Day 3 :
- Track 2: Advances in Imaging
Session Introduction
Yogesh Thakur
The University of British Columbia, Canada
Title: Comparison of simultaneous integrated boost intensity-modulated radiation therapy and conventional accelerated hyper-fractionated radiotherapy for limited disease small-cell lung cancer
Biography:
Yogesh Thakur completed his PhD at The University of Western Ontario in 2009. He is currently the Medical Physics Lead at Vancouver Coastal Health Authority and a Clinical Assistant Professor in the Department of Radiology at the University of British Columbia. He has published more than 15 papers in reputed journals, 1 book chapter, and peer reviewed manuscripts for numerous reputed journals. He is a member of the Canadian College of Physicists in Medicine, certified in Diagnostic Imaging and Mammography.
Abstract:
CT examinations are identified as the largest radiation dose/exam contributor to the population from medical imaging. The AAPM report 204 advocated the use of Size Specific Dose Estimates (SSDEs) to dose estimation; however effective dose calculation using SSDE has not been validated. This work aims to determine whether the published k-factor for chest CT is valid using SSDE approach. 24 patients underwent clinically indicated chest CT exams, scanned with our institutional CT protocol. Patient data was categorized into 4 groups based on sex and BMI (large: >25 kg/m2 and small: <25 kg/m2). Monte Carlo (MC) simulations were performed using patient data to estimate organ absorbed dose and calculate E via ICRP-103 methods (E-MC) and compared with E estimated with k-factor (E-k) and with SSDE/k-factor (E-SSDE). A significant difference was found between E-MC and E-k for small females (P<0.05). Differences in E-SSDE and MC-E were significantly different for all groups (P<0.05) except small females, where the difference between E-SSDE and E-MC was not significantly different (P>0.05). The range of difference between E-MC and E-k was +/- 0.8 mSv. Dose was underestimated by 45% for the smallest female (BMI-17.0). Data suggested that E-k is valid to estimate effective dose in chest CT for males between 17-32 BMI and females between 26-30 BMI. Small females were significantly underestimated using the E-k method by upto 45%. SSDE improved E estimates for small females. Use of the currently established k-factor of 0.014 mSv/(mGy-cm) is a valid method to estimate effective dose for males and large females in chest CT.
Farhood Alsoos
Damascus University, Syria
Title: Evaluation of right ventricle systolic function by right ventricular outflow tract systolic excursion using ultrasound
Biography:
Farhood Alsoos completed her Master’s degree in Cardiology from Damascus University, Syria. He has published many papers in reputed journals. He is currently pursuing his research interests in the field of echocardiography
Abstract:
Background: Assessment of Right Ventricle (RV) systolic function has a prognostic and therapeutic value, and this assessment is not easy by using ultrasound. The aim of this study was to assess a new way to evaluate RV systolic function, by studying Right Ventricular Outflow Tract Systolic Excursion (RVOTSE). Methods: RVOTSE was measured by using M-Mode from the parasternal short-axis view at the level of the aortic valve, and was defined as the systolic excursion of the right ventricular outflow tract anterior wall endocardium in millimeter. A total of 104 patients were studied and separated into two groups: 51 patients with reduced RV function, RV fractional area change (FAC) <35% and tricuspid annular plane systolic excursion (TAPSE) <1.6 cm] and 53 patients with normal RV function (FAC) ≥35% and TAPS ≥1.6 cm. RVOTSE was measured in the two groups and compared with right ventricular outflow tract fractional shortening (RVOTFS) and tricuspid annular systolic excursion velocity S¢. Results: The sensitivity of RVOTSE as a method of diagnosing reduced RV systolic function was 98% and the specificity was 100%. The sensitivity of Tissue S¢ was 96% and the specificity was 94%. The sensitivity of RVOTFS was 80% and the specificity was 98%. There was no correlation between RVOTSE and ejection fraction, also between RVOTSE and pulmonary artery systolic pressure in patients with reduced RV systolic function. There was a strong correlation between RVOTSE and the other ways to evaluate RV systolic function. Conclusion: RVOTSE is a new, simple, sensitive and specific ultrasound way to evaluate RV systolic function.
Andrew Smith
Memorial University, Canada
Title: Estimating fluid responsiveness and volume status via tracking and segmenting the IVC in ultrasound imagery at the point of care
Biography:
A Smith completed his MEng in 2001, MD in 2005 and emergency medicine residency training at Memorial University in 2008. He currently works in the Health Sciences ER and was appointed as an Assistant Professor with Memorial in 2012. To date, he developed and served as director of Memorial’s Point of Care Ultrasound program training students and clinicians to use ultrasound at the bedside. He is cross-appointed with the Faculty of Engineering and Applied Sciences with research interests in non-invasive monitoring, Point of Care Ultrasound, and telemedicine. He is using his research interests to create formal biomedical engineering opportunities at Memorial.
Abstract:
Accurate resuscitation of the critically-ill patient using intravenous fluids and blood products is a challenging, time sensitive task. Insufficient or excessive administration of fluids leads to increased morbidity, mortality and length of stay in hospital. In recent years, clinicians have been integrating portable ultrasound with their clinical impression to improve diagnostic certainty and guide fluid administration. Dynamic imaging of the IVC and its respiratory variation correlates moderately well with fluid responsiveness in the intubated and ventilated patient while suggesting hyper and hypovolemia in the spontaneously breathing patient at extremes of volume status. Unfortunately, ultrasound of the IVC is not a panacea however does represent an opportunity for the application of existing and emerging medical image processing techniques to advance the field of non-invasive monitoring. This presentation will highlight first attempt to develop an algorithm capable of automatically tracking and measuring the IVC compared to human operators across a diverse range of image qualities. Researchers incorporated a modified-watershed segmentation technique and centroid tracking to analyze a convenience sample of 15 ultrasound videos from spontaneously breathing patients collected while in the ER. Minimal tracking failures and high levels of agreement between manual and algorithm measurements were demonstrated on good quality videos. Addressing problems such as gaps in the vessel wall and intra-lumen speckle should result in improved performance in average and poor quality videos. Semi-automated measurement of the IVC for the purposes of non-invasive estimation of fluid responsiveness and volume status poses challenges however is feasible.
Sunanda Bhatnagar
Maharashtra University of Health Sciences, India
Title: Ultrasonographic imaging of salivary glands: An early predictor of Sjogren’s syndrome in patients with rheumatoid arthritis
Biography:
Sunanda Bhatnagar is MDS (Gold Medalist) of D Y Patil University School of Dentistry, Navi Mumbai, and she is specialized in Oral Medicine and Radiology. She is the Author of 10-publications in prestigious journals/conference proceedings inclusive of international PubMed indexed journal and specialty journal. She has received Best Scientific Paper Award from the Indian Academy of Oral Medicine and Radiology.
Abstract:
Rheumatoid arthritis is a slowly progressive systemic chronic inflammatory disease of the connective tissue which affects joints, often leading to permanent deformity, influencing other systems also. Sjogren’s syndrome is a chronic auto-immune disorder of the exocrine glands with associated lymphocytic infiltrates. Dryness of mouth and eyes referred to as Sicca syndrome results from involvement of the salivary and lacrimal glands. This exocrinopathy when occurs in the presence of another auto-immune disorder such as Rheumatoid arthritis is termed as secondary Sjogren’s syndrome. This paper is based on a combined radiological and fundamental study of salivary glands aimed to assess the ultra-sonographic technique as a sensitive and an early predictor of Sjogren’s syndrome in patients with Rheumatoid arthritis. The patients were assessed for significant structural changes and salivary functions. Some of the ultra-sonographic findings derived in the study of patients with Rheumatoid arthritis were: Course and heterogeneous parenchymal echo pattern, a few levels IB lymphadenopathy, increased or decreased vascularity, coarse honeycombed parenchymal appearance. The suggested conclusion of this paper is that ultrasonography of salivary glands with Rheumatoid arthritis compared with normal subjects is an effective method for diagnosing early changes and that patients with early onset and long standing history of Rheumatoid arthritis showed representative structural changes, suggestive of increased pre-disposition to secondary Sjogren’s syndrome.
Sornsupha Limchareon
Burapha University, Thailand
Title: Physician-performed focused ultrasound: An update on its role and performance
Biography:
Sornsupha Limchareon is graduated from University of Thailand in 1990 and completed a residency in radiology from Chulalongkorn Hospital in 1993. She is a Head, Division of Radiology and Nuclear Medicine at Burapha University Hospital, Thailand. She has worked in medical imaging for more than 20 years. Her research interests include ultrasound and medical education.
Abstract:
There is an increase in the use of focused ultrasound (US) by physicians because it offers the major benefit of reduction in time to diagnosis. Some of these physicians have received formal training on focused ultrasound, others have not received any such training. However, among the formal training given on focused US, there is inconsistency across the teaching protocols. This review presents performances of focused US commonly performed by physicians, compared with radiology US. The various teaching protocols are also discussed.
Allan Felipe Fattori Alves
Bioscience Institute of University, Brazil
Title: Construction of pediatric homogeneous phantoms for optimization of chest and skull radiographs
Biography:
Allan Alves has completed his Master Degree at the age of 26 years from Univ. Estadual Paulista, Brazil. He is currently a PhD Student at Univ. Estadual Paulista. His main research lines are image quality evaluation in digital radiography systems and dosimetry applied to interventional radiology. Allan also has experience in quality control of X-ray equipments and quality assurance management in hospital routines.
Abstract:
We developed two pediatric patient-equivalent phantoms, the Pediatric Chest Equivalent Patient (PCEP) and the Pediatric Skull Equivalent Patient (PSEP) for children aged 1 to 5 years. We also used both phantoms for image quality evaluations in computed radiography systems to determine Gold Standard (GS) techniques for pediatric patients. We determined the simulator materials thickness (Lucite and aluminum) through biological tissues quantification (lung, soft, and bone) using an automatic computational algorithm. To objectively establish image quality levels, two physical quantities were used: effective detective quantum efficiency and contrast-to-noise ratio. These quantities were associated to values obtained for standard patients from previous studies. Results: For chest radiographies, the GS technique applied was 81 kVp, associated to 2.0 mAs and 83.6Gy of entrance skin dose (ESD), while for skull radiographies, the GS technique was 70 kVp, associated to 5 mAs and 339Gy of ESD. Conclusion: This procedure allowed us to choose optimized techniques for pediatric protocols, thus improving quality of diagnosis for pediatric population and reducing diagnostic costs to our institution. These results could also be easily applied to other services with different equipment technologies.
- Track 4 : Medical Imaging
Track 5 : Imaging Probes, Chemistry and Reporter Genes
Session Introduction
Jonathan Fitzsimmons
Brookhaven National Lab Upton, USA
Title: When beta therapy fails – Is alpha therapy a solution?
Biography:
Jonathan Fitzsimmons completed his master from Johns Hopkins University in 2000, and received his PhD in radiochemistry in 2005 from University of Missouri-Columbia. He performed postdoctoral studies at Los Alamos National Laboratory and research at the University of North Carolina at Chapel Hill. He is currently a medical scientist at Brookhaven National Laboratory, where he developed a production scale separation of 68Ge, and is part of the TriLab team to develop 225Ac on a production scale. He has published over ten papers in reputed journals, has one patent and is serving on an expert panel for the US Pharmacopeia.
Abstract:
Actinium-225 (225Ac) has a half life of 9.92 days, decaying through multiple intermediate nuclei to a daughter isotope Bismuth-213 (213Bi) with a half life of 45 min. Both isotopes have been investigated for targeted alpha therapy. Researchers have shown 213Bi DOTATOC can shrink tumors in patients that had previously not responded to similar treatments with the beta emitting isotopes 90Y and 177Lu . The United States Department of Energy (US DOE) supplies purified 225Ac from a generator system associated with the parent isotope 229Th, but this approach does not supply enough 225Ac for the applications associated with both 225Ac and 213Bi. To meet this demand the US DOE has initiated a Tri-lab (Los Alamos-Brookhaven-Oak Ridge National Laboratories) effort to develop 225Ac by irradiation of a thorium target with high energy (90-200 MeV) protons. One of the main challenges associated with this production route is isolation of 225Ac from bulk thorium and other radionuclides (~400) formed as a result of fission and other nuclear reactions. In targeted alpha therapy with 225Ac the retention of the multiple daughters of 225Ac at the target site has been problematic. A chemical method to produce a targeting nanochelator to: capture 225Ac, retain the daughters of alpha decay, and target tumors will be discussed.
Yuchong Rachel Jiang
Sheridan College, Canada
Title: A 3D computer assisted treatment planning system for breast cancer brachytherapy treatment
Biography:
Yuchong Rachel Jiang is a faculty of Applied Science and Technology, Sheridan College Institute of Technology and Advanced Learning. He specializes in the treatment of breast by using 3D computer assisted treatment.
Abstract:
This paper describes a 3D computer assisted treatment planning system that we created for breast cancer brachytherapy treatment. The system was developed using mathematical theories for accurate volume estimation and dose analysis as well as advanced 3D visualization technologies. The patient treatment volume reconstructed by a method developed in our system significantly improves the accuracy of existing methods and guarantees the high volume accuracy requirement of radioactive seed implantation procedure for this treatment. The virtual 3D environment in our system enables radiation oncologists to perform volume measurements, seed placements, and dose distribution planning and analysis based on 2D contours on patient CT images. Furthermore, the system is able to embed placed seeds on original patient CT images and displayed in 3D. Our system achieves 99.73% accuracy in volume estimation measured against the true volume and is statistically significantly more accurate than current existing commercial software at the p=0.05 level. Further development will be discussed.
Ibrahim Karademir
Eskisehir Military Hospital, Turkey
Title: Short-term reproducibility of apparent diffusion coefficient estimated from diffusion-weighted MRI of the prostate
Biography:
Ibrahim KARADEMIR has completed his M.D. at the age of 25 years from Gulhane Military Medical Faculty and his radiology residency in the same institution 2007 to 2011. He had studied in University of Chicago in 2011-2012 on Prostate Imaging. He is working as a Radiologist in Eskisehir Military Hospital.
Abstract:
Purpose: The purpose of the study is to determine shortterm reproducibility of apparent diffusion coefficient (ADC) estimated from diffusion-weighted magnetic resonance (DW-MR) imaging of the prostate. Methods: Fourteen patients with biopsy-proven prostate cancer were studied under an Institutional Review Board-approved protocol. Each patient underwent two, consecutive and identical DW-MR scans on a 3T system. ADC values were calculated from each scan and a deformable registration was performed to align corresponding images. The prostate and cancerous regions of interest (ROIs) were independently analyzed by two radiologists. The prostate volume was analyzed by sextant. Per-voxel absolute and relative percentage variations in ADC were compared between sextants. Per-voxel and per-ROI variations in ADC were calculated for cancerous ROIs. Results: Per-voxel absolute difference in ADC in the prostate ranged from 0 to 1.60 9 10-3 mm2 /s (per-voxel relative difference 0% to 200%, mean 10.5%). Variation in ADC was largest in the posterior apex (0% to 200%, mean 11.6%). Difference in ADC variation between sextants was not statistically significant. Cancer ROIs’ per-voxel variation in ADC ranged from 0.001 9 10-3 to 0.841 9 10-3 mm2 /s (0% to 67.4%, mean 11.2%) and per-ROI variation ranged from 0 to 0.463 9 10-3 mm2 /s (mean 0.122 9 10-3 mm2 /s).
Luis Moreno Sánchez
Universidad Central de Venezuela, Venezuela.
Title: Irradiation in central nervous system tumors
Biography:
Moreno Sanchez is a Venezuelan Radiation Oncologist and Nuclear Medicine Physician, graduated in Hospital Universitario de Caracas in the Universidad Central de Venezuela (UCV), Caracas, Venezuela, with a fellowship in Advanced Radiotherapy Techniques. Currently works in CDD Radioterapia – Clinica Abreu as an External Advisory and and Assistant Professor in the only radiation oncology residence of Dominican Republic, few months ago was positioned as Radio Oncology Coordinator in the National Cancer Institute Rosa E. Tavares (INCART).
Abstract:
Historically the treatment of brain metastases is viewed with skepticism. The hospitalization by itself prolongs life by one - two months. Treatments with steroids reduce symptoms, but effect is short. Whole Brain Radiotherapy (WBRT) have been made mainstay for several decades, increasing survival up to six months, but it has been associated with neurocognitive impairment. On the other hand, when possible surgery is is the gold standard indication in a single or with significant mass effect lesions. In the past decade radiosurgery has become a very popular alternative, with high efficiency and few side effects, but until now 3D conformal radiotherapy or IMRT continue to be most employee techniques, including WBRT with hippocampal sparing.
Saira Naz Sufian
The Aga Khan University Hospital, Pakistan
Title: Evaluation of common risk factors related with breast carcinoma in females: A hospital based study in Karachi, Pakistan
Biography:
Saira Naz Sufian is an Assistant Professor of Radiation Oncology at The Aga Khan University Hospital. She specializes in the treatment of breast and gynecological cancers. Her research interests include Evaluation of common risk factors related with Breast Carcinoma in females.
Abstract:
Introduction: Breast malignancy is one of the leading causes of death in female worldwide. In Pakistani females breast carcinoma is the most repeatedly diagnosed malignancy. There are a number of risk factors associated with breast cancer but in Karachi Pakistan there is insufficient data available. Materials & Methods: A case control study was conducted on females, age group between 30-80. This study was done by a retrospective data collection from a proforma obtained prior to mammography in Aga Khan University Hospital Karachi, Pakistan. A total of 108 females with primary malignancy of breast were included and 108 controls were also included from same data. Cases were defined as female patients with a histo-pathological proof of breast malignancy. An equal number of controls were selected from same cohort of patient. The controls were healthy with normal mammogram. Relationship of these factors with disease was studied using logistic regression to calculate Odds ratios (ORs) and 95 % confidence interval (CIs). Male cases were excluded and exclusion criteria for controls were those with endocrine disorders, known malignant, hormonal disease, gynecological diseases. Results: A total of 14 variables were analyzed and based on Odds ratio and confidence interval for each of breast cancer factors 7 variables were found to be “the risk factors†for development of breast cancer, these factors were the older age, family history of breast cancer, family history of other carcinomas, personal history of breast carcinoma, early age of menarche, older age of mother at first delivery and lesser number of children. Five factors i.e. parity, breast feeding, Oral Contraceptive Pills consumption, past history of oophorectomy and hysterectomy showed protective association. One variable i.e. use of hormonal replacement therapy showed controversial association and one of the variable i.e. the marital status was not significant in this study. Conclusion: It is concluded that most of the well-known risk factors of breast cancer are also associated with breast cancer in the female population of Karachi Pakistan. High risk patient can be focused by the help of this study and screening can be more effective in the early diagnosis before clinically evident breast malignancy. The breast cancer screening program would be more preventive and effective if high risk patients are highlighted by the clinician.
Jimoh O Agbaje
Katholieke University Leuven, Belgium
Title: Visibility of mandibular canal on panoramic radiograph after bilateral sagittal split osteotomy (BSSO)
Biography:
Agbaje has completed his PhD in 2013 from Katholieke University Leuven. He is an FWO postdoctoral fellow at the same University. He has published more than 30 papers in reputed journals and has been serving as an editorial board member of repute.
Abstract:
This study aimed to assess the visibility of the mandibular canal (MC) on panoramic radiographs after BSSO, and to investigate what factors affect this MC visibility. We assessed MC visibility on panoramic radiographs of 200 BSSO patients. Images were acquired preoperatively (T0), immediately postoperatively (T1), six months postoperatively (T2), and one year postoperatively (T3), from three different predetermined regions of the mandible: the angle (Angle), distally to the second molar (M2), and mesially to the first molar (M1). All analyses were performed using SAS version 9.22. The visibility of the MC was registered preoperatively in over 96% (387/400) of the measurements at the angle of the mandible, 79% (317/400) at M2, and less than 63% (251/400) at M1. MC visibility decreased immediately after the operation and increased thereafter. Region of the mandible (P ≤ 0.0001), plate removal (P ≤ 0.0001), time of assessment (P ≤ 0.0001), and age (P = 0.0034) were important predictors of whether MC would be radiographically visible. The visibility of the MC decreased immediately after BSSO, especially at the operation site (M2 and M1), while maximum MC visibility was achieved at twelve months postoperatively in our series. Since MC was not visible at the operation site after BSSO for 50% of the subjects, it may be necessary to use additional visualization modalities for postoperative patient assessment in this region.
- Track 3: PET/MRI versus PET/CT Hybrid
Session Introduction
Mark G Benz
Engineering Horizons International and Safer Pediatric Imaging, USA
Title: Improved spatial resolution and lower-dose pediatric CT imaging: a feasibility study to evaluate narrowing the x-ray photon energy spectrum
Biography:
Benz is a metallurgist and currently working on new technologies to reduce the cancer risk associated with the x-ray dose for pediatric CT. From 1961 to 2001 Dr. Benz was on the research staff of the GE Corporate Research and Development Center. Dr. Benz is a graduate of Middlebury College (AB in Chemistry), and the Massachusetts Institute of Technology (SM and ScD in Metallurgical Engineering). He is a recipient of the GE Coolidge Fellowship, a Fellow of ASM International, and a Member of the National Academy of Engineering. He has presented 98 papers and has received 123 patents.
Abstract:
This feasibility study has shown that improved spatial resolution and reduced radiation dose can be achieved in pediatric CT by narrowing the x-ray photon energy spectrum. The approach used to evaluate narrowing the spectrum was to place a hafnium filter between the x-ray generator and a pediatric abdominal phantom. The CT platform used for this study was a GE system originally manufactured in 1999 in the process of being refurbished. This system had the advantage that it provided easy access to the x-ray portion of the system to add the hafnium filter. The observational measurements taken with the hafnium filter in place at 120 kVp showed a Spatial Resolution Metric of 2.3 mm at the low dose of 12 mGY. This is to be compared to the higher dose of 32 mGy required when the hafnium filter was not used. Further improvements are anticipated with installation of modified noise reduction software, currently under development. The research team completing this study included: Mark G Benz ScD, metallurgist retired from GE, consultant for Engineering Horizons International and Safer Pediatric Imaging; Matthew W. Benz MD, pediatrician with Southboro Medical Group; Steven B. Birnbaum MD, radiologist with Dartmouth Hitchcock; Eric Chason PhD and Brian W. Sheldon ScD, materials scientists with Brown University; and Dale McGuire, Director of CT Operations at BC Technical, Inc. A complete description of this study is published in Pediatric Radiology
Biography:
Marsha Haley, MD is board-certified in radiation oncology. She received her medical degree from the University of Virginia School of Medicine in Charlottesville, Va., and completed a residency in radiation oncology at the University of Pittsburgh School of Medicine. She is an Assistant Professor of Radiation Oncology at Magee-Womens Hospital of UPMC. She specializes in the treatment of breast and gynecological cancers. Her research interests include gynecological brachytherapy and the public health effects of unconventional gas extraction. She is a member of the American Brachytherapy Society and the American Society for Radiation Oncology.
Abstract:
MRI is a valuable tool for the radiation oncologist. Pretreatment MRI can be utilized as a tool to help plan radiation treatment portals, by delineating the extent of disease prior to chemotherapy and/or surgery. MRI can also be used post-operatively to assist with treatment planning. Advantages include superior anatomic delineation of soft tissue structures, improvement in lymph node imaging detail, and improved inter observer planning for the boost volume. Care studies include a case locally advanced breast cancer and a case of radiation treatment planning.
Anat Biegon
Stony Brook University, USA
Title: High contrast visualization of breast cancer lesions with [11C] vorozole PET
Biography:
Anat Biegon is Professor of Neurology and Radiology at Stony Brook University School of Medicine. She received a PhD in Neurobiology from the Weizmann Institute of Science in Rehovot, Israel and had held research positions in academia and industry. Employing state of the art brain mapping techniques in human subjects including molecular imaging with positron emission tomography (PET), structural and functional MRI, as well as post mortem analysis of human and animal brain samples, she is engaged in studies of the brain mechanisms affected in brain injury, stroke, Alzheimer’s disease and neuroinflammation. Her work includes development and validation of novel radiotracers and drugs for improving diagnosis and treatment of brain disorders.
Abstract:
More than a half of breast tumors are known to overexpress estrogen synthase (aromatase, Cyp19A gene product); and aromatase inhibitors are the mainstay of current hormonal adjuvant therapy in breast cancer. Vorozole is a potent aromatase inhibitor which was labeled with carbon11 and recently used to image aromatase with PET in healthy men and women. Here we describe the first case of breast cancer to be imaged with this tracer. A 68 year old woman recently diagnosed with stage 4 invasive lobular carcinoma was given 7.3 mCi [11C]vorozole intravenously. Forty minutes after injection, she was positioned in the prone position in a high resolution PET/CT (Siemens) scanner; with both breasts in the field of view. PET emission data were collected over a 50 minute period. The PET images revealed a large area of very high intensity in the left breast; corresponding in location and size to the diagnostic mammography; and multiple smaller regions with high intensity in the sternum and thoracic spine. The dynamic study included 5 frames of 10 min. duration each. Regions of interest (ROIs) were drawn with PMOD over the first frame and the corresponding time-activity curves were obtained. ROIs were placed in 2 locations of the carcinoma, in the breast adjacent to the tumor and in the contralateral breast. The ratio of tracer uptake in the tumor to the uptake in the same location in the contralateral breast ranged from 4.8 to 7.2 in the first frame (40-50 min). Both absolute uptake and ratio of tumor to contralateral breast decreased over time between 50 and 90 minutes post injection; suggesting a short (10-20min) acquisition may be sufficient. The [11C]vorozole PET image compares favorably with other imaging studies performed on the same patient, including FDG and MRI; supporting further investigation and optimization of this tracer in breast cancer.
Radim Jancalek
St. Anne’s University Hospital Brno, Brno, Czech Republic
Title: Developing role of advanced MRI techniques for diagnosis of glioblastoma relapse after complex oncology treatment
Biography:
Radim Jancalek has completed his PhD at the Masaryk University, Brno, Czech Republic. He started to be specialized in neurooncology, functional neurosurgery, and neuroimaging. He is the head of the Department of Neurosurgery, St. Anne’s University Hospital, Brno, Czech Republic, and the leader of the Neurooncology Research Group, St. Anne’s University Hospital. He has published more than 32 papers in reputed journals and has been serving as an editorial board member of repute.
Abstract:
Glioblastoma (GBM) is the most common primary brain tumor of adults. Despite a multidisciplinary approach, GBM frequently recurs as a new gadolinium-enhanced MRI lesion at or near the site of the original tumor; thus, at the site of high-dose target volume for radiotherapy. An early differentiation between GBM relapse and changes in connection with oncology treatment (pseudoprogression) is still problematic by common imaging techniques. The project goal was to verify whether the combination of apparent diffusion coefficient (ADC) and MR spectroscopy increases specificity of a structural MRI for early differentiation between HGG relapse and pseudoprogression. Patients (n=24) with GBM and structural progression on MRI after neurosurgical resection and chemo-radiotherapy underwent DWI (ADC map) and 1H MR spectroscopy focused on N-acetylaspartate (NAA), choline (Cho), creatine (Cr), lactate (Lac), and lipids (Lip). The etiology of a lesion was established by a subsequent MRI or biopsy and correlated with results of the MR techniques. Compared to pseudoprogression, HGG relapse was characterized by a significantly lower ADC value, lower NAA concentration, and appearance of Lac+Lip spectra. We found very high sensitivity and specificity of ADC value (≤1300x10-6 mm2/s) and Cho/NAA ratio (≥1.4) to designate the MRI lesion with gadolinium uptake as GBM relapse. ADC value and MRS (mainly Cho/NAA ratio) have ability for the early non-invasive differentiation of GBM relapse from pseudoprogression after oncology treatment.
Sangeeta Taneja
Indraprastha Apollo Hospitals, India
Title: Simultaneous whole body 18F-FDG PET-MRI in primary staging of breast cancer
Biography:
Sangeeta Taneja, completed her Masters in Radio-diagnosis in Jan 2003; a visiting fellow at Seattle Cancer care alliance (2008) & MSK, NY (2012), distinguished herself as a pioneering figure in MR Breast Imaging in India with largest cumulated experience & first to start MR guided breast interventions at Rajiv Gandhi Cancer Institute Delhi, has more than 25 scientific publications in reputed journal and reviewer to national and international journals, presently placed as Sr. consultant in Department of Molecular Imaging and Nuclear Medicine and an active member in the PET MRI project at Indraprastha Apollo Hospitals Delhi India.
Abstract:
Accurate initial staging in breast cancer is important for treatment planning and prognostication. The purpose of this study was to assess the utility of whole body simultaneous 18F-FDG PET-MRI in initial staging of breast carcinoma. Methods 36 patients of IDC of breast on histology underwent initial staging with whole body 18F-FDG PET-MRI on Biograph mMR (Siemens). Primary lesion, nodes and metastases were evaluated on PET, MRI and PET-MRI for lesion count and diagnostic confidence (DC). Kappa co relation analysis was done to assess agreement between PET and MRI. Histopathology, clinical/ imaging follow-up served as the reference standard. Results: 25 of 36 patients (37 index lesions) underwent surgery and 11 received NACT. Highest diagnostic confidence (DC=5) for index lesions obtained with PET MRI compared to PET and MRI alone. 2/36 (5.5%) patients were found to have synchronous contralateral cancer. MRI detected multifocality/multicentricity in 21 patients & 47 satellite lesions of which 23 were FDG avid. Sensitivity for axillary node detection was 60% and 93.3% with false negative rate of 40% and 6.7 % on PET and MRI respectively, and specificity for both was 91%. Distant metastases were found in 8/36 (22%) patients with 91 metastatic lesions on PET (DC>=4) and 105 on MRI (DC>=4) and found statistically significant (P=0.001). Overall PET-MRI led to a change in management in 12 (33.3%) patients. Conclusion: Simultaneous whole body18F-FDG PET-MR, has been found to be comprehensive single session examination in the initial staging of breast cancer.
Saira Naz Sufian
The Aga Khan University Hospital, Pakistan
Title: Accuracy of M.R.I in pretreatment lymph node assessment in gynecological malignancies
Biography:
Saira Naz Sufian is an Assistant Professor of Radiation Oncology at The Aga Khan University Hospital. She specializes in the treatment of breast and gynecological cancers. Her research interests include Evaluation of common risk factors related with Breast Carcinoma in females.
Abstract:
Objective: To determine the accuracy of MRI in detection of metastasis in pelvic and para-aortic lymph nodes from different gynecological malignancies. Place of study: Department of Diagnostic Radiology, Aga Khan University Hospital, Karachi Pakistan. Duration of study: From January 2011 to December 2012. Materials & Methods: It was a retrospective cross sectional analytic study. A sample of 48 women, age range between 20-79 years, fulfilling inclusion criteria were included. All patients had histopathologically proven gynecological malignancies including cervix, endometrium or ovaries and presented for a pretreatment MRI to our radiology department. Results: MRI is 100% sensitive and has 100 % positive predictive value to detect lymph node metastasis in lymph nodes with spiculated margins and it is 100 % sensitive and has 75 % positive predictive value to detect lymph node metastasis in a lymph node with lobulated margins. The sensitivity and positive predictive value of MRI to detect heterogeneous nodal enhancement were 100 % and 75 % respectively. Conclusion: Our study results reinforce that MRI should be used as a modality of choice in the pretreatment assessment of lymph node in proven gynaecological malignancies in order to determine the line of patient’s management, distinguishing surgical from non –surgical cases.
Biography:
Jacob Horsager is a 5th year medical student. He has finished a research year project and has recently published ‘Metabolic liver function measured in vivo by dynamic 18F-FDGal PET/CT without arterial blood sampling’ in EJNMMI Research.
Abstract:
Measurement of hepatic metabolic function by the Galactose Elimination Capacity (GEC) is a clinically valuable prognostic liver test for patients with acute as well as chronic liver disease. The GEC test is based on nearly exclusive hepatic metabolism of galactose by the galacto-kinase enzyme and gives a measure of the total hepatic metabolic function but no information on regional variations. Based on the principles of GEC, we developed a PET/CT method with the radio-labeled galactose analog 18F-FDGal for 3D-quantification of regional hepatic metabolic function in vivo. The 18F-FDGal PET/CT method comprises a 20-min dynamic PET recording of the liver with intravenous administration of 100MBq 18F-FDGal. 3D images of the metabolic capacity, in terms of hepatic systemic clearance of 18F-FDGal, are created using a model of irreversible metabolism of the tracer in liver tissue (measured by PET) and arterial blood 18F-FDGal concentration as input. Recently, we refined the method by developing a method for replacing arterial blood sampling by an image-derived input function extracted from the abdominal aorta. Using the method, we demonstrated low metabolic capacity as well as increased metabolic heterogeneity in cirrhosis. These findings demonstrate the importance of estimating regional variation in liver function in order to spare well-functioning liver tissue, e.g. in patients with liver tumors undergoing stereotactic radiotherapy or partial liver resection. The method is easy to implement, as 18F-FDGal is produced using commercially available equipment used for routine production of the common glucose tracer 18F-FDG.
Biography:
Heba Nabil, is a MD candidate, he got his Master degree of radio-diagnosis at Faculty of Medicine, Ain Shams University in 2008. He did his first part of MD in 2012 and first part of FRCR in 2013. He has published two papers named: Follow up in chest tumors: Value of integrated PET/CT and Role of PET/CT in management of chest tumors. He is working as a Radiology Specialist at Nasser Institute for research and treatment, Cairo, Egypt.
Abstract:
To identify the value of PET-CT in follow up of chest tumors. PATIENTS AND METHODS: Whole body PET/CT studies were performed on 29 patients of variable primary & secondary chest tumors. RESULTS: Our findings indicate that FDG PET/CT has an important impact on follow up of chest tumors, as it delineated the metabolic activity of the disease in 21 patients (72.41 %), outlined the metabolic activity of the tumoral residue in 4 patients postoperatively (13.79%), delineated the metabolic activity of the disease for preparing for BMT in 2 patient (6.89%). differentiated between tumoral residue & post irradiation pneumonitis in 1 patient (3.44%), and in 1 patient Initial assessment of the metabolic activity of the disease before determination line of treatment CONCLUSION: Integrated PET/CT imaging, which combines both functional and morphologic imaging in a single examination, has shown how the initial staging and subsequent follow-up of patients with chest tumors can supersede the traditional methods of evaluation in terms of diagnostic accuracy and has an impact on the management. Limitations which must be kept in mind are the subcentimetric pulmonary nodules that below 7 or 8 mm (beyond PET resolution).
Shivraj BahadurSingh
University of the West Indies, Trinidad and Tobago
Title: Mammographic Screening: Is it relevant to developing countries?
Biography:
Shivraj BahadurSingh is currently working on new technologies to reduce the cancer risk associated with the x-ray dose for pediatric CT and Mammographic Screening. He is currently working at University of the West Indies which is based at Trinidad and Tobago.
Abstract:
In the First world Mammogram screening for breast cancer is well established, its value, however, continues to be questionable. Multiple recent studies have shown that mammogram screening programs lead to increased costs and unnecessary further testing with no benefit to the patient. In developing countries clinical breast examination can be equally useful and more cost effective than mammograms, as shown by Mittra in 1995. Breast cancer presents at a later stage and in the pre-menapausal age group in the developing world. The unreliability of this modality as a screening tool is well recognized in this population thus further questioning its suitability. In many third world countries mammograms are costly and unavailable to the general population thus hindering screening. The different characteristics of breast cancer presentation in the third world coupled with cost and availability issues suggest that mammographic screening may not be beneficial in developing countries. Financial resources may be better directed to managing other aspects of the disease.
- Track 1: Acquisition of Radiological Images
Session Introduction
Jiani Hu
Wayne State University, USA
Title: Can we improve MRI detection sensitivity by 2 to 3 orders?
Biography:
Jiani Hu’s research interests include the development of MR spectroscopy and its utilization in studying metabolic changes that take place in diseases tissue. He is currently studying: West Nile disease, Breast Cancer and Neuromuscular Disorders.
Abstract:
Introduction: MRI features complex signals and is capable of providing both magnitude and phase information. Unlike MR magnitude information, MR phase information had been largely discarded due to its high sensitivity to susceptibility related field variations and resultant blooming effect that often severely degrades the quality of phase images. However, considering a new point of view, this information may also have the potential to provide indirect information on an ultra-small object that is two to three orders smaller in size than those currently detectable with MRI. In this study, we report our study on the feasibility of improving MRI detection sensitivity by 2 to 3 fold using the combination of phase blooming effects and high susceptibility of MRI contrast agents. Results: The resolution of phantom images was 0.5x0.5x2 mm3. Total acquisition time was 14:52 minutes. TE was 20 ms. The susceptibility difference ∆χ between the straw and background gel was estimated to be about 3.8ppm. Blooming effect was about 8.0 times larger in radius for the ferritin filled straw. This translated into a 512 times increase in 3D volume relative to the size shown in magnitude. There are about 14 such small bubbles in this single slice that are visible in the phase image but only two can be positively identified in magnitude image while the others were either barely visible or not seen at all. The straw phantom results strongly demonstrate the spatial extensibility of the phase blooming effect, and the capability of utilizing this effect for detecting small objects that MRI magnitude images fail to detect. It is important to note that the susceptibility changes caused by air are smaller than ferritin, P904 or other SPIO nanoparticles. This suggests that even smaller objects than those bubbles can be detected if they were filled with SPIO. Discussion: Our theoretical investigation and in vitro model study have demonstrated the feasibility of using blooming effect to image an ultra-small object that is two to three orders smaller than those currently detected with MRI. We are currently performing in vivo experiments to determine whether this is the case for in vivo animal models. Improving spatial resolution is a constant goal in tumor detection. The significance of early cancer detection is well known: Favorable clinical outcomes can be achieved for many cancers using existing medical techniques if the cancer can be detected in its early stages.
Fatemeh Nasri
Khatam hospital, Iran
Title: Evaluation of multi-slice computed tomography in assessment of cochlear implant electrode position
Biography:
Fatemeh Nasri received her medical doctor degree as top one percent from Iran University of Medical Science, Tehran, Iran, in 2007, and the medical speciality degree in Radiology from Tehran University of Medical Science, Tehran, Iran, in 2012. She worked as an assistant professor in Afzalipour Hospital, Kerman University of Medical Science from 2012 to 2013, and as a general radiologist in Khatam Hospital, Iranshahr University of Medical Science, Iran from 2013 to 2015. She then moved to Toronto, ON where she is doing research on head and neck radiology, congenital inner ear dyspepsia, and new diagnostic imaging modalities. She is also interested in women and musculoskeletal imaging.
Abstract:
Cochlear implant has become the standard therapy to rehabilitate patients with severe to profound bilateral sensorineural hearing loss. The position of the electrode in the scala and the depth of its insertion have been shown to be predicting factors of hearing outcomes. This article serves to review the multi-slice computed tomography imaging characteristics and appearance of cochlear implant, their exact position and the depth of insertion in children who underwent cochlear implant surgery. Moreover, in order to evaluate the impact of electrode position on clinical results following the cochlear implant surgery, in this study we also compared the findings about the electrode location with the results of audiometry of children after one year of follow up to find the best location of the electrode, which results in better audiometric outcomes.
Allan Felipe Fattori Alves
Bioscience Institute of University, Brazil
Title: Ischemic stroke detection through image processing techniques
Biography:
Allan Felipe Fattori Alves has completed his Master’s degree from University Estadual Paulista, Brazil. He is currently a PhD student at University Estadual Paulista. His main research lines are image quality evaluation in digital radiography systems and dosimetry applied to interventional radiology. He has experience in quality control of X-ray equipments and quality assurance management in hospital routines.
Abstract:
Stroke is a leading cause of death worldwide. The early diagnosis of both types is essential to avoid irreversible cerebral damage. Non-Enhanced Computed Tomography (NECT) is one of the main diagnostic techniques used to detect strokes. NECT has a wide accessibility to the population, although it is relatively insensitive in detecting acute and small cortical or subcortical infarctions. The Alberta Stroke Program Early CT Score (ASPECTS) is a subjective method of analysis which associated to an adequate CT “windowing and leveling†may increase the detection rate. In this research, we proposed the implementation of an image segmentation system to enhance ischemic stroke and quantify the area and volume of these lesions in NECT. We used different image processing techniques such as morphological filters, discrete wavelet transform and fuzzy c means clustering and developed an automatic computed algorithm to process all images. Subjective analyzes were performed by a neuroradiologist according to the ASPECTS score. These subjective analysis results were compared with objective analyzes performed by the computational algorithm. We evaluated 10 patients with NECT examinations diagnosed with ischemic stroke. Preliminary results indicate that the morphological filters actually improve the ischemic areas. The comparison in area of the ischemic region contoured by the neuroradiologist and the defined area by computational algorithm showed no deviations greater than 12% in any exams. These results show the importance of a computer aided diagnosis software to assist neuroradiology decisions, especially in critical situations such as ischemic stroke.
Biography:
Baosheng Li has completed his PhD/MD in 2004 from Southeast University. He is the Director of the Department of Radiation Oncology and Vice President of Shandong Cancer Hospital. He has published more than 150 papers in reputed journals and has been serving as an Editorial Board Member of several journals.
Abstract:
This study was to compare toxicities, disease control and survival outcomes for limited disease small-cell lung cancer (LD-SCLC) treated with simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) versus conventional accelerated hyper-fractionated radiotherapy. All the patients received 4-6 cycles of platinum plus etoposide. In the SIB-IMRT group (group A) irradiation was given accelerated hyper-fractionated with the dose 57Gy at 1.9Gy twice daily to the gross tumor volume, 51Gy at 1.7Gy twice daily to the clinical tumor volume and 45Gy at 1.5Gy twice daily to the Planning Target Volume (PTV). In the conventional accelerated hyper-fractionated radiotherapy group (group B) the dose was 45Gy in 30 fractions at 1.5Gy twice daily to the PTV. Total of 73 patients were enrolled in the study (35 group A, 38 group B). The white blood cell depression was significantly more common in patients who received SIB-IMRT (P<0.001) and the differences of the other toxicities were not significant between the two groups (P＞0.05). There was a trend toward improved local control for the group A, with an estimated 2-year loco regional recurrence-free survival at 73.8% versus 66.4% for the group A versus the group B, respectively (p=0.350). The median progression free survivals were 29.3 months and 24 months, respectively (p=0.080). The median overall survivals were 37.7 months and 31.9 months, respectively (p=0.108). In one word, SIB-IMRT was well-tolerated in patients with LD-SCLC, and demonstrated a potency to get better progression free survival. It is worth further evaluating in large prospective clinical trials.
N. Purna Chander Reddy
Apollo Health Street, India
Title: CT scan – Automatic tube current modulation
Biography:
Purna Chander Reddy is a Consultant -Principle at Apollo Health Street / Sutherland Healthcare Solutions which is based at India. He has total of 14 years of Radiology field experience. His main area of research interest is radiography and imaging.
Abstract:
AIM OF THE STUDY: To compare the dose difference and state the significance of Automatic Tube Current Modulation (ATCM) in abdominal MDCT examination while maintaining optimum image quality for diagnosis. Results: The varying in MAS values according to ACS for different body counter of the patients was observed. In group A resulted in estimations of dose saving in range of 10-27 %.In group B 8.1-36.6 %, in group C 8.3-33.4%, group D 5.7-19 % with application of ATCM technique. The overall radiation output results shown for forty patients as follows the least is 5.7% and highest is 36.6%.According my study statistics shows there is no correlation between BMI and the estimated dose savings. • Radiation Dose reduction Up to 36.6% was achieved with acceptable diagnostic image quality. • Reduces over all irradiation time. • Helps in reduce stochastic and genetic effects. • Helps in Not only reduce the patient dose as well as occupational dose. • Scan duration is less compare to standard protocol so we can save the time at clinical side. • Effective in breath hold scans (Coronary Angio, Pulmonary Angio, Thorax and Abdomen). • Required dose is applied according to patient body counter. • Helps in decrease scan time in uncooperative and trauma patients. • I conclude that according to the observed results. Aim of the study To compare the dose difference and state the significance of Automatic Tube Current Modulation (ATCM) in abdominal MDCT examination while maintaining optimum image quality for diagnosis. Conclussion The use of Automatic Tube Current Modulation (angular dose modulation and z-axis dose modulation) helps in
Biography:
Waqas Hussain has completed his bachelor’s degree at the age of 24 years from Air University, Islamabad. The research paper of Mr. Waqas manages to attain 3rdp position in the international conference on energy systems and policies (icesp-2014). He developed 3d-model for world wide fund which is an UK based organization. Presented his research papers in different international research based conferences (turkey, Dubai and Pakistan). Currently we have minimum one million hospitals all over the world but none of them have an application catering to sperm morphology. So, now, he is working on this idea using computer graphics and computer vision algorithms.
Abstract:
Currently we have minimum one million hospitals all over the world but none of them have an application catering to sperm morphology. Microscopic evaluation of human sperm quality is a basic requirement of any diagnostic Fertility service, assisted conception (IVF) center or pathology laboratory. Human sperm is evaluated in terms of three key features, namely concentration (sperm count), motility (sperm speed) and morphology (individual sperm shape). Conventional manual microscopic analysis of sperm samples is time consuming (1-2 hours) and lacks accuracy and reproducibility in many IVF centers. Motility and concentration are handled with variable degrees of efficiency (Tomlinson et al 2010) but morphological or individual sperm health and abnormality detection is still missing from the automated software tools. The manual testing for morphology in labs according to world health organization (WHO) standards is labeled flawed by the anthology and fertility researchers due to the following Problems: 1. A dye has to be injected in the immobilized sample so the microscope can pick the Sperms heads well at 1000x magnifications using oil immersion. The dye may transform. The natural morphological characteristics of the original cells. 2. Too much time has to be consumed as 1000x magnification means looking at only a couple of sperms per slide. And if we follow WHO standards at least 200 sperms have to be analyzed, so a lot of images form the microscope has to be taken and processed.