Stereotactic body radiation therapy (SBRT) is derived from the techniques of stereotactic radiosurgery used to treat lesions in the brain and spine. It combines multiple finely collimated radiation beams and stereotaxy to deliver a high dose of radiation to an extracranial target in the body in a single dose or a few fractions. This review provides a broad overview of the current state of SBRT for solid malignant tumors. Reviewers identified a total of 124 relevant studies. To our knowledge, no published comparative studies address the relative effectiveness and safety of SBRT versus other forms of external-beam radiation therapy. Stereotactic body radiation therapy seems to be widely diffused as a treatment of various types of cancer, although most studies have focused only on its use for treating thoracic tumors. Comparative studies are needed to provide evidence that the theoretical advantages of SBRT over other radiation therapies actually occur in the clinical setting; this area is currently being studied in only 1 small trial.
This article presents the Picture Archiving and Communication Systems (PACS) planning methodology used by the Department of Defense's (DOD) Joint Imaging Technology Project Office (JITPO). This methodology evaluates four areas of PACS planning and implementation: strategic planning, clinical scenario planning, installation planning, and implementation planning. The first task is to develop a PACS team, from the local facility, that will execute the program. A written PACS plan is developed by the JITPO, with active input and final say from the site's PACS team. This plan includes the PACS goals and objectives, clinical requirements, facility requirements, and the status of the implementation. This methodology, when applied fully at a military clinical site, has resulted in the site obtaining best "value" in terms of cost and performance by requiring the DOD's contracted PACS vendors to propose a PACS package that meets or exceeds the site's unique requirements. The identification of the requirements and the matching of a known PACS configuration with them has reduced the number of unknowns within the vendors' proposals and created true competition in both initial cost and the cost to maintain PACS in the maintenance years. Although there are certain factors unique to planning a military PACS, such as preselected vendors, the planning methodology described in this article should provide a valuable strategy for any hospital planning a PACS.
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