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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com, https://plus.google.com/communities/115462130054650919641?sqinv=VFJWaER0c2NCRl9ERzRjZWhxQmhzY09kVV84cjRn , ,https://plus.google.com/u/0/+AlexandrosGSfakianakis , https://www.youtube.com/channel/UCQH21WX8Qn5YSTKrlJ3OrmQ , https://www.youtube.com/channel/UCTREJHxB6yt4Gaqs4-mLzDA , https://twitter.com/g_orl?lang=el, https://www.instagram.com/alexandrossfakianakis/,

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Τρίτη, 6 Μαρτίου 2018

4D-CT Parathyroid Adenoma - DAMS Unplugged

4D-CT includes image sets in three planes (axial, coronal, sagittal) from the angle of mandible to the mediastinum. The "fourth" dimension of 4D-CT is the perfusion information derived from multiple phases in non-contrast, arterial, and delayed phase imaging.

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Applying Lean-Six-Sigma Methodology in radiotherapy: Lessons learned by the breast daily repositioning case

Publication date: Available online 6 March 2018
Source:Radiotherapy and Oncology
Author(s): Pietro Mancosu, Giorgia Nicolini, Giulia Goretti, Fiorenza De Rose, Davide Franceschini, Chiara Ferrari, Giacomo Reggiori, Stefano Tomatis, Marta Scorsetti
Background & purposeLean Six Sigma Methodology (LSSM) was introduced in industry to provide near-perfect services to large processes, by reducing improbable occurrence. LSSM has been applied to redesign the 2D-2D breast repositioning process (Lean) by the retrospective analysis of the database (Six Sigma).Materials & methodsBreast patients with daily 2D-2D matching before RT were considered. The five DMAIC (define, measure, analyze, improve, and control) LSSM steps were applied. The process was retrospectively measured over 30 months (7/2014–12/2016) by querying the RT Record&Verify database. Two Lean instruments (Poka-Yoke and Visual Management) were considered for advancing the process. The new procedure was checked over 6 months (1–6/2017).Results14,931 consecutive shifts from 1342 patients were analyzed. Only 0.8% of patients presented median shifts >1 cm. The major observed discrepancy was the monthly percentage of fractions with almost zero shifts (AZS = 13.2% ± 6.1%). Ishikawa fishbone diagram helped in defining the main discrepancy con-causes. Procedure harmonization involving a multidisciplinary team to increase confidence in matching procedure was defined. AZS was reduced to 4.8% ± 0.6%. Furthermore, distribution symmetry improvement (Skewness moved from 1.4 to 1.1) and outlier reduction, verified by Kurtosis diminution, demonstrated a better "normalization" of the procedure after the LSSM application.ConclusionsLSSM was implemented in a RT department, allowing to redesign the breast repositioning matching procedure.



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DAHANCA 10 – Effect of darbepoetin alfa and radiotherapy in the treatment of squamous cell carcinoma of the head and neck. A multicenter, open-label, randomized, phase 3 trial by the Danish head and neck cancer group

Publication date: Available online 6 March 2018
Source:Radiotherapy and Oncology
Author(s): Jens Overgaard, Camilla Molich Hoff, Hanne Sand Hansen, Lena Specht, Marie Overgaard, Pernille Lassen, Elo Andersen, Jørgen Johansen, Lisbeth Juhler Andersen, Jan Folkvard Evensen, Jan Alsner, Cai Grau
PurposeTo evaluate if correction of low hemoglobin (Hb) levels by means of darbepoetin alfa improves the outcomes of radiotherapy in patients with squamous cell carcinoma of the head and neck (HNSCC).Patients and methodsPatients eligible for primary radiotherapy and who had Hb values below 14.0 g/dl were randomized to receive accelerated fractionated radiotherapy with or without darbepoetin alfa. Patients also received the hypoxic radiosensitizer nimorazole. Darbepoetin alfa was given weekly during radiotherapy or until the Hb value exceeded 15.5 g/dl.ResultsFollowing a planned interim analysis which showed inferiority of the experimental treatment the trial was stopped after inclusion of 522 patients (of a planned intake of 600). Of these, 513 were eligible for analysis (254 patients treated with darbepoetin alfa and 259 patients in the control group). Overall, the patients were distributed according to the stratification parameters (gender, T and N staging, tumor site). Treatment with darbepoetin alfa increased the Hb level to the planned value in 81% of the patients. The compliance was good without excess serious adverse events.The results showed a poorer outcome with a 5-year cumulative loco-regional failure rate of 47% vs. 34%, Hazard Ratio (HR): 1.53 [1.16–2.02], for the darbepoetin alfa vs. control arm, respectively. This was also seen for the endpoints of event-free survival (HR: 1.36 [1.09–1.69]), disease-specific death (HR: 1.43 [1.08–1.90]), and overall survival (HR: 1.30 [1.02–1.64]). There was no enhanced risk of cardio-vascular events observed in the experimental arm or any significant differences in acute or late radiation related morbidity. All univariate analyses were confirmed in a multivariate setting.ConclusionCorrection of the Hb level with darbepoetin alfa during radiotherapy of patients with HNSCC resulted in a significantly poorer tumor control and survival.



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An atlas to aid delineation of para-aortic lymph node region in cervical cancer: Design and validation of contouring guidelines

Publication date: Available online 6 March 2018
Source:Radiotherapy and Oncology
Author(s): Lorna G. Keenan, Kathy Rock, Aini Azmi, Osama Salib, Charles Gillham, Orla McArdle
IntroductionPrevious studies have investigated the anatomical distribution of para-aortic lymph nodes (PAN) in patients with cervical cancer. However, an atlas for accurate clinical target volume (CTV) delineation has yet to be defined. The purpose of this study was to design and verify a computerized tomography (CT) atlas to provide guidance for contouring the PAN CTV in patients with cervical cancer.Materials and methodsThis prospective study included 21 cervical cancer patients (design cohort) with 39 pathological PAN identified on (18)F-FDG PET-CT. PAN [left lateral para-aortic (LLPA), aorto-caval (AC), right para-caval (RPC) nodes] were delineated on CT simulation scans. Measurements were taken from the volumetric centre of the nodes to the edge of aorta and inferior vena-cava (IVC). Initially the aorta and IVC were expanded by the mean distance to the lymph node centre to create a CTV. Expansion margins were then increased asymmetrically until the CTV resulted in a clinically acceptable number of PAN included. The CTV was validated on a further 10 patients (validation cohort) with 29 PAN. A detailed contouring guide and accompanying visual atlas for elective PAN CTV delineation was created based on the validated margins.ResultsFor the design cohort (n = 21 patients, 39 PAN), the mean distance from the centre of the node to the aorta was 8 mm (range 4–17) for both LLPA (range 4–17) and AC (range 4–15) regions. Mean distance from the IVC to the centre of the nodes was 5 mm (range 4–6) in the RPC region and 6 mm (range 3–15) in the AC region. No PAN was superior to the T12-L1 interspace or the left renal vein or inferior to the L5-S1 interspace. For validation cohort (n = 10 patients, 29 PAN), mean distance from centre of the node to the aorta was 9 mm (range 5–15) in the LLPA region, 7 mm (range 6.5–14) in the AC region. Mean distance from the ICV to the centre of the nodes was 3 mm (range 2.5–4) in the RPC region and 5 mm (range 3–10) in the AC region. A CTV expansion from the aorta of 10 mm circumferentially and 15 mm laterally, and from the IVC of 8 mm anteromedially and 6 mm posterolaterally resulted in coverage of 97% (38/39) of PAN in the design cohort. On prospective validation, the described CTV included 97% (28/29) of PAN in the validation cohort.ConclusionWe propose the following PAN CTV; expansion from aorta of 10 mm circumferentially except 15 mm laterally, expansion from the IVC of 8 mm anteromedial and 6 mm posterolaterally. The suggested CTV includes 97% (28/29) PAN in a validated patient cohort. A detailed guide and accompanying visual atlas is provided to aid delineation of the PAN CTV in patients with cervical cancer.



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An atlas to aid delineation of para-aortic lymph node region in cervical cancer: Design and validation of contouring guidelines

Previous studies have investigated the anatomical distribution of para-aortic lymph nodes (PAN) in patients with cervical cancer. However, an atlas for accurate clinical target volume (CTV) delineation has yet to be defined. The purpose of this study was to design and verify a computerized tomography (CT) atlas to provide guidance for contouring the PAN CTV in patients with cervical cancer.

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Applying Lean-Six-Sigma Methodology in radiotherapy: Lessons learned by the breast daily repositioning case

Lean Six Sigma Methodology (LSSM) was introduced in industry to provide near-perfect services to large processes, by reducing improbable occurrence. LSSM has been applied to redesign the 2D-2D breast repositioning process (Lean) by the retrospective analysis of the database (Six Sigma).

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DAHANCA 10 – Effect of darbepoetin alfa and radiotherapy in the treatment of squamous cell carcinoma of the head and neck. A multicenter, open-label, randomized, phase 3 trial by the Danish head and neck cancer group

To evaluate if correction of low hemoglobin (Hb) levels by means of darbepoetin alfa improves the outcomes of radiotherapy in patients with squamous cell carcinoma of the head and neck (HNSCC).

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Replacing zoledronic acid with denosumab is a risk factor for developing osteonecrosis of the jaw

Publication date: Available online 6 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Tomoko Higuchi, Yoshihiko Soga, Misato Muro, Makoto Kajizono, Yoshihisa Kitamura, Toshiaki Sendo, Akira Sasaki
ObjectiveIntravenous zoledronic acid (ZA) is often replaced with subcutaneous denosumab in bone metastatic cancer patients. Despite their different pharmacological mechanisms of action, both denosumab and ZA are effective in bone metastasis but have osteonecrosis of the jaw (ONJ) as a side effect. ZA persists in the body almost indefinitely, while denosumab does not persist for long periods. This study evaluated the risks of developing ONJ when replacing ZA with denosumab.Study DesignA total of 161 Japanese patients administered ZA for bone metastatic cancer were enrolled in this single-center, retrospective, observational study. The risk of developing ONJ was evaluated by logistic regression analysis using the following factors: age, sex, cancer type, angiogenesis inhibitors, steroids, and replacement of ZA with denosumab.ResultsSeventeen patients (10.6%) developed ONJ. Multiple regression analysis indicated a significant difference in rate of ONJ associated with replacement of ZA with denosumab (OR = 3.81, 95% CI: 1.04 – 13.97, P = 0.043).ConclusionReplacing ZA with denosumab is a risk factor for developing ONJ. Both bisphosphonate binding to the bone and RANKL inhibition could additively increase the risk of developing ONJ. We bring the replacement of ZA with denosumab to the attention of clinical oncologists.



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A nomogram for classification of temporomandibular joint disc perforation based on magnetic resonance imaging

Publication date: Available online 6 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jae-Young Kim, Kug-Jin Jeon, Myeong-Gyun Kim, Kwang-Ho Park, Jong-Ki Huh
ObjectiveTo analyze risk factors and establish a prediction model for temporomandibular joint (TMJ) disc perforation with a nomogram.Study DesignThe study included a total of 282 joints in 274 patients. All patients underwent open temporomandibular joint surgery after obtaining magnetic resonance imaging (MRI) from 2005 to 2015. The presence or absence of disc perforation was confirmed during the operation. Patients were classified into two groups: perforation and non-perforation. We investigated demographic data and characteristics of disc, joint space, and bone on MRI. A logistic regression analysis was performed to analyze risk factors. A nomogram was constructed and validated internally and externally.ResultsRisk factors for disc perforation were increased age, disc shape (eyeglass or amorphous), low BMS, abnormal joint space, and 2 or more bony changes in the condyle and fossa. The area under the receiver operating characteristic (ROC) curve (AUC) of the nomogram was 0.908 (95% confidence interval [CI], 0.869–0.946) in the internal validation and 0.889 (95% CI, 0.804–0.973) in the external validation with good suitability.ConclusionWe were able to predict the probability of disc perforation with analyzed risk factors and constructed a nomogram, which may aid in proper diagnosis and treatment.



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EGFR is not amplified in ameloblastoma

Publication date: Available online 6 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Victor Costa, Eduardo Rodrigues Fregnani, Felipe Paiva da Fonseca, Fábio de Abreu Alves, Clóvis Antônio Lopes Pinto, Estela Kaminagakura
Objective.The aim of this study was to investigate alterations in the EGFR gene and its protein expression for a better understanding of the biological behavior of ameloblastoma.Study design.Twenty-five samples of ameloblastoma were selected and the dual color fluorescence in situ hybridization (FISH) assay was performed. The results of FISH and immunohistochemistry reaction for EGFR and Ki67 were associated with the clinicopathological features and recurrence.Results.All analyzed cases presented disomy without any gene polysomy or amplification. Regarding to EGFR immunoexpression, 3 (12%) cases were considered negative and 22 (88%) were positive, of which 13 (52%) were weak and 9 (36%) were strong. All samples presented low positivity for Ki67. There is no association between EGFR expression and the clinicopathological features or recurrence (p > 0.05). In some cases, EGFR immunoexpression is observed without gene amplification.Conclusion.Ameloblastoma development, progression or recurrence seems not to be related with EGFR amplification or polysomy.



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Differential expression of organic cation transporter 3 in oral submucous fibrosis–associated buccal squamous cell carcinoma

Publication date: Available online 6 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Yue Hu, Yunmei Qian, Lu Lin, Wenxin Chen, Liudi Yang, Xin Hu, Ke Tian, Kun Xia, Tong Su
ObjectiveThe aim of this study was to examine the expression of organic cation transporter 3 (OCT3) in patients with oral submucous fibrosis (OSF)–associated buccal squamous cell carcinoma (BSCC) and to explore its clinical significance.Study DesignA total of 56 tissue specimens were collected from patients, among which there were 13 specimens with normal buccal mucosa (NBM), 13 with oral submucous fibrosis (OSF), 10 with OSF-associated BSCC (BSCC-OSF), 10 with well-differentiated BSCC (BSCC-I), and 10 with poorly to moderately differentiated BSCC (BSCC-II+III), based on pathologic examination. The expression of OCT3 was detected by using immunohistochemistry and real-time quantitative reverse transcription polymerase chain reaction.ResultsThere was a significant difference in both the protein and mRNA expression levels of OCT3 among the NBM, OSF, BSCC-OSF, BSCC-I, and BSCC-II+III groups (protein: F = 82.45 [P < .0001]; mRNA: F = 50.69 [P < .0001]). The expression of OCT3 from NBM to OSF to BSCC-OSF was gradually upregulated. In addition, as BSCC became better differentiated, the expression of OCT3 increased.ConclusionsThe expression of OCT3 was associated with OSF progression and the differentiation of BSCC. OCT3 expression may serve as a molecular marker for the prevention and early diagnosis of OSF and BSCC.



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Mixed and inhomogeneous expression profile of Th1/Th2 related cytokines detected by cytometric bead array (CBA) in saliva of patients with oral lichen planus

Publication date: Available online 6 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Wei Wei, Qianqian Sun, Yiwen Deng, Yufeng Wang, Guanhuan Du, Chencheng Song, Chenxi Li, Mengxue Zhu, Guoyao Tang
ObjectiveTo measure Th1/Th2 related cytokines expression in saliva from patients with oral lichen planus (OLP), compared to health controls (HC) and disease controls with recurrent aphthous ulcers (RAU).Study DesignSaliva from 41 patients with OLP, 14 HC and 14 RAU was collected for Th1/Th2-related cytokines analysis using cytometric bead array (CBA). Disease activity in OLP was recorded by Reticulation/keratosis, erythema and ulceration (REU) scores.ResultsIL-6, IL-10, IFN-γ and IFN-γ/ IL-4 in saliva were significantly higher in OLP than health control (HC) group. A positive and significant correlation between IL-6, IL-10 and REU scores in OLP groups was revealed. Significantly increased IL-4, IL-5, IL-6, IL-10, TNF-α and IFN-γ/ IL-4 were found in RAU group.ConclusionSalivary cytokine profiles analyzed by CBA may provide a convenient research approach to OLP. Data indicated a complicated Th1/Th2 related cytokine profiles changes rather than simple dominance model in OLP. IL-10 and especially IL-6 might provide a surrogate endpoint for monitoring OLP.



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Asthmatic Exacerbation as a Cause of False-Positive Whole-Body Iodine Scan in a Patient With Treated Papillary Thyroid Carcinoma.

Asthmatic Exacerbation as a Cause of False-Positive Whole-Body Iodine Scan in a Patient With Treated Papillary Thyroid Carcinoma.

Clin Nucl Med. 2018 Apr;43(4):256-257

Authors: Chaussé G, Kader T, Abikhzer G, Probst S

Abstract
A 44-year-old woman was found to have new diffuse lung uptake on a follow-up whole-body I scan 1 year after being treated with surgery and radioactive iodine for papillary thyroid cancer. However, subsequent CT thorax and thyroglobulin levels were both unremarkable. Shortly after, she presented with respiratory symptoms, exhibiting end-expiratory wheezing on auscultation. Metacholine challenge test confirmed asthma. Symptoms improved under inhaled corticosteroids and beta-2 agonists. Resolution of lung uptake was confirmed on a second I imaging 6 months later.

PMID: 29504963 [PubMed - in process]



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