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Evaluation of plan quality, safety, and toxicity of brachytherapy for locally advanced cervical cancer in an Australian setting following changes in prescription and applicator design. 在处方和涂抹器设计改变后,澳大利亚近距离治疗局部晚期宫颈癌的计划质量、安全性和毒性评估
IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-12-12 DOI: 10.1111/1754-9485.13811
Emily Flower, Gemma Busuttil, Eireann Cosgriff, Niluja Thiruthaneeswaran, Salman Zanjani, Emma Sullivan, Alison Salkeld, Jonathan Sykes, David Thwaites, Jennifer Chard

Introduction: Chemoradiotherapy with MRI-guided brachytherapy boosts is the standard of care for locally advanced cervical cancer. Data from the RetroEMBRACE and EMBRACE I trials provide dose-response curves for target volumes and OAR. This study evaluated plan quality, safety and toxicity following escalation of the CTV_HR D90 prescription from 80-90 Gy to 85-95 Gy for two different applicator designs.

Methods: A retrospective dosimetric plan quality review was undertaken for consecutively treated locally advanced cervical cancer brachytherapy boosts between 2017 and 2022, and the relationships between implant total reference air kerma (TRAK), CTV_HR volume and vaginal dose were investigated. Safety and ≤grade 3 toxicity results were evaluated.

Results: Seventy patients were identified. All patients received a CTV_HR D90 dose >85 Gy and rectum D2cm3 of <75 Gy, while 88.6% of patients received a bladder D2cm3 <90 Gy. Needles were used in 48.6% of patients, and the mean percentage needle TRAK was 38.2%. Increasing the percentage of needle TRAK decreased vaginal TRAK. Sixty-three patients had more than 12 months of follow-up (median 27 months). From this cohort, grade 3 or higher toxicity for vaginal, genitourinary, gastrointestinal and fistula events were seen in 3.2%, 1.6%, 0% and 3.2% of patients, respectively.

Conclusion: Increased dose prescriptions and a change of applicator design were successfully adopted into an Australian practice. Applicator design and interstitial needle use affect the plan quality and ability to meet OAR dose constraints following target dose escalation. No safety concerns with needle use or dose escalation were identified.

导读:mri引导下的近距离放化疗是局部晚期宫颈癌的标准治疗方法。RetroEMBRACE和EMBRACE I试验的数据提供了靶体积和OAR的剂量-反应曲线。本研究评估了两种不同涂抹器设计下CTV_HR D90处方从80-90 Gy增加到85-95 Gy后的计划质量、安全性和毒性。方法:回顾性评价2017 - 2022年连续治疗的局部晚期宫颈癌近距离放疗的剂量学计划质量,探讨植入物总参考空气体积(TRAK)、CTV_HR体积与阴道剂量的关系。对安全性和≤3级毒性结果进行了评估。结果:共发现70例患者。所有患者接受CTV_HR D90剂量>85 Gy,直肠D2cm3 3结论:增加剂量处方和改变涂药器设计成功地应用于澳大利亚的实践。施药器的设计和间隙针的使用影响计划的质量和在目标剂量增加后满足OAR剂量限制的能力。没有发现针头使用或剂量增加的安全问题。
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引用次数: 0
Characterising high-risk plaque on cardiac CT. 心脏CT高危斑块的特征分析。
IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-12-12 DOI: 10.1111/1754-9485.13817
Abdul Rahman Ihdayhid, Amro Sehly, Nick S R Lan, Nadia Denston, Benjamin J W Chow, David E Newby, Michelle C Williams, Girish Dwivedi

Coronary computed tomography angiography (CCTA) is a well-established and reliable non-invasive imaging modality that provides a comprehensive assessment of coronary artery anatomy and luminal stenosis due to atherosclerosis. Owing to advances in CCTA software and technology, the composition and morphology of coronary plaque can be accurately evaluated. Adverse features which identify plaque as being high-risk or 'vulnerable' can provide a personalised cardiovascular risk assessment over and above stenosis severity. High-risk plaque features on CCTA include spotty calcification, low attenuation plaque, positive remodelling and the napkin ring sign. However, it can be challenging to characterise high-risk plaque accurately on CCTA, and as such, education and experience are required. In this pictorial essay, a comprehensive visual guide to high-risk plaque features on CCTA is provided, with clear examples and challenging cases that highlight common pitfalls. It is important for expert readers to properly identify these features given their association with adverse outcomes and potential future implications on intensive goal-directed medical therapy.

冠状动脉计算机断层血管造影(CCTA)是一种完善可靠的无创成像方式,可全面评估冠状动脉解剖和动脉粥样硬化引起的管腔狭窄。由于CCTA软件和技术的进步,可以准确地评估冠状动脉斑块的组成和形态。将斑块识别为高风险或“易损”的不良特征可以在狭窄严重程度之上提供个性化的心血管风险评估。CCTA上的高危斑块特征包括点状钙化、低衰减斑块、正性重构和餐巾环征。然而,在CCTA上准确表征高危斑块可能具有挑战性,因此,需要教育和经验。在这篇图片文章中,提供了CCTA高危斑块特征的全面视觉指南,并提供了清晰的例子和具有挑战性的案例,突出了常见的陷阱。对于专业读者来说,重要的是要正确识别这些特征,因为它们与不良后果和潜在的未来对强化目标导向医学治疗的影响有关。
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引用次数: 0
Pulmonary veno-occlusive disease: A systematic review of risk factors, clinical presentation, diagnostic investigations, treatment outcomes and prognostic factors. 肺静脉闭塞性疾病:危险因素、临床表现、诊断调查、治疗结果和预后因素的系统综述。
IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-12-11 DOI: 10.1111/1754-9485.13814
Louisa P Thong, Benyamin Hakak-Zargar, Andrew T Burns, George N Harisis, Samantha J Ellis, Francis J Ha

Pulmonary veno-occlusive disease (PVOD) is a rare cause of pulmonary hypertension. We aimed to systematically evaluate published cases of PVOD to provide an overview of their clinical presentation, management and prognosis to assist early identification and treatment. We conducted a literature search of PubMed and Embase databases for adult cases of 'pulmonary veno-occlusive disease' and 'pulmonary capillary haemangiomatosis'. Data collected included baseline demographics, medical history, clinical presentation, investigations performed, treatment and outcome. Kaplan-Meier survival analysis was used for overall survival with Cox-hazards-regression model used to evaluate treatment outcomes and prognostic factors. A total of 257 cases of PVOD from 113 articles were included in our analysis (mean age 45 ± 17 years, 54% females). Most frequent associations were smoking (28%), systemic sclerosis (10%) and mitomycin exposure (9%). Cardinal CT chest findings included ground glass opacities (75%), interlobular septal thickening (74%) and lymphadenopathy (51%); however, all three features were only seen in 23% (35/151). Median overall survival was 12 months (interquartile range, 3-48 months). Lung transplantation was the only treatment associated with improved survival (P = 0.006). Right ventricular dilatation (P = 0.005), increased mean pulmonary artery pressure (P = 0.01) and reduced 6-minute walk distance (P = 0.04) were associated with poorer overall survival. This systematic review provides a clinically relevant overview of a rare and often fatal condition. There is need for early diagnosis and referral for consideration of lung transplantation, while recognising right ventricular dilatation and elevated pulmonary pressures portend poorer prognosis. PROSPERO international register CRD42024553829.

摘要肺动脉静脉闭塞性疾病(PVOD)是肺动脉高压的罕见病因。我们旨在系统地评估已发表的PVOD病例,以提供其临床表现,管理和预后的概述,以帮助早期识别和治疗。我们在PubMed和Embase数据库中检索了“肺静脉闭塞性疾病”和“肺毛细血管瘤病”的成人病例。收集的数据包括基线人口统计、病史、临床表现、进行的调查、治疗和结果。总生存率采用Kaplan-Meier生存分析,cox -hazard -regression模型评价治疗结果和预后因素。本文共纳入113篇文献中的257例PVOD病例(平均年龄45±17岁,女性占54%)。最常见的关联是吸烟(28%)、系统性硬化症(10%)和丝裂霉素暴露(9%)。胸部枢机CT表现包括磨玻璃影(75%)、小叶间隔增厚(74%)和淋巴结病变(51%);然而,这三个特征仅在23%(35/151)中出现。中位总生存期为12个月(四分位数间距为3-48个月)。肺移植是唯一与生存率提高相关的治疗方法(P = 0.006)。右心室扩张(P = 0.005)、平均肺动脉压升高(P = 0.01)和6分钟步行距离缩短(P = 0.04)与总生存期较差相关。本系统综述提供了一种罕见且经常致命的疾病的临床相关概述。有必要早期诊断和转诊考虑肺移植,而认识到右室扩张和肺动脉压升高预示着预后较差。普洛斯彼罗国际注册号CRD42024553829。
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引用次数: 0
Imperative for a health-centred focus on climate change in radiology. 放射学必须以健康为中心,关注气候变化。
IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-12-11 DOI: 10.1111/1754-9485.13813
Omar Taboun, Chloe DesRoche, Kate Hanneman

Climate change negatively impacts individual and population-level health through multiple pathways, including poor air quality, extreme heat and changes in infectious disease. These health effects will lead to higher health system and medical imaging utilisation. At the same time, the delivery of radiology services generates substantial greenhouse gas emissions. Mitigation strategies to reduce the environmental impact of medical imaging and adaptation strategies to build resiliency to current and future impacts of climate change in radiology should be centred on human health. A health-centred response in radiology reinforces the role of radiologists as physicians and emphasises the opportunity for medical imaging to promote health and advance our understanding of climate-related health effects. This review discusses the need for a health-centred focus on climate change in radiology, including the effects of climate change on human health and health systems, intersection of climate change with health equity, health benefits of climate action and opportunities to leverage medical imaging to improve human health.

气候变化通过多种途径对个人和人群的健康产生负面影响,包括空气质量差、极端高温和传染病的变化。这些健康影响将导致更高的卫生系统和医学成像利用率。与此同时,提供放射服务会产生大量的温室气体排放。减少医学成像对环境影响的缓解战略,以及在放射学领域建立抵御当前和未来气候变化影响的适应战略,都应以人类健康为中心。放射学以健康为中心的应对措施加强了放射科医生作为医生的作用,并强调了医学成像促进健康和增进我们对气候相关健康影响的理解的机会。本综述讨论了在放射学中以健康为中心关注气候变化的必要性,包括气候变化对人类健康和卫生系统的影响、气候变化与卫生公平的交集、气候行动的健康效益以及利用医学成像改善人类健康的机会。
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引用次数: 0
A roadmap for modelling radiation-induced cardiac disease. 辐射诱发心脏病建模路线图。
IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-12-01 Epub Date: 2024-07-10 DOI: 10.1111/1754-9485.13716
Samuel C Zhang, Andriana P Nikolova, Mitchell Kamrava, Raymond H Mak, Katelyn M Atkins

Cardiac risk mitigation is a major priority in improving outcomes for cancer survivors as advances in cancer screening and treatments continue to decrease cancer mortality. More than half of adult cancer patients will be treated with radiotherapy (RT); therefore it is crucial to develop a framework for how to assess and predict radiation-induced cardiac disease (RICD). Historically, RICD was modelled solely using whole heart metrics such as mean heart dose. However, data over the past decade has identified cardiac substructures which outperform whole heart metrics in predicting for significant cardiac events. Additionally, non-RT factors such as pre-existing cardiovascular risk factors and toxicity from other therapies contribute to risk of future cardiac events. In this review, we aim to discuss the current evidence and knowledge gaps in predicting RICD and provide a roadmap for the development of comprehensive models based on three interrelated components, (1) baseline CV risk assessment, (2) cardiac substructure radiation dosimetry linked with cardiac-specific outcomes and (3) novel biomarker development.

随着癌症筛查和治疗的不断进步,癌症死亡率持续下降,因此降低心脏风险是改善癌症幸存者预后的重中之重。半数以上的成年癌症患者将接受放射治疗(RT),因此制定一个评估和预测辐射诱发心脏病(RICD)的框架至关重要。从历史上看,RICD 的建模仅使用平均心脏剂量等全心指标。然而,过去十年的数据发现,心脏亚结构在预测重大心脏事件方面优于全心脏指标。此外,非转录因子因素(如原有的心血管风险因素和其他疗法的毒性)也会导致未来发生心脏事件的风险。在本综述中,我们旨在讨论预测 RICD 的现有证据和知识差距,并为基于以下三个相互关联的组成部分开发综合模型提供路线图:(1)基线心血管风险评估;(2)与心脏特异性结果相关的心脏亚结构辐射剂量测量;(3)新型生物标记物的开发。
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引用次数: 0
Getting to the heart of the matter. 切中要害。
IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-12-01 Epub Date: 2024-08-29 DOI: 10.1111/1754-9485.13749
Shalini K Vinod
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引用次数: 0
Cardiac substructure delineation in radiation therapy - A state-of-the-art review. 放射治疗中的心脏亚结构划分--最新进展回顾。
IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-12-01 Epub Date: 2024-05-17 DOI: 10.1111/1754-9485.13668
Robert N Finnegan, Alexandra Quinn, Jeremy Booth, Gregg Belous, Nicholas Hardcastle, Maegan Stewart, Brooke Griffiths, Susan Carroll, David I Thwaites

Delineation of cardiac substructures is crucial for a better understanding of radiation-related cardiotoxicities and to facilitate accurate and precise cardiac dose calculation for developing and applying risk models. This review examines recent advancements in cardiac substructure delineation in the radiation therapy (RT) context, aiming to provide a comprehensive overview of the current level of knowledge, challenges and future directions in this evolving field. Imaging used for RT planning presents challenges in reliably visualising cardiac anatomy. Although cardiac atlases and contouring guidelines aid in standardisation and reduction of variability, significant uncertainties remain in defining cardiac anatomy. Coupled with the inherent complexity of the heart, this necessitates auto-contouring for consistent large-scale data analysis and improved efficiency in prospective applications. Auto-contouring models, developed primarily for breast and lung cancer RT, have demonstrated performance comparable to manual contouring, marking a significant milestone in the evolution of cardiac delineation practices. Nevertheless, several key concerns require further investigation. There is an unmet need for expanding cardiac auto-contouring models to encompass a broader range of cancer sites. A shift in focus is needed from ensuring accuracy to enhancing the robustness and accessibility of auto-contouring models. Addressing these challenges is paramount for the integration of cardiac substructure delineation and associated risk models into routine clinical practice, thereby improving the safety of RT for future cancer patients.

心脏亚结构的划分对于更好地了解与辐射相关的心脏毒性以及准确计算心脏剂量以开发和应用风险模型至关重要。本综述研究了放射治疗(RT)中心脏亚结构划分的最新进展,旨在全面概述这一不断发展的领域的现有知识水平、挑战和未来方向。用于 RT 计划的成像在可靠地观察心脏解剖结构方面存在挑战。尽管心脏图谱和轮廓指南有助于标准化和减少变异性,但在定义心脏解剖结构方面仍存在很大的不确定性。再加上心脏固有的复杂性,这就需要进行自动轮廓分析,以确保大规模数据分析的一致性,并提高前瞻性应用的效率。自动轮廓模型主要是为乳腺癌和肺癌 RT 而开发的,其性能可与手动轮廓模型相媲美,是心脏划线实践发展的一个重要里程碑。尽管如此,仍有几个关键问题需要进一步研究。扩大心脏自动轮廓模型以涵盖更多癌症部位的需求尚未得到满足。需要将重点从确保准确性转移到提高自动轮廓模型的稳健性和易用性上。要将心脏亚结构划分和相关风险模型纳入常规临床实践,从而提高未来癌症患者接受 RT 治疗的安全性,解决这些挑战至关重要。
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引用次数: 0
IRSA ASM 2024 Abstract. 摘要。
IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-12-01 Epub Date: 2024-12-19 DOI: 10.1111/1754-9485.13763
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引用次数: 0
IRSA ASM 2024 Abstract. 摘要。
IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-12-01 Epub Date: 2024-12-19 DOI: 10.1111/1754-9485.13764
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引用次数: 0
Moving beyond mean heart dose: The importance of cardiac substructures in radiation therapy toxicity. 超越平均心脏剂量:心脏亚结构在放射治疗毒性中的重要性。
IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Pub Date : 2024-12-01 Epub Date: 2024-09-03 DOI: 10.1111/1754-9485.13737
Sarah Bowen Jones, Tom Marchant, Chris Saunderson, Alan McWilliam, Kathryn Banfill

Normal tissue tolerance dose limits to the heart have been established to reduce the risk of radiation-induced cardiac disease (RICD). Dose constraints have been developed based on either the mean dose delivered to the whole heart (MHD) or the dose delivered to a specific volume, for example, volume of heart receiving equal to or greater than 30 Gy (V30). There is increasing evidence that the impact of thoracic radiation on cardiac morbidity and mortality has been underestimated. Consequently, there is a need to reduce the dose delivered to the heart in radical radiotherapy treatment planning. The pathophysiology of RICD may relate to dose to specific cardiac substructures (CS) rather than the traditionally observed MHD for common toxicities. The MHD or V30 Gy threshold dose rarely represents the true dose delivered to individual CS. Studies have shown the dose to specific areas may be more strongly correlated with overall survival (OS). With advances in modern radiotherapy techniques, it is vital that we develop robust, evidence-based dose limits for CS, to fully understand and reduce the risk of RICD, particularly in high-risk populations with cardiac risk factors. The following review will summarise the existing evidence of dose limits to CS, explain how dose limits may vary according to different disease sites or radiation techniques and propose how radiotherapy plans can be optimised to reduce the dose to these CS in clinical practice.

为降低辐射诱发心脏病(RICD)的风险,已制定了心脏正常组织容许剂量限值。剂量限制的制定依据是投射到整个心脏的平均剂量(MHD)或投射到特定体积的剂量,例如,接受等于或大于 30 Gy 的心脏体积(V30)。越来越多的证据表明,胸部辐射对心脏发病率和死亡率的影响被低估了。因此,有必要在根治性放疗治疗计划中减少心脏接受的剂量。RICD的病理生理学可能与特定心脏亚结构(CS)的剂量有关,而非传统上观察到的常见毒性的MHD。MHD或V30 Gy阈值剂量很少代表单个CS的真实剂量。研究表明,特定区域的剂量可能与总生存率(OS)有更密切的关系。随着现代放疗技术的发展,我们必须为CS制定可靠的、以证据为基础的剂量限值,以充分了解并降低RICD的风险,尤其是在有心脏风险因素的高危人群中。以下综述将总结 CS 剂量限值的现有证据,解释不同疾病部位或放疗技术的剂量限值可能存在的差异,并提出在临床实践中如何优化放疗计划以减少这些 CS 的剂量。
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引用次数: 0
期刊
Journal of Medical Imaging and Radiation Oncology
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