International journal of radiation oncology, biology, physics
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Int. J. Radiat. Oncol. Biol. Phys. · Jan 2008
Improving patient safety in anesthesia: a success story?
Anesthesia is necessary for surgery; however, it does not deliver any direct therapeutic benefit. The risks of anesthesia must therefore be as low as possible. Anesthesiology has been identified as a leader in improving patient safety. ⋯ Studies of error during anesthesia and Closed Claims studies have identified sources of risk and methods to reduce the risks associated with anesthesia. These include changes in technology, such as anesthetic delivery systems and monitors, the application of human factors, the use of simulation, and the establishment of reporting systems. A review of the important events in the past 50 years illustrates the many steps that have contributed to the improvements in anesthesia safety.
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Int. J. Radiat. Oncol. Biol. Phys. · Jan 2008
Clinical significance of margin status in postoperative radiotherapy for extremity and truncal soft-tissue sarcoma.
To evaluate whether adjuvant radiotherapy (RT) in extremity and truncal soft-tissue sarcoma (STS) patients with microscopically positive or close margins after excision can achieve comparable local control to that of excision with negative margin plus RT. ⋯ In our series, margin status did not predict for LF when adjuvant RT was used. We believe that when adjuvant RT is used, re-resection may not be necessary for selected patients with positive or close pathologic margins in the management of extremity and truncal STS patients.
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Int. J. Radiat. Oncol. Biol. Phys. · Jan 2008
(125)I monotherapy using D90 implant doses of 180 Gy or greater.
The purpose of this study was to characterize the oncologic results and toxicity profile of patients treated with (125)I implants using the dose delivered to 90% of the gland from the dose-volume histogram (D90) of greater than 144 Gy. ⋯ Patients with a minimum D90 of 180 Gy had outstanding local control based on prostate-specific antigen control and biopsy data. Toxicity profiles, particularly for long-term urinary and sexual function, were excellent and showed that D90 doses of 180 Gy or greater performed using the technique described were feasible and tolerable.
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Int. J. Radiat. Oncol. Biol. Phys. · Jan 2008
IMRT delivery performance with a varian multileaf collimator.
The use of a multileaf collimator (MLC) for intensity-modulated radiotherapy poses unique dosimetric issues. The nature of intensity-modulated radiotherapy dosimetry, centered on leaf position accuracy, is common to all MLCs. However, the mechanical and software designs of MLCs from the different manufacturers distinguish them. ⋯ Moreover, inadequate modeling of the MLC in the planning system can be perceived as erratic performance. Individually, some problems have been shown to be insignificant; others are correctable using software. If these problems are rectified or at least understood by the physicist, quality assurance can be simplified.