British Journal of Radiology最新文献

Objectives: Anaphylactic reactions are dramatic and life-threatening. According to international guidelines, the immediate intramuscular administration of adrenaline is the most important first step for acute management. The aim of this study is to determine whether doctors can recognize and treat severe anaphylactic reactions to contrast agents adequately.

Methods: In this study, 95 doctors were interviewed between January and June 2023 in European clinics that are not affiliated with the authors. Ninety-five doctors from radiology, internal medicine, and anaesthesia departments were randomly selected for interviews. A video was prepared simulating a male patient developing a severe anaphylactic reaction during CT after intravenous administration of an iodinated contrast medium. After the video, 95 doctors were interviewed (59 radiologists, 19 internists, and 17 anaesthesiologists). The doctors were asked 3 questions: (1) What is the diagnosis? (2) What is the therapy of choice? (3) Can you demonstrate the correct way to operate the adrenaline autoinjector?

Results: All 95 doctors made the correct diagnosis (100%). Sixty-three of 95 physicians (66%) were uncertain regarding the appropriate first-line therapy. This was observed across all three medical specialties (internal medicine, anaesthesiology, and radiology) (P = .64). Sixty-five physicians (68%) had difficulties triggering the autoinjection system successfully.

Conclusions: Acute anaphylaxis is life-threatening, but there is uncertainty among professional groups about initiating acute management. Refresher training should be considered to ensure timely and appropriate treatment of the condition when it occurs.

Advances in knowledge: This study highlighted significant gaps in physicians' real-world readiness to manage acute anaphylaxis, despite all doctors correctly diagnosing the condition.

Objectives: Incidence of small renal masses (SRMs) including renal cell carcinoma (RCC) is increasing. Standard of care is to offer partial nephrectomy (PN), with tumour ablation (TA) considered an alternative in frail/co-morbid patients. This study aimed to determine whether microwave ablation (MWA) is a safe and effective treatment for selected cases of RCC.

Methods: All MWAs performed at a regional tertiary care centre between October 2016 and April 2024 were prospectively recorded on a database. Data collected included tumour and patient characteristics, complications, and recurrences.

Results: Two hundred and nine MWAs were recorded with median 37 months (interquartile range [IQR] 15.3-59.4 months) follow-up. About 94.7% of patients had ≥12 months of follow-up. The biopsy rate was 92%. Following MWA, 93% of patients had a hospital stay of 1 night. Two Clavien-Dindo grade ≥III complications occurred within 30 days (0.96%). Local and metastatic recurrence rates were 5.9% and 2.7%, respectively.

Conclusions: MWA was a safe, effective treatment for SRMs in this large cohort which included young, fit patients and underwent long-term follow-up. Recovery times were short, with low complication rates and favourable oncological outcomes in biopsy-proven T1 RCC <5 cm.

Advances in knowledge: The current study demonstrates a large, diverse MWA cohort (including T1b tumours) with high biopsy rate, minimal loss to follow-up, and long follow-up period facilitating assessment of long-term oncological outcomes in biopsy-proven RCC. The results support MWA as a safe, effective treatment for cT1a RCC that should be offered to patients as part of shared decision making.

Radiotherapy treatment can have transformative effects on a patient's overall health and wellbeing, yet current funding models are constrained to curative and palliative aspects of treatment delivery. This therapeutic focus, obscures wider costs associated with radiotherapy, both at a service level and for individual patients and their families. It is essential that policy and services consider quality of life after treatment, including identification and management of long-term side effects. Currently, a lack of service provision means that many patients have no access to services equipped to manage late toxicity or are utilising inappropriate services for their needs which could also be more costly for commissioners. As Integrated Care Boards (ICBs) take greater responsibility for the whole cancer pathway there are potential patient and cost benefits of rolling out more supportive oncology and late effects services. This should be supported with better data, including Patient Reported Data (PRD) and research on the level of need for broader aspects of radiotherapy and post treatment aspects of patient experience.

Objectives: Assessment of patient dose is a critical quality assurance check towards ensuring it is kept as low as reasonably practicable. One metric used to evaluate this is entrance surface dose (ESD)-the summed magnitudes of the incident radiation and Compton scatter resulting from photon interactions within tissue. ESD can be directly measured using a dosemeter that is sensitive to backscattered radiation. However, the increasing use of solid-state detectors such as the tin backed RaySafe X2 R/F detector, means that ESD cannot be directly measured. The IAEA Technical Report No.457, recommends using backscatter factors (BSFs) as calculated by Petoussi-Henss et al in 1998 via Monte Carlo methods when measuring ESD using such dosemeters. This research seeks to practically determine a reliable method of calculating the BSF using a polymethylmethacrylate (PMMA) patient-equivalent phantom.

Methods: A comparison between the solid-state detector and an ionization chamber capable of detecting backscatter was conducted. Special attention was given to BSF variation with both radiation field size and beam quality by varying additional copper and aluminium filtration to mimic the behaviour of patient-dose reducing techniques on modern fluoroscopy systems.

Results: Results have shown significant correspondence with those of Petoussi-Henss et al using the simulated water and International Commission on Radiation Units and Measurements (ICRU) tissue equivalent phantoms.

Conclusions: Given the results consistency, BSFs from this study have been proposed for use when measuring ESD using the RaySafe solid state detector with a PMMA patient-equivalent phantom for quality assurance purposes.

Advances in knowledge: This research provides the opportunity to obtain more accurate patient dose data during quality assurance testing with modern solid-state dosemeters.

Objectives: Magnetic Resonance (MR)-only radiotherapy has been clinically implemented but its dose impact has not been assessed in clinical practice. This study evaluated the volume and dose differences between patients treated with CT-only, MR-CT fusion, or MR-only prostate radiotherapy pathways.

Methods: Four hundred fifty-four patients from a single centre were treated using MR-only (n = 96), CT-only (n = 248), or MR-CT (n = 110) pathways. Patients were selected for different pathways based solely on geographic location and treatment date. Patients were contoured by the same group of delineators and were planned for 60 Gy in 20 fractions by an automated planning algorithm. Clinical Target Volume (CTV), bladder, penile bulb and rectum volumes, and clinical dose constraints were compared with Kurshkal-Wallis tests, adjusted for multiple testing with a P<.05 significance level.

Results: Median MR-only CTVs were 5 cm3 smaller than CT-only (P=.004). Penile bulb Dmean was 12.0 Gy (CT-only), 9.1 Gy (MR-CT), and 5.9 Gy (MR-only, P<.001), with 79.0%, 90.9%, and 95.8% of patients within constraint. Rectum D2 cm3 was 57.4 Gy (CT-only), 57.6 Gy (MR-CT), and 56.5 Gy (MR-only, P<.001), with 35.1%, 20.9%, and 56.2% of patients within rectum V60 Gy constraint.

Conclusions: The MR-only pathway produced significant reductions of 13% in CTV volume, 51% in penile bulb Dmean, and 2% in rectum D2 cm3 compared to CT-only.

Advances in knowledge: The dose benefit from MR-only has been assessed in clinical practice, demonstrating significant reductions in penile bulb and rectum doses compared to both CT-only and MR-CT pathways. This suggests the MR-only pathway is required to provide the full benefit of MR contouring to reduce toxicities from prostate radiotherapy.

Objectives: Hysterosalpingography (HSG) remains the first-line imaging technique for assessing fallopian tube conditions due to its accessibility, cost-effectiveness, and high diagnostic accuracy. Intravasation, the leakage of contrast media into myometrial or vascular structures during HSG, has been documented as a complication. This study aimed to determine the prevalence of intravasation, explore the relationship between intravasation and tubal occlusion, and assess the applicability of grading intravasation.

Methods: A retrospective analysis of 3032 HSG examinations performed between January 2021 and May 2024 was conducted. Intravasation, tubal occlusion, and related findings were recorded using standard X-ray equipment and categorized prospectively. Statistical analysis included logistic regression to identify predictors of tubal occlusion and inter-observer agreement using Fleiss Kappa. Diagnostic metrics for intravasation as a radiological marker of tubal occlusion were calculated.

Results: Intravasation was observed in 2.6% of cases. Among cases with tubal occlusion, 16.4% exhibited intravasation. The sensitivity, specificity, positive predictive value, and negative predictive value of intravasation for detecting tubal occlusion were 14.5%, 99.8%, 92.3%, and 85.6%, respectively. Adjusted odds ratios indicated that intravasation increased the likelihood of tubal occlusion approximately 55-fold. Inter-observer agreement for intravasation detection was almost perfect (Kappa = 0.97). Limitations included the absence of oil-based contrast and a pressure manometer during contrast infusion.

Conclusions: Intravasation, traditionally viewed as a complication, emerges as a significant radiological indicator of tubal occlusion. Incorporating intravasation characteristics, such as initiation time, into grading systems may enhance diagnostic accuracy. Further refinement of classification systems and broader clinical validation are recommended.

Advances in knowledge: About 92.3% of tubes with intravasation were occluded and the site of intravasation correlated with the occlusion site. Occlusion was 55× more likely in cases with intravasation, traditionally viewed as a complication, emerges as a significant radiological indicator of tubal occlusion.

Objectives: This study aims to compare apparent diffusion coefficient (ADC) findings between leiomyosarcoma (LMS) and atypical/degenerate leiomyoma (LM) and evaluate the usefulness of this biomarker for diagnosis. Additionally it will explore the potential of preoperative neutrophil-lymphocyte ratio (NLR) as a haematological marker to aid in the differentiation of LMS from atypical LM.

Methods: Histologically proven LMS and LM patients between 2013 and 2023 were included. For all patients (191 LM, 18 LMS), the preoperative full blood count was analysed, and the NLR calculated. Whole volume of interest (VOI) and focal region of interest (ROI) areas were manually segmented on patients with DW-MRI sequences available (52 LM, 12 LMS). Mann-Whitney and Fishers exact test were used to assess statistical significance and receiver operating characteristic (ROC) curves for diagnostic performance.

Results: VOI and ROI mean ADC values were significantly lower for LMS than LM, with ROI mean ADC demonstrating greater diagnostic accuracy (area under the curve, [AUC] 0.817 vs 0.755). Applying a threshold ROI mean ADC value of ≤1.00 × 10-3 mm2/s achieved a sensitivity and specificity of 88.3% and 65.4%, respectively. A higher NLR was suggestive of LMS (median 2.8 vs 1.7 for LM).

Conclusions: ADC, particularly a focal ROI is useful in differentiating LMS from LM. Differences in preoperative blood markers, suggest an inflammatory-malignancy relationship. Future risk stratification models of ADC and haematological parameters should be explored.

Advances in knowledge: This study adds to few studies comparing using both ROI- and VOI-based methods, and no study has assessed both haematological markers and ADC metrics to aid differentiation.

Objective: Primary and secondary hepatic malignancies are a significant cause of cancer-related mortality worldwide. Radioembolization with yttrium-90 (90Y) microspheres has emerged as a promising treatment option for unresectable hepatic tumours. However, the high cost of commercially available Y-90 microspheres, such as 90Y-TheraSphere or 90Y-SirSphere, limits their accessibility in developing countries. We present the first Indian clinical experience of indigenously developed [90Y] Yttria alumino silicate glass microspheres, known as "90Y-BhabhaSphere," for radioembolization of hepatic malignancies.

Methods: "90Y-BhabhaSphere" formulation developed at Bhabha Atomic Research Centre (BARC), Mumbai, was used to treat a small cohort of 5 patients with unresectable hepatic malignancies. The 90Y-BhabhaSphere delivery system was developed through a rigorous process and in vitro tested using a microcatheter connection to simulate the transarterial radioembolization (TARE) procedure. Feasibility, safety, delivery efficiency, and preliminary efficacy of treatment using 90Y-BhabhaSphere were assessed.

Results: Our initial clinical experience with 90Y-BhabhaSphere demonstrates its safety and feasibility in treating hepatic malignancies. 90Y-BhabhaSphere demonstrated excellent delivery efficiency, reaching 99% in vitro (dummy run) and 97% in vivo (clinical delivery) 90Y-BhabhaSphere was successfully administered to 4 patients, whereas in 1 patient, the delivery had to be terminated due to a leakage in the delivery system. The treatment was well-tolerated, with minimal adverse effects. Preliminary efficacy analysis shows promising results, with a significant reduction in tumour size and improvement in liver function.

Conclusion: 90Y-BhabhaSphere offers a cost-effective alternative to commercially available 90Y-microspheres. Our initial clinical experience demonstrates its safety, feasibility, and preliminary efficacy in treating hepatic malignancies. Large clinical trials need to be conducted to establish the long-term efficacy and safety of 90Y-BhabhaSphere.

Advances in knowledge: This study highlights a key advantage of 90Y-BhabhaSphere: its significantly higher specific activity (approximately 6000 Bq/sphere) compared to commercially available 90Y-TheraSphere (2700 Bq/sphere). This suggests a potential for delivering higher tumour doses while minimizing radiation exposure to healthy liver tissue, thereby reducing the risk of radiation-induced liver damage.

Radiotherapy providers are dependent on capital investment in equipment, which makes up 62% of the cost of delivering radiotherapy. The commissioning of radiotherapy services and duty to replace equipment is currently held by NHS England, but this responsibility and funding will be delegated to all Integrated Care Boards (ICBs). With constraints in national health capital spend over the past decade leaving radiotherapy infrastructure depleted, ICBs are set to inherit an expensive task of updating and replacing radiotherapy equipment. The upcoming National Cancer Plan presents the opportunity for a long-term solution to the renewal and investment in radiotherapy equipment, through rolling ringfenced funding from Government.This paper is part of a series of three papers, on (1) radiotherapy tariff, (2) radiotherapy capital spending and (3) holistic aspects of radiotherapy funding, which together consider what a sustainable, innovative and person centred radiotherapy funding model looks like as specialised services are delegated to Integrated Care Boards.

Objectives: This study aimed to describe pregnancy and maternal outcomes according to radiation doses received to the uterus during photon beam therapy in the French Childhood Cancer Survivor Study (FCCSS) cohort.

Methods: Of the 7670 5-years survivors, 1159 women treated by radiotherapy and with no hysterectomy, followed between 2006 and 2018 were included. Uterus dose were reconstructed within phantoms modelling patient's anatomy in treatment position. A statistical analysis was performed including demographic information, treatment variables, and co-factors.

Results: Among 1159 women, 297 (25.6%) had at least 1 pregnancy, of whom 105/297 (35.3%) had a uterine dose of Dmedian > 1Gy. The proportion of ectopic pregnancy, spontaneous and medical abortions was 20.3% (101/498) and increased to 39% if Dmedian_uterus > 20Gy, versus 12% reported in the French's general population. When medical pregnancy terminations were excluded, significant associations with an increase in risks were found for women who were older than 40 at the time of pregnancy and Dmedian_uterus > 20Gy. Two women whose entire uterus received over 40 Gy had 1 pregnancy, resulting in a live birth. One woman passed away due to haemorrhage during delivery, treated at age 16 with D80%uterus = 35Gy. No other delivery-related deaths were reported.

Conclusion: Assessing the dose to the uterus for pelvic irradiation treatments is necessary, and volume receiving 20 Gy should be minimized. Even if pregnancy is feasible after really high dose received on the uterus (Dmean > 40Gy), a close obstetrical monitoring is recommended, and home delivery should be contraindicated due to the risk of vital haemorrhage.

Advances in knowledge: This article provides valuable data between radiation dose to the uterus and pregnancy outcomes.