ORCID Profile
0000-0002-5521-3455
Current Organisation
Monash University
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 04-2008
DOI: 10.1111/J.1440-1673.2008.01937.X
Abstract: This study investigated the maximum theoretical radiation dose that could safely be delivered to 20 patients diagnosed with non-small-cell lung cancer. Two three-dimensional conformal radiation therapy (RT) class-solution techniques (A and B) and an in idualized three-dimensional conformal RT technique (C) were compared at the standard dose of 60 Gy (part I). Dose escalation was then attempted for each technique successfully at 60 Gy, constrained by predetermined limits for lung and spinal canal (part II). Part I and part II data were reanalysed to include oesophageal dose constraints (part III). In part I, 60 Gy was successfully planned using techniques A, B and C in 19 (95%), 18 (90%) and 20 (100%) patients, respectively. The mean escalated dose attainable for part II using techniques A, B and C were 76.4, 74 and 97.8 Gy, respectively (P < 0.0005). One (5%) patient was successfully planned for 120 Gy using techniques A and B, whereas four (20%) were successfully planned using technique C. Following the inclusion of additional constraints applied to the oesophagus in part III, the amount of escalated dose remained the same for all patients who were successfully planned at 60 Gy apart from two patients when technique C was applied. In conclusion, in idualized three-dimensional conformal RT facilitated greater dose conformation and higher escalation of dose in most patients. With modern planning tools, simple class solutions are obsolete for conventional dose radical RT in non-small-cell lung cancer. Highly in idualized conformal planning is essential for dose escalation.
Publisher: Elsevier BV
Date: 04-2002
Publisher: Elsevier BV
Date: 05-2008
DOI: 10.1016/J.FORSCIINT.2007.12.006
Abstract: The sudden, unexpected death of young persons from ruptured thoracic aortic dissection is suggestive of Marfan syndrome (MFS), a genetic disorder of fibrillin. Establishing such a diagnosis is important so that the same fate might be avoided in living relatives. MFS diagnosis is difficult in the deceased but the presence of arachnodactyly, a common morphological feature of MFS, can be established by assessing the metacarpal index (MCI). MCI is routinely determined using radiographic techniques including computed radiography (CR). The wider availability of computed tomography (CT) in the forensic environment provides an alternative method. CT is predicted to produce measurements at least as accurate as CR. The aims of this study therefore were to (1) validate MCI measurements by comparing CT and CR with direct measurement using calipers on human skeletonised hands, and (2) compare cadaveric CT and CR MCI measurements. The metacarpals of 12 human skeleton hands were measured using CT and CR, and compared with direct measurement using calipers (the "gold standard"). Fifty randomly selected cadavers between 20 and 40 years had the MCI of both hands measured using CT and CR. CT was found to be more accurate in the measurement of MCI than CR. There were significant differences in the MCIs obtained for CT and CR (females: p=0.01 males: p<0.0001) and between CR and calipers (p=0.004). There were no significant differences between MCIs obtained for CT and calipers (p=0.71). CR was found to consistently overestimate the MCI by an average of 7.97%. CT is more accurate in determination of the MCI than CR and should provide the basis for future skeletal measurements.
Publisher: Wiley
Date: 05-08-2009
DOI: 10.1016/J.IJDEVNEU.2009.07.007
Abstract: Ultrasound imaging of the brain is routinely used to monitor the development and resolution of brain lesions among premature and compromised newborn human babies. However, animal studies have shown that ultrasound can cause damage to developing foetal and neonatal tissues. In this study we investigated if ultrasound of the chick brain can lead to learning and memory impairment after hatch. We exposed the brains of chicks on day 19 of a 21 day incubation period to 5 or 10 min of B-mode, or to 1, 2, 3, 4 or 5 min of pulsed Doppler ultrasound in ovo. Learning and memory function were assessed at day 2 post-hatch. Our results show that B-mode exposure at E19 does not affect memory function. On the other hand, 2h after training, significant memory impairment occurred following 4 and 5 min of pulsed Doppler exposure at E19. In separate groups of chicks, short-, intermediate- and long-term memory was equally impaired suggesting an inability to learn. Further, the chicks were still unable to learn with a second training session 5 min after completion of the initial testing. These results demonstrate that extended exposure to pulsed Doppler ultrasound can adversely affect cognitive function in the chick when exposure occurs close to the time of hatch.
Publisher: Wiley
Date: 28-09-2009
Publisher: Wiley
Date: 30-07-2022
DOI: 10.1002/JMRS.611
Abstract: Anal cancer (AC) is 18 F‐FDG‐PET avid and has been used to evaluate treatment response several months after chemoradiotherapy. This pilot study aimed to assess the utility of semi‐automated contouring methods and quantitative measures of treatment response using 18 F‐FDG‐PET imaging at the early time point of 1‐month post‐chemoradiotherapy. Eleven patients with AC referred for chemoradiotherapy were prospectively enrolled into this study, with 10 meeting eligibility requirements. 18 F‐FDG‐PET imaging was obtained pre‐chemoradiotherapy (TP1), and then 1‐month (TP2), 3–6 months (TP3) and 9–12 months (TP4) post‐chemoradiotherapy. Manual and semi‐automated (Threshold) contouring methods were used to define the primary tumour on all 18 F‐FDG‐PET images. Resultant contours from each method were interrogated using quantitative measures, including volume, response index (RI), total lesion glycolysis (TLG), SUV max , SUV median and SUV mean . Response was assessed quantitatively as reductions in these measures and also qualitatively against established criteria. Nine patients were qualitatively classified as complete metabolic responders at TP2 and all 10 at TP3. All quantitative measures demonstrated significant ( P 0.05) reductions at TP2 for both Manual and Threshold methods. All reduced further at TP3 and again at TP4 for Threshold methods. TLG showed the highest reduction at all post‐chemoradiotherapy time points and classified the most responders for each method at each time point. All patients are recurrence‐free at minimum 4‐year follow‐up. Based on our small s le size, semi‐automated methods of disease definition using 18 F‐FDG‐PET imaging are feasible and appear to facilitate quantitative response classification of AC as early as 1‐month post‐chemoradiotherapy. Early identification of treatment response may potentially improve disease management.
Publisher: Wiley
Date: 12-01-2021
DOI: 10.1002/JMRS.457
Abstract: Guidelines recommend that the proximal seminal vesicles (PrSV) should be included in the clinical target volume for locally advanced prostate cancer patients undergoing radiotherapy. Verification and margins for the prostate may not necessarily account for PrSV displacement. The purpose was to determine the inter‐fraction displacement of the PrSV relative to the prostate during radiotherapy. Fiducials were inserted into the prostate, and right and left PrSV (RSV and LSV) in 30 prostate cancer patients. Correctional shifts for the prostate, right and left PrSV and pelvic bones were determined from each patient's 39 daily orthogonal portal images relative to reference digitally reconstructed radiographs. There was a significant displacement of the RSV relative to the prostate in all directions: on average 0.38 mm (95% confidence interval (CI) 0.26 to 0.50) to the left, 0.80–0.81 mm (CI 0.68 to 0.93) superiorly and 1.51 mm (CI 1.36 to 1.65) posteriorly. The LSV was significantly displaced superiorly to the prostate 1.09–1.13 mm (CI 0.97 to 1.25) and posteriorly 1.81 mm (CI 1.67 to 1.96), but not laterally (mean 0.06, CI −0.06 to 0.18). The calculated PTV margins (left–right, superior–inferior, posterior–anterior) were 4.9, 5.3–5.6 and 4.8 mm for the prostate, 5.2, 7.1–8.0 and 9.7 mm for the RSV, and 7.2, 7.5–7.6 and 8.6 mm for the LSV. There is a significant displacement of the PrSV relative to the prostate during radiotherapy. Greater margins are recommended for the PrSV compared to the prostate.
Publisher: SAGE Publications
Date: 08-2014
Abstract: Motion management strategies are important during stereotactic ablative body radiotherapy for abdominal targets. The kidney is a mobile retroperitoneal organ that moves with respiration. A review of the literature was performed to investigate the reported degree of kidney motion associated with various breathing conditions. A structured search was performed using Medline from January 1970 to May 2013 for all publications describing cranial-caudal kidney motion. Relevance to radiotherapy practice was reviewed based on any breathing instructions and/or immobilization equipment that could affect breathing pattern. Studies were categorized under three types of breathing conditions: Forced-shallow, breath-hold/deep and free. A total of 25 publications were identified describing cranial-caudal kidney motion with a combined total of 415 participants. Three publications described forced-shallow breathing using prone positioning or abdominal compression plates. Prone positioning, compared to supine positioning, did little to minimise kidney motion, however use of compression plates can result in kidney motion of less than 5 mm. Eight publications described deep breathing/breath hold techniques that showed average kidney motion ranging between 10 mm-40 mm. Fifteen publications investigated kidney motion under free breathing with the majority reporting mean motion of less than 10 mm. Kidney movement of up to 8.1 mm in the anterior posterior direction and 6.2 mm laterally were reported with no indications that breathing technique can influence the extent of this motion. In summary, kidney movement is complex and consideration should be made to ensure that motion management strategies provide the desired radiotherapy benefit. There are limited publications on the effectiveness of abdominal compression on reducing kidney motion which warrant further investigation in this area.
Publisher: Wiley
Date: 16-03-2022
DOI: 10.1002/JMRS.576
Abstract: Radiographers working in remote Far North Queensland (FNQ), Australia, need to possess unique skills sets in order to provide culturally safe practice to predominantly Indigenous communities. Due to the lack of onsite radiologists in FNQ, radiographers need to provide preliminary findings to referring practitioners including sonographic findings. The accuracy of such findings has not been evaluated to date. The objective of this study was to compare the level of agreement and recommendations for further investigations of FNQ radiographers to teleradiologists’ reports. As radiographic findings are not recorded or stored as part of routine practice, only sonographic findings were included in the study. Consecutive de‐identified ultrasound cases were extracted between January and March 2019 inclusively by an independent investigator. The researcher scored the ultrasound cases between 1 and 4 according to levels of agreement between sonographic findings and teleradiologists’ reports, and recommendations between radiographers and teleradiologists were also compared using frequency analysis. Five‐hundred and thirty‐two ultrasound cases were included for this study. Of those, 517 (97.2%) were in complete agreement and 15 (2.8%) reported minor discrepancies. There were no moderate or major discrepancies suggesting an overall accuracy rate of 100% as the radiographer/sonographer findings were in close agreement with the teleradiologists’ reports. There was complete agreement regarding further clinical recommendations in 453 (85%) cases. The discrepancy in the remaining 15% of cases did not lead to any adverse or changed patient management. This study supports existing evidence about the accuracy and timely communication of sonographic findings to radiologists and other health care professionals, in keeping with the Medical Radiation Practice Board of Australia expectations. It is likely that radiographer comments on plain radiographic images are equally as reliable, but this remains to be explored.
Publisher: American Physiological Society
Date: 08-2011
DOI: 10.1152/AJPRENAL.00564.2010
Abstract: Intrauterine growth restriction (IUGR) leads to a reduction in nephron endowment at birth and is linked to renal dysfunction in adulthood. The aim of the present study was to determine whether kidneys of IUGR rat offspring are more vulnerable to a secondary insult of hyperglycemia. IUGR was induced in Wistar-Kyoto rats by maternal protein restriction. At 24 wk of age, diabetes was induced in male IUGR and non-IUGR offspring by streptozotocin injection insulin was injected daily to maintain blood glucose levels at either a mild (7–10 mmol/l n=8/group) or a moderate (10–15 mmol/l n=8/group) level. At 32 wk of age, renal function was assessed using ultrasound and [ 3 H]inulin and [ 14 C]para-aminohippurate clearance techniques. Conscious mean arterial blood pressure and heart rate were unchanged in IUGR offspring. Relative kidney length was increased significantly in IUGR offspring, and renal function was altered significantly of importance, there was a significant increase in filtration fraction, indicative of glomerular hyperfiltration. Induction of hyperglycemia led to marked impairment of renal function. However, the response to hyperglycemia was not different between IUGR and non-IUGR offspring. Maintaining blood glucose levels at a mild hyperglycemic level led to marked improvement in all measures of renal function in IUGR and non-IUGR offspring. In conclusion, while the IUGR offspring showed evidence of hyperfiltration, the response to hyperglycemia was similar in IUGR and non-IUGR kidneys in adulthood. Importantly, maintaining blood glucose levels at a mild hyperglycemic level markedly attenuated the renal dysfunction associated with diabetes, even in IUGR offspring.
Publisher: Hindawi Limited
Date: 07-2008
DOI: 10.1111/J.1365-2354.2007.00846.X
Abstract: Preparing cancer patients and their families for chemotherapy treatment is difficult. The challenge lies in finding ways to promote self-care and improve their ability to recall instructions. The aim of this study was to evaluate the usefulness of an educational video with regard to patients' ability to recall and report side effects of treatment. Patients referred for adjuvant chemotherapy for breast and colorectal cancer were randomized to receive standard pre-chemotherapy education or standard education plus addition of a video. Patients completed a base line questionnaire assessing existing knowledge and another questionnaire prior to the second chemotherapy cycle evaluating recall of information. Patients who watched the video were asked to assess the video after six cycles of chemotherapy. Telephone calls to the department reporting symptoms were monitored for both groups. The video group demonstrated trends towards higher recall in information concerning fever, mouth problems, low red cell count and prevention of constipation. They more commonly telephoned reporting medical problems of nausea, vomiting and signs of infection compared with the standard group. In summary, our study demonstrated inclusion of video to standard chemotherapy education improves retention of information regarding management of predictable chemotherapy side effects and reporting of treatment-related symptoms.
Publisher: Wiley
Date: 25-05-2011
DOI: 10.1111/J.1365-2303.2011.00871.X
Abstract: To investigate prospectively the diagnostic impact of ultrasound coupling gel on thyroid specimens obtained under ultrasound guidance. Patients presenting for ultrasound-guided fine needle aspiration (USG-FNA) of the thyroid were invited to participate in the study. Four specimens per nodule were collected: two using chlorhexdine wash and two using sterile, colourless ultrasound gel as couplant according to routine protocol. All slides were analysed in a blinded fashion by two senior cytologists for the presence or absence of ultrasound gel-induced artefacts. The presence of gel-induced artefacts between the two groups was analyzed using Pearson's chi-square test. Kappa statistics were used to measure the inter-rater agreement between the cytologists. Twenty thyroid nodules comprising 80 specimen slides were collected. On slides collected with gel, cytological artefacts were detected in 60-65% of cases compared with 10-15% of cases without gel (P<0.001). The inter-rater agreement between the two observers was very good (κ=0.84). Two of the 14 patients required repeat FNA due to non-diagnostic cytology results caused by inadequate s ling and gel-induced artefacts. Clinical cytopathologists, radiologists and sonographers should be aware of the potential for ultrasound gel to cause significant artefacts on cytological specimens. Our findings suggest that staff involved in USG-FNA cytology should remove the gel carefully before taking the aspirate.
Publisher: Springer Science and Business Media LLC
Date: 28-11-2016
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.IJROBP.2013.12.004
Abstract: To compare measurements of the uterus and cervix obtained with magnetic resonance imaging (MRI) and transabdominal ultrasound to determine whether ultrasound can identify the brachytherapy target and be used to guide conformal brachytherapy planning and treatment for cervix cancer. Consecutive patients undergoing curative treatment with radiation therapy between January 2007 and March 2012 were included in the study. Intrauterine applicators were inserted into the uterine canal while patients were anesthetized. Images were obtained by MRI and transabdominal ultrasound in the longitudinal axis of the uterus with the applicator in treatment position. Measurements were taken at the anterior and posterior surface of the uterus at 2.0-cm intervals along the applicator, from the external os to the tip of the applicator. Data were analyzed using Bland Altman plots examining bias and 95% limits of agreement. A total of 192 patients contributed 1668 measurements of the cervix and uterus. Mean (± SD) differences of measurements between imaging modalities at the anterior and posterior uterine surface ranged from 1.5 (± 3.353) mm to 3.7 (± 3.856) mm, and -1.46 (± 3.308) mm to 0.47 (± 3.502) mm, respectively. The mean differences were less than 3 mm in the cervix. The mean differences were less than 1.5 mm at all measurement points on the posterior surface. Differences in the measurements of the cervix and uterus obtained by MRI and ultrasound were within clinically acceptable limits. Transabdominal ultrasound can be substituted for MRI in defining the target volume for conformal brachytherapy treatment of cervix cancer.
Publisher: Springer Science and Business Media LLC
Date: 18-02-2011
DOI: 10.1007/S10554-011-9815-4
Abstract: Accessory left atrial appendages and atrial erticula have an incidence of 10-27%. Their association with atrial fibrillation needs to be confirmed. This study determined the prevalence, number, size, location and morphology of accessory left atrial appendages/atrial erticula in patients with atrial fibrillation compared with those in sinus rhythm. A retrospective analysis of 47 consecutive patients with atrial fibrillation who underwent 320 multidetector Coronary CT angiography (CCTA) was performed. A random group of 47 CCTA patients with sinus rhythm formed the control group. The presence, number, size, location and morphology of accessory left atrial appendages and atrial erticula in each group were analysed. Twenty one patients had a total of 25 accessory left atrial appendages and atrial erticula in the atrial fibrillation group and 22 patients had a total of 24 accessory left atrial appendages and atrial erticula in the sinus rhythm group. Twenty-one atrial erticula were identified in 19 patients in the atrial fibrillation group and 19 atrial erticula in 17 patients in the sinus rhythm group. The mean length and width of accessory left atrial appendage was 6.9 and 4.7 mm, respectively in the atrial fibrillation group and 12 and 4.6 mm, respectively, in the sinus rhythm group, P = ns (not significant). The mean length and width of atrial erticulum was 4.7 and 3.6 mm, respectively in the atrial fibrillation group and 6.2 and 5 mm, respectively in the sinus rhythm group (P = ns). Eighty-four % and 96% of the accessory left atrial appendages/atrial erticula in the atrial fibrillation and sinus rhythm groups were located along the right anterosuperior left atrial wall. Accessory left atrial appendages and atrial erticula are common structures with similar prevalence in patients with atrial fibrillation and sinus rhythm.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Wiley
Date: 26-07-2018
DOI: 10.1111/AVJ.12709
Abstract: Bovine viral diarrhoea virus (BVDV) and border disease virus (BDV) are of the genus Pestivirus. They are known to cause significant reproductive and production losses, with BVDV acknowledged as a major source of economic loss to the Australian cattle industry. Very little is currently known about the prevalence and effect of pestiviruses in the Australian sheep industry. The present study aimed to examine the seroprevalence and effect of both BVDV and BDV in South Australian sheep flocks. In total, 875 breeding ewes on 29 properties were serologically tested by ELISA, AGID and VNT assays for the presence of Pestivirus-specific antibodies. Three (0.34%) in idual animals returned serological results suggestive of previous BDV infection. All three positive animals were collected from one property, giving a property level seroprevalence of 3.45% and a within-flock seroprevalence of 10%. The results suggested that BDV infection is present, albeit at a very low incidence, in the South Australian sheep flock and BVDV infection appears to be absent. Consequently, pestiviruses are unlikely to impair production in South Australian sheep populations.
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJOPEN-2020-041417
Abstract: There is a paucity of data that can be used to guide the management of critically ill patients with COVID-19. In response, a research and data-sharing collaborative—The COVID-19 Critical Care Consortium—has been assembled to harness the cumulative experience of intensive care units (ICUs) worldwide. The resulting observational study provides a platform to rapidly disseminate detailed data and insights crucial to improving outcomes. This is an international, multicentre, observational study of patients with confirmed or suspected SARS-CoV-2 infection admitted to ICUs. This is an evolving, open-ended study that commenced on 1 January 2020 and currently includes sites in over 48 countries. The study enrols patients at the time of ICU admission and follows them to the time of death, hospital discharge or 28 days post-ICU admission, whichever occurs last. Key data, collected via an electronic case report form devised in collaboration with the International Severe Acute Respiratory and Emerging Infection Consortium/Short Period Incidence Study of Severe Acute Respiratory Illness networks, include: patient demographic data and risk factors, clinical features, severity of illness and respiratory failure, need for non-invasive and/or mechanical ventilation and/or extracorporeal membrane oxygenation and associated complications, as well as data on adjunctive therapies. Local principal investigators will ensure that the study adheres to all relevant national regulations, and that the necessary approvals are in place before a site may contribute data. In jurisdictions where a waiver of consent is deemed insufficient, prospective, representative or retrospective consent will be obtained, as appropriate. A web-based dashboard has been developed to provide relevant data and descriptive statistics to international collaborators in real-time. It is anticipated that, following study completion, all de-identified data will be made open access. ACTRN12620000421932 ( anzctr.org.au/ACTRN12620000421932.aspx ).
Publisher: BMJ
Date: 19-05-2015
Publisher: Cambridge University Press (CUP)
Date: 06-2009
DOI: 10.1017/S1460396908006596
Abstract: In recent years the role of the radiation therapist (RT) has increasingly evolved. In Australia, one of the major developments has been the transition from practice which was rarely based on scientific evidence, to the profession today which engages in and incorporates research into everyday practice. The aim of this article is to provide an insight into the current status of Australian radiation therapy research. In order to present a national overview, a survey relating to research activity was e-mailed to all (48) clinical centres in Australia. Thirty-six out of the 48 centres responded, representing 13 private and 23 public centres. The results demonstrated that a research culture is beginning to be established and that there are challenges associated with implementing research. The role of universities in facilitating the development of research skills was considered important with an increasing number of practitioners undertaking higher research degrees. Overall, research activity in the Australian radiation therapy community is becoming more prevalent. If the profession is to continue to strengthen its research profile the professional body and universities need to continue providing academic and funding support. Greater focus on multidisciplinary collaboration is needed with direct involvement of RTs in multi-centre studies.
Publisher: Elsevier BV
Date: 02-2011
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.RADONC.2013.02.010
Abstract: To investigate the impact of treatment delays on radiation therapy (RT) target volumes and overall survival (OS) in patients with non-small cell lung cancer (NSCLC) who underwent two baseline FDG PET/CT scans. Patients underwent a staging (PET1) and RT planning (PET2) FDG PET/CT scan. At PET1 all patients were eligible for radical chemo-RT. OS and progression-free survival (PFS) were compared for patients remaining eligible for radical RT and those treated palliatively because PET2 showed progression. RT target volumes were contoured using PET1 and PET2. Normal tissue doses were compared for patients remaining eligible for radical RT. Eighty-two patients underwent PET2 scans between October 2004 and February 2007. Of these, 21 had a prior PET1 scan, median 23 days apart (range 8-176 days). Six patients (29%) were unsuitable for radical RT after PET2 five received palliative treatment and one received no treatment. Patients treated palliatively had significantly worse OS and PFS than patients treated radically p<0.001. Mean RT tumour volume increased from 105cc to 198cc (p<0.005) between scans. Disease progression while awaiting initiation of curative RT in NSCLC is associated with larger treatment volumes and worse survival.
Publisher: Informa UK Limited
Date: 18-11-2013
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.PRRO.2015.08.002
Abstract: Stereotactic ablative body radiation therapy for primary kidney cancer treatment relies on motion management that can quantify both the trajectory of kidney motion and stabilize the patient. A prospective ethics-approved clinical trial of stereotactic treatment to primary kidney targets was conducted at our institution. Our aim was to report on specific kidney tumor motion and the inter- and intrafraction motion as seen on treatment. Patients with tumor size <5 cm received a dose of 26 Gy in 1 fraction and those with tumor size ≥5 cm received 42 Gy in 3 fractions. All patients underwent a 4-dimensional computed tomography planning scan, immobilized in a dual-vacuum system. A conventional linear accelerator cone beam computed tomography scan was used for pre-, mid-, and posttreatment imaging to verify target position. Between July 2012 and October 2014, 33 targets from 32 consecutive patients (24 males/8 females) were treated. Seventeen targets were prescribed 26 Gy/1 fraction and the remaining 16 targets received 42 Gy/3 fractions. Kidney motion at each of the poles was not affected by the presence of tumor (P = .875), nor was the motion statistically different from the corresponding contralateral kidney pole (P = .909). The mean 3-dimensional displacement of the target at mid- and posttreatment was 1.3 mm (standard deviation ± 1.6) and 1.0 mm (standard deviation ± 1.3), respectively. The maximum displacement in any direction for 95% of the fractions at mid- and posttreatment was ≤3 mm. In summary, stereotactic ablative body radiation therapy of primary kidney targets can be accurately delivered on a conventional linear accelerator with protocol that has minimal intrafractional target motion.
Publisher: SAGE Publications
Date: 09-2007
Abstract: Magnetic resonance (MR) imaging has established its usefulness in diagnosing hamstring muscle strain and identifying features correlating with the duration of rehabilitation in athletes however, data are currently lacking that may predict which imaging parameters may be predictive of a repeat strain. This study was conducted to identify whether any MR imaging-identifiable parameters are predictive of athletes at risk of sustaining a recurrent hamstring strain in the same playing season. Cohort study Level of evidence, 3. Forty-one players of the Australian Football League who sustained a hamstring injury underwent MR examination within 3 days of injury between February and August 2002. The imaging parameters measured were the length of injury, cross-sectional area, the specific muscle involved, and the location of the injury within the muscle-tendon unit. Players who suffered a repeat injury during the same season were reimaged, and baseline and repeat injury measurements were compared. Comparison was also made between this group and those who sustained a single strain. Forty-one players sustained hamstring strains that were positive on MR imaging, with 31 injured once and 10 suffering a second injury. The mean length of hamstring muscle injury for the isolated group was 83.4 mm, compared with 98.7 mm for the reinjury group (P = .35). In the reinjury group, the second strain was also of greater length than the original (mean, 107.5 mm P = .07). Ninety percent of players sustaining a repeat injury demonstrated an injury length greater than 60 mm, compared with only 58% in the single strain group (P = .01). Only 7% of players (1 of 14) with a strain mm suffered a repeat injury. Of the 27 players sustaining a hamstring strain mm, 33% (9 of 27) suffered a repeat injury. Of all the parameters assessed, only a history of anterior cruciate ligament sprain was a statistically significant predictor for suffering a second strain during the same season of competition. A history of anterior cruciate ligament injury was the only statistically significant risk factor for a recurrent hamstring strain in our study. Of the imaging parameters, the MR length of a strain had the strongest correlation association with a repeat hamstring strain and therefore may assist in identifying which athletes are more likely to suffer further reinjury.
Publisher: SAGE Publications
Date: 2014
Abstract: Abdominal stereotactic ablative body radiotherapy is aided by motion management strategies to ensure accurate dose delivery as targets such as the kidney are easily influenced by breathing motion. Commercial devices such as compression plates and dual vacuum technology have been demonstrated to reduce the motion of lung and liver tumors. The aim of this study was to evaluate the effectiveness of a dual vacuum system in reducing kidney motion as well to investigate any relationship between abdominal wall motions with kidney motion. Ten healthy volunteers were set up with and without vacuum compression (Elekta BodyFIX TM ) to simulate free and d ened breathing. Ultrasound imaging was used to visualize kidney motion at the same time an abdominal surface marker was monitored using infrared imaging (Varian, Real Time Position Management). The resulting kidney and abdominal motion tracks were imported into motion analysis (Physmo TM ) and custom built software (Matlab) to calculate litude of motion independent of shifting baselines. Thirty-four kidney datasets were available for analysis, with six datasets unable to be retrieved. With vacuum compression six out of nine participants showed a mean reduction of kidney motion ranging between 1.6 and 8 mm ( p 0.050). One participant showed an increase in motion of 8.2 mm ( p 0.001) with vacuum compression. Two participants showed no significant change ( mm) in kidney motion. No relationship was observed for abdominal wall motion and motion changes in the left kidney ( r = 0.345, p = 0.402) or right kidney ( r = 0.527, p = 0.145). Vacuum compression reduced kidney motion in the majority of participants however larger breathing motion can also result from its use. No pattern emerged regarding which patients may benefit from vacuum immobilization as abdominal wall motion was not found to be an adequate surrogate for kidney motion.
Publisher: Wiley
Date: 03-2003
Publisher: Elsevier BV
Date: 02-2014
Publisher: BMJ
Date: 22-07-2013
Publisher: Wiley
Date: 09-2013
Abstract: The purpose of this study was to determine whether measurement of the near-field lateral ventricular diameter can be reliably obtained within a practical time frame during second-trimester obstetric scans by angling the fetal head approximately 30° away from the horizontal image axis such that the posterior aspect of the fetal head lies closer to the transducer. Fifty consecutive singleton pregnancies presenting for a routine-second trimester scan were recruited for this study. The far-field lateral ventricular diameter was measured, followed by the near-field lateral ventricular diameter using the proposed technique. The measurements were repeated by a second operator who was blinded to the first measurement. Both operators recorded the measurements taken and scored the level of visibility of the near-field lateral ventricle. The difference between the two operators' measurements was compared by a κ analysis. The near-field lateral ventricle was visualized in 49 of 50 cases (98%). There was no statistically significant difference in the measurement of the near-field lateral ventricular diameter by the two operators (P = .34). There was, however, a statistically significant difference in the time it took each operator to obtain the near-field measurement after the far-field measurement (P = .01). Manipulating the transducer to position the falx of the fetal head approximately 30° away from the horizontal image axis allows the near-field lateral ventricle to be routinely visualized and measured with a high degree of interoperator agreement and within a practical time frame once the operator is experienced in performing the technique.
Publisher: Wiley
Date: 29-05-2019
DOI: 10.1002/JUM.15037
Abstract: The purpose of this study was to compare the diagnostic performance of the fat‐to‐lesion strain ratio (FLR) and gland‐to‐lesion strain ratio (GLR) for patients with indeterminate or suspicious breast lesions on ultrasound (US) imaging under a controlled precompression technique and to see whether the technique improves the reproducibility of FLR and GLR measurement. Fifty‐three lesions in 39 consecutive patients who had scheduled core biopsy or excision surgery based on US findings were examined by US elastography. Each lesion was acquired under controlled precompression by 2 sonographers independently. Both the FLR and GLR of the lesion were calculated. For diagnostic performance, the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were obtained. Interobserver reliability between different sonographers was assessed by the intraclass correlation coefficient (ICC). Forty lesions were benign, and 13 lesions were malignant. Both the FLR and GLR were significantly higher in malignant than benign lesions ( P .05). The FLR yielded higher accuracy and specificity compared to the GLR (accuracy, 79.2% versus 60.4% and specificity, 87.5% versus 50.0%). With the controlled precompression applied at less than 25% during elastography, the interobserver agreement was excellent for FLR measurements (ICC, 0.853 95% confidence interval, 0.738–0.920) and GLR measurements (ICC, 0.779 95% confidence interval, 0.619–0.87). The FLR performed better than the GLR in the detection of breast malignancy thus, fatty tissue was a better reference tissue for calculating the strain ratio on malignant breast tumor elastography. Keeping precompression to less than 25% will enable different operators to acquire similar elastograms with reproducible FLR and GLR readings.
Publisher: Public Library of Science (PLoS)
Date: 29-05-2012
Publisher: Medknow
Date: 2015
Publisher: SAGE Publications
Date: 05-2020
Abstract: With ongoing progress of components of extracorporeal membrane oxygenation including improvements of oxygenators, pumps, and coating materials, extracorporeal membrane oxygenation became increasingly accepted in the clinical practice. A suitable testing in an adequate setup is essential for the development of new technical aspects. Relevant tests can be conducted in ex vivo models specifically designed to test certain aspects. Different setups have been used in the past for specific research questions. We conducted a systematic literature review of ex vivo models of extracorporeal membrane oxygenation components. MEDLINE and Embase were searched between January 1996 and October 2017. The inclusion criteria were ex vivo models including features of extracorporeal membrane oxygenation technology. The exclusion criteria were clinical studies, abstracts, studies in which the model of extracorporeal membrane oxygenation has been reported previously, and studies not reporting on extracorporeal membrane oxygenation components. A total of 50 studies reporting on different ex vivo extracorporeal membrane oxygenation models have been identified from the literature search. Models have been grouped according to the specific research question they were designed to test for. The groups are focused on oxygenator performance, pump performance, hemostasis, and pharmacokinetics. Pre-clinical testing including use of ex vivo models is an important step in the development and improvement of extracorporeal membrane oxygenation components and materials. Furthermore, ex vivo models offer valuable insights for clinicians to better understand the consequences of choice of components, setup, and management of an extracorporeal membrane oxygenation circuit in any given condition. There is a need to standardize the reporting of pre-clinical studies in this area and to develop best practice in their design.
Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
Date: 06-2013
Abstract: Diffusion-based MRI tractography is an imaging tool increasingly used in neurosurgical procedures to generate 3D maps of white matter pathways as an aid to identifying safe margins of resection. The majority of white matter fiber tractography software packages currently available to clinicians rely on a fundamentally flawed framework to generate fiber orientations from diffusion-weighted data, namely diffusion tensor imaging (DTI). This work provides the first extensive and systematic exploration of the practical limitations of DTI-based tractography and investigates whether the higher-order tractography model constrained spherical deconvolution provides a reasonable solution to these problems within a clinically feasible timeframe. Comparison of tractography methodologies in visualizing the corticospinal tracts was made using the diffusion-weighted data sets from 45 healthy controls and 10 patients undergoing presurgical imaging assessment. Tensor-based and constrained spherical deconvolution–based tractography methodologies were applied to both patients and controls. Diffusion tensor imaging–based tractography methods (using both deterministic and probabilistic tractography algorithms) substantially underestimated the extent of tracks connecting to the sensorimotor cortex in all participants in the control group. In contrast, the constrained spherical deconvolution tractography method consistently produced the biologically expected fan-shaped configuration of tracks. In the clinical cases, in which tractography was performed to visualize the corticospinal pathways in patients with concomitant risk of neurological deficit following neurosurgical resection, the constrained spherical deconvolution–based and tensor-based tractography methodologies indicated very different apparent safe margins of resection the constrained spherical deconvolution–based method identified corticospinal tracts extending to the entire sensorimotor cortex, while the tensor-based method only identified a narrow subset of tracts extending medially to the vertex. This comprehensive study shows that the most widely used clinical tractography method (diffusion tensor imaging–based tractography) results in systematically unreliable and clinically misleading information. The higher-order tractography model, using the same diffusion-weighted data, clearly demonstrates fiber tracts more accurately, providing improved estimates of safety margins that may be useful in neurosurgical procedures. We therefore need to move beyond the diffusion tensor framework if we are to begin to provide neurosurgeons with biologically reliable tractography information.
Publisher: Springer Science and Business Media LLC
Date: 27-07-2018
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.JMIR.2015.03.004
Abstract: Impairment in health care professionals has been identified as one of the determinants of fitness to practise (FTP), and practitioners have a legal obligation to notify regulatory authorities if they experience it. However, there remains confusion as to how radiation therapists (RTs) discern what constitutes impaired practice and how they would respond to such dilemmas. The aim of this study was to identify the range of responses to hypothetical professional impairment dilemmas, which may inform an educational strategy for improving reporting occurrences. A convenience s le of Australian RTs was invited to participate in an anonymous online survey that presented a range of FTP dilemmas relating to impairment, competence, and values/ethics. Participants were asked to describe how they would deal with such situations. Qualitative responses were coded using NVivo software. This article reports on the themes that emerged from the impairment dilemmas. One hundred eighty-two RTs responded to the survey. The emerging key theme and subthemes included dealing with the situation, removal of the practitioner from the situation, stop working, avoiding responsibility, giving the benefit of the doubt, and carrying on with the workload. Practitioners' interpretations of the impairment dilemmas varied, which, in turn, influenced their suggestions of how they would deal with them. The continuum of responses supports a key tenant of the interpretive paradigm-multiple interpretations of social phenomena exist. Those seeking to improve practitioner understanding of their obligations under national law should consider a scenario-based approach to raising awareness of FTP issues such as impairment.
Publisher: Wiley
Date: 10-2010
DOI: 10.1111/J.1754-9485.2010.02195.X
Abstract: The purpose of this study was to assess the diagnostic accuracy of our early experience with contrast-enhanced ultrasound (CEUS) in the characterisation of focal liver lesions (FLLs) using histopathology, contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI) or other imaging follow-up as the standard of reference. Seventy-three patients with 82 FLLs who underwent liver CEUS from January 2006 to December 2008 were retrospectively reviewed. CEUS was performed with up to 4.8 mL of SonoVue® (Bracco, Milan, Italy) using a low mechanical index mode. The CEUS findings were compared with histopathology, or where histopathology was not available, clinical and imaging follow-up over at least 12 months was used as the standard of reference. Of the 82 FLLs, 50 were malignant and 32 were benign at final diagnosis. CEUS correctly identified 43 malignant FLLs, with final diagnosis confirmed by histopathology in 13 lesions and clinico-radiological follow-up in 30 lesions. Twenty-nine lesions were correctly identified as benign on CEUS, with all these lesions confirmed on clinico-radiological follow-up. CEUS demonstrated a sensitivity of 86.0% and a specificity of 90.6% in the characterisation of liver lesions as malignant, with an overall accuracy of 87.8% (P < 0.05). Our early experience has shown that CEUS can be accurate in differentiating malignant from benign FLLs and may become a useful first-line imaging tool where CT or MRI are not available or contra-indicated.
Publisher: Public Library of Science (PLoS)
Date: 03-08-2012
Publisher: Cambridge University Press (CUP)
Date: 11-11-2012
DOI: 10.1017/S1460396911000379
Abstract: Focus groups are a means of gathering qualitative data from a group of participants who discuss a given topic. This method has been used in health care research for the past 30 years, but has seen limited use in radiation therapy research. Focus group discussions are a useful tool for investigating a variety of educational, training and clinical issues from the perspective of practitioners, students and patients. This paper reviews the issues associated with using focus groups as a means of data collection. In particular, it addresses some of the decisions which have to be made about group composition and conduct of the discussions. The literature review is contextualised using a recent ex le of how the authors used focus groups to investigate fitness to practise in radiation therapy. Other challenges such as familiarity between participants and researchers, power relationships and anonymity are addressed. The paper concludes with a consideration of data analysis.
Publisher: Society of Nuclear Medicine
Date: 15-05-2014
DOI: 10.2967/JNUMED.113.131631
Abstract: We aimed to prospectively observe cellular metabolism and proliferation in patients with non-small-cell lung cancer (NSCLC) during radical chemoradiation therapy using serial PET/CT with (18)F-FDG and 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT). Twenty patients with stage I-III NSCLC and candidates for radical chemoradiation therapy (60 Gy in 30 fractions over 6 wk) were recruited. (18)F-FDG and (18)F-FLT PET/CT were performed at baseline and during therapy (weeks 2 and 4). Tumor response was assessed semiquantitatively and using visual response criteria. The median and range for primary tumor volume (cm(3)) at baseline on (18)F-FDG were 28 and 2-241, respectively, and on (18)F-FLT 31 and 2-184, respectively. At week 2, (18)F-FDG was 26 (range, 2-164), and (18)F-FLT was 11 (range, 0-111). At week 4, (18)F-FDG was 19 (1-147), and (18)F-FLT was 7 (0-48). The median and range of maximum standardized uptake value (SUVmax) at baseline on (18)F-FDG were 14 and 4-31, respectively, and on (18)F-FLT 6 and 2-12, respectively. Week 2 (18)F-FDG median SUVmax was 10 (2-31), and (18)F-FLT median SUVmax was 3 (1-15) week 4 (18)F-FDG median SUVmax was 10 (2-15), and (18)F-FLT median SUVmax was 2 (2-9). There was fair agreement between visual tumor response on (18)F-FDG and (18)F-FLT during therapy (Cohen's unweighted κ statistic, 0.27 at week 2 and 0.355 at week 4). Cerebral metastases were detected on 1 baseline (18)F-FLT scan, resulting in palliative management. Progressive disease was detected on week 2 scans in 3 patients, resulting in changes to radiation therapy (2 patients) and treatment intent (1 patient). This study demonstrates that (18)F-FLT PET/CT is a more sensitive tracer of early treatment response than (18)F-FDG PET/CT. The ability of these tracers to detect distinct biologic processes may lead to their use as biomarkers for personalized radiation therapy and prognosis in the future.
Publisher: Springer Science and Business Media LLC
Date: 04-2014
DOI: 10.1186/BCR3648
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.RADI.2017.03.016
Abstract: Evidence demonstrates that health care professionals in the palliative care context are more burned out than other health professionals. The aims of this study were to examine: (1) occupational burnout levels among radiation therapists in Australia, (2) association between demographic factors on burnout and (3) radiation therapists' perceptions of burnout. A cross-sectional online survey including the Maslach Burnout Inventory was administered to Radiation Therapists in Australia. Data were analysed using SPSS Ver 20 and open ended comments were analysed thematically using Nvivo 10. A total of 200 radiation therapists participated in the survey. RTs had a high mean (±SD) burnout score for emotional exhaustion (38.5 ± 8.2), depersonalisation (17.5 ± 4.7) and personal achievement (30.5.3 ± 4.3) compared to RTs and health workers in other studies. High levels of emotional exhaustion, depersonalisation and low levels of personal achievement were present in 93% (186/200), 87% (174/200) and 61% (122/200) of participants respectively. RTs identified high workload and staff shortages, interpersonal conflict and technology as key sources of stress in the RT work environment. Australian RTs' level of burnout on all three stages of burnout exceed previously reported burnout levels for similar cohorts both locally and internationally. It is important that future interventions aimed at minimising or preventing stressors are identified and implemented in the radiation therapy work environment.
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.IJROBP.2014.07.043
Abstract: To describe our 3-dimensional conformal planning approaches and report early toxicities with stereotactic body radiation therapy for the management of primary renal cell carcinoma. This is an analysis of a phase 1 trial of stereotactic body radiation therapy for primary inoperable renal cell carcinoma. A dose of 42 Gy/3 fractions was prescribed to targets ≥5 cm, whereas for <5 cm 26 Gy/1 fraction was used. All patients underwent a planning 4-dimensional CT to generate a planning target volume (PTV) from a 5-mm isotropic expansion of the internal target volume. Planning required a minimum of 8 fields prescribing to the minimum isodose surrounding the PTV. Intermediate dose spillage at 50% of the prescription dose (R50%) was measured to describe the dose gradient. Early toxicity (<6 months) was scored using the Common Terminology Criteria for Adverse Events (v4.0). From July 2012 to August 2013 a total of 20 patients (median age, 77 years) were recruited into a prospective clinical trial. Eleven patients underwent fractionated treatment and 9 patients a single fraction. For PTV targets 100 cm(3) the median beam number used was 10 (4 noncoplanar) for an average R50% value of 4.3. The R50% was inversely proportional to decreasing PTV volume (r=-0.62, P=.003) and increasing total beams used (r=-0.51, P=.022). Twelve of 20 patients (60%) suffered grade ≤2 early toxicity, whereas 8 of 20 patients (40%) were asymptomatic. Nausea, chest wall pain, and fatigue were the most common toxicities reported. A 3-dimensional conformal planning technique of 8-10 beams can be used to deliver highly tolerable stereotactic ablation to primary kidney targets with minimal early toxicities. Ongoing follow-up is currently in place to assess long-term toxicities and cancer control.
Publisher: Springer Science and Business Media LLC
Date: 25-03-2019
Publisher: Elsevier BV
Date: 2003
Abstract: Placental activin A and inhibin A output is increased in pre-ecl sia, a condition characterized by placental hypoxaemia, whereas follistatin secretion is unaltered. We investigated whether hypoxia was the basis for elevated placental activin A and inhibin A output. First trimester and term placental explants were grown in 5-6% dissolved O(2) (n=10/trimester) and 200 microM cobalt chloride (CoCl(2),n =6/trimester) to simulate environmental and cellular hypoxia respectively, for up to 72 h. Activin A, inhibin A and follistatin production were compared with control cultures grown in standard media at 20% O(2). In first trimester and term placenta, activin A output declined significantly under 5-6% O(2) (P=0.006 and 0.001 after 48 h respectively). Inhibin A declined significantly under 5-6% O(2), mainly in first trimester placenta (P=0.03, 24h). CoCl(2) significantly elevated activin A production in term placenta (P=0.003, 48 h), whereas inhibin A output was unaffected. Neither low O(2) or CoCl(2) altered follistatin output from first trimester or term placenta. These findings suggest that there may be novel O(2) sensing mechanism/s that down regulate activin A and inhibin A in the placenta and that low O(2) is not the mechanism behind increased placental inhibin A or activin A output in pre-ecl sia.
Publisher: SAGE Publications
Date: 06-2006
Abstract: Physicians evaluating hamstring strains in professional football players are increasingly turning to magnetic resonance imaging to support the clinical diagnosis and management of the injury. However, little information is available to assess how magnetic resonance imaging compares with the clinical evaluation in establishing the duration of rehabilitation required. Magnetic resonance imaging of hamstring strains can be useful in determining duration of rehabilitation. Cohort study (Diagnosis) Level of evidence, 1. Fifty-eight professional football players with a diagnosis of hamstring injury made by the team physician were enrolled in the study. All players underwent magnetic resonance imaging and a clinical evaluation by an independent physical therapist within 3 days of the injury. Presence, type, and location of injury were recorded in each examination. The physical therapist estimated the time required until return to competition, and the radiologist used the length of the injury (coronal view) to establish rehabilitation duration. Both clinicians were blinded to the other modality. Clinical and magnetic resonance imaging assessments were in agreement in 38 of 58 cases (65.5%). In 18 cases (31.0%), a clinically positive diagnosis was made, but no abnormalities were evident on magnetic resonance imaging. In 2 cases (3.4%), magnetic resonance imaging detected an injury, whereas the clinical examination had negative or equivocal findings. Both clinical examination and magnetic resonance imaging findings were strongly correlated with the actual time required to return to competition (r = .69, P .001 and r = .58, P .001, respectively). The correlation coefficient between clinical predictions and magnetic resonance imaging findings was moderate (r = .36, P = .006). This study shows that magnetic resonance imaging is not required for estimating the duration of rehabilitation of an acute minor or moderate hamstring injury in professional football players.
Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
Date: 06-2013
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.RADI.2016.10.011
Abstract: Cumulative radiation exposure is linked to increasing the lifetime attributable risk of cancer. To avoid unnecessary radiation exposure and facilitate shared decision making, patients should be aware of these issues. This paper examines patients' awareness of radiation dose and risks associated with medical imaging examinations. Consecutive patients attending a private radiology clinic over a nine week period in 2014 in Metropolitan Melbourne were surveyed while waiting to undergo an imaging examination. Patients who were under 18 years of age, did not speak English and/or were referred for interventional imaging procedures were excluded from participation. Survey questions addressed patients' awareness of radiation dose associated with various imaging modalities' and patients' experience and preferences regarding communication of information about radiation. Data was analysed using SPSS (Ver 20.1). A total of 242 surveys were completed. Most participants were male (143/239, 59.8%) and aged between 33 and 52 years (109/242, 45%). Over half of participants were not concerned about radiation from medical imaging (130/238, 54.6%). Only a third of participants (80/234, 34.2%) correctly reported that CT has a higher radiation dose than X-ray. Very few participants correctly identified mammography, DEXA, PET and PET/CT as radiation emitting examinations. The majority of participants (202/236, 85.6%) indicated that they were not informed about radiation dose and risks by their referring doctor in advance. This paper provides information relevant to a single private radiology clinic in Australia. Nevertheless, our results have shown that patients presenting for medical imaging have little awareness of radiation dose and risks associated with these examinations and received little information by their referring physicians or staff at the radiology clinic.
Publisher: Wiley
Date: 10-04-2012
DOI: 10.1111/J.1754-9485.2012.02371.X
Abstract: To evaluate the prevalence of Schistosoma mansoni-related liver disease in school-age children who live beside the Zambezi River in the Chitokoloki district, North Western Province, Zambia. Liver ultrasounds of school students from the Chitokoloki day school, grades 1-12, were performed. Liver patterns, periportal branch wall thickening and portal hypertension were assessed to evaluate the presence of liver fibrosis due to S. mansoni infection. To obtain incidence rates of acute disease, stool specimens were examined from a subgroup for the presence of S. mansoni eggs using the formol detergent sedimentation technique. Of 976 enrolled students, 764 (78.2%) were examined by ultrasound. Of those, 284 (37.2%) had findings indicative of periportal fibrosis on ultrasound. Stool specimen were collected from 414 (54%) students of which six (1.5%) were positive for S. mansoni eggs. School students living along the Zambezi River, Zambia have a relatively high prevalence of S. mansoni-related liver disease. These findings suggest that all schoolchildren in this area should receive treatment against S. mansoni.
Publisher: Cambridge University Press (CUP)
Date: 21-11-2011
DOI: 10.1017/S1460396911000422
Abstract: Aims: To obtain an estimate of dietary fibre and fluid intake in Australian men undergoing prostate radiotherapy and to establish feasibility and patient compliance with recording normal diet without intervention during the radical course of radiotherapy. Methods: Eleven participants were enrolled and treated with 74–78 Gray (Gy) to the prostate over 8 weeks. Participants were instructed to record a diary of their food and fluid intake and bowel motions for the duration of treatment. Treating radiation therapists were instructed to initial the diet diary daily. Diet diaries were assessed for compliance by analysing the number of days over the treatment period and the number of diary pages submitted. The diet diaries were analysed for nutrient intake of fibre and fluids. Results: A total of 10 of 11 participants submitted a diet record for the full duration of treatment with a median compliance of 100% (range 90.4–100%) of days recorded. The mean (standard deviation) of fibre and fluids recorded in the diets were 21.5 g (5.5) and 2227.1 g (733.1), respectively. Conclusions: It is feasible for patients to record a diet diary over a radical course of prostate radiotherapy. In this study, most patients were highly compliant with submitting a diet record for each day during treatment.
Publisher: Springer Science and Business Media LLC
Date: 13-07-2012
DOI: 10.1038/PR.2012.94
Abstract: Intrauterine growth restriction (IUGR) has been linked to heart disease in adulthood. Hence the IUGR heart is likely to be vulnerable to diabetic heart disease. The aim of this study was to examine the effect of induction of type 1 diabetes on myocardial collagen deposition and cardiac function in adult rats with a history of IUGR, after controlling blood glucose levels. IUGR was induced by protein restriction in the pregnant female rat. When the offspring were 24 wk of age, diabetes was induced in male IUGR and non-IUGR rats by means of streptozotocin insulin injections were used to maintain blood glucose levels at a mild (7-10 mmol/l n = 8 per group) or moderate level (10-15 mmol/l n = 8 per group). Echocardiography and cardiac morphology analyses were carried out when the rats were 32 wk of age. IUGR offspring exhibited cardiac hypertrophy at 32 wk, including a thicker posterior wall and increased interstitial fibrosis in the left ventricle. Hyperglycemia led to an increase in heart size and myocardial fibrosis. The response to hyperglycemia was not different between IUGR and non-IUGR rats however, cardiac fibrosis was greatest when diabetes was present along with a history of IUGR. In general, maintaining blood glucose levels at a mildly hyperglycemic level attenuated the adverse effects of hyperglycemia but did not reverse the fibrosis. Exacerbated fibrosis in hyperglycemic hearts of IUGR offspring may lead to long-term cardiac dysfunction.
Publisher: Bioscientifica
Date: 10-2001
Abstract: Maternal serum activin A levels are elevated in women with preecl sia. To explore whether this could be due, at least in part, to increased production by the gestational tissues, we have measured activin A in the serum of women with (n=23) or without preecl sia (n=62) at 29-40 weeks of gestation and in placenta and fetal membranes from preterm preecl tic (PT-PE, n=8), term preecl tic (T-PE, n=10) and healthy term controls (T-C, n=10). We have also explored if there are associated changes in activin receptor Alk2, ActRII and ActRIIB in these tissues. The relative amounts of receptor proteins were measured by densitometry on Western blots and receptors and activin beta(A) subunit localised by immunohistochemistry in PT-PE, T-PE and T-C gestational tissues (n=8-10/group). Maternal serum activin A levels were significantly elevated in women with preecl sia (multiples of the normal median (MoM)=3.5, P .0001, Mann-Whitney U test) compared with healthy women (median MoM=1.0). Compared with control tissues, the activin A content was significantly higher in preecl tic placentae (P=0.001 and P=0.0005 for PT-PE and T-PE respectively, Mann-Whitney U test), but significantly lower in the amnion (P=0.005 and P=0.014 for PT-PE and T-PE respectively) and choriodecidua (P=0.009 for T-PE). The maternal serum activin A level in women with preecl sia was significantly correlated with elevated placental production (P=0.01, Pearson's correlation). Receptor Alk2 protein levels were significantly elevated in T-PE placentae (P=0.0006, Mann-Whitney U test), ActRIIB levels were significantly lower in PT-PE placentae (P=0.01) and ActRII levels were significantly lower in PT-PE choriodecidua (P=0.0002) compared with controls. There were no apparent differences in the distribution of the beta(A) subunit and receptors Alk2, ActRII and ActRIIB between control and preecl tic tissues. These findings suggest that elevated levels of activin A in the maternal circulation in association with preecl sia are due, at least in part, to increased placental production, and that the regulation of activin synthesis in placenta and fetal membranes is differentially regulated. Further, the differences in activin receptor protein levels between preecl tic and control placenta and choriodecidua suggest that activin A-induced regulation may be altered in preecl sia.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Radiological Society of North America (RSNA)
Date: 11-2012
Abstract: To determine the prevalence of intrahippoc al calcification at brain computed tomography (CT), evaluate any association with calcification involving the intracranial arteries or lentiform nuclei, and assess the clinical importance of intrahippoc al calcification. Study approval was obtained by the Southern Health Human Research Ethics Committee, which waived the requirement for informed consent because of the retrospective nature of the study. The presence of intrahippoc al calcification was assessed by four readers through retrospective review of 300 randomly selected nonenhanced brain CT scans. In addition, the presence of calcification involving the intracranial arteries and lentiform nuclei was assessed, and the clinical histories were reviewed in those patients with intrahippoc al calcifications and a matched control cohort without intrahippoc al calcification. Differences in proportion of patients with intrahippoc al calcifications across different age groups were assessed by using χ2 analysis. Interrater agreement and intrarater agreement were assessed by using κ analysis. Intrahippoc al calcification was demonstrated in 47 (15.7%) of 300 patients, and 47 (21.7%) of 217 patients older than 50 years of age. Its prevalence increased with age (P=.008). All patients with intrahippoc al calcification and the control cohort demonstrated calcification involving the intracranial arteries. Eleven (23.4%) of 47 patients with intrahippoc al calcification had calcification within the lentiform nuclei compared with 14 (29.8%) of 47 in the control cohort (P=.67). The anatomic distribution of intrahippoc al calcification was similar to that described in vascular fibrosis and calcification. The prevalence of intrahippoc al calcification appears to increase with age and is a relatively common finding in patients older than 50 years. It has a similar anatomic distribution to microscopic vascular fibrosis and calcification and likely reflects its latter stages.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.IJROBP.2013.02.030
Abstract: The delineation of internal target volumes (ITVs) in radiation therapy of lung tumors is currently performed by use of either free-breathing (FB) (18)F-fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET/CT) or 4-dimensional (4D)-CT maximum intensity projection (MIP). In this report we validate the use of 4D-PET-MIP for the delineation of target volumes in both a phantom and in patients. A phantom with 3 hollow spheres was prepared surrounded by air then water. The spheres and water background were filled with a mixture of (18)F and radiographic contrast medium. A 4D-PET/CT scan was performed of the phantom while moving in 4 different breathing patterns using a programmable motion device. Nine patients with an FDG-avid lung tumor who underwent FB and 4D-PET/CT and >5 mm of tumor motion were included for analysis. The 3 spheres and patient lesions were contoured by 2 contouring methods (40% of maximum and PET edge) on the FB-PET, FB-CT, 4D-PET, 4D-PET-MIP, and 4D-CT-MIP. The concordance between the different contoured volumes was calculated using a Dice coefficient (DC). The difference in lung tumor volumes between FB-PET and 4D-PET volumes was also measured. The average DC in the phantom using 40% and PET edge, respectively, was lowest for FB-PET/CT (DCAir = 0.72/0.67, DCBackground 0.63/0.62) and highest for 4D-PET/CT-MIP (DCAir = 0.84/0.83, DCBackground = 0.78/0.73). The average DC in the 9 patients using 40% and PET edge, respectively, was also lowest for FB-PET/CT (DC = 0.45/0.44) and highest for 4D-PET/CT-MIP (DC = 0.72/0.73). In the 9 lesions, the target volumes of the FB-PET using 40% and PET edge, respectively, were on average 40% and 45% smaller than the 4D-PET-MIP. A 4D-PET-MIP produces volumes with the highest concordance with 4D-CT-MIP across multiple breathing patterns and lesion sizes in both a phantom and among patients. Freebreathing PET/CT consistently underestimates ITV when compared with 4D PET/CT for a lesion affected by respiration.
Publisher: Elsevier BV
Date: 2019
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.BRACHY.2014.12.001
Abstract: There is wide disparity in the practice of brachytherapy for cervical cancer around the world. Although select well-resourced centers advocate use of MRI for all insertions, planar X-ray imaging remains the most commonly used imaging modality to assess intracavitary implants, particularly where the burden of cervical cancer is high. Incorporating soft tissue imaging into brachytherapy programs has been shown to improve the technical accuracy of implants, which in turn has led to improved local control and decreased toxicity. These improvements have a positive effect on the quality of life of patients undergoing brachytherapy for cervical cancer. Finding an accessible soft tissue imaging modality is essential to enable these improvements to be available to all patients. A modality that has good soft tissue imaging capabilities, is widely available, portable, and economical, is needed. Ultrasound fulfils these requirements and offers the potential of soft tissue image guidance to a much wider brachytherapy community. Although use of ultrasound is the standard of care in brachytherapy for prostate cancer, it only seems to have limited uptake in gynecologic brachytherapy. This article reviews the role of ultrasound in gynecologic brachytherapy and highlights the potential applications for use in brachytherapy for cervical cancer.
Publisher: Informa UK Limited
Date: 18-05-2012
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.ULTRASMEDBIO.2014.08.019
Abstract: This primary aim of this study was to evaluate the diagnostic performance of axial-strain sonoelastography (ASE), B-mode ultrasound (US) and color Doppler US in confirming clinically symptomatic Achilles tendinopathy. The secondary aim was to establish the relationship between the strain ratio during sonoelastography and Victorian Institute of Sport Assessment-Achilles (VISA-A) scores. The VISA-A questionnaire is a validated clinical rating scale that evaluates the symptoms and dysfunction of the Achilles tendon. One hundred twenty Achilles tendons of 120 consecutively registered patients with clinical symptoms of Achilles tendinopathy and another 120 gender- and age-matched, asymptomatic Achilles tendons of 120 healthy volunteers were assessed with B-mode US, ASE and color Doppler US. Symptomatic patients had significantly higher strain ratio scores and softer Achilles tendon properties compared with controls (p < 0.001). The strain ratio was moderately correlated with VISA-A scores (r = -0.62, p < 0.001). The diagnostic accuracy of B-mode US, ASE and color Doppler US in confirming clinically symptomatic Achilles tendinopathy was 94.7%, 97.8% and 82.5% respectively. There was excellent correlation between the clinical reference standard and the grade of tendon quality on ASE (κ = 0.91, p < 0.05), compared with B-mode US (κ = 0.74, p < 0.05) and color Doppler imaging (κ = 0.49, p < 0.05). ASE is an accurate clinical tool in the evaluation of Achilles tendinopathy, with results comparable to those of B-mode US and excellent correlation with clinical findings. The strain ratio may offer promise as a supplementary tool for the objective evaluation of Achilles tendon properties.
Publisher: Springer Science and Business Media LLC
Date: 08-08-2014
DOI: 10.1007/S00256-013-1695-3
Abstract: Injury to a tendon leads to alterations in the mechanical properties of the tendon. Axial-strain sonoelastography and shear-wave elastography are relatively new, real-time imaging techniques that evaluate the mechanical properties of tendons in addition to the existing morphological and vascular information that is obtained with traditional imaging tools. Axial-strain sonoelastography displays the subjective distribution of strain data on an elastogram caused by tissue compression, whereas shear-wave elastography provides a more objective, quantitative measure of the intrinsic tissue elasticity using the acoustic push-pulse. Recent studies suggest that axial-strain sonoelastography is able to distinguish between asymptomatic and diseased tendons, and is potentially more sensitive than conventional ultrasound in detecting early tendinopathy. Shear-wave elastography seems to be a feasible tool for depicting elasticity and functional recovery of tendons after surgical management. While initial results have been promising, axial-strain sonoelastography and shear-wave elastography have not yet found routine use in wider clinical practice. Possible barriers to the dissemination of axial-strain sonoelastography technique include operator dependency, technical limitations such as artefacts and lack of reproducibility and quantification of sonoelastography data. Shear-wave elastography may improve the reproducibility of elastography data, although there is only one published study on the topic to date. Large-scale longitudinal studies are needed to further elucidate the clinical relevance and potential applications of axial-strain sonoelastography and shear-wave elastography in diagnosing, predicting, and monitoring the progress of tendon healing before they can be widely adopted into routine clinical practice.
Publisher: Springer Science and Business Media LLC
Date: 20-08-2019
Publisher: Elsevier BV
Date: 02-2010
DOI: 10.1016/J.FORSCIINT.2009.11.011
Abstract: Following a mass disaster, the aim of the Disaster Victim Identification process is to establish the identity of the victims. The ageing screening process on victims in Victoria may now be complemented with the use of computerized tomography (CT), where previously any dental ageing analysis was performed using conventional radiographs. The aim of this study was to assess the accuracy of age estimation using the dental ageing method proposed by Moorrees, Fanning and Hunt (MFH) using CT images. Intra- and inter-rater variability between two raters, one experienced and one inexperienced, was also assessed. The two raters were blinded to the ages of 96 deceased Australian children aged up to 15 years. Using three-dimensional (3D) shaded surface displays (SSD) and reformatted CT images, the age was first estimated based on prior experience alone, followed at a later date by the age estimation utilizing the MFH method. These estimates were then compared to the known chronological age. The results were statistically analyzed in a one-s le t-test, using the mean log-ratio of the estimated age to the chronological age. Our findings show that the experienced rater was more accurate in age estimation than the less experienced when using prior experience (p<0.0001). The use of reformatted CT images to perform an ageing estimate using the MFH method was found to systematically underestimate the chronological age by 10% by both raters (p=0.784). There was no significant difference between the two raters. Intra-rater reliability was high (p=0.135). CT can provide accurate estimates of dental ages. Prior experience with dental ageing and/or CT improves the accuracy. However, with the use of validated ageing charts, inexperienced raters can also achieve accurate age estimates using CT images.
Publisher: Springer Science and Business Media LLC
Date: 25-05-2020
DOI: 10.1186/S40635-020-00303-5
Abstract: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being used to treat patients with refractory severe heart failure. Large animal models are developed to help understand physiology and build translational research projects. In order to better understand those experimental models, we conducted a systematic literature review of animal models combining heart failure and VA-ECMO. A systematic review was performed using Medline via PubMed, EMBASE, and Web of Science, from January 1996 to January 2019. Animal models combining experimental acute heart failure and ECMO were included. Clinical studies, abstracts, and studies not employing VA-ECMO were excluded. Following variables were extracted, relating to four key features: (1) study design, (2) animals and their peri-experimental care, (3) heart failure models and characteristics, and (4) ECMO characteristics and management. Nineteen models of heart failure and VA-ECMO were included in this review. All were performed in large animals, the majority ( n = 13) in pigs. Acute myocardial infarction ( n = 11) with left anterior descending coronary ligation ( n = 9) was the commonest mean of inducing heart failure. Most models employed peripheral VA-ECMO ( n = 14) with limited reporting. Among models that combined severe heart failure and VA-ECMO, there is a large heterogeneity in both design and reporting, as well as methods employed for heart failure. There is a need for standardization of reporting and minimum dataset to ensure translational research achieve high-quality standards.
Publisher: Elsevier BV
Date: 07-2001
DOI: 10.1016/S0303-7207(01)00504-4
Abstract: Unexplained fetal death in utero in late pregnancy represents an increasing proportion of perinatal deaths. It has been assumed that critical hypoxia is the likely mechanism underlying these losses, but the lack of a physiological marker has h ered both confirmation and prediction which could lead to timely intervention. In this paper, we report studies on hypoxia that we have performed in chronically cannulated late pregnant sheep, complemented by parallel investigations undertaken in human pregnancies. Our initial studies were directed towards determining activin secretion in the fetus and mother during late gestation, and immediately after fetal surgery using a sheep model. This led us to propose that there may be a relationship between hypoxia and activin A, follistatin and prostaglandin (PG) release from the feto-placental unit. Subsequent studies have been directed towards examining this potential relationship in sheep and in humans with compromised pregnancies. As a result of these studies, we have identified a potential mechanism by which activin A may be involved in regulating the response of the fetus to hypoxic insult. Activin A and follistatin concentrations increased in late gestation in ovine maternal plasma and in fetal fluids. Feto-placental hypoxemia or maternal isocapnic hypoxemia, leading to fetal hypoxia, were specific triggers for an acute increase in fetal activin A and follistatin concentrations during late gestation. The source and secretion of activin A, follistatin, and the associated release of PGE(2,) from within the feto-placental unit varied according to the site of the insult. The concomitant secretion of activin A and PGE(2) into the fetal circulation and amniotic fluid during reduced uterine blood flow provides an insight into the physiological regulatory mechanisms that might be involved. Changes observed in maternal activin A concentrations in mid and late gestation in the human may also be associated with fetal compromise. In human pregnancies, elevated activin A concentrations were observed in maternal plasma in mid and late gestation, in association with severe pre-ecl sia and with severe fetal growth restriction, compared to those observed in pregnancies with constitutionally small, healthy fetuses. Activin A was also elevated in maternal and arterial cord plasma in women at term during labour and immediately prior to undergoing emergency Caesarean section for failure to progress. These findings offer exciting new possibilities to gain insights into the mechanisms that underlie the maintenance of fetal wellbeing and provide a rationale for the potential that activin A may prove to be a useful clinical marker of fetal distress.
Publisher: Elsevier BV
Date: 05-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2009
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/01421590600969538
Abstract: Selection of suitable students into graduate medical and specialist health professional courses can be difficult. Historically, selection of students was primarily based on prior academic performance. Recently, however, more emphasis has been placed on considering broader academic backgrounds and personal characteristics and attitudes of students, but no reliable measurement tool is available to predict student success and satisfaction with their choice of profession. The aim of this study was to survey practising radiation therapists in Australia to seek their opinions regarding suitable selection criteria for graduate entry radiation therapy (RT) students in order to optimize selection procedures for future applicants. Four hundred questionnaires were sent to nine RT centres in three states within Australia. All nine clinics participated in the survey and 189 questionnaires were returned. Results show that the majority of radiation therapists place a high level of importance upon a sound knowledge of physics and mathematics, as well as life experience, and agree that a visit to an RT clinic plus an interview comprise important components of the selection process. Humanities, psychology and a psychometric test were not viewed as essential entry requirements. Experienced radiation therapists placed less value on academic performance in the primary degree and were more likely to include an interview as a selection criterion than junior practitioners. Empathy for patients was identified as the most important personal attribute. It is thus recommended that not only cognitive but also personal skills be evaluated during the selection of prospective radiation therapists.
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.IJROBP.2013.08.042
Abstract: Radiation therapy is well established in the treatment of painful plantar fasciitis or heel spur. A retrospective analysis was conducted to investigate the effect of field definition on treatment outcome and to determine the impact of factors potentially involved. A review of treatment data of 250 patients (285 heels) with a mean follow-up time of 11 months showed that complete symptom remission occurred in 38%, partial remission in 32%, and no change in 19% (11% were lost to follow-up). Variables such as radiologic evidence of plantar spurs, their length, radiation dose, field size, age, sex, and onset of pain before administration of radiation therapy were investigated in univariate and multivariate regression analyses. Treatment response depended upon age >53 years, length of heel spur ≤6.5 mm (or no radiologic evidence of a heel spur), and onset of pain <12 months before radiation therapy. Patients with these clinical prerequisites stood a 93% chance of clinical response. Without these prerequisites, only 49% showed any impact. No influence of field size on treatment outcome became evident. Patients with short plantar heel spurs benefit from radiation therapy equally well as patients without any radiologic evidence. Moreover, smaller field sizes have the same positive effect as commonly used large field definitions covering the entire calcaneal bone. This leads to a recommendation of a considerable reduction of field size in future clinical practice.
Publisher: Elsevier BV
Date: 09-2002
Abstract: In pregnancy the feto-placental unit is the major source of activin A. However, the role(s) of activin A in late pregnancy remain uncertain and controversial. In particular, whether activin A levels alter in association with labour is unclear. In a cross-sectional cohort study, maternal serum s les were collected from women at term prior to elective Caesarean section (n=11), during labour prior to a spontaneous vaginal delivery (n=31), an instrumental vaginal delivery (n=16) or an emergent Caesarean section (n=7). Umbilical artery blood s les were collected from 75 pregnancies, after an elective Caesarean section (n=9), a normal vaginal delivery (n=37), an instrumental vaginal delivery (n=15) or an emergent Caesarean section (n=14). Levels of activin A were measured and compared according to modes of delivery.Maternal, but not foetal, serum activin A was increased significantly in women who were delivered by an intrapartum Caesarean section compared to other modes of delivery. Foetal, but not maternal, serum activin A was significantly correlated with umbilical artery pH. Maternal serum activin A is increased in women undergoing an intrapartum Caesarean section compared to either a vaginal delivery or an elective Caesarean section. The mechanism(s) underlying this observation are not clear.
Publisher: Wiley
Date: 20-07-2006
DOI: 10.1111/J.1440-1673.2006.01591.X
Abstract: The kicking action predominantly used in Australian Rules football is considered to be responsible for many lower limb injuries. The aim of this study was to describe a non-invasive method of identifying the thigh muscles involved in kicking an Australian Rules football, using MRI. Both upper thighs of 10 recreational footballers were examined using a 1.5-T General Electric MRI scanner before and immediately after carrying out a set kicking exercise protocol. The signal intensity (SI) changes in 14 in idual muscles were investigated using a standardized region of interest to determine the levels of muscle activity. Significant SI changes were observed in several muscles of the kicking and stance legs among all participants. In the kicking leg, the greatest SI changes were observed in the adductor longus and tensor fascia latae muscles (49.38% (+/-8.95) and 45.47% (+/-7.91), respectively P < 0.05), whereas in the stance leg, the muscles displaying the highest changes were the semitendinosus and tensor fascia latae muscles (46.48% (+/-9.97) and 33.68% (+/-8.36), respectively P < 0.05). This study has shown that MRI can be useful for observing the activity of in idual muscles in the upper thigh during the kicking motion. This non-invasive approach provides a detailed analysis of anatomy and emphasizes the muscles at high risk of injury.
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.IJROBP.2008.12.039
Abstract: To establish whether (18)F-3'-deoxy-3'-fluoro-L-thymidine ((18)F-FLT) can monitor changes in cellular proliferation of non-small-cell lung cancer (NSCLC) during radical chemo-radiotherapy (chemo-RT). As part of a prospective pilot study, 5 patients with locally advanced NSCLC underwent serial (18)F-FLT positron emission tomography (PET)/computed tomography (CT) scans during treatment. Baseline (18)F-FLT PET/CT scans were compared with routine staging (18)F-FDG PET/CT scans. Two on-treatment (18)F-FLT scans were performed for each patient on Days 2, 8, 15 or 29, providing a range of time points for response assessment. In all 5 patients, baseline lesional uptake of (18)F-FLT on PET/CT corresponded to staging (18)F-FDG PET/CT abnormalities. (18)F-FLT uptake in tumor was observed on five of nine (55%) on-treatment scans, on Days 2, 8 and 29, but not Day 15. A "flare" of (18)F-FLT uptake in the primary tumor of one case was observed after 2 Gy of radiation (1.22 x baseline). The remaining eight on-treatment scans demonstrated a mean reduction in (18)F-FLT tumor uptake of 0.58 x baseline. A marked reduction of (18)F-FLT uptake in irradiated bone marrow was observed for all cases. This reduction was observed even after only 2 Gy, and all patients demonstrated a complete absence of proliferating marrow after 10 Gy. This proof of concept study indicates that (18)F-FLT uptake can monitor the distinctive biologic responses of epithelial cancers and highly radiosensitive normal tissue changes during radical chemo-RT. Further studies of (18)F-FLT PET/CT imaging during therapy may suggest that this tracer is useful in developing response-adapted RT for NSCLC.
Publisher: Springer Science and Business Media LLC
Date: 06-11-2014
DOI: 10.1007/S00259-013-2607-4
Abstract: Our group has previously reported on the use of (68)Ga-ventilation erfusion (VQ) PET/CT scanning for the diagnosis of pulmonary embolism. We describe here the acquisition methodology for (68)Ga-VQ respiratory gated (4-D) PET/CT and the effects of respiratory motion on image coregistration in VQ scanning. A prospective study was performed in 15 patients with non-small-cell lung cancer. 4-D PET and 4-D CT images were acquired using an infrared marker on the patient's abdomen as a surrogate for breathing motion following inhalation of Galligas and intravenous administration of (68)Ga-macroaggregated albumin. Images were reconstructed with phase-matched attenuation correction. The lungs were contoured on CT and PET VQ images during free-breathing (FB) and at maximum inspiration (Insp) and expiration (Exp). The similarity between PET and CT volumes was measured using the Dice coefficient (DC) comparing the following groups (1) FB-PET/CT, (2) InspPET/InspCT, (3) ExpPET/Exp CT, and (4) FB-PET/AveCT. A repeated measures one-way ANOVA with multiple comparison Tukey tests were performed to evaluate any difference between the groups. Diaphragmatic motion in the superior-inferior direction on the 4-D CT scan was also measured. 4-D VQ scanning was successful in all patients without additional acquisition time compared to the nongated technique. The highest volume overlap was between ExpPET and ExpCT and between FB-PET and AveCT with a DC of 0.82 and 0.80 for ventilation and perfusion, respectively. This was significantly better than the DC comparing the other groups (0.78-0.79, p < 0.05). These values agreed with a visual inspection of the images with improved image coregistration around the lung bases. The diaphragmatic motion during the 4-D CT scan was highly variable with a range of 0.4-3.4 cm (SD 0.81 cm) in the right lung and 0-2.8 cm (SD 0.83 cm) in the left lung. Right-sided diaphragmatic nerve palsy was observed in 3 of 15 patients. (68)Ga-VQ 4-D PET/CT is feasible and the blurring caused by respiratory motion is well corrected with 4-D acquisition, which principally reduces artefact at the lung bases. The images with the highest spatial overlap were the combined expiration phase or FB PET and average CT. With higher resolution than SPECT/CT, the PET/CT technique has a broad range of potential clinical applications including diagnostic algorithms for patients with suspected pulmonary embolism, preoperative evaluation of regional lung function and improving assessment or understanding of pulmonary physiology in the vast range of pulmonary diseases.
Publisher: SAGE Publications
Date: 04-10-2006
Publisher: Elsevier BV
Date: 08-2014
Publisher: Springer Science and Business Media LLC
Date: 13-08-2015
DOI: 10.1007/S00394-014-0752-6
Abstract: Epidemiological and experimental studies demonstrate that intrauterine growth restriction (IUGR) followed by accelerated postnatal growth leads to increased risk of developing cardiac disease in adulthood. The aim of this study was to examine the effect of early life growth restriction on cardiac structure and function in young adult rats. IUGR was induced in Wistar Kyoto dams through administration of a low protein diet (LPD 8.7% casein) during pregnancy and lactation controls received a normal protein diet (NPD 20% casein). Cardiac function and structure were assessed in female NPD (n = 7) and LPD (n = 7) offspring at 18 weeks of age by echocardiography and pressure-volume techniques, and systolic blood pressure by tail-cuff sphygmomanometry. LPD offspring remained significantly smaller throughout life compared to controls. There were no differences in the levels of systolic blood pressure, left ventricular cardiac dimensions, heart rate, ejection fraction and fractional shortening of the cardiac muscle between the investigated groups. Aortic peak systolic velocity was significantly reduced in the LPD group (P = 0.02). Our findings support the idea that the programming of adult cardiovascular disease can be prevented or delayed in IUGR offspring when postnatal growth trajectory resembles that of in utero.
Publisher: Elsevier BV
Date: 08-2002
Abstract: In pregnancy the feto-placental unit is the major source of activin A. However, the role(s) of activin A in late pregnancy remain uncertain and controversial. In particular, whether activin A levels alter in association with labour is unclear. In a cross-sectional cohort study, maternal serum s les were collected from women at term prior to elective Caesarean section (n=11), during labour prior to a spontaneous vaginal delivery (n=31), an instrumental vaginal delivery (n=16) or an emergent Caesarean section (n=7). Umbilical artery blood s les were collected from 75 pregnancies, after an elective Caesarean section (n=9), a normal vaginal delivery (n=37), an instrumental vaginal delivery (n=15) or an emergent Caesarean section (n=14). Levels of activin A were measured and compared according to modes of delivery. Maternal, but not foetal, serum activin A was increased significantly in women who were delivered by an intrapartum Caesarean section compared to other modes of delivery. Foetal, but not maternal, serum activin A was significantly correlated with umbilical artery pH. Maternal serum activin A is increased in women undergoing an intrapartum Caesarean section compared to either a vaginal delivery or an elective Caesarean section. The mechanism(s) underlying this observation are not clear.
Publisher: Springer Science and Business Media LLC
Date: 06-2010
DOI: 10.1186/BCR2591
Publisher: Wiley
Date: 20-11-2017
DOI: 10.1002/JUM.14481
Abstract: Ultrasound can lead to thermal and mechanical effects in interrogated tissues. This possibility suggests a potential risk during neonatal cranial ultrasound examinations. The aim of this study was to explore safety knowledge and training of neonatal cranial ultrasound among Australian operators who routinely perform these scans. An online survey was administered on biosafety and training in neonatal cranial ultrasound, targeting all relevant professionals who can perform neonatal cranial ultrasound examinations in Australia: namely, radiologists, neonatologists, sonographers, and pediatricians. The survey was conducted between November 2013 and May 2014. A total of 282 responses were received. Twenty of 208 (10%) answered all ultrasound biosafety questions correctly, and 49 of 169 (29%) correctly defined the thermal index. Two-thirds (134 of 214 [63%]) of respondents failed to recognize that reducing the overall scanning time is the most effective method of reducing the total power exposure. Only 13% (31 of 237) indicated that a predetermined fixed period of training or that a specified minimum number of supervised scans was used during training. The reported number of supervised scans during training was highly variable. Almost half of the participants (82 of 181 [45%]) stated that they had received supervision for 10 to 50 scans (median, 20 scans). There is a need to educate operators on biosafety issues and approaches to minimize power outputs and reduce the overall duration of cranial ultrasound scans. Development of standardized training requirements may be warranted.
Publisher: Springer Science and Business Media LLC
Date: 19-03-2015
DOI: 10.1007/S00256-015-2132-6
Abstract: To determine the prevalence of morphological and mechanical stiffness alterations at the mid Achilles tendon in asymptomatic marathon runners before and after a competition. To assess the relationship between pre-existing Achilles tendon alterations and pain after running. All marathon runners from a local running club who were participating in the Melbourne Marathon 2013 (full marathon category) were invited for conventional ultrasound and sonoelastography 1 week leading up to the marathon and again within 3 days post-marathon. Another group of active, healthy in iduals not involved in running activities were recruited as controls. Intratendinous morphological (tendon thickness, hypoechogenicities), Doppler as well as stiffness properties of the Achilles were recorded. Achilles tendon pain was evaluated using the visual analogue scale (VAS) and Victorian Institute of Sports Assessment-Achilles (VISA-A). Twenty-one asymptomatic runners (42 Achilles tendons) and 20 healthy controls (40 Achilles tendons) were examined. On the pre-marathon evaluation, runners showed significantly more morphological changes on B-mode ultrasound compared to the controls (p < 0.001). Marathon running induced a significant reduction in tendon stiffness (p = 0.049) and an increase in Doppler signals (p = 0.036). Four runners (4/21, 19%) reported Achilles tendon pain after the race [VAS 4.0 (±1.9), VISA 74.2 (±10.1)]. Reduced tendon stiffness at baseline was associated with post-marathon Achilles tendon pain (p = 0.016). Marathon runners demonstrate a higher prevalence of morphological alterations compared to non-runners. Marathon running caused a significant change in Achilles tendon stiffness and Doppler signals. Pre-existing soft Achilles tendon properties on sonoelastography may be a predisposing risk for development of symptoms post-running.
Publisher: American Roentgen Ray Society
Date: 06-2011
DOI: 10.2214/AJR.10.5252
Publisher: American Roentgen Ray Society
Date: 12-2009
DOI: 10.2214/AJR.09.2319
Publisher: SAGE Publications
Date: 04-2013
Abstract: After praziquantel treatment for schistosomiasis, parasitological cure rates of 60%–90% are usual. Does this response to treatment correlate with the improvement in liver and bladder changes seen on ultrasound in children? This study shows that ultrasound is an effective way to evaluate liver and bladder changes caused by schistosomiasis infection in children and to assess treatment effects after mass treatment programmes.
Publisher: Wiley
Date: 10-2010
DOI: 10.1111/J.1754-9485.2010.02193.X
Abstract: Despite the frequent introduction of voice recognition (VR) into radiology departments, little evidence still exists about its impact on workflow, error rates and costs. We designed a study to compare typographical errors, turnaround times (TAT) from reported to verified and productivity for VR-generated reports versus transcriptionist-generated reports in MRI. Fifty MRI reports generated by VR and 50 finalized MRI reports generated by the transcriptionist, of two radiologists, were s led retrospectively. Two hundred reports were scrutinised for typographical errors and the average TAT from dictated to final approval. To assess productivity, the average MRI reports per hour for one of the radiologists was calculated using data from extra weekend reporting sessions. Forty-two % and 30% of the finalized VR reports for each of the radiologists investigated contained errors. Only 6% and 8% of the transcriptionist-generated reports contained errors. The average TAT for VR was 0 h, and for the transcriptionist reports TAT was 89 and 38.9 h. Productivity was calculated at 8.6 MRI reports per hour using VR and 13.3 MRI reports using the transcriptionist, representing a 55% increase in productivity. Our results demonstrate that VR is not an effective method of generating reports for MRI. Ideally, we would have the report error rate and productivity of a transcriptionist and the TAT of VR.
Publisher: MedCrave Group, LLC
Date: 12-01-2021
DOI: 10.15406/IJRRT.2021.08.00288
Abstract: Purpose Clinician inexperience, intra–observer and inter–observer variations in tumour definition may affect staging, radiotherapy target definition, and treatment outcomes, particularly in rare cancers. The purpose of this study was to assess the correlation between semi–automated methods of primary anal cancer (AC) definition and our current clinical standard of manual clinician definition using 18F–FDG–PET imaging and to provide recommendations for clinical use. Methods All patients referred for chemoradiotherapy for AC between 2012 and 2016 were prospectively enrolled, with all 18F–FDG–PET imaging acquired within one year of chemoradiotherapy collected. Three methods of primary AC definition were performed on all PET datasets. Manual definition by an experienced radiologist was considered the clinical standard for comparison of volume and coincidence (Dice coefficient) in our study. Semi–automated techniques assessed included a gradient–based SUV (SUV–gradient) method and a SUV threshold method with a range of thresholds relative to SUVmax (40 (T40), 50 (T50) and 60% (T60)). Results Ten patients were enrolled with 33 PET study sets available for analysis. While all methods created contours on pre– and post–treatment scans, manual definition of PET–avid disease was only necessary on 11 of the 33 study sets. SUV–gradient and T40 defined contours were not statistically different in volume to the clinical standard (p = 0.83 & 0.72 respectively). The observed Dice coefficient relative to the manual clinician contours were 0.75 and 0.73 for the SUV–gradient and T40 methods respectively. Conclusions It is possible to define gross AC using SUV–based methods, with the SUV–gradient–based method followed by the T40 method most closely correlating with our current clinical standard. The SUV–gradient–based method studied is housed within a proprietary clinical system. A semi–automated approach that uses a vendor neutral T40 method and the clinician’s knowledge and skill appears optimal in defining AC. With this approach AC may be defined reliably to enhance efficiencies in radiotherapy and nuclear medicine processes, and to support clinicians in identifying and defining this rare disease. Trial registration ANZCTR, ACTRN12620000066987. Registered 28 January 2020–Retrospectively registered, www.anzctr.org.au/ACTRN12620000066987.aspx
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.ULTRASMEDBIO.2013.04.018
Abstract: Experiments and theory were undertaken on the destruction of ultrasound contrast agent microbubbles on needle injection, with the aim of predicting agent loss during in vivo studies. Agents were expelled through a variety of syringe and needle combinations, subjecting the microbubbles to a range of pressure drops. Imaging of the bubbles identified cases where bubbles were destroyed and the extent of destruction. Fluid-dynamic calculations determined the pressure drop for each syringe and needle combination. It was found that agent destruction occurred at a critical pressure drop that depended only on the type of microbubble. Protein-shelled microbubbles (sonicated bovine serum albumin) were virtually all destroyed above their critical pressure drop of 109 ± 7 kPa Two types of lipid-shelled microbubbles were found to have a pressure drop threshold above which more than 50% of the microbubbles were destroyed. The commercial lipid-shelled agent Definity was found to have a critical pressure drop for destruction of 230 ± 10 kPa for a previously published lipid-shelled agent, this value was 150 ± 40 kPa. It is recommended that attention to the predictions of a simple formula could preclude unnecessary destruction of microbubble contrast agent during in vivo injections. This approach may also preclude undesirable release of drug or gene payloads in targeted microbubble therapies. Ex le values of appropriate injection rates for various agents and conditions are given.
Publisher: Wiley
Date: 09-07-2010
DOI: 10.1002/CNCR.25392
Abstract: The authors studied growth and progression of untreated nonsmall cell lung cancer (NSCLC) by comparing diagnostic and radiotherapy (RT) planning fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scans before proposed radical chemo-RT. Patients enrolled on a prospective clinical trial were eligible for this analysis if they underwent 2 pretreatment whole body FDG-PET/CT scans, >7 days apart. Scan 1 was performed for diagnosis/disease staging and scan 2 for RT planning. Interscan comparisons included disease stage, metabolic characteristics, tumor doubling times, and change in treatment intent. Eighty-two patients underwent planning PET/CT scans between October 2004 and February 2007. Of these, 28 patients (61% stage III, 18% stage II) had undergone prior staging PET/CT scans. The median interscan period was 24 days (range, 8-176 days). Interscan disease progression (TNM stage) was detected in 11 (39%) patients. The probability of upstaging within 24 days was calculated to be 32% (95% confidence interval [CI], 18%-49%). Treatment intent changed from curative to palliative in 8 (29%) cases, in 7 because of PET. For 17 patients who underwent serial PET/CT scans under standardized conditions, there was a mean relative interscan increase of 19% in tumor maximum standardized uptake value (SUV) (P=.022), 16% in average SUV (P=.004), and 116% in percentage injected dose (P=.002). Estimated doubling time of FDG avid tumor was 66 days (95% CI, 51-95 days). Rapid tumor progression was detected in patients with untreated, predominantly stage III, NSCLC on serial FDG-PET/CT imaging, highlighting the need for prompt diagnosis, staging, and initiation of therapy in patients who are candidates for potentially curative therapy.
Publisher: BMJ
Date: 24-07-2008
Abstract: To investigate early clinical predictors of time to return to competition and of recurrence following hamstring strain. Prospective observational study. Elite level of Australian football competition. 59 players who suffered a hamstring strain in 2002 season. Clinical assessment by a physiotherapist and questionnaire. Time taken to return to play and recurrence of hamstring injury within 3 weeks. Players taking more than 1 day to walk pain-free were significantly more likely (p=0.018) to take longer than 3 weeks to return to competition (adjusted odds ratio 4.0 95% CI 1.3 to 12.6). Nine players (15.2%) experienced an injury recurrence, all involving the biceps femoris. Recurrence was more likely in players who reported a hamstring injury in the past 12 months (adjusted odds ratio 19.6 95% CI 1.5 to 261.0 p=0.025). Time to walk pain-free and previous hamstring injury are predictors of time to return to competition and recurrence, respectively, and should be included in a clinical assessment to aid in prognosis.
Publisher: Informa UK Limited
Date: 07-2014
Publisher: IEEE
Date: 06-2014
Publisher: Wiley
Date: 07-2013
Abstract: The pretransverse or first segment of the vertebral artery may be confused with adjacent branches of the proximal subclavian artery during Doppler assessment. This study investigated the effectiveness of mastoid process percussion, the "mastoid tap" maneuver, for identification of the vertebral artery ostium. Fifty patients presenting consecutively for carotid sonography were recruited. Doppler waveforms were collected at the vertebral artery ostia, thyrocervical trunks, and proximal subclavian arteries while the mastoid tap maneuver was performed. The outcome indicator was serrate distortion of the Doppler waveform. Two raters graded the waveforms according to a 3-grade system: grade 0, no distortion grade 1, mild distortion and grade 3, marked distortion. The difference between the proportions of the vertebral artery ostia and thyrocervical trunks showing waveform distortion was evaluated with the χ(2) test. The differences in the extents of waveform distortion in the ipsilateral vertebral artery ostia, thyrocervical trunks, and subclavian arteries were evaluated with Friedman and Wilcoxon signed rank tests. Ninety-five vertebral artery ostia in 50 patients were successfully assessed. There was a significant difference between the proportions of vertebral artery ostia (95 of 95 [100%]) and thyrocervical trunks (9 of 95 [9.5%]) that showed waveform distortion (P < .001). There were significant differences in the extents of distortion between the ipsilateral vertebral artery ostia and thyrocervical trunks and between the ipsilateral vertebral artery ostia and subclavian arteries, with the vertebral artery ostia showing a higher degree of distortion in both cases (P < .001). The mastoid tap maneuver is useful for distinguishing between the vertebral arteries and thyrocervical trunks on Doppler studies.
Publisher: Elsevier BV
Date: 08-2001
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.BRACHY.2015.04.011
Abstract: To assess changes to the brachytherapy target over the course of treatment and the impact of these changes on planning and resources. Patients undergoing curative treatment with radiotherapy between January 2007 and March 2012 were included in the study. Intrauterine applicators were positioned in the uterine canal while patients were under anesthesia. Images were obtained by MRI and ultrasound at Fraction 1 and ultrasound alone at Fractions 2, 3, and 4. Cervix and uterine dimensions were measured on MRI and ultrasound and compared using Bland-Altman plots and repeated measures one-way analysis of variance. Of 192 patients who underwent three fractions of brachytherapy, 141 of them received four fractions. Mean differences and standard error of differences between MRI at Fraction 1 and ultrasound at Fraction 4 for anterior cervix measurements were 2.9 (0.31), 3.5 (0.25), and 4.2 (0.27) mm and for posterior cervix 0.8 (0.3), 0.3 (0.3), and 0.9 (0.3) mm. All differences were within clinically acceptable limits. The mean differences in the cervix over the course of brachytherapy were less than 1 mm at all measurement points on the posterior surface. Replanning occurred in 11 of 192 (5.7%) patients, although changes to the cervix dimensions were not outside clinical limits. There were small changes to the cervix and uterus over the course of brachytherapy that were not clinically significant. Use of intraoperative ultrasound as a verification aid accurately assesses the target at each insertion, reduces uncertainties in treatment delivery, and improves efficiency of the procedure benefiting both the patient and staff.
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.JCCT.2011.10.003
Abstract: CT myocardial perfusion imaging is an emerging CT application using density measurements of contrast-enhanced left ventricular (LV) myocardium. Using a 320-MDCT we have consistently observed lower Hounsfield unit (HU) values in the lateral LV myocardium, potentially mimicking perfusion defects. This study aimed to evaluate contrast-enhancement patterns of the LV myocardium in normal studies. Twenty-one clinical cases with normal coronary MDCT-based angiography findings, as determined by 2 qualified readers, were selected for retrospective evaluation. Using 8 identically sized and positioned ROIs, the HU measurements were recorded from short axis axial reconstructions through the LV myocardium in middle, apical, and basal locations. Scans were acquired on a 320-slice MDCT unit. The middle short axis location demonstrated HU densities of 79.4 (range 42.3-162.7) in the lateral myocardial wall (regions 2, 3, and 4) compared with 103.9 (range 11.4-159.6) in the inferior, septal, and anterior walls (regions 1, 5, 6, 7, and 8 P < 0.001). HU densities for the basal slice were 82.3 (range 51.5-168.4) in the lateral wall compared with 94.9 (range 35.3-144) in the inferior, septal, and anterior walls (P < 0.001). In the apical location, HU densities were 79.9 (range 42.3-139.3) in the lateral wall compared with 100.9 (range 69.0-170.5) in the inferior, septal, and anterior walls (P < 0.001). Normal LV myocardial enhancement using a 320-slice MDCT demonstrates significantly lower densities in the lateral wall when compared with the anterior, septal, and inferior walls in patients with normal coronary vascular anatomy. Assessment of CT myocardial perfusion studies should therefore be undertaken with caution, to prevent misrepresenting these lower-density values in the LV lateral wall.
Publisher: SAGE Publications
Date: 04-2019
Abstract: Mesenchymal stem cells exhibit immunomodulatory properties which are currently being investigated as a novel treatment option for Acute Respiratory Distress Syndrome. However, the feasibility and efficacy of mesenchymal stem cell therapy in the setting of extracorporeal membrane oxygenation is poorly understood. This study aimed to characterise markers of innate immune activation in response to mesenchymal stem cells during an ex vivo simulation of extracorporeal membrane oxygenation. Ex vivo extracorporeal membrane oxygenation simulations (n = 10) were conducted using a commercial extracorporeal circuit with a CO 2 -enhanced fresh gas supply and donor human whole blood. Heparinised circuits (n = 4) were injected with 40 × 10 6 -induced pluripotent stem cell–derived human mesenchymal stem cells, while the remainder (n = 6) acted as controls. Simulations were maintained, under physiological conditions, for 240 minutes. Circuits were s led at 15, 30, 60, 120 and 240 minutes and assessed for levels of interleukin-1β, interleukin-6, interleukin-8, interleukin-10, tumour necrosis factor-α, transforming growth factor-β1, myeloperoxidase and α-Defensin-1. In addition, haemoglobin, platelet and leukocyte counts were performed. There was a trend towards reduced levels of pro-inflammatory cytokines in mesenchymal stem cell–treated circuits and a significant increase in transforming growth factor-β1. Blood cells and markers of neutrophil activation were reduced in mesenchymal stem cell circuits during the length of the simulation. As previously reported, the addition of mesenchymal stem cells resulted in a reduction of flow and increased trans-oxygenator pressures in comparison to controls. The addition of mesenchymal stem cells during extracorporeal membrane oxygenation may cause an increase in transforming growth factor-β1. This is despite their ability to adhere to the membrane oxygenator. Further studies are required to confirm these findings.
Publisher: Springer Science and Business Media LLC
Date: 05-2004
DOI: 10.1007/S00256-003-0733-Y
Abstract: The objective of this study was to describe the suprascapular nerve block using CT guidance and to evaluate the short- and medium-term efficacy in a range of shoulder pathologies. CT-guided infiltration around the suprascapular nerve was performed with bupivacaine and Celestone Chronodose on 40 consecutive patients presenting with chronic shoulder pathologies unresponsive to conventional treatment. Patients were interviewed using the Shoulder Pain and Disability Index (SPADI) before the procedure, 30 min after the procedure and at 3 days, 3 weeks and 6 weeks afterwards. Within 30 min of the block overall pain scores decreased from a mean (+/-SEM) pain score of 7.0 (+/-0.4) to 3.5 (+/-0.5) ( n=39, P<0.001). At 3 days after the procedure, the mean overall improvement of the pain and disability scores were 20.4% (+/-4.9, P<0.001) and 16.8% (+/-4.8, P=0.004) respectively. Sustained pain relief and reduced disability were achieved in 10 of 35 (29%) patients at 3 weeks and longer. Patients suffering from soft tissue pathologies were the most likely patients to benefit from the injection. No serious side effects were noted. In some patients with chronic soft tissue pathologies who do not respond to conventional treatment, a CT-guided suprascapular nerve block can provide safe short- and medium-term relief from pain and disability.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.AMJCARD.2018.10.022
Abstract: Magnetic resonance imaging (MRI) studies have consistently identified a high incidence of silent brain infarction (SBI) after cardiac intervention. The frequent occurrence, objective measurement and clinical sequelae of SBI have seen interest in their detection for both research and clinical purposes. However, MRI is expensive, time-consuming, unsafe in acutely-ill patients, and not always available, limiting its use as a routine screening tool. For this purpose, a blood biomarker of SBI would be the "Holy Grail." By performing targeted profiling of serologic biomarkers this study aimed to assess their potential as screening tools for perioperative SBI. This is a nested case-control study of 20 prospectively recruited patients undergoing transcatheter aortic valve implantation under general anesthesia. Clinical and diffusion-weighted MRI assessments were performed at baseline and on day 3 postprocedure to identify the presence (cases) or absence (controls) of new SBI. Blood was collected at baseline and 24, 48, and 72 hours postprocedure and analyzed for S100 calcium-binding protein B, neuron specific enolase (NSE), matrix metalloproteinase 9 (MMP 9), and glial fibrillary acidic protein. Best-fit polynomial curves using a smoothing model were generated for each biomarker and inferential testing at a predefined 24-hour postprocedure timepoint detected a significant difference for MMP 9 (72,435 SEM: 25,030 p = 0.027). Longitudinal regression revealed a statistically significant case-control difference for both NSE (mean: 10,747 SEM: 3,114) and MMP 9 (63,842 SEM: 16,173). In conclusion, NSE and MMP 9 are present in higher levels following SBI and warrant further investigation for their utility as screening tools.
Publisher: Wiley
Date: 06-2008
DOI: 10.1111/J.1440-1673.2008.01957.X
Abstract: This study evaluated the variability among six radiation therapy planners in planning radiation treatment for four patients with lung cancer using two treatment protocols. The interplanner variability for target conformity and homogeneity was smaller than the variability among the patients and planning approaches. The same was found for the dose volume indices achieved for most critical structures, indicating that interplanner variability is not likely to be an important source of variation in radiotherapy studies if concise treatment protocols are followed.
No related grants have been discovered for Michal Schneider.