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Rathod S, Pallikadavath S, Graves E, Rahman MM, Brooks A, Rathod P, Bhargava R, Irfan M, Aly R, Mohammad Saleh Al Gahtani H, Salam Z, Chau SWH, Paterson TSE, Turner B, Gorbunova V, Klymchuk V, Phiri P. Effects of cumulative COVID-19 cases on mental health: Evidence from multi-country survey. World J Psychiatry 2023; 13:461-477. [PMID: 37547737 PMCID: PMC10401503 DOI: 10.5498/wjp.v13.i7.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/27/2023] [Accepted: 04/24/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND Depression and anxiety were both ranked among the top 25 leading causes of global burden of diseases in 2019 prior to the coronavirus disease 2019 (COVID-19) pandemic. The pandemic affected, and in many cases threatened, the health and lives of millions of people across the globe and within the first year, global prevalence of anxiety and depression increased by 25% with the greatest influx in places highly affected by COVID-19.
AIM To explore the psychological impact of the pandemic and resultant restrictions in different countries using an opportunistic sample and online questionnaire in different phases of the pandemic.
METHODS A repeated, cross-sectional online international survey of adults, 16 years and above, was carried out in 10 countries (United Kingdom, India, Canada, Bangladesh, Ukraine, Hong Kong, Pakistan, Egypt, Bahrain, Saudi Arabia). The online questionnaire was based on published approaches to understand the psychological impact of COVID-19 and the resultant restrictions. Five standardised measures were included to explore levels of depression [patient health questionnaire (PHQ-9)], anxiety [generalized anxiety disorder (GAD) assessment], impact of trauma [the impact of events scale-revised (IES-R)], loneliness (a brief loneliness scale), and social support (The Multi-dimensional Scale of Perceived Social support).
RESULTS There were two rounds of the online survey in 10 countries with 42866 participants in Round 1 and 92260 in Round 2. The largest number of participants recruited from the United Kingdom (112985 overall). The majority of participants reported receiving no support from mental health services throughout the pandemic. This study found that the daily cumulative COVID-19 cases had a statistically significant effect on PHQ-9, GAD-7, and IES-R scores. These scores significantly increased in the second round of surveys with the ordinary least squares regression results with regression discontinuity design specification (to control lockdown effects) confirming these results. The study findings imply that participants’ mental health worsened with high cumulative COVID-19 cases.
CONCLUSION Whist we are still living through the impact of COVID-19, this paper focuses on its impact on mental health, discusses the possible consequences and future implications. This study revealed that daily cumulative COVID-19 cases have a significant impact on depression, anxiety, and trauma. Increasing cumulative cases influenced and impacted education, employment, socialization and finances, to name but a few. Building a database of global evidence will allow for future planning of pandemics, particularly the impact on mental health of populations considering the cultural differences.
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Affiliation(s)
- Shanaya Rathod
- Department of Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Saseendran Pallikadavath
- Portsmouth-Brawijaya Centre for Global Health, University of Portsmouth, Portsmouth PO1 2UP, United Kingdom
| | - Elizabeth Graves
- Department of Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Mohammad M Rahman
- Salford Business School, University of Salford, Salford M5 4WT, United Kingdom
| | - Ashlea Brooks
- Department of Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Pranay Rathod
- Patient and Public Involvement, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Rachna Bhargava
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Muhammad Irfan
- Department of Mental Health, Psychiatry and Behavioral Sciences, Peshawar Medical College, Riphah International University, Islamabad 46000, Pakistan
| | - Reham Aly
- Department of Clinical Services, Ministry of Health, Cairo 4262114, Egypt
| | | | - Zahwa Salam
- Peshawar Dental College, Ripah International University, Islamabad 46000, Pakistan
| | - Steven Wai Ho Chau
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Theone S E Paterson
- Department of Psychology, University of Victoria, Victoria BC V8P 5C2, Canada
| | - Brianna Turner
- Department of Psychology, University of Victoria, Victoria BC V8P 5C2, Canada
| | - Viktoria Gorbunova
- Department of Social Psychology, Zhytomyr State University, Zhytomyr 10002, Ukraine
| | - Vitaly Klymchuk
- National Psychological Association, Mental Health for Ukraine Project, European Federation of Psychologists' Association, GFA, Kyiv 04071, Ukraine
| | - Peter Phiri
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
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Oliveira T, Brown J, Juby AG, Schneider P, Wani RJ, Packalen M, Avcil S, Li S, Farris M, Graves E, McMullen S, Kendler DL. Trends in osteoporosis care patterns during the COVID-19 pandemic in Alberta, Canada. Arch Osteoporos 2022; 17:110. [PMID: 35920939 PMCID: PMC9349101 DOI: 10.1007/s11657-022-01132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/13/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE/INTRODUCTION The objective of this study was to describe osteoporosis-related care patterns during the coronavirus disease 2019 (COVID-19) pandemic in Alberta, Canada, relative to the 3-year preceding. METHODS A repeated cross-sectional study design encompassing 3-month periods of continuous administrative health data between March 15, 2017, and September 14, 2020, described osteoporosis-related healthcare resource utilization (HCRU) and treatment patterns. Outcomes included patients with osteoporosis-related healthcare encounters, physician visits, diagnostic and laboratory test volumes, and treatment initiations and disruptions. The percent change between outcomes was calculated, averaged across the control periods (2017-2019), relative to the COVID-19 periods (2020). RESULTS Relative to the average control March to June period, all HCRU declined during the corresponding COVID-19 period. There was a reduction of 14% in patients with osteoporosis healthcare encounters, 13% in general practitioner visits, 9% in specialist practitioner visits, 47% in bone mineral density tests, and 13% in vitamin D tests. Treatment initiations declined 43%, 26%, and 35% for oral bisphosphonates, intravenous bisphosphonates, and denosumab, respectively. Slight increases were observed in the proportion of patients with treatment disruptions. In the subsequent June to September period, HCRU either returned to or surpassed pre-pandemic levels, when including telehealth visits accounting for 33-45% of healthcare encounters during the COVID periods. Oral bisphosphonate treatment initiations remained lower than pre-pandemic levels. CONCLUSIONS This study demonstrates the COVID-19 pandemic and corresponding public health lockdowns further heightened the "crisis" around the known gap in osteoporosis care and altered the provision of care (e.g., use of telehealth and initiation of treatment). Osteoporosis has a known substantial care and management disparity, which has been classified as a crisis. The COVID-19 pandemic created additional burden on osteoporosis patient care with healthcare encounters, physician visits, diagnostic and laboratory tests, and treatment initiations all declining during the initial pandemic period, relative to previous years.
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Affiliation(s)
- T Oliveira
- Amgen Canada Inc, Mississauga, ON, Canada
| | - J Brown
- Department of Medicine, Division of Rheumatology, Laval University and CHU de Québec Research Centre, Quebec City, QC, Canada
| | - A G Juby
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - P Schneider
- Division of Orthopaedic Trauma, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - R J Wani
- Amgen Canada Inc, Mississauga, ON, Canada
| | - M Packalen
- Amgen Canada Inc, Mississauga, ON, Canada
| | - S Avcil
- Amgen Canada Inc, Mississauga, ON, Canada
| | - S Li
- Medlior Health Outcomes Research Ltd, Calgary, AB, Canada
| | - M Farris
- Medlior Health Outcomes Research Ltd, Calgary, AB, Canada
| | - E Graves
- Medlior Health Outcomes Research Ltd, Calgary, AB, Canada
| | - S McMullen
- Medlior Health Outcomes Research Ltd, Calgary, AB, Canada.
| | - D L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
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Oliveira T, Kendler DL, Schneider P, Juby AG, Wani RJ, Packalen M, Avcil S, Li S, Waters-Banker C, Graves E, McMullen S, Brown J. Trends in osteoporotic fracture and related in-hospital complications during the COVID-19 pandemic in Alberta, Canada. Arch Osteoporos 2022; 17:109. [PMID: 35920903 PMCID: PMC9349109 DOI: 10.1007/s11657-022-01114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/25/2022] [Indexed: 02/03/2023]
Abstract
Fragility fractures (i.e., low-energy fractures) account for most fractures among older Canadians and are associated with significant increases in morbidity and mortality. Study results suggest that low-energy fracture rates (associated with surgical intervention and outcomes) declined slightly, but largely remained stable in the first few months of the COVID-19 pandemic. PURPOSE/INTRODUCTION This study describes rates of low-energy fractures, time-to-surgery, complications, and deaths post-surgery in patients with fractures during the coronavirus disease (COVID-19) pandemic in Alberta, Canada, compared to the three years prior. METHODS A repeated cross-sectional study was conducted using provincial-level administrative health data. Outcomes were assessed in 3-month periods in the 3 years preceding the COVID-19 pandemic and in the first two 3-month periods after restrictions were implemented. Patterns of fracture- and hospital-related outcomes over the control years (2017-2019) and COVID-19 restrictions periods (2020) were calculated. RESULTS Relative to the average from the control periods, there was a slight decrease in the absolute number of low-energy fractures (n = 4733 versus n = 4308) during the first COVID-19 period, followed by a slight rise in the second COVID-19 period (n = 4520 versus n = 4831). While the absolute number of patients with low-energy fractures receiving surgery within the same episode of care decreased slightly during the COVID-19 periods, the proportion receiving surgery and the proportion receiving surgery within 24 h of admission remained stable. Across all periods, hip fractures accounted for the majority of patients with low-energy fractures receiving surgery (range: 58.9-64.2%). Patients with complications following surgery and in-hospital deaths following fracture repair decreased slightly during the COVID-19 periods. CONCLUSIONS These results suggest that low-energy fracture rates, associated surgeries, and surgical outcomes declined slightly, but largely remained stable in the first few months of the pandemic. Further investigation is warranted to explore patterns during subsequent COVID-19 waves when the healthcare system experienced severe strain.
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Affiliation(s)
- T Oliveira
- Amgen Canada Inc, Mississauga, ON, Canada
| | - D L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - P Schneider
- Division of Orthopaedic Trauma, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - A G Juby
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - R J Wani
- Amgen Canada Inc, Mississauga, ON, Canada
| | - M Packalen
- Amgen Canada Inc, Mississauga, ON, Canada
| | - S Avcil
- Amgen Canada Inc, Mississauga, ON, Canada
| | - S Li
- Medlior Health Outcomes Research Ltd, Suite 210 - 28 Quarry Park Blvd, Calgary, AB, T2C 5P9, Canada
| | - C Waters-Banker
- Medlior Health Outcomes Research Ltd, Suite 210 - 28 Quarry Park Blvd, Calgary, AB, T2C 5P9, Canada
| | - E Graves
- Medlior Health Outcomes Research Ltd, Suite 210 - 28 Quarry Park Blvd, Calgary, AB, T2C 5P9, Canada
| | - S McMullen
- Medlior Health Outcomes Research Ltd, Suite 210 - 28 Quarry Park Blvd, Calgary, AB, T2C 5P9, Canada.
| | - J Brown
- Department of Medicine, Laval University and CHU de Québec Research Centre, Quebec City, QC, Canada
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Dworkin M, No HJ, Wu Y, Binkley M, Rieger K, Graves E, Barcellos-Hoff M, Von Eyben R, Ashraf R, Manjappa R, Yu A, Skinner L, Surucu M, Kim Y, Loo B, Hoppe R. A RANDOMIZED SPLIT-BODY FEASIBILITY TRIAL OF SINGLE-FRACTION FLASH VS CONVENTIONAL ELECTRON RADIOTHERAPY USING A STANDARD CLINICAL LINEAR ACCELERATOR FOR ADULTS WITH MULTILESIONAL PRIMARY CUTANEOUS LYMPHOMAS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Rathod S, Pallikadavath S, Graves E, Rahman MM, Brooks A, Soomro MG, Rathod P, Phiri P. Impact of lockdown relaxation and implementation of the face-covering policy on mental health: A United Kingdom COVID-19 study. World J Psychiatry 2021; 11:1346-1365. [PMID: 35070782 PMCID: PMC8717029 DOI: 10.5498/wjp.v11.i12.1346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/04/2021] [Accepted: 10/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pandemic mitigation policies, such as lockdown, are known to impact on mental health of individuals. Compulsory face covering under relaxed lockdown restrictions gives assurance of less transmission of airborne infection and has the potential to improve mental health of individuals affected by restrictions. AIM To examine the association of the lockdown relaxation and the implementation of the face covering policy on the mental health of the general population and sub-groups in the United Kingdom using interrupted time series model. METHODS Using a web-based cross-sectional survey of 28890 United Kingdom adults carried out during May 1, 2020 to July 31, 2020, changes in mental health status using generalised anxiety disorder (GAD-7), and impact of events scale-revised (IES-R) scales are examined, at the dates of the first lockdown relaxation (July 4, 2020) and the subsequent introduction of face covering (July 24, 2020) in United Kingdom. A sharp regression discontinuity design is used to check discontinuities in mental health outcomes at policy-change dates. RESULTS Average GAD-7 scores of participants were 5.6, 5.6 and 4.3 during the lockdown period, the lockdown relaxation phase and the phase of compulsory face covering, respectively, with lower scores indicating lower anxiety levels. Corresponding scores for IES-R were 17.3, 16.8 and 13.4, with lower scores indicating less distress. Easing lockdown measures and subsequent introduction of face covering, on average, reduced GAD-7 by 0.513 (95%CI: 0.913-0.112) and 1.148 (95%CI: 1.800-0.496), respectively. Corresponding reductions in IES-R were 2.620 (95%CI: 4.279-0.961) and 3.449 (95%CI: 5.725-1.172). These imply that both lockdown relaxation and compulsory face-covering have a positive association with mental health scores (GAD-7 and IES-R). CONCLUSION The differential impact of lockdown and relaxation on the mental health of population sub-groups is evident in this study with future implications for policy. Introduction of face covering in public places had a stronger positive association with mental health than lockdown relaxation.
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Affiliation(s)
- Shanaya Rathod
- Department of Research and Development, Southern Health NHS Foundation Trust, Southampton SO30 3JB, Hampshire, United Kingdom
- Portsmouth-Brawijaya Centre for Global Health, Population and Policy, University of Portsmouth, Portsmouth PO1 2DT, United Kingdom
| | - Saseendran Pallikadavath
- School of Health and Care Professions, University of Portsmouth, Portsmouth PO1 2DT, Hampshire, United Kingdom
| | - Elizabeth Graves
- Department of Research and Development, Southern Health NHS Foundation Trust, Southampton SO30 3JB, Hampshire, United Kingdom
| | - Mohammad Mahbubur Rahman
- School of Health and Care Professions, University of Portsmouth, Portsmouth PO1 2DT, Hampshire, United Kingdom
| | - Ashlea Brooks
- Department of Research and Development, Southern Health NHS Foundation Trust, Southampton SO30 3JB, Hampshire, United Kingdom
| | - Mustafa G Soomro
- Mental Health, Solent NHS Trust, Portsmouth P03 6AD, United Kingdom
| | - Pranay Rathod
- PPI, PPI Representative, London SO30 3JB, United Kingdom
| | - Peter Phiri
- Department of Research and Development, Southern Health NHS Foundation Trust, Southampton SO30 3JB, Hampshire, United Kingdom
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, United Kingdom
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Goodman S, Mackinnon E, Gregoire J, Raggi P, Wani R, Packalen M, Avcil S, Farris M, Graves E, Cowling T, Anderson T. COVID-19 PANDEMIC INDUCED DISRUPTIONS IN TROPONIN AND LOW-DENSITY LIPOPROTEIN CHOLESTEROL LABORATORY TEST VOLUMES ACROSS ALBERTA. Can J Cardiol 2021. [PMCID: PMC8523089 DOI: 10.1016/j.cjca.2021.07.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in Canada and worldwide. Laboratory tests, including troponin and low-density lipoprotein cholesterol (LDL-C), are important biomarkers of ASCVD risk. The objective of this study was to investigate patterns of testing for troponin and LDL-C test volumes among Alberta residents during the coronavirus disease 2019 (COVID-19) pandemic. METHODS AND RESULTS A repeated cross-sectional study design captured population-level laboratory test volumes between March 15, 2019 and December 14, 2020. Three-month cross-sections were derived to report laboratory test volumes by different COVID-19 restriction periods during 2020-2021 and using 2019-2020 as a preceding control period. Percent change for troponin and LDL-C test volumes were calculated for both control and COVID-19 periods among adult (≥18 years of age) Alberta residents, and stratified by age (18-49, 50-65, 66-79, and ≥80 years), sex, and geographic zones (urban, rural). This preliminary data is part of an ongoing study for which further troponin and LDL-C test volumes will be available up until March 14, 2021 (representing one year of data throughout the COVID-19 pandemic). Among the Alberta population, 292,836 troponin and 794,789 LDL-C tests were captured between March 15, 2020 and December 14, 2020 (Figure 1). Testing patterns during the COVID-19 restriction period showed marked reduction in test volumes from the previous year. The initial cross-section of the COVID-19 period (March-June 2020) was characterized by the largest overall reduction with troponin test volumes decreasing 18% and LDL-C test volumes decreasing 63%, compared to the year prior. As restrictions eased in the summer months of 2020, testing volumes rebounded to near pre-pandemic volumes for both tests. However, in the fall of 2020, troponin tests decreased again (-15%). Within these drops in utilization, slightly larger relative declines were observed for troponin test volumes in women (-20%) and patients ≥80 years-old (-25%) and for LDL-C test volumes among urban residents (-64%), women (-67%) and patients aged 18-49 (-66%) and 50-65 (-65%) years (Table 1). CONCLUSION This study describes declines in troponin and LDL-C test volumes in the initial and second COVID-19 lockdown periods. Women had overall smaller total troponin and LDL-C test volumes and larger relative declines during the pandemic compared to men. The decrease in these ASCVD-related laboratory test volumes during the pandemic may have been accompanied by other important changes in indicators of healthcare utilization and associated clinical outcomes. Ongoing analyses will further explore the impact of the pandemic.
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Rathod S, Graves E, Kingdon D, Thorne K, Naeem F, Phiri P. Cultural Adaptations in Clinical InteractiONs (CoACtION): a multi-site comparative study to assess what cultural adaptations are made by clinicians in different settings. Int Rev Psychiatry 2021; 33:3-15. [PMID: 32368938 DOI: 10.1080/09540261.2020.1750818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Culture influences models of mental illness, help-seeking behaviours and outcomes of interventions. Cultural competency training has been developed to improve clinician practice in addressing these issues. The study aims to identify to what extent culturally competent and informed interactions are used by clinicians in England and how patients experience these interaction. Clinicians and non-white western patients were recruited to complete a questionnaire on culturally adapted practice in 25 areas of England. Clinicians are much more likely to rate their practice as clinically competent whereas patients were more likely to disagree that services were completely culturally competent. Length of time working as clinicians, receipt of specific cultural competence training and a higher percentage of caseload from non-white western backgrounds all increased clinician's perception that their practice was culturally competent. Clinicians recognised the importance of cultural competency but the disparity between their assessment of whether they achieved this and that of patients must be addressed. Ethics approval was obtained via proportionate review from the London - Central Research Ethics Committee (REC Ref no: 17/LO/1962). Study registration: UK Clinical Research Network Portfolio: 36744.
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Affiliation(s)
| | | | - David Kingdon
- Department of Medicine, University of Southampton, Southampton, UK
| | | | - Farooq Naeem
- Centre for Addiction & Mental Health, University of Toronto, Toronto, ON, Canada
| | - Peter Phiri
- Southern Health NHS Foundation Trust, Southampton, UK
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Rathod S, Thorne K, Graves E, Phiri P, Asher C, Griffiths A, Read T, Kingdon D. Results of a prospective, mixed methods study to assess feasibility, acceptability and effectiveness of TRIumPH (Treatment and Recovery In PsycHosis): an integrated care pathway for psychosis, compared to usual treatment. BMJ Open 2020; 10:e033711. [PMID: 32354777 PMCID: PMC7213857 DOI: 10.1136/bmjopen-2019-033711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To evaluate whether a newly developed care pathway, Treatment and Recovery In PsycHosis (TRIumPH), is feasible, acceptable and effective in meeting National Institute of Health and Care Excellence (NICE) quality standards in a timely manner. METHODS This is a pragmatic, non-randomised, prospective, mixed methods study comparing an implementation (TRIumPH) and comparator site (not implementing TRIumPH) across three cohorts to assess feasibility, acceptability and effectiveness of the integrated pathway. SETTING Early intervention in psychosis (EIP) services at two National Health Service organisations in South of England. PARTICIPANTS All patients accepted into EIP services between 1 June 2014 and 31 May 2017 were each followed up for 1 year within their respective cohorts. METHODOLOGY Quantitative data consisted of routinely collected clinical data retrieved from patient records to assess whether the implementation of TRIumPH achieved better concordance to NICE standards. These included time to access services, physical health assessments, clinical outcomes based timeliness of delivery and acute data. The controlled trial has evaluated the effect of TRIumPH (Intervention) with Care As Usual (Comparator). Qualitative measures consisted of questionnaires, interviews and focus groups to assess acceptability and satisfaction. Outcome measures were compared within the baseline, year 1 and year 2 cohorts and between the two sites. Quantitative data were statistically analysed by comparing means and proportions. RESULTS Time to assessment improved in the implementation site and remained within the target in comparator site. Meeting of quality standards increased substantially in the implementation site but was more variable and reached lower levels in the comparator site especially for physical health standards. Cognitive therapy for psychosis, family intervention and carer and employment support were all offered to a greater extent in the implementation site and uptake increased over the period. CONCLUSIONS Pathway implementation generally led to greater improvements in achievement of access and quality standards compared with comparator site. TRIAL REGISTRATION NUMBER UK Clinical Research Network Portfolio (19187).
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Affiliation(s)
- Shanaya Rathod
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Kerensa Thorne
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Elizabeth Graves
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Peter Phiri
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Carolyn Asher
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | | | - Tracy Read
- Dorset HealthCare NHS Foundation Trust, Poole, Poole, UK
| | - David Kingdon
- Medicine, University of Southampton, Southampton, UK
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Affiliation(s)
- Elizabeth Graves
- assistant professor, Department of Human Development and Psychological Services, Appalachian State University, Boone, North Carolina
| | - R W Watkins
- senior physician consultant, Community Care of North Carolina, Asheville, North Carolina
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Graves E. TU-CD-303-04: Radiation-Induced Long Distance Tumor Cell Migration Into and Out of the Radiation Field and Its Clinical Implication. Med Phys 2015. [DOI: 10.1118/1.4925614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nanduri A, Fan Q, Yang J, Yamamoto T, Graves E, Loo B, Mazin S. TH-E-BRF-11: Dynamic Treatment of Clinical Margins Beyond the PET-Avid Target in Emission Guided Radiation Therapy: A Retrospective Patient Study. Med Phys 2014. [DOI: 10.1118/1.4889675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Rafat M, Bazalova M, Palma B, Kozak M, Jiang D, Dunning M, McCormick D, Nelson J, Hemsing E, Lartey F, Graves E, Koong A, Maxim P, Loo B. SU-C-BRE-06: Radiobiological Advantage of Very Rapid Irradiation. Med Phys 2014. [DOI: 10.1118/1.4889712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Keall P, Yang J, Yamamoto T, Pollock S, Diehn M, Berger J, Graves E, Loo B. SU-D-17A-04: The Impact of Audiovisual Biofeedback On Image Quality During 4D Functional and Anatomic Imaging: Results of a Prospective Clinical Trial. Med Phys 2014. [DOI: 10.1118/1.4887897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Yang J, Yamamoto T, Loo B, Graves E, Keall P. WE-G-BRF-06: Positron Emission Tomography (PET)-Guided Dynamic Lung Tumor Tracking for Cancer Radiotherapy: First Patient Simulations. Med Phys 2014. [DOI: 10.1118/1.4889499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Fan Q, Nanduri A, Yang J, Yamamoto T, Loo B, Graves E, Zhu L, Mazin S. Simultaneous Tracking of Multiple Metastases Using FDG-PET Emission-Guided Radiation Therapy (EGRT) in a Breast Cancer Patient. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fan Q, Nanduri A, Yang J, Yamamoto T, Loo B, Graves E, Zhu L, Mazin S. SU-F-500-06: Demonstration of a Planning Scheme for Emission Guided Radiation Therapy (EGRT) in a Metastatic Breast Cancer Patient. Med Phys 2013. [DOI: 10.1118/1.4815196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Park J, Bazalova M, Graves E, Lee J, Park H, Contag C, Suh T. SU-E-J-63: Correlation Between Radiation Dose and Molecular Bioluminescence Responses of 4T1 Breast Cancer Cells for Adaptive Radiation Therapy. Med Phys 2013. [DOI: 10.1118/1.4814275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Yang J, Yamamoto T, Mazin S, Cui J, Graves E, Keall P. TH-A-WAB-09: The Potential of Positron Emission Tomography (PET) for Intra-Treatment Dynamic Tumor Tracking During Radiotherapy: A Phantom Study. Med Phys 2013. [DOI: 10.1118/1.4815703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Yang J, Yamamoto T, Gopalan S, Berger J, Johnston E, Chung M, Eclov N, Diehn M, Loo B, Graves E, Keall P. TU-G-141-08: Impact of Audiovisual Biofeedback Respiratory Training On 4D-PET Image Quality. Med Phys 2013. [DOI: 10.1118/1.4815468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Eclov N, Loo B, Graves E, Maxim P. SU-E-J-177: Characterization of the Effect of 'Lung Detail' CT Reconstruction Algorithm on Radiation Therapy Dose Calculation. Med Phys 2012; 39:3693. [PMID: 28518919 DOI: 10.1118/1.4735016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Precise tumor delineation is important in thoracic radiation therapy planning, and using a 'lung detail' computed tomography (CT) reconstruction algorithm can assist in visualizing the tumor. We seek to determine the dosimetric impact of utilizing a lung detail algorithm versus a standard algorithm on calculated dose in radiation treatment planning. METHODS Ten patients, with 12 tumors, were analyzed in this study. Two CT scans, one reconstructed using a standard algorithm and one using a lung detail algorithm, were generated for each of 12 lung tumors. Treatment plans were calculated for each CT scan, with 7 tumors receiving stereotactic ablative radiotherapy (SABR) and 5 receiving intensity-modulated radiation therapy (IMRT). The Hounsfield unit (HU) and dose values for each voxel of the planning tumor volume (PTV), esophagus, spinal cord, and contralateral lung in both the CT and dose images were exported to MATLAB. For each contour, the voxel-by-voxel differences in the HU and dose distributions between the two scans were analyzed along with dose-volume histogram (DVH) data. RESULTS Despite changes in HU values, the voxel-by-voxel analysis showed a negligible shift in dose values. The mean differences in dose for PTV, esophagus, spinal cord, and contralateral lung ranged from -12.12 to 22.57, -2.21 to 7.40, -0.50 to 5.93, and -1.12 to 7.41 cGy, respectively. DVH comparisons demonstrated no meaningful difference between plans. The mean PTV, esophagus, spinal cord, and contralateral lung doses measured from the DVH shifted between plans an average of 3.5, 2.93, -0.6 and -0.35 cGy, respectively. These dose differences are all less than 1% of the dose prescribed to the tumor and are not measurable by current technology. CONCLUSIONS The lung detail reconstruction algorithm, when applied to thoracic radiation treatment planning CT scans, can help precisely delineate tumor with negligible dosimetric impact.
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Affiliation(s)
- N Eclov
- Stanford University, Stanford, CA
| | - B Loo
- Stanford University, Stanford, CA
| | - E Graves
- Stanford University, Stanford, CA
| | - P Maxim
- Stanford University, Stanford, CA
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Mazin S, Nanduri A, Yang J, Yamamoto T, Loo B, Graves E. TU-A-BRA-05: Lung Cancer Patient Feasibility Study for Emission Guided Radiation Therapy. Med Phys 2012. [DOI: 10.1118/1.4735873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Park J, Schmidt T, Graves E, Bazalova M, Lee J, Contag C, Suh T. SU-E-J-198: Bioluminescence Monitoring of Metastatic Breast Cancer: Quantitative Assessment of Radiation Treatment Effects and Tracking of Tumor Cells. Med Phys 2012; 39:3698. [PMID: 28519066 DOI: 10.1118/1.4735039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate radiation treatment effects on mammary carcinoma cells, quantitative photon radiance were monitored to track light-emitting cancer cells and metastasis using in vivo bioluminescence imaging. METHODS Eight female BALB/c mice aged 8 weeks were orthotopically injected with 5×104/cc 4T1 tumor cells into the abdominal mammary gland. The firefly luciferase-based bioluminescence images were acquired every 2-3 days for 1 month. Bioluminescent intensity was analyzed in average surface radiance (photons/sec/cm2 /sr) taken in 3-dimensional bioluminescence tomography (BLT). After 1 week, single-radiation dose of 20 Gy was delivered by orthovoltage X-rays. Variation of detected bioluminescence signals emitted from molecular cancer cells was depicted on BLT images. To delineate tumor volumes according to bioluminescence intensity on anatomical images for radiation therapy, BLT images were registered with the micro computed tomography (CT) images using surface-constrained warping. RESULTS Multispectral BLT images elaborated on early detection of cancer cells, characteristics of tumor growth, and metastasis for more accurate determination of internal bioluminescent sources. The radiation-treated mice having only primary tumor volumes showed 67% decrease in bioluminescent signals, while the mice with metastatic cancer cells suggested 88% reduction, as compared to the control group. Registration of BLT with CT images guided molecular cancer cells on anatomical coordinates. CONCLUSIONS The BLT imaging was a useful tool to localize cancer cells and to quantify radiation response. Application of BLT led to more accurate definition of tumor volumes including molecular probe-based microscopic cancer cells. Monitoring of bioluminescence signals enables to diagnose real-time metastatic behavior of cancer cells and determine optimal radiation treatment strategies adapted to tumor characteristics.
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Affiliation(s)
- J Park
- The Catholic University of Korea, Seoul, Korea.,Stanford University, Stanford, CA.,Konkuk University Medical Center, Seoul, Korea
| | - T Schmidt
- The Catholic University of Korea, Seoul, Korea.,Stanford University, Stanford, CA.,Konkuk University Medical Center, Seoul, Korea
| | - E Graves
- The Catholic University of Korea, Seoul, Korea.,Stanford University, Stanford, CA.,Konkuk University Medical Center, Seoul, Korea
| | - M Bazalova
- The Catholic University of Korea, Seoul, Korea.,Stanford University, Stanford, CA.,Konkuk University Medical Center, Seoul, Korea
| | - J Lee
- The Catholic University of Korea, Seoul, Korea.,Stanford University, Stanford, CA.,Konkuk University Medical Center, Seoul, Korea
| | - C Contag
- The Catholic University of Korea, Seoul, Korea.,Stanford University, Stanford, CA.,Konkuk University Medical Center, Seoul, Korea
| | - T Suh
- The Catholic University of Korea, Seoul, Korea.,Stanford University, Stanford, CA.,Konkuk University Medical Center, Seoul, Korea
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Yang J, Yamamoto T, Thielemans K, Mazin S, Graves E, Keall P. SU-E-J-156: A Feasibility Study for Real-Time Tumor Tracking Using Positron Emission Tomography (PET). Med Phys 2011. [DOI: 10.1118/1.3611924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Graves E. TU-E-214-01: Preclinical and Clinical Hypoxia Imaging: Current and Emerging Methods and Technology. Med Phys 2011. [DOI: 10.1118/1.3613199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nelson G, Bazalova M, Chang K, Ackerman N, Colomer MV, Graves E. SU-E-T-315: In Silico, in Vitro, and in Vivo Quantification of Tungsten and Iodine in Dose Enhanced RT (DERT). Med Phys 2011. [DOI: 10.1118/1.3612266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Ackerman N, Graves E, Bazalova M. SU-E-T-15: GEANT4 Microdosimetry for Simulation of Dose Enhancement in Vivo at Orthovoltage Energy. Med Phys 2011. [DOI: 10.1118/1.3611965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bazalova M, Graves E. TH-E-BRC-10: Accuracy of Monte Carlo Dose Calculations with Kilovoltage Photon Beams. Med Phys 2011. [DOI: 10.1118/1.3613578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Noll J, Nelson G, Colomer MV, Ali R, Bazalova M, Graves E. SU-E-T-316: Integration of Bioluminescence Imaging with Small Animal Radiotherapy for Treatment Planning and Response Assessment. Med Phys 2011. [DOI: 10.1118/1.3612267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bazalova M, Weil M, Graves E. 434 poster MONTE CARLO MODELING OF THE SCANNING BEAM DIGITAL X-RAY SOURCE (SBDX). Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70556-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chu K, Murphy J, La T, Loo B, Krakow T, Hsu A, Maxim P, Graves E, Chang D, Le Q. Prognostic Value of Metabolic Tumor Volume and Velocity in Predicting Head and Neck Cancer Outcomes. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Noll J, Ali R, Vilalta M, Graves E. TH-C-204B-04: Assessing the Potential of Cerenkov Radiation for in Vivo Imaging of Tumor Hypoxia. Med Phys 2010. [DOI: 10.1118/1.3469498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bazalova M, Nelson G, Noll J, Graves E. SU-GG-J-128: Comparison of Dose Distributions for Small Animal Radiotherapy Using a MicroCT Scanner and a Single-Field Irradiator. Med Phys 2010. [DOI: 10.1118/1.3468352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nelson G, Bazalova M, Vilalta M, Perez J, Graves E. SU-GG-J-131: Immobilization Bed for Multi-Modality Image Registration. Med Phys 2010. [DOI: 10.1118/1.3468355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nelson G, Vilalta M, Pérez J, Bazalova M, Giaccia A, Graves E. 72 poster: Molecular Imaging of Radiation Response in Preclinical Models Using a Novel Small Animal Radiotherapy System. Radiother Oncol 2010. [DOI: 10.1016/s0167-8140(15)34491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Raben D, Chen C, Loo B, Graves E, Kavanagh B. Metabolic Tumor Volume and Oropharynx Subsite as Prognostic Factors in Advanced Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schellenberg D, Ghambir S, Graves E, Wilson D. 36 ANALYZING WHETHER PET SCAN PARAMETERS PREDICT FOR PROGRESSION FREE SURVIVAL IN LOCALLY ADVANCED ESOPHAGEAL CANCER. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72423-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bazalova M, Zhou H, Keall P, Graves E. MONTE CARLO TREATMENT PLANNING FOR SMALL ANIMAL MICROCT-BASED RADIOTHERAPY. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rodriguez M, Nelson G, Zhou H, Keall P, Graves E. SU-FF-J-164: A Calibration Method for Positioning Small Animal Radiotherapy Subjects Using MicroCT. Med Phys 2009. [DOI: 10.1118/1.3181457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Motomura A, Bazalova M, Zhou H, Keall P, Graves E. SU-FF-T-671: Investigation of Effects of Treatment Planning Variables On Small Animal Therapy Dose Distributions. Med Phys 2009. [DOI: 10.1118/1.3182169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bazalova M, Zhou H, Keall P, Graves E. SU-FF-J-155: The Influence of Material Assignment On Monte Carlo Dose Calculations for Kilovoltage Small Animal Radiotherapy. Med Phys 2009. [DOI: 10.1118/1.3181448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Cui G, Maxim P, Graves E. SU-FF-I-152: Influence of Oxygen Tensions and Tissue Optical-Properties On Optical Reporter Genes. Med Phys 2009. [DOI: 10.1118/1.3181273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Rodriguez M, Zhou H, Jogani R, Nelson G, Keall P, Graves E. TH-C-BRC-09: Commissioning of a 3D MicroCT-Based Small Animal Radiotherapy System. Med Phys 2009. [DOI: 10.1118/1.3182623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Zhou H, Xu J, Rodriguez M, van den Haak F, Zhu X, Xian Y, Nelson G, Jogani R, Keall P, Graves E. TH-C-BRC-10: Evaluation of a Micro-CT Based 3D Conformal Animal Radiotherapy System. Med Phys 2009. [DOI: 10.1118/1.3182624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Graves E, Nelson G, Rodriguez M, Zhou H, Keall P. SU-FF-J-158: An Open Source Software Tool for Treatment Planning for Small Animal Conformal Radiotherapy. Med Phys 2009. [DOI: 10.1118/1.3181451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Zhou H, Bazalova M, Rodriguez M, Keall P, Graves E. SU-DD-A3-04: Monte Carlo Simulation of a MicroCT-Based Small Animal Radiotherapy System. Med Phys 2009. [DOI: 10.1118/1.3181084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nelson G, Rodriguez M, Zhou H, Lee A, Wu J, Tran P, Felsher D, Keall P, Graves E. SU-FF-J-162: In Vivo Biological Evaluation of Micro-CT Based 3D Conformal Radiotherapy System. Med Phys 2009. [DOI: 10.1118/1.3181455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Rodriguez M, Zhou H, Graves E, Keall P, Van den Haak F, Xu J. SU-GG-J-77: Dosimetry of a Novel MicroCT/RT System for Small Animal Conformal Radiotherapy. Med Phys 2008. [DOI: 10.1118/1.2961627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Graves E. TU-C-AUD C-02: CT Scanner-Based IGRT. Med Phys 2008. [DOI: 10.1118/1.2962448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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