RSNA 2008 will feature presentations on the latest developments in radiology, including medical imaging informatics, quantitative imaging, and molecular imaging. Notable topics include the use of CT for abdominal trauma, CAD for pulmonary nodule detection, CT colonography for polyp screening, and diffusion-weighted imaging of tumors. Emerging areas like nuclear medicine quantitative imaging, MR-guided therapies, and radiation oncology immunomodulators will also be represented. The meeting aims to deliver cutting-edge research while promoting quality in radiology.
This document provides information on 4D radiotherapy (4D-RT) techniques for accounting for respiratory motion during radiation treatment. It discusses 4D-RT imaging which involves acquiring multiple CT image sets over the breathing cycle to visualize anatomical changes. It also describes 4D treatment planning using these multi-phase CTs and 4D delivery which continuously delivers the treatment throughout the breathing cycle. Respiratory gating and tumor tracking techniques are summarized as methods to synchronize treatment with respiration to reduce motion effects. Clinical applications for 4D-RT include lung, breast, and liver tumors affected by respiratory motion.
Diffusion-weighted imaging relies on detecting the random movement of water molecules using magnetic gradients. It provides information about water mobility in tissues and can help identify areas of restricted diffusion that may indicate malignancies. Developments in MRI technology have improved diffusion-weighted imaging, allowing its increasing use in detecting and characterizing tumors. By measuring the apparent diffusion coefficient, it can aid in tumor detection and assessment of treatment response. Diffusion-weighted imaging is now an important part of MRI exams, especially for evaluating the brain, liver, kidneys and other organs.
This document summarizes new abdominal MR imaging protocols using fast 3D gradients and breath hold techniques. It discusses T1, T2, diffusion weighted sequences and the use of liver specific contrast agents for evaluating conditions like cirrhosis, HCC and cholangiocarcinoma. Protocols for liver lesions include pre and post contrast T1 weighted sequences in arterial, portal venous and hepatobiliary phases. Diffusion imaging and hepatobiliary phase are valuable for small HCC detection. Multiphase kidney protocols evaluate corticomedullary, nephrographic and excretory phases for renal tumors. New protocols combining diffusion and hepatobiliary imaging improve HCC detection over single sequences.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Management dell’organ motion nei trattamenti stereo-RT e radiochirurgici: ruolo di fiducials e on-board imaging
Neuroradiology is the subspecialty of radiology focused on imaging the central and peripheral nervous systems. The document discusses several key imaging modalities used in neuroradiology including CT, MRI, ultrasound, angiography, and myelography. It provides details on the techniques, advantages, and limitations of each modality. CT and MRI are currently the main modalities used for evaluating neurological pathology, though each has specific scenarios where it is particularly useful over the other. Recent technological advances have improved imaging capabilities and increased accessibility of various modalities.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: La prescrizione della dose nei trattamenti stereo-RT e radiochirurgici: dall’ICRU a ROSEL ed altro
This document discusses diffusion and perfusion MRI techniques. It explains that diffusion is the random movement of particles from areas of high concentration to low concentration, and is important for transporting substances into and out of cells. Perfusion MRI uses endogenous and exogenous tracers to monitor hemodynamics and obtain perfusion maps. The combination of diffusion and perfusion MRI is useful for early detection and assessment of conditions like stroke and tumors by showing areas of decreased perfusion and already necrotic tissue.
This document discusses intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT) for head and neck cancers. It provides details on contouring targets and organs at risk for treatment planning. It summarizes evidence from trials on reducing xerostomia with IMRT. It also discusses the benefits of daily imaging with IGRT for accurate treatment delivery and potentially reducing planning target volume margins. Adaptive planning is mentioned as an area that continues to be explored to account for anatomical changes over the course of radiation treatment.
This document provides information on 4D radiotherapy (4D-RT) techniques for accounting for respiratory motion during radiation treatment. It discusses 4D-RT imaging which involves acquiring multiple CT image sets over the breathing cycle to visualize anatomical changes. It also describes 4D treatment planning using these multi-phase CTs and 4D delivery which continuously delivers the treatment throughout the breathing cycle. Respiratory gating and tumor tracking techniques are summarized as methods to synchronize treatment with respiration to reduce motion effects. Clinical applications for 4D-RT include lung, breast, and liver tumors affected by respiratory motion.
Diffusion-weighted imaging relies on detecting the random movement of water molecules using magnetic gradients. It provides information about water mobility in tissues and can help identify areas of restricted diffusion that may indicate malignancies. Developments in MRI technology have improved diffusion-weighted imaging, allowing its increasing use in detecting and characterizing tumors. By measuring the apparent diffusion coefficient, it can aid in tumor detection and assessment of treatment response. Diffusion-weighted imaging is now an important part of MRI exams, especially for evaluating the brain, liver, kidneys and other organs.
This document summarizes new abdominal MR imaging protocols using fast 3D gradients and breath hold techniques. It discusses T1, T2, diffusion weighted sequences and the use of liver specific contrast agents for evaluating conditions like cirrhosis, HCC and cholangiocarcinoma. Protocols for liver lesions include pre and post contrast T1 weighted sequences in arterial, portal venous and hepatobiliary phases. Diffusion imaging and hepatobiliary phase are valuable for small HCC detection. Multiphase kidney protocols evaluate corticomedullary, nephrographic and excretory phases for renal tumors. New protocols combining diffusion and hepatobiliary imaging improve HCC detection over single sequences.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Management dell’organ motion nei trattamenti stereo-RT e radiochirurgici: ruolo di fiducials e on-board imaging
Neuroradiology is the subspecialty of radiology focused on imaging the central and peripheral nervous systems. The document discusses several key imaging modalities used in neuroradiology including CT, MRI, ultrasound, angiography, and myelography. It provides details on the techniques, advantages, and limitations of each modality. CT and MRI are currently the main modalities used for evaluating neurological pathology, though each has specific scenarios where it is particularly useful over the other. Recent technological advances have improved imaging capabilities and increased accessibility of various modalities.
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: La prescrizione della dose nei trattamenti stereo-RT e radiochirurgici: dall’ICRU a ROSEL ed altro
This document discusses diffusion and perfusion MRI techniques. It explains that diffusion is the random movement of particles from areas of high concentration to low concentration, and is important for transporting substances into and out of cells. Perfusion MRI uses endogenous and exogenous tracers to monitor hemodynamics and obtain perfusion maps. The combination of diffusion and perfusion MRI is useful for early detection and assessment of conditions like stroke and tumors by showing areas of decreased perfusion and already necrotic tissue.
This document discusses intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT) for head and neck cancers. It provides details on contouring targets and organs at risk for treatment planning. It summarizes evidence from trials on reducing xerostomia with IMRT. It also discusses the benefits of daily imaging with IGRT for accurate treatment delivery and potentially reducing planning target volume margins. Adaptive planning is mentioned as an area that continues to be explored to account for anatomical changes over the course of radiation treatment.
Cancer of Right Breast with Single-Liver MetastasisSimultaneous Treatment of ...Kanhu Charan
Cancer of Right Breast with Single-Liver Metastasis Simultaneous Treatment of Chest Wall with Radiotherapy for Carcinoma Breast and SBRT for Liver Lesion: Procedural
Details of the Complex Procedure
Radiotherapy Risk Profiles & Its ManagementSubrata Roy
Due to the rapidly increasing complexity during the last years, comprehensive QA has become even more of an issue, including treatment planning software, information handling and treatment delivery. Obviously methods from clinical risk management (RM) can be well adapted and adopted for use in radiotherapy.
Understanding the complex process of radiotherapy requires many different kinds of expertise: it involves understanding principles of medical physics, radio biology, radiation safety, dose measurement and calculation, radiotherapy planning and simulation, and the interaction of radiotherapy with other treatment modalities, among others. Several different professional groups are needed to plan and deliver radiotherapy. The main professionals involved are radiation oncologists, radiation therapists and medical physicists. Each of these disciplines must work together through an integrated process to plan and deliver radiotherapy to patients
Cancer of Right Breast with Single Liver Metastasis - Simultaneous Treatment ...Kanhu Charan
Cancer of Right Breast with Single Liver Metastasis - Simultaneous
Treatment of Chest Wall with Radiotherapy for Carcinoma Breast and
SBRT for Liver Lesion - Procedural Details of the Complex Procedure
Adaptive radiotherapy (ART) can improve treatment for head and neck cancer patients. ART involves modifying the treatment plan based on anatomical changes observed during radiation therapy delivery. For head and neck cancer, target volumes and organs at risk often change significantly over the course of treatment due to factors like weight loss or tumor shrinkage. Studies have shown ART can improve dose distribution by reducing dose to organs at risk while maintaining or improving tumor dose coverage. Clinical benefits of ART include improved local tumor control and fewer treatment toxicities. ART is most beneficial for patients experiencing greater anatomical changes, such as those with more advanced tumors or significant weight loss.
The noms framework_approach_to_the_treatment_of_spinal_metastatic_tumors.pdfAndres Cerquera Victoria
The document describes a framework called NOMS (neurologic, oncologic, mechanical, systemic) used to determine optimal treatment for patients with spinal metastases. NOMS considers the degree of neurologic impairment, tumor response to radiation/surgery, spinal stability, and patient's systemic disease. Treatment may involve radiation therapy, spinal surgery, or both to control the tumor, relieve pain, and preserve neurologic function while minimizing risks. The NOMS framework guides integrated use of technologies like radiosurgery and helps coordinate multidisciplinary care for these complex patients.
Breast conserving surgery followed by adjuvant radiotherapy is adopted in the early detected cases and mastectomy followed by radiotherapy or chemotherapy in the advanced cases are the general practices.
This document discusses principles of cancer therapy and different treatment modalities, including surgery, radiation therapy, and chemotherapy. It provides details on each treatment type, how they work to target cancer cells, their goals and side effects. The key points are:
1) The main treatment modalities are surgery, radiation therapy, chemotherapy and immunotherapy. Each aims to eliminate cancer cells while limiting harm to healthy tissue.
2) Surgery aims to entirely remove the cancer, but recurrence is possible if microscopic cells remain. Radiation therapy damages DNA in cancer cells to stop growth and division.
3) While treatments aim to cure, controlling symptoms and improving quality of life are also important goals, as curing all cancers is unlikely
The document evaluates the ability of T2 turbo spin echo axial and sagittal BLADE sequences to reduce or eliminate motion, pulsatile flow, and cross-talk artifacts in lumbar spine MRI examinations. Forty-four patients underwent lumbar spine MRI with both conventional and BLADE sequences. Quantitative analysis found significantly higher SNR and CNR with BLADE sequences. Qualitative analysis by radiologists also found BLADE sequences significantly superior in image quality and elimination of artifacts. The study concludes that BLADE sequences can potentially eliminate motion and other artifacts to produce high quality lumbar spine MRI images.
PET and radiotherapy for head and neck cancer provides essential information for target volume selection and delineation. Functional imaging with FDG-PET is more sensitive and specific than CT or MRI for detecting metastatic lymph nodes. Integrating PET into the treatment planning process allows more accurate gross tumor volume definition compared to CT alone. Adaptive radiotherapy using serial PET imaging during treatment may enable biological target volume adaptation and improved dose distribution optimization. Future applications include exploring other PET tracers and integrating multi-modality image registration with dose adaptation.
NTCP MODELLING OF ACUTE TOXICITY IN CARCINOMA CERVIX TREATED WITH CONCURRENT ...Dr. Rituparna Biswas
1. The study aimed to develop a predictive nomogram and dose constraints for hematological toxicity in cervical cancer patients treated with chemoradiation including IMRT.
2. Thirty-seven patients were treated with IMRT and cisplatin, and bone marrow was re-delineated to include the entire marrow volume.
3. Dose-volume histograms were combined with toxicity data to create a nomogram from which hematological toxicity probabilities can be estimated based on bone marrow dosimetry.
In this presentation, several aspects about imaging, sentinel node and treatment of the N0 neck in head and neck cancer are discussed with emphasis on oral cancer. 2015
CURRENT STATUS OF ORGAN PRESERVATION IN CA LARYNXManu Babu
The document discusses treatment options for early stage laryngeal cancer, including radical radiotherapy, transoral laser surgery, and function preserving open partial laryngectomy. It notes that treatment selection depends on factors like disease extent, patient preference, occupational considerations, and physician expertise. For early glottic cancer specifically, radiotherapy and transoral laser surgery are standard options that provide equivalent cure rates, though there is debate around their relative efficacy and impact on voice quality. The document also discusses treatment approaches for supraglottic cancers and locally advanced laryngeal cancers, noting the importance of neck treatment for supraglottic cancers and the paradigm shift to organ preservation using induction chemotherapy.
This document discusses image-guided radiation therapy (IGRT) and its evolution and applications. It begins by defining IGRT as external beam radiation therapy using imaging prior to each treatment fraction to verify patient positioning. IGRT allows for reduction of safety margins by compensating for set-up errors and organ motion. The document then reviews the history of IGRT from early portal imaging to modern cone-beam CT and other volumetric imaging techniques. It provides examples of IGRT protocols and clinical outcomes for sites such as prostate, lung, liver, and central nervous system tumors.
This document discusses prostate motion and its impact on image-guided radiotherapy for prostate cancer. It finds that the rectum is a major source of interfractional prostate variation. Strategies like rectal emptying can help reduce shifts. Daily imaging allows for reduced planning target volume margins and decreased rectal toxicity despite dose escalation. However, optimal clinical target volume to planning target volume expansions remain unclear due to factors like extracapsular extension and residual errors. Different image guidance methods each have benefits and limitations for margin reduction and dose escalation in prostate cancer radiotherapy.
Measurement of tumour size with mammography, sonography and magnetic resonanc...Enrique Moreno Gonzalez
Tumour size in breast cancer influences therapeutic decisions. The purpose of this study was to evaluate sizing of primary breast cancer using mammography, sonography and magnetic resonance imaging (MRI) and thereby establish which imaging method most accurately corresponds with the size of the histological result.
The document discusses the evolution of breast radiotherapy over time. Key developments include establishing hypofractionation as equally effective to standard fractionation, ultrahypofractionation being shown to be non-inferior, and partial breast irradiation being shown to have similar outcomes to whole breast irradiation for select patients. Guidelines for regional nodal irradiation have also evolved, with trials demonstrating a survival benefit for patients with higher risk features. Recent studies have also evaluated safely omitting radiotherapy for certain low-risk patient groups defined by precision medicine approaches.
1. The document evaluates volumetric modulated arc therapy (VMAT) for craniospinal irradiation (CSI) treatment planning.
2. It aims to standardize and simplify the CSI planning technique while improving dose conformity and homogeneity in the target volume and reducing dose to organs at risk.
3. VMAT plans for 4 patients using 3 isocenters and 2 arcs each achieved good target coverage with a conformity index of 0.99 and homogeneity index of 1.13 on average while sparing organs at risk.
Barry Fitzgerald is known for his work investigating the paranormal on television, but is also passionate about photography, writing, and his Irish heritage. His photography book "Journeys" aims to transport readers to quiet natural places through images capturing the essence of life outside modern busyness. Fitzgerald has had paranormal experiences since childhood and believes in the existence of elemental spirits and faeries. He describes faeries as taking varied forms and sizes, and thinks the movie "Pan's Labyrinth" depicts them more accurately than popular depictions like Tinkerbell.
The document is an email newsletter providing information about the upcoming RSNA 2009 annual meeting, including details about registration, courses, housing accommodations, and resident events. It also announces new podcasts and webinars on radiology topics and tools for radiologists.
Cancer of Right Breast with Single-Liver MetastasisSimultaneous Treatment of ...Kanhu Charan
Cancer of Right Breast with Single-Liver Metastasis Simultaneous Treatment of Chest Wall with Radiotherapy for Carcinoma Breast and SBRT for Liver Lesion: Procedural
Details of the Complex Procedure
Radiotherapy Risk Profiles & Its ManagementSubrata Roy
Due to the rapidly increasing complexity during the last years, comprehensive QA has become even more of an issue, including treatment planning software, information handling and treatment delivery. Obviously methods from clinical risk management (RM) can be well adapted and adopted for use in radiotherapy.
Understanding the complex process of radiotherapy requires many different kinds of expertise: it involves understanding principles of medical physics, radio biology, radiation safety, dose measurement and calculation, radiotherapy planning and simulation, and the interaction of radiotherapy with other treatment modalities, among others. Several different professional groups are needed to plan and deliver radiotherapy. The main professionals involved are radiation oncologists, radiation therapists and medical physicists. Each of these disciplines must work together through an integrated process to plan and deliver radiotherapy to patients
Cancer of Right Breast with Single Liver Metastasis - Simultaneous Treatment ...Kanhu Charan
Cancer of Right Breast with Single Liver Metastasis - Simultaneous
Treatment of Chest Wall with Radiotherapy for Carcinoma Breast and
SBRT for Liver Lesion - Procedural Details of the Complex Procedure
Adaptive radiotherapy (ART) can improve treatment for head and neck cancer patients. ART involves modifying the treatment plan based on anatomical changes observed during radiation therapy delivery. For head and neck cancer, target volumes and organs at risk often change significantly over the course of treatment due to factors like weight loss or tumor shrinkage. Studies have shown ART can improve dose distribution by reducing dose to organs at risk while maintaining or improving tumor dose coverage. Clinical benefits of ART include improved local tumor control and fewer treatment toxicities. ART is most beneficial for patients experiencing greater anatomical changes, such as those with more advanced tumors or significant weight loss.
The noms framework_approach_to_the_treatment_of_spinal_metastatic_tumors.pdfAndres Cerquera Victoria
The document describes a framework called NOMS (neurologic, oncologic, mechanical, systemic) used to determine optimal treatment for patients with spinal metastases. NOMS considers the degree of neurologic impairment, tumor response to radiation/surgery, spinal stability, and patient's systemic disease. Treatment may involve radiation therapy, spinal surgery, or both to control the tumor, relieve pain, and preserve neurologic function while minimizing risks. The NOMS framework guides integrated use of technologies like radiosurgery and helps coordinate multidisciplinary care for these complex patients.
Breast conserving surgery followed by adjuvant radiotherapy is adopted in the early detected cases and mastectomy followed by radiotherapy or chemotherapy in the advanced cases are the general practices.
This document discusses principles of cancer therapy and different treatment modalities, including surgery, radiation therapy, and chemotherapy. It provides details on each treatment type, how they work to target cancer cells, their goals and side effects. The key points are:
1) The main treatment modalities are surgery, radiation therapy, chemotherapy and immunotherapy. Each aims to eliminate cancer cells while limiting harm to healthy tissue.
2) Surgery aims to entirely remove the cancer, but recurrence is possible if microscopic cells remain. Radiation therapy damages DNA in cancer cells to stop growth and division.
3) While treatments aim to cure, controlling symptoms and improving quality of life are also important goals, as curing all cancers is unlikely
The document evaluates the ability of T2 turbo spin echo axial and sagittal BLADE sequences to reduce or eliminate motion, pulsatile flow, and cross-talk artifacts in lumbar spine MRI examinations. Forty-four patients underwent lumbar spine MRI with both conventional and BLADE sequences. Quantitative analysis found significantly higher SNR and CNR with BLADE sequences. Qualitative analysis by radiologists also found BLADE sequences significantly superior in image quality and elimination of artifacts. The study concludes that BLADE sequences can potentially eliminate motion and other artifacts to produce high quality lumbar spine MRI images.
PET and radiotherapy for head and neck cancer provides essential information for target volume selection and delineation. Functional imaging with FDG-PET is more sensitive and specific than CT or MRI for detecting metastatic lymph nodes. Integrating PET into the treatment planning process allows more accurate gross tumor volume definition compared to CT alone. Adaptive radiotherapy using serial PET imaging during treatment may enable biological target volume adaptation and improved dose distribution optimization. Future applications include exploring other PET tracers and integrating multi-modality image registration with dose adaptation.
NTCP MODELLING OF ACUTE TOXICITY IN CARCINOMA CERVIX TREATED WITH CONCURRENT ...Dr. Rituparna Biswas
1. The study aimed to develop a predictive nomogram and dose constraints for hematological toxicity in cervical cancer patients treated with chemoradiation including IMRT.
2. Thirty-seven patients were treated with IMRT and cisplatin, and bone marrow was re-delineated to include the entire marrow volume.
3. Dose-volume histograms were combined with toxicity data to create a nomogram from which hematological toxicity probabilities can be estimated based on bone marrow dosimetry.
In this presentation, several aspects about imaging, sentinel node and treatment of the N0 neck in head and neck cancer are discussed with emphasis on oral cancer. 2015
CURRENT STATUS OF ORGAN PRESERVATION IN CA LARYNXManu Babu
The document discusses treatment options for early stage laryngeal cancer, including radical radiotherapy, transoral laser surgery, and function preserving open partial laryngectomy. It notes that treatment selection depends on factors like disease extent, patient preference, occupational considerations, and physician expertise. For early glottic cancer specifically, radiotherapy and transoral laser surgery are standard options that provide equivalent cure rates, though there is debate around their relative efficacy and impact on voice quality. The document also discusses treatment approaches for supraglottic cancers and locally advanced laryngeal cancers, noting the importance of neck treatment for supraglottic cancers and the paradigm shift to organ preservation using induction chemotherapy.
This document discusses image-guided radiation therapy (IGRT) and its evolution and applications. It begins by defining IGRT as external beam radiation therapy using imaging prior to each treatment fraction to verify patient positioning. IGRT allows for reduction of safety margins by compensating for set-up errors and organ motion. The document then reviews the history of IGRT from early portal imaging to modern cone-beam CT and other volumetric imaging techniques. It provides examples of IGRT protocols and clinical outcomes for sites such as prostate, lung, liver, and central nervous system tumors.
This document discusses prostate motion and its impact on image-guided radiotherapy for prostate cancer. It finds that the rectum is a major source of interfractional prostate variation. Strategies like rectal emptying can help reduce shifts. Daily imaging allows for reduced planning target volume margins and decreased rectal toxicity despite dose escalation. However, optimal clinical target volume to planning target volume expansions remain unclear due to factors like extracapsular extension and residual errors. Different image guidance methods each have benefits and limitations for margin reduction and dose escalation in prostate cancer radiotherapy.
Measurement of tumour size with mammography, sonography and magnetic resonanc...Enrique Moreno Gonzalez
Tumour size in breast cancer influences therapeutic decisions. The purpose of this study was to evaluate sizing of primary breast cancer using mammography, sonography and magnetic resonance imaging (MRI) and thereby establish which imaging method most accurately corresponds with the size of the histological result.
The document discusses the evolution of breast radiotherapy over time. Key developments include establishing hypofractionation as equally effective to standard fractionation, ultrahypofractionation being shown to be non-inferior, and partial breast irradiation being shown to have similar outcomes to whole breast irradiation for select patients. Guidelines for regional nodal irradiation have also evolved, with trials demonstrating a survival benefit for patients with higher risk features. Recent studies have also evaluated safely omitting radiotherapy for certain low-risk patient groups defined by precision medicine approaches.
1. The document evaluates volumetric modulated arc therapy (VMAT) for craniospinal irradiation (CSI) treatment planning.
2. It aims to standardize and simplify the CSI planning technique while improving dose conformity and homogeneity in the target volume and reducing dose to organs at risk.
3. VMAT plans for 4 patients using 3 isocenters and 2 arcs each achieved good target coverage with a conformity index of 0.99 and homogeneity index of 1.13 on average while sparing organs at risk.
Barry Fitzgerald is known for his work investigating the paranormal on television, but is also passionate about photography, writing, and his Irish heritage. His photography book "Journeys" aims to transport readers to quiet natural places through images capturing the essence of life outside modern busyness. Fitzgerald has had paranormal experiences since childhood and believes in the existence of elemental spirits and faeries. He describes faeries as taking varied forms and sizes, and thinks the movie "Pan's Labyrinth" depicts them more accurately than popular depictions like Tinkerbell.
The document is an email newsletter providing information about the upcoming RSNA 2009 annual meeting, including details about registration, courses, housing accommodations, and resident events. It also announces new podcasts and webinars on radiology topics and tools for radiologists.
The three basic steps of memory are encoding, storage, and retrieval. Encoding involves processing information in two stages - effortful encoding that requires attention and encoding meaning automatically or through rehearsal. Information is then stored, either in sensory memory, short-term memory, or long-term memory. Finally, information can be retrieved from storage through recall, using clues to remember, or through recognition by choosing the correct information. Various factors like context, interference from other learning, and memory tricks affect these three stages of the memory process.
Interview With Jant Farrar And Gavin Bonemburke1963
This document contains an interview with Janet Farrar and Gavin Bone, two influential figures in modern Wicca and Paganism. In the interview, they discuss their personal spiritual journeys and how their views have evolved over time. They provide advice for newcomers to Paganism, discussing how public views of Witchcraft have changed, and addressing common criticisms of their work. Throughout, they emphasize that Wicca is a spiritual practice rather than a rigid tradition defined by books, laws, or lineages.
This document contains an interview with Kala Ambrose about her book "9 Life Altering Lessons". In the interview, Kala discusses the main principles behind the lessons in her book, which focus on connecting with higher dimensions and realizing our unlimited potential. She draws from her study of various mystery schools over lifetimes to uncover ancient wisdom teachings. Kala explains that the lessons build upon each other to help the reader discover who they truly are at the soul level and understand how their thoughts shape their reality.
The document provides information about registering for and attending the RSNA 2010 annual meeting in Chicago from November 28 to December 3. The theme of the meeting is "Personalized Medicine: In Pursuit of Excellence" and it will feature the latest radiological discoveries, educational sessions, and an exhibition of technical innovations. Registering by November 5 ensures receiving full conference materials in advance and taking advantage of discounted rates.
The document provides a 15 point plan for how to succeed. Some key points include working for a challenging boss to learn as much as possible, maintaining good communication skills, dressing professionally for the job you want, showing integrity by always telling the truth, striving to meet deadlines but asking for extensions when needed, and having a backup career plan. The overall message is that taking these steps can help one achieve success through passion and positivity.
The 2009 RSNA Annual Report summarizes the organization's activities that year to advance radiology and provide education and resources to members. Key initiatives included:
1) Launching new programs to shape radiology's future and increase quantitative research.
2) Providing unprecedented continuing education opportunities with over 90,000 CME credits earned.
3) Developing new tools and resources through publications, online platforms, and collaborations to enhance members' practice and research.
4) Hosting the leading radiology conference and exhibition that was recognized for its high quality education and innovation.
This document contains summaries of several medical studies and articles published in the February 2009 issue of Radiology. The summaries discuss studies on using ultrasound and CT to diagnose pediatric appendicitis, using CT texture analysis to predict colorectal cancer survival, using CT to exclude appendicitis even when the appendix is not visualized, using a consensus panel to improve breast cancer screening and reduce recall rates, distinguishing adrenal adenomas from nonadenomas using a combined CT protocol, and more.
This document summarizes some of the key topics and events planned for RSNA 2010. It highlights areas of focus in the scientific program including patient-centered care, dose reduction efforts, emerging technologies, and quantitative imaging. The education program will feature refresher courses, workshops, and exhibits on these topics as well as standardization of results, individualized imaging approaches, and lung and cardiac imaging. A record number of abstracts and exhibits are planned to disseminate the latest research and techniques.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
The document discusses predictions for the future of testing and QA. It predicts that test automation will significantly increase from 31% currently to become a major part of the QA process. It also predicts that testing responsibilities will move earlier in the development cycle, with more testing by developers and end users. Requirements testing will also improve with automation and new technologies that provide 100% test coverage and automatically generate test cases.
John Michael Greer is an occult scholar and the Grand Archdruid of the Ancient Order of Druids in America. In the interview, Greer discusses his background and how he first became interested in occult topics as a teenager. He explains that geomancy is an ancient divination system using 16 figures made from dots that was widely popular in the Middle Ages and Renaissance. Greer discusses how geomancy can be self-taught using his book, which covers the history and practice of geomancy in detail. He also explains how geomancy, meditation, and scrying are interrelated in the traditional Western magical system.
The 2009 RSNA Annual Report summarizes the organization's activities that year to advance radiology and provide education and resources to members. Key initiatives included:
1) Launching new programs to shape radiology's future and increase quantitative research.
2) Providing unprecedented continuing education opportunities with over 90,000 CME credits earned.
3) Developing new tools and resources through publications, online platforms, and collaborations to enhance members' practice and research.
4) Hosting the leading radiology conference and exhibition that was recognized for its high quality education and innovation.
This document provides a summary of Jennifer Crouch's resume and qualifications. It includes her contact information, 7 years of experience in graphic design and marketing, education including graduating magna cum laude from Chapman University, and a recommendation from a former supervisor praising her ability to work under tight constraints and make changes.
A brief to describe the NORAD and NORTHCOM missions and challenge High School students to continue pursuing Science, Technology, Engineering and Mathematics degrees in continuing education.
The document summarizes several studies from the October 2010 issue of Radiology on various medical imaging techniques. It reports that digital tomosynthesis was found to have higher sensitivity than radiography in detecting lung lesions. It also discusses studies finding that some epidural hematomas may remain indolent without treatment, dual-energy CT can help differentiate contrast staining from hemorrhage, and screening CT may not be effective for early detection of ovarian cancer.
This document summarizes a study that evaluated the efficacy of ultrasonography and computed tomography in diagnosing palpable neck masses. 40 patients with neck masses were examined clinically and underwent ultrasound and CT scans. The results found that ultrasound was useful for characterizing masses as solid or cystic and identifying features like margins, calcifications and necrosis. CT provided additional information on tissue attenuation, extent of lesions, and involvement of surrounding structures or distant spread. The study concluded that ultrasound combined with CT provides valuable information to accurately diagnose neck masses and guide their management.
The editorial discusses how collaborations between academic medical centers and industry have advanced MRI through various examples in the magazine issue. It highlights how such partnerships have leveraged MRI's contrast mechanisms and improved image quality, examination speed, and patient comfort. The growing healthcare needs require continued diagnostic imaging advances. The issue features articles demonstrating innovations in motion-robust imaging, rapid protocols, quantitative mapping, and noise reduction.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.
This document summarizes the potential applications of cone beam computed tomography (CBCT) in forensic science based on a review of clinical and scientific literature. CBCT can be used for age and sex estimation, frontal sinus analysis for identification, and 3D facial reconstruction. Studies show CBCT allows for more accurate age estimation compared to 2D radiographs. Measurements of bones like the mastoid and mandible from CBCT scans can determine sex with over 80% accuracy. Comparison of frontal sinus patterns through CBCT provides reliable evidence for identification. While CBCT has advantages like portability and accuracy, limitations include artifacts from metals and limited soft tissue contrast. Further research is still needed to improve 3D reconstruction techniques from CBCT data for forensic
Diagnosis of Maxillary Sinusitis in Water’s view based on Deep learning model Seunghyun Hwang
Presented work is accepted at Korean domestic conference for Medical AI, Korean Society of Artificial Intelligence in Medicine (KOSAIM) 2020.
Special Thanks to Dongmin Choi, the first author and presenter of this work.
(Link to Dongmin Choi Bio: https://www.slideshare.net/DongminChoi6/)
- by Seunghyun Hwang (Yonsei University, Severance Hospital, Center for Clinical Data Science)
The document discusses the increasing use of computed tomography (CT) scans and the resulting rise in medical radiation exposure. While CT scans provide important medical benefits, there is growing concern about the potential long-term health risks of radiation exposure, especially for pediatric patients. The literature review found that average radiation doses have doubled in some cases over the past decade and CT scans are now responsible for a significant portion of population radiation exposure from medical imaging. However, there is no system currently in place to track patients' cumulative lifetime radiation exposure from medical sources. The document examines various proposals to help minimize radiation doses from CT scans and optimize protocols while also exploring the feasibility of developing a standardized method for tracking and recording lifetime medical radiation exposure information.
Lung cancer is one of the leading
causes of mortality in every country, affecting
both men and women. Lung cancer has a low
prognosis, resulting in a high death rate. The
computing sector is fully automating it, and the
medical industry is also automating itself with the
aid of image recognition and data analytics. Lung
cancer is one of the most common diseases for
human beings everywhere throughout the world.
Lung cancer is a disease which arises due to growth
of unwanted tissues in the lung and this growth
which spreads beyond the lung are named as
metastasis which spreads into other parts of the
body.
The objective of our project is to inspect accuracy
ratio of two classifiers which is Support Vector
Machine (SVM), and K Nearest Neighbour
(KNN) on common platform that classify lung
cancer in early stage so that many lives can be
saving. The experimental results show that KNN
gives the best result Than SVM. This report
discusses the Implementation details of our
project.
We have done data preprocessing, data cleaning
and implements machine leaning algorithm for
prediction of lung cancer at early stages through
their symptoms. We have used both classification
algorithms to find or predict the accuracy ratio.
Lung cancer is identified as the most common
cancer in the world that causes death. Early
detection has the ability to reduce deaths by 20%.
In the current clinical process, radiologists use
Computed Tomography (CT) scans to identify
lung cancer in early stages. Radiologists do so by
searching for regions called ‘nodules’, which
correspond to abnormal cell growths. But
identifying process is time consuming, laborious
and depends on the experience of the radiologist.
Hence an intelligent system to automatically
assess whether a patient is prone to have a lung
cancer is a need.
This paper presents a novel method which use
deep learning, namely convolutional neural
networks (CNNs) to identify whether a given CT scan shows evidence of lung cancer or not. The
implementation uses a combination of classical
feature-based candidate detection with modern
deep-learning architectures to generate excellent
results better than either of the methods. The
overall implementation consists of two stages.
Nodule Regions-of-Interest (ROI) extraction and
cancer classification. In nodule ROI extraction
stage, we select top most candidate regions as
nodules. A combination of rule based image
processing method and a 2D CNN was used for
this stage. In the cancer classification stage, we
estimate the malignancy of each nodule regions
and hence label the whole CT scan as cancerous
or non-cancerous. A combination of feature based
eXtreme Gradient Boosting (XGBoost) classifier
and 3D CNN was used for this stage. The LUNA
dataset and LIDC dataset were used for both
training and testing. The results were clearly
demonstrated promising classification
performance. The sensitivity, accuracy and
specificity values obtained for
Unveiling the Wonders of Radiologic Technology: A Comprehensive Explorationgreendigital
Introduction:
Radiologic technology has become a cornerstone in modern healthcare, revolutionizing diagnostics and treatment. This comprehensive exploration will delve into the intricate world of radiologic technology, unraveling its history, evolution, current state, and prospects. From the discovery of X-rays to cutting-edge imaging techniques. this article aims to shed light on the pivotal role of radiologic technology in medicine.
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I. The Genesis of Radiologic Technology:
A. The Discovery of X-Rays:
The journey of radiologic technology began with the groundbreaking discovery of X-rays by Wilhelm Conrad Roentgen in 1895. This serendipitous revelation marked the dawn of a new era in medicine. enabling physicians to visualize the internal structures of the human body without invasive procedures.
B. The Early Years of Radiography:
The initial years saw rapid developments in radiography. with pioneers like Marie Curie contributing to the understanding of radiation properties. As radiologic technology gained momentum, its applications diversified. ranging from fracture detection to identifying internal organ abnormalities.
II. Evolution of Radiologic Technology:
A. Fluoroscopy and Contrast Agents:
The advent of fluoroscopy in the early 20th Century allowed real-time imaging of dynamic processes within the body. Coupled with the introduction of contrast agents, radiologists gained enhanced visibility of blood vessels and soft tissues. opening new avenues for diagnosis and intervention.
B. Computed Tomography (CT) Scan:
The 1970s seen the birth of computed tomography. a revolutionary imaging technique that provided cross-sectional body views. The marriage of X-ray technology and computer processing paved the way for three-dimensional reconstructions. offering unparalleled insights into anatomical structures.
C. Magnetic Resonance Imaging (MRI):
In the quest for non-ionizing imaging modalities, MRI emerged as a game-changer. By harnessing the principles of magnetic fields and radio waves. MRI enables detailed visualization of soft tissues. making it indispensable for neurological and musculoskeletal diagnoses.
D. Nuclear Medicine and Positron Emission Tomography (PET):
The fusion of nuclear medicine with radiologic technology led to the development of PET scans. This modality, relying on detecting positron-emitting radiotracers, became pivotal in oncology and neuroscience. providing functional information alongside anatomical details.
III. Radiologic Technology in the 21st Century:
A. Digital Radiography and PACS:
The transition from traditional film-based radiography to digital systems marked a significant leap in efficiency and accessibility. Picture Archiving and Communication Systems (PACS) streamlined image storage and retrieval. fostering collaboration and remote diagnostics.
B. Interventional Radiology:
Radiologic technology expanded beyond diagnostics into therapeutic realms with the evolution of
Advances of Radiation Oncology in CancManagement: Vision for Role of Theranos...CrimsonpublishersCancer
Significant computational and technological advances in radiation therapy have enhanced our ability to more accurately plan and deliver increasing doses of radiation therapy to limited target volumes in many patients with cancer. Recent developments on magnetic resonance on-line imaging and use of implanted markers allow more precise on-time tumor localization with lower doses delivered to surrounding organs at risk leading to less treatment morbidity. Biological markers and molecular imaging (theranostics) will add new dimensions and precision to radiation therapy techniques. Nanoparticles are promising tools in therapeutic programs. Further research in efficacy, safety, cost utility (value) and institution of robust quality assurance programs will be necessary to optimize these contributions in clinical practice.
Radiology has grown rapidly over the past two decades and allows physicians to see inside the human body without surgery. However, radiology exams expose patients to radiation, which carries a small risk of long-term harm. There is a focus on practicing radiology with radiation doses as low as reasonably achievable (ALARA) to balance diagnostic capabilities with patient safety. Highly trained radiologists ensure exams use minimal radiation while allowing for accurate diagnoses.
Radiologists play an important role in diagnosis and treatment by interpreting medical images. They undergo specialized postgraduate training in modalities like X-rays, ultrasound, MRI, CT, and nuclear imaging. As part of their job, radiologists assist other doctors by using these imaging techniques to identify medical issues, guide procedures, and monitor treatment. While radiology provides benefits, it also involves risks from radiation exposure that radiologists must be trained to mitigate.
Assessing Radiation Protection Knowledge In Diagnostic Radiography In The Rep...Sheila Sinclair
This study assessed the radiation protection knowledge of radiographers in Cyprus through a questionnaire survey.
The results showed that radiographers had very good overall knowledge of radiation protection, but there is still room for improvement in some specific areas like dose limits and informing patients about radiation risks. Work experience, workplace, and type of license held affected participants' knowledge.
The study highlights the importance of ongoing education for radiographers about national radiation protection legislation and linking this knowledge to practice, in order to minimize unnecessary radiation exposure for patients and medical staff.
Reduced Radiation Exposure in Dual-Energy Computed Tomography of the Chest: ...MehranMouzam
ABSTRACT:
Objective: This study purports to answer the question: Does a dual-energy CT scan of the chest using reduced radiation result in images of equal or better quality compared to those produced by the gold standard of care?
Methods: With the agreement of the Ethical Review Committee and written informed consent from 32 patients, who received dual-energy CT (DECT) scan of the chest in a dual-source scanner, a second set of images was taken at a reduced radiation dose. On virtual monochromatic images at 40 and 60 keV, three thoracic radiologists evaluated image quality, normal thoracic structures, and pulmonary and mediastinal aberrations. Students analyzed the data using analysis of variance, Kappa statistics, and Wilcoxon signed-rank tests.
Results: No irregularities in the scans were missed in the virtual monochrome photographs of all patients at a lower radiation dose, and the images were found to be of sufficient quality. At 40 and 60 keV, standard-of-care pictures produced equal contrast enhancement and lesion detection. Observers were entirely consistent with one another. Among other characteristics, reduced-dose DECT had a CTDIvol of 3.0 ±0.6 mGy, and a size specified dose estimate (SSDE) of 4.0 ±0.6 mGy, a dose-length product (DLP) of 107 ±30 mgy.cm, and an effective dose (ED) of 1.15 ±0.4 mSv.
Conclusion: Dual-energy computed tomography of the chest allows for the administration of lower radiation doses (CTDIvol <3 mGy).
This document describes the step-by-step process for stereotactic radiotherapy planning of a surgically resected brain metastasis. It begins with a case history of a 40-year-old male patient who underwent surgery to remove a metastatic papillary adenocarcinoma from his brain. Imaging including MRI and PET-CT was performed before and after surgery. The tumor board then decided on stereotactic radiotherapy followed by chemotherapy. The document outlines the detailed planning process for stereotactic radiotherapy treatment of the postoperative cavity including simulation, contouring, treatment planning, and plan evaluation. It discusses target volumes and organs at risk as well as techniques for fractionated stereotactic radiosurgery.
This document provides an overview of MRI techniques for imaging pediatric brain tumors and summarizes the MRI appearance of common pediatric brain tumor types. It discusses conventional MRI sequences as well as advanced techniques like diffusion tensor imaging, perfusion imaging, and magnetic resonance spectroscopy that provide microstructural, hemodynamic, and metabolic information. The document also notes the importance of spine imaging based on the suspected tumor histology to evaluate for cerebrospinal fluid dissemination of the tumor.
Learn more: https://www.brainlab.com/surgery-products
Abstract
Introduction “Navigation in surgery” spans a broad area, which, depending on the clinical challenge, can have different meanings. Over the past decade, navigation in surgery has evolved beyond imaging modalities and bulky systems into the rich networking of the cloud or devices that are pocket-sized.
Discussion
This article will review various aspects of navigation in the operating room and beyond. This includes a short history of navigation, the evolution of surgical navigation, as well as technical aspects and clinical benefits with examples from neurosurgery, spinal surgery, and orthopedics.
Conclusion
With improved computer technology and a trend towards advanced information processing within hospitals, navigation is quickly becoming an integral part in the surgical routine of clinicians.
Excerpt:
Over the last three decades, technical advances have significantly changed the way we live. From computers to smartphones, from single purpose to multipurpose devices, technology has become an intrinsic part of our daily routine. Navigation in surgery is an important example of today’s technological capabilities being applied to medicine. It has emerged as one of the most reliable representatives of technology as it continues to transform surgical interventions into safer and less invasive procedures. In surgery, navigation has spurred technical progress, enabled more daring procedures, and unlocked new synergies. What was once a simple localization tool has evolved into a centerpiece of technology in the surgical theater.
“Navigation in surgery” spans a broad area, which, depending on the clinical challenge, may have various interpretations. The meaning of navigation in surgery is most accurately defined by the questions posed: “Where is my (anatomical) target?”, “How do I reach my target safely?”, “Where am I (anatomically)?”, or “Where and how shall I position my implant?”. Apart from these important anatomical orientation questions, surgical navigation is also used as a measurement tool and an information center for providing surgeons with the right information at the right time.
There are examples of technological advances in the medical field, whose benefit to the patient became immediately evident which were rapidly adopted and integrated into the clinical routine—without the need for proper randomized clinical trials. Examples range from the introduction of anesthesia to enable safer surgery and the introduction of microscopy enabling microsurgery. Surgical navigation and its wide range of benefits could be next.
Is the increasing availability of automated image analysis a possibility to strengthen the application of diffusion-MRI as a biometric parameter, and to enhance the future of image biobanks? Or is this evolution threatening the position of radiologists as medical doctors. Is a redefinition of radiologist as computer technicians inevitable?
deep learning applications in medical image analysis brain tumorVenkat Projects
The tremendous success of machine learning algorithms at image recognition tasks in recent years intersects with a time of dramatically increased use of electronic medical records and diagnostic imaging. This review introduces the machine learning algorithms as applied to medical image analysis, focusing on convolutional neural networks, and emphasizing clinical aspects of the _eld. The advantage of machine learning in an era of medical big data is that signi_cant hierarchal relationships within the data can be discovered algorithmically without laborious hand-crafting of features. We cover key research areas and applications of medical image classi_cation, localization, detection, segmentation, and registration. We conclude by discussing research obstacles, emerging trends, and possible future directions.
Researchers at Norris Cotton Cancer Center have, for the first time, used Cherenkov emissions to visualize radiation beams as they enter and exit a patient's body during cancer treatment. In a trial with a breast cancer patient, images showed a hot spot in the underarm area, allowing physicians to prevent overdosing. This technique provides real-time information about radiation dosage and location with minimal added time to treatments. The goal is to help optimize treatments and avoid misadministration of radiation. A pilot study with 12 patients is nearing completion.
Similar to RSNA 2008 Delivers Present And Future (20)
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
1. RSNA 2008 PREVIEW
RSNA 2008 Delivers Radiology’s
Present and Future
With increased integration of refresher course material and scientific papers, Emergency Radiology
RSNA 2008 offers attendees myriad opportunities to not only learn about the
Subcommittee Chair Diego B. Nuñez Jr.,
latest breakthroughs in the specialty, but also take home
M.D., M.P.H., noted continuing trends
knowledge to apply immediately in their work settings.
toward validation of current practices,
such as CT utilization and radiation safe-
“Medical imaging informatics, which plays a crucial role in
ty in the emergency setting. He observed
the daily practice of radiology, will be featured in scientific
“particular interest in multidetector CT
and focus sessions, as will quantitative imaging, structured
for abdominal trauma, particularly as it
reporting and molecular imaging,” said RSNA Scientific Pro-
relates to scanning protocols, delayed
gram Committee Chair Robert M. Quencer, M.D., a professor
imaging and multiplanar display.”
and chair of radiology at the University of Miami School of Medicine.
Notable presentations will examine
This year the committee received 10,878 abstracts for consideration—7,052
cumulative data on modality utiliza-
for scientific presentations and 3,826 for education exhibits. Over the summer,
tion, the appropriateness of Prospective
the committee, with its subcommittees, selected 1,803 abstracts as scientific
Investigation of Pulmonary Embolism
papers and 729 as scientific posters. A separate committee accepted 1,606
Diagnosis (PIOPED) II criteria for patients
abstracts for education exhibits.
aged 40 years and younger, the impor-
tance of delayed CT in blunt trauma and
Breast Imaging ment, said subcommittee chair Andre J.
pelvic CT angiography in blunt trauma
Duerinckx, M.D., Ph.D.
Defining breast cancer risk and selecting using 64-slice multidetector CT, said Dr.
patient-specific screening strategies are Cardiac subcommittee members identi- Nuñez.
developing areas this year, said Jennifer fied many great abstracts in two key
Gastrointestinal Radiology
A. Harvey, M.D., subcommittee chair. areas—early population studies about
Presentations examine the cost-effec- clinical acceptance and applications of
CT colonography as a viable screen-
tiveness of MR screening, risk assess- cardiac CT as well as the use of dual-
ing study for polyp detection remains
ment, the role of screening ultrasound source CT, said Dr. Duerinckx.
a popular topic, said Erik K. Paulson,
and how to address the lower sensitivity
M.D., subcommittee chair. “There is also
Other sessions will cover radiation
of mammography in women with denser
continued interest in exploring the ef-
safety, cardiac CT technique improve-
breasts.
ficacy of this technology, applications of
ments, plaque imaging, quantitative
computer-aided detection and develop-
Other presentations examine digital cardiac radiology and comparisons with
ment of novel bowel preparations,” he
tomography, breast-specific gamma im- echocardiography and nuclear stress
said. He also noted increased interest
aging and MR screening for women with testing, he said.
in analyzing the biologic behavior and
prior breast cancer. There is a marked
Chest Radiology treatment response of tumors with
increase in submitted studies on diffu-
quantitative CT and MR techniques,
sion-weighted MR, Dr. Harvey said.
In the chest subspecialty, there is con- including 3T MR applications.
tinued interest in pulmonary emboli and
Notable trends include the application
nodules, said H. Page McAdams, M.D., “Dual-energy CT is now offered on clini-
of cross-sectional and functional imag-
subcommittee chair. cal scanners and the first wave of critical
ing using detectors specifically designed
assessment of this technology will be
for the breast. “This includes positron
Pulmonary embolism presentations will presented,” Dr. Paulson said. “Research-
emission mammography, breast specific
explore dose issues and applications in ers in the subspecialty also continue
gamma imaging, CT, tomosynthesis
pregnancy, while studies in nodule clas- to explore novel methods to reduce
and whole breast ultrasound,” said Dr.
sification will examine computer-aided radiation dose without suffering loss in
Harvey. “These developing applications
detection (CAD), nodule volumes and diagnostic accuracy.”
may play a role in improving diagnostic
screening. Many abstracts focus on CAD
capabilities and provide ancillary screen-
Genitourinary Radiology
applications beyond mere nodule defini-
ing for women at high risk of developing
tion, Dr. McAdams said.
breast cancer.”
Marcia C. Javitt, M.D., subcommittee
Other remarkable topics are texture- chair, reported more studies on diffu-
Cardiac Radiology
based classification of interstitial pneu- sion-weighted imaging of masses in the
monia, variability in pulmonary nodule kidneys, ovaries and prostate. New data
Overall, there is strong interest in car-
volume software and dual-energy CT of also were submitted reporting long-term
diac CT, with presentations focusing on
radiation dose and technique develop- the peripheral vessels, said Dr. McAdams. follow-up on patients who underwent
14 RSNA NEWS OCTOBER 2008
2. RSNA2008.RSNA.ORG
2008 RSNA Scientific Program Committee
The RSNA Scientific Program Committee met in June at RSNA Headquarters in Oak Brook, Ill.
(front row, from left) Jennifer A. Harvey, M.D., Marcia C. Javitt, M.D., N. Reed Dunnick, M.D., Robert M. Quencer, M.D., Diego B. Nuñez Jr., M.D., M.P.H.,
and Ruth C. Carlos, M.D., M.S.
(back row, from left) H. Page McAdams, M.D., James S. Welsh, M.D., M.S., David A. Rubin, M.D., Keith J. Dreyer, D.O., Ph.D., Lane F. Donnelly, M.D.,
Erik K. Paulson, M.D., Mauricio Castillo, M.D., Andre J. Duerinckx, M.D., Ph.D., and Milton J. Guiberteau, M.D.
(not pictured) John A. Kaufman, M.D., Umar Mahmood, M.D., Ph.D., and Martin J. Yaffe, Ph.D.
renal tumor and fibroid ablation, as well imaging center where radiologists consult Molecular Imaging
as cryotherapy. directly with patients, said Dr. Carlos.
Subcommittee Chair Umar Mahmood,
Other presentations this year will address
A groundbreaking area of study, said M.D., Ph.D., noted an increased variety
resident education, evidence-based medi-
Dr. Javitt, is the linkage of gene expres- of applications and agents in this year’s
cine and guideline development.
sion to tissue characterization. In these submissions. “This is exactly what we
Informatics
studies, she said, the morphology visible want as the field moves more into the
on cross-sectional imaging studies was clinic,” he said.
This year’s submissions indicate that
compared with genetic markers of renal
business intelligence and data analytics Topics of note include new MR mo-
cell cancer. She noted another practical
are being increasingly used for clinical lecular imaging methods, multimodal
study of contrast-induced nephropathy
and operational data mining, said Keith agents, the use of fluorodeoxyglucose
and nephrogenic systemic fibrosis, which
Dreyer, D.O., Ph.D., subcommittee chair. PET to predict cardiovascular risk, a new
reported on the use of glomerular filtra-
He also noted a significant trend in the PET tracer to assess innervation and in-
tion rate measurement techniques.
understanding of natural-language for creased use of MR smart agents. “Human
Health Services Policy and radiology reports. application represents a small minority
Research of abstracts, but I think it has increased
Informatics presentations will cover somewhat compared to previous years,”
topics such as the effects of structured
A broader range of research topics and said Dr. Mahmood.
reporting and decision support, using
some novel submissions will be part of
the iGoogle dashboard to monitor a Musculoskeletal Radiology
the program this year, said Subcommit-
radiology department, the RAD-DASH
tee Chair Ruth C. Carlos, M.D., M.S.
Presentations this year represent more
Web-based graphical business platform
attempts to characterize bone and
Notable topics include disparity in types for managing radiology performance,
soft tissue tumors using advanced MR
of imaging related to socioeconomic quality metrics and the National Cancer
techniques like diffusion imaging and
status or insurance coverage, the effects Institute’s Cancer Biomedical Informatics
spectroscopy, said David A. Rubin, M.D.,
of including a patient photo with a radio- Grid (CaBIG), said Dr. Dreyer.
subcommittee chair.
logic exam, occupational stress in radi-
ologists and evaluation of an outpatient Continued on next page
15
RSNANEWS.ORG RSNA NEWS
3. RSNA 2008 PREVIEW
RSNA 2008 Delivers Radiology’s Present and Future
Continued from previous page
Nuclear Medicine Radiation Oncology/Radiobiology
More emphasis is placed on quantitative
PET imaging techniques with respiratory Subcommittee chair James S. Welsh,
analysis of images and data, as opposed
gating and new hybrid technology such M.D., M.S., said notable topics this year
to qualitative analysis, Dr. Rubin added.
as “gamma ultrasound” will be high- include consolidative radiotherapy for
“This trend is present in tumor charac-
lighted this year, said Milton J. Guiber- non-Hodgkin lymphoma, hepatic arterial
terization, imaging methods for osteo-
teau, M.D., subcommittee chair. embolization with Holmium-166 poly
porosis and even tendon sonography,”
(L-lactic acid) to predict distribution of
he said.
Presentations will also represent the therapeutic dose and immunomodula-
emerging literature of correlative clinical
Dr. Rubin also noted a trend toward us- tor therapy to enhance radiotherapy
imaging technologies such as fluorode-
ing CT and ultrasound guidance, rather response. There are also a variety of in-
oxyglucose (FDG) PET, CT and MR, Dr.
than fluoroscopy, to increase the safety teresting radiation biology subjects, said
Guiberteau continued. “In addition to
of risky procedures like cervical spine Dr. Welsh, along with strong submissions
using nuclear medicine to assess and
injections. Other presentations, he said, for the Bolstering Oncoradiologic and
predict lesion response to more estab-
will explore applications of diffusion Oncoradiotherapeutic Skills for Tomor-
lished conventional treatments, impor-
tensor imaging and tractography for row (BOOST) program. (To read more
tant topics will include nuclear medicine
the imaging of peripheral nerves and about BOOST, see Page 18.)
evaluation of the success of emerging
muscles, use of diffusion MR to help
Vascular and Interventional
therapies, such as liposomal-mediated
distinguish benign from malignant
Radiology
oncologic treatments and interventional
musculoskeletal tumors, ultrashort TE
therapy outcomes.”
MR applications, percutaneous tumor
MR-guided galvanotherapy for prostate
and pain management techniques and
cancer, cryotherapy for painful bone
A nuclear medicine quantitative imaging
tendon sonoelasticity.
metastases, drug-coated percutane-
session will address FDG-PET standard-
ous transluminal angioplasty balloons
ized uptake value (SUV) determinations
Neuroradiology/Head and Neck
to improve patency and percutaneous
in a variety of clinical settings, Dr. Guib-
Utilization of advanced imaging tech- recanalization after failed surgery are
erteau said.
niques like diffusion-weighted imaging, remarkable topics this year, said John
Pediatric Radiology
perfusion with MR and CT and spec- A. Kaufman, M.D., subcommittee chair.
troscopy for all masses in the neck are Oncologic interventions constitute the
Subcommittee Chair Lane F. Donnelly,
increasing, said Subcommittee Chair single largest topic, he said.
M.D., said attendees can look forward
Mauricio Castillo, M.D. He noted that
to important presentations on CT dose,
Global Commitment
sonographic elastography for diagno-
helical MR, diffusion tensor imaging for
sis of neck masses is also beginning to
to Quality
body applications and pediatric inter-
emerge as a mature clinical imaging
ventional radiology.
technique.
“The substantial input into the quality
Physics of the meeting by radiologists and
“Diffusion-weighted imaging of the spi-
scientists involved in imaging research
nal cord is being refined and beginning Notable physics abstracts explore non-
throughout the world will make RSNA
to be clinically utilized and helpful,” said contrast MR detection of tumor micro-
2008 an important meeting for all
Dr. Castillo. “Diffusion-weighted imaging vasculature and a four-view CAD system
those involved in radiology and its al-
of the intervertebral disc may be able to for breast masses, said subcommittee
lied fields,” said Dr. Quencer.
identify an abnormal disc before other chair Martin J. Yaffe, Ph.D. Other presen-
techniques. Also, the effects of iron de- tations will address distortion-free MR
position in the brain and its relationship imaging near metallic implants, progno-
to several neurodegenerative disorders sis of breast carcinoma using computer-
are being investigated with susceptibil- extracted morphological and kinetic
ity weighted imaging.” features in dynamic contrast-enhanced
MR and monitoring intrahepatic and
Also presented this year will be several
subcutaneous hepatocellular carcinoma
techniques that may help to distinguish
growth with 23Na and 1H MR.
between symptomatic and asymptomat-
ic atherosclerotic plaques in the internal
carotid arteries, said Dr. Castillo.
16 RSNA NEWS OCTOBER 2008