ABSTRACT
OBJECTIVES: Radiotherapy for breast cancer has been associated with various side effects including cardiac sequelae. Our study aimed to define the spatial arc of spread of coronary vessels in a radian angle. MATERIALS AND METHODS: We analysed the records of 51 CT coronary angiographies done in our hospital from January 2016 to July 2016. Left anterior descending (LAD) and right coronary (RC) were contoured for each patient. In each axial section, the radial spread of each artery was noted. A 5â¯mm brush tool was used to join the start and stop angles for making the summated "coronary strips". RESULTS: Start and end angle of LAD with 95% confidence interval (CI) (in clockwise direction) were 23.9⯱ 4° and 79.0⯱ 6.6°, respectively. Mean LAD arc length⯱ SD (standard deviation) noted was 55.1°â¯± 7.7° (95% CI). For RC the smallest start angle and the largest end angle in all patients was 297.6° and 322.6°, respectively. RC start angle, end angle and arc length for 95% confidence interval were 322.2⯱ 6.1°, 292.4⯱ 11.6° and 29.8⯱ 13.1°, respectively. CONCLUSIONS: Our study provides a measure of the radial spread of the coronary arteries, especially from the perspective of breast radiotherapy. We have proposed a new organ at risk (OAR) of coronary strip. This should provide an easy and cost-effective way to delineate the coronary vasculature in breast cancer patients undergoing radiotherapy.
Subject(s)
Breast Neoplasms/radiotherapy , Coronary Artery Disease/etiology , Coronary Vessels/radiation effects , Organs at Risk , Radiation Injuries/etiology , Thoracic Neoplasms/radiotherapy , Adult , Aged , Computed Tomography Angiography , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/prevention & control , Coronary Vessels/diagnostic imaging , Female , Humans , Image Interpretation, Computer-Assisted , Male , Middle Aged , Radiation Injuries/diagnostic imaging , Radiation Injuries/prevention & control , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted , Risk FactorsABSTRACT
CONTEXT: Acute pulmonary embolism (PE) remains a diagnostic and therapeutic challenge to physicians. There are various non-invasive diagnostic modalities been suggested to diagnose pulmonary embolism. AIM: We tried to find the performance of various non-invasive investigations in comparison to multi-detector Computerized Tomography (MDCT pulmonary angiography for the diagnosis of PE). SETTINGS AND DESIGN: A prospective cohort study was conducted in 80 hospitalized medical patients. MATERIALS AND METHODS: There were 80 patients with Wells score > 2 who were included. The demographic data, non-invasive investigations, and MDCT pulmonary angiography were conducted in these patients. The sensitivity (SEN), specificity (SPE), positive predictive value (PPV), and negative predictive value (NPV) were calculated for each test. RESULTS: Out of 80 patients, 77.5% patients were with Wells score 3-6 and 22.5% patients were with Wells score more than 6. The test with highest sensitivity was d-dimer (SEN - 90%, P = 0.091) followed by PAH on TTE (SEN - 83%, PPV - 86%, P = 0.006). The most specific test was ECG showing S1Q3T3 (SPE - 100%, P = 0.421), followed by Wells score > 6 (SPE - 91%, P = 0.211). There was no test with sensitivity and specificity more than 90% CONCLUSION: In all patients with intermediate to high-risk probability MDCT pulmonary angiography is the most accurate test to diagnose PE and should be performed at the earliest. The combination of 2-dimensional ECHO and d-dimer can be used in patients with a high clinical suspicion of PE on pre-test probability where MDCT pulmonary angiography is not possible.
