M. Alkhorayef

High-Intensity Focused Ultrasound (HIFU) in Uterine Fibroid Treatment: Review Study

Summary Background High-intensity focused ultrasound (HIFU) is a highly precise medical procedure used locally to heat and destroy diseased tissue through ablation. This study intended to review HIFU in uterine fibroid therapy, to evaluate the role of HIFU in the therapy of leiomyomas as well as to review the actual clinical activities in this field including efficacy and safety measures beside the published clinical literature. Material/Methods An inclusive literature review was carried out in order to review the scientific foundation, and how it resulted in the development of extracorporeal distinct devices. Studies addressing HIFU in leiomyomas were identified from a search of the Internet scientific databases. The analysis of literature was limited to journal articles written in English and published between 2000 and 2013. Results In current gynecologic oncology, HIFU is used clinically in the treatment of leiomyomas. Clinical research on HIFU therapy for leiomyomas began in the 1990s, and the majority of patients with leiomyomas were treated predominantly with HIFUNIT 9000 and prototype single focus ultrasound devices. HIFU is a non-invasive and highly effective standard treatment with a large indication range for all sizes of leiomyomas, associated with high efficacy, low operative morbidity and no systemic side effects. Conclusions Uterine fibroid treatment using HIFU was effective and safe in treating symptomatic uterine fibroids. Few studies are available in the literature regarding uterine artery embolization (UAE). HIFU provides an excellent option to treat uterine fibroids.

High-Intensity Focused Ultrasound (HIFU) in Localized Prostate Cancer Treatment

Summary Background High-intensity focused ultrasound (HIFU) applies high-intensity focused ultrasound energy to locally heat and destroy diseased or damaged tissue through ablation. This study intended to review HIFU to explain the fundamentals of HIFU, evaluate the evidence concerning the role of HIFU in the treatment of prostate cancer (PC), review the technologies used to perform HIFU and the published clinical literature regarding the procedure as a primary treatment for PC. Material/Methods Studies addressing HIFU in localized PC were identified in a search of internet scientific databases. The analysis of outcomes was limited to journal articles written in English and published between 2000 and 2013. Results HIFU is a non-invasive approach that uses a precisely delivered ultrasound energy to achieve tumor cell necrosis without radiation or surgical excision. In current urological oncology, HIFU is used clinically in the treatment of PC. Clinical research on HIFU therapy for localized PC began in the 1990s, and the majority of PC patients were treated with the Ablatherm device. Conclusions HIFU treatment for localized PC can be considered as an alternative minimally invasive therapeutic modality for patients who are not candidates for radical prostatectomy. Patients with lower pre-HIFU PSA level and favourable pathologic Gleason score seem to present better oncologic outcomes. Future advances in technology and safety will undoubtedly expand the HIFU role in this indication as more of patient series are published, with a longer follow-up period.

Radiation doses in chest, abdomen and pelvis CT procedures

Computed tomography (CT) scanning is recognised as a high-radiation dose modality and estimated to be 17 % of the radiological procedure and responsible for 70 % of medical radiation exposure. Although diagnostic X rays provide great benefits, their use involves some risk for developing cancer. The objectives of this study are to estimate radiation doses during chest, abdomen and pelvis CT. A total of 51 patients were examined for the evaluation of metastasis of a diagnosed primary tumour during 4 months. A calibrated CT machine from Siemens 64 slice was used. The mean age was 48.0 ± 18.6 y. The mean patient weight was 73.8 ± 16.1 kg. The mean dose-length product was 1493.8 ± 392.1 mGy cm, Volume CT dose index (CTDI vol) was 22.94 ± 5.64 mGy and the mean effective dose was 22.4 ± 5.9 mSv per procedure. The radiation dose per procedure was higher as compared with previous studies. Therefore, the optimisation of patients radiation doses is required in order to reduce the radiation risk.

Patient radiation biological risk in computed tomography angiography procedure

Computed tomography angiography (CTA) has become the most valuable imaging modality for the diagnosis of blood vessel diseases; however, patients are exposed to high radiation doses and the probability of cancer and other biological effects is increased. The objectives of this study were to measure the patient radiation dose during a CTA procedure and to estimate the radiation dose and biological effects. The study was conducted in two radiology departments equipped with 64-slice CT machines (Aquilion) calibrated according to international protocols. A total of 152 patients underwent brain, lower limb, chest, abdomen, and pelvis examinations. The effective radiation dose was estimated using ImPACT scan software. Cancer and biological risks were estimated using the International Commission on Radiological Protection (ICRP) conversion factors. The mean patient dose value per procedure (dose length product [DLP], mGy·cm) for all examinations was 437.8 ± 166, 568.8 ± 194, 516.0 ± 228, 581.8 ± 175, and 1082.9 ± 290 for the lower limbs, pelvis, abdomen, chest, and cerebral, respectively. The lens of the eye, uterus, and ovaries received high radiation doses compared to thyroid and testis. The overall patient risk per CTA procedure ranged between 15 and 36 cancer risks per 1 million procedures. Patient risk from CTA procedures is high during neck and abdomen procedures. Special concern should be provided to the lens of the eye and thyroid during brain CTA procedures. Patient dose reduction is an important consideration; thus, staff should optimize the radiation dose during CTA procedures.

Carbon nanotubes buckypaper radiation studies for medical physics applications.

Graphite ion chambers and semiconductor diode detectors have been used to make measurements in phantoms but these active devices represent a clear disadvantage when considered for in vivo dosimetry. In such circumstance, dosimeters with atomic number similar to human tissue are needed. Carbon nanotubes have properties that potentially meet the demand, requiring low voltage in active devices and an atomic number similar to adipose tissue. In this study, single-wall carbon nanotubes (SWCNTs) buckypaper has been used to measure the beta particle dose deposited from a strontium-90 source, the medium displaying thermoluminescence at potentially useful sensitivity. As an example, the samples show a clear response for a dose of 2Gy. This finding suggests that carbon nanotubes can be used as a passive dosimeter specifically for the high levels of radiation exposures used in radiation therapy. Furthermore, the finding points towards further potential applications such as for space radiation measurements, not least because the medium satisfies a demand for light but strong materials of minimal capacitance.

Radiation exposure during paediatric CT in Sudan: CT dose, organ and effective doses

The purpose of this study was to assess the magnitude of radiation exposure during paediatric CT in Sudanese hospitals. Doses were determined from CT acquisition parameters using CT-Expo 2.1 dosimetry software. Doses were evaluated for three patient ages (0-1, 1-5 and 5-10 y) and two common procedures (head and abdomen). For children aged 0-1 y, volume CT air kerma index (Cvol), air Kerma-length product and effective dose (E) values were 19.1 mGy, 265 mGy.cm and 3.1 mSv, respectively, at head CT and those at abdominal CT were 8.8 mGy, 242 mGy.cm and 7.7 mSv, respectively. Those for children aged 1-5 y were 22.5 mGy, 305 mGy.cm and 1.1 mSv, respectively, at head CT and 12.6 mGy, 317 mGy.cm, and 5.1 mSv, respectively, at abdominal CT. Dose values and variations were comparable with those reported in the literature. Organ equivalent doses vary from 7.5 to 11.6 mSv for testes, from 9.0 to 10.0 mSv for ovaries and from 11.1 to 14.3 mSv for uterus in abdominal CT. The results are useful for dose optimisation and derivation of national diagnostic reference levels.

Tailor-made Ge-doped silica-glass for clinical diagnostic X-ray dosimetry

In the modern clinical practice of diagnostic radiology there is a growing demand for radiation dosimetry, it also being recognized that with increasing use of X-ray examinations additional population dose will result, accompanied by an additional albeit low potential for genetic consequences. At the doses typical of diagnostic radiology there is also a low statistical risk for cancer induction; in adhering to best practice, to be also implied is a low but non-negligible potential for deterministic sensitive organ responses, including in regard to the skin and eyes. Risk reduction is important, in line with the principle of ALARP, both in regard to staff and patients alike; for the latter modern practice is usually guided by Dose Reference Levels (DRL) while for the former and members of the public, legislated controls (supported by safe working practices) pertain. As such, effective, reliable and accurate means of dosimetry are required in support of these actions. Recent studies have shown that Ge-doped-silica glass fibres offer several advantages over the well-established phosphor-based TL dosimeters (TLD), including excellent sensitivity at diagnostic doses as demonstrated herein, low fading, good reproducibility and re-usability, as well as representing a water impervious, robust dosimetric system. In addition, these silica-based fibres show good linearity over a wide dynamic range of dose and dose-rate and are directionally independent. In the present study, we investigate tailor made doped-silica glass thermoluminescence (TL) for applications in medical diagnostic imaging dosimetry. The aim is to develop a dosimeter of sensitivity greater than that of the commonly used LiF (Mg,Ti) phosphor. We examine the ability of such doped glass media to detect the typically low levels of radiation in diagnostic applications (from fractions of a mGy through to several mGy or more), including, mammography and dental radiology, use being made of x-ray tubes located at the Royal Surrey County Hospital. We further examine dose-linearity, energy response and fading.

Radiation exposure in pediatric patients during micturating cystourethrography procedures.

The objectives of this study were to measure the entrance surface air kerma (ESAK) and the effective doses in pediatric patients undergoing micturating cystourethrography (MCU) procedures. The ESAK was determined using calibrated thermoluminescent dosimeters (TLD- GR 200 A) in 167 pediatric patients. The patient population was categorized into three groups according to age (0-5 years (group 1), 6-10 years (group 2) and 11-15 years (group 3)). The mean ESAK±SD and range (mGy) resulting from a MCU procedure was estimated to be 2.2±0.5 (0.8-9.2), 2.48±0.6 (0.9-8.1) and 3.90±0.6 (1.1-10.3) for group 1, 2 and 3, respectively. The mean effective dose was between 0.03 and 0.4 mSv per procedure for the pediatric population. Pediatric patients were exposed to avoidable radiation doses because no gonad shields were used.

Preliminary monte carlo study of 18 F-FDG SPECT imaging with LaBr 3 :Ce Crystal-based Gamma Cameras

The utility of 18F-deoxyglucose (18F-FDG) in oncology, cardiology, and neurology has generated great interest in a more economical ways of imaging 18F-FDG than conventional PET scanners. The main thrust of this work is to investigate the potential use of LaBr3:Ce materials in a low-cost FDG-SPECT system compared to NaI(Tl) using GATE Monte Carlo simulation. System performance at 140 keV and 511 keV was assessed using energy spectra, system sensitivity and count rate performance. Comparison of the LaBr3:Ce and NaI(Tl) crystal-based systems showed 4.5% and 8.9% higher system sensitivity for the LaBr3:Ce at 140 keV and 511 keV, respectively. The LaBr3:Ce scintillator significantly improves intrinsic count rate performance due to its fast decay time with respect to NaI(Tl). In conclusion, because LaBr3:Ce crystal combines excellent intrinsic count rate performance with slightly increased system sensitivity, it has the potential to be used for 18F-FDG -SPECT systems.

The impact of the extensive use of phosphate fertilizers on radioactivity levels in farm soil and vegetables in Tanzania

Soil and vegetables grown in Iringa rural in Tanzania were analysed for radioactivity associated with the use of phosphate fertilizer in farming. The activity concentrations of 226Ra, 228Ra and 40K were determined using gamma spectrometry of Tanzania Atomic Energy Commission, Arusha. Higher activity concentrations of 226Ra and 228Ra in both types of samples were found in samples from fertilized farms than in samples from control. Hence, regular monitoring of radioactivity level in farm soils and agricultural products is recommended.