Investigation of Medical Accidents for the Development of Alert System to Reduce Alert Fatigue.

Alert fatigue, a decrease in sensitivity to alerts, is a problem in the medical field. In this study, a survey was conducted on medical accidents in order to develop an alert that could be expected to reduce alert fatigue. As a result, medical accidents related to drugs are common worldwide, and the need for an alert system that can detect the implementation of medical treatment was found.

Three-dimensional and multienergy gamma-ray simultaneous imaging by using a Si/CdTe Compton camera.

PURPOSE: To develop a silicon (Si) and cadmium telluride (CdTe) imaging Compton camera for biomedical application on the basis of technologies used for astrophysical observation and to test its capacity to perform three-dimensional (3D) imaging. MATERIALS AND METHODS: All animal experiments were performed according to the Animal Care and Experimentation Committee (Gunma University, Maebashi, Japan). Flourine 18 fluorodeoxyglucose (FDG), iodine 131 ((131)I) methylnorcholestenol, and gallium 67 ((67)Ga) citrate, separately compacted into micro tubes, were inserted subcutaneously into a Wistar rat, and the distribution of the radioisotope compounds was determined with 3D imaging by using the Compton camera after the rat was sacrificed (ex vivo model). In a separate experiment, indium 111((111)In) chloride and (131)I-methylnorcholestenol were injected into a rat intravenously, and copper 64 ((64)Cu) chloride was administered into the stomach orally just before imaging. The isotope distributions were determined with 3D imaging after sacrifice by means of the list-mode-expectation-maximizing-maximum-likelihood method. RESULTS: The Si/CdTe Compton camera demonstrated its 3D multinuclear imaging capability by separating out the distributions of FDG, (131)I-methylnorcholestenol, and (67)Ga-citrate clearly in a test-tube-implanted ex vivo model. In the more physiologic model with tail vein injection prior to sacrifice, the distributions of (131)I-methylnorcholestenol and (64)Cu-chloride were demonstrated with 3D imaging, and the difference in distribution of the two isotopes was successfully imaged although the accumulation on the image of (111)In-chloride was difficult to visualize because of blurring at the low-energy region. CONCLUSION: The Si/CdTe Compton camera clearly resolved the distribution of multiple isotopes in 3D imaging and simultaneously in the ex vivo model.

Imaging of 99mTc-DMSA and 18F-FDG in humans using a Si/CdTe Compton camera.

The Compton camera can simultaneously acquire images of multiple isotopes injected in a body; therefore, it has the potential to introduce a new subfield in the field of biomedical imaging applications. The objective of this study is to assess the ability of a prototype semiconductor-based silicon/cadmium telluride (Si/CdTe) Compton camera to simultaneously image the distributions of technetium (99mTc)-dimercaptosuccinic acid (DMSA) (141 keV emission) and 18F-fluorodeoxyglucose (FDG) (511 keV emission) injected into a human volunteer. 99mTc-DMSA and 18F-FDG were injected intravenously into a 25-year-old male volunteer. The distributions of 99mTc-DMSA and 18F-FDG were simultaneously made visible by setting a specified energy window for each radioisotope. The images of these radiopharmaceuticals acquired using the prototype Compton camera were superimposed onto computed tomography images for reference. The reconstructed image showed that 99mTc-DMSA had accumulated in both kidneys, which is consistent with the well-known diagnostic distribution determined by clinical imaging via single-photon emission computed tomography. In the 18F-FDG image, there is broad distribution around the liver and kidneys, which was expected based on routine clinical positron emission tomography imaging. The current study demonstrated for the first time that the Si/CdTe Compton camera was capable of simultaneously imaging the distributions of two radiopharmaceuticals, 99mTc-DMSA and 18F-FDG, in a human body. These results suggest that the Si/CdTe Compton camera has the potential to become a novel modality for nuclear medical diagnoses enabling multi-probe simultaneous tracking.

Analysis of the Stay Time of Patients in Gunma University Heavy Ion Medical Center (GHMC) Using RFID Technology.

We observed the stay time of patients and staff in Gunma University Heavy Ion Medical Center. The stay time of patients with the prostatic cancer and the facing time with radiotherapy technicians in treatment rooms were significantly reduced as times goes by. This decreasing in time has an implication in scheduling algorithm development: for patients. RFID technology can be a potential method to track both staff and patients and thereby to assess the resource utilization efficiency.

MRI response of obturator internus muscle to carbon-ion dose in prostate cancer treatment.

It is important to confirm the dose distribution and its biophysiological response in patients subjected to carbon-ion radiotherapy (CIRT) by using medical imaging methods. In this study, the correlation between the signal intensity changes of muscles observed in magnetic resonance imaging (MRI) after CIRT and planned dose distribution was evaluated. Seven patients were arbitrarily selected from among localized prostate cancer patients on whom CIRT was performed in our facilities in 2010. All subjects received the same dose of CIRT, namely, 57.6 Gy relative biological effectiveness (RBE) in 16 fractions. The following two types of images were acquired for each subject: planning computed tomography (CT) images overlaying the dose distribution of CIRT and MRI T2-weighted images (T2WI) taken 1 year after CIRT. The fusion image of the planning CT and MRI images was registered by using a treatment-planning system, and the CIRT dose distribution was compared with changes observed in the MRI of the obturator internus muscles located near the prostate. The signal changes in the axial image passing through the isocenter of the planning target volume were digitized, and a scatter diagram was created showing the relationship between the radiation dose and digitized signal changes. A strong correlation between the radiation dose and the MRI signal intensity changes was observed, and a quadratic function was found to have the best fit. However, estimating the dose distribution from the normalized MRI signal intensity is difficult at this point, owing to the wide variation. Therefore, further investigation is required.

Annihilation gamma imaging for carbon ion beam range monitoring using Si/CdTe Compton camera.

In this study, we performed on-beam monitoring of 511 keV annihilation gamma emissions using a Compton camera. Beam monitoring experiments were conducted using carbon ion beams of 290 MeV/u irradiated on a polymethyl methacrylate (PMMA) phantom. The intensity of the beams was 3 × 109 particles per pulse, with 20 pulses per minute. A Compton camera based on a silicon/cadmium telluride (Si/CdTe) detector was used to monitor the annihilation gamma rays emitted from the phantom. We successfully reconstructed the energy events of 511 keV annihilation gamma rays and developed Compton images using a simple back-projection method. The distribution of the annihilation gamma ray generation traced the beam trajectory and the peak intensity position was a few millimeters shorter than the Bragg peak position. Moreover, the effect of the beam range shifter with 30, 60, and 90 mm water equivalent thickness (WET) was clearly visualized in the reconstructed Compton images. The experimentally measured values of the corresponding range shifts in the PMMA phantom (28.70 mm, 52.49 mm, and 76.77 mm, respectively) were consistent with the shifts of the Bragg peak position (25.50 mm, 51.30 mm and 76.70 mm, respectively) evaluated by Monte Carlo simulation. The results show that the Si/CdTe Compton camera has strong potential for on-beam monitoring of annihilation gamma rays in particle therapy in clinical situations.

In vivo simultaneous imaging with 99mTc and 18F using a Compton camera.

We have been developing a medical imaging technique using a Compton camera. This study evaluates the feasibility of clear imaging with 99mTc and 18F simultaneously, and demonstrates in vivo imaging with 99mTc and/or 18F. We used a Compton camera with silicon and cadmium telluride (Si/CdTe) semiconductors. We estimated the imaging performance of the Compton camera for 141 keV and 511 keV gamma rays from 99mTc and 22Na, respectively. Next, we simultaneously imaged 99mTc and 18F point sources to evaluate the cross-talk artifacts produced by a higher energy gamma-ray background. Then, in the in vivo experiments, three rats were injected with 99mTc-dimercaptosuccinic acid and/or 18F-fluorodeoxyglucose and imaged. The Compton images were compared with PET images. The rats were euthanized, and the activities in their organs were measured using a well counter. The energy resolution and spatial resolution were measured for the sources. No apparent cross-talk artifacts were observed in the practical-activity ratio (99mTc:18F = 1:16). We succeeded in imaging the distributions of 99mTc and 18F simultaneously, and the results were consistent with the PET images and well counter measurements. Our Si/CdTe Compton camera can thus work as a multi-tracer imager, covering various SPECT and PET probes, with less cross-talk artifacts in comparison to the conventional Anger cameras using a collimator. Our findings suggest the possibility of human trials.

Five-fraction CyberKnife radiotherapy for large brain metastases in critical areas: impact on the surrounding brain volumes circumscribed with a single dose equivalent of 14 Gy (V14) to avoid radiation necrosis.

The efficacy and toxicity of five-fraction CyberKnife radiotherapy were evaluated in patients with large brain metastases in critical areas. A total of 85 metastases in 78 patients, including tumors >30 cm(3) (4 cm in diameter) were treated with five-fraction CyberKnife radiotherapy with a median marginal dose of 31 Gy at a median prescribed isodose of 58%. Changes in the neurological manifestations, local tumor control, and adverse effects were investigated after treatment. The surrounding brain volumes circumscribed with 28.8 Gy (single dose equivalent to 14 Gy: V14) were measured to evaluate the risk of radiation necrosis. Neurological manifestations, such as motor weakness, visual disturbances and aphasia improved in 28 of 55 patients (50.9%). Local tumor control was obtained in 79 of 85 metastases (92.9%) during a median follow-up of eight months. Symptomatic edema occurred in 10 patients, and two of them (2.6%) required surgical resection because of radiation necrosis. The V14 of these patients was 3.0-19.7 cm(3). There were 16 lesions with a V14 of ≥7.0 cm(3), and two of these lesions developed extensive brain edema due to radiation necrosis. None of the patients with a V14 of <7.0 cm(3) exhibited edema requiring surgical intervention. We therefore conclude that a high rate of local tumor control and low rates of complications can be obtained after five-fraction CyberKnife radiotherapy for large metastases in critical areas. The V14 of the surrounding brain is therefore a useful indicator for the risk of radiation necrosis in patients with large metastases.

Optimal hypofractionated conformal radiotherapy for large brain metastases in patients with high risk factors: a single-institutional prospective study.

BACKGROUND: A single-institutional prospective study of optimal hypofractionated conformal radiotherapy for large brain metastases with high risk factors was performed based on the risk prediction of radiation-related complications. METHODS: Eighty-eight patients with large brain metastases ≥10 cm(3) in critical areas treated from January 2010 to February 2014 using the CyberKnife were evaluated. The optimal dose and number of fractions were determined based on the surrounding brain volume circumscribed with a single dose equivalent (SDE) of 14 Gy (V14) to be less than 7 cm(3) for individual lesions. Univariate and multivariate analyses were conducted. RESULTS: As a result of optimal treatment, 92 tumors ranging from 10 to 74.6 cm(3) (median, 16.2 cm(3)) in volume were treated with a median prescribed isodose of 57% and a median fraction number of five. In order to compare the results according to the tumor volume, the tumors were divided into the following three groups: 1) 10-19.9 cm(3), 2) 20-29.9 cm(3) and 3) ≥30 cm(3). The lesions were treated with a median prescribed isodose of 57%, 56% and 55%, respectively, and the median fraction number was five in all three groups. However, all tumors ≥20 cm(3) were treated with ≥ five fractions. The median SDE of the maximum dose in the three groups was 47.2 Gy, 48.5 Gy and 46.5 Gy, respectively. Local tumor control was obtained in 90.2% of the patients, and the median survival was nine months, with a median follow-up period of seven months (range, 3-41 months). There were no significant differences in the survival rates among the three groups. Six tumors exhibited marginal recurrence 7-36 months after treatment. Ten patients developed symptomatic brain edema or recurrence of pre-existing edema, seven of whom required osmo-steroid therapy. No patients developed radiation necrosis requiring surgical resection. CONCLUSION: Our findings demonstrate that the administration of optimal hypofractionated conformal radiotherapy based on the dose-volume prediction of complications (risk line for hypofractionation), as well as Kjellberg's necrosis risk line used in single-session radiosurgery, is effective and safe for large brain metastases or other lesions in critical areas.

Efficiency and safety of new radiofrequency identification system in a hospital.

Radiofrequency identification (RFID) applications have the capability to obtain real-time information on the location and properties of tagged people or objects. The efficiency and safety of the new RFID system (UHF band, 953 MHz) were tested in our hospital. We examined whether 1 to 4 persons and medical equipment with IC tags were captured by RFID readers in a laboratory. We next tested whether electric signals produced by RFID could affect medical devices. New radio frequency tags provided extensive patient identification and helped track capital equipment within a laboratory. Electric fields produced by the new RFID did not significantly affect medical devices in our hospital. New RFID system was safe and useful for tracking people and medical equipments in a hospital. As healthcare systems today involve increasingly complex and interrelated processes, the new RFID technologies may enhance patient safety, and wellness, and reduce staff workloads in a hospital.

Three-fraction CyberKnife radiotherapy for brain metastases in critical areas: referring to the risk evaluating radiation necrosis and the surrounding brain volumes circumscribed with a single dose equivalence of 14 Gy (V14).

The efficacy and toxicity of three-fraction CyberKnife radiotherapy were evaluated in patients with brain metastases in critical areas. One hundred and fifty-nine metastases in 145 patients including tumors >10 cm(3) were treated with three-fraction CyberKnife radiotherapy with a median marginal dose of 27 Gy at a median prescribed isodose of 60%. Changes in the neurological manifestations, local tumor control and adverse effects were investigated after treatment. The surrounding brain volumes circumscribed with 23.1 Gy (single dose equivalence of 14 Gy: V14) were measured to evaluate the risk of adverse effects. Neurological manifestations, such as motor weakness, visual disturbances and aphasia improved in 26 of 97 patients (26.8%). Local tumor control was obtained in 137 of 143 metastases (95.8%) during a median follow-up of 7 months. Nine patients had symptomatic edema and three of them (2.1%) required surgical resection because of radiation necrosis. The V14 of these patients was 4.6-31.5 cm(3). There were 35 lesions with a V14 of 7 cm(3) or more and three of them developed extensive brain edema due to radiation necrosis. None of the patients with a V14 of <7 cm(3) exhibited edema requiring an operation. We therefore conclude that a high rate of local tumor control and low rates of complications are obtained after three-fraction CyberKnife radiotherapy for metastases in critical areas. The V14 of the surrounding brain therefore seems to be a useful indicator for the risk evaluation of radiation necrosis in patients with larger metastases.

Beam range estimation by measuring bremsstrahlung.

We describe a new method for estimating the beam range in heavy-ion radiation therapy by measuring the ion beam bremsstrahlung. We experimentally confirm that the secondary electron bremsstrahlung process provides the dominant bremsstrahlung contribution. A Monte Carlo simulation shows that the number of background photons from annihilation gamma rays is about 1% of the bremsstrahlung strength in the low-energy region used in our estimation (63-68 keV). Agreement between the experimental results and the theoretical prediction for the characteristic shape of the bremsstrahlung spectrum validates the effectiveness of our new method in estimating the ion beam range.

Carbon Ion Radiotherapy at the Gunma University Heavy Ion Medical Center: New Facility Set-up.

Carbon ion radiotherapy (C-ion RT) offers superior dose conformity in the treatment of deep-seated tumors compared with conventional X-ray therapy. In addition, carbon ion beams have a higher relative biological effectiveness compared with protons or X-ray beams. C-ion RT for the first patient at Gunma University Heavy Ion Medical Center (GHMC) was initiated in March of 2010. The major specifications of the facility were determined based on the experience of clinical treatments at the National Institute of Radiological Sciences (NIRS), with the size and cost being reduced to one-third of those at NIRS. The currently indicated sites of cancer treatment at GHMC are lung, prostate, head and neck, liver, rectum, bone and soft tissue. Between March 2010 and July 2011, a total of 177 patients were treated at GHMC although a total of 100 patients was the design specification during the period in considering the optimal machine performance. In the present article, we introduce the facility set-up of GHMC, including the facility design, treatment planning systems, and clinical preparations.

Experimental demonstration of the induction synchrotron.

We report an experimental demonstration of the induction synchrotron, the concept of which has been proposed as a future accelerator for the second generation of neutrino factory or hadron collider. The induction synchrotron supports a superbunch and a superbunch permits more charge to be accelerated while observing the constraints of the transverse space-charge limit. By using a newly developed induction acceleration system instead of radio-wave acceleration devices, a single proton bunch injected from the 500 MeV booster ring and captured by the barrier bucket created by the induction step voltages was accelerated to 6 GeV in the KEK proton synchrotron.

Quasiadiabatic, nonfocusing transition-energy crossing.

A quasiadiabatic nonfocusing transition-energy crossing is proposed for suppressing any nonadiabatic and undesired features in a longitudinally separated function-type accelerator, in which particles are confined by an radio-frequency voltage with an adiabatic reduction of the amplitude and accelerated by a step voltage. This new method has been examined, both theoretically and experimentally.

Observation of the acceleration of a single bunch by using the induction device in the KEK proton synchrotron.

A single rf bunch in the KEK proton synchrotron was accelerated with an induction acceleration method from the injection energy of 500 MeV to 5 GeV.