Radiation Research Methods Research Articles

Radiation methods in the diagnosis and determination of the tactics of surgical treatment of multiple primary lung carcinoid on clinical observation

Early and complete diagnosis of carcinoid lung tumors is of great interest in the clinical oncology, since this is the basis for the possibility of using options for organ-preserving surgical treatment. According to the 2015 WHO classification, carcinoids of the group of neuroendocrine tumors are divided into two types: typical and atypical carcinoids. Based on literature data, there are 0.2–2 cases per 100,000 people. This article discusses the possibilities of radiation research methods in the early diagnosis of this tumor, as well as the assessment of surgical treatment using them.

ЭПИДЕМИОЛОГИЯ, ФАКТОРЫ РИСКА, ДИАГНОСТИКА И ПРОФИЛАКТИКА ТРОМБОЗА ГЛУБОКИХ ВЕН ПРИ ПЕРЕЛОМАХ ДЛИННЫХ КОСТЕЙ НИЖНИХ КОНЕЧНОСТЕЙ

A literature review presents a data concerning the incidence and risk factors for development of venous thromboembolic complications (VTEC), as well as their diagnosis and prevention in long bones fractures of the lower extremities (LBFLE). Literature data show that, despite the widespread implementation of preventive measures in case of LBFLE, it is not always possible to completely avoid VTEC. The main risk factors for their development are the injuries’ severity, the location and nature of the extremity bone fracture, the duration of immobilization, the amount of surgery performed for bone fragments stabilization, as well as age and the presence of concomitant diseases. In the diagnosis of thrombotic process, laboratory and radiation research methods play an essential role, and according to data they has varying degrees of sensitivity and specificity. However, to date, none of them has absolute diagnostic accuracy. Complex thrombosis prophylaxis significantly reduces the risk of VTEC development, however, the choice of the type and dosage of anticoagulants, as well as the duration of their use, remain controversial, and some authors recommend different approaches in this issue. In addition, the diagnostic criteria and therapeutic tactics for embologenic floating thrombi remain open for discussion. In this regard, the conduct of large randomized scientific studies aimed at early diagnosis, prevention and treatment of VTEC using modern diagnostic tests and new generation anticoagulants is relevant and allows to minimize the risk of disability and death.

Organization of postmortem radiological examination in the structure of pathological departments and forensic bureaus

The purpose of this work is to develop an optimal scheme for organizing and conducting postmortem radiation studies in the Russian Federation based on literature data and our own results. One of the primary points in organizing virtopsiy is to determine the place where radiation examinations of deceased patients will be performed. The absence or presence of the equipment and capabilities available in the institution, i.e., the department of radiation diagnostics with functioning CT and MRI devices and software, determines the volume of economic costs. The analysis of the results of radiation research methods should be carried out by a highly qualified radiologist who has both general knowledge of radiation diagnostics and information about the radiation pattern of nonspecific postmortem changes. Based on our own experience in organizing postmortem radiation examinations, we consider it optimal to conduct postmortem CT and/or MRI scans by an X-ray technician in the radiation diagnostics department and to introduce a separate radiologist in the staffing of the pathology department or forensic medical examination bureau. In our opinion, an examination of the corpse by a radiologist in conjunction with a forensic expert is required to determine the most important areas of interest, tactics and methodology of radiation research. The final conclusion of the radiologist should be formed after consultation and agreement of the identified changes with a pathologist or forensic expert. Virtopsy is a highly effective objective method for examining a corpse. This dictates the need for its widespread introduction into the practice of the forensic medical examination bureaus and pathological and anatomical departments.

COMPUTED TOMOGRAPHY IN THE DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF PNEUMOCONIOSIS

Introduction. Pneumoconiosis is a disease caused by exposure industrial dust. The aim of the work was to determine the diagnostic effectiveness of radiation research methods in its diagnosis and systematize CT semiotics. Materials and methods . 105 mining and metallurgical workers were surveyed. All patients underwent a clinical and radiological examination. Results . In addition to focal and interstitial changes, nodular changes were detected, and the presence of a cavity was not always a sign of tuberculosis. The sensitivity of CT was 98,94%, the specificity was 90,0%. Conclusion. CT is necessary for all patients with suspected pneumoconiosis. The combination of the disseminated process in the lungs and professional harmfulness is not decisive in making a diagnosis, a comprehensive approach is necessary.

Partial anomalous drainage of pulmonary venous to the inferior vena cava (scimitar syndrome): the part of radiated methods of research in primary diagnostic and control of surgical treatment

Background.“Scimitar” syndrome is a rare congenital malformation with a frequency of 2 per 100,000 newborns. The syndrome is manifested by complete abnormal drainage of the pulmonary veins of the right lung into the inferior vena cava. According to the literature, a typical symptom of scimitar syndrome can be detected on radiographs in no more than 1/3 of patients. Only complex radiation diagnostics with the inclusion of multispiral computed tomographic angiography allows to diagnose “scimitar” syndrome, determine all its components, clarify the anatomical features and determine the volume and tactics of further cardiac surgery.Objectiveof the present clinical case is to assess the role of radiation research methods in the primary diagnosis and control of surgical treatment of scimitar syndrome.Materials and methods.A 39-year-old patient with a history of open arterial duct ligation and complaints of fatigue, shortness of breath arising from household loads was examined. According to the results of the chest x-ray and MSCT angiography of the chest organs, “scimitar” syndrome was diagnosed, the patient underwent a two-stage cardiosurgical treatment with the assessment of the results by MSCT angiography. Results. According to the results of radiation studies, the patient revealed a rare congenital malformation — “scimitar” syndrome.Conclusion.MSCT angiography of the chest is a highly informative, minimally invasive diagnostic method for the scimitar syndrome. MSCT angiography of the chest allows you to visually and accurately visualize the type of abnormal drainage, the course and place of the confluence of the collector, the presence of anastomoses with the left heart, which directly affects the definition of tactics for surgical correction of the disease. MSCT angiography of the chest allows you to evaluate the results of surgical treatment.

Features of the diagnosis and treatment of patients with postoperative peritonitis

Annotation. The aim of the work is to improve the diagnosis and treatment of patients with postoperative peritonitis. The work is based on an analysis of the treatment results of 98 patients who were in the clinic from 2010 to 2019, of which 47 (48%) were admitted to the hospital with a peritonitis clinic, and 51 (52%) had a prolonged bowel paresis in the postoperative period. The diagnosis was established on the basis of data from an objective examination, laboratory parameters and radiation research methods — radiography of the abdominal organs and ultrasound. Based on the analysis of clinical material, it was found that for patients with primary peritonitis, more pronounced clinical symptoms are more characteristic. Postoperative peritonitis in its clinical manifestations proceeds under the mask of a protracted intestinal paresis. Due to the ultrasound criteria of 51 patients with postoperative paresis, 32 (63%) prolonged paresis were allowed conservatively, which avoided unnecessary repeated surgical interventions. In 19 (37%), the causes of postoperative complications were diagnosed and relaparotomy was performed in a timely manner to these patients. Postoperative mortality was 5.1%.

Socket Preservation During Preimplantation Period: Effi cacy of Osteoplastic Material Application Using Cone Beam Computed Tomography

Aim. To analyse the effi ciency of osteoplastic material application in order to reduce the resorption level after tooth extraction in the preimplantation period according to the data of cone beam computed tomography.Materials and methods. The study involved 80 patients who were divided into 4 equal groups depending on the preservation material used. The fi rst group was treated with Cerabone (Botiss, Germany) xenomaterial based on natural bovine bone. Plasma enriched with PRGF growth factors obtained by the BTI Endoret (Spain) technology was used for the patients of the second group. The third group consisted of patients who underwent a socket preservation of the extracted tooth with a powdered autologous dentin matrix (ADM) obtained from their own tooth. In the fourth group, bone-plastic material based on hydroxyapatite with Collapan-L lincomycin hydrochloride (Intermedapatit, Russia) was used to prevent socket resorption. All patients had a cone beam computed tomography of the maxillofacial region before the extraction and 3 months after the preservation in order to evaluate the level of bone resorption. After the installation of dental implants, a comparative assessment of the bone resorption level in the vertical and horizontal directions before tooth extraction and in the preimplantation period was carried out.Results. The smallest level of vertical bone resorption after socket preservation was observed in group 1 (Cerabone) and group 3 (ADM). The median value of the socket resorption level in group 1 was 0.7 mm (8.54 %) in the vertical direction and 0.5 mm (9.45 %) in horizontal measurement as compared to the level of bone tissue before tooth extraction. Similar indicators were observed in the group using an autologous dentin matrix. The vertical decrease in the socket bone tissue was 0.61 mm (7.75 %), horizontal — 0.51 mm (6.2 %). The level of bone resorption was signifi cantly higher using two other materials.Conclusions. The use of three-dimensional radiation research methods allows a comprehensive assessment of the bone tissue volume to be carried out, which in turn determines the choice of the dental implant size, the need for further bone-plastic surgery to increase the width/height of the alveolar ridge. The use of cone beam computed tomography showed that the most optimal results can be obtained by introducing Cerabone material into the socket of the extracted tooth, as well as using the innovative method of preservation with the patient’s own powdered tooth (ADM).

Some Aspects of the Pathogenesis and Diagnosis of Osteochondrosis of the Cervical Spine (Literature Review)

The aim of this research was to study the most important problems in diagnosing a socially significant problem - osteochondrosis of the cervical spine. According to some authors, in the structure of disability and disability associated with pathology of the spine, diseases of the cervical spine occupy one of the leading positions. The paper analyzes data from 41 sources of literature on the pathogenesis and diagnosis of osteochondrosis of the cervical spine. Due to the complexity and ambiguity of the approaches to the diagnosis of osteochondrosis of the cervical spine, this paper analyzes the most important research methods in the diagnosis of this pathology. Attention is focused on the main pathogenetic prerequisites for the occurrence of pain. According to literature data, the main attention in the diagnosis of osteochondrosis of the cervical spine is given to the basic methods: clinical and neurological examination, where the severity of the disorders is determined using scales that include not only an assessment of the intensity of the pain syndrome, but also the determination of a number of neurological disorders. The authors propose the use of a DN4 questionnaire, LANSS scales, neurological impairment scales (N1S); radiation research methods, such as survey spondylography of the cervical spine in direct and lateral projections, functional spondylography of the cervical spine in the position of maximum flexion and extension, multispiral computed tomography, magnetic resonance imaging data, and neurophysiological studies. Radiation research methods can determine pathological changes in the bone tissue itself. Magnetic resonance imaging indices make it possible to assess the degree of pathological changes in the soft tissue anatomical structures of the spinal canal and intervertebral discs. According to the literature, much attention is paid to functional research methods, in particular, electroneuromyography, which allows to assess the level and degree of damage to nerve fiber, the dynamics of the pathological process. Attention is paid to the allocation of marker indicators. All methods are significant, evidence-based, objective and modern and do not exclude the possibility of using data from other research methods. The analysis of the presented literature once again convinces clinicians of the ambiguity and heterogeneity of approaches to the issues of pathogenesis and diagnosis of the cervical spine, which requires further improvement of the proposed methods for clarifying and objectifying the pathological process. An important andjustified is a pathogeneti-cally grounded approach to their study.

The Experience of Using the Implantable Interspinous System COFLEX in the Surgical Treatment of Compression Forms of Lumbosacral Radiculitis

The paper presents the experience of surgical treatment of 58 patients with discogenic lumbosacral radiculitis. The aim of the surgical treatment was to eliminate the compression of the spinal roots of the herniated disc with the subsequent stabilization of the spinal-motor segment with implantable interspinous system COFLEX. Indications for surgical treatment were persistent radicular pain syndrome, which was not stopped by conservative methods of treatment, and disco-radicular conflict in the area of the interested vertebral-motor segment, confirmed by radiation research methods. In the diagnosis, the following research methods were used: clinical and neurological examination, survey and functional spondylography of the lumbar spine, computed tomography with contrast myelography, morphometric and statistical methods. The effectiveness of treatment was evaluated in 49 patients (84 % of operated) one and a half years after surgery. All patients showed complete regression of neurological deficit and satisfactory standing of the implanted interstitial dynamic system COFLEX in the operated vertebral-motor segment. Thus, the use of the implantable COFLEX dynamic system for the above indications is the choice method for operating surgeons, in which it is assumed that the function of the interested vertebral-motor segment is preserved.

Нарушение кровообращения в легких и развитие хронической дыхательной недостаточности у пациентов с обычной интерстициальной пневмонией

Purpose: To determine the features of circulatory disorders in the lungs in patients with ordinary interstitial pneumonia (OIP) at different stages of the pathological process and with the development of comorbid conditions. 
 Material and methods: The analysis of the results of radiation research methods: computer tomography, computed angiography and single photon emission computed tomography in 64 patients with common interstitial pneumonia. The selection criteria were the presence of respiratory failure and pulmonary hypertension.
 Results: The combination of interstitial and alveolar changes, their distribution in the lower parts of both lungs with subpleural localization are mainly pathognomonic for IPI. In 85 % of patients with OIP and the formation of a “cellular lung”, local perfusion disorders of various forms, of small size, subsegmental level, located symmetrically in the diaphragm regions were determined. The main distinctive CT signs of adherence to vascular pathology: pulmonary pattern mosaic; subpleural infiltration sites of the lung tissue of heterogeneous structure; defects in filling the pulmonary artery with a contrast agent during CT angiography; triangular subpleurally located areas of perfusion disturbance on SPECT (when SPECT/CT is combined), localized in the area of lung infarction, or in the zone of no changes on CT.
 Conclusion: The development of pulmonary hypertension and chronic respiratory failure in OIP is determined by several factors that have an active or passive effect on pulmonary hemodynamics. Worsening of the patient’s condition and an increase in the degree of respiratory failure and pulmonary hypertension, contributes to complication of the pulmonary vascular system – pulmonary thromboembolism and (or) thrombosis in situ, as well as persistent infectious inflammatory processes. In the presence of irreversible morphological changes in the lung parenchyma therapeutic measures do not affect the state of microcirculation in the lungs.

Life-threatening conditions in pericarditis of different etiologies: diagnosis and treatment

Purpose of the study: to analyze the etiology, diagnostic criteria and results of treatment of life-threatening conditions in pericarditis of different etiologies (based on our clinic materials).Materials and methods. The study included cases of hospitalization of patients with a diagnosis of «Pericarditis» and ICD-10 codes for pericardial diseases for the period from 2009 to 2018. In the course of the work, the history and clinical picture of the disease, laboratory and radiation research methods were analyzed. All patients started treatment of the underlying disease and performed symptomatic therapy, including those aimed at restoring hemodynamics and normalizing water and electrolyte disorders, stopping inflammation and auto-aggression of the immune system. When signs of compression/cardiac tamponade were detected, pericardiocentesis was performed, according to indications, drainage/fenestration of the cardiac sac, pericardiotomy were performed. In the postoperative period was carried out antibacterial and symptomatic therapy.Results. Life-threatening diseases of the pericardium accounted for 32,03% of all patients treated in the hospital for pericarditis. The most frequently detected signs of a hemodynamically significant compression and cardiac tamponade, less often purulent and constrictive P. Isolated 25 patients underwent closed drainage with pericardiocentesis, in 1 case the drainage was supplemented with f ibrinolytic therapy. Sanitation of the cavity and fenestration of the pericardium were carried out in 11 patients, pericardiotomy with notched drainage in 2 patients, thoracotomy with pericardiectomy – 4. In the postoperative period, the symptoms of inflammation were reduced, the level of cardiac enzymes decreased, the electrolyte balance stabilized. Most patients noted a distinct regression of the symptoms of pericarditis and cardiac compression. Recurrent P was noted in 5 cases, deaths occurred in 4 cases (8,16%).Conclusion. Early verification of the diagnosis and timely decompression of the heart with fractional evacuation of the exudate or pericardectomy with respect to the sequence of release of the heart chambers from adhesions and adhesions against the background of complex therapy allows to achieve positive dynamics, and fenestration of the cardiac bag with the formation of a sufficiently sized opening during recurrent fluid accumulation or intrapericardial fibrin. development of severe complications of pericarditis even in patients with multiple concomitant diseases evanii and oncopathology.

Life-threatening conditions in pericarditis of different etiologies: diagnosis and treatment

Purpose of the study: to analyze the etiology, diagnostic criteria and results of treatment of life-threatening conditions in pericarditis of different etiologies (based on our clinic materials).Materials and methods. The study included cases of hospitalization of patients with a diagnosis of «Pericarditis» and ICD-10 codes for pericardial diseases for the period from 2009 to 2018. In the course of the work, the history and clinical picture of the disease, laboratory and radiation research methods were analyzed. All patients started treatment of the underlying disease and performed symptomatic therapy, including those aimed at restoring hemodynamics and normalizing water and electrolyte disorders, stopping inflammation and auto-aggression of the immune system. When signs of compression/cardiac tamponade were detected, pericardiocentesis was performed, according to indications, drainage/fenestration of the cardiac sac, pericardiotomy were performed. In the postoperative period was carried out antibacterial and symptomatic therapy.Results. Life-threatening diseases of the pericardium accounted for 32,03% of all patients treated in the hospital for pericarditis. The most frequently detected signs of a hemodynamically significant compression and cardiac tamponade, less often purulent and constrictive P. Isolated 25 patients underwent closed drainage with pericardiocentesis, in 1 case the drainage was supplemented with f ibrinolytic therapy. Sanitation of the cavity and fenestration of the pericardium were carried out in 11 patients, pericardiotomy with notched drainage in 2 patients, thoracotomy with pericardiectomy – 4. In the postoperative period, the symptoms of inflammation were reduced, the level of cardiac enzymes decreased, the electrolyte balance stabilized. Most patients noted a distinct regression of the symptoms of pericarditis and cardiac compression. Recurrent P was noted in 5 cases, deaths occurred in 4 cases (8,16%).Conclusion. Early verification of the diagnosis and timely decompression of the heart with fractional evacuation of the exudate or pericardectomy with respect to the sequence of release of the heart chambers from adhesions and adhesions against the background of complex therapy allows to achieve positive dynamics, and fenestration of the cardiac bag with the formation of a sufficiently sized opening during recurrent fluid accumulation or intrapericardial fibrin. development of severe complications of pericarditis even in patients with multiple concomitant diseases evanii and oncopathology.

Possibilities of Multispiral computed Tomography in the Diagnosis of Occlusive Diseases of the Biliary Tract

The main place in the diagnosis of obstructive jaundice belongs to radiation research methods. Their choice is determined by the nature of the disease, efficacy, safety and cost of the study. The article describes the computer-tomographic symptoms of malignant and benign diseases of the hepatopancreatoduodenal region.To study the possibilities of multispiral computed tomography in the diagnosis of diseases, the results of examination of 62 patients with manifestations of mechanical jaundice syndrome were analyzed on the basis of the surgical Department of the Irkutsk city clinical hospital N 1. The mean age of the examined patients was 56 ± 4.5 years. In the ratio of 2:1.4 women dominated. Biliary obstruction of benign genesis prevailed, which was found in 44 (61.1 %) patients, among which the most common cause was: choledocholithiasis (34 (54.8 %) patients), choledoch strictures (9 (12.5 %) patients) periampular diverticula (2 (1.9 %) patients). The reason for the obstruction of malignant genesis (18 (38.9 %) patients) were: adenocarcinomas of the head of the pancreas (11 (29.0 %) patients), bile duct tumor (5 (8.0 %) patients), volume formations of the duodenum (2 (3.2 %) patients).

Microbiological substantiation and efficiency of using erbium and neodymium lasers in patients with inflammatory diseases of periodontium and peri-implantation tissues

In connection with the preservation of a rather high percentage of inflammatory periodontal diseases among dental patients, an urgent problem of their effective treatment with the possibility of achieving the least favorable postoperative course stays actual. In order to improve the efficiency of treatment of patients in this category, we conducted a study that analyzed the results of treatment of 100 patients with generalized marginal periodontitis and periimplantitis using traditional techniques and using neodymium and erbium lasers. Monitoring the effectiveness of treatment was based on bacteriological, clinical and radiation research methods. The results of quantitative monitoring of the microbiota of the postoperative wound, conducted in our study, indicate that the dynamics of contamination when using traditional surgical and laser technologies are fundamentally different. With the traditional technique of surgical intervention on the 3rd day there is a maximum level of microbial colonization of 8.2±0.4, which creates the risk of developing inflammatory complications, while using laser technology the level of microbial colonization in these terms is significantly lower than after traditional surgery: 4.4±0.3 (using the Nd:YAG laser) and 5.9±0.4 (using the Er:YAG laser). This level of colonization is within the normal content of the resident (normal) microbiota on the oral mucosa.

Early diagnosis of cardiotoxic complications of chemotherapy: the possibility of radiation research methods

Oncological diseases are the main causes of death in the world. Modern treatment of cancer patients contributes to an increase insurvival rate due to strong chemotherapeutic drugs, the use of which is accompanied by toxic effects on cardiomyocytes. The main manifestations of cardiotoxicity are left ventricular dysfunction, myocardial ischemia, thromboembolic complications, chronic heart failure. As a result, the risk of cardiovascular mortality may be higher than the risk of death from the tumor process. An important task of oncologists and cardiologists is the early diagnosis of cardiotoxic complications in order to start treatment in time and reduce mortality from cardiovascular pathology in cancer patients.

TU‐C‐AUD C‐04: Custom Built Small Animal IGRT Platform

Over the past 2 decades, there has been a widening technological disparity between laboratory radiation research and clinical radiation therapy. Whereas simple single beam/single fraction techniques are commonly used to irradiate laboratory animals, advanced three‐dimensional (3D) and computer‐controlled delivery technologies are now used clinically to pinpoint fractionated conformal radiation therapy (CRT) and intensity modulated radiation therapy (IMRT). The technological disparity presents a difficult hurdle in the development of novel treatment methods that combine conformal irradiation and other therapeutic agents. There is clearly a pressing need to bridge the technological gap between laboratory radiation research and human treatment methods.To that end, we have constructed a Small Animal Radiation Research Platform (SARRP) which integrates imaging, radiation delivery and treatment planning capabilities. The SARRP spans 3 ft × 4 ft × 6 ft (W×L×H). A dual‐focal (0.4 mm and 3.0 mm) spot, constant voltage x‐ray source is mounted on isocentric gantry. The source to isocenter distance is 35 cm. Eighty to 100 kVp x‐rays from the smaller focal spot are used for imaging. Both focal spots operate at 225 kVp for irradiation. Robotic translate/rotate stages are used to position the animal. A novel configuration is devised for CBCT imaging by rotating the horizontal animal between the x‐ray source and a flat panel amorphous silicon detector that are fixed at opposite horizontal positions of 90° and 270° respectively. Radiation beams ranging from 0.5 mm in diameter to (60 × 60) mm2 are available. Conformal dose distributions are delivered using a combination of gantry and robotic stage motion. Treatment planning is performed at sub‐mm resolution where Monte Carlo dose calculations are coupled to a research Pinnacle system for visualization. Depending on filtration, the isocenter dose outputs at 1 cm depth in water range from 22 to 375 cGy/min from the smallest to the largest radiation fields. The 20% to 80% dose fall‐off spans 0.16 mm. CBCT with (0.55 × 0.55 × 0.55) mm3 voxel resolution is acquired with less than 1 cGy in 4 min. The ability of our system to focally irradiate a specific anatomic region or target in a mouse subject has generated exciting new collaborations between laboratory and translational research. These include the study of the response of normal tissue and tumor to focal radiation injuries; the development of molecular imaging markers for early assessment of radiation induced toxicity in the lungs; and the study of molecularly targeted therapy in combination with radiation. We are hopeful that our SARRP, and other similar initiatives, will serve to provide the timely and powerful technology to greatly transform future cancer treatment.Educational Objectives:1. Appreciate the disparity between animal radiation research methods and clinical treatment.2. Understand the challenges in down‐sizing human treatment methods for small animal.