4 results
Potential advantages of gEUD optimisation as compared with conventional physical optimisation for stereotactic treatment planning
- A Aziz Sait, Glenn W. Jones, Nikhil Rastogi, Rebecca Mathew, Sunil Mani, Jason Berilgen
-
- Journal:
- Journal of Radiotherapy in Practice / Volume 22 / 2023
- Published online by Cambridge University Press:
- 20 October 2023, e112
-
- Article
- Export citation
-
Introduction:
A small number of studies have confirmed the advantage of generalised equivalent uniform dose (gEUD) optimisation for some standard clinical scenarios; however, its performance with complicated stereotactic treatments is yet to be explored. Therefore, this study compared two planning optimisation methods, gEUD and Physical dose, in stereotactic treatments for several complex anatomical locations.
Methods:Thirty patients were selected, ten each for sites of brain, lung and spine. Two stereotactic plans were generated for each case using the gEUD objective and Physical objective cost functions. Within each of the three sites, dosimetric indices for conformity, gradient and homogeneity, along with parameters of monitor units and dose–volume histograms (DVHs), were compared for statistical significance. Additionally, patient-specific quality assurance was conducted using portal dosimetry, and the gamma passing rate between the two plans was evaluated.
Results:Optimisation was better with a gEUD objective as compared with Physical objective, notably sparing critical organs. Overall, the differences in mean values for six critical organs at risk favoured gEUD-based over Physical-based plans (all six 2-tailed p-values were < 0·0002). Furthermore, all differences in mean values for DVH parameters favoured gEUD-based plans: GTVmean, GTVmax, PTVD100V, homogeneity index, gradient index and monitor unit (treatment time) (each 2-tailed p < 0·05).
Conclusions:gEUD optimisation in stereotactic treatment plans has a clear and general statistical advantage over Physical dose optimisation.
11 - Manufacturing and Automation
-
- By Sunil Mani
- Edited by R. Nagaraj, Indira Gandhi Institute of Development Research, Bombay
-
- Book:
- Industrialisation for Employment and Growth in India
- Published online:
- 31 July 2021
- Print publication:
- 07 October 2021, pp 250-276
-
- Chapter
- Export citation
-
Summary
Introduction
The initiation of the Make in India programme is yet another statement of the desire of the government to increase employment in the country through the manufacturing route. Under this programme, the manufacturing sector is expected to contribute at least a quarter of India's gross domestic product (GDP) by 2020. However, recent events and discussions have brought to the fore the pessimism that not much employment possibilities emanate from the manufacturing sector due to its capital-intensive nature, which the sector had become for quite some time now. The worst fears on this issue have been accentuated with the increasing automation of manufacturing processes elsewhere in the world. Industrial automation is thought to have a deleterious effect on the creation of employment in different sectors of the economy, manufacturing included. This has given rise to an important debate, primarily in the context of developed countries where industrial automation has diffused manifold and that too over a much longer period of time. This debate, although originally in the popular press, has now been brought to the formal academic table by the publication of an influential and highly cited piece of research by Frey and Osborne (2013). Subsequently, one of the leading academic journals, namely the Journal of Economic Perspectives, organised a symposium on the theme of ‘automation and labour markets’ in its 2015 summer issue. Thereafter, there has been a series of studies by academic economists and multilateral institutions such as the Organisation for Economic Co-operation and Development (OECD 2016) as well.
In the context, the purpose of the chapter is to understand the extent of the diffusion of automation technologies in Indian manufacturing and then analyse its effects on manufacturing employment.
Concept of Automation
A range of technologies are involved in industrial automation which manifests itself as both hardware and software. Employment implications of these various automation technologies vary considerably. The specific automation technology that has the most direct impact on employment is the use of multipurpose industrial robots. The International Federation of Robotics – IFR for short – defines an industrial robot as ‘an automatically controlled, reprogrammable, and multipurpose [machine]’ (IFR 2014).
Catheter-based palliation for infants with tetralogy of Fallot
- Dasana Lingaswamy, Louisa Koepcke, Mani Ram Krishna, Brijesh P. Kottayil, Gopalraj S. Sunil, Katie Moynihan, Balaji Seshadri, Raman Krishna Kumar
-
- Journal:
- Cardiology in the Young / Volume 30 / Issue 10 / October 2020
- Published online by Cambridge University Press:
- 10 August 2020, pp. 1469-1472
-
- Article
- Export citation
-
Background:
The optimal management of symptomatic tetralogy of Fallot in neonates and younger infants with unfavourable anatomy is unclear and is further constrained by resource limitations in low and middle income countries.
Methods:Retrospective medical record review of infants with tetralogy of Fallot undergoing corrective or palliative procedures between January 2016 and June 2019.
Results:The study included 120 infants; of whom 83 underwent primary complete repair, four underwent surgical palliation, and 33 underwent catheter-based palliation, including balloon pulmonary valvuloplasty (n = 18), right ventricular outflow tract stenting (n = 14), and stenting of the patent arterial duct (n = 1). Infants undergoing catheter-based procedures were younger in age (median 32 days; inter-quartile range (IQR) 7–144 versus 210 days; IQR 158–250), with lower baseline saturation (65 ± 12% versus 87 ± 7%) and had smaller pulmonary artery z-scores compared to the complete repair cohort. Follow-up was available for 31/33 (94%) infants (median 7 months [IQR 4–11]) who underwent trans-catheter palliation; 12 underwent complete repair, 10 are well, awaiting repair, eight required further palliation (catheter: 6; surgical: 2), and one died post-discharge from non-cardiac causes.
Conclusion:Catheter-based palliation is a safe and effective alternative in infants with tetralogy of Fallot who are at high risk for primary surgical repair.
Radiation-induced second cancer risk from stereotactic ablative radiotherapy (SABR) for lung cancer: a review of planning studies
- Vasanthan Sakthivel, Ganesh Kadirampatti Mani, Sunil Mani, Raghavendiran Boopathy
-
- Journal:
- Journal of Radiotherapy in Practice / Volume 17 / Issue 2 / June 2018
- Published online by Cambridge University Press:
- 11 October 2017, pp. 194-204
-
- Article
- Export citation
-
Purpose
The aim of the current study was to (i) to calculate organ equivalent dose (OED) and (ii) to estimate excess absolute risks (EARs), lifetime attributable risks (LARs) and relative risks (RRs) from stereotactic ablative radiotherapy (SABR) for lung cancer to in-field, close to field, and out of field structures.
MethodsA total of five patients with T1, T2 (≤4 cm), N0, M0 medically inoperable non-small cell lung cancer were selected for treatment planning. Patient selection criteria were based on RTOG 0236. Five treatment deliveries were investigated: (i) three-dimensional conformal radiotherapy (3DCRT), (ii) intensity-modulated radiotherapy (IMRT), (iii) intensity-modulated radiotherapy with flattening filter free beam (IMRTF), (iv) volumetric modulated arc therapy (VMAT) and (v) volumetric modulated arc therapy with flattening filter free arcs (VMATF). Delineated normal structures included chest wall, left and right lung, trachea, small and large airways, spinal cord, oesophagus and involved ribs. All plans were prescribed to 60 Gy in five fractions to primary planning target volume (PTV) volume so that ≥98% of the PTV received ≥98% of the prescription dose and internal tumour volume received 100% of the prescription dose. The OED for all delineated normal structures was calculated using differential dose volume histograms. Using risk models, the age-dependent LAR’s and RR were calculated. Additionally, the secondary cancer risk for organs inside primary radiation was analysed using sarcoma and carcinoma risk models.
ResultsFor all patients, the mean V20 volumes from the SABR plans were 4·1% (3DRT), 11·8% (IMRT), and 12·7% (VMAT), respectively. The EAR (combining all organs EAR) for all the organs studied, ranged from 8·5 to 10·6/10,000 persons/year for VMATF and 3DCRT, respectively. The EAR (combining all organs EAR) for all the organs studied, ranged from 8·5 to 10·6/10,000 persons/year for VMATF and 3DCRT, respectively. The absolute EAR difference between IMRT and IMRTF was low ranging from 0·2 to 0·4/10,000 persons-year, whereas delivery difference (IMRT and VMAT) had a significant impact on EAR with absolute difference ranging from 0·5 to 1·0/10,000 persons-year for IMRT and VMAT and 1·1–1·5/10,000 persons-year for IMRTF, VMATF, respectively. The LAR data showed a strong dependence on age at exposure and the LAR decreased as a function of age at exposure. The absolute attributable risk of bone sarcoma was lower with the VMAT plan and was significantly higher with the 3DCRT plan.
ConclusionFrom a clinical perspective, it should be concluded that all five solutions investigated in the study can offer high quality of patient treatments and only estimates of radiation-induced malignancies can truly differentiate among them. The results suggested it would be reasonable to use the cumulative LAR difference when needed to select between treatment techniques. In conclusion, the LAR of radiation-induced secondary cancer was significantly lower when using VMATF than when using IMRT for SABR lung patients. VMATF would be the right choice for the treatment of SABR lung patients in terms of LAR. However, more work is required for the specific estimation and long-term validation and updating of the models behind LAR estimation.