Faculty Bibliography

PURPOSE: To compare the dosimetry of target and normal tissue when tangents with the breast tissue were applied in a subset of breast cancer patients who had undergone computed tomography (CT) planning both supine and prone. METHODS AND MATERIALS: The CT images of 20 patients who had undergone simulation in supine and prone positions were used for planning. The axillary lymph node regions (level I-III), breast tissue, tumor bed, heart, and bilateral lungs were manually contoured. Standard tangent fields were designed for the whole breast to deliver a prescribed dose of 50 Gy. Dose-volume histograms were compared between the two sets. RESULTS: In each patient, coverage of breast tissue and tumor bed was readily achieved by either technique. In either position, treatment of the nodal regions was inadequate. On average, the mean dose to the nodal regions for levels I-III was approximately 50% less in the prone as compared with the supine position. The mean ipsilateral lung volume receiving 95% of the prescribed dose was 6.3% in the supine position compared to 0.43% in the prone position. When planned supine, the mean heart volume receiving 30 Gy was 0.56% compared with 0.30% in the prone position. CONCLUSIONS: Planning in either position was found to achieve adequate coverage of the breast tissue and tumor bed for all patients. Lung was better spared prone. Coverage of axillary nodes was inadequate in either position, but further reduced in the prone vs. supine position. The choice of optimal setup should take into considerations stage and risk of nodal recurrence

OBJECTIVE: The imaging of pulmonary nodules is an evolving and dynamic field. In this review, we discuss the detection and multitechnique characterization of pulmonary nodules, emphasizing the impact of technological advances on both noninvasive and invasive evaluation and surveillance. The potential contribution of MRI, evolving imaging-guided techniques, and computer applications are also discussed. CONCLUSION: Advances in MDCT and PET and the potential contribution of fast-imaging MRI sequences and computer applications should continue to improve our evaluation of the solitary pulmonary nodule

The immune-reconstitution syndrome is a paradoxical inflammatory response to a preexisting or a coexisting disease, after the initiation of highly active antiretroviral therapy for the human immunodeficiency virus. Infrequently described, the radiographic and computed tomographic findings of the immune-reconstitution syndrome, which is related to the Mycobacterium avium-intracellulare infection and to highly active antiretroviral therapy, are presented in 2 patients. Homogeneous mediastinal and hilar lymphadenopathy were present in both individuals, with one having a large mass accompanied by small nodules