Z. Taklar. MCP Hahnemann University.

Database/retrieval system on the Internet with well known place of publication Current Controlled Trials [Internet] discount 20mg levitra professional with mastercard. Database/retrieval system on the Internet with geographic qualifier added to place of publication for clarity The Cochrane Library [Internet] discount levitra professional line. Database/retrieval system on the Internet with place of publication inferred WormBase: the Biology and Genome of C discount levitra professional 20 mg line. Database/retrieval system on the Internet with unknown place of publication Pfam [Internet]. Database/retrieval system on the Internet with publisher having subsidiary division Nutrition Education for Diverse Audiences [Internet]. Geneva: World Health Organization, Department of Communicable Disease Surveillance and Response, Anti-infective Drug Resistance and Containment Team. National Library of Medicine, Lister Hill National Center for Biomedical Communications. Database/retrieval system on the Internet with joint publication WormBase: the Biology and Genome of C. Database/retrieval system on the Internet with standard date of publication Database of Human Disease Causing Gene Homologues in Dictyostelium Discoideum [Internet]. The Alberta Atlas of Human Pathology: a Resource for Teachers and Learners in the Health Sciences [Internet]. Database/retrieval system on the Internet with date of copyright instead of date of publication Biozon [Internet]. Database/retrieval system on the Internet with date obtained from earliest material in it PubMed [Internet]. Database/retrieval system on the Internet with unknown date The Internet Acronym Server [Internet]. Database/retrieval system on the Internet with update/revision date Health Library for Disasters [Internet]. Database/retrieval system on the Internet with supplemental note included Is Your Doctor Certified? Pfam is a large collection of multiple sequence alignments and hidden Markov models covering many common protein domains and families. Institutional repository of the University of California Libraries intended to provide comparative and historical information about traditional medical beliefs. Databases/Retrieval Systems on the Internet 1297 Drugs and Lactation Database (LactMed) [Internet]. Sample Citation and Introduction to Citing Parts of Databases on the Internet The general format for a reference to a part of a database on the Internet, including punctuation: Examples of Citations to Parts of Databases on the Internet Rather than citing a whole database, portions of a database may be cited. They are contributions when the database has individual records or other components written by various authors, usually called contributors. A reference should start with the individual or organization with responsibility for the intellectual content of the publication: Begin a reference to a part of a database with a citation to the database itself, followed by information about the part. For parts that contain hyperlinks, however, such as those shown in example 11, it will not be possible to provide the length. Citation Rules with Examples for Parts of Databases on the Internet Components/elements are listed in the order they should appear in a reference. Name and Number/Letter of the Part of a Database on the Internet (required) General Rules for Name and Number/Letter Enter the name of the part as it appears in the database Capitalize the name, such as Record, Table, Chart You may abbreviate Number to No. Otdel 6 Romanize or translate titles in character-based languages (Chinese, Japanese). Databases/Retrieval Systems on the Internet 1299 Ichiran-hiyo 3 or [Table 3, ] Ignore diacritics, accents, and special characters in names. In this case, give the name used for the part and follow it with a comma and the title. If there is no number or letter, follow the name with a comma and the title of the part. Part of a database on the Internet with title containing special scripts/characters 5. Part of a database on the Internet with a title in a language other than English Databases/Retrieval Systems on the Internet 1303 Date of Publication for a Part of a Database on the Internet (required) General Rules for Date of Publication Enter the date of publication if it differs from the date of the database as a whole Always give the year Convert roman numerals to arabic numbers. Box 74 Non-English names for months Translate names of months into English Abbreviate them using the first three letters Capitalize them Examples: mayo = May luty = Feb brezen = Mar Box 75 Seasons instead of months Translate names of seasons into English Capitalize them Do not abbreviate them For example: balvan = Summer outomno = Fall hiver = Winter pomlad = Spring Box 76 Date of publication and date of copyright Some publications have both a date of publication and a date of copyright. Box 77 No date of publication, but a date of copyright A copyright date is identified by the symbol, the letter "c", or the word copyright preceding the date. Databases/Retrieval Systems on the Internet 1305 Record 2398879, Reactivity of acid fluoride-terminated self-assembled monolayers; c2006 [cited 2007 Mar 9]; [about 3 screens]. Box 78 No date of publication or copyright can be found If no date of publication or of copyright for the part can be found, use any date of update/revision for the part and the date of citation. Part of a database on the Internet with a date of publication separate from the date of the database as a whole 7. Part of a database on the Internet with a date of update/revision Date of Update/Revision for a Part of a Database on the Internet (required) General Rules for Date of Update/Revision Parts of databases may be updated or revised separately from the database as a whole Begin update/revision information with a left square bracket Use whatever word for update or revision is provided, such as updated or modified Always give the year of update/revision Convert roman numerals to arabic numbers. Look for the date accompanied by such words as updated, modified, revised, reviewed: At the top or bottom of the first screen or the bottom of the last screen of the part 1306 Citing Medicine Below the author name(s) or title In a specific field if the part is subdivided into fields In the source code for the database if it is displayed by the Web browser Box 80 Non-English names for months Translate names of months into English Abbreviate them using the first three letters Capitalize them Examples: mayo = May luty = Feb brezen = Mar Box 81 Seasons instead of months Translate names of seasons into English Capitalize them Do not abbreviate them For example: balvan = Summer outomno = Fall hiver = Winter pomlad = Spring Box 82 Both a date of update and a date of revision Various words are used to show that the content of a part of a database has been changed. Part of a database on the Internet with title containing special scripts/characters 1308 Citing Medicine 5. Part of a database on the Internet with a title in a language other than English 6. Part of a Database on the Internet with location (pagination) expressed as number of screens 9. Part of a Database on the Internet with location (pagination) expressed as number of pages 10. Part of a Database on the Internet with location (pagination) expressed as number of bytes 11. Case 1896, Acute staphylococcal endocarditis; [cited 2007 Feb 16]; [about 1 screen]. Part of a database on the Internet with a title in a language other than English Notes for a Part of a Database on the Internet (optional) General Rules for Notes Notes is a collective term for any further useful information given after the citation itself Complete sentences are not required Be brief Specific Rules for Notes System requirements Other types of material to include in notes Box 88 System requirements System requirements describe the software and hardware needed to view the database. Box 89 Other types of material to include in notes The notes element may be used to provide any further information. Some examples of notes are: Information on any access requirements/limitations Subscription required to view. Part of a Database on the Internet with a note Examples of Citations to Parts of Databases on the Internet 1. Standard part of a database on the Internet with name and number/letter Online Archive of American Folk Medicine [Internet]. Standard part of a database on the Internet without a name or number/letter Jablonski S.

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In contrast order line levitra professional, data in each of the higher layers of the Information Commons will overlay on the patient layer in complex ways (e order levitra professional 20 mg. The Knowledge Network of Disease would allow researchers hypothesize new intralayer cluster and interlayer connections cheap levitra professional 20mg with mastercard. Validated findings that emerge from the Knowledge Network, such as those which define new diseases or subtypes of diseases that are clinically relevant (e. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 17 Rationale and Organization of the Report Today, historic forces are transforming biomedical research and health care. A Knowledge Network of Disease could embrace and inform rapidly expanding efforts by the biomedical research community to define at the molecular level the disease predispositions and pathogenic processes occurring in individuals. This network has the potential to play a critical role across the globe for the public-health and health-care-delivery communities by enabling development of a more accurate, molecularly-informed taxonomy of disease. This report lays out the case for developing such a Knowledge Network of Disease and associated New Taxonomy. This chapter also addresses the impediments that need to be overcome and changes in medical education that will be required before the Knowledge Network of Disease and resulting New Taxonomy can be expected to achieve their full potential for improving human health. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 2 Why Now? Key enablers of this opportunity include: x New capabilities to compile molecular data on patients on a scale that was unimaginable 20 years ago. Scientific research, information technology, medicine, and public attitudes are all undergoing unprecedented changes. Biology has acquired the capacity to systematically compile molecular data on a scale that was unimaginable 20 years ago. Diverse technological advances make it possible to gather, integrate, analyze, and disseminate health-related biological data in ways that could greatly advance both biomedical research and clinical care. Meanwhile, the magnitude of the challenges posed by the sheer scientific complexity of the molecular influences on health and disease are becoming apparent and suggest the need for powerful new research resources. All these changes provide an opportunity for the biomedical science and clinical communities to come together to improve both the discovery of new knowledge and health-care delivery. The National Human Genome Research Institute estimated that the total cost of obtaining a single human-genome sequence in 2001 was $95 million (Wetterstrand 2011). Costs subsequently dropped exponentially following a trajectory described in electronics as Moore s Law, connoting a reduction of cost by 50 percent every two years, until the spring of 2007, at which point the estimated cost of a single human-genome sequence was still nearly $10 million. The cost is still dropping rapidly, with a $1000 genome becoming a realistic target within a few years. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 21 While whole-genome sequencing remains expensive by the standards of most clinical laboratory tests, the trend-line leaves little doubt that costs will drop into the range of many routine clinical tests within a few years. Whole-genome sequencing will soon become cheaper than many of the specific genetic tests that are widely ordered today and ultimately will likely become trivial compared to the cost of routine medical care. Instead, the clinical utility of genome sequences and public acceptance of their use will drive future developments. These technologies will make it possible to monitor and ultimately to understand and predict the functioning of complex molecular networks in health and disease. The Opportunity to Integrate Data-Intensive Biology with Medicine Human physiology is far more complex than any known machine. The molecular idiosyncrasies of each human being underlie both the exhilarating potential and daunting challenges associated with personalized medicine. Individual humans typically differ from each other at millions of sites in their genomes (Ng et al. More than ten thousand of these differences are known to have the potential to alter physiology, and this estimate is certain to grow as our understanding of the genome expands. All of this new genetic information could potentially improve diagnosis and treatment of diseases by taking into account individual differences among patients. We now have the technology to identify these genetic differences and, in some instances, infer their consequences for disease risk and treatment response. Some successes along these lines have already occurred; however, the scale of these efforts is currently limited by the lack of the infrastructure that would be required to integrate molecular information with electronic medical records during the ordinary course of health care. The human microbiome project represents an additional opportunity to inform human healthcare. The microorganisms that live inside and on humans are estimated to outnumber human somatic cells by a factor of ten. The ultimate goal of studying the human microbiome is to better understand the impact of microbial variation across individuals and populations and to use this information to target the human microbiome with antibiotics, probiotics, and prebiotics as therapies for specific disorders. While this field is in its infancy, growing knowledge of the human microbiome and its function will enable disease classification and medicine to encompass both humans and their resident microbes. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 22 individuals. Lifestyle interventions alone are ineffective in these individuals at reducing the likelihood of early-onset cardiovascular disease (Huijgen et al. Consequently, the ability to identify the patients that carry the non-functional receptor makes it possible to proceed directly to the use of statin drugs at an early age, rather than first attempting to control cholesterol with diet and exercise. There is strong evidence that the early use of statin drugs in these individuals can provide a therapeutic benefit. These mutations predispose to cancer, particularly breast and ovarian cancer (King et al. Women who carry these mutations can reduce their risk of death from cancer through increased cancer screening or through prophylactic surgeries to remove their breasts or ovaries (Roukos and Briasoulis 2007); until these mutations were identified it was not possible to determine who carried the mutations or to take proactive steps to manage risk. In addition, epidemiological studies and other data have raised the possibility that H. The human genome and microbiome projects are only two examples of emerging biological information that has the potential to inform health care. It is similarly likely that other molecular data (such as epigenetic or metabolomic data), information on the patient s history of exposure to environmental agents, and psychosocial or behavioral information will all need to be incorporated into a Knowledge Network and New Taxonomy that would enhance the diagnosis and treatment of disease. Traditionally, lung cancers have been divided into two main types based on the tumors histological appearance: small- cell lung cancer and non-small-cell lung cancer. Drivers are mutations in genes that contribute to inappropriate cellular proliferation. If the inappropriate function of the mutant protein is shut down, dramatic anti-tumor effects can ensue. These receptors were known to send signals that promote cellular proliferation and survival, and increased signaling was thought to contribute to some cancers. However, the dramatic tumor shrinkage in some patients was enough for Food and Drug Administration approval in 2003, even though the molecular basis for the response was then unknown. Without the ability to recognize the responding patients as a biologically distinct subset, these agents were tried unsuccessfully on a broad range of lung-cancer patients, doing nothing for most patients other than increasing costs and side effects. In retrospect, some clinical trials with these agents probably failed because the actual responders represented too small a proportion of the patients in the trials (Pao and Miller 2005). This made it possible to predict which patients would respond to the therapy and to administer the therapy only to this subset of patients. This led to the design of much more effective clinical trials as well as reduced treatment costs and increased treatment effectiveness. Since then, many studies have further divided lung cancers into subsets that can be defined by driver mutations.

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Inside cheap levitra professional uk, artist-designed friezes of stained-glass panels let in light near the top of the ceiling while hiding those same air-conditioning units from view order 20mg levitra professional with amex. The frst thing anyone sees upon entering the building are cozy parlors with cushy furniture and a huge order levitra professional 20mg visa, magazine-beautiful kitchen where patients and families can cook and eat meals together. Enormous windows are everywhere, offering in views of the woods and gardens outside. Rollaway beds and rocker recliners are also in each patient room for those who wish to stay near their loved ones. Corridors are indented with garages, deep alcoves that hide parked wheelchairs and carts from view. Deceased patients and their families have a dignifed exit area accessible to vehicles and out of sight of the main entrance, to protect privacy and everyone s feelings. Staff members can walk an outdoor section of corridor or rest in their special staff lounge for needed breaks. Every door is wide enough to push a bed through, ensuring that patients at Ames House can go everywhere they want outside, to do artwork, help bake cookies whether they can walk or sit up or not. So do the roles of design and art in making the end of life as comforting as possible. He calls it an essential part of helping people go through a profound change he compares to a caterpillar turning into a butterfy. Over the course of human development, arts and culture activities have been valued for their utility in codifying traditions and uniting communities through activities that facilitate[d] the need for belonging, fnding and making meaning while contributing to the development of physical skills. In addition,87 arts and culture activities have provided outlets for expression of emotion, self-refection and Key Benefts personal discovery. These perspectives have merged and expanded over time to form a much more transformative view of the role arts and Research has demonstrated that participation culture can play in the lives of individuals and their communities. Arts and culture experiences can in arts and culture activities and/or expressive support outcomes that redefne the self, build arts therapies help patients: 88 community, and address civic issues. An important distinction can be Raise levels of self-esteem made between expressive arts therapies and the Improve measures of specifc clinical outcomes therapeutic use of arts and culture : Expressive such as motor functioning, memory recall and arts therapies are provided in clinical healthcare vital signs settings by trained health care [sic] professionals to heal or ameliorate the effects of disease and disability, while the therapeutic use of arts and culture in healthcare settings includes artist-in- residence programs through which professional artists carry out arts and culture activities to promote health and wellness. This chapter looks90 at how participation in expressive arts therapies, as well as in arts and culture activities, is taking place in Cleveland. Expressive arts therapies have also yielded measurable96 outcomes such as stress reduction, pain management and improved motor and social functioning for groups such as veterans, autistic youth and stroke survivors. A minimum of a bachelor s degree or equivalent is required to become a board certifed music therapist, while a master s degree is required to become a board certifed art therapist. Locally, the Cleveland Music Therapy Consortium, which was formed in 1976, brings together the music therapy programs of the Baldwin Wallace University Conservatory of Music and the Music Department of the College of Wooster. The collaborative arrangement allowed a music therapy degree to be offered for the frst time in Northeast Ohio. The region also provides Ohio s only98 source of Masters in Art Therapy and Counseling degrees, at Ursuline College in Pepper Pike. Arts and culture nonprofts use expressive make up one set of organizations that offers a wide range of such programs throughout the Cleveland area. The arts therapies Music Settlement, for example, was a pioneer in the music therapy feld, developing its Center for Music Therapy in to benefit 1966. Currently, the center offers therapy sessions for individuals with mental illness, terminal illness, learning patients by disabilities and other social or behavioral disorders. It also provides music therapy programming in educational helping them settings to enhance core curriculum standards being taught to children in social services settings such as the Salvation channel Army s Harbor Light complex for those who were formerly incarcerated, homeless and/or are recovering addicts; for emotions, adults in day programming at the United Cerebral Palsy Association; in medical settings such as the burn unit at recover MetroHealth Medical Center; in the palliative-medicine from trauma department at the Cleveland Clinic; and at the Cleveland Sight Center. Cleveland s Art Therapy Studio enhances the quality of life for those with physical, cognitive or emotional challenges through the therapeutic use of visual art. The organization was established in 1967 as a joint partnership with HighlandView Hospital, which is now MetroHealth Medical Center, a partnership that continues today. It also coordinates employee wellness workshops for local businesses, as well as professional development opportunities for practicing art therapists. This program uses music therapy to improve the socialization, literacy and language skills of Cleveland s underserved three- to fve-year olds. The Cleveland Clinic Arts and Medicine Institute has dedicated art and music therapists who work throughout the hospitals with individual patients at bedside, in groups, and in public areas with patients and families. The largest programs are with adult cancer, cardiovascular, and transplant patients and pediatric inpatients. For example, the art therapy program in the Taussig Cancer Institute helps individuals explore their emotions as they undergo treatment, and music therapy is provided to patients undergoing bone marrow transplant to help alleviate pain and anxiety during their hospital stay. Studio therapists also conduct out-patient art groups, an is provided open studio, and an art and occupational therapy group for spinal cord injured patients. Patients make art during their dialysis treatments as a help alleviate way to cope with treatments, restrictive lifestyles (i. Hospice of the Western Reserve offers a series of Healing Arts Workshops led by art therapists to help participants Community Partnership for Arts and Culture 32 Creative Minds in Medicine Participatory Arts and Health cope with grief through arts and culture activities such as the creation of remembrance quilts, craft objects and paper clay sculptures. The program welcomes world-class performers featured on the University of Florida Performing Arts s season schedule into the hospital for residencies and performances. Over time, viewing sessions with patients yield increasingly refned image searches and selections based on each patient s preferences. One of these, the Cleveland Clinic Arts and Medicine Institute, flls the hospital environment every day of the week with live performances from local musicians and arts and culture organizations. Its recently created Musicians-in-Residence program integrates a core group of local musicians into the hospital environment with regular performances in public spaces. For example, the Cleveland Museum of Art, the Alzheimer s Association and the Cleveland Clinic offer Art in the Afternoon tours for individuals with memory loss and their care partners. Community Partnership for Arts and Culture 34 Creative Minds in Medicine Participatory Arts and Health and the Elisabeth Severance Prentiss Center for Skilled Nursing Care at MetroHealth. At Eliza BryantVillage, residents create quilts to share memories and traditions and, through partnerships with organizations such as the Fatima Family Center, share them with the community. Judson, a nonproft retirement community in Cleveland s University Circle area, has brought relationships its residents together with local students to form an ensemble that performs show tunes. Such activities are structured to meet the needs of each individual participant and are developed based on mutually agreed upon goals. Cleveland organizations use a wide variety of expressive arts therapies to bring about positive clinical outcomes for patients. Cleveland s wealth of educational programs focused on the expressive arts therapies, as well as its historic role in the development of the feld, set it apart as an expressive arts therapy leader. In addition to expressive arts therapies, general arts and culture activities are also being used to empower individuals in the creation of artwork and are well-suited to meet the emotional, physical and social needs of specifc groups like older adults. Community Partnership for Arts and Culture 36 Creative Minds in Medicine case study art therapy studio CityScape by Scott Mars, a participant in the Art Therapy Studio s community art program Photo courtesy of Art Therapy Studio Community Partnership for Arts and Culture 37 Creative Minds in Medicine color helps Art makes Scott Mars feel better. When he does, he also creates what he calls his safe space, a space that nobody can invade.

A key starting point in evaluating Second purchase levitra professional online pills, the dose delivered to the patient can be the biological (i order 20 mg levitra professional otc. Annual number of publications related to hadrontherapy cheap levitra professional 20 mg on-line, where respective Monte Carlo codes/tools were used. Estimated fully used now in the feld of hadrontherapy to from the Web of Science database (Thomson Reuters) in October 2013. The main task of any model is to repro- duce the spatial distribution of energy deposition with sub-mm accuracy. The strength of a Monte Carlo model is that not only 1D depth-dose curves can be reliably calculated, but also 3D dose distri- butions in tissues. In particular, the efect of lateral scattering can clearly be seen, which is much stronger for protons 38 than for 12C. In par- Secondary neutrons are produced by proton and ticular, such a validation may be necessary in the carbon-ion beams in materials of beam-line ele- presence of metallic implants in the patients body ments, collimators, range modulators and also in or for other quality assurance tasks (see Section 9). The model was primary and secondary particle is calculated as a validated with experimental data for secondary collection of short steps during particle propagation neutrons produced by 200 A MeV 12C beam in a in the medium. However, the yields of relatively slow Some examples of modelling of nuclear reactions neutrons (with energy below 150 MeV) emitted at relevant to proton and carbon ion therapy are given large angles (20o and 30o) are overestimated by the below. Since Li, Be and B fragments along with 12C projectiles provide the main contribution to the total dose, the depth-dose distribution is also well reproduced. At the same time the yield of helium fragments is underestimated, presumably due to neglecting the cluster structure of 12C, which would otherwise enhance the emission of alpha par- ticles in the fragmentation of 12C. Since the momenta of photons from a single annihilation event are strongly correlated, a spatial distribution of positron-emitting nuclei can be reconstructed by tomographic methods and compared with the dis- tribution calculated for the planned dose. Fragments of target nuclei, 11C and 15O created by protons in tissues are evenly distrib- uted along the beam path with a sharp fall-of close to the Bragg peak. In contrast, the maximum of +- activity created by 12C nuclei is located close to the Bragg peak. Attenuation of 12C beam (black) and build-up of secondary fragments (from H to B, see the legend) in nuclear reactions induced by 400A MeV carbon nuclei in water. The +-activity biological efectiveness in ion beam therapy, profles calculated with these two codes for 12C International Atomic Energy Agency and projectiles agree better than for protons. A wide international collaboration between theoretical and experimental groups is needed to foster the collec- tion of more detailed and accurate data on nuclear reactions relevant to ion-beam therapy and improv- ing their theoretical description. Due to the overall treatment procedure in radiation oncol- the physical selectivity of protons and their strong ogy and takes place prior to the frst fraction being range sensitivity to tissue variations, both in terms delivered to a patient. The aim is to simulate the of dimension and density, the requirement for true dose distribution to the tumour and the surround- three-dimensional (3D) treatment planning and ing normal tissue and organs at risk which would dose calculation was soon realised and pursued. In today s state-of-the-art contributed significantly to reducing the inter- radiation oncology practice, computer tomography observer uncertainties in target defnition. Over recent decades, dedicated immobili- The next step in the treatment planning process 42 sation devices have been developed for the various is the defnition of treatment parameters. Furthermore the selection of the most fraction and the total dose to be delivered, the treat- appropriate beam incidence needs to be based on ment planner has to select beam directions, include the actual anatomic situation and patient geom- aspects of treatment plan robustness against motion, etry as intended for the treatment session. For passively scattered beams, Structure segmentation is a sub-process in treat- treatment plan optimisation is mostly based on ment planning. This process defnes the tumour, the human intelligence and a manual trial and error volume to be irradiated (planning target volume process. Structure segmentation is similar to treatment plan optimisation in standard a manual process and as such prone to inter- and 3D conformal radiotherapy with high energy pho- intra-observer uncertainties. The dark grey area was flled with comparison is shown between a typical pencil beam bone, the white area with air and the light grey areas with water. In addition to the physical dose, radiobiological driven by dose, organ and volume parameters which efects also need to be modelled during dose cal- in turn specify the treatment intent. The basic input ofen subdivided in sub-beams or elementary pencil parameters are alpha-beta ratios of a photon beam beams. However, current developments are rendering limited knowledge of alpha-beta ratios for the vari- ous tissue types and clinical endpoints with respect re-calculation techniques or in situ dose verifca- to toxicity. Assessment parameters for the clini- cal acceptance of a treatment plan are similar to Developments in treatment planning and dose cal- those used in photon beam therapy, i. Monte Carlo based dose calculation is certainly an issue; however, speed gain with cur- 9. This is a rather complex and workload the selective boosting of radio-resistant tumour intensive task which exceeds the scope of this intro- sub-volumes that can be visualised by molecular duction to treatment planning. Tese can be planar or volumetric X-ray therapy and photon beam therapy were developed based imaging devices mostly located in the treat- in parallel rather than in synergy. In recent years ment room and combined with the beam delivery there has been a clear trend towards closer collabo- device. When the tumour/ accumulated selectively into tumour cells by sev- healthy-tissue 10B concentration ratio has reached eral mechanisms. Termal neutrons have into tumour cells via the augmented metabolism of a minor biological efect on living cells. The dis- 10B-doped living cell giving rise to severe biologi- appointing outcomes of these trials were attributable cal damage. The nuclear reaction does not damage to: i) absence of specifc transporters of 10B in the the surrounding cells. From it can selectively hit the tumour cells, sparing the 1990 to today, many cancers have been treated using surrounding healthy tissue. The 10B atom, previously recognised efect from a clinical point of view (reduc- charged into the tumour cell, undergoes nuclear reaction when it absorbs a thermal neutron. The former cially in the case of relapse in brain or other distant is very aggressive and is histopathologically char- organs. Unfortunately, ity for tumour cells than the surrounding healthy data about histological characteristics of treated cells. Other 9 12 4 in particular it can be superfcial or deep, with or drugs are under investigation. The main advantage is its ability to act molecule enriched with 36 10B, have produced directly and specifcally on the tumour, both pri- interesting results in mice skin-melanoma studies. The natural metal occurs as 48 ii) their location outside the clinical environment; of fve stable isotopes. The 157Gd isotope represents iii) the necessity of a multidisciplinary team (nuclear 15. When 157Gdabsorbs a thermal neutron, be best suited as an adjunctive treatment, used in it leaves 158Gd in an excited state. While -rays and fast electrons transport the energy far Boron is a metal with two stable isotopes: 10B (19. The therapy exploits the nuclear electrons, which have energy of <1 keV, release their reaction 10B(n,)7Li. This reaction is very efective energy less than few tens of nanometres from the in destroying a tumour, providing that a sufcient reaction point.