Segmental hypoplasia of liver: The importance of radiologic recognition and reporting despite masterly inactivity

Segmental hypoplasia of the right lobe of liver is a very rare congenital abnormality which is usually asymptomatic and detected incidentally on cross sectional imaging like Computed tomography (CT) and Magnetic resonance imaging (MRI). It is usually associated with various other hepato-biliary anomalies. The radiologic identification of these anatomical variations has significant surgical and interventional implications. We report a case of segmental hypoplasia of posterior segments of right lobe of liver found incidentally on contrast enhanced CT (CECT) abdomen done to determine the cause of sub acute intestinal obstruction in a young adult male patient. Keywords: HepaticSegments, Hypoplasia, Liver, C

Utilization and incorporation of tumor volume data in staging and prognostication of head and neck squamous cell carcinoma treated with definitive radiotherapy: A systematic review

Head and neck squamous cell cancers (HNSCC) are a group of heterogeneous tumors, evident by their diverse behavior and natural history. The largest diameter of tumor measured for T classification may not necessarily reflect the true tumor dimension. There is a need to take into account certain other feature(s) of these tumors other than the maximum single dimension which can reflect the true tumor burden more accurately. Tumor volume has been shown to be a useful and accurate tool burden because it is a measurement of tumor burden in all three dimensions. This review article has compiled and reviewed the literature published in past on impact of tumor volumes (TVs) on the prognosis of head and neck cancers. A comprehensive literature search was performed in PubMed for terms “clonogens,” “TV” or “primary TV (PTV)” or “nodal volume” or “total TV (TTV)” or “volumetric analysis of TV in head and neck” or “predicting response in head and neck cancer” “prognostic factors head and neck cancers” and “outcome in head and neck cancer.” We identified 33 studies which have commented on the impact of TV in HNSCC on treatment outcome, 9 of these had analyzed PTV, 11 studies had analyzed total nodal volume, and 14 studies have analyzed TTV. Besides these, we have dealt with laryngeal cancers separately with 9 studies. This review article is also aimed to enhance our knowledge further regarding how best a physician can incorporate TV data in staging and predicting response to radiotherapy

Tumour volumes: Predictors of early treatment response in locally advanced head and neck cancers treated with definitive chemoradiation

AimTo analyse and predict early response 3 months post definitive chemoradiation (CCRT) utilising tumour volume (TV) measurement in locally advanced head and neck cancers (LAHNC).BackgroundLAHNC are 3-dimentional lesions. The largest diameter of these tumours measured for T-classification may not necessarily reflect the true tumour dimensions. TV accurately reflects the tumour burden because it is a measurement of tumour burden in all three dimensions.Materials and methodsIt is a single institutional prospective study including 101 patients with LAHNC treated with definitive CCRT. TV data noted were primary tumour volume (PTV), total nodal volume (TNV) and total tumour volume (TTV). Response evaluation was done at 3 months after the completion of definitive CCRT and patients were categorised either having achieved complete response (CR) or residual disease.ResultsPatients who had not achieved CR were found to have larger TV compared with those who had achieved CR. There were significant inverse correlations between PTV and response (median 16.37[[ce:hsp sp="0.25"/]]cm3 vs. 45.2[[ce:hsp sp="0.25"/]]cm3; p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.001), and between TTV and response (median 36.14[[ce:hsp sp="0.25"/]]cm3 vs. 66.06[[ce:hsp sp="0.25"/]]cm3; p[[ce:hsp sp="0.25"/]

Effect of contrast medium on treatment modalities planned with different photon beam energies: a planning study

Background: Routinely, patient’s planning scans are acquired after administration of iodinized contrast media but they will be treated in the absence of that. Similarly, high energy photons have a better penetrating power, while low energy photons will result in tighter dose distribution and negligible neutron contamination. The aim of the study was to investigate a suitable photon beam energy in the presence of intravenous contrast medium. Materials and methods: An indigenously made original-contrast (OC) phantom was mentioned as virtual-contrast (VC) and virtual-without-contrast (VWC) phantom were generated by assigning the Hounsfield Units (HU) to different structures. Intensity-modulated (IMRT) and volumetric-modulated-arc (VMAT) plans were generated as per criteria of the TG-119 protocol. Results: It was observed that the maximum dose to the spinal cord was better with 6 mega-voltage (MV) in IMRT. The coverage of Prostate PTV (PR PTV) was similar with all the photon energies and was comparable with TG-119, except for original-contrast (OC) phantom using the VMAT technique. Homogeneity-index (HI) was comparatively better for VMAT plans. Conclusion: The contrast CT images lower the dose to targets. IMRT or VMAT plans, generated on such CT images will be delivered with higher doses than evaluated. However, the overdose remains non-significan

The use of adaptive intensity-modulated radiotherapy in the treatment of small-cell carcinoma lung refractory to chemotherapy in a patient with preexisting interstitial lung disease

This is a case report of a 60-year-old diabetic, hypertensive male with a good performance status and a history of bilateral interstitial lung disease with a left upper lobe lung mass diagnosed to be a Stage IIB mixed small-cell/squamous cell carcinoma which was refractory to carboplatin- and etoposide-based chemotherapy. The patient was then taken up for adaptive intensity-modulated radiotherapy with tighter margin under image guidance with a mid-treatment replanning done at 25#. Acute toxicities were assessed weekly and showed no Grade 3 or more reactions. Pulmonary function test showed no detrimental changes during or after radiation. Response assessment at 12 and 20 weeks showed a partial response with decrease in metabolic activity on serial scans