Radiopaque drug-eluting embolisation beads as fiducial markers for stereotactic liver radiotherapy.

OBJECTIVE: To determine the feasibility of using radiopaque (RO) beads as direct tumour surrogates for image-guided radiotherapy (IGRT) in patients with liver tumours after transarterial chemoembolisation (TACE). METHODS: A novel vandetanib-eluting RO bead was delivered via TACE as part of a first-in-human clinical trial in patients with either hepatocellular carcinoma or liver metastases from colorectal cancer. Following TACE, patients underwent simulated radiotherapy imaging with four-dimensional computed tomography (4D-CT) and cone-beam CT (CBCT) imaging. RO beads were contoured using automated thresholding, and feasibility of matching between the simulated radiotherapy planning dataset (AVE-IP image from 4D data) and CBCT scans assessed. Additional kV, MV, helical CT and CBCT images of RO beads were obtained using an in-house phantom. Stability of RO bead position was assessed by comparing 4D-CT imaging to CT scans taken 6-20 days following TACE. RESULTS: Eight patients were treated and 4D-CT and CBCT images acquired. RO beads were visible on 4D-CT and CBCT images in all cases and matching successfully performed. Differences in centre of mass of RO beads between CBCT and simulated radiotherapy planning scans (AVE-IP dataset) were 2.0 mm mediolaterally, 1.7 mm anteroposteriorally and 3.5 mm craniocaudally. RO beads in the phantom were visible on all imaging modalities assessed. RO bead position remained stable up to 29 days post TACE. CONCLUSION: RO beads are visible on IGRT imaging modalities, showing minimal artefact. They can be used for on-set matching with CBCT and remain stable over time. ADVANCES IN KNOWLEDGE: The role of RO beads as fiducial markers for stereotactic liver radiotherapy is feasible and warrants further exploration as a combination therapy approach.

Food and nutrition research in the Caribbean / Investigación de los alimentos y la nutrición en el Caribe

Studies at the Caribbean Food and Nutrition Institute (CFNI) were conducted to provide information that would guide the prevention and management of major food and nutrition problems in the region. One of the Institute's mandates is to strengthen the capacity of countries to collect, analyse, interpret and use data to monitor, develop, influence, strengthen or inform policy decisions, interventions and public education programmes. Over the years, numerous studies were done with countries at the individual level, however, as a regional institution, the primary aim was (i) to identify the challenges and opportunities that have application across the region and (ii) to go beyond the descriptive work and elaborate the proximal and distal barriers and interventions that relate to the two major food and nutrition problems in the Caribbean - food insecurity and obesity. Central to all the research was the recognition that unless the studies are grounded in the context of poverty and inequity, the importance of the findings on food security and obesity will be consequently diminished.

En el Instituto Caribeño de Nutrición y Alimentos (ICAA) se llevaron a cabo estudios con el propósito de ofrecer información encaminada a servir de guía a la hora de prevenir y tratar los problemas principales de la nutrición en la región. Uno de los mandatos del Instituto es fortalecer la capacidad de los países para recoger, analizar, interpretar y usar datos que permitan monitorear, desarrollar, influir, fortalecer o informar decisiones en cuanto a trazar políticas, realizar intervenciones y organizar programas para la educación del público. A través de los años, se hicieron numerosos estudios en diversos países a nivel individual, Sin embargo, al abordar el problema como institución regional, el objetivo primario fue (i) identificar los desafíos y oportunidades aplicables en toda la región y (ii) ir más allá del trabajo descriptivo y elaborar las barreras distales y proximales así como las intervenciones que guardan relación con los dos problemas principales de los alimentos y la nutrición en el Caribe - la inseguridad de los alimentos y la obesidad. Crucial para toda la investigación ha sido el reconocimiento de que a menos que los estudios tengan por base el contexto de la pobreza y la falta de equidad, la importancia de los hallazgos en relación con la seguridad de los alimentos y la obesidad disminuirá de conformidad con ello.

Obesity prevention: the key to non-communicable disease control / Prevención de la obesidad: clave del control de las enfermedades no comunicables

Non-communicable diseases (NCDs) are the main public health problem in the Caribbean and they place a severe economic burden on the health systems in the region. This paper contends that preventing obesity is a critical factor in controlling NCDs. The paper further argues that obesity prevention is more likely to come from structural and policy-related changes to the environment than from medical interventions targeted at the individual. Rolling back the rapid increase in obesity in the Caribbean requires much more than the traditional passive approach that relied almost entirely on education for individual behavioural change. The traditional models of obesity control have generally failed globally and a new public policy approach needs to be instituted to attack this epidemic in a multisectoral way. Effective control of obesity will require a shift away from the traditional focus on clinical management and individual behaviour change towards strategies which deal with the environment in which such behaviours occur. Outlined in this paper are key policy changes required by the various sectors whose inputs are vital to the success of prevention efforts.

Las enfermedades no comunicables (ENCs) constituyen el problema principal de la salud pública en el Caribe y representan una pesada carga económica para los sistemas de salud en la región. Este trabajo sostiene que la prevención de la obesidad es un factor crítico a la hora de controlar las ENCs. El trabajo sostiene además que la prevención de la obesidad tiene mayor probabilidad de producirse como consecuencia de cambios estructurales y relacionados con las políticas hacia el medio ambient, que como resultado de intervenciones médicas dirigidas al individuo. El retroceso del rápido aumento de los niveles de obesidad en el Caribe requiere mucho más que el enfoque tradicional pasivo basado casi totalmente en la educación encaminada a cambios en la conducta individual. Los modelos tradicionales de control de la obesidad han fallado por lo general globalmente. Se necesita instaurar un nuevo enfoque en materia de políticas públicas para atacar esta epidemia de una manera multisectorial. El control efectivo de la obesidad requerirá un cambio del foco de atención - tradicionalmente centrado en el tratamiento clínico y el cambio de comportamiento individual - hacia estrategias que traten con el ambiente en que tales comportamientos ocurren. El trabajo bosqueja cambios claves en materia de políticas, requeridos por diversos sectores cuya contribución es vital para el éxito de los esfuerzos por la prevención.