METHODS: Shear wave elastography assessments were performed in 75 CKD patients who underwent renal biopsy. The SWE-derived estimates of the tissue Young's modulus (YM), given as kilopascals (kPa), were measured. YM was correlated to patients' renal histological scores, broadly categorized into glomerular, tubulointerstitial and vascular scores.
RESULTS: Young's modulus correlates significantly with tubulointerstitial score (ρ = 0.442, P
METHODS: A survey on medical physics aspects of IMRT is conducted on radiotherapy departments across Malaysia to assess the usage, experience and QA in IMRT, which is done for the first time in this country. A set of questionnaires was designed and sent to the physicist in charge for their responses. The questionnaire consisted of four sections; (i) Experience and qualification of medical physicists, (ii) CT simulation techniques (iii) Treatment planning and treatment unit, (iv) IMRT process, delivery and QA procedure.
RESULTS: A total of 26 responses were collected, representing 26 departments out of 33 radiotherapy departments in operation across Malaysia (79% response rate). Results showed that the medical physics aspects of IMRT practice in Malaysia are homogenous, with some variations in certain areas of practices. Thirteen centres (52%) performed measurement-based QA using 2D array detector and analysed using gamma index criteria of 3%, 3 mm with variation confidence range. In relation to the IMRT delivery, 44% of Malaysia's physicist takes more than 8 h to plan a head and neck case compared to the UK study possibly due to the lack of professional training.
CONCLUSIONS: This survey provides a picture of medical physics aspects of IMRT in Malaysia where the results/data can be used by radiotherapy departments to benchmark their local policies and practice.
METHODS: A systematic search was performed in PubMed, the Cochrane library, CINAHL, Web of Science, ScienceDirect and Scopus, where 20 studies were selected for analysis of scanning parameters and CM reduction methods.
RESULTS: The mean effective dose (HE) ranged from 0.31 to 2.75 mSv at 80 kVp, 0.69 to 6.29 mSv at 100 kVp and 1.53 to 10.7 mSv at 120 kVp. Radiation dose reductions of 38 to 83% at 80 kVp and 3 to 80% at 100 kVp could be achieved with preserved image quality. Similar vessel contrast enhancement to 120 kVp could be obtained by applying iodine delivery rate (IDR) of 1.35 to 1.45 g s-1 with total iodine dose (TID) of between 10.9 and 16.2 g at 80 kVp and IDR of 1.08 to 1.70 g s-1 with TID of between 18.9 and 20.9 g at 100 kVp.
CONCLUSION: This systematic review found that radiation doses could be reduced to a rate of 38 to 83% at 80 kVp, and 3 to 80% at 100 kVp without compromising the image quality. Advances in knowledge: The suggested appropriate scanning parameters and CM reduction methods can be used to help users in achieving diagnostic image quality with reduced radiation dose.
METHODS: In this article, the steps involved in importing, segmenting, and registering tomographic images using 3D Slicer were thoroughly described, before importing them into GATE for MC simulation. The absorbed doses estimated using GATE were then compared with that of PM. SlicerRT, a 3D Slicer extension, was then used to visualize the isodose from the MC simulation.
RESULTS: A workflow diagram consisting of all the steps taken in the utilization of 3D Slicer for personalized dosimetry in 90 Y radioembolization has been presented in this article. In comparison to the MC simulation, the absorbed doses to the tumor and normal liver were overestimated by PM by 105.55% and 20.23%, respectively, whereas for lungs, the absorbed dose estimated by PM was underestimated by 25.32%. These values were supported by the isodose distribution obtained via SlicerRT, suggesting the presence of beta particles outside the volumes of interest. These findings demonstrate the importance of personalized dosimetry for a more accurate absorbed dose estimation compared to PM.
CONCLUSION: The methodology provided in this study can assist users (especially students or researchers who are new to MC simulation) in navigating intricate steps required in the importation of tomographic data for MC simulation. These steps can also be utilized for other radiation therapy related applications, not necessarily limited to internal dosimetry.
METHODS: A systematic review on the classification and assessment techniques to measure breast ptosis was carried out based on the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed using the modified Newcastle-Ottawa scale for observational studies, whereas the Revised Cochrane risk-of-bias tool for randomized trials (RoB2) was used to evaluate randomized studies.
RESULTS: Of 2550 articles identified in the literature search, 16 observational and 2 randomized studies describing the classification and assessment techniques of breast ptosis were included in the review. A total of 2033 subjects were involved. Half of the total observational studies had a Newcastle-Ottawa scale score of 5 and above. In addition, all randomized trials recorded a low overall bias.
CONCLUSION: A total of 7 classifications and 4 measurement techniques for breast ptosis were identified. However, most studies did not demonstrate a clear derivation of sample size beside lacking robust statistical analysis. Hence, further studies that apply the latest technology to combine the strength of previous assessment techniques are needed to develop better classification system that is applicable to all affected women.
PURPOSE: To investigate the relationship between marrow fat and cortical bone thickness in β-thalassemia and to identify key determinants influencing these variables.
STUDY TYPE: Prospective.
SUBJECTS: Thirty-five subjects in four subject groups of increasing disease severity: 6 healthy control (25.0 ± 5.3 years, 2 male), 4 β-thalassemia minor, 13 intermedia, and 12 major (29.1 ± 6.4 years, 15 male).
FIELD STRENGTH/SEQUENCE: 3.0 T, 3D fast low angle shot sequence and T1-weighted turbo spin echo.
ASSESSMENT: Analyses on proton density fat fraction (PDFF) and R2* values in femur subregions (femoral head, greater trochanter, intertrochanteric, diaphysis, distal) and cortical thickness (CBI) of the subjects' left femur. Clinical data such as age, sex, body mass index (BMI), and disease severity were also included.
STATISTICAL TESTS: One-way analysis of variance (ANOVA), mixed ANOVA, Pearson correlation and multiple regression. P-values <0.05 were considered significant.
RESULTS: Bone marrow PDFF significantly varied between the femur subregions, F(2.89,89.63) = 44.185 and disease severity, F(1,3) = 12.357. A significant interaction between subject groups and femur subregions on bone marrow PDFF was observed, F(8.67,89.63) = 3.723. Notably, a moderate positive correlation was observed between PDFF and CBI (r = 0.33-0.45). Multiple regression models for both PDFF (R2 = 0.476, F(13,151) = 10.547) and CBI (R2 = 0.477, F(13,151) = 10.580) were significant. Significant predictors for PDFF were disease severity (βTMi = 0.36, βTMa = 0.17), CBI (β = 0.24), R2* (β = -0.32), and height (β = -0.29) while for CBI, the significant determinants were sex (β = -0.27), BMI (β = 0.55), disease severity (βTMi = 2.15), and PDFF (β = 0.25).
DATA CONCLUSION: This study revealed a positive correlation between bone marrow fat fraction and cortical bone thickness in β-thalassemia with varying disease severity, potentially indicating a complex interplay between bone health and marrow composition.
EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 3.
METHODS: Teaching and Learning (T&L) activities were conducted virtually on e-learning platforms. The students' experience and feedback were evaluated after 15 weeks.
RESULTS: We found that while students preferred face-to-face, physical teaching, they were able to adapt to the new norm of e-learning. More than 60% of the students agreed that pre-recorded lectures and viewing videos of practical sessions, plus answering short questions, were beneficial. Certain aspects, such as hands-on practical and clinical experience, could never be replaced. The e-learning and study-from-home environment accorded a lot of flexibility. However, students also found it challenging to focus because of distractions, lack of engagement and mental stress. Technical problems, such as poor Internet connectivity and limited data plans, also compounded the problem.
CONCLUSION: We expect e-learning to prevail in future. Hybrid learning strategies, which includes face-to-face classes and e-learning, will become common, at least in the medical physics programme of the University of Malaya even after the pandemic.
MATERIALS AND METHODS: Contrast enhanced computed tomography (CT) images of 194 multi-racial NSCLC patients (79 EGFR mutants and 115 wildtypes) were collected from three different countries using 5 manufacturers' scanners with a variety of scanning parameters. Ninety-nine cases obtained from the University of Malaya Medical Centre (UMMC) in Malaysia were used for training and validation procedures. Forty-one cases collected from the Kyushu University Hospital (KUH) in Japan and fifty-four cases obtained from The Cancer Imaging Archive (TCIA) in America were used for a test procedure. Radiomic features were obtained from BN maps, which represent topologically invariant heterogeneous characteristics of lung cancer on CT images, by applying histogram- and texture-based feature computations. A BN-based signature was determined using support vector machine (SVM) models with the best combination of features that maximized a robustness index (RI) which defined a higher total area under receiver operating characteristics curves (AUCs) and lower difference of AUCs between the training and the validation. The SVM model was built using the signature and optimized in a five-fold cross validation. The BN-based model was compared to conventional original image (OI)- and wavelet-decomposition (WD)-based models with respect to the RI between the validation and the test.
RESULTS: The BN-based model showed a higher RI of 1.51 compared with the models based on the OI (RI: 1.33) and the WD (RI: 1.29).
CONCLUSION: The proposed model showed higher robustness than the conventional models in the identification of EGFR mutations among NSCLC patients. The results suggested the robustness of the BN-based approach against variations in image scanner/scanning parameters.
MATERIALS AND METHODS: Nine phantoms were fabricated with different bifurcation angles ranging from 55.3° to 134.5°. General X-ray and CCTA were employed to acquire 2D and 3D images of the bifurcation phantoms, respectively. Multiplanar reformation (MPR) and volume rendering technique (VRT) were used to measure the bifurcation angle between the left anterior descending (LAD) and left circumflex arteries (LCx). The measured angles were compared with the true values to determine the accuracy of each measurement technique. Inter-observer variability was evaluated. The two techniques were further applied on 50 clinical CCTA cases to verify its clinical value.
RESULTS: In the phantom setting, the mean absolute differences calculated between the true and measured angles by MPR and VRT were 2.4°±2.2° and 3.8°±2.9°, respectively. Strong correlation was found between the true and measured bifurcation angles. Furthermore, no significant differences were found between the bifurcation angles measured using either technique. In clinical settings, large difference of 12.0°±10.6° was found between the two techniques.
CONCLUSION: In the phantom setting, both techniques demonstrated a significant correlation to the true bifurcation angle. Despite the lack of agreement of the two techniques in the clinical context, our findings in phantoms suggest that MPR should be preferred to VRT for the measurement of coronary bifurcation angle by CCTA.
METHODS: In total, 154 patients (wild-type EGFR, 72 patients; Del19 mutation, 45 patients; and L858R mutation, 37 patients) were retrospectively enrolled and randomly divided into 92 training and 62 test cases. Two support vector machine (SVM) models to distinguish between wild-type and mutant EGFR (mutation [M] classification) as well as between the Del19 and L858R subtypes (subtype [S] classification) were trained using 3DBN features. These features were computed from 3DBN maps by using histogram and texture analyses. The 3DBN maps were generated using computed tomography (CT) images based on the Čech complex constructed on sets of points in the images. These points were defined by coordinates of voxels with CT values higher than several threshold values. The M classification model was built using image features and demographic parameters of sex and smoking status. The SVM models were evaluated by determining their classification accuracies. The feasibility of the 3DBN model was compared with those of conventional radiomic models based on pseudo-3D BN (p3DBN), two-dimensional BN (2DBN), and CT and wavelet-decomposition (WD) images. The validation of the model was repeated with 100 times random sampling.
RESULTS: The mean test accuracies for M classification with 3DBN, p3DBN, 2DBN, CT, and WD images were 0.810, 0.733, 0.838, 0.782, and 0.799, respectively. The mean test accuracies for S classification with 3DBN, p3DBN, 2DBN, CT, and WD images were 0.773, 0.694, 0.657, 0.581, and 0.696, respectively.
CONCLUSION: 3DBN features, which showed a radiogenomic association with the characteristics of the EGFR Del19/L858R mutation subtypes, yielded higher accuracy for subtype classifications in comparison with conventional features.
METHODS: A questionnaire based on the Joint Commission International Accreditation Standards was electronically sent to 3 institutions each in 10 geographical regions across 9 Asian countries. Questions addressing 45 practices were divided into 3 categories. A five-tier scale with numerical scores was used to evaluate safety practices in each institution. Responses obtained from three institutions in the United States were used to validate the execution rate of each surveyed safety practice.
RESULTS: The institutional response rate was 70.0% (7 Asian regions, 21 institutions). 44 practices (all those surveyed except for the application of wrist tags for identifying patients with fall risks) were validated using the US participants. Overall, the Asian participants reached a consensus on 89% of the safety practices. Comparatively, most Asian participants did not routinely perform three pre-procedural practices in the examination appropriateness topic.
CONCLUSION: Based on the responses from 21 participating Asian institutions, most routinely perform standard practices during radiological examinations except when it comes to examination appropriateness. This study can provide direction for safety policymakers scrutinizing and improving regional standards of care.
ADVANCES IN KNOWLEDGE: This is the first multicenter survey study to elucidate pre-procedural safety practices in radiological examinations in seven Asian regions.