Journal of Medical Imaging and Radiation Oncology最新文献

The urgency for climate action is recognised by international government and healthcare organisations, including the United Nations (UN) and World Health Organisation (WHO). Climate change, biodiversity loss, and pollution negatively impact all life on earth. All populations are impacted but not equally; the most vulnerable are at highest risk, an inequity further exacerbated by differences in access to healthcare globally. The delivery of healthcare exacerbates the planetary health crisis through greenhouse gas emissions, largely due to combustion of fossil fuels for medical equipment production and operation, creation of medical and non-medical waste, and contamination of water supplies. As representatives of radiology societies from across the globe who work closely with industry, and both governmental and non-governmental leaders in multiple capacities, we advocate together for urgent, impactful, and measurable changes to the way we deliver care by further engaging our members, policymakers, industry partners, and our patients. Simultaneous challenges including global health disparities, resource allocation, and access to care must inform these efforts. Climate literacy should be increasingly added to radiology training programmes. More research is required to understand and measure the environmental impact of radiological services and inform mitigation, adaptation and monitoring efforts. Deeper collaboration with industry partners is necessary to support innovations in the supply chain, energy utilisation, and circular economy. Many solutions have been proposed and are already available, but we must understand and address barriers to implementation of current and future sustainable innovations. Finally, there is a compelling need to partner with patients, to ensure that trust in the excellence of clinical care is maintained during the transition to sustainable radiology. By fostering a culture of global cooperation and rapid sharing of solutions among the broader imaging community, we can transform radiological practice to mitigate its environmental impact, adapt and develop resilience to current and future climate and environmental threats, and simultaneously improve access to care.

Introduction: Radionuclide therapy including ⁹⁰Y radioembolization is an established form of brachytherapy for treatment of malignancy including hepatocellular carcinoma. Currently, there are several methods available to estimate patient absorbed dose, including voxel-based dosimetry, that can achieve a level of personalisation in the planning and outcome assessments of radioembolization. Despite the advantages of voxel-based dosimetry, it remains a relatively new concept in radioembolization. This study evaluates if voxel-based dosimetry was associated with improved treatment efficacy in radioembolization planning.

Methods: A systematic review was conducted by searching relevant databases (Medline Ovid, PubMed, Embase Ovid, CINAHL Complete, Cochrane Library, CENTRAL, Australian New Zealand Clinical Trials Registry, ClinicalTrials.gov, WHO International Trials Registry, Google Scholar) for literature regarding voxel-based dosimetry in radioembolization.

Results: A total of 41 papers were included for this systematic review. Review of these studies revealed that voxel-based dosimetry can benefit numerous aspects of radioembolization in radionuclide therapy including predicting tumour response, toxicity and patient survival. Numerous studies also indicated that voxel-based dosimetry in radioembolization is a more accurate approach in establishing a dose-effect relationship in targeted radionuclide therapy when compared to other methods. Despite these promising findings, these studies did not investigate or comment on the accuracy of voxel-based dosimetry.

Conclusion: The evidence from this review highlights that voxel-based dosimetry can improve treatment efficacy in radioembolization planning. However, further studies are required to validate the accuracy and feasibility of voxel-based dosimetry in clinical practice.

Introduction: There is increasing interest regarding the role and value of post-mortem imaging in identifying the causes of stillbirth. We sought to understand the experiences of parents and the perceptions and practices of midwives and obstetricians regarding post-mortem imaging (computed tomography [CT], magnetic resonance imaging [MRI], ultrasound and X-rays of the baby), in the investigation of stillbirths, and how its use and perceived value compares to that of other stillbirth investigations.

Methods: Cross-sectional, web-based surveys of parents who experienced stillbirth in Australia from 2018 to 2022 and midwives and obstetricians involved in the care of parents who experienced stillbirth in the same 5 years. Data were analysed descriptively.

Results: Data from 68 parents and 94 midwives and obstetricians were included. According to parents, post-mortem imaging (CT, MRI, ultrasound and X-ray) were the least discussed (1%-16%) and performed (0%-13%) stillbirth investigations. Twenty-eight percent of midwives and obstetricians had recommended the option of post-mortem imaging to parents, while 45% felt that doing so was beyond their scope of practice. Relative to autopsy, midwives and obstetricians were often unsure of the value of MRI across a range of clinical scenarios, and CT, MRI, ultrasound and X-ray were the investigations least often discussed (17%-47%) with parents.

Conclusions: Post-mortem imaging is currently underutilised in the investigation of stillbirths. Education and training are needed to enhance maternity care professionals' awareness of the role and value of imaging for identifying the causes of stillbirths, and how best to discuss these investigations with families.

Introduction: Portal vein tumour thrombus (PVTT) is a common complication of hepatocellular carcinoma (HCC) and has a poor prognosis. Selective internal radiation therapy (SIRT) with Yttrium-90 (Y90) microspheres is a minimally invasive treatment option that has shown promise in treating PVTT. Studies have suggested a survival advantage of SIRT in this population, but data in the Australasian population are lacking. The aim of this study was to evaluate the safety and efficacy of SIRT in a series of patients at an Australian hospital with advanced HCC and PVTT.

Method: All patients underwent pre-treatment imaging with MRI or CT, and immediate post-treatment imaging with Y90 PET CT and MRIs at 3-, 6-, 9- and 12-months. The primary endpoints were time to progression (TTP) and overall survival (OS) post-SIRT. The secondary endpoint was safety.

Results: Of the 698 patients who underwent SIRT at our institution between 2007 and 2023, 64 patients had HCC and PVTT. 59/64 (92%) were male, with a median age of 61 years (range 37-86 years). The majority of patients had Child-Pugh a cirrhosis (87%), and the majority were ECOG 0 (91%). The majority had main PVTT at the time of SIRT. All patients underwent SIRT with Y90-coated resin microspheres (SIR-Spheres, Sirtex Medical, Australia). Personalised dosimetry planning was performed by the treating interventional radiologist. SIRT was well tolerated by most patients, with major complications reported in a minority of cases (19/64 patients had an episode of biochemical decompensation within 90 days following treatment). The median TTP was 4.8 months (range 1-48 months). The median OS was 11.5 months (range 1-80 months), with those with a favourable MAAPE score having a median OS of 21.2 months (12.6-29.7 months).

Conclusions: Our cohort suggests that SIRT is a safe and effective treatment option for a difficult-to-treat patient population. Our data suggest a longer OS for those with preserved liver function, good functional status and low AFP levels at 21.2 months. Poor pre-treatment liver function and functional status are predictors of decompensation, and decompensation is a predictor of poor survival. These data provide an Australasian perspective and support the expanding role of SIRT in HCC treatment guidelines. Further prospective studies with larger sample sizes and longer follow-up are warranted to confirm these findings.

Introduction: This survey assessed gynaecological brachytherapy caseloads, local training requirements and quality assurance processes across Australia and New Zealand.

Methods: The survey was developed by the Gynaecological Oncology Radiation Oncology Collaboration (GOROC) and emailed to all centres offering gynaecological brachytherapy across Australia and New Zealand. It covered 9 areas including caseloads per centre and per radiation oncologist, techniques practised, local training requirements and quality assurance processes over a 2-year period - 2019 and 2020.

Results: The response rate was 18 out of 25 centres. All centres offered vaginal vault brachytherapy and 89% treated an average of at least 10 patients per annum. Intracavitary and/or interstitial brachytherapy was offered at 89% of centres of which 31% treated less than an average of 10 patients per annum and 23% of radiation oncologists did less than an average of 5 or more insertions per annum as recommended in the GOROC guidelines. Most centres required only Fellowship from the Royal Australian and New Zealand College of Radiologist to practice gynaecological brachytherapy. Peer review of volumes and dosimetry was routinely performed in 28% and 17% of centres, respectively.

Conclusion: This survey adds to the limited literature available regarding practice patterns of brachytherapy worldwide. Ensuring adequate training and robust quality assurance processes with volume and dosimetry review may support all centres and clinicians to continue to safely offer this complex technique.

Purpose: CT-guided microwave ablation (MWA) has become a standard procedure for a range of therapeutic and diagnostic indications, but accurate and stable positioning of the antenna is critical. In this retrospective case series, a navigation guide with a physical cube component, the Access Cube (AC), was investigated as a stability support in addition to its use as a navigation system. To our knowledge, this is the first investigation of stability in MWA.

Materials and methods: Eight MWAs performed at one centre using the AC were reviewed for clinical and technical success. The stability of the antenna was assessed by subjectively comparing the Euclidian distance (ED) between the needle tip location in the final control scan and confirmation scan. A practising radiologist not associated with the study independently assessed the coordinates, and the mean was calculated from the results.

Results: Six patients (eight procedures) were included (4 females). Mean age of the patients was 75.8 years (range 58-87). Diagnoses included liver metastasis (4, 50%), renal cell carcinoma (2, 25%) and 1 case each (12.5%) of hepatocellular carcinoma and lung metastasis. Mean tumour size was 2.4 cm (range 1.0-4.3 cm), with a mean depth of 10.6 cm (range 5-18 cm). Mean ED of needle tip between final control scan and confirmation scan was 5.82 mm. Technical and clinical success were achieved in all cases with one Grade 2 complication arising.

Conclusion: Usage of the AC was a beneficial addition to the MWA process. Good stability of the antenna was achieved when placed through the AC, eliminating the need for the clinician to manually hold the antenna in place during ablation.

Level of evidence: Level 4, Case Series.

Introduction: Patients aged > 85 years are under-represented in research that has established stereotactic body radiotherapy (SBRT) as the standard of care in early stage non-small cell lung cancer (NSCLC) not suitable for or refusing surgery. With an ageing population in Australia, it is important to assess SBRT and cause of death (COD) in elderly patients receiving curative intent lung SBRT.

Methods: This is a multi-centre retrospective review of eligible patients treated across Australia from 2016 to 2022 with curative intent lung SBRT for early stage primary NSCLC, and aged 85 years or over. The primary outcomes were estimated 2-year overall survival (OS) and COD. Secondary outcomes include cancer-specific survival (CSS), progression-free survival (PFS) and local PFS following SBRT. Univariate Cox regression was used to determine factors associated with survival outcomes or progression.

Results: In the study, 103 patients were identified, treated with 109 courses of SBRT. Median age was 87.6 years (range 85-97.1) with 52.4% male (n = 54). Median follow-up was 19.6 months (range 0.2-55.6). The estimated 2-year survival was 78.7% (95% CI 67.8-86.3). Of the 27.2% (n = 28) of patients deceased, COD was established in 89.3% (n = 25) of cases. In addition, 39.2% (n = 11) of deaths were related to lung cancer. Univariate analysis demonstrated that survival varied significantly with poorer performance status.

Conclusion: This study increases knowledge of efficacy of lung SBRT in the very elderly, suggests similar outcomes to the general patient population and supports the use of lung SBRT in those aged 85 years or over. Prospective data including outcomes, comorbidities, pulmonary function and toxicity are required to help inform clinicians and patients about decisions regarding treatment.

Introduction: Recent RANZCR studies have demonstrated gender disparity in research publication output of both radiation oncology (RO) trainees and specialists, favouring men. The purpose of this project was to examine success rates by gender of grant and prize (G&P) submissions to the RO Research Committee (RORC) to determine if anything needs to be done about the appraisal process to potentially address that disparity.

Methods: College records between 2011 and 2024 (where applicable) were searched by gender for one RO trainee, and two other research manuscript prizes, and two research grant rounds. During that period, the averaged gender ratio for the RO Faculty specialist membership was M:F = 61%:39%. Fisher's exact test p < 0.05 was considered significant with respect to gender disparity.

Results: Relative to the gender ratio of applicants, there were no statistically significant gender differences between winners for any of the five G&Ps individually (p ≥ 0.15 for each), or in composite (p = 0.25). Although application rates overall (M:F = 62%:38%) were consistent with the membership gender ratio, women were markedly less likely to apply for prizes (25% of applicants) than grants (44%).

Conclusion: No gender disparity was found for winners of the five RO G&Ps individually or overall relative to applicant gender ratios. Accordingly, it does not appear that the RORC needs to change its assessment processes in relation to gender. However, women were under-represented in prize applications, reflecting previously reported gender differences in award-seeking behaviour.

Introduction: Prostate motion during external beam radiotherapy (EBRT) is common and typically managed using fiducial markers and cone beam CT (CBCT) scans for inter-fractional motion correction. However, real-time intra-fractional motion management is less commonly implemented. This study evaluated the extent of intra-fractional prostate motion using transperineal ultrasound (TPUS) and examined the impact of treatment time on prostate motion.

Methods: Patients undergoing prostate EBRT with TPUS at a single institution from August 2016 to August 2021 were analysed. Pre-treatment daily CBCT corrected inter-fractional prostate shift. Continuous intra-fractional prostate motion was recorded at two frames per second in three dimensions, with three-dimensional (3D) displacement calculated as a vector. Motion data were modelled to determine the probability of the prostate remaining within pre-specified PTV margins relative to treatment delivery time.

Results: The study analysed 3364 fractions delivered to 122 patients. The mean treatment delivery time was 3.8 min. The prostate remained within a 5 mm margin with high frequencies in the superior-inferior (SI) and left-right (LR) directions, 97.8% and 98.4% of fractions respectively while 5.5% of fractions had deviations greater than 5 mm in the anterior-posterior (AP) direction. By contrast, the 3D vector exceeded a 5 mm margin in 14.5% of fractions. Drift motion modelling indicated a 99% probability of the vector staying within a 3 mm margin for 2 min, while for a 5 mm margin, the duration extended to 3.4 min.

Conclusions: Intra-fractional prostate motion monitoring is increasingly important as SABR with reduced PTV margins are utilised in prostate radiotherapy. Smaller PTV margins and longer treatment time require real-time monitoring to avoid geographical miss.