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Radiographics : a Review Publication of... 2016Frostbite is a localized cold thermal injury that results from tissue freezing. Frostbite injuries can have a substantial effect on long-term limb function and mobility... (Review)
Review
Frostbite is a localized cold thermal injury that results from tissue freezing. Frostbite injuries can have a substantial effect on long-term limb function and mobility if not promptly evaluated and treated. Imaging plays a critical role in initial evaluation of frostbite injuries and in monitoring response to treatment. A multimodality approach involving radiography, digital subtraction angiography (DSA), and/or multiphase bone scintigraphy with hybrid single photon emission computed tomography (SPECT)/computed tomography (CT) is often necessary for optimal guidance of frostbite care. Radiographs serve as an initial survey of the affected limb and may demonstrate characteristic findings, depending on the time course and severity of injury. DSA is used to evaluate perfusion of affected soft tissues and identify potential targets for therapeutic intervention. Angiography-directed thrombolysis plays an essential role in tissue preservation and salvage in deep frostbite injuries. Multiphase bone scintigraphy with technetium 99m-labeled diphosphonate provides valuable information regarding the status of tissue viability after initial treatment. The addition of SPECT/CT to multiphase bone scintigraphy enables precise anatomic localization of the level and depth of tissue necrosis before its appearance at physical examination and can help uncover subtle findings that may remain occult at scintigraphy alone. Multiphase bone scintigraphy with SPECT/CT is the modality of choice for prognostication and planning of definitive surgical care of affected limbs. Appropriate use of imaging to direct frostbite care can help limit the effects that these injuries have on limb function and mobility. RSNA, 2016.
Topics: Angiography, Digital Subtraction; Diagnosis, Differential; Frostbite; Humans; Multimodal Imaging; Multiple Trauma; Osteonecrosis; Practice Guidelines as Topic; Radiology; Single Photon Emission Computed Tomography Computed Tomography; Soft Tissue Injuries; Tomography, X-Ray Computed; United States
PubMed: 27494386
DOI: 10.1148/rg.2016160045 -
Radiation Oncology (London, England) May 2023Cancer treatment is gradually entering an era of precision, with multitude studies in gene testing and immunotherapy. Tumor cells can be recognized and eliminated by the... (Review)
Review
Cancer treatment is gradually entering an era of precision, with multitude studies in gene testing and immunotherapy. Tumor cells can be recognized and eliminated by the immune system through the expression of tumor-associated antigens, but when the cancer escapes or otherwise suppresses immunity, the balance between cancer cell proliferation and immune-induced cancer cell killing may be interrupted, resulting in tumor proliferation and progression. There has been significant attention to combining conventional cancer therapies (i.e., radiotherapy) with immunotherapy as opposed to treatment alone. The combination of radio-immunotherapy has been demonstrated in both basic research and clinical trials to provide more effective anti-tumor responses. However, the absolute benefits of radio-immunotherapy are dependent on individual characteristics and not all patients can benefit from radio-immunotherapy. At present, there are numerous articles about exploring the optimal models for combination radio-immunotherapy, but the factors affecting the efficacy of the combination, especially with regard to radiosensitivity remain inconclusive. Radiosensitivity is a measure of the response of cells, tissues, or individuals to ionizing radiation, and various studies have shown that the radiosensitivity index (RSI) will be a potential biomarker for predicting the efficacy of combination radio-immunotherapy. The purpose of this review is to focus on the factors that influence and predict the radiosensitivity of tumor cells, and to evaluate the impact and predictive significance of radiosensitivity on the efficacy of radio-immunotherapy combination.
Topics: Humans; Immunotherapy; Radiation Tolerance; Radiation Oncology; Cell Proliferation; Radiation, Ionizing
PubMed: 37226275
DOI: 10.1186/s13014-023-02278-5 -
Annals of Palliative Medicine Jul 2019Radiation Oncologists are involved in patient care from cancer diagnosis to the end of life, and 30-40% of radiation courses are delivered with palliative intent. Recent... (Review)
Review
Radiation Oncologists are involved in patient care from cancer diagnosis to the end of life, and 30-40% of radiation courses are delivered with palliative intent. Recent data has supported the use of advanced technology in select metastatic settings with respect to improvements in symptom response, local control, and even survival. Practicing physicians must thus be aware of the appropriate uses of advanced radiation techniques, especially with the development of life-prolonging targeted therapy and immunotherapies for individuals with advanced disease. As patients live longer with metastatic burden clinicians may increasingly encounter complex clinical scenarios that strike a 'middle ground' between purely palliative or curative intent. That is, the situation in which aggressive palliation is warranted to provide durable local control and potentially improve progression free and overall survival. This article is intended to provide a framework that clinicians can utilize when considering treatment options in complex palliative settings. The review begins with an introduction to advanced radiation techniques, their relevance with respect to histology, and the importance of dosing and fractionation. It further explores the data supporting the use of advanced techniques in the setting of brain metastases, lung metastases, non-spine bone metastases, spinal bone metastases, spinal cord compression, and liver metastases. Each of the sections also discusses specific site-related factors to consider that may sway a practitioner toward or against the use of such techniques. Where applicable, outcomes of re-irradiation are also discussed.
Topics: Dose Fractionation, Radiation; Humans; Neoplasm Metastasis; Neoplasms; Palliative Care; Prognosis; Radiation Oncology
PubMed: 31370664
DOI: 10.21037/apm.2019.07.07 -
Radiation Oncology (London, England) Jan 2014Innovative strategies in cancer radiotherapy are stimulated by the growing knowledge on cellular and molecular tumor biology, tumor pathophysiology, and tumor... (Review)
Review
Innovative strategies in cancer radiotherapy are stimulated by the growing knowledge on cellular and molecular tumor biology, tumor pathophysiology, and tumor microenvironment. In terms of tumor diagnostics and therapy monitoring, the reliable delineation of tumor boundaries and the assessment of tumor heterogeneity are increasingly complemented by the non-invasive characterization of functional and molecular processes, moving preclinical and clinical imaging from solely assessing tumor morphology towards the visualization of physiological and pathophysiological processes. Functional and molecular imaging techniques allow for the non-invasive characterization of tissues in vivo, using different modalities, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, positron emission tomography (PET) and optical imaging (OI). With novel therapeutic concepts combining optimized radiotherapy with molecularly targeted agents focusing on tumor cell proliferation, angiogenesis, and cell death, the non-invasive assessment of tumor microcirculation and tissue water diffusion, together with strategies for imaging the mechanisms of cellular injury and repair is of particular interest. Characterizing the tumor microenvironment prior to and in response to irradiation will help to optimize the outcome of radiotherapy. These novel concepts of personalized multi-modal cancer therapy require careful pre-treatment stratification as well as a timely and efficient therapy monitoring to maximize patient benefit on an individual basis. Functional and molecular imaging techniques are key in this regard to open novel opportunities for exploring and understanding the underlying mechanisms with the perspective to optimize therapeutic concepts and translate them into a personalized form of radiotherapy in the near future.
Topics: Animals; Diagnostic Imaging; Humans; Magnetic Resonance Imaging; Neoplasms; Neovascularization, Pathologic; Perfusion Imaging; Positron-Emission Tomography; Radiation Oncology; Tomography, X-Ray Computed
PubMed: 24387195
DOI: 10.1186/1748-717X-9-3 -
Cancer Imaging : the Official... Nov 2021Structured reporting and standardized criteria are increasingly recognized as means of improving both radiological and clinical practice by allowing for better content...
BACKGROUND
Structured reporting and standardized criteria are increasingly recognized as means of improving both radiological and clinical practice by allowing for better content and clarity. Our aim was to examine oncologists' opinions and expectations concerning the radiologist's report to identify general needs in daily practice and ways to improve interdisciplinary communication.
METHODS
A 19-question survey was sent to 230 oncologists from three different countries (France, Romania, Switzerland) identified on the online web pages of different hospitals and private clinics. The survey was sent by electronic mail with an online survey program (Google Forms®). All recipients were informed of the purpose of the study. The data were collected by the online survey program and analysed through filtering the results and cross-tabulation.
RESULTS
A total of 52 responses were received (response rate of 22.6%). The majority of the respondents (46/52, 88%) preferred the structured report, which follows a predefined template. Most of the respondents (40/52, 77%) used RECIST 1.1 or iRECIST in tumour assessment. Nearly half of the oncologists (21/52, 40%) measured 1-3 cases per week. On a 10-point Likert scale, 34/52 (65%) oncologists rated their overall level of satisfaction with radiologists' service between 7 and 10. In contrast, 12/52 (19%) oncologists rated the radiologists' service between 1 and 4. Moreover, 42/52 (80%) oncologists acknowledged that reports created by a radiologist with a subspecialty in oncologic imaging were superior to those created by a general radiologist.
CONCLUSION
Structured reports in oncologic patients and the use of RECIST criteria are preferred by oncologists in their daily clinical practice, which signals the need for radiologists also to implement such reports to facilitate communication. Furthermore, most of the oncologists we interviewed recognized the added value provided by radiologists specializing in oncologic imaging. Because this subspecialty is present in only a few countries, generally in large clinics, further training might become a challenge; nevertheless, intensive efforts should be made to enhance expertise in cancer imaging.
Topics: Humans; Medical Oncology; Oncologists; Radiologists; Radiology; Radiology Information Systems
PubMed: 34823599
DOI: 10.1186/s40644-021-00431-5 -
Discovery Medicine Mar 2015The advent of functional imaging facilitates the acquisition of patient-specific tumor characteristics, including its metabolic state and regional oxygen tension. Recent... (Review)
Review
The advent of functional imaging facilitates the acquisition of patient-specific tumor characteristics, including its metabolic state and regional oxygen tension. Recent advances promote incorporating this information with data obtained from current imaging techniques, such as MRI and CT, to manage various malignancies. Functional imaging's vital roles progressively evolved to include: aiding in diagnosis, improving radiation treatment planning, differentiating tumor volume from surrounding normal tissues which enables dose escalation to the former while improving sparing of the latter, adapting radiation therapy regimens according to a tumor's response to initial treatment, and assessing radiation therapy response and toxicity. This review explores functional imaging in radiation oncology in the context of these five applications, as well as its comparison to, and integration with, existing imaging modalities. In parallel with advances in functional imaging and understanding of tumor microbiology, the emergence of diverse tracers provides a plethora of options to distinguish and manage malignancies on the basis of specific metabolic processes and changing microenvironmental cues. Current limitations, potential concerns, and future innovations of functional imaging are also discussed.
Topics: Humans; Magnetic Resonance Imaging; Neoplasms; Positron-Emission Tomography; Radiation Oncology; Radiopharmaceuticals; Radiotherapy; Radiotherapy Planning, Computer-Assisted; Tomography, X-Ray Computed
PubMed: 25828524
DOI: No ID Found -
AJNR. American Journal of Neuroradiology Aug 2020A uniform policy on parental leave in radiology training programs is lacking. Although previous publications have addressed the status of parental leave policy among...
BACKGROUND AND PURPOSE
A uniform policy on parental leave in radiology training programs is lacking. Although previous publications have addressed the status of parental leave policy among radiology residency programs, the state of parental leave in radiology fellowships has not been addressed to date. Our aim was to determine the state of parental leave policies in American neuroradiology fellowship programs.
MATERIALS AND METHODS
An Internet survey was sent to the directors of neuroradiology fellowship programs listed on the Accreditation Council for Graduate Medical Education Web site ( = 87) in January 2020. The questionnaire assessed the policies of the fellowship programs and Program Directors' attitudes toward maternal and paternal leave. Four reminders were sent during the 3 weeks before closing data collection.
RESULTS
The response rate was 76% (66/87). Ninety-four percent (62/66) of program directors claimed to have a maternal leave policy, of which 51/62 (82%) were written and 53/62 (85%) were paid. Additionally, 77% (51/66) had a policy for paternal leave, of which 80% (41/51) were written and 76% (39/51) were paid. The average length of paid leave was 6.7 ± 3.25 weeks for new mothers and 2.9 ± 2 weeks for new fathers. Unpaid leave was mostly based on the Family and Medical Leave Act. Fellows were responsible for making up call duties during the parental leave in 47% of the programs. Radiation exposure was restricted in 89% of the programs during pregnancy. Policies addressed breast feeding and untraditional parenthood in just 41% of the responding programs. Most program directors supported the development of a unified national policy on maternal (83%) and paternal (79%) leave.
CONCLUSIONS
Most neuroradiology fellowship programs have explicit maternal and paternal leave policies that grant paid leave to trainees. Some also offer unpaid leave, mostly through Family and Medical Leave Act guidelines. A uniform policy derived from the Accreditation Council for Graduate Medical Education and/or American Board of Radiology would be useful and overwhelmingly accepted.
Topics: Education, Medical, Graduate; Fellowships and Scholarships; Female; Humans; Internship and Residency; Male; Parental Leave; Pregnancy; Radiologists; Radiology; Surveys and Questionnaires; United States
PubMed: 32646942
DOI: 10.3174/ajnr.A6648 -
International Journal of Radiation... 2022Hypoxia (low oxygen) is a common feature of solid tumors that has been intensely studied for more than six decades. Here we review the importance of hypoxia to... (Review)
Review
PURPOSE
Hypoxia (low oxygen) is a common feature of solid tumors that has been intensely studied for more than six decades. Here we review the importance of hypoxia to radiotherapy with a particular focus on the contribution of hypoxia to immune responses, metastatic potential and FLASH radiotherapy, active areas of research by leading women in the field.
CONCLUSION
Although hypoxia-driven metastasis and immunosuppression can negatively impact clinical outcome, understanding these processes can also provide tumor-specific vulnerabilities that may be therapeutically exploited. The different oxygen tensions present in tumors and normal tissues may underpin the beneficial FLASH sparing effect seen in normal tissue and represents a perfect example of advances in the field that can leverage tumor hypoxia to improve future radiotherapy treatments.
Topics: Female; Humans; Hypoxia; Immunity; Neoplasms; Oxygen; Radiation Oncology; Radiotherapy; Radiotherapy Dosage
PubMed: 34726575
DOI: 10.1080/09553002.2021.1988178 -
International Journal of Radiation... Jan 2022Proton therapy is increasingly being used as a radiation therapy modality. There is uncertainty about the biological effectiveness of protons relative to photon... (Review)
Review
Proton therapy is increasingly being used as a radiation therapy modality. There is uncertainty about the biological effectiveness of protons relative to photon therapies as it depends on several physical and biological parameters. Radiation oncology currently applies a constant and generic value for the relative biological effectiveness (RBE) of 1.1, which was chosen conservatively to ensure tumor coverage. The use of a constant value has been challenged particularly when considering normal tissue constraints. Potential variations in RBE have been assessed in several published reviews but have mostly focused on data from clonogenic cell survival experiments with unclear relevance for clinical proton therapy. The goal of this review is to put in vitro findings in relation to clinical observations. Relevant in vivo pathways determining RBE for tumors and normal tissues are outlined, including not only damage to tumor cells and parenchyma but also vascular damage and immune response. Furthermore, the current clinical evidence of varying RBE is reviewed. The assessment can serve as guidance for treatment planning, personalized dose prescriptions, and outcome analysis.
Topics: Photons; Proton Therapy; Protons; Radiation Oncology; Radiotherapy Planning, Computer-Assisted; Relative Biological Effectiveness
PubMed: 34407443
DOI: 10.1016/j.ijrobp.2021.08.015 -
Skeletal Radiology Apr 2022To assess the perception of equity and respect in the workplace and within the SSR. We hypothesized that responses would differ by gender and minorities underrepresented...
PURPOSE
To assess the perception of equity and respect in the workplace and within the SSR. We hypothesized that responses would differ by gender and minorities underrepresented in medicine (URiM) status.
METHODS
An electronic survey was sent to 1,531 SSR members between January 2020 and March 2020 to determine perception of equity and respect. Descriptive statistics were calculated, and analysis of differences in response by gender/minority status was performed using the Fisher's exact test. The study was exempt from IRB approval.
RESULTS
There were 176 responses (11.5%). Most respondents (61.9%) were between 30 and 50 years. Members identified as male (M) in 74.4%, as female (F) in 25.0%, and as "other" in 0.6%. URiM comprised 9.1% of members. Women worked more commonly in academia (p = 0.005), had the perception of unequal opportunities for leadership positions within the institution (p = 0.006), and emphasized the importance of having a mentor of the same gender (p = 0.001). URiM members were less likely to hold a leadership position (p = 0.1, trend), had a perception of unequal opportunities for leadership positions within the institution (p = 0.06, trend), and reported the importance of having a mentor of the same race (p = 0.06, trend). There were no significant differences between gender or URiM status and perception of the SSR to provide an inclusive environment and leadership opportunities (p ≥ 0.39).
CONCLUSION
While survey participation was limited and potentially biased, respondents perceived that women and minorities have fewer opportunities and are treated with lower regard in the workplace compared to male, non-minority colleagues.
Topics: Female; Humans; Leadership; Male; Minority Groups; Perception; Radiology; Respect
PubMed: 34477922
DOI: 10.1007/s00256-021-03901-w