The British journal of radiology (Br J Radiol)

Publisher: British Institute of Radiology; HighWire Press, British Institute of Radiology

Journal description

The British Journal of Radiology is the official peer reviewed journal of the British Institute of Radiology covering all clinical and technical aspects of diagnostic imaging, radiotherapy and radiobiology.

Current impact factor: 2.03

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 2.026
2013 Impact Factor 1.533
2012 Impact Factor 1.217
2011 Impact Factor 1.314
2010 Impact Factor 2.062
2009 Impact Factor 2.105
2008 Impact Factor 2.366
2007 Impact Factor 1.773
2006 Impact Factor 1.279
2005 Impact Factor 1.394
2004 Impact Factor 1.232
2003 Impact Factor 1.089
2002 Impact Factor 0.925
2001 Impact Factor 0.959
2000 Impact Factor 0.951
1999 Impact Factor 1.067
1998 Impact Factor 0.867
1997 Impact Factor 0.811
1996 Impact Factor 0.794
1995 Impact Factor 0.675
1994 Impact Factor 0.766
1993 Impact Factor 0.694
1992 Impact Factor 0.671

Impact factor over time

Impact factor

Additional details

5-year impact 1.98
Cited half-life 9.20
Immediacy index 0.30
Eigenfactor 0.01
Article influence 0.67
Website British Journal of Radiology website
Other titles British journal of radiology (Online), The British journal of radiology, BJR
ISSN 1748-880X
OCLC 47629775
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

British Institute of Radiology

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo
  • Conditions
    • On funder's repositories, institutional repository or subject-based repositories
    • Publisher's version/PDF can be used on non-commercial open access repositories
    • Published source must be acknowledged
    • Must link to publisher version
    • Authors retain copyright
    • Author copyright and source must be acknowledged with full citation and set statement (see policy)
    • Non-commercial use
    • Publisher last contacted on 20/06/2013
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To develop an alpha dosimetry technique for activity calibration of alpha emitting radiopharmaceuticals using the Gafchromic EBT3(®) (Gaf-EBT3) radiochromic film. Methods: The Gaf-EBT3 has a tissue equivalent radiosensitive layer (∼28 µm) sandwiched between two 100 µm thick polyester sheaths; thereby making it insensitive to alpha particles. We have split a Gaf-EBT3 sheet using a surgical scalpel to remove one of the polyester protective layers and covered the radiosensitive layer with thin Mylar foil (2.5 µm). Small pieces of modified film were exposed at contact with a 560 Bq thin (241)Am source for 5, 10, 24 and 94 hours. The optical density of the films was evaluated using a optical densitometer. The alpha energy spectra of the (241)Am source were recorded using a Si(Li) surface barrier detector. Results: Time integrated specific alpha surface activity (kBqcm(-2)h) was represented as a function of optical density. Conclusion: By removing one of the 100µm thick polyester protective layers the authors have modified the Gaf-EBT3 film to a sensitive alpha dosimeter. The calibration function relevant to a (241)Am reference source was evaluated from the optical densities of the dosimeter foils. Furthermore, calibration functions for important alpha emitters like (223)Ra, (225)Ac or (210)Bi were parameterised from the (241)Am reference data. Advances in knowledge: Authors have developed and tested the principle of a clinical alpha dosimeter using Gaf-EBT3 radiochromic films originally developed for photon dosimetry. This novel, user friendly technique could be implemented in QA and calibration procedures of important alpha emitting radiopharmaceuticals prior to their clinical applications.
    The British journal of radiology 10/2015; DOI:10.1259/bjr.20150035
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    ABSTRACT: Objective: To characterize the multidetector computed tomography (MDCT) imaging characteristics of mucinous tubular and spindle cell carcinoma (MTSCC) and collecting duct carcinoma (CDC) of the kidney. Methods: Twenty-one patients with MTSCC and 18 patients with CDC were studied retrospectively. MDCT was undertaken to investigate differences in tumor characteristics. Results: Five patients with MTSCC had calcifications as did 9 patients with CDC (P =0.108). In three patients with MTSCC and four patients with CDC the tumors had a clear boundary (P = 0.682). No patient with MTSCC had retroperitoneal lymph node metastasis as did 5 patients with CDC (P =0.015). Sixteen patients with MTSCC showed homogeneous enhancement, whereas 11 patients with CDC showed heterogeneous enhancement (P = 0.025). The attenuation value of CDC tumors was greater than that of MTSCC and normal renal parenchyma on an unenhanced CT (P =0.027). MTSCC and CDC tumor enhancement was less than the normal renal cortex and medulla in all phases (P < 0.001). Tumor enhancement was greater with CDC compared with MTSCC in all phases (P = 0.011, P = 0.006, P = 0.052). Conclusion: Unenhanced and dynamic MDCT may aid in diagnosis and differentiation of MTSCC and CDC of the kidney. Advances in knowledge: This is the first series evaluating the imaging findings of MTSCC and CDC of which we are aware and identification of such findings may improve diagnosis of these rare two tumors.
    The British journal of radiology 10/2015; DOI:10.1259/bjr.20140434
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    ABSTRACT: Objectives: To evaluate the role of perfusion-based assessment of inflammatory activity in patients with treated and untreated aortitis and chronic periaortitis as compared with clinical and serological markers. Methods: 35 patients (20 female; median age 66 years) with (peri-)aortitis were retrospectively evaluated. All patients had clinical symptoms prompting at the time of imaging. All patients first underwent whole-body contrast-enhanced computed tomography and subsequently segmental volume perfusion-CT for assessment of the degree of vascularization of (peri-)aortitis as a surrogate marker for inflammatory activity. Blood flow, blood volume, volume transfer constant (k-trans), time-to-peek and mean transit time were determined. The thickness of the increased connective tissue formation was measured. Perfusion data was correlated with clinical symptoms and acute phase inflammatory parameters like C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leukocyte number. Results: 21/35 patients were untreated, 14/35 had previous/ongoing immunosuppression. The interobserver agreement was good (ĸ=0.78) for all perfusion parameters. Average values of perfusion parameters were higher in untreated patients, but remained abnormally elevated in treated patients as well. Perfusion data and ESR and CRP correlated well both in aortitis (p <0.05) and in periaortitis (p <0.05). In periaortitis perfusion parameters agreed well with ESR and CRP values (p <0.05) only in untreated patients. Conclusions: Perfusion-CT parameters in untreated aortitis and chronic periaortitis correlate well with serological markers with respect to disease activity assessment. However, in treated periaortitis, correlations were weak suggesting an increased role for (perfusion-based) imaging. Advances in Knowledge: Volumen-perfusion CT may be used for diagnosis of aortitis/periaortitis.
    The British journal of radiology 10/2015; DOI:10.1259/bjr.20150526
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    ABSTRACT: Objective: The application of bronchial artery embolisation (BAE) using N-butyl-2-cyanoacrylate (NBCA) for haemoptysis was recently reported to be useful. A triple co-axial (triaxial) system consisting of a 4-Fr. catheter, 2.7-Fr. microcatheter, and 1.9-Fr. no-taper microcatheter has been developed. The aim of the present study was to evaluate the usefulness of the triaxial system in BAE using NBCA. Methods: Twelve patients with haemoptysis, 8 males and 4 females with a median age of 64 years (range, 49-88 years), underwent BAE between August 2012 and October 2014. Medical records and images were reviewed, and the technical success rate, clinical success rate, haemoptysis-free rate, and complications were evaluated. Technical success was defined as the complete cessation of the target artery as confirmed by digital subtraction angiography, while clinical success was defined as the cessation of haemoptysis within 24 hours of BAE. Recurrent haemoptysis was defined as a total of >30 mL of bleeding per day. Results: The target artery was embolised successfully in all patients, and the technical success rate was 100 % (12/12). The cessation of haemoptysis was achieved in 11 out of 12 patients within 24 hours, and, thus, the clinical success rate was 92% (11/12). The 6-, 12-, and 24-month haemoptysis-free rates were 89%, 89%, and 76%, respectively. No patients exhibited any signs of complications such as spinal ischaemia. Conclusion: BAE using the triaxial system and NBCA appears to be a useful and safe procedure for haemoptysis. Advances in knowledge: The triaxial system contributes to safe and effective BAE using NBCA.
    The British journal of radiology 10/2015; DOI:10.1259/bjr.20150265
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    ABSTRACT: Objective: The purpose of this study was to develop size-based radiotherapy kilovoltage cone beam CT (CBCT) protocols for the pelvis. Methods: Image noise was measured in an elliptical phantom of varying size for a range of exposure factors. Based on a previously defined 'small pelvis' reference patient and CBCT protocol, appropriate exposure factors for small, medium, large and extra-large patients were derived that approximate the image noise behaviour observed on a Philips CT scanner with automatic exposure control (AEC). Selection criteria, based on maximum tube current-time product per rotation selected during the radiotherapy treatment planning scan were derived based on an audit of patient size. Results: It has been demonstrated that 110 kVp yields acceptable image noise for reduced patient dose in pelvic CBCT scans of small, medium and large patients, when compared with manufacturer default settings (125 kVp). Conversely, extra-large patients require increased exposure factors to give acceptable images. 57% of patients in the local population now receive much lower radiation doses, whilst 13% require higher doses (but now yield acceptable images). Conclusion: The implementation of size based exposure protocols has significantly reduced radiation dose to the majority of patients with no negative impact on image quality. Increased doses are required on the largest patients to give adequate image quality. Advances in knowledge: The development of size-based CBCT protocols that use the planning CT scan (with AEC) to determine which protocol is appropriate, ensures adequate image quality whilst minimising patient radiation dose.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20150364
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    ABSTRACT: Background: To evaluate the efficacy of intraoperative 3D Iso-C C-arm navigated percutaneous radiofrequency ablation (RFA) of osteoid osteomas. Methods: 35 patients (20 male, 15 female) with osteoid osteomas underwent treatment with intraoperative 3D Iso-C C-arm navigation-guided RFA. The tumor was first biopsied for pathological examination, the core needle was removed, and the RFA needle was inserted into the nidus. Postoperative x-rays and CT scans were performed to evaluate degree of ablation and to assess for recurrence at 3 month follow-up. Patients also completed a visual analogue scale (VAS) both preoperatively and 3 days postoperatively to subjectively assess pain. Results: Pathological diagnosis of osteoid osteoma was confirmed in 19 cases. The other 16 cases were not pathologically diagnosed due to inadequate biopsy specimens. In all cases, localized pain was immediately relieved following RFA. Patients reported significantly decreased pain, with mean preoperative VAS scores of 3.4 reducing to 0.8 at 3 days postoperatively, and further to 0.06 at three month follow-up (P < 0.05). The mean follow-up time was 15.5 months (range, 3-38 months). Conclusion: 3D Iso-C C-arm navigation-guided RFA is a safe and effective option for the treatment of osteoid osteomas that may be considered in place of intraoperative CT-guided and open resection. Advances in knowledge: C-arm image-guided percutaneous RFA mitigates the need for preoperative CT as well as intraoperative scintigraphy, and provides real-time imaging of the anatomy, facilitates accurate resection of the tumor, and enables immediate confirmation of excision.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20140535
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    ABSTRACT: Magnetic resonance imaging (MRI) is one of the most dynamic and safe imaging techniques available in the clinic today. However, MRI acquisitions tend to be slow, limiting patient throughput and limiting potential indications for use while driving up costs. Compressed sensing (CS) is a method for accelerating MRI acquisition by acquiring less data through undersampling of k-space. This has the potential to mitigate the time-intensiveness of MRI. The limited body of research evaluating the effects of CS on MR images has been mostly positive with regards to its potential as a clinical tool. Studies have successfully accelerated MRI with this technology, with varying degrees of success. However, more must be done before its diagnostic efficacy and benefits are clear. Studies involving a greater number radiologists and images must be completed, rating CS based on its diagnostic efficacy. Also, standardized methods for determining optimal imaging parameters must be developed.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20150487
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    ABSTRACT: Objective: The aim of this study was to evaluate the potential of simultaneously modulated accelerated radiation therapy (SMART) to reduce the incidence of severe acute esophagitis in the treatment of unresectable locally advanced non-small cell lung cancer (LANSCLC). Method: Twenty one patients (pts) were treated with SMART and concomitant platinum based chemotherapy. SMART consisted on radiation doses limited to 54 Gy at 1,8 Gy per day to the zones of presumed microscopic extent while simultaneously maintaining doses of 66 Gy at 2,2 Gy per day to the macroscopic disease. The whole treatment was delivered over 30 fractions and 6 weeks. Dosimetric parameters of SMART and the standard technique of irradiation (IMRTs) were compared. Acute toxicity was prospectively recorded. Results: The highest grade of esophagitis was 62% (13 pts) grade 1, 33% (7 pts) grade 2 and 5% (1 pt) grade 3. Three (14%) pts experienced acute grade 2 pneumonitis. There was no grade 4 esophageal or pulmonary toxicity. Doses to the organs at risk were significantly reduced in SMART compared to IMRTs [esophagus: V50Gy: 28,5Gy vrs 39,9Gy (p=0,003); V60Gy: 7,1Gy vrs 30,7Gy (p=0,003); lung: V20Gy: 27,4Gy vrs 30,1Gy (p=0,002); heart: V40Gy: 7,3Gy vrs 10,7Gy (p=0,006); spine: Dmax: 42,4Gy vrs 46,4Gy (p=0,003)]. With a median follow-up of 18 months (6-33), the 1 year LC rate was 70% and the disease free survival rate was 47%. Conclusion: SMART reduces the incidence of severe esophagitis and improves the whole dosimetric predictors of toxicity for the lung, heart and spine. Advances in knowledge: Our study shows that SMART optimize the therapeutic ratio in the treatment of LANSCLC opening a window for dose intensification.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20150311
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    ABSTRACT: Objective: The current literature has described the usefulness of elastography and diffusion weighted MRI in cancer patients, but to the best of our knowledge so far none of them have compared the two new methods. The tumour cell density is related to the MRI measured apparent diffusion weighted coefficient (ADC). The purpose of the present study was to compare quantitative elastography based on ultrasound shear wave measurements with MRI ADC. Methods: We prospectively examined 52 patients with histopathologically proven rectal cancer. The mean age was 67 years (range 42 - 90 years). Men: 39, women: 13. Tumour elasticity was measured transgluteally using the Acoustic Radiation Force Impulse (ARFI) to generate information on the mechanical properties of the tissue. The objective quantitative elastography shear wave velocity was blindly compared to the ADC measurements using a 1.5 Tesla MRI system. Results: The mean tumour elasticity was 3.05 m/s (SD: 0.79) and the mean ADC was 0.69 x10(-3) mm(2)/s (SD: 0.27). Elasticity was inversely strongly correlated with ADC, r = -0.65 (Salkin scale). ARFI = 4.392 - 1.949 x ADC, R(2) = 0.43, P < 000.1. Intercept = 4.392 (95% CI:3.92 - 4.86), Slope = -1.949 (95% CI: -1.31 - -2.59), P < 0.0001. Conclusion: Elasticity correlates with the estimated diffusion restriction by MRI ADC measurements in rectal tumours. The relationship between ARFI and ADC measurement was linear in our study population. Advances in knowledge: This work describes a correlation between tissue elasticity and diffusion in rectal cancer.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20150294
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    ABSTRACT: We present a case of a 55 year old male with history of urethroscopic calculus removal who later developed urinary tract infection, complicated by periurethral abscess formation with osteomyelitis of the inferior pubic ramus and a urethrocutaneus fistula after surgical drainage of the abscess. Urinary tract infection with periurethral abscess and urethrocutaneus fistula (watering can perineum) is a rare complication of urinary tract infection (UTI). A periurethral abscess with pubic osteomyelitis has not been previously reported.
    The British journal of radiology 09/2015; DOI:10.1259/bjrcr.20150045
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    ABSTRACT: Objectives: To investigate the effect of TNF-α antagonists on MRI dynamic contrast enhanced (DCE) and diffusion weighted Imaging (DWI) parameters in Crohns disease (CD). Methods: 42 CD patients (median age 24, 22 female) commencing anti-TNF-α therapy with baseline and follow up (median 51 weeks) 1.5T MR enterography (MRE) were retrospectively identified. MRE included DCE (n=20), and/or multi-B-value DWI (n=17). Slope of enhancement (SoE); maximum enhancement (ME); area under the time-intensity curve (AUC), Ktrans, ve, ADC, ADCfast/slow were derived from the most inflamed bowel segments. A physician global assessment of disease activity (remission, mild, moderate and severe) at the time of MRE was assigned and the cohort divided into responders and non-responders. Data was compared using Mann Whitney and ANOVA. Results: Follow-up Ktrans , ME, SoE, AUC and ADC(ME) changed significantly in clinical responders but not in non-responders, baseline; ((median (IQR); 0.42 (0.38) , 1.24 (0.52), 0.18 (0.17), 17.68 (4.70), 1.56mm2/ (0.39) versus follow-up; 0.15 (0.22), 0.50(0.54), 0.07(0.1), 14.73 (2.06), 2.14mm2/sec(0.62), for responders respectively p = 0.006 to p = 0.037). SOE was higher, ME and AUC lower for patients in remission compared to those with severe activity ((Mean (SD); 0.55(0.46), (0.49(0.28), (14.32(1.32)) versus (0.32(0.37), (2.21(2.43), (23.05(13.66)) respectively p =0.017 to 0.033. ADC was significantly higher for patients in remission (2.34mm2/sec (0.67)) compared to those with moderate (1.59mm2/sec (0.26)) (p =0.005) and severe disease (1.63mm2/sec (0.21)) (p = 0.038) Conclusion: DCE and DWI parameters change significantly in responders to TNF-α antagonists and are significantly different according to clinically defined disease activity status Advances in knowledge: DCE and DWI parameters change significantly in responders to TNF-α antagonists in Crohns disease suggesting an effect on bowel wall vascularity.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20150547
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    ABSTRACT: Objective: Radiation induced anal toxicity can be induced by low radiation doses in patients with hemorrhoids. The object of this study was to determine the dosimetric benefits of different whole pelvic radiotherapy (WPRT) techniques in terms of dose delivered to the anal canal in postoperative cervical cancer patients. Methods: The planning computed tomography images of 10 patients with cervical cancer undergoing postoperative RT were used for comparison of different three plans. All patients had already been treated using the conventional box technique WPRT (CV-WPRT), and we tried low margin modified WPRT (LM-WPRT), three dimensional conformal techniques WPRT (CF-WPRT) and intensity-modulated WPRT (IM-WPRT) planning for dosimetric comparison of anal canal, retrospectively. Results: Mean anal canal doses of the IM-WPRT were significantly lower (p<0.05) than those of CV-WPRT, LM-WPRT and CF-WPRT, and V10, V20, V30, and V40 to the anal canal were also significantly lower for IM-WPRT (p<0.05). The proportion of PTVs that received ≥98% of prescribed dose for all plans was >99%, and the proportion that received ≥108% of the prescribed dose for IM-WPRT was < 2%. Volumes of bladders and rectums that received ≥30 Gy or ≥40 Gy were significantly lower for IM-WPRT than for three 4F-WPRT (p=0.000). Conclusions: IM-WPRT can significantly reduce radiation dose delivered to the anal canal and does not compromise PTV coverage. In patients with hemorrhoids, IM-WPRT may be of value for the prevention of anal complications. Advances in knowledge: Although tolerance of the anal canal tends to be ignored in patients undergoing postoperative WPRT, patients with hemorrhoids may suffer complications at low radiation doses. The present study shows IM-WPRT can be meaningful in these patients.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20150223
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    ABSTRACT: Purpose: To compare mammographic features before and after accelerated hypo-fractionated adjuvant whole breast radiotherapy (AWB-RT) and to evaluate possible appearance of modifications. Methods: A retrospective review of 177 women before and after an AWB-RT treatment (follow-up ranging from 5 years to 9 years) was done by four radiologists focused in breast imaging who independently evaluated diffuse mammographic density patterns and reported about possible onset of focal alterations: modifications in density and fibrosis with parenchymal distortion were deemed as indicators of AWB-RT treatment impact in breast imaging. Results: Prevalent mammographic density (D) patterns in the 177 women evaluated were, according to the American College of Radiology-Breast Imaging Reporting and Data System (ACR-BIRADS): D1-fibroadipose density (score percentage from 55.9% to 43.5%) and D2- scattered fibroglandular density (from 42.9% to 32.7%). No change in diffuse mammographic density and no significant difference in mammographic breast parenchymal structure were observed. "No Change" was reported with score percentage from 87% to 79.6%. Appearance of fibrosis with parenchymal distortion was reported by all radiologists in only two cases (1.1%, "P value"=0.3); dystrophic calcification was identified with score percentage from 2.2% to 3.3% (small type) and from 9.6% to 12.9% (coarse type). Conclusions: No statistically significant changes in follow-up mammographies 5-9 years after AWB-RT were detected justifting large-scale selection of AWB-RT treatment with no risk of altering radiological breast parameters of common use in tumor recurrence detection. Advances in knowledge: The hypo-fractionated radiotherapy (AWB-RT treatment) is a new proven, safe and effective modality in postoperative early breast cancer patients with excellent local control and survival. In our study the absence of changes in mammographic density patterns and in breast imaging before and after AWB-RT treatment (up to 5-9 years after radiotherapy) justifies large-scale use of AWB-RT treatment without hindrance in tumor recurrence diagnosis.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20150312
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    ABSTRACT: Objectives: Evidence regarding adjuvant and salvage radiation therapy RT (ART, SRT) following radical prostatectomy (RP) for prostate cancer is inconsistent. Study objectives were to collect survey information on Italian radiation oncologists' (RO) beliefs regarding the use of ART and SRT following RP and to compare results of Italian RO to those of American RO available from an analogous survey. Materials and methods: A modified version of a United States-based questionnaire captured attitudes and clinical approaches regarding post-RP RT of all 716 RO practicing in 147 radiation-oncology centers in Italy. Bivariate analyses compared the responses of Italian RO with those of American RO retrieved from a previously published study. Results: Analyzable questionnaires were completed by 153 Italian RO (response rate, 21%). Variations in practice were found for RT use, timing, dosage and technique. All Italian RO supported ART use, although factors influencing the decision to initiate ART varied. Most (81%) would wait 3-6 months after surgery before beginning RT. Compared to Italian RO, more American RO believed ART improves survival outcomes (70% vs. 35%, p<0.001), would initiate ART based solely on adverse pathological features (79% vs. 69%, p<0.001), and would initiate SRT based on any detectable PSA (37% vs. 11%, p<0.001). Conclusions: Italian RO strongly supported ART, but their approach to patient selection for ART and SRT varied. Striking differences between Italian and American RO regarding ART and SRT practices were found. Advance in knowledge: Differential RT practices and perceptions exist among RO internationally. Clinical studies must inform evidence-based guidelines to harmonize the use of post-RP RT.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20150587
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    ABSTRACT: Purpose: This study investigates correlation between dose volume histogram derived from three bowel contouring methods and late toxicity in patients undergoing postoperative radiation (PORT) for cervical cancer. Methods and materials: From June 2010- May 2013, 103 patients undergoing PORT were included. Three different contouring methods were used; A) individual small bowel (SB) and large bowel (LB) loops, B) Total bowel (TB; including SB & LB) and C) Peritoneal cavity (PC). The volume of SB, LB, and TB & PC receiving 15 Gy, 30 Gy and 40 Gy was calculated. Acute and late bowel toxicity was scored using CTCAE version 3.0. Receiver operator characteristics curve identified thresholds predicting late toxicity with highest specificity. All data was dichotomized across these thresholds. Univariate and multivariate analysis was performed using SPSS version 20. Results: On univariate analysis V30 PC ≥ 900 cc (p= 0.01), V40 PC≥ 750cc (p= 0.03) and VTB ≥ 280 cc (p= 0.03) and use of concurrent chemotherapy (p= 0.03) predicted for grade ≥ II acute toxicity. On multivariate analysis use of concurrent chemotherapy (Odd's Ratio (OR) 3.5; 95% CI 1.1-11.1, p= 0.03) and V30 PC ≥ 900cc (OR= 2.3; 95% CI 1-5.5 p= 0.05) predicted for acute grade ≥ II toxicity. On univariate analysis for late toxicity, SB (V30 ≥190cc; p =0.009, V40 ≥150cc; p= 0.03), LB (V15 ≥250cc; p= 0.04), V40 PC (V40 ≥750 cc; p= 0.001) and presence of acute grade ≥ III toxicity (p= 0.006), treatment technique (3DCRT or IMRT, p= 0.02) predicted late grade ≥bowel toxicity. On multivariate analysis only BMI ≥ 25 mg/m(2) (OR= 7.3; (95% CI= 1.6-31.6, p =0.008)), and presence of acute grade III toxicity predicted for late grade II or higher toxicity (OR=5.1; 95% CI 1.4-18.1, p= 0.007). Conclusions: V30 PC ≥ 900 cc and use of concurrent chemotherapy independently predicts for acute toxicity. Presence of acute grade ≥ III toxicity independently predicts for late toxicity. Minimizing dose to PC subvolumes can therefore reduce both acute and late toxicity. Advances in Knowledge: Study establishes PC threshholds that can minimize both acute and late bowel toxicity.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20150054
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    ABSTRACT: Objective: The objective was to identify acute skin toxicity risk factors linked to anthropometric characteristics of breast cancer patients treated with radiation therapy. Methods: Consecutive patients with breast cancer were enrolled after breast-conserving surgery, and before radiotherapy course. Acute skin toxicity was assessed weekly during the 7 weeks of radiotherapy with the International Classification from National Cancer Institute. Grade 2 defined acute skin toxicity. Patient characteristics and anthropometric measurements were collected. Results: 54 patients were enrolled in 2013. Eight patients (14.8%) had ≥ grade 2 toxicity. The average weight and chest size were 65.5 kg and 93.6 cm, respectively. Bra cup size is significantly associated with a risk of grade 2 dermatitis (OR 3.46, 95% CI (1.29 to 11.92) with p < 0.05). Anthropometric breast fat mass measurements such as thickness of left (OR 2.72, 95% CI (1.08 to 8.26) p = 0.04) and right (OR 2.45, 95% CI (0.99 to 7.27) p = 0.05) axillary fat, are correlated with an increased risk. Distance between pectoral muscle and nipple is a reproducible measurement of breast size, and is associated with acute skin toxicity with significant tendency (OR=2.21; CI 95% (0.97-5.98), p=0.07). Conclusions: Breast size and its different anthropometric measurements (thickness of left and right axillary fat, nipple to pectoral muscle distance) are correlated with the risk of skin toxicity. Advances in knowledge: The present article analyzes several characteristics and anthropomorphic measurements of breast in order to assess breast size. A standardized and reproducible protocol to measure breast volume is described.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20150414
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    ABSTRACT: Objectives: New linear accelerators can be equipped with a 6D robotic couch, providing two additional rotational motion axes: pitch and roll. These shifts in kV-CBCT image-guided radiotherapy (IGRT) were evaluated over the first 6 months usage of a 6D Robotic couch-top, ranking the treatment sites for which the two compensations are larger for patient setup. Methods: The couch compensations of 2945 fractions for 376 consecutive patients treated on the PerfectPitch™ 6D couch (Varian Medical System) were analyzed. Among these patients, 169 were treated for brain, 111 lung, 54 liver, 26 pancreas, and 16 prostate. During the setup, patient anatomy from planning CT was aligned to kV-CBCT and 6D movements were executed. Information related to pitch and roll were extracted by proper querying of the Microsoft SQL server ARIA database (Varian). Mean values and standard deviations were calculated for all sites. Kolmogorov-Smirnov (KS) test was performed. Results: Considering all the data, mean pitch and roll adjustments were: -0.10°±0.92° and 0.12°±0.96°; mean absolute values were, respectively, 0.58°±0.69° and 0.69°±0.72°. Brain treatments showed the highest pitch and roll mean absolute values (respectively, 0.73°±0.69° and 0.80°±0.78°); the lowest values of 0.36°±0.47° and 0.49°±0.58° were found for pancreas. KS-test was significant for brain vs. liver, pancreas and prostate. Collective corrections (pitch+roll) greater than 0.5°, 1.0°, 2.0° were observed in, respectively, 79.8%, 61.0%, and 29.1% for brain and 56.7%, 39.4%, and 6.7% for pancreas. Conclusions: Adjustments in all six dimensions, including unconventional pitch and roll rotations, improve the patient setup in all treatment sites. In limited available resources, brain tumors treatments are the first choice. Advances in knowledge: At our knowledge, this is the first systematic evaluation of the clinical efficacy of a 6D Robotic couch-top in CBCT image-guided radiotherapy (IGRT) over different tumor regions.
    The British journal of radiology 09/2015; 115:20150468. DOI:10.1259/bjr.20150468
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    ABSTRACT: Objectives: To investigate the feasibility and determine the recommended preoperative intensity modulated radiotherapy (IMRT) dose of extended field chemoradiation along with simultaneous integrated boost (SIB) dose escalation Methods: A radiation dose of 40 Gy over four weeks, 2 Gy per fraction, was delivered to the tumor and the lymphatic drainage (planning target volume, PTV3), which encompassed a volume larger than standard (common iliac lymphatic area up to its apex, in front of the L3 vertebra ), concurrently with chemotherapy (cisplatin and 5- fluorouracil). Radiation dose was escalated to the pelvis (PTV2) and to the macroscopic disease (PTV1) with the SIB-IMRT strategy. Three dose levels were planned: level 1 (PTV3: 40/2 Gy, PTV2: 40/2 Gy; PTV1: 45/2.25 Gy), level 2 (PTV3: 40/2 Gy, PTV2: 45/2.25 Gy; PTV1: 45/2.25 Gy) and level 3 (PTV3: 40/2 Gy, PTV2: 45/2.25 Gy; PTV1: 50/2.5 Gy). All treatments were delivered in 20 fractions. Patients were treated in cohorts of 3 to six per group using a phase I study design. The recommended dose was exceeded if N=2 of 6 patients in a cohort experienced dose-limiting toxicity (DLT) within 3 months from treatment. Results: 19 patients (median age: 46 years; FIGO stage IB2: 3, IIB: 10, IIIA-IIIB: 6) were enrolled. Median follow-up was 24 months (9-60 months). The most common grade 3/4 toxicity was gastrointestinal (diarrhea, mucous discharge, rectal/abdominal pain). At level 1 and 2 only one grade 3 GI toxicity per level were recorded, while at level 3 two grade 3 GI toxicity (diarrhea, emesis and nausea) were recorded. Conclusions: The SIB-IMRT technique was found feasible and safe at the recommended doses of 45 Gy to PTV1 and PTV2, and 40 Gy to PTV3 in the preoperative treatment of LACC patients. Unfortunately this complex technique was unable to safely escalate dose beyond levels already achieved with 3D-conformal radiotherapy technique given acute GI toxicity. Advances in knowledge: A phase I radiotherapy dose escalation trial with SIB-IMRT technique is proposed in cervical cancer. This complex technique is feasible and safe at the recommended doses.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20150385
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    ABSTRACT: Total pelvic floor ultrasound is used for the dynamic assessment of pelvic floor dysfunction and allows multicompartmental anatomical and functional assessment. Pelvic floor dysfunction includes defaecatory, urinary and sexual dysfunction, pelvic organ prolapse and pain. It is common, increasingly recognised and associated with increasing age and multiparity. Other options for assessment include defaecation proctography and defaecation Magnetic Resonance Imaging. Total pelvic floor ultrasound is a cheap, safe, imaging tool which may be performed as a first line investigation in outpatients. It allows dynamic assessment of the entire pelvic floor; essential for treatment planning for women who often have multiple diagnoses where treatment should address all aspects of dysfunction to yield optimal results. Transvaginal scanning using a rotating single crystal probe provides sagittal views of bladder neck support anteriorly. Posterior transvaginal ultrasound may reveal rectocoele, enterocoele or intussusception whilst bearing down. The vaginal probe is also used to acquire a 360 degree cross sectional image to allow anatomical visualisation of the pelvic floor and provides information regarding levator plate integrity and pelvic organ alignment. Dynamic transperineal ultrasound using a conventional curved array probe provides a global view of the anterior, middle and posterior compartments and may show cystocoele, enterocoele, sigmoidocoele or rectocoele. This pictorial review provides an atlas of normal and pathological images required for global pelvic floor assessment in women presenting with defaecatory dysfunction. Total pelvic floor ultrasound may be used with complementary endoanal ultrasound to assess the sphincter complex but this is beyond the scope of this review.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20150494
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    ABSTRACT: Objective: To determine whether visually stratified CT findings and pulmonary function variables are helpful in predicting mortality in patients with combined pulmonary fibrosis and emphysema (CPFE). Methods: We retrospectively identified 113 patients with CPFE who underwent high-resolution CT between January 2004 and December 2009. The extent of emphysema and fibrosis on CT was visually assessed using a six- and five-point scale, respectively. Univariate and multivariate Cox proportional hazards regression analyses were performed to determine the prognostic value of visually stratified CT findings and pulmonary function variables in CPFE patients. Differences in 5-year survival rates in CPFE patients according to the extent of honeycombing were calculated using Kaplan-Meier analysis. Results: An increase in the extent of visually stratified honeycombing on CT (hazard ratio [HR] 1.95, P = 0.018, 95% confidence interval [CI] 1.12 to 3.39) and reduced diffusing capacity of lung for carbon monoxide (DLCO) (HR 0.97, P = 0.017, 95% CI 0.94 to 0.99) were independently associated with increased mortality. In CPFE patients, the 5-year survival was 78.5% for < 5% honeycombing, 55.7% for 6 - 25% honeycombing, 32% for 26 - 50% honeycombing, and 33.3% for > 50% honeycombing on CT. Conclusion: The > 50% honeycombing on CT and reduced DLCO are important prognostic factors in CPFE. Advances in Knowledge: Visual estimation of honeycombing extent on CT can help in the prediction of prognosis in CPFE.
    The British journal of radiology 09/2015; DOI:10.1259/bjr.20150545