ABSTRACT
La progresiva implantación de las acciones previstas en el Plan Global para el desarrollo de actuaciones sociosanitarias y comunitarias ante la COVID-19 en Navarra permitió ir aumentando gradualmente la conciencia de que, para una adecuada y más eficaz gestión de la pandemia desde una perspectiva biopsicosocial, no era suficiente con reaccionar ante las necesidades que emergían diariamente, sino que era necesario tratar de anticiparse, o incluso ir un paso más allá con enfoques comunitarios para tratar de incidir en las causas de las causas. Volver al origen desde un modelo salutogénico, centrado más en las fortalezas de las comunidades para generar salud que en el modelo patogénico clásico centrado en controlar comportamientos individuales. Dentro del citado Plan desde el nivel de intervención comunitario, inicialmente se actuó de manera reactiva ante brotes localizados con alta concentración de indicadores de riesgo social en un total de nueve Zonas Básicas de Salud, generando conocimiento útil desde las primeras experiencias a las últimas, llegando a plantear recomendaciones organizativas para facilitar la intervención posterior en esas situaciones. La evolución lógica de estas enseñanzas llevó a avanzar en actuaciones de promoción de la salud mediante la potenciación y facilitación del trabajo con la comunidad a través de las Mesas de Trabajo Comunitario existentes anteriormente o impulsadas durante la pandemia, y a la articulación de redes de sensibilización en determinados puntos del territorio como Tudela.(AU)
Subject(s)
Humans , Pandemics , Coronavirus Infections , Social Planning , Community Health Services , Community Networks , Spain , Health Management , Public Health , Health Programs and PlansABSTRACT
BACKGROUND: Prior radioembolization, a simulation using 99mTc-macroaggregated albumin as 90Y-microspheres surrogate is performed. Gamma scintigraphy images (planar, SPECT, or SPECT-CT) are acquired to evaluate intrahepatic 90Y-microspheres distribution and detect possible extrahepatic and lung shunting. These images may be used for pre-treatment dosimetry evaluation to calculate the 90Y activity that would get an optimal tumor response while sparing healthy tissues. Several dosimetry methods are available, but there is still no consensus on the best methodology to calculate absorbed doses. The goal of this study was to retrospectively evaluate the impact of using different dosimetry approaches on the resulting 90Y-radioembolization pre-treatment absorbed dose evaluation based on 99mTc-MAA images. METHODS: Absorbed doses within volumes of interest resulting from partition model (PM) and 3D voxel dosimetry methods (3D-VDM) (dose-point kernel convolution and local deposition method) were evaluated. Additionally, a new "Multi-tumor Partition Model" (MTPM) was developed. The differences among dosimetry approaches were evaluated in terms of mean absorbed dose and dose volume histograms within the volumes of interest. RESULTS: Differences in mean absorbed dose among dosimetry methods are higher in tumor volumes than in non-tumoral ones. The differences between MTPM and both 3D-VDM were substantially lower than those observed between PM and any 3D-VDM. A poor correlation and concordance were found between PM and the other studied dosimetry approaches. DVH obtained from either 3D-VDM are pretty similar in both healthy liver and individual tumors. Although no relevant global differences, in terms of absorbed dose in Gy, between both 3D-VDM were found, important voxel-by-voxel differences have been observed. CONCLUSIONS: Significant differences among the studied dosimetry approaches for 90Y-radioembolization treatments exist. Differences do not yield a substantial impact in treatment planning for healthy tissue but they do for tumoral liver. An individual segmentation and evaluation of the tumors is essential. In patients with multiple tumors, the application of PM is not optimal and the 3D-VDM or the new MTPM are suggested instead. If a 3D-VDM method is not available, MTPM is the best option. Furthermore, both 3D-VDM approaches may be indistinctly used.
