Advances on Clinical Application of Adaptive Radiotherapy in Treatment of Nasopharyngeal Carcinoma / 肿瘤防治研究

Radiotherapy is the first treatment choice for nasopharyngeal carcinoma. With the rapid development of image-guided radiotherapy, adaptive radiotherapy (ART) has become widely available in clinical practice. ART may be implemented to monitor the anatomical or physiological variations of patients using dynamic imaging technology and feedback information during the treatment course, including geometric changes (size, shape, and position) of tumor and normal organs. ART also allows the modification of the treatment plan to accurately deliver the maximize dose to target and minimize normal tissue explosion. This review discusses the physics basis of ART and its state-of-art application and potential pitfalls.

Best Practice Guidelines for Breast Imaging, Breast Imaging Society, India: Part—2

Breast imaging is a prerequisite for providing high quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease in patients who present to health professionals for treatment. These patients present to doctors of different subspecialties as well as to general practitioners in our country. It is important, therefore, to provide uniform guidance to doctors in different healthcare setups of our country, urban and rural, government and private, for optimal management of breast diseases. These guidelines framed by the task group set up by the Breast Imaging Society, India, have been formulated focusing primarily on the Indian patients and health care infrastructures. They aim to provide a framework for the referring doctors and practicing radiologists to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases, so that breast cancer is not missed. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India. Part 2 of these guidelines focuses on the best practice principles for breast interventions and provides algorithms for the investigation of specific common breast symptoms and signs. Ultrasound is the preferred imaging modality for image-guided breast interventions due to real-time needle visualization, easy availability, patient comfort and absence of radiation. Stereotactic mammography guided procedures are performed if the lesion is visualized on mammography but not visualized on ultrasound. 14-gauge automated core biopsy device is preferred for breast biopsies although vacuum assisted biopsy devices are useful for biopsy of certain abnormalities as well as for imaging guided excision of some pathologies. MRI guided biopsy is reserved for suspicious lesions seen only on MRI. Algorithms for investigation of patients presenting with mastalgia, breast lumps, suspicious nipple discharge, infections and inflammation of the breast have been provided. For early breast cancers routine use of investigations to detect occult distant metastasis is not advised. Metastatic work up for advanced breast cancer is required for selection of appropriate treatment options.

Quality Control Test of Transcranial MRI-guided Focused Ultrasound Treatment System before Surgery / 中国医疗器械杂志

OBJECTIVE@#To investigate the pre-treatment preventive maintenance and quality control procedure of MRI system and transcranial MRI-guided focused ultrasound (TcMRgFUS) treatment system by monitoring quality control of these two systems.@*METHODS@#The general performance index and image quality control index of MRI system, as well as the quality assurance program of TcMRgFUS EXABLATE 4000 system were tested and recorded.@*RESULTS@#The general performance index and image quality control index of MRI system met requirements.@*CONCLUSIONS@#Through system detection, the system performance could be monitored, ensuring the accuracy and safety of surgery.

Advances in magnetic resonance imaging guided radiation therapy / 生物医学工程学杂志

Image-guided radiation therapy using magnetic resonance imaging (MRI) is a new technology that has been widely studied and developed in recent years. The technology combines the advantages of MRI imaging, and can offer online real-time tracking of tumor and adjacent organs at risk, as well as real-time optimization of radiotherapy plan. In order to provide a comprehensive understanding of this technology, and to grasp the international development and trends in this field, this paper reviews and summarizes related researches, so as to make the researchers and clinical personnel in this field to understand recent status of this technology, and carry out corresponding researches. This paper summarizes the advantages of MRI and the research progress of MRI linear accelerator (MR-Linac), online guidance, adaptive optimization, and dosimetry-related research. Possible development direction of these technologies in the future is also discussed. It is expected that this review can provide a certain reference value for clinician and related researchers to understand the research progress in the field.

Lead sulfide quantum dots for the near-infrared IIb window fluorescence imaging of colon cancer / 药学学报

The near-infrared-IIb (NIR-IIb, 1 500-1 700 nm) window fluorescence with long emission wavelength has reduced light scattering and tissue auto-fluorescent background, achieving deep tissue imaging with high spatial resolution. Herein, we prepared an NIR-IIb fluorescent quantum dots (QDs) composed of lead sulfide (PbS). The fluorescence spectrum of PbS QDs were adjusted by controlling the size of the PbS core. Cadmium sulfide (CdS) shell was synthesized by the cation exchange method to form the core/shelled lead sulfide/cadmium sulfide quantum dots (CSQDs). The surface of CSQDs was modified with polyethylene glycol (PEG) to increase their stability in aqueous solution. The resulting PEG-modified CSQDs (PEG-CSQDs) had the emission peak at ~1 550 nm with quantum yield of 7.2%. The animal procedures were approved by the Institutional Animal Care and Use Committee (IACUC) of Fudan University School of Pharmacy. At 2 h postinjection, PEG-CSQDs clearly delineated the tumor region of mice bearing orthotopic CT26-Luc colon cancer model in the NIR-IIb fluorescence imaging. The fluorescent intensity ratio of primary tumor and adjacent normal tissue was 42.3, and that of metastatic tumor and adjacent normal tissue was 22.3, which allowed to detect the primary tumor of 3.4 mm×2.5 mm in dimension and the metastatic tumor of 1.2 mm×0.9 mm in dimension, and accurately guided the excision of tumors. The PEG-CSQDs prepared in this study provided a new approach for the early diagnosis and guidance of surgical resection of colon cancer.

Magnetic resonance imaging-guided transperineal prostate biopsy

Purpose: The purpose of the study is to assess the clinical value of magnetic resonance imaging (MRI)-guided transperineal prostate biopsy in the diagnosis of prostate disease. Materials and Methods: The institutional ethics committee approved this study. MRI-guided transperineal prostate biopsy was performed on 78 patients who had presented to our hospital with a prostate-specific antigen level >4 ng/mL or with MRI scans suggesting prostate cancer between January 2015 and August 2017. Written informed consent was obtained from all patients. Results: Of the 78 patients, pathological diagnosis could not be carried out in one because insufficient prostate tissue was obtained during biopsy. Prostate adenocarcinoma was confirmed in 34 patients, small-cell neuroendocrine carcinoma in 1 patient, prostatic tuberculosis in 1 patient, and benign prostatic hyperplasia in 41 patients. These diagnoses were confirmed by surgical pathology in 31 patients, and all results were consistent with the biopsy pathology, with no false positives. Postoperative urinary tract infection occurred in one patient, and mild postoperative hemorrhage around the prostate gland was seen in 65 patients, without the need for further clinical treatment. Conclusion: MRI-guided transperineal prostate biopsy is helpful in the diagnosis and treatment of prostatic disease

Research progress on ViewRay magnetic resonance guided radiotherapy system / 中华放射医学与防护杂志

ViewRay magnetic resonance (MR) guided radiotherapy system not only solves the problem of imaging dose,but also can set up accurately,online adaptive radiotherapy and gated irradiation according to magnetic resonance imaging (MRI).The development of this system provides a new technical means of accurate radiotherapy.This review describes the main structure of the ViewRay system,and summarizes quality assurance (QA),dosimetric comparison,respiratory motion management,online adaptive radiotherapy,and preliminary treatment effect.

CT-guided percutaneous splanchnic nerves block in treatment of advanced pancreatic cancer pain / 中国介入影像与治疗学

Objective To explore the effect and safety of CT-guided percutaneous splanchnic nerves block in treatment of advanced pancreatic cancer pain. Methods Thirty patients with advanced pancreatic cancer pain were treated with CT-guided percutaneous splanchnic nerves block. The complications, such as pneumothorax, intractable hypotension, diarrhea, during operation and hospitalization were evaluated using CTCAE v3.0 grading system, and the clinical efficacy was evaluated 1 week after operation. Visual analogue pain scale (VAS) and daily dosage of morphine were assessed before operation and 1 week, 1 month and 3 months after operation, respectively. Results Percutaneous splanchnic nerves block were successfully completed in all 30 patients without pneumothorax, intractable hypotension or arrhythmia during operation and hospitalization. or Ⅱ diarrhea occurred in 6 cases and then cured after symptomatic treatment. There were 5 cases of clinical cure, 21 cases of obvious effect, 4 cases of effective effect 1 week after operation. Postoperative pain relief more than 50% was observed in 26 patients (26/30, 86.67%). VAS and daily dosage of morphine were significantly reduced at 1 week, 1 month and 3 months after treatment compared with those pre-operation (all P<0.05). And VAS at 3 months after treatment was higher than that at 1 week after treatment. Conclusion CT-guided percutaneous splanchnic nerves block has definite efficacy and high safety in treatment of advanced pancreatic cancer pain.

Low dose Gemstone Spectrum CT in guiding percutaneous lung biopsy / 中国介入影像与治疗学

Objective To explore the feasibility of low dose Gemstone Spectrum CT in guiding percutaneous lung puncture biopsy. Methods Totally 80 patients underwent Gemstone Spectrum CT-guided lung puncture biopsy were enrolled. Conventional dose and low-dose CT (noise index [NI]=20, 24, 28) scanning in turn were performed on the progress of biopsy location. The quality of CT image, CT volume dose index (CTDIvol), dose length product (DLP) and effective dose (ED) were compared between conventional dose and low dose CT images. Results Both conventional dose and low dose CT images clearly showed the location relationship between puncture needle and lesion and met the need of puncture. There was no statistical significance of CT image quality among low dose CT images of NI=20, 24, 28 and conventional dose CT images (P=0.08). Meanwhile, significant differences of CTDIvol, DLP and ED were found among low doses CT images of NI=20, 24, 28 and conventional dose CT images (all P<0.01). With the increasing of NI, CTDIvol, DLP and ED decreased gradually (all P<0.05). Conclusion Low-dose scanning scheme of Gemstone Spectrum CT could meet the need of percutaneous lung puncture biopsy and reduce the radiation dose.

CT-guided low temperature plasma coblation of sphenopalatine ganglion for treating sphenopalatine neuralgia / 中国介入影像与治疗学

Objective To: evaluate the efficacy and safety of CT-guided low temperature plasma coblation of sphenopalatine ganglion for treating sphenopalatine neuralgia. Methods: Totally 37 patients with sphenopalatine neuralgia underwent CT-guided low temperature plasma coblation of sphenopalatine ganglion. Visual analogue scale (VAS) and numerical rating scale (NRS) were obtained at 24 hours, 7 days, 1 month, 3 months and 6 months after operation. The efficacy and postoperative incidence of facial numbness were evaluated and calculated,and the postoperative adverse reactions were recorded. Results: VAS scores significantly decreased 24 hours, 7 days, 1 month, 3 months and 6 months after operation (all P<0.01). The effective rate of coblation 24 hours, 7 days, 1 month, 3 months and 6 months after operation was 89.19% (33/37), 97.30% (36/37), 100% (37/37), 100% (37/37) and 100% (37/37), respectively, and the incidence of facial numbness was 67.57% (25/37), 54.05% (20/37), 29.73% (11/37), 8.11% (3/37) and 5.41% (2/37), respectively. No severe numbness was observed. Facial hematoma and postural hypotension were noticed in 18 (18/37, 48.65%) and 3 (3/37, 8.11%) patients 24 hours after operation, respectively. All the symptoms remitted completely within 72 hours after expectant treatment. No other adverse reaction was found. Conclusion: CT-guided low temperature plasma coblation is effective and safe for treating sphenopalatine neuralgia.

Clinical application of MRI-guided argon-helium cryoablation of tumors / 中国介入影像与治疗学

Objective To: investigate the clinical value of MRI-guided argon-helium cyoablation in the treatment of tumors. Methods: MRI-guided argon helium cyoablation was performed in 90 tumor patients, including 52 cases of liver tumor, 10 of kidney tumor, 6 of chest wall tumor, 12 of pelvic tumor, 9 of limb tumors and 1 case of sciatic tumor. SE T1W, FSE T2W and SPGR T1W sequences were used to monitor the process of puncture and cyoablation. MRI findings and the complications during cyoablation were observed. Enhanced MRI was performed after cyoablation to evaluate the therapeutic efficacy. Results: All lesions could be clearly displayed with MRI during cyoablation, and the whole probes could be clearly showed on SPGR T1WI. A total of 24 patients with large lesions (maximum diameter 10.80-15.06 cm) underwent tumor cytoreduction therapy, the average times of cytoreduction therapy was 2.96±0.76. Among them, the part of lesion covered by ice-ball during cyoablaion showed no enhancement in 17 patients, while in the rest 7 patients, enhancement could be observed at the edge of lesions which became larger on enhanced MRI 1 month after the last treatment. In 66 patients underwent single time cyoablation, the lesions were all covered by the ice-ball during cyoablation treatment, and enhanced MRI showed complete ablation of lesions in 47 cases and partial ablation in 19 cases 1 month after cyoablation. Local bleeding around puncture point was observed in 11 patients, no serious complication occurred. Conclusion: MRI-guided argon-helium cyoablation can be used as an effective method in the treatment of tumor on different sites.

CT-guided different pathways percutaneous lung biopsy for diagnosis of subpleural pulmonary nodules / 中国介入影像与治疗学

Objective: To investigate the value of CT-guided percutaneous transthoracic needle biopsy (PTNB) in diagnosis of subpleural nodules. Methods: CT-guided PTNB was performed in 147 patients with subpleural nodules. According to the angle of needle and pleura, the patients were divided into long path group (the angle of the needle and pleura ≤50°, n=83) and short path group (the angle of the needle and pleura >50°, n=64). The accuracy rate of diagnosis, success rate of single puncturing, pneumothorax and hemorrhage after operation were compared between the two groups. The number of needle adjustments, puncture time, pneumothorax and hemorrhage in patients with nodular diameter ≤10 mm, 10-20 mm and ≥20 mm were compared, respectively. Results: There was no significant difference in accuracy rate of diagnosis, success rate of single puncturing, pneumothorax nor hemorrhage after operation between the two groups (all P>0.05). The number of needle adjustments and puncture time of lesions with nodular diameter ≤10 mm and 10-20 mm in long path group were all shorter than those in short path group (all P<0.05). Conclusion: CT-guided PTNB has high accuracy for subpleural nodules. For subpleural pulmonary nodule diameter <20 mm, long path puncture is the preferred approach.

Application progress of 125I radioactive seeds interstitial implantation in brachytherapy of malignant solid tumors / 中国介入影像与治疗学

125I radioactive seeds interstitial implantation in brachytherapy of malignant solid tumors develop quickly, which had been used in treatment of various solid malignant tumors and obtained good effects, such as prostate carcinoma, malignant tumors of head and neck, intracranial malignant tumor, lung cancer and hepatoma, etc. However, there exist some problems, including the unclear disciplinary location, practitioner chaos, arbitrary clinical practice, non-uniform operating techniques and so on. The application progresses of 125I radioactive seeds interstitial implantation in brachytherapy of malignant solid tumors were reviewed in this article.

Ultrasound-guided percutaneous needling and interventional therapy for rotator cuff calcific tendinopathy / 中国介入影像与治疗学

Objective: To explore the value of ultrasound-guided percutaneous needling and interventional therapy for rotator cuff calcific tendinopathy (RCCT).Methods: Ultrasound-guided percutaneous needling and intervention were performed on 31 patients diagnosed as simple RCCT. Then the follow-up was carried out after operation. Visual analogue scale (VAS) and Neer shoulder joint function score were observed before treatment, 1 month and 6 months after treatment to evaluate the degree of pain and the improvement of shoulder function, and statistical analysis was performed. Results: No adverse events such as treatment-related infection and tendon injury occurred among 31 patients. There was no statistical difference of VAS before and 1 month after treatment compared with that before treatment (P=0.412). However, VAS separately decreased 6 months after treatment compared with that before and 1 month after treatment (both P<0.001). Neer shoulder function scores were significantly improved 1 month and 6 months after treatment compared with that before treatment (both P<0.001). In addition, Neer shoulder joint function score of 6 months after treatment was significantly higher than that 1 month after treatment (P<0.001). Conclusion: Ultrasound-guided percutaneous needling and interventional therapy for RCCT is effective, non-ionizing, minimally invasive and safety.

CT-guided methylene blue and/or Hookwire localization of pulmonary ground-glass nodules before video-assisted thoracoscopic surgery / 中国医学影像技术

Objective:To explore the clinical application value of CT-guided methylene blue staining and/or Hookwire localization of pulmonary ground-glass nodule (GGN) before video-assisted thoracoscopic surgery (VATS). Methods: Totally 141 patients with 160 GGN underwent VATS after CT-guided methylene blue staining and/or Hookwire implantation for localization of nodules. The success rate of localization, puncture complications and success rate of surgery were calculated. Results: All GGN were successfully located and resected. Among 160 nodules, 18 were located with stained with methylene blue, 12 with Hookwire implantation, while 130 nodules were located with combination of two methods, and the success rates of methylene blue staining, Hookwire implantation and combination of these two methods were all 100%. Small amount of pulmonary hemorrhage and pneumothorax were observed in 25 and 38 cases respectively during puncture, including 13 cases with both pulmonary hemorrhage and pneumothorax. Postoperative pathology showed that 117 nodules were malignant and 43 were benign nodules. Conclusion: CT-guided methylene blue staining and/or Hookwire implantation before VATS can accurately locate GGN, reduce puncture complications and improve the success rate of resection.

Efficacy and safety of ultrasound-guided stellate ganglion block: Comparison of through anterior scalenus muscle and through internal jugular vein / 中国医学影像技术

Objective: To compare the efficacy and safety of ultrasound-guided stellate ganglion block (UGSGB) through anterior scalenus muscle (ASM) and through internal jugular vein (IJV). Methods: Totally 144 patients with cervicogenic headache were distributed into 2 groups randomly. USSGB was performed through ASM (ASM group, n=72) or through IJV (IJV group, n=72), respectively. The ratio of successful blocks, the appearing time of Honer syndrome and the ratio of adverse reaction were compared between two groups. Results: The successful block ratio was 97.22% (70/72) of ASM group and 98.61%(71/72) of IJV group, while Honer syndrome appearing times was (2.18±0.96)min and (1.96±0.87)min after operation, respectively. There was no significant difference between 2 groups (both P>0.05). The adverse reaction ratio was 19.44%(14/72) of SCM group and 4.17%(3/72) of IJV group (P=0.01). Conclusion: USSGB through ASM approach and USSGB through IJV approach are both safe and efficient. IJV approach has less adverse reaction than SCM approach.

Correlation between cone beam computed tomography-guided scheme and setup errors in nasopharyngeal carcinoma / 肿瘤研究与临床

Objective@#To study the more safe and accurate guidance scheme of cone beam computed tomography (CBCT) in nasopharyngeal carcinoma.@*Methods@#CBCT was regularly performed on 87 patients with nasopharyngeal carcinoma in Meizhou People's Hospital from November 2014 to August 2015. For each patient, 10 times CBCT scans were obtained pre-treatment. All the setup errors were obtained and analysed on the orientation X (left and right), Y (head and foot) and Z (vertical) axis.@*Results@#With the increase of the number of CBCT scans, there was no statistically significant difference among the mean setup errors of the 10 times scans in X (left and right) and Y (head and foot) directions (all P > 0.05). And there was no statistically significant difference among the mean setup errors of 6 times scans in Z (vertical) direction, but from the beginning of the 7th, the systematic error in Z direction was increasing, the system error of the 7th, 8th, 9th, 10th time was 0.140, 0.292, 0.461, and 0.640 mm. Moreover, the difference of the mean systematic errors among the first 7 times was statistically significant (H = 15.232, P = 0.019), and the differences of the mean systematic errors among the first 8, 9 and 10 times were statistically significant (all P < 0.05).@*Conclusions@#Non-consecutive scans of CBCT could reduce the systematic and random errors. The appropriate frequency of application of CBCT based on the change law of setup errors is an ideal CBCT guidance scheme for nasopharyngeal carcinoma.

Application progresses of percutaneous imaging-guided cryoablation in oncotherapy / 中国介入影像与治疗学

Percutaneous imaging-guided cryoablation (PICA) is a recently developed technique,which applies extreme hypothermia to destroy tumors guided with CT,MRI or ultrasound images.Compared with other oncologic cryoablation therapies,PICA has some advantages,such as treating under local anesthesia,superior monitoring capability on multimodal imaging,less intraoperative and postoperative pain and preservation of tissue collagenous architecture.In recent years,PICA has been used in treatment of tumors in lung,liver,kidney,breast,prostate and so on.In this article,the principle of cryoablation and the application progresses of PICA in oncotherapy were reviewed.

Cryoablation of renal cell carcinoma: six-year experience with 64 cases / 中华泌尿外科杂志

Objective To summarize our clinical experience of cryoablation for renal cancer and to analyze the therapeutic indication,security,selection of cryoablation and outcomes.Methods Sixty-four patients suffered with T1a renal cell carcinoma were enrolled in this study from March 2012 to March 2018.Among them,5 cases were senile patients (≥ 80 years),5 cases complicated with other cancers,3 cases complicated with renal insufficiency,4 cases complicated with decompensated cirrhosis,3 cases with bilateral renal cancer,4 cases with solitary kidney cancer and 39 cases with some other complications.The preoperative serum creatinine level was(80.5 ± 38.2)μmol/L.The patients underwent laparoscopic singlesite (LESS) renal cryoablation,conventional laparoscopic renal cryoablation,or percutaneous image-guided cryoablation according to individual situation.Contrast-enhanced CT scan or MRI were used during the procedures and follow-up was performed.Results All operations were completed successfully and technical success was achieved as well in all cases.Blood transfusion was necessary for 2 cases because of hemorrhage.The mean diameter of the mass was (2.6 ± 0.90) cm,the median volume of blood loss was 50ml(10-110 ml),and the mean operation time was(96.0 ± 24.5) min.The median inpatient hospital stay was 3 d (1-6 d).In one case,digital subtraction angiography (DSA) embolization was performed due to hemorrhage after surgery.None of the other cases had intraoperative or postoperative complications.The serum creatinine level after surgery was not significantly decreased [postoperative (83.8 ±42.1) μmol/L,P =0.64].The contrast-enhanced CT or MRI of the kidneys one week postoperatively showed uniform low density in all lesion areas,which represented complete ablation and regression of the tumor.All cases were followed up regularly.One case showed relapse at the 6 th month follow-up and underwent cryoablation again.Another case,who was not regularly followed up,relapsed at 69th month after surgery.No relapse was observed in the other cases during the follow-up.Conclusions Renal cancer cryoablation is a safe,feasible and efficacious therapy for the patients who suffered from unresectable T1a renal cell carcinoma because of high surgical risk or multifocal lesions.

Advances in magnetic resonance imaging-guided adaptive radiotherapy / 中华放射肿瘤学杂志

Cone-beam computed tomography (CBCT)-guided radiotherapy has been widely used in radiotherapy, but it still has many limitations.Using magnetic resonance imaging (MRI) instead of CBCT for imaging-guided radiotherapy can not only make use of the advantages of MRI, but it also allows for online and real-time tracking of tumor motion and biological changes.This technique truly realizes the real-time MRI-guided adaptive radiotherapy (ART) in anatomy and biology, and sets another milestone in the advancement of radiotherapy.This review summarizes the technical advantages of MRI-guided radiotherapy, the basic structure and type of MR-Linac, and the technical difficulties and solutions of MRIgART.