Left Lung Research Articles

Clinicopathological Manifestations of Contagious Bovine Pleuro-Pneumonia in a Herd of Sokoto Gudali Heifers

Contagious bovine pleuro-pneumonia (CBPP) is an endemic disease in Nigeria, mostly affecting cattle. Despite the endemic status of CBPP in Nigeria, there is a dearth of information on the clinicopathological manifestations of the disease in Sokoto Gudali breed of cattle, hence the need to highlight our findings in this report. The carcass of 11-month-old Sokoto Gudali heifer was presented for necropsy with a history of respiratory distress amongst the herd. A detailed postmortem examination was conducted, and representative tissue sections collected for histopathologic tissue processing. Swabs of the lung tissue and pleural effusion were also collected for bacteriology. A farm visit to assess and manage the disease within the herd was also carried out. Nasal swabs and blood samples were also collected for bacteriological and haematological analyses. Necropsy revealed marked fibrinous effusion in the pleural cavity, fibrinous consolidation of the left lung, and chronic pneumonia of the right lung. Clinical observations of the herd made on farm visit included emaciation, cough, nasal discharge, anorexia and fever in some of the heifers. Haematological analysis of the blood samples revealed anaemia and leukopenia due to neutropenia. Histopathological analysis of samples from the left lung revealed acute fibrinous pleuro-pneumonia whereas analysis of the right lung revealed chronic interstitial pneumonia. Microbial culture of the pleural effusion and nasal swab yielded growths of Mycoplasma mycoides subspecies mycoides (Mmm) colonies. Consequently, the sick heifers were culled while others were treated with enrofloxacin and tetracycline injections. The burden of CBPP in cattle in Nigeria is enormous and discourages investments in the livestock sector thereby thwarting efforts to meet the protein requirements of the growing population.

Heparanase-induced endothelial glycocalyx degradation exacerbates lung ischemia/reperfusion injury in male mice.

The endothelial glycocalyx (eGC) is a carbohydrate-rich layer on the vascular endothelium, and its damage can lead to endothelial and organ dysfunction. Heparanase (HPSE) degrades the eGC in response to cellular stress, but its role in organ dysfunction remains unclear. This study investigates HPSE's role in lung ischemia-reperfusion (I/R) injury. A left lung hilar occlusion model was used in B6 wildtype (WT) and HPSE genetic knockout (-/-) mice to induce I/R injury invivo. The left lungs were ischemic for 1 h followed by reperfusion for 4 h prior to investigations of lung function and eGC status. Data were compared between uninjured lungs and I/R-injured lungs in WT and HPSE-/- mice. WT lungs showed significant functional impairment after I/R injury, whereas HPSE-/- lungs did not. Inhibition or knockout of HPSE prevented eGC damage, inflammation, and cellular migration after I/R injury by reducing matrix metalloproteinase activities. HPSE-/- mice exhibited compensatory regulation of related gene expressions. HPSE facilitates eGC degradation leading to inflammation and impaired lung function after I/R injury. HPSE may be a therapeutic target to attenuate graft damage in lung transplantation.

The combination of postmortem sevoflurane ventilation and in situ topical cooling provides improved 6 hours lung preservation in an uncontrolled DCD porcine model

BackgroundRecent clinical series on donation after uncontrolled cardiovascular death (uDCD) reported successful transplantation of lungs preserved by pulmonary inflation up to 3h post-mortem. This study aims to investigate the additive effects of in situ lowering of intrathoracic temperature and sevoflurane preconditioning on lung grafts in a porcine uDCD model. MethodsAfter uDCD induction, donor pigs were allocated to one of the following groups: Control – static lung inflation only (SLI); TC – SLI + continuous intrapleural topical cooling (TC); or TC+Sevo – SLI + TC + sevoflurane. Lungs were retrieved 6h post-asystole and evaluated via ex vivo lung perfusion (EVLP) for 6h. A left single lung transplant was performed using lungs from the best performing group, followed by 4h of graft evaluation. ResultsAnimals that received topical cooling achieved intrathoracic temperature < 15°C within 1 hour after chest filling of coolant. Only lungs from donors that received TC and TC+Sevo completed the planned post-preservation 6h EVLP assessment. Despite similar early performance of the two groups on EVLP, the TC+Sevo group was superior - associated with overall lower airway pressures, higher pulmonary compliances, less edema development, and less release of inflammatory cytokines. Transplantation was performed using lungs from the TC+Sevo group, and excellent graft function was observed post-reperfusion. ConclusionPreservation of uDCD lungs with a combination of static lung inflation, topical cooling and sevoflurane treatment maintains good pulmonary function up to 6h post-mortem with excellent early post-lung transplant function. These interventions may significantly expand the clinical utilization of uDCD donor lungs.

Protective effect of recombinant interleukin-10 on newborn rat lungs exposed to short-term sublethal hyperoxia.

Lung injury imposed by hyperoxia is the main cause of bronchopulmonary dysplasia in newborns. These injuries are generated from the early stage of hyperoxia through the main biologic effects of cell death and inflammatory response. Interleukin (IL)-10 is a potent anti-inflammatory cytokine that may have the inhibitory effects on these biologic actions induced by hyperoxia. Based on our former in vitro studies investigating the effect of recombinant IL-10 (rIL-10) on protecting cultured alveolar type II cells exposed to short-term hyperoxia, we performed the in vivo study to investigate the effect of rIL-10 in newborn rats aged P4 exposed to hyperoxia. Rats were classified into 3 groups; the control group exposed to normoxia for 24 hours; the hyperoxia group exposed to 65% hyperoxia for 24 hours; and the IL10 group treated with intratracheal instillation of rIL-10 prior to exposure to 65% hyperoxia for 24 hours. Following each treatment, the rats were euthanized. Individual lobes of the right lung were prepared for hematoxyling and eosin (H&E) staining and immunohistochemical staining for thyroid transcription factor-1 (TTF1). Bronchoalveolar lavage (BAL) was performed in the left lung to analyze cell counts and cytokines. The IL10 group showed preserved air spaces similar to the control group, with decreased cellularity compared to the hyperoxia group, whereas the hyperoxia group showed markedly reduced air spaces with increased cellularity compared to the IL10 group. And, the IL10 group showed more TTF1-positive cells, which represented alveolar type II cells, compared to the hyperoxia group. Inflammatory cells, such as neutrophils and lymphocytes and proinflammatory cytokines of tumor necrosis factor-α, IL-1α, IL-8, and macrophage inflammatory protein-1α were significantly lower in BAL fluid of the IL10 group compared to the hyperoxia group. These results indicate that rIL-10 may be a promising pharmaceutical measure for protecting newborn lungs from injury induced at the early stage of hyper oxia.

Chronic Pulmonary Aspergillosis with Tracheobronchial Involvement

Introduction: Aspergillosis is a fungal infection commonly found in human lungs and takes several forms. Chronic pulmonary aspergillosis (CPA) commonly affects individuals with underlying disease, most usually lung tuberculosis (TB). Aspergillosis can cause the formation of a fungus ball in the lung cavity and can also manifest in the tracheobronchial area, although this is rarely seen in immunocompetent patients. Case: A 23-year-old woman came with persistent cough, hemoptysis, and shortness of breath for 4 months. The patient also had a significant weight loss and a history of lung TB 3 years ago. She had completed her lung TB medication. Physical examination showed increased respiratory rate and rhonchi on the left lung. GeneXpert showed no Mycobacterium tuberculosis (MTB) detected. The chest X-ray showed a cavity on the left superior lobe of the lung. Bronchoscopy showed multiple plaques along the trachea, carina, and left main bronchus. A chest computed tomography (CT) scan with contrast enhancement was performed, and a fungus ball was found inside the cavity in the left upper lobe of the lung. The patient was given intravenous fluconazole as therapy and continued with oral fluconazole when discharged. A second bronchoscopy was performed, and improvement was shown. Conclusion: Early detection and treatment should be applied to CPA patients since some studies showed poor prognosis and low five-year survival rates.

Extremely Rare Coexistence of Peripherally Located Mucous Gland Adenoma and Pulmonary Chondroid Hamartoma.

Pulmonary mucous gland adenomas (MGAs) originating in mucous-secreting cells in the bronchi are extremely rare benign tumours. Pulmonary chondroid hamartomas (PCHs) are the most common benign neoplasms of mesenchymal origin of the lung. This study reports an unusual case where MGA and PCH coexisted in a peripheral intra-parenchymal location. A patient with a 1-cm non-specific nodule in the left lung on a computed tomography scan underwent wedge resection. Microscopically, mesenchymal elements consisting of fat and cartilage tissue were observed. Mucous glands were present around these mesenchymal elements. No cellular atypia or mitosis was observed. This allowed for complete treatment without the need for a segmentectomy.

Right Lung Agenesis Associated with Dextrocardia in Adulthood

Introduction: Pulmonary agenesis is a rare lung disease, occurring in approximately 1 out of every 100,000 births. Most cases of pulmonary agenesis result in death during the neonatal period. Although survival in cases of pulmonary agenesis is rare, it is possible to encounter lung agenesis in adults. Case: A 26-year-old female patient presented with progressive dyspnea. On physical examination, retraction of the breathing muscles, reduced chest excursions, and decreased breath sounds on the right side were observed. A chest X-ray raised suspicion of pulmonary agenesis. A computed tomography (CT) scan showed hypoplasia of the right lung, accompanied by mediastinal shift, hyperinflation of the left lung, and retraction of the diaphragm and liver to the right. Spirometry showed moderate obstruction. Conclusion: Pulmonary agenesis in adult patients is extremely rare. Chest X-rays and CT scans are the main diagnostic modalities for pulmonary agenesis. There is no specific treatment for asymptomatic cases. Management focuses on conservative and symptomatic care.

Effect of using bolus on the efficiency of the 3DCRT of the breast cancer after mastectomy.

To assess the effect of using bolus on the efficiency of three-dimensional conformation radiation treatment of breast cancer post-mastectomy. The prospective, clinical study was conducted at Al-Amal Center for Radiation Therapy and Nuclear Medicine, Iraq, from November 2020 to April 2021, and comprised patients with synchronous bilateral breast cancer with regional lymph nodes who underwent mastectomy. The three-diensional conformation radiation treatment technique was used to evaluate the dose received by the planning target volume and the organs at risk. The plans were generated using a treatment planning system, the plans were then fed into a linear accelerator. The plans had one isocenter for both breasts to avoid the errors that may cause the overlapping of the radiation fields with and without the use of bolus. Data was analysed using SPSS 24. There were 23 female patients with mean age 49.28±8.79 years (range: 35-62 years). There were 7(30.4%) females residing in rural areas, while 16(69.6%) lived in urban areas. The use of bolus increased the radiation dose coverage percentage of the planning target volume of the right (p=0.0002) and left (p=0.0164) breasts, while the right (p=0.3977) and left (p=0.7940) supraclavicular nodes were not significantly covered by the radiotherapy dose. The use of bolus showed a strong significant decrease of the mean dose that was received by the left lung (p=0.00001). Also, the use of bolus caused significant reduction in the amount of the mean scattered dose that reached the heart (p=0.00001) and larynx (p=0.00004). The use of bolus provided a complete radiotherapy dose coverage for the right and left breasts, as well as an excellent protection for the left lung, heart and larynx.

Assessment of secondary cancer risks within non-target organs during proton therapy for lung cancer: A Monte Carlo study

Proton therapy is a rapidly progressing modality with a significant impact on lung cancer treatment. However, there are concerns about the subsequent effects of secondary radiation in out-of-field organs. Thus, the present study aimed to evaluate the risk of subsequent secondary cancers within non-target organs during proton therapy for lung cancer. A Monte Carlo model of the International Commission on Radiological Protection (ICRP) 110 male phantom was employed to calculate the absorbed dose associated with secondary photons and neutrons within out-of-field organs for different tumor locations. The risk of induced secondary cancers was then estimated using the Biological Effects of Ionizing Radiation Committee (BEIR) VII and National Council on Radiation Protection and Measurements (NCRP) 116 risk models. Organs close to the tumor, such as the heart, esophagus, thymus, and liver, received the highest equivalent doses. The calculated equivalent doses increased as the tumor depth increased from 4–8 cm to 12–16 cm. The contribution of neutrons to the total equivalent dose was dominant (up to 90%) in most of the organs studied. The calculated risks of secondary cancers were higher in the liver and esophagus compared with other organs when using the BEIR risk model. The maximum risk value was obtained for the left lung when the NCRP 116 risk model was used. Furthermore, the estimated risks of secondary malignancies increased with the tumor depth using both risk models. The calculated risks of radiation-induced secondary cancers were relatively lower than the baseline cancer risks. However, extra attention is warranted to minimize subsequent secondary cancers after proton therapy for lung cancer.

Large-language-model empowered 3D dose prediction for intensity-modulated radiotherapy.

Treatment planning is currently a patient specific, time-consuming, and resource demanding task in radiotherapy. Dose-volume histogram (DVH) prediction plays a critical role in automating this process. The geometric relationship between DVHs in radiotherapy plans and organs-at-risk (OAR) and planning target volume (PTV) has been well established. This study explores the potential of deep learning models for predicting DVHs using images and subsequent human intervention facilitated by a large-language model (LLM) to enhance the planning quality. We propose a pipeline to convert unstructured images to a structured graph consisting of image-patch nodes and dose nodes. A novel Dose Graph Neural Network (DoseGNN) model is developed for predicting DVHs from the structured graph. The proposed DoseGNN is enhanced with the LLM to encode massive knowledge from prescriptions and interactive instructions from clinicians. In this study, we introduced an online human-AI collaboration (OHAC) system as a practical implementation of the concept proposed for the automation of intensity-modulated radiotherapy (IMRT) planning. The proposed DoseGNN model was compared to widely employed DL models used in radiotherapy, including Swin Transformer, 3D U-Net CNN, and vanilla MLP. For PTV, DoseGNN achieved the mean absolute error (MAE) of , , , and between true plans and predicted plans that were 64%, 53%, 64%, 61% of the best baseline model. For the worst case among OARs (left lung, right lung, chest wall, heart, spinal cord), DoseGNN achieved the mean absolute error of , , that were 85%, 91%, 80% of the best baseline model. Moreover, the LLM-empowered DoseGNN model facilitates seamless adjustment to treatment plans through interaction with clinicians using natural language. We developed DoseGNN, a novel deep learning model for predicting delivered radiation doses from medical images, enhanced by LLM to allow adjustment through seamless interaction with clinicians. The preliminary results confirm DoseGNN's superior accuracy in DVH prediction relative to typical DL methods, highlighting its potential to facilitate an online clinician-AI collaboration system for streamlined treatment planning automation.

Dose advantage of abdominal deep inspiratory breath-hold (aDIBH) in postoperative adjuvant radiotherapy for left breast cancer

PurposeWe explored the dosimetric efficacy of the abdominal deep inspiration breath hold (aDIBH) technique using an audio-guided device in patients with left breast cancer undergoing postoperative adjuvant radiotherapy compared to free breathing (FB).MethodsA total of 35 patients with early stage left breast cancer underwent two computed tomography simulation scans each with aDIBH and FB after breast-conserving surgery. Treatment planning was optimized using the Pinnacle3 9.10 planning system. The heart, left anterior descending coronary artery (LADCA), and left lung was defined as organs at risk (OARs). The dosimetric differences in the planning target volume (PTV) and OARs were compared between aDIBH and FB.ResultsCompared with FB, the heart moved farther caudally and away from the chest wall, and the volume of heart became smaller under aDIBH due to expansion of the lungs. The D mean of the heart, LADCA and left lung of aDIBH were respectively reduced by 332.79 ± 264.61 cGy (P < 0.001), 1290.37 ± 612.09 cGy (P < 0.047) and 69.94 ± 117.73 cGy (P < 0.001). The V20 and V30 of the OARs were also significantly reduced with statistical differences (P < 0.05). In addition, there was no significant difference in the dosimetric parameters of the PTV between the two groups (P > 0.05).ConclusionsImplementation of the aDIBH technique for postoperative radiotherapy after breast-conserving surgery of the left breast cancer could reduce irradiation of the heart dose, LADCA dose and left lung dose, without compromising target coverage.

H-marker via bronchoscopy under LungPro navigation combined with cone-beam computed tomography for locating multiple pulmonary ground-glass nodules: A case report and literature review.

Pulmonary ground-glass nodules (GGNs) pose challenges in intraoperative localization due to their primarily nonsolid composition. This report highlights a novel approach using H-marker deployment guided by LungPro navigation combined with cone-beam computed tomography (CBCT) for precise localization of multiple GGNs. A 55-year-old female patient presented at Sir-Run-Run-Shaw Hospital, Zhejiang University School of Medicine, in June 2021, requiring thoracoscopic surgery for the management of multiple GGNs in her right lung. She had a recent history of thoracoscopic wedge resection for a lesion in her lower left lung 3 months prior. Computed tomography scans revealed the presence of 3 mixed GGNs in the right lung, with further confirmation identifying these as solitary pulmonary nodules, necessitating surgical intervention. The patient underwent thoracoscopic surgery, during which the multiple nodules in her right lung were precisely localized utilizing an H-marker implanted bronchoscopically under the guidance of LungPro navigation technology, with CBCT providing additional confirmation of nodule positioning. This innovative combination of technologies facilitated accurate targeting of the lesions. Postoperative histopathological analysis confirmed the nodules to be microinvasive adenocarcinomas. Radiographic examination with chest X-rays demonstrated satisfactory lung expansion, indicating effective lung function preservation following the procedure. Follow-up assessments have shown no evidence of tumor recurrence, suggesting successful treatment. The employment of H-marker implantation guided by the LungPro navigation system with CBCT confirmation presents a feasible and efficacious strategy for localizing multiple pulmonary GGNs. To further validate its clinical utility and safety, large-scale, multicenter, prospective studies are warranted. This approach holds promise in enhancing the precision and outcomes of surgeries involving GGNs.

Towards hybrid approach based SVM and Radiomics features for COVID-19 classification and segmentation

In the battle against the COVID-19 pneumonia outbreak, which is brought on by the coronavirus strain SARS-Cov-2, radiological chest exams, such as chest X-rays, are crucial. In order to understand the unique radiographic characteristics of COVID-19, this research looks into classification models to distinguish chest X-ray images based on Radiomics features. This study is performed with datasets composed of 136 segmented chest X-rays, which were used to train and test the categorization algorithms. First and second-order statistical texture characteristics were extracted from the right (R), left (L), superior, middle, and bottom lung zones for each lung side using the Pyradiomics collection. Data was divided into training (80%) and test (20%) groups for feature selection. After assessing the respective feature significance and confirmation accuracy, the most pertinent Radiomics features were chosen. A model of lung segmentation based grey level pixels was used to evaluate support vector machines (SVM) as possible classifiers (AUC = 83.7%). Our research reveals a preference for the upper lung zone and a preponderance of Radiomics feature selection in the right lung. Our future research will concentrate on COVID-19 categorization and segmentation for more precise forecast using a hybrid method based on SVM and Radiogenomics features.

Radioterapia piersi lewej – porównanie leczenia techniką bramkowania oddechowego DIBH z techniką na swobodnym oddechu.

Breast cancer is the most common cancer in women. Radiotherapy is a very important part of the treatment of this cancer. As breast cancer patients survive longer, any long-term side effects caused by treatment become increasingly important. The aim of this study is to determine whether deep breath-hold (DIBH) respiratory-gated radiotherapy is superior to free-breathing (FB) radiotherapy in reducing cardiac exposure. The analysis included 50 patients treated in 2022-2023 for left breast cancer who underwent breast-conserving surgery. The obtained data allow us to conclude that DIBH is a more advantageous technique than FB. There is a visible decrease in the average dose to the heart from 3.29±1.77Gy to 1.43±0.54Gy, V20 to the heart from 5.14±4.95% to 0.67±0.81% in favor of DIBH. A slightly smaller difference, but still supporting the DIBH technique, is for the doses received by the left lung, i.e. a decrease in the average value from 7.39±2.21Gy to 7.14±1.9Gy, and in V20 from 15.42±5.17 % to 14.55±3.92%.

Plasma Circulating HPV DNA Surveillance in a Patient With Nasopharyngeal Cancer.

Nearly one third of nasopharyngeal carcinomas (NPCs) in the United States are associated with human papillomavirus (HPV). Surveillance for Epstein-Barr virus (EBV)-negative subtypes is customarily based solely on imaging and physical examinations. We present a case of HPV-positive NPC using serial circulating tumor HPV DNA (ctHPVDNA) as a biomarker of disease status. A 58-year-old Caucasian female initially presented with T1N1M0 EBV-negative p16-positive squamous cell carcinoma of the nasopharynx and was treated with concurrent chemoradiation. Regional nodal recurrence identified 7 months post-radiotherapy was treated with salvage left neck dissection. Surveillance was supplemented using a commercially available polymerase chain reaction (PCR)-based ctHPVDNA assay. Rising ctHPVDNA levels at 9 and 10 months post salvage surgery prompted positron emission tomography (PET). Biopsy confirmed recurrence in avid right hilar and paraoesophageal lymph nodes. Following definitive radiotherapy to the involved nodes and concurrent pembrolizumab, posttreatment ctHPVDNA decreased to baseline, but then increased after 6 cycles of pembrolizumab. Follow-up PET found left mediastinal recurrence outside of the prior treatment field, which was treated with concurrent chemoradiation with cetuximab. Again, ctHPVDNA level dropped to baseline but increased 3 months postradiation. PET scan showed a left lung nodule, and the patient received systemic therapy. Plasma ctHPVDNA monitoring correlated well with disease activity in our patient with HPV-positive NPC. ctHPVDNA detected disease earlier than standard surveillance methods and allowed for earlier intervention. Larger studies are needed to validate the utility of HPV biomarker surveillance in NPC.

Exploring the impact of field shape on predicted dose distribution in breast cancer patients using deep learning in radiation therapy

BackgroundGeometrical information such as field shape is essential for dose calculation in radiation therapy. However, new methods of dose prediction based on deep learning only use CT images and contouring of patients. The aim of this study is to develop a deep learning method for three-dimensional dose prediction for breast cancer radiotherapy using field shape as well as CT and contouring images of patients. MethodsA total of 150 breast cancer patients' data treated with 3D conformal radiation therapy (CRT) technique were used to train and test 3D-U-Res-F-Net model. The model inputs were CT images, patients' contouring and field shape. The network output was the corresponding the patients’ dose distribution. Then, the dosimetric parameters extracted from the dose volume histograms related to the planned and predicted dose distributions were compared and were statistically analysed with the paired-samples t-test. These parameters include Dmean and Dmax for planning target volume and organs at risk, D95%, D50%, V47.5Gy for PTV, V30Gy and V25Gy for heart and V20Gy for left lung. The gamma index with 3%/3 mm criteria was calculated for PTV and OARs. ResultsThe average absolute difference of the Dmean relative to the prescribed dose for the PTV, heart, left lung, right lung and spinal cord were 1.37 ± 0.4%, 2.02 ± 2%, 2.12 ± 1%, 0.37 ± 0.3% and 0.41 ± 0.3%, respectively. The average absolute difference of the Dmax relative to the prescribed dose for the PTV and OARs varied from 0.23 ± 0.2% to 2.04 ± 2%. The 3D gamma pass rate with 3mm/3% criteria for planning target volume, heart, left lung, right lung, spinal cord and body were 89 ± 3%, 91 ± 5%, 93 ± 5%, 99 ± 3%, 99 ± 1% and 96 ± 2% respectively. ConclusionsThe results of the proposed model demonstrate that there is no significant difference between the predicted and planned dose distributions. The deep learning model can directly predict the 3D dose distribution faster than treatment planning systems. Further studies with more patients and on other cancer sites are essential to fully validate the proposed method.

Comparing right- versus left-first implantation in off-pump sequential double-lung transplantation: an observational cohort study.

Historically, the perfusion-guided sequence suggests to first transplant the side with lowest lung perfusion. This sequence is thought to limit right ventricular afterload and prevent acute heart failure after first pneumonectomy. As a paradigm shift, we adopted the right-first implantation sequence, irrespective of lung perfusion. The right donor lung generally accommodates a larger proportion of the cardiac output. We hypothesized that the right-first sequence reduces the likelihood of oedema formation in the firstly transplanted graft during second-lung implantation. Our objective was to compare the perfusion-guided and right-first sequence for intraoperative extracorporeal membrane oxygenation (ECMO) need and primary graft dysfunction (PGD). A retrospective single-centre cohort study (2008-2021) including double-lung transplant cases (N = 696) started without ECMO was performed. Primary end-points were intraoperative ECMO cannulation and PGD grade 3 (PGD3) at 72 h. Secondary end-points were patient and chronic lung allograft dysfunction-free survival. In cases with native left lung perfusion ≤50% propensity score adjusted comparison of the perfusion-guided and right-first sequence was performed. When left lung perfusion was ≤50%, right-first implantation was done in 219 and left-first in 189 cases. Intraoperative escalation to ECMO support was observed in 10.96% of right-first versus 19.05% of left-first cases (odds ratio 0.448; 95% confidence interval 0.229-0.0.878; P = 0.0193). PGD3 at 72 h was observed in 8.02% of right-first versus 15.64% of left-first cases (0.566; 0.263-1.217; P = 0.1452). Right-first implantation did not affect patient or chronic lung allograft dysfunction-free survival. The right-first implantation sequence in off-pump double-lung transplantation reduces need for intraoperative ECMO cannulation with a trend towards less PGD grade 3.

Analysis of Wedge Angle Variations in the Treatment Planning System Based on Dose Volume Histogram on Ca Mammae Sinistra

Breast cancer ranks first in terms of the highest number of cancers in Indonesia and is one of the first contributors to cancer deaths. According to IARC, radiotherapy is one of the most important modalities in the treatment of breast cancer. Radiotherapy is a type of treatment that uses ionizing radiation to kill cancer cells without damaging surrounding healthy tissue. To obtain an even or homogeneous dose distribution on an uneven skin surface, a wedge is used so that the radiation given to the tumor area is truly optimal and the surrounding healthy tissue receives a minimum dose. This research was carried out by evaluating the Planning Target Volume (PTV) value based on ICRU-83 and dose distribution in Organs at Risk (OAR) based on QUANTEC standards at four different wedge angles, namely 15°, 30°, 45°, and 60°, used the 3D-CRT technique of tangential radiation with a dose of 50 Gy in 25 fractions on 5 left-sided breast cancer patients. The research results showed that the average Homogeneity Index (HI) values for the 15°, 30°, 45° and 60° wedges were 0.286, 0.346, 0.436 and 0.578, respectively. In the left and right lung dose distribution, the results obtained for the 15°, 30°, 45°, and 60° wedge were respectively 2231.4 and 116.2 cGy, 2257.8 and 114.6 cGy, 2141 and 100 cGy, and 2059.4 and 88.8 cGy. For the average dose distribution to the heart, the values obtained at the 15°, 30°, 45°, and 60° wedges were 2005.6 cGy, 2040.4 cGy, 1930.6 cGy, and 1844.4 cGy, respectively. where the average dose received by OAR is still below the limit allowed by QUANTEC. Using a wedge angle of 15° provides a homogeneous dose distribution for the PTV and a wedge angle of 60° provides the lowest dose distribution for the OAR.

Left Lower Lobe Non-Resolving Lung Consolidation: Detected to have Proximal Endobronchial Stenosis in a Young Male

Left Lower Lobe Non-Resolving Lung Consolidation: Detected to have Proximal Endobronchial Stenosis in a Young Male

Role of Virtual Monoenergetic Images in the Assessment of Vessel Enhancement in Segmental Level in Third-Generation Dual-Source Dual-Energy CT Pulmonary Angiography—A Prospective Study

Abstract Introduction Pulmonary embolism is the third most common cause of cardiovascular death worldwide and imaging plays a pivotal role in establishing the diagnosis. Computed tomography pulmonary angiography (CTPA) scores over other modalities and is the current diagnostic investigation of choice. In this study, we assessed the main pulmonary artery and its corresponding segmental artery attenuation in reconstructed virtual monoenergetic (mono plus) images (VMI-MP) and linear blended images (spectral post processing, SPP) obtained from dual-energy CTPA. The values were compared using contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). Materials and Methods Forty patients (mean age group, 53.6 years; 26 females and 14 males) with segmental pulmonary thromboembolism were included in this prospective study. The patients underwent CTPA study using bolus tracking in the dual-source CT-SOMATOM Force, Siemens. Postcontrast datasets (90 kV, 150 kV, and SPP) were used to reconstruct the monoenergetic images using syngo.via software virtually. Comparison was done between bivariate samples using the paired sample t-test. Results The mean Hounsfield unit (HU) artery in the left lung for VMI-MP and SPP images were 886.9 ± 242 and 356.8 ± 121.3 HU, respectively. Similarly, for the right lung, it was 868.3 ± 243.5 and 336.1 ± 105.5 HU, respectively. The mean attenuation of the arteries in MP images was higher and statistically significant (p-value &lt;0.005). Likewise, the CNR) and SNR were found to have a statistically significant p-value (&lt;0.005). An acceptable increase in image noise was seen in VMI as compared with SPP images. Conclusion Low-keV VMIs perform more effectively than the conventional polyenergetic spectrum to evaluate vessel attenuation, which in turn increases thrombus detectability. The increased CNR in VMI enables improved lesion conspicuity.