Computer Assignment Example | Topics and Well Written Essays - 1000 words - 1

Computer - Assignment Example From the depiction, it is clear that technology has to be employed in order to provide a superb solution for the bad designing concept. Therefore, that objective was well met. Besides, the other important concept is the description of the image that proves the depiction characterizes a bad design. The essay clearly explains the picture describing the four buttons on it. It talks about the two lights, which are switches and two arrows, which give information about the direction of turning on and off (Ursula 2007). The fact that the description of the picture has a direct association and is consistent with the picture makes it incredible. The explanation also brings in the concept of technology because the aspect of light and arrows on switches it is all about advancement of technology. Therefore, this objective was also well met and clearly brought out. The last and quite important concept is the fact that the essay provides the solution for the bad design. There is no way, for example, a doctor can examine a patient, make a diagnosis and then explain the entire issue of illness to the patient but fail to treat him. Once a problem is identified and examined well, there must be a way to find solution for the problem. As a matter of fact, that the essay identified the problem of bad design and illustrated it well, thus, it had to come up with the solution to the problem so that the same mistakes are not repeated (Ursula 2007). Therefore, the objective was well met. The analysis is clear enough as it addresses the concept of Bad Design essay. It begins from looking at how the issue of technology was implemented on the picture. The fact that the device can light up by just pressing a button clearly implies that technology was used in making it. In order to come up with a good design in a mechanical device requires a lot of research and involvement of

Social Disorganization Qeustion and Answer Essay

Social Disorganization Qeustion and Answer - Essay Example A city develops when people gather together at a particular place with a wide range of activities. The resultant is concentration that forms the city centre which is characterized by high population. The theory argues that due to the high population at the city centre, people and their activities will tend to disperse to the suburbs. This suburbs display distinctive characteristics as well as class. However, they all face similar ecological pressures. In such a society competition is not an option since once a particular suburb becomes prosperous it is invaded by people seeking job opportunities. From there on the former society setup is disorganized. This disorganization makes it hard for the current administration to govern because somewhere in the bureaucratic administration a disruption occurred and led to a breakdown of normative structures of the society. Therefore, social disorganization refers to the failure of the society in stages. First, the economic organizations fail to satisfy the whole population leading to competition for basic requirements such as food, security and housing. Next, social institutions fail. Then, people take upon themselves to provide what the societal structures were meant for. The different social groups in different suburbs define own ways for resource distribution. This leads to the formation of informal structures in the society and in this effort criminals are also involved in this process. The class disparity in this kind of society aggravates the crime aspect as the lower class seeks redistribution of wealth through informal means. To understand this effect of social disorganization, gang theory approaches this problem by identifying cultural deviance or subcultural theories as factors contributing to social disorganization (Lander, 1954). Basically, whenever social institutions fail

ASDA Essay Example | Topics and Well Written Essays - 750 words

ASDA - Essay Example Management, another problem, was too busy putting up stores and playing or having fun hiding themselves from the realities of the daily store activities. The buying department buys what it wants without asking what the marketing department and the store managers their inputs as to what to buy, when to buy and how many they will buy There are too many red tapes. What should Archie Norman do Archie Norman should talk (Elliott et al, 2002) with some key personnel of the company, from the top management down to the lowest ranking employees. He should also ask questions from walk in customers and passersby why the will or will buy or what they think of the company. Based on these facts, he will now come up with counter measures that will bring back the customers and the morale of the employees. The red tapes must be removed by reducing or terminating redundant top management people. He must help bring up the declining stock market price of ASDA shares (Exhibit 3) by institutionalizing major reforms in inter-departmental communication. What changes should Norman make, when, and in what order should be make them Archie Norman must institute many drastic changes NOW, not tomorrow, to improve the financial performance of ASDA. Most of its store outlets must lower their selling prices to bring back droves of its former loyal customers who could not afford the sudden increase in prices.The ASDA increased its upscale offerings to corner the rich client's market segment. The rich clients prefer to shop with upscale store which carried high end brands. A few branches of ASDA located near rich neighborhoods can still continue with its upscale offerings to continue serving its rich clients. Another change that Archie Norman will have to do is to call a general meeting of all its rank and file employees. The financial problem of the company will be brought out and each will submit before the meeting ends their comments, suggestions, and complaints.A select committee will be formed composed of the managers of each branch and other upper level management staff. They will now come up with projected (or forecasted) income statements and balance sheets. The forecast will be brainstormed by the different departments involved such as the finance department ( to give assurance that enough cash inflow will be available to pay its obligations when they become due), the buying department ( the buying department must only buy what the marketing department asks them to buy), marketing department ( the marketing department will make sales forecast based on its historical (past) sales trend and its new and more vigorous promotional ventures ( advertisements in the tri-media [ radio, t elevision, newspaper] to drum up sales), store managers ( each store is treated a cost center meaning they have to forecast their own sales and expenses and to explain why there is an increase or decrease in the assets, liabilities, capital, income and expenses for each month).Those top manager who have not performed well with no hope of improving will be retrenched after reviewing the results of the psychological tests given to them.All ASDA stores will now have a fast food corner. Since the customers have declined for the past few years ending 1991( Exibibit 4 sales per square foot of only 519), A fast food chain that will rival Mcdonalds inside an ASDA store will cater to

Computer Assignment Example | Topics and Well Written Essays - 1000 words - 1

Computer - Assignment Example From the depiction, it is clear that technology has to be employed in order to provide a superb solution for the bad designing concept. Therefore, that objective was well met. Besides, the other important concept is the description of the image that proves the depiction characterizes a bad design. The essay clearly explains the picture describing the four buttons on it. It talks about the two lights, which are switches and two arrows, which give information about the direction of turning on and off (Ursula 2007). The fact that the description of the picture has a direct association and is consistent with the picture makes it incredible. The explanation also brings in the concept of technology because the aspect of light and arrows on switches it is all about advancement of technology. Therefore, this objective was also well met and clearly brought out. The last and quite important concept is the fact that the essay provides the solution for the bad design. There is no way, for example, a doctor can examine a patient, make a diagnosis and then explain the entire issue of illness to the patient but fail to treat him. Once a problem is identified and examined well, there must be a way to find solution for the problem. As a matter of fact, that the essay identified the problem of bad design and illustrated it well, thus, it had to come up with the solution to the problem so that the same mistakes are not repeated (Ursula 2007). Therefore, the objective was well met. The analysis is clear enough as it addresses the concept of Bad Design essay. It begins from looking at how the issue of technology was implemented on the picture. The fact that the device can light up by just pressing a button clearly implies that technology was used in making it. In order to come up with a good design in a mechanical device requires a lot of research and involvement of

ASDA Essay Example | Topics and Well Written Essays - 750 words

ASDA - Essay Example Management, another problem, was too busy putting up stores and playing or having fun hiding themselves from the realities of the daily store activities. The buying department buys what it wants without asking what the marketing department and the store managers their inputs as to what to buy, when to buy and how many they will buy There are too many red tapes. What should Archie Norman do Archie Norman should talk (Elliott et al, 2002) with some key personnel of the company, from the top management down to the lowest ranking employees. He should also ask questions from walk in customers and passersby why the will or will buy or what they think of the company. Based on these facts, he will now come up with counter measures that will bring back the customers and the morale of the employees. The red tapes must be removed by reducing or terminating redundant top management people. He must help bring up the declining stock market price of ASDA shares (Exhibit 3) by institutionalizing major reforms in inter-departmental communication. What changes should Norman make, when, and in what order should be make them Archie Norman must institute many drastic changes NOW, not tomorrow, to improve the financial performance of ASDA. Most of its store outlets must lower their selling prices to bring back droves of its former loyal customers who could not afford the sudden increase in prices.The ASDA increased its upscale offerings to corner the rich client's market segment. The rich clients prefer to shop with upscale store which carried high end brands. A few branches of ASDA located near rich neighborhoods can still continue with its upscale offerings to continue serving its rich clients. Another change that Archie Norman will have to do is to call a general meeting of all its rank and file employees. The financial problem of the company will be brought out and each will submit before the meeting ends their comments, suggestions, and complaints.A select committee will be formed composed of the managers of each branch and other upper level management staff. They will now come up with projected (or forecasted) income statements and balance sheets. The forecast will be brainstormed by the different departments involved such as the finance department ( to give assurance that enough cash inflow will be available to pay its obligations when they become due), the buying department ( the buying department must only buy what the marketing department asks them to buy), marketing department ( the marketing department will make sales forecast based on its historical (past) sales trend and its new and more vigorous promotional ventures ( advertisements in the tri-media [ radio, t elevision, newspaper] to drum up sales), store managers ( each store is treated a cost center meaning they have to forecast their own sales and expenses and to explain why there is an increase or decrease in the assets, liabilities, capital, income and expenses for each month).Those top manager who have not performed well with no hope of improving will be retrenched after reviewing the results of the psychological tests given to them.All ASDA stores will now have a fast food corner. Since the customers have declined for the past few years ending 1991( Exibibit 4 sales per square foot of only 519), A fast food chain that will rival Mcdonalds inside an ASDA store will cater to

Benefits and Effectiveness of Accounting Essay Example for Free

Benefits and Effectiveness of Accounting Essay The research was based on two variables these are computerized accounting systems which comprise of definitions, components of computerized accounting software and benefits and limitation of computerized system and financial reporting which also comprises of definitions of financial reports, benefits and effectiveness of accounting system used at National Water and Sewerage Corporation. The study will enable management to understand the significance of preparing quality and reliable financial reports. The study will point out weakness in the accounting system which management needs to address. The Government of Malaysia through the Department of Accountant General (MDAG) has instructed MARA to implement the Standard Accounting System for Government Agencies (SAGA). This is a total Enterprise Resource Planning (ERP) System, developed based on web-based application and is using an accrual basis of accounting. The SAGA financial system enables its users, particularly the government agencies to close their accounts on a daily basis, monitor their daily financial activities as well as produce standardized financial reports to the stakeholders at any place and any time. However, upon completion of the SAGA financial system analysis, MARA identifies that the system could not cater all MARA business activities. Processes such as disbursement of scholarship and loans to students and entrepreneurs are not covered by the system. As such, MARA still has to maintain its existing databases and therefore made special request to the MDAG to exclude the implementation of SAGA while awaiting MARA ICT consultant’s recommendations on the development of a new MARA Total Information and Financial System. As a conclusion, the SAGA financial systems could not be used by MARA on its own. The end-users in MARA need to operate both, SAGA and its own systems at the same time. This situation could lead to users’ confusion if they are to use different type of system when updating certain type of financial transaction. This is because the end-user of MARA Computerized Accounting System could only utilized the SAGA Financial System just for ordinary operating expenditures whilst any disbursement of expenditure pertaining to subsidiary system, they still need to use the existing MARA Financial Systems. Consequently, internal controls and security functions may not be easily built in the systems. Concurrent use of both systems may affect job satisfaction and performance of the end-users. Introducing Computerized Accounting Information Systems in a Developing Nation: Egyptian International Motors This study aims to assess the implementation of accounting information system on a company in a developing nation. To answer this question this manuscript attempts to do the following: (1) identify the reasons for the shift to an automated system and the main goals that the company aim to achieve form this shift, (2) determine the company’s strategic decisions like choices between outsourcing versus in-house development, and ready made packages versus tailor made software, (3) describe the steps of implementation, (4) understand the reaction of the employees to the new automated system, (5) study the required changes on the organizational chart and human resources qualifications that are required, (6) recognize the problems that the company met during the process, (6) point the advantages of the shift to the automated system. A computerized accounting System provides many advantages over manual systems, for example entries do not have to be recorded in multiple ledgers so as to fulfill the cardinal rules of financial reporting.A single entry is made and the system will populate all the appropriate corresponding accounts automatically. Computerized accounting also makes it possible for people in other departments,not just accounting to enter data.It does not require avast amount of accounting knowledge for a payroll clerk to enter wages details into the accounts,a basic understanding of how to use the system is sufficient The study intends to find out the effect of a computerized accounting system on the quality of financial reports generated by an organization. To examine the effect of computerize accounting systems quality financial reporting. To determine the challenges encountere by organizations before and after implementing a computerized accounting system. To identify strategies/measures of ensuring quality financial reporting. An accounting system is part of the organisation’s management information system therefore a good or decent accounting system must be able to produce reports like trial balance, aged debtors and aged creditors. Accounting systems must provide data that should enable the production of management accounts, statutory accounts and must also assist the managers and accountants in discharging their stewardship roles. Production Of Accounts A good system should enable the firm to produce its management reports and management accounts at short notice. This will enable the organisation to monitor performance, to take decisions quickly and to make decision based on objective and verifiable information. Audit Trail Audit trail is very important as it will enable auditors and senior managers to monitor transactions entered in the accounting system and this will ensure that there is information integrity. A good system should document the changes that have been made in the system, who made the changes and it should also be able to track what was changed. Compatibility With Other Programmes A strong characteristic of a good accounting system is that it must be compatible with other systems. For example, it should easily be configurable so that it can communicate with other programmes like Excel or Crystal. An accounting system should be able to export transactions and reports into Excel and it should allow data and transactions to be imported from an external source. This will lead to time savings as there will be no need to duplicate a role or process. Error Detection If an accounting system does not dictate errors then it is not a good accounting package as it is failing to perform a basic functionality. An accounting package should decline to post transactions that do not balance for example the total debits should equal the total credits and if this is not the case, then the accounting system should automatically flag this error. Internal Controls Internal controls are the eyes and ears of the organisation and a good accounting system should embed these internal controls into the system. Internal controls enable prevention and detection of fraud and error. An accounting system should enable internal control tools like segregation of duties, reconciliations and account allocations. A good accounting system should not allow users to delete data that has been posted into the system. Manual Vs Computerized Accounting Computerized accounting systems provide more benefits than manual ones, allowing for more accurate calculations, in less time. Compared to manual accounting, with a computerized system errors are far less common, eliminating human error. And with accounting programs that are industry-specific, you can benefit from various preset templates for your general ledger, saving more time. You can store virtually endless information, without any trouble at all. And if you later want to review financial information from several years ago, with a computerized accounting system you can do it easily, while with a manual one you would have to sort through stacks of paper ledgers. Bottom line, both systems may be useful to some extent. But for more accurate bookkeeping and increased efficiency, a computerized accounting system seems to have more advantages. You can find several free versions online, as well as more proficient accounting software available for purchase. Search online for such accounting systems, read about their features and decide which one would be better for your particular business needs. Although they will not allow you to physically handle the ledgers, it will provide a better accounting solution. The advantages of Computerized Accounting seem to be unknown by business owners and individuals who are in doubt of purchasing Accounting Software. Accounting Software has been a trend nowadays. With the vast Computerized System Providers and wide range of versions to choose from, Accounting System has evolved to be one of the trends in information technology. Computerized Systems are designed to create more value in Financial Accounting. Value can be relayed in terms of speed, accuracy and reliability of accounting data. With Computerized System, invoices can be transmitted in an instant through email; inventories are appropriately monitored; and disbursements are tracked for payments to be done before due dates. It helps Bookkeepers to reduce manual activities. When transactions are entered in the Accounting System, automatic entries are posted to generate data needed for financial reporting. Accounting Software enables Bookkeepers and Accountants to adjust necessary accounts to reflect the correct amount of each Account. Computerized Accounting allows Accountants to trace erroneous data and entry in a creative and organized manner through the help of summaries, list of accounts and original entries. Article Source: http://EzineArticles.com/?expert=Jason_Tsang Article Source: http://EzineArticles.com/7017983 Computers are extensively used in accounting and there are multitude of computer software for Accounting, MIS, CRM. HiTech Financial Accounting is one such software which has been customized for users in many segments in business and services. Payroll accounting was the first commercial area to become widely computerized. The calculation of wages or salaries involves a number of variables which relate to the personal details of each employee, such as gross pay or rate for the job, individual deductions, tax liabilities of the employees and so on. These facts can be retained in the computers and processed every month of produce pay slips for the employees. The computer helps to exercise the type of stock control needed by the organization. It up to dates the sales and purchases records, determines optimum re-order levels for different items and prints out the stock lists when desired. The system can be so designed that it triggers orders when stock level reaches order point for variou s material items; tests those item which are slow moving or gives list for over stock items. Programming can be done for any sales accounting system. The computer will pin point defaulting debtors, determine the right limit for credit for each debtor and maintain stores ledger. Costing and budgetary control can be affected through the computer, the computer will point out the variations from the planned performance.The computer also helps greatly in production planning and control. It is possible that scheduling of the work may become necessary due to break downs etc. A new critical path may have to be worked out. A critical path is the shortest path to be followed in production to achieve production objectives. The computer helps the management lay down this new critical path. The increasing competition and the highly demands of globalization, Malaysia government attempt for Small Medium Enterprise, SME for the development of innovative, competitive with high technology. Computerized accounting system (CAS) adoption may be decisive factor for an organization to be success and also to survive. This research project which aimed to investigate SME practice of CAS and to identify the factor affecting the adoption among SMEs in Melaka. A survey was carried out through a set of questionnaires to examine the CEO Innovativeness Factors Scale, Perceive Usefulness Factors Scale, Perceive Ease of Use Factors Scale and Business Competitiveness. The sample selected comprised of CEOs of SMEs in three districts in Melaka, namely Melaka Tengah, Alor Gajah and Jasin. The data gathered were coded and analyzed using descriptive statistics, linear regression analysis, Pearson Correlation analysis and Analysis of Variance (ANOVA).This study reveals that CAS adoption rate in SMEs in Melaka is high. Results from the analysis also shown the significant of independent variables and proved the relationships have been substantiated to the dependent variable which contribute to the usage of CAS adoption between SMEs in Melaka. The findings indicate that CEO innovativeness; perceive ease of use and business competitiveness negatively correlated to the adoption of CAS. Results reveals that only perceive usefulness are significantly positive correlated to CAS adoption. Therefore it can be deduced that adoption of CAS among SMEs in Melaka is caused by its usefulness. The findings reveal that types of business and business location influence the adoption of CAS. However, size (paid up capital, sales turnover and number of employee) do not influence the adopter. Results also indicate that CEO literacy on ICT, accounting and CAS has influence the responded CEO to adopt CAS in their business. However, the advantages by using the accounting systems software were not fully utilized by CAS adopters. http://www.ccsenet.org/journal/index.php/ijbm/article/view/18273

Beam Energies Treatment for Lung and Larynx

Beam Energies Treatment for Lung and Larynx Larynx Error Plan Errors: Beam energies for larynx treatment are not correct both fields have 10MV instead of 6MV Field sizes are not right The Right Lateral (RLat) field is too big resulting in shielding errors The Left Lateral (LLat) field is too small and is just skimming the anterior portion of the patients shell The number of fractions on the plan is one (1) instead of 20 daily fractions. The global maximum dose is 110.98% (given as 6103.7 cGy) and is largely outside the Planning Target Volume (PTV), meaning the plan is too hot The 108% region is a hot spot as it exceeds the International Commission on Radiation Units and Measurements (ICRU 50 62) maximum value of 107% The LLat field wedge is too thin 1o, so not helping with uniform dose distribution of the plan, hence the right skewed isodoses and the 108% hot spot The plans maximum spinal cord dose of 5112 cGy, exceeds the maximum dose constraint value for the organ of 5000 cGy. Multi-Leaf Collimators (MLC) use on the plan There is not much conformality to the PTV anteriorly from the RLat field There is insufficient shielding of the neck anteriorly Some MLC are not pulled up properly as they are on the field edge which is better shielded by the Primary collimators The RLat field is over-wedged (60o), resulting in the 108% hotspot region The RLat field is not placed optimally re-collimator angle in order to better avoid the spinal cord The Dose Volume Histogram (DVH) data/graph/chart is insufficient as it is only for the spinal cord excluding for example the PTV information The isocentre could be placed more centrally for the plan Criteria use to evaluate the suitability of the treatment plan This is a conventional parallel-opposed field arrangement, which is suitable for head and neck treatment of the larynx (Barrett and Dobbs, Practical Radiotherapy Planning, page 171). Since this is an error plan, the fields do not match in size though they are parallel opposing. The radical dose prescription is 55 Gy in 20 daily fractions of 2.75 Gy over 4 weeks (Barrett and Dobbs, 4th Ed., page 175). This would apply as a prescription for a T1-2 N0 glottic larynx tumour with a volume of 26-49 cm3 (RSCH, St Lukes Radiotherapy Clinical Protocol, Head and Neck Larynx). Use is made of isodose charts, PTV coverage as indicated by the D95 (95% isodose line), maximum PTV dose (Dmax), maximum spinal cord dose, dose volume histograms (for PTV and spinal cord), and departmental protocols to evaluate the suitability of the treatment plan. The Quantec/Emami et. al. (2013) document of Tolerance of Normal Tissue to Therapeutic Radiation provided the dose constraints for the organs at risk e.g. the spinal cord. NICE guidelines only stipulate an offer of choice of trans-oral microsurgery or radiotherapy to people with newly diagnosed T1b-2 squamous cell carcinoma of the glottic larynx. The plan is optimised by use of beam modifying devices like wedges and MLC (Barrett and Dobbs, page 171), and checking the effect using the planning software. Solutions to eliminate identified errors: The beam energy needs to change from 10MV to 6MV in the field properties of the planning software. This will ensure adequate coverage of the PTV as a significant part of the larynx is very close to the skin. A less energy beam offers less penetration and lower build up depth (for skin sparing effect) for dose deposition. The RLat field size can decrease slightly anteriorly, while the LLat field size can increase slightly to ensure adequate anterior coverage. The fields could also be more symmetrical. The LLat wedges orientation needs to change so that the Thick end is Anterior as per the setup information (Toe in). The number of fractions is should change to 20 from the current one fraction. This would give the appropriate dose prescription for the plan of 55Gy/20#/4weeks/2.75Gy per fraction The current plan is too hot, so the beam weightings need adjusting downwards until the plan conforms to the ICRU limits of maximum 100% + 7% (= 107%), and the lower limit of 100% 5% (= 95%) of the proscription dose (ICRU). This process can also improve by correcting the wrongly orientated LLat wedge and using a better wedge angle on it, as well as adjusting down the angle of the over-wedged RLat wedge. Correcting the 108% hotspot region is through adjusting the wedge angles, re-orienting the LLat wedge and adjusting the field weightings. The thin 1o LLat wedge angle needs changing up to 30o for the wedge to have an effect on the isodose distribution, on top of reversing its orientation. This would help in creating a uniform dose distribution for the plan and a reduction/elimination in/of hotspots. According to the Quantec/Emami et al. (2013) guidelines, the spinal cord is to receive a maximum core dose of 50Gy, but the current plan is exceeding this limit. Adjusting theÂÂ   collimator angle for the fields to be parallel to the spinal cord will help avoid treating this critical organ This is also aided by reducing the field weightings, adjusting the wedge angles and orientation of one of them, adjusting the field sizes posteriorly. The MLC leaves need to close where they are open outside the treatment field edges. There is a leaf to shield the anterior corner of the neck but is pulled back, so needs to be part of the configuration. There are five (5) pairs of almost central leaves, that are on the field edges inferiorly and superiorly, they need pulling back by 0.5 cm from the field edge so they do not interfere with primary collimation (Royal Surrey County Hospital (RSCH), St Lukes Radiotherapy Clinical Protocols). Adjusting the RLat field size anteriorly will aid in correcting the shielding of the neck and improve conformality to the PTV. The RLat field wedge needs reducing to at most 30o to aid uniform dose distribution and reduction of hotspots. Changing the collimator angle of the RLat field so that it is parallel to the spinal cord, will avoid treating through this critical organ. This will result in reducing the spinal cords maximum dose for the plan to within the organs maximum dose constraint value of less than 50Gy, thus aiding in optimising the plan. The DVH information of the plan should include the PTV data and line plot to enable plan evaluation of its suitability. Making the isocentre more central may improve the uniform dose distribution of the plan. Suitability of Plan and Alternative beam arrangement According to De Virgilio, A., et. al. (2012), there is currently no set therapeutic gold standard for the treatment of laryngeal squamous cell carcinoma. This contributes to a lack of consistency and inhomogeneity in treatment planning. The plan under consideration is a 2D conventional plan, which in itself is suitable with the exception of the errors, but is not optimal. The identified errors are correctable and the plan optimisable. In remaining with the conventional plan, a third anterior low-neck field with a light weighting (3DCRT) is an option to improve dose distribution and eliminate hotspots. However, this would require the addition of electron beams to match the photon fields, according to Herrassi, M. Y., Bentayeb, F, and Malisan M. R. (page 98-105). Another option is to use Intensity Modulated RadioTherapy (IMRT) with 3 or 5 beams, or Volumetric Modulated Arc Therapy (VMAT) with one arc, (Matthiesen C, SinghÂÂ   H, Mascia et. al. (2012)). IMRT offers more conformalit y in regards to carotid arteries as stated by Gomez, D., Cahlon, O., et. al. (2010). Portaluri, M., et. al (2006), suggest that 3D Field-in-Field techniques are a valid alternative as they offer the best global performance when considering PTV coverage and parotid sparing. Conclusion The task was instrumental in reinforcing the importance of understanding the process of treatment planning, and how to check the suitability of the plan before its approval. There is not much information to work with in suggesting alternative beam arrangements. Useful information could have been correct TNM classification, appropriate oncological classification taking into account the anatomic-embryologic and functional complexity of the larynx. There were glaring errors in the plan, and as an exercise, they were useful in sharpening treatment planning knowledge. IMRT is the preferred treatment technique that is efficacious especially for parotid gland and carotid artery sparing. Lung Plan Errors: Beam energies should all be 6MV, some are 10MV on the plan There are too many fields for the plan The LLat beam is going through the contralateral lung The field placement of the right posterior oblique (RPO) is not optimal as its MLCs are shielding part of the PTV contributing to the inadequate 95% dose coverage of the PTV. The global max value of 109% exceeds the ICRU guidelines, meaning the plan is very hot in places. There is an 80% hot spot on the chest, which is very hot for the area close to the skin There are many wedges on this plan resulting in hot and cold spots and a high dose gradient in the PTV. The Right Lateral and Anterior fields are over-wedged, resulting in the 80% and 109% hot spots. The RPO and LLat field wedge angles are not conventional (50o and 33o respectively, when considering the standard wedge angle specifications of 15o, 30o, 45o and 60o. The Lateral fields (Right Lateral and Left Lateral), are too big in relation to the size of the PTV, resulting in unnecessary irradiation of healthy tissue. The current plan exceeds the spinal cord core dose (maximum 50Gy), as interpreted from the DVH data. There is less than 95% PTV coverage laterally , resulting in a max dose to the PTV of 5304 cGy, which is very much less than the expected 6080 cGy (95% of 6400 cGy). Criteria use to evaluate the suitability of the treatment plan Barrett and Dobbs (page 252), acknowledge that there are a number of challenges to covering the PTV fully and remaining within the ICRU constraints, while maintaining acceptable toxicity levels at the same time. A three (3) field conformal plan is normally used for stage I or II non-small cell lung cancer (NSCLC). A compromise on choosing the best plan is mostly dependent upon the location and size of the PTV, and its closeness to critical structures, like the spinal cord and oesophagus. The plan should try to minimise dose to the contralateral lung as much as possible by using anterior oblique, posterior oblique and lateral beams. Beam modifying devices such as wedges compensate for obliquity at the chest, with MLC shielding conforms each beam to the shape of the PTV (Dobbs and Barrett). Use is made of the Quantec/Emami et. al. (2013), document on Tolerance of Normal Tissue to Therapeutic Radiation in checking dose constraints to organs at risk e.g. brachial plexus, oesophagus and spinal cord. Plan evaluation also uses isodose charts, dose volume histograms and departmental protocols to establish the suitability of the plan. NICE guidelines for Radiotherapy with curative intent for Non-small cell Lung Cancer stipulate that the patient should have good performance status (WHO 0 or 1). It says, CHART should be offered first, but if unavailable then conventional radiotherapy of 64-66 Gy in 32-33 fractions over 6 ÂÂ ½ weeks or 55 Gy in 20 fractions over 4 weeks is the next option. This plan is for 64 Gy in 32 fractions over 6 ÂÂ ½ weeks, so meets with this criterion. Dobbs and Barrett (page 253), mention that careful evaluation of the plan using DVHs is especially important when considering keeping the V20 below 32 per cent (the volume of lung receiving more than 20Gy of the dose). Solutions to eliminate identified errors: Barrett and Dobbs (page 255), point out that beam energies above 10 MV should be avoided due to greater range of secondary electrons in lung tissue, which result in a wider penumbra and thus more radiation to normal tissue. Beam energy of 6MV is adequate, while use of 10MV is for separation at the centre is greater than 28 cm. (Dobbs and Barrett, page 252). As no mention of the separation, it is appropriate to use 6MV on all the beams for this plan instead on mixed energies. This is a conventional plan, and the common number of beams 3 instead of the current 5. The many fields have not helped in conforming the plan to the PTV and improving the dose distribution, but have contributed in unnecessary irradiation of normal tissues. So, removal of the anterior and left lateral beams, would bring the plan back to a conformal 3 field plan. The right posterior oblique field would need setting at around 215o-225o in order to cover the PTV better and its MLC not to shield the PTV as at the present. (RSCH and London Cancer centre protocols). The left lateral field is treating through the contralateral lung, which is operationally against ICRP (2007), ICRU and IR(ME)R 2000 guidelines of keeping dose as low as reasonably achievable (ALARA) to patients, employees and the general public. The corrective measure is to remove the left lateral field from the plan. The gantry angle for the right posterior field is not optimal and moving it to around 215o-225o range would improve coverage of the PTV and avoid the spinal cord, even though the MLC is shielding the cord (ideal) in the current setup but also part of the PTV that is not ideal and compromising the 95% coverage of the PTV. The global maximum value of 109% exceeds the ICRU target of maximum 107% within the PTV. Removing the anterior and left lateral fields, and adjusting the over-wedged posterior and right lateral field wedge angles to either 15o or 30o depending on the uniformity of the dose distribution within the PTV, will rectify this issue. The remaining field weights will need adjusting as well to fully optimise the plan. Moving the RPO beam angle to between 215o and 225o, as well as reducing the wedge angle to 30o and removing the anterior beam from the plan will correct the 80% hotspot region. Removing the anterior field will effectively eliminate the 80% hot spot region on the chest. Removing the left lateral field and wedging the right anterior oblique field will help in reducing or eliminating the 109% hot spot region in the PTV. These measures will also result in more uniformity in dose distribution when combined with adjusting the weights of the remaining fields. The current plan has many wedged fields (some over-wedged), which is rectified by removing the anterior and left lateral field from the plan, adjusting the right lateral wedge angle to either 15o or 30o, and that of the posterior field from 50o to either 15o or 30o and inserting a 15o or 30o wedge on the anterior oblique field. This should improve the uniformity of the dose distribution within the PTV. The non-conventional wedge angles of the posterior and left lateral fields (50o and 33o respectively), have not improved the dose distribution in any noticeable way, as there is still a high dose gradient in the PTV. Reverting to the standard angles and using either 15o or 30o at most, would improve the dose distribution of the plan. The two lateral fields are too big; therefore adjusting them posteriorly would improve the PTV coverage of the plan and less irradiation of normal tissue. The left lateral field however needs taking off the plan altogether. The current plan shows excessive dose to the spinal cord and according to the Quantec/Emami et. al. (2013) document, the maximum core dose to the spinal cord should not exceed 50Gy. Moving the right posterior field angle to 215o-225o range and removing the anterior beam will correct this anomaly The less than 95% coverage of the PTV is achieved by: positioning the posterior field optimally (between 215o and 225o), so that the MLC will not shield the PTV but still manage to shield the spinal cord; adjusting the field sizes of the oblique fields; applying 15o or 30o wedge to the right anterior oblique field andÂÂ   adding MLCs to it so that it conforms the PTV better thus improving the dose distribution to the plan; and applying MLCs to the right lateral field to conform the PTV better. Suitability of Plan and Alternative beam arrangement This plan is not suitable for patient treatment in many respects, as highlighted by the errors identified. Improving it is by reverting to the conventional three field/beam plan, with two right oblique fields and the right lateral field as the third one (Barrett and Dobbs, page 252). Other treatment techniques, e.g. IMRT (with emphasis on carotid sparing), helical tomotherapy, VMAT have been found to offer better results on dosimetric comparisons. However, a multi-modality approach could be the best approach when considering new data coming from immunology, molecular biology and genetics on top of the usual surgery, chemotherapy and radiotherapy treatment options (Franco, P., et. al. (2016)). Conclusion This exercise highlighted the importance of quality assurance and having several layers of checking the suitability of treatment plans that are eventually used on the patients.