This document discusses imaging challenges in obese patients and strategies to address them. Obesity is defined using Body Mass Index (BMI) and has more than doubled worldwide since 1980. Imaging modalities like ultrasound, radiography, fluoroscopy, and CT can have problems penetrating thick layers of fat, resulting in reduced image quality. Solutions include using harmonic imaging in ultrasound, grids in radiography, overhead views in fluoroscopy, and optimized CT protocols with higher kVp and mAs. Automatic tube current modulation can help maintain image quality for different patient sizes. Overall, special techniques are needed to properly image obese individuals across modalities.
A presentation by Dr Jacob Chisholm on Developments In Gastrointestinal Therapies.
Jacob Chisholm is an upper gastrointestinal and general surgeon with an interest in weight loss and metabolic surgery. Jacob received his undergraduate degree (MBBS) from the University of Adelaide, a postgraduate research degree (Masters of Surgery) from Flinders University and is a Fellow of the Royal Australasian College of Surgeons. He trained in surgery at the Royal Adelaide and Flinders Medical Centre before completing a bariatric fellowship in 2007. Jacob was appointed chief surgical resident at Flinders Medical Centre in 2008 and has been a consultant surgeon at that institution since 2010. Jacob joined the Adelaide Bariatric Centre in 2010.
RADIOTHERAPY IN CARCINOMA BREAST (EARLY AND LOCALLY ADVANCED)DrAnkitaPatel
This document discusses radiation therapy for breast cancer. It begins by outlining the important role of radiation therapy at various stages of breast cancer, including as part of breast conservation and after mastectomy. It then discusses indications for adjuvant radiation therapy based on factors like tumor size and lymph node involvement. The document reviews evidence from clinical trials demonstrating the benefits of radiation therapy after breast-conserving surgery in reducing recurrence rates and improving survival. It also discusses techniques, dosing, and toxicity considerations for radiation therapy delivery.
Radiotherapy in Early stage invasive breast carcinomaastha17srivastava
This document discusses radiotherapy treatment for early stage invasive breast carcinoma. It provides details on diagnostic workup, treatment options including mastectomy and breast conserving therapy. It describes different types of mastectomies and details on breast conserving therapy including whole breast radiotherapy and tumor bed boost. It summarizes key studies showing no overall survival advantage of mastectomy over breast conserving therapy with radiotherapy and the benefit of tumor bed boost in reducing local recurrence. It also discusses techniques for delivering radiotherapy to different treatment volumes.
Talk by Sir. Michael Brady, given at the Department of Computer Science, University of Cyprus.
Date: 24 June, 2015
This talk has two inter-twined aims. First, it introduces the medical challenges, and the science that is being developed to address those challenges, that underlie my (current) companies: Mirada Medical, Volpara Solutions, Perspectum Diagnostics, ScreenPoint bv, further illustrated by Guidance Navigation Holdings, IRISS Medical Technologies, and Acuitas Medical. Second, it asks why I am driven by the translation of mathematics and computing (white board) to clinical practice (white coats).
Professor Sir Michael Brady is currently Professor in Oncological Imaging in the Department of Oncology at the University of Oxford, having recently retired as Professor in Information Engineering (1985-2010). Mike is co-Director of the Oxford Cancer Imaging Centre, one of four national cancer imaging centres in the UK. He is the author of over 750 articles and 45 patents in computer vision, robotics, medical image analysis, and AI, and the author or editor of ten books. He has successfully supervised the PhD theses of 115 students. He is particularly well known for his pioneering research in quantitative methods for mammography and breast cancer more generally. Mike has a continuing strong commitment to commercialisation of his science and to entrepreneurial activity more generally. Current companies he has founded are: Mirada Medical; Matakina; Perspectum Diagnostics; Guidance; and ScreenPoint. As well, he is an NED of IRISS Medical Technologies; Acuitas Medical; and colwiz. He recently stepped down after 19 years as Deputy Chairman of Oxford Instruments plc. Finally, he is a member of the Syncona Advisory Board and Chair of the Royal Society Publications Board.
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.
Redustim a medical device class IIA based on biostimology technology that naturally stimulates adipocyte lipolysis (triglyceride hydrolysis) with release of energy and consumption of excess visceral fat.
This document discusses intra-operative radiotherapy (IORT) for breast cancer. It provides background on breast cancer risk factors, diagnosis, staging, and treatment options. It then describes IORT specifically, noting that it allows targeted radiation to be delivered during surgery directly to the tumor bed in one session using a miniature X-ray source. The technique aims to complete local radiation treatment immediately while avoiding six weeks of daily external beam radiotherapy. Details are provided on the Intrabeam system and applicators used to deliver a uniform radiation dose in a spherical field confined to the tumor bed.
Breast imaging techniques have advanced significantly since the 1950s. Mammography was introduced in the 1960s and digital mammography in the 2000s improved image quality and reduced radiation exposure. Tomosynthesis was developed in the 2010s to reduce tissue superimposition by creating 1mm slices. Ultrasound is used as an adjunct to mammography to differentiate cysts from solid masses and guide biopsies. The BI-RADS classification system standardizes how breast imaging findings are reported and communicated. While mammography remains the primary breast cancer screening tool, tomosynthesis and ultrasound have improved cancer detection rates by reducing false negatives, especially for women with dense breasts.
A presentation by Dr Jacob Chisholm on Developments In Gastrointestinal Therapies.
Jacob Chisholm is an upper gastrointestinal and general surgeon with an interest in weight loss and metabolic surgery. Jacob received his undergraduate degree (MBBS) from the University of Adelaide, a postgraduate research degree (Masters of Surgery) from Flinders University and is a Fellow of the Royal Australasian College of Surgeons. He trained in surgery at the Royal Adelaide and Flinders Medical Centre before completing a bariatric fellowship in 2007. Jacob was appointed chief surgical resident at Flinders Medical Centre in 2008 and has been a consultant surgeon at that institution since 2010. Jacob joined the Adelaide Bariatric Centre in 2010.
RADIOTHERAPY IN CARCINOMA BREAST (EARLY AND LOCALLY ADVANCED)DrAnkitaPatel
This document discusses radiation therapy for breast cancer. It begins by outlining the important role of radiation therapy at various stages of breast cancer, including as part of breast conservation and after mastectomy. It then discusses indications for adjuvant radiation therapy based on factors like tumor size and lymph node involvement. The document reviews evidence from clinical trials demonstrating the benefits of radiation therapy after breast-conserving surgery in reducing recurrence rates and improving survival. It also discusses techniques, dosing, and toxicity considerations for radiation therapy delivery.
Radiotherapy in Early stage invasive breast carcinomaastha17srivastava
This document discusses radiotherapy treatment for early stage invasive breast carcinoma. It provides details on diagnostic workup, treatment options including mastectomy and breast conserving therapy. It describes different types of mastectomies and details on breast conserving therapy including whole breast radiotherapy and tumor bed boost. It summarizes key studies showing no overall survival advantage of mastectomy over breast conserving therapy with radiotherapy and the benefit of tumor bed boost in reducing local recurrence. It also discusses techniques for delivering radiotherapy to different treatment volumes.
Talk by Sir. Michael Brady, given at the Department of Computer Science, University of Cyprus.
Date: 24 June, 2015
This talk has two inter-twined aims. First, it introduces the medical challenges, and the science that is being developed to address those challenges, that underlie my (current) companies: Mirada Medical, Volpara Solutions, Perspectum Diagnostics, ScreenPoint bv, further illustrated by Guidance Navigation Holdings, IRISS Medical Technologies, and Acuitas Medical. Second, it asks why I am driven by the translation of mathematics and computing (white board) to clinical practice (white coats).
Professor Sir Michael Brady is currently Professor in Oncological Imaging in the Department of Oncology at the University of Oxford, having recently retired as Professor in Information Engineering (1985-2010). Mike is co-Director of the Oxford Cancer Imaging Centre, one of four national cancer imaging centres in the UK. He is the author of over 750 articles and 45 patents in computer vision, robotics, medical image analysis, and AI, and the author or editor of ten books. He has successfully supervised the PhD theses of 115 students. He is particularly well known for his pioneering research in quantitative methods for mammography and breast cancer more generally. Mike has a continuing strong commitment to commercialisation of his science and to entrepreneurial activity more generally. Current companies he has founded are: Mirada Medical; Matakina; Perspectum Diagnostics; Guidance; and ScreenPoint. As well, he is an NED of IRISS Medical Technologies; Acuitas Medical; and colwiz. He recently stepped down after 19 years as Deputy Chairman of Oxford Instruments plc. Finally, he is a member of the Syncona Advisory Board and Chair of the Royal Society Publications Board.
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.
Redustim a medical device class IIA based on biostimology technology that naturally stimulates adipocyte lipolysis (triglyceride hydrolysis) with release of energy and consumption of excess visceral fat.
This document discusses intra-operative radiotherapy (IORT) for breast cancer. It provides background on breast cancer risk factors, diagnosis, staging, and treatment options. It then describes IORT specifically, noting that it allows targeted radiation to be delivered during surgery directly to the tumor bed in one session using a miniature X-ray source. The technique aims to complete local radiation treatment immediately while avoiding six weeks of daily external beam radiotherapy. Details are provided on the Intrabeam system and applicators used to deliver a uniform radiation dose in a spherical field confined to the tumor bed.
Breast imaging techniques have advanced significantly since the 1950s. Mammography was introduced in the 1960s and digital mammography in the 2000s improved image quality and reduced radiation exposure. Tomosynthesis was developed in the 2010s to reduce tissue superimposition by creating 1mm slices. Ultrasound is used as an adjunct to mammography to differentiate cysts from solid masses and guide biopsies. The BI-RADS classification system standardizes how breast imaging findings are reported and communicated. While mammography remains the primary breast cancer screening tool, tomosynthesis and ultrasound have improved cancer detection rates by reducing false negatives, especially for women with dense breasts.
EBCTCG METAANALYSIS
INDICATION OF POST OP RADIOTHERAPY
Immobilization devices
Conventional planning
Alignment of the Tangential Beam with the Chest Wall Contour
Doses To Heart & Lung By Tangential Fields
ReduStim SP dynamic protocol is a device that enables the prevention of cardio-vascular risks by the reduction of the waist circumference, a major risk factor of the metabolic syndrome.
Management of cacrinoma cervix: Techniques of radiotherapy (2D conventional, 3D Conformal radiotherapy (3DCRT) and IMRT with a review of various contouring guidelines.
MRI is useful for staging cervical, endometrial, and vaginal cancers. It can determine tumor size and extent, parametrial invasion, lymph node involvement, and distant metastases. Accurate staging helps guide treatment decisions such as surgery versus radiation or chemotherapy. Diffusion-weighted imaging may help identify malignant lymph nodes and assess tumor response to treatment.
This document discusses obesity, its causes and health risks, and the evidence that bariatric surgery is an effective treatment option. It provides details on different types of bariatric surgeries performed since the 1950s and their effectiveness based on clinical studies. It also outlines patient selection criteria and risks for bariatric surgery, and discusses how surgery works to induce weight loss and resolve obesity-related diseases through hormonal and other physiological changes.
This document discusses the management of locally advanced breast cancer (LABC). Key points:
1. LABC includes stages IIIA, IIIB, IIIC breast cancer with large tumors (>5cm), chest wall involvement, skin ulcers, or fixed lymph nodes. Inflammatory breast cancer is an aggressive subtype of LABC.
2. Diagnosis involves history, physical exam, imaging like mammography and MRI, and biopsy. Staging workup includes labs, imaging of chest, abdomen, pelvis and bone.
3. Treatment involves neoadjuvant chemotherapy to downstage the cancer and allow for surgery. Surgery may include mastectomy or breast conservation. Postoperative radiation and endocrine therapy
MRI is useful in the diagnosis, treatment, and follow-up of prostate cancer. It can visualize the prostate gland and detect tumors, assess extracapsular spread and seminal vesicle invasion, and detect bone metastases. The standard MRI protocol includes T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences. Prostate cancer appears as a low T2 signal, exhibits restricted diffusion, and shows early contrast enhancement and washout. While other conditions like BPH, inflammation, and radiation effects can mimic cancer, MRI findings along with PSA, biopsy and clinical data are used to evaluate patients. MRI also helps plan and guide radiation therapy and assess treatment response or recurrence.
Optimization of ct scan protocol in acute abdomen 2003 revised aaHisham Khatib
This document provides guidance on optimizing CT scan protocols for evaluating acute abdomen. It defines acute abdomen and lists common causes such as appendicitis, cholecystitis, and bowel obstruction. The document recommends CT as the best first-line imaging modality for evaluating upper right quadrant and pelvic pain. It provides details on oral, IV, and rectal contrast administration as well as scanning parameters and protocols for common acute abdomen conditions to optimize diagnostic image quality while minimizing radiation dose.
MR imaging plays an important role in the staging and management of cervical carcinoma. It can accurately assess tumor size, parametrial invasion, pelvic sidewall invasion, organ invasion, and lymph node metastasis. This allows for appropriate clinical staging according to FIGO guidelines and determination of optimal treatment protocols. MR imaging has high sensitivity of 95% for staging IB or greater disease. It can also be used to monitor treatment response and detect recurrent disease.
Radiotherapy plays an important role in the treatment of cancer. It can be used with curative or palliative intent. New techniques allow for more precise delivery of radiation doses to tumors while minimizing exposure of surrounding normal tissues. This improves treatment outcomes and reduces side effects. Adaptive radiotherapy using real-time tracking may further enhance precision and enable dose escalation for better tumor control.
This document discusses the management of ovarian cancer. It covers risk-reducing salpingo-oophorectomy (RRSO) for high-risk patients, surgical staging techniques including open and minimally invasive approaches, management of early-stage disease including adjuvant chemotherapy and radiation, cytoreductive surgery and goals for advanced-stage disease, and the role of interval debulking surgery after neoadjuvant chemotherapy. Complete resection of all tumor is the optimal outcome for advanced ovarian cancer to improve survival outcomes.
Breast cancer is a common and serious form of cancer that affects millions of women globally each year. It starts in the breast tissue and can spread to other parts of the body if not detected early. Some key risk factors include gender, age, family history and lifestyle factors. Symptoms may include a breast lump, skin changes, nipple discharge or inversion. Diagnosis involves examinations, mammography, ultrasound and biopsy. Cancer is staged according to tumor size and spread. Treatment options include surgery to remove all or part of the breast, chemotherapy, radiation therapy, hormone therapy and targeted drug therapies. The goal is cure, remission or palliation depending on the stage and type of cancer.
This document summarizes a study on sleeve gastrectomy outcomes in patients with a BMI between 30-35. The study analyzed 474 patients undergoing laparoscopic sleeve gastrectomy (LSG) between 2006-2014. It found that LSG led to an average weight loss from a preoperative BMI of 33.57 to 27.0 after 24 months and 27.02 after 36 months. Comorbidities like insulin resistance, dyslipidemia, and hypertension saw remission rates of over 90%, and complications from LSG were low at 1.4%. The conclusions were that LSG can be performed safely in patients with a BMI of 30-35, with comparable or better results to those with higher BMIs
This document provides an overview of the management of hepatocellular carcinoma (HCC). It discusses the diagnosis, staging, prognostic factors and various treatment modalities for HCC including surgery, chemotherapy, targeted therapy, radiotherapy, radiofrequency ablation, and transarterial chemoembolization. It provides details on specific surgical procedures, chemotherapy regimens, targeted agents like sorafenib, and radiotherapy techniques including three-dimensional conformal radiotherapy, stereotactic body radiotherapy, and charged particle therapy. It also covers follow-up and potential complications like radiation-induced liver disease.
This document outlines considerations for obesity and surgery. It defines obesity metrics like body mass index and discusses increased risks obesity poses for surgery like higher morbidity and technical challenges. Pre-operative assessment of obesity-related medical conditions and intra/post-operative management strategies are reviewed. Both non-operative and operative treatment options for obesity are presented, with bariatric surgery shown to have better long-term outcomes than diet/exercise alone for severe obesity.
HEMANTH ADJUVANT This is adjuvant therapy utilised for education purpose(1) (...surimallasrinivasgan
This document discusses adjuvant treatment for breast cancer, including metastatic breast cancer. It covers radiotherapy techniques, indications, target volumes, and dose schedules. It also discusses neoadjuvant systemic therapy and adjuvant systemic therapy including chemotherapy, targeted therapy, and hormonal therapy. The goal of adjuvant therapy is to eradicate micrometastases and reduce the risk of recurrence after primary treatment.
Breast cancer is the most common cancer in Indian women, accounting for over 25% of female cancers in major cities. Early detection and diagnosis is low in India, with over 50% of cases presenting at late stages with poor survival rates. Physiotherapy can help breast cancer patients with common issues like pain, shoulder dysfunction, breathing problems, fatigue, osteoporosis, lymphedema, and axillary web syndrome. Treatments include exercises, manual therapy, electrotherapy, and education on lifstyle changes to improve quality of life during and after cancer treatment.
This document discusses innovations in pancreatic cancer treatment and research. It provides hope by highlighting advances that allow patients to live longer with the disease or be cured. These include early diagnosis, dedicated cancer specialists, clinical trials of new treatments, and laboratory research. The author advocates for a focus on both immediate patient care and long-term cures through a combination of new treatments and optimized patient selection for surgery.
Gastric cancer is the 4th most common cancer and 2nd leading cause of cancer death worldwide. Risk factors include H. pylori infection, smoking, and genetic syndromes. Adenocarcinoma is the most common type, usually diagnosed in advanced stages with nonspecific symptoms. Diagnosis involves endoscopy with biopsy. Treatment depends on stage, and may include surgery, chemotherapy, and radiation therapy. Combined modality treatment with perioperative or adjuvant chemotherapy and chemoradiation has shown improved survival compared to surgery alone.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
EBCTCG METAANALYSIS
INDICATION OF POST OP RADIOTHERAPY
Immobilization devices
Conventional planning
Alignment of the Tangential Beam with the Chest Wall Contour
Doses To Heart & Lung By Tangential Fields
ReduStim SP dynamic protocol is a device that enables the prevention of cardio-vascular risks by the reduction of the waist circumference, a major risk factor of the metabolic syndrome.
Management of cacrinoma cervix: Techniques of radiotherapy (2D conventional, 3D Conformal radiotherapy (3DCRT) and IMRT with a review of various contouring guidelines.
MRI is useful for staging cervical, endometrial, and vaginal cancers. It can determine tumor size and extent, parametrial invasion, lymph node involvement, and distant metastases. Accurate staging helps guide treatment decisions such as surgery versus radiation or chemotherapy. Diffusion-weighted imaging may help identify malignant lymph nodes and assess tumor response to treatment.
This document discusses obesity, its causes and health risks, and the evidence that bariatric surgery is an effective treatment option. It provides details on different types of bariatric surgeries performed since the 1950s and their effectiveness based on clinical studies. It also outlines patient selection criteria and risks for bariatric surgery, and discusses how surgery works to induce weight loss and resolve obesity-related diseases through hormonal and other physiological changes.
This document discusses the management of locally advanced breast cancer (LABC). Key points:
1. LABC includes stages IIIA, IIIB, IIIC breast cancer with large tumors (>5cm), chest wall involvement, skin ulcers, or fixed lymph nodes. Inflammatory breast cancer is an aggressive subtype of LABC.
2. Diagnosis involves history, physical exam, imaging like mammography and MRI, and biopsy. Staging workup includes labs, imaging of chest, abdomen, pelvis and bone.
3. Treatment involves neoadjuvant chemotherapy to downstage the cancer and allow for surgery. Surgery may include mastectomy or breast conservation. Postoperative radiation and endocrine therapy
MRI is useful in the diagnosis, treatment, and follow-up of prostate cancer. It can visualize the prostate gland and detect tumors, assess extracapsular spread and seminal vesicle invasion, and detect bone metastases. The standard MRI protocol includes T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences. Prostate cancer appears as a low T2 signal, exhibits restricted diffusion, and shows early contrast enhancement and washout. While other conditions like BPH, inflammation, and radiation effects can mimic cancer, MRI findings along with PSA, biopsy and clinical data are used to evaluate patients. MRI also helps plan and guide radiation therapy and assess treatment response or recurrence.
Optimization of ct scan protocol in acute abdomen 2003 revised aaHisham Khatib
This document provides guidance on optimizing CT scan protocols for evaluating acute abdomen. It defines acute abdomen and lists common causes such as appendicitis, cholecystitis, and bowel obstruction. The document recommends CT as the best first-line imaging modality for evaluating upper right quadrant and pelvic pain. It provides details on oral, IV, and rectal contrast administration as well as scanning parameters and protocols for common acute abdomen conditions to optimize diagnostic image quality while minimizing radiation dose.
MR imaging plays an important role in the staging and management of cervical carcinoma. It can accurately assess tumor size, parametrial invasion, pelvic sidewall invasion, organ invasion, and lymph node metastasis. This allows for appropriate clinical staging according to FIGO guidelines and determination of optimal treatment protocols. MR imaging has high sensitivity of 95% for staging IB or greater disease. It can also be used to monitor treatment response and detect recurrent disease.
Radiotherapy plays an important role in the treatment of cancer. It can be used with curative or palliative intent. New techniques allow for more precise delivery of radiation doses to tumors while minimizing exposure of surrounding normal tissues. This improves treatment outcomes and reduces side effects. Adaptive radiotherapy using real-time tracking may further enhance precision and enable dose escalation for better tumor control.
This document discusses the management of ovarian cancer. It covers risk-reducing salpingo-oophorectomy (RRSO) for high-risk patients, surgical staging techniques including open and minimally invasive approaches, management of early-stage disease including adjuvant chemotherapy and radiation, cytoreductive surgery and goals for advanced-stage disease, and the role of interval debulking surgery after neoadjuvant chemotherapy. Complete resection of all tumor is the optimal outcome for advanced ovarian cancer to improve survival outcomes.
Breast cancer is a common and serious form of cancer that affects millions of women globally each year. It starts in the breast tissue and can spread to other parts of the body if not detected early. Some key risk factors include gender, age, family history and lifestyle factors. Symptoms may include a breast lump, skin changes, nipple discharge or inversion. Diagnosis involves examinations, mammography, ultrasound and biopsy. Cancer is staged according to tumor size and spread. Treatment options include surgery to remove all or part of the breast, chemotherapy, radiation therapy, hormone therapy and targeted drug therapies. The goal is cure, remission or palliation depending on the stage and type of cancer.
This document summarizes a study on sleeve gastrectomy outcomes in patients with a BMI between 30-35. The study analyzed 474 patients undergoing laparoscopic sleeve gastrectomy (LSG) between 2006-2014. It found that LSG led to an average weight loss from a preoperative BMI of 33.57 to 27.0 after 24 months and 27.02 after 36 months. Comorbidities like insulin resistance, dyslipidemia, and hypertension saw remission rates of over 90%, and complications from LSG were low at 1.4%. The conclusions were that LSG can be performed safely in patients with a BMI of 30-35, with comparable or better results to those with higher BMIs
This document provides an overview of the management of hepatocellular carcinoma (HCC). It discusses the diagnosis, staging, prognostic factors and various treatment modalities for HCC including surgery, chemotherapy, targeted therapy, radiotherapy, radiofrequency ablation, and transarterial chemoembolization. It provides details on specific surgical procedures, chemotherapy regimens, targeted agents like sorafenib, and radiotherapy techniques including three-dimensional conformal radiotherapy, stereotactic body radiotherapy, and charged particle therapy. It also covers follow-up and potential complications like radiation-induced liver disease.
This document outlines considerations for obesity and surgery. It defines obesity metrics like body mass index and discusses increased risks obesity poses for surgery like higher morbidity and technical challenges. Pre-operative assessment of obesity-related medical conditions and intra/post-operative management strategies are reviewed. Both non-operative and operative treatment options for obesity are presented, with bariatric surgery shown to have better long-term outcomes than diet/exercise alone for severe obesity.
HEMANTH ADJUVANT This is adjuvant therapy utilised for education purpose(1) (...surimallasrinivasgan
This document discusses adjuvant treatment for breast cancer, including metastatic breast cancer. It covers radiotherapy techniques, indications, target volumes, and dose schedules. It also discusses neoadjuvant systemic therapy and adjuvant systemic therapy including chemotherapy, targeted therapy, and hormonal therapy. The goal of adjuvant therapy is to eradicate micrometastases and reduce the risk of recurrence after primary treatment.
Breast cancer is the most common cancer in Indian women, accounting for over 25% of female cancers in major cities. Early detection and diagnosis is low in India, with over 50% of cases presenting at late stages with poor survival rates. Physiotherapy can help breast cancer patients with common issues like pain, shoulder dysfunction, breathing problems, fatigue, osteoporosis, lymphedema, and axillary web syndrome. Treatments include exercises, manual therapy, electrotherapy, and education on lifstyle changes to improve quality of life during and after cancer treatment.
This document discusses innovations in pancreatic cancer treatment and research. It provides hope by highlighting advances that allow patients to live longer with the disease or be cured. These include early diagnosis, dedicated cancer specialists, clinical trials of new treatments, and laboratory research. The author advocates for a focus on both immediate patient care and long-term cures through a combination of new treatments and optimized patient selection for surgery.
Gastric cancer is the 4th most common cancer and 2nd leading cause of cancer death worldwide. Risk factors include H. pylori infection, smoking, and genetic syndromes. Adenocarcinoma is the most common type, usually diagnosed in advanced stages with nonspecific symptoms. Diagnosis involves endoscopy with biopsy. Treatment depends on stage, and may include surgery, chemotherapy, and radiation therapy. Combined modality treatment with perioperative or adjuvant chemotherapy and chemoradiation has shown improved survival compared to surgery alone.
Similar to Imging in Large and Obese Final.pptx (20)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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
The Nervous and Chemical Regulation of Respiration
Imging in Large and Obese Final.pptx
1. IMAGING IN LARGE AND OBESE
Dr Syed Arsalan Raza
MBBS, FRCR, FRCPC
Assistant Professor
Dalhousie University
Consultant Radiologist
Nova Scotia Health Authority
2. Outline
• Obesity facts
• Imaging Obesity
• Imaging in Obese with different modalities
– Problems
– Suggested strategies
4. Definitions
Overweight and obesity are defined as abnormal or
excessive fat accumulation that may impair health
Category BMI (kg/m2
)
Very severely underweight less than 15
Severely underweight from 15.0 to 16.0
Underweight from 16.0 to 18.5
Normal (healthy weight) from 18.5 to 25
Overweight from 25 to 30
Obese Class I (Moderately obese) from 30 to 35
Obese Class II (Severely obese) from 35 to 40
Obese Class III (Very severely obese) over 40
Body mass index (BMI)
• Simple index of weight-for-
height that is commonly
used to classify overweight
and obesity in adults
• Defined as a person's
weight in kilograms divided
by the square of his height
in meters (kg/m2)
5. Definitions
• Lean body mass
– The combination of cell solids, extracellular and intracellular water, and
mineral mass of the body
– Comprised of everything in your body besides body fat
– Also called fat-free body mass
• Calculated lean body mass:
– Lean Body Weight (men) = (1.10 x Weight(kg)) – 128 x ( Weight2/(100 x Height(m))2)
Lean Body Weight (women) = (1.07 x Weight(kg)) – 148 x ( Weight2/(100 x Height(m))2)
– Predict the lean body weight "average" of a group of people with
similar height and weight
• Measured Lean Body Mass: TBW(1–BFP/100)
– BFP is body fat percentage as measured by using a commercially available body fat
monitor
James WPT. Research on obesity. London. Her Majesty’s Stationery Office.
Hume R. Prediction of lean body mass from height and weight. J Clin Path. 1966; 19
6. Epidemiology
• Worldwide obesity has more than
doubled since 1980.
• According to the 1985 Canadian
Health Promotion Survey, 6.1% of
Canadian adults were found to be
obese
• 18.1% reported from the 2010
Canadian Community Health Survey
(CCHS)
Current and predicted prevalence of obesity in Canada: a
trend analysis. CMAJ Open. 2014 Mar 3;2(1):E18-26.
7. Current and predicted prevalence of obesity in Canada: a
trend analysis. CMAJ Open. 2014 Mar 3;2(1):E18-26.
8. Consequences
• Mortality attributed to
obesity from 5.1% in 1985 to
9.3% in 2000
• Indirect cost to healthcare
• Economic burden of obesity
4.6 - 7.1 billion annually
http://www.phac-aspc.gc.ca
9. Bariatric Surgery
•Impact on radiology
• Preoperative ultrasound
• Postoperative upper GIs
• Complications
• No optimal imaging modality
• Image quality is severely limited
11. Adiposity Distribution
• High volumes of Visceral Adipose Tissue (AT)
– Reduced insulin sensitivity
– Dyslipidemia
– Impaired glucose tolerance
• Clinical methods suboptimal to assess different AT
compartments and distribution of AT within the body
– Waist-height-ratio (WHtR) –index for abdominal obesity
• Better differentiation and volumetric assessment of
AT compartments required
12. MRI
Diagnostic imaging in obesity
Best Practice & Research Clinical Endocrinology & Metabolism
(2013) 261–277
High amount of SCAT
(subcutaneous adipose
tissue)
Lower VAT (visceral
adipose tissue)
High amount of VAT
(visceral adipose tissue)
Lower SCAT
(subcutaneous adipose
tissue)
13. Ultrasound
Mesenteric leaves Preperitoneal fat Subcutaneous fat
Mesenteric fat thickness and cardiovascular risk factor.
International Journal of Obesity (2003) 27, 1267–1273
15. Individual’s diameter and body weight
is more important than total body fat
or BMI from an imaging perspective
16. Potential Problems
• Ability of patients to fit on existing imaging
equipment
• Ability to acquire and interpret images
adequately
• Increased radiation dose
• Patient positioning (includes access for image-
guided interventional procedures)
• Injury to technologists and transport personnel
• Increased wear and tear on equipment
17. Scheduling/transportation/throughput
• Knowledge of a patient’s weight and body diameter is important
before scheduling a patient for an imaging examination
• Appropriate transportation resources
– larger beds
– larger wheelchairs
– adequate nursing and transport
18. Limitations vary with imaging modality
• For CT, MRI and fluoroscopy
–Can the patient fit on the imaging
equipment?
• For ultrasound, plain radiographs and
nuclear medicine
–Attenuation through excessive fat
23. Obstetric scans
• Use all available technical tools improving image
quality in obesity
• Consider approaching fetus through the four major
abdominal areas with least subcutaneous fat:
– Periumbilical area
– Suprapubic area
– Right and left iliac fossae
• Transvaginal approach for CNS in fetus with vertex
presentation
• Color Doppler to check cardiac inflows and outflows
• Report limitations
Ultrasound in Obs & Gyne.
Volume 33, Issue 6, pages 720–729, June 2009
25. Color Doppler in Cardiac Assessment
D. Paladini. Ultrasound in Obs & Gyne.
Volume 33, Issue 6, pages 720–729, June 2009
26. Abdominal Scans
• Modified lateral decubitus position displaces
the fatty panniculus and aids scanning
through the flank.
• Aorta and kidney with coronal or posterior
oblique approach
29. Problems
• Increased patient thickness leads to increased
photon scatter and reduced contrast
resolution
• Higher peak tube voltage to penetrate excess
tissue reduces image contrast
• Increased exposure time increases the
probability of motion artifact
31. Solutions
• Use a grid
– Typically, 85%–95% of scatter photons are
absorbed, in comparison with 40%–50% of
primary photons
– An antiscatter grid with a high grid ratio (8:1 or
10:1) can dramatically reduce scatter and greatly
improve image quality
33. Solutions
• Increasing kVp
• Increasing mAs
• Multiple films to cover the area of interest
(i.e., Segmental/Quadrantic approach)
• Cassette mapping
35. High Radiation Dose
• Effective doses from radiographic
examinations in the extremely obese can
exceed 100 mSv from only a small number of
abdominal examinations
• Positioning the patient so that the thinnest fat
layer (anterior or posterior) is closest to the
image receptor – Substantial dose reduction
• Increasing the tube voltage also reduces the
dose.
Radiology: Volume 252: Number 1—July 2009
37. Problems
• Table weight capacity
• Width of the opening (table to image tower)
• Table width
• X-ray tube capacity
38. Table weight limit
• Approximately 350 lbs
– 300 to 400 pounds with full table movement
capabilities
– 350 to 550 pounds with a static table (no horizontal or
vertical table movement)
• Newer machines – better profile (our
Multipurpose Room machine: 440 lbs vs old
machine: 330 lbs)
• May be possible to perform the study with the
patient in the upright position only
39. Width of opening and Table width
• The distance from the table top to the digital
image tower
– Standard fluoroscopic equipment: maximum
distance of 45–49 cm
– Newer systems: 76 cm
• Table width
– Standard: 45 cm wide (range 69–80 cm)
– Newer systems: 56 cm (88 cm with extender)
40. X-ray Tube Capacity
• Greater tube capacity will allow for multiple
exposures without tube overload and
decreased delay between exposures
41. Additional Problems
• Suboptimal exposures
– Difficult penetration
– Long-exposure time
– Blurry images
• Small fluoroscopic coverage area may limit
fluoroscopic evaluation
– Use overhead images for diagnosis
44. Challenges in Large Patients
• Table weight limit
• Gantry and FOV
• Image Quality
45. Table weight limit
• Limitations related to the table motor
• Motor must be able to move the table into the
gantry at a consistent speed to an accuracy of
0.25 mm
• Table weight limit: 450 – 500 lbs
46. Gantry and FOV
Standard gantry diameter: 130 cm
• More clinically relevant measurement is the vertical diameter with the
table in the gantry: 55 cm
Table width: 68 cm
FoV: Standard 50 cm
• Large-bore CT scanners have an extended field of view up to 82 cm
Part of body
outside the
scan FOV;
may yield
artifacts
51. Automatic tube current modulation
Uppot et al. AJR 2007;188(2):437
xyz-axis modulation according to patient-specific attenuation
High-output X-ray tubes are capable of producing peak tube currents up
to 800 mA to maintain constant image quality over a wide range of patient
53. Automatic tube current modulation
Automatic tube current modulation yields a significant
increase in effective dose in large patients
54. Inference
• Using the same operator-selected image quality
settings for all-sized patients may results in very
high radiation doses to large patients
• The operator-selected image quality settings (e.g.,
image noise, reference mAs) of automatic tube
current modulation have to be adjusted to large
patients
55. Manual Modification of CT Protocol
Image quality of abdominal-pelvic CT in large patients can be
improved by manually modifying the protocol without
substantially increasing the radiation dose to deep organs.
56. Modified anthropomorphic phantom with one or two
circumferential layers of fat equivalent material (- 80 HU)
4 cm
8 cm
Acad Radiol 2007; 14(4):486-94
8 cm of s/c fat
4 cm of s/c fat
58. At 8 cm of subcutaneous fat thickness, the radiation dose
to the liver using the modified protocol B is actually
decreased as compared to standard protocol A at 0 cm of
subcutaneous fat thickness.
Radiation dose to the liver
59. 0
5
10
15
20
25
C/N
RATIO
4 cm 8 cm
Protocol A
Protocol B
Contrast to Noise Ratio
At 4 cm fat thickness, optimized protocol B increased CNR by 86%
At 8 cm fat thickness, optimized protocol B increased CNR by 137 %
Fat thickness
60. Modified High Flux Protocol
The modified, high flux CT protocol for obese patients yields
decreased image noise (40% ↓) and increased CNR (76% ↑).
Schindera et al. RSNA 2006
61. Modified High Flux Protocol
The modified, high flux CT protocol for obese patients
yields increased overall diagnostic acceptancy
High Flux
Regular Flux
62. Inference
• The abdominopelvic CT protocol manually adjusted
for simulated obese patient:
1. Increased mAs
2. Increased section collimation
3. Diminished table speed
• The manually adjusted abdominal-pelvic CT protocol
yields improved image quality in the simulated
obese patient without increasing the radiation dose
to the abdominal organs
63. Linear model may overestimate the amount of
contrast material needed in larger patient
– Metabolically inactive body fat does not disperse
or dilute IV contrast
Contrast administration during MDCT
64. Contrast optimization
Patient’s weight-tailored contrast dose
2.0-2.5 mL/kg of IV contrast material produced
better results than 1.5 mL/kg or a fixed dose
Yamashita et al. Radiology. 2000;216(3):718-723
65. Contrast optimization
Lean Body Weight (LBW) for calculating the
Iodine concenteration
– More precise and consistent hepatic and vascular
enhancement
– Reduced patient-to-patient variability
Ho et al. Radiology. 2007, 243:431-437
Kondo et al. Radiology. 2008;249(3):872-877
66. Summed Enhancement Data for Liver, Portal Vein, Aorta
The measured lean body weight is least variable.
Ho et al. Radiology. 2007, 243:431-437
Contrast optimization
67. Kondo et al. Radiology. 2008;249(3):872-877
No significant correlation between adjusted MHE and BW
positive correlation between adjusted MHE with BMI and BFP
Contrast optimization
68. CT optimization – Summary
• Optimizing abdominal CT protocols by:
– Increased mAs
– Increasing slice thickness
– Slowing table speed
Result in:
– Decreased image noise
– Increased CNR
– Similar or lower organ dose
69. CT optimization – Summary
• Automatic tube current modulation for
abdominal CT can result in very high radiation
doses in large patients
– The quality settings for automatic tube current
modulation have to be adjusted in large patients
• Contrast media dose & rate adjusted based on
lean body weight rather than total body
weight in large patients may deliver better
enhancement