International Journal of Radiation Research
Volume:21 Issue: 3, Jul 2022

Dosimetry calculations in radioembolization therapy are known to include some uncertainties due to working assumptions. First, the microspheres used in the procedure are homogeneously distributed within the tumor volume. Second, Medical Internal Radiation Dosimetry (MIRD) method of dose calculation involves a mono-compartmental model only. To minimize the impact of these uncertainties, this study proposes Monte Carlo (MC) simulations as an alternative to MIRD method to verify the absorbed doses in the volumes of interest (tumor and its surroundings). 

Lung, liver, and tumor volumes of 30 radioembolization patients were defined in a mathematical whole-body phantom and MC simulations were performed using Monte Carlo N-Particle code. Absorbed doses were calculated for these tissues both in addition to stomach wall, pancreas, spleen, and kidneys which are close to the tumor volume being treated with microspheres of radioembolization therapy containing the beta-emitting 90Y radioisotope.

The doses absorbed by tumor, lung, and liver volumes of each patient were calculated by both MIRD methodology and MC simulations. The differences between the two methods were evaluated for normal lung tissue and tumor tissues in the liver where maximum differences were observed for tumor tissues (16.18%) and lungs (11.69%). Furthermore, it was observed through MC simulations; the organs that are close to the liver being treated were also exposed to the radiation for which absorbed doses could not be calculated by MIRD method.

MC simulations may offer significant advantages for dose verification in radioembolization therapy.

Due to the excellent physical and biochemical characteristics of 68Ga, 68Ga-1,4,7-triazacy–clononane–glutaric acid– 4,7 acetic acid- arginyl-glycyl-aspartic acid- bombesin (68Ga-NODAGA-RGD-BBN) was prepared as a new positron emission tomography (PET) imaging agent, and afterward, the preclinical evaluation of this labeled peptide was studied.

68Ga radioisotope was extracted from a 68Ge/68Ga generator with high radionuclide, chemical and radiochemical purities. Then; the 68Ga-NODAGA-RGD-BBN radiolabeled complex was prepared at optimized conditions. The stability of the complex was evaluated in phosphate-buffered saline (PBS) for at least 2 h. Cell studies of the radiolabeled peptide were also assessed on the gastrin releasing peptide receptor (GRPR)-expressing cell line. Finally; the biodistribution and whole-body scan imaging study of 68Ga-NODAGA-RGD-BBN was studied in normal and tumor-bearing mice.

The biodistribution and whole-body scan imaging of the radiolabeled compound on GRPR-expressing tumor-bearing mice demonstrated the high uptake in the tumor site at all post-injection intervals.  The biodistribution results also demonstrated the major excretion route of the complex is the urinary tract.

68Ga-NODAGA-RGD-BBN shows high potential for PET imaging of patients with GRPR-expressing tumors; however, more biological studies are still needed.

We aimed to analyze the value of volume rendering (VR) in diagnosing different solitary pulmonary nodules (SPNs) with diameter less than 1.0 cm and assessing invasion depth in lung adenocarcinoma.

In total, 908 patients with SPN that was confirmed by postoperative pathology were included, followed by an analysis of the imaging characteristics (including microvascular sign, vascular convergence, lobulation, and spiculation) of malignant and benign SPN based on VR. Moreover, the detection rates of imaging signs of three types of malignant SPNs (pure ground grass nodule, pGGN; part-solid nodule; and solid nodule) classified by SPN density and three invasion depths of adenocarcinoma (pre-invasion lesion, PIL; micro invasive adenocarcinoma, MIA; and invasive adenocarcinoma, IAC) were also analyzed.

The microvascular sign detection rate was higher while vascular convergence and spiculation detection rates were lower in malignant SPN than in benign SPN. The microvascular sign possessed high sensitivity (82%) and specificity (72%) in predicting malignant and benign SPNs. The microvascular sign detection rate decreased while vascular convergence, lobulation, and spiculation detection increased with the rising density of malignant SPN. Furthermore, the detection rates of the four imaging signs all increased with the adenocarcinoma invasion depth. Microvascular sign showed good detecting ability in low density SPNs pGGN (81.8%), part-solid nodules (95.8%), and in all three invasion depths of adenocarcinoma (PIL [68.2%], MIS [95.3%], and IAC [87.2%]).

These imaging features distinguished by VR exhibited an excellent differential diagnostic ability of various SPNs as well as invasion depth of lung adenocarcinoma.

The Background Currently, surgical resection of the small and sub-centimeter pulmonary nodules (< 2 cm) is quite challenging via the thoracoscopic procedure. Our retrospective study aimed to evaluate the clinical efficiency of pre-operative CT-guided hook-wire localization of targeted pulmonary nodule patients prior to video-assisted thoracoscopic surgery (VATS) or surgery.

60 patients comprising pre-operative computed tomography (CT)-guided hook-wire localization of pulmonary nodules with < 2 cm diameter were retrospectively enrolled. Herein, we evaluated clinical variables, pathological outcomes, hook-wire localization procedure-related features, and complications from targeted pulmonary nodules patients.

Pre-operative CT-guided hook-wire localization was carried out successfully in 60 (100%) patients with wedge resection 41 (68%), segmentectomy 10 (16.7%), and lobectomy 9 (15%). Hook-wire localization procedure had mean time of 0.91±0.29 h, and 11 (18.3%) blood loss. All pulmonary nodule patients were positive pathological diagnoses for benign or malignant lesions, such as 5 (8.3%) benign lesions, 29 (48.3%) minimal adenocarcinoma (MIA) or invasive adenocarcinoma (IAC), and 21 (33.3%) adenocarcinoma in situ (AIS) malignant lesions. The majority of patients with hook-wire localization were either asymptomatic 19 (31.7%) or shown to have mild pain 25 (41.7%) and irritable cough 7 (11.7%).

Preoperative CT-guided hook-wire localization of pulmonary nodules is safe and effective, which can reduce the operative time of targeted pulmonary nodules, and improvise the safety and outcomes of surgery.

To evaluate the diagnostic performance of different radiomics models for preoperatively predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC).

A total of 124 patients who had histologically confirmed HCC (training dataset: n=86; validation dataset: n=38) were included. Clinical factors (CFs) were extracted from medical data. Radiomics features were derived from the unenhanced phase, artery phase (AP), portal venous phase and delay phase CT images. The least absolute shrinkage and selection operator (LASSO) method was chosen to select the radiomics feature. Twelve models were established using three modeling methods (logistic regression [LR], support vector machine [SVM], and Bayes) with the radiomics signature. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of the models. A radiomics signature that performs well was integrated with the clinical factors into a combined model.

AP radiomics signatures achieved the best efficiency than other radiomics models. The LR model with the AP radiomics signature as the input factor showed better performance than the SVM and Bayes models, with an area under the curve (AUC) of 0.848 in the validation datasets. When integrating the AP radiomics signatures and clinical factors, the combined model performed better and reached an AUC of 0.875 in the validation datasets.

The radiomics model demonstrated excellent performance for preoperatively predicting MVI in patients with HCC, especially the combined model. Different modeling methods could influence the effects of the diagnostic performance.

Bystander (B.s) effect can influence non-irradiated cells and affect the desired effect in cancer treatment. This study was conducted to assess this effect on simultaneous administration of ultrasound (US) and Gold nanoparticles as a sonodynamic therapy (SDT) which is an important newly stimuli-responsive method in cancer treatment.

Firstly, the appropriate concentration of Gold nanoparticles (GNPs) and US intensity for SDT on melanoma cancer cells (A375) were evaluated. After treatments, the target cell culture was transferred to the bystander cells and the induced bystander effects including cell viability, apoptosis, expression of P53 (a promoter of apoptosis gene) and HO-1 (an inhibitor of apoptosis gene) were examined.

According to the MTT results, 50 µg/ml concentration of GNPs and 1.5 W/cm2 intensity of US wave were selected. Our results revealed that SDT induced B.s effect can alter the cell viability and apoptosis up to 20% and 51.61%, respectively. Moreover, a 2.9-fold increase in p53 gene expression and a decrease in OH-1 gene expression to 0.181-fold in comparison to the control groups were observed.

These results confirmed that B.s effect of sonodynamic can reduce the cancerous cell viability. Our finding showed that this treatment can potentially be an alternative to traditional treatment modalities.

To explore the impact of the combined application of multidimensional nursing and early postoperative activities on gastric cancer (GC) patients underwent laparoscopic radical gastrectomy (LRG).

156 GC patients who underwent LRG between January 2020 and December 2021 in our hospital were selected and separated into the observation group (OG) as well as the control group (CG) following the different nursing methods adopted by the patients. The CG carried out conventional nursing, while the OG adopted multidimensional nursing and early postoperative activity intervention. The pain degree, self-living ability, patient’s anxiety and depression, postoperative recovery, nursing satisfaction and adverse reactions of patients in both groups were compared.

After nursing intervention, pain score and anxiety and depression scores of the OG were declined relative to the CG (P<0.05), the recovery time of bowel sounds, first anal exhaust time, first feeding time, first anal defecation time as well as hospitalization time in the OG were lessened relative to the CG (P<0.05), the self-living ability score and nursing satisfaction of patients of the OG were promoted relative to the CG (P<0.05), the occurrence of adverse reaction in the OG was lower relative to the CG (P<0.05).

Multidimensional nursing combined with early activities applied to GC patients undergoing LRG could effectively reduce postoperative pain, promote postoperative gastrointestinal function recovery and promote the self-living ability.

This paper aimed to assess the clinical effects of abdominal aortic balloon occlusion (AABO) under color Doppler ultrasound guidance in treating pelvic tumors.

Various databases, which contained China National Knowledge Infrastructure, Wanfang Data, Chinese Biomedical Literature Database, PubMed, Excerpta Medica Database (Embase), and Cochrane Library, were used for searching randomized controlled studies published from 2010 to present. The quality of the literature was assessed using the Newcastle-Ottawa Scale (NOS). Outcome measurements included intraoperative blood loss, transfusion volume, operative time, hospital stay, recurrence, and postoperative complications.

Six reference articles were obtained, including 223 patients who underwent AABO and 300 patients who did not. The NOS score was greater than 7 points in both groups. Meta-analysis showed that the intraoperative blood loss, transfusion volume, and surgery duration of patients undergoing pelvic tumor resection with AABO were all reduced (95% confidence interval (CI): -1504.53~-762.10, P<0.00001; 95% CI: -902.22~-575.45, P<0.00001; 95% CI: -80.20~-26.54, P<0.0001). No difference was discovered in the occurrence of postoperative complications, including nerve injury (95% CI: 0.30~1.34, P=0.23) and urethral injury (95% CI: 0.19~1.97, P=0.41) between both groups. The incidence of wound infection was relatively low (95% CI: 0.22~0.81, P=0.010). Additionally, no difference was discovered in hospital stay (95% CI: -6.85~0.79, P=0.12) and recurrence (95% CI: 0.45~1.53, P=0.12) between both groups (P>0.05).

AABO under color Doppler ultrasound guidance can reduce intraoperative blood loss, transfusion volume, and operative time during pelvic tumor resection and can also reduce the incidence of some postoperative complications.

This study aimed to evaluate the optimal criteria and conditions in which single-measurement (SM) and high-resolution measurement (HM) provide a similar evaluation accuracy for ArcCHECK (AC) and Octavius (OT) detectors.

In the SM and HM for AC and OT, we evaluated γ-analysis pass-rate differences for various conditions (criteria, calculation grid size, and shift of the isocenter) of 20 patients who received volumetric modulated arc therapy. All results of the γ-analysis pass rate were analyzed using the Anderson–Darling normality test.

In the AC detector, an SM with a 1%/1 mm criterion, 1.25 mm calculation grid size, and two standard deviations (2SD) of tolerance showed an evaluation accuracy similar to that of an HM. In the OT detector, an SM with a 2%/2 mm criterion, 2.0 mm calculation grid, and 2SD of tolerance had an evaluation accuracy similar to that of an HM. The γ-pass-rate data of the OT detector for the 3%/3 mm criterion did not follow a normal distribution in both SM and HM.

Most high γ-analysis pass rates achieved using inadequate criteria may not detect errors; therefore, accurate evaluation is necessary for optimizing the criteria settings of individual QA devices based on the characteristics and the uncertainties of array detectors. The characteristics of a detector array can be enhanced by evaluating the relationship between SM and HM, which reduces the workload of patient-specific QA.

We aimed to investigate the relationship between the radiation dose received by the spleen and the hematological parameters of patients who underwent chemoradiotherapy after the diagnosis of locally advanced pancreatic cancer (LAPC).

Patients with LAPC who were treated with chemoradiotherapy were retrospectively reviewed. Surgical status,chemoradiotherapy details, complete blood count values (baseline, mid-treatment, and end-of-treatment), mean spleen dose, and dose-volume parameters (V5, V10, V15, V20, V25, and V30) were recorded. The relationship between spleen dose-volume parameters and the development of grade 3 lymphopenia was evaluated by Spearman's rank correlation and receiver operating characteristic (ROC) analysis.

All dose parameters for the spleen were significantly correlated with the mid-treatment absolute lymphocyte count. In the ROC analysis, mean spleen dose (p=0.011; area under the curve [AUC]: 0.856; 95% confidence interval [CI]: 0.675-0.995), V15 (p=0.020; AUC: 0.938; 95% CI: 0.830-0.997), and V20 (p=0.002; AUC: 0.940; 95% CI: 0.811-0.1000) were significantly associated with mid-treatment grade ≥3 lymphopenia.

A significant correlation was found between the dose received by the spleen during chemoradiotherapy in LAPC patients and the development of lymphopenia. Contouring the spleen as an organ at risk (OAR) and documenting doses is important to establish dose limitations.

This study aims to evaluate and compare Three-Dimensional Conformal Radiotherapy (3D-CRT) versus Helical Tomotherapy (HT) based on treatment planning and selection of the most appropriate method to reduce side effects.

Treatment planning was performed on images of 20 patients with head and neck cancer with lymph node involvement by HT and 3D-CRT techniques in Seyed Al-Shohada hospital, Isfahan, Iran. The quality of target coverage, the exposure of normal tissue, and radiation delivery efficiency in two studied methods were compared.

Tomotherapy showed significant improvement over 3D-CRT in terms of D2%, D50% Dmean, V95%, CI (conformity index), and HI (homogeneity index) for PTV (planning target volume) and in terms of D2%, D98%, Dmean, V95%, CI and HI for PTV Nodal. The mean dose received by 98% of PTV (D98%) increased in HT compared to 3D-CRT. Whereas, higher doses received in organs at risk (OARs) in 3D-CRT compared to HT.

Results showed improvements in target quality for HT over 3D-CRT, including dosimetric coverage of target volumes, homogeneity and conformity indices, and reduction of the volume of cold and hot spots. Tomotherapy also performed better than that of 3D-CRT in OARs. Overall, with the satisfactory results obtained here, HT technique has considerable promise for treating head and neck cancers with the involvement of regional lymph nodes.

The development of neurotoxicity in healthy, non-targeted brain tissue exposed to radiation during cranial radiotherapy (RT) is the most frequent event of radiation-induced adverse effects. The 5-hydroxytryptamine-3 (5-HT3) receptor antagonists may also have a range of neuroprotective, anti-inflammatory, and antiphlogistic properties in addition to their anti-emetic effects.

Study groups were formed in the following ways: Group 2: Irradiation (IR)-only (IR+Saline); Group 1: Normal control (orally fed control); Group 3: IR+Granisetron (IR+Granisetron): whole-brain IR and Granisetron 1 mg/kg/day (Merck) administered orally. 15 days of all therapies were given. The 15 days were completed with behavioral testing. In the entire brain IR-only (placebo) group, a substantial deterioration was seen in all studied marker levels and behavioral test results.

Compared to the IR-only group, all of these biochemical indicators significantly improved in the granisetron group (IR+Granisetron), and levels of the control group returned to normal. In behavioral test analyses, a substantial decline in the open field and passive avoidance learning social recognition tests was seen in the IR-only group compared to the healthy control group, whereas an improvement was seen in the IR+Granisetron group. In addition, the IR-only group showed a reduction in hippocampus neurons and Purkinje neurons as well as an increase in hippocampal gliosis, whereas the IR+Granisetron group showed an improvement and a return to the normal control group counts.

In summary, we discovered that granisetron had neuroprotective properties in a rat model of radiation-induced brain damage.

To explore the accuracy of infrared thermal imaging and ultrasound in evaluating knee osteoarthritis (KOA) dysfunction.

From November 2021 to June 2022, 50 KOA patients diagnosed by our hospital were selected. According to the results of ultrasound examination, the subjects were separated into mild group (30 cases) as well as moderate to severe group (20 cases). Pain as well as dysfunction was assessed using the visual analog Scale (VAS) and Western Ontario and McMaster osteoarthritis index (WOMAC). The forward-looking infrared (FLIR) thermal imager was used for infrared thermal imaging on the day of treatment as well as 1 month later.

The degree of cartilage wear detected by ultrasound was strongly correlated with the pain of knee osteoarthritis (r=0.674, P<0.05) and WOMAC osteoarthritis index (r=0.643, P <0.05). The knee temperature in the moderate to severe group was higher relative to the mild group (P<0.05, figure 2). The reliability and repeatability of the two infrared thermal imaging tests in knee were good (ICC=0.78). The knee temperature was positively correlated with the degree of cartilage wear under ultrasound (r=0.426, P<0.05, table 2). The knee temperature was positively related to pain (r=0.403, P<0.05) and WOMAC osteoarthritis index (r=0.382, P<0.05).

Combined application of infrared thermal imaging and ultrasound in the evaluation process of knee osteoarthritis can assess the pain and dysfunction of knee osteoarthritis to a certain extent.

To investigate the diagnostic value of multi-slice spiral computed tomography (MSCT) in the anatomical variation of left renal vein (LRV).

The clinical and imaging data of 96 patients with LRV variation in our hospital from June 2019 to December 2022 were retrospectively analyzed, and the imaging manifestations, classification, and clinical significance were discussed in combination with the literature.

Among the 96 patients with LRV variation, 30 patients (30/96, 31.25%) were type I (annular aortic type), including 20 cases of type IA, 7 cases of type IB, and 3 cases of type IC. A total of 17 cases (17/96, 17.71%) were type II (complete retroaortic type), with 15 cases were type IIA and 2 cases were type IIB. There were 52 cases (52/96, 54.17%) of type III (abnormal reflux type), with 32 cases of type IIIA and 20 cases of type IIIB. There were 15 cases (15/96, 15.63%) of type IV (delayed confluence type). Taken together, 18 of the 96 patients (18/96, 18.75%) had both types of variants, including 10 cases with other types of variants accompanied by delayed confluence of the LRV, and 5 cases with other types of variants combined with abnormal reflux.

Fully understanding the anatomical variation of renal vein before operation is of great guiding significance for the selection of renal transplant donors, and helps to formulate the best renal surgery plan, guide the correct treatment of renal vein before operation, avoid renal vein tear, bleeding, miscut and misligation, and reduce surgical complications.

The Background To assess the radiation protection and radiation monitoring practices among medical radiation workers (MRWs) in Malaysian hospitals, and to identify demographic and occupational factors influencing the consistent use of radioprotective garments and dosimeters.

A link to an online survey was distributed to MRWs with the help of research coordinators at participating hospitals. A total of 387 respondents answered the online survey between April and June 2019. They reported the consistency with which they used radioprotective garments, dosimeters and other protective measures, together with the reasons for inconsistency. We then compared consistent and inconsistent groups by demographic and occupational data.

The respondents exhibited excellent adherence to radiation protection but showed poor adherence to radiation monitoring. The main reasons for non-use of radioprotective garments were inadequate items and the need to prioritize others. Forgetfulness and fear of losing dosimeters were the common reasons for the non-consistent use of monitoring devices. Radiologists were the most consistent group using radioprotective garments compared to other job positions (p<.050). Middle-aged respondents were more consistent in using radioprotective aprons than younger respondents (p<.005). Work schedule, institution and gender also influenced the consistency of using radioprotective garments and dosimeters.

There is an urgent need to improve the personal dosimeter adherence rate in this country and any shortage of radioprotective garments should be tackled immediately. Ultimately, it is crucial to understand the workers’ tasks and their safety measures to avoid underestimating occupational radiation exposure and risk.

Recently, volumetric modulated arc therapy (VMAT) has been applied to the treatment of moving targets, such as lung tumors. The displacement of actual tumors during treatment based on an averaged four-dimensional (4D) planning computed tomography (CT) image set induces inconsistencies between dose distribution determined during the treatment planning step and the actual irradiated dose. The present study introduces a 4D dose reconstruction system and demonstrates its feasibility based on the results of dynamic thorax phantom experiments.

Linear accelerator log files of two types—dynamic beam delivery log files and DynaLog files—were used to create the DICOM-RT Plan file with multiple-field irradiation. Dose distribution corresponding to each respiratory phase was calculated by planning the corresponding CT image set, and the accumulated dose distribution was subsequently reconstructed. In the experiment conducted in this study, two types of lung-tumor motion were considered—linear motion in the craniocaudal direction and combined motion in the craniocaudal and rotational directions.

The dose delivered to the center of a tumor was observed to vary by up to 4.4 %, depending on the initiation time of VMAT irradiation—the proposed system estimated the administered dose with an accuracy of 1.3 % or less. In the case of two-dimensional dose distribution, the pass rate of gamma analysis with a tolerance of 3 mm/3 % exceeded 96.6 %.

The proposed system exhibited high dose-estimation accuracy for intricately moving targets, e.g., lung tumors, undergoing combined linear and rotational motion.

The combination of radiotherapy and surgery is used to treat locally advanced non-small cell lung cancer (NSCLC). The aim of this study was to analyze IIIA/B NSCLC patients treated with chemotherapy from the Surveillance, Epidemiology, and End Results (SEER) database to clarify whether patient prognosis correlated with surgery and radiotherapy.

The IIIA/B NSCLC patients were selected from the SEER database and classified into IIIA (N0-1), IIIA (N2), IIIB (N2), and IIIB (N3). Cox analyses and Kaplan–Meier method were used to estimate the prognostic factors and lung cancer specific survival (LCSS) curves.

We divided 7933 cases into IIIA (N0-1), IIIA (N2), IIIB (N2), and IIIB (N3). Cox regression showed that age, sex, primary site, grade, treatment, T stage, and marriage were independent risk factors for IIIA (N0-1); age, sex, treatment, and T stage had prognostic significance for IIIA (N2); age, sex, primary site, grade, treatment, and T stage were prognostic factors for IIIB (N2); and age and primary site had effect on the prognosis of IIIB(N3). The effect of chemotherapy-surgery was better than that of chemotherapy-preoperative radiotherapy-surgery and chemotherapy-surgery-postoperative radiotherapy for IIIA (N0-1). In IIIA (N2) and IIIB, radiotherapy did not improve the LCSS.

Surgery offered more survival benefits for IIIA (N0-1) patients. Radiotherapy did not improve the LCSS of IIIA (N2) and IIIB patients.

Our aim was to draw attention to the dominant role of C-reactive protein (CRP) on prognosis by examining the effect of the high CRP interval, Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS) and CAR (CRP to albumin ratio)  in patients undergoing chemoradiotherapy (CRT).

85 patients, with the diagnosis of esophageal cancer and who were scheduled for neoadjuvant or definitive CRT, were included in the study. CRP levels of each patient during the follow-up period were determined separately, and the total number of days for which serum CRP levels were > 5 mg/L was expressed as "days when CRP>5". The effects of the GPS, mGPS, CAR, and‘’days when CRP>5’’ on the prognosis and survival of these patients with esophageal cancer were analyzed in this retrospective study.

In the survival analysis, CAR (p=0.007), GPS (p<0.001), mGPS (p<0.001) and ‘’days when CRP > 5’’ (p=0.002) were determined to be independent predictive factors for mortality. In the long-rank test results, it was observed that the patients with GPS 0 and mGPS 0 had longer overall survival than the others (p < 0.001). In addition, with the increase in ‘’days when CRP>5’’, disease recurrence also increased significantly (p = 0.01). Similarly, in the ROC analysis, the area under the curve (AUC) was significant for the ‘’days when CRP>5’’ (AUC: 0.956, 95% CI: 0.915‒0.998; P < 0.001).

In patients diagnosed with esophageal cancer, beginning from the pretreatment period and throughout the follow-up period, serum CRP levels are an independent factor in predicting survival, both in terms of the number of days it is high and in terms of the scoring systems it is associated with.

To assess and compare image quality characteristics of x-ray computed tomography (CT) and cone beam (CBCT) imaging systems of the Varian linear accelerator.

The CatPhan®504, was examined on the CT simulator (SOMATOM Definition AS, VA48A) and two CBCTs (TrueBeam™ and Clinac® iX linear accelerators) attached to Varian linear accelerator. Image quality parameters including pixel value stability, spatial linearity, pixel size verification, uniformity, noise, spatial resolution, low contrast resolution, and contrast-to-noise ratio (CNR) were assessed using different scanning protocols.

The mean pixel values of regions of interest were stable for CT, TB, and iX-CBCT imaging. Noise on CT was slightly lower and was seen to decrease with increasing mAs, while CNR increased with CT mAs and two CBCTs. For all schemes, the Modulation Transfer Function (MTF) of the reconstructed image was limited by the pixel size. Low contrast targets for TB-CBCT were visible, with up to 6 and 2 targets for 1% and 0.5% for contrast, respectively. However, up to 4 targets of 1% contrast on iX-CBCT images are visible for the low-contrast objectives. Also, up to 8, 4, and 1 targets of 1%, 0.5%, and 0.3% contrast were visible for the low-contrast targets on CT images.

CT and CBCT image quality parameters have been quantified and compared for clinical protocols in different mAs conditions. Selecting the right protocol will boost contrast, based on image quality criteria. The mAs can be decreased to minimize patient dosage.

To probe the impact of portable vaginal irrigator in patients with cervical cancer undergoing radiotherapy.

A total of 100 patients with advanced cervical cancer who received radiotherapy in our hospital from January 2021 to December 2022 were chosen and separated into control group (CG, n=50) and research group (RG, n=50). After radiotherapy, patients in the CG control group adopted extrusion balloon irrigator for vaginal irrigation, while patients in the RG adopted portable vaginal irrigator for vaginal irrigation. The cleanliness, vaginal length, vaginal width, comfort ratio, patient satisfaction, and occurrence of complications in both groups were compared.

The number of patients with a white blood cell count of 15-30 in the RG was less than that of the CG (P<0.05). The number of patients in cleanliness degree I in the RG was higher relative to the CG (P<0.05), while the number of patients in cleanliness degree III in the RG was lower compared to the CG (P<0.05). Three months after radiotherapy, the vaginal length and vaginal width of the RG were higher relative to the CG (P<0.05). The comfort ratio and satisfaction of patients in the RG was higher compared to the CG (P<0.05). The occurrence of complications in the RG was declined compared to the CG (P<0.05).

The use of portable vaginal irrigation device realizes the comfortable feeling of patients in the process of use, improves the effect of vaginal irrigation, reduces the occurrence of complications after radiotherapy, which is worthy of clinical promotion.

Gamma analysis is an effective tool used to verify treatment plan accuracy with regard to patient specific quality assurance. In this method, accuracy is validated through the major parameters presented in the acceptance criterion (AC). The Hybrid AC (HAC) method has been proposed and validated via the Traditional AC (TAC) method of comparison.

The performance of the HAC method was investigated through one-dimensional (1D) relative dose profile and clinical planar dose distribution. By employing the HAC method, Gamma values were observed at different regions of the profile as well as at the different treatment sites of clinical planar dose distribution. Both results were compared by employing the TAC method, but only planar dose distribution was analyzed by 95% confidence interval of statistics.

The results of the HAC method indicate higher Gamma values at the penumbra of the dose profile when compared with the results of the TAC method. In low dose and high dose areas, both methods produced comparable results. In terms of planar dose distribution, the proposed method demonstrated a higher degree of sensitivity than the TAC method by indicating low values for the Gamma passing rate at all treatment sites.

The HAC method could effectively increase the sensitivity of the tool at a high dose gradient of planar dose distribution, whereas it had no impact on the area of the low dose gradient. Therefore, this method could be an alternative option for evaluation of treatment planning accuracy in clinical practice.

The aim of this study was to examine the imaging features of patients diagnosed with pulmonary sarcoma (PSC) exhibiting small bowel metastases, utilizing magnetic resonance imaging (MRI) and computed tomography (CT), and to report the clinical outcomes of surgical resection in conjunction with duvacizumab drug therapy. 

Clinical data and CT imaging markers of patients with pathologically confirmed primary pulmonary sarcoma from January 2020 to April 2021 were retrospectively assessed.

Immunohistochemical analysis of lung tissue samples indicated Galectin-3(+), PAS(-), Myoglobin(-), F8(-), CD31(-), TTF(+), P40(-), D2-40(-), HMB45(-), AE1/AE3(+), MC(-), and CD68(-). PD-L1 positive cell count, as determined through immunohistochemical evaluation, was 50%. Immunohistochemical findings of the patient's small intestine tissue revealed AE1/AE3(+), CD117(-), CD34(-), Desmin(-), SMA(-), Vimentin(+), S-100(-), CK7(-), CK20(-), CEA(-), EMA(-), PAS(-), CD45(-), with a Ki-67 positivity rate of approximately 40%. Following 11 cycles of duvacizumab drug therapy, the volume of the patient's left upper lung mass decreased from 7.1 cm × 5.7 cm to 2.8 cm x 3.3 cm.

The combination of surgical resection and duvacizumab drug therapy demonstrated clinical efficacy in patients with PSC and holds promise as a potential treatment option for patients suffering from PSC.

We developed a convergent arcCOS (cACOS) technique capable of dealing with the virtual source position delivered by different carbon ion energies from the pattern of scanning-passive scatter beam in this study.

A homemade large-format CMOS sensor and Gaf Chromic EBT3 films were used for the virtual source position measurement. The Gaf films were embedded in a self-designed rectangular plastic frame to tighten the films and set up on a treatment couch for irradiation in the air with the film perpendicular to the carbon ion beam at the point of nominal source-axis-distance (SAD) as well as upstream and downstream from the SAD. The horizontal carbon ion beam with 5 energies at a machine opening field size was carried out in this study. The virtual source position was determined with a convergent arcCOS method and compared with the linear regression by back projecting the FWHM to zero at a distance upstream from the various point of source-film distance.

The determination of virtual source position using convergent arcCOS method agrees with the method by back projecting the FWHM to zero, and for higher carbon ion energy has an obvious longer distance from the SAD since the more carbon ion beam energy, the less spreading affected by the horizontal and vertical magnetism, therefore, the distance of virtual source positions is decreased from SAD with high to low energy.

We have developed a technique capable of dealing with the virtual source position with a convergent arcCOS method to avoid any manual measurement mistakes in scanning-passive scatter carbon ion beam. The method for investigating the virtual source position in the carbon ion beam in this study can also be used for external electrons and the proton.

To explore the effect of kilovolt (kV) selection based on body mass index (BMI) on reducing the radiation dose of radiofrequency ablation (RFA) in liver tumours under computed tomography (CT) guidance.

This study retrospectively reviewed CT-guided RFA of liver tumours performed between 1 January 2019 and 31 December 2019. The radiation dose received by the patients was recorded after the planning, execution and surgery. The RFA protocol for liver tumours was subsequently modified according to the patients’ BMI. Changes in tube voltage and tube current were recorded for the RFA protocol based on BMI. The image quality and overall operator satisfaction were recorded for each case based on the BMI-modified protocol. The radiation dose received by the patients was also recorded, and the degree of dose reduction adjusted based on BMI was calculated.

The results showed that the mean (± SD) overall CT dose index (CTDI) of CT-guided RFA was 12.83 ± 3.78 mGy. Following protocol modification, the mean CTDI decreased to 3.84 ± 2.24 mGy, a 70.07% reduction overall. The image quality was slightly lower compared with before the modification, but the image quality in both stages met the needs of CT-guided RFA for liver tumours. Electrode needle display and operator confidence satisfaction showed no significant difference between the groups (P > 0.05).

Modification of the BMI-based kV protocol could significantly reduce the radiation dose received by patients during CT-guided ablation of liver tumours. Furthermore, the image quality was not significantly compromised.

To assess the use of computed tomography (CT), ultrasonography and magnetic resonance imaging (MRI) in distinguishing papillary thyroid cancer (PTC) from benign thyroid nodules.

A total of 45 cases with benign thyroid nodules and 75 cases with papillary thyroid cancer were included from our hospital from March 2020 to December 2021. All patients were examined by MRI, ultrasonography and dual-energy CT. The outcomes of the two groups' MRI, CT and ultrasonography scans were compared.

The benign nodule group had significantly higher pure diffusion coefficient (D) (1.38±0.32 vs 0.95±0.12), perfusion fraction (F) values (17.13±4.35 vs 12.83±2.93) and iodine concentration (IC) plain scan scores (0.96±0.44 vs 0.56±0.37), whereas it had lower IC artery scores (2.65±1.11 vs 3.92±1.22) than those of the PTC group (p<0.001 for all). The Emax value of the PTC group was substantially greater than that of the benign nodule group (62.53±37.93 vs 25.37±8.38, p<0.001), and the percentage of nodules with aspect ratio ≥ 1 was higher in the PTC group than in the benign nodule group (48.0% vs 22.2%, p=0.005). The area under the curve (AUC) for MRI in the diagnosis of PTC patients was 0.885, which was substantially higher than those for ultrasonography (AUC=0.705) and CT exams (AUC=0.753) (p<0.001).

MRI, ultrasonography and CT examinations are essential for discriminating between benign thyroid nodules and PTC. MRI has better diagnostic accuracy than the other two tests.

Light and portable handheld X-ray devices are being used more often for diagnosis because they allow radiography procedures to be performed on patients in settings where there may not be stationary X-ray devices, such as islands or mountainous regions. In this study, the performances of handheld X-ray devices (HXD) and stationary X-ray devices (SXD) were compared to determine whether the handheld device could produce diagnostically acceptable image quality outside of hospitals, particularly during a global pandemic.

For performance evaluation, the accuracy of tube voltage, reproducibility of X-ray dose, linearity, leakage dose, and accuracy of focal spot size were obtained. The accuracy of the tube voltage and the reproducibility and linearity of the X-ray dose were measured to reduce the frequency of patient reimaging as a performance evaluation of the devices.

After conducting various experiments, it was found that the percentage average error (PAE) value of the tube voltage was -0.01% for the HXD, and the error of the tube voltage was 0.01% for the SXD, which is lower than the standard 10%. Additionally, when using an HXD according to these standards, medical staff is considered safe from exposure to leakage dose because the leakage dose is 0.26 mSv/year without the use of a partition.

Our results provide evidence that images of appropriate quality can be taken with an HXD, offering comparable diagnostic value. It was concluded that the leakage radiation dose would be safe at 0.26 mSv/year without using a radiation shielding partition.

The present study aims to estimate the effect of collimator, phantom and Multi-Leaf Collimator (MLC) scatters on dose calculation in different breast cancer cases using acrylic, brass build-up caps and acrylic mini-phantom in the measurements.

Collimator scatter factors (Sc), phantom scatter factors (Sp) and MLC transmission factors for different field sizes ranging from 1 × 1 cm2 to 40 × 40 cm2  for energies 6 MV and 15 MV  were measured using acrylic mini-phantom (PTW and local mini-phantom), acrylic build up cap and brass build up cap where the farmer ionization chamber was used as detector in this study and semiflex detector was used but only with small field sizes from 1 × 1 cm2  to 4 × 4 cm2 and scatter effect on the dose calculation in different breast cancer cases was evaluated.

The results in this study show that there is no significant difference between MLC transmission factors using acrylic mini-phantom and brass build-up cap with energy 6 MV where the transmission factor value is 0.007 and 0.0071 with acrylic mini-phantom and brass build- up cap, respectively.  Also it is clear that brass build-up cap gives the highest collimator scatter factors results where collimator scatter factors start at value 0.963 at field size 4 × 4 cm2 then increase gradually to end at point value 1.049 at field size 40 × 40 cm2. In breast cancer cases, there is sharp increase in organ at risk doses with brass build-up cap.

From this study it is evident that almost there is large variation between the acrylic build-up cap, acrylic mini-phantom and brass build-up cap where brass build-up achieve higher results in most measurements.

In recent years, volumetric-modulated arc therapy (VMAT) and fixed field intensity-modulated radiotherapy (IMRT) have been used as the two mainstream radiotherapy techniques for the treatment of nasal tumors. In this study, we compared effectiveness of these two radiotherapy techniques in the treatment of nasal tumors through analysis of relevant literature and meta-analysis.

A search was performed on PubMed, Web of Science, Embase, and Cochrane Library databases on April 2022 to identify all related literature in line with pre-determined eligibility criteria. The included/excluded studies were screened manually and relevance data were extracted. Forest plots were plotted and analyze, Egger’s asymmetry tests and sensitivity analysis were conducted using software Stata 16.0.

Eight studies were included in the meta-analysis. We found no significant difference in D2% and D98% of the Planning Target Volumes (PTV) between VMAT and IMRT. In contrast, the conformity index (CI) and the homogeneity index (HI) were significantly different between the two groups. Further analysis revealed no significant differences in dose sparing for all analyzed organs at risk (OARs) between VMAT and IMRT techniques. In addition, the monitor unit (MUs) of VMAT plan was significantly lower than that of the IMRT plan.

VMAT has better local tumor control rate compared with IMRT, but it does not significantly reduce maximum dose (Dmax) or mean dose (Dmean) of OARs. We suggest that VMAT plan may be a better radiation therapy technology in the treatment of nasal tumors.

To assess accurately the URT treatment planning system from the United Imaging Healthcare, the American Academy of Pain Medicine (AAPM) TG 119 test plans for Intensity-Modulated Radiation Therapy (IMRT) and Volumetric-Modulated Arc Therapy (VMAT) were used.

Based on the URT-Linac 506C, the plans were sent to the phantom. The overall accuracy was tested and examined using five geometry tests supplied in TG 119 for various treatment modes of IMRT and VMAT, with three types of beams using the Flattening Filter modality, estimated using the URT-TPS Monte Carlo algorithm. Moreover, a Farmer-type ion chamber was used to measure the point values, and a film was used to measure the fluence.

The disparities between the measured point doses and the anticipated doses for the FF photon beams for static MLC, dynamic MLC, and VMAT were within 2.16%, 1.89%, and 1.89%, respectively. The TG 119 report confidence limits were all met, and SMLC, DMLC, and VMAT had gamma passing rates greater than 99.80%, 99.60%, and 99.70%, respectively.

The URT treatment planning system and the URT-Linac 506C have correctly commissioned IMRT and VMAT processes, according to this analysis, which was completed following the recommendations given by TG 119.

Ultrasound-guided percutaneous laser ablation (US-PLA), as a minimally invasive ablation method, has been widely used in the treatment of benign and malignant tumors. The objective of the current study was to determine the efficacy and safety of US-PLA for unifocal papillary thyroid microcarcinoma (PTMC).

Totally 18 PTMC patients underwent US-PLA at our hospital were selected. Tumor location, tumor volume and thyroid function of patients were examined before percutaneous laser ablation (PLA). Contrast-enhanced ultrasound (CEUS) was performed immediately after PLA treatment. Complications, thyroid function, ablation area size and volume, tumor recurrence rate and metastasis rate were recorded.

Eighteen nodules were completely ablated in 18 patients, and postoperative CEUS showed no contrast fill in the ablated areas. Fifteen patients underwent single needle and single PLA ablation, and 3 cases underwent a second ablation due to incomplete ablation as confirmed by CEUS. All patients tolerated and completed ablation with no serious complications. The maximum diameter and volume of the ablation zones at 6, 12, 18, and 24 months after PLA were significantly smaller than the preoperative nodules (P<0.05). The number of tumors that completely disappeared at 6, 12, 18, and 24 months was 1 (5.7%), 6 (38.9%), 4 (61.1%), and 2 (72.2%), respectively. No local tumor recurrence, lymph node metastasis and distant metastasis occurred.

US-PLA is a safe and effective technique for unifocal PTMC treatment, which may provide a new therapeutic option for PTMC patients who are not eligible or unwilling to receive surgery.

Thyroid nodules account for 10-15 % of thyroid cancers or malignancies and ultrasound (US) is the most accurate technique for evaluating thyroid nodules.  Ultrasound-based datasets aid in detecting malignancy risk and avoiding Fine Needle Aspiration (FNA) biopsy. There are several guidelines for determining thyroid nodules, and ACR-TIRADS (American College of Radiology Thyroid Imaging Reporting and Data Systems) is the most accurate and widely used. However, very few or no studies have compared various grades of ACR-TIRADS based on benign and malignant nodules. Therefore, this study aimed to investigate the predictive risk of malignant cancer in thyroid nodules obtained from an ultrasound dataset based on the ACR-TIRADS classification.

PubMed, Medline, EMBASE (Excerpta Medica dataBASE), Google Scholar, Cochrane Library, and Web of Science were searched for articles published between Jan 2018 to 30 June, 2022, and ultrasound-based datasets were obtained for benign and malignant thyroid nodules based on ACR-TIRADS.

Ten articles were included with 12723 total cases of thyroid ultrasound dataset for benign and malignant thyroid nodule classification. The total number of benign was 6641 and the total number of malignant thyroid nodules was 6082 respectively (95 % CI=1.14, 0.75-1.74) with P=0.53. The number of TR4 and TR5 malignancies were 1397 and 3733 respectively (95 % CI=0.42, 0.22-0.83) with P=0.01.

The TR4 and TR5 grading of the ACR-TIRADS represents an excellent stratification system for classifying thyroid lesions thereby avoiding biopsies performed on benign nodules.

The purpose of this study is to retrospectively compare annual changes (between 2019 and 2022 years) in selected hematological parameters in radiology workers during the COVİD-19 pandemic.

A total of sixteen radiology unit workers, seven male and nine female, aged 18-40 years, working in Ataturk University Faculty of Medicine, Department of Radiology in 2019-2022, were included in this retrospective study. The annual changes (between 2019-2022) of the participants in selected hematological parameters such as white blood cell (WBC), hemoglobin (HGB) and red blood cell (RBC) during the COVID-19 pandemic were compared.

There was a statistically significant difference when comparing the annual changes in WBC value during the COVID-19 pandemic (F(3, 36)=3.141, p=.037, ηp2= .207). It was observed that WBC decreased significantly in 2022 compared to 2021 (p<0.05). Moreover, a statistically significant difference was found in the comparison of the annual changes in the RBC value during the COVID-19 pandemic (F(3, 36)=25.370, p=.000, ηp2= .712). It was found that RBC diminished significantly in 2020, 2021, and 2022 compared to 2019. Additionally, a statistically significant difference was detected when comparing the annual changes in HGB value during the COVID-19 pandemic (F(3, 36)=26.794, p=.000, ηp2= .691). It was determined that HGB decreased significantly in 2022 compared to 2020 and 2022 compared to 2021 (p<0.05).

It is known that radiology workers are exposed to more and more prolonged radiation due to the increase in patient density and the length of their working hours during the COVID-19 pandemic period. Radiation also has harmful acute and chronic effects on human health. In this process, it is seen that exposure to both COVID-19 and Ionizing Radiation (IR) increases the sensitivity of hematological parameters.

Milk is a fundamental part of the human daily diet, so radioactivity concentrations in milk must have been controlled regularly. In this study, radiation activities were measured in 12 ultra-high temperature (UHT) milk samples collected in Kütahya, Turkey, in August 2021.

Radium (Ra-226), thorium (Th-232) and potassium (K-40) values were determined by using the Canberra 3x3 NaI(Tl) gamma spectroscopy method in 8 samples, and Radon (Rn-222) activity measurements have been conducted in 12 samples using the E-perm method.

Radium (Ra-226), thorium (Th-232) and potassium (K-40) levels are measured as < MDA (2.28 Bq/kg), < MDA (2.53 Bq/kg), 40.43 ± 2.25 to 53.31 ± 2.30 Bq/kg, respectively. Radon (Rn-222) concentrations were determined by the E-perm system between 0.46 ± 0.02 and 2.01 ± 0.05 Bq/l with an average of 1.11 ±  0.03 Bq/l.

Annual ingested radiation doses were calculated using radioactivity levels for different age groups as a result of milk consumption. Ingestion dose levels are below the worldwide average values given in the UNSCEAR report. It has been observed that the results are below the safety limits.

Mamuju is regarded as a high background radiation location (HBRA). The local population's cells may be harmed by the high ionizing radiation dosage in this region. Micronuclei (MN), nucleoplasmic bridges (NPB), nuclear buds (NBUD), and 8-shaped blood cells can be used to detect cytogenetic abnormalities. By comparing blood samples from HBRA to control site samples, this study focused on determining the impacts of high-risk levels of natural radiation in the cells.

The study employed a cytokinesis-block micronucleus cytome (CBMN Cyt) test.

In comparison to the control group, the study group had a higher nuclear division index (NDI) and a higher frequency of all abnormalities. The formation of MN and 8-shaped nuclei was significantly influenced by high natural radiation, whereas levels of NPB and NBUD were not significantly affected. Cytogenetic abnormalities were within normal limits and did not correlate with age or gender.

Chronic high background radiation exposure impacted human lymphocyte cell growth and the levels of certain biomarkers.

Breast cancer is the most common cancer in women and the most common cause of cancer-related death in women worldwide. Distant metastases in breast cancer occur in the bones, lungs, liver, and brain. Surgical treatment is recommended because the resection of primary tumor in breast cancer has a positive effect on prognosis and survival. The importance of ablative therapy has increased with the development of systemic treatments for a small number of organ metastases, which are referred to as oligometastases. Patients with isolated bone metastases have better prognosis than those with other visceral metastases. In single bone metastases, systemic and local treatments are preferred using a multidisciplinary approach. This case report presents a breast cancer patient with contralateral isolated scapula glenoid metastases, which have not been reported in the literature.