Nerve blocks are excellent adjuncts to multimodal systemic analgesia in patients needing complex pain management, often producing days, weeks, or months of pain-free periods. Pain often debilitates patients with significant disruption to quality of life. Intercostal nerve injection and ablations are very useful procedures in patients suffering from pain caused by trauma, tumour, or inflammation. Traditionally done using anatomical landmarks, these procedures have been associated with a higher rate of complications. When imaging modalities (such as ultrasonography or computed tomography (CT)) are used for guidance, complications are significantly reduced, ensuring better outcomes in these vulnerable patients. A variety of other regional techniques can also be used as alternatives to intercostal nerve block such as epidural, paravertebral, erector spinae plane blocks, anterolateral and anteromedial chest wall plane blocks. Interventions for intercostal neuralgia are relatively easy to perform under imaging guidance, with reliable results and fewer complications.
Improvements in cancer survival have led to more patients requiring radiotherapy within or near previously irradiated regions. Despite advances in diagnostic imaging, image guidance and highly conformal delivery techniques, reirradiation remains complex because of uncertainties in radiobiology, tissue recovery, dose summation and cumulative organ-at-risk tolerance. We implemented a multidisciplinary workflow to support safe and reproducible reirradiation practice in an Australian radiation oncology department. The pathway defines the roles of radiation oncologists, radiation therapists and radiation oncology medical physicists and integrates biological dose conversion, dose summation strategy selection, tissue recovery assumptions, independent verification and documentation of uncertainty. This article describes the rationale, operational steps and early experience in our department, providing a practical framework for clinical implementation and future audit.
INTRODUCTION:Offline adaptive replanning is an appealing strategy in cervical cancer external beam radiotherapy (EBRT) to account for tumour shrinkage. It remains unclear whether volume reduction with adaptation improves geometric coverage in the presence of daily pelvic variation. This study evaluated the volumetric and geometric impact of offline EBRT adaptation in this setting. METHODS:Seventeen patients who completed definitive radio(chemo)therapy and brachytherapy were retrospectively assessed. An MRI in the last 2 weeks of EBRT was used to generate adaptive targets and organs at risk, which were compared with original volumes for changes in gross tumour volume (GTV), internal target volume (ITV) and planning target volume (PTV). Geometric coverage by the low-risk ITV (ITV-T-LR) and PTV was assessed on 128 cone-beam CTs. RESULTS:The mean GTV regressed by 47.9% (p = 0.0101), corresponding to a 24.2% reduction in ITV-T-LR (p = 0.0038) and a 10% reduction in PTV (p = 0.0011). Despite this, offline adaptation reduced ITV-T-LR coverage from 75% with the original volumes to 59% (p = 0.024). A 5 mm PTV margin increased coverage to 96% for the original plan and 77% for the adapted plan. On multivariable analysis, each 1% increase in on-treatment bladder volume relative to simulation was associated with a 1.3% increase in odds of anterior ITV-T-LR coverage (p = 0.0279) but a 0.7% decrease in odds of posterior coverage (p = 0.0017). CONCLUSIONS:The offline adaptation approach used in this study reduced tumour and target volumes for this patient cohort, but worsened geometric target coverage, failing to compensate for daily pelvic anatomical variation. These findings raise concerns about the suitability of offline adaptation for cervical cancer EBRT.
PURPOSE:Spinal metastases are a common complication of advanced malignancy and can result in significant pain, neurological dysfunction, and reduced quality of life. In patients with oligometastatic disease, stereotactic ablative body radiation therapy (SABR) offers the potential for durable local control. This study reports outcomes following spinal SABR at Waikato Hospital and compares these with published literature. METHODS:A retrospective single-centre cohort study was conducted of patients with oligometastatic spinal metastases treated with SABR at Waikato Hospital between September 2019 and December 2023. Patient, tumour, and treatment characteristics were collected from electronic records. The primary outcome was freedom from local failure. Overall survival and adverse events were also assessed. RESULTS:Twenty-seven patients received 30 courses of spinal SABR. Median age was 66 years (range 37-81), 74.1% were male, and prostate cancer was the most common primary malignancy (48.1%). Metachronous oligorecurrent disease was present in 53.3% of patients. Patients received either 24 Gy in 2 fractions (60.0%) or 35 Gy in 5 fractions (40.0%). Median follow-up was 29.7 months. No failures occurred within 12 months. Freedom from local progression was 95.2% (95% CI 86.6-100) at 18 months and 77.6% (95% CI 57.3-100) at 3 years. Overall survival was 88.9% (95% CI 77.8-100) at 1 year and 66.3% (95% CI 49.5-88.9) at 3 years. Vertebral compression fractures occurred in 13.8% of treated sites. CONCLUSION:This study provides important outcome data from a New Zealand tertiary centre and demonstrates the feasibility of spinal SABR, with outcomes which are broadly consistent with those reported internationally.
OBJECTIVE:To systematically evaluate the effects of music therapy on physiological indicators and psychological states in patients undergoing large medical imaging examinations, providing evidence-based support for clinical auxiliary interventions. METHODS:A comprehensive literature search was conducted across English and Chinese databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Database, and VIP Database, from inception to May 2026. RCTs investigating music therapy interventions in patients undergoing medical imaging examinations were collected. Two independent reviewers performed literature screening, data extraction, and quality assessment. A meta-analysis was conducted on outcome indicators including heart rate, anxiety scores, depression scores, and examination cooperation rate. Heterogeneity among studies was evaluated using the I2 statistic. RESULTS:A total of 9 RCTs were included. The meta-analysis results demonstrated that music therapy significantly reduced patients' heart rates, with a pooled mean difference (MD) of -2.14 (95% CI: -2.21, -2.08; p < 0.05). It also significantly alleviated anxiety levels, with a pooled SMD of -1.43 (95% CI: -1.49, -1.38; p < 0.05). The analysis of depression scores indicated no statistically significant difference between the two groups (SMD = 0.11, 95% CI: -0.62, 0.84; p = 0.77). The analysis of examination cooperation rates showed that music therapy improved the examination cooperation rate, with a pooled risk ratio (RR) of 1.34 (95% CI: 1.28, 1.40; p < 0.05). High heterogeneity was observed in certain outcome indicators. CONCLUSION:Music therapy can, to a certain extent, improve the physiological and psychological states of patients undergoing medical imaging examinations, as manifested by reduced heart rates, alleviated anxiety, and an increased examination cooperation rate. However, its efficacy in improving depressive states remains unclear. Given the high heterogeneity in some analytical results, further large-sample, high-quality RCTs are required for verification.
OBJECTIVE:To evaluate the 12-month symptom relief rate of super-selective haemorrhoidal artery embolisation (HAE) for Grade I-IV internal haemorrhoids and analyse the impact of haemorrhoid grading and embolisation site on treatment efficacy. METHODS:A retrospective analysis was conducted on 32 patients with internal haemorrhoids who underwent HAE at the Interventional Radiology Department of The Second Affiliated Hospital of Soochow University between April 2020 and January 2025. Efficacy was assessed using Visual Analogue Scale (VAS) and French Bleeding Scale (FBS) scores at 1, 3, 6, and 12 months postoperatively. RESULTS:The clinical success rate at 1 month post-procedure (defined as clinical success: ≥ 50% reduction in VAS or FBS from baseline without requiring any reintervention during follow-up) was 87.5% (28/32). The rates at 3 months, 6 months, and 12 months were 68.8% (22/32), 59.4% (19/32), and 56.2% (18/32). The VAS score decreased from 4.25 ± 1.08 preoperatively to 3.53 ± 1.39 at 1 month postoperatively (p < 0.001), rising to 3.72 ± 1.46 at 12 months postoperatively (p < 0.001). The FBS score decreased from 6.09 ± 1.84 preoperatively to 2.06 ± 1.41 at 1 month postoperatively (p < 0.001), and rebounded to 3.84 ± 2.10 at 12 months postoperatively (p < 0.001). The 12-month efficacy rate remained at 100% for Grade I haemorrhoids, 54.5% for Grade II, 50% for Grade III, and 40% for Grade IV. Minor complications occurred in 9.4% of patients, all resolving without intervention. CONCLUSION:HAE demonstrates reliable short-term efficacy for bleeding from Grade I-III internal haemorrhoids. As follow-up duration increases and severity grades rise, symptom relief rates gradually decline. The procedure is safe and reproducible, serving as an alternative minimally invasive option for patients unwilling or unable to undergo excision for Grade I-III internal haemorrhoids. However, patients should be informed of the recurrence risk, and long-term efficacy requires further investigation.
INTRODUCTION:Dynamic Single Photon Emission Computed Tomography (dynSPECT) is an advanced functional imaging modality that enables estimation of temporal changes in radiopharmaceutical distribution and physiological function. While dynSPECT has been employed in several clinical applications, it has not been widely applied to liver imaging. This review aims to investigate the role and effectiveness of dynSPECT in assessing hepatic function. METHODS:Following PRISMA guidelines, literature searches were conducted in MEDLINE, PubMed, Scopus, Embase, IEEE, and Web of Science, including all publications available up to December 2025 that assessed liver function using dynSPECT imaging, standard laboratory function tests and clinical scoring systems. Search results were screened by two authors. Included studies were assessed for bias using the QUADAS-2 quality assessment test tool. RESULTS:Sixteen eligible studies were incorporated in this review, involving 715 participants, of whom 87% (624) had hepatic diseases. Meta-analysis revealed correlations between dynSPECT measures of liver function and the laboratory tests, including Hepaplastin (r = 0.5471; 95% CI: 0.4523 to 0.6418), Indocyanine Green (ICG) (r = -0.461; 95% CI: -0.831 to -0.081), and Bilirubin (r = -0.425; 95% CI: -0.714 to -0.14). Furthermore, the comparison between the two dynSPECT parameters and clinical scoring systems, including the Child-Pugh score, MELD, and the histologic activity index (HAI), has a significant effect on liver disease assessment, with a combined p-value < 0.001. CONCLUSION:DynSPECT is a useful tool for the assessment of liver function in patients with hepatic dysfunction, providing results comparable to clinical laboratory function tests and scoring systems.
BACKGROUND:Differentiating transition zone (TZ) prostate cancer (PCa) from benign prostatic hyperplasia (BPH) on multiparametric MRI is challenging. The comparative performance of synthetic MRI (Sy-MRI) and apparent diffusion coefficient (ADC) for this task is unclear. PURPOSE:To evaluate the utility of Sy-MRI parameters and ADC in distinguishing TZ PCa from BPH. MATERIALS AND METHODS:This retrospective study included 261 patients (89 PCa, 172 BPH) who underwent preoperative MRI (including DWI and Sy-MRI). Two independent radiologists, who did not have access to the histopathological diagnosis and clinical data, placed regions of interest (ROIs) by manually tracing the lesion margins at the largest cross-sectional area of the lesion on the ADC map to record the ADC values. On synthetic T1-mapping, T2-mapping and proton density (PD) maps, ROIs of comparable size were placed at the same level and in a corresponding location to record T1, T2 and PD values. Parameters were compared using the t-test or Mann-Whitney U test. Diagnostic performance was assessed with ROC analysis and the DeLong test. RESULTS:T1, T2 and ADC values were significantly lower in PCa than in BPH (all p ≤ 0.001), while PD showed no difference (p = 0.073). ADC yielded the highest diagnostic performance (AUC, 0.996 [95% CI: 0.992, 1]), which was significantly higher than that of T1 (AUC, 0.928 [95% CI: 0.893, 0.964]) and T2 (AUC, 0.907 [95% CI: 0.868, 0.947]) (both p < 0.001). CONCLUSION:Sy-MRI-derived T1 and T2 values can help differentiate PCa from BPH in the TZ; however, ADC remains the superior diagnostic performance within this enriched cohort of predominantly intermediate- to high-risk tumours.
ABSTRACT Background Sarcoidosis is a multisystem granulomatous disease that commonly affects the lungs and intrathoracic lymph nodes. On imaging, characteristic patterns of lymphadenopathy, such as the lambda sign on fluorodeoxyglucose positron emission tomography (FDG PET), are considered suggestive of the disease and can assist in differentiating sarcoidosis from differential diagnoses. FDG PET/CT is increasingly used to assess disease extent, identify extrapulmonary involvement, guide biopsy and monitor inflammatory activity. The prevalence and imaging characteristics of the lambda sign and periportal/portocaval lymphadenopathy, termed the 1–2–3‐4 sign on FDG PET/CT in sarcoidosis, remain poorly defined. Methods A retrospective cohort study was performed of patients with sarcoidosis who underwent FDG PET/CT imaging at a tertiary centre in 2019. PET studies were assessed for the presence of the lambda sign and for FDG‐avid periportal and/or portocaval lymph nodes. The frequency of the lambda and 1–2–3‐4 sign, nodal distribution, and metabolic activity were analysed, including maximum standardised uptake values (SUVmax). Results The lambda sign was identified in a substantial proportion of patients. FDG‐avid periportal and/or portocaval lymph nodes were observed in a subset of cases, although only one patient demonstrated the complete 1–2–3‐4 sign. Periportal and portocaval nodes showed FDG uptake comparable to intrathoracic nodal disease. Conclusion FDG‐avid periportal and portocaval lymphadenopathy may occur alongside classic intrathoracic nodal patterns in sarcoidosis, although the complete 1–2–3‐4 sign appears uncommon. Recognition of this imaging pattern on FDG PET/CT may support diagnostic confidence in appropriate clinical contexts and help differentiate sarcoidosis from alternative causes of mediastinal and abdominal lymphadenopathy.
BACKGROUND:Vascular malformations (VMs) are congenital anomalies that often cause pain, swelling, disfigurement, and functional impairment. Conventional sclerotherapy, though widely used, typically requires multiple sessions and may yield incomplete resolution. Bleomycin-Electrosclerotherapy (BEST) and Bleomycin-Electroperfusiontherapy (BEPT) combine bleomycin with reversible electroporation to enhance endothelial uptake, potentially improving outcomes. METHODS:We conducted a retrospective cohort study (January 2024-August 2025) at Christchurch Hospital of 27 patients (40 procedures) with clinically and radiologically confirmed vascular malformations, where bleomycin had been administered percutaneously, intra-arterially or intravenously, followed by electroporation using the IGEA Cliniporator VITAE. Primary outcome was clinical improvement assessed by GAIS. Secondary outcomes included VAS pain scores, number of treatments, complication rates and subgroup analyses. This study is reported in accordance with the STROBE statement for observational studies. RESULTS:The cohort included venous (40.7%), lymphatic (18.5%), venolymphatic (7.4%) and glomovenous malformations (11.1%), intramuscular fast-flow vascular anomaly (3.7%), Klippel-Trenaunay spectrum (3.7%), FAVA (3.7%) and arteriovenous malformations (11.1%). Clinical improvement (GAIS 1-3) was observed in 24/27 patients (88.9%; 95% CI 71.9%-96.1%). Exceptional improvement or resolution (GAIS 1) was achieved in 37.0% and partial improvement (GAIS 2-3) in 51.9%, after a mean of 1.48 sessions. Mean VAS score improved from 6.3 to 2.4 (p < 0.001; Cohen's d = 1.68). Subgroup analysis demonstrated a 100% improvement rate in treatment-naïve patients (n = 7; 95% CI 64.6-100%) and in lymphatic malformations (n = 5; 95% CI 56.6%-100%); both subgroups were small and the wide confidence intervals preclude definitive conclusions. Adverse events included transient sensory nerve loss (18.5%), hyperpigmentation (44.4%) and localised necrosis in intraoral lesions (11.1%), all resolving except for 1 case of permanent hyperpigmentation. No systemic toxicity occurred. CONCLUSION:BEST and BEPT are effective adjuncts for vascular malformations, reducing treatment burden compared to conventional sclerotherapy and showing particular promise in microcystic lymphatic malformations and selected high-flow AVMs. Larger multicentre studies with extended follow-up are warranted to confirm safety, efficacy, refine patient selection and optimise dosing.
Chest radiography (CXR) remains the most frequently performed imaging modality worldwide and serves as the first-line investigation for cardiopulmonary conditions. Despite its widespread use, interpretation is limited by the two-dimensional representation of three-dimensional anatomy, resulting in structural overlap and reduced lesion conspicuity. This review provides a structured, pattern-based approach to commonly overlooked regions on CXR, emphasizing key anatomical blind spots including the lung apices, pleura, trachea, lung bases, hila, mediastinum, retrocardiac region, thoracic skeleton, soft tissues, upper abdomen, and medical devices. Both perceptual and cognitive errors are highlighted, particularly satisfaction of search and under-recognition of subtle abnormalities.
BACKGROUND:When planning prostate radiotherapy, full bladder preparation is widely used to displace bowel and bladder from high-dose regions but is difficult to reproduce and can prolong workflows. METHODS:Twenty men with localised prostate cancer ± seminal vesicles underwent CT simulation with full and empty bladders. VMAT plans prescribing 60Gy in 20 fractions, with simultaneous integrated boost to 66Gy for Dominant intraprostatic lesions where indicated, were created on both datasets. Bladder, rectum, CTV and PTV were compared; dose-volume histogram (DVH) endpoints included V30 and V60. Paired t-tests (two-sided α = 0.05) were used to assess differences. RESULTS:Bladder volumes were significantly lower with the empty-bladder preparation (median 126.4 cm3; range 49.0-246.3; p < 0.001) versus full bladder (median 276.0 cm3; range 159.3-625.7). CTV volumes were comparable (empty 65.9 cm3 vs. full 62.8 cm3; p = 0.100). CTV dose was slightly reduced with empty bladder (60.0 Gy vs. 60.1 Gy; p < 0.001), a statistically significant but clinically negligible difference, while PTV coverage (D50%) remained similar (60.5 vs. 60.3 Gy; p = 0.365). Bladder V30 was higher with an empty bladder (26.9% vs. 20.7%; p < 0.001), while V60 was comparable (0.8% vs. 1.0%; p = 0.368). In contrast, rectal V30 was lower with an empty bladder (15.6% vs. 19.9%; p = 0.002), and V60 was low in both groups (0.1% vs. 0.4%; p = 0.077). CONCLUSIONS:Empty bladder planning maintained target coverage, increased bladder V30, and reduced rectal V30, with all other dose constraints satisfied. This approach may enhance comfort and efficiency without compromising dosimetry.
