Something as easy as hanging a picture requires a ruler or other device to make sure it's leveled. Dr. William A. Leone, Orthopedic Surgeon and head of the Leone Center for Orthopedic Care in Ft. Lauderdale , took what may seem like a simple concept and applied it to total hip replacement surgery by inventing the Pelvic Alignment Level™ or PAL, a surgical device that allows for greater implant precision when performing total hip replacements. The PAL is receiving recognition throughout the orthopedic community, including a published article in Techniques in Orthopaedics, September 2011, as a powerful, new tool that helps to facilitate accurate component positioning and proper leg length during and after total hip replacement surgery. What this means for orthopedic surgery patients is that during surgery, when a patient's position may shift, PAL readings assure that the artificial joint maintains proper positioning for a better outcome including correct leg length and angle of the prosthesis. According to Dr. Leone, "This device eliminates the 'guess factor' and the potential for error when relying strictly on visual assessment for prosthesis placement."

Pelvic Alignment Level

Using the PAL during surgery does not require surgeons to significantly alter operating techniques. The PAL device has a sterile bubble level, similar to common construction levels, which attaches to a small pin anchored in the pelvis. It allows surgeons easily to see pelvis movement by monitoring the bubble level. The PAL also can be placed on instruments used to implant the prosthetic hip cup, directly measure cup position and is equipped to measure leg length. "PAL gives surgeons a simple method to visualize unintended pelvic motion which can occur during surgery and to make any necessary corrections," added Dr. Leone. "There has been a need for this type of device for hip replacement surgery, especially with use of smaller surgical incisions and an increased rate in obesity." As the baby boomer generation ages, the number of total hip replacement surgeries is predicted to increase. According to a study by US Markets for Large-Joint Reconstructive Implants, more than 400,000 total hip replacements are performed annually in the United States alone.

Re-doing a hip surgery, called a revision, can be painful and reduces mobility. Revisions also result in higher costs, because the patient or insurance company has to pay for the new corrected surgery. A tool like PAL, invented by an experienced orthopedic surgeon like Dr. Leone, reduces the likelihood of revision surgery. "I invented the PAL because I saw the need," said Dr. Leone. "It's all about balance, providing a better experience for my patients and helping people return to full and active lives."

Radiation therapy has an important role in treating all stages of breast cancer because it is so effective and relatively safe. It may be appropriate for people with stage 0 through stage III breast cancer after lumpectomy or mastectomy. Radiation can also be very helpful to people with stage IV cancer that has spread to other parts of the body. Women who are pregnant should not have radiation.

After lumpectomy: Radiation therapy is recommended to most people who have lumpectomy (lumpectomy plus radiation is sometimes called breast-preservation surgery). Radiation attempts to destroy any cancer cells that may have been left in the breast after the tumor was removed. Typically a doctor will recommend lumpectomy followed by whole breast radiation if the cancer is:

After mastectomy: Radiation therapy may be recommended after mastectomy to destroy any breast cells that may remain at the mastectomy site. During breast removal, it's difficult to take out every cell of breast tissue, especially the tissue behind the skin in front of the breast or back along the muscle behind the breast. Usually any leftover breast cells are normal. But because it's possible for some breast cancer cells to linger, there is a risk of recurrence in the area where the breast was. Based on your pathology report, your doctor may recommend radiation therapy if you've had a mastectomy. These factors are associated with a high risk of recurrence after mastectomy. Radiation may be recommended if any of these factors are present:

• The cancer is 5 centimeters or larger (the cancer can be 1 lump, a series of lumps, or even microscopic lumps that together are 5 centimeters or larger).
• The cancer had invaded the lymph channels and blood vessels in the breast.
• The removed tissue has a positive margin of resection.
• Four or more lymph nodes were involved OR, for pre-menopausal women, at least 1 lymph node was involved.
• The cancer has invaded the skin (with locally advanced or inflammatory breast cancer).

Patient on the Radiation Therapy Table, Doral Oncology Center

Based on these risks of recurrence factors, about 20% to 30% of people are considered at high risk of recurrence after mastectomy. Radiation would be recommended to help reduce this risk by up to 70% (for example, a 30% risk may be reduced to just under 10%). Treatment is given to the area where the breast used to be and sometimes to the lymph node regions nearby. Some people have a moderate risk of recurrence.

The timing of radiation: The sequence and timing of radiation treatment depends on your individual situation. Radiation may be given immediately after surgery or after other forms of treatment. Here are some examples of various treatment sequences that involve radiation:

• surgery → radiation → possible hormonal therapy
• surgery → chemotherapy → radiation → possible hormonal therapy
• chemotherapy, targeted therapy, or hormonal therapy → surgery → radiation → possible hormonal therapy

Source: CancerOrgUSA