L. Fraser, Nasreen Parkar, K. Adamson, Alison Fletcher, P. Julyan, C. Kalirai, Daniel McGowan, F. Mckiddie
The Ionising Radiation (Medical Exposure) Regulations require employers to appoint suitable medical physics experts (MPE) for Nuclear Medicine services, and they also define the areas where MPEs are required to provide advice and specify matters that they must contribute towards. Applications for employer licences under IR(ME)R require employers to specify the level of MPE support available and if this is provided by on-site MPEs or remotely. Assessment of these applications by the Administration of Radioactive Substances Advisory Committee (ARSAC) has highlighted variability in the levels of MPE support being provided for similar services across the UK. A working party including representatives from IPEM, ARSAC, BIR and BNMS was formed and has produced these recommendations on MPE support. Nuclear medicine services were divided into seven broad categories and MPE support for each category has been considered. However, some services that differ from the scenarios provided in this guidance may require different levels of MPE support. PET/CT and γ camera imaging have been considered separately here, although it is recognised that both PET/CT and γ cameras are often sited within the same department in many centres. The separation has been done for pragmatic purposes, as there are felt to be sufficient differences in the MPE role requirements. This guidance sets out recommendations for MPE support, and broader physics support, to run a safe nuclear medicine service and defines the responsibilities of these staff for a range of clinical nuclear medicine services. The recommendations on MPE support made are advice, but will assist employers in meeting regulatory requirements.
{"title":"Guidance on medical physics expert support for nuclear medicine.","authors":"L. Fraser, Nasreen Parkar, K. Adamson, Alison Fletcher, P. Julyan, C. Kalirai, Daniel McGowan, F. Mckiddie","doi":"10.1259/bjr.20211393","DOIUrl":"https://doi.org/10.1259/bjr.20211393","url":null,"abstract":"The Ionising Radiation (Medical Exposure) Regulations require employers to appoint suitable medical physics experts (MPE) for Nuclear Medicine services, and they also define the areas where MPEs are required to provide advice and specify matters that they must contribute towards. Applications for employer licences under IR(ME)R require employers to specify the level of MPE support available and if this is provided by on-site MPEs or remotely. Assessment of these applications by the Administration of Radioactive Substances Advisory Committee (ARSAC) has highlighted variability in the levels of MPE support being provided for similar services across the UK. A working party including representatives from IPEM, ARSAC, BIR and BNMS was formed and has produced these recommendations on MPE support. Nuclear medicine services were divided into seven broad categories and MPE support for each category has been considered. However, some services that differ from the scenarios provided in this guidance may require different levels of MPE support. PET/CT and γ camera imaging have been considered separately here, although it is recognised that both PET/CT and γ cameras are often sited within the same department in many centres. The separation has been done for pragmatic purposes, as there are felt to be sufficient differences in the MPE role requirements. This guidance sets out recommendations for MPE support, and broader physics support, to run a safe nuclear medicine service and defines the responsibilities of these staff for a range of clinical nuclear medicine services. The recommendations on MPE support made are advice, but will assist employers in meeting regulatory requirements.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121498289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shawn Lyo, L. Tierradentro-García, A. Viaene, M. Hwang
OBJECTIVES To assess the feasibility of visualizing lenticulostriate vessels (LV) using a linear high-resolution ultrasound probe and characterize LV morphology to determine whether morphological alterations in LV are present in neonatal hypoxic-ischemic encephalopathy (HIE) as compared to the unaffected infants. METHODS We characterized LV by their echogenicity, width, length, tortuosity, and numbers of visualized stems/branches in neurosonographic examinations of 80 neonates. Our population included 45 unaffected (Non-HIE) and 35 with clinical and/or imaging diagnosis of HIE. Of the neonates with clinical diagnosis of HIE, 16 had positive MRI findings for HIE (HIE +MRI) and 19 had negative MRI findings (HIE-MRI). Annotations were performed twice with shuffled datasets at a one-month interval and intra rater reliability was assessed. Focused comparison was conducted between non-HIE, HIE +MRI and HIE-MRI neonates whose images were acquired with a high frequency linear transducer. RESULTS Studies acquired with the two most frequently utilized transducers significantly differed in number of branches (p = 0.002), vessel thickness (p = 0.007) and echogenicity (p = 0.009). Studies acquired with the two transducers also significantly differed in acquisition frequency (p < 0.001), thermal indices (p < 0.001) and use of harmonic imaging (p < 0.001). Groupwise comparison of vessels imaged with the most frequently utilized transducer found significantly fewer branches in HIE + MRI compared to HIE-MRI negative and non-HIE patients (p = 0.005). CONCLUSIONS LV can be visualized in the absence of pathology using modern high-resolution neurosonography. Visualization of LV branches varies between HIE + MRI, HIE-MRI neonates and controls. ADVANCES IN KNOWLEDGE High-resolution neurosonography is a feasible technique to assess LV morphology in healthy neonates and neonates with HIE.
{"title":"High-resolution neurosonographic examination of the lenticulostriate vessels in neonates with hypoxic-ischemic encephalopathy.","authors":"Shawn Lyo, L. Tierradentro-García, A. Viaene, M. Hwang","doi":"10.1259/bjr.20211141","DOIUrl":"https://doi.org/10.1259/bjr.20211141","url":null,"abstract":"OBJECTIVES\u0000To assess the feasibility of visualizing lenticulostriate vessels (LV) using a linear high-resolution ultrasound probe and characterize LV morphology to determine whether morphological alterations in LV are present in neonatal hypoxic-ischemic encephalopathy (HIE) as compared to the unaffected infants.\u0000\u0000\u0000METHODS\u0000We characterized LV by their echogenicity, width, length, tortuosity, and numbers of visualized stems/branches in neurosonographic examinations of 80 neonates. Our population included 45 unaffected (Non-HIE) and 35 with clinical and/or imaging diagnosis of HIE. Of the neonates with clinical diagnosis of HIE, 16 had positive MRI findings for HIE (HIE +MRI) and 19 had negative MRI findings (HIE-MRI). Annotations were performed twice with shuffled datasets at a one-month interval and intra rater reliability was assessed. Focused comparison was conducted between non-HIE, HIE +MRI and HIE-MRI neonates whose images were acquired with a high frequency linear transducer.\u0000\u0000\u0000RESULTS\u0000Studies acquired with the two most frequently utilized transducers significantly differed in number of branches (p = 0.002), vessel thickness (p = 0.007) and echogenicity (p = 0.009). Studies acquired with the two transducers also significantly differed in acquisition frequency (p < 0.001), thermal indices (p < 0.001) and use of harmonic imaging (p < 0.001). Groupwise comparison of vessels imaged with the most frequently utilized transducer found significantly fewer branches in HIE + MRI compared to HIE-MRI negative and non-HIE patients (p = 0.005).\u0000\u0000\u0000CONCLUSIONS\u0000LV can be visualized in the absence of pathology using modern high-resolution neurosonography. Visualization of LV branches varies between HIE + MRI, HIE-MRI neonates and controls.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000High-resolution neurosonography is a feasible technique to assess LV morphology in healthy neonates and neonates with HIE.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115206411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Loveland, K. Young, J. Oduko, Alistair Mackenzie
OBJECTIVES To record the radiation doses involved in UK breast screening and to identify any changes since previous publications related to technical factors and the population screened. METHODS Mammographic exposure factors for 68,998 women imaged using 411 X-ray sets spread across the UK were compiled. Local output and half value layer measurements for each X-ray set were used to estimate mean glandular dose (MGD) using the standard UK method. RESULTS Mean MGDs in digital mammography have increased by 11% since 2010-12 for both medio-lateral oblique (MLO) and cranio-caudal (CC) views. The mean compressed breast thickness (CBT) has increased (4.8% CC, 5.2% MLO) over the same period. The mean MLO CBT value of 62.4 ± 0.1 mm is outside the 50 to 60 mm range used for diagnostic reference levels. The increase in MGD is consistent with the CBT changes. The mean MGD in the 50 to 60 mm CBT range is 1.44 ± 0.03 mGy for MLO views. CBT varies with age and peaks at 51. CONCLUSIONS Mean CBT has increased with time, and this has increased mean MGDs for digital mammography. CBT also varies with age. ADVANCES IN KNOWLEDGE Updated average MGDs in the UK are provided. There is evidence that breast size is increasing in the UK and that mean CBT is affected by age related changes in the breast.
{"title":"Radiation doses in the united Kingdom breast screening programmes 2016-2019.","authors":"J. Loveland, K. Young, J. Oduko, Alistair Mackenzie","doi":"10.1259/bjr.20211400","DOIUrl":"https://doi.org/10.1259/bjr.20211400","url":null,"abstract":"OBJECTIVES\u0000To record the radiation doses involved in UK breast screening and to identify any changes since previous publications related to technical factors and the population screened.\u0000\u0000\u0000METHODS\u0000Mammographic exposure factors for 68,998 women imaged using 411 X-ray sets spread across the UK were compiled. Local output and half value layer measurements for each X-ray set were used to estimate mean glandular dose (MGD) using the standard UK method.\u0000\u0000\u0000RESULTS\u0000Mean MGDs in digital mammography have increased by 11% since 2010-12 for both medio-lateral oblique (MLO) and cranio-caudal (CC) views. The mean compressed breast thickness (CBT) has increased (4.8% CC, 5.2% MLO) over the same period. The mean MLO CBT value of 62.4 ± 0.1 mm is outside the 50 to 60 mm range used for diagnostic reference levels. The increase in MGD is consistent with the CBT changes. The mean MGD in the 50 to 60 mm CBT range is 1.44 ± 0.03 mGy for MLO views. CBT varies with age and peaks at 51.\u0000\u0000\u0000CONCLUSIONS\u0000Mean CBT has increased with time, and this has increased mean MGDs for digital mammography. CBT also varies with age.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000Updated average MGDs in the UK are provided. There is evidence that breast size is increasing in the UK and that mean CBT is affected by age related changes in the breast.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128464874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVES To evaluate the safety, effectiveness and cost benefit of ambulatory pleural vent compared to conventional chest drain for pneumothorax following CT-guided biopsy of lung lesions (CTGB). METHODS We retrospectively analysed electronic hospital records of patients requiring intervention for pneumothorax following CTGB. All patients treated with pleural vent over a 2 year period (August 2017 - July 2019) were included and compared to a control group of all patients treated with chest drain over a previous 2 year period (August 2014 - July 2016). RESULTS Patients managed with a pleural vent had a shorter length of hospital stay compared to the chest drain group (median 0 days vs 4.5 days, p < 0.01). The mean cost of follow-up in the pleural vent group was £530.36 per patient compared to a mean of £2699.38 per patient in the chest drain group (p value < 0.01). CONCLUSION Pleural vent can be a safe and effective alternative to conventional chest drain for the management of CTGB-related pneumothorax which allows patients to be managed on an outpatient basis with reduced hospital stays and lower associated healthcare costs. ADVANCES IN KNOWLEDGE To the best of our knowledge, this is the first study demonstrating the safety and effectiveness of pleural vent for CT guided biopsy-related pneumothorax.
{"title":"Promising role for pleural vent in pneumothorax following CT-Guided biopsy of lung lesions.","authors":"M. Ball, S. Babu, A. Wallis, R. Asciak","doi":"10.1259/bjr.20210965","DOIUrl":"https://doi.org/10.1259/bjr.20210965","url":null,"abstract":"OBJECTIVES\u0000To evaluate the safety, effectiveness and cost benefit of ambulatory pleural vent compared to conventional chest drain for pneumothorax following CT-guided biopsy of lung lesions (CTGB).\u0000\u0000\u0000METHODS\u0000We retrospectively analysed electronic hospital records of patients requiring intervention for pneumothorax following CTGB. All patients treated with pleural vent over a 2 year period (August 2017 - July 2019) were included and compared to a control group of all patients treated with chest drain over a previous 2 year period (August 2014 - July 2016).\u0000\u0000\u0000RESULTS\u0000Patients managed with a pleural vent had a shorter length of hospital stay compared to the chest drain group (median 0 days vs 4.5 days, p < 0.01). The mean cost of follow-up in the pleural vent group was £530.36 per patient compared to a mean of £2699.38 per patient in the chest drain group (p value < 0.01).\u0000\u0000\u0000CONCLUSION\u0000Pleural vent can be a safe and effective alternative to conventional chest drain for the management of CTGB-related pneumothorax which allows patients to be managed on an outpatient basis with reduced hospital stays and lower associated healthcare costs.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000To the best of our knowledge, this is the first study demonstrating the safety and effectiveness of pleural vent for CT guided biopsy-related pneumothorax.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128495355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephen Supple, Shahjehan Ahmad, S. Gaddikeri, M. Jhaveri
Advancements in technology and multidisciplinary management have revolutionized the treatment of spinal metastases. Imaging plays a pivotal role in determining the treatment course for spinal metastases. This article aims to review the relevant imaging findings in spinal metastases from the perspective of the treating clinician, describe the various treatment options, and discuss factors influencing choice for each available treatment option. Cases that once required radical surgical resection or low-dose conventional external beam radiation therapy (EBRT), or both, are now being managed with separation surgery, spine stereotactic radiosurgery(SRS)/stereotactic body radiation therapy (SBRT), or both, with decreased morbidity, improved local control, and more durable pain control. The primary focus in determining treatment choice is now on tumor control outcomes, treatment-related morbidity, and quality of life.
{"title":"Treatment of metastatic spinal disease, What the Radiologist Needs to Know.","authors":"Stephen Supple, Shahjehan Ahmad, S. Gaddikeri, M. Jhaveri","doi":"10.1259/bjr.20211300","DOIUrl":"https://doi.org/10.1259/bjr.20211300","url":null,"abstract":"Advancements in technology and multidisciplinary management have revolutionized the treatment of spinal metastases. Imaging plays a pivotal role in determining the treatment course for spinal metastases. This article aims to review the relevant imaging findings in spinal metastases from the perspective of the treating clinician, describe the various treatment options, and discuss factors influencing choice for each available treatment option. Cases that once required radical surgical resection or low-dose conventional external beam radiation therapy (EBRT), or both, are now being managed with separation surgery, spine stereotactic radiosurgery(SRS)/stereotactic body radiation therapy (SBRT), or both, with decreased morbidity, improved local control, and more durable pain control. The primary focus in determining treatment choice is now on tumor control outcomes, treatment-related morbidity, and quality of life.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132449755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nikolaos Galanakis, T. Maris, N. Kontopodis, Konstantinos Tsetis, E. Kehagias, D. Tsetis
Lower limb peripheral arterial disease (PAD) characterizes the impairment of blood flow to extremities caused by arterial stenoses or occlusions. Evaluation of PAD is based on clinical examination, calculation of ankle-brachial index and imaging studies such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). These modalities provide significant information about location, extension and severity of macrovasular lesions in lower extremity arterial system. However, they can be also used to evaluate limb perfusion, using appropriate techniques and protocols. This information may be valuable for assessment of the severity of ischemia and detection of hypoperfused areas. Moreover, they can be used for planning of revascularization strategy in patients with severe PAD and evaluation of therapeutic outcome. These techniques may also determine prognosis and amputation risk in patients with PAD. This review gives a basic overview of the perfusion techniques for lower limbs provided by imaging modalities such as US, CT, MRI, DSA and scintigraphy and their clinical applications for evaluation of PAD and revascularization outcome.
{"title":"Perfusion imaging techniques in lower extremity peripheral arterial disease.","authors":"Nikolaos Galanakis, T. Maris, N. Kontopodis, Konstantinos Tsetis, E. Kehagias, D. Tsetis","doi":"10.1259/bjr.20211203","DOIUrl":"https://doi.org/10.1259/bjr.20211203","url":null,"abstract":"Lower limb peripheral arterial disease (PAD) characterizes the impairment of blood flow to extremities caused by arterial stenoses or occlusions. Evaluation of PAD is based on clinical examination, calculation of ankle-brachial index and imaging studies such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). These modalities provide significant information about location, extension and severity of macrovasular lesions in lower extremity arterial system. However, they can be also used to evaluate limb perfusion, using appropriate techniques and protocols. This information may be valuable for assessment of the severity of ischemia and detection of hypoperfused areas. Moreover, they can be used for planning of revascularization strategy in patients with severe PAD and evaluation of therapeutic outcome. These techniques may also determine prognosis and amputation risk in patients with PAD. This review gives a basic overview of the perfusion techniques for lower limbs provided by imaging modalities such as US, CT, MRI, DSA and scintigraphy and their clinical applications for evaluation of PAD and revascularization outcome.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132604559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sandra Sjöstrand, M. Bacou, Katarzyna Kaczmarek, M. Evertsson, I. Svensson, A. Thomson, S. Farrington, S. Moug, T. Jansson, C. Moran, H. Mulvana
OBJECTIVES Despite advances in MRI the detection and characterisation of lymph nodes in rectal cancer remains complex, especially when assessing the response to neo-adjuvant treatment. An alternative approach is functional imaging, previously shown to aid characterization of cancer tissues. We report proof of concept of the novel technique Contrast-Enhanced Magneto-Motive Ultrasound (CE-MMUS) to recover information relating to local perfusion and lymphatic drainage, and interrogate tissue mechanical properties through magnetically induced deformations. METHODS The feasibility of the proposed application was explored using a combination of experimental animal and phantom ultrasound imaging, along with finite element analysis. First, contrast enhanced ultrasound imaging on one wild type mouse recorded lymphatic drainage of magnetic microbubbles after bolus injection. Second, tissue phantoms were imaged using MMUS to illustrate the force- and elasticity dependence of the magneto-motion. Third, the magneto-mechanical interactions of a magnetic microbubble with an elastic solid were simulated using finite element software. RESULTS Accumulation of magnetic microbubbles in the inguinal lymph node was verified using contrast enhanced ultrasound, with peak enhancement occurring 3.7 s post injection. The magnetic microbubble gave rise to displacements depending on force, elasticity, and bubble radius, indicating an inverse relation between displacement and the latter two. CONCLUSIONS Combining magnetic microbubbles with MMUS could harness the advantages of both techniques, to provide perfusion information, robust lymph node delineation and characterisation based on mechanical properties. ADVANCES IN KNOWLEDGE (a)Lymphatic drainage of magnetic microbubbles visualised using contrast enhanced ultrasound imaging and (b) magneto-mechanical interactions between such bubbles and surrounding tissue could both contribute to (c) robust detection and characterisation of lymph nodes.
{"title":"Modelling of magnetic microbubbles to evaluate contrast enhanced magneto-motive ultrasound in lymph nodes - a pre-clinical study.","authors":"Sandra Sjöstrand, M. Bacou, Katarzyna Kaczmarek, M. Evertsson, I. Svensson, A. Thomson, S. Farrington, S. Moug, T. Jansson, C. Moran, H. Mulvana","doi":"10.1259/bjr.20211128","DOIUrl":"https://doi.org/10.1259/bjr.20211128","url":null,"abstract":"OBJECTIVES\u0000Despite advances in MRI the detection and characterisation of lymph nodes in rectal cancer remains complex, especially when assessing the response to neo-adjuvant treatment. An alternative approach is functional imaging, previously shown to aid characterization of cancer tissues. We report proof of concept of the novel technique Contrast-Enhanced Magneto-Motive Ultrasound (CE-MMUS) to recover information relating to local perfusion and lymphatic drainage, and interrogate tissue mechanical properties through magnetically induced deformations.\u0000\u0000\u0000METHODS\u0000The feasibility of the proposed application was explored using a combination of experimental animal and phantom ultrasound imaging, along with finite element analysis. First, contrast enhanced ultrasound imaging on one wild type mouse recorded lymphatic drainage of magnetic microbubbles after bolus injection. Second, tissue phantoms were imaged using MMUS to illustrate the force- and elasticity dependence of the magneto-motion. Third, the magneto-mechanical interactions of a magnetic microbubble with an elastic solid were simulated using finite element software.\u0000\u0000\u0000RESULTS\u0000Accumulation of magnetic microbubbles in the inguinal lymph node was verified using contrast enhanced ultrasound, with peak enhancement occurring 3.7 s post injection. The magnetic microbubble gave rise to displacements depending on force, elasticity, and bubble radius, indicating an inverse relation between displacement and the latter two.\u0000\u0000\u0000CONCLUSIONS\u0000Combining magnetic microbubbles with MMUS could harness the advantages of both techniques, to provide perfusion information, robust lymph node delineation and characterisation based on mechanical properties.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000(a)Lymphatic drainage of magnetic microbubbles visualised using contrast enhanced ultrasound imaging and (b) magneto-mechanical interactions between such bubbles and surrounding tissue could both contribute to (c) robust detection and characterisation of lymph nodes.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126161386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Nair, R. Syed, I. Chan, N. Gorelik, J. Chankowsky, R. del Carpio-O'Donovan
The lacrimal gland is a bilobed serous gland located in the superolateral aspect of the orbit. Lacrimal system pathologies can be broadly divided into pathologies of the lacrimal gland and those of the lacrimal drainage system. These include distinct congenital, infectious, inflammatory, and benign, indeterminate, and malignant neoplastic lesions. Trauma and resultant fractures affecting lacrimal drainage apparatus is not part of this review; only non-traumatic diseases will be discussed. CT is the initial modality of choice because of its ability to delineate lacrimal system anatomy and demonstrate most lacrimal drainage system abnormalities and their extent. It also assesses bony architecture and characterizes the osseous changes. MRI is helpful in further characterizing these lesions and better assessing involvement of the surrounding soft tissue structures. In this pictorial review, we hope to revisit the anatomy of the lacrimal system, describe CT/MRI findings of the common/uncommon lacrimal system abnormalities and discuss relevance of imaging with regards to patient management.
{"title":"The forgotten lacrimal gland and lacrimal drainage apparatus: Pictorial review of CT and MRI imaging findings and differential diagnosis.","authors":"J. Nair, R. Syed, I. Chan, N. Gorelik, J. Chankowsky, R. del Carpio-O'Donovan","doi":"10.1259/bjr.20211333","DOIUrl":"https://doi.org/10.1259/bjr.20211333","url":null,"abstract":"The lacrimal gland is a bilobed serous gland located in the superolateral aspect of the orbit. Lacrimal system pathologies can be broadly divided into pathologies of the lacrimal gland and those of the lacrimal drainage system. These include distinct congenital, infectious, inflammatory, and benign, indeterminate, and malignant neoplastic lesions. Trauma and resultant fractures affecting lacrimal drainage apparatus is not part of this review; only non-traumatic diseases will be discussed. CT is the initial modality of choice because of its ability to delineate lacrimal system anatomy and demonstrate most lacrimal drainage system abnormalities and their extent. It also assesses bony architecture and characterizes the osseous changes. MRI is helpful in further characterizing these lesions and better assessing involvement of the surrounding soft tissue structures. In this pictorial review, we hope to revisit the anatomy of the lacrimal system, describe CT/MRI findings of the common/uncommon lacrimal system abnormalities and discuss relevance of imaging with regards to patient management.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134011211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Tramacere, S. Arcangeli, R. Colciago, R. Lucchini, F. Pati, M. Portaluri
OBJECTIVES We aimed to analyze the impact of a 3 week schedule of HypoFractionated (HF) radiotherapy (RT) after axillary dissection and breast surgery, in terms of safety and efficacy in patients with locally advanced Breast Cancer (BC). METHODS Eligible patients were females with stage IIA - IIIC BC who underwent axillary dissection and breast surgery, either quadrantectomy or mastectomy. HF RT was delivered in 15 or 16 fractions for a total dose of 40.05 Gy or 42.56 Gy, respectively, to the clavicular nodal region along with the whole breast (HF WBRT) or the chest wall (HF PMRT), according to the type of surgery. Loco-regional recurrence (LRR), distant metastases free survival (DMFS), overall survival (OS) and acute and late treatment-related toxicities were estimated. RESULTS 57 patients with a median age of 60 years (32 - 85) were retrospectively analyzed. 34 (60%) of patients underwent breast conservative surgery in the form of quadrantectomy and 23 (40%) were offered radical mastectomy. All patients underwent hypofractionated regional nodal irradiation (HF RNI). Thirty-four (60%) of them underwent HF WBRT, while 23 (40%) received HF PMRT.At a median follow-up of 80 months (30 - 113), the 7-year LRR-free survival was 93% (95% CI, 74% - 95%). The same features for DMFS and OS were 76% (95% CI, 52% - 78%) and 67% (95% CI, 50% - 80%), respectively. Only 1 (2%) patient experienced G3 acute skin toxicity. No grade ≥ 2 late toxicity was observed. CONCLUSIONS Our study shows that HF RNI with HF RT to the whole breast or the chest wall after breast surgery is safe and effective in patients with locally advanced BC. Longer follow up is needed to strengthen further analyses on late toxicity and clinical outcomes. ADVANCES IN KNOWLEDGE This paper adds to the evidence that postoperative RNI with WBRT or PMRT can be safely and effectively delivered with 3-week hypofractionated (HF) regimen. Locally advanced BC patients can be offered HF RT to the regional nodes and the breast or the chest wall regardless the type of surgery.
{"title":"Outcomes and toxicity following postoperative hypofractionated radiotherapy to the regional nodes and the breast or the chest wall in locally advanced breast cancer.","authors":"F. Tramacere, S. Arcangeli, R. Colciago, R. Lucchini, F. Pati, M. Portaluri","doi":"10.1259/bjr.20211299","DOIUrl":"https://doi.org/10.1259/bjr.20211299","url":null,"abstract":"OBJECTIVES\u0000We aimed to analyze the impact of a 3 week schedule of HypoFractionated (HF) radiotherapy (RT) after axillary dissection and breast surgery, in terms of safety and efficacy in patients with locally advanced Breast Cancer (BC).\u0000\u0000\u0000METHODS\u0000Eligible patients were females with stage IIA - IIIC BC who underwent axillary dissection and breast surgery, either quadrantectomy or mastectomy. HF RT was delivered in 15 or 16 fractions for a total dose of 40.05 Gy or 42.56 Gy, respectively, to the clavicular nodal region along with the whole breast (HF WBRT) or the chest wall (HF PMRT), according to the type of surgery. Loco-regional recurrence (LRR), distant metastases free survival (DMFS), overall survival (OS) and acute and late treatment-related toxicities were estimated.\u0000\u0000\u0000RESULTS\u000057 patients with a median age of 60 years (32 - 85) were retrospectively analyzed. 34 (60%) of patients underwent breast conservative surgery in the form of quadrantectomy and 23 (40%) were offered radical mastectomy. All patients underwent hypofractionated regional nodal irradiation (HF RNI). Thirty-four (60%) of them underwent HF WBRT, while 23 (40%) received HF PMRT.At a median follow-up of 80 months (30 - 113), the 7-year LRR-free survival was 93% (95% CI, 74% - 95%). The same features for DMFS and OS were 76% (95% CI, 52% - 78%) and 67% (95% CI, 50% - 80%), respectively. Only 1 (2%) patient experienced G3 acute skin toxicity. No grade ≥ 2 late toxicity was observed.\u0000\u0000\u0000CONCLUSIONS\u0000Our study shows that HF RNI with HF RT to the whole breast or the chest wall after breast surgery is safe and effective in patients with locally advanced BC. Longer follow up is needed to strengthen further analyses on late toxicity and clinical outcomes.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000This paper adds to the evidence that postoperative RNI with WBRT or PMRT can be safely and effectively delivered with 3-week hypofractionated (HF) regimen. Locally advanced BC patients can be offered HF RT to the regional nodes and the breast or the chest wall regardless the type of surgery.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120849372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Masaoki Kusunoki, T. Nakayama, A. Nishie, Y. Yamashita, K. Kikuchi, M. Eto, Y. Oda, K. Ishigami
OBJECTIVES To develop and validate deep convolutional neural network (DCNN) models for the diagnosis of adrenal adenoma (AA) using CT. METHODS This retrospective study enrolled 112 patients who underwent abdominal CT (non-contrast, early, and delayed phases) with 107 adrenal lesions (83 AAs and 24 non-AAs) confirmed pathologically and with eight lesions confirmed by follow-up as metastatic carcinomas. Three patients had adrenal lesions on both sides. We constructed 6 DCNN models from 6 types of input images for comparison: non-contrast images only (Model A), delayed Phase images only (Model B), three phasic images merged into a 3-channel (Model C), relative-washout-rate (RWR) image maps only (Model D), non-contrast and RWR maps merged into a 2-channel (Model E), and delayed phase and RWR maps merged into a 2-channel (Model F). These input images were prepared manually with cropping and registration of CT images. Each DCNN model with six convolutional layers was trained with data augmentation and hyper-parameter tuning. The optimal threshold values for binary classification were determined from the receiver-operating characteristic curve analyses. We adopted the nested cross-validation method, in which the outer 5-fold cross-validation was used to assess the diagnostic performance of the models and the inner 5-fold cross-validation was used to tune hyperparameters of the models. RESULTS The AUCs with 95% confidence intervals of Models A-F were 0.94 [0.90, 0.98], 0.80 [0.69, 0.89], 0.97 [0.94, 1.00], 0.92 [0.85, 0.97], 0.99 [0.97, 1.00] and 0.94 [0.86, 0.99], respectively. Model E showed high AUC greater than 0.95. CONCLUSION DCNN models may be a useful tool for the diagnosis of AA using CT. ADVANCES IN KNOWLEDGE The current study demonstrates a deep learning-based approach could differentiate adrenal adenoma from non-adenoma using multiphasic CT.
{"title":"A deep learning-based approach for the diagnosis of adrenal adenoma: A new trial using CT.","authors":"Masaoki Kusunoki, T. Nakayama, A. Nishie, Y. Yamashita, K. Kikuchi, M. Eto, Y. Oda, K. Ishigami","doi":"10.1259/bjr.20211066","DOIUrl":"https://doi.org/10.1259/bjr.20211066","url":null,"abstract":"OBJECTIVES\u0000To develop and validate deep convolutional neural network (DCNN) models for the diagnosis of adrenal adenoma (AA) using CT.\u0000\u0000\u0000METHODS\u0000This retrospective study enrolled 112 patients who underwent abdominal CT (non-contrast, early, and delayed phases) with 107 adrenal lesions (83 AAs and 24 non-AAs) confirmed pathologically and with eight lesions confirmed by follow-up as metastatic carcinomas. Three patients had adrenal lesions on both sides. We constructed 6 DCNN models from 6 types of input images for comparison: non-contrast images only (Model A), delayed Phase images only (Model B), three phasic images merged into a 3-channel (Model C), relative-washout-rate (RWR) image maps only (Model D), non-contrast and RWR maps merged into a 2-channel (Model E), and delayed phase and RWR maps merged into a 2-channel (Model F). These input images were prepared manually with cropping and registration of CT images. Each DCNN model with six convolutional layers was trained with data augmentation and hyper-parameter tuning. The optimal threshold values for binary classification were determined from the receiver-operating characteristic curve analyses. We adopted the nested cross-validation method, in which the outer 5-fold cross-validation was used to assess the diagnostic performance of the models and the inner 5-fold cross-validation was used to tune hyperparameters of the models.\u0000\u0000\u0000RESULTS\u0000The AUCs with 95% confidence intervals of Models A-F were 0.94 [0.90, 0.98], 0.80 [0.69, 0.89], 0.97 [0.94, 1.00], 0.92 [0.85, 0.97], 0.99 [0.97, 1.00] and 0.94 [0.86, 0.99], respectively. Model E showed high AUC greater than 0.95.\u0000\u0000\u0000CONCLUSION\u0000DCNN models may be a useful tool for the diagnosis of AA using CT.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000The current study demonstrates a deep learning-based approach could differentiate adrenal adenoma from non-adenoma using multiphasic CT.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"38 11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128518587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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