Medicine and Health Sciences Commons^™

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 …

Comparative Anatomical Study Of The Brachial Plexus Of Primates, Alison Leann Camero

Masters Theses

Old world monkeys, new world monkeys, and humans all originate from a common ancestor. Although humans and old world monkeys are phylogenetically more closely related, old world monkeys and new world monkeys have similar locomotion. A difference in muscle patterns exists between old world monkeys, new world monkeys, and humans. Different musculature may be due to differences in locomotive patterns and species-specific use of their forearms. Muscles in the forelimbs are innervated by the nerves of the brachial plexus. There are differences among the brachial plexuses of human and non-human primates as well as variability within the species.

In this …

When Comparing Hyperarc And Gammaknife Treatment Techniques For Brain Metastasis, Which Technique Offers Optimal Treatment To Achieve The Highest Biological Effective Dose (Bed)?, Carrie Merfert

Culminating Experience Projects

Introduction

HyperArc-VMAT and GammaKnife treatment techniques are both considered to be the best types of SRS treatment methods regarding conformity, homogeneity, gradient, and mean brain dose. The BED calculation is used to calculate the treatment regimens that are effective biologically and used for extrapolation to normal tissue limits.

Methods

This is a retrospective study that analyzes 15 lesions from 10 randomly selected patients with brain metastasis within the cerebrum. Each of the lesions had a single fraction treatment plan created using the same PTV for the HyperArc-VMAT and GammaKnife techniques. Each treatment technique was dose escalated until the healthy brain …

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 …

A Dosimetric Comparison Using Avoidance Sectors Vs Avoidance Structures For Hip Prostheses In Cancer Patients Receiving Pelvic Irradiation, Grace E. Bowhall

Culminating Experience Projects

Purpose

The majority of prostate cancers are detected in men ages 65 and older, resulting in an increased probability that these patients have prosthetic devices. Hip prostheses can pose a challenge when creating a radiation therapy treatment plan for prostate cancer patients. The purpose of this study is to compare two planning techniques that treat the target volume while avoiding irradiation through these prostheses.

Methods

This retrospective study obtained previously treated patient data from the center’s treatment planning system. Patients who were treated for prostate cancer and had one or two hip prostheses were included in this study. Two plans …

Spine Stereotactic Body Radiation Therapy (Sbrt): Using Biological Objectives In Treatment Planning A Comparative Plan Study, Joseph E. Pagano

Culminating Experience Projects

Introduction: The purpose of the study is intended to determine if gEUD optimization can be useful in the treatment planning for SBRT to the spine. The main goal was to study the dose effects when placing gEUD objectives on the targeted vertebral structure (Target gEUD) and spinal cord (Upper gEUD). Furthermore, to provide a better understanding of the utility of this tool.

Methods: Two planning techniques for SBRT spine treatments were compared retrospectively on 10 radiation therapy patients. The Varian Eclipse treatment planning system was utilized with the volumetric modulated arc therapy treatment technique. The planning techniques used different objectives …

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 …

Dose Comparison Of Automatic Feathering Algorithm Versus Traditional Techniques With The Introduction Of Setup Uncertainties, Caleb D. Mcgowan

Culminating Experience Projects

Introduction: Inter fractional setup uncertainties for patients receiving cervical radiation therapy treatments can cause a significant change in dose to the target structures resulting in under dosing or over dosing the patient. Varian has created an auto feathering algorithm for extended field radiotherapy to help smooth out the dose located at the junction between the two fields. This may reduce the percent change to the dose distribution when the setup uncertainties are introduced.

Methods: The study is a retrospective dosimetric analysis of 10 randomly selected female cervical cancer patients. Each patient had a plan created using the traditional technique of …

Plan Quality Comparison Between Cyberknife And Vmat Lung Sbrt After Modified Cyberknife Treatment Times., Lindsey Money

Culminating Experience Projects

Introduction

This retrospective study will aim compare Cyberknife SBRT and VMAT SBRT lung plans quality when the Cyberknife plans are replanned to have a comparable treatment time to the VMAT plans. Having data to show the difference in plan quality between the two treatment techniques could be a useful tool when deciding the best treatment option.

Methodology

Select ten SBRT lung patients who were all treated using the Cyberknife and plan a comparable VMAT treatment for each. Modify the original Cyberknife treatment plan so that the treatment time is similar to that of the corresponding VMAT plan. Then, evaluate and …

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 …

The Use Of Occupational Therapy Services In Outpatient Mental Health, Kelsey A. Wasik, Matt T. Valois, Kaylee M. Essenberg, Kelcie P. Beck

Masters Theses

The purpose of this study is aimed to explore the structure and utilization details of occupational therapy in outpatient behavioral health settings. Two occupational therapists participated in qualitative phenomenological interviews which were transcribed and analyzed using the thematic approach. A total of two themes emerged: billing and coverage, and education and advocacy. Participants identified there are necessary factors for reimbursement of services, in addition to the need for education and advocacy for occupational therapists to practice in outpatient behavioral health settings. Future research should be aimed at recruiting more participants, occupational therapists, and from other roles in these clinics such …

Addressing Food Insecurity And Obesity Within A Rural Primary Care Setting, Alec Joseph Tuchowski

Culminating Experience Projects

Background and Objectives: There is a need to screen, assess, and potentially make referrals for social determinants of health (SDOH) to help coordinate healthcare services across the care continuum and identify factors impacting health.

Problem: The majority of primary care offices do not routinely screen patients for social needs, despite the influence they can have on an individual’s health.

Methods: This quality improvement project was implemented using the Plan-Do-Study-Act (PDSA) framework at a small, midwestern rural primary care clinic in the United States. Participants included office staff and 31 adult patients who presented to the clinic for …

Thru-Hiker Mentality During The Covid-19 Pandemic: Implications For Mental Health, Brooke Fox

Culminating Experience Projects

Thru-hiking is where an individual hikes a long distance, end-to-end trail for an extended period of time. While the mental health benefits of hiking and being in nature is well known in current literature, there has been little focus on how the thru-hiker experiences contributes to overall wellness after a person completes their hike. This study investigates how thru-hiker experiences can have a lasting impact on how hikers handle future adversities. This case specifically looks at how thru-hikers have handled the COVID-19 pandemic through in-depth interviews with thru-hikers that have completed the Pacific Crest Trail (PCT) and through blogs written …

Formalized Diabetes Education In A Safety-Net Clinic, Haley N. Wanic

Doctoral Dissertations

Uncontrolled diabetes mellitus in a Hispanic population can be helped through a quality improvement project focused on progressive verbal and written diabetes self-management education (DSME) Purpose of this article is to review the background, an organizational assessment, a literature review, results of the quality improvement project that took place at a safety-net clinic in the Midwest. This project included four patients and data was analyzed through descriptive statistics. Results include improved hemoglobin (Hg) A1c, minimal workflow adjustments for providers, completed microalbumins, and written education given to patients. In conclusion, the quality improvement project showed positive trends in outcome measures over …

Institutions Implementation Of Trauma-Informed Care Practices For Sexual Assault Survivors, Calli Ackels

Culminating Experience Projects

The purpose of this research is to understand the importance of trauma-informed care practices on college campuses for sexual assault survivors. The empirical research surrounding institutions implementation of trauma-informed care practices for sexual assault survivors discusses the prevalence of individuals who have experienced trauma, the importance of trauma-informed care education, and the need to utilize community resources. These findings determine the need for trauma-informed care practices as well as important tools for implementation. In order to improve institutions implementation of trauma-informed care practices for sexual assault survivors, much of the research suggests increased professional development dedicated to becoming informed on …

The Influence Of Dash Diet Education On Knowledge And Adherence In Primary Care: A Quality Improvement Project, Paige Bekker

Culminating Experience Projects

Background/Local Problem: A rural family practice was concerned about the number of

patients with uncontrolled hypertension, 19.86% n = 56, as defined by the Centers for Disease Control and Prevention (CDC). After several quality improvement (QI) initiates to lower the prevalence rate of uncontrolled hypertension, including proper measurement techniques and home monitoring, the modifiable risk factor of adapting one’s food intake was introduced using the Dietary Approach to Stop Hypertension (DASH) diet as an intervention. The DASH diet is an evidence-based approach for lowering blood pressure. The QI project was completed with the purpose of implementing DASH diet education and …

Recovery Posture Post Hiit Exercise In The Active Population, Sydney Goll

Masters Theses

Introduction: By stimulating the sympathetic nervous system during a high intensity cycle HIIT workout, the effects of body posture on heart rate recovery can be recorded as the body is returning to a resting state. Purpose: The purpose of this study is to explore the physiology of recovery related to different body positions after high intensity exercise in order to account for the quickest recovery. Design: Original research. Methods: 18 healthy college aged individuals, 9 males, 8 females, mean age 21.7 ± 2.22, performed a submaximal HIIT workout on a cycle ergometer with a metabolic cart to record respiratory data. …

An Examination Of The Underutilization Of Mental Health Resources In Collegiate Student-Athletes, Kathleen Olivia Glover

Masters Theses

Previous and developing literature indicates that collegiate student-athletes, while more susceptible to psychological problems, are underutilizing mental health resources. This project examines the aforementioned problem through the use of extensive student-athlete mental health literature to identify themes that are affecting student-athlete’s likeliness of seeking psychological services. Throughout the themes, the need for additional support from student-athlete stakeholders is presented. A workshop series to guide increased mental health literacy in student-athlete stakeholders to create opportunities to recognize signs of mental illness and form cultures that encourage the utilization of psychological services is constructed. It is anticipated that by including stakeholders in …

Improving Vaccination Rates In Pediatric Primary Care, Lauren E. Osbeck

Doctoral Dissertations

Objectives: In a small, rural pediatric primary care clinic, the effectiveness of electronic patient portal reminders were evaluated at improving vaccination rates for school required immunizations.

Methods: A quality improvement project was initiated utilizing The Social Ecological Model. All pediatric patients were sent reminders who were under-immunized. This QI project evaluated the effectiveness of vaccine reminders on the improvement of immunization rates in the clinic

Results: Total number of fully-vaccinated patients within the practice improved (2%) and patients under-immunized decreased by 1%. 87 immunizations were given to patients were given to patients who were under-immunized and an average of 10% …

Blood Flow Restriction And Various Intensity Exercise In The Upper Extremity, Noelle Ashlyn Kaminski, Andrew Lowe

Masters Theses

Purpose: To determine if using Blood Flow Restriction (BFR) combined with low-load exercise can elicit an increase in strength and tendon size of the distal biceps tendon when compared to high-load exercise protocol. Methods: Twenty-one participants (11 M, 10 F; 2 Left-handed: 19 Right-handed; Age range 18-25yoa) were randomized to either the treatment group (BFR + low load exercise) or the control group (high load exercise). Participants were enrolled in a 7-week exercise protocol, with exercise sessions held twice weekly. The first week included measurements of each participant's 1 repetition maximum (1RM) and ultrasound measurements of the dominant distal bicep’s …

The Effects Of A Dynamic Warm-Up On Low-Dye Taping In Pronated Participants, Trevor Daniel Aukerman

Culminating Experience Projects

Context: The low-dye taping (LDT) is a commonly used method that is intended to prevent overpronation and support the medial longitudinal arch (MLA) of the foot. There is limited investigation into the effectiveness of the LDT after dynamic, multiplanar exercises, and if the LDT’s effectiveness is affected by the degree of foot pronation.

Objective: Determine if the LDT is effective after a dynamic warm-up and if the degree of the taping’s effectiveness is changed with the severity of foot pronation.

Design: Cross-sectional study

Setting: Multipurpose court

Patients or Other Participants: Thirty-four participants (26 women, 8 men; age=21.4±1.9; height=167.0±9.0cm, weight=67.6±14.3kg) with …

Development Of A Point-Of-Care Ultrasonography Workflow Within A Rural Clinic, Lauren Myers

Culminating Experience Projects

Abstract

Background and Objectives: Healthcare has revolutionized with advancements in ultrasound technology. Among these advancements and the increasing availability of imaging modalities is point-of-care ultrasonography (POCUS) technology.

Problem: While POCUS has gained considerable ground in primary care, infrastructure to support its utility is deficient. The purpose of this project was to design, pilot, and evaluate a POCUS workflow to facilitate technology utilization and increase access to care.

Methods: Program development and evaluation involves the design, implementation, and evaluation of an evidence-based workflow for POCUS technology. The project was intended to address the needs of individuals in a rural setting. Participants …