Accuracy of upper abdominal ultrasound examinations by sonographers in Norway

BackgroundNorway educated their first sonographers in 2008. The Norwegian Society of Radiology made a public statement discouraging Norwegian hospital departments of radiology to employ sonographers. Few sonographers work in Norway.PurposeTo investigate the accuracy of sonographers educated in Norway and to assess the quality of their work.Material and method244 patients were included in a prospective controlled study involving five sonographers and four advanced radiologists working in three separately located radiological departments belonging to the same hospital trust. All patients underwent ultrasound examinations by a sonographer and subsequently by an advanced radiologist who assessed the work of the sonographer.ResultsThe sonographers demonstrated a sensitivity of 0.97 and a specificity of 0.93, and there was an agreement of 0.9 (Cohens Kappa test) between the sonographers and the advanced radiologists. 95.1% of the sonographers' main findings were consistent with those of the radiologists. 99.2% of their examinations were found to be “best” or “medium” in the overall evaluation by the advanced radiologists. The advanced radiologists reported to have been mistaken in 3.3% of the cases where they considered the sonographers' results to be correct. If examined by the sonographers alone, pathology would have been undetected in 1.64% of the cases.ConclusionNorwegian sonographers are able to differentiate negative from positive findings in the upper abdomen, and demonstrate accuracies similar to experienced radiologists.     

Intraoperative ultrasonography of extramedullary spinal tumours

Summary Intraoperative spinal sonography (IOSS) was performed in 28 patients with extramedullary spinal tumours. Images were obtained of 31 tumours, because 2 patients had multiple tumours. There were 17 neurilemmomas, 9 meningiomas and 2 dermoid, cysts. All tumours appeared well-defined and highly echogenic. There was no difficulty differentiating extramedullary spinal tumours from intramedullary nasses excepting case, a big neurilemmoma at the conus medullaris. All images were assessed with reference to the surface of the lesions, the existence of cysts, and movement. Neurilemmomas had smooth surfaces, some cysts, and exhibited a floating movement. Meningiomas had irregular surfaces, were more highly echogenic than neurilemmomas, and adhered tightly to the dura mater. However, some neurilemmomas and meningiomas did not have these, and it was not always possible to differentiate them. Although, IOSS has limitations of resolution, it gave useful information about the size of the tumours, the degree of displacement of the spinal cord, and even about the type of tumour in some cases. It was extremely helpful to the surgeon.     

Intraoperative und perkutane Radiotherapie des Pankreaskarzinoms

Summary Therapeutic strategies in the treatment of pancreatic carcinoma are based on the high number of non-resectable cancers, the high relative radioresistance and the high distant metastases rate. Even in curatively resected carcinomas, a locally effective treatment modality is needed because of the risk of microscopical residual disease in the peripancreatic tissue. The efficacy of radiotherapy is dose dependent. Based on an analysis of published data a dose of more than 50 Gy is recommended, resulting in a high morbidity rate with external beam radiotherapy alone. The use of intraoperative radiotherapy allows locally restricted dose escalation without increased perioperative morbidity. In adjuvant and in primary treatment, local tumor contol was improved (70–90 %). With palliative intent, pain relief was obtained rapidly in over 60 % of patients and led to improved patient performance. As a result of the high distant metastases rate, even in curatively resected carcinomas, the overall prognosis could not be significantly improved. Further dose escalation is limited by the increasing incidence of upper gastrointestinal bleeding (20–30 %). Eingegangen am 19. April 1996 Angenommen am 23. April 1996     

移动式术中放疗电子加速器手术室剂量场与防护实验研究

目的 研究移动式术中放疗电子加速器(Mobetron)在手术室中的剂量分布特征,为制定相应防护措施与标准提供基础数据.方法 对于常用的电子束能量9 MeV,在50、100、150和200 cm 4个高度平面,每个平面在每隔45°的8个方位上,距中心轴每隔50 cm处分别布放热释光剂量计.选择高度为100 cm的平面,对电子束能量为4、6、9、12 MeV的4个能量档位,进行对比测量.在10 Gy/min条件下出束10 Gy后测读热释光剂量计.结果 9 MeV时,在高度为100 cm的平面上,距中心参考点50、100、150和200 cm处的剂量当量平均值分别为169、756、395和241 μSv;在距中心参考点50 cm不同角度上的剂量与平均值最大相差9.1％.9 MeV时50、100、150和200 cm 4个高度平面各方向距中心轴100 cm处,平均剂量分别为527、756、570和141 μSv.而4、6、9和12MeV在100 cm高度平面90°上,距中心轴100 cm处的剂量分别为573、486、689和781 μSv.结论 同一能量时,同一平面各角度上剂量都随距离增大呈幂指数衰减;同一高度平面,不同角度的剂量分布基本一致.不同高度平面上,100 cm平面的剂量最大.在不同能量档,剂量随能量的升高而增大.     

低能X射线术中放射治疗的辐射屏蔽

目的 依据国内外标准和指南评估低能X射线术中放射治疗室的屏蔽需求,测量屏蔽材料的透射系数、关注位置的周围剂量当量率水平以及防护装置的应用效果,为此类设备屏蔽方案的设计和防护装置的应用提供参考。方法 分别依据我国GBZ 121标准、英国医学物理与工程研究所（IPEM）75号报告和美国国家辐射防护与测量委员会（NCRP）151号报告计算INTRABEAM术中放射治疗室所需的屏蔽厚度。实际测量固体水板、屏蔽贴片和防辐射围裙对于此设备产生低能X射线的透射系数,对模拟治疗条件下关注位置处的周围剂量当量率进行测量并评估辐射防护屏的应用效果。结果 依据不同标准和指南计算得到治疗室全部关注点处所需铅屏蔽厚度均<0.6 mm,差异为亚毫米水平。此设备产生的低能X射线在屏蔽物质中衰减明显,0.05 mm铅当量屏蔽贴片和0.25 mm铅当量防辐射围裙的透射系数为0.068和0.0038。使用球形施用器在空气中进行照射时,距离射线源1和2 m处测得的周围剂量当量率为10.7和2.6 mSv/h。将施用器置于小水箱中后,相应的周围剂量当量率降为3.8和0.9 μSv/h,防护屏的使用可以使2 m处的周围剂量当量率降为本底水平。结论 低能X射线术中放射治疗设施的屏蔽需求较低,设备产生的射线有效能量低,但在邻近未屏蔽辐射源位置的剂量率较高,应优化设计治疗室屏蔽方案并合理使用防护装置。     

Abutment of adjacent intraoperative radiotherapy electron fields to treat large tumor volumes

Abutment of unmodified Intraoperative Radiotherapy (IORT) electron fields to irradiate large volumes can lead to dose inhomogeneities at the junction site of the matched fields. Although precise field matching is difficult to achieve in the IORT setting, we have fabricated special cones and dosimetrically evaluated their use. Based on these results, we have established guidelines for the routine use of multiple IORT fields that require field matching. This study examines the abutment of adjacent IORT electron fields for various cone sizes and beam energy combinations, using film dosimetry and a scanning densitometer. Results indicate that for abutting two adjacent 9 × 9 cm square cones, an optimum field separation at the depth of the 90% isodose line (d₉₀) can be obtained as follows: For 6, 9, and 12-MeV electron beams, abut the inner wall of the second IORT cone to the inner wall of the first IORT cone. For 16- and 20-MeV electron beams, abut the inner wall of the second IORT cone to outer wall of the first IORT cone.     

原发性上腹部癌肿淋巴结转移的CT分析

目的:探讨原发性上腹部癌肿的淋巴结转移的CT表现及诊断价值。方法:回顾性分析38例经手术、病理证实的上腹部癌肿的淋巴结转移的CT表现。结果:原发性肝、胆、胰及胃癌均可发生上腹部淋巴结转移的CT征象,癌肿不同,淋巴结转移发生的部位可不同。结论:CT对上腹部癌肿淋巴结转移的诊断有很高的价值     

Early mammographic and sonographic findings after intraoperative radiotherapy (IORT) as a boost in patients with breast cancer

The aim of this study was to evaluate mammographic and sonographic changes at the surgical site within the first 2 years after IORT as a boost followed by whole-breast radiotherapy (WBRT), compared with a control group treated with WBRT alone. All patients had breast-conserving surgery for early-stage breast cancer. Group A: n = 27, IORT (20 Gy) followed by WBRT (46 Gy). Group B (control group): n = 27, WBRT alone (56-66 Gy). Mammography: fat necrosis in 14 group A versus four group B patients (P < 0.001); parenchymal scarring classified as unorganized at the last follow-up in 16 vs seven cases, respectively (P = 0.03). Ultrasound: overall number of patients with circumscribed findings 27 vs 18 (P < 0.001); particular hematomas/seromas in 26 vs 13 patients (P < 0.001). Synopsis of mammography and ultrasound: overall postoperative changes were significantly higher classified in group A (P = 0.01), but not judged to have a significantly higher impact on interpretation. Additional diagnostic procedures, due to unclear findings at the surgical site, were performed on four patients of both groups. Within the first 2 years after IORT as a boost, therapy-induced changes at the original tumor site are significantly more pronounced compared with a control group. There is no evidence that the interpretation of findings is complicated after IORT.     

Intraoperative radiotherapy for abdominal malignancies: new prospects in multimodality treatment

Intraoperative radiotherapy (IOR) using a high-dose electron beam was first attempted in Japan about 20 years ago. Since then a continuing effort to effectively apply this innovative treatment has been underway. Radiotherapy promises to be a useful technique, since information regarding improved survival, alleviation of symptoms, and reduced radiation injury has become widely available. This report focuses on a general historical review of IOR, its advantages and disadvantages, complications, and indications in the treatment of abdominal neoplasms by comparing Japanese and Western experience.     

常规放疗结合后程立体定向放射治疗老年非小细胞肺癌患者的预后分析

目的观察老年非小细胞肺癌立体定向放疗疗效,并探讨其预后因子。方法128例老年非小细胞肺癌患者行常规放疗结合立体定向放疗,定期随访。结果全组患者1年生存率65.72%,单因素分析表明肿瘤体积、肿瘤剂量、卡氏评分影响近期结果,多因素分析仅肿瘤体积和肿瘤剂量为近期疗效预后因子,与生存期有关的预后因素为近期疗效、肿瘤剂量、临床分期。结论立体定向放疗可延长生存时间,对Ⅲ期患者,肿瘤剂量提高至72Gy是安全的。     

基于体膜开窗定位的保乳术后大分割与常规分割的不良反应对比

目的 分析基于体膜开窗定位方式的乳腺癌保乳术后大分割放疗和常规分割放疗患者的不良反应、美容效果,对改良定位方式进行探讨。方法 前瞻性对2019年1月至2020年4月收治的75例乳腺癌保乳术后患者,采用随机数字表法分为两组：大分割组,38例,42.4 Gy/16次,2.65 Gy/次;常规组,37例,50 Gy/25次,2.0 Gy/次。均采用热塑体膜定位,并沿患侧乳腺根部将乳房上方体膜剪去。观察两组的不良反应、美容效果及随访生存情况。结果 随访期间,两组患者8个月内无复发病例,局部控制率100%,生存率100%。两组患者急性皮肤反应总发生率为大分割组36.84%（14/38）和常规组67.57%（25/37）,差异有统计学意义（χ²=7.09,P<0.05）;美容效果优良率为大分割组89.47%（34/38）和常规组78.38%（29/37）,但差异无统计学意义（P>0.05）;白细胞减少、血小板减少及晚期皮肤反应差异无统计学意义（P>0.05）。结论 基于体膜开窗定位方式的乳腺癌保乳术后大分割放疗方案具有可行性,可明显减轻急性放射性皮肤反应,且并未增加放疗不良反应。但长期效果仍需长期随访研究来证实。     

The role of follow-up imaging in paediatric blunt abdominal trauma

AIM: To assess the role of follow-up imaging in paediatric blunt abdominal trauma. METHOD: All children who underwent CT scanning of their abdomen at our institution following acute blunt injury between January 1997 and December 2000 were included in the study. Case notes where researched for details regarding mechanism of injury, initial clinical presentation, acute management, complications and follow-up until discharge. Reports of imaging investigations were retrieved from the RIS database. RESULTS: In the study period 75 children underwent CT scanning of their abdomen as a primary investigation for acute blunt abdominal trauma. Of these, 12 were normal, 52 showed evidence of intra-abdominal organ injury and 11 showed findings other than abdominal organ injury. Of the 52 children that sustained intra-abdominal organ injury, 48 (92 percent) were treated conservatively. 4 (8 percent) underwent emergency surgery, 3 for bowel injury and 1 for renal trauma. Of the 48 that were treated conservatively, 9 had a complicated clinical course with 7 showing complications on follow-up imaging. The remaining 39 children had an uneventful clinical course with follow-up imaging by CT or US in 34. None showed complications that required a change in management. CONCLUSION: In our series, follow-up imaging did not contribute to further management in children with an uncomplicated clinical course following blunt abdominal trauma.     

基于蒙特卡罗方法的脑转移瘤术中放疗施照器设计及剂量学评估

目的 设计适用脑转移瘤术中放疗的施照器并评估其剂量学特征。方法 施照器设计首先通过模拟计算电子束经过一系列不同厚度散射箔后的散射角和剂量率,确定散射箔厚度;其次,建立散射箔位于不同高度的位置评估模型,通过计算模型表面平均能量方差,确定散射箔位置;最后,建立调节层几何结构特征与施照器表面剂量之间的关系,确定调制器的内表面特征。使用蒙特卡罗（MC）EGSnrc/BEAMnrc和EGS4/DOSXYZ程序完成Mobetron加速器、位置评估模型、调节层、施照器建模和剂量学分析。结果 半球囊状施照器的限光筒直径为2.5 cm、筒壁厚0.5 cm,材料为0.2 cm厚水等效材料加0.3 cm厚不锈钢;散射箔厚度0.14 cm,材料为金属钨,位置高度为0.5 cm;调制器为月牙形,材料为水等效材料。该施照器能够使Mobetron 12 MeV的电子束产生半球面剂量分布,剂量率为160 cGy/min,治疗深度为0.85 cm。结论 采用MC模拟设计的适用于高能电子束的半球囊状施照器,能产生半球面剂量分布。     

对术中超声在神经胶质瘤分级中的诊断价值的探讨

通过分析不同等级胶质瘤的超声声像图表现,探讨术中超声在胶质增生和胶质瘤鉴别诊断以及胶质瘤分级中的临床应用价值.材料和方法:对21例胶质增生及胶质瘤患者的术中超声声像图进行回顾性分析,比较胶质增生及不同等级胶质瘤的超声声像图特征.结果:2例胶质增生,6例低级别胶质瘤,4例间变性胶质瘤和9例胶质母细胞瘤的声像图各具特征.尤其是高级别胶质瘤内的坏死液化发生率达到了53.8%(7/13),而胶质增生和低级别胶质瘤中均未见坏死液化灶,两者差异存在显著性(P＜0.05).结论:术中超声在诊断胶质增生及对胶质瘤分级中具有一定的应用价值.     

同步加量调强放疗对颈胸上段食管癌患者长期预后的影响

目的:评估同步加量调强放疗(SIB-IMRT)对颈、胸上段食管癌患者长期预后的影响。方法:对2011年1月至2014年12月,接受IMRT的颈、胸上段食管癌的172例患者进行了回顾性分析。首先对全组患者的预后进行了单因素和多因素分析,依据患者照射方式,将全组患者分为常规IMRT(C-IMRT)和SIB-IMRT两组,应...     

乳腺癌保乳术后正向与逆向调强放疗计划的比较

目的 比较乳腺癌调强放疗计划的正向和逆向2种设计模式的区别。方法 针对6例左侧乳腺癌保乳术后的患者应用Pinnacle³7.4f计划系统,分别设计正向和逆向调强放疗计划,在射野方向相同、保证处方剂量线包绕95%靶区体积的前提下,比较2种计划的剂量体积直方图参数和加速器总跳数。结果 2种调强计划相比,正向及逆向调强计划的计划靶区体积适形度指数值分别为0.67±0.06和0.66±0.06(t=2.423,P>0.05),均匀性指数值分别为(28.2±6.0)%和(26.1±6.8)%(t=2.164,P>0.05);左肺V₂₀分别为(18.7±3.3)%和(17.0±2.8)%(t=5.087,P<0.05),V₃₀分别为(15.5±3.0)%和(14.0±2.6)%(t=7.272,P<0.05);心脏V₃₀分别为(4.1±3.1)%和(3.5±2.5)%(t=1.916,P>0.05);机器跳数分别为(262±5)MU和(308±14)MU(t=7.515,P<0.05)。结论 与正向调强放疗计划相比,乳腺癌逆向调强计划中靶区适形度和均匀性无差别,左肺受量降低,心脏受量无差别;但机器跳数显著增加,增加了机器的磨损和治疗实施时间。     

The therapeutic impact of abdominal ultrasound in patients with acute abdominal symptoms

AIM: The technical performance of abdominal ultrasound in the investigation of acute abdominal pain has been thoroughly investigated but its therapeutic effects are less well understood. We aimed to determine the therapeutic effect of abdominal ultrasound in the investigation of acute abdominal pain. MATERIAL AND METHODS: A pre- and post-intervention observational study design was used to determine the diagnostic and therapeutic effects of abdominal ultrasound for acute abdominal pain. Referring clinicians completed a pre-ultrasound questionnaire that detailed their leading diagnosis, confidence in this and intended management in 100 consecutive adult patients. Following ultrasound a second questionnaire was completed. This again detailed the leading diagnosis, confidence in this and their intended management. Clinicians quantified the management contribution of ultrasound both for the individual case in question and in their clinical experience generally. RESULTS: The leading diagnosis was either confirmed or rejected in 72 patients and a new diagnosis provided where no prior differential diagnosis existed in 10. Diagnostic confidence increased significantly following ultrasound (mean score 6.5 pre-ultrasound vs 7.6 post-ultrasound, P < 0.001). Intended management changed following ultrasound in 22 patients; 15 intended laparotomies were halted and a further seven patients underwent surgery where this was not originally intended. Ultrasound was rated either 'very' or 'moderately' helpful in 87% of patients, with 99% of clinicians finding it either 'very' or 'moderately' helpful generally. CONCLUSION: Abdominal ultrasound has considerable diagnostic and therapeutic effect in the setting of acute abdominal pain.