Nuclear Medicine & Radiation Therapy

Molecular imaging represents a paradigm shift in the realm of medical diagnostics, offering a deeper understanding of cellular activity in health and disease. In nuclear medicine, this cutting-edge approach utilizes radiopharmaceuticals and advanced imaging techniques to visualize molecular processes within the body. This article explores the significance of molecular imaging, its applications and the transformative impact it has on healthcare. The foundation of molecular imaging lies in radiopharmaceuticals compounds that combine a radioactive isotope with a biologically active molecule. These molecules can selectively bind to specific cellular targets, allowing the visualization of molecular processes.

Multidisciplinary healthcare involves professionals from various fields working together to develop personalized treatment plans for each patient. In the context of cancer, this often includes medical oncologists, surgical oncologists, radiation oncologists, radiologists, pathologists and other specialists. Before initiating radiation therapy, a thorough assessment of the patient's medical history, diagnostic imaging and pathology results is essential. The meticulously analyse of the images to identify the tumor's precise location and the location of critical structures. After identifying the target volume and critical structures, dosimetrists use specialized software to calculate the optimal distribution of radiation dose.

Radioactive tracers make them powerful tools in medical diagnostics, offering insights into the function, structure and metabolism of organs and tissues. Unlike traditional imaging methods that focus on anatomy, nuclear medicine primarily provides functional information. Radioactive tracers can be designed to target specific tissues or organs based on their physiological characteristics. This targeted approach enhances the specificity of diagnostic imaging, providing detailed information about the area of interest. Radiopharmaceuticals are used to detect abnormalities or changes in the function of organs and tissues This article explores the significance of molecular imaging, its applications and the transformative impact it has on healthcare. The foundation of molecular imaging lies in radiopharmaceuticals compounds that combine a radioactive isotope with a biologically active molecule. These molecules can selectively bind to specific cellular targets, allowing the visualization of molecular processes.

Nuclear medicine often contain regions with limited oxygen supply (hypoxia), which are more resistant to radiation. Radiosensitizers can help overcome this resistance by improving oxygen levels in tumor tissues The meticulously analyse of the images to identify the tumor's precise location and the location of critical structures. After identifying the target volume and critical structures, dosimetrists use specialized software to calculate the optimal distribution of radiation dose.

The question for the radiologic technologist is: What does a radiologic technologist do when it is time for them to clock in but they have a million things on their mind? How do they deal with the chaos in their mind from the morning chaos? What if they lack the motivation to do their job and they have an 8-hour shift staring them in the face? The answer is simple: They have 3 minutes. Three minutes to get it together before they start their shift, 3 minutes to get their professional demeaner on and 3 minutes to leave it all behind and focus on the patient. This article will discuss exactly how to do that exact thing, by utilizing three items in the radiologic technologist toolbox: A good attitude, professionalism and education. When utilized correctly, these items will help the radiologic technologist prepare for their upcoming shift and assist them in leaving the drama off the clock and patient care in focus.

Introduction: With the improvement in prognosis for patients with breast cancer, reducing long-term toxicity from treatment has become increasingly important. Left breast Radiotherapy (RT usually results in higher dose delivery to the heart and lungs, which are treated as Organs at Risk (OAR. Heart irradiation increases the risk of radiation induced heart disease and major coronary artery disease in long term survivors.

Material and methods: After obtaining informed consent, 50 patients were enrolled in the study between October 2020 and February 2021. Two scans were performed on each patient, one in Free Breathing (FB) and one using Deep Inspiratory Breath Hold technique (DIBH). Contouring of target volume and Organ at Risk (OAR) were performed on both scans. Dose Volume Histograms (DVH) was generated for both scans for plan evaluation. Dose parameters were calculated and compared to assess doses to heart and lungs. In addition, anatomical parameters including Maximum Heart Distance (MHD), Haller Index (HI), Central Long Distance (CLD), chest wall separation (CWS), Heart Chest Distance (HCD), Lung Volume Difference (LVD), and Cardiac Contact Distance (CCD) in axial and parasagittal planes were also studied for impact on doses to heart and lung.

Results: The reduction in mean doses using DIBH was statistically significant for both heart and lung. Overall, the mean heart dose in FB was 5.60 ± 2.20 and in DIBH it is 2.50 ± 1.24 leading to a difference of 3.4 Gy.

About 17 patients (34% failed to attain a difference of ≥2 Gy with DIBH scans. This difference was persistent and significant in V10, V30, V35 of heart. Similarly, mean left lung dose reduction of 4.89 Gy was seen from 9.42 ± 2.80 in FB to 4.53 ± 2.20 using DIBH scan with statistically significant (p value=<0.05. Overall, V₂₀ V₅ and V₁₀ of both lungs showed no statistical difference in either group (FB and DIBH, respectively. On contrary to this, the impact of DIBH dose reduction was more pronounced in V₂₀ and V₃₀ of left lung and less marked in V₅ and V₁₀. The mean differences in different anatomical parameters between FB and DIBH scan were significant for all stated parameters except chest wall separation (FB=20.35 cm, DIBH=20.55 cm, p-value=0.68. The moderate correlation between the anatomical parameters and mean heart dose reduction was statically significant for CLD (r=-0.36, p- value 0.01, MHD (r=-0.40, p-value=0.007, HCD (r=0.50, p-value=0.001, CCDps (r=-0.43, p-value=0.002 while the rest of the parameters including CCDax, LVD, CWS and Haller index showed weak correlation with outcome variable. The Multivariate regression analysis concluded HCD (β=2.02 (CI=1.14-2.89),p -value=0.001)a nd CLD (β-1.499 (CI=-2.448-0.549),p - value=0.003 two variables that independently predict mean heart dose reduction for patients undergoing DIBH based left sided breast radiotherapy.

Conclusion: DIBH is a sublime technique and it is cost effective if used in suitable cohorts of patients. To improve selection criteria, HCD and CLD can be used as suitable anatomical predictors for reduction in mean doses to organs at risk.