Digital Commons Network^™

Perception Of Pediatric Readiness Across A Health System's Emergency Departments, Rebekah L. Sabo

Doctoral Dissertations

The recent pandemic and pediatric respiratory syncytial virus surge have reinvigorated pediatric care readiness conversations. National strategies and associations exist to guide health systems in improving the quality of emergency care offered to pediatric populations by first assessing readiness for care. These research strategies center on survey implementation and staff engagement in general emergency departments with the goal to improve staff readiness to care for pediatric patients that may present for treatment. What impact would developing a consolidated pediatric readiness program that includes: pediatric emergency care coordinator designation for each emergency department, pediatric readiness education and committee engagement have on …

Deprescribing Proton Pump Inhibitors In A Rural Health Clinic, Jason Thomas Barney

Doctoral Dissertations

Background: Proton pump inhibitors (PPIs) have been extensively prescribed for gastrointestinal pathologies, contributing to $14 billion in annual expenditure in the United States alone. Inappropriate PPI prescriptions, affecting 48% of adults, raise concerns about prolonged usage and associated health risks. Addressing these issues is vital, considering the significant impact of PPIs on patient health and healthcare costs.

Local Problem: A Midwestern clinic grapples with inappropriate and unnecessary PPI use among patients. In response, a comprehensive deprescribing intervention combining a provider algorithm with patient education was implemented to reduce PPI usage that was medically unnecessary.

Methods: A literature …

Comparative Analysis Of Rectum Delineation: Inter-Observer Agreement Among Treatment Planners Versus Auto Segmentation In A Single Institution, Haley Douglas

Culminating Experience Projects

Abstract

Introduction

The past 20 years have seen a continuous rise in the cancer patient population, resulting in staffing shortages, longer wait times for patients, and potentially lower-quality care. Artificial intelligence has been incorporated into the healthcare system and has provided ease with understaffing. Using AI technology to delineate structures can reduce planning time and variation between planners. The objective of this research is to assess the level of consistency in the rectum boundary delineation performed by different dosimetrists working at a single institution, as compared to the performance of the AutoContour software. This analysis will help determine the efficacy …

Comparative Retrospective Study Of Proton Arc Planning With Elsa Algorithm And Impt With Monte Carlo Algorithm With Raystation Treatment Planning System, Matthew L. Carpenter Ms, Msha, Bsrt(R)(T)

Culminating Experience Projects

Proton arc therapy (PAT) will become widely available soon. It is crucial to determine if this technique and the associated calculation algorithms provided by treatment planning system vendors compete favorably with established proton therapy techniques like intensity modulated proton therapy (IMPT) and the Monte Carlo dose calculation algorithm used to compute IMPT doses in today’s clinic. RaySearch Laboratories have produced a modified Monte Carlo algorithm called ELSA.

ELSA stands for early layer spot assignment and is RaySearch Laboratories proposed solution to reduce optimization time during treatment planning for PAT. This research study will look at proton plan robustness to determine …

Dosimetric Evaluation Of Left-Sided Chest Wall Vmat Treatment With And Without Jaw Tracking; Dose Comparison Of Left Anterior Descending Artery Versus Heart Mean Dose, Jacqueline J. Emus

Culminating Experience Projects

Radiation therapy has significantly improved breast cancer survival rates; however, it can still lead to long-term side effects, particularly affecting the heart. Left-side breast cancer patients face higher risks due to the proximity of the heart to the treatment area. To mitigate cardiac toxicity, various strategies, including jaw tracking and Volumetric Modulated Arc Therapy (VMAT), have been proposed. This study investigates the dosimetric impact of VMAT plans with and without jaw tracking on the left anterior descending artery (LAD) dose and heart mean dose in post-mastectomy breast cancer patients. Ten patients previously treated with VMAT were evaluated, and the results …

A Retrospective Comparison Of Dose Distribution Within Density Override And Avoidance Structures In Volumetric Arc Therapy Prostate Plans With Hip Prosthetics: A Dosimetric Evaluation, Jared Richard Brinkman

Culminating Experience Projects

Introduction

Prostate cancer is one of the most common cancers among men, and its incidence is a significant health concern. The optimal radiation treatment for prostate cancer patients needs to be tailored to reduce toxicities to organs at risk within the treated area. This study aims to retrospectively evaluate the dose distribution to organs at risk (OARs) in patients with hip prosthetics for volumetric modulated arc therapy (VMAT) prostate cancer plans.

Methods

The study included ten prostate cancer patients with at least one prosthetic hip who received VMAT plans at a Midwest Radiation Oncology Center. Various data points, including target …

What Effect Does Flexible Work Arrangements Have On Efficiency And Job Satisfaction In Medical Dosimetry?, Michelle Walters

Culminating Experience Projects

Abstract

The purpose of this research study is to determine new trends in the medical dosimetry profession that relate to when and where work is being completed. It is also of interest to understand efficiencies within radiation oncology departments as well as how medical dosimetrists work arrangements impact job satisfaction. A voluntary survey of current medical dosimetrists was conducted which asked close-ended questions about simulation to treatment time frames, employment type, hours worked, departmental efficiency and perceived job satisfaction. It was established that the resulting 185 responses provided statistically significant results. Greater than half of participants answered yes to either …

Dosimetric Comparison Of Glioblastoma Radiotherapy Treatment Plans On A Low-Field Mri-Guided Linear Accelerator Compared To Conventional C-Arm Linear Accelerator, Emily J. Moats

Culminating Experience Projects

Introduction

MRI-guided radiation therapy has proven to provide many benefits such as real-time tracking, dose escalation, and the ability to perform online adaptive therapy. The objective of this study is to compare curative treatment plans for glioblastoma tumors on a low-field MR-guided linac vs a C-Arm linac and evaluate if they are comparable in terms of coverage, organ at risk sparing, delivery time, and deliverability.

Methods

This is a retrospective study that consisted of 15 previously treated patients who received radiation therapy for glioblastoma on a C-Arm linac. The CT simulation data that was used for the original treated plans …

A Quantitative Dosimetric Comparison Of Dibh Vmat And Static-Imrt Apbi Treatments: Evaluating Large Left Sided Lumpectomy Cavities Located Near The Chest Wall, Christopher Jordan Clifton

Culminating Experience Projects

Abstract

Introduction

The main purpose of this study was to determine whether there was a significant difference between the dose distributions when comparing static-IMRT and VMAT plans for patients with large left sided lumpectomy cavities located near the chest wall while utilizing DIBH. Thorough planning and statistical analysis was performed to determine whether there was a clear advantage for either treatment technique to better benefit patient outcomes.

Methods

Ten female patients with large left sided lumpectomy cavities were selected to be retrospectively planned using both static-IMRT and VMAT plans. Each patient fell within the ASTRO eligibility criteria for APBI treatments. …

A Dosimetric Comparison Of Jaw Tracking Versus Non-Jaw Tracking Using 6mv Vmat Treatment Beams In Prostate Patients With Involved Lymph Nodes, Rebecca Todd

Culminating Experience Projects

Introduction:

Jaw tracking is the process of the collimator jaws dynamically following the multileaf collimators during modulated therapy. Jaw tracking can be used throughout the dosimetry treatment planning process for IMRT and VMAT treatment plans. It can reduce a patient’s OAR dose by reducing low dose spillage from MLC interleaf leakage. This study aims to investigate if jaw tracking reduces OAR dose while maintaining PTV coverage in prostate patients with involved lymph nodes using 6MV VMAT treatment planning technique.

Methods:

This is a quantitative study of 10 patients. For each patient, two plans were created, one plan using a non-jaw …

A Comparison Of Hypofractionated Radiation Therapy Breast Plans For Large Breasted Patients - Hybrid 3d Conformal, And Volumetric Modulated Arc Therapy Vs Standard Hypofractionated 3d Conformal, Kelsie Wentland

Culminating Experience Projects

Abstract

Introduction

Patients with a large breast volume are more at risk of adverse skin effects with radiation therapy. Studies concerning these patients are very limited, especially in regard to comparison of planning techniques. While traditional tangent 3D conformal radiation therapy has been the standard of care, recent literature has shown possible benefits of hybrid planning for average breast volume patients. Little has been studied regarding breast cancer patients with large breast volumes and the possible benefits of hybrid planning of this patient demographic. Creating a hybrid plan could have the benefits of both different treatment modalities to provide a …

Dosimetric Significance Of Manual Density Overrides In Oropharyngeal Cancer, Thomas Lo Greco

Culminating Experience Projects

Kilovoltage computed tomography plays a crucial role in radiotherapy planning. However, the presence of high-density metallic objects can introduce streaking artifacts in CT scans, resulting in inaccurate dose calculations by the treatment planning software. Previous studies have explored manual density overrides and artifact reduction algorithms individually to enhance dose calculation accuracy, but their combined application on patient plans within a treatment planning system remains unexplored.

This research aims to assess the necessity of manual density overrides when an artifact reduction algorithm is already employed to address dental artifacts in oropharyngeal cancer treatment plans. A total of 20 previously treated volumetric …

Evaluating The Efficacy Of An Acuity Stratification Tool In Community Based Palliative Care, Madison K. Niederer

Doctoral Dissertations

Background: Community-based palliative (CBPC) care teams strive to optimize the quality of life of patients living with serious illness while also providing value-based care. An acuity tool was previously implemented at a CBPC site to promote resource allocation and improve follow-up care. Initial implementation failed, and re-implementation was undertaken.

Objective: Address barriers to acuity tool uptake and provide education on correct acuity tool documentation to improve the number of patients that receive prescribed follow-up care.

Setting/Subjects: An urban CBPC service in the Midwestern United States with a patient panel of 443 patients. Subjects include nurses, social workers, providers, and patients. …

Regeneration Of Neurons In Human Brain Tissue; A Revolutionary Concept With Therapeutic Potential, Mackenzie R. Dunn

Other Undergraduate Research

There is current research to suggest that endogenous neuronal regeneration, exogenous neuronal stem cell transplantation and glial cell reprogramming could be prospective therapeutic treatments for neurodegeneration and traumatic injury. With these conditions, there is significant brain atrophy, loss of neurons and loss of synaptic connections which can have devastating effects on executive functioning, cognition, learning and memory. This review will examine these modern approaches to adult neurogenesis, and assess the viable mechanisms and future outlook of these three therapies for neurological regenerative medicine.

Effect Of Exercise Training Intensity On Cognition, Jaclyn Voyt

Honors Projects

A literature review examining the effects of exercise intensity and modality on cognitive performance.

Intercellular Communication Via Gap Junctions Influences Cell Survival During Hypoxia, Lauren E. Harmon, David L. Geenen

Student Summer Scholars Manuscripts

Stem cell therapy can be beneficial following myocardial infarction. However, when murine bone marrow-derived mesenchymal stem cells (mBM-MSCs) are injected into the ischemic area, a large percentage of these cells undergo apoptosis resulting in decreased therapeutic benefits. We hypothesize that the loss of these mBM-MSCs is regulated by intercellular channels or gap junctions (GJs) that provide apoptotic signals passed between ischemic cardiomyocytes and mBM-MSCs. Our research aims to attenuate these GJs by suppressing Connexin-43 (Cx43) expression, the predominant channel-forming protein. We will accomplish this by transiently transfecting a Cx43 siRNA into mBM-MSCs. Our data demonstrate that intracellular fluorescent dyes and …

Spinal Cord Dose Reduction Using A Jaw-Blocking Vmat Technique - A Retrospective Study Of Chordoma And Chondrosarcoma Patients, Amber Wyatt

Culminating Experience Projects

Chordomas and chondrosarcomas are rare tumors that commonly experience loco-regional recurrence after primary treatment, making management of these tumors complex and difficult. Published case series reporting post-surgical outcomes for chordoma indicate that loco-regional recurrence affects more than 50% of patients treated with macroscopic complete resection with or without RT. Notably, a high proportion of recurrences occur late (after 5 and 10 years), requiring long-term follow-up. Chordomas and chondrosarcomas are considered to be radioresistant and require high doses of radiation greater than 60 Gy (Catanzano et al., 2019). There is a little data available regarding the most effective way to minimize …

A Quantitative Investigation Of Treating Lung Tumors With Dynamic Conformal Arcs Vs. Vmat For Lung Sbrt Plans, Shawn Loutos

Culminating Experience Projects

Introduction

This study aims to investigate the comparisons in dynamic conformal arc, VMAT (no ASC), forced MU limitations (ASC), or a 50/50 hybrid arc (ASC) in how they can improve a lung SBRT case where the tumor is abutting a dose critical structure. The goal of this research is to investigate multiple treatment techniques in an attempt to increase the dose constraint pass rate. The variables in comparison are how well different plan iterations can successfully meet constraints as well as pass a 0.5 modulation complexity score (MCS).

Methods

10 previously treated patients were used in this study who exhibited …

Quantifying The Dosimetric Impact Of Target Margins In The Oligometastatic Setting, Jessica E. Strang

Culminating Experience Projects

Introduction

With advancements in cancer treatment therapies, patients are living longer with oligometastatic disease. These patients may have multiple targets and may be treated in a single isocenter to reduce overall treatment time. However, the most considerable risk of treating multiple lesions in a single isocenter is a geometric miss. It can be challenging to perform daily alignment of multiple lesions creating a need to prioritize one lesion alignment over others or abort treatment.

Methods

This study quantified the dosimetric impact of total lung exposure as the planning target volume (PTV) margin incrementally increased for multiple intrathoracic lesions.

The analysis …

Deep Inspiration And End Exhale Breathhold Evaluation For The Treatment Of Locally Advanced Pancreatic Adenocarcinoma Using The Viewray Mridian Linactm, Tatum Mcglynn

Culminating Experience Projects

Introduction

Radiation therapy has been limited in the treatment of locally advanced pancreatic cancer. This is due to the dose tolerance to nearby organs at risk and breathing motion. Advancements in radiation treatment technology have now allowed pancreatic patients to be treated to higher doses in fewer fractions using stereotactic body radiotherapy treatment. With the use of MRI-guided treatments, using the ViewRay MRIdian linac, doses can be escalated using online adaptive treatment planning and real time tracking. However, there has yet to be an optimal breathhold technique investigated that can aid in this process.

Methods

Five patients that had been …

Effects Of Ezfluence Planning Software On Dosimetric Parameter Compliance For Early-Stage Breast Cancer, Jackie Loomis

Culminating Experience Projects

Each year over 2 million women are given a breast cancer diagnosis and over half a million women succumb to the disease yearly. As technology advances in the world of radiation oncology, automated planning softwares, such as Radformation’s EZFluence, are being utilized to streamline the treatment planning process. This study was designed to investigate whether the automated plans are dosimetrically equivalent to traditionally planned 3D field in field tangential plans. Is there a disadvantage to using these automated softwares? Three different dosimetrists with varying backgrounds replanned 27 previously treated breast cancer patients and an assortment of comparisons were ran between …

Dosimetric Comparison Of Static Imrt And Vmat Apbi Treatment Planning In The Prone Position For Breast Conservation Therapy, Kelly A. Foucher

Culminating Experience Projects

Introduction

Prevalence of early-stage breast cancer is increasing with the aid of preventative screenings and early diagnosis. The standard of care is transforming from conventional approaches with long treatment regimens towards hypofractionation and tissue sparing techniques. Based on studies over the past ten years, there are reasons to consider a partial-breast, hypo fractionated treatment option in the supine position. In practice, aPBI is often produced using several static intensity modulated beams to control dose to the normal breast tissue and limit dose to the heart and lungs. Patients may also be treated in the prone treatment setup in order to …

Using Radformation Ezfluence Software To Simplify Three Field Breast Radiation Therapy Planning Compared To Field-In-Field Technique, Brianna L. Woodburn

Culminating Experience Projects

Purpose: To evaluate time savings, efficiency, and accuracy of an automated planning software.

Methods: 10 previously treated breast cancer patients with supraclavicular involvement were retrospectively planned using a monosiocentric field-in-field technique by both an automated treatment planning software and a human planner. Time spent on planning was recorded and after plans were generated, dose constraints and target coverage were measured to evaluate overall plan quality.

Results: Time spent for planning was significantly decreased when using a FIF plan generated by the automated planning software. CTV target coverage for both the breast and supraclavicular volumes and dose to OARs for both …

An Evaluation Of Methods To Reduce Inframammary Surface Dose In Prone Breast Irradiation, Seth Alvarado

Doctoral Dissertations

In cases of breast radiation treatments via external beam radiation therapy, the incidence of radiation dermatitis has been reported. In prior studies, this acute radiation side-effect has been correlated with the immobilization devices in cases of prone breast irradiation. They attribute this to the bolus effect that occurs with the interaction of the incident photon beam at different projections causing an increase in measured surface dose. The type of radiation planning technique, and patient positioning during the undertaking of these techniques, have also shown to influence this bolus effect. This study focuses on these factors in treatment planning in order …

An Evaluation Of Methods To Reduce Inframammary Surface Dose In Prone Breast Irradiation, Seth Alvarado

Culminating Experience Projects

In cases of breast radiation treatments via external beam radiation therapy, the incidence of radiation dermatitis has been reported. In prior studies, this acute radiation side-effect has been correlated with the immobilization devices in cases of prone breast irradiation. They attribute this to the bolus effect that occurs with the interaction of the incident photon beam at different projections causing an increase in measured surface dose. The type of radiation planning technique, and patient positioning during the undertaking of these techniques, have also shown to influence this bolus effect. This study focuses on these factors in treatment planning in order …

A Quantitative Comparison Of Linac Vs. Cyberknife For Sbrt Prostate Boost: A Retrospective Study, Vicente Miguel Ornelas

Culminating Experience Projects

Purpose: The purpose of this study is to retrospectively evaluate the quantitative difference of prostate SBRT boost between LINAC boost and CK boost treatments, with a primary plan using LINAC volumetric modulated arc therapy.

Materials and Methods: Nine prostate cancer patients were treated with a SBRT fractionated schedule of 21 Gy in 3 fractions, given every other day over the course of a week. The LINAC-BOOST were created by the researcher followed the same fractionation schedule, treatment volumes, OAR, and dose constraints as the original CK-BOOST treatment. The CK-BOOST was completed on the Multiplan (v14) TPS, while the LINAC-BOOST was …

A Quantitative Investigation At Dose To Tissue When Using Physical Constraints Versus Biological Based Constraints In Pancreatic Carcinoma Patients, Kelly R. Alley

Culminating Experience Projects

Introduction

The purpose of this study was to compare dose to organs at risk as well as PTV coverage. Physical objectives, biological objectives, and a combination of the two were utilized to compare which technique provided the best coverage of the PTV while also preserving the greatest amount of healthy tissue.

Methods

Each randomly selected patient had three separate plans created for them. The first plan used only physical based constraints in the form of upper objectives. The second plan used only biological based constraints in the form of gEUD objectives. The third plan used a combination of both upper …

A Dosimetric Evaluation Of Skin Dose In Post Mastectomy Radiation Therapy: A Comparison Of Static Field Intensity Modulated Radiation Therapy And Volumetric Modulated Arc Therapy, Dusti M. Henion

Culminating Experience Projects

Introduction

Post mastectomy radiation therapy can cause significant skin reaction for patients treated with bolus. The elimination of bolus as a standard practice for this treatment has been suggested in recent literature. Additionally, volumetric modulated arc therapy (VMAT) may deliver a comparable plan with the benefit of reducing treatment times for this population compared to static field intensity modulated radiation therapy (IMRT).

Methods

This study is a retrospective dosimetric analysis of ten right-sided postmastectomy radiation therapy patients. The subjects had previously completed a course of radiation therapy consisting of static field IMRT with the use of bolus every other day …

A Dosimetric Study On Photon Beam Energies With And Without A Flattening Filter In Sbrt Treatments For Prostate Cancer, Alexis F. Puruleski

Culminating Experience Projects

Purpose: The role of radiation therapy in managing prostate cancer has developed and improved greatly throughout the years. The purpose of this study was to analyze a newly developing method of treatment practices with two different therapy energies.

Methods: This retrospective study pulled patient data from the facility’s treatment planning system database who had primary prostate cancer treated to the prostate bed. Each patient was planned for the same treatment technique with two different beam energies, 6X and 6FFF (flattening filter free).

Results: A two-sample t-test was done to compare means of the max doses to the bladder, rectum, and …

Dosimetric Evaluation Of Fixed Jaw And Jaw Tracking Vmat Treatment Plans For Prostate Cancer With Involved Pelvic Nodes, William Rios

Culminating Experience Projects

Intro

A mechanical limitation of modern linacs affecting the quality of radiotherapy treatments of large tumor volumes is the travel length of multicollimator leaves. Considering this limitation, research was carried out to evaluate the dosimetric differences between a split-field fixed-jaw volumetric arc radiotherapy (SF-FJ VMAT) technique and a jaw tracking VMAT (JT VMAT) technique for the treatment of prostate cancer with involved lymph nodes.

Methods

Plans for 16 patients treated with the same dose regimen were created using both techniques. Initial JT-VMAT plans were planned with two arcs to encompass the entire tumor volume without jaw restrictions and jaw tracking …