The POLO (Partially Omitted Lobe) approach to safely treat in-breast recurrence after intraoperative radiotherapy with electrons

Objectives: The aim of this study is to evaluate feasibility of salvage 4-week hypofractionated whole breast radiotherapy (WBRT) in patients with in-breast recurrence after receiving intraoperative radiotherapy with electrons (IOERT) for primary breast cancer (BC). Methods: BC patients who had repeated quadrantectomy underwent modified WBRT with intensity-modulated radiotherapy using Helical Tomotherapy to underdose the IOERT region. This approach, called POLO (Partially Omitted Lobe), excluded the IOERT volume from receiving the full prescription dose. Results: Nine patients were treated with this approach, receiving 45 Gy in 20 fractions. A simultaneous integrated boost of 2.5 Gy in 20 fractions was delivered in 6/9 patients. Dose constraints and planning objectives were reported. No severe toxicity was reported while local control and overall survival were 100%. Conclusion: The POLO approach is technically feasible and capable to achieve a significant reduction of radiation dose delivered to the previous treated IOERT area. Advances in knowledge: The study demonstrates the technical and dosimetric feasibility of conservative salvage whole breast radiotherapy, while sparing the area already treated with IORT, in patients with in-breast recurrence.

Evaluation of Direct Chest Circumference Measurement as an Efficient Tool in the Reduction of Radiation Dose in Multi-Slice Computerized Tomography of Chest- A Suggestion for Radiographers

Non-contrast computerized tomography (NCCT) is in rampant use in daily practice for the diagnosis of various chest diseases. In the era of COVID-19 pandemic, the use of chest NCCT has increased many fold. The reason was because it will resolve many issues and quick diagnosis can be made. The same was also required to see the behavior of the disease as well as in the follow-up. Basically two parameter are in use to described the amount of radiation dose received by the patient in volumetric CT. These are, one is CT Dose Index (CTDIvol) & its unit is mGy, and the second is dose length product (DLP). With normal pitch factor i.e. 1, the CTDIw is use on the description of CTDIvol. Multiplication of scan length and CTDIvol parameter is known as Dose Length Product (DLP). There was much concern about the radiation dose received by the individual. A total of twenty-six individuals were studied. The measurement of direct chest circumference before each CT chest examination and correlation of CT chest protocol parameter in combination use was an effective tool to reduce the amount of radiation dose in patients. Chest circumference values can also be correlated with body mass index (BMI) values for more accuracy in the reduction of radiation dose. Lower chest circumference patients should be irradiated with the least amount of radiation dose and so on.

Fungsi pelindung tiroid dan persepsi dokter gigi terhadap penggunaannya pada teknik radiografi sefalometri dan CBCT

Objectives: The aims of this review is to describe thyroid shield function and to look the dentists’ perceptions considering the application in dental radiographic examination, particularly in cephalometric and Cone Beam Computed Tomography (CBCT) examination. Literature Review: The utilization of thyroid shield has been signified reduction of radiation dose about 34% in cephalometric examination and 18-40.1% in CBCT. The absence of universal guidelines has led to minimal perception of dentists on the importance of using thyroid shield as indicated by the low utilization of thyroid shield among patients. This low perception can be improved through adequate education and applied training in the use of thyroid shield. Conclusion: Dentists’ perceptions regarding the application of thyroid shield need to be improved so that the application of thyroid shield can be increased in order to protect patients from the risk of dental radiation exposure.

Recanalization and Stenting of the Celiac and the Superior Mesenteric Artery Supported by Use of a Steerable Introducer Sheath: Report on 2 Years’ Experience

Purpose: To compare technical parameters and success of recanalization of celiac (CA) or superior mesenteric artery (SMA) with usage of steerable vs not steerable introducer sheaths. Methods: A retrospective analysis was performed on all consecutive patients who underwent recanalization with stent implantation of CA or SMA between 2015 and 2019. Data regarding technical success (successful stent placement with restoration of sufficient blood flow by the first attempt without changing kind of introducer sheath or access site), indication for treatment, vascular access, kind of introducer sheath, fluoroscopy time and radiation dose were collected. Preinterventional CT were analyzed to classify the difficulty of catheterization of target vessels. Technical parameters were compared with independent t-test (p ≤ 0.05). Results: 66 patients underwent recanalization of CA or SMA. Usage of steerable introducer sheaths was associated with higher technical success compared to not steerable introducer sheaths with transfemoral approach respectively of 8/8 vs 15/19 for the CA and 11/11 vs 17/20 for the SMA. Steerable introducer sheaths were used in recanalization considered more technically difficult compared to not steerable introducer sheaths (58% vs 33%). Usage of steerable introducer sheath showed a statistically significant reduction of radiation dose in the recanalization of the SMA (respectively 32035 ± 15716 cGy cm2 vs 60102 ± 28432 cGy cm2; p = 0.005). Conclusion: Even if used in more difficult interventions, steerable introducer sheaths showed a higher technical success compared to not steerable introducer sheaths with transfemoral access.

OCCUPATIONAL DOSE AND RADIATION PROTECTION PRACTICE IN UAE: A RETROSPECTIVE CROSS-SECTIONAL COHORT STUDY (2002–2016)

A two-phased retrospective cross-sectional study analysed the occupational dose and radiation protection practice among medical workers in two hospitals in the UAE. Phase 1 evaluated radiation protection practice using a questionnaire, whereas phase 2 assessed the occupational dose. Readings of 952 thermoluminescence dosimeters were analyzed. The result showed 52% of medical workers have a good level of radiation protection practice. Readings of 952 thermoluminescence dosimeters were analyzedAverage annual effective dose per worker ranged from 0.39 to 0.83 mSv. Cardiologists and nurses displayed a higher average of occupational radiation dose compared to other workers. There were no significant correlations between radiation protection practice and hospital, occupation or department. Finally, the occupational dose was within the international and national limits, but the reduction of radiation dose to cardiologist and nurses is essential. Moreover, training is essential to promote radiation safe practice among medical workers.