The British journal of radiology
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Review Case Reports
Tracheal chondrosarcoma--a rare complication in Maffucci syndrome.
Maffucci syndrome is a rare congenital non-hereditary disease characterised by subcutaneous haemangiomata and multiple enchondromata. We present a case of an intermediate grade myxoid chondrosarcoma of the tracheal cartilage in a 34-year-old man with a history of Maffucci syndrome. ⋯ A review of the radiological literature reveals approximately 15 previously published cases. No case was found with a history of Maffucci syndrome.
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A wide spectrum of intracranial injuries has been described as complicating difficult birth, particularly following instrumental delivery. We describe five children in whom isolated cortical tears were observed on MRI. Four cases were characterised by a difficult instrumental delivery. ⋯ As far as we are aware, isolated cerebral cortical tears have not been reported previously although recognition of this injury pattern is important because of its possible misinterpretation as a marker of a non-accidental head injury. Other differential diagnoses that should be considered include cerebral infarcts, schizencephaly and accidental head injury. The importance of high-quality cross-sectional brain imaging in newborn infants with seizures is emphasised.
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The purpose of this study was to assess the potential dose reductions to the rectum with three-dimensional conformal radiotherapy in the prone position (prone 3D-CRT) compared with intensity-modulated radiotherapy in the supine position (supine IMRT) for prostate cancer. 17 prostate cancer patients underwent treatment planning CT scans in the supine and prone positions. Prone 3D-CRT and supine IMRT plans were constructed for each patient and compared in terms of the volume of rectum exposed to the V90 (volume of rectum receiving at least 90% of the prescription dose) as the high dose region. It was confirmed that supine IMRT was significantly superior to prone 3D-CRT (p = 0.023). ⋯ While prone 3D-CRT resulted in significant improvements in some patients in terms of rectal sparing, the degree of the effect may be dependent on a patient's anatomy and physical condition in prone 3D-CRT compared with supine IMRT. If the cases in which prone 3D-CRT was more effective in rectal dose reduction could be extracted using some anatomical predictor before treatment planning, prone 3D-CRT may be appropriate in such a case. We consider that prone 3D-CRT still warrants further investigation because of its advantages in terms of simplicity, cost-effectiveness and labour saving; continued research to find an appropriate anatomical predictor is required.
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Conversion factors for effective dose (CF(E) = effective dose/dose-area product (mSv (Gy cm2)(-1)) in paediatric interventional cardiology were estimated retrospectively for 249 patients using the dose-area product (DAP), irradiation geometry, exposure parameters and tissue-weighting factors (TWFs) from the International Commission on Radiological Protection (ICRP) 60. Two methods for estimating the conversion factors, which differed in the description of the irradiation geometry, were evaluated. The effective doses obtained with the two methods were almost identical. ⋯ With the new ICRP value for TWF(b), increases in the CFs in the order of 10-30%, and in the effective dose of 10-20%, were indicated. The results indicated that the effective dose in paediatric interventional cardiology is of much greater concern than the skin dose. Furthermore, age-dependent CF(E) values are required so as not to underestimate the doses to very young patients.
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Randomized Controlled Trial Multicenter Study Comparative Study
Pre-trial quality assurance processes for an intensity-modulated radiation therapy (IMRT) trial: PARSPORT, a UK multicentre Phase III trial comparing conventional radiotherapy and parotid-sparing IMRT for locally advanced head and neck cancer.
The purpose of this study was to compare conventional radiotherapy with parotid gland-sparing intensity-modulated radiation therapy (IMRT) using the PARSPORT trial. The validity of such a trial depends on the radiotherapy planning and delivery meeting a defined standard across all centres. At the outset, many of the centres had little or no experience of delivering IMRT; therefore, quality assurance processes were devised to ensure consistency and standardisation of all processes for comparison within the trial. ⋯ Each exercise had to be accepted before patients could be recruited into the trial. 10 centres successfully completed the quality assurance exercises. A range of treatment planning systems, linear accelerators and delivery methods were used for the planning exercises, and all the plans created reached the standard required for participation in this multicentre trial. All 10 participating centres achieved implementation of a comprehensive and robust IMRT programme for treatment of head and neck cancer.