Digital Radiography News

Based on a new study recently published in The Lancet Respiratory Medicine, people who have suspected idiopathic pulmonary fibrosis (IPF) without typical patterns on high resolution computed tomography scans could in the future be spared the considerable risks of lung biopsy and be given a strong diagnosis of IPF predicated on clinical and radiological findings alone. Studies from the UK and USA suggest IPF is becoming more prevalent. There are an approximated 5000 new cases in the UK annually and IPF causes more annual deaths than either leukaemia, ovarian cancer, or kidney cancer. In the USA, around 50,000 new cases are diagnosed every year and as many as 40,000 Americans die from IPF each year, the same number as die of breast cancer.   IPF causes progressive scarring of lung tissue, which eventually obstructs the lungs from being able to supply the body with sufficient oxygen. IPF has no known cure and most people live only 3 to 5 years following diagnosis. Suitable treatment is difficult due to the fact that a definitive diagnosis often requires a lung biopsy.   HRCT scans of the lungs can identify typical 'honeycombing pattern' of lung scarring and damage to the air sacs known as usual interstitial pneumonia (UIP) in people with IPF. In a patient with progressive breathlessness who has no major environmental exposures leading to pulmonary fibrosis, or evidence of collagen vascular diseases, the UIP pattern on HRCT is indicative of IPF. When patients suspected to have IPF do not have the definitive UIP pattern on HRCT images, international guidelines suggest a surgical lung biopsy to make a solid diagnosis of IPF in such patients.   "Surgical lung biopsy is associated with substantial risks and many patients are too elderly, sick, and/or have comorbid conditions to tolerate the invasive procedure", explains Professor Ganesh Raghu from the University of Washington Medical Center, Seattle, USA who led the research.   "A confident diagnosis of IPF is needed to ensure that patients are well informed of the poor prognosis associated with IPF, are treated with the most appropriate therapies, consider participation in clinical trials of new therapies, and to identify those most suitable for lung transplantation."   In this retrospective study of 315 patients aged 40 years and older with little or no (5% or less) honeycombing on high resolution CT, 79 (94%) of 84 patients who had a high-resolution pattern of possible UIP diagnosed by an expert radiologist and pathologist had histopathological UIP confirmed after analysis of lung biopsy samples.   "Our findings suggest that when a team of multidisciplinary experts in interstitial lung disease at a regional center (that includes a chest radiologist and a pulmonologist) work together to interpret possible UIP pattern on high-resolution CT in a patient suspected to have IPF, surgical lung biopsy might not be necessary to reach a diagnosis of IPF,” said Raghu.   "Since the patients enrolled in our study were a highly selected cohort of patients suspected to have IPF and referred to regional sites for consideration of participation in a clinical trial, the findings from our study must not be extrapolated for all patients demonstrating the possible UIP pattern on HRCT images interpreted by general pulmonologists and radiologists in the community,” he concludes   "The results will also help to provide clarity about treatment options for a greater number of patients and increase the pool of patients suitable for inclusion in clinical trials of new therapies…In the modern era with optimal high-resolution CT imaging and thoracic radiologists familiar with interpretation of interstitial lung disease patterns through participation in multidisciplinary meetings, the role of lung biopsy assessment might diminish further. In future, combination of high-resolution CT with new noninvasive biomarkers and functional imaging could be used to better define phenotypes of fibrotic interstitial lung disease,” wrote Dr Simon Hart from Hull York Medical School in the ... Read more

In the latest development, clinical research from New Zealand reveals that severe skin reactions during radiation therapy (RT) could be all together avoided by applying a thin transparent silicone dressing to the skin from the first day of treatment. “Although many skincare products have been tested in clinical trials over the years, until now none have been able to completely prevent severe skin reactions,” said senior lecturer Dr. Patries Herst of University of Otago Wellington's Department of Radiation Therapy. Herst and her colleagues of radiation therapists, oncology nurses, and medical physicists have finished five randomized controlled clinical trials in public hospitals in Dunedin, Wellington, Palmerston North, and Auckland Radiation Oncology over the course of five years, all concentrating on the side effects caused by RT. Their most recent trial was an intimate cooperation with Dunedin Hospital, and daned it is in fact possible to prevent skin reactions from developing in breast cancer patients receiving RT. “Skin reactions are common in these patients, ranging from mild redness to ulceration with symptoms of pain, burning and itchiness. This can impact negatively on day-to-day life for patients who already have to cope with being diagnosed with and treated for cancer,” said Herst. Herst has been quite pleased with the results, and discovering an application that really works. "This is fantastic news for cancer patients and it has put New Zealand firmly on the world map as a leader in clinical research into radiation-induced acute side effects." The dressings work by adhering closely to the small folds in the skin without the use of adhesives and therefore do not stick to open wounds. By protecting the radiation-damaged skin from friction against fabrics of clothing or other parts of the body, they enable the stem cells of the skin to heal from the radiation damage in a tranquil environment. The dressings are also devoid of chemicals that could negatively react/agitate the skin. In the meantime, Herst is currently setting up a trial that will test the dressings in head and neck cancer ... Read more

Based on a University of Florida Proton Therapy Institute study, 5 years after undergoing proton therapy for early- and intermediate-risk prostate cancer, 99 percent of men are living cancer-free and with excellent quality of life. Moreover, ... Read more

Based on a recent study conducted by Norwegian cancer researcher Sophie Fosså , combination treatments of radiation therapy (RT) and hormone therapy drastically halves mortality rates for prostate cancer. Fosså, lead author of the study and a professor at Oslo University Hospital in Norway, presented her findings  at an international conference sponsored by the American Society of Clinical Oncology (ASCO) in San Francisco this week. Furthermore the study has gone on to be published in the Norwegian health journal Dagens Medisin. According to the long term follow-up study, by introducing RT to the standard hormone treatment against prostate cancer, the 10 to 15 year survival rate for men with prostate cancer more than doubled. Behind the study are Fosså and her team of researchers from The Scandinavian Prostate Cancer Group. "When this study started in 1996, the standard treatment was hormone therapy alone, but this trial continues to show that adding radiotherapy substantially boosts long-term survival," explains Fosså. "This combination more than doubles the 10-year survival rate and confirms that this approach should be a standard option for men with this type of prostate cancer who are expected to live at least another 10 years." All in all, 875 male patients from Norway, Sweden, and Denmark took part in the study. Of these, 653 participants were Norwegians.Among the 439 men who received hormone therapy alone, 118 died of prostate cancer. - Among the 436 who were administered the combination treatment, 45 died of cancer. - Among the patients who received hormone therapy only, the 10 and 15 year mortality rates were 18.9 percent and 30.7 percent, respectively. - Among those who underwent the combination treatment, the rates amounted to 8.3 percent and 12.4 percent, respectively. The figures presented by Fosså at the ASCO conference are a follow-up to a previous study, published in The Lancet in 2009 where Fosså and her colleagues display how RT in conjunction with hormone treatment diminished prostate cancer mortality from 24 to 12 ... Read more

Results of clinical research that treated mesothelioma with radiation prior to surgery reveal the three-year survival rate more than doubled for study participants troubled with this fatal disease, as opposed to treating with surgery first. The ... Read more

In studying the affect of DNA damage on the Golgi, the cell's shipping department, a research team from the University of California, San Diego School of Medicine and the Ludwig Institute for Cancer Research have found a new pathway initiated by ... Read more

The first comprehensive, large-scale group study of the long-term survival of children treated for low-grade gliomas, the most common pediatric brain tumor, revelas that almost 90 percent are alive 20 years later and that few die from the tumor as adults. However, children who underwent radiation as part of their treatment had considerably lower long-term survival rates than children who did not receive radiation, researchers from Dana-Farber/Boston Children's Cancer and Blood Disorders Center report.   Such findings stand regardless of whether surgeons could successfully remove a child's entire tumor or only part of it, suggesting that the radiation itself may explain the difference.   The study's findings were published online by the journal Pediatric Blood and Cancer. Administration of radiation to children's developing brains has been associated to a number of adverse long-term effects, including cognitive development and endocrine function. While a variety of major hospitals, including Dana-Farber/Boston Children's, have almost removed radiation in treating low-grade gliomas; although the degree to which other hospitals employ radiation differes, according to the study's senior author, Peter Manley, MD, of the Brain Tumor Center at Dana-Farber/Boston Children's. "We found for the first time that once you survive your childhood with a low-grade glioma, you are not likely to die of that tumor as an adult. This is incredibly encouraging for patients and families. However, we also found some things that we are currently doing to treat low-grade gliomas, such as radiation, are increasing the rate of death later, so that as an adult you won't die of the tumor, but you may die from the treatment," said Manley. The data did not enable researchers to determine the exact apparatus leading the link between radiation treatment and reduced long-term survival (e.g., second cancers, other radiation-induced toxicities). Yet, given the exceptional overall long-term survival findings among the patients studied, the researchers believe that doctors treating children for a pediatric low-grade glioma should make reducing long-term toxicity risk one of their top priorities. "We strongly recommend treatments that are less likely to cause long-term effects and second cancers. According to our analysis, radiation was the most common factor linked to differences in mortality among long-term survivors. There are multiple options available today for treating children with these tumors. We should exhaust all those before considering the use of radiation," added Manley. Low-grade gliomas, a family of non-malignant, usually non-aggressive tumors that includes pilocytic astrocytomas, diffuse astrocytomas and mixed gliomas, make up around 30 percent of all childhood brain tumors. Treatment usually involves surgery and chemotherapy. Radiation, which was once a vital ingredient of therapy for these gliomas, has been losing credibility and consequently falling out of favor since the mid-1990s, as it has for other childhood cancers such as Hodgkin's lymphoma and germ cell tumors. In order to understand survival factors among the cohort, Manley, lead author Pratiti Bandopadhayay, MBBS, PhD, of Dana-Farber/Boston Children's, and their team analyzed Surveillance, Epidemiology and End Results (SEER) data from the National Cancer Institute on more than 4,000 patients diagnosed with pediatric low-grade gliomas between 1973 and 2008. Eighteen percent of the patients in the cohort underwent radiation as part of their treatment. Overall the diagnosis for children with low-grade gliomas is not bad, with five- and 10-year survival rates almost reaching 90 percent. However, until now, the long-term survival, 20 years and beyond, of adult survivors has never been comprehensively studied. Manley and his collaborators found a slight drop-off in survival at 20 years post-treatment, with almost 90 percent of pediatric survivors still alive. Surprisingly though, only around 70 percent of patients treated with radiation were still alive 20 years post-treatment. Other elements that impacted survival included tumor location (cerebellum or not), tumor type (pilocytic or not), aggressiveness of the tumor (grade 1 vs. grade 2), year of diagnosis (before or after 1990) and age at diagnosis ( "There is an impression that children diagnosed with anything more aggressive than a grade 1 tumor do poorly in the long term," said Manley, who also directs Dana-Farber Cancer Institute's Stop & Shop Family Pediatric Neuro-Oncology Outcomes Clinic, which focuses on survivorship issues. "However, we found regardless of whether the diagnosis is grade 1 or grade 2, children with low-grade gliomas still do ... Read more

A ground-breaking scientific discovery may provide the field of radiation oncology with new tools to increase the accuracy and safety of radiation treatment in cancer patients by helping physicians "see" the powerful beams of a linear accelerator as they enter or exit the body.   Given the obvious fact humans don't have X-ray vision, when an X-ray or mammogram is performed, the radiation beam that passes through bone or soft tissue, goes undetected by the human eye. However, what if there was a way to actually see X-rays? When powerful X-rays for cancer treatment are applied, physicians could observe how the beams hit the tumor. If the rays were off target, doctors could halt the operation, make the necessary adjustments to improve or enhance accuracy, and resume the operation; for exact precision is critical. The goal of any radiation technique is to kill cancer cells without the risk of harming surrounding, healthy tissue.   In and effort to make radiation much improved and safer, Dartmouth began to investigate a scientific phenomenon called the Cherenkov effect in 2011. Dartmouth scientists and engineers theorized that by employing Cherenkov emissions the beam of radiation could be "visible" to the treatment team. The ability to capture and see an X-ray would show:   §How the radiation signals travel through the body   §The dose of radiation to the skin   §Any errors in dosage.   It is possible that TV viewers may have seen images of sunken fuel rods from a nuclear power plant emitting a blue-green glow. That is the Cherenkov effect; when a particle with an electric charge travels faster than the speed of light through a vessel that does not conduct electricity, such as the human body or water, it glows. As the matter relaxes from polarization, it emits light. As a first step, engineers at the Thayer School of Engineering at Dartmouth modified a regular camera with a night vision scope to take photos of radiation beams as they passed through water. What appeared on the photos is the Cherenkov effect, a luminescent blue glow. In order to refine the approach for use in radiation treatment, scientists used a mannequin of the human body. They measured and studied the results to improve their ability to capture the luminescence, experimenting with beam size, position, and wavelength. With the clinical aspects vastly improved, Geisel School of Medicine researchers photographed luminescence during the routine radiation treatment of a dog with an oral tumor. This was the first time Cherenkov studies came out of the laboratory and into a treatment setting. The scientists dubbed the approach Cherenkoscopy. As they anticipated, during the session they were able to see detailed information about the treatment field and the dose. The results have since gone on to be published in the Journal of Biomedical ... Read more

Based on a position report from the European Society of Cardiology (ESC), cardiologists must be mindful of the radiation dosages related with the tests they order or prescribe for their patients. Moreover, despite the fact that cardiovascular imaging accounts for about 40% of medical radiation exposure in the general population (after excluding radiotherapy), cardiologists are often un-aware of the radiation doses, and subsequent risks, from the exams, Eugenio Picano, MD, PhD, of the Institute of Clinical Physiology in Pisa, Italy, and peers wrote and published online in the European Heart Journal. Therefore in order to address such a point, representatives from the ESC's Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions, and Electrophysiology reviewed the reports regarding the effective radiation doses from a range of imaging exams, discovering that doses ranged from about 1 to 60 milliSievert (mSv). For comparison, the natural background radiation globally is about 2.4 mSv per person annually. "All other considerations being equal, it is not recommended to perform tests involving ionizing radiation when the desired information can be obtained with a non-ionizing test with comparable accuracy. If you perform a test that utilizes ionizing radiation, choose the one with the lowest dose and be aware of the many factors modulating dose," the authors wrote. The authors also added that the actual administered dose should be documented in patient records. “Because radiation used in imaging tests is proven to cause cancer, cardiologists should make every effort to give 'the right imaging exam, with the right dose, to the right patient,” they continued. Additionally, cardiovascular imaging and interventional methods that call for radiation are being employed more often, raising concerns about both the short- and long-term risks of radiation exposure, such as tissue damage or cancer. The concerns revolve around patients, but certain practitioners, mainly interventional cardiologists and cardiac electrophysiologists, can have elevated exposures, as well. Consequently, cardiologists "have a particular responsibility to avoid unjustified and non-optimized use of radiation," the authors noted. A list of mean doses of radiation with common procedures could help cardiologists consider the risks and benefits of a certain test for a certain patient, and the paper includes a table with such values. For instance, the mean effective radiation dose for a percutaneous coronary intervention (PCI), a 64-slice coronary CT angiogram, or an ablation procedure is about 15 mSv, equal to 750 chest x-rays or exposure to approximately 6 years of background radiation. "The available epidemiological evidence linking increased cancer risk to radiation exposure is now strong for doses greater than 50 mSv, also for diagnostic medical exposures. In contemporary imaging practice, doses greater than 50 to 100 mSv are sometimes reached after cumulative exposures in a single hospital admission and not infrequently by a patient in multiple examinations and diagnostic or interventional procedures for a single imaging technique and even in a single admission,” the authors wrote. The cancer risks differ depending on patient age and sex, with higher risks accounting more in females and children. One way to raise awareness of the radiation doses accompanying different cardiovascular exams suggested by Picano and co-workers was the use of an informed consent form that would have a projected reference dose in several easy-to-understand formats, including chest x-ray equivalents and time frames of natural background radiation. After the test, the actual administered radiation dose would be documented in patient and lab records and could be provided to the patient upon request. "This simple consent process will gently force the doctor to learn what he/she already should know, enabling him/her to make more responsible choices," the authors ... Read more

Plasmonic nanostructures are of great current interest as chemical sensors, in vivoimaging agents, and for photothermal therapeutics explained Willett Professor and head of the Department of Materials Science and Engineering at Illinois, David G. Cahill. Applications in imaging and sensing typically involve the emission of light at a different wavelength than the excitation, or 'secondary light emission'. The interpretation of resonant secondary light emission in terms of fundamental processes has been a subject for controversy for 40 years. "In this work, we point out that resonant electronic Raman scattering and resonant fluorescence may both be useful descriptions of the secondary emission," added Cahill, who is also a researcher at the Frederick Seitz Materials Research Laboratory. "Better understanding of these principles and their limitations can result in improved biological and medical imaging modalities." Fluorescence is a comparatively familiar process by which light of one color or wavelength is absorbed by a material, such as an organic dye or a phosphor, and then light is emitted at a different color following a short period of time. In Raman scattering, the wavelength of light is altered to a different color in an immediate scattering event. Raman scattering is not common in everyday life, but is an essential tool of analytical chemistry. "Light emission from plasmonic nanostructures at wavelengths shorter than the wavelength of pulsed laser excitation is typically described as the simultaneous absorption of two photons followed by fluorescence, which is used a lot in biological imaging. However, we found that by modeling the emission as Raman scattering from electron-hole pairs can predict how the light emission depends on laser power, pulse duration, and wavelength,” explained first author of the paper that appears in the Proceedings of the National Academy of Sciences, Jingyu Huang. "Since we understand more of the mechanism of this kind of light mission, we can help to design the biological and medical imaging experiments better, and at the same time we can also have more insight into the broad background of surface-enhanced Raman scattering which is also related to this kind of light emission," Huang ... Read more

A new technique for studying the structure of the respiratory syncytial virus (RSV) virion and the activity of RSV in living cells could help researchers solve the mysteries and unknowns of the virus, including how it enters cells, how it duplicates, how many genomes it inserts into its hosts, and possibly why specific lung cells escape the infection comparatively unharmed, which could allow scientists with the information they need to develop new antiviral drugs and perhaps even a vaccine to prevent severe RSV infections. Most children, by the time they are two-years-old, have contracted RSV and suffered symptoms similar to a serious cold. However, for some children, specifically for premature infants and those with underlying health problems, RSV can lead to pneumonia and bronchitis, which can lead to hospitalization and have long-lasting repercussions. “We want to develop tools that would allow us to get at how the virus really works,” said associate professor in the Wallace H. Coulter department of biomedical engineering at Georgia Institute of Technology (Georgia Tech; Atlanta, GA, USA) and Emory University (Atlanta, GA, USA), Dr. Philip Santangelo. “We really need to be able to follow the infection in a single living cell without affecting how the virus infects its hosts, and this technology should allow us to do that.” The research has gone on to be published online ahead of print in the journal ACS Nano. While RSV will be the first target for the work, the researchers believe the imaging technique they developed could be used to study other RNA viruses, including influenza and Ebolavirus. “We’ve shown that we can tag the genome using our probes. What we’ve learned from this is that the genome does get incorporated into the virion, and that the virus particles created are infectious. We were able to characterize some aspects of the virus particle itself at super-resolution, down to 20 nm, using direct stochastic optical reconstruction microscopy [dSTORM] imaging,” explained Santangelo. RSV can be tricky and complicated to study. For example, the infectious particle can take different forms, varying from 10-µm filaments to ordinary spheres. The virus can inject more than one genome into the host cells, and the RNA orientation and structure are disordered, which makes it difficult to typify. The research team, which included scientists from Vanderbilt University (Nashville, TN, USA) and Emory University, used a probe technology that hastily latches to RNA within cells. The probe uses several fluorophores to point out the presence of the viral RNA, enabling the researchers to see where it goes in host cells, and to view as infectious particles leave the cells to spread the infection.  The research relied on a new procedure for characterizing RNA viruses using multiply labeled tetravalent RNA imaging probes (MTRIPS). The probes comprise of a chimeric combination of DNA and RNA oligonucleotide labeled internally with fluorophores tetravalently complexed to neutravidin. The chimeric combination was used to help the probes evade cellular defenses. The probes, when introduced into cells, quickly diffuse through a cell infected with RSV and attach to the virus’s RNA. Though gripping tightly, the probe does not affect the normal activities of the virus and allows researchers to follow the activity for days using standard microscopy techniques. The MTRIPS can be used to complement other probe technology, such as green fluorescent protein (GFP) and gold nanoparticles. To study the infection’s progress in individual cells, the researchers faced another challenge: living cells move around, and following them complicates the research. To tackle that movement, the laboratory of Thomas Barker, also from the Coulter department, used micropatterned fibronectin on glass to create 50-µm “islands” that contained the cells during the study. Among the mysteries, that the researchers would like to solve is why certain lung cells are gravely infected, while others appear to go unscathed by ill effects.  “If you look at a field of cells, you see huge differences from cell to cell, and that is something that’s not understood at all. If we can figure out why some cells are exploding with virus while others are not, perhaps we can figure out a way to help the bad ones look more like the good ones,” said ... Read more

Those who have recevied extensive back surgery and require repeated X-rays to observe their progress may soon have access to a new technology that does away with the X-rays and repeated radiation exposure, opting instead for an innovative, noninvasive, non-X-ray device that assess spinal movement. The technology was created and developed by two engineering undergraduate students who recently founded their own company in a bid to market the device. The paper describing the novel tool is featured in the current special issue of Technology and Innovation- Proceedings of the National Academy of Inventors®, and was presented at the Second Annual Conference of the National Academy of Inventors® hosted by the University of South Florida, last February 21-23, 2013. "Surgical treatment is inevitable for some of the 80 percent of Americans who at some point in their lives suffer from back pain. We developed an evaluation device that uses battery powered sensors to evaluate spinal motion in three-dimensions. It not only reduces the amount of X-ray testing patients undergo but also has the potential to save over $5 billion per year nationwide in health care costs,” said Kerri Killen of Versor, Inc. who, along with Samantha Music, developed the new device while they were undergraduate students at Stevens Institute of Technology in New Jersey. According to co-developer Music, there are 600,000 spinal surgeries annually in the U.S. with a yearly exposure of 2,250 mrem of radioactivity for every patient prior to and following surgery. The "electrogoniometer" they developed can be used by surgeons before admitting the patient to surgery and after surgery. It can also used by physical therapists to further diagnose the progression of a patient's surgery. Additionally, the technology can also be used in other orthopedic specialties to reduce both costs and remove X-ray exposure. "The electrogoniometer contains three rotary potentiometers, which are three-terminal resistors with a sliding contact that forms a voltage divider to control electrical devices, such as a rheostat. Each potentiometer measures one of the three spinal movements. It also contains a transducer - a device that converts a signal in one form to energy of another form - to measure the linear displacement of the spine when it curves while bending,” explained Music. The developers described that the device is "easy to use" and requires basic training for the health professional end-user. The vest-like attachment to a patient eradicates the need for any other special equipment and can be utilized during a routine clinical evaluation. "It is comfortable for the patient and efficient, providing immediate and accurate results," they said. Furthermore, Music and Killen noted that the device could also be for measuring movement spinal angles and to determine when an injured worker might be able to return to work. By developing innovative ways in which the device is attached to different areas of the body; and can be evaluated for movement, whether it be the hip, shoulder, knee, or ... Read more