ASSESSMENT OF OVERRANGING AS A FUNCTION OF PITCH, COLLIMATION AND ROTATION TIME FOR THREE OF THE MOST RECENT AND WIDESPREAD CT SCANS IN FRANCE.

PURPOSE: to assess overranging (OR) as a function of pitch, collimation and rotation time for three commonly used CT models in France. METHODS: OR was measured using XR-SP2 Gafchromic films (Ashland, USA) and computed from exposure data for three widely used CT models in France. The impact of collimation, pitch and rotation time on OR was analyzed while comparing the three CT models. RESULTS: for a typical head protocol, measured OR was found to be equal to 1.64 cm for CT scan A, 0.5 cm for CT scan B and 3.44 cm for CT scan C. OR values were respectively of 4.47, 3.24 and 7.81 cm for the typical chest protocol and the 3 CT models. OR was lowest at pitch values <1 for CT scan A, while it linearly increased with pitch for CT scan B and was lowest for high pitch values for CT scan C. Additionally, OR increase with collimation (24 mm to 38.4 mm) was most pronounced for CT scan B (factor of 2.2 for low pitch (0.5) and 2.8 for high pitch (1.2)) while it increased linearly regardless of the pitch for CT scans A and C. Rotation time also proved to slightly affect OR mainly for CT scan B (up to 2.2 mm). CONCLUSION: the present study shows that overranging remains an issue in modern CT scanners with large disparities across the vendors.

Psychodynamic interventions in cancer care I: psychometric results of a randomized controlled trial.

OBJECTIVE: This study aimed to assess the effectiveness of psychodynamic interventions in cancer care. METHODS: Between 2006 and 2009, each consecutive outpatient of the Oncology Center of the University Hospital of Lausanne was invited to participate in a trial evaluating the effects of psychological support. Accepting patients were randomly assigned to an immediate intervention or a delayed intervention [4-month waiting list]. Patients who declined support were asked to participate in an observational group [OG]. Socio-demographic and medical data, anxiety, and depression [HADS], psychological distress [SCL-90], alexithymia [TAS] and quality of life [EORTC] were recorded at baseline, and at 1, 4, 8, and 12-months follow-up. RESULTS: Of the 1973 approached patients, 1057 were excluded, 530 refused, and 386 were included with 196 of them participating in the OG. Of the patients in the intervention group [IG] [N = 190], 94 were randomized to the immediate intervention and 96 to the delayed intervention group (dIG). IG patients were younger, predominantly female, and had more psychological symptoms compared with those in the OG. Although patients of the IG and OG showed significant improvement in quality of life from baseline to 12-months follow-up, other outcomes [anxiety, depression, psychological distress, and alexithymia] remained unchanged. CONCLUSIONS: The intervention was not effective with regards to psychometric outcome. The results have to be interpreted in light of the study design [untargeted intervention], the low levels of psychiatric symptoms, dropout of symptomatic patients, and the high prevalence of alexithymia.

[The role of the auxiliary ego in the care of the chronic pain patient]. / La fonction de Moi auxiliaire dans la prise en charge des douloureux chroniques.

The management of the patient suffering from chronic pain, situated on the interface between body and psyche, necessitates a global approach and often a coordinated, stable and containing network of care. Liaison psychiatry has become part of this network, together with various health care professionals from somatic disciplines. Based on these experiences, this article aims to better understand the therapeutic role of those who take care of the chronic pain patient by identifying the auxiliary ego as a key element of care. The historical development and conceptual framework of the auxiliary ego are utilized to highlight its roles in the different aspects of care of these patients:in the medical consultation, individual psychotherapy, group psychotherapy and in the interdisciplinary meetings.

[Follow-up of the cancer patient, maintaining self-identity]. / Suivi du patient oncologique, garant de la permanence de soi.

The individual facing the diagnosis of cancer is subjected to abrupt changes with regard to his inner world, his life, habits and social relationships. The patient's capacity to cope, to integrate changes in the way of living and to face the future is determined by his personal resources. However, psychological support may also be an important mean to search for and find sense to the singular experience of the illness. The narrative reconstruction within a supportive setting provides the patient a possibility to recognise his pain as an integral part of himself. A life narrative, which integrates the illness, allows the patient to re-appropriate his history again. Such a therapeutic project necessitates from the therapist a psychological and temporal availability and a capacity to create links all along the different stages of the disease.

[Improving communication skills is possible: "clinical" experience and scientific assessment]. / Améliorer les compétences communicationnelles: expérience "clinique" et evaluation scientifique.

While the importance of individualized and comprehensive care, taking into account the bio-psychosocial characteristics of the patient, has been demonstrated, this remains a considerable challenge in daily clinical practise. The Swiss Cancer League promotes since many years so called Communication Skills Training (CST). Different studies have demonstrated a positive impact of CST, illustrating that communicational competence is not only a consequence of a personal and professional development, but can be modified by an intensive and interactive training. A new scientific approach aims to elucidate the underlying mechanisms of communicational improvements, based on the hypothesis that CTS modify participants' defence mechanisms.

[Diagnosis and treatment of depression in patients with cancer]. / Diagnostic et traitement de la dépression chez les patients souffrant de cancer.

Thirty percent of cancer patients experience depression during the course of their illness. Depression may occur at several key-moments: after diagnosis, a relapse, in the context of treatment failure. Depression is correlated with biological factors due to illness itself and its treatments, but also with inappropriate coping strategies. Diagnosis of depression is not straightforward in cancer patients. Its phenomenology is specific. Moreover, patients as well as clinicians may be reluctant to address the problem of psychological well-being. The treatment of depression has proven to increase quality of life as well as satisfaction with treatments and compliance. Antidepressants are the first line treatment. Psychotherapy and several psychological interventions are considered to be a valid alternative. In most severe cases a combined treatment is mandatory.

[Progress in dosage optimization for stereotactic radiosurgery]. / Progrès en optimisation dosimétrique pour la radiochirurgie stéréotaxique.

Stereotactic radiosurgery is a technique for treatment of intracranial lesions requiring high precision in all steps--from image acquisition to final irradiation. One of most difficult steps is the treatment planning phase, consisting of determination of irradiation parameters sufficient to cover the target volume by avoiding sensitive volumes. A manual and empirical definition can be very long and difficult, especially in the case of complex target volumes situated in sensitive zones. As in conventional radiotherapy, stereotactic radiosurgery has taken advantages from dosimetric optimization. The question is: "What is the configuration of irradiation parameters used in order to obtain the treatment plan by satisfying defined constraints?". The purpose of this article is to summarize optimization methods used in radiosurgery and to describe the technical alternatives proposed for this treatment as well as the possibilities of plan evaluation between different techniques. This purpose will be illustrated by the optimization methodology used in the Center Oscar Lambret of Lille, France for the radiosurgical treatment with linear accelerator.

[Dosimetric quality control in stereotactic radiotherapy with the aid of radiosensitivity]. / Contrôle de qualité dosimétrique en radiothérapie stéréotaxique à l'aide de gels radiosensibles.

Typical dosimeters used in stereotactic radiation therapy, such as ionization chambers, films, and thermoluminescent diodes, allow basic physical measurements. They are, however, neither well suited to discern small target volumes with high dose gradient, nor suitable for three-dimensional (3D) dose measurements. Gel dosimetry is becoming more and more interesting, owing to magnetic resonance imaging (MRI). It permits isocenter position planning verification of accuracy and the precision of the 3D dose mapping in the brain (when irradiated in realistic conditions), especially when several different targets are concerned. Many authors have assessed stereotactic radiation therapy quality control using different gels, and different irradiation procedures. This paper consists of the review of these different methods to assess quality control. Gel dosimetry cannot provide absolute dose measurements. However, gels can be used to check the 3D dose mapping with a high degree of detail. In our experiment, the difference between the stereotactic frame center and the isocenter is about 1 mm. The difference between the theoretical isodoses obtained by the treatment planning system and the experimental isodoses obtained by the MRI gray level calibration is also about 1 mm, the order of magnitude of the MRI pixel size.

[Determination of target volume for dosimetric planning in stereotactic radiosurgery]. / Détermination de volumes cibles pour la planification dosimétrique en radiochirurgie stéréotaxique.

Stereotactic radiosurgery needs an accurate determination of the target volumes to be irradiated and of sensitive volumes to be spared: position, external boundaries, internal volume. These parameters can be obtained by using either projection imaging (radiographs, digital angiography), or tomographic imaging (magnetic resonance imaging, computerized tomography). The authors describe the methods used in these different imaging modalities and the problems encountered in target determination. Methods of validations are described. Results obtained on phantoms and on actual target volume are given and discussed.

Effect of calcitonin on free and total plasma tryptophan in human.

The injection of calcitonin (0.5 or 1 microgram/Kg wt.) did not affect free and total tryptophan plasma levels in six healthy human subjects. Calcitonin besides a significant diuresis produced a slight hypoinsulinemia parallelled by a slight hyperglycemia.