Functional imaging equivalence and proof of concept for image-guided adaptive radiotherapy with fixed gantry and rotating couch.

PURPOSE: The purpose of this article is to present the first imaging experiments to demonstrate the functional equivalence between a conventional rotational gantry and a fixed-beam imaging geometry, and the feasibility of an iterative image-reconstruction technique under gravitational deformation. METHODS AND MATERIALS: Experiments were performed using an Elekta Axesse with Agility MLC and XVI, a custom-built rotating phantom stage, a Catphan QA phantom, and a porcine heart. For the imaging equivalence, a conventional cone beam computed tomography (CBCT) of the Catphan was acquired, as well as a set of 660 x-ray projections with a static gantry and rotating Catphan. Both datasets were reconstructed with the Feldkamp-Davis-Kress (FDK) algorithm, and the resultant volumetric images were compared using standard metrics. For imaging under gravitational deformation, a conventional CBCT of the Catphan and a set of 660 x-ray projections with a static gantry and rotating Catphan were also acquired with a porcine heart. The conventional CBCT was reconstructed using FDK. The projections that were acquired with the heart rotating were sorted into angular bins and reconstructed with prior image constrained compressed sensing using a deformation-blurred FDK prior. Deformation was quantified with B-spline transformation-based deformable image registration. RESULTS: For imaging equivalence, the difference between the two Catphan images was consistent with Poisson noise. For imaging under gravitational deformation, the conventional CBCT porcine heart image (ground truth at 0 degrees) matched the static gantry, rotating heart reconstruction with a mean magnitude of <3 mm and maximum magnitude of <5 mm of the deformation vector field. The mean deformation of the rotating heart was 3.0 to 8.9 mm, up to 16.1 mm maximum deformation. Deformation was mainly observed in the direction of gravity. CONCLUSIONS: We have demonstrated imaging equivalence in cone beam CT reconstructions between rigid phantom images acquired with a conventional rotating gantry and with a fixed-gantry and rotating phantom. We have presented a method for image reconstruction under a fixed-beam imaging geometry using a deformable phantom.

SWITCH for safety: Perioperative hand-off tools.

Communication breakdown is the leading cause of reported sentinel events in the perioperative setting. Barriers to optimal communication include noise, stress, multitasking, and rapid turnover between procedures. AORN has identified communication during personnel changes (ie, hand offs) as a point of vulnerability for the surgical patient. A standardized hand-off method provides an opportunity for personnel to ask and answer questions and should be available in the perioperative setting. At one facility, the standardization of hand-off reporting resulted in the development of new hand-off tools specific to the perioperative environment. A standardized reporting method enabled health care providers to address communication barriers and to maintain their focus on the patient during critical moments (eg, shift changes), thereby improving patient safety.

Power to the people: using learner control to improve trainee reactions and learning in web-based instructional environments.

This experimental study investigated the mechanisms by which learner control influences learning in an e-learning environment. The authors hypothesized that learner control would enhance learning indirectly through its effect on trainee reactions and learner engagement (in particular, off-task attention), such that learners who were more satisfied with the training and devoted more cognitive resources toward the instructional content versus off-task thoughts would possess greater posttraining knowledge. The study also examined the role of individual differences (training motivation and goal orientation) in the prediction of these 2 mediating variables. A sample of 274 undergraduates completed an e-learning program, either with or without interactive, learner control tools. Results suggest that both training satisfaction and off-task attention predicted subsequent learning. Learner control had a positive impact on training satisfaction but was not related to off-task attention. The individual difference variables had a differential impact on the mediating variables. In particular, performance orientation was linked to off-task attention, whereas mastery orientation was found to indirectly influence satisfaction via its direct effect on training motivation. Implications for the design and further study of e-learning are discussed.

Five-year surveillance of West Nile and eastern equine encephalitis viruses in Southeastern Virginia.

To investigate the occurrence of West Nile virus (WNV) and Eastern equine encephalitis virus (EEE) in southeastern Virginia, the Bureau of Laboratories at the Norfolk Department of Public Health (NDPH) analyzed mosquito pools and the sera of sentinel chickens from the southeastern Virginia area each year from 2000 to 2004. Mosquito pool supernatants were screened for the presence of viral RNA by conventional reverse transcription polymerase chain reaction (RT-PCR) and Taqman RT-PCR with the i-Cycler. Mosquito pools were also tested for virus activity by Vero cell culture. The primary enzootic vector of WNV was Culex (Cx.) pipiens and that of EEE was Culiseta (Cs.) melanura. During the five-year surveillance period, the peak minimum infection rates (MIRs) of WNV and EEE in these mosquito species were 2.7 (2002) and 0.9 (2001), respectively. In 2003, the MIRs in Cs. melanura for WNV and EEE were 0.24 and 0.56, respectively; and the MIR for WNV in Cx. pipiens was 0.64. In 2004, Cs. melanura was less active in the WNV transmission cycle (MIR = 0.07) than was Cx. pipiens (MIR = 1.8), and Cs. melanura was the only vector for EEE (MIR = 0.37). The trend was for EEE activity to peak in July; WNV activity peaked in August. Sentinel-chicken sera were tested for IgM antibodies, and peak IgM seroconversions to these arboviruses were recorded in August 2003 for WNV and in July 2003 for EEE. In 2004, the highest IgM seroconversions to EEE occurred later in August. The overall trend of arbovirus activity was greater in 2003 than in 2004.