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Tharavichtikul, Ekkasit,Meungwong, Pooriwat,Chitapanarux, Taned,Chakrabandhu, Somvilai,Klunklin, Pitchayaponne,Onchan, Wimrak,Wanwilairat, Somsak,Traisathit, Patrinee,Galalae, Razvan,Chitapanarux, Imj The Korean Society for Radiation Oncology 2014 Radiation Oncology Journal Vol.32 No.2
Purpose: To evaluate association between equivalent dose in 2 Gy (EQD2) to rectal point dose and gastrointestinal toxicity from whole pelvic radiotherapy (WPRT) and intracavitary brachytherapy (ICBT) in cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University. Materials and Methods: Retrospective study was designed for the patients with locally advanced cervical cancer, treated by radical radiotherapy from 2004 to 2009 and were evaluated by rectosigmoidoscopy. The cumulative doses of WPRT and ICBT to the maximally rectal point were calculated to the EQD2 and evaluated the association of toxicities. Results: Thirty-nine patients were evaluated for late rectal toxicity. The mean cumulative dose in term of EQD2 to rectum was 64.2 Gy. Grade 1 toxicities were the most common findings. According to endoscopic exam, the most common toxicities were congested mucosa (36 patients) and telangiectasia (32 patients). In evaluation between rectal dose in EQD2 and toxicities, no association of cumulative rectal dose to rectal toxicity, except the association of cumulative rectal dose in EQD2 >65 Gy to late effects of normal tissue (LENT-SOMA) scale ${\geq}$ grade 2 (p = 0.022; odds ratio, 5.312; 95% confidence interval, 1.269-22.244). Conclusion: The cumulative rectal dose in EQD2 >65 Gy have association with ${\geq}$ grade 2 LENT-SOMA scale.
Bongkot Jia-Mahasap(Bongkot Jia-Mahasap ),Chakri Madla(Chakri Madla ),Patumrat Sripan(Patumrat Sripan ),Imjai Chitapanarux(Imjai Chitapanarux ),Ekkasit Tharavichitkul(Ekkasit Tharavichitkul ),Somvilai 대한방사선종양학회 2022 Radiation Oncology Journal Vol.40 No.4
Purpose: Specific radiation delivered to tumors by stereotactic radiosurgery (SRS) has become widely used in the treatment of brain metastasis. This study aimed to compare radiation therapy planning and its parameters from SRS using three different modalities: helical tomotherapy (HT), volumetric modulated arc therapy (VMAT), and cone-based linac radiosurgery (Cone-based). Materials and Methods: Each contouring dataset of patents who experienced one to four brain metastasis received SRS in our center was re-planned to create radiation therapy planning in all three treatment systems (HT, VMAT, and Cone-based). The parameters of conformity index (CI), homogeneity index (HI), CI50, and gradient index (CGI) were analyzed to compare the effects of the three techniques. Decision score analysis was used to evaluate the performance on dosimetric and organs-at-risk parameters among the different techniques by applying the Cone-based technique as a benchmark. Results: A total of 21 patients with 39 lesions were included in this study. The results from the decision score analysis demonstrated statistically identical CI, CI50, and CGI values between Cone-based and VMAT for single lesions. For multiple lesions, VMAT also provided better CI when compared to Cone-based technique while HT exhibited the poorest dosimetric parameters. Moreover, VMAT exhibited the lowest BrainV5Gy value and displayed the shortest beam-on time calculation. Conclusion: We have conducted a comprehensive comparison of SRS planning approaches. The Cone-based technique revealed the highest HI value, while VMAT provided the best estimated beam-on time value. HT displayed a feasible SRS modality for single lesions, but not for multiple lesions.
Phisamon Kengkard(Phisamon Kengkard ),Jirachaya Choovuthayakorn(Jirachaya Choovuthayakorn ),Chollada Mahakkanukrauh(Chollada Mahakkanukrauh ),Nadee Chitapanarux(Nadee Chitapanarux ),Pittayarat Intasuw 대한해부학회 2023 Anatomy & Cell Biology Vol.56 No.1
Age at death estimation has always been a crucial yet challenging part of identification process in forensic field. The use of human skeletons have long been explored using the principle of macro and micro-architecture change in correlation with increasing age. The clavicle is recommended as the best candidate for accurate age estimation because of its accessibility, time to maturation and minimal effect from weight. Our study applies pre-trained convolutional neural network in order to achieve the most accurate and cost effective age estimation model using clavicular bone. The total of 988 clavicles of Thai population with known age and sex were radiographed using Kodak 9000 Extra-oral Imaging System. The radiographs then went through preprocessing protocol which include region of interest selection and quality assessment. Additional samples were generated using generative adversarial network. The total clavicular images used in this study were 3,999 which were then separated into training and test set, and the test set were subsequently categorized into 7 age groups. GoogLeNet was modified at two layers and fine tuned the parameters. The highest validation accuracy was 89.02% but the test set achieved only 30% accuracy. Our results show that the use of medial clavicular radiographs has a potential in the field of age at death estimation, thus, further study is recommended.
Spatial and Temporal Analyses of Cervical Cancer Patients in Upper Northern Thailand
Thongsak, Natthapat,Chitapanarux, Imjai,Suprasert, Prapaporn,Prasitwattanaseree, Sukon,Bunyatisai, Walaithip,Sripan, Patumrat,Traisathit, Patrinee Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.11
Background: Cervical cancer is a major public health problem worldwide. There have been several studies indicating that risk is associated with geographic location and that the incidence of cervical cancer has changed over time. In Thailand, incidence rates have also been found to be different in each region. Methods: Participants were women living or having lived in upper Northern Thailand and subjected to cervical screening at Maharaj Nakorn Chiang Mai Hospital between January 2010 and December 2014. Generalized additive models with Loess smooth curve fitting were applied to estimate the risk of cervical cancer. For the spatial analysis, Google Maps were employed to find the geographical locations of the participants' addresses. The Quantum Geographic Information System was used to make a map of cervical cancer risk. Two univariate smooths: x equal to the residency duration was used in the temporal analysis of residency duration, and x equal to the calendar year that participants moved to upper Northern Thailand or birth year for participants already living there, were used in the temporal analysis of the earliest year. The spatial-temporal analysis was conducted in the same way as the spatial analysis except that the data were split into overlapping calendar years. Results: In the spatial analysis, the risk of cervical cancer was shown to be highest in the Eastern sector of upper Northern Thailand (p-value <0.001). In the temporal analysis of residency duration, the risk was shown to be steadily increasing (p-value =0.008), and in the temporal analysis of the earliest year, the risk was observed to be steadily decreasing (p-value=0.016). In the spatial-temporal analysis, the risk was stably higher in Chiang Rai and Nan provinces compared to Chiang Mai province. According to the display movement over time, the odds of developing cervical cancer declined in all provinces. Conclusions: The risk of cervical cancer has decreased over time but, in some areas, there is a higher risk than in the major province of Chiang Mai. Therefore, we should promote cervical cancer screening coverage in all areas, especially where access is difficult and/or to women of lower socioeconomic status.
Radiotherapy Service Improvement: Simulation Study
Chawis Boonmee,Auttharat Kosayanon,Imjai Chitapanarux,Chompoonoot Kasemset 대한산업공학회 2020 Industrial Engineeering & Management Systems Vol.19 No.4
Radiotherapy service has seen a spur of interest in the health care system. Many cancer centers aim to develop and enhance radiotherapy service to support the increasing demand. Because Thailand is a developing country, some cancer centers still have limited resources, both staff and machinery, while the number of cancer patients in Thailand has increased every year. To enhance the operational efficiency of radiotherapy service, this research aims to propose an integrated simulation approach and theory of constraints (TOC) approach for increasing radiotherapy service capability in Thailand. As simulation and TOC were applied in the case study, the real bottlenecks were identified in each treatment room. Considering four treatment rooms, only two rooms were selected for improvement (Room 2 and Room 3) after the simulation. The eight proposed solutions concentrated on improving both human- and machine-related bottlenecks. The simulation experiments were conducted to evaluate each solution. The results presented the best solution as adding one technician to Room 3 and replacing the radiation machine in Room 2 with the same machine as in Room 3. With this solution, the number of patients served was increased by 12.32% from the current system. As for the investment needed, the benefit-cost ratio and payback period were calculated as 1.89 and 2.80 years, respectively, for this solution.
Ekkasit Tharavichtikul,MD,Pooriwat Meungwong,MD,Taned Chitapanarux,MD,Somvilai Chakrabandhu,MD,Pitchayaponne Klunklin,MD,Wimrak Onchan,MD,Somsak Wanwilairat,PhD,Patrinee Traisathit,PhD,Razvan Galalae 대한방사선종양학회 2014 Radiation Oncology Journal Vol.32 No.2
Purpose: To evaluate association between equivalent dose in 2 Gy (EQD2) to rectal point dose and gastrointestinal toxicity from whole pelvic radiotherapy (WPRT) and intracavitary brachytherapy (ICBT) in cervical cancer patients who were evaluated by rectosigmoidoscopy in Faculty of Medicine, Chiang Mai University. Materials and Methods: Retrospective study was designed for the patients with locally advanced cervical cancer, treated by radical radiotherapy from 2004 to 2009 and were evaluated by rectosigmoidoscopy. The cumulative doses of WPRT and ICBT to the maximally rectal point were calculated to the EQD2 and evaluated the association of toxicities. Results: Thirty-nine patients were evaluated for late rectal toxicity. The mean cumulative dose in term of EQD2 to rectum was 64.2 Gy. Grade 1 toxicities were the most common findings. According to endoscopic exam, the most common toxicities were congested mucosa (36 patients) and telangiectasia (32 patients). In evaluation between rectal dose in EQD2 and toxicities, no association of cumulative rectal dose to rectal toxicity, except the association of cumulative rectal dose in EQD2 >65 Gy to late effects of normal tissue (LENT-SOMA) scale ≥ grade 2 (p = 0.022; odds ratio, 5.312; 95% confidence interval, 1.269–22.244). Conclusion: The cumulative rectal dose in EQD2 >65 Gy have association with ≥ grade 2 LENT-SOMA scale.
( Siripa Puasripun ),( Nithi Thinrungroj ),( Kanokwan Pinyopornpanish ),( Phuripong Kijdamrongthum ),( Apinya Leerapun ),( Taned Chitapanarux ),( Satawat Thongsawat ),( Ong-ard Praisontarangkul ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2020 Journal of Neurogastroenterology and Motility (JNM Vol.26 No.2
Background/Aims The treatment of refractory functional dyspepsia (FD) is a challenge. Clidinium/chlordiazepoxide is a combination of antispasmodic and anxiolytic drugs that has been used as an adjunct treatment for FD in clinical practice with limited supporting evidence of efficacy. The aim of the study is to assess the efficacy and safety of clidinium/chlordiazepoxide as an adjunct treatment to a proton pump inhibitor (PPI) in refractory dyspepsia. Methods We performed a study of patients who met the Rome IV criteria for FD who failed to respond to PPIs. Patients were randomly assigned to groups that received clidinium/chlordiazepoxide or placebo as an add-on treatment to PPI for 4 weeks. The primary outcome was the rate of responders, which was defined as a > 50% reduction in dyspepsia symptom score after 4 weeks of treatment. The secondary outcomes were an improvement in the quality of life and the safety profile. Results Between March 2017 and February 2018, 78 patients were enrolled. The rates of responders in the clidinium/chlordiazepoxide group and placebo groups were 41.03 % and 5.13% at week 4 (P < 0.001). The clidinium/chlordiazepoxide group also showed significant improvement in overall quality of life over placebo. However, the clidinium/chlordiazepoxide group had more frequent drowsiness than the placebo group (30.27% vs 6.52%, P = 0.034). There were no major adverse events in either group. Conclusions Clidinium/chlordiazepoxide significantly improved dyspeptic symptoms and quality of life. This combination may be used as an add-on therapy in FD patients without major adverse events. (J Neurogastroenterol Motil 2020;26:259-266)
Thailand Dyspepsia Guidelines: 2018
Rapat Pittayanon,Somchai Leelakusolvong,Ratha-korn Vilaichone,Jarin Rojborwonwitaya,Sombat Treeprasertsuk,Pisaln Mairiang,Supphamat Chirnaksorn,Taned Chitapanarux,Uayporn Kaosombatwattana,Jaksin Sotti 대한소화기 기능성질환∙운동학회 2019 Journal of Neurogastroenterology and Motility (JNM Vol.25 No.1
The management of dyspepsia in limited-resource areas has not been established. In 2017, key opinion leaders throughout Thailand gathered to review and evaluate the current clinical evidence regarding dyspepsia and to develop consensus statements, rationales, levels of evidence, and grades of recommendation for dyspepsia management in daily clinical practice based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. This guideline is mainly focused on the following 4 topics: (1) evaluation of patients with dyspepsia, (2) management, (3) special issues (overlapping gastroesophageal reflux disease/irritable bowel syndrome and non-steroidal anti-inflammatory drug/aspirin use), and (4) long-term follow-up and management to provide guidance for physicians in Thailand and other limited-resource areas managing such patients.
Tharavichitkul, Ekkasit,Janla-or, Suwapim,Wanwilairat, Somsak,Chakrabandhu, Somvilai,Klunklin, Pitchayaponne,Onchan, Wimrak,Supawongwattana, Bongkot,Galalae, Razvan M.,Chitapanarux, Imjai The Korean Society for Radiation Oncology 2015 Radiation Oncology Journal Vol.33 No.2
We present a case of cervical cancer treated by concurrent chemoradiation. In radiation therapy part, the combination of the whole pelvic helical tomotherapy plus image-guided brachytherapy with megavoltage computed tomography of helical tomotherapy was performed. We propose this therapeutic approach could be considered in a curative setting in some problematic situation as our institution.