Journal of Medical Imaging and Radiation Oncology最新文献

The uptake of stereotactic radiosurgery (SRS) for the treatment of brain metastases (BM) has been rapid. SRS differs from other forms of radiation therapy in that large radiation doses are typically delivered with small margins for error and high dose heterogeneity. Geometric accuracy relies on the integrity of the entire treatment chain including patient immobilisation, imaging, treatment equipment and verification. Given this requirement for high fidelity geometric and dosimetric accuracy, credentialing for SRS within clinical trials requires special considerations. This process is further complicated by the range of treatment equipment that may be used to deliver SRS. The Trans-Tasman Radiation Oncology Group (TROG) SRS Technical Working Group was established to develop technical guidelines for SRS to BM in clinical trials in Australia, New Zealand and any other countries contributing to TROG recruitment. The panel comprised experts from Radiation Oncology, Medical Physics, Radiation Therapy and the TROG Quality Assurance (QA) team. These guidelines were developed collaboratively to assist trial management committees to formulate SRS credentialing and QA requirements appropriate for the clinical questions addressed by their trial.

Lung cancer is a major disease that seriously threatens human life and health. As one of the main treatment methods for lung cancer, radiotherapy (RT), while combating cancer cells, inevitably causes damage to the surrounding normal lung tissues. Radiation-induced lung injury (RILI) is a common and serious complication of RT that can seriously affect the treatment process of patients, reducing their quality of life (QOL) and survival time. Conventional RT aims to reduce the incidence of RILI in patients by limiting the radiation dose to normal lung tissue. This approach assumes that lung function is uniformly distributed. However, there is heterogeneity in human lung function. To address this challenge, functional lung imaging (FLI) has emerged and become a research focus. In the field of medical imaging technology, Single-Photon Emission Computed Tomography (SPECT), Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI), CT, and other technologies can all obtain FLI. Whatever imaging modality is used, lung perfusion (Q) on imaging serves as a surrogate for RILI. Furthermore, the combination of FLI and RT has given rise to functional lung avoidance RT (FLART), which can precisely reduce radiation exposure to functional lung (FL) regions by adjusting the radiation dose distribution, thereby effectively reducing the incidence of RILI. This narrative review comprehensively explores several key aspects, including FLI modalities, the definition of FL, the clinical applications of FLART, the impact of FLART on QOL, and the limitations of FLART. These discussions provide a good basis and guidance for the follow-up clinical work.

Introduction: CT guided microwave ablation (MWA) provides a suitable nonsurgical alternative for the treatment of hepatocellular carcinomas (HCC) in order to improve overall survival and local tumour progression. The purpose of this retrospective audit was to evaluate the overall efficacy of MWA and provide local data into the treatment's success, recurrence rates and overall survival.

Methods: A retrospective single centre audit of MWA for Hepatocellular Carcinomas (HCC) undertaken by interventional radiology at a large tertiary centre identified 90 eligible participants between January 2019 and 31st August 2024. Analysis among participants evaluated the overall technical success, procedural morbidity and mortality, and oncological outcomes including overall survival and local tumour progression through descriptive statistics.

Results: Of the 89 included participants (90 ablated HCCs), there was no reported immediate post-procedure residual disease with a peri-procedure morbidity of 5.6%, with all reported procedural complications minor. Median recurrence-free survival was 26.5 months (IQR 8.25-39.75 months) with a median time to local tumour progression of 12 months (IQR 8.5-48.1 months). The overall local tumour progression rate was 13.3%. The overall survival at one year was 88.89% (n = 63) and two years of 72.92% (n = 48). The median survival time was 35 months (95% CI 30-42 months).

Conclusion: MWA provides an effective and feasible nonsurgical treatment option for solitary HCCs with reported local tumour progression, overall survival, and technical success consistent with internationally published literature.

Introduction: The purpose of this study was to understand the clinical indications and utility of a barium swallow study in patients who have already been investigated with an upper gastrointestinal (UGI) endoscopy. It would be useful to determine the additional diagnostic information provided by a barium swallow study given endoscopy is considered the gold standard for examining the UGI tract.

Methods: This retrospective study examined all barium swallow studies performed at a single tertiary hospital and identified patients who had been investigated with an UGI endoscopy in the preceding 6 months. The radiology request forms, barium swallow reports, UGI endoscopy reports and clinic letters were reviewed to determine the most frequent clinical indications, quantify and characterise new findings on barium swallow and determine the proportion of patients with alteration in management.

Results: Between 1 January 2023 and 30 September 2023, 105 of 318 patients investigated with barium swallow studies had received a recent UGI endoscopy. Over half of the study requests were non-specific, aimed at identifying the cause of dysphagia. A total of 59 studies (56.2%) demonstrated findings that were not apparent on UGI endoscopy. The most common new finding was dysmotility (n = 53, 89.8%). Of the patients with new findings, 24 (40.7%) experienced no change in management, nine (15.2%) were offered lifestyle advice, seven (11.9%) were referred to speech and language therapy and seven (11.9%) were started on medication.

Conclusion: A barium swallow study is a helpful adjunct to UGI endoscopy, especially in the diagnosis of dysmotility.

Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy and remains one of the most common causes of cancer-related death in children and adolescents. It is characterised by the proliferation of immature lymphoid cells capable of infiltrating bone marrow, blood and extramedullary sites. Five-year overall survival rates exceed 90% with current multidrug chemotherapeutic regimens. This manuscript reviews the abdominal imaging features of leukaemic infiltration in children with ALL at the time of initial diagnosis and following relapse.

Introduction: This retrospective single-institution study evaluated the safety, efficacy and durability of stereotactic radiosurgery (SRS) for trigeminal neuralgia (TN) and related facial pain syndromes-including TN1, TN2, multiple sclerosis (MS) associated-TN and atypical facial pain (AFP).

Methods: We included 192 patients treated with Gamma Knife SRS between 2015 and 2022 at Australia's only publicly funded GK centre. Outcomes included Barrow Neurological Institute (BNI) pain scores, time to response and relapse. Kaplan-Meier and Cox regression analyses were performed.

Results: Median follow-up was 5 years. Treatment response occurred in 88.5%, with a relapse rate of 30%. Faster response was seen with 85 Gy (p = 0.004) and prior SRS (p = 0.02). MS-related TN relapsed earlier than vascular, tumour, idiopathic or stroke-related causes (p = 0.027) and TN1/TN2/AFP (p < 0.0001). On multivariable analysis, prior balloon compression (HR 3.02, 95% CI 1.07-8.51, p = 0.036) and 85 Gy (HR 2.07, 95% CI 1.29-3.33, p = 0.003) were associated with faster response. Patients with vascular TN (HR 0.32, 95% CI 0.13-0.79, p = 0.013), tumour/stroke/idiopathic aetiology (HR 0.36, 95% CI 0.14-0.91, p = 0.031) had utilised prior medication only (HR 0.18, 95% CI 0.06-0.48, p = 0.001) and had undergone prior MVD alone (HR 0.11, 95% CI 0.03-0.5, p = 0.004) were less likely to relapse.

Conclusion: SRS remains a valuable option for refractory facial pain, including redo SRS in select patients.

Aim: To evaluate the incidence of pseudoprogression on ¹⁸F-FDG PET/CT scans in metastatic melanoma patients commencing immune checkpoint inhibitor therapy and to determine the average time to confirmed ¹⁸F-FDG PET/CT response in the pseudoprogression cohort identified.

Methods: Patients with metastatic melanoma who underwent baseline and follow-up ¹⁸F-FDG PET/CT scans after commencing immune checkpoint inhibitor therapy at Alfred Hospital (2012-2023) were retrospectively reviewed. Cases of pseudoprogression were identified by a keyword search of reports and confirmed on image review by a nuclear medicine physician. Data on timing of confirmed response, immune-related adverse events, and autoimmune history were also collected.

Results: 10/401 (2.49%) metastatic melanoma patients were confirmed as having pseudoprogression on PET/CT. 8/10 (80%) had new FDG-avid lesions and 2/10 (20%) had an increase in size and SUVmax of original disease. 8/10 (80%) of patients achieved complete metabolic remission on subsequent PET/CT scans with an average time to confirmed reduction of disease on PET/CT of 28.4 weeks. 4/10 (40%) received dual agent immunotherapy. 8/10 (80%) developed irAEs of varying types and severity. 2/10 (20%) had a history of pre-existing autoimmune disease. 9/10 (90%) of pseudoprogression patients are alive at last review.

Conclusion: Pseudoprogression on ¹⁸F-FDG PET/CT occurred in approximately 2.5% of metastatic melanoma patients commencing immunotherapy with an average time to subsequent confirmed response of ~6 months. This highlights the importance of not ceasing immunotherapy prematurely based on early ¹⁸F-FDG PET/CT findings.

Introduction: Cancer is the current leading cause of death in Australia, with a mortality and morbidity burden that is expected to rise with the aging population. Despite radiotherapy being indicated in 52% of cancer cases and contributing to 40% of cancer survival, radiation oncology (RO) research has not been prioritised by domestic or international research funding groups.

Methods: This study reviewed the past 5 years of publicly available oncology grant funding data from Australia's largest funding organisations, including commonwealth, individual state and territory governments, and philanthropic organisations. Data were retrieved from individual organisations' websites and GrantConnect. Grants for potential RO projects were identified using search terms. Additional descriptive information was retrieved using search engines. The combined data were assessed to determine inclusion/exclusion from the final RO grant pool. Descriptive statistics were generated using Microsoft Excel.

Results: Our analysis identified 1660 oncology grants, of which 74 (4.5%) were deemed to be RO grants. The total value of oncology grants was AUD$1.89 B, and RO grants was $60 M (3.2%). Of the RO grants, 39% were provided by philanthropic organisations, 39% by the Commonwealth Government and 22% by state and territory governments. Only 9% of RO grants were awarded to radiation oncologists.

Conclusions: This study demonstrates the low proportion of Australian oncology research funding awarded to RO projects. The gap between the clinical importance of RO and the funding it receives risks delays in more effective and less toxic radiation therapy reaching Australian cancer patients.

Introduction: Diagnostic radiologist reporting productivity can be measured via Relative Value Units (RVU). The volume of other operational or clinical activities during a radiologist's workday is burdensome but has thus far escaped quantitation and is often not recognised by referrers or administrators. The purpose of this study was to quantify and classify non-RVU-generating activities and measure their impact on productivity.

Methods: A prospective, observational study was performed at a large public hospital. Radiologists' activities were observed for a whole day over a total of 62 days. Radiologists' RVUs straddling 5 days before and after the observation day were reviewed to account for potential Hawthorne Effect bias.

Results: Across all radiologists, a median of 31% (IQR: 22%-36%) of their workday was occupied by non-RVU-generating activities. Despite that, in their remaining workday, in aggregate, the radiologists' median productivity-as measured by RVU-equivalent minutes-was 62% (IQR: 26%-114%) higher than their expected EFT equivalent. 46% of radiologists' non-RVU activities were devoted to trainees. Another 34% is devoted to interactions with referring colleagues, whilst 12% is spent on administration and operations.

Conclusions: Almost one third of a radiologist's daily responsibilities encompass non-RVU-generating activities crucial for the effective operation of an academic radiology department. Implementing tools to capture and quantify such activities is essential for garnering recognition within the organisation and with hospital administrators. At our hospital, each radiologist produces nearly two-thirds of an additional radiologist's workload during the remaining reporting time; a critical warning indicator for burnout risk and quality deterioration.

Objective: To evaluate the correlation between cardiac MRI and FDG-PET/CT findings in the diagnosis of cardiac sarcoidosis (CS) and assess their complementary roles in clinical decision-making.

Methods: A retrospective study was conducted on patients referred for both FDG-PET/CT and cardiac MRI for suspected CS at a single tertiary Australian hospital between January 2022 and June 2024. Imaging studies were categorised as 'negative', 'equivocal' or 'probable/positive' for CS. Clinical diagnosis was determined based on imaging, histopathology, and multidisciplinary assessment. Concordance between MRI, FDG-PET/CT and final clinical diagnosis was analysed.

Results: Twenty patients met inclusion criteria (mean age 55.6 ± 13.8 years, 70% male). MRI identified eight positive, seven equivocal, and five negative cases, whereas FDG-PET/CT detected eight positive and 12 negative cases. Clinical diagnosis confirmed CS in eight patients, with nine deemed negative and one equivocal. Direct concordance between MRI and FDG-PET/CT was observed in 9 of 20 cases (45%), with positive agreement in five and negative agreement in four cases. Imaging findings correlated with clinical diagnosis in seven of eight confirmed CS cases. Discordant imaging findings occurred in four cases, including MRI-positive but FDG-PET/CT-negative cases, later diagnosed as myocarditis or non-ischaemic cardiomyopathy.

Conclusion: Cardiac MRI and FDG-PET/CT demonstrate a complementary role in CS evaluation, with MRI excelling in detecting fibrosis and structural abnormalities, while FDG-PET/CT identifies active inflammation. Concordant imaging findings strongly correlated with clinical diagnosis, reinforcing the need for a multimodal approach in CS assessment and management.