Current Issue : April - June Volume : 2019 Issue Number : 2 Articles : 6 Articles
Background: Guidelines currently do not recommend the routine use of chest x-ray (CXR) in bronchiolitis. However,\nCXR is still performed in a high percentage of cases, mainly to diagnose or rule out pneumonia. The inappropriate use\nof CXR results in children exposure to ionizing radiations and increased medical costs. Lung Ultrasound (LUS) has\nbecome an emerging diagnostic tool for diagnosing pneumonia in the last decades. The purpose of this study was\nto assess the diagnostic accuracy and reliability of LUS for the detection of pneumonia in hospitalized children with\nbronchiolitis and to evaluate the agreement between LUS and CXR in diagnosing pneumonia in these patients.\nMethods: We enrolled children admitted to our hospital in 2016â??2017 with a diagnosis of bronchiolitis and\nundergone CXR because of clinical suspicion of concomitant pneumonia. LUS was performed in each child by a\npediatrician blinded to the patientâ??s clinical, laboratory and CXR findings. An exploratory analysis was done in the\nfirst 30 patients to evaluate the inter-observer agreement between a pediatrician and a radiologist who independently\nperformed LUS. The diagnosis of pneumonia was established by an expert clinician based on the recommendations of\nthe British Thoracic Society guidelines.\nResults: Eighty seven children with bronchiolitis were investigated. A final diagnosis of concomitant pneumonia was\nmade in 25 patients. Sensitivity and specificity of LUS for the diagnosis of pneumonia were 100% and 83.9%\nrespectively, with an area under-the-curve of 0.92, while CXR showed a sensitivity of 96% and specificity of 87.1%.\nWhen only consolidation > 1 cm was considered consistent with pneumonia, the specificity of LUS increased to\n98.4% and the sensitivity decreased to 80.0%, with an area under-the-curve of 0.89. Cohenâ??s kappa between\npediatrician and radiologist sonologists in the first 30 patients showed an almost perfect agreement in diagnosing\npneumonia by LUS (K 0.93).\nConclusions: This study shows the good accuracy of LUS in diagnosing pneumonia in children with clinical bronchiolitis.\nWhen including only consolidation size > 1 cm, specificity of LUS was higher than CXR, avoiding the need to perform\nCXR in these patients. Added benefit of LUS included high inter-observer agreement.\nTrial registration: Identifier: NCT03280732. Registered 12 September 2017 (retrospectively registered)....
Objective: To describe the radiological and histological aspects of breast nodules\namong men in our practice setting. Methodology: This is a descriptive\nand retrospective study conducted from January 2014 to October 2017. The\nstudy included male patients with breast nodules classified ACR3, 4 or 5 after\na mammographic and ultrasound scan. These lesions were explored through\nan ultrasound-guided breast microbiopsy. The following are the variables\ncollected: age, family history of breast cancer, medical history, ACR classification,\nnodule size, and anatomopathologic diagnosis....
Background: Ultrasound has become the most widely practiced medical imaging\nexamination even in developing countries because of its non-irradiating,\nnon-invasive nature and its relatively affordable cost. Objective: The objective\nof this study was to review the practice of medical ultrasound in Lome\ncity. We carried out a descriptive cross-sectional study using the pre-established\nfact sheets. It took place from 16 August to 30 November 2013 in the healthcare\nfacilities of the city of Lome. Results: A total of 47 centers were surveyed,\nincluding 14 public centers and 33 private centers. The ultrasound scanners\nwere mostly acquired in the new state (59.6%) with only 34.1% of these ultrasound\nscanners equipped with the Doppler mode. There were 3 ultrasound\nscanners (6.4%) that had a 3D probe. Radiologists were the ones who carried\nout most of the ultrasound examinations in public centers, while in private\nthey accounted for half of the performers (45.5%). Physicians enrolled in a\nspecialty in radiology played a significant role in these private structures, accounting\nfor 24.2% of performers. Cardiac ultrasound was performed only in\n2 centers (4.2%). The ultrasound report was available in all public centers using\nthe pre-established and standardized forms. The qualification of sonographers\nand the status of ultrasound scanners are relatively acceptable. Conclusion:\nUltrasound scanners were mostly acquired in new condition. Radiologists\nremained the ones who carried out the largest number of ultrasound\nexamination in Lome....
Purpose: To investigate the feasibility of partial arc volumetric modulated arc\ntherapy (VMAT) in lung cancer stereotactic body radiotherapy (SBRT), as\nwell the volumetric and dosimetric effects of different internal target volume\n(ITV) definitions with 4D CT. Methods: Fourteen patients with primary and\nmetastatic lung cancer underwent SBRT were enrolled. Full and partial arc\nVMAT plans were generated with four different ITVs: ITVall, ITVMIP, ITVAIP\nand ITV2phases, representing ITVs generated from all 10 respiratory phases,\nmaximum intensity projection (MIP), average intensity projection (AIP), and\n2 extreme respiratory phases. Volumetric and dosimetric differences, as well\nas MU and delivery time were investigated. Results: Partial arc VMAT irradiated\nmore dose at 2 cm away from planning target volume (PTV) (P =\n0.002), however, it achieved better protection on mean lung dose , lung V5,\nspinal cord, heart and esophagus compared with full arc VMAT. The average\nMU and delivery time of partial arc VMAT were 240 and 1.6 min less than\nthose of full arc VMAT. There were no significant differences on target coverage\nand organ at risks (OARs) sparing among four ITVs. The average percent\nvolume differences of ITVMIP, ITVAIP and ITV2phases to ITVall were 8.6%,\n13.4%, and 25.2%, respectively. Conclusions: Although partial arc VMAT\ndelivered more dose 2 cm out of PTV, it decreases the dose to lung, spinal\ncord, and esophagus, as well decreased the total MU and delivery time compared\nwith full arc VMAT without sacrificing target coverage. Partial arc\nVMAT was feasible and more efficient for lung SBRT....
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Objective: To investigate the effect of onboard image (OBI) system-based\nimage guided radiotherapy (IGRT) on the precision of fractionated intensity\nmodulated radiotherapy (IMRT) for patients with locally advanced rectal\ncancer. Methods: The IGRT validation images of the 12 patients with rectal\ncancer were obtained after initial setup by the OBI system of Varian Novalis\nTX linear accelerator, and registered to the planning CT image system. Subsequently,\nthe setup deviations on three translational directions [ventral-dorsal\ndirection (VD), cranial-caudal direction (CD) and lateral direction (LD)] for\nthe three-validation phase including Pre-treatment (Pre-RT1), repositioning\n(Pre-RT2) and Post-treatment (Post-RT) were obtained and comparatively\nanalyzed. Results: The frequency of setup deviation of <--2.0 mm in the lateral,\ncephalocaudal and ventral direction was 83.01%, 65.71%, and 68.91%, respectively\nfor Pre-RT1; 100%, 98.72% and 100%, respectively for Pre-RT2; 100%,\n97.76%, and 99.68%, respectively for Post-RT. Compared with the Pre-RT1\nphase, the ranges of setup deviation on Pre-RT2 and Post-RT phases possessed\na significant contraction trend. The absolute values of setup deviations\non the three translation directions between the Pre-RT1 and Pre-RT2 or\nPost-RT were statistically significant (p < 0.05). Through positioning adjustment\nbased on IGRT based on the OBI system, the setup deviations on the\nthree translational directions decreased significantly. Conclusion: Application\nof OBI-based daily IGRT may help improve the precise delivery of fractionated\nIMRT by decreasing the inter- and intra-fractionated setup deviation\nin the ventral-dorsal direction, cranial-caudal direction and lateral direction\nfor patients with locally advanced rectal cancer....
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