Journal of Medical Radiation Sciences最新文献

The axillary lymph node (LN) burden of breast cancer patients guides multidisciplinary management and treatment regimes. Sonographic imaging is used to identify the presence, number and location of axillary LNs suspicious of malignancy and used to guide nodal fine needle aspirations and biopsies. Axillary LNs suspicious of harbouring breast cancer metastasis can be localised to three surgical axillary levels, numbered according to their location relative to the pectoralis minor muscle and lymph flow. To sonographically identify and localise suspicious axillary LNs, an understanding of the axillary anatomy, muscular sonographic landmarks, surgical axillary levels, and the sonographic technique to image and distinguish between benign and suspicious LNs is required.

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, and early diagnosis via gadolinium ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) significantly impacts patient outcomes. However, patient anxiety during MRI can affect image quality. This study investigates the impact of pre-examination video education on anxiety, satisfaction and image quality in Gd-EOB-DTPA-enhanced liver MRI.

Methods: We prospectively enrolled 480 patients who underwent Gd-EOB-DTPA-enhanced liver MRI from January 2022 to May 2023 at our hospital. Patients were divided into study and control groups in order of odd and even days, with 240 cases in each group. Before the examination, the radiology staff provided routine verbal guidance and breathing training to the patients in the control group, while the study group was given additional video education. The state anxiety scores, satisfaction scores of the provided information and motion artefact scores of the images before and after the examination were compared between the two groups.

Results: The state anxiety scores of both groups of patients were lower than before the examination (all P < 0.05), but the change value of the study group was significantly greater than that of the control group (P = 0.004). The satisfaction rate of the information provided before the scan in the study group was significantly higher (P < 0.001). The image quality scores of the arterial phase were similar between the two groups (P = 0.403), but the image quality of the study group in the pre-contrast, portal phase, transitional phase and hepatobiliary phase was significantly better than that of the control group (all P < 0.05).

Conclusion: Supplementing routine pre-scan care with video guidance for Gd-EOB-DTPA-enhanced liver MRI offers several benefits, including reduced patient anxiety, increased satisfaction and improved image quality. These results suggest the potential for widespread application of video-based interventions to enhance the MRI experience for patients.

The rapid advancement of technology has brought significant changes to various fields, including medical imaging (MI). This discussion paper explores the integration of computing technologies (e.g. Python and MATLAB), digital image processing (e.g. image enhancement, segmentation and three-dimensional reconstruction) and artificial intelligence (AI) into the undergraduate MI curriculum. By examining current educational practices, gaps and limitations that hinder the development of future-ready MI professionals are identified. A comprehensive curriculum framework is proposed, incorporating essential computational skills, advanced image processing techniques and state-of-the-art AI tools, such as large language models like ChatGPT. The proposed curriculum framework aims to improve the quality of MI education significantly and better equip students for future professional practice and challenges while enhancing diagnostic accuracy, improving workflow efficiency and preparing students for the evolving demands of the MI field.

Theranostics is a new term for long-established principles in nuclear medicine. The generalisability of the term means there is a very broad use of the term across the medical literature, not all of which is consistent with the intent in nuclear medicine. The term molecular theranostics better reflects the philosophy and application in nuclear medicine. Even with a clearer definition, there are a number of challenges or controversies whose debate provides a richer understanding of the principles and applications of molecular theranostics. Radioiodine imaging and therapy of hyperthyroidism and thyroid cancer provide the historical context for theranostics. The prototype molecular theranostic is the ⁶⁸Ga/¹⁷⁷Lu DOTATATE pair that targets somatostatin receptor subtype 2 in neuroendocrine tumors. The potential value of precision medicine of radiation dosimetry in molecular theranostics needs a balanced discussion with limitations of reactive dosimetry and the opportunities for predictive or pre-treatment dosimetry. Despite challenges and limitations, molecular theranostics is a powerful tool in the precision medicine landscape. Molecular theranostics is a vehicle for improved outcomes in cancer patients with a future-facing portfolio of opportunities.

Introduction: Occupational burnout can be associated with negative feelings about the workplace and feeling that a person's efforts are of little consequence. Within a healthcare setting, occupational burnout can be attributed to a high workload or a non-supportive work environment. Higher levels of burnout are associated with increased absenteeism and turnover, increased medical errors and decreased patient care. The aim of this study was to investigate the levels of occupational burnout within nuclear medicine technologists (NMTs) working in Australia and New Zealand.

Methods: An online questionnaire was distributed via QuestionPro. The questionnaire consisted of four sections, including the Professional Quality of Life Scale (ProQOL) Version 5 (2009) measuring compassion satisfaction, burnout and secondary traumatic stress in the workplace. For this study, only the burnout component of this scale is reported.

Results: There were 162 survey responses. Of the 18 New Zealand participants, 10 (56%) reported moderate levels of burnout. Of the 144 Australian participants, 114 (79%) reported moderate levels of burnout. No NMTs reported high levels of burnout. All states of Australia were represented in the survey, with Queensland, Western Australia and Victoria having the highest number of participants reporting moderate levels of burnout.

Conclusion: This study revealed that more than half of New Zealand participants and three quarters of Australian participants reported moderate levels of burnout. It is imperative to address the wellbeing needs of NMTs working in Australia and New Zealand at an individual and organisational level to support NMTs to be more engaged in their work and help organisations retain staff.

Introduction: Size-specific dose estimates (SSDE) are used to assess patient-specific radiation exposure in Computed Tomography (CT), complementing the volume CT dose index (CTDIvol). This study compared SSDE calculated using patient's lateral size from scan projection radiograph (SPR) with SSDE calculated using water equivalent diameter (D_w) from tomographic images in adult chest high-resolution CT (HRCT).

Methods: In a single-centre study, the CTDIvol and dose-length product (DLP) were recorded from HRCT dose reports of adult patients. Lateral width (SLat), at the centre of the scan range, from the SPR was measured and the SSDE (SSDE_R) was calculated using conversion factors related to SLat. Average CT number, area of the slice, and lateral size of the patient (AxLat) were measured on the middle slice. The D_w and SSDE from D_w (SSDE_W) were calculated. SSDE_R and SSDE_W were compared using Wilcoxon signed rank test. Correlation between patient size and dosimetry parameters were investigated using Spearman Correlation test with statistical significance at P < 0.05. Bland-Altman plot was also used to test agreement between the two SSDE values.

Results: Median CTDIvol, DLP, SSDE_R and SSDE_W were 11.0 mGy, 372 mGy.cm, 11.6 mGy and 12.9 mGy, respectively. Small but statistically significant differences (P < 0.03) were found between SLat and AxLat as well as between SSDE_R and SSDE_W. Bland-Altman analysis resulted in borderline agreement between SSDE values. Moderate correlations were observed between dosimetry quantities and patient size measurements (ρ > 0.640; P < 0.001). SSDEw showed statistically significant correlation (ρ = 0.587 and P < 0.001) with SSDE_R.

Conclusion: SSDE_R may be used to assess patients' absorbed radiation dose, before the scan, in adult chest HRCT. The median value of SSDE_R was about 10% lower than the median value SSDE_W. However, the SSDE_W should be used after the scan to establish effective dose and radiation risk to the patient.

Introduction: Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death. Definitive treatment includes chemotherapy and radiation therapy. Tumour hypoxia impacts the efficacy of these treatment modalities. Novel positron-emission tomography (PET) imaging has been developed to non-invasively quantify hypoxic tumour subregions, and to guide personalised treatment strategies. This review evaluates the reliability of hypoxia imaging in NSCLC in relation to various tracers, its correlations to treatment-related outcomes, and to assess if this imaging modality can be meaningfully applied into radiation therapy workflows.

Methods: A literature search was conducted on the Medline (Ovid) and Embase databases. Searches included terms related to 'hypoxia', 'positron-emission tomography', 'magnetic resonance imaging' and 'lung cancer'. Results were filtered to exclude studies prior to 2011, and animal studies were excluded. Only studies referring to a confirmed pathology of NSCLC were included, while disease staging was not a limiting factor. Full-text English language and translated literature examined included clinical trials, clinical cohort studies and feasibility studies.

Results: Quantification of hypoxic volumes in a pre-treatment setting is of prognostic value, and indicative of treatment response. Dosimetric comparisons have highlighted potential to significantly dose escalate to hypoxic volumes without risk of additional toxicity. However, clinical data to support these strategies are lacking.

Conclusion: Heterogenous study design and non-standardised imaging parameters have led to a lack of clarity regarding the application of hypoxia PET imaging in NSCLC. PET imaging using nitroimidazole tracers is the most investigated method of non-invasively measuring tumour hypoxia and has potential to guide hypoxia-targeted radiation therapy. Further clinical research is required to elucidate the benefits versus risks of dose-escalation strategies.

Introduction: Online adaptive radiotherapy is well suited for stereotactic ablative radiotherapy (SABR) in pancreatic cancer due to considerable intrafractional tumour motion. This study aimed to assess intrafraction motion and generate adjusted planning target volume (PTV) margins required for online adaptive radiotherapy in pancreatic cancer treatment using abdominal compression on the magnetic resonance linear accelerator (MR-Linac).

Methods: Motion monitoring images obtained from 67 fractions for 15 previously treated pancreatic cancer patients were analysed. All patients received SABR (50 Gy in five fractions) on the MR-Linac using abdominal compression. The analysis included quantification of intrafraction motion, leading to the development of adjusted PTV margins. The dosimetric impact of implementing the adjusted PTV was then evaluated in a cohort of 20 patients.

Results: Intrafraction motion indicated an average target displacement of 1-3 mm, resulting in an adjusted PTV margin of 2 mm in the right-left and superior-inferior directions, and 3 mm in the anterior-posterior direction. Plans incorporating these adjusted margins consistently demonstrated improved dose to target volumes, with improvements averaging 1.5 Gy in CTV D99%, 4.9 Gy in PTV D99% and 1.2 Gy in PTV-high D90%, and better sparing of the organs at risk (OAR).

Conclusions: The improved target volume coverage and reduced OAR dose suggest potential for reducing current clinical margins for MR-Linac treatment. However, it is important to note that decreasing margins may reduce safeguards against geographical misses. Nonetheless, the continued integration of gating systems on MR-Linacs could provide confidence in adopting reduced margins.