castro AG, Jose D Artiga M, Ceniceros-Barros A, Montiel González R, Parrilla Toribio D, Penuelas O, Roser TP, Olga MF, Gallego Curto E, Manzano Sánchez R, Imma VP, Elisabet GM, Claverias L, Magret M, Pellicer AM, Rodriguez LL, Sánchez-Ballesteros JS, González-Salamanca A, Jimenez AG, Huerta FP, Sotillo Diaz JJ, Bermejo Lopez E, Llinares Moya DD, Tallet Alfonso AA, Eugenio Luis PS, Sanchez Cesar P, Rafael SI, Virgilio CG, Recio NN, Adamsson RO, Rylander CC, Holzgraefe B, Broman LM, Wessbergh J, Persson L, Schiöler F, Kedelv H, Oscarsson Tibblin A, Appelberg H, Hedlund L, Helleberg J, Eriksson KE, Glietsch R, Larsson N, Nygren I, Nunes SL, Morin AK, Kander T, Adolfsson A, Zender HO, Leemann-Refondini C, Elatrous S, Bouchoucha S, Chouchene I, Ouanes I, Souissi AB, Kamoun S, Demirkiran O, Aker M, Erbabacan E, Ceylan I, Girgin NK, Ozcelik M, Ünal N, Meco BC, Akyol OO, Derman SS, Kennedy B, Parhar K, Srinivasa L, McAuley D, Hopkins P, Mellis C, Kakar V, Hadfield D, Vercueil A, Bhowmick K, Humphreys SK, Ferguson A, Mckee R, Raj AS, Fawkes DA, Watt P, Twohey L, Jha RR, Thomas M, Morton A, Kadaba V, Smith MJ, Hormis AP, Kannan SG, Namih M, Reschreiter H, Camsooksai J, Kumar A, Rugonfalvi S, Nutt C, Oneill O, Seasman C, Dempsey G, Scott CJ, Ellis HE, Mckechnie S, Hutton PJ, Di Tomasso NN, Vitale MN, Griffin RO, Dean MN, Cranshaw JH, Willett EL, Ioannou N, Gillis S, Csabi P, Macfadyen R, Dawson H, Preez PD, Williams AJ, Boyd O, Ortiz-Ruiz De Gordoa L, Bramall J, Symmonds S, Chau SK, Wenham T, Szakmany T, Toth-Tarsoly P, Mccalman KH, Alexander P, Stephenson L, Collyer T, Chapman R, Cooper R, Allan RM, Sim M, Wrathall DW, Irvine DA, Zantua KS, Adams JC, Burtenshaw AJ, Sellors GP, Welters ID, Williams KE, Hessell RJ, Oldroyd MG, Battle CE, Pillai S, Kajtor I, Sivashanmugavel M, Okane SC, Donnelly A, Frigyik AD, Careless JP, May MM, Stewart R, Trinder TJ, Hagan SJ, Wise MP, Cole JM, MacFie CC, Dowling AT, Nuñez E, Pittini G, Rodriguez R, Imperio MC, Santos C, França AG, Ebeid A, Deicas A, Serra C, Uppalapati A, Kamel G, Banner-Goodspeed VM, Beitler JR, Reddy Mukkera S, Kulkarni S, Lee J, Mesar T, Shinn Iii JO, Gomaa D, Tainter C, Yeatts DJ, Warren J, Lanspa MJ, Miller RR, Grissom CK, Brown SM, Bauer PR, Gosselin RJ, Kitch BT, Cohen JE, Beegle SH, Gueret RM, Tulaimat A, Choudry S, Stigler W, Batra H, Huff NG, Lamb KD, Oetting TW, Mohr NM, Judy C, Saito S, Kheir FM, Kheir F, Schlichting AB, Delsing A, Crouch DR, Elmasri M, Ismail D, Dreyer KR, Blakeman TC, Baron RM, Quintana Grijalba C, Hou PC, Seethala R, Aisiku I, Henderson G, Frendl G, Hou SK, Owens RL, Schomer A, Bumbasirevic V, Jovanovic B, Surbatovic M, Veljovic M., Bellani, Giacomo, Laffey, John G., Pham, Tai, Madotto, Fabiana, Fan, Eddy, Brochard, Laurent, Esteban, Andre, Gattinoni, Luciano, Bumbasirevic, Vesna, Piquilloud, Lise, Van Haren, Frank, Larsson, Ander, McAuley, Daniel F., Bauer, Philippe R., Arabi, Yaseen M., Ranieri, Marco, Antonelli, Massimo, Rubenfeld, Gordon D., Taylor Thompson, B., Wrigge, Hermann, Slutsky, Arthur S., Pesenti, Antonio, Rios F, Van Haren F, Sottiaux T, Depuydt P, Lora FS, Azevedo LC, Fan E, Bugedo G, Qiu H, Gonzalez M, Silesky J, Cerny V, Nielsen J, Jibaja M, Pham T, Wrigge H, Matamis D, Ranero JL, Amin P, Hashemian SM, Clarkson K, Bellani G, Kurahashi K, Villagomez A, Zeggwagh AA, Heunks LM, Laake JH, Palo JE, do Vale Fernandes A, Sandesc D, Arabi Y, Bumbasierevic V, Nin N, Lorente JA, Larsson A, Piquilloud L, Abroug F, McAuley DF, McNamee L, Hurtado J, Bajwa E, Démpaire G, Francois GM, Sula H, Nunci L, Cani A, Zazu A, Dellera C, Insaurralde CS, Alejandro RV, Daldin J, Vinzio M, Fernandez RO, Cardonnet LP, Bettini LR, Bisso MC, Osman EM, Setten MG, Lovazzano P, Alvarez J, Villar V, Pozo NC, Grubissich N, Plotnikow GA, Vasquez DN, Ilutovich S, Tiribelli N, Chena A, Pellegrini CA, Saenz MG, Estenssoro E, Brizuela M, Gianinetto H, Gomez PE, Cerrato VI, Bezzi MG, Borello SA, Loiacono FA, Fernandez AM, Knowles S, Reynolds C, Inskip DM, Miller JJ, Kong J, Whitehead C, Bihari S, Seven A, Krstevski A, Rodgers HJ, Millar RT, Mckenna TE, Bailey IM, Hanlon GC, Aneman A, Lynch JM, Azad R, Neal J, Woods PW, Roberts BL, Kol MR, Wong HS, Riss KC, Staudinger T, Wittebole X, Berghe C, Bulpa PA, Dive AM, Verstraete R, Lebbinck H, Depuydt P, Vermassen J, Meersseman P, Ceunen H, Rosa JI, Beraldo DO, Piras C, Rampinelli AM, Nassar Jr AP, Mataloun S, Moock M, Thompson MM, Gonçalves CH, Antônio AP, Ascoli A, Biondi RS, Fontenele DC, Nobrega D, Sales VM, Shindhe S, Aiman M, Laffey J, Beloncle F, Davies KG, Cirone R, Manoharan V, Ismail M, Goligher EC, Jassal M, Nishikawa E, Javeed A, Curley G, Rittayamai N, Parotto M, Ferguson ND, Mehta S, Knoll J, Pronovost A, Canestrini S, Bruhn AR, Garcia PH, Aliaga FA, Farías PA, Yumha JS, Ortiz CA, Salas JE, Saez AA, Vega LD, Labarca EF, Martinez FT, Carreño NG, Lora P, Liu H, Qiu H, Liu L, Tang R, Luo X, An Y, Zhao H, Gao Y, Zhai Z, Ye ZL, Wang W, Li W, Li Q, Zheng R, Yu W, Shen J, Li X, Yu T, Wu YQ, Huang XB, He Z, Lu Y, Han H, Zhang F, Sun R, Wang HX, Qin SH, Zhu BH, Zhao J, Liu J, Li B, Liu JL, Zhou FC, Li QJ, Zhang XY, Li-Xin Z, Xin-Hua Q, Jiang L, Gao YN, Zhao XY, Li YY, Li XL, Wang C, Yao Q, Yu R, Chen K, Shao H, Qin B, Huang QQ, Zhu WH, Hang AY, Hua MX, Li Y, Xu Y, Di YD, Ling LL, Qin TH, Wang SH, Qin J, Han Y, Zhou S, Vargas MP, Silesky Jimenez JI, González Rojas MA, Solis-Quesada JE, Ramirez-Alfaro CM, Máca J, Sklienka P, Gjedsted J, Christiansen A, Nielsen J, Villamagua BG, Llano M, Burtin P, Buzancais G, Beuret P, Pelletier N, Mortaza S, Mercat A, Chelly J, Jochmans S, Terzi N, Daubin C, Carteaux G, de Prost N, Chiche JD, Daviaud F, Pham T, Fartoukh M, Barberet G, Biehler J, Dellamonica J, Doyen D, Arnal JM, Briquet A, Hraiech S, Papazian L, Follin A, Roux D, Messika J, Kalaitzis E, Dangers L, Combes A, Au SM, Béduneau G, Carpentier D, Zogheib EH, Dupont H, Ricome S, Santoli FL, Besset SL, Michel P, Gelée B, Danin PE, Goubaux B, Crova PJ, Phan NT, Berkelmans F, Badie JC, Tapponnier R, Gally J, Khebbeb S, Herbrecht JE, Schneider F, Declercq PM, Rigaud JP, Duranteau J, Harrois A, Chabanne R, Marin J, Bigot C, Thibault S, Ghazi M, Boukhazna M, Zein SO, Richecoeur JR, Combaux DM, Grelon F, Le Moal C, Sauvadet EP, Robine A, Lemiale V, Reuter D, Dres M, Demoule A, Goldgran-Toledano D, Baboi L, Guérin C, Lohner R, Kraßler J, Schäfer S, Zacharowski KD, Meybohm P, Reske AW, Simon P, Hopf HF, Schuetz M, Baltus T, Papanikolaou MN, Papavasilopoulou TG, Zacharas GA, Ourailogloy V, Mouloudi EK, Massa EV, Nagy EO, Stamou EE, Kiourtzieva EV, Oikonomou MA, Avila LE, Cortez CA, Citalán JE, Jog SA, Sable SD, Shah B, Gurjar M, Baronia AK, Memon M, Muthuchellappan R, Ramesh VJ, Shenoy A, Unnikrishnan R, Dixit SB, Rhayakar RV, Ramakrishnan N, Bhardwaj VK, Mahto HL, Sagar SV, Palaniswamy V, Ganesan D, Hashemian SM, Jamaati H, Heidari F, Meaney EA, Nichol A, Knapman KM, O’Croinin D, Dunne ES, Breen DM, Clarkson KP, Jaafar RF, Dwyer R, Amir F, Ajetunmobi OO, O’Muircheartaigh AC, Black CS, Treanor N, Collins DV, Altaf W, Zani G, Fusari M, Spadaro S, Volta CA, Graziani R, Brunettini B, Palmese S, Formenti P, Umbrello M, Lombardo A, Pecci E, Botteri M, Savioli M, Protti A, Mattei A, Schiavoni L, Tinnirello A, Todeschini M, Giarratano A, Cortegiani A, Sher S, Rossi A, Antonelli MM, Montini LM, Casalena P, Scafetti S, Panarello G, Occhipinti G, Patroniti N, Pozzi M, Biscione RR, Poli MM, Raimondi F, Albiero D, Crapelli G, Beck E, Pota V, Schiavone V, Molin A, Tarantino F, Monti G, Frati E, Mirabella L, Cinnella G, Fossali T, Colombo R, Terragni P, Pattarino I, Mojoli F, Braschi A, Borotto EE, Cracchiolo AN, Palma DM, Raponi F, Foti G, Vascotto ER, Coppadoro A, Brazzi L, Floris L, Iotti GA, Venti A, Yamaguchi O, Takagi S, Maeyama HN, Watanabe E, Yamaji Y, Shimizu K, Shiozaki K, Futami S, Ryosuke S, Saito K, Kameyama Y, Ueno K, Izawa M, Okuda N, Suzuki H, Harasawa T, Nasu M, Takada T, Ito F, Nunomiya S, Koyama K, Abe T, Andoh K, Kusumoto K, Hirata A, Takaba A, Kimura H, Matsumoto S, Higashijima U, Honda H, Aoki N, Imai H, Ogino Y, Mizuguchi I, Ichikado K, Nitta K, Mochizuki K, Hashida T, Tanaka H, Nakamura T, Niimi D, Ueda T, Kashiwa Y, Uchiyama A, Sabelnikovs O, Oss P, Haddad Y, Liew KY, Ñamendys-Silva SA, Jarquin-Badiola YD, Sanchez-Hurtado LA, Gomez-Flores SS, Marin MC, Villagomez AJ, Lemus JS, Fierro JM, Cervantes MR, Flores Mejia FJ, Dector D, Dector DM, Gonzalez DR, Estrella CR, Sanchez-Medina JR, Ramirez-Gutierrez A, George FG, Aguirre JS, Buensuseso JA, Poblano M, Dendane T, Zeggwagh AA, Balkhi H, Elkhayari M, Samkaoui N, Ezzouine H, Benslama A, Amor M, Maazouzi W, Cimic N, Beck O, Bruns MM, Schouten JA, Rinia M, Raaijmakers M, Heunks LM, Van Wezel HM, Heines SJ, Strauch U, Buise MP, Simonis FD, Schultz MJ, Goodson JC, Browne TS, Navarra L, Hunt A, Hutchison RA, Bailey MB, Newby L, Mcarthur C, Kalkoff M, Mcleod A, Casement J, Hacking DJ, Andersen FH, Dolva MS, Laake JH, Barratt-Due A, Noremark KL, Søreide E, Sjøbø BÅ, Guttormsen AB, Yoshido HL, Aguilar RZ, Oscanoa FM, Alisasis AU, Robles JB, Pasanting-Lim RB, Tan BC, Andruszkiewicz P, Jakubowska K, Coxo CM, Alvarez AM, Oliveira BS, Montanha GM, Barros NC, Pereira CS, Messias AM, Monteiro JM, Araujo AM, Catorze NT, Marum SM, Bouw MJ, Gomes RM, Brito VA, Castro S, Estilita JM, Barros FM, Serra IM, Martinho AM, Tomescu DR, Marcu A, Bedreag OH, Papurica M, Corneci DE, Negoita SI, Grigoriev E, Gritsan AI, Gazenkampf AA, Almekhlafi G, Albarrak MM, Mustafa GM, Maghrabi KA, Salahuddin N, Aisa TM, Al Jabbary AS, Tabhan E, Arabi YM, Arabi YM, Trinidad OA, Al Dorzi HM, Tabhan EE, Bolon S, Smith O, Mancebo J, Lopez-Delgado JC, Esteve F, Rialp G, Forteza C, De Haro C, Artigas A, Albaiceta GM, De Cima-Iglesias S, Seoane-Quiroga L, Ruiz-Aguilar AL, Claraco-Vega LM, Soler JA, Lorente MC, Hermosa C, Gordo F, Prieto-González M, López-Messa JB, Perez MP, Perez CP, Allue RM, Roche-Campo F, Ibañez-Santacruz M, Temprano S, Pintado MC, De Pablo R, Gómez PA, Rodriguez Ruiz S, Iglesias Moles S, Jurado MT, Arizmendi A, Piacentini EA, Franco N, Honrubia T, Perez Cheng M, Perez Losada E, Blanco J, Yuste LJ, Carbayo-Gorriz C, Cazorla-Barranquero FG, Alonso JG, Alda RS, Algaba A, Navarro G, Cereijo E, Diaz-Rodriguez E, Pastor Marcos D, Alvarez Montero L, Herrera Para L, Jimenez Sanchez R, Blasco Navalpotro MA, Diaz Abad R, Castro AG, Jose D Artiga M, Ceniceros-Barros A, Montiel González R, Parrilla Toribio D, Penuelas O, Roser TP, Olga MF, Gallego Curto E, Manzano Sánchez R, Imma VP, Elisabet GM, Claverias L, Magret M, Pellicer AM, Rodriguez LL, Sánchez-Ballesteros JS, González-Salamanca A, Jimenez AG, Huerta FP, Sotillo Diaz JJ, Bermejo Lopez E, Llinares Moya DD, Tallet Alfonso AA, Eugenio Luis PS, Sanchez Cesar P, Rafael SI, Virgilio CG, Recio NN, Adamsson RO, Rylander CC, Holzgraefe B, Broman LM, Wessbergh J, Persson L, Schiöler F, Kedelv H, Oscarsson Tibblin A, Appelberg H, Hedlund L, Helleberg J, Eriksson KE, Glietsch R, Larsson N, Nygren I, Nunes SL, Morin AK, Kander T, Adolfsson A, Piquilloud L, Zender HO, Leemann-Refondini C, Elatrous S, Bouchoucha S, Chouchene I, Ouanes I, Souissi AB, Kamoun S, Demirkiran O, Aker M, Erbabacan E, Ceylan I, Girgin NK, Ozcelik M, Ünal N, Meco BC, Akyol OO, Derman SS, Kennedy B, Parhar K, Srinivasa L, McNamee L, McAuley D, Hopkins P, Mellis C, Kakar V, Hadfield D, Vercueil A, Bhowmick K, Humphreys SK, Ferguson A, Mckee 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Subjects
Male, ARDS, procedure, blood oxygen tension, Critical Care and Intensive Care Medicine, Severity of Illness Index, law.invention, 0302 clinical medicine, law, Hospital Mortality, Respiratory Distress Syndrome, Acute respiratory distress syndrome, adult respiratory distress syndrome, Middle Aged, Intensive care unit, Intensive Care Units, medicine.anatomical_structure, Treatment Outcome, priority journal, positive end expiratory pressure, Noninvasive ventilation, disease severity, Female, treatment outcome, Aged, prospective study, Human, Adult, Pulmonary and Respiratory Medicine, medicine.medical_specialty, cohort analysi, Intensive Care Unit, disease classification, Acute respiratory distress, Article, NO, 03 medical and health sciences, acute respiratory distress syndrome, noninvasive ventilation, length of stay, Severity of illness, Settore MED/41 - ANESTESIOLOGIA, medicine, Sequential Organ Failure Assessment Score, Humans, In patient, Aged, Respiratory Distress Syndrome, Adult, Noninvasive Ventilation, Intensive care medicine, outcome assessment, Lung, business.industry, 030208 emergency & critical care medicine, medicine.disease, major clinical study, mortality, respiratory tract diseases, breathing rate, multicenter study, 030228 respiratory system, incidence, Observational study, observational study, business
Abstract

Rationale: Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory distress syndrome (ARDS). The evidence supporting NIV use in patients with ARDS remains relatively sparse.Objectives: To determine whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful.Methods: The LUNG SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) study described the management of patients with ARDS. This substudy examines the current practice of NIV use in ARDS, the utility of the PaO2/FiO2 ratio in classifying patients receiving NIV, and the impact of NIV on outcome.Measurements and Main Results: Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severity based on PaO2/FiO2 ratio was associated with an increase in intensity of ventilatory support, NIV failure, and intensive care unit (ICU) mortality. NIV failure occurred in 22.2% of mild, 42.3% of moderate, and 47.1% of patients with severe ARDS. Hospital mortality in patients with NIV success and failure was 16.1% and 45.4%, respectively. NIV use was independently associated with increased ICU (hazard ratio, 1.446 [95% confidence interval, 1.159–1.805]), but not hospital, mortality. In a propensity matched analysis, ICU mortality was higher in NIV than invasively ventilated patients with a PaO2/FiO2 lower than 150 mm Hg.Conclusions: NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV seems to be associated with higher ICU mortality in patients with a PaO2/FiO2 lower than 150 mm Hg.

Published
2017
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49. Electrochemical Degradation of Molecularly Imprinted Polymers for Future Applications of Inflammation Sensing in Cochlear Implants.

Author

Nguyen MH, Onken A, Sündermann J, Shamsuyeva M, Singla P, Depuydt T, Peeters M, Wagner P, Bethmann K, Körner J, Endres HJ, Lenarz T, and Doll T

Abstract

After cochlear implant (CI) insertion, there is a possibility of postoperative inflammation, which may involve proinflammatory markers such as interleukin-6. Detecting this inflammation promptly is crucial for administering anti-inflammatory drugs, if required. One potential method for detecting inflammation is using molecular imprinted polymers (MIPs). These MIPs, which can be deposited on the CI electrode, provide readout employing impedance measurements, a feature already available on the CI circuit. MIPs designed for this purpose should possess biocompatibility, conductivity, and degradability. The degradability is crucial because there is a limitation on the number of electrodes available, and once the inflammation sensor degrades after the acute inflammation period, it should remain usable as a regular electrode. In this work, conductive poly(3,4-ethylenedioxythiophene) polystyrenesulfonate-based MIPs were synthesized against biotin as a surrogate target marker. Specific biotin binding with MIPs was determined before and after degradation using electrochemical impedance spectroscopy (EIS) and compared with the control nonimprinted polymers (NIPs). Subsequently, MIPs were electrochemically degraded by EIS with different potentials, wherein a potential dependence was observed. With decreasing potential, fewer dissolved polymers and more monomer molecules were detected in the solution in which degradation took place. At a potential of 0.205 V a negligible amount of dissolved polymer in addition to the dissolved monomer molecules was measured, which can be defined as the limiting potential. Below this potential, only dissolved monomer molecules are obtained, which enables renal clearance. Biocompatibility testing revealed that both the polymer and the solution with dissolved monomer molecules do not exceed the ISO 10993-5 cytotoxicity threshold. Based on these findings, we have developed conductive, biocompatible, and controllably degradable MIPs capable of detecting biotin. This research work paves the way for the advancement of CIs, where inflammation can be detected using molecular imprinting technology without compromising the stability and biosafety of the product., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Published
2024
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50. Challenges and opportunities for proton therapy during pregnancy.

Author

Blommaert J, De Saint-Hubert M, Depuydt T, Oldehinkel E, Poortmans P, Amant F, and Lambrecht M

Subjects
Female, Humans, Pregnancy, Fetus, Neutrons, Protons, Radiometry, Radiotherapy Dosage, Proton Therapy
Abstract

During pregnancy, the use of radiation therapy for cancer treatment is often considered impossible due to the assumed associated fetal risks. However, suboptimal treatment of pregnant cancer patients and unjustifiable delay in radiation therapy until after delivery can be harmful for both patient and child. In non-pregnant patients, proton-radiation therapy is increasingly administered because of its favorable dosimetric properties compared with photon-radiation therapy. Although data on the use of pencil beam scanning proton-radiation therapy during pregnancy are scarce, different case reports and dosimetric studies have indicated a more than 10-fold reduction in fetal radiation exposure compared with photon-radiation therapy. Nonetheless, the implementation of proton-radiation therapy during pregnancy requires complex fetal dosimetry for the neutron-dominated out-of-field radiation dose and faces a lack of clinical guidelines. Further exploration and standardization of proton-radiation therapy during pregnancy will be necessary to improve radiotherapeutic management of pregnant women with cancer and further reduce risks for their offspring., (© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Published
2024
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