BJR open最新文献

Mediastinal masses represent a heterogeneous group of entities characterized by a variety of histopathological and radiological features. Imaging plays a pivotal role in the detection and interpretation of mediastinal abnormalities. CT remains the modality of choice due to its high spatial and temporal resolution and its ability to assess tissue composition, including the detection of fluid, fat, and calcifications. MRI represents a complementary tool in specific scenarios, such as differentiating complicated cysts from solid lesions or identifying intracellular fat content, as seen in thymic hyperplasia. The differential diagnosis of mediastinal masses relies primarily on the location of the mass and tissue composition, integrated with clinical characteristics of the patient. This review discusses the most common mediastinal masses in adults, providing a practical approach to their differentiation mainly based on the predominant density pattern and location.

Objectives: This work describes a unified workflow for classifying patterns of locoregional recurrence (LRR) using radiotherapy planning dose distributions. This approach aims to incorporate dose parameters into LRR classifications and facilitate application across different treatment sites and dose prescriptions to standardise classification terminology.

Methods: The relapse diagnostic CT (rCT) and manually delineated relapse gross tumour volume (rGTV) were co-registered with the radiotherapy planning CT (pCT) using deformable image registration (DIR). The DIR accuracy was quantified using the target registration error (TRE) using the absolute centroid distance between cancer site-specific regions of interest (ROIs). Dosimetric structures were delineated for planning regions receiving 95% of the dose prescribed to high-risk, intermediate-risk, and low-risk CTVs, relative to the cancer site or trial. The mapped rGTV was compared relative to each dose structure and classified into one of five categories: central and peripheral high-dose (Type A, Type B), central and peripheral elective-dose (Type C, Type D), and extraneous dose (Type E) failures.

Results: The unified workflow was successfully implemented on two different patient use cases, one from the IMPORT HIGH breast cancer trial, one from the VoxTox head-and-neck study, classifying LRR as Type A and Type E failures, respectively.

Conclusion: This workflow for classifying LRR is applicable across different cancer sites, despite differences in treatment protocol, target dose, and dose delivery. This provides a basis for utilising radiotherapy dose distributions to analyse patterns of failure irrespective of trial design or cancer-site.

Advances in knowledge: Standardised classifications of LRR that are correlated with the planning dose distribution could provide insight into the underlying causes of LRR burden post-radiotherapy and allow for critical evaluation of the current concepts of defined clinical tumour volumes and optimal PTV dose regions.

Objectives: Artificial intelligence (AI) deep learning algorithms trained on non-contrast CT scans effectively detect and quantify acute COVID-19 lung involvement. Our study explored whether radiological contrast affects the accuracy of AI-measured lung opacities, potentially impacting clinical decisions. We compared lung opacity measurements from AI software with visual assessments by radiologists using CT pulmonary angiography (CTPA) images of early-stage COVID-19 patients.

Methods: This prospective single-centre study included 18 COVID-19 patients who underwent CTPA due to suspected pulmonary embolism. Patient demographics, clinical data, and 30-day and 90-day mortality were recorded. AI tool (Pulmonary Density Plug-in, AI-Rad Companion Chest CT, SyngoVia; Siemens Healthineers, Forchheim, Germany) was used to estimate the quantity of opacities. Visual quantitative assessments were performed independently by 2 radiologists.

Results: There was a positive correlation between radiologist estimations (r ² = 0.57) and between the AI data and the mean of the radiologists' estimations (r ² = 0.70). Bland-Altman plot analysis showed a mean bias of +3.06% between radiologists and -1.32% between the mean radiologist vs AI, with no outliers outside 2×SD for respective comparison.

The AI protocol facilitated a quantitative assessment of lung opacities and showed a strong correlation with data obtained from 2 independent radiologists, demonstrating its potential as a complementary tool in clinical practice.

Conclusion: In assessing COVID-19 lung opacities in CTPA images, AI tools trained on non-contrast images, provide comparable results to visual assessments by radiologists.

Advances in knowledge: The Pulmonary Density Plug-in enables quantitative analysis of lung opacities in COVID-19 patients using contrast-enhanced CT images, potentially streamlining clinical workflows and supporting timely decision-making.

Objective: A Linac Replacement Programme (LRP) was completed to ensure continuity of treatment whilst maintaining the highest standards of care. Clinical contingencies were devised to mitigate the impact of unscheduled interruptions during the LRP. This service evaluation was undertaken to appraise the effectiveness of contingencies on treatment delivery (TD) during the LRP.

Method: The oncology management system MOSAIQ was used to generate reports of treatment adjustments. These reports were then generated for Linac service history in the 2019-2020 year for comparative analysis and causative factors in Linac breakdowns. Adjustments to treatment were analysed for each patient.

Results: Of the 855 patients receiving treatment during the LRP, 184 were impacted in some way. Of these, 113 experienced some increase in overall treatment time (OTT); 742 (86.8%), therefore, experienced no increase in OTT, through deployment of clinical contingencies or not encountering machine breakdown during their treatment schedules. Throughout the LRP, Conebeam CT (CBCT) faults were the primary cause for machine closure. Due to this, breast patients remained on treatment at a higher rate than prostate patients who required 3D-geometric verification prior to TD.

Conclusions: This project highlighted the importance of preparation for CBCT faults and patient categorization in the development of contingencies. The extended dose and fractionation 60 Gy in 20# presented increased opportunities for cancellation in prostate patients, however, the use of MV imaging to assess patient set-up enabled continuation of TD. Increases in OTT could not be eliminated completely, however, for 21.5% of patients who experienced treatment adjustments the implementation of contingencies effectively prevented them exceeding Royal College of Radiologists guidance of 2-day extension in OTT.

Advances in knowledge: We believe this radiographer-led project is the first service evaluation reporting the practical effects on treatment of a LRP and impact of clinical contingencies used to mitigate and limit unscheduled interruptions in treatment and minimize the extension of OTT for patients during the transition.

Acute pulmonary emboli can manifest as a spectrum of physiological status ranging from an incidental finding to life threatening right heart failure. We discuss the crucial role imaging plays in the accurate and rapid diagnosis. In addition, imaging features are central in assessing the severity of the presentation allowing for appropriate risk stratification and escalation of care. The relative strengths of the various imaging modalities used in the management of chronic thromboembolic pulmonary hypertension are also discussed.

Ultrasound is as accurate as MRI in the detection of most brachial pathologies but tends to be underutilized in clinical practice compared to MRI. The main reason for this under-usage is a relative lack of knowledge regarding how to perform brachial plexus ultrasound and a lack of awareness of the ultrasound appearances of brachial pathologies. This review serves to re-address this imbalance by providing a practical overview on how to perform brachial plexus ultrasound as well as highlighting the ultrasound appearances of common pathologies likely to be encountered in everyday clinical practice.

Objective: Assessing the frequency of ovarian metastasis from nonovarian cancer (N-OC) and evaluate whether any PET-derived parameters can distinguish metastasis from primary ovarian cancer.

Methods: Patients undergoing FDG PET/CT due to suspected ovarian malignancy from 2006 to 2021 with subsequent histologically proven ovarian metastasis from N-OC were included. Exclusion criteria included ovarian metastasis diagnosed prior to PET/CT or >3 months after. Baseline characteristics were collected from electronic medical records, and PET/CT data were analysed using Siemens syngo.via software.

Results: Patients (N =1502) were scanned for suspected ovarian malignancies. Sixty-five patients (4%) were included. The most common origin of metastases was lower gastrointestinal cancer (n = 29, 45%), followed by gynaecological cancer (n = 10, 15%) and breast cancer (n = 9, 14%). Among patients with previous cancer history (n = 26), 18 experienced ovarian metastases from a known cancer. Time from primary diagnosis to ovarian metastasis ranged from 47 days to 11.4 years. There were no differences in maximized standardized uptake value, peak standardized uptake value, or clinical parameters between ovarian metastases and primary ovarian tumours.

Conclusion: The frequency of ovarian metastases from N-OCs was 4%, the most common origin of metastases was lower gastrointestinal tract. Previous cancer history is an important factor in assessing an unknown tumour of the ovary, as metastases can occur several years later. No PET or clinical parameters were useful for separating primary ovarian cancer from ovarian metastases.

Advances in knowledge: The study finds a low frequency of ovarian metastasis from N-OC and indicates that no PET or clinical parameters can distinguish ovarian metastasis from primary ovarian cancer.

Objectives: The purpose of the present study was to evaluate outcomes with radiation therapy (RT) in multimodality treatment for inoperable hepatocellular carcinoma (HCC) with portal vein tumour thrombosis (PVTT).

Methods: The present retrospective study included 24 patients without extrahepatic metastases. The patients had received drug eluting beads - transarterial chemoembolization (DEB-TACE) (n = 10) and systemic treatment (n = 14) before RT. The dose fractionation was 12-31.5 Gy in 3-7 fractions of 4-5 Gy to PVTT or PVTT plus the liver parenchymal tumour. All patients were advised systemic treatment with sorafenib, lenvatinib, or nivolumab after RT. After RT, patients had received DEB-TACE within 8 weeks (n = 2) or at 5-10 months (n = 3). Treatment response was evaluated as per mRECIST and PERCIST, and Kaplan-Meier survival analysis was performed.

Results: The disease control rate in PVTT was 50% at 3 months. The median overall survival (OS) was 10.9 months (95% CI, 0.74-21) for all patients. The 6-month, 1-year, 2-year, and 3-year OS rates were 75%, 45.8%, 25%, and 12.5%, respectively. The median OS was 30.4 months (95% CI, 12.1-48.7) versus 18.1 months (0.00-38.8) with complete or partial response versus stable or progressive disease in PVTT (P = .036). Eleven patients had a decline in Child Pugh score of 2 or more points within 3 months after RT. One patient underwent live donor liver transplantation (LDLT) and complete necrosis with no viable tumour was observed in the explant. The patient is cancer- and liver disease-free at 1 year after LDLT.

Conclusions: The present study showed the benefit of radiotherapy with systemic therapy and DEB-TACE in patients with HCC with PVTT.

Advances in knowledge: Radiotherapy as part of the multimodality treatment offers the potential to improve disease control and survival in patients with HCC with PVTT.

Objectives: Determine the incidence, location, and features of insufficiency fractures (IFs) in sacral chordoma patients treated with high-dose radiation therapy (HDR) with(out) resection, relative to radiation therapy type and irradiation plans.

Methods: Clinical data, including details of all surgical procedures and radiotherapies of patients histologically diagnosed with sacral chordoma between 2008 and 2023 available at our database, were retrospectively reviewed. Inclusion criteria were as follows: availability of diagnostic, treatment planning and follow-up magnetic resonance and/or computed tomography scans, and completed treatment. Scans were re-evaluated for the presence and location of IF defined as linear abnormalities with(out) bone marrow oedema (BME)-like changes.

Results: From 48 included patients (29 male, median age 66, range 27-85), 22 were diagnosed with 56 IF (45.8%). IF occurred 3-266 months following the treatment. All sacral and iliac bone IF had vertical components parallel to the SI joint. Twenty patients had bilateral and 16 unilateral IF. BME-like changes were visible in 46 IF (82.1%, 0.80, P ≤ .001). In 13/56 IF (23.2%), BME-like changes were seen prior to IF diagnosis; in only 1 patient, BME-like changes did not develop into an IF. Thirty-nine IF (84.7%) occurred within low-dose volume and 7 (15.3%) outside of irradiated volume in 16/44 irradiated patients. Six IF occurred in 1 patient treated with surgery only.

Conclusions: Pelvic IFs are common in sacral chordoma patients treated with definitive or (neo)adjuvant HDR, occurring months to years following treatment. Not all IF occur in the irradiated volume.

Advances in knowledge: When present, BME-like changes indicate risk of IF developing. IF do not heal over time.

Objectives: To establish a link between radiation dosimetry and disability-adjusted life-years (DALY) with the aim of quantifying the justification of medical exposures.

Methods: The health detriment, defined as lifetime loss of DALY at age of exposure to ionizing radiation for a US-European population was calculated. A simple model of the relationship was fitted to the results. Apart from in late life within the latency period for radiation-induced cancers, most of the relationship can be adequately fitted to a straight line of negative gradient. The gradient of this line corresponds to a loss of DALY per year following exposure to radiation and is therefore equivalent to a disability weight (DW) used in the calculation of DALY.

Results: Radiation dose-dependent DWs for radiation exposure to a US-European population are estimated as 0.020 DALY/yr/Sv for males and 0.022 DALY/yr/Sv for females.

Conclusions: By comparing a range of 66 radiological examinations in terms of the DWs of the disease or injury states with the DWs resulting from the associated radiological exposures, it is demonstrated graphically that the resulting benefit is far greater than the detriment in every case.

Advances in knowledge: The definition of a DW for ionizing radiation, proportional to effective dose as currently defined, can link radiation exposure to the existing large body of data on the DALY burden and DWs for a wide range of diseases and injuries, providing a means for the quantitative justification of the benefit-detriment balance of medical exposures.