Radiation therapy is usually applied on orthovoltage machines (with 100 - 120 kV X-rays) or linear accelerators (with 4 - 6 MeV electrons). On both radiation machines the intention is to provide sufficient dose to the palmar side of the hand and avoid dose to the dorsal side of the hand.
With this in mind a recent publication from Ruby Meridith et al. regarding dose optimization is important. They show that the application of sufficient bolus material (5 - 10mm) is important to place on the treatment area to adapt the dose depth profile. The enclosed figure demonstrate the dose distribution within the hand in a cross section view:
Figure 1: Dupuytren_RT_3D-Planning
The different depth dose profiles of electrons (6 MeV and 18 MeV) and photons (6 MV) are demonstrated in the other figure.
Figure 2: Radiation-Dose-Depth-Profile of Electrons-and-Photons
New address for treatment by Professor Seegenschmiedt.
New address for treatment by Professor Seegenschmiedt.
OUR RADIATION THERAPY PRACTICE has moved to a new and very modern location only about 800 meters away from the old practice which I shared with my colleague Dr. med. Sedat Yilmam (see attached photograph together with our ORTHOVOLT machine which applies 100 - 200 kV X-rays sufficient for DUPUYTREN & LEDDERHOSE & PEYRONIEs DISEASE or KELOID treatments ...
Moreover, we can now offer every patient our modern imaging methods like Computer Tomography (one CT machine) and Magnetic Resonance Imaging (two MRI machines) together with ultrasound and mammography. We are excited about the spacious setting and the nice atmosphere within and around our new center.
Further data links and postal address are as follows:
Prof. Dr. med. M. Heinrich Seegenschmiedt FA für Strahlentherapie & Radioonkologie MVZ RUHRRADIOLOGIE – RUE191 GmbH
spanishbuddha:Thank you SPANISH BUDDHA & WOLFGANG WACH for the great work of Counselling & Discussing DD & LD many years.
With CORONA I have learned to perform VIDEO CONSULTATIONS and develop skills to detect early signs of Dupuytren Disease and make sure clients / members of the FORUM do not panic with the diagnosis and overcome an "initial diagnostic shock, obtain rationale decisions and decide for appropriate steps and actions on a long way to go.
After over 100 VIDEO CONSULTATIONS within 18 months, I will explain the components of the video consultation.
( A ) POSSOBLE OPTIONS OF CONSULTATION
Clinical conditions of Dupuytren & Ledderhose Disease may vary among the affected individuals. Moreover, the different individual conditions and disease developments may require different approaches and specific single or combined treatment strategies. The following five options are only a few out of many other altered or combined strategies available:
(1) First Assessment of your disease with further help for decision-making of "Watch & Wait" strategy with regular follow-up (via video appointments). Not every patient will need treatment immediately even with the full diagnosis being assessed
(2) Prophylactic radiotherapy (RT) with precise definition of RT areas to be treated due to progressive early stage disease to avoid further progression or surgery
(3) Prophylactic radiotherapy (RT) following an invasive procedure such as collagen injections (CI), needle fasciotomy (NF) or limited Fasciectomy (FE) to avoid relapse in the operated areas and progression in untreated areas
(4) Therapeutic plus prophylactic radiotherapy (RT) after relapse / progression inside or at the edge or outside of the previously irradiated areas
(5) Specific Consultation of Doctors together with their patients for specific problems of diagnostic assessment and discussion of specific radiation therapy techniques
( B ) UNDERSTANDING AND DEFINTION OF THE "PROM"
It is important to understand your PROM (= P atient R elated O utcome M easures), i.e. goals of the planned consultation with the client. To be best prepared myself for the video consultation high quality photographs of all affected extremities in case of Dupuytren or Ledderhose Disease (i.e. bilateral hand palms and foot soles with ink-marked lesions) and a summary of the disease history is required; previous diagnostic and therapeutic measures and a structured BASIC DATA SET related to DUPUYTREN (DD) and LEDDERHOSE DISEASE (LD) is required together with the VIDEO CONSULTATION REQUEST FORM (attached files).
In case of other DISORDERS additional data can be added (imaging data, reports; laboratory work-up; letters of doctors). After receiving this information and SPECIFIC QUESTIONS, I will provide the client with an INTERNET LINK, ACCESS CODE and 2 - 3 VIDEO CONSULTATION dates, e.g. SATURDAY / SUNDAY / MONDAY, September 25 - 27 , 2021 at 9 PM (CET = Central Europan Time) which is 8 PM at London / UK or 3 PM at New York or at the East Cost (USA) or noon in San Francisco or Pacific Coast (USA) ( C ) PREPARATION OF VIDEO CONFERENCE At HOME OFFICE
To hold the special medical video consultation with the client personally on the lap top / PC I usually reserve about 30 minutes unless the client requests more time in advance. The conversation will be a direct laptop-to-laptop (face-to-face interaction) w/o any intermediate server storage. Our German Data Protection Laws and Data Handling Requirements limit the use of video conference platforms in medicine. The other preparatory steps for the planned VIDEO CONFERENCE are:
(1) Good Illumination coming from upfront, i.e. at least one better TWO LIGHTS (about 30 - 45° angulation towards face)
(2) Turn down LIGHTS in the background or on the ceiling of the client´s living room
(3) Clients test the movements of the hands in front of a mirror (movements to the RIGHT move left and vice versa)
(4) Preparation of the following materials :
. 4 BLANK WHITE SHEETS OF PAPER - 1 thin dark MARKER PEN (black, blue) - 2 broad GREEN and RED MARKER PENS - 1 CENTIMETER RULER ( üleas NO INCH only ruler)
( D ) PERFORMANCE OF VIDEO CONSULTATION
- Anatomical DESCRIPTION - Physiological MOVEMENTS - Comparative ANANLYSIS (Measurements) - Performance of FUNCTION TESTS - Analysis of RISK FACTORS - Summary of ALL FINDINGS - Conclusion for FUTURE PROCEDURES : To Treat or Not-to-Treat
( E ) REPORTING Short / Extensive Form ( F ) FOLLOW-UP VIDEO or ON-SITE CONSULTATIONS for LONG-TERM-ANALYIS and DECISION MAKING
Prof. Dr. med. M. Heinrich Seegenschmiedt E-mail: firstname.lastname@example.org MVZ Ruhrradiologie RUE191 GmbH Rüttenscheider Strasse 191, 45131 Essen (Germany)
P.S. Richard Shaffer (UK) is also offering VIDEO CONSULTATIONS