Screening and Psycho-Oncological Support for Patients With Head and Neck Cancer and Brain Malignancies Before Radiotherapy With Mask Fixation: Results of a Feasibility Study

This single-center, single-arm trial investigates the feasibility of a psycho-oncological care program, which aims to reduce psychological distress and improve compliance with radiotherapy with mask fixation in patients with head and neck cancer or brain malignancies. The care program comprised (1) a screening/needs assessment and (2) the provision of a psycho-oncological intervention using imaginative stabilization techniques for distressed patients (distress due to anxiety ≥5) or in a case of subjective interest in the psycho-oncological intervention. Another allocation path to the intervention was directly through the radiation oncologist in charge who classified the patient as: in need of support to tolerate the immobilization device. Of a total of 1,020 screened patients, 257 (25.2%) patients indicated a distress ≥5 and 141 (13.8%) patients reported panic attacks. 25% of the patients reported a subjective interest in psycho-oncological support. A total of 35 patients received the psycho-oncological intervention, of which 74% were assigned by radiation oncologists. In this small patient cohort, no significant pre-post effects in terms of depression, anxiety, distress, and quality of life (mental and physical component scores) could be detected. Our results indicate a good feasibility (interdisciplinary workflow and cooperation, allocation by physicians in charge) of the psycho-oncological care program for this cohort of patients before radiotherapy with mask fixation. The screening results underline the high psychological distress and demand for psycho-oncological support. However, since the utilization of our intervention was low, future studies should reduce the barriers and improve compliance to psycho-oncological services by these patients.Clinical Trial Registration: https://www.drks.de/drks_web/setLocale_EN.do #DRKS00013493

Complications of Halo Vest Orthosis: A Narrative Study

Background and Aim: Perry and Nickel introduced the halo vest in 1959. It is the most common immobilization device for the unstable cervical spine. In the literature review, most articles review the beneficial effects of the halo vest, and a few report its complications. This study aims to evaluate the complications associated with halo orthosis. Methods and Materials/Patients: This is a narrative study about halo vest complications. To provide up-to-date information, we reviewed the articles written about halo complications. All relevant articles were retrieved from Google Scholar, Medline, PubMed, etc., using the keywords of “halo vest orthosis”, “unstable cervical spine fracture”, “halo vest complications”, “halo vest immobilization”, “pin-site-related complications”, and “vest-related complications”. Afterward, we reviewed and critically analyzed the articles. Results: At first, the halo vest was used for postoperative paralyzed poliomyelitis patients, and later, it was also used for traumatic injury of the cervical spine or postoperatively in cervical spine reconstructive surgery. Compared to other orthoses, the halo vest provides a more effective external fixation and maintains normal anatomic alignment of the cervical spine without impacting jaw motion and resulting in eating problems. However, it has many temporary complications. To prevent halo vest complications, experienced people should apply it, and the patients should be regularly followed up for early detection and treatment of complications. Conclusion: Our review is the starting point for the evaluation and investigation of halo vest complications. Because of the high incidence of pin loosening and infection, it is better to evaluate the design and application of halo pin. Since the initial design of the halo vest, only its superstructure has been redesigned without any significant change in other parts of it.

Surface and the Build-up Dose Distribution Due to Applying Thermoplastic Masks in External Radiotherapy

Background: Thermoplastic immobilization devices are used to position the patient on the table in order to correctly reposition the patient during treatment courses. Objective: The Purpose of this work is investigating the degradation of surface dose and the dose distribution in the build-up region for photon beams associated with immobilization devices using Gafchromic films. Materials and Methods: After heating, these masks are stretched and fitted over the considered location of body before treatment simulation for insuring the reproducibility of patient position during treatment fractions. In this research, dosimetry was carried out using Gafchromic EBT3 film and three kinds of thermoplastic masks (Orfit with thickness 2.2mm, holes diameter 2.5mm, Orfit with thickness 2mm, holes diameter 1mm, and Klarity mask, thickness 2mm, holes diameter 3mm). Measurements were made with and without the mask materials on the surface of the Perspex phantom for 6 and 15 MV X-ray beams of a LINAC machine. Results: The results showed that surface dose increases 2.1 to 6.7 times and 2 to 3.9 times than the surface dose in the open field for 15 MV and 6 MV photons, respectively. According to the obtained results from the Analyses of Variances (ANOVA) test , it is defined that there is a significant difference in surface dose among three kind of thermoplastic masks (χ2=49.78 and df=3 and P<0.0001). The surface dose in Klarity has a significant difference in comparison of other masks according to PostHoc exams and there is no significant difference among two other masks (P>0.05). Conclusion: According to the results, Klarity mask is more acceptable immobilization device when compared with other masks in the test.

Feasibility study of a 3D-printed personalized immobilization device integrating a patient-specific probe holder for prostate radiotherapy combined with adjuvant MR-guided transperineal ultrasound hyperthermia

The authors have requested that this preprint be removed from Research Square.

Correction of Valgus Dislocation of the Radio-Carpal Joint in a Dog through Ligament Reconstruction with Synthetic Wire: an Alternative to Arthrodesis

Background: Radio-carpal dislocations are normally related to situations of trauma and may be treated with open or closed reduction, reconstruction of injured structures or arthrodesis. The treatment aims to eliminate pain, abnormal joint movement and restore member functions, avoiding or minimizing the development of arthrosis. Notwithstanding the literature on the treatment options, few of them explain the restorative technical applications and their evolution in a later postoperative period. The aim of the present report is to discuss extra-articular joint reconstruction with nylon wire in a canine patient with radio-carpal joint dislocation and ligament rupture.Case: A 10-year-old mixed-breed bitch, weighing 10 kg, after an 8-meter fall, received care at Animal Care Barueri Clínica Veterinária. The animal presented left thoracic member functional impotence and radio-carpal joint valgus dislocation, pain and joint swelling. The patient was sedated and medium-lateral and dorso-palmar X-rays of the distal area of the thoracic member were performed, showing radio-carpal dislocation and a slight radiotransparent line in caudal cortical of the middle third of the left radium, possibly related to an incomplete fracture due to compaction. At this point, the choice was for a closed reduction performed by means of traction followed by internal rotation of the distal extremity of the member. An immobilization device was placed using a vinyl splint for 4 days, until the date of the surgery. For the surgical procedure, a dorso-medial access was opened in the left radio-carpal joint, restoring the short radium collateral joint with nylon 0 suture, anchored on 3 pathways opened in the bones (2 pathways in the radium and 1 in the carpo-radial bone), forming one knot. The subcutaneous tissue was closed and sutured using absorbable wire of 2-0 polyglycolic acid. The skin was sutured using nonabsorbable wire of 3-0 nylon. The immediate postoperative X-rays showed the pathways created, conservation of the bone structures and restoration of the anatomic axis of the radio-carpal joint. The member was again immobilized for 70 days and, 30 days after removal of the splint, the animal could already bear load over the member, without lameness. At 10 months after the surgery, the patient performed X-rays of the medium-lateral and dorso-palmar projections, showing absence of the signs of arthrosis or any joint impairment. There was also absence of lameness and pain, however with reduction in joint movement amplitude, with total extension but more limited flexion.Discussion: Through comparison with the literature it was possible to find similarities with the joint injury approach reported, mainly regarding the form of the suture and the clinical alterations observed, such as short radium collateral ligament rupture related to joint valgus deviation. The treatment strategy in the case combined temporary closed reduction of the joint, immobilization, later joint access and restoration with synthetic wire and long-term immobilization. The postoperative results obtained showed favorable evolution, without signs of joint degeneration, pain or lameness. Possible unwanted consequences related to arthrodesis make the options for reconstruction techniques seem more interesting; however, further information of their application and the combination of its variations in a more directed fashion are still required. Understanding the types of injuries, together with the development of research that assess their diagnosis and evolution, may help treatments to show even better perspectives.Keywords: dislocation, joint, radio-carpal, reconstruction, ligament.Título: Correção de luxação valga da articulação rádio-cárpica em um cão através da reconstrução ligamentar com fio sintético: uma alternativa à artrodeseDescritores: luxação, articulação, rádio-cárpica, reconstrução, ligamento.

Acceptance and Image Quality of High-Resolution Peripheral Quantitative Computed Tomography of the Metacarpophalangeal Joints in Rheumatoid Arthritis.

Objective: To investigate the acceptance of the high-resolution peripheral quantitative computed tomography (HR-pQCT) in rheumatoid arthritis (RA). The second objective was to investigate the motion artefacts of the metacarpophalangeal (MCP) joints with two different custom-made positioning devices. Methods: Fifty patients with established RA had their MCP joints scanned by HR-pQCT with two different custom-made positioning devices and examined by conventional X-ray. Afterwards, the patients answered a questionnaire of imaging experience. The comparability of the erosion measures was investigated between the two different custom-made positioning devices by Bland-Altman plot, and intrareader repeatability by intraclass correlation coefficient. The motion artefacts were graded for each acquisition, and intrareader repeatability was investigated by Cohen's kappa coefficient.Results: Forty percent of the patients preferred HR-pQCT imaging, only 6% preferred conventional X-ray. Seventy-four percent found it difficult to keep their fingers steady during the scan. Fifty percent of the patients reported the inflatable immobilization device helped to keep their fingers steady while only 6% reported that it impaired their ability to do so. However, this difference was not reflected in the visual grading, as motion artefacts were sparse, and no clinically relevant difference could be observed. The intrareader repeatability and comparability for the erosion measures were excellent.Conclusion: The high acceptance among patients adds to the feasibility of HR-pQCT imaging of MCP joints in patients with RA. The inflatable immobilization device did not reduce motion-induced image degradation, as the overall visual grading for motion artefacts was low for imaging of the MCP joints in both acquisitions.