Interventional spine procedures under CT guidance: How to reduce patient radiation dose without compromising the successful outcome of the procedure?

This technical note proposes a method to reduce radiation dose for spine interventions under CT guidance without compromising the successful outcome of the procedure. Two consecutive periods of 14 months before and after optimization were investigated with 162 and 440 patients, respectively. By optimizing the acquisition parameters (decreased kV and mAs) and appropriately adjusting the reconstruction (kernels, slice thickness, etc) and visualization parameters, image quality was maintained suitable to perform the procedure. By reducing both kV and mAs, dose was reduced by 72% on fluoroscopy mode (i-fluoro) and sequential mode (i-sequence). Moreover, dose was reduced by 58% on helical mode (i-spiral). Depending on the radiologist, the fluoroscopy time was decreased by between 37% and 56%. Acquisitions with i-sequence were less irradiating than the i-fluoro or the i-spiral modes. Radiation doses were reduced by 65% for infiltrations, 51% for vertebral expansions, and 56% for bone biopsies. Median (1st quartile; 3rd quartile) effective dose were 2.1 (1.3; 3.5) mSv, 10.8 (6.7; 18.3) mSv for and 3.0 (2.4; 4.3) mSv, respectively. Radiologists reported “satisfactory” image quality. During interventional spine procedures under CT scan, reducing kV and mAs associated with the use of i-sequence substantially reduces patient dose.     

Comparison of image registration performed with MV cone beam CT and CT on rails and Syngo™ Adaptive Targeting software

BackgroundMinimization of geometric errors in treatment delivery is essential in modern conformal and intensity-modulated techniques.AimIn this paper two Siemens systems, MVision megavoltage cone beam CT, and CTVision (CT on rails), are compared.Material and MethodsThe reproducibility and uncertainty of the image registration procedure performed with Adaptive Targeting (AT) software were evaluated. Both systems were evaluated by means of simulating the clinical situation with an anthropomorphic phantom in three anatomical sites: head & neck, thorax and pelvis.ResultsThe results for two methods of image registration, manual and automatic, were evaluated separately. The manual procedure was used by two users, more and less experienced.ConclusionsThe MVision system and CTVision and the Therapist Adaptive software ensure image registration with the uncertainty of about 2.0 mm (2 standard deviations). In the case of the automatic registration method better reproducibility of image registration was obtained for MVision. For CTVision the necessity of manual identification of the machine isocentre made the registration less reproducible. In the case of MVision, the automatic method was more reproducible than the manual one (smaller dispersion of results). In the case of CTVision, similar results were obtained for both registration methods. In the case of manual registration slightly better reproducibility for CT data acquired at 2 mm slice thickness and 2 mm slice separation than for data acquired at 5 mm slice thickness and 5 mm slice separation were obtained. Similar results of manual registration performed by more and less experienced users were obtained.     

Three-dimensional image fusion guidance of percutaneous pulmonary valve implantation to reduce radiation exposure and contrast dose: A comparison with traditional two-dimensional and three-dimensional rotational angiographic guidance

Introduction

Three-dimensional rotational angiography (3DRA) has been used in the guidance of various transcatheter therapies including percutaneous pulmonary valve implantation (PPVI). The most recently available 3D image fusion software (VesselNavigator, Philips) extends this technology to use pre-registered computed tomography or magnetic resonance imaging datasets, promising reductions in contrast and radiation exposure along with shorter procedural times.

Methods

In this retrospective review, patients were assigned to three groups according to the mode of imaging guidance: two-dimensional angiography (2DA), 3DRA and VesselNavigator (VN) assisted valve implantation. Patient characteristics and catheterisation data were reviewed with a focus on contrast and radiation exposure, fluoroscopy, and procedural times.

Results

Between July 2012 and June 2016, 21 patients underwent PPVI: 8 with 2D guidance, 6 patients with 3DRA and most recently 7 patients with VN assistance. Patents in the VN group received significantly less absolute and weight indexed contrast when compared with those with 2DA or 3DRA guided PPVI. Patients in the 2DA group received a significantly higher total dose area product radiation dose and air kerma in comparison with patients with 3DRA and VN guided intervention. Application of VN resulted in the shortest fluoroscopy time, although not statistically significant, and a significantly shorter study time when compared with 2DA.

Conclusions

Utilisation of pre-intervention image manipulation with VesselNavigator for 3D guidance of PPVI results in a reduction in contrast and radiation exposure and study time as compared with traditional 2D guidance, and contrast usage as compared with 3DRA.

     

Evaluation of two commercial methods for the susceptibility testing of Candida species: Vitek 2® and Sensititre YeastOne®

Background

An increased incidence of fungal infections caused by Candida species, especially Candida glabrata and Candida krusei, which are less susceptible to azoles, has been observed. Standardized susceptibility testing is essential for clinical management and for monitoring the epidemiology of resistance.

Weak coherent radiation of OH and ortho- H2O space masers as a carrier in biocommunication: the ortho/para-conversion of H2O spin isomers?

A conception of biocommunication based on the principle of radiophysics stating that the carrier modulation takes place at the resonance frequency in the transmission-receiver system has been substantiated and proved. The coherent radiation of space OH-masers (1.6-1.7 GHz) and ortho-H2O-maser (22.3 GHz) is proposed as a source of the carrier frequency. The narrow lines of rotational transition of H2O and OH molecules in liquid water were proposed to be considered as an analog of selective resonances of transmitter and receiver in radiocommunication. The possibility of the ortho-para conversion of H2O spin isomers, induced by weak electromagnetic fields, is discussed.     

Reply and explanation to Little et al. “Response to: On the choice of methodology for evaluating dose‑rate effects on radiation‑related cancer risks”

Radiation and Environmental Biophysics -     

The relative effectiveness of .OH,H2O2,O2−, and reducing free radicals in causing damage to biomembranes: A study of radiation damage to erythrocyte ghosts using selective free radical scavengers

The relative effectiveness of oxidizing (^.OH, H₂O₂), ambivalent (O₂^?) and reducing free radicals (e^? and CO₂^?) in causing damage to membranes and membrane-bound glyceraldehyde-3-phosphate dehydrogenase of resealed erythrocyte ghosts has been determined. The rates of damage to membranebound glyceraldehyde-3-phosphate dehydrogenase ($\text{R}$(enz)) were measured and the rates of damage to membranes ($\text{R}$(mb)) were assessed by measuring changes in permeability of the resealed ghosts to the relatively low molecular weight substrates of glyceraldehyde-3-phosphate dehydrogenase. Each radical was selectively isolated from the mixture produced during gamma-irradiation, using appropriate mixtures of scavengers such as catalase, superoxide dismutase and formate. ^.OH, O₂^? and H₂ O₂ were approximately equally effective in inactivating membrane-bound glyceraldehyde-3-phosphate dehydrogenase, while e^? and CO₂^? were the least effective. $\text{R}$(enz) values of O₂^? and H₂O₂ were 10-times and of ^.OH 15-times that of e^?. $\text{R}$(mb) values were quite similar for e^? and H₂O₂ (about twice that of O₂^?), while that of ^.OH was 3-times that of O₂^?. Hence, with respect to $\text{R}$(mb): ${}^{\mathrm{.}}\text{OH}\text{>}\text{e}{}^{\mathrm{?}}\text{=}\text{H}{}_2\text{O}{}_2\text{>}\text{O}{}_2{}^{\mathrm{?}}$ , and with respect to $\text{R}$(enz): ${}^{\mathrm{.}}\text{OH}\text{>}\text{O}{}_2{}^{\mathrm{?}}\text{=}\text{H}{}_2\text{O}{}_2\text{>}\text{e}{}^{\mathrm{?}}$. The difference between the effectiveness of the most damaging and the least damaging free radicals was more than 10-fold greater in damage to the enzyme than to the membranes. Comparison between H₂O₂ added as a chemical reagent and H₂O₂ formed by irradiation showed that membranes and membrane-bound glyceraldehyde-3-phosphate dehydrogenase were relatively inert to reagent H₂O₂ but markedly susceptible to the latter.     

Structural,Morphological, and Optical Properties of Nanocrystalline (Bi2O3)1−x:(TiO2)x Thin Films for Transparent Electronics

The fabrication of low cost and eco-friendly transparent electronics using metal oxide semiconductors is still a challenging task. In this work, transparent nanocrystalline (Bi₂O₃)_1−x:(TiO₂)_x thin films were synthesized using a pulsed laser deposition technique (PLD); XRD analysis shows the films have polycrystalline structure of monoclinic Bi₂O₃; morphological and topographical properties were analyzed by SEM and AFM showing the films have smooth surfaces with RMS roughness (4.26–7.37 nm) with micro-and nano-spheres (2 μm to 23 nm); the optical properties were analyzed by Uv-Vis spectrometer and revealed high transmittance in the visible range; the best results were obtained at x = 0.05 where the highest crystallinity, highest transmittance (> 82%), and highest band gap (3.769 eV) were achieved; and empirical models have been proposed to estimate the band gap and Bi–O bond lengths as a function of TiO₂ concentration with excellent coincidence with the experimental data.

     

Phosphorylation Sites Within α4 Subunits of α4β2 Neuronal Nicotinic Receptors: A Comparison of Substrate Specificities for cAMP-Dependent Protein Kinase (PKA) and Protein Kinase C (PKC)

The present study determined whether putative phosphorylation sites within the M3/M4 cytoplasmic domain of the human 4 subunit of 42 neuronal nicotinic receptors are substrates for cAMP-dependent protein kinase (PKA) or protein kinase C (PKC). Five peptides corresponding to predicted phosphorylation sequences were synthesized, and phosphorylation was compared with standard peptide substrates for each kinase, that is, Kemptide for PKA and glycogen synthase (GS) 1-8 for PKC. VRCRSRSI had the highest affinity for PKA, with a Km of 44.5 M; Kemptide had a Km of 7.7 M. LMKRPSVVK and KARSLSVQH were also phosphorylated by PKA, but had lower affinities of 593 M and 2896 M, respectively. LMKRPSVVK had the highest affinity for PKC with a Km of 182 M; GS 1–8 had a Km of 2.1 M. VRCRSRSI had a comparative affinity for PKC with a Km of 327 M. PCKCTCKK was not phosphorylated by PKA, but was a substrate for PKC with a Km of 1392 M, whereas PGPSCKSP was not phosphorylated by either kinase. Based on these findings, results suggest that Ser-362 and Ser-486 on the human 4 subunit may be phosphorylated by either PKA or PKC, Ser-467 is a putative PKA site, and Thr-532 represents a likely PKC substrate; Ser-421 does not appear to be phosphorylated by either kinase.     

Handbook of Biosolar Resources : Vol. 1, parts 1 and 2, ‘Basic Principles’ Edited by A. Mitsui and C.C. Black (Editor-in-Chief,O.R. Zaborsky) CRC Press; Boca Raton,USA, 1982 643 pages. $95.00 each part; approx. £113 for both parts

Glycerate kinase from spinach leaves was purified to near homogeneity using PEG/MgCl₂ fractionation, ion exchange, molecular sieving and affinity chromatography. The purified enzyme is a monomer of M_r 40 000, shows a pI-value of 4.8 and a broad pH optimum of 6.5–8.5 and is specific for D-isomer of glycerate. The high activity of crude enzyme (≈ 150 μmol. h^?1.mg chl^?1) indicates that glycerate kinase does not limit the oxidative photosynthetic carbon cycle.     

The structure of Λ-β1-[Co(R,R-picchxn)(S-tyr)]Br2 · 3.5H2O and solution configuration of Λ-β1-[Co(R,R-picchxn)(aromatic S-aminoacidate)] complexes: model systems for the investigation of non-covalent aromatic interactions

Intramolecular non-covalent interactions involving aromatic residues in the ternary species Λ-β₁-[Co(R,R-picchxn)(S-aa)]²⁺ (aa=Tyr, OMe-tyr or Phe) have been investigated. Such interactions are important to discriminatory processes associated with molecular recognition in chemical and biochemical systems. The single-crystal X-ray study of Λ-β₁-[Co(R,R-picchxn)(S-tyr)]Br₂ · 3.5H₂O demonstrates the influence of intramolecular π-π and bifurcated NH-π interactions in determining the molecular conformation of the complex cation in the solid state. The Co(III) complexes synthesised are diamagnetic, and have been fully assigned in solution using multidimensional NMR techniques. Remarkably, the solid state conformation observed for Λ-β₁-[Co(R,R-picchxn)(S-tyr)]²⁺ has been shown to predominate in solutions of all the complexes, as evidenced by appropriate rOe correlations. ¹H NMR measurements carried out in order to determine equilibrium rotamer distributions confirm the dominance of this conformer in solution. NMR measurements also show that rotamer populations are relatively unchanged at elevated temperatures and in a variety of solvents. The results of this detailed study, which demonstrate the significance of non-covalent interactions involving aromatic residues to the determination of the molecular conformation, serve to highlight the suitability of these simple ternary Co(III) complexes to act as models for such interactions.