Journal of Medical Imaging and Radiation Oncology最新文献

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.

Background: Pelvic Congestion Syndrome (PCS) is a condition characterised by chronic pelvic pain resulting from the dilation and reflux of veins within the pelvis. While pelvic pain is the primary symptom of PCS, other associated symptoms may vary among individuals. Bladder symptoms have been commonly observed in PCS, including increased urination frequency, urinary urgency, nocturia and rarely haematuria. This study aimed to investigate the prevalence of bladder symptoms in women with pelvic congestion syndrome and the effectiveness of Ovarian Vein Embolisation in alleviating these symptoms.

Methods: This was a retrospective cohort study on women diagnosed with PCS between January 1, 2017, and December 31, 2022. Inclusion criteria were defined as the presence of clinical symptoms and radiological evidence of PCS undergoing Ovarian Vein Embolisation (OVE). Participants were followed up at least 6 months post-procedure using a web-based survey to assess their bladder symptoms.

Results: One hundred and twenty-three women underwent OVE for PCS during the study period and consented to participate in the study, and 65% (n = 80) reported experiencing bladder symptoms. The most common bladder symptoms during pre-procedure consultations included daytime frequency, a sense of incomplete emptying, and nocturia. Among the individuals with bladder symptoms, 60/80 (75%) reported symptom improvement following OVE. Furthermore, 11/80 patients (13.8%) noted a complete resolution of their symptoms post-OVE, and 30/80 patients (37.5%) reported significant improvement. There were no reported major complications or mortality following OVE.

Conclusion: The findings of this study provided compelling evidence that bladder symptoms are common in women with PCS. Ovarian Vein Embolization emerges as a safe and effective intervention for alleviating concurrent bladder symptoms in these patients.

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.

A prominent subarachnoid space (SAS) in infants under 24 months is a very common finding and is a normal variant that can be associated with macrocephaly. This must be differentiated from various pathological conditions that also cause a prominent SAS, including a reduction in brain volume, obstruction to the cerebrospinal fluid (CSF) or malformations of the skull. The inappropriate labelling of normal SAS prominence as enlargement due to pathology and misrepresentation of published literature by some author groups has created confusion medicolegally, contributing to inappropriate conclusions that a normal prominent SAS may cause subdural haemorrhage (SDH) and brain injury. This paper aims to review the characteristics of the SAS in infants, the terminology relating to the prominence of the SAS and the possible association between the prominence of the SAS and SDH.

Uterine leiomyomata, commonly known as fibroids, are prevalent benign tumours affecting a significant percentage of women of reproductive age. Although many patients remain asymptomatic, a substantial proportion experience severe symptoms, including abnormal uterine bleeding and adverse reproductive outcomes. Surgical intervention often becomes necessary for patients with symptomatic fibroids, despite advancements in medical therapies. This article explores the critical role of Magnetic Resonance Imaging (MRI) in the preoperative planning and management of fibroid surgeries. MRI has been proven superior to traditional imaging methods, such as transvaginal ultrasound (TVS), offering a more accurate evaluation of fibroid size, location, number, and characteristics. This enhanced imaging aids in surgical planning by providing detailed anatomical insights, helping gynaecologists choose the appropriate surgical techniques and predict potential complications. Moreover, MRI is instrumental in assessing the risk of malignancy, guiding decisions on whether to proceed with myomectomy or hysterectomy. Technological advancements, such as 3D MRI modelling and augmented reality, promise further improvements in surgical outcomes by enhancing anatomical understanding and precision. These innovations, along with artificial intelligence integration, show potential in reducing operation times and improving patient outcomes. This review underscores the essential role of MRI in contemporary fibroid management and highlights future directions in the field.

Background: CT-guided percutaneous transthoracic needle biopsy is the primary method for diagnosing lung lesions. Widely accepted validated risk prediction models are yet to be developed. A recently published study conducted at Grampians Health Services (GHS) developed two risk prediction models for predicting pneumothorax and intercostal catheter (ICC) insertion. This study aims to validate these models.

Methods: This is a single-centre, retrospective cohort study performed at GHS. Patients with a CT-guided lung biopsy between January 2020 and July 2023 were included, alongside target-lesion characteristics, procedural-related factors and complications. Predicted probabilities for pneumothorax and ICC insertion were generated for each patient, and the diagnostic accuracy of the previous risk prediction models was evaluated the area under the receiver operating characteristic. A Youden Index was used to determine the sensitivity and specificity at the optimal probability thresholds.

Results: The validation found the model published by GHS demonstrated a diagnostic accuracy of 0.695 (95% CI: 0.601-0.695) for predicting pneumothorax following CT-guided percutaneous biopsy. The model for predicting intercostal catheter insertion had a diagnostic accuracy of 0.762 (95% CI: 0.642-0.762). The sensitivity for predicting pneumothorax and ICC insertion was 81.97% and 92.86%, respectively, for their optimum probability thresholds.

Conclusion: The findings suggest that the previously published models may be useful in predicting pneumothoraces and ICC insertion following CT-guided percutaneous biopsy. We recommend these models as an adjunctive tool to aid in clinical decision-making during the peri-procedural management of these patients pending further validation with an external cohort.