Objectives: To determine if the postoperative delivery of fractionated stereotactic radiotherapy (FSRT) for resection cavity for patients with single and resectable brain metastases is safe and effective. Methods: A prospective feasibility protocol was set up to include patients with single and resectable brain metastases who underwent surgery and had low risk profile according to RPA classification. Fractionated stereotactic radiotherapy was applied. Single dose: 3.8 Gy, total dose: 41.8 or 49.6 Gy. Results: There was no case of break due to clinical problems. There was no case of delay of FSRT. The onset acute toxicity was observed in 40 cases (76.9%), no grade 3 and more was seen. Local recurrence free survival was 32.6 months, local control rate at 6, 12, 18 and 24 months were 85%, 77.9%, 65.9% and 65.9%. Overall local failure occurred in 34.1% of patients. Overall survival rates at 6, 12, 18 and 24 months were 90.3%, 63.9%, 47.7% and 31.6%. Median survival was 18.3 months (13.8-22.8) and overall 17.3% were living at the time of last analysis. Distant control rates at 6, 12, 18 and 24 months were 49.4%, 38.2%, 25.5% and 22.3%. Median distant recurrence free survival was 6 months (0-12.0) with overall distant failure in 77.7% of patients. Conclusion: FSRT for surgical cavity might be one possible option in treatment of single and resectable brain metastases.

Background: Fluoroscopy is the main visualization technique for EP procedures. A radiation protection cabin (RPC) shielded with 2 mm lead-equivalent walls was tested as an alternative protection tool (Cathpax®, Lemer Pax). Methods: To assess the scattered radiation to the operator inside the RPC an electronic personal dosimeter (EPD; Mk2, Thermo Electron) was placed at the neck level of the operator. A second EPD was located outside the RPC at 150 cm height from the floor, to record the presumable head radiation dose. Results: Radiation doses were measured in a total of 138 consecutive patients (age 54±16 yrs, BMI 28±5 kg/m2 (18-45), 64% male) undergoing a variety of ablation procedures (SVT=75, AFL=32, AF=17, VT=14). Median fluoroscopy time was 39 min (7-140), the cumulative dose-area product (DAP) 4702 cGy.cm2 (493-65620). Doses outside the RPC showed a median of 135 µSv (1-4881). Doses inside the RPC were detected only at sensitivity threshold or background levels (mean 0.2SD0.7 µSv, median 0.0, range 0-4). The dose reduction to the operator was highest for AF ablations (354 vs 0.5 µSv, respectively; p<0.001). The total accumulated dose outside the RPC was 37883 µSv for all 138 procedures, whereas for the protected operator inside only 30 µSv. Conclusions: There were highly concordant low dose values measured for the operator inside the RPC in comparison to high doses outside the RPC. The use of a RPC represents a major benefit over a lead apron and contributes to a significant dose reduction as low as reasonably achievable (ALARA principle).

Paddle wheel technique is a reconstruction method of displaying images, which uses planar slabs pivot on the central horizontal axis at bifurcation of pulmonary artery trunk. With this method, each image depicts complete track of branching structures from central hilum to the periphery. Objective: The purpose of this study was to assess the role of paddle wheel reformation and compare it with standard axial multi detector CT images in cases of pulmonary embolism. Methods: CT scans of 50 patients presented for CT pulmonary angiography were selected and interpreted by two radiologists using reformatted paddle wheel technique besides standard axial CT scans. The scans were reviewed independently and randomly to reduce bias. Standard axial CT scan for pulmonary embolism was carried out with collimation of 1.25 mm, pitch of six and a reconstruction interval of 0.8 mm. Paddle wheel reconstruction was carried out by using inbuilt software, setting 5 mm slab thickness and 5 degree rotation. Reference standard was overall interpretation of axial CT scans by both the radiologists. Results: Sensitivity and specificity for axial images was between 90 to 100%; sensitivity for paddle wheel technique ranged from 65 to 72% while specificity turned out to be 80 to 100%. Final consensus agreement for standard axial imaging was higher than paddle wheel technique. Conclusion: No significant difference between two imaging methods was noted in cases of central pulmonary embolism, however standard axial imaging was better than paddle wheel technique in detecting peripheral pulmonary embolism.

Brachial plexopathy is a type of peripheral neuropathy. Injuries to the brachial plexus can be classified according to their severity, ranging from neuropraxia, the mildest form, to axonotmesis and neurotmesis, the most severe forms. The causes of brachial plexopathy include traumatic and non-traumatic injuries. Because the brachial plexus can sustain various types of injuries, different imaging modalities are required. Recent advances in diagnostic imaging have enabled better investigation of brachial plexopathy. This article reviews the major and most widely used imaging methods used for investigating brachial plexopathy along with newer modalities. The indications, advantages, and disadvantages of each modality are examined. The major factor in realizing the full potential of any imaging method is the knowledge of the requesting physician about the capabilities and limitations of each method. Magnetic resonance imaging (MRI) is the standard imaging modality for evaluating non-traumatic injury to the brachial plexus; however, there are several limitations to its use and, therefore, other modalities should be pursued. MR myelography should be used for traumatic meningoceles and root avulsions. MR neurography is a relatively new technique with massive potential. It is a tissue-specific modality with the ability to elicit morphological as well as pathological features of nerves. CT myelography is the gold standard for evaluating traumatic injury of the brachial plexus. Other potential uses are with tumors of the brachial plexus as well as obstetric brachial plexus palsies. Finally, sonography is addressed. With its ability to detect almost all plexopathies and the fact that it does not employ radiation and can be done in virtually every patient, it should be the baseline or, at least, the screening method for plexopathies.

Background: Pulmonary atelectasis is common following sternotomy for cardiac surgery. The degree of atelectasis present on chest x-ray has been used to assess efficacy of interventions designed to reduce atelectasis, however radiological atelectasis scoring systems used may exaggerate the clinical effect of atelectasis in these patients. We have produced an alternative scoring system that seeks to correct this problem and this study aimed to evaluate this. Methods: Following ethics approval we retrospectively selected 50 consecutive patients admitted to the intensive care unit following cardiac surgery. Electronic copies of chest x-ray taken on return to the intensive care unit, on day 1 and day 3 postoperative were obtained and corresponding details of oxygenation were collected from patient records. Anonymised chest x-rays were scored, using both the old and new scoring system, by a radiologist blinded to the clinical data. Chest x-ray scores were compared with oxygenation indices at the time of chest x-ray. Day 1 scores were also assessed for their ability to reflect day 3 oxygenation indices and supplemental oxygen requirement. Results: The new score demonstrated better ability to detect atelectasis on chest x-ray and better specificity than the old score when comparing the chest x-ray findings with the clinical oxygenation status of the patients. The new score also performed better at predicting day 3 oxygenation status from the day 1 chest x-ray. Conclusions: This new scoring method performed better as an outcome measure for atelectasis in studies of patients following cardiac surgery. It may also better identify patients who require ongoing administration of supplemental oxygen on postoperative day 3.