Journal of Medical Imaging and Radiation Oncology最新文献

Introduction

Rib fractures following falls are common among patients over 70 years of age. While nonoperative management is standard, surgical stabilisation of rib fractures (SSRF) is increasingly performed in selected elderly patients despite concerns about frailty and comorbidities. Although osteoporosis significantly increases fracture risk, rib fractures have not traditionally been categorised as fragility fractures.

Methods

This study retrospectively evaluated bone mineral density (BMD), represented by L1 vertebral Hounsfield units (HU) and correlated clinical outcomes in patients with rib fractures from trauma. A control group of 100 age- and sex-matched nontrauma patients was included for comparison.

Results

Overall, trauma patients exhibited higher mean L1 HU values, 125.0, compared to controls, 105.5 (p = 3 × 10⁻⁵). Within the patients sustaining rib fractures, the low-energy trauma group had lower mean L1 HU values (112.6) than those from high-energy trauma (133, p = 0.002), suggesting a link between lower BMD and susceptibility to rib fractures. Low BMD (L1 HU ≤ 110) was not associated with worse clinical outcomes such as hospital length of stay, analgesia requirements or fracture healing, whether managed operatively or nonoperatively. Low BMD did not affect rib union post-SSRF, with no hardware failures. These results suggest that low BMD alone should not contraindicate SSRF.

Conclusion

The authors recommend routine osteoporosis screening using opportunistic L1 HU measurement on trauma CT scans, particularly in elderly patients sustaining low-energy trauma, to facilitate early osteoporosis management and reduce future fracture risk.

Background

Hypothalamic hamartoma (HH) is a rare congenital malformation that can significantly disrupt patient quality of life and typically presents with either central precocious puberty or gelastic seizures.

Objective

We seek to add to the current literature through a retrospective review of all cases of HH seen at our paediatric tertiary centre over the previous two decades. We also sought to test the novel hypothesis that lesions located closer to or contacting the infundibulum were more likely to present with central precocious puberty (CPP).

Materials and Methods

Retrospective review of the public PACS system was performed, yielding a total of sixteen patients with HH identified on MRI between January 2000 and February 2022. Imaging and patient records were retrospectively evaluated.

Results

Six patients presented with central precocious puberty (CPP), six with gelastic or other seizure disorders, and four had alternate presenting issues. Our study demonstrates a statistically significant relationship between pedunculated lesions and CPP and between sessile/intrahypothalamic lesions and gelastic seizure/neuropsychiatric symptoms. We did not demonstrate a relationship between tumour location relative to the infundibulum or mammillary bodies and clinical manifestations.

Conclusion

Hypothalamic hamartomas are rare congenital malformations which typically present with one of two classical phenotypes: CPP or gelastic seizure. The study demonstrates a statistically significant relationship between pedunculated lesions and CPP and between lesions with third ventricular involvement and gelastic seizure/neuropsychiatric symptoms. We did not demonstrate a clear relationship between specific tumour location within the hypothalamus and phenotype; larger cohort studies are recommended to further investigate this hypothesis.

Introduction

Radiation Oncology Nurses (RONs) are key members of the radiation oncology team; however, the role of the RON is not always clear. The aims of this study were to provide an overview of the RON workforce in Australia, to describe the roles and responsibilities of RONs, and to identify challenges and job satisfaction of RONs.

Methods

This was a two-part multi-methods survey study. Two self-reported questionnaires were distributed online using purposive and snowball sampling: Radiation Oncology Facility Survey (ROFS) and RON Workforce Survey (RONWS). The surveys used tick boxes, Likert scale and open and closed-ended questions. Frequencies and percentages were calculated for categorical variables; mean/standard deviation for continuous variables.

Results

A total of 42 responses were received for the ROFS and 139 for the RONWS, representing all States and Territories in Australia except the Australian Capital Territory (ACT): 52% were metropolitan and 50% were public facilities. Only 17% reported radiation oncology specific training, but 58% had plans to further their education. 80% reported being satisfied with their career and position, believing their role was recognised and generally respected among colleagues and patients. Areas of dissatisfaction included salary, staffing resources and opportunities for advancement.

Conclusion

This is the largest study of RONs in Australia, revealing that RON is a satisfying oncology specialty. Data from this study can be used to identify opportunities for improvement in staffing, engagement and retention of RONs, possibly leading to the development of national guidelines for radiation oncology nursing in Australia.

Introduction

Prostate cancer is a prevalent malignancy with rising incidence rates globally. High-intensity focused ultrasound (HIFU) is a promising, minimally invasive treatment for localised prostate cancer. However, recurrence following HIFU, indicated by rising PSA levels or imaging-confirmed local recurrence, remains a concern. Salvage radiotherapy is a potential treatment for recurrent prostate cancer post-HIFU, but evidence on its efficacy and safety is limited.

Method

This retrospective study evaluated eight patients with localised prostate cancer who underwent salvage radiotherapy following HIFU failure. Salvage treatment consisted of external beam radiation therapy (EBRT), delivered either as conventional fractionation (76 Gy in 38 daily fractions) or stereotactic ablative radiotherapy (36.25–40 Gy in five alternate-day fractions). Outcomes assessed included prostate-specific antigen (PSA) response, biochemical progression-free survival (bPFS), overall survival (OS) and treatment-related toxicity profiles.

Results

All eight patients experienced a significant decline in PSA levels, with no biochemical failures observed during a median follow-up of 72.4 months. The 5-year biochemical failure-free survival and overall survival rates were 100%. Among the eight patients, 6 (75%) had Grade 2 or lower genitourinary toxicity, and 5 (62.5%) had Grade 2 or lower gastrointestinal toxicity, with no Grade 3 or higher adverse events.

Discussion

Salvage EBRT after HIFU failure provides durable disease control with manageable side effects. Further research with larger cohorts is needed to refine treatment strategies for recurrent prostate cancer.

Introduction

The emergence of search engines powered by artificial intelligence and large language models (LLMs), such as ChatGPT, provides easy access to seemingly accurate health information. However, the accuracy of the information produced is uncertain. The purpose of this research is to assess the quality of information produced by ChatGPT about the treatment of health conditions commonly managed by Interventional Radiologists (IRs).

Methods

ChatGPT was asked “what is the best treatment” in relation to six conditions commonly managed by IRs. The output statements were assessed using the DISCERN instrument and compared against the current evidence base for the management of those conditions.

Results

Six conditions were assessed. The mean overall score for the ChatGPT output statements was 1.3 compared to 3.8 for the reference articles. This poor performance by ChatGPT is largely attributable to the lack of transparency regarding sources. Although ChatGPT performed well in some areas such as presenting information in an unbiased manner, it showed significant weaknesses regarding source materials, the risks and benefits of each treatment, and the treatment's mechanism of action.

Conclusion

LLMs signify a considerable shift in how patients obtain and consume medical information. Understanding the strengths and weaknesses of ChatGPT's outputs regarding conditions commonly treated by IRs will enable tailored messaging and constructive discussions with patients in consultation with their IR.

Introduction

Radiology education has evolved significantly with the rise of online learning resources. While digital platforms are now integral to trainee study, the growing volume of content and variable access present challenges. Globally, studies have highlighted the benefits of curated digital learning, yet there is limited data on how radiology trainees in Australia and New Zealand use online resources and integrate them with traditional materials. This study aimed to evaluate the study habits of RANZCR (Royal Australian and New Zealand College of Radiology) radiology trainees, focusing on resource usage, perceptions of teaching modalities, and engagement with the RANZCR curriculum.

Methods

A cross-sectional study of current RANZCR trainees was performed, with data collected via an anonymous, voluntary online questionnaire distributed to all accredited RANZCR trainees via official College communications and at key educational events. The questionnaire covered six domains: demographics, textbook use, online resource use, in-person and remote teaching, and attitudes towards the curriculum. Both quantitative and qualitative data were collected. Descriptive statistics and group comparisons were performed using SPSS and OpenEpi. Free-text responses underwent thematic analysis.

Results

A total of 145 trainees responded (22% response rate). 74% reported using online resources for over half of their learning, while only 15% relied similarly on textbooks. Cost was a major barrier, with 84% of trainees limited by subscription fees. Case-based, in-person teaching was consistently rated the most effective teaching method, though 89% also valued on-demand didactic content. Qualitative analysis revealed learners valued the convenience of online learning, but raised concerns over variability in teaching quality and a perceived disconnect between the curriculum structure and exam relevance.

Conclusion

This study demonstrates a clear shift towards online learning among Australian and New Zealand radiology trainees, reflecting broader global trends. While digital resources are preferred for their accessibility and targeted content, cost and content overload remain key barriers. Greater institutional support, structured guidance on resource use, and refinement of the RANZCR curriculum are needed to ensure the curriculum aligns with modern study habits and exam preparation needs.

Introduction

This paper reports the key findings of the Faculty of Radiation Oncology 2022 workforce census. This is the first census since the COVID-19 pandemic and questions have been updated to assess the impact on RANZCR trainees and fellows. This report focuses on the analysis of respondents from Australia, New Zealand and overseas members, with a separate paper to follow focusing exclusively on New Zealand respondents.

Method

The census was conducted in mid-late 2022 with many questions repeated from previous censuses. New questions were asked about theranostics, working remotely, hypofractionation and the impact of COVID-19 on work practices.

Results

The census was sent to 591 radiation oncologists with an overall response rate of 52%. Almost half of respondents (n = 94/210; 45%) indicated that COVID-19 had no impact on the uptake of hypofractionation. Hypofractionation was most used by respondents in breast and prostate treatment (n = 134/200; 67% and n = 112/194; 58% respectively). Five respondents (n = 5/270; 2%) currently practise in theranostics, with the majority treating thyroid cancers within the public sector.

Just under half (n = 81/167; 49%) of invited trainees responded. The majority felt that COVID-19 had a negative impact on their training. There has been a decrease in the number of new fellows seeking to complete further fellowships. Employment remains at very high levels for new fellows ( > 98%).

Conclusion

The impact of COVID-19 on local practices and workloads was not as significant as seen overseas. There continues to be an increasing trend of radiation oncologists working in the private sector. The lack of indigenous representation within our profession continues to be an area that needs further attention.

Introduction

Optimal radiotherapy (RT) use in cancer patients results in substantial 5-year local control (LC) and overall survival (OS) benefits at the population level. This study aimed to estimate the average per capita cost of the first course of RT treatment and the associated cost per LC and OS outcomes, both overall and by cancer stage.

Methods

Data on RT activities from 2017 to 2020 for lung, rectum, cervix, prostate, brain and head and neck (H&N) cancers were extracted from South-Western Sydney Local Health District electronic oncology information system MOSAIQ (Elekta, version 2.63). Costs were assigned based on activity codes and adjusted for yearly inflation rates. The average cost per treatment course was calculated (average cost per activity × number of fractions). Costs per 5- and 1-year LC and OS outcomes were estimated for all stages and for stages I–II and III.

Results

A total of 106,174 RT activities were extracted. The average cost of an RT treatment course was highest for prostate cancer ($10,332) and lowest for lung cancer ($5598). The lowest costs per 5-year outcome were observed for cervical cancers (LC: $15,780, OS: $28,370) and H&N cancers (LC: $17,500, OS: $29,750). The cost per 5-year LC and OS outcome remained below $100,000 across all stages for each cancer type, except for prostate cancer, where the cost per OS outcome exceeded this level.

Conclusion

This study demonstrates that the absolute costs associated with achieving 5-year local control and overall survival outcomes with radiotherapy are comparatively low across several major cancer types. These findings highlight the efficiency of radiotherapy in delivering meaningful clinical outcomes and can help inform service planning, investment decisions and prioritisation of radiotherapy within cancer care strategies.