SU-E-T-301: A Novel Daily QA Device for Proton Therapy.

PURPOSE: We describe the design and use of a daily QA device for proton therapy. The device is designed for therapists to check the readiness of the IBA Proton Therapy System (IBA, Louvain-la-Neuve, Belgium) during morning QA. The checks include connectivity, positioning, mechanical, imaging and dosimetric parameters of the proton therapy system. METHODS: The device consists of a commercial QA device, (rf-DailyQA3 -Sun Nuclear Corporation, Melbourne, FL), in conjunction with a home-made acrylic phantom and mechanical indexing jig. The indexing jig indexes the rf-DailyQA3 to treatment couch. Fiducial markers embedded in the phantom are used for checking the x-ray image and alignment accuracy of the imaging system (VeriSuite, MedCom, Darmstadt- Germany). The rf- DailyQA3 is used to check the proton beam output, range and symmetry, which are acquired during one single beam delivery of 100 monitor units. We developed in-house software to calculate the variation of beam range and symmetry, based on readings from the various ion chambers inside the rf-DailyQA3. RESULTS: The device has been employed to perform daily QA since June 2010 at two operational proton treatment centers and will soon be implemented at ProCure's New Jersey center. All QA tests are performed by radiation therapists and reviewed by the medical physicist on duty. Due to the simplicity of the device and the associated processing software, the QA time is less than 20 minutes per room. The measurement data collected by the device during daily QA are recorded in the OIS. The integrity of the data is validated by comparing against other independent measurements. CONCLUSIONS: The daily QA device has been proven to be robust, reliable and user-friendly. The performance of this system has been proven to be stable and accurate using trend analyses. Key words:proton therapy, daily QA, output, range, symmetry.

[Active and healthy living in old age--results from a representative survey of community-dwelling senior citizens in Hamburg]. / Im Alter aktiv und gesund leben--Ergebnisse einer repräsentativen Seniorenbefragung in Hamburg.

BACKGROUND: The majority of community-dwelling people 60 years and older are independent and live actively. However, there is little information about elderly persons' views on aging, health and health promotion. METHODS: Therefore, an anonymous, written questionnaire survey was performed in a representative sample of inhabitants from a section of the city of Hamburg, 60 years and older; 5 year intervals, 14 subsamples according to 7 age groups of females and males. RESULTS: Questionnaires from 950 participants (29% response) could be evaluated: mean age 71.5 years, 58% women, 34% living alone, 5% with professional healthcare needs as indicated by status according to German nursing care insurance. Senior citizens' positive attitudes towards aging and health were predominant: 69% of respondents felt young, 85% worried about loss of autonomy in old age. CONCLUSIONS: The results provide evidence indicating potential for improving health-promoting lifestyles in parts of the older population by evaluating and strengthening older persons' competencies and by considering their concerns seriously. These results provide valuable information for future plans in the public-health sector in the city of Hamburg where particular health-promoting actions for elderly persons will be considered.

[Impact of fall risk and fear of falling on mobility of independently living senior citizens transitioning to frailty: screening results concerning fall prevention in the community]. / Einfluss von Sturzgefährdung und Sturzangst auf die Mobilität selbstständig lebender, älterer Menschen am Ubergang zur Gebrechlichkeit: Screeningergebnisse zur kommunalen Sturzprävention.

PROBLEM: There is a strong relation between mobility, walking safety and living independently in old age. People with walking problems suffer from fear of falling and tend to restrict their mobility and performance level in the community environment--even before falls occur. This study was planned to test the validity and prognostic value of a fall risk screening instrument ("Sturz-Risiko-Check") that has already shown its feasibility, acceptance and reliability, targeting independently living senior citizens. METHODS: The study sample was recruited from a sheltered housing complex in Hamburg (with written consent). Persons with need of professional care ("Pflegestufe" in Germany) were excluded. The residents were asked to fill in the multidimensional questionnaire ("Sturz-Risiko- Check"). In a second step, a trained nurse asked the participants in a phone call about their competence in the instrumental activities of daily living (I-ADL mod. from Lawton, Brody 1969) and about their usual mobility performance level (e.g. frequency and distance of daily walks, use of public transport). According to the number and weight of self-reported risk factors for falling, three groups: "low fall risk", "medium fall risk" and "high fall risk" were classified. Finally, this classification was re-tested after one year, asking for falls and fall related injuries. RESULTS: A total of 112 senior citizens without need of personal care, living in a sheltered housing facility were asked to participate. Acceptance was high (76.1%). Self-reported data from 79 participants concerning falls, fall-risk, mobility and instrumental activities of daily living were included in the statistical analyses. Mean age was 78 (64 to 93) years and associated by a high percentage of women (75.9%) in this sample. The older participants reported 0 to 13 different factors (mean 5) related to a high risk of future falls. Most participants (78.5%) quit cycling because of fear of falling. There was a high incidence in the study sample and over the three risk groups of chronic disorders like cardiac failure (75.9%) and disturbed vision or hearing (64.6%). According to the rising risk of falling over the three risk groups (low, medium and high), there were symptoms of fast functional decline or frailty like diminished walking speed (6.3 vs 36.8 vs 72.0%), sarcopenia (failed chairrise test: 0 vs 18.4 vs 28%) or already perceived fall events (0 vs 5.3 vs 56.0%) and ongoing restriction in basic activities. Those results were proven by the data on fall frequencies after one year (follow-up). We found an increase in falls over all three risk groups (12.5 vs 31.6 vs 28%) with fall-related severe injuries (fractures) in two persons classified in the high fall-risk group. DISCUSSION: The results of the fall-risk screening were useful to classify groups with different probability to fall in the near future. Fear-offalling and symptoms of frailty were related to an increasing risk of falling and loss of mobility and autonomy in still independently living senior citizens. CONCLUSION: The fall-risk screening instrument ("Sturz-Risiko-Check" questionnaire) was useful and valid to predict risk of falling and functional decline in independently living senior citizens transitioning to frailty. This screening will be part of a prevention approach in the City of Hamburg to offer primary and secondary prevention interventions adapted to special target groups of community- dwelling elder people (robust in contrast to frail elderly). The implementation should be accompanied by training sessions for physicians in the primary care sector and health improvement programmes for elder citizens.