Image optimization and reduction of radiation dose in CT of the paranasal sinuses.

INTRODUCTION: Due to use of ionization radiation in the computed tomography (CT), optimal parameters should be used to reduce the risk of incidence of secondary cancers in patients who are constantly exposed to x-rays. To reduce the dose delivered to patients in each scan, CT technologists can change the image acquisition parameters. However, this reduces image quality. The present study aimed to optimize and reduce radiation dose in a CT of the paranasal sinuses while minimizing deterioration of image quality. METHODS: In this study patients were divided in two groups: Group A was scanned axially and coronally using default parameters, while Group B was scanned axially and coronally using new parameters. Common CT dose descriptors including weighted computed tomography dose index (CTDIw), volumetric CTDI (CTDIvol), dose length product (DLP), effective dose (ED) and image noise were measured for each group. The patients' organ doses were estimated using the ImPACT CT patient Dosimetry Calculator. The tube voltage, tube current, pitch, rotation time, and other parameters were then reduced and optimized. After reconstruction and analysis, all of the images were of good diagnostic quality in both groups Results: Using the new parameters, good agreement was found between the direct and reconstructed images. The CT parameters were reduced by the following proportions: kVp-16.6%, mA-75%, rotation time-20%, and mAs-80%. However, these reductions did not obscure any anatomical landmarks. These parameters reduced the CTDIw, CTDIvol and DLP by 88.2%, 91.3%, and 91.3% respectively. CONCLUSION: The results suggest that the use of a Bone algorithm reduces the total amount of radiation used during CT of the sinuses. We recommend using these parameters in children, in the evaluation of facial trauma, and in emergency CT of the paranasal sinuses.

STRATEGY OF COMPUTED TOMOGRAPHY IMAGE OPTIMISATION IN CERVICAL VERTEBRAE AND NECK SOFT TISSUE IN EMERGENCY PATIENTS.

INTRODUCTION: With regards to the use of ionisation radiation in the computed tomography (CT), optimal parameters should be used to reduce the risk of incidence of secondary cancers in patients who are constantly exposed to X-rays. The aim of this study was to optimise the parameters used in CT scan of cervical vertebrae and neck soft tissue with minimal loss of image quality in emergency patients. MATERIALS AND METHODS: In this study, the patients were divided into two groups. The first group consisted of patients scanned with default parameters and the second group scanned with optimised parameters. All the study has been implemented in emergency settings. The cases included cervical vertebrae and soft tissue protocols. Common CT dose descriptors including weighted computed tomography dose index (CTDIw), volumetric CTDI (CTDIvol), dose length product (DLP), effective dose (ED) and image noise were measured for each group. The ImpactDose program was used to estimate the organs doses. Statistical analysis was performed using Kruskal-Wallis test using SPSS software. RESULTS: There was no significant quality reduction in the optimised images. Decreasing in radiation dose parameters for the soft tissue was: kVp=16.7%, mAs=64.3% and pitch=24.1%, and for the cervical vertebrae was: kVp=16.7%, mAs=54.2% and pitch=48.3%. Consequently, decreasing these parameters reduced CTDIw=81.0%, CTDIvol=90.0% and DLP = 90.2% in the cervical vertebral protocol, as well as CTDIw=75.5%, CTDIvol=81.3% and DLP = 81.4% in the soft tissue protocol. CONCLUSION: Regarding the results, the optimised parameters in the mentioned organ scan reduce the radiation dose in the target area and the organs surrounding. Therefore, these protocols can be used for reducing the risk of cancer.

Docetaxel-loaded nanostructured lipid carriers functionalized with trastuzumab (Herceptin) for HER2-positive breast cancer cells.

The aim of the present study was to prepare Herceptin targeted nanostructured lipid carriers (NLCs) of docetaxel (DTX). Herceptin was conjugated by chemical and physical methods to NLCs prepared by solvent extraction technique followed by probe sonication. Different types of fatty amines were used in construction of NLCs. The NLCs were characterized for their antibody coupling efficiency, particle size, zeta potential, polydispersity index, drug entrapment efficiency and drug release profiles. The toxicity of NLCs on MDA-MB-468 (HER2 negative receptor) and BT-474 (HER2 positive) breast cancer cell lines was evaluated by MTT assay. Also their cellular uptake was studied by flow-cytometry and fluorescent microscopy. The results showed the NLCs containing stearyl amine had the lowest particle size, the highest zeta potential and antibody coupling efficiency values. Herceptin binding to NLCs led to reduction in zeta potential and drug entrapment efficiency while, particle size increased. The NLCs containing spermine(SP) released DTX slower than other fatty amines. Non-conjugated nanoparticles containing DTX had more toxicity than the free DTX on both cell lines. Herceptin targeted NLCs caused more mortality on BT-474 cells than MDA-MB-468 cells. Flow-cytometry studies revealed enhanced cellular uptake of nanoparticles chemically conjugated by Herceptin on the BT-474 cells. DTX loaded in chemically conjugated NLCs to Herceptin showed more cytotoxic effects than the physically coated nanoparticles. The Herceptin conjugated NLCs seem promising in oriented delivery of DTX to HER2 positive breast cancer cells.

Willingness to Communicate Orally: The Case of Iranian EFL Learners.

This study sets out to develop a questionnaire on willingness to communicate (WTC) orally specific to English as a Foreign Language setting. It also aims to investigate the effect of three independent variables of interlocutor, age and gender on the same construct of WTC orally. Exploratory factor analysis resulted in three dimensions to WTC, namely WTC with teacher, with classmate, and stranger. Also Cronbach's alpha of .86 indicated a high internal consistency. Mixed between-within subjects analysis of variance was used to assess the impact of interlocutors, age and gender on participants' WTC across the three WTC subscale scores. The results showed no interaction effect between any of pairs of variables but the main effect of interlocutor on WTC orally. The results are discussed in the context of language teaching and some pedagogical implications are suggested.

Non-Newtonian Blood Flow Simulation of Diastolic Phase in Bileaflet Mechanical Heart Valve Implanted in a Realistic Aortic Root Containing Coronary Arteries.

Coronary arteries, which are branched from the sinuses, have tangible effects on the hemodynamic performance of the bileaflet mechanical heart valve (BMHV), especially in the diastolic phase. To better understand this issue, a computer model of ascending aorta including realistic sinus shapes and coronary arteries has been generated in this study in order to investigate the BMHV performance during diastole. Three-dimensional transient numerical analysis is conducted to simulate the diastolic blood flow through the hinges and in coronary arteries under the assumption of non-Newtonian behavior. Results indicate that as blood flows to the coronary arteries mainly during diastole, leakage flow from the hinge and other gaps will change considering the influence of coronary arteries. In addition, BMHV in the case of aortic replacement will increase blood flow rate into the coronary arteries about 100% as the mechanical valve resistance is higher than a native heart valve. Also, it will change the wall shear stress (WSS) distribution and increase coronary artery disease (CAD) potential. It is found out that although less leakage flow reduces the velocity magnitudes through the gaps, the shear stress acting on blood elements with non-Newtonian assumption will be detrimental in the hinge corner at the ventricular side. High WSS of 1800 Pa is observed at beginning of diastole at this region.

On-X Heart Valve Prosthesis: Numerical Simulation of Hemodynamic Performance in Accelerating Systole.

Numerical simulation of the bileaflet mechanical heart valves (BMHVs) has been of interest for many researchers due to its capability of predicting hemodynamic performance. A lot of studies have tried to simulate this three-dimensional complex flow in order to analyze the effect of different valve designs on the blood flow pattern. However, simplified models and prescribed motion for the leaflets were utilized. In this paper, transient complex blood flow in the location of ascending aorta has been investigated in a realistic model by fully coupled simulation. Geometry model for the aorta and the replaced valve is constructed based on the medical images and extracted point clouds. A 23-mm On-X Medical BMHV as the new generation design has been selected for the flow field analysis. The two-way coupling simulation is conducted throughout the accelerating phase in order to obtain valve dynamics in the opening process. The complex flow field in the hinge recess is captured precisely for all leaflet positions and recirculating zones and elevated shear stress areas have been observed. Results indicate that On-X valve yields relatively less transvalvular pressure gradient which would lower cardiac external work. Furthermore, converging inlet leads to a more uniform flow and consequently less turbulent eddies. However, the leaflets cannot open fully due to middle diffuser-shaped orifice. In addition, asymmetric butterfly-shaped hinge design and converging orifice leads to better hemodynamic performance. With the help of two-way fluid solid interaction simulation, leaflet angle follows the experimental trends more precisely rather than the prescribed motion in previous 3D simulations.

The role of the pediatric plastic surgeon in limb salvage surgery for osteosarcoma of the lower extremity.

Limb salvage for management of osteosarcoma of the lower extremity has become the mainstay of treatment for patients with malignant bony and soft tissue tumors. The knee has become a special area of concern for the reconstructive surgeon due to the high rate of wound complications and difficulties of soft tissue reconstruction. With the availability of new prosthetic implants, the advancement of surgical soft tissue techniques and introduction of adjuvant and neoadjuvant chemotherapy, resection and reconstruction has become the standard approach for patients presenting to St. Jude Children's Research Hospital. The pediatric plastic surgeon's role usually requires handling of wound complications in these reconstructive procedures. This article will discuss the authors' approach to dealing with wound complications in this difficult patient population and their interaction with the orthopedic oncologic service in obtaining primary resection and soft tissue coverage.