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Chennai, India

Jalali R.,Tata Memorial Hospital | Dutta D.,Apollo Specialty Hospital

We performed a literature review with respect to factors influencing health-related quality of life (QOL) in adults with primary brain tumors. A comprehensive, peer-reviewed literature search was performed including studies examining QOL in adults with high-grade gliomas and low-grade gliomas and in routine neuro-oncology practice. The interpretation and implication of QOL domain scores may be different in high-grade, low-grade, and benign brain tumors. Several patient-related, treatment-related, and sociocultural factors influence QOL scores. Pretreatment baseline QOL domain scores have been shown to be a predictive parameter for survival function. Implementation of QOL scores in routine clinical practice is underused. QOL is an important outcome measure in the treatment of patients with brain tumors and should be incorporated as a surrogate end point along with traditional end points, such as disease-free and overall survival in most current trials. © 2012 The Author(s). Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. Source

Roopesh Kumar V.R.,Post Graduate Institute of Medical Education and Research | Madhugiri V.S.,Post Graduate Institute of Medical Education and Research | Sasidharan G.M.,Post Graduate Institute of Medical Education and Research | Shankar Ganesh C.V.,Apollo Specialty Hospital | Gundamaneni S.K.,Post Graduate Institute of Medical Education and Research
European Spine Journal

Purpose: Primary intraosseous spinal malignant peripheral nerve sheath tumor (MPNST) is exceedingly rare. MPNST with multifocal origin has been described to occur in the extremities. Such a lesion has not been described to occur in the spine. We describe a case of multifocal spinal MPNST and to review the literature relevant to this rare entity and its management. Methods: A 40-year-old immunodeficient patient presented with rapidly progressive paraparesis and mid back ache. Results: Despite aggressive surgical decompression, he developed multiple metastases 3 months after surgery. However, he remained stable for 1 year without any adjuvant therapy. Presently, he has received palliative radiotherapy for spinal recurrence and cerebral metastasis. Conclusion: Multifocal spinal MPNST is a rare lesion. In this instance, the multifocality of the disease and its odd location could be attributed to the immunodeficiency state. The prolonged survival could be due to an improvement in his immune status due to HAART. © Springer-Verlag 2013 MPNST,. Source

Harikrishnaperumal S.,Apollo Specialty Hospital
Journal of applied clinical medical physics / American College of Medical Physics

Prolonged treatment execution time is a concern in CyberKnife robotic radiosurgery. Beam reduction and node reduction technique, and monitor unit optimization methods are adopted to reduce the treatment time. Usage of single collimator in the CyberKnife treatment plan can potentially reduce collimator exchange time. An optimal single collimator, which yields an acceptable dose distribution along with minimum number of nodes, beams, and monitor units, can be a versatile alternative for shortening treatment time. The aim of the present study is to find the optimal single collimator in CyberKnife treatment planning to shorten the treatment time with the acceptable dose distribution. A spherical planning target volume PTV1 was drawn in an anthropomorphic head and neck phantom. Plans with same treatment goals were generated for all the 12 collimators independently. D(95%) was selected as the prescribing isodose and the prescribed dose was 10 Gy. The plan of the optimal collimator size was evaluated for conformity, homogeneity, and dose spillage outside the target. The optimum collimator size and the target dimensions were correlated. The study was repeated with two other target volumes PTV2 and PTV3 for generalizing the results. Collimator sizes just above the diameter of the spherical PTVs were yielding least number of nodes and beams with acceptable dose distributions. The collimator size of 35 mm is optimum for the PTV1, whose diameter is 31.4 mm. Similarly, 50 mm collimator is optimum for PTV2 (diameter= 45.2 mm) and 20 mm collimator is optimum for PTV3 (Diameter = 17.3 mm). The total number of monitor units is found to reduce with increasing collimator size. Optimal single collimator is found to be useful for shortening the treatment time in spherical targets. Studies on two clinical targets, (a brain metastasis and a liver metastasis cases) show comparable results with the phantom study. Source

Manickam K.,Indian Institute of Technology Madras | Machireddy R.R.,Indian Institute of Technology Madras | Raghavan B.,Apollo Specialty Hospital
Progress in Biomedical Optics and Imaging - Proceedings of SPIE

It has been observed that many pathological process increase the elastic modulus of soft tissue compared to normal. In order to image tissue stiffness using ultrasound, a mechanical compression is applied to tissues of interest and local tissue deformation is measured. Based on the mechanical excitation, ultrasound stiffness imaging methods are classified as compression or strain imaging which is based on external compression and Acoustic Radiation Force Impulse (ARFI) imaging which is based on force generated by focused ultrasound. When ultrasound is focused on tissue, shear wave is generated in lateral direction and shear wave velocity is proportional to stiffness of tissues. The work presented in this paper investigates strain elastography and ARFI imaging in clinical cancer diagnostics using real time patient data. Ultrasound B-mode imaging, strain imaging, ARFI displacement and ARFI shear wave velocity imaging were conducted on 50 patients (31 Benign and 23 malignant categories) using Siemens S2000 machine. True modulus contrast values were calculated from the measured shear wave velocities. For ultrasound B-mode, ARFI displacement imaging and strain imaging, observed image contrast and Contrast to Noise Ratio were calculated for benign and malignant cancers. Observed contrast values were compared based on the true modulus contrast values calculated from shear wave velocity imaging. In addition to that, student unpaired t-Test was conducted for all the four techniques and box plots are presented. Results show that, strain imaging is better for malignant cancers whereas ARFI imaging is superior than strain imaging and B-mode for benign lesions representations. © 2016 SPIE. Source

Ravindran P.B.,Christian Medical College | Das K.J.M.,Sanjay Gandhi Post Graduate Institute of Medical Sciences | Kurup P.G.G.,Apollo Specialty Hospital
IFMBE Proceedings

Medical Physics education in India started in 1962 by the Bhabha Atomic Research Center, Mumbai and since then several universities have started the Medical Physics program in India. The syllabus, curriculum and training facilities vary significantly among these institutions and hence the need for a Certification program with a common examination process was recognized. The College of Medical Physics of India (CMPI) was started with the mission to serve the public and the medical professional by certifying the members who have acquired, demonstrated, and maintained a requisite standard of knowledge in medical physics and demonstrated their competence required for the practice in any of the field/ areas of Diagnostic Imaging, Radiation Oncology and Nuclear Medicine. The first certification examination was conducted in 2010 and 14 medical physicists have been certified so far. This paper explains the certification process adopted in India. © 2013 Springer-Verlag. Source

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