Perspectives of Emergency Physicians, Primary Care Physicians, and Otolaryngologists on the Diagnosis and Treatment of Acute Vertigo.

PURPOSE: This study aimed to explore the differences in diagnosis (Dix-Hallpike test; the head impulse, nystagmus, and the test of skew [HINTS] procedures; imaging modalities; and audiological battery) and treatment (pharmacological treatments and the Epley maneuver) of acute vertigo (AV) by examining the perspectives of otolaryngologists, emergency physicians (EPs), and primary care physicians (PCPs). METHOD: A total of 123 physicians (otolaryngologists [n = 40], EPs [n = 41], PCPs [n = 42]) were included in this study. This study was conducted using an online questionnaire created in Google Forms. The questionnaire included five demographic questions and eight questions assessing the diagnosis and treatment of four case scenarios (benign paroxysmal positional vertigo [BPPV], vestibular neuronitis, Meniere's disease [MD], and vertebrobasilar insufficiency). Multiple-response and chi-square tests were used to analyze the data. RESULTS: In the case of BPPV, 82.5% of otolaryngologists, 73.2% of EPs, and 59.6% of PCPs preferred the "Dix-Hallpike maneuver" (p = .067). In addition, 72.5% of otolaryngologists, 48.8% of EPs, and 47.6% of PCPs preferred the Epley maneuver for treatment in a case with BPPV (p = .032). It was found that physicians preferred the most (18.9%) "videonystagmography (VNG)-caloric" test for diagnosis in the MD case. There was a statistically significant difference in the intravenous serum therapy and rest, and Epley maneuver preferences of physicians for the treatment of cases with MD (p = .002 and p = .046). CONCLUSIONS: In this study, significant differences were found in the AV care provided by different specialties. Standardized education systems for AV (symposiums, congresses, scientific activities, etc., with multidisciplinary participation) may be beneficial for improving the diagnosis and treatment process of AV in our country.

Effect of Multileaf Collimator Leaf Position Error Determined by Picket Fence Test on Gamma Index Value in Patient-Specific Quality Assurance of Volumetric-Modulated Arc Therapy Plans.

Aim The correlation between the MLC QA (IBA Dosimetry, Germany) results of the picket fence test created with intentional errors and the patient's quality assurance (QA) evaluation was investigated to assess the impact of multileaf collimator (MLC) positioning error on patient QA. Materials and methods The picket fence, including error-free and intentional MLC errors, defined in Bank In, Bank Out, and Bank Both were analyzed using MLC QA. The QA of 15 plans consisting of stereotactic radiosurgery (SRS), stereotactic body radiotherapy (SBRT), and conventionally fractionated volumetric-modulated arc therapy (VMAT) acquired with electronic portal imaging devices (EPID) was evaluated in the presence of error-free and MLC errors. The QA of plans were analyzed with 2%/2 mm and 3%/3 mm criteria. Results The passing rates of the picket fence test were 97%, 92%, 91%, and 87% for error-free and intentional errors. The criterion of 3%/3 mm wasn't able to detect an MLC error for either SRS/SBRT or conventionally fractionated VMAT. The criterion of 2%/2mm was more sensitive to detect MLC error for the conventionally fractionated VMAT than SRS/SBRT. While only two of SBRT plans had <90%, four of conventionally fractionated VMAT plans had a <90% passing rate. Conclusion We found that the systematic MLC positioning errors defined with picket fence have a smaller but measurable impact on SRS/SBRT than the VMAT plan for a conventionally fractionated and relatively complex plan such as head and neck and endometrium cases.