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Advances in Diagnostic and Therapeutic Radiology — 2nd Edition

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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Physics General".

Deadline for manuscript submissions: 20 May 2025 | Viewed by 9980

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Dr. Miguel Alcaraz

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1. Radiology and Physical Medicine Department, School of Medicine, University of Murcia, 30100 Murcia, Spain
2. Instituto Murciano de Investigación Biosanitaria “Virgen de la Arrixaca” (IMIB-Arrixaca), 30100 Murcia, Spain
Interests: ionizing radiation; radiation effects; radiobiology; radiation protection; radiology; radiotherapy; radioprotectors; radiosensitizers; nonionizing radiation
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Dear Colleagues,

This Special Issue focuses on the wide range of advances in the different clinical and technical aspects of medical imaging, both diagnostic and therapeutic nuclear medicine, radiation oncology, radiation protection, and the biological effects produced by ionizing radiation.

This broad spectrum of topics includes articles on all aspects of clinical and/or basic research that describe original observations, techniques, instruments, new technologies, and meta-analyses.

Dr. Miguel Alcaraz
Guest Editor

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Keywords

radiography
computed tomography
positron emission tomography
magnetic resonance imaging
ultrasonography
digital subtraction angiography
image-guided interventions
fluoroscopy
mammography
radiotherapy
nuclear medicine
radiation protection
radiation effects

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Published Papers (9 papers)

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Research

8 pages, 3708 KiB

Open AccessCommunication

Retrospective Dosimetric Comparison of HDR Interventional Radiotherapy (Brachytherapy) Versus Planning with VMAT and Electron Beam Therapy for Non-Melanoma Skin Cancer Treatment

by Elisa Placidi, Bruno Fionda, Enrico Rosa, Valentina Lancellotta, Antonio Napolitano, Martina De Angeli, Gabriele Ciasca, Francesco Pastore, Maria Antonietta Gambacorta, Luca Tagliaferri and Marco De Spirito

Appl. Sci. 2024, 14(22), 10669; https://doi.org/10.3390/app142210669 - 19 Nov 2024

Viewed by 471

Abstract

This study compares dosimetric outcomes of high-dose-rate (HDR) interventional radiotherapy (IRT) using Iridium-192, Volumetric Modulated Arc Therapy (VMAT), and electron beam therapy for non-melanoma skin cancer (NMSC). A retrospective analysis of 25 patients showed that IRT provided a significantly higher mean dose to the clinical target volume (CTV) compared to VMAT and electron beam therapy. IRT and VMAT had comparable V95%CTV coverage, whilst electron therapy was less feasible for large CTVs. IRT delivered higher surface doses while minimizing deep tissue exposure compared to partial arc VMAT. Our findings support IRT for personalized and effective NMSC treatment. Full article

(This article belongs to the Special Issue Advances in Diagnostic and Therapeutic Radiology — 2nd Edition)

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13 pages, 5341 KiB

Open AccessArticle

Effects of Different Fields of View and Rotation Angles on Radiation Doses to Highly Radiosensitive Organs in Children Using Dental Cone Beam Computed Tomography

by Misaki Ito, Ikuho Kojima, Masahiro Iikubo, Shu Onodera, Masahiro Sai, Masaki Fujisawa, Toshiki Kato, Masaaki Nakamura, Masayuki Zuguchi and Koichi Chida

Appl. Sci. 2024, 14(19), 9154; https://doi.org/10.3390/app14199154 - 9 Oct 2024

Viewed by 786

Abstract

Dental cone beam computed tomography (CBCT) is a diverse 3D X-ray imaging technique that has enabled clear visualization of the teeth and surrounding structures. The most common diagnostic purpose of dental CBCT examination in children is ectopic eruption and impacted teeth, and a small field of view (FOV) is often used. Since it is difficult for children to control their body movements, reducing the rotation angle is effective. However, no studies have examined the effects of different rotation angles on radiation doses to highly radiosensitive organs in children using small FOVs. The purpose of this study was to examine the effects of small FOVs (4 × 4 cm and 6 × 6 cm) and rotation angles (360° and 180°) on doses that highly sensitize organs in children using dental CBCT. The entrance surface doses to lenses, thyroid lobes, parotid glands, and sublingual glands of a pediatric whole-body phantom were measured. By reducing the FOV from 6 × 6 cm to 4 × 4 cm, the dose to the sublingual gland could be significantly decreased. Additionally, by reducing the rotation angle from 360° to 180°, the lens dose can be decreased significantly. As the rate of dose reduction varies among organs, it is important to consider the relative positions of different organs with respect to the FOV and the trajectory of the X-ray tube. Full article

(This article belongs to the Special Issue Advances in Diagnostic and Therapeutic Radiology — 2nd Edition)

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11 pages, 1010 KiB

Open AccessArticle

Three-Dimensional Bone Alignment from Cone-Beam Computed-Tomography Scans in Weight-Bearing and Clinical Outcomes Following the Modified Grice–Green Surgical Procedure for Adult Acquired Flatfoot

by Giulio Sacchetti, Claudio Belvedere, Maurizio Ortolani, Alberto Leardini, Luigi Piarulli, Marco Miceli, Daniela Platano and Lisa Berti

Appl. Sci. 2024, 14(18), 8521; https://doi.org/10.3390/app14188521 - 21 Sep 2024

Viewed by 865

Abstract

Severe adult-acquired flatfoot deformity is widely addressed surgically via the Grice–Green subtalar arthrodesis. Standard radiographic measurements have been reported, but these are limited to planar views. These complex deformities and the relevant corrections after surgery should be assessed in weight-bearing using 3D analyses now enabled by modern cone-beam CT scans. The present study is aimed at reporting these 3D radiographical foot bone alignments and the clinical results for this surgery. Ten patients were treated with the Grice–Green procedure. This implies inserting an autologous bone graft from the proximal tibial into the extra-articular sinus-tarsi to perform a subtalar arthrodesis. Before and after surgery, the patients were assessed based on the clinical range-of-motion and Foot-Function and Posture Indexes. Three-dimensional models of the tibia, calcaneus, talus, navicular, and 1st metatarsus were reconstructed from cone-beam CT scans in a single-leg up-right posture. Relevant longitudinal axes were defined to calculate ten spatial angles. Post-operatively, a significant realignment was observed for seven angles, including corrections lift-up of the talus (on average by 15°) and subtalar joint (13° in 3D), as well as the Meary’s angle (21°). Only few correlations were found between traditional clinical and novel 3D radiographical measurements, suggesting the former only limitedly represent the corresponding real skeletal status, and the latter thus offer the physician a more comprehensive evaluation. The present original analysis from modern cone-beam CT scans shows precisely the correction of foot and ankle bone alignments achieved using the Grice–Green surgical procedure, finally in 3D and in weight-bearing. For the first time, traditional clinical and score system evaluations are reported together with bone orientation and joint angles in the three anatomical planes. Full article

(This article belongs to the Special Issue Advances in Diagnostic and Therapeutic Radiology — 2nd Edition)

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15 pages, 6568 KiB

Open AccessArticle

Evaluation of Radiation Doses Received by Physicians during Permanent ¹⁹⁸Au Grain Implant Brachytherapy for Oral Cancer

by Yohei Inaba, Keiichi Jingu, Masaki Fujisawa, Kazuki Otomo, Hiroki Ishii, Toshiki Kato, Yuuki Murabayashi, Masatoshi Suzuki, Masayuki Zuguchi and Koichi Chida

Appl. Sci. 2024, 14(14), 6010; https://doi.org/10.3390/app14146010 - 10 Jul 2024

Cited by 3 | Viewed by 795

Abstract

Brachytherapy is a practical, effective procedure for the local treatment of cancer; it delivers a high radiation dose to a limited tissue volume while sparing the surrounding normal tissues. Although the clinical benefit of brachytherapy is clear, there have been very few studies on the radiation dose received by physicians during the procedure. Furthermore, no study has investigated the eye radiation dose received by physicians performing ¹⁹⁸Au grain (seed) brachytherapy, using an eye dosimeter. Recently, the International Commission on Radiological Protection (ICRP) recommended significantly reducing the occupational lens dose limit, from 150 to 20 mSv/yr (100 mSv/5 years). Therefore, it has become essential to evaluate the eye radiation doses of medical workers. We evaluated the eye radiation dose of a brachytherapy physician performing ¹⁹⁸Au permanent grain implantation for tongue cancer; this is the first study on this topic. The maximum eye dose was ~0.1 mSv/procedure, suggesting that it is unlikely to exceed the ICRP limit (20 mSv/yr) for the lens, unless many procedures are performed with inappropriate radiation protection. To reduce the dose of radiation received by ¹⁹⁸Au grain brachytherapy physicians, it is necessary to use additional lead shielding equipment when preparing the treatment needles, i.e., when loading the grains. This study provides useful information on radiation exposure of physicians conducting ¹⁹⁸Au permanent grain brachytherapy. Full article

(This article belongs to the Special Issue Advances in Diagnostic and Therapeutic Radiology — 2nd Edition)

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10 pages, 551 KiB

Open AccessArticle

Radiotherapy-Related Clinical and Functional Sequelae in Lung Cancer Survivors

by Alejandro Heredia-Ciuró, Paula Blasco-Valls, Andrés Calvache-Mateo, Geraldine Valenza-Peña, Laura López-López, Araceli Ortiz-Rubio and Marie Carmen Valenza

Appl. Sci. 2024, 14(13), 5874; https://doi.org/10.3390/app14135874 - 5 Jul 2024

Viewed by 659

Abstract

It is known that lung cancer survivors experience sequelae due to the evolution of the disease and oncological treatment. However, there is no consensus about their sequelae after radiotherapy treatment. The aim of this study was to analyze the clinical–functional profile of lung cancer survivors who receive radiotherapy treatment. This prospective observational study evaluated lung cancer patients who were candidates for radiotherapy treatment in the oncological radiotherapy unit of San Cecilio University Hospital in Granada. Symptoms (i.e., fatigue, cough, and dyspnea), functionality (i.e., physical activity levels and muscle mass), and quality of life were evaluated pre- and post-radiotherapy treatment. Sixty-five participants were included, and sixty-one completed both evaluations. Patients showed a significant increase in symptoms (p < 0.05) and a decline in functionality (p < 0.001) after completing radiotherapy. Quality of life was significantly lower after completing radiotherapy treatment (p < 0.05). Lung cancer survivors showed an increase in symptoms, a decline in physical activity levels, and a decline in perceived quality of life after receiving radiotherapy treatment. These results provide more accurate knowledge about the functional impairment experienced by lung cancer patients and can facilitate the future management of impairment in lung cancer patients, thus improving their quality of life. Full article

(This article belongs to the Special Issue Advances in Diagnostic and Therapeutic Radiology — 2nd Edition)

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11 pages, 890 KiB

Open AccessArticle

Risk of Radiation-Induced Second Primary Cancers and Cardiotoxicity following Therapeutic Irradiation for Thymoma with Photon Beams: A Treatment Planning Study

by Michalis Mazonakis, Stefanos Kachris, Maria Tolia and John Damilakis

Appl. Sci. 2024, 14(11), 4926; https://doi.org/10.3390/app14114926 - 6 Jun 2024

Viewed by 956

Abstract

This study compared the risks for developing second primary cancers and cardiotoxicity following radiotherapy for thymoma. Three different 3D-CRT, IMRT, and VMAT plans were generated with 6 MV photons for 12 females with thymoma. Dose-volume histogram data were employed to estimate the second cancer risks using a mechanistic non-linear model. The radiation doses to the heart and cardiac substructures were combined with linear models to assess the probability of cardiotoxicity. The mean lifetime risk for lung, esophageal, thyroid, left breast, and right breast cancer induction was 4.34–4.49%, 0.30–0.31%, 0.05–0.07%, 2.06–2.30%, and 2.04–2.34%, respectively, depending upon the radiotherapy technique. The relative risk for major cardiac events, including myocardial infarction, coronary revascularization, and death, was 1.43–1.55, whereas that for chronic heart failure was 1.20–1.29. The IMRT and VMAT significantly reduced the risk for cardiotoxicity with respect to 3D-CRT (p ≤ 0.023). Small but significant reductions were observed for most organ-specific cancer risks with IMRT compared to conformal treatment (p ≤ 0.008). Similar decreases were detected only for esophageal and thyroid cancer with VMAT (p ≤ 0.033). No difference was found in the probability for radiation-induced lung cancer with the three techniques (p ≥ 0.06). Healthcare professionals may use these data to select the appropriate radiotherapy technique and restrict the risk of late effects. Full article

(This article belongs to the Special Issue Advances in Diagnostic and Therapeutic Radiology — 2nd Edition)

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14 pages, 845 KiB

Open AccessArticle

Robotic Stereotactic Body Radiotherapy for Spine Metastasis Pain Relief

by Daniel Rivas, Alejandro de la Torre-Luque, Vladimir Suárez, Rafael García, Castalia Fernández, Daniela Gonsalves, Elena Moreno-Olmedo, María Isabel Núñez and Escarlata López

Appl. Sci. 2024, 14(5), 1775; https://doi.org/10.3390/app14051775 - 22 Feb 2024

Viewed by 1763

Abstract

Spinal metastasis may occur in 40–70% of patients with cancer. Symptoms can vary from pain to spinal cord compression (SCC) and can affect their quality of life (QoL). Stereotactic body radiotherapy (SBRT) allows dose escalation of spinal tumor metastases, minimizing doses to organs at risk and improving pain control. The aim of this study is to retrospectively describe our institution’s experience with robotic SBRT (CyberKnife^®, Accuray Incorporated, Sunnyvale, CA, USA) for spinal metastases, in terms of feasibility, oncological results, toxicities, and pain relief observed. In total, 25 patients with 43 lesions were assessed, most of them with dorsal metastases (48.8%). The median total dose was 27 Gy (16–35 Gy), the median number of fractions administered was 3 (1–5), and the median dose per fraction was 9 Gy. Pain was evaluated using the visual analogue scale at baseline and at the end of treatment. The statistically significant reduction in pain (p < 0.01) was associated with the total dose of radiotherapy delivered (p < 0.01). Only one patient developed grade 3 dermatitis. Female gender, adenocarcinoma tumors, and lack of previous surgery were associated with better response to SBRT (p < 0.05). Robotic spine SBRT is feasible, well-tolerated, and improves patients’ QoL through a statistically significant reduction in pain, so it should be offered to patients at an early stage in their process. Full article

(This article belongs to the Special Issue Advances in Diagnostic and Therapeutic Radiology — 2nd Edition)

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17 pages, 10725 KiB

Open AccessArticle

Introduction of a Novel Technique in Density-Adjusted 3D Printing for the Manufacture of Soft-Tissue-Equivalent Radiological Phantoms

by Ismail Ozsoykal and Ayşegül Yurt

Appl. Sci. 2024, 14(2), 509; https://doi.org/10.3390/app14020509 - 6 Jan 2024

Cited by 2 | Viewed by 1395

Abstract

The aim of this study is to introduce a new filament and novel 3D printing technique to adjust the density of a printing job in order to mimic the radiological properties of different tissues. We used a special filament, Light Weight PLA (LW-PLA), which utilizes foaming technology triggered by temperature. Cylindrical samples were printed at various temperatures, flow rates, print speeds, and diameters. A computed tomography (CT) scan was performed to identify their radiological properties in terms of the mean Hounsfield Unit (HU). The densities of the samples ranged from 0.36 g/cm³ to 1.21 g/cm³, corresponding to mean HU values between −702.7 ± 13.9 HU and +141.4 ± 7.1 HU. Strong linear correlations were observed between the flow rate and density as well as the flow rate and mean HU. The axial homogeneity of the samples was reported as being comparable to that of distilled water. A reduction in the mean HU was observed at a lower print speed and it changed slightly with respect to the sample size. Reproducibility assessments confirmed consistent results for identical printing jobs. Comparisons with regular PLA samples revealed a superior homogeneity in the LW-PLA samples. The findings of this study suggest a practical and accessible solution for mimicking all of the soft tissues, including the lungs, by using a single filament. Full article

(This article belongs to the Special Issue Advances in Diagnostic and Therapeutic Radiology — 2nd Edition)

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16 pages, 3666 KiB

Open AccessArticle

Volumetric Modulated Arc Therapy for Radiosurgery of Brain Metastases: A Single-Center Study

by José Manuel Sánchez-Villalobos, Alfredo Serna-Berna, Juan Salinas-Ramos, Pedro Pablo Escolar-Pérez, Marina Andreu-Gálvez, Emma Martínez-Alonso, José Antonio Pérez-Vicente and Miguel Alcaraz

Appl. Sci. 2023, 13(18), 10097; https://doi.org/10.3390/app131810097 - 7 Sep 2023

Viewed by 1494

Abstract

Whole-brain radiation therapy and stereotactic radiosurgery are two treatment modalities commonly utilized to treat brain metastases (BMs). The aim of this study is to retrospectively analyze the main radio-oncologic and clinical-demographic aspects of a cohort of BM patients treated with Volumetric Modulated Arc Therapy for radiosurgery (VMAT-RS). This is a cross-sectional observational design study with a retrospective review of the medical records of patients with brain metastases treated with VMAT-RS between 2012 and 2018. Clinical and demographic data, with special attention to sex, age, primary tumor, brain tumor-related epilepsy (BTRE), number and brain location of BMs, Karnofsky Performance Status (KPS), the updated DS-GPA prognostic index, and the survival estimated according to the Kaplan–Meier model from the date of radiosurgery, were analyzed. One hundred and twenty-one patients with 229 BMs were treated with VMAT-RS. Patients presented 1–4 BMs, which were treated with five non-coplanar VMAT arcs. Sixty-eight percent of the patients had lung cancer, and 35% of the BMs were in the frontal lobe. The proportion of local control was 88.5%. BTRE prevalence was 30.6%. The median survival time (MST) was 7.7 months. In the multivariate analysis of the Cox regression model, KPS ≥ 70 (HR_{KPS < 70} = 2.59; p = 0.001) and higher DS-GPA (HR_DS-GPAII = 0.55, p = 0.022; HR_DS-GPAIII-IV = 0.38, p = 0.006) were associated with improved survival. In the univariate analysis, primary tumor, age, and the presence of metastases in the posterior fossa (PFBMs) were also significant. In conclusion, the VMAT-RS is a technique with an overall survival rate comparable to other radiosurgery techniques. The median survival is significantly longer for those with higher KPS and DS-GPA. Other variables, such as the type of primary tumor, age, and PFBMs, could also influence survival, although further studies are needed. Full article

(This article belongs to the Special Issue Advances in Diagnostic and Therapeutic Radiology — 2nd Edition)

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