Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 44
Filter
1.
J Am Coll Radiol ; 21(4): 567-575, 2024 Apr.
Article in English | MEDLINE | ID: mdl-37473855

ABSTRACT

OBJECTIVE: Compare the cost of performing an osteoid osteoma ablation using cone beam CT (CBCT) with overlay fluoroscopic guidance to ablation using conventional CT (CCT) guidance and microwave ablation (MWA) to radiofrequency ablation (RFA). METHODS: An 11-year retrospective study was performed of all patients undergoing osteoid osteoma ablation. Ablation equipment included a Cool tip RFA probe (Covidien, Minneapolis, Minnesota) or a Neuwave PR MWA probe (Ethicon, Rariton, New Jersey). The room times as well as immediate recovery time were recorded for each case. Cost analysis was then performed using time-driven activity-based costing for rate-dependent variables including salaries, equipment depreciation, room time, and certain supplies. Time-independent costs included the disposable interventional radiology supplies and ablation systems. Costs were reported for each service providing care and using conventional cost accounting methods with variable and fixed expenditures. RESULTS: A total of 91 patients underwent 96 ablation procedures in either CBCT (n = 66) or CCT (n = 30) using either MWA (n = 51) or RFA (n = 45). The anesthesia induction (22.7 ± 8.7 min versus 15.9 ± 7.2 min, P < .001), procedure (64.7 ± 27.5 min versus 47.3 ± 15.3 min; P = .001), and room times (137.7 ± 33.7 min versus 103.9 ± 22.6. min; P < .001) were significantly longer for CBCT procedures. The procedure time did not differ significantly between MWA and RFA (62.1 ± 27.4 min versus 56.1 ± 23.3 min; P = .27). Multiple regression analysis demonstrated lower age (P = .046), CBCT use (P = .001), RFA use (P = .02), and nonsupine patient position (P = .01) significantly increased the total procedural cost. After controlling for these variables, the total cost of CBCT ($5,981.32 ± $523.93 versus $5,378.93 ± $453.12; P = .001) remained higher than CCT and the total cost of RFA ($5,981.32 ± $523.93 versus $5,674.43 ± $549.14; P = .05) approached a higher cost than MWA. CONCLUSION: The use of CBCT with overlay fluoroscopic guidance for osteoid osteoma ablation resulted in longer in-room times and greater cost when compared with CCT. These cost considerations should be weighed against potential radiation dose advantage of CBCT when choosing an image guidance modality. Younger age, RFA use, and nonsupine patient position additionally contributed to higher costs.


Subject(s)
Ablation Techniques , Bone Neoplasms , Catheter Ablation , Osteoma, Osteoid , Humans , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/surgery , Osteoma, Osteoid/diagnostic imaging , Osteoma, Osteoid/surgery , Retrospective Studies , Catheter Ablation/methods , Costs and Cost Analysis , Treatment Outcome
2.
Laryngoscope ; 133(4): 956-962, 2023 04.
Article in English | MEDLINE | ID: mdl-35657104

ABSTRACT

OBJECTIVES: Large (De Serres stage [IV-V]) head and neck lymphatic malformations (HNLMs) often have multiple, high-risk, invasive treatments (ITs) to address functional compromise. Logically reducing HNLM ITs should reduce treatment risk. We tested whether delaying HNLM ITs reduces total IT number. MATERIALS: Consecutive HNLM patients (n = 199) between 2010 and 2017, aged 0-18 years. METHODS: ITs (surgery or sclerotherapy) were offered for persistent or dysfunction causing HNLMs. Treatment effectiveness categorized by IT number: optimal (0-1), acceptable (2-5), or suboptimal (>5). Clinical data were summarized, and outcome associations tested (χ2 ). Relative risk (RR) with a Poisson working model tested whether HNLM observation or IT delay (>6 months post-diagnosis) predicts treatment success (i.e., ≤1 IT). RESULTS: Median age at HNLM diagnosis was 1.3 months (interquartile range [IQR] 0-45 m) with 107/199(54%) male. HNLM were stage I-III (174 [88%]), IV-V (25 [13%]). Initial treatment was observation (70 [35%]), invasive (129 [65%]). Treatment outcomes were optimal (137 [69%]), acceptable (36 [18%]), and suboptimal (26 [13%]). Suboptimal outcome associations: EXIT procedure, stage IV-V, oral location, and tracheotomy (p < 0.001). Stage I-III HNLMs were initially observed compared with stage I-III having ITs within 6 months of HNLM diagnosis, had a 82% lower relative treatment failure risk ([i.e., >1 IT], RR = 0.09, 95% CI 0.02-0.36, p < 0.001). Stage I-III HNLMs with non-delayed ITs had reduced treatment failure risk compared with IV-V (RR = 0.47, 95% CI 0.33-0.66, p < 0.001). CONCLUSION: Observation and delayed IT in stage I-III HNLM ("Grade 1") is safe and reduces IT (i.e., ≤1 IT). Stage IV-V HNLMs ("Grade 2") with early IT have a greater risk of multiple ITs. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:956-962, 2023.


Subject(s)
Head , Lymphatic Abnormalities , Humans , Male , Infant , Female , Neck , Lymphatic Abnormalities/surgery , Treatment Outcome , Sclerotherapy/methods
3.
J Vasc Interv Radiol ; 34(3): 460-465, 2023 03.
Article in English | MEDLINE | ID: mdl-36521790

ABSTRACT

The purpose of this study was to compare the adverse event (AE) rates of percutaneous pediatric transplant liver biopsies in patients receiving periprocedural antithrombotic agents with those in patients not receiving them. A 19-year retrospective single-center study of ultrasound-guided transplant liver biopsies was conducted. Patients who received aspirin for <5 days (n = 51) or heparin <4 hours (n = 15) before biopsy were separately grouped. AEs were reported using the Society of Interventional Radiology classification. In 276 biopsy samples from patients with a mean age of 6.75 years ± 5.80, the overall AE (P = .72) and moderate AE (P = .78) rates for control and antithrombotic groups were not significantly different. No severe AEs or deaths occurred. In conclusion, aspirin continuation during percutaneous pediatric transplant liver biopsies may be safe, but more studies are necessary to confirm the safety of periprocedural heparin.


Subject(s)
Fibrinolytic Agents , Liver , Child , Humans , Retrospective Studies , Liver/pathology , Image-Guided Biopsy/adverse effects , Heparin , Aspirin
4.
Genet Med ; 24(11): 2318-2328, 2022 11.
Article in English | MEDLINE | ID: mdl-36066547

ABSTRACT

PURPOSE: PIK3CA-related overgrowth spectrum (PROS) conditions of the head and neck are treatment challenges. Traditionally, these conditions require multiple invasive interventions, with incomplete malformation removal, disfigurement, and possible dysfunction. Use of the PI3K inhibitor alpelisib, previously shown to be effective in PROS, has not been reported in PIK3CA-associated head and neck lymphatic malformations (HNLMs) or facial infiltrating lipomatosis (FIL). We describe prospective treatment of 5 children with PIK3CA-associated HNLMs or head and neck FIL with alpelisib monotherapy. METHODS: A total of 5 children with PIK3CA-associated HNLMs (n = 4) or FIL (n = 1) received alpelisib monotherapy (aged 2-12 years). Treatment response was determined by parental report, clinical evaluation, diary/questionnaire, and standardized clinical photography, measuring facial volume through 3-dimensional photos and magnetic resonance imaging. RESULTS: All participants had reduction in the size of lesion, and all had improvement or resolution of malformation inflammation/pain/bleeding. Common invasive therapy was avoided (ie, tracheotomy). After 6 or more months of alpelisib therapy, facial volume was reduced (range 1%-20%) and magnetic resonance imaging anomaly volume (range 0%-23%) were reduced, and there was improvement in swallowing, upper airway patency, and speech clarity. CONCLUSION: Individuals with head and neck PROS treated with alpelisib had decreased malformation size and locoregional overgrowth, improved function and symptoms, and fewer invasive procedures.


Subject(s)
Phosphatidylinositol 3-Kinases , Thiazoles , Child , Humans , Phosphatidylinositol 3-Kinases/genetics , Mutation , Class I Phosphatidylinositol 3-Kinases/genetics , Thiazoles/therapeutic use
5.
J Vasc Interv Radiol ; 32(10): 1479-1487, 2021 10.
Article in English | MEDLINE | ID: mdl-34358685

ABSTRACT

PURPOSE: To compare the direct bundled costs of interventional radiology (IR) suite versus bedside placement of noncuffed central venous catheters in infants. METHODS: A single-center retrospective review was performed of all noncuffed upper extremity (peripherally inserted central venous catheter [PICC]) and tunneled femoral (tunneled femoral central venous catheter [TCVC]) catheters placed in infants between January 1, 2018, and December 31, 2018. Propensity score matching was performed adjusting for age, birth weight, procedure weight, and catheter days. Process maps for each procedure were created based on location and sedation type. Technical success and complications were recorded for each placement. The total direct bundled cost for each catheter placement was calculated by summing the procedure and complication costs. RESULTS: A total of 142 procedures were performed on 126 matched patients with a technical success of 96% at the bedside and 100% in the IR suite (P = .08). The complication rates did not significantly differ between the 2 groups (P = .51). The total direct bundled costs for catheter placement were $1421.3 ± 2213.2 at the bedside and $2256.8 ± 3264.7 in the IR suite (P = .001). CONCLUSIONS: The bundled cost of bedside femoral catheter placement is significantly less than that of fluoroscopic TCVC and PICC placement performed in the IR suite, mainly related to differences in sedation costs.


Subject(s)
Catheterization, Central Venous , Catheterization, Peripheral , Central Venous Catheters , Catheterization, Central Venous/adverse effects , Catheterization, Peripheral/adverse effects , Costs and Cost Analysis , Humans , Infant , Radiology, Interventional , Retrospective Studies
6.
Diagn Interv Radiol ; 24(5): 295-297, 2018 Sep.
Article in English | MEDLINE | ID: mdl-30179160

ABSTRACT

An 11-year-old male with vasculitis was found to have a large abdominal aortic pseudoaneurysm on diagnostic angiography. This report describes endovascular repair of the pseudoaneurysm by stent-graft exclusion. The existing literature surrounding this rare and potentially fatal condition is also reviewed.


Subject(s)
Aneurysm, False/diagnostic imaging , Aorta, Abdominal/abnormalities , Behcet Syndrome/complications , Stents/standards , Aneurysm, False/pathology , Aneurysm, False/surgery , Angiography/methods , Aorta, Abdominal/pathology , Child , Endovascular Procedures/methods , Humans , Male , Treatment Outcome
7.
Pediatr Radiol ; 48(3): 392-397, 2018 03.
Article in English | MEDLINE | ID: mdl-29130140

ABSTRACT

BACKGROUND: Nusinersen, the only treatment approved by the United States Food and Drug Administration for spinal muscular atrophy (SMA), is delivered intrathecally. Many children with SMA have extensive spinal instrumentation and deformities, often precluding the use of standard approaches for gaining intrathecal access. Furthermore the anatomical distortion that often occurs with rotoscoliosis can complicate the use of fluoroscopic guidance. Compared to fluoroscopy, CT affords superior guidance for complex needle placements. This opens up alternatives to the posterior (interlaminar) technique, including transforaminal and caudal approaches. OBJECTIVE: This study describes the early results of technical success, complications and radiation dose of intrathecal delivery of nusinersen using cone-beam CT guidance with two-axis fluoroscopic navigational overlay. MATERIALS AND METHODS: We conducted a retrospective review of 15 consecutive nusinersen injections performed in four children with SMA and extensive spinal hardware precluding standard posterior lumbar puncture techniques. These children were treated using transforaminal thecal access employing cone-beam CT with navigational overlay. We analyzed results including technical success, complications and total fluoroscopy time. RESULTS: All procedures were technically successful. No major complications and one minor complication were reported; the minor complication was a post-procedural neuropathic headache that was attributed to procedural positioning and was treated successfully with gabapentin. The average procedural fluoroscopy time and air kerma were 1.9 min and 55.8 mGy, respectively. CONCLUSION: Cone-beam CT guidance with two-axis navigational overlay is a safe, effective method for gaining transforaminal intrathecal access in children with spinal abnormalities and hardware precluding the use of standard techniques.


Subject(s)
Cone-Beam Computed Tomography , Muscular Atrophy, Spinal/drug therapy , Oligonucleotides/administration & dosage , Radiography, Interventional , Adolescent , Female , Humans , Injections, Spinal , Internal Fixators , Male , Muscular Atrophy, Spinal/diagnostic imaging , Muscular Atrophy, Spinal/surgery , Retrospective Studies
8.
JNMA J Nepal Med Assoc ; 56(206): 226-233, 2017.
Article in English | MEDLINE | ID: mdl-28746320

ABSTRACT

INTRODUCTION: Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss, and bone loss. In addition to declining oral health, there is always low grade infection present in periodontitis. Studies show increased levels of systemic biomarkers in periodontal disease such as CRP, which is considered a key-marker of CVD. Research has also shown positive association between BMI and smoking with periodontitis and CRP. The objective of the study was to assess the levels of CRP in patients with and without periodontitis and their relation with BMI and smoking behaviour. METHODS: Patients visiting the Dental department of Bir Hospital were invited to participate in the study. Total 31 subjects in each group: Case (periodontitis) and Control (without periodontitis) were selected using convenience sampling technique. All subjects underwent periodontal examination by a single examiner. Serum CRP samples were taken before periodontal treatment. Data analysis was done by SPSS 17 software program. RESULTS: Increase in mean CRP levels in periodontitis (5.8595mg/L) with high statistical significance (P=0.000) in comparison to subjects without periodontitis (1.1214mg/L) was observed. BMI showed positive association with periodontitis (P=0.046) but not with CRP (0.213). Smoking behaviour showed no significant relation with either CRP (P=0.344) or periodontitis (P=0.541). CONCLUSIONS: We found highly significant association between periodontitis and CRP levels but not always with BMI and smoking. CRP, which is an established marker for CVD was significantly increased in periodontal infections. Hence, a close interaction among Physician, Periodontist and Patient to prevent adverse health situations is recommended.


Subject(s)
Body Mass Index , C-Reactive Protein/analysis , Periodontitis , Smoking/epidemiology , Adult , Biomarkers/analysis , Biomarkers/blood , Correlation of Data , Female , Humans , Male , Middle Aged , Nepal/epidemiology , Oral Health/statistics & numerical data , Periodontitis/blood , Periodontitis/epidemiology , Periodontitis/psychology
9.
J Nepal Health Res Counc ; 15(1): I-II, 2017 Jan.
Article in English | MEDLINE | ID: mdl-28714483

Subject(s)
Publishing , Research , Humans
10.
Neuromuscul Disord ; 26(2): 160-4, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26782016

ABSTRACT

We recently evaluated two of the original three patients (siblings) diagnosed with Proximal Myopathy with Focal Depletion of Mitochondria. The condition was named for the distinctive pattern of enlarged mitochondria around the periphery of muscle fibres with a complete absence in the middle. These siblings, aged 37 and 40, are cognitively normal with mild non-progressive muscle weakness and a susceptibility to rhabdomyolysis. Both were shown to be compound heterozygotes for novel mutations (c.263C>T + c.950T>A) in CHKB, the gene currently associated with Megaconial Congenital Muscular Dystrophy. Individuals with this condition have early-onset muscle weakness and profound intellectual disability but share the same unique pattern on muscle biopsy as was noted in Proximal Myopathy with Focal Depletion of Mitochondria; focal depletion of mitochondria was surrounded by abnormally large "megaconial" mitochondria. Thus the phenotypic spectrum of CHKB mutations ranges from a congenital muscular dystrophy with intellectual disability to a later-onset non-progressive muscular weakness with normal cognition.


Subject(s)
Choline Kinase/genetics , Mitochondrial Diseases/genetics , Mitochondrial Diseases/physiopathology , Muscular Diseases/genetics , Muscular Diseases/physiopathology , Muscular Dystrophies/genetics , Muscular Dystrophies/physiopathology , Adult , Female , Humans , Male , Phenotype , Siblings
11.
Neuromuscul Disord ; 25(12): 952-4, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26453141

ABSTRACT

Two patients with exercise-induced myalgias and rhabdomyolysis with myoglobinuria were evaluated with muscle biopsy and comprehensive myopathy next generation sequencing (NGS) gene panels. Genetic analysis revealed homozygosity for two known pathogenic SGCA mutations (R284C in Patient 1 and V247M in Patient 2). Muscle biopsy showed minimal changes with normal immunohistochemistry for α-sarcoglycan. Western blotting showed 27% and 35% of normal α-sarcoglycan immunoreactivity when compared to age matched controls, confirming the diagnosis of α-sarcoglycanopathy in both patients. The sarcoglycan genes should be added to the differential diagnosis for cases that present with rhabdomyolysis, exercise intolerance, and hyperCKemia, even in the absence of muscle weakness or normal α-sarcoglycan immunohistochemistry. Work-up of patients with these types of non-specific presentation may be best facilitated through the use of non-specific NGS myopathy panels.


Subject(s)
Exercise Tolerance , Rhabdomyolysis/complications , Sarcoglycanopathies/complications , Sarcoglycanopathies/genetics , Sarcoglycans/genetics , Adult , Female , Humans , Male , Muscle, Skeletal/pathology , Myalgia/complications , Sarcoglycanopathies/physiopathology
12.
Comput Math Methods Med ; 2015: 571473, 2015.
Article in English | MEDLINE | ID: mdl-26078777

ABSTRACT

OBJECTIVE: The aim of this work was to assess robustness and reliability of an adaptive thresholding algorithm for the biological target volume estimation incorporating reconstruction parameters. METHOD: In a multicenter study, a phantom with spheres of different diameters (6.5-57.4 mm) was filled with (18)F-FDG at different target-to-background ratios (TBR: 2.5-70) and scanned for different acquisition periods (2-5 min). Image reconstruction algorithms were used varying number of iterations and postreconstruction transaxial smoothing. Optimal thresholds (TS) for volume estimation were determined as percentage of the maximum intensity in the cross section area of the spheres. Multiple regression techniques were used to identify relevant predictors of TS. RESULTS: The goodness of the model fit was high (R(2): 0.74-0.92). TBR was the most significant predictor of TS. For all scanners, except the Gemini scanners, FWHM was an independent predictor of TS. Significant differences were observed between scanners of different models, but not between different scanners of the same model. The shrinkage on cross validation was small and indicative of excellent reliability of model estimation. CONCLUSIONS: Incorporation of postreconstruction filtering FWHM in an adaptive thresholding algorithm for the BTV estimation allows obtaining a robust and reliable method to be applied to a variety of different scanners, without scanner-specific individual calibration.


Subject(s)
Positron-Emission Tomography/statistics & numerical data , Algorithms , Computational Biology , Fluorodeoxyglucose F18 , Head and Neck Neoplasms/diagnostic imaging , Humans , Image Processing, Computer-Assisted/methods , Linear Models , Models, Statistical , Phantoms, Imaging , Radiopharmaceuticals , Reproducibility of Results , Tomography, X-Ray Computed
13.
JNMA J Nepal Med Assoc ; 53(198): 137-40, 2015.
Article in English | MEDLINE | ID: mdl-26994037

ABSTRACT

Rhabdomyolysis is a syndrome characterized by injury to skeletal muscle fibers with disruption and release of toxic metabolites into circulation. It is characterized by triad of muscle weakness, myalgia and dark urine and is associated with increased creatine kinase and lactate dehydrogenase. A severely malnourished 10 year old girl with severe diabetic ketoacidosis as hemr initial presentation of type 1 diabetes mellitus developed rhabdomyolysis (CK- 12,000 U/L) with non-oliguric renal failure during her initial course of hospital stay. The possible cause of her RM was attributed to severe hypophosphatemia (minimum serum phosphate, 0.8 mg/dL). Management of diabetic ketoacidosis phosphate supplementation and urinary alkalinization with diuresis improved her clinical course. She was discharged on Day 9 with Insulin. We recommend frequent monitoring of serum phosphate during early period of DKA, particularly in malnourished children, and its normalization in case of severe hypophosphatemia.


Subject(s)
Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/complications , Hypophosphatemia/complications , Rhabdomyolysis/etiology , Child , Diabetes Mellitus, Type 1/diagnosis , Diabetic Ketoacidosis/metabolism , Diabetic Ketoacidosis/therapy , Female , Fluid Therapy , Humans , Hypoglycemic Agents/therapeutic use , Hypophosphatemia/therapy , Insulin/therapeutic use , Phosphates/therapeutic use , Rhabdomyolysis/therapy , Severity of Illness Index , Sodium Bicarbonate/therapeutic use
14.
J Cancer Res Ther ; 11(4): 1029, 2015.
Article in English | MEDLINE | ID: mdl-26881610

ABSTRACT

Invasive papillary carcinoma of the breast is a rare, distinct variant comprising approximately less than 1-2% of all newly diagnosed cases of breast carcinoma and is usually found in postmenopausal women with a more favorable prognosis. We report an unusual case in a 45-year-old perimenopausal female who came with a complaint of lump in right breast for duration of 1 year. A simple mastectomy was undertaken for histopathological study and immunohistochemistry (IHC) which showed characteristic features of an invasive papillary breast carcinoma. We present this case in view of its rarity and to highlight this clinicopathological subtype for its good prognosis and to avoid overtreatment.


Subject(s)
Biomarkers, Tumor/metabolism , Breast Neoplasms/pathology , Carcinoma, Papillary/pathology , Breast Neoplasms/metabolism , Breast Neoplasms/surgery , Carcinoma, Papillary/metabolism , Carcinoma, Papillary/surgery , Female , Humans , Immunoenzyme Techniques , Mastectomy , Middle Aged , Neoplasm Invasiveness , Prognosis
15.
AJR Am J Roentgenol ; 203(6): W674-83, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25415734

ABSTRACT

OBJECTIVE: Myotendinous strains, contusions, and hematomas are common injuries in American football. Along with ligament sprains and inflammatory disorders, musculoskeletal injuries often result in lost participation time. This article summarizes 18 years of experience with 128 ultrasound-guided drainages and injections in 69 football players with 88 injuries. CONCLUSION: When performed by an operator with sufficient expertise in diagnostic and procedural skills, ultrasound-guided musculoskeletal interventions are minimally invasive, are safe, and can play an integral role in injury management.


Subject(s)
Athletic Injuries/epidemiology , Athletic Injuries/therapy , Football/injuries , Football/statistics & numerical data , Joints/injuries , Ultrasonography, Interventional/statistics & numerical data , Adolescent , Adult , Athletic Injuries/diagnostic imaging , Drainage/statistics & numerical data , Football/trends , Humans , Injections, Intra-Articular/statistics & numerical data , Joints/diagnostic imaging , Longitudinal Studies , Male , Ultrasonography, Interventional/trends , United States/epidemiology , Young Adult
16.
Technol Cancer Res Treat ; 12(5): 411-20, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23617288

ABSTRACT

Intensity modulated radiation therapy (IMRT) is increasingly employed in glioblastoma (GBM) treatment. The present work aimed to assess which clinical-dosimetric scenario could benefit the most from IMRT application, with respect to three-dimensional conformal radiation therapy (3D-CRT). The number of organs at risk (OARs) overlapping the planning target volume (PTV) was the parameter describing the clinical-dosimetric pattern. Based on the results, a dosimetric decision criterion to select the most appropriate treatment technique is provided. Seventeen previously irradiated patients were retrieved and re-planned with both 3D-CRT and IMRT. The prescribed dose was 60 Gy/30fx. The cases were divided into 4 groups (4 patients in each group). Each group represents the scenario where 0, 1, 2 or 3 OARs overlapped the target volume, respectively. Furthermore, in one case, 4 OARs overlapped the PTV. The techniques were compared also in terms of irradiated healthy brain tissue. The results were evaluated by paired t-test. IMRT always provided better target coverage (V95%) than 3D-CRT, regardless the clinical-dosimetric scenario: difference ranged from 0.82% (p = 0.4) for scenario 0 to 7.8% (p = 0.02) for scenario 3, passing through 2.54% (p = 0.18) and 5.93% (p = 0.08) for scenario 1 and 2, respectively. IMRT and 3D-CRT achieved comparable results in terms of dose homogeneity and conformity. Concerning the irradiation of serial-kind OARs, both techniques provided nearly identical results. A statistically significant dose reduction to the healthy brain in favor of IMRT was scored. IMRT seems a superior technique compared to 3D-CRT when there are multiple overlaps between OAR and PTV. In this scenario, IMRT allows for a better target coverage while maintaining equivalent OARs sparing and reducing healthy brain irradiation. The results from our patients dataset suggests that the overlap of three OARs can be used as a dosimetric criterion to select which patients should receive IMRT treatment.


Subject(s)
Brain Neoplasms/radiotherapy , Decision Support Techniques , Glioblastoma/radiotherapy , Organs at Risk/radiation effects , Patient Selection , Radiotherapy, Intensity-Modulated , Brain Neoplasms/surgery , Brain Stem/radiation effects , Dose Fractionation, Radiation , Glioblastoma/surgery , Humans , Optic Chiasm/radiation effects , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted , Radiotherapy, Adjuvant
17.
Med Phys ; 39(6Part8): 3691, 2012 Jun.
Article in English | MEDLINE | ID: mdl-28518949

ABSTRACT

PURPOSE: To find an optimized workflow for the use of respiratory-gated PET (4D-PET) in target volume delineation of tumors subject to respiratory-gated radiation therapy. METHODS: 15 patients with lung (11) and pancreas (4) tumors who had FDG-PET-CT for target delineation prior to EBRT were studied. Patients were selected among the group that showed respiratory-induced tumor motion 〉5mm. 4D-PET was performed by means of a Philips Gemini BigBore scanner, using the Varian RPM gating system. An identical system was available at the linac for treatment. The breathing cycle was equally divided in 4 phases, according to a previous study. Since planning was made on a single CT-phase, no ITV was explicitly built from the set of phases. The BTV was identified with SUV=2.2 threshold and the PTV was obtained expanding the BTV by 8mm(S-I), 5mm(A-P) and 3mm(L-R) to account for residual motion and setup errors. The most advantageous CT-phase for treatment planning was then identified by simulating plans on each phase and analyzing the resulting DVHs of OARs (lung, trachea, oesophagus, spinal cord, left ventricle). RESULTS: The observed maximum range of motion was 5.5mm(L-R), 12.3mm(A-P) and 19.2mm(S-I). The standard deviation of the BTV volume in the 4 phases ranged from 6% to 13.7%. V20 (lung) ranged 7.1%-15.2% in inspiration and 7.8%-18.6% in expiration. The mean dose to the oesophagus ranged 0.1-2.2Gy in inspiration and 1.4-2.0Gy in expiration. In general, the dose to OARs was smaller when planning on a single phase than on the overall, respiratory-uncontrolled volume (p-value〈0.05). CONCLUSIONS: The BTV volume was almost constant between phases, confirming that the motion might be described by 4 phases. There was no obvious choice of the optimal phase for treatment planning, suggesting patient-by-patient studies. However, planning and delivery on one phase consistently allowed dose sparing to be obtained compared to non-gated techniques.

18.
J Clin Pharm Ther ; 36(5): 602-13, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21143256

ABSTRACT

WHAT IS KNOWN AND OBJECTIVE: There is little evidence from well-designed randomized controlled trials of the impact of community pharmacist intervention on the clinical management of patients with type 2 diabetes. It is also not known how sustainable any observed effects on glycaemic control are, over time. This study was initiated to address both these issues. METHODS: A 6-month, randomized, controlled parallel-group trial in 66 community pharmacies was conducted in Belgium. Patients were randomly assigned to receive usual pharmacist care (n = 135) or a predefined pharmacist intervention (n = 153). The intervention mainly focused on correct medication use, medication adherence and healthy lifestyle promotion. Primary outcome was glycaemic control, as measured by fasting plasma glucose and HbA1c. Sustainability of changes in glycaemic control was assessed by additional glucose measurements 18 months after the end of the study. RESULTS AND DISCUSSION: The intervention significantly reduced HbA1c (between-group difference: 0·5%, P = 0.009). The largest impact on HbA1c was observed when pharmacotherapy changes (i.e., type and/or dose of hypoglycaemic agents) initiated by the physician were sustained with pharmaceutical care: HbA1c was reduced by 1·05% in the intervention group, whose medication was changed, compared with a reduction of 0·02% in the therapy-modification only, group. It was also found that the diabetes education program resulted in improved self-management and better knowledge of diabetes. Eighteen months after the end of the formal study period, the mean HbA1c of the intervention group did not differ significantly from the control group (7·4% vs. 7·2%). WHAT IS NEW AND CONCLUSION: This study provides new evidence, from a randomized controlled trial, of the beneficial effect of community pharmacist intervention in the clinical management of type 2 diabetic patients. However, questions remain about the sustainability of the observed improvements.


Subject(s)
Community Pharmacy Services , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/therapeutic use , Pharmacies , Adult , Aged , Aged, 80 and over , Belgium , Blood Glucose , Disease Management , Drug Prescriptions , Female , Glycated Hemoglobin/analysis , Health Services Research , Humans , Life Style , Male , Medication Adherence , Middle Aged , Patient Compliance , Patient Education as Topic , Pharmacists , Self Care , Time Factors , Treatment Outcome
19.
Br J Radiol ; 84(999): 271-8, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21045069

ABSTRACT

OBJECTIVES: Delineation of clinical target volume (CTV) is still controversial in glioblastomas. In order to assess the differences in volume and shape of the radiotherapy target, the use of pre-operative vs post-operative/pre-radiotherapy T(1) and T(2) weighted MRI was compared. METHODS: 4 CTVs were delineated in 24 patients pre-operatively and post-operatively using T(1) contrast-enhanced (T1(PRE)CTV and T1(POST)CTV) and T(2) weighted images (T2(PRE)CTV and T2(POST)CTV). Pre-operative MRI examinations were performed the day before surgery, whereas post-operative examinations were acquired 1 month after surgery and before chemoradiation. A concordance index (CI) was defined as the ratio between the overlapping and composite volumes. RESULTS: The volumes of T1(PRE)CTV and T1(POST)CTV were not statistically different (248 ± 88 vs 254 ± 101), although volume differences >100 cm(3) were observed in 6 out of 24 patients. A marked increase due to tumour progression was shown in three patients. Three patients showed a decrease because of a reduced mass effect. A significant reduction occurred between pre-operative and post-operative T(2) volumes (139 ± 68 vs 78 ± 59). Lack of concordance was observed between T1(PRE)CTV and T1(POST)CTV (CI = 0.67 ± 0.09), T2(PRE)CTV and T2(POST)CTV (CI = 0.39 ± 0.20) and comparing the portion of the T1(PRE)CTV and T1(POST)CTV not covered by that defined on T2(PRE)CTV images (CI = 0.45 ± 0.16 and 0.44 ± 0.17, respectively). CONCLUSION: Using T(2) MRI, huge variations can be observed in peritumoural oedema, which are probably due to steroid treatment. Using T(1) MRI, brain shifts after surgery and possible progressive enhancing lesions produce substantial differences in CTVs. Our data support the use of post-operative/pre-radiotherapy T(1) weighted MRI for planning purposes.


Subject(s)
Brain Neoplasms/diagnosis , Glioblastoma/diagnosis , Magnetic Resonance Imaging/methods , Radiotherapy Planning, Computer-Assisted/methods , Tomography, X-Ray Computed/methods , Brain Neoplasms/pathology , Brain Neoplasms/surgery , Female , Glioblastoma/pathology , Glioblastoma/surgery , Humans , Male , Observer Variation , Postoperative Period , Preoperative Period , Radiation Injuries/prevention & control , Reproducibility of Results , Tumor Burden
20.
Int J Hyperthermia ; 23(5): 451-6, 2007 Aug.
Article in English | MEDLINE | ID: mdl-17701536

ABSTRACT

PURPOSE: Hyperthermia has been used in several trials to treat pelvic cancers without excessive toxicity and with positive results. The aim of this study was to evaluate feasibility and results in terms of biochemical recurrence-free, disease-free survival, overall survival, and treatment toxicity profile of hyperthermia combined with radiotherapy in locally advanced high risk prostate cancer. PATIENTS AND METHODS: From November 1998 to December 2004, 144 patients with locally advanced prostate cancer (LAPC) were enrolled in a phase II study. They were treated using conformal radiotherapy (CRT) plus local hyperthermia (LHT) and androgen suppression therapy (AST). Treatment modalities consisted of: 1) CRT with a mean dose of 74 Gy (2 Gy/fraction/5 fractions per week); 2) LHT: one session per week during the first, second, third, and fourth week of the radiotherapy course; 3) AST was administered as neo-adjuvant and adjuvant therapy in more than 60% of patients. RESULTS: The median follow-up time was 51.7 months. Four patients were lost at follow-up. Of 140 evaluated patients, four died because of intercurrent diseases and 12 because of progression of disease. Patients were evaluated in terms of five-year overall survival (87%), and five-year biochemical progression-free survival (49%). No significant side effects, except symptoms related to AST have been reported. No late grade 3 toxicity occurred. CONCLUSIONS: In advanced high risk prostatic cancer, hyperthermia is feasible and well tolerated. It may be useful to enhance the radiotherapy efficacy at intermediate dose in order to avoid higher doses of irradiation which increases acute and late sequelae. The advantage of LHT combined with CRT should be confirmed by a randomized phase III trial, comparing irradiation plus AST with or without hyperthermia.


Subject(s)
Hyperthermia, Induced/methods , Prostatic Neoplasms/therapy , Radiotherapy, Conformal/methods , Adult , Aged , Aged, 80 and over , Androgen Antagonists/therapeutic use , Combined Modality Therapy , Disease Progression , Dose-Response Relationship, Radiation , Humans , Male , Middle Aged , Prospective Studies , Treatment Outcome
SELECTION OF CITATIONS
SEARCH DETAIL
...