Browsing by Subject "radiology"

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    Open Access
    Does hair curl variation influence the efficacy of scalp cooling in the prevention of chemotherapy-induced alopecia in breast cancer patients? A randomized controlled pilot study
    (2021) Obuseng, Odirile; Khumalo, Nonhlanhla P; Naiker, Thurandrie; Thebe, Tselane
    Background: Chemotherapy-induced alopecia (CIA) is a common side-effect of breast cancer treatment. Scalp cooling is reported to reduce CIA; however, it is unknown whether the efficacy is influenced by hair curvature. Methods: This 20-month randomized controlled trial recruited females, (18-65 years) with breast cancer to receive chemotherapy (Adriamycin or Epirubicin and Cyclophosphamide followed by Paclitaxel) with or without scalp cooling. The main outcomes were percentage alopecia (Severity ALopecia Tool scored by 3 dermatologists) in straight versus curly hair and treatment retention rates. Results: Forty-eight patients (24 per group) were randomized; 4 in each group withdrew before study visit1 and photographs of 3 in the cooling group could not be found for severity assessment. Thus 77% constituted the intention to treat population (17 cooling versus 20 control). Agreement on alopecia severity was good overall (ICC=0,94; 95% CI: 0.85 - 0.97) and at 6 of 7 time points. Overall, cooling significantly reduced CIA, relative to no cooling (58.15 ± 28.46 versus 37.29 ± 20.52; p:0.0167), however, percentage alopecia was cosmetically significant. There was no difference in CIA between cooling participants with straight (8) versus curly hair (9), (p:0.0740). The number of patients completing the various cycles of chemotherapy, declined from 77.1% at cycle 1 to 18.8% at cycle 7 for the whole study; from 100% each to 17.6% and 30% for cooling and control groups, respectively (p:0.451). Conclusions: This small study suggests that hair curvature has no significant impact on the efficacy of scalp cooling to reduce CIA, however this requires confirmation.
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    Open Access
    Identifying non-value added waste that delay emergency CT brain workflow using lean management principles
    (2020) van Zyl, Carike; Weimann, Edda; Ahmed, Nazir
    Introduction: The Department of Radiology at Groote Schuur Hospital receives numerous emergency CT brain requests especially from the Emergency and Trauma departments. Improvement in emergency CT brain workflow should reduce waiting times for CT scans resulting in earlier diagnosis and treatment of these patients. Identification of the nonvalue-added waste (NVAW) (steps regarded as wasteful to the customer) in the CT brain workflow can be determined by use of a lean management tool namely a value stream map (VSM - a flow analysis of information required to provide service to the customer). AIM: The study aims to identify non-value-added waste in the CT brain workflow value stream map which may result in delay in emergency CT brain reporting. Method: This study investigated NVAW in emergency CT brain workflow for 5 working days between 08h00 to 22h00 from Monday to Friday. Nineteen patients booked for an emergency CT brain scan by the Emergency Department (ED) only between 08h00 and 22h00 over the specific 5 day working period were randomly selected using convenience sampling. The indications for emergency CT brain scans in the sample were similar to the wider group of patients undergoing emergency CT brain scans. A VSM identifying all the relevant steps in the emergency CT brain workflow was constructed. The investigator accompanied each of the nineteen patients from the ED to the CT scanner and back and manually recorded the time elapsed in minutes for each separate step on the data collection sheet. The outstanding information required was obtained from the Xiris system on the Phillips PACS (Picture Archiving and Communicating System). The average time interval for each of the steps as indicated on the VSM was calculated, and the rate limiting step(s) which resulted in a delay in emergency CT brain reporting was identified. Results: Overall, the longest step was the time interval from the time of completion of the scan to the generation of the report (turnaround time (TAT)) with an average time of 72.21 minutes (p value of < 0,01). Conversely, the time interval from placing the request by the clinician on the PACS to the time of annotation by the radiologist was the shortest with an average time of 5.84 minutes. Discussion: The lean management system was used to identify the rate limiting step(s) which resulted in delay in emergency CT brain reporting. Possible reasons identified for the delay caused by the rate limiting step include the backlog in reporting of the large number of already scanned cases which may be due to staff constraints as only one radiologist was on duty during most of the study period. Additional contributory factors include clinician telephonic query interruptions to radiology registrars during reporting sessions and delay in the emergency doctor authorising and facilitating transport of the patient from the emergency unit to the CT scanner. Conclusion: The value stream map tool in lean management can be utilised to identify non value added waste in emergency CT brain workflow.
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    Open Access
    Measured and calculated dose distributions in the “claws” – a specially designed gold applicator loaded with I-125 seeds
    (2020) Trauernicht, Christoph Jan; Hering, Egbert; Du Plessis, Frederik
    Introduction: The “Claws” is a unique gold applicator for whole-eye radiotherapy that was designed at Groote Schuur Hospital. It is used to treat retinoblastoma. Under general anaesthesia, a pericorneal ring is attached to the four extraocular muscles, and four legs, each loaded with I125 seeds, are inserted beneath the conjunctiva in-between each pair of muscles and attached anteriorly to the ring. The four legs that are now sutured onto the ring give it a claw-like appearance, hence the name for the applicator. The applicator was designed in such a way that the dose is directed towards the middle of the eye, while sparing surrounding tissues. The dose to the organs at risk could never be determined accurately, because the treatment planning system (TPS) is not able to take into account the gold shielding. Additionally, the TPS approximates each seed as a point source and not as a line source, therefore not taking any anisotropy into account. Aims: The first aim of this project was to accurately determine various dosimetric and physical characteristics of a single I-125 seed and to then compare these to published data. Spectral measurements of the OncoSeed 6711 using various detectors were also done. The next aim was to formalize the model of the “Claws” so that the applicator can potentially also be manufactured elsewhere. The next aim was to describe the “Claws” dosimetrically. This was done - Using thermoluminescent dosimeters in a solid water phantom - Using gafchromic film in a solid water phantom - Using treatment planning systems TheraPlan Plus and BrachyVision - Using Monte Carlo simulations – egs_brachy The final aim of the thesis was the comparison of measured and calculated data. The Monte Carlo simulations take into account the seed anisotropy as well as the gold shielding; therefore the relative dose to critical structures can be estimated more reliably. Method and Materials: Gafchromic film and thermoluminescent dosimeters (TLDs) were used for measurements in various specially designed phantoms to determine the seed parameters, as well as dose distributions in the eye. Dose distributions were calculated on two treatment planning systems. A CAD drawing of the “Claws” was created and used to create the input file for Monte Carlo simulations using egs_brachy. The final Monte Carlo calculation simulated 64.000.000.000 particle histories at voxel sizes of 0.1 mm x 0.1 mm x 0.1 mm. Results: Measured seed data matched published seed data. Significant dose distribution changes were found when comparing measured and Monte Carlo data to planned data, especially near the periphery of the eye between adjacent legs. The Monte Carlo calculated dose to the optic nerve is 64.8 % of the central dose in the eye, while the planned dose is 93.7 %. The Monte Carlo lens dose varies from 72.0 % - 86.1 %, while the planned dose varies from 73.0 % - 84.3 %. Monte Carlo calculated dose to the bony orbit is 11.3 %, while the planned dose is 54.7 %. Conclusion: Measured seed data matched published seed data. The “Claws” were formalized with CAD drawings. Measured and Monte Carlo simulated dose distributions matched well, while planned dose distributions showed discrepancies in certain regions of the eye and outside of the eye. This clearly indicates that the gold shielding of the applicator walls must be taken into account during dose calculations. It can be concluded that the “Claws” were extensively described and characterized in this work.
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    Open Access
    Retrospective study at a single tertiary hospital in South Africa (Groote Schuur) on the treatment outcome in patients who underwent TransArterial Chemo-Embolization (TACE) for hepatocellular carcinoma
    (2022) Sihlahla, Irvine; Said-Hartley, Mariam
    Background: Hepatocellular carcinoma is amongst the common causes of cancer deaths and has few curative treatment options. Transarterial chemoembolisation (TACE) is an option widely reported and used for palliative care and as a bridge to liver transplantation. Limited South African studies have examined the outcome of this type of therapy, with one comparing survival benefit and hospital stays in TACE using Adriamycin with lipiodol, with no benefit demonstrated. The current study aims to compare the imaging and alpha fetoprotein (AFP) responses with previous international studies on treatment response. Objectives:. To elucidate imaging and AFP outcomes after TACE in patients with hepatocellular carcinoma by measuring these in comparison with previous studies. Methods: 24 patients with hepatocellular carcinoma treated with TACE in the radiology department at Groote Schuur Hospital over a 4-year period were retrospectively reviewed by using an structured protocol. Baseline and post-TACE radiological features were assessed including tumour size and necrosis in conjunction with AFP levels were evaluated to determine tumour response. Results: During the study period 24 patients (17 males [70.8%] and 7 females[29.2%], with a mean age of 52.9 years) underwent TACE for HCC. 15 patients (62.5%) had documented cirrhosis, 14 patients (54 % ) had concomitant hepatitis, with hepatitis B being the commonest in 11 patients (45.8%). The majority of patients were Child Purgh A 21 patients (87.5% ) while 3 (12.5%) were Child Pugh B, 20 patients (83.3%) were TACE naïve, while 4 patient's (16.7%) had prior TACE treatment. 4 patient's (16.7%) of the study population had histologically confirmed hepatocellular carcinoma, 5 patients (20%) had HCC metastasis at baseline, 11 patients (45.8%) had AFP levels below 200ug/L and 13 patient's (54.2%) had levels above 200ug/L at baseline. 13 patients had large > 100 mm tumours at baseline, with median tumour size of 115 mm ( range 55,50-173 mm). 20 patients (83.3%) had imaging by 6 months (mean of 84 days, range 34- 126 days) post-TACE with a median tumour size of 91.00 mm [range 36.50-168.50 mm]. By both mRECIST criteria and EASL criteria, 10% of the study population had complete responses, 10% demonstrated partial responses by mRECIST criteria alone and none by EASL criteria. 20% had progressive disease by both mRECIST and EASL criteria. Stable disease was evident in 60% by mRECIST and 70% by EASL criteria.15 patients (62.5%) of the study population had AFP results post treatment, with a median of 624.00 micrograms/L (range 5.00 – 11548.00 micrograms/L). No patients demonstrated more than 90% reduction or normalisation of alpha-fetoprotein levels. 7 patients (46,67%) had greater than 50% but less than 90% reductions while 8 patients (53.3 %) had increased levels. The study demonstrated a weak correlation between alpha fetoprotein reduction and radiological response post-TACE (r = 0.085). Conclusion: Our study revealed 60% stable disease following TACE similar to 77% in the previous study by Lewandowski RJ et al ,with our 10% partial response compared to the 35% obtained by Llovet JM et al. The AFP had a 46% response compared to the one shown by Sherman et al which had 65%. TACE in patients with hepatocellular carcinoma has a modest radiological and biochemical response, with the majority of patients having stable disease.
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    Sequential improvement in paediatric medulloblastoma outcomes in a low-and-middle-income country setting over three decades
    (2021) Riedemann, Johann; Parkes, Jeannette; Davidson, Alan; Figaji, Anthony
    Background: Medulloblastoma (MB) is the commonest malignant brain tumour of childhood. Accurate clinical data for paediatric MB in the LMIC setting is lacking. Sequential improvements in outcome seen in high income countries are yet to be reflected in LMIC. Aim: Quantification of paediatric MB outcomes in the LMIC setting over three decades of advances in multidisciplinary intervention. Setting: Cape Town, South Africa Methods: This was a retrospective study of 136 children with MB diagnosed between 1985 and 2015. Modified Chang criteria were used for risk stratification. The primary study objective was overall survival (OS), quantified by analysis of epidemiological, clinical and pathological data. Results: OS improved significantly during the most recent decade (2005-2015) when compared with the preceding two decades (1985-1995 and 1995-2005). Despite reduced dose craniospinal irradiation for standard risk cases, OS was significantly greater than during the preceding two decades. High-risk disease was identified in 71.4% of cases and was associated with significantly inferior OS compared with standard risk cases. Improved OS was positively correlated with therapeutic era, 3-D conformal radiotherapy technique, older age at diagnosis, classic and desmoplastic histology, extent of resection and absence of leptomeningeal spread on imaging. Conclusion: Advances in multidisciplinary management of MB in our combined service are associated with improved survival. Access to improved imaging modalities, advances in surgical techniques, increased number of patients receiving risk-adapted combination chemo- and/or radiotherapy as well as craniospinal irradiation using a linear accelerator with 3D planning, are considered as contributing factors.