The role of volumetric modulated arc therapy (VMAT) in gynaecological radiation therapy: A dosimetric comparison of intensity modulated radiation therapy versus VMAT.

INTRODUCTION: For gynaecological cancers, volumetric modulated arc therapy (VMAT) offers comparable plan quality with shorter treatment delivery times when compared to intensity modulated radiation therapy (IMRT). METHODS: The clinical IMRT plans of twenty gynaecological cancer patients were compared with a retrospectively generated VMAT plan. Planning target volume (PTV) metrics compared were D95 > 99%, homogeneity index, and conformity index. Organs at risk (OAR) doses compared were bladder V45 < 35%, bowel V40 < 30%, femoral head and neck (FHN) V30 < 50%, V44 < 35% and V44 < 5%. Plan quality was also assessed by comparing the monitor units (MU), treatment time and the patient-specific quality assurance results. RESULTS: VMAT and IMRT resulted in comparable PTV coverage with D95 values of 98.92% ± 0.69% and 98.91% ± 1.43% respectively, and homogeneity index values of 0.08 ± 0.02 (VMAT) and 0.08 ± 0.03 (IMRT). The conformity index for VMAT was 0.93 ± 0.04 and IMRT 0.85 ± 0.06 (P < 0.001). For the bowel tolerance (40 Gy < 30%) VMAT resulted in 22.39% ± 12.5% compared to 28.8% ± 16.78% for IMRT, with bladder and FHN VMAT doses also lower. VMAT MU were 694.35 ± 126.56 compared to 606.8 ± 96.16 for IMRT (P < 0.01). Treatment times of 6.6 ± 0.82 min and 2.47 ± 0.35 min were achieved for IMRT and VMAT respectively. CONCLUSION: VMAT showed improvements in sparing OAR compared to IMRT. Target volume coverage with VMAT was equivalent or better than that of IMRT. These results in conjunction with the confirmed shorter treatment delivery time, have led to the development and implementation of a clinical protocol.

Self-injurious behavior in correctional settings.

This article reviews the literature concerning self-injury among criminal offenders. It describes many of the problems, barriers, and obstacles to effective assessment and treatment of self-injury and discusses the absence of a clear paradigm within which to develop a classification system and standardized nomenclature to describe the spectrum of self-injurious behaviors. This article distinguishes between self-injury resulting from suicidal versus nonsuicidal intent, presents treatment strategies for managing each, and concludes with a proposed set of eight recommended goals for creating a national strategy to develop self-injury programming in correctional settings.

Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment.

Despite growing interest in assessment of program implementation, little is known about the best way to evaluate whether a particular program has implemented the intended service to a level that is minimally acceptable to a funding source, such as a state mental health authority. Such is the case for assertive community treatment (ACT), an evidence-based practice being widely disseminated. Using an exploratory, actuarial approach to defining program standards, this study applies different statistical criteria for determining whether or not a program meets ACT standards using the 28-item Dartmouth Assertive Community Treatment Scale. The sample consists of 51 ACT programs, 25 intensive case management programs, and 11 brokered case management programs which were compared to identify levels of fidelity that discriminated between programs, but were still attainable by the majority of ACT programs. A grading system based on mean total score for a reduced set of 21 items appeared to be most attainable, but still discriminated ACT programs from other forms of case management. Implications for setting and evaluating ACT program standards are discussed.