Sonographie bei intrakorporalem Drogenschmuggel

Um die Bedeutung der Sonographie zur Erfassung inkorporierter Drogenpäckchen (»body-packs«) zu überprüfen, wurden nach Erarbeitung sonographisch-diagnostischer Kriterien im Wasserbad zehn Probanden zwischen 23 und 30 Jahren, die je vier »body-packs« geschluckt hatten, sonographisch untersucht. Die »body-packs« bestanden aus mit festgepreßter Glucose gefüllten Fingerlingen mit einem Durchmesser von 1,5-1,8 cm. Im Wasserbadversuch zeigte sich als Identifikationskriterium der »body-packs« ein sichelförmiger Reflex mit dorsaler Schallauslöschung. Aufgrund dieses Kriteriums konnten bei acht der zehn Probanden 23 der 40 »body-packs« im Magen identifiziert werden. Dabei ließen sich innerhalb der ersten drei Stunden nach Ingestion bei acht Probanden 22 »body-packs« und nach etwa 17 Stunden bei vier Probanden neun »body-packs« im Magen nachweisen; nur bei einem Probanden gelang der Nachweis von zwei »body-packs« im Dünn-Dickdarm-Bereich. Da in der Praxis des intrakorporalen Drogenschmuggels zum möglichen Untersuchungszeitpunkt fast immer »body-packs« im Magen vorhanden sind, kann ein breiter Einsatz des Ultraschalls im Screening des Drogenschmuggels empfohlen werden.To evaluate the place of ultrasonography in the detection of intracorporeal drug packets (body-packs) ten volunteers were examined by ultrasound after having swallowed four body-packs each. Diagnostic criteria had first been established by ultrasound imaging of body-packs in a water bath. The body-packs contained fingerstalls, 1.5-1.8 cm in diameter, filled with hard-pressed glucose. The criterion for identification in the water-bath was shown to be a sickle-shaped echo with a dorsal echo deficit. This sign identified 23 of the 40 body-packs in eight of the ten subjects. Within the first three hours of ingestion 22 body-packs were demonstrated in eight of the subjects; after 17 hours nine body-packs were identified in the stomach of four subjects. In only one subject was it possible to identify (two) body-packs in the region of the small-large intestine. In practice, intracorporeal drug smugglers will almost always have the body-packs in the stomach at the time of likely examination. Extensive ultrasound screening of suspected smugglers is, therefore, recommended

Screening of Illegal Intracorporeal Containers ("Body Packing"): Is Abdominal Radiography Sufficiently Accurate? : a Comparative Study with Low-Dose CT

Purpose: To evaluate the diagnostic performance of abdominal radiography in the detection of illegal intracorporeal containers (hereafter, packets), with low-dose computed tomography (CT) as the reference standard. Materials and Methods: This study was approved by the institutional ethical review board, with written informed consent. From July 2007 to July 2010, 330 people (296 men, 34 women; mean age, 32 years [range, 18-55 years]) suspected of having ingested drug packets underwent supine abdominal radiography and low-dose CT. The presence or absence of packets at abdominal radiography was reported, with low-dose CT as the reference standard. The density and number of packets (≤12 or <12) at low-dose CT were recorded and analyzed to determine whether those variables influence interpretation of results at abdominal radiography. Results: Packets were detected at low-dose CT in 53 (16%) suspects. Sensitivity of abdominal radiography for depiction of packets was 0.77 (41 of 53), and specificity was 0.96 (267 of 277). The packets appeared isoattenuated to the bowel contents at low-dose CT in 16 (30%) of the 53 suspects with positive results. Nineteen (36%) of the 53 suspects with positive low-dose CT results had fewer than 12 packets. Packets that were isoattenuated at low-dose CT and a low number of packets (≤12) were both significantly associated with false-negative results at abdominal radiography (P = .004 and P = .016, respectively). Conclusion: Abdominal radiography is mainly limited by low sensitivity when compared with low-dose CT in the screening of people suspected of carrying drug packets. Low-dose CT is an effective imaging alternative to abdominal radiography. © RSNA, 201

Recent advances in Surface Guided Radiation Therapy

The growing acceptance and recognition of Surface Guided Radiation Therapy (SGRT) as a promising imaging technique has supported its recent spread in a large number of radiation oncology facilities. Although this technology is not new, many aspects of it have only recently been exploited. This review focuses on the latest SGRT developments, both in the field of general clinical applications and special techniques. SGRT has a wide range of applications, including patient positioning with real-time feedback, patient monitoring throughout the treatment fraction, and motion management (as beam-gating in free-breathing or deep-inspiration breath-hold). Special radiotherapy modalities such as accelerated partial breast irradiation, particle radiotherapy, and pediatrics are the most recent SGRT developments. The fact that SGRT is nowadays used at various body sites has resulted in the need to adapt SGRT workflows to each body site. Current SGRT applications range from traditional breast irradiation, to thoracic, abdominal, or pelvic tumor sites, and include intracranial localizations. Following the latest SGRT applications and their specifications/requirements, a stricter quality assurance program needs to be ensured. Recent publications highlight the need to adapt quality assurance to the radiotherapy equipment type, SGRT technology, anatomic treatment sites, and clinical workflows, which results in a complex and extensive set of tests. Moreover, this review gives an outlook on the leading research trends. In particular, the potential to use deformable surfaces as motion surrogates, to use SGRT to detect anatomical variations along the treatment course, and to help in the establishment of personalized patient treatment (optimized margins and motion management strategies) are increasingly important research topics. SGRT is also emerging in the field of patient safety and integrates measures to reduce common radiotherapeutic risk events (e.g. facial and treatment accessories recognition). This review covers the latest clinical practices of SGRT and provides an outlook on potential applications of this imaging technique. It is intended to provide guidance for new users during the implementation, while triggering experienced users to further explore SGRT applications