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  • ISSN: 2333-7095
    Early Online
    Volume 6, Issue 1
    Review Article
    Guler Yavas* and Cagdas Yavas
    Grade 3 gliomas include 6–10 % of all newly diagnoses of primary brain tumors and comprise 6–15% of all primary brain tumors. Three histological subtypes are characterized: anaplastic astrocytoma (AA), anaplastic oligodendroglioma (AO) and anaplastic oligoastrocytoma (AOA). During the past decade, understanding of molecular and prognostic significance of genetic alterations in anaplastic gliomas (AG) has changed treatment strategies of these tumors, particularly for oligodendroglial subtype. The initial treatment for AG is maximal safe resection. The management after initial surgery of AG with 1p/19q codeletion includes radiotherapy (RT) and PCV (procarbazine, CCNU, vincristine) chemotherapy as established by EORTC 29651 and RTOG 9402 trials. The sequence of RT and chemotherapy has not been defined; therefore both neoadjuvant and adjuvant chemotherapy may be applied. The second treatment option is RT plus Temozolomide chemotherapy for 1p19q co-deleted tumors. The treatment of uni- or nondeleted AG is either RT only or primary alkylator-based chemotherapy only with deferred RT as determined in NOA-04. The combined therapy with radiation plus Temozolomide in patients with newly diagnosed AA patients is an alternative treatment option. We should await mature results from CATNON study to help determine whether use of concurrent Temozolomide during radiation, in addition to 12 cycles of adjuvant Temozolomide, provides increased benefit. There has been no standard therapy for patients with recurrent AG. At progression, the option of second surgery should be explored. Alkylating chemotherapy is the treatment of choice for most patients previously untreated with chemotherapy. Re-irradiation is another option for recurrent AG.
    Research Article
    Asare HK*
    Aim: To assess the extent to which x-ray request forms referred to the x-ray unit of the Tamale Central Hospital are filled by referring practitioners.
    Methods: 189 x-ray request forms were audited. The research was conducted between October 2017 and December 2017. Each request form was thoroughly assessed for completeness or adequate filling of information provided by referring practitioners. The components of information on the form included: patient demographic data, brief clinical history, date of requested examination, investigation required, x-ray serial numbers, and referring practitioner details (see appendix 1). The data was processed and analyzed with Microsoft excel 2013. The result is summarized in Table 1. The study received approval from the hospital's regional health directorate, and patient anonymity was ensured.
    Results: The x-ray serial number and previous serial number/ previous exams details fields in the request form were not filled at all in 100%. Also, 97% of referring practitioners did not fill-in their station/address.
    Significant number of the forms (31% and 39%) did not have the ages and wards of patients completed respectively.
    Furthermore, other fields were partly completed; brief clinical history 143 (76%), referring practitioner name 163 (86%), date of requested investigation 172 (91%), radiological investigation requested 186 (98%), patient's name 188 (1%).
    Conclusion: Practitioners who refer patients for x-ray at the Tamale Central Hospital do not thoroughly complete the request form. This emphasizes a need for the radiographers who review the x-ray request forms to engage the referrers in regular education to improve or change the habit. Aside, some fields of the request form may require update and revision.
    Suvendu Kumar Sahoo*, Kshitish Chandra Mishra, V. Sathish Kumar, Tapan Kumar Sahoo, Sanjib Kumar Mishra, and Rabinarayan Mukharjee
    The position of radiation isocenter is an important part in quality assurance checks of a medical linear accelerator (Linac). All radiotherapy treatment planning’s and their delivery are done by taking radiation isocenter as a reference point. This isocenter can shift when the gantry, collimator and patient couch do not move symmetrically with each other. In our study, the radiation isocenter verification was done by using a special therapeutic film with digital image processing by using special software. Image acquisition was done using scanning of radiation exposed film by 6 MV photon beam with star shot method. This star shaped beam was designed by the rotation of the collimator, gantry and couch individually. The consistency of position of radiation isocenter was checked five times within last one year randomly by rotation of gantry, collimator to the couch of the medical Linac which is being used since fourteen years for cancer treatment. The mean value throughout the year shows that the size (diameter) for rotational gantry is 0.46 mm, collimator is 0.42 mm and 0.48 mm for the couch. As per AAPM report 40, the size of the Linac radiation isocenter diameter used in this study is still in good agreement because the value of the radiation isocenter is less than 2 mm diameter.
    Case Report
    Francisco Aldo Rodrigues Junior*, Isabel Marlucia Lopes Moreira de Almeida, Rogerio de Araujo Medeiros, Ivo Lima Viana, Alexandre GabrielSilva Rego, Marina Nogueira Barbosa Rego, and Bruno Pinheiro Falcao
    Introduction: Congenital Midline Cervical Cleft (CMCC) is a rare congenital malformation characterized by a classic presentation. A typical case of CMCC is reported, reiterating the importance of imaging for an accurate diagnosis and adequate surgical planning.
    Case presentation: Newborn full term, at birth, a thin fusiform area was identified, located at the base of the anterior cervical region, in the midline, with a non-specific aspect, which may correspond to the congenital alteration. Doppler ultrasonography showed hypoechoic image, thin and apparently on blind bottom, measuring 0.8 x 0.2 cm. Nuclear magnetic resonance imaging identified a thin, low-signal area, located in the subcutaneous area, without areas of edema or associated fluid collections and no signs of extension to larynx / trachea, confirming the diagnosis of CMCC and excluding the presence of fistula.
    Conclusion: The CMCC has its diagnosis classically established through physical examination, although - in some cases - it may be inconclusive. Ultrasound is already used as a diagnostic modality in relation to other cervical abnormalities, besides being fundamental for the surgical planning, since it shows the relation of the injury with the adjacent structures. Magnetic resonance imaging is a useful modality to demonstrate the extent of the cleft, to determine other associated anomalies, and to plan surgical treatment for repair. The relevance of imaging tests to define the extent of the congenital defect and exclusion of differential diagnoses, minimizing complications, is reiterated.
    Special Issue on Head and Neck Imaging
    Review Article
    Toru Chikui1*, Masahiro Ohga2, Erina Kitamoto1, Tomoko Shiraishi3, Shintaro Kawano4, Takashi Yoshiura5 and Kazunori Yoshiura1
    Abstract: Diffusion Weighted Image (DWI) has various roles such as tissue characterization, the prediction and monitoring of the response to treatment and differentiation of recurrent tumors from post-therapeutic changes. The malignant tumors have a lower ADC compared to benign lesions. Follow-up of early response to cancer treatment is reflected in an ADC increase in the primary tumor and nodal metastases; whereas nonresponding lesions tend to reveal only a slight increase or even a decrease in ADC during follow-up. However, there are many limitations regarding the performance of DWI in the head and neck region, therefore, many attempts has been performed to overcome the flaws of the diffusion-weighted single-shot-echo planar imaging.
    The pharmacokinetic analyses of dynamic contrast enhanced MRI (DCE-MRI) can provide physiological condition of the tissue, and Tofts and Kermode Model has been applied to the head and neck region. Some researchers have used it for the prediction and monitoring of the tumor response to cancer therapy. The general consensus is that the early changes of these parameters during the early phase after the treatment are useful for the interpretation of the response to the treatment. However, the parameters reported in the literature vary considerably; therefore, it is difficult to compare the values of the parameters among research groups.
    Both DWI and the pharmacokinetic analysis of the DCE-MRI have shown a wide range of potential benefits in this region, but more comparative studies with established scan techniques and the quantification of the data are required.
    Tanaka R* and Hayashi T
    Abstract: Dual Energy or dual source Computed Tomography (DECT) is advantageous for clinical CT interpretation. Compared to conventional imaging, this technique enables tissue differentiation of tissues, such as kidney stones, with higher precision and has additional features such as automatic bone-, bone marrow-, and plaque removal and virtual non-contrast image generation. Moreover, DECT can potentially remove beam hardening artifacts and generate images as good as those acquired using monoenergetic high energy. This review includes studies on DECT dentomaxillofacial imaging and discusses potential applications of DECT in dentomaxillofacial imaging, focusing on monoenergetic imaging.
    Ariji Y*, Nakayama M, Nishiyama W and Ariji E
    Abstract: Sonographic elastography is a new technique for measurement of the tissue stiffness, and is currently under investigation for tissue characterization in several anatomic sites. This article introduces methodologies of sonographic elastography, and mentions the possibility of its application to oral and maxillofacial regions.
    Sonographic elastography seems to be suboptimal for salivary gland malignancies, because there are many pathological types, and overlap between pleomorphic adenoma and malignant tumors. As to cervical lymph nodes, most studies have documented promising results of high accuracy for malignancy, although further larger studies are required to validate these findings. Therefore, sonographic elastography may become a useful ancillary technique in the routine diagnostic work-up for lymph nodes in the near future. For the masseter muscle, sonographic elastography has a possibility for exploring the causes of muscle pain, understanding the state of the muscle, selecting therapeutic methods, and evaluating therapeutic effect.s
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