Göran Svensson

The addition of local hyperthermia to radiation therapy has significantly improved the ability of oncologists to control superficial malignancies. Large tumours, tumours which cannot be heated adequately, and those situated in areas where surrounding normal tissues have decreased radiation tolerance, however, are difficult to eradicate even with this combination treatment. We believe that properly selected and scheduled anticancer drugs will add substantially to the efficacy of local hyperthermia and radiation. A review of the literature concerning the cytotoxic interactions of various anticancer agents with hyperthermia, with radiation and with relevant physiological parameters is presented. From this review, anticancer drugs which are good candidates for trimodality therapy are identified and a general approach to trimodality scheduling is suggested.

Ensuring safe operation for a medical accelerator is a difficult task. Users must assume more responsibility in using contemporary equipment. Additionally, users must work closely with manufacturers in promoting the safe and effective use of such complex equipment. Complex treatment techniques and treatment modality changeover procedures merit detailed, unambiguous written procedural instruction at the control console. A thorough "hands on" training period after receiving instructions, and before assuming treatment responsibilities, is essential for all technologists. Unambiguous written instructions must also be provided to guide technologists in safe response when equipment malfunctions or exhibits unexpected behavior or after any component has been changed or readjusted. Technologists should be given a written list of the appropriate individuals to consult when unexpected machine behavior occurs. They should be assisted in identifying aberrant behavior of equipment. Many centers already provide this instruction, but others may not. Practiced response and discussion with technologists should be a part of an ongoing quality assurance program. An important aspect of a safety program is the need for continuous vigilance. Table III gives a summary of a comprehensive safety program for medical accelerators. Table IV gives a list of summary recommendations as an example of how one might mitigate the consequences of an equipment failure and improve procedures and operator response in the context of the environment described. Most of these recommendations can be implemented almost immediately at any individual treatment center.

Abstract. Purpose: The purpose of this study was to construct a new clinical tool for establishing levels of indications for cataract surgery, and to validate this tool. Methods: Teams from nine eye clinics reached an agreement about the need to develop a clinical tool for setting levels of indications for cataract surgery and about the items that should be included in the tool. The tool was to be called ‘NIKE’ (Nationell Indikationsmodell för Kataraktextraktion). The Canadian Cataract Priority Criteria Tool served as a model for the NIKE tool, which was modified for Swedish conditions. Items included in the tool were visual acuity of both eyes, patients' perceived difficulties in day‐to‐day life, cataract symptoms, the ability to live independently, and medical/ophthalmic reasons for surgery. The tool was validated and tested in 343 cataract surgery patients. Validity, stability and reliability were tested and the outcome of surgery was studied in relation to the indication setting. Results: Four indication groups (IGs) were suggested. The group with the greatest indications for surgery was named group 1 and that with the lowest, group 4. Validity was proved to be good. Surgery had the greatest impact on the group with the highest indications for surgery. Test‐retest reliability test and interexaminer tests of indication settings showed statistically significant intraclass correlations (intraclass correlation coefficients [ICCs] 0.526 and 0.923, respectively). Conclusions: A new clinical tool for indication setting in cataract surgery is presented. This tool, the NIKE, takes into account both visual acuity and the patient's perceived problems in day‐to‐day life because of cataract. The tool seems to be stable and reliable and neutral towards different examiners.