Objective: To compare volumetric modulated arc therapy (VMAT) with simultaneous tumor bed boost (dpSIB-VMAT) to the whole breast and regional nodal irradiation (RNI) against standard three-dimensional conformal radiotherapy plus RNI with sequential tumor bed boost (3D-CRT-seqB).Methods: Thirty patients who underwent breast cancer surgery (BCS) with axillary lymph node dissection (ALND) were enrolled. Two plans were generated for each case:(1) dpSIB-VMAT, and (2) 3D-CRT-seqB plans. Planning target volume (PTV)-Breast and PTV-Nodes were prescribed at a dose of 50 Gy in 25 fractions in both plans. PTV-Boost was prescribed at a dose of 60 Gy in 25 fractions simultaneously in the dpSIB-VMAT plans, whereas it was planned sequentially in the 3D-CRT-seqB plans at 10 Gy in 5 fractions. Dosimetric parameters were compared between the two plans.Results: Both plans achieved the target coverage. D mean of the heart was lower with dpSIB-VMAT in left-sided cases (7.17 ± 0.66 Gy vs. 10.12 ± 2.91 Gy; t = 4.02; p = 0.001). Ipsilateral mean lung dose (15.87 ± 1.40 Gy vs. 19.82 ± 3.20 Gy; t = 6.30; p<0.001) was significantly lower but mean doses of the contralateral breast (4.30 ±
Research methodology
This case is based on a project carried out in a tertiary care hospital of the Northeastern region of India for a period of eight months and is written by Dr Ankit Singh, Dr Meenal Kulkarni and Mr Avinash Poojari. The case was developed with the help of the hospital’s management team, disguised on request as Mr Raghugopal Ramalinga (Chief Hospital Administrator), Mr Suresh Kumar (Chief Engineer), Ms Linney Krubah (Chief Nursing Superintendent), Dr Premanand Ale (Chief Medical Superintendent) and Mr Srikrishna Shukla (Chief Finance Officer).
Case overview/synopsis
This case is about Trident Hospital, which faces issues pertaining to oxygen supply. Oxygen supply at Trident Hospitals is through three options as highlighted in the case, but due to the lack of preventive maintenance and no risk assessment done for the crucial medical oxygen, interruptions and additional work for the staff became a common phenomenon. The existing situation can lead to patient harm or death and can attract medico-negligence suit against the hospital, threatening the overall existence of the hospital. The hospital administrator is currently viewing the problem from only the cost perspective, which is a high-risk and a short-term approach.
Complexity academic level
Students pursuing full time/part time/diploma programme in health-care management, hospital administration/hospital operations; and undergraduate and post-graduate level students.
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