Professional Documents
Culture Documents
(VWLPDWLRQRI&79WR3790DUJLQVLQ+HDGDQG1HFN
&DQFHU3DWLHQWV8VLQJ2Q%RDUG,PDJHU>2%,@
6DQJXWLG7KRQJVDZDG06F:LODL0DVDQJD%6F
6DZDQHH6XQWLZRQJ06F.LWWLSRO'DFKDZRUDNRO06F
&KLUDVDN.KDPIRQJNKUXHD06F6DVLNDUQ&KDPFKRG0'&KLUDSKD7DQQDQRQWD06
)DFXOW\RI0HGLFLQHDQG3XEOLF+HDOWK+5+3ULQFHVV&KXODEKRUQ&ROOHJHRI0HGLFDO6FLHQFH
&KXODEKRUQ5R\DO$FDGHP\%DQJNRN7KDLODQG
'HSDUWPHQWRI5DGLDWLRQ2QFRORJ\&KXODEKRUQ+RVSLWDO+5+3ULQFHVV&KXODEKRUQ&ROOHJHRI0HGLFDO6FLHQFH
&KXODEKRUQ5R\DO$FDGHP\%DQJNRN7KDLODQG
Background: $W&KXODEKRUQ+RVSLWDOXQLIRUPFOLQLFDOWDUJHWYROXPH>&79@WRSODQQLQJWDUJHWYROXPH>379@PDUJLQRI
FPLVXVHGIRUKHDGDQGQHFNFDQFHUUDGLDWLRQWKHUDS\WUHDWPHQWDV5DGLDWLRQ7KHUDS\2QFRORJ\*URXS>572*@SURWRFRO
VXJJHVWHG+RZHYHU379PDUJLQVUHODWHWRW\SHVRIWKHUPRSODVWLFPDVNLPDJHYHULILFDWLRQPRGDOLW\DQGLPDJHJXLGDQFH
SURWRFRO
Objective: 7RHVWLPDWHWKH&79WR379PDUJLQVLQKHDGDQGQHFNFDQFHUSDWLHQWVWUHDWHGZLWKLQWHQVLW\PRGXODWHGUDGLDWLRQ
WKHUDS\>,057@DW&KXODEKRUQ+RVSLWDOLQRUGHUWRYHULI\ZKHWKHURXUFXUUHQWDGGLWLRQRIFPZDVDSSURSULDWH
Results: 7KH&79WR379PDUJLQVFDOFXODWHGZLWK'PDUJLQZHUHDQGFPIRU9HUW/QJDQG/DWFRXFK
GLUHFWLRQVUHVSHFWLYHO\7KH&79WR379PDUJLQFDOFXODWHGZLWKDQLVRWURSLF'PDUJLQH[SDQVLRQZDVFP
Conclusion: 7KLVVWXG\LQGLFDWHGWKDWWKHXQLIRUP&79WR379PDUJLQRIFPXVHGIRUKHDGDQGQHFNFDQFHUSDWLHQWVDW
RXUKRVSLWDOLVDGHTXDWHWRFRYHUVHWXSHUURUV
Keywords: 379PDUJLQVHVWLPDWLRQ6HWXSHUURUV2QERDUGLPDJHU+HDGDQGQHFNFDQFHU
-0HG$VVRF7KDL>6XSSO@66
:HEVLWHKWWSZZZMPDWRQOLQHFRP
,QWHQVLW\PRGXODWHGUDGLDWLRQWKHUDS\>,057@ DQGWXPRUGHOLQHDWLRQHUURUV7RHQVXUHWKDWUDGLDWLRQ
ZDVGHYHORSHGWRLPSURYHGRVHWRWXPRUDQGWRUHGXFH GRVHFRYHULQJDWXPRUFOLQLFDOWDUJHWYROXPH>&79@
GRVH WR VXUURXQGLQJ QRUPDO RUJDQV ,Q KHDG DQG LV H[SDQGHG DV SODQQLQJ WDUJHW YROXPH >379@ 7KH
QHFNFDQFHUWKH,057WHFKQLTXHLVXVHGWRLPSURYH 5DGLDWLRQ7KHUDS\2QFRORJ\*URXS>572*@SURWRFRO
WKH WUHDWPHQW UHVXOWV $OWKRXJK SDWLHQWV DUH IL[HG +VXJJHVWHGXVLQJDXQLIRUP&79WR379PDUJLQ
E\ XVLQJ WKHUPRSODVWLF PDVN UHVLGXDO HUURU FRXOG RIDWOHDVWFPXQWLOLQVWLWXWLRQVSHFLILFXQFHUWDLQW\
RFFXUGXHWRYDULDWLRQVRIVHWXSHUURUVWXPRUPRWLRQ KDVEHHQHYDOXDWHG $W&KXODEKRUQ+RVSLWDOXQLIRUP
&79WR379PDUJLQRIFPKDVEHHQXVHGIRUKHDG
&RUUHVSRQGHQFH WR DQG QHFN FDQFHU DV 572* SURWRFRO VXJJHVWHG 7KH
7KRQJVDZDG 6 )DFXOW\ RI 0HGLFLQH DQG 3XEOLF +HDOWK +5+ IRUPXODWRHVWLPDWH&79WR379PDUJLQVZDVSXEOLVKHG
3ULQFHVV &KXODEKRUQ &ROOHJH RI 0HGLFDO 6FLHQFH &KXODEKRUQ E\9DQ+HUN0HWDO 0DQ\VWXGLHVHVWLPDWHG&79
5R\DO$FDGHP\ .DPSKDHQJSKHW 5RDG 7DODW %DQJNKHQ
WR379PDUJLQVLQKHDGDQGQHFNFDQFHUDQGIRXQG
/DNVL %DQJNRN 7KDLODQG
3KRQH )D[ WKDWDGHTXDWH379PDUJLQVFRXOGEHOHVVWKDQFP
(PDLO VDQJXWLGWKR#SFFPVDFWK ZKLFK ZHUH UHODWHG WR W\SHV RI WKHUPRSODVWLF PDVN
+RZ WR FLWH WKLV DUWLFOH 7KRQJVDZDG 6 0DVDQJD : 6XQWLZRQJ 6 'DFKDZRUDNRO . .KDPIRQJNKUXHD & &KDPFKRG 6
7DQQDQRQWD & (VWLPDWLRQ RI &79 WR 379 0DUJLQV LQ +HDG DQG 1HFN &DQFHU 3DWLHQWV 8VLQJ 2Q%RDUG ,PDJHU >2%,@ - 0HG$VVRF
7KDL 6XSSO 66
-0HG$VVRF7KDL_9RO_6XSSO_ 6
LPDJH YHULILFDWLRQ PRGDOLW\ DQG LPDJH JXLGDQFH VTXDUH RI WKH VWDQGDUG GHYLDWLRQ RI FRXFK
SURWRFRO GLVSODFHPHQW
7KH SXUSRVH RI WKH SUHVHQW VWXG\ ZDV WR
HVWLPDWHWKH&79WR379PDUJLQVLQKHDGDQGQHFN PTV margin estimation
FDQFHUWUHDWHGZLWK,057DW&KXODEKRUQ+RVSLWDOLQ ,QWKLVVWXG\WKH379PDUJLQVZHUHFDOFXODWHG
RUGHUWRYHULI\ZKHWKHURXUFXUUHQWDGGLWLRQRIFP E\XVLQJ9DQ+HUNHTXDWLRQIRUWZRW\SHVRIPDUJLQV
ZDVDSSURSULDWH RQH GLPHQVLRQDO D 379 DQG DQLVRWURSLF WKUHH
GLPHQVLRQDO D379 H[SDQVLRQPDUJLQVDVWKHIROORZLQJ
0DWHULDOVDQG0HWKRGV HTXDWLRQV
Patient setup and data acquisition
7KHGDWDRIKHDGDQGQHFNFDQFHUSDWLHQWV 379 Σecah_directionσecah_direction
WUHDWHG ZLWK ,057 WHFKQLTXH ZHUH UHWURVSHFWLYHO\ D379 Σtotalσtotal
FROOHFWHGDQGDQDO\]HG$OOSDWLHQWVLQWKLVVWXG\ZHUH
WUHDWHGZLWK09SKRWRQEHDPVRIDOLQHDUDFFHOHUDWRU 7KHWRWDOV\VWHPDWLF ΣWRWDO DQGUDQGRPHUURUV
/,1$& PDFKLQH 7ULORJ\PRGHO9DULDQ3DOR$OWR σWRWDO ZHUHFDOFXODWHGE\XVLQJWKHHTXDWLRQV
86$ DW&KXODEKRUQ+RVSLWDO%DQJNRN7KDLODQG7KH
2Q%RDUG,PDJHUV\VWHP 2Q%RDUG,PDJHU®9DULDQ σtotal = Σ/QJΣ/DWΣ9HUW
YHULI\SDWLHQWSRVLWLRQ
7KH SDWLHQWV ZHUH LPPRELOL]HG XVLQJ :KHUHΣ/QJΣ/DW DQGΣ9HUWDUHWKHV\VWHPDWLF
WKHUPRSODVWLFPDVN 0HG7HFK®2UDQJH&LW\86$ DV HUURUVDQGσ/QJσ/DWDQGσ9HUWDUHWKHUDQGRPHUURUVLQ
VKRZQLQ)LJXUH7KHUPRSODVWLFPDVNZHUHIL[HGWR /QJ/DWDQG9HUWGLUHFWLRQVUHVSHFWLYHO\
WKHEDVHSODWHRQWKHWDEOHFRXFKWRSRIWKHWUHDWPHQW 7KHSURWRFRORIWKLVUHVHDUFKZDVUHYLHZHG
PDFKLQH7KHSDWLHQWVZHUHVFDQQHGZLWKWKHSURWRFRO DQGDSSURYHGE\WKH+XPDQUHVHDUFKHWKLFVFRPPHWWH
RIFPVOLFHWKLFNQHVVDQGFPH[WHQGHGOHQJWK &KXODEKRUQ5HVHDUFK,QVWLWXWH1R
IURPWKHWDUJHWYROXPHWRDFFRXQWIRUVFDWWHUHGGRVH
7KUHHLVRFHQWHUVHWXSSRLQWVIRUDQWHULRUULJKWDQGOHIW 5HVXOWV
ODWHUDOGLUHFWLRQVRIHDFKSDWLHQWZHUHPDUNHGRQWKH 7DEOHVKRZVPHDQDQGVWDQGDUGGHYLDWLRQ
WKHUPRSODVWLFPDVN,QWKH/,1$&URRPWKHSDWLHQWV >6'@RIFRXFKGLVSODFHPHQWIRUKHDGDQGQHFNFDQFHU
ZHUHVHWXSXVLQJWKHWKUHHLVRFHQWHUPDUNHUVWKHQWKH SDWLHQWV ZKLFK ZHUH XVHG WR FDOFXODWH V\VWHPDWLF
SODQDU LPDJHV DQWHULRU DQG ODWHUDO IURP 2Q%RDUG HUURUV0HDQFRXFKGLVSODFHPHQWZHUHWR
,PDJHU>2%,@ZHUHWDNHQEHIRUHHDFKWUHDWPHQW FPWRFPDQGWRFPLQ9HUW
6-0HG$VVRF7KDL_9RO_6XSSO_
)LJXUH 2%,VRIWZDUHXVHGIRUSODQDULPDJHPDWFKLQJLQ/DWHUDO /HIW DQG$QWHULRU 5LJKW YLHZV
-0HG$VVRF7KDL_9RO_6XSSO_ 6
7DEOH 0HDQ DQG VWDQGDUG GHYLDWLRQ 6' RI FRXFK 7DEOH 6WDQGDUG GHYLDWLRQ >6'@ DQG URRWPHDQVTXDUH
GLVSODFHPHQWIRUKHDGDQGQHFNFDQFHUSDWLHQWV >506@RIFRXFKGLVSODFHPHQWIRUKHDGDQGQHFN
FDQFHUSDWLHQWV
3DWLHQW 0HDQRIFRXFKGLVSODFHPHQW FP
3DWLHQW 6'RIFRXFKGLVSODFHPHQW FP
9HUW /QJ /DW
9HUW /QJ /DW
6'
506
HUURUVLQ'PDUJLQVHVWLPDWLRQDUHEDVHGRQRI
WKH SDWLHQW SRSXODWLRQ ZKLFK KDV FRYHUDJH RI LQKHDGDQGQHFNFDQFHUUDGLDWLRQWUHDWPHQWZLWKGDLO\
LVRGRVHOHYHOWR&79 &7RQUDLOVLPDJLQJDQGIRXQGWKH'PDUJLQVZDV
$OWKRXJKWKHPD[LPXPPDUJLQFDOFXODWHGZLWK FP /XHWDOHVWLPDWHG'PDUJLQZLWK&RQH
'HTXDWLRQZDVFPWKH379PDUJLQZDVVWLOOOHVV EHDP&RPSXWHG7RPRJUDSK\>&%&7@DQGIRXQGWKH
WKDQFPDVUHFRPPHQGHGE\WKH572* 7KXV PDUJLQVRIPPPPDQGPPZHUHUHTXLUHG
WKLVPD\LPSO\WKDWRXU379PDUJLQZLWKDQXQLIRUP LQWKH5/6,DQG$3GLUHFWLRQVUHVSHFWLYHO\
H[SDQVLRQ RI FP LV DGHTXDWH IRU DOO GLUHFWLRQV $OWKRXJKRXUVWXG\HPSKDVL]HGRQ&79WR
%DVLFDOO\ WKH WUXH PDUJLQV PD\ EH OHVV WKDQ RXU 379PDUJLQVWKHRUJDQDWULVN>2$5@WRWKHSODQQLQJ
FDOFXODWLRQ EHFDXVH WKH FRXFK ZLOO EH VKLIWHG WR WKH RUJDQ DW ULVN YROXPH >359@ PDUJLQV FDQ DOVR EH
FRUUHFWSRVLWLRQEHIRUHEHDPGHOLYHU\LIWKH,*57KDV FDOFXODWHG ZLWK WKH VDPH GDWD E\ XVLQJ HTXDWLRQ RI
EHHQH[HFXWHGKHQFHWKHFDOFXODWHG379PDUJLQPD\ 0F.HQ]LH 7KXV WKH 2$5 WR 359 PDUJLQV ZHUH
EHRYHUHVWLPDWHG2XUVWXG\IRXQGWKH'PDUJLQVZDV FDOFXODWHGDV
FPZKLFKZHUHFRPSDUDEOHZLWKWKHRWKHUVWXG\
:DQJHWDOIRXQGWKH379PDUJLQVRIWRFP DPRV Σtotal +σtotal
ZDVUHTXLUHGWRHQVXUHDGHTXDWHFRYHUDJHRI&79LIQR
RQOLQHFRUUHFWLRQZDVSHUIRUPHG .DSDQHQHWDO $GGLWLRQDOO\ WKLV VWXG\ DOVR HVWLPDWHG WKH
IRXQGWKDW'PDUJLQVZDVOHVVWKDQFPZLWKSODQDU 2$5WR359PDUJLQVFDOFXODWHGXVLQJWKH0F.HQ]LH
LPDJHVYHULILFDWLRQLQKHDGDQGQHFNFDQFHUUDGLDWLRQ HTXDWLRQDQGIRXQGWKDWWKH359PDUJLQZDVFP
WUHDWPHQWLPPRELOL]HGZLWKSRLQW&IUDPH &DQGRU ZKLFK DSSHDUHG WR EH DGHTXDWH IRU RXU 359PDUJLQ
*LVOHY'HQPDUN %DURQHWDOHVWLPDWHG'PDUJLQV ZLWKFPIRUVSLQDOFRUG2XU359PDUJLQHVWLPDWLRQ
6-0HG$VVRF7KDL_9RO_6XSSO_
7DEOH 7KH YDOXHV RI V\VWHPDWLF Σ UDQGRP σ WRWDO WKLV VWXG\
V\VWHPDWLF ΣWRWDO DQGWRWDOUDQGRP σWRWDO HUURUV
LQ9HUW/QJDQG/DWGLUHFWLRQVLQFP $FNQRZOHGJHPHQWV
7KHDXWKRUVZRXOGOLNHWRH[WHQGRXUVSHFLDO
(UURU &RXFKGLUHFWLRQ WKDQNVWRRXUFOLQLFDOFDUHWHDPDW&KXODEKRUQ5R\DO
7\SH 7RWDOHUURU
$FDGHP\IRUWKHLUNLQGDVVLVWDQFHDQGVXSSRUWWRZDUGV
9HUW /QJ /DW
WKHVXFFHVVDQGDFFRPSOLVKPHQWRIWKLVUHVHDUFKVWXG\
Σ ΣWRWDO 7KHDXWKRUVZRXOGOLNHWRWKDQN'U'DQXSRQ1DQWDMLW
σ σWRWDO IRU KLV DVVLVWDQFH LQ UHYLHZLQJ WKH PDQXVFULSW 7KH
DXWKRUV ZRXOG DOVR OLNH WR WKDQN 3URI 3LWWD\DSRRP
3DWWDUDQXWUDSRUQIRUFRQWULEXWLQJWRWKLVSURMHFW
7DEOH 379PDUJLQVLQWHUPVRI'DQG'LQFP
3RWHQWLDOFRQIOLFWVRILQWHUHVW
7KHDXWKRUVGHFODUHQRFRQIOLFWRILQWHUHVW
379PDUJLQV &RXFKGLUHFWLRQ
-0HG$VVRF7KDL_9RO_6XSSO_ 6
$GDE)+DUULQJWRQ.HWDO)LUVWUHVXOWVRIDSKDVH WRHYDOXDWHWLPHWUHQGV379DQG359PDUJLQV
,,, PXOWLFHQWHU UDQGRPL]HG FRQWUROOHG WULDO RI $FWD2QFRO
LQWHQVLW\PRGXODWHG ,057 YHUVXVFRQYHQWLRQDO =KDQJ/*DUGHQ$6/R-$QJ..$KDPDG$
UDGLRWKHUDS\ 57 LQ KHDG DQG QHFN FDQFHU 0RUULVRQ:+HWDO0XOWLSOHUHJLRQVRILQWHUHVW
3$563257,65&71&58. - DQDO\VLVRIVHWXSXQFHUWDLQWLHVIRUKHDGDQGQHFN
&OLQ2QFRO/%$ FDQFHUUDGLRWKHUDS\,QW-5DGLDW2QFRO%LRO3K\V
(LVEUXFK$&KDR.*DUGHQ$5DGLDWLRQ7KHUDS\
2QFRORJ\*URXS572*3KDVH,,,VWXG\RI %LMKROG - /HEHVTXH -9 +DUW$$9LMOEULHI 5(
FRQIRUPDODQGLQWHQVLW\PRGXODWHGLUUDGLDWLRQIRU 0D[LPL]LQJVHWXSDFFXUDF\XVLQJSRUWDOLPDJHVDV
RURSKDU\QJHDOFDQFHU>,QWHUQHW@>FLWHG DSSOLHGWRDFRQIRUPDOERRVWWHFKQLTXHIRUSURVWDWLF
0DU@$YDLODEOHIURPZZZUWRJRUJPHPEHUV FDQFHU5DGLRWKHU2QFRO
SURWRFROVKKSGI GH%RHU+&YDQ6RUQVHQGH.RVWH-56HQDQ6
YDQ+HUN05HPHLMHU3/HEHVTXH-9,QFOXVLRQ 9LVVHU$*+HLMPHQ%-$QDO\VLVDQGUHGXFWLRQRI
RI JHRPHWULF XQFHUWDLQWLHV LQ WUHDWPHQW SODQ 'V\VWHPDWLFDQGUDQGRPVHWXSHUURUVGXULQJWKH
HYDOXDWLRQ ,QW - 5DGLDW 2QFRO %LRO 3K\V VLPXODWLRQDQGWUHDWPHQWRIOXQJFDQFHUSDWLHQWV
ZLWK&7EDVHGH[WHUQDOEHDPUDGLRWKHUDS\GRVH
%DURQ &$$ZDQ 0- 0RKDPHG $6 $NHO , SODQQLQJ,QW-5DGLDW2QFRO%LRO3K\V
5RVHQWKDO',*XQQ*%HWDO(VWLPDWLRQRIGDLO\
LQWHUIUDFWLRQDO ODU\Q[ UHVLGXDO VHWXS HUURU DIWHU :DQJ-%DL6&KHQ1;X)-LDQJ;/L<HWDO
LVRFHQWULF DOLJQPHQW IRU KHDG DQG QHFN 7KHFOLQLFDOIHDVLELOLW\DQGHIIHFWRIRQOLQHFRQH
UDGLRWKHUDS\TXDOLW\DVVXUDQFHLPSOLFDWLRQVIRU EHDP FRPSXWHU WRPRJUDSK\JXLGHG LQWHQVLW\
WDUJHWYROXPHDQGRUJDQVDWULVNPDUJLQDWLRQXVLQJ PRGXODWHG UDGLRWKHUDS\ IRU QDVRSKDU\QJHDO
GDLO\&7RQUDLOVLPDJLQJ-$SSO&OLQ0HG3K\V FDQFHU5DGLRWKHU2QFRO
0F.HQ]LH$YDQ+HUN00LMQKHHU%0DUJLQV
.DSDQHQ0/DDNVRPDD07XOLMRNL73HOWROD6 IRUJHRPHWULFXQFHUWDLQW\DURXQGRUJDQVDWULVNLQ
:LJUHQ 7 +\RG\QPDD 6 HW DO (VWLPDWLRQ RI UDGLRWKHUDS\5DGLRWKHU2QFRO
DGHTXDWHVHWXSPDUJLQVDQGWKUHVKROGIRUSRVLWLRQ /X+/LQ+)HQJ*&KHQ-6KX/3DQJ4HWDO
HUURUVUHTXLULQJLPPHGLDWHDWWHQWLRQLQKHDGDQG ,QWHUIUDFWLRQDODQGLQWUDIUDFWLRQDOHUURUVDVVHVVHG
QHFN FDQFHU UDGLRWKHUDS\ EDVHG RQ ' LPDJH E\ GDLO\ FRQHEHDP FRPSXWHG WRPRJUDSK\ LQ
JXLGDQFH5DGLDW2QFRO QDVRSKDU\QJHDOFDUFLQRPDWUHDWHGZLWKLQWHQVLW\
6ULYDVWDYD63&KHQJ&:'DV,-,PDJHJXLGDQFH PRGXODWHGUDGLDWLRQWKHUDS\DSURVSHFWLYHVWXG\
EDVHGWDUJHWYROXPHPDUJLQH[SDQVLRQLQ,057RI -5DGLDW5HV
KHDGDQGQHFNFDQFHU7HFKQRO&DQFHU5HV7UHDW 3LRWURZVNL7.D]PLHUVND-6RNRORZVNL$6NRUVND
0-RGGD$5\F]NRZVNL$HWDO,PSDFWRIWKH
0RQJLRM 9 2UODQGL ( 3DOD]]L 0 'HSRQWL ( VSLQDO FRUG SRVLWLRQ XQFHUWDLQW\ RQ WKH GRVH
0DU]LD)6WXFFKL&HWDO6HWXSHUURUVDQDO\VHVLQ UHFHLYHGGXULQJKHDGDQGQHFNKHOLFDOWRPRWKHUDS\
,057WUHDWPHQWVIRUQDVRSKDU\QJHDOFDUFLQRPD -0HG,PDJLQJ5DGLDW2QFRO
6-0HG$VVRF7KDL_9RO_6XSSO_