Can an 8th grade student learn point of care ultrasound?

BACKGROUND: Point-of-care ultrasound has gained widespread use in developing countries due to decreased cost and improved telemedicine capabilities. Ultrasound training, specifically image acquisition skills, is occurring with more frequency in non-medical personnel with varying educational levels in these underdeveloped areas. This study evaluates if students without a high school education can be trained to acquire useful FAST images, and to determine if an 8th grade student can teach peers these skills. METHODS: The 8th grade students at a small middle school were divided into two groups. One group received training by a certified medical sonographer, while the other group received training by a peer 8th grade student trainer who had previously received training by the sonographer. After training, each student was independently tested by scanning the four FAST locations. A blinded ultrasound expert evaluated these images and deemed each image adequate or inadequate for clinical use. RESULTS: Eighty video image clips were obtained. The overall image adequacy rate was 74%. The splenorenal window had the highest rate at 95%, followed by retrovesical at 90%, hepatorenal at 75%, and subxiphoid cardiac at 35%. The adequacy rate of the sonographer-trained group was 78%, while the adequacy rate of the student-trained group was 70%. The difference in image adequacy rate between the two groups was not significant (P-value 0.459). CONCLUSION: The majority of 8th graders obtained clinically adequate FAST images after minimal training. Additionally, the student-trained group performed as well as the sonographer-trained group.

Image-guided intracavitary high-dose-rate brachytherapy for cervix cancer: A single institutional experience with three-dimensional CT-based planning.

PURPOSE: To evaluate and report volumetric dose specification of clinical target volume (CTV) and organs at risk with three-dimensional CT-based brachytherapy. In this study, we analyzed CTV volumes and correlated the dose specification from CT-based volumes with doses at classical point A and International Commission on Radiation Units and Measurements (ICRU) points. METHODS AND MATERIALS: Ten patients who underwent definitive high-dose-rate brachytherapy for cervical cancer between May 2006 and March 2007 were retrospectively identified for this study. Each patient underwent five intracavitary insertions with CT-compatible ring and tandem applicators using a universal cervical Smit sleeve. Dose of 6.0Gy per fraction was prescribed to the 100% isodose line. The dose distribution was modified using the feature of "geometry optimization" to achieve maximum CTV coverage and to spare the organs at risk. The minimal doses for most irradiated 2, 1, 0.1cm(3) of bladder (D(BV2) , D(BV1), and D(BV0.1)) and rectum (D(RV2), D(RV1), and D(RV0.1)) were determined from dose-volume histograms and were compared with the doses estimated at the ICRU reference points. RESULTS: The mean CTV of the 10 patients had a shrinkage trend over the five fractions, with a mean of 77.4cm(3) from the first fractions and a mean of 65.5cm(3) from the last fractions (r=-0.911, p=0.031). CTV volumes directly correlated with dose to point A (r=0.785, p=0.007). Eight of 10 patients achieved an average dose received by at least 90% of volume (D(90)) >/=6.0Gy. For bladder, the doses determined from the 3-dimensional (3D) plan correlated significantly with the doses to the ICRU reference bladder point, for example, D(BV2) (r=0.668, p<0.001), D(BV1) (r=0.666, p<0.001), and D(BV0.1) (r=0.655, p<0.001). However, for rectum, the estimated doses to the ICRU reference rectal point did not correlate significantly with doses determined from 3D plan, for example, D(RV2) (r=0.251, p=0.079), D(RV1) (r=0.279, p=0.049), and D(BV0.1) (r=0.282, p=0.047). CONCLUSIONS: Our experience showed that excellent dose coverage of CTV can be achieved with image-guided CT-based planning with geometric optimization although maximal sparing of rectum was not achieved. Careful dose constraints and standardization of D(90) should be considered when optimizing doses to target tissues such that normal tissue constraints can be met.

Hypofractionated stereotactic radiotherapy for the treatment of brain metastases.

BACKGROUND: This retrospective review evaluated the efficacy and toxicity profiles of various dose fractionations using hypofractionated stereotactic radiotherapy (HSRT) in the treatment of brain metastases. METHODS: Between 2004 and 2007, 36 patients with 66 brain metastases were treated with HSRT. Nine of these subjects were excluded because of the absence of post-treatment magnetic resonance imaging scans, resulting in 27 patients with a total of 52 lesions. Of these 52 lesions, 45 lesions were treated with whole-brain radiotherapy plus a HSRT boost and 7 lesions were treated with HSRT as the primary treatment. The median prescribed dose was 25 grays (Gy) (range, 20 Gy-36 Gy) with a median of 5 fractions (range, 4 fractions-6 fractions) to a median 85% isodose line (range, 50%-100%). The median follow-up interval was 6.6 months (range, 0.9 months-26.8 months). RESULTS: The median overall survival time was 10.8 months, and 66.7% of patients died of disease progression. After HSRT treatment of 52 brain lesions, 13 lesions demonstrated complete responses, 12 lesions demonstrated partial responses, 22 lesions demonstrated stable disease, and 5 lesions demonstrated progressive disease. Actuarial local tumor control rates at 6 months and 1 year were 93.9% and 68.2%, respectively. Maximum tumor dimension, concurrent chemotherapy, and a tumor volume <1 cc were found to be statistically significant factors for local tumor control. One patient had a grade 3 toxicity (according to National Cancer Institute Common Terminology Criteria for Adverse Events). CONCLUSIONS: HSRT provides a high level of tumor control with minimal toxicity comparable to single-fraction stereotactic radiosurgery (SRS). The results of the current study warrant a prospective randomized study comparing single-fraction SRS with HSRT in this patient population.