Chest Region Research Articles

Preliminary study on the effects of boysenberry juice intake on brown adipose tissue activity in healthy adults

Brown adipose tissue (BAT) plays an important role in energy metabolism because it uses fatty acids for thermogenesis during cold exposure. Preclinical studies found that boysenberry anthocyanins (BoyACs) activate BAT. Therefore, the aim of this preliminary study was to evaluate how BoyAC intake affects BAT in humans. We performed an open-label single-arm nonrandomized study in healthy volunteers. Before and after 4 weeks of daily consumption of 100 ml boysenberry juice (BoyJ) containing 61 mg of BoyACs, participants were assessed at 24 °C and then after 1 h of mild cold exposure (18 °C). An infrared thermography camera was used to measure skin surface temperatures in the supraclavicular BAT region (Tscv) and the non-BAT region of the upper chest (Tch). Energy metabolism was measured by indirect calorimetry. For each endpoint, we calculated Δ as the difference between values before and after cold exposure and compared the values before and after BoyJ intake. 10 volunteers participated (age: 36.1 ± 4.1, body mass index (BMI): 20.9 ± 0.6). After BoyJ intake, ΔTscv-ch was significantly higher (p = 0.029), but Δ energy expenditure, Δ fat oxidation, and Δ carbohydrate oxidation were not significantly different. We found a significant positive correlation between BMI and Δfat oxidation with BoyJ intake. The results indicate that 4 weeks of BoyJ intake activates cold-induced thermogenesis in the scv-BAT but does not have a significant effect on energy metabolism. BoyJ intake may increase fat oxidation during cold exposure in individuals with higher BMI.Trial registry number: UMIN000043476, 05/03/2021.

Fully Automated Region-Specific Human-Perceptive-Equivalent Image Quality Assessment: Application to 18 F-FDG PET Scans.

We propose a fully automated framework to conduct a region-wise image quality assessment (IQA) on whole-body 18 F-FDG PET scans. This framework (1) can be valuable in daily clinical image acquisition procedures to instantly recognize low-quality scans for potential rescanning and/or image reconstruction, and (2) can make a significant impact in dataset collection for the development of artificial intelligence-driven 18 F-FDG PET analysis models by rejecting low-quality images and those presenting with artifacts, toward building clean datasets. Two experienced nuclear medicine physicians separately evaluated the quality of 174 18 F-FDG PET images from 87 patients, for each body region, based on a 5-point Likert scale. The body regisons included the following: (1) the head and neck, including the brain, (2) the chest, (3) the chest-abdomen interval (diaphragmatic region), (4) the abdomen, and (5) the pelvis. Intrareader and interreader reproducibility of the quality scores were calculated using 39 randomly selected scans from the dataset. Utilizing a binarized classification, images were dichotomized into low-quality versus high-quality for physician quality scores ≤3 versus >3, respectively. Inputting the 18 F-FDG PET/CT scans, our proposed fully automated framework applies 2 deep learning (DL) models on CT images to perform region identification and whole-body contour extraction (excluding extremities), then classifies PET regions as low and high quality. For classification, 2 mainstream artificial intelligence-driven approaches, including machine learning (ML) from radiomic features and DL, were investigated. All models were trained and evaluated on scores attributed by each physician, and the average of the scores reported. DL and radiomics-ML models were evaluated on the same test dataset. The performance evaluation was carried out on the same test dataset for radiomics-ML and DL models using the area under the curve, accuracy, sensitivity, and specificity and compared using the Delong test with P values <0.05 regarded as statistically significant. In the head and neck, chest, chest-abdomen interval, abdomen, and pelvis regions, the best models achieved area under the curve, accuracy, sensitivity, and specificity of [0.97, 0.95, 0.96, and 0.95], [0.85, 0.82, 0.87, and 0.76], [0.83, 0.76, 0.68, and 0.80], [0.73, 0.72, 0.64, and 0.77], and [0.72, 0.68, 0.70, and 0.67], respectively. In all regions, models revealed highest performance, when developed on the quality scores with higher intrareader reproducibility. Comparison of DL and radiomics-ML models did not show any statistically significant differences, though DL models showed overall improved trends. We developed a fully automated and human-perceptive equivalent model to conduct region-wise IQA over 18 F-FDG PET images. Our analysis emphasizes the necessity of developing separate models for body regions and performing data annotation based on multiple experts' consensus in IQA studies.

Is there value in the routine inclusion of chest computed tomography for patients with gastrointestinal stromal tumor?

PurposeNational Comprehensive Cancer Network guidelines suggest chest CT when gastrointestinal stromal tumors are larger than 2 cm. We evaluate the value of screening the chest region during initial and follow-up CT. MethodSingle institution retrospective analysis of GIST cancer registry for patients diagnosed between May 2010 and November 2019 with tumor > 2 cm. We collected the patient demographics and clinical data; reviewed all CT scans of the chest region and recorded the lung nodules. Patients were grouped into lung nodule group and non-nodule group. Categorical variables were compared with the Chi square test and continuous variables with the Mann-Whitney U test. The survival probability was determined from Kaplan-Meier survival analysis and log-rank test for comparing differences. ResultsThe final cohort included 382 patients (median age 61 years-old [interquartile range: 52–71]) and grouped into non-nodule group (n = 284) and lung nodule group (n = 98). The frequency of the CT scan was more in lung nodule group (8 [5–12]) than in non-nodule group (4 [2–9], p < 0.001). The lung nodule group had more CT including the chest region (6 [3–10] vs 3 [1–7], p < 0.001). In progressive lung nodules (8/98 [8 %]), only one patient had confirmed lung metastasis from GIST (1/382 [3 %]). There was no difference in overall survival between nodule groups (p = 0.12). ConclusionsGIST patients with tumors larger than 2 cm have extremely low risk for lung metastasis. Routine inclusion of chest CT scan in staging and follow up is unnecessary.

Design and research on the posture-adjustable mannequin for chest-up and hunchbacked posture

The development of garment personalization has put forward diverse requirements for mannequins. In this paper, we present a garment mannequin that can continuously alter the body posture in response to changes in human body posture in the chest and back regions. This research is founded on an analysis of the patterns and ranges of movement in the mannequin's chest and hunchbacked motions. We segmented the mannequin into six modules: neck, front chest, back, left and right shoulders, and waist and abdomen. By employing stepper motors, we independently drive the front chest, back, and left and right shoulders to achieve the simulation and continuous adjustment of the mannequin's body posture for chest and hunchbacked positions. The comparison of the 3D scans shows that the mannequin fits well in several cross-sections with the corresponding body variations of real people, and the results of the real shirt also show that the shirt made based on the simulated hunchbacked body mannequin is significantly better than the standard shirt in terms of comfort and aesthetics for a person with a hunchbacked body posture. The body posture adjustable mannequin can replace multiple static mannequins, which can provide strong support for the business model of personalized clothing customization. Compared with the existing dynamic mannequin, it has the advantages of high relevance, simple structure and low production cost.

Treatment outcomes of surgery followed by short-course every other day radiotherapy in keloid

BackgroundPostoperative radiotherapy can significantly reduce keloid recurrence. However, consensus on the optimal radiotherapy dose and treatment schedule remains elusive. This study aims to evaluate the effectiveness of surgery followed by a short-course of radiotherapy administered every other day for keloid treatment.Materials/MethodsWe conducted a retrospective analysis of 498 patients with keloids treated at our institution between January 2010 and December 2017. All patients underwent electron beam irradiation at a dose of 16 Gy, delivered in four fractions every other day, starting within 24 h post-surgery. The primary endpoint of the study was the local control rate.ResultsA total of 130 (26.5%) keloids recurred after a median follow-up of 68.1months (42.6-129.9 months). The local control rates at 1 year, 3 years and 5 years for all patients were 89.5%, 82.5% and 81%, respectively. The highest recurrence rate was observed in keloids located in the chest region (50.8%), followed by the suprapubic (47.8%), head and neck (38.8%), limbs (33.3%) and ear (14%). Both multivariate and univariate analyses identified the presence of pain and or pruritus as an independently prognostic factor for keloid recurrence (p<0.0001). The local control rates at 1-year, 3-years and 5-years for patients with or without symptom of pain or pruritus were 45% vs. 98.8%, 12.5% vs. 95.9%, and 8.8% vs. 95%, respectively (HR:37.829, 95%CI: 24.385–58.686, p<0.001). In the ear keloid subgroup, the 1-year, 3-year and 5-year local control rates for patients with pruritus were significantly lower than those without pain or pruritus (60.0% vs. 97.9%, 26.7% vs. 94.7%, 26.7% vs. 94.3%, HR:30.209, 95% CI:14.793–61.69, p<0.001). The same results were found in other location(p<0.001). During treatment and follow-up, two patients experienced infections, and one patient developed a cutaneous fibroblastoma.ConclusionThis study suggests that a combination of surgery followed by short-course, every-other-day radiotherapy can yield satisfactory local control rates for keloids. Pain and or pruritus symptom was an independently prognostic factors for recurrence of keloid. To further validate these results, a prospective randomized controlled trial is recommended.

A CASE STUDY- MANAGEMENT OF DYSLIPIDEMIA W.S.R. TO MEDO DHATU DUSTI THROUGH AYURVEDA MANAGEMENT

Dyslipidemia is a disorder of lipoprotein metabolism, including lipoprotein overproduction or deficiency. These disorders may be manifested by an elevation of the serum total cholesterol, low-density lipoprotein (LDL) cho-lesterol and triglyceride concentrations and a decrease in the high-density lipoprotein (HDL) cholesterol concen-tration. As per Ayurveda, Acharya Charaka has counted Sthoulya under the eight impediments designated as Ninditapurusha. Lipids are discussed in terms of Sneha Dravya in Ayurveda. Mansa Dhatu is combined with Agni-Medodhatwagni, stirred up by the Agni, combined with the quality of Apa and unctuous substance, and finally converted into Medodhatu. As Chikitsa sutra of Medo Vridhi, Lekhan Karma is an essential therapeutic measure. Moreover, drugs of Arogya Vardhini Vati, Avipattikar Churna, Navaka Guggulu, Yakrit plihari Loha and Lekhaniya Mahakashaya are most effective in the management of Medo Dhatu Dushti or Medo Vridhi. INTRODUCTION: AIM AND OBJECTIVES- To evaluate the role of Ayurvedic Formulations in managing Medovriddhi with particular reference to Dyslipidemia. MATERIAL AND METHODS – A 44-year-old male patient came with the complaint of nausea, vomiting and burning sensation in the chest region and feet for the last two months. The patient has taken 20 days of modern medicine, but no relief was found, so he came to Ayurveda Hospital for better treatment. RESULT AND DIS-CUSSION The outcomes were noteworthy regarding the clinical and analytical criteria. According to statistics, there is an improvement in nausea, vomiting, and burning sensation in the chest region and feet, as well as cho-lesterol, triglycerides, LDL, and VLDL levels.

Radiogenic cancer risk from contrast enhanced computed tomography during pediatric abdomen and pelvis examinations in Saudi Arabia

The sensitivity to ionizing radiation is increasing by age of development for some malignant tumors. Therefore, children have higher risk to radiation induced tumors due the high cellular rate of proliferation and long lifespan probability. The risk is also increase with increase the effective and organ doses. Computed tomography (CT) exposed pediatric patients to higher radiation dose during multiphase image acquisition, repeated exams, for follow-up procedures. This research intended to estimate the radiogenic risks and effective radiation doses resulted from CT enhanced contrast for abdomen and pelvis. 126 (66 (62.3%) males, 60 (47.7%) females) pediatric patients underwent CT enhanced abdominal examination at Medical Imaging Department at King Khalid Hospital and Prince Sultan Center for Health Services, Alkharj, Saudi Arabia. The average and range of pediatric age (years) is 11.6 ± 5.0 (0.1–17). The mean, standard deviation, and range of the volume CT air kerma index (CVOL (mGy) and the air kerma length product (PKL, mGy.cm) were 9.8 ± 9.4 (2.1–45.8) and 1795 (221–3150) per abdominopelvic procedure, respectively. The mean and range of the effective dose (mSv) per procedure are 26.9 (2.4–59.1). The effective dose is higher compared to the most previously published studies. The effective dose per pediatric abdomen and pelvis with contrast procedure suggest that the patient dose is not optimized yet. Because the chest and pelvis region contain sensitive organs that are irradiated repeatedly, dose optimization is crucial.

Bayesian Parametric Survival Analysis of Patients With Non-Hodgkin’s Lymphoma in Yazd, Iran, During 2009-2019

Background and aims: Non-Hodgkin’s lymphoma (NHL) is one of two main types of lymphoma. This present study aimed to investigate the survival rate in patients with NHL. Methods: This analytical survival-type study examined 372 patients with NHL referred to Shahid Sadoughi Hospital in Yazd in 2009-2019. The data were extracted from patients’ files. STATA/17 software, the Kaplan-Meier method, and Bayesian parametric survival analysis were used for data analysis. Results: The overall survival rate and the mean overall survival time were 65% and 129±17.94 months, respectively. According to the Kaplan-Meier method, the survival rates of 1, 2, 3, 5, and 10 years were 86%, 80%, 76%, 69.5%, and 52%. The results revealed that men, people over 70 years old, patients with the NHL.T-cell subtype, patients with involvement in the chest, inguinal, and abdominal-pelvic regions, and patients in stage III or IV of the disease had a shorter survival time. In addition, survival time was shorter in patients with disease recurrence at the primary site. The variables of gender (hazard ratio [HR]=0.65; 95% confidence interval [CI]: 0.44‒0.93), type of treatment (HR=3.43; 95% CI: 1.58‒6.16), stage of disease (HR=2.87; 95% CI: 2.09‒3.57), and involvement site (HR=1.45:95%; CI: 1.03‒1.99) had a significant effect on survival time using the Bayesian parametric regression model. Conclusion: If patients are identified at an early stage, they have the best chance of survival. In chronic lymphocytic leukemia (CLL) patients, the best survival is achieved without treatment. At the same time, in other types of cancer, chemotherapy offers the best survival.

Designing an improved model of the adult female ICRP reference phantom dedicated to mammography procedure

Mammography is an x-ray-based imaging method to examine breast abnormalities. Since low-energy photons are used in mammography, doses to different organs would depend strongly on the phantom posture and anatomy. Until now, a few studies have been performed on doses delivered to different organs during mammography. However, in none of them, the correct posture of the patient has been considered. In the present study, the effect of accurate patient positioning, on doses to organs in the chest region were investigated through Monte Carlo simulations. The results show the rotation of the phantom head, may affect organ doses up to 60%. Also, ignoring the head in dosimetry calculations changes scattering effects and causes dose uncertainty of about 8% for these organs. Moreover, according to the obtained results, not compressing the breast causes serious dose misestimation. Finally, using developed phantoms dedicated for mammography, total doses received by different organs have been calculated for the tube voltages of 25, 28, 30 and 35 kVp and for craniocaudal and mediolateral oblique views.

A phase II exploratory trial of adebrelimab in combination with chemotherapy and concurrent radiotherapy as a first-line treatment for oligo-metastatic extensive-stage small-cell lung cancer.

TPS8131 Background: Oligometastasis of extensive-stage small-cell lung cancer (ES-SCLC) is an intermediate state between local and extensive metastasis, characterized by reduced metastatic potential and a limited number of metastatic sites, which makes local treatment of each lesion possible. Multiple clinical studies have shown that adding local therapy to standard systemic therapy can improve the prognosis of patients with oligometastatic disease. The PD-L1 inhibitor adebrelimab combined with chemotherapy has become one of the standard regimens for first-line treatment of ES-SCLC. Based on these, we hypothesize that in patients with oligometastatic ES-SCLC at risk of early progression, the early addition of chest radiotherapy and stereotactic radiotherapy (SBRT) for metastatic lesions to first-line treatment with adebrelimab combined with chemotherapy may be expected to achieve local control, thereby improving survival benefits. Methods: This is a prospective, single-arm, multicenter, phase II exploratory trial. Patients will be eligible if they are 18 to 75 years of age; have histopathologically or cytologically confirmed ES-SCLC with the number of metastatic lesions of ≤ 5 and organ metastasis of ≤ 3 (i.e. oligometastases); have an ECOG PS of 0-1; and have no previous systemic treatment. The treatment period in this trial is subdivided into induction therapy, concurrent chemoradiotherapy, and consolidation and maintenance therapy. In the induction setting, patients will receive two 3-week cycles of adebrelimab (20 mg/kg on day 1), carboplatin (AUC of 5 mg/mL per min on day 1)/cisplatin (75 mg/m2 on day 1), and etoposide (100 mg/m2 on days 1-3). Patients who achieve partial response or stable disease after induction therapy will then receive concurrent chemoradiotherapy, of which chemotherapy regimen is the same as the induction setting. Radical IMRT radiotherapy (2.5-3 Gy/f, total dose 45-55 Gy) will be performed for the primary tumor in the chest and lymph node region, and SBRT radiotherapy will be given to metastatic lesions. Prophylactic cranial irradiation is optional. After the end of chemoradiotherapy, patients will receive 1-2 cycles of consolidation treatment with the same regimen as induction treatment, followed by adebrelimab monotherapy (20 mg/kg on day 1, q3w) as maintenance treatment until disease progression, intolerance toxicity, or up to 2 years of adebrelimab. The total cycle number of chemotherapy is 4-6. The primary endpoint is progression-free survival (PFS), and secondary endpoints are objective response rate, duration of response, overall survival (OS), 6-month and 1-year PFS rates, 1-year and 2-year OS rates, and safety. The trial is under recruitment, and a total of 62 patients are planned to be enrolled. Clinical trial information: NCT06177925 .

Retrospective Analysis of Injuries Resulting from Traffic Accidents

Aim: To evaluate injuries and organ damage occurring in traffic accidents, and the cause of death in cases with mortality. Material and Method: The study included cases involved in traffic accidents who presented at hospital in a 4-year period. The cases were evaluated in respect of age, gender, injuries, alcohol consumption, form of involvement in traffic, and cause of death in deceased cases. The data were analyzed using SPSS vn. 26.0 software. Results: The total 3039 cases included in the study comprised 68.08% males and 31.92% females. Of the cases who presented at hospital, 4.11% died. The age group most involved in accidents was the 20-29 years group. The bones most frequently fractured were the costae. According to body regions, the nasal bone was the bone most often fractured in the head region, the humerus in the upper extremities, the pubis in the pelvis, the tibia in the lower extremities, and the costae in the chest region. The abdominal organ most often damaged was the liver. Conclusion: A statistically significant correlation was determined between gender and fractures of the ischium, sacrum, iliac, and pubic bones, with these fractures seen more in females than males. This higher rate of pelvic fractures in females can be attributed to the differences in male and female pelvic anatomy.

Novel CAD Diagnosis Method Based on Search, PCA, and AdaBoostM1 Techniques.

Background: Cardiovascular diseases (CVDs) are the primary cause of mortality worldwide, resulting in a growing number of annual fatalities. Coronary artery disease (CAD) is one of the basic types of CVDs, and early diagnosis of CAD is crucial for convenient treatment and decreasing mortality rates. In the literature, several studies use many features for CAD diagnosis. However, due to the large number of features used in these studies, the possibility of early diagnosis is reduced. Methods: For this reason, in this study, a new method that uses only five features-age, hypertension, typical chest pain, t-wave inversion, and region with regional wall motion abnormality-and is a combination of eight different search techniques, principal component analysis (PCA), and the AdaBoostM1 algorithm has been proposed for early and accurate CAD diagnosis. Results: The proposed method is devised and tested on a benchmark dataset called Z-Alizadeh Sani. The performance of the proposed method is tested with a variety of metrics and compared with basic machine-learning techniques and the existing studies in the literature. The experimental results have shown that the proposed method is efficient and achieves the best classification performance, with an accuracy of 91.8%, ever reported on the Z-Alizadeh Sani dataset with so few features. Conclusions: As a result, medical practitioners can utilize the proposed approach for diagnosing CAD early and accurately.

Repeated Thoracic Paravertebral Blocking to Alleviate Pain Symptoms in 66-years-old Man with Post-herpetic Neuralgia: A Case Report

Introduction Post-herpetic Neuralgia (PHN) is a neuropathic pain syndrome resulting from the sequelae of Herpes Zoster (HZ). Case Report Therefore, this study aimed to report a case of a 66-year-old male who presented with chronic pain characterized by a burning sensation in the right chest region, specifically at the areola level. The patient had been experiencing these symptoms for a year, which progressed to the severe stage over the past few months. To mitigate pain, a Thoracic Paravertebral Block (TPVB) procedure was proposed and conducted 3 times, with a solution containing levobupivacaine 0.25% and dexamethasone 10 mg in 5 ml. Conclusion The procedure was replicated three times. After two weeks, the pain had almost subsided, showing less need for further analgesia.

A universal medically assisted model for anatomical landmark detection in radioactive images

AbstractAnatomical landmark detection is a critical task in medical image analysis with significant research and practical value. The analysis of landmarks in radiological images is beneficial for its diagnosis and treatment. Currently, most methods are applied to datasets from specific anatomical regions, with only a few deep neural network models designed for mixed datasets. Meanwhile, the precise and fast localization of landmarks remains a significant challenge due to interdependencies among landmarks and the demanding accuracy requirements in medical clinical applications. In this work, we leverage the advantages of attention mechanisms for focusing on specific information, and propose a universal landmark detection model trained on mixed‐domain radioactive image datasets. The model consists of three main components: the local network, the global network, and the attention feature extraction module. The local network employs a U‐Net architecture with depthwise separable convolutions to extract local image features. Notably, we introduce partial depthwise separable convolutions as an option for further lightweight models. The global network comprises a sequence of dilated convolutions with varying dilation rates, expanding the receptive field to extract global features. The attention feature extraction module efficiently utilizes intermediate outputs to refine the precise location information of landmarks. Additionally, we introduce the regional attention loss function to provide the model with landmark offset information. We conduct experiments on three publicly available x‐ray image datasets covering head, hand, and chest regions. The experimental results demonstrate that the proposed universal model achieves fast convergence and excellent performance across multiple datasets.

Myxofibrosarcoma of the Chest Wall Detected on 99mTc-MDP Whole-Body Bone Scan.

Myxofibrosarcoma is a type of soft tissue sarcoma, predominantly characterized by a high propensity for local recurrence, albeit demonstrating a relatively diminished risk for distant metastasis. Its prevalence is notably higher in elderly patients. Here, we present a case of a 73-year-old woman diagnosed with Myxofibrosarcoma. She was subjected to a whole-body bone scan using 99mTc-methylene diphosphonate (MDP) to survey potential bony metastasis. It revealed marked MDP accumulation with peripheral soft tissue uptake in the right lateral chest region of this patient. This imaging phenotype could potentially be attributed to the augmented vascularity within the tumor, a finding that was prominently displayed in this particular case.

Exploring the Impact of Mismatch Conditions, Noisy Backgrounds, and Speaker Health on Convolutional Autoencoder-Based Speaker Recognition System with Limited Dataset

This paper presents a novel approach to enhance the success rate and accuracy of speaker recognition and identification systems. The methodology involves employing data augmentation techniques to enrich a small dataset with audio recordings from five speakers, covering both male and female voices. Python programming language is utilized for data processing, and a convolutional autoencoder is chosen as the model. Spectrograms are used to convert speech signals into images, serving as input for training the autoencoder. The developed speaker recognition system is compared against traditional systems relying on the MFCC feature extraction technique. In addition to addressing the challenges of a small dataset, the paper explores the impact of a "mismatch condition" by using different time durations of the audio signal during both training and testing phases. Through experiments involving various activation and loss functions, the optimal pair for the small dataset is identified, resulting in a high success rate of 92.4% in matched conditions. Traditionally, Mel-Frequency Cepstral Coefficients (MFCC) have been widely used for this purpose. However, the COVID-19 pandemic has drawn attention to the virus's impact on the human body, particularly on areas relevant to speech, such as the chest, throat, vocal cords, and related regions. COVID-19 symptoms, such as coughing, breathing difficulties, and throat swelling, raise questions about the influence of the virus on MFCC, pitch, jitter, and shimmer features. Therefore, this research aims to investigate and understand the potential effects of COVID-19 on these crucial features, contributing valuable insights to the development of robust speaker recognition systems.

Drug Induced Rowell’s Syndrome: A Rare Presentation

Rowell’s syndrome (RS) is a rare disorder characterized by Erythema multiforme (EM)-like lesions in a patient with lupus erythematosus, either systemic lupus erythematosus (SLE) or cutaneous lupus erythematosus (CLE). A 35 years old female presented in our dermatology outpatient department (OPD) with complaint of hemorrhagic crusting of lips and multiple discrete targetoid lesions over the chest, upper limb, and gluteal region. Investigations revealed a speckled pattern of antinuclear antibody (ANA), anti-Smith antibody, anti-ds DNA antibody, and strongly positive anti-Ro antibody. According to the clinical evaluation and investigations, the diagnosis of drug induced RS was made. The likely role of proton pump inhibitors, namely esomeprazole as a triggering factor is discussed. After stopping esomeprazole and starting medications with oral steroids and hydroxychloroquine, her good response to treatment was noted.

Fluoroscopic Procedure-Room Scatter-Dose Reduction Using a Region-of-Interest (ROI) Attenuator.

During fluoroscopically-guided interventional (FGI) procedures, dose to the patient as well as the scatter dose to staff can be high. However, a significant dose reduction can be possible by using a region-of-interest (ROI) attenuator that reduces the x-ray intensity in the peripheral x-ray field while providing full field of view imaging. In this work, we investigated the magnitude of scatter dose reduction to staff made possible by using an ROI attenuator composed of 0.7 mm Cu with a central circular hole that projected a 5.4 cm ROI onto a Kyoto anthropomorphic phantom in the head, chest, and abdomen regions. A 150-cc ionization chamber was placed on a stand at a height of 150 cm (eye level) from the floor and 25 cm and 50 cm lateral distance from the gantry isocenter in a direction perpendicular to the table centerline to measure scatter dose at different positions along the length of the table. Scatter dose per entrance air kerma (mGy/Gy) was measured with and without the ROI attenuator and the percent scatter reduction for the ROI attenuator was determined as a function of staff positions, beam energy and gantry angulation. For head imaging, the measured percent dose reduction was 50%-65% and, for chest and abdomen imaging, the scatter dose reduction was 63%-72% at 50 cm lateral distance when using this ROI attenuator with about 20% beam transmission at 80 kVp. Overall, a considerable reduction of scattered radiation in the interventional room can be realized using an ROI attenuator.

The Efficacy of an Extraoral Suction Apparatus on Reduction of Splatter Contamination during Impacted Lower Third Molar Surgical Procedure: An Observational Study.

The COVID-19 pandemic has affected the delivery of dental care globally. Air contamination during aerosol and splatter-generating procedures is of great concern to dental healthcare provider during these times. Extra oral suction (EOS) apparatus has been shown to be effective in preventing infection by control of aerosol. But very limited data is available regarding the efficacy of the apparatus in preventing splatter contamination. To assess the efficacy of EOS apparatus in reducing frequency and mean intensity of splatter contamination at clinician, assistant, patient sites during lower third molar surgical procedures. Patients who required surgical removal of an impacted lower third molar were divided into two groups (EOS and non-EOS) with 20 patients each. Universal indicating paper (UIP) was placed in specific locations on the surgeon, patient, and assistant. Colour changes after the settling of splatter on the UIP were analyzed to calculate the percentage intensity of splatter contamination. The use of an EOS device has shown an overall reduction in the total number of contaminated sites, with a difference of 6.36%. Surgeon, patient, and assistant sites showed reductions of 6.25, 10%, and 1.66%, respectively. The apparatus has showed statistically significant reduction of splatter frequency and intensity at the patient's chest and left shoulder regions respectively, during surgical removal of the impacted 48. The magnitude of splatter contamination during minor dentoalveolar surgical procedures is inevitable. Therefore, to achieve a better working environment, usage of an EOS apparatus is advocated.

Increased lesion detectability in patients with locally advanced breast cancer—A pilot study using dynamic whole-body [18F]FDG PET/CT

BackgroundAccurate diagnosis of axillary lymph node (ALN) metastases is essential for prognosis and treatment planning in breast cancer. Evaluation of ALN is done by ultrasound, which is limited by inter-operator variability, and by sentinel lymph node biopsy and/or ALN dissection, none of which are without risks and/or long-term complications. It is known that conventional 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) has limited sensitivity for ALN metastases. However, a recently developed dynamic whole-body (D-WB) [18F]FDG PET/CT scanning protocol, allowing for imaging of tissue [18F]FDG metabolic rate (MRFDG), has been shown to have the potential to increase lesion detectability. The study purpose was to examine detectability of malignant lesions in D-WB [18F]FDG PET/CT compared to conventional [18F]FDG PET/CT.ResultsThis study prospectively included ten women with locally advanced breast cancer who were referred for an [18F]FDG PET/CT as part of their diagnostic work-up. They all underwent D-WB [18F]FDG PET/CT, consisting of a 6 min single bed dynamic scan over the chest region started at the time of tracer injection, a 64 min dynamic WB PET scan consisting of 16 continuous bed motion passes, and finally a contrast-enhanced CT scan, with generation of MRFDG parametric images. Lesion visibility was assessed by tumor-to-background and contrast-to-noise ratios using volumes of interest isocontouring tumors with a set limit of 50% of SUVmax and background volumes placed in the vicinity of tumors. Lesion visibility was best in the MRFDG images, with target-to-background values 2.28 (95% CI: 2.04–2.54) times higher than target-to-background values in SUV images, and contrast-to-noise values 1.23 (95% CI: 1.12–1.35) times higher than contrast-to-noise values in SUV images. Furthermore, five imaging experts visually assessed the images and three additional suspicious lesions were found in the MRFDG images compared to SUV images; one suspicious ALN, one suspicious parasternal lymph node, and one suspicious lesion located in the pelvic bone.ConclusionsD-WB [18F]FDG PET/CT with MRFDG images show potential for improved lesion detectability compared to conventional SUV images in locally advanced breast cancer. Further validation in larger cohorts is needed.Clinical trial registrationThe trial is registered in clinicaltrials.gov, NCT05110443, https://www.clinicaltrials.gov/study/NCT05110443?term=NCT05110443&rank=1.