Beaumont Health

About: Beaumont Health is a nonprofit organization based out in Royal Oak, Michigan, United States. It is known for research contribution in the topics: Medicine & Population. The organization has 1483 authors who have published 1448 publications receiving 15407 citations. The organization is also known as: William Beaumont Health System & Beaumont Hospitals.

Improve dosimetric outcome in stage III non-small-cell lung cancer treatment using spot-scanning proton arc (SPArc) therapy.

Abstract: To evaluate spot-scanning proton arc therapy (SPArc) and multi-field robust optimized intensity modulated proton therapy (RO-IMPT) in treating stage III non-small-cell lung cancer (NSCLC) patients. Two groups of stage IIIA or IIIB NSCLC patients (group 1: eight patients with tumor motion less than 5 mm; group 2: six patients with tumor motion equal to or more than 5 mm) were re-planned with SPArc and RO-IMPT. Both plans were generated using robust optimization to achieve an optimal coverage with 99% of internal target volume (ITV) receiving 66 Gy (RBE) in 33 fractions. The dosimetric results and plan robustness were compared for both groups. The interplay effect was evaluated based on the ITV coverage by single-fraction 4D dynamic dose. Total delivery time was simulated based on a full gantry rotation with energy-layer-switching-time (ELST) from 0.2 to 4 s. Statistical analysis was also evaluated via Wilcoxon signed rank test. Both SPArc and RO-IMPT plans achieved similar robust target volume coverage for all patients, while SPArc significantly reduced the doses to critical structures as well as the interplay effect. Specifically, compared to RO-IMPT, SPArc reduced the average integral dose by 7.4% (p = 0.001), V20, and mean lung dose by an average of 3.2% (p = 0.001) and 1.6 Gy (RBE) (p = 0.001), the max dose to cord by 4.6 Gy (RBE) (p = 0.04), and the mean dose to heart and esophagus by 0.7 Gy (RBE) (p = 0.01) and 1.7 Gy (RBE) (p = 0.003) respectively. The average total estimated delivery time was 160.1 s, 213.8 s, 303.4 s, 840.8 s based on ELST of 0.2 s, 0.5 s, 1 s, and 4 s for SPArc plans, compared with the respective values of 182.0 s (p = 0.001), 207.9 s (p = 0.22), 250.9 s (p = 0.001), 509.4 s (p = 0.001) for RO-IMPT plans. Hence, SPArc plans could be clinically feasible when using a shorter ELST. This study has indicated that SPArc could further improve the dosimetric results in patients with locally advanced stage NSCLC and potentially be implemented into routine clinical practice.

Evaluating Which Dose-Function Metrics Are Most Critical for Functional-Guided Radiation Therapy

Abstract: Purpose Four-dimensional (4D) computed tomography (CT) ventilation imaging is increasingly being used to calculate lung ventilation and implement functional-guided radiation therapy in clinical trials. There has been little exhaustive work evaluating which dose-function metrics should be used for treatment planning and plan evaluation. The purpose of our study was to evaluate which dose-function metrics best predict for radiation pneumonitis (RP). Methods and Materials Seventy lung cancer patients who underwent 4D CT imaging and pneumonitis grading were assessed. Pretreatment 4D CT scans of each patient were used to calculate ventilation images. We evaluated 3 types of dose-function metrics that combined the patient's 4D CT ventilation image and treatment planning dose distribution: (1) structure-based approaches; (2) image-based approaches using the dose-function histogram; and (3) nonlinear weighting schemes. Log-likelihood methods were used to generate normal tissue complication probability models predicting grade 3 or higher (ie, grade 3+) pneumonitis for all dose-function schemes. The area under the curve (AUC) was used to assess the predictive power of the models. All techniques were compared with normal tissue complication probability models based on traditional, total lung dose metrics. Results The most predictive models were structure-based approaches that focused on the volume of functional lung receiving ≥20 Gy (AUC, 0.70). Probabilities of grade 3+ RP of 20% and 10% correspond to V20 (percentage of volume receiving ≥20 Gy) to the functional subvolumes of 26.8% and 9.3%, respectively. Imaging-based analysis with the dose-function histogram and nonlinear weighted ventilation values yielded AUCs of 0.66 and 0.67, respectively, when we evaluated the percentage of functionality receiving ≥20 Gy. All dose-function metrics outperformed the traditional dose metrics (mean lung dose, AUC of 0.55). Conclusions A full range of dose-function metrics and functional thresholds was examined. The calculated AUC values for the most predictive functional models occupied a narrow range (0.66-0.70), and all showed notable improvements over AUC from traditional lung dose metrics (0.55). Identifying the combinations most predictive of grade 3+ RP provides valuable data to inform the functional-guided radiation therapy process.

Infections Associated with Use of Ultrasound Transmission Gel: Proposed Guidelines to Minimize Risk

Abstract: Affiliations: 1. Department of Epidemiology, Beaumont Health System, Royal Oak, Michigan; 2. Oakland University William Beaumont School of Medicine, Royal Oak, Michigan. Received April 26, 2012; accepted July 21, 2012; electronically published October 23, 2012. 2012 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2012/3312-0008$15.00. DOI: 10.1086/668430 Ultrasound transmission gel (USTG) is used in a variety of healthcare settings for both diagnostic and interventional procedures. Its potential role as a vehicle for spread of infections to patients is frequently overlooked. It has been shown on multiple occasions that USTG can become contaminated with bacteria, leading to significant outbreaks of infection among patients. It is incumbent upon all medical professionals to be aware of the potential risks these products pose to patients. Manufacturers of USTG should label products clearly as to their intended use. Producers of medical devices where USTG is likely to be used should provide explicit instructions on the type of USTG recommended and methods of use. Finally, standardized professional society guidelines would enhance patient safety and improve outcomes. On the basis of our recently described outbreak of infections associated with intrinsically contaminated ultrasound gel and a review of all other clusters, we would like to describe the differences between gels and propose guidelines for use of both nonsterile and sterile ultrasound gel. USTG is available from multiple manufacturers and comes in a variety of formulations and dispenser sizes, often without clearly defined differences between products or suggested uses. A review of one manufacturer’s website found 6 separate USTGs available for purchase, although it was not made clear what significant differences existed between products or if there were specific intended uses for them. Although these gels are often considered bacteriostatic because of components such as parabens or methyl benzoate, one study demonstrated that an ultrasound gel had no intrinsic antimicrobial properties and could function as a medium for bacterial growth. Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus were all demonstrated to survive in USTG in another in vitro study. The term “bacteriostatic” should not be used unless the product meets defined requirements to prove this. Contaminated USTG has been associated with outbreaks of infection due to a variety of procedures and microorganisms (Table 1). In all circumstances, the outbreaks were aborted after a switch to single-dose sterile gel. Our more recent report of cases of respiratory infections and colonizations with P. aeruginosa strongly suggested that gel contaminated at or around the time of manufacture was associated with infections. In this series, 16 patients were found to have P. aeruginosa in their respiratory tract after undergoing cardiovascular surgery. Laboratory isolates for 10 patients were saved, and all 10 proved to be more than 99% similar by molecular typing via repetitive extragenic palindromic polymerase chain reaction (rep-PCR). This surgery included the use of an intraoperative transesophageal echocardiogram (TEE) that utilized USTG as a conducting agent. The TEE probes were culture negative, but cultures of in-use multidose bottles of gel as well as sealed, unopened bottles of gel grew P. aeruginosa, which were also more than 99% similar to the outbreak strain by rep-PCR. Procedures utilizing USTG can range from noninvasive studies (such as transthoracic echocardiography, bladder scans, and vascular scans), to those with mucous membrane contact (such as TEE and transvaginal ultrasonography), to frankly invasive procedures (such as transrectal prostate biopsy [TRPB], thyroid biopsy, epiaortic ultrasonography [EAU], and stereotactic breast biopsies). As such, the Spaulding classification scheme can be applied to guide clinicians in making decisions regarding proper disinfection and sterilization of devices on the basis of the risk of infection involved with use of the item. By this scheme, scanning devices used for noninvasive procedures could be considered “noncritical devices” because of their contact with intact skin. Likewise, diagnostic studies using TEE or TRPB would require “semicritical” disinfection because of contact with mucous membranes. EAU transducers are required to be sterile, as they are introduced directly into the surgical field. On the basis of the Spaulding classification scheme, how does one define the appropriate use of USTG for procedures? Any procedure involving sterile skin preparation would likely also require sterile USTG. Sterility is not a necessary require-