Siriraj Medical Journal

31-35

Authors: Lalida Tuntipumiamorn, M.Sc., Piyanan Liammookda, M.Sc., Sutee Dechawongsuwan, M.Sc., Satjah Chaikreng, B.Sc., Porntip Iampongpaiboon, M.Sc., Chumpot Kakanaporn, M.Sc.

Objective: Setup accuracy of our head and neck intensity-modulated radiation therapy (IMRT) patients based on the non- extended standard thermoplastic masks was examined using a Varian onboard imaging system. Methods: Retrospective analysis of thirty head and neck IMRT patients treated during April 2009-July 2010 was performed. All two-dimensional kilovoltage (2DkV) and cone-beam computed tomography (CBCT) images were acquired weekly during the same session and reviewed by oncologists using an of ine review 8.6 program on an Eclipse treatment planning system. Couch shifts predicted by software between 2DkV and CBCT images were recorded. The planning target volume (PTV) margin using VanHerk’s margin formula was calculated. Results: Four-hundred and forty-four images of 2DkV and CBCT alignment were analyzed. Positioning errors within ± 3 mm. were shown in 84.07% of 2DkV radiographs and 85.84% of CBCT images. Average displacement found in antero- posterior (AP), cranio-cuadal (CC) and left-right (LR) axes , were 0.3±2.0 mm , 0±1.7 mm, 0.5±1.5 mm for the 2DkV, and 0.3±2.3, 0.7±2.1, 0.4±2.1 mm for the CBCT data set, respectively. Systematic and random variations from both methods which were seen in the range of 0.5-1.8 mm. PTV margins determined from 2DkV pair images, in AP ,CC and LR directions were presented at 4.60, 3.80 and 2.41 mm. when compared to 5.4, 4.32 and 4.35 mm from CBCT, respectively. Adaptive treatment planning on six patients were undertaken as well owing to the great bene t of CBCT to detect the patient’s contour changes ,which can be seen in the range of 1.20-3.12 cm. Conclusion: Based on our immobilization masks and laser-based positioning, the majority of treatment setups were accurate within our acceptable criteria. Both 2DkV and CBCT were shown to be effective methods to reduce the residual setup error. The results from this study will be used as a baseline for further improving the setup accuracy for head and neck IMRT patients at our institution.

41-46

Authors: Kattiya Manomayangkul, M.D., Arunotai Siriussawakul, M.D., Khemchat Wangtawesap, M.D., Onuma Chaiwat, M.D., Tipa Chakorn, M.D., Sudta Parakkamodom, RN, Panisara Saengsung, RN, Thanawin Chawaruechai, RN, Chulaluk Komoltri, Dr PH.

Objective: To assess the quality of nurses’ basic life support (BLS) and to determine pitfalls in BLS in relation to ward characteristics. Setting: A 2,400-bed university hospital in Thailand. Methods: A 1-year retrospective simulated audit for 2009 to assess nurses’ BLS performance at each step. Each observer as- sessed the subjects’ performance by using a scoring sheet and noting the objective manikin data related to chest compression. Results: A total of 57 wards from intensive care units, critical wards, procedural units, general wards or outpatient units were audited. Only 24 out of 57 (42.1%) did airway maneuvers correctly, while only 2 out of 57 (3.5%) could rescue breathing with chest movement. For the circulation maneuvers, carotid pulse check, hand position, the depth and the rate of cardiac compression were mostly performed incorrectly. Exactly 14.0% of subjects did not palpate the carotid pulse, and 52.6% palpated it incorrectly. Thirty-three nurses (57.9%) located and placed their hands on the wrong position. Forty-one nurses (71.9%) did not achieve the requisite chest compression depth, while thirty-one nurses (54.4%) did not achieve the target chest compression rate. The overall BLS performance of nurses in the High Risk Zone was better than that of nurses in the Low Risk Zone, except in the case of the airway sector. Conclusion: The CPR audit evaluated the resuscitation performance during simulated cardiac arrest in the service setting, and compared wards nurses in 2 categories related to the risk of cardiac arrest. Improvement in the organisation of training and the systematic approach to CPR should be adopted.

51-54

Authors: Samut Chongvisal, M.D., Suchitra Prasansuk, M.D., Siriporn Limviriyakul, M.D., Kanthong Thongyai, M.D., Sarun Prakairungthong, M.D., Suvajana Atipas, M.D.

Deafness and hearing impairment are globally increasing. The Otological Center, Bangkok Unit, Department of Otorhinolaryngology, Siriraj Hospital is the rst World Health Organization collaborating center in terms of hearing prevention since1985. A school survey in the southern part of Thailand was conducted in 1990 for a prevalence, strengthening network, early detection and management at different levels. Our center performed a school survey at the same area to nd out the prevalence and ear pathology of hearing impairment. It was found that the prevalence of hearing impairment decreased in all severities, when compared to the prevalence found in the survey in 1990. The most common cause of ear pathology was earwax impaction.

58-68

Authors: Michiaki Takahashi, M.D., Ph.D.

No abstract available.