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        Prospective evaluation of fiducial marker placement quality and toxicity in liver CyberKnife stereotactic body radiotherapy

        Debnarayan Dutta,Kaushik Jagannath Kataki,Shibu George,Sruthi K,Reddy,Ajay Sashidharan,Rajesh Kannan,Ram Madhavan,Haridas Nair,Tushar Tatineni,Raghavendra Holla 대한방사선종양학회 2020 Radiation Oncology Journal Vol.38 No.4

        Background: Evaluate morbidities and “quality” of fiducial marker placement in primary liver tumours (hepatocellular carcinoma [HCC]) for CyberKnife. Materials and Methods: Thirty-six HCC with portal vein thrombosis (PVT) were evaluated for “quality” of fiducial placement, placement time, pain score, complications, recovery time and factors influencing placement. Results: One hundred eight fiducials were placed in 36 patients. Fiducial placement radiation oncologist score was “good” in 24 (67%), “fair” in 4 (11%), and “poor” in 3 (8%) patients. Concordance with radiologist score in “poor”, “fair”, and “good” score was 2/2 (100%), 4/5 (80%), and 24/27 (89%), respectively (p=0.001). Child-Pugh score (p=0.080), performance status (PS) (p=0.014) and accrued during “learning curve” (p=0.013) affected placement score. Mean placement time (p=0.055), recovery time (p=0.025) was longer and higher major complications (p=0.009) with poor PS. Liver segment involved (p=0.484) and the Barcelona Clinic Liver Cancer (BCLC) stage did not influence placement score. “Good” placement score was 30% in first cohort whereas 93% in last cohort (p=0.023). Time for placement was 42.2 and 14.3 minutes, respectively (p=0.069). Post-fiducial pain score 0-1 in 26 patients (72%) and pain score 3-4 was in 2 (6%). Five patients (14%) admitted in “day-care” (2 mild pneumothorax, 3 pain). Mortality in 1 patient (3%) admitted for hemothorax. Conclusion: Fiducial placement is safe and in experienced hands, “quality” of placement is “good” in majority. Major complications and admission after fiducial placement are rare. Complications, fiducial placement time, recovery time is more during the “learning curve”. Poor Child-Pugh score, extensive liver involvement, poor PS have higher probability of complications.

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        Musculoskeletal Applications of Elastography: a Pictorial Essay of Our Initial Experience

        Palle Lalitha,Balaji Reddy,K.Jagannath Reddy 대한영상의학회 2011 Korean Journal of Radiology Vol.12 No.3

        Elastography is an ultrasound-based newer imaging technique that is currently being used for the evaluation of breast lesions and hepatic pathology. It is also being evaluated for characterizing lesions of the prostate, thyroid, cervix and lymph nodes. We have applied real-time sonoelastography to a variety of musculoskeletal pathologies and here we report the findings of elastography for the evaluation of various musculoskeletal pathologies. Elastography of musculoskeletal lesions is not yet being routinely used in clinical practice, but it is being extensively researched.

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