Radical brachytherapy for early stage external auditory canal
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1) Early stage squamous cell carcinoma of the external ear canal is rare and current treatment options like surgery can result in poor cosmesis or loss of function. 2) Brachytherapy provides a high dose to the target area while sparing surrounding organs but traditional applicators are costly. 3) The author proposes using a simple plastic earbud as a low-cost applicator for brachytherapy of the external ear canal. Dosimetry studies showed the earbud dimensions are comparable to catheter applicators and it can be stabilized using a stethoscope earpiece, providing a reproducible method of brachytherapy.
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ADVANCES
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Radiation safety and protection measures are important to minimize radiation exposure for patients and dental staff. Early pioneers in dental radiography suffered health effects from excessive radiation doses. Radiation can come from natural sources like cosmic rays and radioactive elements in the ground, or man-made sources like medical imaging. Protection techniques include using thyroid collars and lead aprons for patients, fast film, rectangular collimation, and selecting proper exposure factors. Proper handling and processing of films is also needed to avoid retakes and reduce unnecessary radiation exposure.
Working length determination
There are several radiographic and non-radiographic methods to determine working length described in the document. The radiographic methods include Ingle's technique, Grossman's method, Kuttler's method, and the radiographic grid method. Electronic apex locators and tactile sense are two non-radiographic methods mentioned. The document recommends that a combination of an electronic apex locator and Ingle's radiographic technique provides the most accurate determination of working length. It advises against relying solely on non-radiographic methods.
Challenges in working length determination
working length determination in endodontics poses great challenges, even tooth formation determines the fate of endodontic treatment in the future
Igrt prostate
This document summarizes IGRT techniques for prostate cancer radiation therapy. It discusses the history of using radiation to treat prostate cancer dating back to 1909. It describes advances like 3D conformal radiation therapy and IMRT which allow shaping radiation doses to the target volume. The document outlines the simulation, planning, and contouring process including using fiducial markers and CT/MRI imaging. It discusses dose escalation trials and techniques to reduce organ motion like immobilization devices. Interfractional and intrafractional prostate motion is analyzed from several studies.
CT dose reduction
This document discusses various techniques for optimizing radiation dose in thoracic computed tomography (CT) scans. It begins with an introduction to the growth of CT technology and increasing use of CT exams. It then covers conventional techniques like using indication-specific protocols, limiting scan passes and length, optimizing patient positioning, and adjusting tube current, potential, and rotation time. Contemporary techniques discussed include iterative reconstruction, high pitch scanning, automatic tube potential selection, and organ-based dose modulation. The document emphasizes that chest CT is important but doses should be optimized to get necessary information while keeping radiation exposure as low as reasonably possible.
How Centers Can Thrive in the Modern Era
SGRT USA 2021
Presentation by Snehal Desai, MD
Radiation Oncologist
Houston Methodist Hospital
Houston, TX
How Centers Can Thrive in the Modern Era
This document discusses how radiation oncology centers can thrive in the modern era through advances like surface guided radiation therapy (SGRT). SGRT allows for accurate initial patient positioning, continuous monitoring of intrafraction motion, and automatic beam holds if motion exceeds thresholds. It can help centers by reducing costs through more efficient treatments, improving quality outcomes by mitigating adverse events, and enhancing patient experience through reduced toxicity and more comfortable treatments without skin marks. SGRT fits into a center's needs by supporting evidence-based hypofractionated treatments, total cost of care, quality outcomes, patient experience, and shared decision making.
Beam Direction
Beam direction techniques are used to accurately direct radiation beams towards the tumor while sparing surrounding healthy tissues. Key steps include patient localization using imaging like CT/MRI to delineate the tumor and organs, patient positioning and immobilization, field selection using beam directing devices like lasers, collimators and pointers, and dose distribution analysis to calculate and verify the prescribed dose. Proper beam direction allows obtaining conformal dose distributions and reproducible treatments for better therapeutic outcomes.
Cleaning and shaping the root canal system
The document discusses various techniques for cleaning and shaping the root canal during endodontic treatment. The objectives are to remove infected tissue, provide access for irrigants and medicaments, create space for obturation, and maintain tooth integrity. Key steps discussed include determining working length, instrumentation using techniques like step-back preparation, and irrigation. Factors that can affect working length determination and techniques to enhance cleaning and shaping are also outlined.
safe imaging.pptx
This document discusses radiation protection in radiology. It begins by outlining the objectives of radiation protection as defined by ICRP - to provide appropriate protection without unduly limiting beneficial practices. It then analyzes the increasing use of CT exams. Key principles for safe imaging are justification, optimization, and dose limitation. The document provides detailed explanations of each principle and guidelines for reducing radiation dose in various radiology exams and procedures like CT, fluoroscopy, and pediatric imaging. It emphasizes adjusting protocols based on patient size, utilizing automated exposure control, and following the principles of time, distance and shielding.
HDR brachytherapy for Non-Melanoma Skin cancers
This document discusses the use of interventional radiotherapy called brachytherapy for the treatment of non-melanoma skin cancers. Brachytherapy involves placing radioactive sources close to or inside the tumor to deliver a high radiation dose. It has advantages over surgery or external beam radiation including a steep dose gradient that limits dose to nearby tissues, shorter treatment time, and a higher biological effect. The document outlines indications, evidence, techniques, dosimetry, and the author's experiences using brachytherapy for various skin cancers and keloids.
Working Length Determination.pptx
- Determining the accurate working length is critical for successful endodontic treatment. The working length is defined as the distance from a coronal reference point to the point where canal preparation and filling should terminate, usually 1mm short of the anatomical apex. Several radiographic and non-radiographic methods can be used to estimate the working length, with the goal of terminating instrumentation at the apical constriction. Common radiographic techniques include using pre-operative measurements, grids, or mathematical formulas based on relative instrument and tooth lengths on radiographs.
Lecture 14 Optimization Dental radiology.ppt
This document discusses optimization of radiation protection in dental radiology. It describes different types of dental x-ray equipment including intra-oral, panoramic, and cephalometric units. It emphasizes that while individual dental x-ray exposures result in low doses, the frequent nature of exposures poses risks. The document outlines topics to cover which include dental x-ray equipment, radiation protection in dental radiology, and quality control for dental equipment. It provides details on technical specifications and quality control tests that can be performed by dental staff and medical physicists to ensure safe and optimized use of dental radiology equipment.
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UNUSUAL SITES OF BRACHYTHERAPY IN HEAD AND NECK CANCER
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April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATRO
This document appears to be a newsletter or e-book with summaries of oncology research articles and case studies from March 2024 to mid-April 2024. It includes summaries on topics like radiotherapy dosing in head and neck cancer, genetic factors in breast cancer treatment, algorithms for surveillance of colorectal polyps, emerging tracers in neuro-oncology, target delineation workflows for various cancer sites, radiation therapy options for pituitary adenoma, comparisons of APBI guidelines for breast cancer, and associations between Chlamydia psittaci and orbital MALT lymphoma. The document also notes that April is National Oral Cancer Awareness Month.
TARGET DELINEATION OF THORACIC NODAL. STATION
The document discusses the different thoracic nodal stations that are relevant for staging lung cancer. It lists 24 different nodal station groups in the thoracic region, including supraclavicular, upper paratracheal, prevertebral, lower paratracheal, subaortic, para aortic, carinal, paraesophageal, and hilar nodal stations. Accurate identification of involved nodal stations is important for determining the stage and treatment planning for lung cancer patients.
TARGET DELINEATION IN RECTUM CANCER BY DR KANHU
This document outlines the workflow for target delineation in radiation oncology for carcinoma of the rectum. It defines the gross tumor volume for the primary tumor (GTVp) and involved nodes (GTVn), as well as the clinical target volumes (CTVs) which add margins around the GTVs to cover microscopic disease. It describes the borders of the mesorectum and lists the lymph node regions included in the CTV for involved nodes. It concludes by specifying the planning target volumes (PTVs) which expand the CTVs and listing the dose schedules.
TARGET DELINEATION IN ANAL CANAL CANCER BY DR KANHU
1. The document discusses target delineation and radiation therapy workflow for anal cancer, including definitions of gross tumor volume (GTV) and clinical target volumes (CTVs) based on anatomical locations.
2. It provides guidelines for determining margins around the GTV and nearby anatomical structures to create the CTVs for the primary tumor (CTVp), involved nodes (CTVn), and elective nodal regions (CTVnLR) to cover possible microscopic disease.
3. Treatment planning volumes (PTVs) are created by adding margins to the CTVs, with the PTV-HR receiving the full prescription dose and the PTV-LR receiving a lower dose.
TARGET DELINEATION IN VULVAL CANCER BY DR KANHU
The document outlines the steps and guidelines for target delineation in vulval cancer radiation therapy planning. It discusses delineating the gross tumor volume (GTV), clinical target volume (CTV), organs at risk (OAR), and planning target volume (PTV). Specific guidelines are provided for contouring depending on the location and extent of the primary tumor, including the vulva, mons pubis, vagina, anorectum, urethra, and clitoris. Radiation dose parameters and OAR constraints are also reviewed. The target delineation workflow aims to adequately cover suspected disease while minimizing dose to surrounding healthy tissues.
TARGET DELINEATION IN CERVIX CANCER BY DR KANHU
This document outlines the 10 step workflow for target delineation in cervical cancer radiotherapy treatment planning. It describes the clinical target volumes that should be contoured for the primary gross tumor (GTVp), primary clinical target (CTVp), nodal gross tumor (GTVn), nodal clinical targets (CTVn) and elective nodal volumes. It provides explanations and guidelines for delineating each target volume, including the parametrium and nodal regions. Diagrams and images are included to illustrate the anatomical locations and boundaries of the target volumes.
Oncology cartoons by Dr Kanhu Charan Patro
This document provides guidance on target volume delineation for vulval cancer from the Royal College of Radiologists. It outlines the clinical target volume (CTV) for different disease sites, including the vulva, mons pubis, vagina, anorectum, urethra and pelvic nodes. Contouring workflows and organ-at-risk constraints are also discussed. Recommendations are given for radiation dose and treatment of resectable and unresectable head and neck cancer. The final item notes that smoking increases the risk of kidney cancer.
RADIATION THERAPY IN BILIARY TRACT CANCER
This document provides information on biliary tract cancers and the role of chemoradiotherapy in their treatment. It discusses the anatomy and types of biliary cancers, risk factors, presentation, diagnosis, staging, and standard treatment approaches including surgery. It then focuses on the evidence and guidelines for use of radiation therapy, including as adjuvant therapy after surgery for positive margins or nodes, as radical/definitive therapy for unresectable disease, and for palliation of symptoms from local or metastatic disease. Key findings are that chemoradiation improves local control and survival as adjuvant or radical therapy, and brachytherapy and external beam radiation are effective for palliation. Optimal regimens involve fluorouracil or capec
FEBRUARY 2024 ONCOLOGY CARTOON /95TH VOLUME
Dr Kanhu Charan Patro provides summaries of statistical concepts in 3 sentences or less, beginning each summary with the date. Summaries from January 19th to February 15th are presented, covering topics such as p-values, censoring in survival analysis, hazard ratios, and ISRS guidelines for stereotactic radiosurgery. On February 15th, a 3 sentence summary of World Cancer Day is provided, noting the date it is held, the organization that leads it, and the 2024 slogan of "Close the care gap".
Molecular Profile of Endometrial cancer.
The document discusses molecular analysis and classification of endometrial cancer, which impacts staging and treatment decisions. It describes aggressive histological subtypes and how molecular markers like POLE mutations, MMRd, and p53 abnormalities determine low, intermediate, or high risk stratification. Ongoing PORTEC trials are exploring the impact of molecular profiling on adjuvant treatment, with POLE mutations potentially downstaging while p53 mutations upstage disease. Molecular analysis provides predictive significance for personalized adjuvant therapies in endometrial cancer.
ONCOLOGY CARTOONS JANUARY 2024 BY DR KANHU CHARAN PATRO
This document discusses cervical cancer awareness month in January and provides 3 recommendations: 1) Be loyal to your partner to reduce risk of HPV infection, 2) Maintain genital hygiene, 3) Get vaccinated against HPV to prevent cervical cancer, and 4) Get screened regularly to detect cervical cancer early.
TYPES OF STATISTICAL DATA BY DR KANHU CHARAN PATRO
This document discusses types of data in statistics. It defines qualitative and quantitative data, and describes different types of quantitative data like discrete, continuous, ordinal, and nominal. Examples of love and fight data are provided to illustrate these concepts. The document concludes with a short poem about not fighting in marriage.
WHY STEREOTATXY IN CRANIAL AVM / DR KANHU CHARAN PATRO
This document discusses stereotactic radiosurgery (SRS) for the treatment of cerebral arteriovenous malformations (AVMs). It begins by explaining what an AVM is and the risks they pose if untreated, such as bleeding in the brain. It then covers treatment options for AVMs and why SRS is often preferred for certain cases, such as when the AVM is in an eloquent or deep brain area. The document provides details on patient selection, imaging and planning for SRS, anticipated outcomes, and risks of treatment complications. It emphasizes the importance of multidisciplinary discussion and informed consent when determining if SRS is appropriate for a patient's individual AVM.
PORTAL VEIN TUMOR THROMBOSIS SBRT/DR KANHU CHRAN PATRO
1) SBRT is an effective treatment for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT). In a study of 70 HCC patients with PVTT treated with SBRT, median survival was 10 months and 6-month and 12-month survival rates were 67.3% and 40% respectively.
2) Patients who received SBRT combined with transarterial chemoembolization (TACE) had significantly longer survival compared to those who did not receive TACE after SBRT.
3) SBRT is a promising bridging therapy prior to liver transplantation or hepatectomy by downstaging PVTT to make these curative procedures possible.
DR KANHU CHARTAN PATRO/ FOR ENT SURGEONS
1. Radiotherapy plays a crucial role in the treatment of head and neck cancers, both as a primary treatment and in combination with surgery. It is used for cancers of the nasopharynx, larynx, hypopharynx, and as postoperative treatment for most oral cancers.
2. Advances in radiotherapy technology such as IMRT have allowed for better tumor targeting while minimizing doses to surrounding healthy tissues, reducing treatment toxicities. Imaging techniques such as PET-CT provide improved visualization of tumors and affected lymph nodes, helping determine accurate target volumes.
3. Organ preservation approaches using radiotherapy and chemotherapy are increasingly used to treat head and neck cancers, avoiding disfiguring surgeries while achieving high
DECEMBER 2023 ONCOLOGY CARTOONS DRKANHU CHARAN PATRO
Here are the key points about the hepatitis B vaccine and liver cancer:
- Hepatitis B virus (HBV) infection can lead to chronic hepatitis B and significantly increase the risk of developing liver cancer later in life.
- The hepatitis B vaccine is effective at preventing HBV infection and therefore helps prevent liver cancers caused by the virus. It was the first vaccine referred to as an "anti-cancer" vaccine by the FDA.
- Around 25% of people with chronic HBV infection may develop liver cancer according to the CDC. Getting vaccinated helps avoid this risk.
- The hepatitis B vaccine is available and affordable in India, ranging from around 45 rupees per pediatric dose to 250 rupees for the
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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/
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Radical brachytherapy for early stage external auditory canal
- 1. EAR BUD BRACHYTHERAPY Dr kanhu charan patro
- 2. Radical Brachytherapy for Early Stage External Auditory Canal Squamous Cell Carcinoma : A feasibility Study using plastic ear-bud as an applicator
- 12. Primary Squamous Cell Carcinoma of External Ear Canal (SCC-EAC) • Extremely rare: 0.2% of all HNSqCC Arriaga M et al, Otolaryngol Head Neck Surg 1989 • No Optimum Guidelines due to lack of large randomised study based evidences. • Current standard of care: Radical Surgery ± Radio(Chemo)therapy • Surgery : En-block resection of tumor with adequate margin Results in poor cosmesis, loss of organ function - Alternative: Radical Radiotherapy (RT) has been used successfully. - Radical Radiotherapy : High Prescision Conformal External Beam RT Brachytherapy (BRT) Or, Sequential combination of EBRT+BRT
- 13. Evidence for Sequential EBRT + BRT Case Summary: Purpose: Dosimetry & Long term tumor related outcome Patient details: 64yrs Male, Squamous cell carcinoma in Left External Ear (SqCC-EAC), cT1cN1 M0 (Stage-I) CECT: No bone erosion, middle ear not involved Treatment: Radical EBRT (40Gy/20fx/26days followed by BRT(4.5Gy x 5fx in 3days) Result at 4 years: Disease-free
- 14. Pre-treatment CECT: Growth at EAC Post-treatment CECT at 4 yrs: Complete Response
- 15. Applicator using nylon catheter & dental wax Dosimetry
- 16. Why BRT? BRT • Growing interest • Very high dose to target • High conformity & Precision • Better sparing of OARs • Less treatment time EBRT • Being used since long • Conventional dosimetry • Less sparing of OARs • Long treatment time BRT is difficult: -Lack of proper source career applicator - Costly nylon catheter tubes - Skill for making dental-wax mould for source career applicator
- 17. plastic ear-bud as an applicator • Reason: - Commonly available - Extremely Cheap - Dimensions comparable to Nylon catheters - Length -5cm ( same as Ext Auditory Meatus) - Internal Diameter: 3mm - Ear-piece of a stethoscope: used for stabilisation of Ear-bud - Stethoscope Ear-piece with Plastic Ear-bud : Reproducible
- 18. Fig-1 Fig-2 Fig-3 Fig-1: Plastic Ear-Bud Fig-2: HDR Brachytherapy needle Fig-3: Dimensional comparison between above two
- 19. Figure-1 Figure-2 Figure-3 Fig-1: Assembly of Plastic Ear-Bud along with Stethoscope Ear-piece Fig-2: Assembly used in a volunteer Fig-3: Dosimetry
- 20. KEEP INNOVATING
- 25. WHO PRESERVES-HE DESERVES EAR BUD BRACHYTHERAPY