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Biomedical subjects

Jean St Germain

Publications and source records attributed to Jean St Germain.

8 recordsLinked to original sources
PubMed2007

Whole-body clearance kinetics and external dosimetry of 131I-3F8 monoclonal antibody for radioimmunotherapy of neuroblastoma.

The purpose of this retrospective study was to evaluate the whole-body clearance kinetics of I-3F8 monoclonal antibody, an anti-ganglioside 2 antibody, used in the treatment of pediatric patients with late-stage neuroblastoma (NB). Serial whole-body dose rate measurements were obtained on pediatric patients participating in phase I dose escalation studies of therapeutic I-3F8. Whole-body retention fractions were derived and fit for each treatment to exponential curves to determine both the effective half-lives and corresponding clearance fractions. 27 patients were administered I-3F8 over the course of cyclical administrations with a median administered activity of 2.5 GBq (range, 1-8.14 GBq), typically every 2-4 d for up to 9 treatment cycles. Based on whole-body dose rate measurements, there was a large variability in the calculated mono-exponential clearance effective half-life time, with a mean of 26.4 h (range, 12.4-45.5 h). The data from a subset of 12 treatments were fit to a bi-exponential curve with a rapid clearance component mean effective half-time of 16.9 h (range, 4.3-26 h) and a slower clearance component mean effective half-time of 65.5 h (range, 16.9-136 h). The use of whole-body dose rate measurements, obtained for patient-release and other radiation safety considerations, can be useful in estimating whole-body clearance kinetics for photon emitting radionuclide labeled mAbs and other therapeutic radiopharmaceuticals. In the case of I-3F8 for pediatric NB therapy, the demonstrated variability in effective half-time suggests the need for patient-specific tracer dosimetry for both optimization of treatment and radiation safety precaution decision-making.

Adolescent↗
PubMed2006

Evaluating the effectiveness of a radiation safety training intervention for oncology nurses: a pretest-intervention-posttest study.

BACKGROUND: Radiation, for either diagnosis or treatment, is used extensively in the field of oncology. An understanding of oncology radiation safety principles and how to apply them in practice is critical for nursing practice. Misconceptions about radiation are common, resulting in undue fears and concerns that may negatively impact patient care. Effectively educating nurses to help overcome these misconceptions is a challenge. Historically, radiation safety training programs for oncology nurses have been compliance-based and behavioral in philosophy. METHODS: A new radiation safety training initiative was developed for Memorial Sloan-Kettering Cancer Center (MSKCC) adapting elements of current adult education theories to address common misconceptions and to enhance knowledge. A research design for evaluating the revised training program was also developed to assess whether the revised training program resulted in a measurable and/or statistically significant change in the knowledge or attitudes of nurses toward working with radiation. An evaluation research design based on a conceptual framework for measuring knowledge and attitude was developed and implemented using a pretest-intervention-posttest approach for 15% of the study population of 750 inpatient registered oncology nurses. RESULTS: As a result of the intervention program, there was a significant difference in nurse's cognitive knowledge as measured with the test instrument from pretest (58.9%) to posttest (71.6%). The evaluation also demonstrated that while positive nursing attitudes increased, the increase was significant for only 5 out of 9 of the areas evaluated. CONCLUSION: The training intervention was effective for increasing cognitive knowledge, but was less effective at improving overall attitudes. This evaluation provided insights into the effectiveness of training interventions on the radiation safety knowledge and attitude of oncology nurses.

Adult↗
PubMed2006

A review of educational philosophies as applied to radiation safety training at medical institutions.

This paper examines the educational philosophy of radiation safety education programs at medical institutions. The regulatory mandates for radiation safety training have traditionally emphasized competency-based training. This emphasis led to the adoption of a behaviorist philosophy that requires predetermined responses to certain situations. The behaviorist approach determines the roles of teacher and learner as well as the methods to be used. This paper examines these roles and methods and the influence of a highly regulated environment on the adoption of the behaviorist model. The paper also suggests that other educational philosophies, such as the progressive philosophy, should be examined to provide a rich foundation for improving the educational experience and outcomes.

Curriculum↗
PubMed2006

Organ and fetal absorbed dose estimates from 99mTc-sulfur colloid lymphoscintigraphy and sentinel node localization in breast cancer patients.

UNLABELLED: The purpose of this retrospective study was to determine whether lymphoscintigraphy (LSG) for sentinel lymph node (SNL) mapping in a woman with a breast mass presents an unacceptable risk to her fetus. We assessed radiation-absorbed dose to various organs from 99mTc-sulfur colloid (TSC) LSG using standard internal absorbed dose assessment methodologies for both reference phantoms as well as for phantom models using the specific patient population characteristics such as total body and injected organ mass. The study also projected the radiation-absorbed dose to the fetus from LSG for SLN mapping. METHODS: Data from 1,021 nonpregnant women with early-stage breast cancer who underwent SLN mapping and biopsy procedures were analyzed. Patients had a single-site intradermal injection of unfiltered TSC in 0.05 mL normal saline: 3.7 MBq (0.1 mCi) on the morning of surgery (1-d protocol) or 18.5 MBq (0.5 mCi) on the afternoon before surgery (2-d protocol). A standard internal dose calculation methodology was used to calculate absorbed doses to various organs and to a modeled fetus at 3-, 6-, and 9-mo gestation from the injection site as well as from systemic activity. RESULTS: The highest estimated absorbed doses were observed for the reference 9-mo-pregnant model under the 2-d protocol. Absorbed doses of 14.9, 0.214, 0.062, 0.151, 0.004, 0.163, 0.075, and 0.014 mGy were received by the injected breast, heart, liver, lung, ovaries, thymus, total body, and fetus, respectively. Effective doses from the 2-d protocol were estimated to be 0.460, 0.186, and 0.245 mSv for the reference population, the total Memorial Sloan-Kettering Cancer Center (MSKCC) study patient population, and childbearing-age MSKCC patient population (i.e., <45 y old), respectively. CONCLUSION: SLN procedures lead to a negligible dose to the fetus of 0.014 mGy or less. This is much less than the National Council on Radiation Protection and Measurements limit to a pregnant woman. Calculations using actual patient population characteristics resulted in lower organ dose estimates than more conservative reference models.

Adult↗
PubMed2004

Results of a one year survey of output for linear accelerators using IMRT and non-IMRT techniques.

This paper presents the results of a one year survey of treated fields for 3 treatment machines at our New Jersey regional center. One machine predominantly treated IMRT prostate patients using a sliding window technique. The others were not equipped to deliver IMRT. Information obtained for each treated field included patient number, modality, monitor units delivered, gantry angle, and time. Data was obtained directly from our record and verify system and analyzed using a spreadsheet. We studied workload (MU/week), patient load, and average MU per patient as a function of time, as well as angular distributions and number of treatment fractions per patient. We also calculated the fraction of time the beam was on during treatments. By the end of the survey year, the workload of the IMRT machine reached approximately 100,000 MU/week and that of the non-IMRT machines was approximately 40-45000 MU/week. This was due predominantly to the higher number of monitor units for IMRT plans. Patient loads were not significantly different for the 3 machines. Duty cycle was 14% and 16% for the non-IMRT machines and 27% for the IMRT machine. The difference in workload for IMRT treatments relative to non-IMRT treatments confirms an earlier study performed at our institution using a much smaller data sample. One needs to consider the increase in leakage associated with this higher workload when designing shielding for an IMRT room.

Data Collection↗
PubMed2004

Assessment of radiation safety instructions to patients based on measured dose rates following prostate brachytherapy.

PURPOSE: To validate radiation safety instructions to patients and to evaluate the potential radiation doses to members of the public after (125)I or (103)Pd prostate implantation. METHODS AND MATERIALS: Radiation dose rate measurements were made in the immediate postoperative period on 636 consecutive patients with stage T1-T2 prostate cancer who underwent transperineal (125)I or (103)Pd implantation at Memorial Sloan-Kettering Cancer Center during the period from August 1995 through January 2003. RESULTS: The mean radiation dose rate at the anterior skin surface following a prostate implant was 37 microSv/hr for (125)I and 8 microSv/hr for (103)Pd. At 30 cm from the anterior skin surface, these dose rates were reduced to 6 microSv/hr for (125)I and 3 microSv/hr for (103)Pd. At 1 m from the anterior skin surface the dose rates from both types of implants were reduced to less than 1 microSv/hr. The effect of body weight on dose rates from (125)I sources was examined for a select sub-group of patients and the measured dose rate was found to decrease with increasing body weight. In another group of patients, dose rate measurements were made on both lateral skin surfaces and were less than 16.8 microSv/hr in all cases. Assuming a 33% occupancy factor and utilizing the mean measured dose rate for (125)I, the time required to reach an effective dose equivalent limit of 5 mSv for caregivers was estimated to be 19 days on contact with the skin surface. Using a similar calculation, the lifetime doses for (125)I at a distance of 30 cm from the anterior skin surface, as well as the lifetime doses for (103)Pd on contact with the skin surface and at 30 cm from the anterior skin surface can be shown to be less than 5 mSv. CONCLUSIONS: The large number of cases available for this study permits a validation of radiation safety recommendations and provides concrete information from which the permitted exposure times following implantation can be estimated. The data support the conclusion that patients treated with these implants do not represent a radiation risk to members of the public.

Brachytherapy↗
PubMed2002

Estimation of shielding factors for linear accelerators.

There have been a number of persons who have estimated that the use of multi-leaf collimation and IMRT techniques increase the workload in treatment rooms to the extent that assumptions used in shielding calculations should reflect these increased workloads. This paper examines the workloads in a large department with treatment machines of varying energies and techniques. While the sample size examined is limited, the data presented demonstrate that the standard assumptions may still be sufficiently conservative that no substantive changes may be needed.

Humans↗