ENERGY METER WITH DIRECT THREE – PHASE CONNECTION. TECHNICAL CHARACTERISTICS. DVH A. DVH A. VOLTAGE INPUTS. Oct 3, The purpose of this request is to obtain variance relief allowing for the construction of a foot high ground sign adjacent to the I-4 right-of-way. impulse/kWh DVH (-M). Width: 30ms. Standard display. 7 digits + 1 digit after the comma. Dimensions. x mm x – 6TE width. Weight .
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C DRR showing patient with a superior sulcus tumor with contours of the brachial plexus generated by deformable image registration followed by manual modification. Characteristics Value or No. We identified C5 through T1 roots, which served as the medial borders of the brachial plexus; the plexus was contoured from medial to lateral using the scalene muscles as landmarks[ 11 ].
We further attempted to address the difficulties in consistently contouring this structure by using deformable image registration. This patient later developed grade 2 toxicity. The underlying mechanismis thought to be due to demyelination leading to axon loss [ 9 ].
This overall framework is illustrated in Figure 2. We developed a computer-assisted image segmentation method which allowed us to rapidly and consistently contour the brachial plexus and establish the dose limits to minimize the risk of brachial plexopathy. For lung cancers near the apical region, brachial plexopathy is a major concern for high-dose radiation therapy.
Brachial plexus lesions in patients with cancer: Tolerance of normal tissue to therapeutic irradiation. Validation of Deformable Image Registration Auto-segmentation using deformable image registration followed by modification was found to be accurate for the majority of the cases, with only slight modification needed, mostly based on aberrant arm position. Other significant risk factors were having plexopathy before treatment OR 4. Radiation-induced brachial plexopathy can be quite debilitating and is difficult to treat [ 7 ].
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Brachial plexus contouring using deformable image registration. It is well known that peripheral nerves are sensitive to recurrent episodes of trauma, whether from tumor invasion or from surgical intervention [ 915 ]; multiple traumas might be expected to reduce the threshold for development of symptoms. Balancing the benefit of local control with the risk of considerable toxicity is a particular challenge for tumorsof the superior sulcus or tumors with supraclavicular adenopathy.
The authors declare no conflicts of interest regarding the work presented here.
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The two curves were nearly superimposable. Significant effect of adjuvant chemotherapy on survival in locally advanced non-small-cell lung carcinoma. Several explanations are possible, including the difficulty of accurately predicting the dose to a very small portion of a structure that is itself quite small in relation to other surrounding organs; tumor motion, change in tumor size, and variations in patient anatomy and positioning during treatment would all dch further sources of inaccuracy.
Finally, dvu brachial plexopathy is relatively rare, the number of events in our study was low, which complicates our ability to generalize our defined dose limits to a larger population of patients with lung cancer. In this retrospective analysis, we compared dose-volume histogram information with the incidence of plexopathy to establish the maximum tolerated dose to the brachial plexus. Evaluation of Brachial Plexus Dose The Pinnacle planning system was used to calculate the dose to the brachial plexus using the original treatment plan.
The purpose of this study was to identify a threshold radiation dose at which plexopathy becomes evident when that radiation is delivered using modern-day techniques to tumors in the superior sulcus, upper mediastinum, or supraclavicular regions. Radiation-induced brachial plexus neuropathy in breast cancer patients. Statistical tests were based on a two-sided significance level.
Lung cancer is the leading cause of cancer-related death worldwide, with approximately 1. B Digitally-reconstructed radiographs DRR showing manual contours green and computer-generated contours red.
Interestingly, we found that doses to 0. Even with the differences in anatomy and positioning among patients, we noticed excellent correlation between the STAPLE fused contours and the manually generated contours, suggesting that STAPLE fusion of multiple individual segmentations can reduce variability and produce accurate contours. As a service to our customers we are providing this early version of the manuscript.
There 5116 minimal differences in DVHs between the auto-segmented contours and the modified contours. These auto-delineated contours for the entire cohort were then reviewed and modified individually by hand after auto-segmentation had been completed to maintain consistency in contours for all 90 patients.
Dvn histogram data showing the median radiation dose of 10 patients manually contoured forming the training set dotted line compared to the automatically generate plexus contours using deformable image registration, prior to modification.
Please review our dv policy. This may prove to be problematic for complying with dose constraints to structures like the brachial plexus. Also, changes in arm position can affect the visibility of the brachial plexus and can contribute to inaccuracies in deformable image registration.
Dose-volume histograms DVHs of the brachial plexuses for the first 10 patients original training set contoured manually werecompared to those created by deformable image registration deformable image set Fig. Author manuscript; available in PMC Sep This study was approved by the appropriate institutional review board of MD Anderson. Atlas of human anatomy.
Dose escalation introduces challenges with regard to meeting dose constraints for proximal critical structures such as the brachial plexus.