Optimal Protocol for Contrast-enhanced Free-running 5D Whole-heart Coronary MR Angiography at 3T.

Free-running 5D whole-heart coronary MR angiography (MRA) is gaining in popularity because it reduces scanning complexity by removing the need for specific slice orientations, respiratory gating, or cardiac triggering. At 3T, a gradient echo (GRE) sequence is preferred in combination with contrast injection. However, neither the injection scheme of the gadolinium (Gd) contrast medium, the choice of the RF excitation angle, nor the dedicated image reconstruction parameters have been established for 3T GRE free-running 5D whole-heart coronary MRA. In this study, a Gd injection scheme, RF excitation angles of lipid-insensitive binominal off-resonance RF excitation (LIBRE) pulse for valid fat suppression and continuous data acquisition, and compressed-sensing reconstruction regularization parameters were optimized for contrast-enhanced free-running 5D whole-heart coronary MRA using a GRE sequence at 3T. Using this optimized protocol, contrast-enhanced free-running 5D whole-heart coronary MRA using a GRE sequence is feasible with good image quality at 3T

The Efficacy of a Bilateral Approach for Treating Lesions With Chronic Total Occlusions The CART (Controlled Antegrade and Retrograde subintimal Tracking) Registry

ObjectivesThe aim of this study was to evaluate the safety and feasibility of a new concept for chronic total occlusion (CTO) recanalization—using a bilateral approach that utilizes a Controlled Antegrade and Retrograde subintimal Tracking (CART) technique.BackgroundSuccessful percutaneous recanalization of coronary CTOs results in improved long-term outcomes. The recanalization of CTOs in native coronary arteries no doubt represents one of the most technically challenging of interventional procedures.MethodsA total of 224 consecutive patients (mean age 61 ± 9 years; 86.2% men) were enrolled in this prospective multicenter registry. This technique combines the simultaneous use of antegrade and retrograde approaches. A subintimal dissection is created in both antegrade and retrograde fashion, thereby limiting the extension of the subintimal dissection within the CTO portion.ResultsOf 224 CTO lesions (>3 months in duration) undergoing attempted recanalization using the CART technique, 145 cases (64.7%) had undergone previous CTO recanalization attempts. The success rates of crossing in a retrograde fashion with a wire and a balloon were 87.9% and 79.9%, respectively. The overall technical and procedural success rates achieved in this registry were 92.4% and 90.6%, respectively.ConclusionsA bilateral approach for CTO lesions using the CART technique is feasible, safe, and has a higher success rate than previous approaches. These results indicate that a bilateral technique can solve a major dilemma that commonly affects CTO procedures

Carbon Ion Therapy for Ocular Melanoma: Development of Dedicated Nozzles for Orthogonal Two-port Treatment

[Purpose] To realize the orthogonal two-port treatment to ocular melanoma using carbon-ion beam, we developed detachable dedicated nozzles on vertical and horizontal beam snout. [Methods] HIMAC doesn’t have the exclusive treatment room for eye irradiation because the number of patients with ocular melanoma is a very few for Japanese and HIMAC is only one facility to treat the ocular melanoma by particle beam in Japan, e.g. 10-15 patients/year in HIMAC. The patient is set on the treatment couch at spine position that is same position at CT scanning for treatment planning. The details of treatment planning are reported separately in this meeting. Nozzles for eye-irradiation are attached to the forefront of fixed vertical and horizontal beam snouts that are routinely used for general clinical purpose of carbon-ion radiotherapy. Nozzles were designed to be easy to detach with high reproducibility. A pair of patient collimator and compensator is set on the nozzle. When we take the x-ray image at BEV for patient positioning, the part of the nozzle is shifted aside to keep a large x-ray field. Setting conditions of these devices are checked automatically, and linked to the beam-interlock system. [Results] Weights of vertical and horizontal nozzle were 12.0kg and 16.0kg, respectively. It is easy to detach the nozzle on the fixed beam snout, and the reproducibility of setting position by repeated detaches was less than +- 0.2mm. Nozzle position is possible to verify at each irradiation by the flat-panel x-ray image of hair cross-wire inside the nozzle. [Conclusions] Since April 2001, we have started the carbon-ion therapy for ocular melanoma at single port with 140MeV/u. At October 2005 we developed the lateral nozzle for carbon-170Mev/u, and begun the orthogonal two-port treatment to ocular melanoma. Over 60 patients with eye melanoma had already been treated successfully, and 7 patients were treated with the orthogonal two-field.PTCOG4

Multi slice DENSE in a single breath hold

Displacement ENcoding with Stimulated Echoes (DENSE) is a method to acquire displacement maps of the myocardial motion. This can in turn be used to estimate strain which is an important measure of myocardial function. Previously, DENSE imaging has primarily been performed using multiple breath holds per slice, severely limiting its incorporation into the tight schedule of clinical routine. Strain maps are further desired throughout the left ventricle, not only in