TS05 WHOLE-BODY MULTISLICE CT-SCANNING AS PRIMARY IMAGING TOOL IN THE EMERGENCY MANAGEMENT OF SEVERE TRAUMA

Abstract Abstract 4526 Intensity modulated total marrow irradiation (IM-TMI) represents an innovative technique to irradiate the bone marrow in hematologic malignancies. IM-TMI has been performed previously using tomotherapy in combination with a reduced intensity preparative regimen. Here we report 2 cases where IM-TMI 300cGy was delivered using a linear accelerator in combination with fludarabine/IV busulfan. To plan IM-TMI, 5 mm-slice CT scanning from top of the head to the mid femur was performed with immobilization using a customized whole body alpha cradle. All bones (excluding the arms and lower extremities) were contoured as the clinical target volume. A 3 mm margin was added to obtain the planning target volume (PTV). The organs at risk (OAR) including the brain, lenses, lungs, liver, kidney, small bowel and heart were identified and contoured. The IM-TMI technique consisted of three separate treatment plans: the head and neck; trunk; and pelvis. Patients received fludarabine 40mg/m2 on days -8 to -5. IV busulfan was given on days -5 to -2 targeting an AUC of 4800microM/min based on a pretransplant test dose. IM-TMI was delivered on day -5. The patients received a total of 300 cGy IM-TMI dose in two fractions, 8 hours apart. Two patients were treated: one is a 63 year old male with multiple myeloma who relapsed within 6 months after an autologous transplant with new cytogenetic abnormalities; and the second is a 52 years old female with AML who failed initial induction chemotherapy and at the time of transplant was in complete remission after receiving a second induction and one consolidation chemotherapy. Both patients received PBSC from HLA matched siblings. IM-TMI technique achieved 95% coverage of the PTV. The mean doses to the lenses and lungs were 99 and 195 cGy, respectively. Overall doses delivered to OAR were reduced by 20–67% on average when compared to standard total body irradiation. Treatment time was 44 min and 32 min for the beam-on and set-up, respectively, using the Varian 21 EX linac and MV imaging. Both patients suffered Bearman grade 1 mucositis. No other extramedullary toxicities were observed. Both engrafted in a timely manner achieving neutrophil >0.5 × 109/L at day 13 and 14, and platelet >20 × 109/L at day 8 and 9, respectively. Full donor chimerism was noted by day +30. After follow up of 246 and 218 days, respectively, both patients are alive and in remission. One developed a grade 2 acute GVHD and none of them has chronic GVHD. This study demonstrates for the first time the use of IM-TMI using a linear accelerator. The possibility of adding higher doses of IM-TMI to a myeloablative regimen without toxicity will be tested in a dose escalating clinical trial. Disclosures: No relevant conflicts of interest to declare.

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Optimisation of whole-body PET/CT scanning protocols

Biomedical Imaging and Intervention Journal ◽

10.2349/biij.3.2.e36 ◽

2007 ◽

Vol 3 (2) ◽

Cited By ~ 2

Author(s):

H Zaidi

Keyword(s):

Ct Scanning ◽

Whole Body ◽

Pet Ct

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Characterization of adrenal masses with non-enhanced CT and 18F FDG-PET in patients with primary malignancies

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20180069 ◽

2018 ◽

Vol 5 (1) ◽

pp. 120

Author(s):

Prasanth P. S. ◽

Indu Kandanga ◽

Robert P. Ambooken ◽

Priya P. Sankaran

Keyword(s):

Positive Predictive Value ◽

Predictive Value ◽

Fdg Pet ◽

Scoring System ◽

Ct Scanning ◽

Whole Body ◽

P Value ◽

Lower Sensitivity ◽

Primary Malignancy ◽

18F Fdg

Background: Characterizing adrenal lesions in patients with a known primary malignancy has a vital role in treatment and prognostication. A study by Gufler et al proposed a scoring system based on density, contour, homogeneity and size and found a high accuracy in differentiating adrenal adenomas from metastasis in patients with a known malignancy. This study evaluates the sensitivity and specificity of this NECT scoring system and comparing it with that of 18F FDG PET.Methods: The study was conducted on patients with diagnosed malignancies with adrenal mass, referred for 18F-FDG PET-CT scanning as a part of work up or follows up between October 2014 and March 2016. Whole-body CT and PET images were obtained using standard protocol. NECT scoring and quantitative analysis of FDG uptake in the adrenal lesions (SUVavg analysis) is done separately.Results: Of the 50 patients studied, 33 patients had benign adrenal lesions and the rest had metastatic lesions. Most common site of primary was lung. NECT score yielded a sensitivity of 88.2%, specificity of 100% and positive predictive value of 100%. SUVavg analysis yielded a 100% sensitivity, specificity and positive predictive value. Comparison of the predictive power of the two tests showed a z score of 2.5 and p value of 0.0124.Conclusions: 18-FDG PET can be considered as a gold standard for differentiating between metastasis and benign lesions of adrenal glands in patients with known primary. NECT has a comparable specificity as that of FDG PET, however with lower sensitivity.

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Meningioma metastases: incidence and proposed screening paradigm

Journal of Neurosurgery ◽

10.3171/2019.1.jns181771 ◽

2020 ◽

Vol 132 (5) ◽

pp. 1447-1455 ◽

Cited By ~ 6

Author(s):

Cecilia L. Dalle Ore ◽

Stephen T. Magill ◽

Adam J. Yen ◽

Maryam N. Shahin ◽

David S. Lee ◽

...

Keyword(s):

Significant Proportion ◽

Ct Scanning ◽

Additional Treatment ◽

Whole Body ◽

Who Grade ◽

Recurrent Meningioma ◽

Number Needed To Screen ◽

Grade Ii ◽

Grade Iii

OBJECTIVEExtracranial meningioma metastases are uncommon, occurring in less than 1% of patients diagnosed with meningioma. Due to the rarity of meningioma metastases, patients are not routinely screened for distant disease. In this series, we report their experience with meningioma metastases and results of screening for metastases in select patients with recurrent meningiomas.METHODSAll patients undergoing resection or stereotactic radiosurgery for primary or recurrent meningioma from 2009 to 2017 at a single center were retrospectively reviewed to identify patients who were diagnosed with or underwent imaging to evaluate for systemic metastases. Imaging to evaluate for metastases was performed with CT scanning of the chest, abdomen, and pelvis or whole-body PET/CT using either FDG or 68Ga-DOTA-octreotate (DOTATATE) tracers in 28 patients. Indications for imaging were symptomatic lesions concerning for metastasis or asymptomatic screening in patients with greater than 2 recurrences being evaluated for additional treatment.RESULTSOf 1193 patients treated for meningioma, 922 (77.3%) patients had confirmed or presumed WHO grade I tumors, 236 (19.8%) had grade II tumors, and 35 (2.9%) had grade III tumors. Mean follow-up was 4.3 years. A total of 207 patients experienced recurrences (17.4%), with a mean of 1.8 recurrences. Imaging for metastases was performed in 28 patients; 1 metastasis was grade I (3.6%), 16 were grade II (57.1%), and 11 were grade III (39.3%). Five patients (17.9%) underwent imaging because of symptomatic lesions. Of the 28 patients screened, 27 patients had prior recurrent meningioma (96.4%), with a median of 3 recurrences. On imaging, 10 patients had extracranial lesions suspicious for metastasis (35.7%). At biopsy, 8 were meningioma metastases, 1 was a nonmeningioma malignancy, and 1 patient was lost to follow-up prior to biopsy. Biopsy-confirmed metastases occurred in the liver (5), lung (3), mediastinum (1), and bone (1). The observed incidence of metastases was 0.67% (n = 8). Incidence increased to 2% of WHO grade II and 8.6% of grade III meningiomas. Using the proposed indications for screening, the number needed to screen to identify one patient with biopsy-confirmed malignancy was 3.83.CONCLUSIONSSystemic imaging of patients with multiply recurrent meningioma or symptoms concerning for metastasis may identify extracranial metastases in a significant proportion of patients and can inform decision making for additional treatments.

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Trauma Computed Tomography in the Modern Era: Not Always Quick and Safe

The American Surgeon ◽

10.1177/00031348211061330 ◽

2021 ◽

pp. 000313482110613

Author(s):

Cameron Ghafil ◽

Kazuhide Matsushima ◽

Hiroto Chiba ◽

Renqing Wu ◽

Heeseop Shin ◽

...

Keyword(s):

Computed Tomography ◽

Adverse Events ◽

Ct Scanning ◽

Trauma Team ◽

Whole Body ◽

Trauma Patients ◽

Diagnostic Modality ◽

Scanning Process ◽

Whole Body Ct ◽

Trauma Ct

Background Computed tomography (CT) has emerged as the diagnostic modality of choice in trauma patients. Recent studies suggest its use in hemodynamically unstable patients is safe and potentially lifesaving; however, the incidence of adverse events (AE) during the trauma CT scanning process remains unknown. Study Design Over a 6-month period at a Level 1 trauma center, data on patients undergoing trauma CT (whole-body CT (WBCT) +/− additional CT studies) were prospectively collected. All patients requiring a trauma team activation (TTA) were included. Adverse events and specific time intervals were recorded from the time of TTA notification to the time of return to the resuscitation bay from the CT suite. Results Of the 94 consecutive patients included in the study, 47.9% experienced 1 or more AE. Median duration away from the resuscitation bay for all patients was 24 minutes. Patients with AE spent a significantly longer time away from the resuscitation bay and had longer scan times. Vasopressor support and ongoing transfusion requirement at the time of CT scanning were associated with AE. Conclusion Adverse events of varying clinical significance occur frequently in patients undergoing emergent trauma CT. A standard trauma CT protocol could improve the efficiency and safety of the scanning process.

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Total marrow and lymphoid irradiation with helical tomotherapy: A practical implementation report

10.21203/rs.3.rs-23984/v1 ◽

2020 ◽

Author(s):

Srinivas Chilukuri ◽

Sham Sundar ◽

Rajesh Thiyagarajan ◽

Jose Easow ◽

Mayur Sawant ◽

...

Keyword(s):

Helical Tomotherapy ◽

Organs At Risk ◽

Conditioning Regimen ◽

Ct Scanning ◽

Whole Body ◽

Patient Specific ◽

Practical Implementation ◽

Allogenic Bone ◽

Megavoltage Ct

Abstract Objective To standardize the technique and resources for total marrow and lymphoid irradiation (TMLI) as part of the conditioning regimen before allogenic bone marrow transplantation (ABMT) using helical tomotherapy.Methods We used this technique in our first 5 patients requiring TMLI. Patients were immobilized using a mask and a whole-body vacuum cushion. CT scanning was performed in head first supine (HFS) and feet first supine (FFS) orientations with an overlap at mid-thigh. Target consisted of the entire skeleton, spleen, sanctuary sites and major lymphatics whereas lungs, kidneys, aero-digestive tract, bowel, parotids, heart and liver were defined as organs at risk (OAR). Treatment was performed in two parts based on 2 different plans generated in HFS and FFS orientations with an overlap at the mid thigh. Patients along with the immobilization device were manually rotated by 180° to change the orientation after the delivery of HFS plan. The dose at the junction was contributed by a complementary dose gradient from each of the plans. Plan was to deliver 95% of 12Gy to 98% of CTV with dose heterogeneity < 10% and pre-specified OAR doe constraints. Megavoltage-CT was used for position verification before each fraction. Patient specific quality assurance and an in-vivo film dosimetry to verify junction dose were performed in all patients.Results Treatment was delivered in two daily fractions of 2Gy each for 3 days with at least 8-hours gap between each fraction. The target coverage goals were met in all the patients. The average person-hours per patient were 16.5, 21.5 and 25.75 for radiation oncologist, radiation therapist and medical physicist respectively. Average in-room time per patient was 9.25 hours with an average beam-on time of 3.32 hours for all the six fractions. Conclusion This report comprehensively describes technique and resource requirements for TMLI and would serve as a practical guide for departments keen to start this service. Despite being time and labor intensive, it can be implemented safely and robustly. We will be using this methodology in a prospective phase II trial to study safety and feasibility of dose escalated TMLI as part of conditioning regimen before ABMT.

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COMPARISON OF VARIOUS 18F-FDG PET/CT ACQUISITION PROTOCOLS IN CHILDREN WITH HODGKIN’S LYMPHOMA

PEDIATRIA Journal named after G N SPERANSKY ◽

10.24110/0031-403x-2021-100-3-28-34 ◽

2021 ◽

Vol 100 (3) ◽

pp. 28-34

Author(s):

Yu.N. Likar ◽

◽

E.D. Kireeva ◽

А. Kailash ◽

M.Ya. Yadgarov ◽

...

Keyword(s):

Hodgkin’S Lymphoma ◽

Ct Scanning ◽

Early Response ◽

Diagnostic Value ◽

Hodgkin's Lymphoma ◽

Whole Body ◽

Pet Ct ◽

Scanning Area ◽

18F Fdg ◽

Ct Studies

In adults with oncological diseases, most PET/CT studies with 18F-FDG are performed using a scanning protocol with a reduced scanning area (r-PET/CT). In pediatric oncology, PET/CT with 18F-FDG is recommended to be performed in the «whole body» mode. We hypothesized that the use of r-PET/CT in children with Hodgkin's lymphoma (HL) may be sufficient without loss of diagnostic value. Materials and methods of research: a comparative analysis of PET/CT scanning protocols in «whole body» mode and r-PET/CT mode in children with HL was carried out. The retrospective analysis included 105 patients aged 0–18 years. All patient underwent primary whole-body PET/CT examinations at the time of initial staging and intermediate follow-up PET/CT scan after 2-cycle of chemotherapy. 210 PET/CT studies were retrospectively analyzed. Results: in 94 (89,5%) of 105 patients the identified lesions were localized within the area of the field-of-view of r-PET/CT, and additional lesions detected in 11 (10,5%) patients in the whole-body PET/CT examinations have not affected the results of staging and management. Conclusion: the detection of additional foci of pathological metabolic activity beyond r-PET/CT has no further impact on the stage of the disease, the protocol of treatment and the evaluation of the early response to the therapy. The advantage of r-PET/CT protocol is the reduction in radiation exposure and study time, which is very important for pediatric patients with HL.

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3D Whole-Body MRI of the Musculoskeletal System

Seminars in Musculoskeletal Radiology ◽

10.1055/s-0041-1730401 ◽

2021 ◽

Vol 25 (03) ◽

pp. 441-454

Author(s):

Vassiliki Pasoglou ◽

Sandy Van Nieuwenhove ◽

Frank Peeters ◽

Gaetan Duchêne ◽

Thomas Kirchgesner ◽

...

Keyword(s):

Inflammatory Diseases ◽

Three Dimensional ◽

Short Review ◽

Diagnostic Methods ◽

Whole Body ◽

Correct Treatment ◽

Whole Body Mri ◽

Imaging Tool ◽

Technological Advances ◽

Oncologic Patients

AbstractWith its outstanding soft tissue contrast, spatial resolution, and multiplanar capacities, magnetic resonance imaging (MRI) has become a widely used technique. Whole-body MRI (WB-MRI) has been introduced among diagnostic methods for the staging and follow-up assessment in oncologic patients, and international guidelines recommend its use. In nononcologic applications, WB-MRI is as a promising imaging tool in inflammatory diseases, such as seronegative arthritis and inflammatory myopathies. Technological advances have facilitated the introduction of three-dimensional (3D) almost isotropic sequences in MRI examinations covering the whole body. The possibility to reformat 3D images in any plane with equal or almost equal resolution offers comprehensive understanding of the anatomy, easier disease detection and characterization, and finally contributes to correct treatment planning. This article illustrates the basic principles, advantages, and limitations of the 3D approach in WB-MRI examinations and provides a short review of the literature.

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