Quality assurance of simultaneous treatment of two targets in pelvic region planned with single isocenter using three dimensional conformal radiotherapy (3DCRT) technique

Purpose: The purpose of this study was to conduct quality assurance of a three dimensional conformal radiotherapy (3DCRT) of two targets in pelvis region planned with single isocenter technique. Methods: A treatment plan was generated with two identical water phantoms with ionization chamber (IC) sleeves (IC-1 & IC-2), simulated as if targets are in pelvis region, simultaneously irradiated with single isocenter technique with a dose prescription of 300 cGy for point dose verification. A two dimensional ion chamber array detector was used for fluence verification.Results: Calculated minimum, mean and maximum dose (in cGy) for IC-1 & IC-2 were 295, 303 and 307 as per dose volume histogram. The global dose maximum was found to be 307.4 cGy. Measured point doses to both lesions were within ±2.5% of the computed dose. A pass percentage of 97% was obtained with the set of criteria 3 mm distance to agreement and 3% dose difference for fluence verification.Conclusion: Treatment execution of two targets simultaneously with single isocenter can reduce positional errors and delivery time

Left Main Coronary Artery Disease: Current Updates on CABG versus PCI

Most patients of LMCA disease are symptomatic and at high risk of cardiovascular (CV) events, since occlusion compromises flow, and it is associated with >20% mortality at 1 year. Coronary artery by-pass graft (CABG) is the main mode of revascularization procedure for significant left-main coronary artery (LMCA) disease unless contraindicated or unsuitable for surgery, and in patients with complex coronary anatomy. Percutaneous coronary intervention (PCI) of left-main (LM) is emerging as an alternative to CABG especially in patients with low syntax score with suitable coronary anatomy for PCI, and life-saving emergency situations like acute coronary syndrome (ACS) with hemodynamically unstable, and high risk group patients who are unsuitable coronary anatomy for grafting or due to associated co-morbidities

Experience of stenting in the left main coronary artery using optical coherence tomography: A case-series

Over the past decade, optical coherence tomography (OCT) imaging, with its high spatial resolution, has emerged as useful tool for planning percutaneous coronary intervention (PCI) and optimizing stent deployment, particularly in patients with complex lesions. However, there are limited reports of OCT-guided stent implantation in patients with left main coronary artery (LMCA) disease. Here, we present three cases of frequency-domain OCT-guided stenting in complex LMCA lesions, performed at our institute. The procedures were successful in all three cases. We opine that OCT-guided PCI could be a good alternative to coronary artery bypass grafting in patients with LMCA stenosis

A Challenging Case of Bifurcation Lesion in Left Anterior Descending Artery: Managed Successfully with Everolimus-Eluting Bioresorbable Vascular Scaffold and Kissing Balloon Technique under Optical Coherence Tomography Guidance

A 54-year-old Indian male patient was presented to our hospital with the complaints of chest pain since 1-day prior to admission. He was diagnosed, elsewhere, with anterior-wall myocardial infarction and was treated with tenecteplase. Subsequently, he was referred to us for the management of postinfarction angina. He was a known case of hypertension and had no family history of coronary artery disease. Echocardiogram demonstrated hypokinesia of anterolateral wall with normal left ventricular function. Angiography revealed a single vessel disease-99% stenosis in the mid-segment of left anterior descending (LAD) coronary artery with significant narrowing at the proximal site of diagonal 1 (D1) branch. An optical coherence tomography-guided percutaneous coronary intervention to the LAD-D1 bifurcation lesion was performed successfully using ABSORB bioresorbable vascular scaffold (Abbott Vascular, USA) and kissing balloon angioplasty. No postprocedural complication was observed and the patient was discharged the next day. Clinical evaluation at 1-year follow-up was satisfactory

Mechanical properties of jute polyester composites.13;

The tensile, flexural and impact properties of unidirectional and bidirectional laminates of jute fiber-polyester composites and the mechanical properties of glass-jute-polyester composites are reported. The effects of lignin coating, uni- and bidirectional reinforcement and the addition of glass fiber on the properties of the composites are discussed

Evaluation of Jute as a Reinforcement in Composites

87-92<span style="font-size:11.0pt;line-height:115%; font-family:" calibri","sans-serif";mso-ascii-theme-font:minor-latin;mso-fareast-font-family:="" "times="" new="" roman";mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:="" minor-latin;mso-bidi-font-family:"times="" roman";mso-ansi-language:en-us;="" mso-fareast-language:en-us;mso-bidi-language:ar-sa"="">A detailed evaluation of jute fibres for use in polymer composites has been made. The mechanical properties, thermal stability, moisture absorption and resin consumption of jute fibres have been studied. Methods for reducing moisture absorption and resin consumption are reported.</span

Bioresorbable vascular scaffolds for LMCA with double vessel disease under IVUS guidance

An 80-year-old male patient, presented with chest pain. ECG showed ST elevation in leads V2 to V4 and T wave inversion in leads V2-V6. Check angiogram revealed ostial LMCA 70% lesion & mid-LAD 90% lesion and LCX proximal 80% lesion. Predilatation of LMCA lesion was done with 2.0 × 12 mm NC Trek balloon and the LAD lesion with 2.0 × 12 mm and 2.5 × 08 mm (NC Trek balloons). Prestenting IVUS (Intravascular ultrasound) was done with Atlantis SR pro 40 MHz 3.6Fr catheter. IVUS showed the LAD to have a minimal lumen area of 2.6 sq mm with 90% fibrotic plaque and a vessel size of 2.5 mm and the LMCA to have a minimal lumen area of 8.8 sq mm with 70% fibrotic plaque and vessel size of 3.8 mm. Mid-LAD stenting was done with 2.5 × 28 mm Absorb Stent (BVS). Predilatation of LCX lesion was done with 2.5 × 08 mm NC Trek balloon. Then stenting was performed with 3.0 × 28 mm Absorb Stent (BVS). Check angiogram showed edge dissection proximal to the BVS Stent which was covered with 3.0 × 12 mm Xience Xpedtion Stent (DES). Then LMCA Stenting was done with 3.5 × 12 mm Absorb Stent. Post dilatation was done with 4.0 × 08 mm NC Trek balloon. Post Stenting LMCA - LAD IVUS was done. LMCA and LAD Stents were well opposed without any dissection or residual stenosis. TIMI III Flow was achieved in the final results

Usefulness of GuideLiner Catheter during Percutaneous Coronary Intervention in Difficult to Cross Complex Lesions due to Calcification and Tortuosity

Failure of stent delivery during percutaneous coronary intervention is one of the common causes of procedural failure. The GuideLiner catheter is a novel device with rapid exchange characteristic that ease the device delivery in deep vessel. We are reporting four cases on the usefulness of the GuideLiner catheter during percutaneous coronary intervention to enable stenting in complex, calcified, tortuous or distal lesions