Search results for: interventional oncology

Authors: Alisher Agzamov, Hanan Al Harbi

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BACKGROUND: The timely assessment and treatment of ICU Surgical and Medical Oncology patients is important for Oncology surgeons and Medical Oncologists and Intensivists (1). We hypothesized that the use of Robot Physician’s (RP - 7) ICU management and care in ICU can improve ICU physician rapid response to unstable ICU Oncology patients. METHODS: This is a prospective study of 1501 oncology patients using a before-after, cohort-control design to test the effectiveness of RP. We have used RP to make multidisciplinary ICU rounds in the ICU and for Emergency cases. Data concerning several aspects of the RP interaction, including the latency of the response, the problem being treated, the intervention that was ordered, and the type of information gathered using the RP, were documented. The effect of RP on ICU length of stay and cost was assessed. RESULTS: The use of RP was associated with a reduction in latency of attending physician face-to-face response for routine and urgent pages compared to conventional care (RP: 10.2 +/- 3.3 minutes vs conventional: 210 +/- 40 minutes). The response latencies to Oncology Emergency (8.0 +/- 2.8 vs 140 +/- 35 minutes) and for Respiratory Failure (12 +/- 04 vs 110 +/- 45 minutes) were reduced (P < .001), as was the LOS for oncology patients (5 days) and ARDS (10 day). There was an increase in ICU occupancy by 29 % compared with the prerobot era, and there was an ICU cost savings of KD2.2 million attributable to the use of RP. CONCLUSION: The use of RP enabled rapid face-to-face ICU Intensivist - physician response to unstable ICU Oncology patients and resulted in decreased ICU cost and LOS.

Keywords: robot physician, oncology patients, icu management and care, cost and icu occupancy

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Authors: Kholood Baron

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Radiologic interventional studies use fluoroscopy imaging guidance to perform both diagnostic and therapeutic procedures. These could result in high radiation doses being delivered to the patients and also to the radiology team. This is due to the prolonged fluoroscopy time and the large number of images taken, even when dose-minimizing techniques and modern fluoroscopic tools are applied. Hence, these procedures are part of the everyday routine of interventional radiology doctors, assistant nurses, and radiographers. Thus, it is important to estimate the radiation exposure dose they received in order to give objective advice and reduce both patient and radiology team radiation exposure dose. The aim of this study was to find out the total radiation dose reaching the radiologist and the patient during an interventional procedure and to determine the impact of certain parameters on the patient dose. Method: The radiation dose was measured by TLD devices (thermoluminescent dosimeter; radiation dosimeter device). Physicians, patients, nurses, and radiographers wore TLDs during 12 interventional radiology procedures performed in two hospitals, Mubarak and Chest Hospital. This study highlights the need for interventional radiologists to be mindful of the radiation doses received by both patients and medical staff during interventional radiology procedures. The findings emphasize the impact of factors such as fluoroscopy duration and the number of images taken on the patient dose. By raising awareness and providing insights into optimizing techniques and protective measures, this research contributes to the overall goal of reducing radiation doses and ensuring the safety of patients and medical staff.

Keywords: dosimetry, radiation dose, interventional radiology procedures, patient radiation dose

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Authors: Alisher Agzamov, Hanan Al Harbi

Abstract:

BACKGROUND: The timely assessment and treatment of ICU Surgical and Medical Oncology patients is important for Oncology surgeons and Medical Oncologists and Intensivists. We hypothesized that the use of Robot Physician’s (RP - 7) ICU management and care in ICU can improve ICU physician rapid response to unstable ICU Oncology patients. METHODS: This is a prospective study using a before-after, cohort-control design to test the effectiveness of RP. We have used RP to make multidisciplinary ICU rounds in the ICU and for Emergency cases. Data concerning several aspects of the RP interaction including the latency of the response, the problem being treated, the intervention that was ordered, and the type of information gathered using the RP were documented. The effect of RP on ICU length of stay and cost was assessed. RESULTS: The use of RP was associated with a reduction in latency of attending physician face-to-face response for routine and urgent pages compared to conventional care (RP: 10.2 +/- 3.3 minutes vs conventional: 220 +/- 80 minutes). The response latencies to Oncology Emergency (8.0 +/- 2.8 vs 150 +/- 55 minutes) and for Respiratory Failure (12 +/- 04 vs 110 +/- 45 minutes) were reduced (P < .001), as was the LOS for patients with AML (5 days) and ARDS (10 day). There was an increase in ICU occupancy by 20 % compared with the prerobot era, and there was an ICU cost savings of KD2.5 million attributable to the use of RP. CONCLUSION: The use of RP enabled rapid face-to-face ICU Intensivist - physician response to unstable ICU Oncology patients and resulted in decreased ICU cost and LOS.

Keywords: robot physician, oncology patients, rp - 7 in icu management, cost and icu occupancy

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Authors: Rujnan Tuna, Ulku Baykal

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The antineoplastic drugs used in cancer treatment directly have adverse effects on health of both patients receiving the treatment and oncology nurses preparing and administering the treatment. The purpose of this study is to determine the working conditions of the oncology nurses in terms of employee safety as well as their knowledge levels regarding the safe use of antineoplastic drugs. This is a qualitative study conducted in the phenomenological design. Purposeful sampling method was used to carry out the interviews. The individual, in-depth, and semi-structured face-to-face interviews continued with 25 oncology nurses, who were working in an oncology centre in the city of Istanbul. Qualitative content analysis approach was used for the analysis of the obtained data in the study. The results of the study were gathered under 4 main themes; work-related factors, employee safety, working conditions, and training. The interviewed oncology nurses stated that the protective measures related to the safe use of the antineoplastic drugs were insufficient, and only 20% of the nurses have chemotherapy preparation certificate and they received this certificate after they started working in this unit. Also, after they had begun to work in that unit, they started to experience with so many health problems As happens all over the world, there have also been policies and standards regarding the safe use of antineoplastic drugs in Turkey; however, it is found that they remain insufficient to put into practice.

Keywords: antineoplastic drug, employee safety, nurse, oncology, qualitative study

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Authors: Alejandro Salicrup, Riacrdo Gelhman, Geetha Gopalakrishna

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The main aim of this session is to have a panel to discuss specific steps for the integration of traditional, complementary and alternative medicine (TCAM) with conventional oncology for enhancing treatment practices at the global level, specifically in low-and-middle-income-countries (LMICs). Concrete current and required programs for strengthening Integrative Oncology research in LMICs will also be discussed. Case Studies from Latin America, Asia, Europe and Africa will discuss and highlight 1) What is working regarding treatment practices in integrative oncology in their countries/regions providing concrete examples 2) What is not working on this integration for cancer treatment in their countries/regions with concrete examples and 3) What are the challenges and opportunities for research related to integrative oncology treatment. Discussion will include potential next steps and potential mechanisms to enhance global integrative oncology research aimed to enhance the use of TCAM therapies and strengthening cancer treatment in LMICs.

Keywords: global cancer treatment, integrative oncology research, low and middle income countries, traditional, complementary and alternative medicines

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Authors: Fernando Antonio Bacchim Neto, Allan Felipe Fattori Alves, Maria Eugênia Dela Rosa, Regina Moura, Diana Rodrigues De Pina

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Interventional Radiology is the radiology modality that provides the highest dose values to medical staff. Recent researches show that personal dosimeters may underestimate dose values in interventional physicians, especially in extremities (hands and feet) and eye lens. The aim of this work was to study radiation exposure levels of medical staff in different interventional radiology procedures and estimate the annual maximum numbers of procedures (AMN) that each physician could perform without exceed the annual limits of dose established by normative. For this purpose LiF:Mg,Ti (TLD-100) dosimeters were positioned in different body regions of the interventional physician (eye lens, thyroid, chest, gonads, hand and foot) above the radiological protection vests as lead apron and thyroid shield. Attenuation values for lead protection vests were based on international guidelines. Based on these data were chosen as 90% attenuation of the lead vests and 60% attenuation of the protective glasses. 25 procedures were evaluated: 10 diagnostics, 10 angioplasty, and 5-aneurysm treatment. The AMN of diagnostic procedures was 641 for the primary interventional radiologist and 930 for the assisting interventional radiologist. For the angioplasty procedures, the AMN for primary interventional radiologist was 445 and for assisting interventional radiologist was 1202. As for the procedures of aneurism treatment, the AMN for the primary interventional radiologist was 113 and for the assisting interventional radiologist were 215. All AMN were limited by the eye lens doses already considering the use of protective glasses. In all categories evaluated, the higher dose values are found in gonads and in the lower regions of professionals, both for the primary interventionist and for the assisting, but the eyes lens dose limits are smaller than these regions. Additional protections as mobile barriers, which can be positioned between the interventionist and the patient, can decrease the exposures in the eye lens, providing a greater protection for the medical staff. The alternation of professionals to perform each type of procedure can reduce the dose values received by them over a period. The analysis of dose profiles proposed in this work showed that personal dosimeters positioned in chest might underestimate dose values in other body parts of the interventional physician, especially in extremities and eye lens. As each body region of the interventionist is subject to different levels of exposure, dose distribution in each region provides a better approach to what actions are necessary to ensure the radiological protection of medical staff.

Keywords: interventional radiology, radiation protection, occupationally exposed individual, hemodynamic

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Authors: Yun-Hsiang Lee

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Cancer is the main cause of death worldwide. With advances in medical technology, immunotherapy, which is a newly developed advanced treatment, is currently a crucial cancer treatment option. For better quality cancer care, the ability to communicate and critical thinking plays a central role in clinical oncology settings. However, few studies have explored the impact of communication skills on immunotherapy-related issues and their related factors. This study was to (i) explore the current status of communication skill ability for immunotherapy-related issues, self-efficacy for immunotherapy-related care, and critical thinking ability; and (ii) identify factors related to communication skill ability. This is a cross-sectional study. Oncology nurses were recruited from the Taiwan Oncology Nursing Society, in which nurses came from different hospitals distributed across four major geographic regions (North, Center, South, East) of Taiwan. A total of 123 oncology nurses participated in this study. A set of questionnaires were used for collecting data. Communication skill ability for immunotherapy issues, self-efficacy for immunotherapy-related care, critical thinking ability, and background information were assessed in this survey. Independent T-test and one-way ANOVA were used to examine different levels of communication skill ability based on nurses having done oncology courses (yes vs. no) and education years (< 1 year, 1-3 years, and > 3 years), respectively. Spearman correlation was conducted to understand the relationships between communication skill ability and other variables. Among the 123 oncology nurses in the current study, the majority of them were female (98.4%), and most of them were employed at a hospital in the North (46.8%) of Taiwan. Most of them possessed a university degree (78.9%) and had at least 3 years of prior work experience (71.7%). Forty-three of the oncology nurses indicated in the survey that they had not received oncology nurses-related training. Those oncology nurses reported moderate to high levels of communication skill ability for immunotherapy issues (mean=4.24, SD=0.7, range 1-5). Nurses reported moderate levels of self-efficacy for immunotherapy-related care (mean=5.20, SD=1.98, range 0-10) and also had high levels of critical thinking ability (mean=4.76, SD=0.60, range 1-6). Oncology nurses who had received oncology training courses had significantly better communication skill ability than those who had not received oncology training. Oncology nurses who had higher work experience (1-3 years, or > 3 years) had significantly higher levels of communication skill ability for immunotherapy-related issues than those with lower work experience (<1 year). When those nurses reported better communication skill ability, they also had significantly better self-efficacy (r=.42, p<.01) and better critical thinking ability (r=.47, p<.01). Taken altogether, courses designed to improve communication skill ability for immunotherapy-related issues can make a significant impact in clinical settings. Communication skill ability for oncology nurses is the major factor associated with self-efficacy and critical thinking, especially for those with lower work experience (< 1 year).

Keywords: communication skills, critical thinking, immunotherapy, oncology nurses, self-efficacy

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Authors: Minhui Chiu

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According to relevant studies, clinical nurses have high work pressure and relatively high job adaptation needs. The nurses who work in oncology wards have more adaptation needs when they face repeating hospitalization patients. The aims of this study were to investigate the job stress adaptation and related factors of nurses in oncology wards and to understand the predictors of job stress adaptation needs. Convenience sampling was used in this study. The nurses in the oncology specialist ward of a regional teaching hospital in southern Taiwan were selected as the research objects. A cross-sectional survey was conducted using a structured questionnaire, random sampling, and the questionnaires were filled out by the participating nurses. A total of 68 people were tested, and 65 valid questionnaires (95.6%). One basic data questionnaire and nurses’ job stress adaptation needs questionnaire were used. The data was archived with Microsoft Excel, and statistical analysis was performed with JMP12.0. The results showed that the average age was 28.8 (±6.7) years old, most of them were women, 62 (95.38%), and the average clinical experience in the hospital was 5.7 years (±5.9), and 62 (95.38%) were university graduates. 39 people (60.0%) had no work experience. 39 people (60.0%) liked nursing work very much, and 23 people (35.3%) just “liked”. 47 (72.3%) people were supported to be oncology nurses by their families. The nurses' job stress adaptation needs were 119.75 points (±17.24). The t-test and variance analysis of the impact of nurses' job pressure adaptation needs were carried out. The results showed that the score of college graduates was 121.10 (±16.39), which was significantly higher than that of master graduates 96.67 (±22.81), and the degree of liking for nursing work also reached a Significant difference. These two variables are important predictors of job adaptation needs, and the R Square is 24.15%. Conclusion: Increasing the love of clinical nurses in nursing and encouraging university graduation to have positive effects on job pressure adaptation needs and can be used as a reference for the management of human resources hospitals for oncology nurses.

Keywords: oncology nurse, job stress, job stress adaptation needs, manpower

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Authors: Ava Zarif Sanayei, Sedigheh Sina

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Interventional radiology (IR) uses imaging guidance, including X-rays and CT scans, to deliver therapy precisely. Most IR procedures are performed under local anesthesia and start with a small needle being inserted through the skin, which may be called pinhole surgery or image-guided surgery. There is increasing concern about radiation exposure during interventional radiology procedures due to procedure complexity. The basic aim of optimizing radiation protection as outlined in ICRP 139, is to strike a balance between image quality and radiation dose while maximizing benefits, ensuring that diagnostic interpretation is satisfactory. This study aims to estimate the equivalent doses to the main trunk of the body for the Interventional radiologist and Superintendent using LiF: Mg, Ti (TLD-100) chips at the IR department of a hospital in Shiraz, Iran. In the initial stage, the dosimeters were calibrated with the use of various phantoms. Afterward, a group of dosimeters was prepared, following which they were used for three months. To measure the personal equivalent dose to the body, three TLD chips were put in a tissue-equivalent batch and used under a protective lead apron. After the completion of the duration, TLDs were read out by a TLD reader. The results revealed that these individuals received equivalent doses of 387.39 and 145.11 µSv, respectively. The findings of this investigation revealed that the total radiation exposure to the staff was less than the annual limit of occupational exposure. However, it's imperative to implement appropriate radiation protection measures. Although the dose received by the interventional radiologist is a bit noticeable, it may be due to the reason for using conventional equipment with over-couch x-ray tubes for interventional procedures. It is therefore important to use dedicated equipment and protective means such as glasses and screens whenever compatible with the intervention when they are available or have them fitted to equipment if they are not present. Based on the results, the placement of staff in an appropriate location led to increasing the dose to the radiologist. Manufacturing and installation of moveable lead curtains with a thickness of 0.25 millimeters can effectively minimize the radiation dose to the body. Providing adequate training on radiation safety principles, particularly for technologists, can be an optimal approach to further decreasing exposure.

Keywords: interventional radiology, personal monitoring, radiation protection, thermoluminescence dosimetry

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Authors: Shujon Mohammed Alazzam, Sarah Saad Alamer, Omar Hassan Kasule, Lama Suliman Aleid, Mohammad Abdulaziz Alakeel, Boshra Mosleh Alanazi, Abdullah Abdulelah Altowairqi, Yahya Ali Al-Asiri

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Background: Interventional radiology (IR) is a specialized field within radiology that diagnose and treat several conditions through a minimally invasive surgical procedure that involves the use of various radiological techniques. In the last few years, the role of IR has expanded to include a variety of organ systems which have been led to an increase in demand for these Specialties. The level of knowledge regarding IR is relatively low in general. In this study, we aimed to investigate the perceptions of interventional radiology (IR) as a specialty among medical students and medical interns in Riyadh, Saudi Arabia. Methodology: This study was a cross section. The target population is medical students in January 2023 in Riyadh city, KSA. We used the questionnaire for face-to-face interviews with voluntary participants to assess their knowledge of Interventional radiology. Permission was taken from participants to use their information. Assuring them that the data in this study was used only for scientific purposes. Results: According to the inclusion criteria, a total of 314 students participated in the study. (49%) of the participants were in the preclinical years, and (51%) were in the clinical years. The findings indicate more than half of the students think that they had good information about IR (58%), while (42%) reported that they had poor information and knowledge about IR. Only (28%) of students were planning to take an elective and radiology rotation, (and 27%) said they would consider a career in IR. (73%) of the participants who would not consider a career in IR, the highest reasons in order were due to "I do not find it interesting" (45%), then "Radiation exposure" (14%). Around half (48%) thought that an IRs must complete a residency training program in both radiology and surgery, and just (36%) of the students believe that an IRs must finish training in radiology. Our data show the procedures performed by IRs that (66%) lower limb angioplasty and stenting (58%) Cardiac angioplasty or stenting. (68%) of the students were familiar with angioplasty. When asked about the source of exposure to angioplasty, the majority (46%) were from a cardiologist, (and 16%) were from the interventional radiologist. Regarding IR career prospects, (78%) of the students believe that IRs have good career prospects. In conclusion, our findings reveal that the perception and exposure to IR among medical students and interns are generally poor. This has a direct influence on the student's decision regarding IR as a career path. Recommendations to attract medical students and promote IR as a career should be increased knowledge among medical students and future physicians through early exposure to IR, and this will promote the specialty's growth; also, involvement of the Saudi Interventional Radiology Society and Radiological Society of Saudi Arabia is essential.

Keywords: knowledge, medical students, perceptions, radiology, interventional radiology, Saudi Arabia

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Authors: Danny Hjeij, Karine Bilodeau, Caroline Arbour

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Background: Chemotherapy infusions often lead to a cluster of co-occurring and difficult-to-treat symptoms (nausea, tingling, etc.), which may negatively impact the treatment experience at the outpatient clinic. Although several complementary approaches have shown beneficial effects for chemotherapy-induced symptom management, they are not easily implementable during chemotherapy infusion. In response to this limitation, comfort talk (CT), a simple, fast conversational method inspired by the language principles of clinical hypnosis, is known to optimize the management of symptoms related to antineoplastic treatments. However, the perception of nurses who have had to integrate this practice into their care has never been documented. Study design: A qualitative descriptive study with iterative content analysis was conducted among oncology nurses working in a chemotherapy outpatient clinic who had previous experience with CT. Semi-structured interviews were conducted by phone, using a pre-tested interview guide and a sociodemographic survey to document their perception of CT. The conceptual framework. Results: A total of six nurses (4 women, 2 men) took part in the interviews (N=6). The average age of participants was 49 years (36-61 years). Participants had an average of 24 years of experience (10-38 years) as a nurse, including 14.5 years in oncology (5-32 years). Data saturation (i.e., redundancy of words) was observed around the fifth interview. A sixth interview was conducted as confirmation. Six themes emerged: two addressing contextual and organizational obstacles at the chemotherapy outpatient clinic, and three addressing the added value of CT for oncology nursing care. Specific themes included: 1) the outpatient oncology clinic, a saturated care setting, 2) the keystones that support the integration of CT into care, 3) added value for patients, 4) a positive and rewarding experience for nurses, 5) collateral benefits, and 6) CT an approach to consider during the COVID-19 pandemic. Conclusion: For the first time, this study describes nurses' perception of the integration of CT into the care surrounding the administration of chemotherapy at the outpatient oncology clinic. In summary, contextual and organizational difficulties, as well as the lack of training, are among the main obstacles that could hinder the integration of CT in oncology. Still, the experience was reported mostly as positive. Indeed, nurses saw HC as an added value to patient care and meeting their need for holistic care. HC also appears to be beneficial for patients on several levels (for pain management in particular). Results will be used to inform future knowledge transfer activities related to CT in oncology nursing.

Keywords: cancer, chemotherapy, comfort talk, oncology nursing role

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Authors: Sevil Inal, Leman Yantiri, Meral Kelleci

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Aim: In this study, it was aimed to qualitatively analyze the feelings, thoughts and meanings of the nurses who had experience in child hematology in the past. Method: In this qualitative study, in-depth interviews were conducted with 15 nurses between 29 and 53 years of age who had previously worked in child hematology-oncology unit. Interviews were conducted with a semi-structured interview form. Each interview lasted 20-30 minute. Some of the questions are: ‘What kind of experiences do you experience when you think about the periods you are working in hematology-oncology service?’ ‘Do you explain the reason for living these feelings?’ The data were analyzed with QSR NVivo 7 software. Results: From the perspective of the nurses who had experience working in the pediatric hematology-oncology service in the past, five main themes and sub-themes related to emotions and thoughts towards this experiment were identified in the study. 1) Positive and negative emotions: (a) fear and anxiety, (b) desperation, pity, guilt, (c) burnout, (d) longing; 2) Being coping 3) Professional implications 4) Meaning of life 5) Unmet needs and suggestions. Conclusions: Working in hematology should be viewed as a multidimensional situation that affects the way nurses view their profession and life, leading to a wide range of emotional lives. Data obtained from this study can be used to strengthen hematologic nurses.

Keywords: cancer, child, care, hematology, nursing

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Authors: Sara Ataei, Molouk Hadjibabaie, Shirinsadat Badri, Amirhossein Moslehi, Iman Karimzadeh, Ardeshir Ghavamzadeh

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Purpose: To assess the pattern and probable risk factors for moderate and major drug–drug interactions in a referral hematology-oncology ward in Iran. Methods: All patients admitted to hematology–oncology ward of Dr. Shariati Hospital during a 6-month period and received at least two anti-cancer or non-anti-cancer medications simultaneously were included. All being scheduled anti-cancer and non-anti-cancer medications both prescribed and administered during ward stay were considered for drug–drug interaction screening by Lexi-Interact On- Desktop software. Results: One hundred and eighty-five drug–drug interactions with moderate or major severity were detected from 83 patients. Most of drug–drug interactions (69.73 %) were classified as pharmacokinetics. Fluconazole (25.95 %) was the most commonly offending medication in drug–drug interactions. Interaction of sulfamethoxazole-trimethoprim with fluconazole was the most common drug–drug interaction (27.27 %). Vincristine with imatinib was the only identified interaction between two anti-cancer agents. The number of administered medications during ward stay was considered as an independent risk factor for developing a drug–drug interaction. Conclusions: Potential moderate or major drug–drug interactions occur frequently in patients with hematological malignancies or related diseases. Performing larger standard studies are required to assess the real clinical and economical effects of drug–drug interactions on patients with hematological and non-hematological malignancies.

Keywords: drug–drug interactions, hematology–oncology ward, hematological malignancies

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Authors: Yi-Fung Lin, Pei-Chen Tsai

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Background: The hospital healthcare team provides 24-hour patient care, and therefore shift-work is inevitable in the nursing field. There is an increased awareness that shift-work affecting circadian rhythms may cause various health problems, especially in poor sleep quality, which may harm the quality of life. Purposes: The purpose of this study was to investigate the influences of demographic characteristics on nurses’ sleep quality and quality of life and the relationship between these predictors of nurses’ quality of life. Methods: A cross-sectional, descriptive correlational study was conducted with purposive sampling of 520 female nurses in a medical center in north Taiwan from July to September 2014. Data were collected with structured questionnaires using Psychometric Evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) and the World Health Organization Quality of Life (WHOQOL-BREF). Outcomes: The main results include: 1) Irregular menstruation, non-regular exercisers, and more daily caffeine consumption have negative impacts on sleep quality. 2) Younger age, fewer children, low education level, low annual income, irregular menstruation, pain during menstrual cycles, non-regular exercisers, constipation, and poor sleep quality all contribute negative impacts on the quality of life. 3) The odds ratio of sleep disturbance between 12-hour shifts and 8-hour shifts was 2.26, but there was no significant difference regarding their quality of life scores. Conclusion: This study showed that there is a strong correlation between oncology nurses’ sleep quality and quality of life. Sleep quality is a significant predictor of quality of life in oncology nurses.

Keywords: oncology nurses, sleep quality, quality of life, shift-work

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Authors: Esra Danaci, Tugba Kavalali Erdogan, Sevil Masat, Selin Keskin Kiziltepe, Tugba Cinarli, Zeliha Koc

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This study was conducted in a descriptive and cross-sectional manner to determine that factors that influence the self-efficacy and self-sufficiency levels among oncology patients. The research was conducted between January 24, 2017 and September 24, 2017 in the oncology and hematology departments of a university hospital in Turkey with 179 voluntary inpatients. The data were collected through the Self-Sufficiency/Self-Efficacy Scale and a 29-question survey, which was prepared in order to determine the sociodemographic and clinical properties of the patients. The Self-Sufficiency/Self-Efficacy Scale is a Likert-type scale with 23 articles. The scale scores range between 23 and 115. A high final score indicates a good self-sufficiency/self-efficacy perception for the individual. The data were analyzed using percentage analysis, one-way ANOVA, Mann Whitney U-test, Kruskal Wallis test and Tukey test. The demographic data of the subjects were as follows: 57.5% were male and 42.5% were female, 82.7% were married, 46.4% were primary school graduate, 36.3% were housewives, 19% were employed, 93.3% had social security, 52.5% had matching expenses and incomes, 49.2% lived in the center of the city. The mean age was 57.1±14.6. It was determined that 22.3% of the patients had lung cancer, 19.6% had leukemia, and 43.6% had a good overall condition. The mean self-sufficiency/self-efficacy score was 83,00 (41-115). It was determined that the patients' self-sufficiency/self-efficacy scores were influenced by some of their socio-demographic and clinical properties. This study has found that the patients had high self-sufficiency/self-efficacy scores. It is recommended that the nursing care plans should be developed to improve their self-sufficiency/self-efficacy levels in the light of the patients' sociodemographic and clinical properties.

Keywords: oncology, patient, self-efficacy, self-sufficiency

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Authors: Aisha Khodijah Kholib Jati, Suharni Mohamad, Azlan Husin, Wan Suriana Wan Ab Rahman

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Introduction: Toxoplasmosis is caused by an obligate intracellular parasite, Toxoplasma gondii (T. gondii). It is commonly asymptomatic in normal individual, but it can be fatal to immunocompromised patients as it can lead to severe complications such as encephalitis, chorioetinitis and myocarditis. Objective: The aim of the study was to determine the seroprevalence of toxoplasmosis and its association with socio-demographic and behavioral characteristics among hemato-oncology patients in Hospital USM. Methods: In this cross-sectional study, 56 hemato-oncology patients were screened for immunoglobulin M (IgM) antibodies, immunoglobulin G (IgG) antibodies, and IgG avidity of T. gondii by using ELISA Kit (BioRad, USA). For anti-T. gondii IgG antibody, titer ≥ 9 IU/ml was considered as recent infection, while for IgM, ratio ≥ 1.00 was considered as reactive for the anti-T. gondii IgM antibodies. Low avidity index is considered as recent infection within 20 weeks while high avidity considered as past infection. T. gondii exposure, socio-demographic and behavioral characteristics was assessed by a questionnaire and interview. Results: A total of 28 (50.0%) hemato-oncology patients were seropositive for T. gondii antibodies. Out of that total, 27 (48.21%) patients were IgG+/IgM- and one patient (1.79%) was IgG+/IgM+ with high avidity index. Univariate analysis showed that age, gender, ethnicity, marital status, educational level, employment status, stem cell transplant, blood transfusion, close contact with cats, water supply, and consumption of undercooked meat were not significantly associated with Toxoplasma seropositivity rate. Discussion: The seropositivity rate of IgG anti-T. gondii was high among hemato-oncology patients in Hospital USM. With impaired immune system, these patients might have a severe consequence if the infection reactivated. Therefore, screening for anti-T. gondii may be considered in the future. Moreover, health programme towards healthy food and good hygiene practice need to be implemented.

Keywords: immunocompromised, seroprevalence, socio-demographic, toxoplasmosis

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Authors: Stefaan Carpentier, Aya Al Masri, Fabrice Leroy, Thibault Julien, Safoin Aktaou, Malorie Martin, Fouad Maaloul

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Introduction: During an 'Interventional Radiology (IR)' procedure, the patient's skin-dose may become very high for a burn, necrosis, and ulceration to appear. In order to prevent these deterministic effects, a prediction of the peak skin-dose for the patient is important in order to improve the post-operative care to be given to the patient. The objective of this study is to estimate, before the intervention, the patient dose for ‘Chronic Total Occlusion (CTO)’ procedures by selecting relevant clinical indicators. Materials and methods: 103 procedures were performed in the ‘Interventional Cardiology (IC)’ department using a Siemens Artis Zee image intensifier that provides the Air Kerma of each IC exam. Peak Skin Dose (PSD) was measured for each procedure using radiochromic films. Patient parameters such as sex, age, weight, and height were recorded. The complexity index J-CTO score, specific to each intervention, was determined by the cardiologist. A correlation method applied to these indicators allowed to specify their influence on the dose. A predictive model of the dose was created using multiple linear regressions. Results: Out of 103 patients involved in the study, 5 were excluded for clinical reasons and 2 for placement of radiochromic films outside the exposure field. 96 2D-dose maps were finally used. The influencing factors having the highest correlation with the PSD are the patient's diameter and the J-CTO score. The predictive model is based on these parameters. The comparison between estimated and measured skin doses shows an average difference of 0.85 ± 0.55 Gy for doses of less than 6 Gy. The mean difference between air-Kerma and PSD is 1.66 Gy ± 1.16 Gy. Conclusion: Using our developed method, a first estimate of the dose to the skin of the patient is available before the start of the procedure, which helps the cardiologist in carrying out its intervention. This estimation is more accurate than that provided by the Air-Kerma.

Keywords: chronic total occlusion procedures, clinical experimentation, interventional radiology, patient's peak skin dose

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Authors: Kholood A. Baron

Abstract:

While radiologist numbers specialized in spine interventional procedures are limited in Kuwait, the number of patients demanding these procedures is increasing rapidly. Due to this high demand, the workload of radiologists is increasing, which might represent a radiation exposure concern. During these procedures, the doctor’s hands are in very close proximity to the main radiation beam/ if not within it. The aim of this study is to measure the radiation dose for radiologists during several interventional procedures for the spine. Methods: Two doctors carrying different workloads were included. (DR1) was performing procedures in the morning and afternoon shifts, while (DR2) was performing procedures in the morning shift only. Comparing the radiation exposures that the hand of each doctor is receiving will assess radiation safety and help to set up workload regulations for radiologists carrying a heavy schedule of such procedures. Entrance Skin Dose (ESD) was measured via TLD (ThermoLuminescent Dosimetry) placed at the right wrist of the radiologists. DR1 was covering the morning shift in one hospital (Mubarak Al-Kabeer Hospital) and the afternoon shift in another hospital (Dar Alshifa Hospital). The TLD chip was placed in his gloves during the 2 shifts for a whole week. Since DR2 was covering the morning shift only in Al Razi Hospital, he wore the TLD during the morning shift for a week. It is worth mentioning that DR1 was performing 4-5 spine procedures/day in the morning and the same number in the afternoon and DR2 was performing 5-7 procedures/day. This procedure was repeated for 4 consecutive weeks in order to calculate the ESD value that a hand receives in a month. Results: In general, radiation doses that the hand received in a week ranged from 0.12 to 1.12 mSv. The ESD values for DR1 for the four consecutive weeks were 1.12, 0.32, 0.83, 0.22 mSv, thus for a month (4 weeks), this equals 2.49 mSv and calculated to be 27.39 per year (11 months-since each radiologist have 45 days of leave in each year). For DR2, the weekly ESD values are 0.43, 0.74, 0.12, 0.61 mSv, and thus, for a month, this equals 1.9 mSv, and for a year, this equals 20.9 mSv /year. These values are below the standard level and way below the maximum limit of 500 mSv per year (set by ICRP = International Council of Radiation Protection). However, it is worth mentioning that DR1 was a senior consultant and hence needed less fluoro-time during each procedure. This is evident from the low ESD values of the second week (0.32) and the fourth week (0.22), even though he was performing nearly 10-12 procedures in a day /5 days a week. These values were lower or in the same range as those for DR2 (who was a junior consultant). This highlighted the importance of increasing the radiologist's skills and awareness of fluoroscopy time effect. In conclusion, the radiation dose that radiologists received during spine interventional radiology in our setting was below standard dose limits.

Keywords: radiation protection, interventional radiology dosimetry, ESD measurements, radiologist radiation exposure

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Authors: Ki Hwa Lee, Eunsu Kang, Jae Hong Park

Abstract:

Background: Interventional neuroradiology (INR) has been a rapidly growing and evolving neurosurgical part during the past few decades. Sevoflurane and propofol are both suitable anesthetics for INR procedure. Monitoring of depth of anesthesia is being used very widely. SEDLine™ monitor, a 4-channel processed EEG monitor, uses a proprietary algorithm to analyze the raw EEG signal and displays the Patient State Index (PSI) values. There are only a fewer studies examining the PSI in the neuro-anesthesia. We aimed to investigate the difference of PSI values and hemodynamic variables between sevoflurane and propofol anesthesia during INR procedure. Methods: We reviewed the medical records of patients who scheduled to undergo embolization of non-ruptured intracranial aneurysm by a single operator from May 2013 to December 2014, retrospectively. Sixty-five patients were categorized into two groups; sevoflurane (n = 33) vs propofol (n = 32) group. The PSI values, hemodynamic variables, and the use of hemodynamic drugs were analyzed. Results: Significant differences were seen between PSI values obtained during different perioperative stages in both two groups (P < 0.0001). The PSI values of propofol group were lower than that of sevoflurane group during INR procedure (P < 0.01). The patients in propofol group had more prolonged time of extubation and more phenylephrine requirement than sevoflurane group (p < 0.05). Anti-hypertensive drug was more administered to the patients during extubation in sevoflurane group (p < 0.05). Conclusions: The PSI can detect depth of anesthesia and changes of concentration of anesthetics during INR procedure. Extubation was faster in sevoflurane group, but smooth recovery was shown in propofol group.

Keywords: interventional neuroradiology, patient state index, propofol, sevoflurane

Procedia PDF Downloads 181

Authors: Karina Peron, Ricardo Ghelman, Monica Taminato, Katia R. Oliveira, Debora C. A. Rodrigues, Juliana R. C. Mumme, Olga K. M. Sunakozaua, Georg Seifert, Vicente O. Filho

Abstract:

The nurse is the most available health professional for the interventions of support in the integrative approach in hospital environment, therefore a professional group key to changes in the model of care. The central components in the performance of anthroposophic nursing procedures are direct physical contact, promotion of proper rhythm, thermal regulation and the construction of a calm and empathic atmosphere, safe for patients and their caregivers. The procedures of anthroposophic external therapies (AET), basically composed of the application of compresses and the use of natural products, provide an opportunity to intensify the therapeutic results through an innovative, complementary and integrative model in the university hospital. The objective of this work is to report the implementation of a program of nursing techniques (AET) through a partnership between the Pediatric Oncology Sector of the Department of Pediatrics of the Faculty of Medicine of the University of Sao Paulo and Charite University of Berlin, with lecturers from Berlin's Integrative Hospital Havelhöhe and Witten-Herdecke Integrative Hospital, both in Germany. Intensive training activities of the Hospital's nursing staff and a survey on AET needs were developed based on the most prevalent complaints in pediatric oncology patients in the three environments of the Hospital of Pediatric Oncology: Bone Marrow Transplantation Unit, Intensive Care Unit and Division of Internal Patients. We obtained the approval of the clinical protocol of external anthroposophic therapies for nursing care by the Ethics Committee and the Academic Council of the Hospital. With this project, we highlight the key AET needs that will be part of the standard program of pediatric oncology care with appropriate scientific support. The results of the prevalent symptoms were: vomiting, nausea, pain, difficulty in starting sleep, constipation, cold extremities, mood disorder and psychomotor agitation. This project was the pioneer within the Integrative Pediatrics Program, as an innovative concept of Medicine and Integrative Health presented at scientific meetings.

Keywords: integrative health care, integrative nursing, pediatric nursing, pediatric oncology

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Authors: Mohammed S. Mohammed, Asmaa M. S. Mohammed

Abstract:

Background: To achieve the quality of cancer care, the oncologic academic programs should be continuously developed with establishing new ones. We highlighted three disciplines, Clinical nutrition, medical biophysics and radiobiology and Psycho-oncology programs; without a doubt, the Egyptian National Cancer Institute, in ‎the accreditation era, will be establishing them ‎ due to their importance in improving the skills of cancer practitioners. Methods: The first suggested program in Clinical Nutrition that is dealing with the assessment of the patient's well-being before, during and after treatment to avoid the defects in the metabolism resulting from the cancer disease and its treatment by giving the supplements in the patient's diet. The second program is Medical Biophysics and Radiobiology, which there's no denying that it ‎is ‎provided ‎in Cairo University as a good program in the faculty of science but lacks the clinical ‎practice. Hence, it is probably better to establish this program in our institute to ‎improve the ‎practitioner skills and introduce a tailored radiation therapy regimen for every patient according to ‎their characteristic profile.‎ While patients are receiving their treatment, the risk of post-traumatic stress disorder arises, so the importance of the third program, Psycho-Oncology, is clearly obtained. This program is concerned with the psychological, social, behavioral, and ethical aspects of cancer. The area of multi-disciplinary interest has boundaries with the major specialties in oncology: the clinical disciplines (surgery, medicine, pediatrics, and radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology. Results: It is a prospective academic plan which is compatible with the institutional vision and its strategic plan. Conclusion: In this context, evaluating and understanding the suggested academic programs has become a mandatory part of cancer care. And it is essential to be provided by the NCI.

Keywords: clinical nutrition, psycho-oncology, medical biophysics and radiobiology, medical education

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Authors: Surendra B. Chand, P. P. Chaurasia, M. P. Adhikari, R. N. Yadav

Abstract:

Objective: The objective of this work was to evaluate all the safety procedures toward the radiation protection for workers in the radiation oncology department. Materials and Methods: The annual thermoluminescent dosimeters (TLDs) reports for five years of the staffs were evaluated, radiation surveys were done in the control consoles, radiotherapy machines room and waiting areas of all machines using Aloka survey meter. Results: The five years TLD reports shows that the whole body dose of the individual staffs is found within the annual dose limit except the accidental exposures. Radiation exposures in the working areas are also safe limits. Conclusion: The radiation safety practices for radiation protection are satisfactory and the radiation workers of the departments are found working within the safe limit.

Keywords: radiation protection, safety, ICRP, dose limits, TLD, radiation devices

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Authors: Jaci Marie Mastrandrea, Rosario Haro

Abstract:

Background: The National Comprehensive Cancer Network (NCCN) recommends that healthcare institutions have established processes for integrating palliative care (PC) into cancer treatment and that all cancer patients be screened for PC needs upon initial diagnosis as well as throughout the entire continuum of care (National Comprehensive Cancer Network, 2021). Early PC screening and intervention is directly associated with improved patient outcomes. The Sky Lakes Cancer Treatment Center (SLCTC) is an institution that has access to PC services yet does not have protocols in place for identifying patients with palliative needs or a standardized referral process. The aim of this quality improvement project was to improve early access to PC services by establishing a standardized screening and referral process for outpatient oncology patients. Method: The sample population included all adult patients with an oncology diagnosis who presented to the SLCTC for treatment during the project timeline. The “Palliative and Supportive Needs Assessment'' (PSNA) screening tool was developed from validated, evidence-based PC referral criteria. The tool was initially implemented using paper forms, and data was collected over a period of eight weeks. Patients were screened by nurses on the SLCTC oncology treatment team. Nurses responsible for screening patients received an educational inservice prior to implementation. Patients with a PSNA score of three or higher received an educational handout on the topic of PC and education about PC and symptom management. A score of five or higher indicates that PC referral is strongly recommended, and the patient’s EHR is flagged for the oncology provider to review orders for PC referral. The PSNA tool was approved by Sky Lakes administration for full integration into Epic-Beacon. The project lead collaborated with the Sky Lakes’ information systems team and representatives from Epic on the tool’s aesthetic and functionality within the Epic system. SLCTC nurses and physicians were educated on how to document the PSNA within Epic and where to view results. Results: Prior to the implementation of the PSNA screening tool, the SLCTC had zero referrals to PC in the past year, excluding referrals to hospice. Data was collected from the completed screening assessments of 100 patients under active treatment at the SLCTC. Seventy-three percent of patients met criteria for PC referral with a score greater than or equal to three. Of those patients who met referral criteria, 53.4% (39 patients) were referred for a palliative and supportive care consultation. Patients that were not referred to PC upon meeting criteria were flagged in EPIC for re-screening within one to three months. Patients with lung cancer, chronic hematologic malignancies, breast cancer, and gastrointestinal malignancy most frequently met the criteria for PC referral and scored highest overall on the scale of 0-12. Conclusion: The implementation of a standardized PC screening tool at the SLCTC significantly increased awareness of PC needs among cancer patients in the outpatient setting. Additionally, data derived from this quality improvement project supports the national recommendation for PC to be an integral component of cancer treatment across the entire continuum of care.

Keywords: oncology, palliative and supportive care, symptom management, outpatient oncology, palliative screening tool

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Authors: Raffaele Danilo Esposito, Domingo Planes Meseguer, Maria Del Pilar Dorado Rodriguez

Abstract:

As far as we know, it is still unavailable a commercial solution which would allow to manage, openly and configurable up to user needs, the huge amount of data generated in a modern Radiation Oncology Department. Currently, available information management systems are mainly focused on Record & Verify and clinical data, and only to a small extent on physical data. Thus, results in a partial and limited use of the actually available information. In the present work we describe the implementation at our department of a centralized information management system based on a web server. Our system manages both information generated during patient planning and treatment, and information of general interest for the whole department (i.e. treatment protocols, quality assurance protocols etc.). Our objective it to be able to analyze in a simple and efficient way all the available data and thus to obtain quantitative evaluations of our treatments. This would allow us to improve our work flow and protocols. To this end we have implemented a relational data base which would allow us to use in a practical and efficient way all the available information. As always we only use license free software.

Keywords: information management system, radiation oncology, medical physics, free software

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Authors: Sneha Noble, Rahul Krishnan, Uma G., D. K. Vijaykumar

Abstract:

Breast-Cancer related Lymphedema is a major problem that affects many women. Lymphedema is the swelling that generally occurs in the arms or legs caused by the removal of or damage to lymph nodes as a part of cancer treatment. Treating it at the earliest possible stage is the best way to manage the condition and prevent it from leading to pain, recurrent infection, reduced mobility, and impaired function. So, this project aims to focus on the multi-modal approaches to identify the risks of Lymphedema in post-surgical oncology patients and prevent it at the earliest. The Kinect IR Sensor is utilized to capture the images of the body and after image processing techniques, the region of interest is obtained. Then, performing the voxelization method will provide volume measurements in pre-operative and post-operative periods in patients. The formation of a mathematical model will help in the comparison of values. Clinical pathological data of patients will be investigated to assess the factors responsible for the development of lymphedema and its risks.

Keywords: Kinect IR sensor, Lymphedema, voxelization, lymph nodes

Procedia PDF Downloads 138

Authors: Jaci Mastrandrea

Abstract:

Background: The National Comprehensive Cancer Network (NCCN) recommends that healthcare institutions have established processes for integrating palliative care (PC) into cancer treatment and that all cancer patients be screened for PC needs upon initial diagnosis as well as throughout the entire continuum of care (National Comprehensive Cancer Network, 2021). Early PC screening is directly correlated with improved patient outcomes. The Sky Lakes Cancer Treatment Center (SLCTC) is an institution that has access to PC services yet does not have protocols in place for identifying patients with palliative needs or a standardized referral process. The aim of this quality improvement project is to improve early access to PC services by establishing a standardized screening and referral process for outpatient oncology patients. Method: The sample population included all adult patients with an oncology diagnosis who presented to the SLCTC for treatment during the project timeline from March 15th, 2022, to April 29th, 2022. The “Palliative and Supportive Needs Assessment'' (PSNA) screening tool was developed from validated and evidence-based PC referral criteria. The tool was initially implemented using paper forms and later was integrated into the Epic-Beacon EHR system. Patients were screened by registered nurses on the SLCTC treatment team. Nurses responsible for screening patients received an educational inservice prior to implementation. Patients with a PSNA score of three or higher were considered to be a positive screen. Scores of five or higher triggered a PC referral order in the patient’s EHR for the oncologist to review and approve. All patients with a positive screen received an educational handout on the topic of PC, and the EHR was flagged for follow-up. Results: Prior to implementation of the PSCNA screening tool, the SLCTC had zero referrals to PC in the past year, excluding referrals to hospice. Data was collected from the first 100 patient screenings completed within the eight-week data collection period. Seventy-three percent of patients met criteria for PC referral with a score greater than or equal to three. Of those patients who met referral criteria, 53.4% (39 patients) were referred for a palliative and supportive care consultation. Patients that were not referred to PC upon meeting the criteria were flagged in the EHR for re-screening within one to three months. Patients with lung cancer, chronic hematologic malignancies, breast cancer, and gastrointestinal malignancy most frequently met criteria for PC referral and scored highest overall on the scale of 0-12. Conclusion: The implementation of a standardized PC screening tool at the SLCTC significantly increased awareness of PC needs among cancer patients in the outpatient setting. Additionally, data derived from this quality improvement project supports the national recommendation for PC to be an integral component of cancer treatment across the entire continuum of care.

Keywords: oncology, palliative care, symptom management, symptom screening, ambulatory oncology, cancer, supportive care

Procedia PDF Downloads 76

Authors: S. Hatamikia, A. Biguri, H. Furtado, G. Kronreif, J. Kettenbach, W. Birkfellner

Abstract:

Nowadays, three dimensional Cone Beam CT (CBCT) has turned into a widespread clinical routine imaging modality for interventional radiology. In conventional CBCT, a circular sourcedetector trajectory is used to acquire a high number of 2D projections in order to reconstruct a 3D volume. However, the accumulated radiation dose due to the repetitive use of CBCT needed for the intraoperative procedure as well as daily pretreatment patient alignment for radiotherapy has become a concern. It is of great importance for both health care providers and patients to decrease the amount of radiation dose required for these interventional images. Thus, it is desirable to find some optimized source-detector trajectories with the reduced number of projections which could therefore lead to dose reduction. In this study we investigate some source-detector trajectories with the optimal arbitrary orientation in the way to maximize performance of the reconstructed image at particular regions of interest. To achieve this approach, we developed a box phantom consisting several small target polytetrafluoroethylene spheres at regular distances through the entire phantom. Each of these spheres serves as a target inside a particular region of interest. We use the 3D Point Spread Function (PSF) as a measure to evaluate the performance of the reconstructed image. We measured the spatial variance in terms of Full-Width-Half-Maximum (FWHM) of the local PSFs each related to a particular target. The lower value of FWHM shows the better spatial resolution of reconstruction results at the target area. One important feature of interventional radiology is that we have very well-known imaging targets as a prior knowledge of patient anatomy (e.g. preoperative CT) is usually available for interventional imaging. Therefore, we use a CT scan from the box phantom as the prior knowledge and consider that as the digital phantom in our simulations to find the optimal trajectory for a specific target. Based on the simulation phase we have the optimal trajectory which can be then applied on the device in real situation. We consider a Philips Allura FD20 Xper C-arm geometry to perform the simulations and real data acquisition. Our experimental results based on both simulation and real data show our proposed optimization scheme has the capacity to find optimized trajectories with minimal number of projections in order to localize the targets. Our results show the proposed optimized trajectories are able to localize the targets as good as a standard circular trajectory while using just 1/3 number of projections. Conclusion: We demonstrate that applying a minimal dedicated set of projections with optimized orientations is sufficient to localize targets, may minimize radiation.

Keywords: CBCT, C-arm, reconstruction, trajectory optimization

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Authors: Alexandru Grigorescu, Alexandra Protesanu

Abstract:

Background: Approximately 34-67 percent of cancer patients experience an episode of uncontrolled pain during the course of their disease, depending on the stage. The aim is to provide evidence-based data for pain prevalence, diagnosis and treatment recommendations on an integrative model of medical oncology and palliative care for patients with cancer diagnostic in a day hospital. Patients and method: Consultation registers and electronic records of 166 Patients (Pts) were studied from April 2022 to March 2023. Pts with pain syndrome were selected. The pain was objectified by the visual pain scale. To elucidate the causes of the pain, investigations were carried out: bone scintigraphy, CT scan, and PET-CT. The analgesic treatments were represented by weak and strong morphine, radiotherapy, and bisphosphonates. Result: During the mentioned period, 166 oncological patients (74 women and 92 men) were treated in the oncology day hospitalization service. There were 1,500 consultations, 40 of which were only for pain. The neoplastic locations were: gynecological, malignant melanoma, breast, gastric, bronchopulmonary, colorectal, liver, pancreatic, bladder, and kidney. 70 Pts presented pain syndrome. The causes of the pain were represented by bone metastases, compressive tumors, and post-surgical status. Drug treatment: Tramadol 47 Pts, of which 10 switched to a major opioid (Oxycodonum, Morphine sulfate), 20 Pts were treated with Oxycodonum as the first intention. In 5 patients ry to rotated morphine, 20 Pts received palliative radiotherapy, 10 Pts were treated with bisphosphonates. 2 Pts required neurosurgery consultation for an antalgic intervention. 5 Pts had important adverse reactions to morphine. All patients and their families were advised by a medical oncologist and psychologist for a lifestyle change. Conclusions: The prevalence of pain was similar to that described in the literature. In most cases, the pain could be managed in the day hospital. Weak and strong morphine represented the main pain therapy. Palliative radiotherapy was the second most effective therapy. Treatment with bisphosphonates was useful. Surgical interventions were rarely indicated. Discussions with patients and their families regarding the lifestyle change were important.

Keywords: cancer pain, opioids, medical oncology, palliative care

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Authors: Aya Al Masri, Stefaan Carpentier, Fabrice Leroy, Thibault Julien, Safoin Aktaou, Malorie Martin, Fouad Maaloul

Abstract:

Introduction: During an 'Interventional Radiology (IR)' procedure, the patient's skin-dose may become very high for a burn, necrosis and ulceration to appear. In order to prevent these deterministic effects, an accurate calculation of the patient skin-dose mapping is essential. For most machines, the 'Dose Area Product (DAP)' and fluoroscopy time are the only information available for the operator. These two parameters are a very poor indicator of the peak skin dose. We developed a mathematical model that reconstructs the magnitude (delivered dose), shape, and localization of each irradiation field on the patient skin. In case of critical dose exceeding, the system generates warning alerts. We present the results of its comparison with clinical studies. Materials and methods: Two series of comparison of the skin-dose mapping of our mathematical model with clinical studies were performed: 1. At a first time, clinical tests were performed on patient phantoms. Gafchromic films were placed on the table of the IR machine under of PMMA plates (thickness = 20 cm) that simulate the patient. After irradiation, the film darkening is proportional to the radiation dose received by the patient's back and reflects the shape of the X-ray field. After film scanning and analysis, the exact dose value can be obtained at each point of the mapping. Four experimentation were performed, constituting a total of 34 acquisition incidences including all possible exposure configurations. 2. At a second time, clinical trials were launched on real patients during real 'Chronic Total Occlusion (CTO)' procedures for a total of 80 cases. Gafchromic films were placed at the back of patients. We performed comparisons on the dose values, as well as the distribution, and the shape of irradiation fields between the skin dose mapping of our mathematical model and Gafchromic films. Results: The comparison between the dose values shows a difference less than 15%. Moreover, our model shows a very good geometric accuracy: all fields have the same shape, size and location (uncertainty < 5%). Conclusion: This study shows that our model is a reliable tool to warn physicians when a high radiation dose is reached. Thus, deterministic effects can be avoided.

Keywords: clinical experimentation, interventional radiology, mathematical model, patient's skin-dose mapping.

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Authors: Nicole Ramlachan, Samuel Mark West

Abstract:

Lung cancer is the leading cause of cancer-associated deaths in North America, with the vast majority being non-small cell lung cancer (NSCLC), with a five-year survival rate of only 24%. Non-invasive discovery of biomarkers associated with early-diagnosis of NSCLC can enable precision oncology efforts using liquid biopsy-based multiomics profiling of plasma. Although tissue biopsies are currently the gold standard for tumor profiling, this method presents many limitations since these are invasive, risky, and sometimes hard to obtain as well as only giving a limited tumor profile. Blood-based tests provides a less-invasive, more robust approach to interrogate both tumor- and non-tumor-derived signals. We intend to examine 30 stage III-IV NSCLC patients pre-surgery and collect plasma samples.Cell-free DNA (cfDNA) will be extracted from plasma, and next-generation sequencing (NGS) performed. Through the analysis of tumor-specific alterations, including single nucleotide variants (SNVs), insertions, deletions, copy number variations (CNVs), and methylation alterations, we intend to identify tumor-derived DNA—ctDNA among the total pool of cfDNA. This would generate data to be used as an accurate form of cancer genotyping for diagnostic purposes. Using liquid biopsies offer opportunities to improve the surveillance of cancer patients during treatment and would supplement current diagnosis and tumor profiling strategies previously not readily available in Trinidad and Tobago. It would be useful and advantageous to use this in diagnosis and tumour profiling as well as to monitor cancer patients, providing early information regarding disease evolution and treatment efficacy, and reorient treatment strategies in, timethereby improving clinical oncology outcomes.

Keywords: genomics, multiomics, clinical genetics, genotyping, oncology, diagnostics

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