The diagnostic efficacy of ultrasound (US) in the diagnosis of infantile hypertrophic pyloric stenosis (IHPS) was evaluated, with particular attention paid to whether prematurity, age or weight correlate significantly to the sonographic measurements. The medical records of 187 infants with suspected IHPS were reviewed retrospectively. Eighty-seven had an US examination with details of the pylorus. Fifty-nine of these gave a positive diagnosis. The US criteria for a positive diagnosis were pyloric muscle thickness (PMT)>or=3 mm and pyloric muscle length (PML)>or=17 mm. The mean overall PMT was 4.14 mm and mean overall PML was 18.99 mm. Premature infants had a lower mean PML (17.8 mm) than the term infants (PML mean 19.3 mm); however, this was not significant (t-value 1.92, P=0.062). The sensitivity and specificity of PMT was 91 and 85%, respectively, and of PML 76 and 85%, respectively. The ability of US to diagnose IHPS using our criteria was significant (t-value, PMT 14.93 and PML 6.89; P<0.0001). There was no significant correlation between age, weight or prematurity and a sonographic diagnosis of IHPS (Pearson's coefficient<0.3). Therefore, the same US criteria should apply irrespective of prematurity, age or weight. Borderline PMT and PML measurements necessitate repeat US or alternative imaging.

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In patients with pituitary adenomas (PA) who are unable to undergo complete surgical resection, radiation therapy (RT), specifically stereotactic radiosurgery (SRS), results in excellent local control. However, the utility of radiosurgery may be limited by the proximity of the lesion to the optic chiasm (OC). We evaluate the efficacy of debulking surgery in increasing the PA-OC separation to convert patients into SRS candidates. From 2007 to 2015, 31 patients with PA < 2 mm from the OC underwent debulking surgery followed by RT within 2 years of resection. Coronal and sagittal T1-pre- and post-contrast sequences were used to determine PA-OC separation. Time interval between postoperative and pre-radiotherapy MRI scans and type of radiation therapy were analyzed. Functional tumor status, tumor characteristics [cavernous sinus (CS) or suprasellar (SS) involvement, chiasm/nerve encasement (NE)], and presence of ≥ 2 of these characteristics (multiple factors, MF) was also noted. Surgery converted 9 of 31 patients (29%) to SRS candidates. Median time from surgery to pre-RT planning MRI was 8 months (range 2-20). Of the 31 patients initially ineligible for SRS, 6 became eligible immediately after surgery, and another 3 were deemed eligible on follow-up. Mean PA-OC separation was 0.3 mm preoperative, 1.4 mm postoperative, and 2.1 mm at time of SRS (p = 0.002). Preoperative SS, NE, and MF involvement predicted pre-RT separation < 2 mm. Debulking surgery of unresectable pituitary tumors is a successful strategy for converting select radiosurgery-ineligible patients to radiosurgery candidates. Absence of preoperative SS, NE, and MF predicts for successful conversion.

invasion. Cancer pathology for nine patients was identified as adenoid cystic carcinoma (ACC) (41%), and 13 patients demonstrated squamous cell carcinoma (SCC). The median tumor volume was 10.9 mL (1.6-64.9 mL) and the median margin dose was 14.5 Gy (10-20 Gy). Patients were assessed for tumor recurrence at periodic imaging and clinical follow-up (1.5-51 months). Results: Disease recurred in 9 patients (median 7.6 months after SRS) and three patients died due to skull base tumor progression throughout the observance period (median: 9 months). The progression-free survival was 22% at 1 year, 13% at 2 years, and 9% at 3 years. In univariate testing, variables that associated with improved progression-free survival were ACC pathology (PZ.038) and age 55 (PZ.008). The overall survival was 31% at 1 year, 26% at 2 years, and 10% at 3 years. The overall survival was also significantly associated with ACC pathology (PZ.020) and age 55 (PZ.016). One patient developed mild symptomatic adverse radiation effects. Conclusion: Stereotactic radiosurgery (SRS) is a potent treatment option for primary and secondary nasopharyngeal carcinomas directly invading the skull base, especially in younger adenoid cystic carcinoma patients.

incorrect data recorded (23%), while the top contributing factor to treatment errors are inattention to details (49%). The survey showed that majority have good personal overall communications with the other staff of the department ranging from 50% (administrators) to 84% (physicians). Also, the results showed a good overall interdisciplinary communication within the department staff ranging from 47% (medical physicists-administrators) to 74% (medical physicists-physicians). About 68% and 58% of the respondents are encouraged and comfortable to report errors, respectively. The top 3 obstacles to reporting errors are: fear of reprimand (42%), poor communication (34%), and lack of reporting system (26%). Although the system does not promote blaming, 16% of the respondents perceived that they have been personally reprimanded due to an error. Conclusion: The adaptation of the ASTRO framework on reporting errors resulted in better identification of areas and factors for improvement Majority of the interpersonal and interdisciplinary communications in the facility is good. Most of the personnel are encouraged and comfortable in reporting treatment errors, although, the top obstacles to error reporting identified need immediate actions in order to promote a better treatment error reporting environment.