RESUMO
The IAEA-AAPM new dosimetry formalism [Med. Phys. 35, 5179 (2008)] was applied to clinical IMRT quality assurance (QA). Twenty different IMRT QA fields were created on the CT images of a 30×30×17 cm3 Solid Water™ phantom. Two Farmer-type chambers, Exradin A12 and NE2571, and a smaller Exradin A1SL ionization chamber were cross-calibrated against a reference detector, the PTW micro liquid ion chamber (microLion), in the lowest dose gradient region in each IMRT QA field delivery. Based on the new dosimetry formalism, the clinical correction factor was measured in a fully-rotated delivery and a delivery at a single gantry angle, a collapsed delivery. For the calibrated Exradin A12, the measured dose with the clinical correction factor was compared with a calculated dose using Monte Carlo (MC) methods. The clinical correction factor deviated from unity by up to 2.4% and 3.7% in the fully-rotated and collapsed deliveries, respectively, depending on the dose distribution in the chamber collecting volume. For the Exradin A1SL, the correction factor was generally closer to unity due to the reduced dose gradient on the smaller collecting volume. In the fully-rotated delivery, the measured dose with the clinical correction factor is different from the MC-calculated dose to within 4%; while the discrepancy was greater, up to 8%, in the collapsed delivery due to the much heterogeneous dose distribution in the chamber collecting volume. This work proves that the suggested dosimetry technique is effective to improve the dosimetric consistency of clinical IMRT QA.
RESUMO
Little information on the practice of female circumcision/female genital mutilation (FC/FGM) in the West is currently available. Recent legislative efforts have largely ignored the main public health issue: the needs of girls and women living with circumcision in a new country that condemns the practice and where health care providers are not trained in the management of its complications. We report here on a needs assessment designed to determine the extent of FC/FGM in African immigrant communities in New York City, the health and social service needs of African immigrant women, and the training and information needs of their providers. Obstetrics/ gynecology providers in 8 of New York's 11 public hospitals and 10 maternal infant care/family planning (MIC/FP) clinics were surveyed, along with 20 women from FGM-practicing countries. Quality services for women living with circumcision can be fostered if care is provided in a sensitive and culturally appropriate manner, with thorough training and education of health care providers on the physical and mental health consequences and clinical management of FC/FGM, along with counseling guidelines, interdepartmental linkages, referrals and integrated service delivery, and the provision of translators and information in African languages.
