International Journal of Radiation Research
Volume:20 Issue: 2, Apr 2022

The appropriate extent of the radiation field (primary site ± neck) in pathologically node-negative (pN0) head and neck cancer (HNC) with adverse features at the primary site remains controversial. We investigated the effect of adjuvant neck radiotherapy (RT) on regional control and survival in patients with pN0 HNC.

A systematic search of databases (MEDLINE, EMBASE, and Cochrane library) was performed for literature published until January 2021. Studies of HNC patients with pN0 neck that reported on the regional recurrence (RR) rate and regional recurrence-free survival (RRFS) with respect to adjuvant neck RT were included.

Five studies comprising 553 patients, with a median follow-up of 50 months, were included. The overall RR rates were 2.0% (3/153) for patients treated with adjuvant neck RT and 6.5% (26/400) for patients treated with neck dissection (ND) only. Patients who received adjuvant neck RT had a 0.37-fold (95% confidence interval [CI]=0.13–1.04, P=0.06, I2=0%) lower risk of RR than did patients with ND only. The addition of adjuvant neck RT did not significantly improve RRFS (hazard ratio=0.58, 95% CI=0.16–2.08, P=0.41, I2=0%).

Given the RR rate of 6.5% in the RT-negative group, ND alone appears to be sufficient for treating neck disease in pN0 HNC. However, the neck RT group had a lower RR rate than that of the non-RT group, suggesting that pN0 HNC patients with a high risk of recurrence may benefit from elective neck RT.

Meta-analysis experiments can be used to judge the hypothesis of SMI benign and malignant thyroid nodules.

We explored Cochrane Library, PubMed, Google Scholar, CBM and Web of Science, databases according to the required content, and used a number of analysis equipment to analyze, and through the conclusions drawn to determine the sensitivity (Sen) and specificity (Spe), the probability ratio of pragmatic and dismissive (LR + / LR-), diagnostic factor (DOR) and receiver performance typical curve (SROC) are calculated for summary statistics.

The meta-analysis included nine studies that met the participation criteria. An aggregation of 636 malignant thyroid legumes and 732 benign thyroid nodules were evaluated. The comprehensive Sen was 0.79 (95% confidence interval (CI) = 0.76-0.82), and the comprehensive Spe was 0.89 (95% CI = 0.85-0.92). The comprehensive LR + was 7.04 (95% CI = 5.26-9.43), and the comprehensive negative LR- was 0.23 (95% CI = 0.20-0.27). The comprehensive DOR of thyroid nodules diagnosed by SMI was 30.33 (95% confidence interval = 20.73–44.38). The range beneath the SROC curve was 0.82 (95% confidence interval = 0.79 to 0.86). We established no proof of reporting bias (t = 0.91, P = 0.39).

In a related meta-analysis, the study found that SMI has a very high prognosis accuracy in distinguishing malignant and benign thyroid nodules.

Tumor cells with high aldehyde dehydrogenase activity (ALDHhigh cells) are induced by an intratumoral hypoxic condition and lead to radioresistance, tumor recurrence, and metastasis. Therefore, to enhance the anti-tumor effect of radiotherapy, it is reasonable to efficiently control ALDHhigh cells by targeting them. In this study, we evaluated the effect of tirapazamine, a hypoxic toxin, combined with irradiation on ALDHhigh cells.

Human tongue squamous cell carcinoma SAS cells were used in this study. Spheroids were irradiated with 6 Gy following treatment with 40 μM tirapazamine. After 24, 48, and 72 hours, the populations of ALDHhigh cells were analyzed. The frozen sections of spheroids were prepared, and hypoxia-inducible factor-1α-positive areas and ALDH1-positive areas were detected.

Compared with the cells grown in monolayer culture, the SAS cells grown in spheroids exhibited radioresistance. Furthermore, the proportion of ALDHhigh cells was significantly higher in spheroids than in monolayer culture. The ALDHhigh cells were sustained in a hypoxic fraction localized at the center of the spheroids after irradiation. Tirapazamine effectively reduced these ALDHhigh cells. The combination of tirapazamine with irradiation showed an additive cytotoxic effect in spheroids, but not in parental cells, which was consistent with a preferential killing effect of tirapazamine on ALDHhigh cells.

Combined tirapazamine and radiotherapy administration appeared to be a reasonable approach to control ALDHhigh cells in hypoxic regions that may be involved in recurrence and metastasis.

Pulsed magnetic field (PMF) application is an alternative therapy method used especially in the treatment of musculoskeletal system diseases. However, its effects on the vascular system are unclear. On the other hand, an imbalance in the synthesis of reactive oxygen species (ROS) can cause crucial vascular diseases such as hypertension or atherosclerosis. Therefore, this study aimed to elucidate the modulatory effect of PMF pre-exposure and the protective role of the application on ROS-related vascular dysfunctions.

Rats were exposed to 1.5 mT, 40 Hz PMF for 30 days. Vascular smooth muscle cells (VSMCs) were isolated enzymatically at the end of the application. Cell proliferation in the presence or absence of hydrogen peroxide (H2O2, oxidative stress and apoptosis inducer) was determined by MTT assay. Caspase-3 activity and protein expressions were also determined.

Incubation of VSMCs with H2O2 decreased the cell proliferation dose-dependently. However, the cells isolated from PMF pre-treated rats had higher proliferation levels at high dose H2O2 (1 mM) than their controls. Moreover, PMF pre-applied cells had less caspase-3 expression at high dose H2O2 incubation. A similar effect of PMF was also observed in caspase-3 enzyme activity.

The present study demonstrated that PMF pre-exposed cells showed resistance to H2O2-induced oxidative stress. Notably, the decreased activity and expression of caspase-3 in PMF pre-treated groups indicated that PMF has regulatory effects on apoptosis formation mechanisms. The present study demonstrated that PMF pre-application should be considered as protective in the development of vascular diseases.

The objective of this study was to retrospectively analyze the application of dual-energy spectral computerized tomography (DECT) to accurately diagnose breast cancer and lymph node metastasis.

Between May 2018 and December 2019, 37 patients (22 with breast cancer and 15 with normal breast cancer) who underwent spectral CT imaging were analyzed. Metastatic lymph nodes were identified in 14 patients with breast cancer. Twelve patients who underwent traditional CT were included randomly as the control group to compare the radiation dose with spectral CT. Monochromatic levels with an optimal contrast-to-noise ratio for normal breast tissue were obtained. Quantitative parameters of spectral CT were compared between normal breast and breast cancer patients. The spectral curve, histogram, and scatter plot features of metastatic lymph nodes and primary lesions were analyzed.

The monochromatic level with the optimal contrast-to-noise ratio of the breast was approximately 65keV. All quantitative parameters, including values at 40keV–140keV, the concentrations of iodine, spectral curve slope (λHU), and relative iodine concentration were increased in breast cancer compared to those in healthy breasts. Metastatic lymph nodes were more consistent with primary breast cancer lesions in the spectral curve, histogram, and scatter plot, especially in the venous phase. Additionally, the radiation of spectral CT was decreased compared to that of traditional CT.

Spectral CT can be used to identify breast cancer and metastatic lymph nodes.

Although chemotherapy (CT) and radiotherapy (RT) are important breast cancer (BC) treatment modalities, they can cause other cancers. However, second cancers of liver and stomach tend to be ignored during BC treatment. In this study, the incidence patterns of second primary cancer of liver and stomach were analyzed.

The insurance claim data of patients that underwent definitive surgery from 2009 to 2010 were analyzed. Standardized incidence ratios (SIRs) were used to estimate the relative risks of second primary liver cancer (SPLC) and second primary stomach cancer (SPSC). In addition, hazard ratios (HRs) of risk factors were analyzed. Data were obtained on 21,024 BC patients that underwent definitive mastectomy.

The median follow-up period was 105.5 months. Overall SIRs for SPLC and SPSC were 7.26 (p<0.01) and 2.92 (p<0.01). In the young age group (aged 20–39 years), the crude HR for CT was 2.27 (p < 0.05) and the age/RT adjusted HR was 2.37 (p<0.05). RT also showed a tendency to induce SPLC. The effect of CT peaked within 5 years after treatment, whereas the effect of RT gradually increased after 5 years.

This study shows CT and RT both increase the risk of SPLC in BC patients and that these increases are greater in young BC patients. Times to SPLC occurrence after RT and CT were found to differ.

This study aims to perform quality control (QC) practices for setup reproducibility during radiotherapy for nasopharyngeal carcinoma (NPC) using statistical process control (SPC) tools.

A total of 480 fractional images from 48 NPC patients with the first 10 fractions of the treatment were collected. In QC practices, setup errors were described using the histogram and normal curve, cumulative frequencies of absolute setup errors and 3D Euclidean Distance (Eu) were analyzed; the X ̅-S chart and process capability index (Cpk) with the variable Eu were utilized to identify whether the outlier occurred and to evaluate the QC process.

The translational setup error distributions were almost normal in Lateral, Longitudinal and Vertical directions and were narrower in Lateral and Vertical directions. Vertical translational errors and Eu with a larger magnitude sag appeared the most frequently. Between the couch sag and no sag, the Eu mean of 7 to 7 NPC patients with the same 3 patients was out of control and the standard deviation of Eu  of nil to 2 patients was outlier based on the X ̅-S chart, and the Cpk was 1.05 and 1.36 respectively, when the specification limit of translational errors was ±3 mm.

Daily imaging is necessary to increase setup reproducibility for NPC patients and more measures should be taken to facilitate quality assurance procedures. SPC is better applied to QC practices depending on the reliable data and the acceptable tolerance levels in further studies.

Various developed intensity modulated radiation therapy (IMRT) and a three dimensional conformal radiation therapy (3D-CRT) protocols were assessed for treating nasopharyngeal cancer (NPC) based on radiobiological parameters.

Treatment plans were made for 30 NPC patients using 15 developed IMRT and 3D-CRT protocols. The IMRT protocols comprised of three 7-fields with various collimator (0°, 5°, and 10°) and couch (0°, 4°, 8°, 12°) angles. The 3D-CRT technique included two phases. In the 1st phase a dose of 60 Gy was prescribed to the total PTV, but in the 2nd phase a dose of 10 Gy was prescribed to the PTV-70. The tumour control probability (TCP), normal tissues complication probability (NTCP), and complication-free tumor control probability (P+) parameters were estimated for assessing the IMRT protocols. Then, the ideal protocol (s) were proposed through comparing the IMRT protocols with each other and 3D-CRT protocol based on TCP, NTCP, and P+ values.

The IMRT protocol with 10° collimator and 8° couch angles had the lowest NTCP mean values. Significant differences were observed among the mean NTCP values for the brainstem and parotid glands, and P+ of the developed IMRT and 3D-CRT protocols. However, no significant differences were observed among the mean NTCP values for the spinal cord, optic chiasm and optic nerves among the protocols.

The 3D-CRT protocol had a good outcome for the NPC patients having a lower common volume between their total planning target volume and OARs, while the results of the IMRT showed the opposite.

This study aims to investigate voxel-level dose calculation methods and improve its calculation efficiency in nuclear medicine that can consider animal-specific heterogeneous tissue compositions and radiopharmaceutical biodistributions simultaneously.

The voxelized mouse phantom was constructed from real mouse CT images and simulated using the Monte Carlo GEANT4 code. According to the dynamic PET images of real mouse, the real distribution of radiopharmaceutical activity was set in the Monte Carlo simulation. The sampling method to improve the calculation efficiency was proposed. Two voxel-level dose calculation methods were implemented in this study. The average absorbed dose in vital target organs and the tumor was calculated by the proposed voxel-level dose calculation methods and the traditional MIRD method respectively. The results of the average absorbed dose calculated by the two methods were compared. Based on the voxel-level dose calculation method, the three-dimensional dose distribution in organs and the tumor was obtained and evaluated.

The relative difference of average absorbed dose between the two voxel-level dose calculation methods was mostly less than 10%. The sampling method proposed to improve calculation efficiency for the voxel-level dose calculation can decrease the calculation time by ~34% with less deviation.

The results confirmed that the voxel-level dose calculation methods proposed in this study allow for more accurate and efficient assessment of the internal radiation dose.

To determine the patterns of recurrence, prognostic factors and treatment outcomes in stage I-II lip cancer. 

 A retrospective review was made of the data of 74 patients diagnosed with squamous cell carcinoma (SCC) of the lip between 2000 and 2009. 

 In all, 44 of the patients had stage I disease and 30 had stage II disease. Surgery was performed on the primary tumor in all patients, 15 received adjuvant radiotherapy and 23 underwent elective neck therapy. Recurrence occurred in 23 (31%) of the patients, with a mean time from surgery to relapse of 23 months. The frequency of nodal recurrence increased as tumor stage and depth increased. Adjuvant radiotherapy and neck dissection or elective radiotherapy decreased the risk of recurrence in tumors with depths of over 0.5 cm, with positive or close margins, and with perineural invasion. The median overall survival (OS) was 120 months and the median disease-free survival (DFS) was 83 months. A univariate analysis revealed tumor stage and depth, adjuvant radiotherapy, and neck treatment (lymphatic dissection + nodal irradiation) to affect DFS, while a multivariate analysis showed that elective neck radiotherapy improved DFS. 

 Greater tumor stage and depth increase the risk of nodal recurrence in early-stage lip cancer, although the frequency of recurrence is decreased in such patients if treated with elective neck dissection and/or postoperative radiotherapy.

To determine the degree of lung inflation sufficient to compensate for cardiac motion in patients receiving standard tangential left-breast radiotherapy during deep inspiration breath hold (DIBH).

Computed tomography (CT) scans were performed in 20 patients with left-sided early breast cancer during free breathing (FB) and DIBH. Standard tangential field plans were generated in both CT sets. Doses to the organs at risk were assessed. The margin between the left anterior descending artery (LAD) and posterior field edge was measured from the closest point.

The DIBH plans showed equal coverage of the breasts, so it was possible to obtain lower cardiac doses with DIBH. The median increase in the left-lung volume with DIBH was 53% (range 12.6% - 108%).  A LAD safety distance ≥ 5mm from field edges was not obtained in any of the patients during FB, whereas in 60% of the patients during DIBH the safety distance was obtained. The lung inflation rate and cardiac safety distance were strongly correlated. The mean distance between the LAD and tangential field posterior edge increased significantly from 0.23 cm to 0.64 cm (p=0.041) in the patients who inflated their ipsilateral lung  > 1.5 times.

Lung inflation of  ≥50% compensated for cardiac motion during treatment using DIBH. The lung inflation capacity should be considered in choosing the irradiation technique in left-sided breast cancer patients.

Often diagnosed at late stages, ovarian cancer is one of the leading causes of global cancer death. Major therapeutic choices include debugging surgery followed by chemotherapy and adjuvant therapy. Bevacizumab is an anti-VEGF medication used to treat various malignancies such as colorectal, lung, and renal cancer. The combination therapy of bevacizumab with other platinum-based medications has proved promising. Thus, researchers sought to evaluate the clinical efficacy of intraperitoneal bevacizumab combined with intravenous paclitaxel and cis-platinum and their subsequent effect on blood levels of VEGF, MIF, and CA125.

Ninety patients diagnosed with late-stage ovarian cancer were enrolled. Patients were divided into control and experimental groups receiving intravenous and combination chemotherapy, respectively. Clinical efficacy and alterations in tumor markers blood levels were afterward compared between the two groups.

Combination therapy elicited significantly higher response and total effectiveness rates with a p-value of 0.015 and 0.002, respectively. Both treatments significantly decreased tumor markers blood levels (p-value<0.05), however, combination therapy significantly induced a more profound reduction (p-value<0.01).

Intraperitoneal bevacizumab combination therapy with intravenous paclitaxel and cis-platinum is superior to intravenous chemotherapy alone in treating late-stage ovarian cancer and increases 1- and 2-year survival rates.

This study aimed to evaluate the relationship of tumor size and ultrasound (US) Breast Imaging Reporting and Data System (BI-RADS), and further analyze if tumor size can impact the evaluation for US features in patients with breast cancer.

In this retrospective study, preoperative US features and postoperative pathological results were collected from 498 patients with breast cancer. The association of BI-RADS classification with tumor size was analyzed, and the US features related to tumor size were determined.

A significant association was found between tumor size and BI-RADS category, and tumor with small size was classified into the low BI-RADS category (p < 0.05). Some US features including shape, growth orientation, microcalcification and color Doppler flow imaging (CDFI) were influenced by tumor size (p<0.001).

Tumor size can influence the diagnosis performance for US BI-RADS category in patients with breast cancer.

The development of radiosensitizers that modulate activated signaling pathways has enhanced effective cancer treatment via radiation therapy. The phosphoinositide 3-kinases (PI3K)/protein kinase B (AKT) pathway induces cancer progression and radioresistance. Therefore, we investigated if HS-173, a novel PI3K inhibitor, could increase the radiosensitivity in breast cancer cells.

Breast cancer cell lines (MCF-7, BT-474, and T47D, MDA-MB-231) were exposed to radiation (2–8 Gy). After irradiation, cell viability was assessed using the MTT assay. MDA-MB-231 cells were exposed to radiation (5 Gy) alone and/or in combination with HS-173 (1 μM). After treatment, the levels of PI3K/AKT signaling protein were measured using western blotting. The radiosensitivity of HS-173 was assessed using a clonogenic assay and flow cytometry.

We observed that HS-173 decreased the radiation-induced phosphorylation of AKT in MDA-MB-231 cells and increased their radiosensitivity in the clonogenic assay. Upon investigation of the mechanism underlying the enhanced radiosensitivity by HS-173, we observed a significant increase in the IR-induced G2/M cell cycle arrest and apoptosis pathway components, including poly (ADP-ribose) polymerase (PARP-1) and cleaved caspase-3. It can be concluded that HS-173 significantly improved radiosensitivity by inducing apoptosis and G2/M arrest in radio-resistant breast cancer cells.

HS-173 may be applied as a radiosensitizer with promising potential in radio-resistant breast cancer treatment.

There is not yet an appropriate biomarker to predict or follow radiosensitivity of Breast cancer (BC) patients during or after radiotherapy. The aim of this study was to monitor chromosomal aberrations (CA) induced before and during radiotherapy in peripheral blood lymphocytes of BC patients.

Age-matched twenty normal healthy individuals and 20 invasive ductal BC patients were enrolled in this study. A blood sample was obtained from normal healthy women and BC patients before and after the first, two and four weeks after radiotherapy. Lymphocyte microculture was initiated in 4.5ml complete RPMI-1640 medium. Cells were harvested 50 hours after culture initiation. Cells were harvested based on standard protocols. Hundreds of well-spread mitoses were scored under a light microscope with a magnification of x1000 for various types of CA. Data were statistically analyzed and p<0.05 was considered a significant difference.

Results indicated a higher frequency of CA in lymphocytes of un-irradiated BC patients compared to healthy normal individuals, although not statistically significant (p>0.05). High frequencies of CA were observed in lymphocytes of BC patients after radiotherapy, significantly different from the un-irradiated group (p<0.01). The increase in the frequency of CA was increased with increasing radiation dose.

Genome instability may contribute to high background and radiation-induced CA in lymphocytes of BC patients. However, there is also the possibility of a radio-adaptation of cells during the course of radiotherapy. Results imply that dicentric chromosomes might be valuable cytogenetic bioindicators to monitor the response of BC patients to radiotherapy.

In our recent studies, yeast double-stranded RNA showed radioprotective effect in mice exposed to 9.4 Gy of gamma radiation. The current work continues our inquiry and describes the changes in the number and morphology of blood cells in mice injected with double-stranded RNA from Saccharomyces cerevisiae prior to gamma irradiation. To be capable of estimating the required parameters, we have used 8 Gy of radiation, which allowed mice to survive for up to 37 days (LD60/30).

Animals received single intravenous injections of one of the following compounds: (1) 7 mg of total RNA isolated from baking yeast Saccharomyces cerevisiae, (2) 200 μg of double-stranded RNA or (3) 400 μg of double-stranded RNA. 30 minutes later, using a 137Cs gamma emitter, mice were irradiated with a dose of 8 Gy at the rate of 1.4 Gy/min. The radioprotective effect of preparations was assessed based on death rates.

Injections of both 200 μg of double-stranded RNA and 7 mg of total RNA prior to irradiation provided the best radioprotective effects, ensuring the survival of 100% of animals. Changes in the number of blood cells and their morphological aberrations were being monitored for 37 days after irradiation.

The protection from lethal radiation doses is associated with the preservation and rapid recovery of leukocytic and erythroid lineages.

Cardiac disease is a documented risk factor in left breast irradiation. In an attempt to reduce cardiac toxicity, different treatment techniques adapted to respiratory cycle phases have been developed. The aim of this study is to investigate the feasibility of the voluntary breath hold technique when irradiating the left breast in selected patients.

The study included 20 patients with left sided breast cancer. For each patient, two computed tomography (CT) scans were acquired, one with the free breathing (FB) technique and one with the voluntary deep inspiration breath hold (DIBH) technique. Treatment plans were created using a field-in-field intensity-modulated radiation therapy technique. A dosimetric comparison was made between the two techniques for the heart, left anterior descending (LAD) coronary artery, ipsilateral lung and contralateral breast.

The average of the mean dose of the heart decreased from 7.7 Gy to 5.8 Gy and V20Gy (%) from 12.8% to 8.3% using the DIBH technique (p=0.009, p<0.001). The DIBH technique demonstrated significantly smaller maximum heart distance (2.0 cm vs. 0.9 cm, p < 0.001) and 8.0% reduction in LAD mean dose. Furthermore, Dmean for the ipsilateral lung was reduced from 12.8 Gy to 12.2 Gy and V20Gy (%) from 25.6% to 22.8%.

In the treatment plans made using the DIBH technique, a significant reduction in the radiation dose delivered to the heart has been observed. In order to reduce long-term morbidity and mortality risks from cardiovascular disease affecting the survival of patients with left sided breast cancer, irradiation techniques such as the DIBH should be considered, especially for premenopausal patients.

To compare the dosimetric parameters, clinical complications, and efficacy of helical tomotherapy (HT) and fixed-field intensity-modulated radiotherapy (f-IMRT) in radical radiotherapy for cervical cancer.

From November 2016 to December 2018, 77 cervical cancer patients in radical irradiation were selected, 38 patients undergoing treatment with HT and 39 with f-IMRT. The dosimetic parameters, clinical complications, and efficacy were compared.

The homogeneity index (HI) and conformity index (CI) of HT plans were both superior to those of f-IMRT plans(P=0.000). HT plans resulted in a reduction in the dosimetric parameters of organs at risk (OARs) (P<0.05) except the V10 of small intestine (P=0.682). The incidence of myelosuppression showed no significant differences (P=0.265).The patients with HT had no radiocystitis, grade 2 or above radiation proctitis. The complete remission (CR) rates, efficacy rates (CR+PR) and local control rates of two years were 81.58%,100% and 97.37%.

HT showed advantages in dosimetry, and provided more superior clinical results. It has a good application prospect in radical irradiation for cervical cancer.

Hypofractionation radiotherapy (HFx) following breast-conserving surgery (BCS) in ductal carcinoma in situ (DCIS) has been shown to be safe in many retrospective studies. In this paper, we report our data and assess those outcomes to support the use of HFx in DCIS.

All patients with DCIS after BCS were treated with 4250cGy in 16 fractions to whole breast with tumor bed boost 1000cGy in 4 fractions. The toxicity was evaluated using CTCAE v.5.0. On the last day of radiation (day 0) then 1 and 6 months post radiation. The cosmesis was evaluated at 6 months.

Between July 2018 and December 2019 at our center, 33 patients were analyzed with a median follow up of 7.3 months. No toxicity of more than grade2 occurred. At day 0 and 1 month after radiation, 89% and 85% of patients had grade1 dermatitis and hyperpigmentation, respectively. For induration, 33% had grade1 at day 0, 29% at 1 month, and 44.8% at 6 months. Only 3% had grade2 induration at 1 month. In addition, 67% of the subjects had grade1 pruritus and 37% had grade1 pain at day0. Radiation oncologists assessed good-to-excellent cosmesis in 93% of these patients, while the 96.6% of patients self-evaluated as good to excellent without impact on their self-confidence.

This prospective trial showed that HFx can be safely used in DCIS with no more than grade2 skin toxicity and good to excellent cosmesis.

The Japanese clinical guidelines and the 2015 American Thyroid Association Management Guidelines recommend that indolent papillary thyroid microcarcinoma (PTMC) be monitored actively and that patients with aggressive PTMC immediately undergo surgery. This study aimed to establish a stage model and provide a reference for the preoperative identification of aggressive PTMC and indolent PTMC, which might guide the treatment of PTMC.

Risk factors for the aggressive PTMC were identified through multivariate logistic regression analysis. According to the regression coefficient, each risk factor was assigned a risk score; thereafter, a risk score (RS) model and a stage model were established.

The tumor’s largest diameter > 6 mm, BRAFV600E (v-Raf murine sarcoma viral oncogene homolog B1, V600E) mutation, ultrasound-suspected lymph node metastasis, ultrasound-suspected extrathyroidal extension, and microcalcification were identified as risk factors for aggressive PTMC. The stage model was divided into three stages: stage I (RS=0.0; predictive probability for PTMC aggressiveness <10%), stage II (RS=1.0–2.3; predictive probability for PTMC aggressiveness, 10–50%), stage III (RS=3.2–7.6; predictive probability for PTMC aggressiveness, >50%). Based on the abovementioned results, stages I and II were considered to be probably indolent PTMC, and stage III was considered as probably aggressive PTMC.

We suggest that patients with stages I and II PTMC be recommended for active surveillance, while those with stage III PTMC be recommended for immediate surgery.

Factors affecting the patient’s voice and Quality of Life (QOL) by means of Persian Voice Handicap Index (VHI) are important in non-laryngeal Head and Neck Cancers (HNCs) following (chemo)radiation therapy. This study aimed to investigate the vocal problems caused by (chemo)radiation therapy among Iranian patients with non-laryngeal HNCs and to evaluate the factors affecting the patient’s voice QOL by means of Persian VHI.

Seventy patients with non-laryngeal Head and Neck Cancers (HNCs) were treated by radiation therapy, and eighty individuals with normal voice were considered. Acoustic analysis and self-assessment with the Persian VHI questionnaire were performed before, during, and 6 months after the treatment. Normal subjects were tested once. Changes in the acoustic parameters and VHI questionnaire scores over the time and their correlation was assessed using statistical analysis. The effect of important factors on the patient’s voice and QOL in different groups was investigated.

The results showed that the acoustic parameters except mean F0, and questionnaire data deteriorated significantly (P < 0.001) during the treatment and improved at the final assessment, but not to the initial level. There was a significant relationship between some of the acoustic parameters and subgroups of the VHI questionnaire at the end and 6 months after treatment. Chemotherapy, mean laryngeal dose and smoking were factors that affecting the patient’s QOL.

Radiation dose in non-laryngeal tumor in HNCs causes laryngeal damage and vocal problems. Acoustic analysis and Persian VHI questionnaire were two valuable methods in evaluating the patients’ voice and QOL. Radiation dose, chemotherapy and smoking greatly impact the aggravation of vocal problems.

Most parts of the Erongo region of Namibia have shown high background radiation. The aim and objective of this study is to determine the natural radioactivity levels and evaluate the radiological hazards in Usakos marble dome in the Erongo region.

A high purity germanium (HPGe) detector was used in this study to measure the activity concentrations 226Ra, 232Th, and 40K in marble samples from 20 different points in Usakos marble dome in the Erongo region, Namibia.

The mean activity concentrations were found in the range of 0.37 to 339.60 Bq kg-1 for 226Ra, 0.20 to 210.30 Bq kg-1 for 232Th, and 2.96 to 928.70 Bq kg-1 for 40K, respectively. The activity concentrations of 226Ra, 232Th, and 40K were used to estimate values of radium equivalent activity (Raeq), Absorbed dose rate (Dr), internal and external hazard indices (Hex & Hin) and the activity utilization index (Iγ). The calculated mean values were Raeq (226.75 Bq kg-1), (Dr) (102.99 nGyh-1), Hex(0.61), Hin (0.95) and Iγ (1.59).

From a radiological point, the results of (Dr) and (Iγ) were found above the world recommended average and the performed correlation analysis showed strong positive correlation amongst 232Th and 226Ra, which confirms these radionuclides as the main contributors to gamma radiation in the Usakos marble dome. The high activity concentrations at some sampling points higher than the world average value pose possible radiological hazards for the marble samples usage for building materials.

Modern treatment techniques such as Intensity-Modulated Radiotherapy(IMRT)or Volumetric-Modulated Arc Therapy(VMAT) are standard in practice; it is possible to obtain much better dose distributions using HYBRID plans generated applying these techniques together. Thus patient’s quality of life improves. 

In this study, treatment plan is generated for 10 prostate patients who underwent primary prostate radiotherapy with 7-field IMRT, double arc VMAT and HYBRID techniques. The prescribed treatment dose (78 Gray(Gy)) is defined as the isodose covering 95% of PTV.

The study results revealed better Planning Target Volume (PTV) dose coverage in the HYBRID plan than the other plans. At the same time, HYBRID plans were found to be significant in terms of heterogeneity index. It was observed that there was no statistically significant difference in terms of fit index. Bladder and rectum V50 doses were lower in HYBRID plans than IMRT plans. The mean doses of the right and left femoral heads and the penile bulb V90 in HYBRID plans were statistically significant compared to the IMRT and VMAT plans. VMAT plans had a lower rate of Monitor Unit (MU) in the MU assessment than IMRT plans; however, the MU rate obtained in the HYBRID plan was lowest compared to IMRT and VMAT plans.

It was concluded that the HYBRID method is suitable for routine clinical use together with IMRT and VMAT plans since more optimum results were obtained in HYBRID plans, especially in critical organ doses.

Radiotherapy enhances the risk of ovarian injury induced by oxidative stress in the female patients. Hesperidin, as a natural compound has various biological properties included anti-tumoral, antioxidant, and anti-inflammatory activities. This research evaluated the effects of hesperidin on ovarian damage induced by IR.

Twenty-eight female mice distributed to four groups randomly: Control, Hesperidin (100mg/kg), ionizing radiated (IR) (3.2 Gy), and ionizing radiated + hesperidin groups (3.2Gy + 100mg/kg). Hesperidin was administrated orally for 7 successive days. Animals were exposed to total body irradiation on the 8th day of study. Biochemical, hormonal (estrogen and progesterone), and histopathological assessments did on day 12.

IR group demonstrated necrosis, apoptosis, and atresia in ovaries, decreased estrogen and progesterone and increased oxidative stress. While Hesperidin pre-treatment improved histological features, recovered the number of follicles in ovaries of the irradiated mice. In addition, the Hesperidin increased estrogen and progesterone and decreased oxidative stress (malondialdehyde, Ferric Reducing Antioxidant Power, and catalase).

Data of this research indicate that hesperidin is may be useful in female patients with pelvic cancer during radiotherapy for their ovarian conservation.

In this study, the changes in the entrance surface dose (ESD) and image quality were examined when an air mattress was used to reduce the X-ray scattering caused by treatment tables commonly used for computed tomography (CT).

Dual-energy CT (DECT) was used, with the ESD of Alderson Radiation Therapy (ART) phantom measured by scanning with different X-ray tube voltages and X-ray tube currents for three scenarios: when no air mattress was employed, and when a 5 cm or 10 cm thick air mattress was employed. The statistical significance of the changes in ESD and image quality were based on the presence and thickness of the air mattress. Additionally, the variations of the X-ray tube voltage and current for different air mattress thicknesses were investigated using paired t-test.

For all X-ray tube voltages and currents, applying an air mattress significantly improved both the ESD and image quality, with the 5 cm air mattress improving both the ESD and image quality.

The 5 cm air mattress produced no artifacts in the diagnostic images, and demonstrated a statistically significant reduction in patient ESD during DECT imaging.

Coronavirus disease 2019 (COVID-19) is a pandemic and increasing rapidly as a global health emergency which is caused by SARS-CoV-2 virus. The real-time reverse transcription polymerase chain reaction test (RT-PCR test) is considered as a gold standard method for diagnosing (COVID-19). However, the test has some limitations as it is not universally available, turnaround times can be lengthy, and reported sensitivities vary The aim of the study was to describe the imaging features of thorax computed tomography (CT) in diagnosing COVID-19.

In this retrospective study, 36 patients were recruited from the emergency room and outpatient settings at a tertiary-care hospital, Istanbul, Turkey. Thorax CT was done and correlated with clinical findings to diagnose COVID-19.

A total of 36 of 41 patients were screened for thorax CT and were confirmed as COVID-19. There was no significant difference (p>0.05) between the age-distribution and gender for clinical and radiological findings.

Thorax CT with clinical findings should be preferred as early diagnosis of COVID-19 and follow-up period.

 One of the most important qualities of a radiation dosimeter is tissue-equivalent, which represents radiation absorption and scattering that is similar to that of human tissue. The goal of this study is to determine the radiological and structural properties of several MAGAT gel dosimeter formulations prior to irradiation. This will provide a basis on how radiation properties altered prior to irradiation, which will later affect radiation absorption behaviour.

Radiological properties of different MAGAT gel formulations (MAGAT, MAGAT doped methylene blue, MAGAT doped zinc oxide nanoparticles, MAGAT dope methylene blue and zinc oxide nanoparticles) were measured from density, linear attenuation coefficients, mass attenuation coefficients and CT values. The results were compared to soft tissue and water as references. The gel’s morphological structures were investigated using electron microscopy for better understanding of gel’s absorption mechanism.

The mass density of all MAGAT gel formulations differed by up to 2.5% from that of water and are very close to that of muscle tissue. This is due to the high gelatin and monomer concentration used in MAGAT gel formulation. The CT-values, furthermore, are within the soft tissue range. The MAGAT doped with methylene blue and ZnO NPs demonstrated the greatest increase in linear attenuation value, as well as having a nano spider-web morphological structure with a large surface area, which may have increased gel sensitivity and attenuation coefficients of MAGAT gel.

Different MAGAT gel formulations were found to exhibit similar radiological properties to soft tissues and water.

To quantify the influence of photon dose-calculation algorithm selection on the cervical esophagus (CE) dose indices and the derived equivalent uniform dose (EUD) and normal-tissue complication probability (NTCP) for acute esophagitis in patients with head-and-neck cancer (HNC).

The Fast Photon Effective Path (FPEP) and Collapsed-Cone Convolution Superposition (CCCS) algorithms on the Prowess Panther treatment planning system were compared for 30 patients (six tumor sites). The Lyman-Kutcher-Burmann (LKB) model was used to calculate the EUDs and NTCPs.

On average, the more simplistic FPEP algorithm overestimated the mean dose to CE planning organ-at-risk volumes (PRVs) by 2.0% (p = 0.003). The average absolute difference in mean dose was 2.7% and the maximum difference was 9.3%. The V5Gy, V10Gy, V15Gy, V20Gy, V25Gy and V30Gy values were significantly higher with FPEP, while the point-dose and D2cc hot spots were similar. In turn, the dose differences led to an underestimation of the LKB-model prediction of the EUD by 1.4% (p = 0.297). The mean absolute difference in EUD was 4.5% and the maximum difference was 15.3%. In the 14-50 Gy mean dose range, the resulting NTCPs with FPEP were lower on average by 2.6% than CCCS (p = 0.041).

In the group of HNC patients considered in this study, the EUD and NTCP for acute esophagitis showed to be moderately sensitive to the choice of dose-calculation algorithm. Despite an overestimated mean dose by the simpler algorithm, the NTCP underestimation, which can be large in some patients, is of clinical concern.

Cytogenetic and immunological damages after ionizing radiation exposure are critical factors that lead to many different events and consequences cascade reactions starting from inflammation, ending with cell damage. These biological events if not well controlled will lead to deleterious effects and cancer. The present study aimed to evaluate the efficacy of the Nicotiflorin and Rutin (NR) combination against drastic effects resulted from γ-irradiation.

Rats were divided into four groups. (Control) group, (NR) group: treated with 20mg/kg body weight orally daily one dose for two weeks, (Irrad) group: rats exposed to 6Gy as a single dose, and (NR+ Irrad) group which treated with NR combination before irradiation. Detection of DNA damage was done with the Micronucleus test (MN) and Comet assay. Immunological responses were detected by assessing inflammatory cytokines Interluekines-1β (IL-1β), tumor necrosis factor (TNF-α), and homeostasis maintenance cytokines (IL-6 & IL-10).

Irradiated group recorded a significant increase in micronuclei (MNi) incidences and significant DNA fragmentation. As well, immunological parameters displayed a significant increase in all measured interleukins except IL-10 which recorded a significant decline. The group injected with NR before irradiation showed significant improvement in all measured parameters.

The efficacy of the NR combination may be attributed to its dual protective effects (cytogenetic and immunological enhancement) against damage caused by γ-irradiation.

Among the natural radioactive sources, two-thirds of radiation dose received by living tissue is caused by radon and its progeny because it can interact with biological tissue when it is inhaled or ingested. Accordingly, this study planned to measure indoor radon and evaluates its doses in addition to studying metrological parameter to understand the correlation between them.

This study focused on the indoor radon concentration by two different protocols which are short term and long term. In short term, radon concentration was measured in seven dwellings in Duhok city at the beginning of both winter and summer using RAD7 detector and Airthings Corentium monitor. Then annual effective dose of radon and its decay product to the inhabitance were estimated. In long term protocol, radon concentration was measured continually for one year by fixing Corentoum detector in one building.

outcomes showed that the concentration of radon is higher in winter than summer; with range of 1-56 Bq m-3. The average level of indoor radon concentration in both seasons was 19 ± 6.1 Bq m-3. The radon and its progeny average annual effective dose were 0.59 ± 0.17 and 0.23 ± 0.14 mSv y-1 in winter and 0.37 and 0.15 mSv y-1 in summer respectively.

The results of average indoor radon concentration obtained were considerably less than the action levels prescribed by ICRP. Also, the results indicated that radon concentration negatively correlated with wind speed and positively with outdoor temperature while outdoor humidity effect has almost neglected.

Natural radioactivity in the soil is the main reason behind this research. So, the natural radioactivity (40K, 238U, and 232Th) in soil samples have been measured in ten primary schools at north of Al-Najaf province.

The specific activities (214Bi belongs to the uranium-238 series; 208TI belongs to the thorium-232 string and a natural radionuclide 40K) have been indicated by using spectral analysis technique of Gamma-ray of 3”x3” NaI(Tl) scintillation detector has been used.

The average value of specified activity for 40K, 238U, and 232Th in all samples is (201.47±24.47) Bq/kg, (10.17±1.78) Bq/kg, and (5.91±0.83) Bq/kg respectively. In this work, the majority of the hazard indices were calculated. The average value of radium Equivalent Activity was (16.673±1.71) Bq/kg, Absorbed Gamma Dose was (16.673±1.71) nGy⁄h, external hazard index was (0.092±0.009), internal hazard index was (0.120±0.013), representative gamma index was (0.261±0.026), Annual influential dose equivalent indoor was (0.082±0.008), for Annual influential dose equivalent outdoor was (0.020±0.002) mSv/y, and excess lifetime cancer risk was (0.358±0.03) × 10-3.

Most of the detected readings are in the recommended values by (UNSCEAR, OECD, and ICRP) When compared with the worldwide average (40K=412 Bq/kg, 238U=35 Bq/kg, and 232Th= 45 Bq/kg). In other words, ten primary schools at Al-Najaf governorates are safe for work and free of radiation hazards to students.

Geological materials usually contain trace amounts of radioactive materials and may serve as a natural source of background radiation exposure to the general public. This study presents results of radiometric and radon exhalation rate (RER) analysis of 28, export quality marble samples taken from various quarries of Gahirat Chitral area.

The marble specimens were investigated using gamma spectroscopy by HPGe detector. Samples were also analyzed for radon exhalation rate using closed CAN technique.

The mean values of 226Ra, 232Th and 40K were found as 31.598± 0.989, 1.529± 0.308 and 5.273± 1.593Bqkg-1 respectively. Average value of Raeq was estimated as 34.19±1.55 Bqkg-1. Radiation risk parameters viz. internal (Hin), external (Hex), alpha (Iα) and gamma (Iγ) hazard indices were estimated and found less than unity value. The values for effective indoor (Ḋin) and outdoor gamma dose rates (Ḋout) due to the contents of primordial radionuclides were also estimated. The contribution of radon towards radiation exposure was assessed by estimating RER, which was found in the range (1.01±0.07 to 9.67±0.27) ×10-2 Bqm-2 h-1 with mean value of (5.84±0.002) ×10-2 Bqm-2 h-1.

The surface radon exhalation rate values estimated in the current study were found smaller than as reported for many other countries. The results obtained for gamma emitting radionuclides have been compared with the data available in the literature. Measurements shows that marble samples investigated have low concentrations of radionuclides and uses of marbles in dwellings do not pose significant threat to the inhabitants.

Radionuclide ingestion has raised a global concern due to its radiological implication on man.

Activity concentration of natural radionuclides (226Ra, 232Th and 40K) in soil, leaf and fruit samples of mango plants from Akure, Nigeria has been estimated using gamma ray spectrometer NaI (Tl) detector. Spectra analyses were performed with the Genie2K spectrometry software, version 2.1 (Canberra industries Inc).

The mean activities concentration of 40K, 226Ra and 232Th in soils were 469.72 ± 86.44, 25.17 ± 9.87 and 19.33 ± 6.98 Bq kg-1 respectively. The mean activities concentration of 40K, 226Ra and 232Th in leaves were 444.76 ± 89.10, 20.43 ± 7.47 and 17.23 ± 7.39 Bq kg-1 respectively. The mean activities concentration of 40K, 226Ra and 232Th in fruits were 439.54 ± 87.39, 18.96 ± 6.80 and 15.43 ± 5.64 Bq kg-1 respectively. The mean total absorbed dose rate in air and the mean annual effective dose equivalent for soil sample were estimated at 39.37 ± 11.43 nGy h-1 and 48.28 ± 14.01 µSv y-1.

The mean radium equivalent, hazard indices and excess lifetime cancer risks (ELCR) through soil exposures are below the world average, but the mean annual effective dose equivalent and ELCR for different age groups, from radionuclide ingestion through mango consumption in the area are above the world average.

To differentiate prostate cancer and benignprostatichyperplasia by WAHPP (the whole lesion histogram analysis of the pharmacokineticparameters) of dynamic contrast-enhancedMRI (DCE-MRI).

Totally 62 patients with elevated prostate specific antigen (PSA) (> 4 ng/ml) were grouped as prostate cancer (PCa) group (n=33) and benign prostatic hyperplasia (BPH) group (n=29) based on transrectal ultrasound (TRUS)-guided random biopsy diagnosis and their WAHPP- Ktrans (constant is transferred from the blood plasma to the extracellular extravascular (EE) space), Kep (back into blood plasma at a steady rate from EE space), Ve (EE volume fraction) and Vp (fractional blood plasma volume) were compared.

WHAPP shows the 5th percentile and entropy of Ktrans, 5th/10th/25th/50th/75th/90th/95th percentiles, mean value and entropy of Kep, 5th percentile and uniformity of Ve, 5th/10th/25th/50th/75th percentiles, Vp had a considerably greater mean value and entropy in PCa than in BPH (p0.05). The 90th percentile of Kep's maximum AUC (area under the curve) was 0.764, according to receiver operating characteristic (ROC) study, the Youden index 0.5507, the sensitivity 75.76%, and the specificity 79.31%.

Ktrans, Kep, and Ve of WHAPP canbe used to quantify prostate DCE-MRI. The 90th percentile of Kep possibly will be the best indicator for the differential diagnosis of malignant and BPH.

To investigate the performance of Auto-Planning intensity modulated radiation therapy (IMRT) plans for patients with central lung cancer and to determine whether Auto-Planning improves the quality of IMRT plans.

Thirty patients treated with IMRT for central lung cancer were replanned with the Pinnacle3 Auto-Planning module. The dose distribution at the target, organ at risk (OAR) sparing, dose falloff in the five rings outside of target, monitor units (MUs), planning time, and dosimetric verification in terms of the γ passing rate were evaluated. A Wilcoxon signed-rank test was performed to assess differences between groups (p<0.05).

The target homogeneity in the Auto-Planning were significantly better than that in the manual plans, the target conformity in both groups were similar. The Auto-Planning plans yielded lower V5, V10, V13, V20, V30, V40 values, mean lung dose of total lung (p<0.01), and Dmax of spinal cord (p<0.01) and V30 of heart (p<0.01). No significant difference was found for the V40 of the heart (p=0.203). The Auto-Planning module reduced the Dmean, D2 and D5 values in all rings outside of PTV. The planning time was 52.5% shorter for Auto-Planning plans than for manual plans (p<0.01), and 4.4% additional MUs were required with Auto-Planning. No difference was observed for the γ passing rate.

Auto-Planning for central lung cancer could improve homogeneity of target volumes, significantly delivery lower dose to OARs and steeper dose falloff outside of tumors while reducing the planning time.

The present study was carried out to estimate the effect of Ultraviolet B (UVB) radiation on the thyroid gland of female Wistar rats.

Female rat (n=24) of 12-16 weeks with body weight of 130-150gm were housed in standard cages, fed sterilized food and water ad libitum. Animals were divided into four groups. Ist group was control, IInd group was exposed to 280 nm of UVB radiation for 2 h/day. IIIrd group was exposed to 280 nm of UVB radiation for 2 h/day and 25 mg/kg body weight curcumin orally. IVth group was given 25 mg/kg body weight curcumin orally. All treatments last for 15 days.

The results showed that UVB radiation decreased body and thyroid gland weight. However at the same time increased T3, T4, FT3, and FT4 levels (p<0.01: p<0.001; p<0.05) and decreased the level of TSH (p<0.001) significantly. Histologically, UVB radiation-damaged follicular cells and disappeared colloid fluid, and decreased follicle diameter significantly (p<0.01).

It is concluded that UVB radiation generates imbalance in thyroid hormones and induced hyperthyroidism on female Wistar rat and curcumin play protective role in hyperthyroidism against UVB radiation.

Ewing's sarcoma/primary neuroectodermal tumors (EWs/PNETs) originating in the kidney have been rarely reported. To date, EWs/PNETs have not been demonstrated to have specific clinical characteristics and imaging findings.

A 13-year-old boy was admitted to the hospital with abdominal pain following minor trauma. The patient underwent CT examination on the doctor's recommendation, which revealed contusion of the left kidney and the possibility of a space-occupying lesion in the lower pole of the left kidney. Hence, laparotomy was performed at our hospital, followed by excision of the left kidney, tumor detection and removal of hematoma. The pathological diagnosis was left kidney EWs/PNET with hemorrhagic infarction. Postoperatively, the patient did not receive radiotherapy or chemotherapy. After three months, the patient returned to the hospital for Positron Emission Topography (PET)/CT examination, and no obvious signs of tumor recurrence and metastasis were found all over the body. To date, the patient has been followed-up for 15 months, and remains alive and healthy.

EWs/PNETs are highly invasive tumors, with frequent distant metastasis at diagnosis. Hence, early diagnosis and surgical removal of tumor tissue is critical for the prognosis of patients. CT can be used as the primary auxiliary examination of primary renal EWs/PNET. Cystic necrosis is found in the tumor tissue on the CT image. Moreover, cystic necrosis located around the tumor and septal enhancement are observed on the CT enhanced scan, which is helpful for the diagnosis of primary renal EWs/PNET.

Bladder pheochromocytoma, as a rare bladder tumor, which originated from the chromaffin tissue of the sympathetic nervous system. It is difficult to distinguish from other non-epithelial tumors on imaging. This study reported a 31-year-old female, whose physical examination revealed a bladder mass for 50 days. The patient’s main clinical symptoms included sudden headache, dizziness, increased blood pressure, and chest palpitations after intermittent micturition. However, laboratory tests showed that the 24-hour urine catecholamine levels (norepinephrine, vanillylmandelic acid [VMA] and metanephrine) were normal. Magnetic resonance imaging (MRI) showed a mass in the posterior bladder wall, the typical performance is“light-bulb” bright lesion on T2-weighted imaging. The mass was surgically excised, and histopathological examination revealed that it was a pheochromocytoma. During the first 3-month of postoperative follow-up, the patient’s symptoms gradually subsided. To our knowledge, this is the first case reporting on the use of MRI imaging and specific image features of this rare bladder pheochromocytoma. Due to the better soft tissue resolution and multi-parameter on MRI, changes in the size and internal signal of the lesion can be clearly displayed. Thus, MRI is an indispensable tool in tumor diagnosis and prognosis assessment.