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Author(s):
Benjamin, Henry, Stephen.
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EVALUATION OF WORKFLOW PATTERN OF THE RADIATION MEDICINE DEPARTMENT: A CASE STUDY OF A NIGERIAN TERTIARY HOSPITAL
Abstract
Background: An organizational workflow is a set of processes involving a group of people and necessary resources to achieve a predetermined goal. It is a reproducible pattern of action taken daily to achieve a particular task. Consequent to the pivotal role of the radiation medicine department in modern medicine, it has many steps and processes comprising different staff, rooms and equipment. Patients are normally passed from one step to another in a series of chains of workflow which when disrupted results in a high patient service delay, hence the need to examine the workflow pattern. This study aimed to assess the workflow pattern, identify its barriers, and highlight areas that need improvements to reduce patient waiting time and foster exemplary patient care.
Material and Methods: A prospective cross-sectional survey of all the staff working in the radiation medicine department of the University of Nigeria Teaching Hospital, Nigeria was carried out using 84 semi-structured questionnaires of which 70 were completed and returned (83.3% response rate).
Results: The major factors affecting the workflow pattern of the department are shortage of staff 36(58.1%), inadequate modern technologies 27(38.6%), equipment breakdown 27(38.6%), and inadequate power supply 23(32.9%). It was also revealed that the major areas that need improvement are the reporting 22(31.4%) and reception/registration area 20(28.6%).
Conclusion: More hands are required in image reporting. A dedicated unit and computer system for costing in the reception area, and an uninterrupted power supply are required to meet the current demand and bolster the quality of imaging services.
| 2 |
Author(s):
Mohsen, Mina, Mehrahad, Mohammad Reza, Hamidreza, Amirmasoud.
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Correlation of ERNV scan with transthoracic echocardiography in early determination of LVEF drop due to cardiotoxicity of anthracycline treatment in patients with acute lymphoid leukemia
Abstract
Introduction:
Chemotherapy is the basis of treatment for ALL patients, and anthracyclines are prescribed in combination with other drugs to destroy malignant cells in patients diagnosed with acute lymphoblastic leukemia (ALL).
Current intensive chemotherapy regimens have achieved overall cure rates of 85% to 90% in children and 40% to 50% in adults.
Early diagnosis of cardiotoxicity caused by chemotherapy drugs in ALL patients is of great importance; the proper behavior is to diagnose cardiac involvement as soon as possible in order to prevent the occurrence of heart failure in these patients, because an early change of drugs can prevent irreversible cardiac complications.
Methodology:
44 patients with ALL or lymphoblastic lymphoma with a minimum patient age of 15 years will be evaluated in the hematology department of Imam Khomeini Hospital in Tehran between 2022-2024.
The diagnosis of ALL is based on the evaluation of bone marrow and blood samples, and flow cytometry and morphology based on standard diagnostic guidelines.
Result:
Only 3 of the patients with abnormalities as a result of scan and echo were treated before chemotherapy, and 1 person had an abnormality as a result of scan and echo after the second anthracycline.
In this study, 13 patients (7 women, 6 men) out of 44 patients underwent transthoracic echocardiography and MOGA scan after 3 months of chemotherapy (after second anthracycline). The reason for the decreased number of people evaluated in the second round was non-cardiac mortality or referral for bone marrow transplantation or discontinuation of treatment.
Conclusion:
It can be assumed initial diagnosis of ejection fraction loss in MUGA scan is reliable and the probability of its occurrence is almost equal to transthoracic echocardiography
| 3 |
Author(s):
Catalin Stefan, Mariana, Livia Marieta .
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Review of a rare precancerous lesions – Intraductal Papillary Neoplasm of the Bile Duct (IPNB)
Abstract
Intraductal papillary neoplasms of the bile duct (IPNB) are rare precancerous lesions that play a role in the development of cholangiocarcinoma (CCA). They were finally recognised as a separate entity in the World Health Organisation's 2019 classification of tumours of the digestive system. Based on the new histological and clinical criteria of 2019, it is divided into types: 1 and 2. Neoplasms of the biliary tract usually develop through an evolutionary process that includes various preliminary stages, from the first lesion that can only be recognised microscopically (biliary intraepithelial neoplasia) through the various grades of IPNB to the final stage, invasive cholangiocarcinoma. New investigations, mainly based on magnetic resonance imaging (MRI), ERCP and cholangioscopy, are necessary to make a correct diagnosis and to correctly evaluate the biliary tract. Surgical resection is the mainstay of treatment, although endoscopic treatments are currently used in inoperable patients.
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Author(s):
Claudia Florina, Maria Francesca, Andreea Maria, Alexandru.
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MARANTIC ENDOCARDITIS AS A RARE COMPLICATION OF METASTATIC PANCREATIC ADENOCARCINOMA: CASE REPORT AND LITERATURE REVIEW
Abstract
Hypercoagulability is a common complication in pancreatic cancer, and nonbacterial thrombotic endocarditis (NBTE), or marantic endocarditis, is a frequently underdiagnosed manifestation of this prothrombotic state. It can lead to significant morbidity, especially through recurrent ischemic cerebrovascular events.
We report the case of a 62-year-old male diagnosed with pancreatic adenocarcinoma and liver metastases, initially investigated for deep venous thrombosis (DVT). Following the diagnosis, the patient was treated with palliative polychemotherapy (PCT). However, before the second cycle of PCT, he developed neurological symptoms, including dysarthria and paresthesia, which were later confirmed to be due to ischemic strokes. Further investigation, including transesophageal echocardiography, revealed a vegetation on the anterior mitral valve, consistent with marantic endocarditis. Blood cultures were negative, so the diagnosis of NBTE was confirmed.
A review of recent literature on pancreatic cancer complicated by NBTE was conducted, revealing common clinical manifestations, predominantly ischemic cerebral strokes and thrombotic episodes. The majority of NBTE diagnoses in the published cases occurred before cancer diagnosis, often in advanced stages with liver metastasis. Despite anticoagulation therapy, recurrent thromboembolic events were common. This case highlights the need for heightened awareness of marantic endocarditis in cancer patients, as neurological symptoms may obscure the underlying malignancy. Early recognition and multidisciplinary management are crucial for improving patient outcomes.
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Author(s):
Angel, Helena BZ, Ivica .
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SABR vs. SBRT: A New Deal for Radiotherapy Beyond Terminology
Abstract
ABSTRACT:
Employed shortly after its discovery over a century ago, radiotherapy has become the most effective cancer treatment after surgery. Its utility, however, extends beyond oncology, with proven success in managing non-malignant conditions as well. Over its 120-year history, the evolution of radiotherapy has been driven by two main pillars: radiobiological knowledge—explaining the "how," "why," and "when" of its application—and technological advancements, which enable and enhance these principles. Efforts to increase precision, amplify therapeutic effects, shorten treatment duration, and ultimately improve clinical outcomes and patient quality of life are central to translational research in radiation oncology. Stereotactic radiotherapy techniques represent the pinnacle of these ongoing advancements.
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Author(s):
Paul, Monica, Ioana, Florina, Monica, Ana-Maria , Andreea-Elena, Elena, Ciprian.
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Predictive Value of Circulating Tumor DNA (ctDNA) and Neutrophil To Lymphocyte Ratio (NLR): Case Series Of Patients With Digestive Cancers
Abstract
Monitoring disease progression and adjusting treatment based on biomarkers is essential in oncology. Circulating tumor DNA (ctDNA) is an emerging biomarker used for early detection of recurrence and monitoring response to treatment, while the neutrophil/lymphocyte ratio (NLR) is a recognized inflammatory marker for oncological prognosis. The aim of this study was to report two clinical cases and to assess the efficiency of ctDNA and NLR in guiding oncological treatments. Two clinical cases were analyzed: for one patient with colon cancer, five comparative determinations of ctDNA and NLR were performed, while for a patient with gastric cancer, three such determinations were performed. Both methods were compared in terms of sensitivity and correlation with patients' clinical course. The findings indicated that for the patient with colon cancer, ctDNA demonstrated heightened sensitivity and a more precise correlation with patient progression in comparison to NLR. In the case of gastric cancer, ctDNA values remained positive, whereas NLR exhibited one normal value, suggesting that ctDNA possesses a superior capacity to detect disease persistence. Consequently, ctDNA may serve as a pivotal instrument in the surveillance and customization of oncological treatments, transcending the constraints of conventional inflammatory markers.
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Author(s):
Mara, Ioana-Maria , Monica.
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Syncronous Esophageal Squamos Cell Carcinoma And Oropharyngeal Carcinoma: Diagnosis And Management In A 45-Year-Old Patient
Abstract
The occurrence of multiple primary cancers in patients is increasing. Esophageal cancer is the ninth most common cancer globally. Esophageal squamous cell carcinoma (ESCC) is often associated with a head and neck second primary malignancy (HNSPM, which worsens prognosis. This case report highlights a 54-year-old male with ESCC presenting as a tumor in the middle third of the thoracic esophagus, accompanied by progressive dysphagia and significant weight loss. Initial staging identified the esophageal tumor as cT4N0Mx in conformity with American Joint Committee on Cancer (AJCC 7). A subsequent PET-CT revealed a secondary mass at the oropharyngeal level, confirmed as squamous cell carcinoma (SCC) via biopsy. Treatment included neoadjuvant chemoradiotherapy with Carboplatin and Paclitaxel, alongside 54 Gy radiotherapy targeting the esophageal tumor. Post-treatment imaging demonstrated regression of the esophageal tumor, but without clinical and imagistic response of the oropharyngeal tumor. Definitive radiotherapy with concurrent Cetuximab was initiated for the oropharyngeal SCC, but due to skin toxicity (grade 3 radioepitheliitis) a 7 day treatment break was needed. Follow-up CT imaging revealed a favorable response of the oropharyngeal tumor.There is no surgical indication because the oropharyngeal tumor is central. Prospective studies are essential to evaluate the impact of such strategies on survival outcomes.
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Author(s):
Quaovi, Mack.
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Stereotactic Ablative Radiotherapy, “Microbeam” Boost, “Overtreatment”, and “Limited Life Expectancy”: Flawed Terminology in an Increasingly Precise Field of Prostate Cancer
Abstract
Technological advancements have firmly established radiation therapy as a cornerstone of cancer treatment. This is particularly true for prostate cancer, where radiation therapy is often employed with curative intent. These innovations have given rise to terminologies that have sparked debates and differing opinions. In this context, we explore some of these terms and address the challenges they present. Finally, we propose clarifications that we believe can guide these debates toward more constructive and meaningful discussions.
