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: 2.02

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 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
Year

Additional details

5-year impact 0.00
Cited half-life 9.70
Immediacy index 0.33
Eigenfactor 0.01
Article influence 0.63
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: Percutaneous musculoskeletal procedures are widely accepted as low invasive, highly effective, efficient and safe methods in a vast amount of hip pathologies either in diagnostic or in therapeutic management. Hip intraarticular injections are used for the symptomatic treatment of osteoarthritis. Peritendinous or intrabursal corticosteroid injections can be used for the symptomatic treatment of greater trochanteric pain syndrome and anterior iliopsoas impingement. In past decades, the role of interventional radiology has rapidly increased in metastatic disease thanks to the development of many ablative techniques. Image-guided percutaneous ablation of skeletal metastases provides a minimally invasive treatment option that appears to be a safe and effective palliative treatment for localized painful lytic lesion. Methods of tumor destruction based on temperature, such as radiofrequency ablation and cryotherapy, are performed for the management of musculoskeletal metastases. Magnetic resonance-guided focused ultrasound surgery provides a noninvasive alternative to these ablative methods. Cementoplasty is now widely used for pain management and consolidation of acetabular metastases and can be combined with RFA. RFA is also used to treat benign tumors, namely osteoid osteomas. New interventional procedures such as percutaneous screw fixation are also proposed to treat nondisplaced or minimally displaced acetabular roof fractures.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150408
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    ABSTRACT: Visceral adipose tissue (VAT) is a significant risk factor for obesity-related metabolic diseases. This study investigates 1) the best single CT slice location for predicting total abdominal VAT volume in paediatrics and 2) relations between waist circumference, sagittal diameter, gender, and VAT volume. A random sample of 130 paediatric abdomen CT scans, stratified according to age and gender, was collected. Three readers measured VAT area at each intervertebral level between T12 and S1 using Image J analysis software by thresholding -190 to -30 HU and manually segmenting VAT. Single-slice VAT measurements were correlated with total VAT volume to identify the most representative slice. Waist circumference (WC) and sagittal diameter (SD) were measured at L3-L4 and L4-L5 slices, respectively. Regression analysis was used to evaluate WC, SD and gender as VAT volume predictors. Inter- and intra-viewer reliability were excellent (ICC = 0.99). Although VAT measured at multiple slices correlated strongly to abdominal VAT, only one slice in females at L2-L3, and two slices in males at L1-L2 and L5-S1, were strongly correlated across all age groups. Linear regression analysis showed that waist circumference was strongly correlated to VAT volume (Beta=0.970, p<0.001). Single slice VAT measurements are highly reproducible. Measurements performed at L2-L3 in females, and L1-L2 or L5-S1 in males were most representative of VAT. Waist circumference is indicative of VAT. Advances in knowledge: VAT should be measured at L2-L3 in female children and at either L1-L2 or L5-S1 in males. Waist circumference is a strong indicator of VAT in children.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20140711
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    ABSTRACT: Ultrasound is an established modality for shoulder evaluation, being accurate, low-cost and radiation-free. Different pathologic conditions can be diagnosed using ultrasound and treated using ultrasound guidance, such as degenerative, traumatic or inflammatory diseases. Subacromial-subdeltoid bursitis is the most common finding on ultrasound evaluation for painful shoulder. Therapeutic injections of corticosteroids are helpful to reduce inflammation and pain. Calcific tendinopathy of rotator cuff affects up to 20% of painful shoulders. Ultrasound-guided treatment may be performed with both single- and double-needle approach. Calcific enthesopathy, a peculiar form of degenerative tendinopathy, is a common and mostly asymptomatic ultrasound finding; dry-needling has been proposed in symptomatic patients. An alternative is represented by autologous platelet-rich plasma injections. Intra-articular injections of the shoulder can be performed in the treatment of a variety of inflammatory and degenerative diseases, respectively with corticosteroids or hyaluronic acid. Steroid injections around the long head of the biceps brachii tendon are indicated in patients with biceps tendinopathy, reducing pain and humeral tenderness. The most common indication for acromion-clavicular joint injection is degenerative osteoarthritis, with ultrasound representing a useful tool in localizing the joint space and properly injecting various types of drugs (steroids, lidocaine or hyaluronic acid). Suprascapular nerve block is an approved treatment for chronic shoulder pain non-responsive to conventional treatments as well as those patients candidate for shoulder arthroscopy. This review provides an overview of these different ultrasonography guided procedures that can be performed around the shoulder.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150372
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    ABSTRACT: Aggressive spinal hemangiomas (those with significant osseous expansion/extraosseous extension) represent approximately 1% of spinal hemangiomas and are usually symptomatic. In this study we correlate imaging findings with presenting symptomatology, review treatment strategies and their outcomes, and propose a treatment algorithm. 16 patients with aggressive hemangiomas were retrospectively identified from 1995 to 2013. Imaging was assessed for size, location, CT/MR characteristics, osseous expansion and extraosseous extension. Presenting symptoms, management and outcomes were reviewed. Median patient age was 52 years. Median size was 4.5 cm. Lumbar spine was the commonest location (n=8), followed by thoracic spine (n=7) and sacrum (n=2); one case involved the lumbosacral junction. Twelve hemangiomas had osseous expansion; thirteen had extraosseous extension (epidural n=11, pre-/paravertebral n=10, and foraminal n=6). On CT, eleven had accentuated trabeculae; five showed lysis. On MRI, eight were T1 hyperintense; six were T1 hypointense, and all were T2 hyperintense. Eleven symptomatic patients underwent treatment: chemical ablation (n=6), angio-embolization (n=3, two had subsequent surgery), radiotherapy (n=2, 1 primary and 1 adjuvant) and surgery (n=4). Median follow-up was 20 months. Four of six patients managed only by percutaneous methods had symptom resolution. Three of four patients requiring surgery had symptom resolution. Aggressive hemangiomas cause significant morbidity. Treatment is multidisciplinary, with surgery reserved for large lesions and those with focal neurologic signs. Minimally invasive procedures may be successful in smaller lesions. Advances in knowledge: Aggressive hemangiomas are rare, but knowledge of their imaging features and treatment strategies enhances the radiologist's role in their management.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20140771
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    ABSTRACT: The role of radiological guided intervention is integral in the management of patients with musculoskeletal pathologies. The key to image guided procedures is to achieve an accurately placed intervention with minimal invasion. This review article specifically concentrates on radiological procedures of the hand and wrist using ultrasound and fluoroscopic guidance. A systematic literature review of the most recent publications relevant to image guided intervention of the hand and wrist was conducted. During this search it became clear that there is little consensus regarding all aspects of image guided intervention, from the technique adopted to the dosage of injectate and the specific drugs used. The aim of this article is to formulate an evidence based reference point which can be utilised by radiologists and to describe the most commonly employed techniques.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150373
  • The British journal of radiology 08/2015; DOI:10.1259/bjr.20150692
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    ABSTRACT: Pulsed dose rate (PDR) brachytherapy is a treatment modality that combines physical advantages of high dose rate (HDR) brachytherapy with the radiobiological advantages of low dose rate (LDR) brachytherapy. The aim of this review was to describe the effective clinical use of PDR brachytherapy worldwide in different tumor locations. We found 66 articles to report on clinical PDR brachytherapy including the treatment procedure and outcome. Moreover, PDR brachytherapy has been applied in almost all tumor sites for which brachytherapy is indicated and with good local control and low toxicity. The main advantage of PDR is, because of the small pulse sizes used, the ability to spare normal tissue. In certain cases HDR resembles PDR brachytherapy by the use of multifractionated low fraction dose.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150310
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    ABSTRACT: To evaluate the tolerance of stereotactic body radiation therapy (SBRT) for the treatment of secondary lung tumors in patients who underwent previous pneumonectomy. 12 patients were retrospectively analyzed . The median maximum tumour diameter was 2.1 cm (1-4.5). The median planning target volume (PTV) was 20.7 cm3 (2.4-101.2). Five patients were treated with a single fraction of 26 Gy and 7 with fractionated schemes (3x10 Gy, 4x10 Gy, 4x12 Gy). Lung toxicity, correlated with volume (V) of lung receiving more than 5, 10 and 20 Gy, local control and survival rate were assessed. Median follow up was 28 months. none of the patients experienced pulmonary toxicity > 2 at the median dosimetric lung parameters of V5 , V10 and V20 of 23 % (range 10.7-56.7), 7.3 % (2.2-27.2) and 2.7 % (0.7-10.9) respectively. No patients required oxygen or had deterioration of the performance status during follow up if not as a result of clinical progression of disease. The local control probability at 2 y was 64.5% and the overall survival at 2 y was 80 %. SBRT appears to be a safe an effective modality for treating patients with a second lung tumor after pneumonectomy. Advances in knowledge: ours results and similar literature results show that keeping V5, V10 , V20 below 50%, 20% and 7% respectively the risk of significant lung toxicity is acceptable. Our experience also shows that BED10 > 100 Gy, necessary for high local control rate, can be reached while complying with the doses constraints for most patients.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150228
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    ABSTRACT: The purpose of the study was to evaluate the spectrum and incidence of intrahepatic portal vein variations on triphasic abdomen Multidetector computed tomography (MDCT)and to discuss the surgical and radiological implications. A retrospective review of 1000 triphasic MDCT abdomen scans was performed in patients sent for various liver and other abdominal pathologies between January 2014 and August 2014. A total of 967 patients (N=967) were included in the study. The variations in branching pattern of portal vein were classified according to classification used by Covey et al. and Koçet al. Normal anatomy (Type I) was seen in 773 patients (79.94%) out of 967 patients in our study. Trifurcation (Type II) anomaly was seen in 66 (6.83%) of cases. Right posterior vein as first branch of main portal vein (Type III) anomaly was seen in 48 (4.96%) of cases. Type IV anomaly and Type V anomaly was seen in 26 (2.69%) and 13 (1.34%) cases respectively. 19 cases showed other types of variations. Variations in the hepatic portal vein branching patterns are commonly seen similar to variations in hepatic artery and biliary anatomy. Knowledge of these variations is extremely important for transplant surgeons and intervention radiologists. Advances in knowledge: Awareness of the variations in portal vein branching patterns is essential for intervention radiologists and vascular surgeons and avoids major catastrophic events.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150326
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    ABSTRACT: To investigate if there was parity between treatment fields localised by radiographers and clinicians, by comparing geographical variations and hence determining the feasibility of a radiographer led service. 23 patients with metastatic spinal cord compression (MSCC) were prospectively sampled. 4 radiographers not involved in the original planning performed a localisation on each patient. The 92 localisations were compared to the clinicians approved field. Agreement was defined as ≤0.5cm between field length, width and 3 isocentre coordinates. To be feasible agreement was required in a minimum of 97% of the cases. The potential time saved with a radiographer led approach was also recorded. Agreement between clinicians and radiographers was 97.8%. For all field parameters, the average differences were <0.3cm and was significantly different from the 0.5cm median (p<0.0001) that would establish no agreement using wilcoxon signed rank test. The average (range) delay waiting for clinician approval was 54 minutes (4 minutes to 141 minutes). Strong agreement between radiographers and clinicians localisation was established. It was also highlighted that time could be saved in the patient's pathway by removing the need to wait for clinician approval. We believe this supports a radiographer led service. Advances in Knowledge: This article is novel as it is the first known comparison between clinicians and radiographers in the localisation of MSCC radiotherapy. This data shows the feasibility of introducing radiographer led practice and a methodology that could be potentially transferred to investigate the localisation parity for other treatment sites.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150586
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    ABSTRACT: Magnetic resonance imaging (MRI) has an important role for radiotherapy (RT) treatment planning in prostate cancer (PCa) providing accurate: visualization of the dominant intraprostatic tumor lesion (DIL) and loco-regional anatomy, assessment of local staging and depiction of implanted devices. MRI enables the radiation oncologist to optimize RT planning by better defining target tumor volumes (thereby increasing local tumour control), as well as, decreasing morbidity (by minimizing the dose to adjacent normal structures). Using MRI, radiation oncologists can define the DIL for delivery of boost doses of RT using a variety of techniques including: Stereotactic Body Radiotherapy (SBRT), Intensity Modulated Radiotherapy (IMRT), proton RT or brachytherapy to improve tumor control. Radiologists require a familiarity with the different RT methods used to treat PCa, as well as, an understanding of the advantages and disadvantages of the various MR pulse sequences available for RT planning in order to provide an optimal multi-disciplinary RT treatment approach to PCa. Understanding the expected post-RT appearance of the prostate and typical characteristics of local tumor recurrence is also important because MRI is rapidly becoming an integral component for diagnosis, image-guided histological sampling and treatment planning in the setting of biochemical failure after RT or surgery.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150507
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    ABSTRACT: The aim of this study was to develop a low dose protocol suitable for CBCT examination of an impacted maxillary canine in children by using a combination of dosimetry with subjective and objective image quality assessment. Radiation dose and image quality measurements were made using a dental cone beam CT machine. An image quality phantom was used to investigate the relationship between objective image quality and dose-area product (DAP) for a broad range of exposure settings. Subjective image quality assessment was achieved using a paediatric skull phantom submerged in a water bath for the same range of exposure settings. Eight clinicians assessed each CBCT dataset for nine aspects of image quality using a five-point rating scale of agreement. Acceptable image quality, defined using subjective judgements by the clinicians of the skull phantom images, was achievable with DAP values of 127 mGy.cm(2) or greater and a polytetrafluoroethylene (PTFE) contrast-to-noise ratio (CNR) of 4.8 or greater. A cautious choice was made to recommend a low dose protocol of 80kV and 3mA for implementation into clinical practice, corresponding to a DAP value of 146 mGy.cm(2) and a PTFE CNR of 5.0. A low dose protocol for this particular CBCT machine was established which represents as much as a 50% reduction compared with manufacturer's recommendations. Advances in knowledge: To the authors' best knowledge, this is the first study that addresses dose optimisation in paediatric clinical protocols in dental cone beam CT. Furthermore, this study explores the relationship between radiation dose, objective and subjective image quality.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150559
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    ABSTRACT: To evaluate the feasibility of high frequency ultrasound and ultrasound elastography (USE) in discriminating benign from malignant skin lesions in a prospective cohort study, and to introduce the use of a "strain ratio" for evaluation of skin lesions. A commercial ultrasound system with a 14 MHz transducer was used to visualize skin lesions requiring biopsy on clinical evaluation. Anatomic ultrasound and USE imaging of the skin lesions was performed using 2-4 mm gel standoff pads. A region of interest was manually selected over the area of each lesion with the lowest strain. The concept of a "strain ratio" of the compressibility of the normal skin at the corresponding layer to that of the least compressible region of a lesion in question was created and applied. This ratio was subsequently correlated with blind histopathological evaluation for malignancy. Fifty-five patients were included in the study with a total of 67 lesions evaluated. Twenty-nine lesions were malignant and 38 benign. All malignant lesions had strain ratios ≥3.9. All benign lesions had strain ratios ≤3.0. A diagnostic value between 3.0 and 3.9 would result in 100% sensitivity and specificity in the characterization of these lesions as malignant. This pilot study demonstrated that USE plus strain ratio appears to be a promising modality in providing diagnostic determination between cancerous and benign primary solitary skin lesions prior to biopsy. Advances in Knowledge: This is the first reported study applying an original mathematical elastographic ratio, or strain ratio, to evaluate primary solitary skin lesions.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150344
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    ABSTRACT: Evaluate breath hold stability and constancy for a voluntary breath hold (VBH) technique in a retrospective analysis. Movie loop sequences of electronic portal image data from multiple breath holds in a cohort of 19 patients were used to assess within and between breath hold stability. In-vivo dosimetry data based on electronic portal imaging (EPI) were analysed for 31 VBH patients plus a cohort of free-breathing (FB) patients to provide a reference. A phantom experiment simulated the impact on dose of free breathing, breath hold and unplanned release of breath hold. 165/174 (93%) movie loop datasets had no detectable displacement. For the remaining 12, median displacement = 1.5 mm, and maximum = 3mm (one patient on one fraction). In-vivo dosimetry data analysis showed a median dose difference measured to planned of -0.2% (VBH) and -0.1% (FB). Dose distribution evaluation (γ) pass rates were 84% (VBH) and 91% (FB) including the lung region; 93% and 96% with a lung override. Unplanned release of phantom breath hold position changed median dose by ≤1% and degraded γ pass rates to 79% - 62%. Failing regions were mostly in the periphery of the treated volume. The data confirmed that multiple voluntary breath holds using visual monitoring are stable; in-vivo dose verification via EPI was within expected and acceptable levels Advances in knowledge: These data provide further reassurance that voluntary breath hold is a safe technique for cardiac sparing breast radiotherapy and support its rapid, widespread implementation.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150309
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    ABSTRACT: Multiparametric MR imaging (mp-MRI) of the prostate is increasingly being used for local staging and detection for recurrence of prostate cancer (PCA). In patients with elevated PSA, mp-MRI could provide information on the position of the cancer, allowing adjustments to be made to the needle depth and direction before repeat transrectal ultrasound (TRUS)-guided biopsy to ensure accurate sampling of lesions. The purpose of the prospective study was to evaluate mp-MRI of the prostate in patients with PSA-elevation before initial TRUS-guided biopsy. Mp-MRI was performed in 94 patients using a 1.5-T scanner and 16-channel phased-array body coil. T2WI, DWI, DCE MRI and MR spectroscopy were obtained. TRUS-guided random biopsies and additional targeted biopsies of suspicious MRI areas were performed. Additional targeted biopsies were obtained in 17/43 (40%) patients with PCA. 11/17 targeted biopsies contained PCA. 5/11 PCA were diagnosed only by additional targeted biopsies. Sensitivity of mp-MRI in patients was 97.7%, specificity 11.8%. Mp-MRI was false negative in one patient. Sensitivity of mp-MRI in 207 lesions was 80.9%, specificity 44.7%. In a logistic regression model, the ADC-value was the only significant parameter to differentiate malignant and benign lesions. Mp-MRI should be performed in patients with PSA-elevation before initial TRUS-guided biopsy to allow additional targeted biopsies from suspicious areas of MRI. We recommend mp-MRI with T2WI, DWI, DCE MRI and MR spectroscopy. DWI as the most reliable technique should be used in every mp-MRI. Advances in knowledge: DWI is the most reliable technique in Mp-MRI of the prostate.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150422
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    ABSTRACT: To investigate the feasibility of using glass beads as novel thermoluminescence dosimeters (TLD) for radiotherapy treatment plan verification. Commercially available glass beads with a size of 1 mm thickness and 2 mm diameter were characterized as TLDs. Five clinical treatment plans including a conventional larynx, a conformal prostate, an IMRT prostate plan and two stereotactic body radiation therapy (SBRT) lung plans were transferred onto a CT-scan of a water-equivalent phantom (Solid Water®) and the dose distribution recalculated. The number of MUs was maintained from the clinical plan and delivered accordingly. The doses determined by the glass beads were compared to those measured by a graphite walled ionisation chamber and the respective expected doses determined by the treatment-planning system (TPS) calculation. The mean percentage difference between measured dose with the glass beads and TPS was found to be 0.3%, -0.1%, 0.4%, 1.8% and 1.7% for the conventional larynx, conformal prostate, IMRT prostate and each of the SBRT delivery techniques respectively. The percentage difference between measured dose with the ionisation chamber and glass bead was found to be -1.2%, -1.4%, -0.1%, -0.9% and 2.4% for the above mentioned plans respectively. The results of measured doses with the glass beads and ionisation chamber in comparison with TPS expected doses were analysed using a two-sided paired t-test and there was no significant difference at p < 0.05. It is feasible to use glass bead TLDs as dosimeters in a range of clinical plan verifications. Advances in knowledge: Commercial glass beads utilised as low-cost novel TLDs for treatment-plan verification.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20140804
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    ABSTRACT: In vivo cell tracking has emerged as a much sought after tool for the design and monitoring of cell-based treatment strategies. Various techniques are available for pre-clinical animal studies, from which much has been learned and still can be learned. However, there is also a need for clinically translatable techniques. Central to in vivo cell imaging is labeling of cells with agents that can give rise to signals in vivo, that can be detected and measured non-invasively. The current imaging technology of choice for clinical translation is magnetic resonance imaging in combination with labeling of cells with magnetic agents. The main challenge encountered during the cell labeling procedure is to efficiently incorporate the label into the cell, such that the labeled cells can be imaged at high sensitivity for prolonged periods of time, without the labeling process affecting the functionality of the cells. In this respect nanoparticles offer attractive features since their structure and chemical properties can be modified to facilitate cellular incorporation and because they can carry a high payload of the relevant label into cells. While these technologies have already been applied in clinical trials and have increased the understanding of cell-based therapy mechanism, many challenges are still faced.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150375
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    ABSTRACT: The outcome of postsurgical recurrences of cervical cancer may be improved through radiation dose escalation, which hinges on accurate identification and treatment of the target. The present study quantifies target motion during course of image guided radiotherapy (IGRT) for vault cancers. All patients underwent planning CT-simulation after bladder filling protocol. A daily pre-treatment megavoltage CT was performed. All translations and rotations were recorded. Postregistration displacement of gross tumour volume (GTV) and centre of mass (COM) of GTV was independently recorded by two observers for fraction 1-7. Day 1 image sets served as reference images against which the displacements of COM were measured. We calculated the displacements of common volume (CV) and encompassing volume (EV) of GTV for both the observers. A total of 90 image datasets of 15 patients were available for evaluation. Individual patient GTV and average GTV by both the observers were comparable. The average shifts for EV were 2.4mm (SD ±1.2) in the medio-lateral, 4.2mm (SD ±2.8) in the antero-posterior and 4.0mm (SD ±2.1) in supero-inferior direction. Similarly the average shifts for CV were 1.9mm (SD ±0.6) in the medio-lateral, 3.7mm (SD ±2.7) in the antero-posterior and 4.4mm (SD ±2.7) in supero-inferior direction. Using Stroom's/ Van Herk's formula the minimum recommended margins would be 4.5/5.2 mm, 8.2/9.4 mm and 7.3/8.3 mm respectively for lateral, antero-posterior and supero-inferior directions. Differential directional internal margin is recommended in patients undergoing IGRT for postsurgical recurrence of cervical cancers. Advances in Knowledge: Internal organ motion of vault cancers can be accounted by a directional margin to the gross tumour.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20140783
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    ABSTRACT: Radiotherapy has a universal and predictable mode of action, i.e. a physical mode of action consisting in the deposit of a dose of energy in tissues. Tumor cell damage is proportional to the energy dose. However, the main limitation of radiotherapy is the lack of spatial control of the deposition of energy, i.e. it penetrates the healthy tissues, damages them and renders unfeasible the delivery of an efficient energy dose when tumors are close to important anatomical structures. True nano-sized radiation enhancers may represent a disruptive approach to broaden the therapeutic window of radiation therapy. They offer the possibility of entering tumor cells and depositing high amounts of energy in the tumor only when exposed to ionizing radiations (on/off activity). They may unlock the potential of radiation therapy by rendering feasible the introduction of a greater energy dose, exactly within the tumor structure without passing through surrounding tissues. Several nano-sized radiation enhancers have been studied in in vitro and in vivo models with positive results. One agent has received the authorization to conduct clinical trials for human use. Opportunities to improve outcomes for patients receiving radiotherapy, to create new standards of care and to offer solutions to new patients' populations are looked over here.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150171
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    ABSTRACT: Cone beam CT (CBCT) enables soft tissue registration to planning CT for position verification in radiotherapy. Study aims were to determine the inter-observer error in prostate position verification using a standard CBCT protocol, and the effect of reducing CBCT scan length or increasing exposure, compared to standard imaging protocol. CBCT images were acquired using a novel 7cm length image with standard exposure (1644mAs) at fraction one (7), standard 12 cm length image (1644mAs) at fraction two (12) and a 7cm length image with higher exposure (2632mAs) at fraction three (7H) on 31 patients receiving radiotherapy for prostate cancer. Eight observers (2 clinicians and 6 radiographers) registered the images. Guidelines and training were provided. The means of the inter-observer errors were compared using a Kruzkal Wallis test. Levene' s test was used to test for differences in the variances of the inter-observer errors (IOE) and the independent prostate position (IPP). No significant difference was found between the inter-observer errors of each image protocol in any direction. Mean absolute inter-observer error was greatest in the anterior-posterior direction. SD of the inter-observer error was least in the left-right direction for each of the three image protocols. The SD of the inter-observer error was significantly less than the independent prostate motion in the AP direction only (1.8mm and 3.0mm respectively: p=0.017). Inter-observer errors were within 1SD of the independent prostate motion in 95%, 77%, and 96% of the images in the RL, SI and AP direction. Reducing CBCT scan length and increasing exposure did not have a significant effect on inter-observer errors. To reduce imaging dose, a reduction in CBCT scan length could be considered without increasing the uncertainty in prostate registration. Precision of CBCT verification of prostate radiotherapy is affected by inter-observer error and should be quantified prior to implementation. Advances in knowledge: This study shows the importance of quantifying the magnitude of inter-observer errors prior to CBCT implementation.
    The British journal of radiology 08/2015; DOI:10.1259/bjr.20150208