PurposeRadiosurgery requires precise lesion localization. Fiducial markers enable lesion tracking, but complications from insertion may occur. The purpose of this study was to describe complications of fiducial marker insertion into pulmonary lesions.Materials and MethodsClinical and imaging records of 28 consecutive patients with 32 lung nodules or masses who underwent insertion of a total of 59 fiducial markers before radiosurgery were retrospectively reviewed.ResultsEighteen patients (67%) developed a pneumothorax, and six patients (22%) required a chest tube. The rates of pneumothorax were 82% and 40%, respectively, when 18-gauge and 19-gauge needles were used for marker insertion (P = 0.01). Increased rate of pneumothorax was also associated with targeting smaller lesions (P = 0.03) and tumors not in contact with the pleural surface (P = 0.04). A total of 11 fiducials (19%) migrated after insertion into the pleural space (10 markers) or into the airway (1 marker). Migration was associated with shorter distances from pleura to the marker deposition site (P = 0.04) and with fiducial placement outside of the target lesion (P = 0.03).ConclusionFiducial marker placement into lung lesions is associated with a high risk of pneumothorax and a risk of fiducial migration.

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Funding to convert the IUCF K220 separated sector cyclotrons into a dedicated proton source for Cancer Therapy was released by Indiana University in August of 2000. Phase I of the Midwest Proton Radiation Institute (MPRI) will initially consist of the IUCF separated sector cyclotrons upgraded to operate at a fixed energy of 205 MeV, a treatment room containing both a general purpose large field horizontal fixed line and a small field line for the treatment of eye melanoma, a second treatment room with a 360 o rotating Gantry, and a comprehensive medical clinic. A third treatment room with a gantry is incorporated into the beam delivery system design as a future upgrade. The MPRI beam delivery system is now under construction and will incorporate a beam sharing system to allow simultaneous beam delivery to all medical treatment rooms, as well as to medical and commercial research facilities. Additional Funding is anticipated for the construction of a dedicated Radiation Effects Research (RERP) facility for NASA and other commercial users requiring beam similar to those used for proton therapy. This report will outline the goals and design of the MPRI medical and commercial facilities, its present construction status and projected completion schedules.

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AimA tracheostomy is life-changing and brings many associated new challenges. This study offers an insight into the life of children with tracheostomies and the impact this has on them, their caregiver(s) and the family unit on a daily basis. We explore how they have coped with the transformation in their life and the issues important to them. Little is known to date about such families’ experiences and quality of life once they have been discharged from hospital. Patient experience is being increasingly recognised as an important part of quality of care and as such we have a duty to allow our patients and their families express their views.MethodsIn July 2015 all children with tracheostomies or who had recently been decannulated, in our Trust were identified. A letter was sent out to the identified eligible nine families in January 2016 inviting them to participate in this project by completing age appropriate questionnaires- Paediatric Quality of Life questionnaire, Strength and Difficulties questionnaire and Hospital Anxiety and Depression score and advising them that a follow up phone call would take place to offer them an opportunity to participate in a semi-structured face to face interview should they opt in to the project and want to participate.ResultsOf the nine families contacted five agreed to the face to face interviews and six families returned the questionnaires.Interview data were transcribed and evaluated for emerging themes. Interpretative analysis was performed by the lead researcher, and independently analysed by a Clinical Psychologist for quality assurance. Themes were developed from the analysis and agreed upon by both researchers.The main themes identified included adjusting to new roles, inconsistent care, effect on family relationships, present and future worries and coping with difficult decision-making.ConclusionThe study helped us gain a deeper understanding of what matters to these families and identify the following opportunities for improving care.Multidisciplinary tracheostomy teams with allocated slot at one stop clinic for psychologist and social work to destigmatise these roles and meet families to ensure they know how to access these professions when required.Opportunity to meet other families as standard.