ABSTRACT
Different planning and treatment systems for intracranial stereotactic radiosurgery available in the Netherlands are compared. The systems for intracranial radiosurgery include: Gamma Knife, Cyberknife, Novalis, and Tomotherapy. Electronic data of 5 patients was transferred to all participating centres and treatment plans were generated according to 2 different prescription protocols. For this study, plans were also generated for a conventional linac. Even systems with a high resolution (Gammaknife and Novalis) have conformity indices in violation with RTOG guidelines (CI > 2.5) when target volumes of <0.5 cc are treated. For medium sized targets (0.5-1 cc) all systems performed reasonably well, but for the different systems a large range of conformity indices was seen (1.1 to 3.7). The differences are partly system dependent but depend also on specific planning choices made. For larger target volumes (> 1 cc), all systems perform well. The workload of the different techniques was comparable although the treatment times were usually longer for Gamma Knife radiosurgery. We conclude that small targets should be treated by dedicated systems, larger volumes (> 0.5-1 cc) can also be treated using conventional treatment systems equipped with a MLC.
Subject(s)
Brain Neoplasms/surgery , Radiosurgery/methods , Therapy, Computer-Assisted/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Netherlands , Practice Guidelines as TopicABSTRACT
Charcot's arthropathy is a relative uncommon complication of diabetic neuropathy. The aetiology remains poorly understood. According to the neurotraumatic theory, the foot, which has become insensitive through neuropathy, is subjected to extensive (micro)trauma through continuation of use. Ultimately this leads to destruction. According to the neurovascular theory, autonomic neuropathy results in an increased blood flow in the foot with osteopenia consequently resulting due to increased osteoclastic activity and decreased osteoblastic activity. Acute Charcot's arthropathy presents with a red, warm, swollen foot, which is usually not painful and which eventually becomes ulcerated. An insidious development of the condition is also possible. The X-ray of the foot often is normal at presentation, but will later show local osteoporosis, erosions, subluxations or fractures. Technetium scintigraphy will be abnormal from the beginning, while IgG scans are usually normal. The traditional treatment is cast immobilisation with careful introduction of protected weight-bearing. After stabilisation, orthopaedic footwear is necessary to improve foot function and to prevent ulceration. Regular checkups are important.
