Radiotherapy Process Integration Using A Compact Photon Source Together With Fluence Control And Patient Imaging

Process integration, combining diagnostic, simulation and therapy in a single instrument will overcome many limitations in cancer care. But it asks for a miniturization of the high energy photon source. Such effort could open unforeseen developments as mobile "global therapy" units. Parameter values for the photon source will be achieved with an X-band linac integrated with target and collimator as a shielded compact sub-unit. I. NEEDS AND OBJECTIVES A. The needs (user's point of view): The therapeutic treatment consists of 3 phases: diagnostic imaging, simulation of the dose delivery conditions, dose delivery. It is done today with 3 different instruments with inherent problems such as induced incompatibility of materials (today without standards) and difficulties in coordinating the phases into a coherent process. The use of multiple, independent systems creates an incoherence resulting in faults of treatment efficacy and safety, and a waste of time and discomfort for the patient...

Syndrome emphysème des sommets et fibrose pulmonaire des bases combinés (syndrome emphysème/fibrose) : aspects tomodensitométriques et fonctionnels

National audiencePurpose. To describe the high resolution CT (HRCT) imaging and functional features of the emphysema/fibrosis syndrome. Patients and methods. A total of 61 patients were included based on HRCT. We have quantified the extent of fibrosis and emphysema lesions and a combined score was calculated. The scores were correlated to pulmonary function test parameters and specific HRCT features were described. Results. The emphysema and fibrosis scores correlated with functional parameters of obstruction and restriction respectively. The combined score correlated with the reduction in DLCO and degree of pulmonary hypertension. Three HRCT patterns were identified : progressive transition (n = 23, 38%) with diffuse emphysema (centrilobular and/or bullous) and zone of transition between bullae and honeycombing ; paraseptal emphysema (n = 13, 21%) with predominent subpleural bullae of enlarging size at the bases ; separate processes (n = 14, 23%) with independent areas of fibrosis and emphysema. Eleven patients (18%) could not be classified. The HRCT imaging features changed based on TLC (p = 0.04) and FEV1/FVC (p = 0.01). Conclusion. The emphysema/fibrosis syndrome may be associated with different patterns on HRCT corresponding to specific profiles on pulmonary function tests.Objectifs. Décrire les aspects tomodensitométriques en haute résolution (TDM-HR) et fonctionnels associés au syndrome emphysème/fibrose. Patients et méthodes. Soixante et un patients ont été inclus sur la base de la TDM-HR. Nous avons quantifié l’extension des lésions de fibrose et d’emphysème et nous avons calculé un score combiné. Ces scores ont été corrélés aux paramètres fonctionnels puis les tableaux TDM-HR spécifiques de ce syndrome ont été décrits. Résultats. Les scores d’emphysème et de fibrose étaient corrélés avec les paramètres fonctionnels d’obstruction et de restriction, respectivement. Le score combiné était corrélé à la réduction de la DLCO et au niveau d’hypertension pulmonaire. Nous avons identifié trois tableaux TDM-HR : Transition progressive (n = 23, 38 %) consistant en l’association d’un emphysème diffus (centro-lobulaire et/ou bulleux) et la présence d’une zone de transition entre les bulles et le rayon de miel ; Emphysème para-septal (n = 13, 21 %) consistant en des bulles sous pleurales prédominantes augmentant de taille dans les bases pulmonaires ; Entités séparées (n = 14, 23 %) où la fibrose et l’emphysème n’avaient pas de relation topographique. Onze patients (18 %) ne pouvaient être classés. Les présentations TDM-HR différaient en fonction de la CPT (p = 0,04) et du rapport VEMS/CVF (p = 0,01). Conclusion. Le syndrome emphysème/fibrose peut réaliser des tableaux TDM-HR distincts qui sont associés à des profils fonctionnels spécifiques

European registry of babies born to mothers with antiphospholipid syndrome.

OBJECTIVE:This study aimed to describe the long-term outcome and immunological status of children born to mothers with antiphospholipid syndrome, to determine the factors responsible for childhood abnormalities, and to correlate the child's immunological profile with their mothers. METHODS: A prospective follow-up of a European multicentre cohort was conducted. The follow-up consisted of clinical examination, growth data, neurodevelopmental milestones and antiphospholipid antibodies (APL) screening. Children were examined at 3, 9, 24 months and 5 years. RESULTS: 134 children were analysed (female sex in 65 cases, birth weight 3000\ub1500 g, height 48\ub13 cm). Sixteen per cent had a preterm birth (<37 weeks; n=22), and 14% weighted less than 2500 g at birth (n=19). Neonatal complications were noted in 18 cases (13%), with five infections (4%). During the 5-year follow-up, no thrombosis or systemic lupus erythematosus (SLE) was noted. Four children displayed behavioural abnormalities, which consisted of autism, hyperactive behaviour, feeding disorder with language delay and axial hypotony with psychomotor delay. At birth lupus anticoagulant was present in four (4%), anticardiolipin antibodies (ACL) IgG in 18 (16%), anti-\u3b2(2) glycoprotein-I (anti-\u3b22GPI) IgG/M in 16 (15%) and three (3%), respectively. ACL IgG and anti-\u3b22GPI disappeared at 6 months in nine (17%) and nine (18%), whereas APL persisted in 10% of children. ACL and anti-\u3b22GPI IgG were correlated with the same mother's antibodies before 6 months of age (p<0.05). CONCLUSION: Despite the presence of APL in children, thrombosis or SLE were not observed. The presence of neurodevelopmental abnormalities seems to be more important in these children, and could justify long-term follow-up