Journal of Medical Imaging and Radiation Oncology最新文献

Characterisation of an indeterminate ovarian mass is important as it guides management and clinical outcomes. Ultrasound is the first-line modality in the assessment of ovarian tumours. When ovarian masses are indeterminate on ultrasound, MRI provides excellent resolution in tissue characterisation and enhancement patterns. Ovarian masses can be categorised based on risk-scoring systems such as the American College of Radiology (ACR) MRI Ovarian-Adnexal Reporting and Data System (O-RADS). The imaging features of non-neoplastic, benign, borderline and malignant neoplastic ovarian lesions are discussed in this review with a focus on the pathology process accounting for the MRI appearance. Characteristic findings and clues in differentiating a benign lesion from a malignancy are presented in this review.

Aim: Interventionalist experience high-lifetime radiation dosages due to the use of pulsed fluoroscopy. They also experience orthopaedic problems due to the necessity of wearing lead gowns to protect from this radiation. To alleviate both the radiation and orthopaedic issues, we trialled an innovative shielding system, Rampart (tm) which surrounds the patient's torso with lead equivalent acrylic shielding. Our trial period coincided with the initial COVID-19 outbreak and lockdowns which provided an additional use of the shielding as a protection from spread of COVID-19 infection from patients.

Method: Using Ray safe (tm) i3 Dosimeters, we measured primary operator radiation dosimetry. This was measured at the head (H), upper torso (T) and waist height (W). Both with the Rampart (tm) shield and without it. The measurements were conducted over a usual week's case load.

Results: 20 cases were performed, 10 with the Rampart (tm) system in place and 10 without. At the primary operator position we found an effective radiation attenuation of H: 70.3%, T: 98.3%, W: 99.5% with lead gowns. Compared to an effective radiation attenuation just using the Rampart(tm) external shielding of H: 89.3%, T: 92.4%, W: 89.0%. Using both lead gowns and the Rampart (tm) gave over 99.9 %. Airflow test also showed a laminar air flow away from the operator from the patient's head.

Conclusion: Whilst not as effective alone as lead gowns in radiation attenuation, the Rampart (tm) system was demonstrated to be an effective radiation safety device with the possibility of no lead or lighter lead use. Additional benefits that were observed from its use included significant radiation protection to the operator, protection to body areas not protected by lead, (head arms) as well shielding from direct aerosol contact with the patient which has proven to be an important consideration in the current COVID-19 pandemic.

Aim: Radiological interventions are increasingly complex and also increasingly performed on high body mass index (BMI) patients. As such we sought to quantify the radiation dose to the eyes of the operator, the dose area product and skin dose to the patient, as well as variations in cardiac angiographic image quality. Over the range of normal to high BMI's.

Methods: Five thickness of Acrylic 15, 20, 25, 30 and 35 cm were used to simulate increasing patient BMI. The patient dose area product and skin dose were measured from the built-in metering systems of the angiographic system. The simulated operator eye dose was measured using (Rando) tm Phantom and a (Unfors)tm radiation detector at 150–170 cm in 5 cm gradients at the primary operator position. For image quality measurement, a Westmead testing object was used to test high and low contrast range and line pairs per 0.5 mm.

Results: Our study shows that whilst a low-grade linear decrease in image quality and corresponding rise in radiation dose is seen over the standard patient BMI ranges. There is a very large nonlinear drop in image quality and corresponding large rise in radiation dose in the high BMI patient range (over 25) using standard settings. Our secondary aim was proven in the results showing the high effectiveness (over 90%) of the standard lead equivalent acrylic shielding in protecting the operators' eyes. Especially for the very high levels found in the extreme patient size cohort.

Conclusion: These results indicate the important need of the radiographers' role in radiation safety. Selecting the most efficient frame rate/Ma settings possible, positioning of the detector, monitoring of ongoing case dose and that operators are using radiation protection equipment, especially the ceiling acrylic (Pb) shield for the higher BMI patients.

Introduction: The LVIS EVO (MicroVention^®) is a braided stent designed to assist coil embolisation of intracranial aneurysms. It offers several structural innovations over previous and currently available braided, and laser-cut, stents that are theorised to improve procedural success. This retrospective audit aims to determine the success and complication rates of LVIS EVO-assisted coil embolisation in unruptured saccular aneurysms at a tertiary neurovascular referral centre in Queensland, Australia.

Methods: The medical records of all patients who underwent elective LVIS EVO-assisted coil embolisation at our institution between 2020 and 2024 were reviewed. Clinical and radiologic outcomes, including occlusion rate, occlusion grade (modified Raymond Roy classification-MRRC), complications, recurrence rate, and change in modified Rankin scale (mRS) were recorded, alongside aneurysm characteristics and technical procedural details.

Results: Of 29 cases, 2 were excluded due to complex aneurysms requiring off-label LVIS EVO use. Twenty-seven (27) saccular aneurysms in 26 patients (18 female; 8 male) were included. Most (22/27) involved the anterior cerebral artery (ACA), primarily the anterior communicating artery (18/27). Complete occlusion was seen in 55.6% (15/27) of cases immediately post-procedure, in 85.2% (23/27) at 3 months, and in 84.2% (16/19) at a median of 12-months post-procedure. A recurrence was seen in 7.4% (2/27) of patients. No procedural or long-term complications, and no significant changes in 90-day mRS, were noted.

Conclusion: Our results show 100% technical success reflecting existing literature and contribute further by providing data on medium to long-term success rates with LVIS EVO-assisted coil embolisation for unruptured saccular aneurysms.

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.

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.

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.

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.

Background: Climate change is a critical global issue, impacting ecosystems, economies and communities worldwide. The shift from paper-based to digital systems is becoming increasingly prevalent across industries, with downstream positive impacts on sustainability. In 2020, Austin Health, a public tertiary hospital in Victoria, Australia, adopted a web-based outpatient booking application, which succeeded the prior paper-based system. The application served as an integrated platform for administrative staff to access various Austin Information Technology platforms and replaced previous mail-based outpatient appointment notifications with Short Message Service-based notifications. This study aimed to assess the environmental impact and organisation-wide economic cost of a web-based outpatient booking application compared to the prior paper-based system across the same time period.

Methods: A retrospective environmental and economic assessment was conducted for both the web-based booking application and the paper-based system. The evaluation covered 36,925 outpatient diagnostic imaging studies - including CT, MRI, ultrasound and mammography - performed at Austin Health from 1st July 2023 until 30th June 2024. The environmental impact was assessed by calculating the expected carbon dioxide equivalent (CO₂e) emissions produced by each system. The economic cost analysis was conducted from the perspective of the hospital and included the direct costs of labour and materials/consumables.

Results: CO₂e emissions were significantly reduced using the web-based outpatient booking application compared to the prior paper-based system (38.5 tonnes compared to 0.002 tonnes), predominantly attributable to the elimination of postage-related fuel emissions (27.7 tonnes). The estimated net operating cost savings across the year was at least AUD 175,000 (in 2024 Australian Dollars, adjusted for inflation). This was primarily due to labour savings from the elimination of workflow inefficiencies (at least 2342 h saved) amounting to at least AUD 85,272 in salary, followed by savings from eliminated pathology tests (AUD 57,422) and postage costs (AUD 55,193).

Conclusion: The adoption of the web-based outpatient booking application led to a substantial reduction in carbon emissions and operating costs, alongside enhanced operational efficiency and productivity. These benefits are anticipated to be enduring, especially in the face of an ever-increasing demand for medical imaging services.