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This study aimed to understand the key factors experienced accredited exercise physiologists (AEPs) and medical professionals consider when prescribing/recommending aerobic exercise to patients with breast cancer undergoing chemotherapy. Modified Delphi Survey. A four-round, two-phase survey was conducted. Following a Delphi approach, four cancer-specific AEPs, four oncologists, and one breast cancer surgeon (median 13-yr breast-cancer-specific experience) completed phase one. Eighty-four AEPs (median 5-yr experience) completed phase two. Phase one participants answered open- and close-ended questions regarding key considerations for aerobic exercise in patients with breast cancer undergoing chemotherapy, and what information should be collected to guide exercise prescription. All questions and considerations agreed upon in phase one (> 70 % rating 7–9 on a 0–9 Likert Scale) were rated by AEPs in phase two. Key considerations for exercise assessment and prescription aligned closely with exercise guidelines for cancer survivors. Common strategies for exercise individualisation were identified by AEPs, including separating aerobic exercise into 5‐to‐–9-minute bouts when required and avoiding exercising to complete exhaustion. Exercise intensity and duration should be adjusted throughout chemotherapy to improve tolerance and adherence. Novel considerations for subjective questioning and objective assessments to tailor exercise prescription were outlined. This study identifies how professionals approach exercise assessment and prescription in patients with breast cancer undergoing chemotherapy. Findings can guide AEPs in practice when prescribing tailored exercise to breast cancer patients undergoing chemotherapy and inform future guidelines. [ABSTRACT FROM AUTHOR]

• A novel signal analysis method for rtOSL measurements and bleaching corrections is presented. • The presented method reduced the uncertainties in corrected rtOSL dose responses. • Uncertainties in rtOSL responses ranged from 3.4% to 6.5% for the range of dose rates tested. A new analysis method for the rtOSL of BeO ceramics is presented, using temporal curve fitting of an expected rtOSL signal to measured rtOSL signals. The presented technique does not require heavy signal averaging to determine the OSL bleaching correction associated with the Δ rtOSL method, reducing uncertainties in the post-correction rtOSL. The corrected rtOSL signal was demonstrated to be linear with dose, and dose-rate independent. The presented technique is expected to be applicable for many other dosimeters capable of the rtOSL technique. The presented technique achieved relative uncertainties in the corrected rtOSL between 3.4% and 6.5%. The initial measurements are promising, but uncertainties are required to be further improved upon before the technique can be used clinically. [ABSTRACT FROM AUTHOR]

Objective: Head and neck carcinomas are clinically challenging malignancies because of tumor heterogeneities and resilient tumor subvolumes that require individualized treatment planning and delivery for an improved outcome. Although current approaches to diagnosis and therapy have boosted locoregional control, the long-term survival in this patient group remains unchanged over the last decades. A new approach to head and neck cancer management is therefore needed to better identify patient subgroups that are responsive to specific therapies. The aim of this article is to review the current status of knowledge and practice utilizing big data toward personalized therapy in head and neck cancers based on CT and PET imaging modalities.Methods: Literature published in English since 2000 was searched using Medline. Additional articles were retrieved via pearling of identified literature. Publications were reviewed and summarized in tabulated format.Results: Studies based on big data in head and neck cancer are limited; however, the field of radiomics is under continuous development and provides valuable input for personalized treatment. Using PET/PET CT biomarkers for patient treatment individualization and response prediction seems promising, especially in regard to detection of hypoxia and clonogenic cancer stem cells. Literature shows that macroscopic changes in medical images (whether structural or functional) are correlated with biologic and biochemical changes within a tumor.Conclusion: Current trends in data science suggest that the ideal model for decision support in head and neck cancers should be based on human-machine collaboration, namely, on (1) software-based algorithms, (2) physician innovation collaboratives, and (3) clinician mix optimization. [ABSTRACT FROM AUTHOR]

Background: Despite the clinical knowledge accumulated over a century about tumor hypoxia, this biologic parameter remains a major challenge in cancer treatment. Patients presenting with hypoxic tumors are more resistant to radiotherapy and often poor responders to chemotherapy. Treatment failure because of hypoxia is, therefore, very common. Several methods have been trialed to measure and quantify tumor hypoxia, with varied success. Over the last couple of decades, hypoxia-specific functional imaging has started to play an important role in personalized treatment planning and delivery. Yet, there are no gold standards in place, owing to inter- and intrapatient phenotypic variations that further complicate the overall picture. The aim of the current article is to analyze, through the review of the literature, the potential role of radiomics and radiogenomics in patient stratification by tumor hypoxia status.Methods: Search of literature published in English since 2000 was conducted using Medline. Additional articles were retrieved via pearling of identified literature. Publications were reviewed and summarized in text and in a tabulated format.Results: Although still an immature area of science, radiomics has shown its potential in the quantification of hypoxia within the heterogeneous tumor, quantification of changes regarding the degree of hypoxia after radiotherapy and drug delivery, monitoring tumor response to anti-angiogenic therapy, and assisting with patient stratification and outcome prediction based on the hypoxic status.Conclusions: The lack of technique standardization to measure and quantify tumor hypoxia presents an opportunity for data mining and machine learning in radiogenomics. [ABSTRACT FROM AUTHOR]

• A real-time optically stimulated BeO ceramic fibre dosimeter developed. • Evaluated using therapeutic condition using a superficial X-ray beam. • A linear dose-rate response was observed for the ΔrtOSL. • The ΔrtOSL is shown to be stem effect free. The purpose of this study was to investigate the potential of real-time optically stimulated luminescence (rtOSL) measurements of a beryllium oxide (BeO) ceramic fibre-coupled luminescence dosimetry system. By pulsing the stimulation laser during the exposure to ionizing radiation, an rtOSL dose-rate measurement can be obtained which could be stem effect free. A portable rtOSL BeO ceramic fibre-coupled dosimetry system is presented and characterized using a constant dose-rate superficial 140 kVp X-ray beam. The rtOSL was measured for dose-rates between 0.29 and 3.88 Gy/min, controlled by varying the source to surface distance. After correcting for OSL decay during the exposure, a linear dose-rate response of the change in rtOSL (ΔrtOSL) was observed. The ΔrtOSL was also observed to be stem effect free. [ABSTRACT FROM AUTHOR]

• The response of a PMMA and silica optical fibre when exposed to 16.5 MeV protons is investigated. • A linear response observed in the change in ratio between the 460 nm and 650 nm peaks of the silica fibre. • Changes in PMMA emission spectrum are shown to be due to activation and photodarkening within the fibre. An investigation into the response of optical fibres to 16.5 MeV protons is presented here. A silica and a poly(methyl methacrylate) (PMMA) optical fibre was exposed to 16.5 MeV protons from a GE PETtrace cyclotron. The optical fibres were exposed to beam currents of 30nA – 270nA and the emission spectrum analysed. The silica fibre was the most sensitive and had two main peaks at 460 nm and 650 nm. The ratio between the peaks was observed to increase as irradiation of the fibres continued, where the 460 nm peak increased at a rate >4 times the 650 nm peak. The rate of increase of the ratio between the peaks was observed to be constant at a constant target current and linear with target current. In the case of the PMMA fibre, significant spectral changes were observed during the exposure to 16.5 MeV protons. A simple method for estimating the effect of photodarkening and activation is presented here and indicated that the changes in the spectrum for the PMMA fibres may be due to photodarkening and activation. [ABSTRACT FROM AUTHOR]

• Despite advances in knowledge, tumour hypoxia remains a challenge in radiotherapy. • Several hypoxia-targeting methods exists, all with their advantages and drawbacks. • In silico models are complementary tools offering novel solutions to manage hypoxia. • The paper reviews the current landscape of hypoxia models and response to therapy. • Future models must consider connected vascular networks to simulate agent delivery. The negative impact of tumour hypoxia on cancer treatment outcome has been long-known, yet there has been little success combating it. This paper investigates the potential role of in silico modelling to help test emerging hypoxia-targeting treatments in cancer therapy. A Medline search was undertaken on the current landscape of in silico models that simulate cancer therapy and evaluate their ability to test hypoxia-targeting treatments. Techniques and treatments to combat tumour hypoxia and their current challenges are also presented. Hypoxia-targeting treatments include tumour reoxygenation, hypoxic cell radiosensitization with nitroimidazoles, hypoxia-activated prodrugs and molecular targeting. Their main challenges are toxicity and not achieving adequate delivery to hypoxic regions of the tumour. There is promising research toward combining two or more of these techniques. Different types of in silico therapy models have been developed ranging from temporal to spatial and from stochastic to deterministic models. Numerous models have compared the effectiveness of different radiotherapy fractionation schedules for controlling hypoxic tumours. Similarly, models could help identify and optimize new treatments for overcoming hypoxia that utilize novel hypoxia-targeting technology. Current therapy models should attempt to incorporate more sophisticated modelling of tumour angiogenesis/vasculature and vessel perfusion in order to become more useful for testing hypoxia-targeting treatments, which typically rely upon the tumour vasculature for delivery of additional oxygen, (pro)drugs and nanoparticles. [ABSTRACT FROM AUTHOR]

Introduction: The most common solid tumours that develop in children are cancers of the central nervous system. Due to the increased rate of survival over the past decades, greater focus has been placed on the minimisation of long term side effects. In childhood cancer survivors, over 60% report one or more radiation-related late toxicities while half of these adverse events are graded as life-threatening or severe. Proton therapy enables high conformity with the planning target volume and a reduction in dose to areas beyond the target. Owing to the unique nature of dose delivery with proton therapy a reduction of low doses to normal tissues is achievable, and is believed to allow for a decrease in long-term treatment-related side effects. This paper aims to review the published literature around the effectiveness of proton therapy for the treatment of paediatric cancers of the central nervous system, with a focus on treatment outcomes and treatment-related toxicities.Methods: A search strategy utilising the Medline database was created with the intent of including all articles reporting on proton therapy, paediatric cancers, CNS tumours and treatment outcomes. The final search strategy included the following limitations: limited to humans, English, published from 2000 onwards. The final article count total was 74.Results and Conclusions: Proton therapy for the treatment of paediatric cancers of the central nervous system was found to provide survival and tumour control outcomes comparable to photon therapy. Reduced incidence of severe acute and late toxicities was also reported with the use of proton therapy. This includes reduced severity of endocrine, neurological, IQ and QoL deficits. Currently, extensive follow-up of proton patient populations still needs to be made to determine incidences of late-onset toxicities and secondary malignancies. Current evidence surrounding proton therapy use in paediatric patients supports its effectiveness and potential benefits in reducing the incidence of severe toxicities in later life. [ABSTRACT FROM AUTHOR]

The use of gold nanoparticle (GNP) and other metal nanoparticle (MNP) radiosensitisers to enhance radiotherapy offers the potential of improved treatment outcomes. Originally intended for use with X-ray therapy, the possibility of enhanced hadron therapy is desirable due to the superior sparing of healthy tissue in hadron therapy compared to conventional X-ray therapy. While MNPs were not expected to be effective radiosensitisers for hadron therapy due to the limited Z dependence of interactions, recent experimental measurements have contradicted this expectation. Key experimental measurements and Monte Carlo simulations of MNP radiosensitisation for hadron irradiation are reviewed in the current work. Numerous experimental measurements have found a large radiosensitisation effect due to MNPs for proton and carbon ion irradiation. Experiments have also indicated that the radiosensitisation is due in large part to enhanced reactive oxygen species (ROS) production. Simulations have found a large radial dose and ROS enhancement on the nanoscale around a single MNP. However, the short range of the dose enhancement is insufficient for a large macroscale dose enhancement or enhanced biological effect in a cell model considering dose to the nucleus from GNPs in the cytoplasm (a distribution observed in most experiments). [ABSTRACT FROM AUTHOR]

• Worldwide medical physicists (MP)workforce survey was conducted by IOMP. • 64 valid country responses were received from all continents. • Good MP numbers are in high income countries: Europe, Australia and North America. • In HICs MPs are more likely to subspecialize (e.g. imaging or radiation therapy). • Low MP numbers in middle/low-income countries result in combined specialization. • There appears to be a more prominent shortage of MPs in imaging modalities. Realizing the need for periodic surveys about global medical physics human resource, the International Organization for Medical Physics (IOMP) performed a third survey following the previous two (2015 and 2018). The objective was to collect information about the current numbers of medical physicists (MPs) in individual countries, about their MP training, and accreditation pathways. The survey was designed using Google Forms. Forms were distributed to national MP associations around the world. The data was collected during May-Nov 2022. MS Excel and SPSS software were used to perform descriptive statistics. 64 valid responses were received covering all continents. The largest numbers of MPs are in high income countries of Europe, Australia and North America, while the lowest numbers of MPs are seen in middle and low-income countries of Asia, Latin America and Africa. Among the respondents, 73% reported MP shortages in their countries. 69% reported the existence of an official MP training program which comprises university courses and in-service training. Furthermore, 85% of the respondents indicated the availability of MP university courses, primarily at the Master's degree level. Participation in research was between 10 and 30% of allocated work time for 42% and below 10% for 33% respondents. There are new findings on number of MPs per million population in different countries, with some expressing adequacy in the total number of MPs, but the data breakdown indicates a shortage in diagnostic X-ray physicists. Future surveys should also investigate in more detail data on outsourcing, and involvement in research. [ABSTRACT FROM AUTHOR]

Purpose: To simulate stereotactic ablative radiation therapy on hypoxic and well-oxygenated in silico tumors, incorporating probabilistic parameter distributions and linear-quadratic versus linear-quadratic-cubic methodology and the evaluation of optimal fractionation schemes using biological effective dose (BEDα/β=10 or 3) comparisons.Methods and Materials: A temporal tumor growth and radiation therapy algorithm simulated high-dose external beam radiation therapy using stochastic methods. Realistic biological proliferative cellular hierarchy and pO2 histograms were incorporated into the 10(8)-cell tumor model, with randomized radiation therapy applied during continual cell proliferation and volume-based gradual tumor reoxygenation. Dose fractions ranged from 6-35 Gy, with predictive outcomes presented in terms of the total doses (converted to BED) required to eliminate all cells that could potentially regenerate the tumor.Results: Well-oxygenated tumor control BED10 outcomes were not significantly different for high-dose versus conventional radiation therapy (BED10: 79-84 Gy; Equivalent Dose in 2 Gy fractions with α/β of 10: 66-70 Gy); however, total treatment times decreased from 7 down to 1-3 weeks. For hypoxic tumors, an additional 28 Gy (51 Gy BED10) was required, with BED10 increasing with dose per fraction due to wasted dose in the final fraction. Fractions of 9 Gy compromised well for total treatment time and BED, with BED10:BED3 of 84:176 Gy for oxic and 132:278 Gy for non-reoxygenating hypoxic tumors. Initial doses of 12 Gy followed by 6 Gy further increased the therapeutic ratio. When delivering ≥9 Gy per fraction, applying reoxygenation and/or linear-quadratic-cubic cell survival both affected tumor control doses by a significant 1-2 fractions.Conclusions: The complex temporal dynamics of tumor oxygenation combined with probabilistic cell kinetics in the modeling of radiation therapy requires sophisticated stochastic modeling to predict tumor cell kill. For stereotactic ablative radiation therapy, high doses in the first week followed by doses that are more moderate may be beneficial because a high percentage of hypoxic cells could be eradicated early while keeping the required BED10 relatively low and BED3 toxicity to tolerable levels. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Despite the large variety of treatment methods available for the management of advanced head and neck carcinomas, these tumours remain highly challenging due to their aggressiveness and complex anatomical location. Among the treatment challenges associated with head and neck cancers, hypoxia and tumour repopulation during treatment are, most likely, the main reason for locoregional treatment failure. Whilst the number of techniques and predictive assays designed to assess the oxygenation status or the proliferative ability of tumours is rather large, they all come with drawbacks which limit their implementation as routine clinical procedures. Latest developments in the field of nuclear medicine have opened the road to new possibilities in functional imaging, thus overcoming some of the confines imposed by the more conventional techniques. Materials and methods: The current paper presents the role of PET imaging as a quantitative evaluation tool for hypoxia status and proliferative ability of advanced head and neck tumours. Traditional as well as novel radioisotopes with high affinity towards hypoxia and proliferative tumour activity are presented and their pre-clinical/clinical results analysed. Results: While the number of clinical studies which aimed to validate novel radiotracers for head and neck cancer is limited, a number of results show promising correlation between uptake/marker activity and treatment outcome. Conclusion: There is need for further studies and well designed clinical trials to obtain more conclusive results. [Copyright &y& Elsevier]

Abstract: Advanced head and neck cancers are one of the most challenging cancers facing the oncologists due to their aggressiveness attributable to the high hypoxic content and the tumour''s ability to repopulate during radiotherapy. Alterations of radiotherapy fractionation schedules are possible ways to improve tumour control. Clinical trials have shown that both hyperfractionated radiotherapy (multiple fractions a day, over the same treatment time), and accelerated radiotherapy (higher doses per fraction, six days a week, over 5 weeks or less) are more effective than conventional radiotherapy in the management of head and neck cancer. However, the treatment choice between hyperfractionated and accelerated radiotherapy is still debated, due to very similar results obtained regarding tumour control. Furthermore, while radiotherapy alone has an impact on the short-term prognosis of advanced head and neck cancer, the long-term benefits have been moderate. Cisplatin is a chemotherapeutic agent which combined with conventional radiotherapy has shown to improve patient survival. The present paper employs a Monte Carlo modelling approach in assessing the effect of combined cisplatin-altered fractionation schedule on tumour response. The growth of a head and neck carcinoma has been modelled using probabilistic functions sampled by computer generated random number sequences, maintaining the biological constitution of a tumour. The tumour growth model has been built to simulate the in vivo processes taking place before and after radiotherapy/chemotherapy. The model has shown that adding cisplatin to radiotherapy improves tumour control in both hyperfractionated and accelerated radiotherapy. [Copyright &y& Elsevier]

Abstract: The current work focuses on the verification of transmitted dose maps, measured using a scanning liquid ionization chamber–electronic portal imaging device (SLIC–EPID) for a typical step-and-shoot prostate IMRT treatment using an anthropomorphic phantom at anterior–posterior (A–P), and several non-zero gantry angles. The dose distributions measured using the SLIC–EPID were then compared with those calculated in the modelled EPID for each segment/subfield and also for the corresponding total fields using a gamma function algorithm with a distance to agreement and dose difference criteria of 2.54mm and 3%, respectively. [Copyright &y& Elsevier]

In the current pandemic times, medical physicists may not be aware that there is an interesting story on two significant discoveries related to the coronavirus. One is the invention of the polymerase chain reaction (PCR) and the other is the first electron microscopic observation and identification of the coronavirus. Both of them were disregarded by the reviewers and major journals declined to publish these discoveries. These days, PCR, for example, is a widespread method for analyzing DNA, having a profound effect on healthcare, especially now during the Covid-19 pandemic. Prejudice or perhaps ignorance prevail in every aspect of our society, and there is no exception in scientific research. We need to, however, learn from these two stories and be open-minded about novel discoveries and findings – as they may be just disruptive in the "right" way to lead to an unexpected breakthrough. [ABSTRACT FROM AUTHOR]

Purpose: Improvements in personalized therapy are made possible by the advances in molecular biology that led to developments in molecular imaging, allowing highly specific in vivo imaging of biological processes. Positron emission tomography (PET) is the most specific and sensitive imaging technique for in vivo molecular targets and pathways, offering quantification and evaluation of functional properties of the targeted anatomy.Materials and Methods: This work is an integrative research review that summarizes and evaluates the accumulated current status of knowledge of recent advances in PET imaging for cancer diagnosis and treatment, concentrating on novel radiotracers and evaluating their advantages and disadvantages in cancer characterization. Medline search was conducted, limited to English publications from 2007 onward. Identified manuscripts were evaluated for most recent developments in PET imaging of cancer hypoxia, angiogenesis, proliferation, and clonogenic cancer stem cells (CSC).Results: There is an expansion observed from purely metabolic-based PET imaging toward antibody-based PET to achieve more information on cancer characteristics to identify hypoxia, proangiogenic factors, CSC, and others. 64Cu-ATSM, for example, can be used both as a hypoxia and a CSC marker.Conclusions: Progress in the field of functional imaging will possibly lead to more specific tumor targeting and personalized treatment, increasing tumor control and improving quality of life. [ABSTRACT FROM AUTHOR]

Objectives: Low exercise adherence is common amongst breast cancer (BC) patients. This study aimed to understand BC patients exercise identity and fears of exercise to identify barriers to exercise participation.Methods: Women (18 years plus) currently undergoing, or completed (in remission), chemotherapy for BC, and women (18 years plus) with no cancer history completed three validated questionnaires: Exercise Identity Scale (EI), Exercise Fear Avoidance Scale (EFAS) and Fear of Physical Activity/Exercise Scale - Breast Cancer.Results: 86 women were included (BC: n = 51 - non-cancer: n = 35). There were no significant differences between groups when comparing overall EI (p = 0.240; d=0.127) and EFAS (p = 0.060; d=0.203) scores. BC reported significantly higher scores on specific questions related to fear during exercise (EFAS 2,3, and 5; p = <0.005). Associations were observed between EI and EFAS questionnaire scores in BC (r = -0.342; p = 0.014), and EI scores and exercise levels in both groups (BC, r = 0.527; p = <0.001; non-cancer, r = 0.639; p = <0.001).Conclusion: Results suggest women with BC may have specific concerns and fears of exercise compared to age-matched controls. Education may mitigate fears, increase exercise identity, and promote exercise uptake.Practical Implications: Education provided by clinicians at BC diagnosis regarding the benefits and safety of exercise may help mitigate fear and promote exercise identity. [ABSTRACT FROM AUTHOR]

Access to health services, including antenatal ultrasound scanning, is a key risk factor associated with neonatal and maternal mortality and morbidity. Proportionately fewer pregnant women in rural and remote Australia have access to timely ultrasound services compared to women in metropolitan and regional areas, due in part to a chronic shortage of trained sonographers1,2,3. PoCUS is receiving growing attention and offers a practical solution to address this deficit in best practice care. However, questions remain surrounding how to best teach PoCUS and ensure training is contextually delivered to our remotely located clinicians who face considerable barriers to professional development. This research aimed to deliver PoCUS training to small groups of GPs and midwives recruited from rural and remote areas in Australia. The effectiveness of the teaching and experiences of the trainees were examined and the impact of the training on clinical practice explored. Two intensive two-day antenatal PoCUS training workshops (endorsed by ASUM and ISUOG) were conducted for twelve GPs and thirteen midwives in early 2018. They consisted of lectures and practical hands-on sessions with high fidelity simulators and live pregnant models. Pre- and post-training assessment and evaluation was conducted and progress surveyed at 3 and 6 months. The Kirkpatrick Evaluation Framework (KEF) was used to appraise the efficacy of the PoCUS training provided. All participants found the training useful and relevant to their role, and highly rated the workshop design, content and delivery. The advantages of High fidelity simulators and live pregnant volunteers featured heavily in the feedback. Pre/post testing analysis showed 26% improvement in antenatal US knowledge (P < 0.0001). 88% of participants applied knowledge from training to practice and reported improved scanning confidence. 83% of participants increased scanning frequency, 8% had no change in frequency and 8% were not scanning (broken equipment, no antenatal patients). Further practice, additional courses and mentored support were listed by 83% of participants as necessary to consolidate knowledge/skills and increase scanning frequency, highlighting the need for ongoing training and emphasising the challenge of professional skill development without direct specialist supervision or mentorship. PoCUS presents a viable solution to assist resource-poor settings in rural and remote Australia. Intensive workshops are able to equip clinicians with valuable life-saving skills which can benefit our most disadvantaged communities. Geographical isolation and lack of onsite specialist supervision poses an ongoing challenge to the development of remote trainees' PoCUS skills. [ABSTRACT FROM AUTHOR]

Introduction: There is currently no definitive diagnostic test for Parkinson's disease (PD) and the current diagnostic procedure primarily relies on clinical manifestations. A hypointense appearance of nigrosome-1 (or absence of the "swallow tail" sign) on magnetic resonance imaging (MRI) has been proposed as a biomarker for PD. This meta-analysis examined the diagnostic accuracy of the appearance of nigrosome-1 on Magnetic Resonance Imaging (MRI) in differentiating idiopathic PD patients from healthy adults.Methods: Databases (MEDLINE, Embase, Scopus) were searched from 2012 (first publication of nigrosome-1 MRI scans) up until September 2019. Two researchers independently screened all titles and abstracts to identify studies that met the inclusion criteria and extracted relevant articles in a uniform manner. Two authors independently extracted data and assessed the risk of bias using a customized QUADAS-2 tool. Pooled sensitivity and specificity were calculated using a hierarchical summary receiver operating characteristic approach, as were positive and negative likelihood ratios.Results: Nineteen studies containing a total of 1508 participants (903 idiopathic PD patients and 605 healthy controls) were included. The overall sensitivity and specificity were 0.94 (95%CI, 0.93-0.96) and 0.90 (95%CI, 0.88-0.92), respectively. The likelihood ratios for positive and negative test results were 9.72 (95%CI, 5.58-16.04) and 0.08 (95%CI, 0.05-0.12). The pooled area under the receiver operating characteristics curve (AUC) in the diagnosis of idiopathic PD was 0.98.Conclusions: Visual assessment of the nigrosome-1 appearance, at 3 or 7T, yields excellent diagnostic accuracy for differentiating idiopathic PD from healthy adults. [ABSTRACT FROM AUTHOR]

Abstract: Radio-resistant hypoxic tumor cells are significant contributors to the locoregional recurrences and distant metastases that mark failure of radiotherapy. Due to restricted tissue oxygenation, chronically hypoxic tumor cells frequently become necrotic and thus there is often an association between chronically hypoxic and necrotic tumor regions. This simulation study is the first in a series to determine the feasibility of hypoxic cell killing after first targeting adjacent areas of necrosis with either an α- or β-emitting radioimmunoconjugate. [Copyright &y& Elsevier]

Abstract: Enhanced radiosensitivity is an uncommon phenomenon attributable to deficient DNA repair after radiotherapy which can be assessed with the γ-H2AX assay. Reports of radiosensitivity after stereotactic radiosurgery (SRS) are uncommon. We describe a case where the clinical, radiological and laboratory findings suggest enhanced radiosensitivity after SRS for an acoustic neuroma. [Copyright &y& Elsevier]

[Display omitted] • Gaps exist in evidence-based proton therapy planning for paediatric brain cancer patients. • Large variations in normal tissue tolerance reporting critical structures (i.e. hypothalamic-pituitary region; 20 to 30 and 54.6 Gy). • Difficulty validating normal tissue dose constraints have the potential for significant late effects go unmeasured. • Consensus must be reached to optimise individual patient plans to reduce side-effects. • Improved data collection and collaboration are needed to draw comparisons and lead to guideline establishment. Proton radiotherapy (PT) is used increasingly for paediatric brain cancer patients. However, as demonstrated here, the knowledge on normal tissue dose constraints, to minimize side-effects, for this cohort is limited. A search strategy was systematically conducted on MEDLINE® database. 65 papers were evaluated ranging from 2013 to 2021. Large variations in normal tissue tolerance and toxicity reporting across PT studies makes estimation of normal tissue dose constraints difficult, with the potential for significant late effects to go unmeasured. Mean dose delivered to the pituitary gland varies from 20 to 30 Gy across literature. Similarly, the hypothalamic dose delivery ranges from 20 to 54.6 Gy for paediatric patients. There is a significant lack of radiobiological data for paediatric brain cancer patients undergoing proton therapy, often using data from x-ray radiotherapy and adult populations. The way forward is through standardisation of reporting in order to validate relevant dose constraints. [ABSTRACT FROM AUTHOR]

Endometriosis is a common, chronic gynaecological condition affecting as many as 1 in 10 women (approximately 700,000 Australians)[1]. The current consensus produced by the World Endometriosis Society (WES) suggests women with severe disease should be managed in centralised highly specialised endometriosis centres[2]. In order to facilitate accurate triage of patients to such centres, a reliable and accurate method of diagnosis is needed[3] however, we are still currently at the point where TVS for endometriosis is a highly specialised niche modality available in only a few selected centres. In Australia, our expansive geography means some women will be forced to travel extraordinary distances to access just to obtain an initial diagnosis. This literature review aims to determine the current accuracy of TVS for endometriosis as performed by sonographers. A review of the literature was performed to determine the current reported accuracy of TVS in the diagnosis of deep infiltrating endometriosis (DIE). A search of four databases was performed following a PICO (MEDLINE, EMBASE, EMCARE and Google Scholar). 31 papers were included in the final review. Overall accuracy of TVS as compared to laparoscopy is reported to be very good by many authors with sensitives and specificities of up to 100% reported depending on location. Most of the published data has come from specialised endometriosis centres around the world (or specialised gynaecological pain clinics) leaving a gap in the literature for evidence affirming the accuracy of TVS outside of these centres. Heterogenicity exists within the literature as to the qualifications and training of those performing TVS with few authors reporting this. Reports of a sonographer (rather than a gynaecologist) performing the TVS are rare. TVS is a reliable and accurate tool in the assessment of DIE prior to surgery. More studies are required to validate these findings outside of specialised endometriosis centres particularly utilising sonographers rather than gynaecologists to perform the scanning. Without evidence to support TVS being accurate in a generalised setting, diagnosis of endometriosis via TVS will remain a specialised and restricted service for Australian women. [ABSTRACT FROM AUTHOR]