[Relative Error between Organ Doses and Size-specific Dose Estimates for a Specific Location When the Mean CTDIvol Value Is Used for Calculation]

Size-specific dose estimates (SSDEs) are dose indices that account for differences in body shape in computed tomography (CT) scans, allowing the evaluation of approximate absorbed doses in any cross section that could not be obtained with the volume CT dose index (CTDIvol). When using automatic exposure control (AEC), CTDIvol is modulated in the body axis direction, but the value displayed after the examination is the mean CTDIvol for the entire scan, and it is expected that the SSDE value will change depending on which value is used in the calculation. In this study, using a human body phantom, we examined the influence of whether the mean CTDIvol or the modulation value for each slice is used to calculate the SSDE on local organ dose evaluation. A program to calculate water equivalent diameter according to the procedure in the American Association of Physicists in Medicine Report No. 220 was developed and compared. As a result, SSDE calculated using the mean CTDIvol (local-SSDEmean) overestimated organ doses in the lung region by 18%-56% compared with those calculated by a web system for evaluating CT exposure doses (WAZA-ARIv2, Japan). In contrast, local-SSDEmodulated, which was calculated using the modulated value of the CTDIvol, was able to estimate the organ dose with a relative error of 10%-13%. The average local-SSDE over the entire body axis direction was not significantly different between the two methods, regardless of which method was used for CTDIvol. If the mean CTDIvol is stored in the Digital Imaging and Communications in Medicine (DICOM) header tag (0018, 9345) of the CT image and the modulated CTDIvol value is not available for each slice, the calculated local SSDE will contain many errors and will not correctly reflect the organ doses at the scan region. In such cases, it is available to use the method of evaluating local organ doses by multiplying the SSDE, which is the average of the SSDE for the entire scan, by a factor for each organ.

Management of luspatercept therapy in patients with transfusion-dependent β-thalassaemia

Patients with transfusion-dependent β-thalassaemia require lifelong, regular red blood cell transfusions for survival; however, frequent blood transfusions are associated with an increased risk of iron overload, transfusion-transmitted disease and alloimmunization, as well as reduced quality of life. Luspatercept, an erythroid maturation agent that promotes late-stage erythroid maturation independently of erythropoietin, has demonstrated efficacy in reducing transfusion burden in patients with transfusion-dependent β-thalassaemia. In this review, we discuss treatment initiation, ongoing evaluation, dose adjustment and management of adverse events in transfusion-dependent patients with β-thalassaemia receiving luspatercept, and we provide guidance on how to determine whether patients are deriving clinical benefit.

[Estimation of Shooting Part Using a Camera with Depth Sensors and Pose Estimation Method and Automatic Setting of Optimal X-ray Imaging Conditions]

PURPOSE

In this study, we propose a system that combines a depth camera with a deep learning model for estimating the human skeleton and a depth camera to estimate the shooting part to be radiographed and to acquire the thickness of the subject, thereby providing optimized X-ray imaging conditions.

METHODS

We propose a system that provides optimized X-ray imaging conditions by estimating the shooting part and measuring the thickness of the subject using an RGB camera and a depth camera. The system uses OpenPose, a posture estimation library, to estimate the shooting part.

RESULTS

The recognition rate of the shooting part was 15.38% for the depth camera and 84.62% for the RGB camera at a distance of 100 cm, and 42.31% for the depth camera and 100% for the RGB camera at a distance of 120 cm. The measurement accuracy of the subject thickness was within ±10 mm except for a few cases, indicating that the X-ray imaging conditions were optimized for the subject thickness.

CONCLUSION

The implementation of this system in an X-ray system is expected to enable automatic setting of X-ray imaging conditions. The system is also useful in preventing increased exposure dose due to excessive dose or decreased image quality due to insufficient dose caused by incorrect setting of X-ray imaging conditions.

[Effect of Residual Volume in a Three-way Stopper and a Syringe on Actual Dose of Radiopharmaceuticals: Effect of Different Three-way Stoppers and Washing]

The purpose of this study were to evaluate the residual volume of radiopharmaceuticals in the three-way stopper and syringe used during radiopharmaceutical administration and the effect of washing. The three-way stoppers were a top injector tube, a top three-way stopper, and a Nipro three-way stopper with a needle. Sodium pertechnetate [^99mTc] injection (^99mTcO₄^-) was used to compare the residual volume of radiopharmaceuticals in the three-way stopper and syringe without and with washing. Clinically, 137 patients who underwent cerebral blood flow scintigraphy, dopamine transporter scintigraphy, and bone scintigraphy were included. N-isopropyl-p-[¹²³I]iodoamphetamine (¹²³I-IMP), ¹²³I-N-ω-fluoropropyl-2β-carboxymethoxy-3β-(4-iodophenyl)nortropane (¹²³I-FP-CIT), and ^99mTc-methylene diphosphonate (^99mTc-MDP) were used to compare the residual volume of radiopharmaceuticals in the three-way stopper and syringe without and with washing. The residual volume depended on the type of three-way stopper and radiopharmaceutical used. The residual volume could be reduced by washing, but the effect depended on the type of three-way stopper and radiopharmaceutical used. The residual volume of radiopharmaceuticals in three-way stoppers and syringes can be determined and subtracted to achieve more accurate dose control.

[Development of Dose Management Software Using Visual Basic for Applications and Dose Evaluation in the Field of Nuclear Medicine]

PURPOSE

The purpose of this study was to develop software for smooth dose management based on the Japan diagnostic reference levels (DRLs 2020) in the field of nuclear medicine.

METHOD

Using the programming language Visual Basic for Applications (VBA), we implemented a function for calculating actual doses, a function for comparing doses at one's own facility with those of DRLs 2020, a function for calculating appropriate doses for pediatric nuclear medicine examinations, and so on. In addition, we evaluated actual doses before and after the software implementation.

RESULT

The software enabled easy calculation of actual doses and comparison with DRLs 2020 for smooth dose management. Furthermore, we were able to use the results of dose evaluation to determine the dosage at our facility and to use them as a reference for optimization.

CONCLUSION

In the field of nuclear medicine, it is possible to manage doses in accordance with DRLs 2020 by introducing own software into our clinical practice.

[Restructuring Torso CT Protocol for Radiation Dose Management]

PURPOSE

There are problems with dose management in X-ray computed tomography (CT) because the protocol used for any examination is not always in the same scan range. The purpose of this study was to investigate the usefulness of setting the CT protocol based on the scan range.

METHODS

We evaluated the examination data of patients who underwent plain CT based on a scan range of chest to pelvis and abdomen to pelvis. The previous protocol [Chest-Abdomen Routine] was changed to the current protocols [Chest_Abdomen] and [Chest_Pelvis], and the previous protocol of [Abdomen Routine] was changed to the current protocols [Abdomen] and [Abdomen_Pelvis]. Examination data of height, scan length, volume CT dose index (CTDI_vol), and dose length product (DLP) were obtained from digital imaging and communications in medicine, and radiation dose structured report using Radimetrics. The relationship between patient height and scan range, and CTDI_vol and DLP was indicated in a scatter plot. Standard deviation (SD) of scan length and DLP were compared between current and previous protocols. Outliers were defined as the data exceeding average ±2SD.

RESULTS

The SD of scan length decreased by 77.1% on abdomen to pelvis, and the SD of DLP decreased by 65.2% on abdomen to pelvis. The causes of the outliers were CT scan range, scan parameter, arm position, metal implants, and body thickness of patients.

CONCLUSION

Setting CT protocols based on the scan range reduced SD of scan length and DLP. It was helpful for reducing the number of scan range outliers and analyzing the cause of outliers.

SPIONs Conjugate Supported Anticancer Drug Doxorubicin's Delivery: Current Status, Challenges, and Prospects

Considerable efforts have been directed towards development of nano-structured carriers to overcome the limitations of anticancer drug, doxorubicin's, delivery to various cancer sites. The drug's severe toxicity to cardio and hepatic systems, low therapeutic outcomes, inappropriate dose-demands, metastatic and general resistance, together with non-selectivity of the drug have led to the development of superparamagnetic iron oxide nanoparticles (SPIONs)-based drug delivery modules. Nano-scale polymeric co-encapsulation of the drug, doxorubicin, with SPIONs, the SPIONs surface end-groups' cappings with small molecular entities, as well as structural modifications of the SPIONs' surface-located functional end-groups, to attach the doxorubicin, have been achieved through chemical bonding by conjugation and cross-linking of natural and synthetic polymers, attachments of SPIONs made directly to the non-polymeric entities, and attachments made through mediation of molecular-spacer as well as non-spacer mediated attachments of several types of chemical entities, together with the physico-chemical bondings of the moieties, e.g., peptides, proteins, antibodies, antigens, aptamers, glycoproteins, and enzymes, etc. to the SPIONs which are capable of targeting multiple kinds of cancerous sites, have provided stable and functional SPIONs-based nano-carriers suitable for the systemic, and in vitro deliveries, together with being suitable for other biomedical/biotechnical applications. Together with the SPIONs inherent properties, and ability to respond to magnetic resonance, fluorescence-directed, dual-module, and molecular-level tumor imaging; as well as multi-modular cancer cell targeting; magnetic-field-inducible drug-elution capacity, and the SPIONs' magnetometry-led feasibility to reach cancer action sites have made sensing, imaging, and drug and other payloads deliveries to cancerous sites for cancer treatment a viable option. Innovations in the preparation of SPIONs-based delivery modules, as biocompatible carriers; development of delivery route modalities; approaches to enhancing their drug delivery-cum-bioavailability have explicitly established the SPIONs' versatility for oncological theranostics and imaging. The current review outlines the development of various SPIONs-based nano-carriers for targeted doxorubicin delivery to different cancer sites through multiple methods, modalities, and materials, wherein high-potential nano-structured platforms have been conceptualized, developed, and tested for, both, in vivo and in vitro conditions. The current state of the knowledge in this arena have provided definite dose-control, site-specificity, stability, transport feasibility, and effective onsite drug de-loading, however, with certain limitations, and these shortcomings have opened the field for further advancements by identifying the bottlenecks, suggestive and plausible remediation, as well as more clear directions for future development.

[Development and Validation of Dose Management Software in IVR Utilizing Radiation Information System]

PURPOSE

In each clinical case, the equipment display dose is used for interventional radiology (IVR) dose management and conform to the Japan diagnostic reference levels 2020 (DRLs 2020). However, dose management software corresponding to the DRLs 2020 using radiation dose structured report (RDSR) is not sufficiently widespread. This study aimed to assess the usefulness of in-house developed dose management software in IVR utilizing radiology information system (RIS), which can record both procedures and lesions.

METHODS

In this study, IVR from July to September 2020 was analyzed (cardiac regions: 141 cases and other regions: 149 cases). The evaluation items were air kerma-area product, air kerma at the patient entrance reference point, and patient information (height, weight, and BMI). Each subject of DRLs 2020 was analyzed by 12 radiological technologists in charge of IVR. The difference between results of the manual analysis and those of the in-house developed dose management software was calculated using paired t-test in terms of analysis time.

RESULTS

The analysis time for the cardiac and other regions was 4180.25±1161.79 s and 4366.92±1393.19 s in the manual analysis, and 36.25±15.32 s and 38.08±17.34 s in the software. The use of software indicated a significant reduction in analysis time (p<0.05). The analysis accuracy of the cardiac and other regions was 96.30% and 98.89% in the software.

CONCLUSION

These results show the usefulness of dose management software utilizing RIS.