Browsing by Department "Division of Radiology"

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    Open Access
    A phantom based evaluation on the effects of patient breathing motion on Stereotactic Body Radiotherapy treatment volumes
    (2020) Coetzee, Nicolene; Burger, Hester; Joubert Nanette
    Aim: The aim of the study was to design an upper body phantom to mimic the movement of the lesion inside the lungs during a breathing cycle. Phantom design included an assessment of the motion observed for lung lesions, identification of suitable phantom materials as well as design of a motorized arm to mimic the movements observed inside the lung area of the phantom. Introduction: Expansion margins are added to clinical target volumes contoured by Oncologists in order to safeguard against under- or over-treatment of the target volume. They are designed to account for errors during setup, inaccuracies on the linear accelerator, and movement of targets inside the patient. If the margins are too small, there is a risk that the lesion/target may not receive the necessary dose, due to being partially missed. On the other hand, if the margins are too wide, the lesion will be covered, but normal tissue may receive unnecessary dose, resulting in additional side effects to the patient. Assessment of the impact of these margins is not possible in a static phantom and the availability of a low-cost motorized phantom would assist in the validation of these margins. Method: Previously treated patients' 4D CT scanning data were used to quantify the amount of movement seen for lesions within the lung. A phantom was then designed and built in an attempt to mimic both patient anatomy and movement. Materials were identified to replicate anatomical shape and densities of various organs in the thorax, as seen on CT scan data. Two treatment planning systems (Monaco, (Elekta) and Eclipse (Varian)) were used to determine the dosimetric characteristics of the materials. This was compared to actual dose as delivered by a linear accelerator (Elekta Synergy). Results: Paths were calculated from the breathing cycles during the 4D-CT scan sets and templates designed to mimic these movements. A thorax phantom was built with the appropriate materials suitable and matched densities to replicate a human thorax. Comparing transmission for these materials on a linear accelerator for 6MV and 10MV energy, the deviation from planned versus measured dose varied between 1.67% to 3.32% and 0.45% to 2.30%, respectively for the silicon material and between 0.77% to 3.22% and 0.17% to 2.57% for the 3D printed bone for 6MV and 10MV. iv Conclusion: The measurements done on the linear accelerator matched closely with the calculated values on the treatment planning system for transmission through the materials in the customised phantom. Various proposals were put forward to mimic the movement of the targets within the lung regions. However, it was not possible to manufacture a mechanically based working model due to the small movements observed (<5mm). It is recommended that a robotic solution be investigated as alternative to mimic these small movements.
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    A re-evaluation of isotope screening for skeletal metastases in node-negative breast cancer
    (1996) Gudgeon, CA; Werner, I D; Dent, D M
    The International Society for Burns Injuries (ISBI) has published guidelines for the management of multiple or mass burns casualties, and recommends that 'each country has or should have a disaster planning system that addresses its own particular needs.' The need for a national burns disaster plan integrated with national and provincial disaster planning was discussed at the South African Burns Society Congress in 2009, but there was no real involvement in the disaster planning prior to the 2010 World Cup; the country would have been poorly prepared had there been a burns disaster during the event. This article identifies some of the lessons learnt and strategies derived from major burns disasters and burns disaster planning from other regions. Members of the South African Burns Society are undertaking an audit of burns care in South Africa to investigate the feasibility of a national burns disaster plan. This audit (which is still under way) also aims to identify weaknesses of burns care in South Africa and implement improvements where necessary.
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    A retrospective review of computed tomography pulmonary angiography image quality and the impact on diagnostic outcome at a tertiary South African hospital
    (2022) Holtzhausen, Jeanette; Moosa, Sulaiman E I; Esmail, Aliasgar
    Background: Computed Tomography Pulmonary Angiography (CTPA) is a key diagnostic imaging modality for pulmonary embolism. These studies are technically challenging to perform. Degraded image quality may result from inadequate pulmonary artery contrast opacification, motion- or streak artefact as well as patient factors. Literature suggests that poor quality scans could lead to indeterminate outcomes and suboptimal clinical decisions with risk of increased mortality. Objective: The study aimed to benchmark the image quality and diagnostic outcomes of CTPA studies in the setting of a tertiary Southern African hospital. The relationships between CTPA image quality and diagnostic and clinical outcomes, as well as related variables such as health risk factors and effective dose, were also explored. Methods: A retrospective cross-sectional study evaluated consecutive CTPA studies performed at Groote Schuur hospital, Cape Town, South Africa, over a six-month period from 1 July 2018 to 31 December 2018. All studies performed for suspected acute or chronic pulmonary embolism (PE) in patients 18 years and older were included. Records were reviewed regarding image quality and diagnostic and clinical outcomes. Correlation tests were performed between continuous variables and chisquare tests among categorical variables. Results: During the study period, 231 CTPA studies were performed, of which 226 were included. The sample comprised 69 % females and 31 % males, with median age of 45 years (range 19-84 years). In 204 (90.3 %) of studies, adequate contrast opacification ≥ 211 HU was obtained. Inadequate contrast opacification was present in 9.7% of cases, in line with previous research. Motion and/ or streak artefacts were present in 45.6%. PE was confirmed in 22% and excluded in 65 % of cases. The number of scans with indeterminate diagnostic results only comprised 30 out of the 226 scans reviewed, however, the percentage was higher than previously reported (13.3% vs mean of 6.4 % in published literature). Amongst these, inadequate contrast opacification occurred in 15 (50 %) of studies and artefacts degraded image quality in 24 (80 %). Patients with a diagnosis of PE had higher mortality, compared to patients with negative and indeterminate scans. Clinicians interpreted indeterminate scans as negative, however, this did not impact adversely on mortality. Conclusions It was encouraging that the percentage of studies with adequate contrast opacification met published bench-marks. Although the higher-than-expected percentage of indeterminate studies may partially be explained by the prevalence of artefacts, it requires further investigation. This did not, however, translate into adverse mortality outcomes.
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    A retrospective review of CTPA confirmed pulmonary emboli in COVID-19 patients admitted to Groote Schuur Hospital, Cape Town
    (2025) Ahlers, Petri; Said-Hartley, Mariam
    Background: A high incidence of thromboembolic phenomena has been widely reported in patients with COVID-19 pneumonia. There is, however, a paucity of data detailing the incidence and characteristics of pulmonary emboli (PE) in COVID-19 patients in the South African setting. An improved understanding of the presentation and course of these patients is warranted, considering the serious and potentially fatal outcomes. Objectives: To describe the incidence and characteristics of PE confirmed by Computer Tomography Pulmonary Angiogram (CTPA) in patients with COVID-19 pneumonia admitted to a tertiary hospital in the Western Cape, South Africa. Methods: We performed a retrospective-, descriptive study of all adult patients with COVID-19 pneumonia confirmed by Polymerase Chain Reaction (PCR) undergoing CTPA for suspected PE while admitted to Groote Schuur Hospital. The study period was from 1 April 2020 to 30 September 2020. Results: Our study cohort consisted of 116 patients, 59% being female, of whom, 29% were pregnant or in the postpartum period. The median age for both genders combined was 49.5 years. The overall incidence of PE was 19 %, with 20 % in our subset of pregnant and postpartum patients. The majority (64%) of PE's were reported as being segmental in anatomical location. Conclusion: Our study cohort was noteworthy in including pregnant and postpartum patients. The overall incidence of PE was 19 % with no significant differences in demographics, comorbidities or D-dimer levels between patients with or without PE. The importance of a high clinical index of suspicion together with the role of CTPA in diagnosing PE in hospitalised COVID-19 patients is emphasised.
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    Advanced breast cancer: A retrospective review comparing two palliative radiotherapy protocols used at Groote Schuur Hospital between 2010 and 2013
    (2016) Fakie, Nazia; Simonds, Hannah M; Naiker, Thurandarie
    Purpose: To retrospectively evaluate and compare the loco-regional progression free survival (PFS), overall survival (OS) and acute effects of the two breast palliative regimes used in patients with locally advanced or metastatic breast cancer between 2010 and 2013 in a single institution. Methods: Compliance to treatment, acute skin reactions, progression free and overall survival were retrospectively evaluated in patients who received palliative breast radiotherapy for locally advanced breast cancer between 2010 and 2013. The radiotherapy regimes were either 4Gy per fraction for 5 fractions treated 4 times a week (20Gy) or 6Gy per fraction for 6 fractions treated once a week (36Gy). They may have received previous chemotherapy with minimal or no clinical response, as well as hormonal treatment. Results: Forty three patients were followed up over a median period of 24 months, 14 of which received 20Gy and 29 received 36Gy. The average age was 64 years old. Compliance was 88% in both groups. Both groups had either grade 1 (71% vs 62%), grade 2 (21% vs 24%) or grade 3 (8% vs 14%) acute skin reactions. No grade 4 skin reactions were documented. The PFS was shorter at 4.5 months in the 20Gy group compared to 7.7 months in the 36Gy group (p=0.27). The OS was also shorter at 25.8 months in the 20Gy group compared to 29.6 months in the 36Gy group (p=0.51) Conclusion: This study did not show a statistically significant difference in terms of PFS and OS between the two radiotherapy regimes. They both remain reasonable options in local palliation in patients with locally advanced breast cancer.
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    An analysis of the CT and CT angiogram findings of methamphetamine induced stroke in young adults (≤45 years) presenting to GSH Emergency department
    (2023) Ngamolane, Aaron; Candy, Sally
    MMED Title: An analysis of the CT and CT angiogram findings of methamphetamine induced stroke in young adults (≤ 45 years) presenting to GSH emergency department. The recreational use of methamphetamine in the Republic of South Africa is on the rise accounting for 30% of patients admitted to addiction rehabilitation centres countrywide1 . In the Western Cape province alone methamphetamine is the commonly abused drug, detected in 44% of patients admitted for addiction rehabilitation2 . Methamphetamine is a risk factor for stroke especially in young adults, it is therefore important to determine key radiological features of methamphetamine related stroke for prompt and accurate differentiation from other stroke aetiologies. Study of stroke in this group of participants is of paramount importance as stroke is the second most common cause of death worldwide, responsible for 11.8% of all deaths after ischaemic heart disease (14.8%)3 . Stroke is also responsible for 4.5% of disability adjusted life years (DALYs)3 . The aim of the study was to determine whether stroke in young adults (≤ 45 years) exposed to methamphetamine can be differentiated from other stroke aetiologies on brain CT and CT angiogram. A cross-sectional retrospective study was performed in the department of radiology in Groote Schuur Hospital on brain CT and CT angiograms and their final reports from October 2012 to October 2020. All patients aged 45 years old or younger with clinical features of stroke and a history of methamphetamine or polysubstance abuse were included. Data collection tools were designed to suit inclusion criteriums and used as search keywords in the PACS for GSH. A re-read was done by the principal investigator as a second-year radiology registrar with limited neuroradiology experience guided by the study parameters outlined in the data collection tool. The obtained data was correlated with the finalized reports from each study. Our study has shown that in a group of young patients who admitted to using tik and who presented to the emergency room with clinical features of cerebral stroke, ischaemic infarct was found significantly more often than intracerebral haemorrhage. This study demonstrated that MCA territories were most frequently involved with occlusion of the M1 segments bilaterally. Radiologically loss of grey-white matter interface and a wedge-shaped appearance are the predominant patterns of radiographic presentation. This study has demonstrated that CT appearance of methamphetamine induced stroke does not differ from stroke patterns seen with traditional risk factors.
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    An appropriateness review of urgent in-hours nontrauma CT brain scans at a single tertiary referral centre in South Africa - are we scanning rationally?
    (2019) Jacobs, Donovan George; Andronikou, Savvas
    Aim: To determine if urgent, non-trauma in-hours CT head scan requests in the GSH department of radiology are being appropriately requested and completed, as well as determining the radiation dose for each study. Secondly, to make recommendations to improve local practice based on the findings of this study. Methods: A retrospective study was undertaken of 100 qualifying in-hours urgent, nontrauma CT head scans completed at the GSH department of radiology between 01/10/2015 and 31/03/2016. All qualifying CT request data and dose records were collected and anonymised, after ethical and institutional approval. Three radiologists at GSH were enlisted to review the request information. Each request was reviewed and categorised by both the researcher and each consultant individually to determine the indication and appropriateness. The researcher used previously published, objective criteria (Rothrock Criteria) to review requests, while the radiologists used their own interpretation of accepted local practice. The researcher recorded positive and negative scan outcomes, radiation doses and calculated the Effective Dose (ED) for each study. Results were recorded in Excel and statistical analysis using weighted Kappa analysis was undertaken. Results: Study cohort CT scans made up 15.6% of the total emergency head CT scans over the study period. The mean patient age was 52.3 years (range: 18.8-87.4 years). One-third (34; 34%) were older than 60 years with 33 (97%) having at least 2 positive Rothrock criteria. Most CT scans (86%) consisted of a single study, while the remaining comprised two or more. Average ED was 3.27 mSv (range: 1.03-4.33 mSv). 52 (52%) participants had abnormal CT findings, independent of age-group. Discrepancy in assigning study indication and appropriateness between the researcher and consultants was present, with at best moderate agreement (weighted-Kappa range 0.09-0.52). The researcher showed slight to fair agreement between scan outcome and request appropriateness using the Rothrock criteria (weighted kappa 0.20; 95% CI: 0.06-0.35, p=.00861), while the consultant consensus performed slightly worse (0.10; 95% CI: -0.05-0.26, p=.19728). Conclusion: Retrospective application of the Rothrock criteria to patient referrals produced better correlation with outcome than current departmental practice. However, there is at best moderate agreement between consultants with regard to classification of referrals which could negatively affect the application of Rothrock criteria in practice. Incorporating the Rothrock criteria into published departmental guidelines, in conjunction with other interventions to improve clinician requesting practices, is recommended. The formation of a Quality Assurance team and the use of existing dose-reducing techniques may assist in reducing radiation doses further.
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    The analysis of radiation-induced micronuclei in peripheral blood lymphocytes for purpose of biological dosimetry
    (1995) Le Roux, Jacques; Blekkenhorst, Gerhardus Hendrikus
    In the investigation of radiation accidents, it is of great importance to estimate the dose absorbed by exposed persons in order to plan their therapy. Although occasionally in these situations physical dose measurements are possible, most often biological methods are required for dose estimation. The aim of this investigation was to assess the suitability of the cytokinesis blocked (CB) micronucleus assay as a biodosimetric method using lymphocytes irradiated in vivo. The approach adopted to achieve this was to estimate whole body doses by relating micronuclei yields in patients undergoing radiotherapy treatment with an in vitro radiation dose-response curve. These biologically derived estimates were then compared with the corresponding doses obtained by physical measurement and calculation. As a first approach a study was performed of the in vitro dose-response of gamma-ray induced micronuclei following cytokinesis-block in the lymphocytes of peripheral blood samples obtained from 4 healthy donors. The results indicated that the distribution of the induced micronuclei were overdispersed. Furthermore, a linear dose-response relationship was established when a curve was fitted to the data by an iteratively reweighted least squares method. By means of an analysis of covariance it was demonstrated that this result is in agreement with the dose-response relationships found by various other workers (Fenech et al., 1985; Fenech et al., 1986; Fenech et al., 1989; Balasem et al., 1992, and Slabbert, 1993). To assess the suitability and accuracy of dose assessment using the CB micronucleus assay for in vivo exposure of lymphocytes, blood samples obtained from 8 patients undergoing radiotherapy before, during and after treatment were examined. The physical doses of these patients were determined according to conventional radiation treatment plans and cumulative dose-volume histograms. The dose-volume histograms permitted calculation of integral doses and subsequently the estimate of equivalent whole-body doses. The results of the CB micronucleus assay applied to peripheral blood lymphocytes of 6 patients undergoing fractionated partial-body irradiation showed a dose-related increase in micronucleus frequency in each of the patients studied. This demonstrated that micronuclei analysis may serve as a quantitative biological measure of such exposures. The pooled data of these patients compared to the pooled data of the healthy donors show that there was no statistically significant difference between in vitro and in vivo results, however a slightly lower induced micronuclei frequency was observed after in vivo exposure. When the biological dose estimates for equivalent whole-body doses obtained from the in vitro dose response curve were compared with calculated physical doses, it was found that: biologically estimated dose = 0.936 physical dose. However, there was inadequate statistical evidence to discard the hypothesis that the gradient of the equation was equal to one. Therefore, the analysis of micronuclei induced in lymphocytes in vivo yields highly quantitative information on the equivalent whole-body dose. The negative binomial method was used for analysing the micronucleus data from two patients who received single, relatively larger tumour doses of 10 Gy each, with the objective to obtain estimates of the exposed body fraction and the dose to this fraction. The dose estimates to the irradiated volume were found to be within 30% of the physical tumour dose. The irradiated volume estimates seemed to be higher than the physically calculated volumes but by discarding the correction for the loss of cells due to interphase death the agreement was good between the physically and biologically determined integral doses. This study has revealed that the CB micronucleus assay appears to offer a reliable, consistent and relatively rapid biological method of whole body dose estimation. It is recognised that further corroborative work using the techniques described in this thesis is required for estimating localized exposure.
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    Assessment of airway compression on chest radiographs in children with pulmonary tuberculosis
    (2018) Richter-Joubert, Lisel
    Study rationale: Diagnosis of pulmonary tuberculosis (PTB) in children relies heavily on chest radiography as sputum samples are difficult to obtain and only yield positive results in 30-74% of children treated for PTB. However, radiological signs between lower respiratory tract infections (LRTI) and PTB overlap considerably and there is a wide inter-observer agreement in the detection of lymphadenopathy, considered the hallmark of PTB. Small pliable paediatric airways are easily compressed by enlarged lymph nodes. Unlike lymph nodes, however, the lucent airways contrast against the surrounding mediastinal structures on radiographs, thus airway compression may serve as a more objective criterion for diagnosing PTB. Many studies have reviewed the radiographic features of PTB in children but few included airway compression or used a control group and none have evaluated inter-observer agreement. Objective: To investigate frequency and inter-observer agreement of airway compression on chest radiographs in children with PTB compared to those with another LRTI. Methods: Chest radiographs of children admitted to Red Cross War Memorial Children’s Hospital with suspected PTB were read by two readers according to a standardised format and a 3rd when there was disagreement. Radiographs of children with definite PTB were compared to those with another LRTI. Frequency and location of airway compression were evaluated. Findings were correlated with human immunodeficiency virus (HIV) infection and age. Inter-observer agreement was assessed using kappa statistic. Results: Radiographs of 505 children (median age 25.9 months [IQR 14.3-62.2]) were reviewed; 97/505 (19%) children were HIV-infected. Airway compression occurred in 54/188 (28.7%) definite PTB cases versus 24/317 (7.6 %) of other LRTI cases (OR 4.9; 95%CI 2.9–8.3). The left main bronchus was most affected in 51/493 (10.3%). A higher frequency of airway compression occurred in infants at 22/101 (21.8%) compared to 56/404 (13.9%) in older children (OR 1.7; 95%CI 1.00–3.00). No association between airway compression and HIV infection was found. Inter-observer agreement ranged from none to fair (kappa of 0.0-0.4). Discussion: The overall frequency of airway compression in definite PTB is compatible with reports in the literature. Although airway compression used alone is not a specific sign, if seen on radiographs, there is a strong correlation with PTB compared to other LRTI with infants at higher risk due to their smaller airways. Contradictory to other studies, our study showed the left main bronchus to be affected twice more commonly than the bronchus intermedius in both age groups. This is thought to be due to different patient selection. Confirming reports in the literature, no significant association between airway compression and HIV status was found. A disappointing finding was the poor inter-observer agreement. Contributing aspects include the lack of standardised criteria in the definition of airway compression and suboptimal visualisation of the airways on standard chest radiographs due to patient, technical and post processing factors. Conclusion: There is a strong association between airway compression on chest radiographs and definite PTB, particularly in infants, irrespective of HIV status. However, its clinical use as an objective criterion in the diagnosis of PTB is limited by poor inter-observer agreement.
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    Assessment of the interobserver and the intra observer reproducibility for the detection of renal cortical defects in adults and children using [99mtc]Tc-MAG3
    (2022) Hashlan, Mohammed Hussain; Brink, Anita
    Objectives: One can assess cortical defects on the early images of [99mTc]Tc-MAG3 renography. We aim to assess interobserver and intraobserver reproducibility for detecting renal cortical defects using [ 99mTc]Tc-MAG3 for adults and children; identify causes for poor inter- and intraobserver reproducibility and to assess the effect of the kidney to background ratio (KTBR) on reproducibility. Methods: A 100 adult and 200 paediatric renograms were included. The observers reviewed the summed 1- min posterior images for the first four minutes to detect cortical defects. Interobserver reproducibility between three observers and intra-observer reproducibility for two observers were determined. Agreement was tested using percentage agreement, Krippendorff's reliability coefficient alpha and Cohen's kappa statistic. The association between KTBR and agreement was assessed. Results: Interobserver agreement on the 1-2 minute images was 78 (95% CI: 74.8 - 82.7%) and 79.7 (95% CI: 75.9 - 83.5%) for left and right kidneys respectively. Intraobserver percentage was 89.7% (95% CI: 86.2 - 93.1%) for the senior and 80.7% (95% CI: 76.2 - 85.2%) for the junior observer. In 13.5% (27) of the adult and 4.5% (19) of the paediatric kidneys the difference in image interpretation between the observers would have had a clinical impact. If the KTBR is ≤ 2, the percentage agreement was between 61.5% and 64.8%. In cases with a KTBR > 2, the percentage agreement was between 83.6% and 87.1%. Conclusion: The percentage interobserver agreement was moderate. Disagreement between normal and abnormal cases were infrequent. The interobserver reproducibility was decreased when the KTBR was ≤ 2.
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    Atypical tuberculosis of the knee joint
    (AOSIS, 2006) Albuquerque-Jonathan, G
    This case report demonstrates the MRI findings of atypical tuberculosis (TB) of the knee joint, caused by Mycobacterium kansasii. Osteoarticular TB caused by atypical mycobacteria is rare; instead, it is predominantly a synovial disease affecting the tendon sheaths rather than bone. Predisposing factors are immunocompromised individuals, including the elderly, alcoholics, those with HIV, diabetes mellitus, malnutrition and other chronic debilitating illnesses, and local factors, such as preexisting trauma, rheumatoid arthritis, systemic lupus erythematosis, and prosthetic joints. We present a case that occurred in an individual without any predisposing factors, which is also a rare occurrence.
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    Breast conservation treatment at Groote Schuur Hospital : treatment outcome
    (2005) Elhaj, Ahmed Mohammed; Werner, I D; Murray, Elizabeth; Hunter, Alistair
    Includes bibliographical references (leaves 56-62).
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    Breast ultrasound in females 35 years old and below at a tertiary referral academic center in Cape Town, South Africa: indications and outcomes analysis, a retrospective quantitative study
    (2024) Juggath, Nitin; Gamieldien, Rufkah
    Title: Breast ultrasound in females 35 years old and below at a tertiary referral academic center in Cape Town, South Africa: indications and outcomes analysis, a retrospective quantitative study. Background A high number of patients are referred to our resource limited tertiary institution for specialty breast imaging. Despite the accepted application of ultrasound in young women with focal signs/symptoms, there are sparse outcomes data to validate its use in this clinical setting for certain indications and no prior study done at our facility. Objectives To decrease morbidity and expenditure related to breast imaging in young women by correlating clinical predictors for worrisome or benign findings, thus allowing refinement of referral criteria. Methods Ultrasounds performed on females below 35 years old in a 1-year period between 1 st March 2019-1 st March 2020 at Groote Schuur Hospital were retrospectively analyzed. Evaluation of the reports stored on the hospitals PACS system and review of the histological diagnosis of biopsies-if performed, from the NHLS. Clinical data and indication for referral was assessed and imaging results were categorised as either positive or negative. Positive findings were subcategorized into benign breast disease, breast abscess or malignancy. Results 352 breast ultrasound studies were performed. 65% were palpable mass referrals, and one-third were referred without any palpable mass or focal breast pain. 67% of the studies had a positive imaging result and 33% had a negative result. 214 were classified as benign breast disease, 11 as breast abscesses and 12 were malignant. Conclusions Majority of disease encountered was benign breast disease. Most referrals were appropriate and predominantly for a palpable mass. One-third of studies were inappropriately referred, adding to the burden on an already strained specialty center. Keywords Benign breast disease, breast abscess, malignancy, palpable mass, focal breast pain.
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    Clinical symptoms and volumetric radiological responses of acoustic neuroma patients, treated with hypo-fractionated image guided radiotherapy (IGRT) at Groote Schuur hospital between 2013 and 2016
    (2018) Riddick, Alison; Parkes, J; Burger, Hester
    Background: Stereotactic radiosurgery (SRS) is the gold standard for treatment of small and medium sized tumours, although fractionated regimens are well described. Access is limited in resource-constrained settings. There are no South African data describing outcomes of AN patients treated with fractionated stereotactic radiotherapy (SRT) using photons. We describe clinical and radiological outcomes of AN patients treated with SRT at an academic centre in Cape Town, South Africa. Objectives: To describe patient demographics, tumour characteristics and patients’ symptoms and changes in symptoms at follow-up. To investigate tumour local control (LC) rates at last follow up MRI, and compare LC rates described for SRS in the literature. To correlate radiologists’ serial 2D maximum linear diameter (MLD) measurements with calculated 3D tumour volume (TV). Methods: Fifteen AN patients treated with modified SRT (18.0gy/3fractions, were identified from the planning database; 13 were included. Patient data and tumour characteristics (size, laterality and previous surgery) were retrospectively extracted from clinic folders. Initial planning data was accessed and checked. Tumour volumes were contoured by the author on all subsequent MRI’s per patient and validated by a second investigator; tumour volume (TV) was automatically calculated. Radiologist’s 2D MLDs were compared with 3D TV. Sensitivity and specificity of radiologist reported change of MLD as a measure of actual change in TV was calculated. LC was calculated, from time of treatment to time of last MRI or time of progression (defined as ≥20% increase in TV). Results: Mean age was 60.4years (range 45-79years), with 4 (30.8%) being female. Seven patients (53.8%) had left sided tumours and median tumour size was 1.15cm3 (mean 1.59 cm3; range 0.62-3.35 cm3). Nine patients (69.2%) had Koos stage 2 ANs, 3 (23.1%) had stage 3 tumours and 1 (7.7%) had a stage I tumour. Two patients had NF2.Median follow-up time 12 was 29 months (range 0-50 months). Median baseline TV, as was 1.15 cm3 (mean 1.59cm3 with range 0.62-3.35 cm3). Three patients had no follow-up MRIs: 2 demised and 1 declined further follow-up. In total 5 patients died, 4 of unrelated causes and 1 of unknown cause (median time to death after RT 24 months, range 6 - 36 months). LC was 74% at 36months. Hearing preservation rate was 67%. No new facial or trigeminal nerve symptoms were noted. Radiologists correctly reported tumour growth in 100% of tumours that grew, and specificity was 77.3% in those that were stable. Conclusion: This is the first local study in hypofractionated SRT using photons. We show lower LC rates than seen in literature; our numbers are small and short follow up time short, with high attrition rates. Acute treatment toxicities were absent. Longer term follow-up is needed to assess late RT effects. A prospective study using this method of treatment would better define LC.
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    Computed tomography findings in patients with minor head trauma presenting with a history of loss of consciousness and/or amnesia, Glasgow Coma Scale 15 and no focal neurological deficit
    (2017) Singata, Chuma; Candy, Sally
    Background: South Africa is a developing country with limited resources. Currently, in our institution, patients who have suffered a minor head injury with a Glasgow Coma Scale (GCS) 15, loss of consciousness (LOC) and amnesia obtain a computed tomography (CT) scan, regardless of the cost that is incurred by the use of this limited resource. Applying recommendations in developing countries requires consideration of resource limitations and patient burden. Objective: Our objectives were twofold: 1. To determine the number of abnormalities found on routine head CTs in patients who have a history of LOC and amnesia/PTA post trauma, but with a normal mental status (GCS 15) on presentation to the trauma unit. 2. To determine the clinical value of routine CT scan of the head in patients who have suffered minor head injury with GCS 15, LOC and amnesia. Methods: The CT scan reports of 460 patients with minor head injury, GCS 15, LOC and amnesia were reviewed retrospectively in the radiology unit of Groote Schuur Hospital between the years 2012 and 2014. These patients were assessed by the trauma doctor and referred to the radiology department for a CT scan of the head. Reports had been prepared and verified by a radiology specialist or senior registrar. Results: The findings on CT were categorized as significant and insignificant. A total of 33 patient reports (7%) met the criteria of significant findings that required neurosurgical intervention. (CI 4, 7-9, 6). 320 patients (70%) had normal findings while 107 patients (23%) had insignificant findings. Conclusion: CT scan of the head in minor head injury patients with normal mental status (GCS 15) is recommended even in the face of the limited resource in view of our study results.
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    Corpus callosum morphology in children on mid-sagittal MR imaging
    (2018) Raubenheimer, Lauren; Andronikou, Savvas; Kilborn,Tracy
    Background: There is little published research on the wide variation of corpus callosum (CC) morphology in children, the assessment of which is made difficult by the complex alteration of its appearance in childhood. Objective: The purpose of our study was to assess the morphology of the CC on mid-sagittal T1- weighted magnetic resonance imaging (MRI) in a large number of children and correlate the findings with demographic and clinical criteria. Materials and methods: We reviewed all brain mid-sagittal T1-weighted MRI’s performed from July to December 2015 and obtained relevant demographic and clinical information from the accompanying report and laboratory system. The CC morphology was analysed by three radiologists and compared using cross tabulation with the chi-square test and ANOVA. Interobserver correlation was assessed using Kappa coefficient of conformance. Results: 257 patients with mean age 72±60 months were included, 142 were male (55%). In abnormal MRI’s the CC was less likely to have an identifiable isthmus and was more likely to be convex, thin and have separation of the fornix insertion (all p<0.01). In young children (< 5 years) the CC was also less likely to have an identifiable isthmus (p=0.01) and was more likely to be convex (p=0.04) but the fornix was more likely to insert normally (p<0.01). Children with tuberous sclerosis had significantly thinner splenia (p=0.02). Conclusion: There is a distinct pathological appearance of the CC. The immature appearance of the corpus callosum can mirror this but is distinguished by normal insertion of the fornix and normal quantitative measurements. Splenial thinning in children with tuberous sclerosis warrants further investigation.
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    CT angiographic detection of cerebral aneurysms in patients with subarachnoid haemorrhage in a South African institution
    (2020) Chisha, Mike; Candy, Sally; Hartley, Qonita Said
    Study rationale The incidence, location, morphology and size characteristics of cerebral aneurysms in patients presenting to Groote Schuur hospital with either subarachnoid haemorrhage or 3 rd nerve palsy have not been established by a formal audit. Objectives To determine the patient demographics, frequency of CT angiographic detection of cerebral aneurysms and aneurysmal characteristics in patients presenting to Groote Schuur Hospital with sub-arachnoid haemorrhage and /or 3 rd nerve palsy Materials and methods Computed tomographic angiographic reports of cerebral vessels of patients who presented either with subarachnoid haemorrhage or 3 rd nerve palsy to Groote Schuur hospital were reviewed over a 19-month period from January 2018 – July 2019. The data obtained were coded, entered and analysed using IBM SPSS version 25 software. Descriptive statistics was used to report the means, modes and frequencies. Demographic and aneurysmal data were compared with a similar period 5 years previously. Results One hundred and twenty-one aneurysms (121) were analysed in 2018 -2019 and 124 in 2013-2014. The large majority were solitary (92% in both groups), small (94% and 90%) and saccular (96% and 87%) respectively. Significantly more fusiform aneurysms (13% vs 6%) were seen in the earlier group. 8 % of patients had multiple aneurysms. Less than 1% were ‘giant' ( >20mm). The mean age of the patients was the same for both periods (47 years). The mean aneurysm body size was 5.7mm and 7.1mm and the mean body: neck ratio was 6 2.1 vs 1.8b). Themost frequent locations were the posterior communicating artery (31.4% [2018/2019], 35% [2013- 2014]), anterior communicating artery (29% [2018/2019], 18.5% [2013/2014]) and the middle Cerebral Arteries (13.2% [2018/2019], 13.7% [2013/2014]). The least common sites were the Superior Cerebellar artery (SCA) [2018/2019] and the Vertebral artery (0.8%) [2013/2014]. Conclusion This study has compared the demographics of patients presenting to Groote Schuur Hospital with CT angiographically confirmed symptomatic intracranial aneurysms over two periods (January to July) 5 years apart. Both the patient demographics and the aneurysmal architecture were consistent over these time periods. Further our findings conform to that described previously both in Southern Africa and abroad i.e aneurysms which have bled are most commonly related to the posterior communicating, anterior communicating and the middle cerebral arteries and most aneurysms are small and saccular in shape. Over the periods studied, there was no change in the number of patients presenting to Groote Schuur Hospital for CT cerebral angiography and Interventional treatment post aneurysm rupture. These data represent a baseline for future statistical comparison and the information extrapolated from this study will be useful for interventive planning and resource mobilization at our institution and within the Western Cape Department of Health.
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    Determination of an optimal treatment margin for intracranial tumours treated with radiotherapy at Groote Schuur Hospital
    (2020) Vos, Andre; Naiker, Thuran; Mac Gregor, Hannelie
    Background Accurate delivery of radiotherapy is a paramount component of providing safe oncological care. Margins are applied when planning radiotherapy to account for subclinical tumour spread, physiological movement and set-up error. Set-up error is unique to each radiotherapy institution and should be calculated for each organ site to ensure safe delivery of treatment. Aim and setting The aim of this study is to calculate the random and systematic set-up error for a cohort of patients with intracranial tumours treated with 3D Conformal Radiotherapy at the Department of Radiation Oncology, Groote Schuur Hospital, South Africa. After obtaining above mentioned data the ideal CTV-PTV expansion margin was calculated using published CTV-PTV expansion margin recipes. Patients and methods The Electronic Portal Images (EPID) of 20 patients who met the inclusion criteria were compared to their Digitally Reconstructed Radiograph (DRR). The set-up error for each patient was measured after which the random (s) and systematic (S) set-up error for the study group could be calculated. With both these values known the CTV-PTV expansion margin could be determined. Results The largest error was in the Superior/Inferior (SI) direction, followed by the Medial/Lateral (ML) direction and least in the Anterior/Posterior (AP) direction with 87.7%, 76.2% and 91.6% of the errors in the ML, SI and AP directions respectively being less than 3mm. There was no error larger than 5mm in the ML or AP direction with 6.1% of the SI error larger than 5mm. The random and systematic error in all three directions for this patient cohort were less than 2mm conforming to acceptable standards of delivering safe radiotherapy. Using Stroom's margin recipe (2S + 0.7s) a CTV-PTV expansion margin of 5mm can safely be applied for this patient cohort. Conclusion When treating patients with intracranial tumours at Groote Schuur Hospital the CTV-PTV expansion margin can safely be reduced from 1cm to 5mm.
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    Diagnostic outcomes of CT-guided lung biopsy in an HIV and TB co-infection prevalent region
    (2024) van Rensburg, Juan Janse; Said-Hartley, Mariam Qonita
    Background: Tuberculosis (TB) and the Human Immunodeficiency Virus (HIV) are a major burden on the health of the people in the Western Cape with approximately 56 000 new cases of TB diagnosed in 2018 and 16 287 incident cases of HIV during the same period. CT-guided lung biopsy is a limited resource primarily used for diagnosing suspected cancer. TB is occasionally diagnosed on samples obtained by CT-guided lung biopsy. Objectives: To quantify the burden of TB on the CT-guided lung biopsy (CTLB) service at Groote Schuur Hospital (GSH). Secondary aims include summarising the diagnoses observed in an HIV-positive subset and comparison of diagnostic performance of different methods for TB diagnosis on biopsy samples. Method: A retrospective review of results from 406 consecutive CTLB performed at a tertiary hospital in the Western Cape during 2018 and 2019. Results: The mean age of subjects was 61 years, and the male to female ratio 1.1:1. A total of 40 specimens (9.9%) had confirmed tuberculosis, 264 (65%) had malignancy, and 3 had concurrent TB and malignancy. Conclusion: This study confirmed a high yield of TB among CTLB specimens as expected in a TB-prevalent region. There was also a higher proportion of TB and of non-TB non-malignant causes of lung nodules and masses in the HIV-positive subset as compared to HIV negative subjects.
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    Diagnostic yield of ultrasound-guided fine needle aspiration biopsy (US-guided FNAB) and post-surgical histopathological correlation of thyroid nodules in the Department of Radiology, Groote Schuur Hospital, Cape Town, South Africa over a two-year period
    (2022) Matimati, Bornaventure; Ahmed, Nazir
    Background: Nodular thyroid disease is common worldwide, and the incidence of thyroid nodules is increasing globally. Ultrasound (US)-guided thyroid nodule fine needle aspiration biopsy (FNAB) is a reliable and cost-effective method of distinguishing between benign and malignant nodules before major surgery is performed. Aims: The study aimed to establish the diagnostic yield of US-guided thyroid FNAB's done at Groote Schuur Hospital over two years and to correlate findings with histopathological results in those patients that underwent thyroidectomy. Objectives: The objectives were to establish the number of US-guided FNABs performed, the number of repeat FNABs and the number of patients who subsequently had thyroidectomy over two years. A further objective was to evaluate the diagnostic yield by comparing the cytology and histology results for patients that underwent thyroidectomy. Methods: This was a retrospective study of all patients referred for US-guided FNAB from 1 January 2018 to 31 December 2019. All patients with cytology results after FNAB and histology results after thyroidectomy, were included in the study. US-guided FNAB data was collected from the Picture Archiving and Communication System (PACS) and Radiology Information System (RIS), while cytology and histology data were obtained from the National Health Laboratory Services (NHLS). Results: A total of 236 patients were included in the study (220 females and 16 males), with ages ranging from 19 to 82 years. The diagnostic yield was 34-% on the first, 36-% on the second and 48-% on the third FNAB. Most of the US-guided FNABs were non-diagnostic (66- % on the first, 64-% on the second and 52-% on the third FNAB). A total of 107 patients (45 %) had a repeat FNAB, while 23 patients (9.7-%) had a second repeat FNAB. A total of 48 patients (20.3-%) underwent thyroidectomy. Cancer was detected in 29/236 (12.3-%), of which 17/29 (59-%) were papillary thyroid carcinomas. There was no significant correlation between FNAB results and post-surgical histopathological results in patients who underwent thyroidectomy, with a p value of .15. Conclusion: The overall cancer rate of 12.3-% was comparable with that of other institutions. 66-% of US-guided FNABs were non-diagnostic, while 34-% were diagnostic on the first FNAB with 45-% requiring a repeat second FNAB. The assistance of a cytopathologist during the biopsy has been known to result in fewer non-diagnostic results, avoiding repeat attempts. Further diagnostic and cost-effective analysis of cytopathology assistance in the US-guided FNAB for characterising thyroid nodules is advised.