COMPREHENSIVE CALCULATION-BASED IMRT QA USING R&V DATA, TREATMENT RECORDS, AND A SECOND TREATMENT PLANNING SYSTEM

Purpose: Traditional patient-specific IMRT QA measurements are labor intensive and consume machine time. Calculation-based IMRT QA methods typically are not comprehensive. We have developed a comprehensive calculation-based IMRT QA method to detect uncertainties introduced by the initial dose calculation, the data transfer through the Record-and-Verify (R&V) system, and various aspects of the physical delivery. Methods: We recomputed the treatment plans in the patient geometry for 48 cases using data from the R&V, and from the delivery unit to calculate the “as-transferred” and “as-delivered” doses respectively. These data were sent to the original TPS to verify transfer and delivery or to a second TPS to verify the original calculation. For each dataset we examined the dose computed from the R&V record (RV) and from the delivery records (Tx), and the dose computed with a second verification TPS (vTPS). Each verification dose was compared to the clinical dose distribution using 3D gamma analysis and by comparison of mean dose and ROI-specific dose levels to target volumes. Plans were also compared to IMRT QA absolute and relative dose measurements. Results: The average 3D gamma passing percentages using 3%-3mm, 2%-2mm, and 1%-1mm criteria for the RV plan were 100.0 (σ=0.0), 100.0 (σ=0.0), and 100.0 (σ=0.1); for the Tx plan they were 100.0 (σ=0.0), 100.0 (σ=0.0), and 99.0 (σ=1.4); and for the vTPS plan they were 99.3 (σ=0.6), 97.2 (σ=1.5), and 79.0 (σ=8.6). When comparing target volume doses in the RV, Tx, and vTPS plans to the clinical plans, the average ratios of ROI mean doses were 0.999 (σ=0.001), 1.001 (σ=0.002), and 0.990 (σ=0.009) and ROI-specific dose levels were 0.999 (σ=0.001), 1.001 (σ=0.002), and 0.980 (σ=0.043), respectively. Comparing the clinical, RV, TR, and vTPS calculated doses to the IMRT QA measurements for all 48 patients, the average ratios for absolute doses were 0.999 (σ=0.013), 0.998 (σ=0.013), 0.999 σ=0.015), and 0.990 (σ=0.012), respectively, and the average 2D gamma(5%-3mm) passing percentages for relative doses for 9 patients was were 99.36 (σ=0.68), 99.50 (σ=0.49), 99.13 (σ=0.84), and 98.76 (σ=1.66), respectively. Conclusions: Together with mechanical and dosimetric QA, our calculation-based IMRT QA method promises to minimize the need for patient-specific QA measurements by identifying outliers in need of further review.

Thatsachen für landwirthe sowie für den familienkreis. Eine zusammenstellung reicher materialien für grundeigenthümer : betreffend hausthiere und hausverwaitung /

Deutsche bearb. von Heinrich Gruge.

The life of Samuel Johnson, LL. D. Together with the journal of a tour to the Hebrides, James Boswell.

Vols. 1-4 contain the Life; v. 5: The Journal of a tour to the Hebrides, and A diary of a journey into North Wales in the year 1774, by Samuel Johnson ... edited ... by R. Duppa ... 1816.

In honor of the ninetieth birthday of Charles Frederick Johnson, professor of English in Trinity college, 1883-1906; papers, essays, and stories by his former students,

CONTENTS. (cont.) --The Christianity of the fourth Gospel, by the Rev. C. B. Hedrick.--Correctness, by the Rev. M. B. Stewart.--An optimistic realist, Ernst Zahn, by B. Q. Morgan.--The hermit story, as used by Voltaire and Mark Twain, by F. A. G. Cowper.--Thumbnail classics. Jack Harker at Yalevard, by P. Curtiss.--The man who heard everything, by W. Trumbull.--"Whiskey, bullets, and..."--The novelist takes to real estate, by R. Wright.

Jāṉsaṉ Paṇṭitar iyaṟṟiya R��silas : eṉum kaṟpitakkataiyiṉ Tamiḻ moli̲peyarppu ;

Added title page: Translation of Rasselas : a tale by Dr. Johnson.

Sir Joshua Reynolds' notes and observations on pictures, chiefly of the Venetian school, being extracts from his Italian sketch books; also, The Rev. W. Mason's observations on Sir Joshua's method of coloring, and some unpublished letters of Dr. Johnson, Malone, and others. With an appendix, containing a transcript of Sir Joshua's account book, showing what pictures he painted and the prices paid for them.

Mode of access: Internet.

Memoirs of the war of secession : from the original manuscripts of Johnson Hagood, brigadier-general, C.S.A.

Includes indexes.

An inaugural dissertation on the operation of pestilential fluids upon the large intestines, termed by nosologists dysentery : Submitted to the public examination of the faculty of physic, under the authority of the trustees of Columbia College in the state of New-York, William Samuel Johnson, LL.D. president, for the degree of Doctor of Physic, on the 3d of May, 1797. /

Signatures: [A]⁴ B-O⁴ (O3 verso, O4 blank).

Letters to and from the late Samuel Johnson, LL.D. : to which are added, some poems never before printed /

Publisher statement in v. 2: Printed for Messrs. G. Burnet, R. Moncrieffe ... [and 7 others].

Miscellaneous papers, 1672-1865, now first printed from the manuscript in the collections of the Virginia Historical Society; comprising charter of the Royal African Company, 1672; report on the Huguenot settlement, 1700; Papers of George Gilmer, of "Pen Park," 1775-1778; Orderly book of Capt. George Stubblefield, 1776; career of the iron-clad Virginia, 1862; memorial of Johnson's Island, 1862-4; Beales' cav. brigade parole, 1865.

Mode of access: Internet.

The life of Samuel Johnson /

Mode of access: Internet.

Patient experiences of serious adverse drug reactions and their attitudes to medicines:a qualitative study of survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis in the UK

Background: Adverse drug reactions (ADRs) cause significant morbidity and mortality and account for around 6.5% of hospital admissions. Patient experiences of serious ADRs and their long-term impact on patients' lives, including their influence on current attitudes towards medicines, have not been previously explored. Objective: The aim of the study was to explore the experiences, beliefs, and attitudes of survivors of serious ADRs, using drug-induced Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) as a paradigm. Methods: A retrospective, qualitative study was undertaken using detailed semi-structured interviews. Fourteen adult survivors of SJS and TEN, admitted to two teaching hospitals in the UK, one the location of a tertiary burns centre, were interviewed. Interview transcripts were independently analysed by three different researchers and themes emerging from the text identified. Results: All 14 patients were aware that their condition was drug induced, and all but one knew the specific drug(s) implicated. Several expressed surprise at the perceived lack of awareness of the ADR amongst healthcare professionals, and described how the ADR was mistaken for another condition. Survivors believed that causes of the ADR included (i) being given too high a dose of the drug; (ii) medical staff ignoring existing allergies; and (iii) failure to monitor blood tests. Only two believed that the reaction was unavoidable. Those who believed that the condition could have been avoided had less trust in healthcare professionals. The ADR had a persisting impact on their current lives physically and psychologically. Many now avoided medicines altogether and were fearful of becoming ill enough to need them. © 2011 Adis Data Information BV. All rights reserved. Conclusions: Life-threatening ADRs continued to affect patients’ lives long after the event. Patients’ beliefs regarding the cause of the ADR differed, and may have influenced their trust in healthcare professionals and medicines. We propose that clear communication during the acute phase of a serious ADR may therefore be important.

Characterization of expiration air jets and droplet size distributions immediately at the mouth opening

Size distributions of expiratory droplets expelled during coughing and speaking and the velocities of the expiration air jets of healthy volunteers were measured. Droplet size was measured using the Interferometric Mie imaging (IMI) technique while the Particle Image Velocimetry (PIV) technique was used for measuring air velocity. These techniques allowed measurements in close proximity to the mouth and avoided air sampling losses. The average expiration air velocity was 11.7 m/s for coughing and 3.9 m/s for speaking. Under the experimental setting, evaporation and condensation effects had negligible impact on the measured droplet size. The geometric mean diameter of droplets from coughing was 13.5m and it was 16.0m for speaking (counting 1 to 100). The estimated total number of droplets expelled ranged from 947 – 2085 per cough and 112 – 6720 for speaking. The estimated droplet concentrations for coughing ranged from 2.4 - 5.2cm-3 per cough and 0.004 – 0.223 cm-3 for speaking.