A cost-minimization analysis of measures against metallic dental restorations for head and neck radiotherapy

Abstract The aim of this study was to compare the estimated public medical care cost of measures to address metallic dental restorations (MDRs) for head and neck radiotherapy using high-energy mega-voltage X-rays. This was considered a first step to clarify which MDR measure was more cost-effective. We estimated the medical care cost of radiotherapy for two representative MDR measures: (i) with MDR removal or (ii) without MDR removal (non-MDR removal) using magnetic resonance imaging and a spacer. A total of 5520 patients received head and neck radiation therapy in 2018. The mean number of MDRs per person was 4.1 dental crowns and 1.3 dental bridges. The mean cost per person was estimated to be 121 720 yen for MDR removal and 54 940 yen for non-MDR removal. Therefore, the difference in total public medical care cost between MDR removal and non-MDR removal was estimated to be 303 268 800 yen. Our results suggested that non-MDR removal would be more cost-effective than MDR removal for head and neck radiotherapy. In the future, a national survey and cost-effectiveness analysis via a multicenter study are necessary; these investigations should include various outcomes such as the rate of local control, status of oral mucositis, frequency of hospital visits and efforts of the medical professionals.

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Effect of Surgical Mask on Setup Error in Head and Neck Radiotherapy

Technology in Cancer Research & Treatment ◽

10.1177/1533033820974021 ◽

2020 ◽

Vol 19 ◽

pp. 153303382097402

Author(s):

Yi Ding ◽

Pingping Ma ◽

Wei Li ◽

Xueyan Wei ◽

Xiaoping Qiu ◽

...

Keyword(s):

Head And Neck ◽

Radiation Treatment ◽

Virus Disease ◽

T Test ◽

Setup Error ◽

Setup Errors ◽

Significant Difference ◽

The Mean ◽

Head And Neck Radiotherapy ◽

Head Neck

Purpose: With the widespread prevalence of Corona Virus Disease 2019 (COVID-19), cancer patients are suggested to wear a surgical mask during radiation treatment. In this study, cone beam CT (CBCT) was used to investigate the effect of surgical mask on setup errors in head and neck radiotherapy. Methods: A total of 91 patients with head and neck tumors were selected. CBCT was performed to localize target volume after patient set up. The images obtained by CBCT before treatment were automatically registered with CT images and manually fine-tuned. The setup errors of patients in 6 directions of Vrt, Lng, Lat, Pitch, Roll and Rotation were recorded. The patients were divided into groups according to whether they wore the surgical mask, the type of immobilization mask used and the location of the isocenter. The setup errors of patients were calculated. A t-test was performed to detect whether it was statistically significant. Results: In the 4 groups, the standard deviation in the directions of Lng and Pitch of the with surgical mask group were all higher than that in the without surgical mask group. In the head-neck-shoulder mask group, the mean in the Lng direction of the with surgical mask group was larger than that of the without surgical mask group. In the lateral isocenter group, the mean in the Lng and Pitch directions of the with surgical mask group were larger than that of the without surgical mask group. The t-test results showed that there was significant difference in the setup error between the 2 groups ( p = 0.043 and p = 0.013, respectively) only in the Lng and Pitch directions of the head-neck-shoulder mask group. In addition, the setup error of 6 patients with immobilization open masks exhibited no distinguished difference from that of the patients with regular immobilization masks. Conclusion: In the head and neck radiotherapy patients, the setup error was affected by wearing surgical mask. It is recommended that the immobilization open mask should be used when the patient cannot finish the whole treatment with a surgical mask.

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Average medical cost of fatal and non-fatal injuries by type in the USA

Injury Prevention ◽

10.1136/injuryprev-2019-043544 ◽

2019 ◽

pp. injuryprev-2019-043544 ◽

Cited By ~ 1

Author(s):

Cora Peterson ◽

Likang Xu ◽

Curtis Florence

Keyword(s):

Medical Care ◽

Medical Cost ◽

Cost Effective ◽

Medical Care Cost ◽

Body Region ◽

Injury Type ◽

Inpatient Settings ◽

The Usa ◽

Multivariable Regression ◽

Fatal Injuries

ObjectiveTo estimate the average medical care cost of fatal and non-fatal injuries in the USA comprehensively by injury type.MethodsThe attributable cost of injuries was estimated by mechanism (eg, fall), intent (eg, unintentional), body region (eg, head and neck) and nature of injury (eg, fracture) among patients injured from 1 October 2014 to 30 September 2015. The cost of fatal injuries was the multivariable regression-adjusted average among patients who died in hospital emergency departments (EDs) or inpatient settings as reported in the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample, controlling for demographic (eg, age), clinical (eg, comorbidities) and health insurance (eg, Medicaid) factors. The 1-year attributable cost of non-fatal injuries was assessed among patients with ED-treated injuries using MarketScan medical claims data. Multivariable regression models compared total medical payments (inpatient, outpatient, drugs) among non-fatal injury patients versus matched controls during the year following injury patients’ ED visit, controlling for demographic, clinical and insurance factors. All costs are 2015 US dollars.ResultsThe average medical cost of all fatal injuries was approximately $6880 and $41 570 per ED-based and hospital-based patient, respectively (range by injury type: $4764–$10 289 and $31 912–$95 295). The average attributable 1-year cost of all non-fatal injuries per person initially treated in an ED was approximately $6620 (range by injury type: $1698–$80 172).Conclusions and relevanceInjuries are costly and preventable. Accurate estimates of attributable medical care costs are important to monitor the economic burden of injuries and help to prioritise cost-effective public health prevention activities.

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Dosimetric evaluation of scattered and attenuated radiation due to dental restorations in head and neck radiotherapy

Journal of Radiation Research and Applied Sciences ◽

10.1016/j.jrras.2017.10.004 ◽

2018 ◽

Vol 11 (1) ◽

pp. 23-28 ◽

Cited By ~ 3

Author(s):

Mona Azizi ◽

Ali Asghar Mowlavi ◽

Mahdi Ghorbani ◽

Behnam Azadegan ◽

Fatemeh Akbari

Keyword(s):

Head And Neck ◽

Dental Restorations ◽

Head And Neck Radiotherapy

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Anatomic reconstruction for acromioclavicular joint injuries: a pilot study of a cost-effective new technique

Clinics in Shoulder and Elbow ◽

10.5397/cise.2021.00325 ◽

2021 ◽

Vol 24 (4) ◽

pp. 209-214

Author(s):

Radhakrishnan Pattu ◽

Girinivasan Chellamuthu ◽

Kumar Sellappan ◽

Chendrayan Kamalanathan

Keyword(s):

Acromioclavicular Joint ◽

Cost Effective ◽

Anatomic Reconstruction ◽

X Rays ◽

Effective Technique ◽

Ac Joint ◽

Joint Injuries ◽

Cost Effective Technique ◽

The Mean

Background: The treatment for acromioclavicular joint injuries (ACJI) ranges from a conservative approach to extensive surgical reconstruction, and the decision on how to manage these injuries depends on the grade of acromioclavicular (AC) joint separation, resources, and skill availability. After a thorough review of the literature, the researchers adopted a simple cost-effective technique of AC joint reconstruction for acute ACJI requiring surgery.Methods: This was a prospective single-center study conducted between April 2017 and April 2018. For patients with acute ACJI more than Rockwood grade 3, the researchers performed open corococlavicular ligament reconstruction using synthetic sutures along with an Endobutton and a figure of 8 button plate. This was followed by AC ligament repair augmenting it with temporary percutaneous AC K-wires. Clinical outcomes were evaluated using the Constant Murley shoulder score. Results: Seventeen patients underwent surgery. The immediate postoperative radiograph showed an anatomical reduction of the AC joint dislocation in all patients. During follow-up, one patient developed subluxation but was asymptomatic. The mean follow-up period was 30 months (range, 24–35 months). The mean Constant score at 24 months was 95. No AC joint degeneration was noted in follow-up X-rays. The follow-up X-rays showed significant infra-clavicular calcification in 11 of the 17 patients, which was an evidence of a healed coracoclavicular ligament post-surgeryConclusions: This study presents a simple cost-effective technique with a short learning curve for anatomic reconstruction of acute ACJI. The preliminary results have been very encouraging.

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Acute xerostomia in head and neck radiotherapy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190757 ◽

2019 ◽

Vol 5 (2) ◽

pp. 262

Author(s):

Dalya S. A. Al-Nuaimi ◽

Khudair J. Al-Rawaq ◽

Ali G. M. Noori ◽

Marwa A. N. Fattah

Keyword(s):

Head And Neck ◽

Salivary Glands ◽

Medical History ◽

Associated Factors ◽

High Dose ◽

Past Medical History ◽

Common Complaint ◽

The Mean ◽

Head And Neck Radiotherapy ◽

High Chance

Background: Xerostomia is a common complaint experienced with radiotherapy to the head and neck and it is caused by salivary glands dysfunction. Methods: Xerostomia is a common complaint experienced with radiotherapy to the head and neck and it is caused by salivary glands dysfunction. Results: The mean age was 51.69±13.7 years; 67% were men and 33% were women. Nasopharyngeal tumor and larynx cancer were the common tumors diagnosed (29% and 28% respectively), 78% of the tumors were squamous cell carcinoma and 53% of them in stage III. Most patients didn’t take chemotherapy during radiotherapy (90%), while 68% of them have previously received chemotherapy. The mean dose of radiotherapy used was 63.2±9.65 Gray. Post radiotherapy, the highest proportion diagnosed with xerostomia grade I (37%), while 21% of them were free of xerostomia. Female, negative past medical history, site, stage and dose of radiation were associated factors that increased prevalence of xerostomia. Conclusions: After radiotherapy, there is a high chance for developing xerostomia. Females, negative past medical history, advanced stage of tumor, high dose of radiation and site of tumor (oral, nasopharyngeal, and parotid) were significantly associated factors. Tumor site was a significant factor associated with the grade of xerostomia.

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Finding fossils in Malapa breccia – medical CT scanning or micro-CT scanning?

South African Journal of Science ◽

10.17159/sajs.2017/20170057 ◽

2017 ◽

Vol 113 (11/12) ◽

Author(s):

Jacqueline S. Smilg

Keyword(s):

Computed Tomography ◽

Lower Energy ◽

Ct Scanning ◽

Cost Effective ◽

High Energy ◽

X Rays ◽

Micro Ct ◽

X Ray ◽

Mechanical Preparation ◽

X Ray Computed

Computed tomography (CT) imaging of fossils has revolutionised the field of palaeontology, allowing researchers to gain a better understanding of fossil anatomy, preservation and conservation. Micro focus X-ray computed tomography (μXCT) has been far more extensively used for these purposes than medical CT (XCT) – mostly because of the exquisite detail that the μXCT scanning modality, using slices of micron thicknesses, can produce. High energy X-rays can potentially penetrate breccia more effectively than lower energy beams. This study demonstrates that lower energy beams produce superior images for prioritising breccia for preparation. Additionally, XCT scanners are numerous, accessible, fast and relatively cost-effective when compared to μXCT scanners – the latter are not freely available, scanning times are much longer and there are significant limitations on the size and weight of scannable objects. Breccia blocks from Malapa were scanned at high and lower energy and images were analysed for image quality, artifact and certainty of diagnosis. Results show that lower energy images are deemed superior to higher energy images for this particular application. This finding, taken together with the limitations associated with the use of μXCT for the imaging of the large breccia from Malapa, shows that XCT is the better modality for this specific application. The ability to choose fossil-bearing breccia, ahead of manual mechanical preparation by laboratory technicians, would allow for the optimal use of limited resources, manual preparatory skills as well as the curtailment of costs.

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LECX: a cubesat experiment to detect and localize cosmic explosions in hard X-rays

Monthly Notices of the Royal Astronomical Society ◽

10.1093/mnras/staa500 ◽

2020 ◽

Vol 493 (4) ◽

pp. 4852-4860

Author(s):

J Braga ◽

O S C Durão ◽

M Castro ◽

F D’Amico ◽

P E Stecchini ◽

...

Keyword(s):

Gravitational Wave ◽

Gamma Ray ◽

Low Cost ◽

Cost Effective ◽

High Energy ◽

Compact Objects ◽

X Rays ◽

X Ray ◽

Competitive Capabilities ◽

Cosmic Explosions

ABSTRACT With the advent of the nanosat/cubesat revolution, new opportunities have appeared to develop and launch small (∼1000 cm3), low-cost (∼US$ 1M) experiments in space in very short time frames (∼2 yr). In the field of high-energy astrophysics, in particular, it is a considerable challenge to design instruments with compelling science and competitive capabilities that can fit in very small satellite buses, such as a cubesat platform, and operate them with very limited resources. Here, we describe a hard X-ray (30–200 keV) experiment, LECX (‘Localizador de Explosões Cósmicas de Raios X’ – Locator of X-Ray Cosmic Explosions), that is capable of detecting and localizing within a few degrees events like gamma-ray bursts and other explosive phenomena in a 2U-cubesat platform, at a rate of ∼5 events per year. In the current gravitational wave era of astronomy, a constellation or swarm of small spacecraft carrying instruments such as LECX can be a very cost-effective way to search for electromagnetic counterparts of gravitational wave events produced by the coalescence of compact objects.

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A confident source of hard X-rays: radiation from a tokamak applicable for runaway electrons diagnosis

Journal of Synchrotron Radiation ◽

10.1107/s1600577516010262 ◽

2016 ◽

Vol 23 (5) ◽

pp. 1227-1231 ◽

Cited By ~ 7

Author(s):

M. Kafi ◽

A. Salar Elahi ◽

M. Ghoranneviss ◽

M. R. Ghanbari ◽

M. K. Salem

Keyword(s):

Magnetic Field ◽

Electric Field ◽

High Energy ◽

Toroidal Magnetic Field ◽

Vacuum Vessel ◽

X Rays ◽

Runaway Electrons ◽

High Energy Electrons ◽

High Loop ◽

The Mean

In a tokamak with a toroidal electric field, electrons that exceed the critical velocity are freely accelerated and can reach very high energies. These so-called `runaway electrons' can cause severe damage to the vacuum vessel and are a dangerous source of hard X-rays. Here the effect of toroidal electric and magnetic field changes on the characteristics of runaway electrons is reported. A possible technique for runaways diagnosis is the detection of hard X-ray radiation; for this purpose, a scintillator (NaI) was used. Because of the high loop voltage at the beginning of a plasma, this investigation was carried out on toroidal electric field changes in the first 5 ms interval from the beginning of the plasma. In addition, the toroidal magnetic field was monitored for the whole discharge time. The results indicate that with increasing toroidal electric field the mean energy of runaway electrons rises, and also an increase in the toroidal magnetic field can result in a decrease in intensity of magnetohydrodynamic oscillations which means that for both conditions more of these high-energy electrons will be generated.

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Evaluation of oral mucositis in oral cancer patients undergoing radiotherapy

Journal of Chitwan Medical College ◽

10.3126/jcmc.v8i2.23730 ◽

2018 ◽

Vol 8 (2) ◽

pp. 6-9

Author(s):

Barsha Bajracharya ◽

Subrata Bhattacharyya ◽

Pratibha Poudel

Keyword(s):

Radiation Therapy ◽

Oral Cancer ◽

Radiation Exposure ◽

Head And Neck ◽

Cancer Patients ◽

Oral Mucositis ◽

Oral Cancer Patients ◽

The Mean ◽

Head And Neck Radiotherapy ◽

Grade Iii

Introduction: The present study was conducted to evaluate oral mucositis in oral cancer patients receiving head and neck radiotherapy. Methods: Sixty oral cancer patients who had received at least 40 grays of radiation were included in the study. Mucositis was scored by oroscopy using WHO scale. Grades of mucositis were then compared with total dose of radiation received by the patients. Results: The cases were receiving the mean cumulative dose of standard radiation therapy of 2Gy per fraction, 5 fractions per week. All the patients developed oral mucositis. The majority had grade I mucositis, followed by grade III, II and IV. The grade of mucositis was directly proportional to the dose of radiation exposure. Conclusion: Oral mucositis occurs among all the patients undergoing head and neck radiotherapy and grade of mucositis is proportional to the dose of radiation exposure.

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Dosimetry of cell-monolayers in multiwell plat

Nuklearmedizin ◽

10.3413/nukmed-0206 ◽

2009 ◽

Vol 48 (03) ◽

pp. 120-126 ◽

Cited By ~ 6

Author(s):

M. Andreeff ◽

L. Oehme ◽

J. Kotzerke ◽

R. Freudenberg

Keyword(s):

Dose Distribution ◽

Absorbed Dose ◽

High Energy ◽

X Rays ◽

Sphere Model ◽

Cell Monolayers ◽

Calculated Dose ◽

The Mean ◽

The Impact

Summary Aim: Irradiation of cells in-vitro with unsealed radionuclides is often carried out in cylindrical multi-well-plates. For calculation of the absorbed dose using the sphere model is common. This model assumes a spherical distribution of activity. However, by physical aspects a dose reduction in the peripheral area of the activity volume is expected and predicted especially for high-energy beta-emitting radionuclides. The impact on cellular dosimetry shall be depicted in this paper. Methods: The dose-distribution inside a multi-well-plate was calculated by convolving the dose distribution around a point source with a given activity. This was performed for the radionuclides I-131, Re-188 and Y-90 in wells of different sizes. For comparison the sphere dose was also calculated. Results: Depending on the beta-energy differences up to 40% between the mean calculated dose and the mean sphere dose were found, whereby calculated dose was always lower than the sphere model prediction. Furthermore a fall-off was calculated for the bottom-dose compared to dose in the centre. An analytical expression was revealed for the bottom-dose with respect to the filling level for three different wells. Conclusion: The shape of geometry and the influence on dose distribution must be considered especially at in-vitro exposure with low energy and short range beta-emitting radionuclides. There could be a great impact for exact dose estimation, which is especially necessary to know for comparison of different irradiation experiments (e.g. different radionuclides, various irradiation geometries or comparison with x-rays).

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