Impact of random and scattered coincidences from outside of field of view on positron emission tomography/computed tomography imaging with different reconstruction protocols

Image quality in positron emission tomography(PET)is affected by random and scattered coincidences and reconstruction protocols.In this study,we investigated the effects of scattered and random coincidences from outside the field of view(FOV)on PET image quality for different reconstruction protocols.Imaging was performed on the Discovery 690 PET/CT scanner,using experimental configurations including the NEMA phantom(a body phantom,with six spheres of different sizes)with a signal background ratio of 4:1.The NEMA phantom(phantom I)was scanned separately in a one-bed position.To simulate the effect of random and scatter coincidences from outside the FOV,six cylindrical phantoms with various diameters were added to the NEMA phantom(phantom II).The 18 emission datasets with mean intervals of 15 min were acquired(3 min/scan).The emission data were reconstructed using different techniques.The image quality parameters were evaluated by both phantoms.Variations in the signal-to-noise ratio(SNR)in a 28-mm(10-mm)sphere of phantom II were 37.9%(86.5%)for ordered-subset expectation maximization(OSEM-only),36.8%(81.5%)for point spread function(PSF),32.7%(80.7%)for time of flight(TOF),and 31.5%(77.8%)for OSEM+PSF+TOF,respectively,indicating that OSEM+PSF+TOF reconstruction had the lowest noise levels and lowest coefficient of variation(COV)values.Random and scatter coincidences from outside the FOV induced lower SNR,lower contrast,and higher COV values,indicating image deterioration and significantly impacting smaller sphere sizes.Amongst reconstruction protocols,OSEM+PSF+TOF and OSEM+PSF showed higher contrast values for sphere sizes of 22,28,and 37 mm and higher contrast recovery coefficient values for smaller sphere sizes of 10 and 13 mm.

Impacted Lower Third Molar Fused with a Supernumerary Tooth—Diagnosis and Treatment Planning Using Cone-Beam Computed Tomography

This paper reported a case of fusion between an impacted third molar and a supernumerary tooth, in which a surgical intervention was carried out, with the objective of removing the dental elements. The panoramic radiography was complemented by the Donovan＇s radiographic technique; but because of the proximity of the dental element to the mandibular ramus, it was not possible to have a final fusion diagnosis. Hence, the Cone-Beam Computed Tomography--which provides precise three- dimensional information--was used to determinate the fusion diagnosis and also to help in the surgical planning. In this case report we observed that the periapical, occlusal and panoramic were not able to show details which could only be examined through the cone-beam computed tomo- graphy.

A Pilot Survey of Odontomas for Size Constancy Using Cone-Beam Computed Tomography: Effect of Age, Sex, Lesion Location, and Histological Type: A Case Series

Objectives: Odontoma is the most common type of odontogenic tumors. Many studies have analyzed the statistical associations between odontoma location and patient age and sex, according to the histological tumor type. However, few studies have assessed odontoma morphological characteristics using cone-beam computed tomography (CBCT). We aimed to evaluate the association between odontoma location and size. Methods: We performed CBCT on patients with odontomas (19 patients;10 women, 9 men;average age, 12.6 [range, 6 - 34] years) according to the pathology type at a university hospital between April 2008 and February 2017. The locations of the lesions were noted, and their sizes were measured on CBCT images. Buccolingual, mesiodistal, and vertical diameters of the lesions were recorded on the same slice with the greatest diameters on axial, coronal, and sagittal CBCT images. Results: Altogether, 9 (47.4%) and 10 (52.6%) odontomas were located in the mandible and maxilla, respectively. There was no significant difference in the mesiodistal and vertical diameters on the CBCT image between the mandibular and maxillary groups when the odontoma size was compared with location (p < 0.05). However, the average diameters in only the buccolingual diameter were significantly greater in the maxilla. There were no significant differences between the two groups according to sex, age, or histological type. Conclusions: These data suggest that the sizes of odontomas in the maxilla are affected by bone expansion in the buccolingual direction, but they may be invariable in most settings. Three-dimensional assessment across the age groups suggests a lack of variation in size.

Advanced 4-dimensional cone-beam computed tomography reconstruction by combining motion estimation, motioncompensated reconstruction, biomechanical modeling and deep learning

4-Dimensional cone-beam computed tomography(4D-CBCT)offers several key advantages over conventional 3DCBCT in moving target localization/delineation,structure de-blurring,target motion tracking,treatment dose accumulation and adaptive radiation therapy.However,the use of the 4D-CBCT in current radiation therapy practices has been limited,mostly due to its sub-optimal image quality from limited angular sampling of conebeam projections.In this study,we summarized the recent developments of 4D-CBCT reconstruction techniques for image quality improvement,and introduced our developments of a new 4D-CBCT reconstruction technique which features simultaneous motion estimation and image reconstruction(SMEIR).Based on the original SMEIR scheme,biomechanical modeling-guided SMEIR(SMEIR-Bio)was introduced to further improve the reconstruction accuracy of fine details in lung 4D-CBCTs.To improve the efficiency of reconstruction,we recently developed a U-net-based deformation-vector-field(DVF)optimization technique to leverage a population-based deep learning scheme to improve the accuracy of intra-lung DVFs(SMEIR-Unet),without explicit biomechanical modeling.Details of each of the SMEIR,SMEIR-Bio and SMEIR-Unet techniques were included in this study,along with the corresponding results comparing the reconstruction accuracy in terms of CBCT images and the DVFs.We also discussed the application prospects of the SMEIR-type techniques in image-guided radiation therapy and adaptive radiation therapy,and presented potential schemes on future developments to achieve faster and more accurate 4D-CBCT imaging.

Evaluation of response to gemcitabine plus cisplatin-based chemotherapy using positron emission computed tomography for metastatic bladder cancer

BACKGROUND The purpose of the present study was to examine retrospectively the contribution of 18Fluorodeoxyglucose positron emission tomography computed tomography(18FDG-PET/CT)to the evaluation of response to first-line gemcitabine plus cispla-tin-based chemotherapy in patients with metastatic bladder cancer.AIM To evaluate the response to Gemcitabine plus Cisplatin-based chemotherapy using 18FDG-PET/CT imaging in patients with metastatic bladder cancer.METHODS Between July 2007 and April 2019,79 patients underwent 18FDG-PET/CT imaging with the diagnosis of Metastatic Bladder Carcinoma(M-BCa).A total of 42 pa-tients(38 male,4 female)were included in the study,and all had been admi-nistered Gemcitabine plus Cisplatin-based chemotherapy.After completion of the therapy,the patients underwent a repeat 18FDG-PET/CT scan and the results were compared with the PET/CT findings before chemotherapy according to European Organisation for the Research and treatment of cancer criteria.Mean age was 66.1 years and standard deviation was 10.7 years(range:41–84 years).RESULTS Of the patients,seven(16.6%)were in complete remission,17(40.5%)were in partial remission,six(14.3%)had a stable disease,and 12(28.6%)had a pro-gressive disease.The overall response rate was 57.1 percent.CONCLUSION 18FDG-PET/CT can be considered as a successful imaging tool in evaluating response to first-line chemotherapy for metastatic bladder cancer.Anatomical and functional data obtained from PET/CT scans may be useful in the planning of secondline and thirdline chemotherapy.

Radiation Dose Survey of Pediatric Chest Computed Tomography Examinations: A Local Diagnostic Reference Levels Approach to Patient Safety

Objectives: The aim of this work was to initially establish both age and weight driven pediatric diagnostic reference levels (DRLs) for chest computed tomography (CT) examinations performed at tertiary care medical institution. Another aim was to compare the presented data with internationally published ones. This initial data shall serve as basis for establishing a national DRLs values for pediatric diagnostic CT examinations. Methods: Dosimetric indexes were collected for the chest examination for 93 patients during the past 2 years in a tertiary care medical city. Results: The results are within and below the international reported levels for chest CT in several countries. Conclusion: Continuous monitoring of the radiation doses received by the patients in computed tomography is continuous and ongoing process in order to ensure compliance and to optimize clinical imaging protocols. More extensive data acquisition and analysis are required to allow better understanding of the contributing factors leading to less patient radiation dose while preserving the clinical image quality. .

Short-term outcomes of radiofrequency ablation for hepatocellular carcinoma using cone-beam computed tomography for planning and image guidance

BACKGROUND Percutaneous radiofrequency ablation(RFA)is an effective treatment for unresectable hepatocellular carcinoma(HCC)and a minimally invasive alternative to hepatectomy for treating tumour recurrence.RFA is often performed using contrast-enhanced computed tomography(CECT)and/or ultrasonography.In recent years,angiographic systems with flat panel image detectors and advanced image reconstruction algorithms have broadened the clinical applications of cone-beam computed tomography(CBCT),including RFA.Several studies have shown the effectiveness of using CBCT for immediate treatment assessments and follow-ups.AIM To assess the treatment response to RFA for HCC using CBCT.METHODS Forty-eight patients(44 men;aged 37-89 years)with solitary HCC[median size:3.2(1.2-6.6)cm]underwent RFA and were followed for 25.6(median;13.5-35.2)mo.Image fusion of CBCT and pre-operative CECT or magnetic resonance imaging(MRI)was used for tumour segmentation and needle path and ablation zone planning.Real-time image guidance was provided by overlaying the threedimensional image of the tumour and needle path on the fluoroscopy image.Treatment response was categorized as complete response(CR),partial response(PR),stable disease(SD),or progressive disease(PD).Disease progression,death,time to progression(TTP),and overall survival(OS)were recorded.Kaplan-Meier and Cox regression analyses were performed.RESULTS Initial post-RFA CECT/MRI showed 38 cases of CR(79.2%),10 of PR(20.8%),0 of SD,and 0 of PD,which strongly correlated with the planning estimation(42 CR,87.5%;6 PR,12.5%;0 SD;and 0 PD;accuracy:91.7%,P<0.01).Ten(20.8%)patients died,and disease progression occurred in 31(35.4%,median TTP:12.8 mo)patients,resulting in 12-,24-,and 35-mo OS rates of 100%,81.2%,and 72.2%,respectively,and progression-free survival(PFS)rates of 54.2%,37.1%,and 37.1%,respectively.The median dose-area product of the procedures was 79.05 Gy*cm2(range 40.95-146.24 Gy*cm2),and the median effective dose was 10.27 mSv(range 5.32-19.01 mSv).Tumour size<2 cm(P=0.008)was a significant factor for OS,while age(P=0.001),tumour size<2 cm(P<0.001),tumour stage(P=0.010),and initial treatment response(P=0.003)were significant factors for PFS.CONCLUSION Reliable RFA treatment planning and satisfactory outcomes can be achieved with CBCT.

Performance evaluation of the simpli¯ed spherical harmonics approximation for cone-beam X-ray luminescence computed tomography imaging

As an emerging molecular imaging modality,cone-beam X-ray luminescence computed tomog-raphy(CB-XLCT)uses X-ray-excitable probes to produce near-infrared(NIR)luminescence and then reconst ructs three-dimensional(3D)distribution of the probes from surface measurements.A proper photon-transportation model is critical to accuracy of XLCT.Here,we presented a systematic comparison between the common-used Monte Carlo model and simplified spherical harmonics(SPN).The performance of the two methods was evaluated over several main spec-trums using a known XLCT material.We designed both a global measurement based on the cosine similarity and a locally-averaged relative error,to quantitatively assess these methods.The results show that the SP_(3) could reach a good balance between the modeling accuracy and computational efficiency for all of the tested emission spectrums.Besides,the SP_(1)(which is equivalent to the difusion equation(DE))can be a reasonable alternative model for emission wavelength over 692nm.In vivo experiment further demonstrates the reconstruction perfor-mance of the SP:and DE.This study would provide a valuable guidance for modeling the photon-transportation in CB-XLCT.

Experiences and benefits of positron emitted tomography-computed tomography (PET-CT) combined with video-assisted thoracoscopic surgery (VATS) in the diagnosis of Stage 1 sarcoidosis

Background: The purpose of this study was to describe our experiences and analyze the benefits of video-assisted thoracoscopic surgery (VATS) combined with positron emitted tomography (PET)-computed tomography (CT) in the diagnosis of patients with early (Stage 1) sarcoidosis. Methods: From 1995 to 2006, seven patients (two males, five females), with ages ranging from 26 to 58 years, were impressed with Stage 1 sarcoidosis (mediastinal or hilar lymph nodes involvements without lung in- volvement) by histological examination of intrathoracic lymph nodes (LNs) and/or lung parenchyma taken from VATS biopsy. Three of them received PET or PET-CT evaluation. VATS was approached from the right and left side in one and six patients, respectively, according to the locations of their lesions. Results: All the VATS biopsied LNs or lung specimens were adequate for establishing diagnosis. Mediastinal LNs were taken from Groups 3, 4 in four, Group 7 in two, and Groups 5, 6 in one of them. Hilar LNs biopsies were performed in four cases. Lung biopsy was performed in all but two cases. All of them were expressed pathologically or radiologically as Stage 1 sarcoidosis. PET-CT revealed high emission signals over these affected LNs. These patients received oral steroid treatment or follow up only. All of them were followed up from 5 months to 11 years with satis- factory results. Conclusion: VATS biopsy is a minimally invasive, safe and effective procedure. It can be used as a diagnostic alternative of transbronchial lung biopsy (TBLB), and can harvest larger and more areas of specimens than mediastinoscopy for staging patients with sarcoidosis. PET-CT can provide us more accurate information about the characteristics and localization of these lesions before biopsy. VATS combined with PET-CT can provide more accurate and earlier diagnosis of patients with unknown intrathoracic lesions, including the sarcoidosis.

Characterization of microstructure evolution of cement paste by micro computed tomography

Micro computed tomography (Micro-CT) was applied to obtain three-dimensional images of the microstructure of cement paste (water-to-cement mass ratio of 0.5) at different ages. By using the Amira software, component phases of the cement paste such as pores, hydration products, and unhydrated clinker particles were segmented from each other based on their 3D image grey levels; their relative contents were also calculated with the software, and the data are 61.2%, 0% and 38.8% at the beginning of hydration and 11.8%, 78.5% and 9.7% at 28 d age, respectively. The hydration degree of cement paste at different ages was compared with the experimental data acquired by loss on ignition (LOI) tests. The results show that the calculated and measured data reasonably agree with each other, which indicates that micro-CT is a useful and reliable approach to characterize the micro structure evolution of hydrating cement paste.

Clinical Endodontic Applications of Cone Beam-Computed Tomography in Modern Dental Practice

Nearly two decades since Cone Beam-Computed Tomography (CBCT) was introduced in dentistry, this technology has been proven to be a useful asset in modern dental practice. The information gleaned from a CBCT scan influences treatment decisions and prognostication of challenging endodontic cases. The authors present six cases that utilized CBCT to diagnose vertical root fracture, to assess resorption, to guide the clinician in overcoming anatomical complexities, to hurdle diagnostic dilemmas and to perform pre-surgical evaluation. Initially, a thorough clinical assessment was performed;however, conventional periapical radiographs were not able to provide sufficient information to arrive at a definite diagnosis or a thorough treatment plan. CBCT was therefore deemed helpful for these cases. Clearly, there are advantages to using CBCT. With a better understanding of each case, the clinician can plan a definitive treatment plan and offer a clearer case prognosis to their patient.

Relation between Epicardial Adipose Tissue Thickness Assessed by Multidetector Computed Tomography and Significance of Coronary Artery Disease

Objective: To evaluate the relation between epicardial adipose tissue (EAT) thickness and also pericoronary fat assessed by Multidetector Computed Tomography (MDCT) with both calcium score and significance of coronary artery disease. Background: Epicardial adipose tissue (the visceral fat of the heart present under the visceral layer of the pericardium) has the same origin of abdominal visceral fat, which is known to be strongly related to the development of coronary artery atherosclerosis. Multidetector CT (MDCT) provides an accurate and reproducible quantification of EAT due to its high spatial and temporal resolution. Patients and Methods: The current study included 70 patients with low-intermediate probability of coronary artery disease. All patients were subjected to 256 Multidetectors CT to assess EAT thickness, the mean thickness of the pericoronary fat surrounding the three coronary arteries and coronary calcium score. Also coronary CT angiography was done and patients were then divided into 3 groups according to significance of coronary atherosclerosis: Group 1: No atherosclerosis (20 patients), Group 2: Non obstructive atherosclerosis (luminal narrowing less than 50% in diameter) (25 patients), Group3: Obstructive atherosclerosis (luminal narrowing ≥ 50%) (25 patients). Results: The mean EAT thickness and the mean pericoronary fat thickness were significantly higher in patients with obstructive coronary artery disease (CAD) with stenosis > 50% (group 3) compared to other groups with normal coronaries or non obstructive (CAD). ROC curve was used to define the best cut off value of the thickness of both EAT and pericoronary fat in predicting the obstructive CAD group which was ≥7.2 and 12.6 mm for epicardial and pericoronary fat respectively. Also there is a positive correlation between both epicardial adipose tissue and pericoronary fat thickness and the coronary calcium score. Conclusion: EAT thickness and pericoronary fat thickness can be used in predicting the significance of coronary artery disease.

Acute coronary syndrome on non-electrocardiogram-gated contrastenhanced computed tomography

It is not rare for acute coronary syndrome(ACS)patients to present with symptoms that are atypical,rather than chest pain.It is sometimes difficult to achieve a definitive diagnosis of ACS for such patients who present with atypical symptoms,normal initial biomarkers of myocardial necrosis,and normal or nondiagnostic electrocardiograms(ECGs).Although cardiac CT allows for assessments of coronary artery stenosis as well as myocardial perfusion defect in patients with suspected ACS,it requires ECG gating and is usually performed with high-performance multislice CT for highly probable ACS patients.However,several recent reports have stated that ACS is detectable by myocardial perfusion defects even on routine non-ECG-gated contrast-enhanced CT.A growing number of contrast-enhanced CT scans are now being performed in emergency departments in search of pathologies responsible for a patient’s presenting symptoms.In order to avoid inappropriate management for this life-threatening event,clinicians should be aware that myocardial perfusion defect is more commonly detectable even on routine non-ECG-gated contrast-enhanced CT performed in search of other pathologies.

Comparison of computed tomography and magnetic resonance imaging for the detection of mandibular condylar osteochondroma

Objective The purpose of this study was to compare computed tomography(CT) and magnetic resonance imaging(MRI) for the detection of mandibular condylar osteochondroma.Methods Preoperative CT and MRI of 33 patients with unilateral condylar osteochondroma were reviewed. The morphology, location, continuity with the parent bone, cartilage cap, perichondrium of tumors, and changes in soft and hard tissues adjacent to the lesions were investigated by two reviewers. Data were analyzed using Mc Nemar test. A P value < 0.05 was considered significant.Results Among the 33 condylar osteochondromas, 11 were of the diffuse type, 10 were of the sessile type, and 12 were of the pedunculated type. Continuity with the cortex and marrow of the host condyle was observed on both CT and MRI. Both modalities had identical detection rates of surface reconstruction of the temporal bone joint, condylar dislocation, and pseudarthrosis formation. However, MRI showed significantly higher detection rates of the cartilage cap and perichondrium than CT(P < 0.05). Furthermore, MRI showed ipsilateral and contralateral temporo-mandibular joint(TMJ) disc displacement in 4 cases and 6 cases, respectively, and ipsilateral and contralateral TMJ effusion in 20 cases and 14 cases, respectively.Conclusion CT can intuitively display the morphology and spatial location of condylar osteochondromas through three-dimensional reconstruction. MRI may be superior to CT in the detection of cartilage cap, perichondrium of the condylar osteochondroma, and changes in the TMJ and adjacent soft tissues.

Qualitative visual trichotomous assessment improves the value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in predicting the prognosis of diffuse large B-cell lymphoma

Introduction:Fluorine-18 fluorodeoxyglucose(18F-FDG)positron emission tomography/computed tomography(PET/CT)is a powerful tool for monitoring the response of diffuse large B-cell lymphoma(DLBCL)to therapy,but the criteria to interpret PET/CT results remain under debate.We investigated the value of post-treatment PET/CT in predicting the prognosis of DLBCL patients when interpreted according to qualitative visual trichotomous assessment(QVTA)criteria compared with the Deauvil e criteria.Methods:In this retrospective study,final PET/CT scans of DLBCL patients treated with rituximab-based regimens between October 2005 and November 2010 were interpreted using the Deauvil e and QVTA criteria.Survival curves were estimated using Kaplan-Meier analysis and compared using the log-rank test.Results:A total of 253 patients were enrol ed.The interpretation according to the Deauvil e criteria revealed that 181patients had negative PET/CT scan results and 72 had positive results.The 3 year overal survival(OS)rate was significantly higher in patients with negative scan results than in those with positive results(91.6%vs.57.5%,P<0.001).The72 patients with positive scan results according to the Deauville criteria were divided into two groups by the interpretation according to the QVTA criteria:29 had indeterminate results,and 43 had positive results.The 3 year OS rate was significantly higher in patients with indeterminate scan results than in those with positive results(91.2%vs.33.5%,P<0.001)but was similar between patients with negative and indeterminate scan results(91.6%vs.91.2%,P=0.921).Conclusions:Compared with the Deauvil e criteria,using the QVTA criteria for interpreting post-treatment PET/CT scans of DLBCL patients is likely to reduce the number of false positive results.The QVTA criteria are feasible for therapeutic outcome evaluation and can be used to guide risk-adapted therapy.

Hybrid reconstruction algorithm for computed tomography based on diagonal total variation

Inspired by total variation(TV), this paper represents a new iterative algorithm based on diagonal total variation(DTV) to address the computed tomography image reconstruction problem. To improve the quality of a reconstructed image, we used DTV to sparsely represent images when iterative convergence of the reconstructed algorithm with TV-constraint had no effect during the reconstruction process. To investigate our proposed algorithm, the numerical and experimental studies were performed, and rootmean-square error(RMSE) and structure similarity(SSIM)were used to evaluate the reconstructed image quality. The results demonstrated that the proposed method could effectively reduce noise, suppress artifacts, and reconstruct highquality image from incomplete projection data.

Assessment of Organ Dose by Direct and Indirect Measurements for a Wide Bore X-Ray Computed Tomography Unit That Used in Radiotherapy

The aim of this study was to investigate the organ doses of patients undergoing computed tomography (CT) examination using the wide bore General Electric (GE) “Light Speed RT” unit. The head, chest and pelvic regions of the Rando-phantom were scanned with 120 kV, 200 mA, and 2.5 mm slice thickness for helical and axial modes. Thermoluminescent Dosimeter (TLD) pairs were used for the dosimetry of 10 organs. TL-counts were converted to dose by using CTDIcenter dose on CT-phantom. For the calculation of the organ doses, the ImPACT software was utilized by entering CTDIair (100 mAs) in small and large field of view (26.43 and 21.17 mGy respectively). The in-field dose ranges in helical and axial modes were 64.3 - 38 mGy and 47.6 - 19.7 mGy in head, 48.3 - 14.1 mGy and 34.1 - 10 mGy in chest, 28.4 - 10.2 mGy and 21 - 8.5 mGy in pelvic, respectively. The organ doses from software and TLD were compared and tailored as the in-field and the out-field radiation. First results showed that the organ dose was relatively higher in the helical mode on both direct and indirect measurement. The in-field organ dose differences between TLD and software were seen. In helical and axial modes, the dose differences ranged from +1 to +13.3 and -8.3 to +9.6 mGy for head exam, +1.1 to +15.3 and +0.3 to +9.1 mGy for chest, and -21.7 to +1.9 and -15.5 to +1.8 mGy for pelvic. The availability of this program for organ dose calculations by measuring CTDIair value for CT device used in the radiotherapy would be considered valuable.

Usefulness of intra-procedural cone-beam computed tomography in modified balloon-occluded retrograde transvenous obliteration of gastric varices

AIM:To evaluate whether intra-procedural conebeam computed tomography(CBCT)performed during modified balloon-occluded retrograde transvenous obliteration(mB RTO)can accurately determine technical success of complete variceal obliteration.METHODS:From June 2012 to December 2014,15 patients who received CBCT during m BRTO for treatment of portal hypertensive gastric variceal bleeding were retrospectively evaluated.Three-dimensional(3D)CBCT images were performed and evaluated prior to the end of the procedure,and these were further analyzed and compared to the pre-procedure contrast-enhanced computed tomography to determine the technical success of m BRTO including:Complete occlusion/obliteration of:(1)gastrorenal shunt(GRS);(2)gastric varices;and(3)afferent feeding veins.Post-mB RTO contrast-enhanced CT was used to confirm the accuracy and diagnostic value of CBCT within 2-3 d.RESULTS:Intra-procedural 3D-CBCT images were 100% accurate in determining the technical success of m BRTO in all 15 cases.CBCT demonstrated complete occlusion/obliteration of GRS,gastric varices,collaterals and afferent feeding veins during m BRTO,which was confirmed with post-m BRTO CT.Two patients showed incomplete obliteration of gastric varices and feeding veins on CBCT,which therefore required additional gelfoam injections to complete the procedure.No patient required additional procedures or other interventions during their follow-up period(684 ± 279 d).CONCLUSION:CBCT during mB RTO appears to accurately and immediately determine the technical success of mB RTO.This may improve the technical and clinical success/outcome of m BRTO and reduce additional procedure time in the future.

Comparison of bone alignment and fiducial marker alignment for online cone-beam computed tomography-guided radiation therapy for prostate cancer

Objective The aim of the study was to evaluate the coverage of the prostate when prostatic implanted fiducial markers are used to verify setup of the patients in comparison to the pelvic bones while using conebeam computed tomography(CBCT). Methods Seventeen patients with prostate cancer were included. For each patient, daily online CBCT was done. CT planning was matched with CBCT with the help of fiducial markers(3–5 markers) and another matching with done the help of pelvic bony landmarks. Registration of clinical target volume(CTV) 1 including prostate plus seminal vesicles and CTV2 including prostate only was done and were used to confirm the target volume during the process of matching. Delineation of the rectum on every CBCT was done. Two automatic margin representing planning target volume(PTV) were created. PTV1 was generated by adding 1 cm in all directions(PTV1a) and 0.7 cm in the posterior direction(PTV1b). PTV2 was generated by adding 0.5 cm in all directions(PTV2a) and 0.3 cm in the posterior direction(PTV2b). PTV1a was prescribed to receive 46 Gy in conventional fractionation with a boost dose of 30 Gy to PTV1b. The same dose was prescribed to PTV2a and PTV2b. Calculation of the percentage of intersection between CTV1and CTV2 created on CBCT with the original CTV scan was done. A comparison between the two CTVs(CTV1and CTV2) mean dose and the original delineated CTV was done. Then a comparison to the mean dose of the original CTV of PTV1a, PTV2a(CTV1a and CTV2a), and for PTV1b and PTV2b(CTV1b and CTV2b). Calculation of the mean rectal dose and also V60, V70 and V74 was done on the delineated rectum on every CBCT, and then a comparison to the planned original rectal dose. Results The created CTV1and CTV2 intersection percentage with the original CTV1and CTV2 significantly increased by 85%(range, 65%–95%, P < 0.05), when fiducial markers were used. The main difference of the received mean dose was significantly less in comparison to pelvic bone alignment(0.03% to 2% vs 0.03% to 11.6% for PTV1a, P < 0.006;0.01% to 1.8% vs 0.03% to 10.2% for PTV2a, P < 0.014;0.08 to 2.11 vs 0.04 to 11.29 for PTV1b, P < 0.015 and 0.01 to 1.79 vs 0.01 to 9.69 for PTV2b, P < 0.004). With the use of less PTV margins, significant decrease of the rectal mean dose, V60, V70 and V74 by P < 0.004, P < 0.004, P < 0.0005 and P < 0.009, respectively. Reduction of the CTV1a and CTV1b mean dose by 1.13% and 0.28% in comparison to the initial CTV1a and CTV2a.Conclusion A significant improvement of prostatic cancer patients alignment when fiducial markers are used, with more homogenous dose distribution, and with significant decrease in PTV margins. The delivered rectal dose is significantly less allowing prostate dose escalation.

Alveolar Ridge Preservation Utilizing Composite (Bioceramics/Collagen) Graft: A Cone-Beam Computed Tomography Assessment in a Randomized Split-Mouth Controlled Trial

Background: The vast percentage of the alveolar bone resorption process happens within the first 12 to 24 weeks post extraction;however, this phenomenon is chronic, and the alveolar ridge continues to resorb. In order to prevent this reduction or at least recompense the loss of bone dimensions, the alveolar ridge preservation (ARP) technique was developed. Objectives: This research studied the vertical and horizontal bone dimensional changes as a result of non-molar teeth extraction alone against extraction with alveolar ridge preservation utilizing composite (bioceramics/collagen) graft by cone-beam computed tomography radiographies analyses. Material and Methods: This research was a randomized split-mouth controlled trial. 12 patients need extraction of the maxillary non-molar teeth were enrolled and allocated into 2 groups. 12 sockets after atraumatic extraction were filled with a composite graft in the role of the test group, 12 sockets left to unassisted healing after atraumatic extraction without any graft materials in the role of the control group. Two CBCT radiographs were taken at baseline and at 4 months after extraction for comparison. Both vertical and horizontal resorptions of the alveolar ridge were analyzed between test and control group by CBCT radiographs. Results: 4 months after extraction, there was a mean of vertical alveolar bone resorption compared with the baseline (0.56 ± 0.15 mm) in the test group and (1.47 ± 0.30 mm) in the control group. Whereas it was a mean of horizontal alveolar bone resorption compared with the baseline (0.90 ± 0.16 mm) in the test group and (2.26 ± 0.30 mm) in the control group. Therefore, there was a significant difference between the two groups. Conclusions: Within the limitations of this research, we demonstrated that the osteogen-plug technique significantly decreased the reduction of the bone dimensional in comparison to the tooth extraction alone, and showed that the dimensional change of the alveolar ridge after tooth extraction was minimized by using an osteogen-plug.