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At least 19 recordsLinked to original sources
PubMed1990

[3-D-irradiation planning based on the TOMOSCAN CX (Philips) computed tomograph. I. Principles of the CT-irradiation planning program. II. CT-irradiation planning for after-irradiation of breast cancer].

Actually CT-cross-sections are the best base for irradiation planning. Bases are represented to use CT-picture matrices of scanner TOMOSCAN CX (Philips) for irradiation planning. The direct application of CT-pictures is done in "off-line"-running with the magnetic tape set. For figuring on colour display and estimation of density matrix limits of Hounsfield values are given. Adjustment of the CT to take off scan planes requires a special work-regime for irradiation planning. Repair and use of defective CT-pictures are realized by input of specific outlines. In daily routine the output of sagittal dose distribution is most advantageous in form of a table. Application of this CT-irradiation planning system, being implemented on microcalculator K 1630, is shown for telecobalt irradiation of mammary carcinoma.

Breast Neoplasms↗
PubMed1991

Evaluation of high energy photon external beam treatment planning: project summary. Photon Treatment Planning Collaborative Working Group.

A three-year project for the "Evaluation of High Energy Photon External Beam Treatment Planning," sponsored by the National Cancer Institute, is summarized. The participants in this project were determined on a competitive basis and included staff from four institutions: Massachusetts General Hospital; Memorial Sloan-Kettering Cancer Center; the University of Pennsylvania; and Mallinckrodt Institute of Radiation. This project built on the developments in three-dimensional anatomical and dose distribution reconstruction at these institutions and on the clinical guidance at these centers for quantitative evaluation of treatment plans. Protocols for acceptance of patients with lesions at eight different sites were developed and utilized. The technical methodology for interchange of treatment planning tapes, specifications for computerized tomography sections and their reconstruction, and the employment of dose-volume histograms of target regions and specified normal tissues and organs were all developed. Data were accumulated for tumor control probabilities (TCP) and for normal tissue complication probabilities (NTCP) for use in treatment plan design and evaluation. Several treatment parameters were studied as influenced by the availability of three-dimensional treatment planning and specific conclusions were reached.

Humans↗
PubMed1991

Role of inhomogeneity corrections in three-dimensional photon treatment planning. Photon Treatment Planning Collaborative Working Group.

The role of inhomogeneity corrections in three-dimensional (3-D) radiation treatment planning (RTP) was one of the issues addressed in a National Cancer Institute sponsored research contract. In eight selected disease sites, plans calculated with and without inhomogeneity corrections were compared. The one-dimensional Effective Path Length (EPL) method was used by all four participating institutions as the standard inhomogeneity correction method. However, the dose calculation algorithms were different, particularly in the treatment of blocking effects near the edge of the field. Evaluation tools such as dose-volume histogram, dose statistics, 3-D display of dose distributions and others were used in the comparison. Dose distributions were significantly altered by inhomogeneity corrections in the treatment plans for the lung tumors, and, to a lesser degree, for the breast and Hodgkin's diseases. Dose distributions for tumors of the head and neck region and in the abdomen were not significantly affected. The results should be regarded as particular to the EPL calculations. A treatment plan for the tumor of the larynx was calculated using both the EPL method and a 3-D scatter ray-trace Delta Volume method. For that particular site, inhomogeneity corrections were less important than correctly accounting for the effects of blockings on the scatter dose. Perturbations of electron transport were not accounted for by any of the methods used and not reflected in those sites where the effects were expected to be important. Fully quantitative evaluation of the role of inhomogeneity corrections in treatment planning requires an as yet unavailable all-encompassing accurate method of dose calculation.

Humans↗
PubMed1979

Mental health services: utilization by low income enrollees in a prepaid group practice plan and in an independent practice plan.

Mental health services were included in a comprehensive package of benefits available to low income enrollees in a prepaid group practice plan (PGP) and in an independent practice plan (IPP) under the Seattle Prepaid Health Care Project. There were no out-of-pocket costs for enrollees. Utilization of services was studied for four years under conditions that might simulate universal entitlement. The analyses indicated that females used substantially more mental health services than males and that enrollees aged 20-44 used more services than those in other age groups. The prepaid group practice generally experienced higher utilization than the prepaid independent plan. Significant racial differences were evident with whites using more services than blacks and black males using strikingly few services. The prepaid independent plan was oriented toward physician providers and emphasized individual psychotherapy while the prepaid group practice employed a diversity of practitioners and therapeutic modalities. The data indicated that the per cent of enrollees using any mental health services was twice as great in the PGP as in the IPP. However, once access to the provider system was achieved, the number of services utilized was greater in the PGP. Inpatient services were also examined. A significantly higher proportion of IPP enrollees were admitted for inpatient care as compared to PGP enrollees. Finally, the cost of mental health services was less than ten per cent of total health service costs in both plans.

Adolescent↗
PubMedDate not supplied

[Teaching of pediatrics within the plan of studies for general medicine (plan A-36)].

In this article the author exposes some of the bases about the instruction program of General Integral Medicine (plan A-36); also, he compares the teaching aspects of pediatrics of this plan and the traditional plan, both carried out at the medical School of the National Autonomous University of Mexico. The author points out the best distribution of the pediatric aspects through the medical curriculum, which results in more effective teaching hours, besides, the application of the most current pedagogic and didactic technics in Plan A-36. Also the pediatric clinical practice is performed in more appropriate places and the relation between practice and theory shows more adequate equilibrium than the traditional plan.

Education, Medical↗
PubMed1990

Planning for primary health care: the case of the Sierra Leone National Action Plan.

The National Action Plan for Primary Health Care, a planning document of the Sierra Leonean Ministry of Health for the restructuring of the country's rural health services, is analyzed in its social, economic, and historical context. It appears to be an attempt of the national government to gain control over the highly devolved health care delivery system, but the state has neither the political will nor the power to achieve this goal. The utility of the document is therefore in doubt, which raises two important questions: Whose interests does this plan serve, and at whose cost?

Health Planning↗
PubMed1991

State-of-the-art of external photon beam radiation treatment planning. Photon Treatment Planning Collaborative Working Group.

A virtual revolution in computer capability has occurred in the last few years, largely based on rapidly decreasing costs and increasing reliability of digital memory and mass-storage capability. These developments have now made it possible to consider the application of both computer and display technologies to a much broader range of problems in radiation therapy, including planning of treatment, dose computation, and treatment verification. Several methods of three-dimensional dose computations in heterogeneous media capable of 3% accuracy are likely to be available, but significant work still remains, particularly for high energy x-rays where electron transport, and possibly pair production, need to be considered. Innovative display and planning techniques, as well as plan evaluation schemes, are emerging and show great promise for the future. No doubt these advances will lead to substantially improved treatment planning systems in the next few years. However, it must be emphasized that for many of these applications a tremendous software and hardware development effort is required.

Computer Graphics↗
PubMedDate not supplied

Optimal electron-beam treatment planning for retinoblastoma using a new three-dimensional Monte Carlo-based treatment planning system.

Electron-beam treatment planning for retinoblastoma was investigated and an optimal treatment plan was devised for a particular case using a new three-dimensional Monte Carlo-based treatment planning system known to be capable of correctly predicting dose perturbations caused by body surface obliquities and tissue heterogeneities. Computed tomography (CT) data files were used to construct a three-dimensional eye phantom representing the anatomy of a child's orbit. Dose distributions in sagittal, transverse, and coronal planes were predicted with 1-mm resolution. Study of these distributions led to an optimal treatment plan consisting of an anterior-lateral pair, with the anterior field being a 10-MeV, 30-mm-diam circular field, centrally blocked by a 10-mm-diam lucite lens shield and the lateral field being a 16-MeV, 30 x 25-mm D-shaped field. The anterior field delivers a therapeutic dose to the ora serrata, but it underdoses the posterior retinal surface behind the lens shield; the lateral field provides the necessary boost dose to the posterior retinal surface. An equally weighted combination of the two fields produces a dose distribution in which the entire retinal surface receives a therapeutic dose, with less than 10% of that dose being delivered to the lens, brain, and the contralateral orbit.

Electrons↗
PubMed1991

Employer health care plan design and its effect on plan costs.

This study uses claims data from employers in the Houston Area Health Care Coalition (HAHCC) for 1985 through the first half of 1987 to examine the effect of health care plan attributes on health care costs. Plan attributes affect the site of care and the costs of care. Utilization review clearly was effective in reducing the demand for inpatient services, but that reduction was in large measure matched by increases in care in the outpatient setting. Restrictions on mental health benefits also shifted the site of care. In contrast, neither premium sharing nor the plan's deductible had a significant impact on total plan charges. The study results demonstrate the need to have a comprehensive cost management strategy.

Adolescent↗
PubMed1991

The natural family planning--lactational amenorrhea method interface: observations from a prospective study of breastfeeding users of natural family planning.

Methods of natural family planning are sometimes difficult for women to use during lactation. When this is so, the lactational amenorrhea method may prove useful. Researchers agree that a fully breastfeeding woman who is amenorrheic is 98% protected from pregnancy for up to 6 months after delivery. The fertility status of 74 users of natural family planning during the time they would have been protected by the lactational amenorrhea method is examined. Underlying hormonal profiles show that there was little ovarian activity during this time. Eight ovulatory events occurred during the period of protection by the lactational amenorrhea method, of which four fulfilled minimum criteria for adequacy; there were no pregnancies during this period. However, some women did report experiencing fertile mucus symptoms during this time that were often unrelated to estrogen production. Using the lactational amenorrhea method rather than natural family planning allows them to avoid unnecessary abstinence.

Amenorrhea↗
PubMed1992

A comparison of the individualized education plan and the individualized family service plan.

The individualized education plan (IEP) and the individualized family service plan (IFSP) are mandated for children with special needs. Occupational therapists participate in the development of both the IEP and the IFSP. This paper summarizes the similarities and the differences in the mandated components. The components addressed are (a) information about the child's status, (b) information about the family, (c) outcomes for the child and family, (d) intervention services, (e) other services, (f) dates and duration of services, (g) selection of a case manager, and (h) transition plans.

Child↗
PubMed1990

[Financial planning for surgical research. Project portfolio as an instrument for research planning].

Planning of research funding should assure both volume and continuity of economic support. Funding of new research concepts usually depends largely on the internal budget of the research institution (primary economical resources). More mature projects can be funded by governmental and non-profit (secondary) or industrial sources (tertiary economical resources). In general, a balanced proportion of financial support will assure maximal research independence. The respective funding of a research project should be regarded as extrinsic to the quality of the said project. Portfolio analysis of research projects is introduced as a new means of planning and controlling academic and industrial research. In principle, research projects will be evaluated with regard to the inherent potential of development (e.g. potential impact on clinical or scientific concepts) and the current productivity (e.g. output of results and publications). The 2-dimensional portfolio-matrix will be used to analyse these factors, manifesting both the overall activity of a research unit and the development of new research and funding strategies. In addition, repetitive project-portfolio analyses will enable control of both spending and efficiency in research. The application of the current project-portfolio method is exemplified by an analysis of the research activities of the department of surgery at the university of Basel. To date, project-portfolio analysis is not a mature method: Development of more quantitative portfolio strategies and of multidimensional project-portfolios are proposed. However, project-portfolio analysis is a promising means of planning and controlling research. It should be used and developed further in institutions with a number of concurrent research activities.

Animals↗