Journal of Medical Radiation Sciences最新文献

Introduction: Accurate identification and grading of clinically significant prostate cancer (csPCa, Gleason Score ≥ 7) without invasive procedures remains a significant clinical challenge. This study aims to develop and evaluate a two-stage model designed for precise Gleason grading. The model initially uses radiomics-based multiparametric MRI to identify csPCa and then refines the Gleason grading by integrating clinical indicators and radiomics features.

Methods: We retrospectively analysed 399 patients with PI-RADS ≥ 3 lesions, categorising them into non-significant prostate cancer (nsPCa, 263 cases) and csPCa (136 cases, subdivided by GGs). Regions of interest (ROIs) for the prostate and lesions were manually delineated on T2-weighted and apparent diffusion coefficient (ADC) images, followed by the extraction of radiomics features. A two-stage model was developed: the first stage identifies csPCa using radiomics-based MRI, and the second integrates clinical indicators for Gleason grading. Model efficacy was evaluated by sensitivity, specificity, accuracy and area under the curve (AUC), with external validation on 100 patients.

Results: The first-stage model demonstrated excellent diagnostic accuracy for csPCa, achieving AUCs of 0.989, 0.982 and 0.976 in the training, testing and external validation cohorts, respectively. The second-stage model exhibited commendable Gleason grading capabilities, with AUCs of 0.82, 0.844 and 0.83 across the same cohorts. Decision curve analysis supported the clinical applicability of both models.

Conclusions: This study validated the potential of T2W and ADC image radiomics features as biomarkers in distinguishing csPCa. Combining these features with clinical indicators for csPCa Gleason grading provides superior predictive performance and significant clinical benefit.

Breast cancer is the most frequently diagnosed cancer worldwide. The treatment options for breast cancer can cause side effects and adversely impact quality of life. Side effects, including fatigue, pain, cognitive changes, and psychosocial complications, can be life altering and continue beyond treatment into survivorship. Traditionally, health professionals focused almost entirely on achieving cancer survival; however, due to significant success in cancer treatment outcomes, most women now live beyond their breast cancer treatment. Consequently, addressing side effects and compromises in quality of life are becoming more important issues to include in a comprehensive approach to breast cancer treatment. For women, these unmet needs may involve body image concerns, sexual dysfunction, and other lifestyle challenges, and may not have previously been given sufficient recognition or priority. It is necessary for us, as oncology healthcare professionals, to modify our delivery of cancer care and ensure that more comprehensive care is provided to women. By addressing women's unmet needs, we can contribute to achieving the United Nations' Sustainable Development Goals regarding improving health and equality. This commentary seeks to emphasise the advantages of providing comprehensive care for women with breast cancer and advocates for cancer care professionals to actively participate in initiating and implementing this care.

Over the past decade, our institution delivered conventional total body irradiation (TBI) using Elekta's Monaco treatment planning system (TPS) with an extended SSD field arrangement and 18 megavoltage (MV) energy lateral fields. In 2020, there was a transition to the Eclipse™ treatment planning system and Truebeam® linear accelerators with 6 MV and 10 MV energies. These changes meant that essential components of the existing technique were unavailable for clinical use and a new approach to the institution technique was required to ensure continuation of service. The aim was to implement a volumetric-modulated arc therapy (VMAT) TBI technique using existing infrastructure, the new planning system and treatment hardware to continue providing a TBI service for patients of all ages, including those under general anaesthetic (GA). A multidisciplinary team within the institution was created to evaluate existing literature and to implement a VMAT TBI technique that was feasible within our institution. This article will discuss the resultant technique, the practicalities faced and the radiation therapy pathway within our institution.

Introduction: Sonography students require a deep understanding of structural anatomy, including where structures sit relative to one another. Additionally, they need to learn the complex task of identifying structures on medical images including X-rays, computed tomography, magnetic resonance imaging and ultrasound imaging. Anatomy can be taught online, but learning can be challenging for students. Online three-dimensional (3D) anatomy platforms aid student learning, but research investigating how to use them effectively when teaching is scarce. This project evaluated the impact of incorporating a three-dimensional (3D) online anatomy platform into teaching relative structural anatomy and assist sonography students when learning how to recognise structures on medical images.

Methods: Sixty-one first-year sonography students within an articulated undergraduate and postgraduate medical sonography programme in Australia, studying anatomy online participated in this mixed methods study. The impact of using a 3D online anatomy platform on their conceptual 3D anatomy understanding of relative anatomy, development of medical image recognition skills and their learning experience was assessed via a Qualtrics survey.

Results: Students who used this platform collaboratively enhanced their relative anatomy understanding and developed the skill of identifying structures from medical images. The scaffolded use of this platform generated enquiry discussions between teachers and students and made learning anatomy online a social and enjoyable experience.

Conclusion: Collaborative and interactive scaffolded use of 3D online anatomy platforms can motivate and encourage student questions and discussions, enabling social connections and enhancing their learning experience. Student enquiry skills were developed, and the more complex task of identifying structures from medical images was made achievable.

Children requiring veno-arterial extracorporeal membrane oxygenation (VA ECMO) or cardiac surgery often undergo cervical cannulation or carotid artery clamping, which can interrupt cerebral circulation. Inadequate collateral flow through the circle of Willis (CoW) may lead to cerebral ischaemia within the vascular territory and/or watershed regions. Pre-cannulation survey of the CoW using transcranial Doppler (TCD) ultrasound may be performed to predict and plan neuroprotection. It is important to note in this article TCD refers to Duplex or colour coded trans-cranial Doppler (TCCD) using radiology-based machines, which is distinct from the more traditional trans-cranial Doppler technique that does not incorporate a B-mode image. This article describes our technique, in use since 2019, to guide surgical approaches and neuroprotective measures when an incomplete CoW is identified. High-end radiology-based ultrasound platforms and various transducers are used to assess brain morphology and haemorrhage through the anterior fontanelle in neonates. TCD is performed with the highest frequency transducer possible, utilising Doppler imaging to visualise cerebral arteries. Manual carotid compression can be used to functionally assess collateral flow when segments appear aplastic or hypoplastic. Potential pitfalls include mistaking the anterior choroidal artery for a hypoplastic posterior communicating artery (PCommA). Since implementing this protocol 5 years ago, no catastrophic infarcts related to cervical cannulation have occurred. This technique provides a practical solution for pre-operative assessment of cerebral collateral circulation in children undergoing VA ECMO or cardiac surgery, allowing for consideration of neuroprotective measures and improving patient safety.

Maximise your Continuing Professional Development (CPD) by reading the selected articles and answer the five questions. Please remember to self-claim your CPD and retain your supporting evidence.

Ultra-Hypofractionated Whole Breast Radiotherapy (U-WBRT) has been proven to be a viable treatment option for breast cancer patients receiving radiation therapy, however, due to its novelty our understanding of its non-clinical benefits is still evolving. With increasing U-WBRT selection during COVID and in rural and regional settings such as the Western New South Wales Local Health District (WNSWLHD), it's important to quantify the savings when compared to other fractionation schedules (e.g. Conventional fractionation (C-WBRT) involving 25 fractions and Moderate hypofractionation (M-WBRT) with 15 fractions.) Using literature sourced from Medline, Embase, Pubmed and reports from relevant websites and organisations this narrative review investigates quantifiable methods of assessing non-clinical benefits of U-WBRT in rural settings according to the triple bottom line philosophy. This review was able to identify a standard set of quantifiable metrics that can compare the non-clinical benefits of various fractionation schedules, with relevance to a rural setting. These include: fractionation trends, financial subsidy, average linear accelerator (Linac) minutes, hospital visits, travel time and distance, Linac energy consumption, travel and Linac carbon emissions. By identifying these metrics, non-clinical benefits between the fractionation schedules can easily be quantified and compared.

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.