ABSTRACT
BACKGROUND: Ketamine is a short acting anesthetic with excellent analgesic property,and has been widely used for short surgical procedures like wound suturing and dressing. It has been shown that in low doses, intravenous ketamine provides good intraoperative and postoperative analgesia. This prospective interventional study was an effort to evaluate the efficacy of low dose ketamine as a labour analgesic, thereby providing a safe and inexpensive alternative, especially for the developing countries with limited resources and economical constraints. AIM: The aims of this study are: 1. To evaluate the efficacy of low dose intravenous ketamine in providing analgesia during labour. 2. To assess the safety of low dose intravenous ketamine on the parturient and the fetus, and its effect on the progress of labour. 3. To standardise a “low dose ketamine” regimen for labour analgesia. METHODS: Parturients with no antenatal risk factors and expected to have normal vaginal delivery were eligible to be included in the study. Women with known cardiac disease, gestational hypertension, epilepsy or known psychiatric disorder were excluded, as were parturients with multifetal pregnancy, suspected cephalopelvic disproportion and those who have had previous caesarean section. RESULTS: All the parturients experienced adequate analgesia within 1–2hrs of administration of ketamine infusion. The infusionrate of ketamine during the course of labour was also calculated and the average infusion required was 0.17 +/– 0.06mg.kg–1.hr–1 (range 0.08–0.32). The parturients who had a spontaneous onset of labour required a lower dose of ketamine when compared to those who had induction of labour.The changes in heart rate and blood pressure were statistically insignificant. CONCLUSION: Ketamine, a NMDA receptor antagonist, is shown to be an excellent analgesic. Although it is associated with unpleasant side effects, these can be minimised when ketamine is administered slowly in very low doses (0.1–0.2mg.kg–1.hr–1) while retaining its analgesic property. Since, the efficacy and safety of low dose intravenous ketamine as a labour analgesic has been established, a regimen, with slight modification, would be ratified on a larger population, before being recommended as a standard technique of labour analgesia.
ABSTRACT
Background: To evaluate the risk involved, there is need to know the quantum of personnel exposures in whole service. Dose reports from an Oncology Centre over 7 block periods, 5 years each from 1979 till 2013 are analyzed. Materials and Methods: Personnel monitoring [PM] reports till 1990s with film badges and later thermoluminescent [TL] badges [CaSo4.Dy] were evaluated. 35 years total service was taken to represent total professional service of staff superannuating at age 60 years. Results: Mean personnel equivalent dose for 5 year block period is 3.30+/-0.43 mSv [n=7 blocks]. Maximum dose in any block period was 30-60 mSv. Equivalent doses 22% were zero, 64.3% within 5 mSv. 2.1% were above 30 mSv in 5 year periods. Doses were decreasing order 11.8 mSv [radiopharmaceutical preparation], 4.3 mSv [nuclear medicine], 4.1 mSv [medical physics], 2.2 mSv[brachytherapy]; 1.2 mSv [radiodiagnosis], 1.1 mSv [external beam radiotherapy] and 0.73 mSv [radiation sterilization plant]. Conclusion: The whole body personnel dose in are much lower than recommended annual dose equivalent limits of 100 mSv/ 5 years. The magnitude of recorded doses to staff show that the risk is negligible and the principle of ALARA is being practiced in the work areas
ABSTRACT
The purpose of this study is to examine the plan quality and monitor unit with sliding window IMRT and RapidArc [RA] treatment plans using American Association Physicists in plans using American Association Physicits in Medicine TG119 test suite DICOM-RT images and structure sets. The structure set includes multi-target [superior, central, inferior], prostate, head and neck and C-shape. Plans were performed with Eclipse planning system using AAA algorithm with the plan goals specified in TG119. The plan results for multitarget shows that the D99 is greater than the plan goal for all the targets. The D10 is less than the plan goal for superior and inferior targets in both IMRT and RA plans. The D10 is 5% more with IMRT plan and 7% more with RA plan from central target in comparison with plan goal. The plan results for prostate shows that D95 is greater than the plan goal for both IMRT and RA plans. The D5 is less than the plan goal for IMRT plan and almost equal to plan goal for RA plan. The D30 is less than the plan goal for bladder and rectum in both the plans. The D10 is higher than the plan goal by 1.9% and 2.5% in IMRT and RA plan for rectum. The plan results for head and neck shows that the D99 and D90 were greater than the plan goal for PTV. The spinal cord and parotid doses were less than the plan goal in both the plans. The plan results for C-shape shows that the D95 was greater than the plan goal and D10 was less than the plan goal for PTV. The dose to central core was less than the plan goal in both IMRT and RA plans. Both the IMRT and RapidArc plans have met the plan goal for all the target and normal structures. RapidArc optimization and treatment planning requires more time than the IMRT plan. The monitor unit calculated by the RapidArc plan is less compared to IMRT plan, which reduces the treatment error caused by patient motion during treatment and integral dose
Subject(s)
Humans , Neoplasms/radiotherapy , Radiotherapy Planning, Computer-Assisted , AlgorithmsABSTRACT
Implementation of Intensity Modulation Radiotherapy [IMRT] and patient dose verification was carried out with film and I'mariXX using linear accelerator with 120- leaf Millennium dynamic multileaf collimator [dMLC]. The basic mechanical and electrical commissioning and quality assurance test of linear accelerator were carried out. The leaf position accuracy and leaf position repeatability checks were performed for static MLC positions. Picket fence test and garden fence test were performed to check the stability of the dMLC and the reproducibility of the gap between leaves. The radiation checks were performed to verify the position accuracy of MLCs in the collimator system. The dMLC dosimetric checks like output stability, average leaf transmission and dosimetric leaf separation were also investigated. The variation of output with gravitation at different gantry angles was found to be within 0.9%. The measured average leaf transmission for 6 MV was 1.6% and 1.8% for 18 MV beam. The dosimetric leaf separation was found to be 2.2 mm and 2.3 mm for 6 MV and 18 MV beams. In order to check the consistency of the stability and the precision of the dMLC, it is necessary to carryout regular weekly and monthly checks. The dynalog files analysis for Garden fence, leaf gap width and step wedge test patterns carried out weekly were in good agreement. Pretreatment verification was performed for 50 patients with ion chamber and I'mariXX device. The variations of calculated absolute dose for all treatment fields with the ion chamber measurement were within the acceptable criterion. Treatment Planning System [TPS] calculated dose distribution pattern was comparable with the I'mariXX measured dose distribution pattern. Out of 50 patients for which the comparison was made, 36 patients were agreed with the gamma pixel match of >95% and 14 patients were with the gamma pixel match of 90-95% with the criteria of 3% delta dose [DD] and 3 mm distance-to-agreement [DTA]. Commissioning and quality assurance of dMLC for IMRT application requires considerable time and effort. Many dosimetric characteristics need to be assessed carefully failing which the delivered dose will be significantly different from the planned dose. In addition to the issues discussed above we feel that individual MU check is necessary before the treatment is delivered