ABSTRACT
In the present research, we have developed a model-based crisp logic function statistical classifier decision support system supplemented with treatment planning systems for radiation oncologists in the treatment of glioblastoma multiforme (GBM). This system is based on Monte Carlo radiation transport simulation and it recreates visualization of treatment environments on mathematical anthropomorphic brain (MAB) phantoms. Energy deposition within tumour tissue and normal tissues are graded by quality audit factors which ensure planned dose delivery to tumour site thereby minimising damages to healthy tissues. The proposed novel methodology predicts tumour growth response to radiation therapy from a patient-specific medicine quality audit perspective. Validation of the study was achieved by recreating thirty-eight patient-specific mathematical anthropomorphic brain phantoms of treatment environments by taking into consideration density variation and composition of brain tissues. Dose computations accomplished through water phantom, tissue-equivalent head phantoms are neither cost-effective, nor patient-specific customized and is often less accurate. The above-highlighted drawbacks can be overcome by using open-source Electron Gamma Shower (EGSnrc) software and clinical case reports for MAB phantom synthesis which would result in accurate dosimetry with due consideration to the time factors. Considerable dose deviations occur at the tumour site for environments with intraventricular glioblastoma, haematoma, abscess, trapped air and cranial flaps leading to quality factors with a lower logic value of 0. Logic value of 1 depicts higher dose deposition within healthy tissues and also leptomeninges for majority of the environments which results in radiation-induced laceration.
Subject(s)
Brain Neoplasms , Glioblastoma , Monte Carlo Method , Glioblastoma/radiotherapy , Humans , Brain Neoplasms/radiotherapy , Phantoms, Imaging , Radiotherapy Planning, Computer-Assisted/methods , Radiation Oncologists , Decision Support Systems, Clinical , Radiotherapy DosageABSTRACT
Hepatic involvement has been reported in 20-30% of patients with systemic sarcoidosis. However, isolated liver involvement is rare. We report a case of cirrhosis with portal hypertension, diagnosed as hepatic sarcoidosis based on high angiotensin-converting enzyme level and presence of multiple non-caseating granulomas in liver histopathology. She improved clinically after treatment with steroid and ursodeoxycholic acid.
