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A clinical implementation of ion-beam radiography (iRad) is envisaged to provide a method for on-couch verification of ion-beam treatment plans. The aim of this work is to introduce and evaluate a method for quantitative water-equivalent thickness (WET) measurements for a specific helium-ion imaging system for WETs that are relevant for imaging thicker body parts in the future.Helium-beam radiographs (αRads) are measured at the Heidelberg Ion-beam Therapy Center with an initial beam energy of 239.5 MeV/u. An imaging system based on three pairs of thin silicon pixel detectors is used for ion path reconstruction and measuring the energy deposition (dE) of each particle behind the object to be imaged. The dE behind homogeneous plastic blocks is related to their well-known WETs between 280.6 and 312.6 mm with a calibration curve that is created by a fit to measured data points. The quality of the quantitative WET measurements is determined by the uncertainty of the measured WET of a single ion (single-ion WET precision) and the deviation of a measured WET value to the well-known WET (WET accuracy). Subsequently, the fitted calibration curve is applied to an energy deposition radiograph of a phantom with a complex geometry. The spatial resolution (modulation transfer function at 10 % -MTFIn the optimal imaging WET-range from ∼280 to 300 mm, the fitted calibration curve reached a mean single-ion WET precision of 1.55Using a beam energy of 239.5 MeV/u and the proposed calibration procedure, quantitative αRads of WETs between ∼280 and 300 mm can be measured and show high potential for clinical use. The proposed approach with the resulting image qualities encourages further investigation toward the clinical application of helium-beam radiography.

Introduction: Given that primary care has been found to be the most likely point of entry into the health care system for concussion patients, diagnosis and management of concussions are vital to the education of family medicine physicians. Studies of primary care residencies reveal a self-perceived deficiency in sports medicine education. This project was designed to determine the effect of a concussion management clinic on family medicine residents’ confidence in and personal value placed on diagnosing and managing concussions. Methods: This project was completed in a family medicine residency as a retrospective evaluation of an educational improvement project during the 2016-2017 academic year. The intervention involved implementation of a structured clinical experience focused on management of concussions. Residents were surveyed preintervention, as well as 5 and 11 months postintervention, measuring resident exposure to and confidence in diagnosing and managing concussions. Results: Residents demonstrated significantly increased confidence in diagnosing concussions and managing complicated concussions following the intervention (both F [2, 84]=3.56, P=0.03). Post hoc analysis indicated the statistical difference was found between preintervention measures and 1 academic year later. The number of concussions seen positively correlated with resident confidence in both diagnosing and managing concussions while personal value remained high. Conclusions: This project is the first to evaluate the impact of a concussion clinic on resident education, demonstrating significant improvement in multiple areas of concussion education. Replicating the project in other family medicine residencies could be beneficial in determining if this clinic education model improves resident outcomes in other residencies.

Die chronische Kniegelenkluxation ist ein seltenes Ereignis und stellt eine Herausforderung in der Therapie dar. Ein stufenweises Behandlungskonzept ist notwendig, um die aus mehreren Komponenten bestehende Pathologie zu behandeln. In diesem Artikel wird aufgrund eines Fallberichts ein Algorithmus fur die Therapie der chronischen Kniegelenkluxation gegeben.