Search Results (310)

Background: Epidermal growth factor receptor (EGFR) mutations are presented in approximately 50% of East Asian populations with advanced non-small cell lung cancer (NSCLC). While EGFR-tyrosine kinase inhibitors (TKIs) are the standard treatment, patient outcomes are also influenced by host-related factors. This study aimed to investigate clinical and radiological factors associated with early mortality and develop a prognostic prediction model in advanced EGFR-mutated NSCLC. Methods: A retrospective cohort was conducted in patients with EGFR-mutated NSCLC treated with first line EGFR-TKIs from January 2012 to October 2022 at Chiang Mai University Hospital. Clinical data and radiologic findings at the initiation of treatment were analyzed. A multivariable flexible parametric survival model was used to determine the predictors of death at 18 months. The predicted survival probabilities at 6, 12, and 18 months were estimated, and the model performance was evaluated. Results: Among 189 patients, 84 (44.4%) died within 18 months. Significant predictors of mortality included body mass index <18.5 or ≥23, bone metastasis, neutrophil-to-lymphocyte ratio ≥ 5, albumin-to-globulin ratio < 1, and mean pulmonary artery diameter ≥ 29 mm. The model demonstrated good performance (Harrell’s C-statistic = 0.72; 95% CI: 0.66–0.78). Based on bootstrap internal validation, the optimism-corrected Harrell’s C-statistic was 0.71 (95% CI: 0.71–0.71), derived from an apparent C-statistic of 0.75 (95% CI: 0.74–0.75) and an estimated optimism of 0.04 (95% CI: 0.03–0.04). Estimated 18-month survival ranged from 87.1% in those without risk factors to 2.1% in those with all predictors. A web-based tool was developed for clinical use. Conclusions: The prognostic model developed from fundamental clinical and radiologic parameters demonstrated promising utility in predicting 18-month mortality in patients with advanced EGFR-mutated NSCLC receiving first-line EGFR-TKI therapy. Full article

Background and Objectives: Multiple sclerosis (MS) is a chronic immune-mediated neurological disorder that primarily affects young adults and is frequently accompanied by psychiatric comorbidities such as depression and anxiety, both of which significantly diminish patients’ quality of life (QoL). This study investigated the effect of two oral disease-modifying therapies (DMTs), fingolimod and cladribine, on mental health and QoL in patients with relapsing-remitting MS (RRMS). The aim of the study was to compare levels of depression, anxiety, and health-related quality of life (HRQoL) in RRMS patients treated with fingolimod or cladribine, and to evaluate their associations with clinical and radiological parameters. Materials and Methods: Eighty RRMS patients aged 18 to 50 years with Expanded Disability Status Scale (EDSS) scores of 3.0 or less, no recent disease relapse, and no history of antidepressant use were enrolled. Forty patients were treated with fingolimod and forty with cladribine. Depression and anxiety were assessed using the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). QoL was evaluated using the Multiple Sclerosis QoL-54 (MSQOL-54) instrument. Additional clinical data, including MRI-based lesion burden, EDSS scores, age, disease duration, and occupational status, were collected. Results: No statistically significant differences were observed between the two groups regarding HDRS and HARS scores (p > 0.05). However, patients treated with fingolimod had significantly higher scores in the Energy/Fatigue subdomain (7.55 ± 2.02 vs. 6.56 ± 2.57, p = 0.046) and Composite Mental Health (CMH) score (64.73 ± 15.01 vs. 56.00 ± 18.93, p = 0.029) compared to those treated with cladribine. No significant differences were found in the independent items of the MSQOL-54. A negative correlation was identified between total lesion load and QoL scores. Conclusions: Although fingolimod and cladribine exert comparable effects on depression and anxiety levels, fingolimod may be associated with better mental health outcomes and reduced fatigue in RRMS patients. Furthermore, lesion burden and clinical parameters such as age and EDSS score may independently influence QoL, regardless of the DMT used. Full article

Background: Atypical carcinoid of the thymus is an exceptionally rare neuroendocrine tumor originating from neuroendocrine cells within the thymus. These tumors often present with no symptoms or with nonspecific clinical signs, making early diagnosis particularly challenging. Despite their rarity, atypical carcinoids are clinically significant due to their aggressive nature and relatively poor prognosis. Early detection and appropriate management are therefore crucial to improving patient outcomes. Results: In this report, we present the case of a 64-year-old patient in whom an atypical carcinoid of the thymus was incidentally discovered following a thoracic computed tomography scan performed for unrelated reasons. Imaging revealed a suspicious anterior mediastinal mass, which was subsequently surgically resected. Histopathological examination, supported by immunohistochemical analysis, confirmed the diagnosis of an atypical carcinoid of the thymus. The tumor demonstrated coexpression of epithelial and neuroendocrine markers, consistent with this rare entity. Conclusions: This case adds to the limited body of literature on atypical carcinoid of the thymus and highlights the importance of considering this diagnosis when evaluating anterior mediastinal masses. It also underscores the value of thorough radiological and pathological assessment in identifying early-stage disease, which may significantly influence prognosis and therapeutic strategies. Full article

Background/Objectives: Computed tomography (CT) of the head is vital in diagnosing neurological conditions but poses concerns regarding radiation exposure. Traditional diagnostic reference levels (DRLs) are based on anatomical regions, potentially overlooking variations in radiation requirements driven by clinical indication. This study aimed to establish clinical indication-specific DRLs (DRLCIs) for adult head CT to support precision benchmarking and optimise patient safety. Methods: A retrospective observational study was conducted using data from 378 adult patients undergoing non-contrast CT head scans between September 2022 and February 2024. Data on patient demographics, protocols, and radiation dose metrics (Computed Tomography Dose Index Volume and Dose–Length Product) were extracted using DoseWatch™ software. Protocol parameters were standardised across clinical indications such as trauma, stroke, headache, seizure, and infection. Descriptive statistics and correlation analyses were performed. Descriptive statistics, including means, standard deviations, and percentile distributions, were calculated. Correlation analyses were conducted using Pearson’s correlation coefficient to examine relationships between dose metrics and patient variables such as age and body mass index. Results: Mean CTDIvol values ranged from 50.58 mGy (trauma) to 52.90 mGy (infection), while DLP values ranged from 1052.52 to 1219.98 mGy·cm. Percentile distributions were narrow, indicating effective protocol standardisation. The strongest correlation was observed between CTDIvol and DLP (r = 0.89), while age and body mass index showed negligible influence on dose metrics. Comparative analysis showed alignment with international benchmarks from the UK, Qatar, Bahrain, and Nigeria. Conclusions: This study establishes DRLCIs for adult head CT, demonstrating consistent radiation dose delivery across indications with minimal variability. Clinical indication-based benchmarking enhances dose optimisation and aligns with global radiological protection frameworks. Full article

Chemical, biological, radiological, and nuclear (CBRN) incidents pose significant challenges requiring swift, coordinated responses to safeguard public health. This is especially the case in densely populated urban areas, where the public is not only at risk but can also be of assistance. Public cooperation is critical to the success of mass decontamination efforts, yet prior research has primarily focused on technical and procedural aspects, neglecting the psychological and social factors driving casualty behaviour. This paper addresses this gap through a narrative literature review, chosen for its flexibility in synthesising fragmented and interdisciplinary research across psychology, sociology, and emergency management. The review identified two primary pathways influencing casualty decision making: rational and affective. Rational pathways rely on deliberate decisions supported by clear communication and trust in responders’ competence, while affective pathways are shaped by emotional responses like fear and anxiety, exacerbated by uncertainty. Trust emerged as a critical factor, with effective —i.e., transparent, empathetic, and culturally sensitive— communication being proven to enhance public cooperation. Cultural and societal norms further shape individual and group responses during emergencies. This paper demonstrates the value of narrative reviews in addressing a complex, multifaceted topic such as casualty behaviour, enabling the integration of diverse insights. By emphasising behavioural, psychological, and social dimensions, the results of this paper offer actionable strategies for emergency responders to enhance public cooperation and improve outcomes during CBRN incidents. Full article

Introduction: Synovitis and damage to natural stabilizers of many axial and peripheral joints make patients with rheumatoid arthritis particularly susceptible to sagittal balance disorders of the axial skeleton. This may determine the high individual variability of cervical spine deformities as well as differences in the rate of development of disease symptoms in these patients, such as radiculopathy and myelopathy. Methods: In the scientific literature, in addition to systemic factors, more and more attention is paid to work on biomechanical factors in the development of cervical spine instability. One of the methods for assessing the influence of biomechanical factors, which can also be used in everyday practice, is the analysis of radiological parameters of sagittal balance. Results: Among the selected sagittal balance parameters studied, a statistical relationship between C4 and C5 distance and the OI parameter has been found, indicating a relationship to a parameter that remains constant throughout an individual’s life in the group of patients with disease duration over 20 years. Conclusions: The development of instability and deformity in the subaxial segment of the cervical spine in patients with rheumatoid arthritis may be the result of insufficiently understood components of biomechanical factors; hence, further research in this field is necessary. Full article

Thyroid nodules are a common clinical finding, with their prevalence influenced by multiple environmental and occupational factors, including exposure to ionizing radiation. Healthcare workers, particularly those operating in radiology, nuclear medicine, interventional cardiology, and radiation oncology, are potentially at increased risk due to chronic low-dose radiation exposure. This review aims to evaluate the current evidence regarding the association between occupational radiation exposure and the development of thyroid nodules among healthcare professionals. The findings suggest a higher prevalence of thyroid nodules in radiation-exposed workers compared to the general population, although data heterogeneity and methodological limitations exist. Factors such as the duration of exposure, radiation protection practices, and frequency of monitoring play critical roles in modulating the individual risk. While some studies report no significant difference in malignancy rates, the increased detection of nodules underlines the need for regular thyroid surveillance in at-risk populations. Further longitudinal and multicentric studies are warranted to clarify the causality and guide preventive strategies. This review highlights the importance of occupational health protocols, including radiation shielding and periodic thyroid evaluation, in safeguarding the long-term endocrine health of healthcare workers. Full article

Introduction: Computed tomography-guided biopsies (CTGB) are essential in diagnosing various conditions, particularly in respiratory medicine, with lung cancer being a primary focus. A significant complication associated with CTGB is pneumothorax, which can occur in up to 26% of cases. At Northumbria Healthcare NHS Foundation Trust, a large interventional service collaborates closely with radiologists and respiratory physicians. This study aims to evaluate the incidence of pneumothorax following CTGB. Methods: A retrospective service review was conducted on all lung parenchymal CTGBs performed between April 2011 and July 2023, with approval from the local information governance. Demographic data and clinical outcomes were analyzed using descriptive statistics. Continuous variables are presented as medians with interquartile ranges (IQR), while categorical variables are reported as frequencies and percentages. Results: A total of 1492 CT-guided lung biopsies were analyzed. The median age of patients was 72 years (IQR 10.5), and 50.9% were male. Pneumothorax occurred in 23.8% (n = 355) of cases. Of these, 159 (44.8%) were detected on post-biopsy CT scans. The average number of pleural passes was 1.8 (range 1–4). Among those with pneumothorax, 53.6% had radiologically evident emphysema. The median forced expiratory volume in 1 s (FEV1) was 1.97 L (IQR 1.04). Sixty-seven percent (n = 234) of patients had no pleural contact, and the median lesion size was 26 mm (IQR 24). Seventy-two percent (n = 255) of lesions with pneumothoraces were less than 3 cm deep. Forty-four percent of biopsies were performed using 18 French gauge tru-cut needles. Of the 355 pneumothoraces, 89% (n = 315) were managed conservatively, with 42 requiring pleural intervention (41 small-bore 12 Fr intercostal chest drains and one pleural vent). Symptoms were initially present in 40 cases, and two cases developed symptoms up to 7 days post-procedure. Conclusions: The incidence of pneumothorax is consistent with expected rates, with more occurrences observed in biopsies of smaller lesions lacking pleural contact, lesions with surrounding emphysema, and cases requiring multiple pleural passes. FEV1 does not appear to influence the risk of pneumothorax. Conservative management is generally effective, without significant complications. Full article

Background/Objectives: Degenerative lumbar spinal stenosis (LSS) is a prevalent cause of disability in elderly populations, often treated with decompressive surgery. However, postoperative functional outcomes are variable and influenced by factors beyond neural compression alone. This study aimed to investigate the prognostic significance of the Goutallier Classification System (GS), a radiological index of paravertebral muscle fatty degeneration, in predicting long-term postoperative disability and pain in elderly patients undergoing decompression for LSS. Methods: A retrospective cohort study was conducted on 100 elderly patients who underwent primary lumbar decompression surgery for LSS between January 2020 and July 2022, with a minimum two-year follow-up. Patients were stratified according to their preoperative GS grades assessed via MRI. The Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain were collected preoperatively and at follow-up. Changes in the ODI and VAS (ΔODI and ΔVAS) were analyzed to evaluate associations between GS grades and functional outcomes. Results: Significant improvements in the ODI (from 41.0 ± 17.5 to 16.9 ± 8.2) and VAS (from 6.23 ± 2.52 to 3.75 ± 2.38) were observed postoperatively (p < 0.01). However, higher GS grades were associated with greater residual disability and pain at follow-up, as well as with smaller postoperative improvements in these scores (p < 0.01 for ODI; p = 0.01 for VAS). Gender differences were noted, with females predominating in higher GS grades. No significant differences in comorbidities or complication rates were identified across GS subgroups. Conclusions: Preoperative paravertebral muscle degeneration, as measured by the GS, emerged as a significant predictor of postoperative disability and pain in elderly LSS patients. Incorporating GS assessment into preoperative planning may refine surgical risk stratification and inform shared decision-making to optimize long-term functional recovery. Full article

The combustion of hard coal and lignite in power and combined heat and power plants generates significant amounts of coal fly ash (CFA), a waste material with variable properties. CFA naturally contains radionuclides, specifically naturally occurring radioactive materials (NORMs), which pose potential radiological risks to the environment and human health during their storage and utilization, including their incorporation into building materials. Although global research on the radionuclide content in CFA is available, there is a clear gap in detailed and current data specific to Central and Eastern Europe and notably, a lack of a systematic analysis investigating the influence of installed power plant capacity on the concentration profile of these radionuclides in the generated ash. This study aimed to fill this gap and provide crucial data for the Polish energy and environmental context. The objective was to evaluate the concentrations of selected radionuclides (²³²Th, ²²⁶Ra, and ⁴⁰K) in coal fly ash samples collected between 2020 and 2023 from 19 Polish power and combined heat and power plants with varying capacities (categorized into four groups: S1–S4) and to assess the associated radiological risk. Radionuclide concentrations were determined using gamma spectrometry, and differences between groups were analyzed using non-parametric statistical methods, including PERMANOVA. The results demonstrated that plant capacity has a statistically significant influence on the concentration profiles of thorium and potassium but not radium. Calculated radiological hazard assessment factors (Ra_eq, H_ex, H_in, IAED) revealed that although most samples fall near regulatory limits (e.g., 370 Bq kg⁻¹ for Ra_eq), some exceed these limits, particularly in groups S1 (plants with a capacity less than 300 MW) and S4 (plants with a capacity higher than 300 MW). It was also found that the frequency of exceeding the annual effective dose limits (IAEDs) showed an increasing trend with the increasing installed capacity of the facility. These findings underscore the importance of plant capacity as a key factor to consider in the radiological risk assessment associated with coal fly ash. This study’s outcomes are crucial for informing environmental risk management strategies, guiding safe waste processing practices, and shaping environmental policies within the energy sector in Central and Eastern European countries, including Poland. Full article

The occurrence of osseous, fibrous, and fibro-osseous lesions in the jaw bones might pose challenges for accurate diagnosis and the selection of the best therapeutic approach. Certain radiolucent, radiopaque, or mixed-origin lesions can look very similar to other bone lesions, because of the stages of their growth, calcification, maturation, and possible local factors affecting the lesion. Ossifying fibroma (OsF, OF) is a type of fibro-osseous lesion, whose radiological characteristics might sometimes be uncertain. It may appear on classic radiographs and cone beam computed tomography as a radiolucent/radiopaque lesion with calcification bodies or a shape with a cloud-like appearance. The appearance is mostly related to the lesion’s maturation level, calcification stage, and number of fibrous elements. Diagnosis might be challenging. Its histopathological evaluation reveals a combination of mineralized and fibrous connective tissues in the mass. From a radiological point of view, because of the tumor’s various stages of bone remodeling, formation, and resorption, diagnosis might be troublesome. Different diagnoses should include cemento-osseous dysplasia, fibrous dysplasia, or cementoblastoma. A biopsy could provide an accurate histopathological examination, improving diagnosis and influencing later surgical approaches. Regardless of the final specimen evaluation, surgery is the treatment of choice. The authors would like to present the correlation between radiological and histopathological data in tumor treatment outcomes. Full article

Background/Objectives: Morphological spinal alterations in adolescents, including idiopathic scoliosis (IS) and postural scoliotic attitudes (paramorphisms), may be associated with leg length discrepancy (LLD) and breast asymmetry (BA). This study aimed to assess the prevalence and characteristics of LLD and BA in adolescents with spinal paramorphisms and dysmorphisms (IS), and to explore associations between these asymmetries and spinal curve features. Methods: A cross-sectional observational study was conducted. Adolescents aged 10–18 years were included. LLD was measured clinically via direct tape measurement and, when necessary, ultrasound. BA was assessed via visual inspection. Spinal deformities were characterized via clinical and radiological examination. Results: Among the 44 participants, 26 (60%) had IS and 18 (40%) had postural scoliotic attitudes. LLD was present in 79.5% (mean 0.7 ± 0.6 cm; all mild). BA was observed in 14% of the sample. LLD was more frequent in IS (87%) than in postural scoliotic attitudes (72%). In lumbar postural curves, the shorter limb was consistently ipsilateral to the curve convexity. In IS, no consistent association was found between LLD and curve characteristics. BA was slightly more prevalent in IS (19%) than postural scoliotic attitudes (17%), with no consistent pattern relative to curve convexity. Conclusions: Mild LLD is common in adolescents with spinal asymmetries and reflects general population norms. While LLD may influence compensatory postural curves, it does not appear to affect IS curve patterns or severity. BA is more frequent in IS, but shows variable association with curve features. Considering LLD and BA prevalence in adolescents with spinal asymmetries routine assessment is warranted, though their impact on IS progression is limited. Full article

Radiological assessment following pancreaticoduodenectomy is critical for the prompt diagnosis and management of postoperative complications, significantly influencing patient outcomes. Pancreaticoduodenectomy, or the Whipple procedure, is the standard surgical intervention for pancreatic and periampullary malignancies, but it involves notable risks, especially from complications like fistulas, bleeding, or leakage. Cross-sectional imaging, particularly contrast-enhanced computed tomography, serves as the primary diagnostic tool due to its rapid acquisition, high resolution, and effective delineation of postoperative anatomy and complications. Magnetic resonance imaging (with cholangiopancreatography and hepatobiliary contrast agents) complements CT by providing superior contrast resolution for specific complications, notably in the biliary system and pancreatic duct. This narrative review discusses various imaging techniques and their applications, highlighting characteristic radiological features of common postoperative complications. It underscores the importance of a multidisciplinary approach, emphasizing close collaboration between radiologists and surgeons to optimize surgical decision-making and improve patient management post-pancreatic surgery. Full article

Background/Objectives: This study aimed to investigate the results of surgical intervention in cases of scaphoid nonunion and delayed healing among individuals aged 18 or younger, focusing on both clinical and radiological aspects, as well as identifying possible factors that may impact the effectiveness or failure of the treatment. Methods: A total of 20 boys with impaired scaphoid bone healing underwent surgical treatment, with the average duration between the suspected injury and the procedure being approximately 10.8 months. At the time of surgery, the patients had a mean age of 15 years, and the average follow-up period was 20 months. We assessed the type of surgery performed, along with range of motion and pain intensity, comparing preoperative findings with those recorded at the final evaluation. Based on lateral X-ray examination, CLA (capitolunate angle), SCA (scaphocapitate angle), and SLA (scapholunate angle) angles were measured before and after surgery and at the last follow-up. Results: The treatment results showed bone union in 18 out of 20 patients (90%), complete pain relief in 17 patients (85%), and a significant improvement in ROM. There was a statistically significant improvement in the SLA angle and an increase in wrist dorsal flexion. We also identified three factors that significantly influence better ROM after surgery, namely the values of the CLA and SLA angles, as well as the time from injury to surgery. Conclusions: Our findings suggest that surgical intervention contributes to improved joint mobility, pain reduction, and restoration of anatomical alignment in the wrist. While we identified factors associated with more favorable functional results, we did not find any that were linked to a higher likelihood of treatment failure. Full article

Background/Objectives: The management of patients with severe systemic comorbidities undergoing radiologic interventional procedures presents a significant challenge for anesthesiologists. Selecting an appropriate combination of anesthetic drugs is crucial to ensure a safe, painless procedure, facilitate rapid recovery, and minimalize complications. Here, we present a case of a 68-year-old female patient of ASA V status with a history of diabetes, coronary artery disease, and severe chronic obstructive pulmonary disease due to lung emphysema and dependence on a home oxygenator, requiring sedation for CT-guided percutaneous drainage of the aortic graft infection. Methods: After on-site emergent patient preparation and several position adjustments, sedation was initiated and maintained using continuous infusions of remimazolam and esketamine. Results: Throughout the procedure, the patient remained sedated, comfortable, and free of unwanted movements. The patient was hemodynamically stable and maintained oxygen saturation between 92 and 96%. Conclusions: In our opinion, the combination of remimazolam and esketamine demonstrated an effective and safe profile for procedural sedation. This approach holds the potential to influence standard operating protocols, particularly for patients with severe and multiple comorbidities requiring personalized anesthetic management. Full article