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Brunelle CL, Boyages J, Jung AW, Suami H, Juhel BC, Heydon-White A, Mackie H, Chou SHS, Paramanandam VS, Koelmeyer L, Taghian AG. Breast lymphedema following breast-conserving treatment for breast cancer: current status and future directions. Breast Cancer Res Treat 2024; 204:193-222. [PMID: 38100015 DOI: 10.1007/s10549-023-07161-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/05/2023] [Indexed: 03/19/2024]
Abstract
PURPOSE To examine the current evidence on breast lymphedema (BL) diagnosis and treatment after breast-conserving surgery, identify gaps in the literature, and propose future research directions. METHODS A comprehensive literature review was conducted using Ovid, PubMed, and Cochrane, including studies published between 2000 and 2023. References were reviewed manually for eligible studies. Inclusion criteria were as follows: patients who underwent breast conserving treatment (surgery ± radiation) for breast cancer, goals of the paper included analyzing or reviewing BL measurement with ultrasound or tissue dielectric constant, or BL treatment. Twenty-seven manuscripts were included in the review. RESULTS There is variation in incidence, time course, and risk factors for BL. Risk factors for BL included breast size, primary and axillary surgery extent, radiation, and chemotherapy but require further investigation. Diagnostic methods for BL currently rely on patient report and lack standardized criteria. Tissue dielectric constant (TDC) and ultrasound (US) emerged as promising ambulatory BL assessment tools; however, diagnostic thresholds and validation studies with ICG lymphography are needed to establish clinical utility. The evidence base for treatment of BL is weak, lacking high-quality studies. CONCLUSION The natural history of BL is not well defined. TDC and US show promise as ambulatory assessment tools for BL; however, further validation with lymphatic imaging is required. BL treatment is not established in the literature. Longitudinal, prospective studies including pre-radiation measurements and validating with lymphatic imaging are required. These data will inform screening, diagnostic criteria, and evidence-based treatment parameters for patients with BL after breast-conserving surgery and radiation.
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Affiliation(s)
- Cheryl L Brunelle
- Department of Physical and Occupational Therapy, Massachusetts General Hospital, 15 Parkman Ave, WACC 128, Boston, MA, 02114, USA.
| | - John Boyages
- Australian Lymphoedema Education Research and Treatment Program (ALERT), Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- Icon Cancer Centre, Wahroonga, NSW, Australia
- The ANU School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - Amanda W Jung
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Hiroo Suami
- Australian Lymphoedema Education Research and Treatment Program (ALERT), Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Brooke C Juhel
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Asha Heydon-White
- Australian Lymphoedema Education Research and Treatment Program (ALERT), Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Helen Mackie
- Australian Lymphoedema Education Research and Treatment Program (ALERT), Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | | | - Vincent S Paramanandam
- Australian Lymphoedema Education Research and Treatment Program (ALERT), Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Louise Koelmeyer
- Australian Lymphoedema Education Research and Treatment Program (ALERT), Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
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Mayrovitz HN. Medical Applications of Skin Tissue Dielectric Constant Measurements. Cureus 2023; 15:e50531. [PMID: 38222165 PMCID: PMC10787628 DOI: 10.7759/cureus.50531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Tissue dielectric constant (TDC) values assess certain skin properties that are dependent on multiple factors but mainly on the relative amount of water content within a locally measured tissue volume. Because of the non-invasive nature of these measurements and their ease of use, the method has been widely used in various medically related applications. The goal of this paper was to review and describe the uses and findings of such TDC measurements, considering and including the wide array of medical applications. The review is in part based on information derived from an analysis of published material obtained via literature searches of four major electronic databases and, in part, based on the author's experience with the TDC measurement methods and their various applications and his professional experiences. The databases searched were PubMed, Web of Science, EMBASE, and CINAHL Complete. Based on the initial search criteria, a total of 1257 titles were identified. After removing duplicates and filtering according to relevancy, 160 remained for detailed further review. In some cases, the bibliography of these retrieved articles provided additional sources. The findings demonstrate multiple research and medical uses and applications of TDC measurements, focusing on detecting and quantifying localized edema and lymphedema in multiple target sites. These include the upper and lower extremities, breasts, and trunk as regions involved in medical conditions causing lymphedema. In addition, the findings suggest that TDC evaluations are a convenient, non-invasive method to study and evaluate other conditions impacting skin, including diabetes mellitus and skin wounds or ulcers. Its ability to detect aspects of tissue changes simply and rapidly at almost any anatomical location makes it a useful tool for investigating multiple dermatological conditions and their treatment as future applications of this method.
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Affiliation(s)
- Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
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3
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Wang J, Zhou B, Yang X, Tridandapani S, Lin J, Torres MA, Liu T. Ultrasound-Based Grading System for Radiation-Induced Acute Breast Toxicity. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1307-1317. [PMID: 36583524 DOI: 10.1002/jum.16144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/11/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To introduce an ultrasound-based scoring system for radiation-induced breast toxicity and test its reliability. METHODS Breast ultrasound (BUS) was performed on 32 patients receiving breast radiotherapy (RT) to assess the radiation-induced acute toxicity. For each patient, both the untreated and irradiated breasts were scanned at five locations: 12:00, 3:00, 6:00, 9:00, and tumor bed to evaluate for heterogenous responses to radiation within the entire breast. In total, 314 images were analyzed. Based on ultrasound findings such as skin thickening, dermis boundary irregularity, and subcutaneous edema, a 4-level, Likert-like grading scheme is proposed: none (G0), mild (G1), moderate (G2), and severe (G3) toxicity. Two ultrasound experts graded the severity of breast toxicity independently and reported the inter- and intra-observer reliability of the grading system. Imaging findings were compared with standard clinical toxicity assessments using Common Terminology Criteria for Adverse Events (CTCAE). RESULTS The inter-observer Pearson correlation coefficient (PCC) was 0.87 (95% CI: 0.83-0.90, P < .001). For intra-observer repeatability, the PCC of the repeated scores was 0.83 (95% CI: 0.78-0.87, P < .001). Imaging findings were compared with standard clinical toxicity assessments using CTCAE scales. The PCC between BUS scores and CTCAE results was 0.62 (95% CI: 0.35-0.80, P < .001). Among all locations, 6:00 and tumor bed showed significantly greater toxicity compared with 12:00 (P = .04). CONCLUSIONS BUS can investigate the cutaneous and subcutaneous tissue changes after RT. This BUS-based grading system can complement subjective clinical assessments of radiation-induced breast toxicity with cutaneous and subcutaneous sonographic information.
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Affiliation(s)
- Jing Wang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Boran Zhou
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Srini Tridandapani
- Department of Radiology, University of Alabama, Birmingham, Alabama, USA
| | - Jolinta Lin
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Mylin A Torres
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Tian Liu
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
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Gupta SS, Mayrovitz HN. The Breast Edema Enigma: Features, Diagnosis, Treatment, and Recommendations. Cureus 2022; 14:e23797. [PMID: 35518543 PMCID: PMC9065943 DOI: 10.7759/cureus.23797] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022] Open
Abstract
Breast edema most commonly occurs after breast cancer treatment involving breast-conserving therapy, although it may have a variety of other causes. As compared to research on breast cancer treatment-related lymphedema, breast edema and its objective measurement and diagnosis is far behind. Consequences of this disparity contribute to uncertainty and variability in its diagnosis, its treatment, and even the characterization of its incidence and morbidity. Moreover, consensus on a standardized definition, objective diagnostic method, and treatment techniques for breast edema has not yet been reached, making it difficult to provide appropriate guidelines with respect to its management. Given the recent rise in breast edema incidence as an outcome of the increasing use of breast-conserving therapy, this timely review examines the current state of breast edema assessment and makes a case for standardization in part via quantitative methods to diagnose and track breast edema.
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Abdlaty R, Fang Q. Skin erythema assessment techniques. Clin Dermatol 2021; 39:591-604. [PMID: 34809765 DOI: 10.1016/j.clindermatol.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Skin erythema may present owing to many causes. One of the common causes is prolonged exposure to sunrays. Other than sun exposure, skin erythema is an accompanying sign of dermatologic diseases, such as psoriasis and acne. Quantifying skin erythema in patients enables the dermatologist to assess the patient's skin health. Quantitative assessment of skin erythema has been the focus of several studies. The clinical standard for erythema evaluation is visual assessment; however, this standard has some deficiencies. For instance, visual assessment is subjective and ineffectual for precise color information exchange. To overcome these limitations, in the past three decades various methodologies have been developed in an attempt to achieve objective erythema assessments, such as diffuse reflectance spectroscopy and both optical and nonoptical systems. This review considers the studies published during the past three decades and discusses the performance, the mathematical tactics for computation, and the limited capabilities of erythema assessment techniques for cutaneous diseases. The achievements and limitations of the current techniques in erythema assessment are presented. The advantages and development trends of optical and nonoptical methods are presented to make the reader aware of the present technological advances and their potential for dermatological disease research.
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Affiliation(s)
- Ramy Abdlaty
- Biomedical Engineering, Military Technical College, Kobry-Elkobba, Cairo, Egypt
| | - Qiyin Fang
- Department of Engineering Physics, McMaster University, Hamilton, ONT, Canada.
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Quantitative assessments of late radiation-induced skin and soft tissue toxicity and correlation with RTOG scales and biological equivalent dose in breast cancer. Clin Transl Oncol 2021; 24:836-845. [PMID: 34792726 PMCID: PMC8600910 DOI: 10.1007/s12094-021-02729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/31/2021] [Indexed: 11/13/2022]
Abstract
Purpose Radiation-induced toxicity (RIT) is usually assessed by inspection and palpation. Due to their subjective and unquantitative nature, objective methods are required. This study aimed to determine whether a quantitative tool is able to assess RIT and establish an underlying BED-response relationship in breast cancer. Methods Patients following seven different breast radiation protocols were recruited to this study for RIT assessment with qualitative and quantitative examination. The biologically equivalent dose (BED) was used to directly compare different radiation regimens. RIT was subjectively evaluated by physicians using the Radiation Therapy Oncology Group (RTOG) late toxicity scores. Simultaneously an objective multiprobe device was also used to quantitatively assess late RIT in terms of erythema, hyperpigmentation, elasticity and skin hydration. Results In 194 patients, in terms of the objective measurements, treated breasts showed higher erythema and hyperpigmentation and lower elasticity and hydration than untreated breasts (p < 0.001, p < 0.001, p < 0.001, p = 0.019, respectively). As the BED increased, Δerythema and Δpigmentation gradually increased as well (p = 0.006 and p = 0.002, respectively). Regarding the clinical assessment, the increase in BED resulted in a higher RTOG toxicity grade (p < 0.001). Quantitative assessments were consistent with RTOG scores. As the RTOG toxicity grade increased, the erythema and pigmentation values increased, and the elasticity index decreased (p < 0.001, p = 0.016, p = 0.005, respectively). Conclusions The multiprobe device can be a sensitive and simple tool for research purpose and quantitatively assessing RIT in patients undergoing radiotherapy for breast cancer. Physician-assessed toxicity scores and objective measurements revealed that the BED was positively associated with the severity of RIT. Supplementary Information The online version contains supplementary material available at 10.1007/s12094-021-02729-z.
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Qin F, Zhang W, Zhang M, Long X, Si L, Li Z, Huang J, Wang X. Adipose-Derived Stem Cells Improve the Aging Skin of Nude Mice by Promoting Angiogenesis and Reducing Local Tissue Water. Aesthet Surg J 2021; 41:NP905-NP913. [PMID: 33428732 DOI: 10.1093/asj/sjab001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adipose-derived stem cells (ASCs) are considered promising cells for skin rejuvenation. However, whether the angiogenetic effect of ASCs plays an important role in the treatment of aging skin and its influence on skin tissue remain elusive. OBJECTIVES The aim of this study was to evaluate the effect of ASCs on angiogenesis and local tissue water (LTW) in the aging skin of nude mice. METHODS Twelve nude mice were randomly divided into a UVB-induced photoaging group and a natural aging group. After the mouse model had been established, ASCs and phosphate-buffered saline (PBS) were then each injected into different sides of the dorsal skin of the mice. Blood perfusion and LTW content were measured. After 7 weeks, mice were killed, and skin samples were collected to measure the thickness of the dermis, the density of the capillaries, and the expression of angiogenic growth factors. RESULTS ASC therapy significantly increased the thickness of the dermis, the number of capillaries, and the expression of some angiogenic growth factors (vascular endothelial growth factor, insulin-like growth factor 1, and epidermal growth factor). At 7 weeks after injection, blood perfusion was significantly higher on the side injected with ASCs than on the side injected with PBS. LTW content was increased in the PBS-injected side, but the ASC-injected side showed no significant changes over time. CONCLUSIONS ASCs increased dermal thickness, promoted angiogenesis, and reduced LTW content in the skin of photoaging mice, providing a potential clinical therapy for skin rejuvenation.
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Affiliation(s)
- Feng Qin
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Wenchao Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Mingzi Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Loubin Si
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Zhenjiang Li
- Department of Vascular Surgery, First Affiliated Hospital of the Medical School of Zhejiang University, Hangzhou, China
| | - Jiuzuo Huang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
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8
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Abdlaty R, Hayward J, Farrell T, Fang Q. Skin erythema and pigmentation: a review of optical assessment techniques. Photodiagnosis Photodyn Ther 2020; 33:102127. [PMID: 33276114 DOI: 10.1016/j.pdpdt.2020.102127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/28/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Skin erythema may present due to many causes. One of the common causes is prolonged exposure to sun rays. Other than sun exposure, skin erythema is an accompanying sign of dermatological diseases such as acne, psoriasis, melasma, post inflammatory hyperpigmentation, fever, as well as exposure to specific electromagnetic wave bands. METHODS Quantifying skin erythema in patients enables the dermatologist to assess the patient's skin health. Therefore, quantitative assessment of skin erythema was the target of several studies. The clinical standard for erythema evaluation is visual assessment. However, the former standard has some imperfections. For instance, it is subjective, and unqualified for precise color information exchange. To overcome these shortcomings, the past three decades witnessed various methodologies that aimed to achieve erythema objective assessment, such as diffuse reflectance spectroscopy (DRS), and both optical and non-optical systems. DISCUSSION This review article reports on the studies published in the past three decades where the performance, the mathematical tactics for computation, and the capabilities of erythema assessment techniques for cutaneous diseases are discussed. In particular, the achievements and limitations of the current techniques in erythema assessment are presented. CONCLUSION The profits and development trends of optical and non-optical methods are displayed to provide the researcher with awareness into the present technological advances and its potential for dermatological diseases research.
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Affiliation(s)
| | - Joseph Hayward
- Juravinski Cancer Centre, Hamilton Health Sciences, Ontario, Canada
| | - Thomas Farrell
- Department of Medical Physics and Applied Radiation Sciences, McMaster University, Ontario, Canada
| | - Qiyin Fang
- Engineering Physics, McMaster University, Ontario, Canada
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Mayrovitz HN, Mikulka A, Woody D. Minimum Detectable Changes Associated with Tissue Dielectric Constant Measurements as Applicable to Assessing Lymphedema Status. Lymphat Res Biol 2018; 17:322-328. [PMID: 30526306 DOI: 10.1089/lrb.2018.0052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Tissue dielectric constant (TDC) measurements are increasingly being used as a tool to help characterize lymphedema features, detect its presence, and assess treatment related changes. Although the underlying physics of this technology has been well described in the literature, there has been little systematic study of in vivo reliability aspects. A central unanswered question is the minimal detectable change (MDC) that, with a given level of confidence, may be ascribed to this technology. Our goal was to address this issue using test-retest measurements from which intraclass correlations coefficients (ICC) and MDC could be estimated. Methods and Results: Forty volunteers (20 females) aged 19-61 years with body mass indices of 14.7-47 kg/m2 and body fat percentages of 12.0%-48.9% were evaluated. Two measurers (M1 and M2) used two different TDC measuring devices (multiprobe and compact) to measure TDC in triplicate sequentially and bilaterally at three locations; anterior forearm, hand palmar mid-thenar eminence, and dorsum mid-web. These measurements were made by each measurer twice constituting test-retest values (T1 and T2). From these measurements ICC2,1 and MDC at 95% confidence were determined for each site and probe for absolute TDC values and for inter-side ratios. MDC values for absolute TDC ranged from 2 to 9 TDC units, and for inter-side ratios ranged from 5.3% to 8.0% depending on site and probe. ICC2,1 values ranged from 0.765 to 0.982. Conclusions: The MDC values herein documented may be used to provide guidance to aid interpretation of measured TDC changes or differences in a clinical environment.
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Affiliation(s)
- Harvey N Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, Florida
| | - Alexander Mikulka
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, Florida
| | - Don Woody
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, Florida
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Demba S, Hoffmann G, Ammon C, Rose-Meierhöfer S. Sensor-Based Detection of the Severity of Hyperkeratosis in the Teats of Dairy Cows. SENSORS 2018; 18:s18113925. [PMID: 30441773 PMCID: PMC6263564 DOI: 10.3390/s18113925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/01/2018] [Accepted: 11/08/2018] [Indexed: 11/24/2022]
Abstract
The aim of this study was to evaluate whether the severity of hyperkeratosis (HK) in the teats of dairy cows can be assessed by a dielectric measurement. The study focused on surveying the occurrence of hyperkeratosis in a total of 241 teats of lactating dairy cows. A scoring system consisting of four categories was used to macroscopically assess the severity of HK. Additionally, the dielectric constant (DC) of all teats with milkability was measured in a double iteration with the MoistureMeterD (Delfin Technologies, Kuopio, Finland) on four different days. The Spearman rank correlation coefficient revealed a negative correlation between the DC and HK score (rs = −0.55 to −0.36). The results of the regression analysis showed that the DC values differed significantly between healthy teat ends (≤2) and teat ends with HK (≥3). Thus, the non-invasive measurement of DC provides a promising method of objectively assessing the occurrence and severity of HK.
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Affiliation(s)
- Susanne Demba
- Department of Engineering for Livestock Management, Leibniz Institute for Agricultural Engineering and Bioeconomy e.V. (ATB), Max-Eyth-Allee 100, 14469 Potsdam, Germany.
| | - Gundula Hoffmann
- Department of Engineering for Livestock Management, Leibniz Institute for Agricultural Engineering and Bioeconomy e.V. (ATB), Max-Eyth-Allee 100, 14469 Potsdam, Germany.
| | - Christian Ammon
- Department of Engineering for Livestock Management, Leibniz Institute for Agricultural Engineering and Bioeconomy e.V. (ATB), Max-Eyth-Allee 100, 14469 Potsdam, Germany.
| | - Sandra Rose-Meierhöfer
- Hochschule Neubrandenburg, Department of Agricultural Machinery, University of Applied Science, Brodaer Straße 2, 17033 Neubrandenburg, Germany.
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Marcenaro M, Sacco S, Pentimalli S, Berretta L, Andretta V, Grasso R, Parodi RC, Guarrera M, Scarpati D. Measures of Late Effects in Conservative Treatment of Breast Cancer with Standard or Hypofractionated Radiotherapy. TUMORI JOURNAL 2018; 90:586-91. [PMID: 15762361 DOI: 10.1177/030089160409000609] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background To confirm the equivalence in terms of late effects between two fractionation schedules of radiotherapy in conservative treatment of breast cancer. Methods Fifty-eight patients treated at our institution from 1999 to 2002, with a median follow-up of 15 months (range, 7-46 months), were evaluated retrospectively. Twenty-nine patients (group A) were treated with standard fractionation: 5000 cGy/25fx/5 weeks, and 29 patients (group B) were treated with a hypofractionated schedule: 4500 cGy/15fx/5 weeks, three fractions per week. Late effects were evaluated using the LENT-SOMA scoring scale. The cosmetic results were assessed on a five-point scale. Skin elasticity was measured using a dedicated device (Cutometer SEM 575). Results There were no differences in breast volume, age at diagnosis and follow-up between groups. The LENT-SOMA toxicity observed in groups A and B, respectively, was as follows: grade 2-3 pain in five patients in each group; grade 2 breast edema in two and three patients; grade 2-3 and grade 2 fibrosis in six and eight patients; grade 2 and grade 2-3 telangiectasia in two and three patients; grade ≥2 and 2 arm edema in two and one patients; no ulceration or atrophy were observed. Two patients in group A and one patient in group B needed treatment for breast and arm edema and arm edema, respectively. Very good, good-acceptable, and poor cosmetic results were observed in seven and two, fifteen and nineteen, and six and eight patients, respectively. Median skin elasticity loss due to treatment was −4.19% in group A and −6.29% in group B. These results are not statistically different. Conclusions LENT-SOMA toxicities were minimal and no differences were observed between groups. Few patients in the hypofractionated group had very good cosmetic results, but it is debatable if radiotherapy was the only cause. Skin elasticity was not different between groups. Our results seem to suggest that it is possible to treat patients with both schedules, with similar late toxicity.
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Sedaghatian T, Momennezhad M, Rasta SH, Makhdoomi Y, Abdollahian S. An Update of Couch Effect on the Attenuation of Megavoltage Radiotherapy Beam and the Variation of Absorbed Dose in the Build-up Region. J Biomed Phys Eng 2017; 7:279-288. [PMID: 29082219 PMCID: PMC5654134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 09/22/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE Fiber carbon is the most common material used in treating couch as it causes less beam attenuation than other materials. Beam attenuation replaces build-up region, reduces skin-sparing effect and causes target volume under dosage. In this study, we aimed to evaluate beam attenuation and variation of build-up region in 550 TxT radiotherapy couch. MATERIALS AND METHODS In this study, we utilized cylindrical PMMA Farmer chamber, DOSE-1 electrometer and set PMMA phantom in isocenter of gantry and the Farmer chamber on the phantom. Afterwards, the gantry rotated 10°, and attenuation was assessed. To measure build-up region, we used Markus chamber, Solid water phantom and DOSE-1 electrometer. Doing so, we set Solid water phantom on isocenter of gantry and placed Markus chamber in it, then we quantified the build-up region at 0° and 180° gantry angels and compared the obtained values. RESULTS Notable attenuation and build-up region variation were observed in 550 TxT treatment table. The maximum rate of attenuation was 5.95% for 6 MV photon beam, at 5×5 cm2 field size and 130° gantry angle, while the maximum variation was 7 mm for 6 MV photon beam at 10×10 cm2 field size. CONCLUSION Fiber carbon caused beam attenuation and variation in the build-up region. Therefore, the application of fiber carbon is recommended for planning radiotherapy to prevent skin side effects and to decrease the risk of cancer recurrence.
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Affiliation(s)
- T Sedaghatian
- Department of Medical Physics, Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - M Momennezhad
- Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Iran
- Radiotherapy and Oncology Reza Center, Mashhad, Iran
| | - S H Rasta
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medical Bioengineering, Tabriz University of Medical Sciences, Iran
- Faculty of Medical Sciences, University of Aberdeen, UK
| | - Y Makhdoomi
- Radiotherapy and Oncology Reza Center, Mashhad, Iran
| | - S Abdollahian
- Radiotherapy and Oncology Reza Center, Mashhad, Iran
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Mayrovitz HN, Fasen M, Spagna P, Wong J. Role of handedness on forearm skin tissue dielectric constant (TDC) in relation to detection of early-stage breast cancer-related lymphedema. Clin Physiol Funct Imaging 2017; 38:670-675. [PMID: 28795491 DOI: 10.1111/cpf.12466] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/03/2017] [Indexed: 12/24/2022]
Abstract
skin tissue dielectric constant (TDC) measurements help assess local skin water to detect incipient early-stage lymphedema subsequent to breast cancer treatment-related lymphedema. However, presurgery measurements are not always obtained and assessments for evolving lymphedema are only made after surgery. Thus, subsequent TDC assessments may be biased in an unknown way dependent on a patient's handedness in relation to the at-risk arm. We investigated this issue by comparing TDC values in dominant and non-dominant volar forearms of 31 left-handed women and 31 right-handed women (age range 24-84 years). Body fat and water percentages were assessed by bioimpedance at 50 KHz. Results showed that TDC values of dominant versus non-dominant arms did not significantly differ for left-handers or for right-handers. There was also no statistically significant difference in absolute TDC values between left- and right-handers or a statistically significant difference in dominant-to-non-dominant arm ratios between left- and right-handers. For the composite data set (N = 62), TDC values for dominant and non-dominant arms were, respectively, 30·0 ± 4·6 and 29·6 ± 4·2 and the dominant-to-non-dominant arm TDC ratio for combined left- and right-handers was 1·015 ± 0·075. These results suggest that handedness is not a major factor when assessing lymphedema status in women who have previously been treated for breast cancer but for whom pretreatment TDCvalues have not been obtained. Moreover, these results suggest that threshold ratios of incipient subclinical unilateral lymphedema based on interarm TDC ratios apply independent of a patient's handedness for the site and tissue depths herein measured.
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Affiliation(s)
- Harvey N Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Madeline Fasen
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Paige Spagna
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Jennifer Wong
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
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Tesselaar E, Flejmer AM, Farnebo S, Dasu A. Changes in skin microcirculation during radiation therapy for breast cancer. Acta Oncol 2017; 56:1072-1080. [PMID: 28281359 DOI: 10.1080/0284186x.2017.1299220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The majority of breast cancer patients who receive radiation treatment are affected by acute radiation-induced skin changes. The assessment of these changes is usually done by subjective methods, which complicates the comparison between different treatments or patient groups. This study investigates the feasibility of new robust methods for monitoring skin microcirculation to objectively assess and quantify acute skin reactions during radiation treatment. MATERIAL AND METHODS Laser Doppler flowmetry, laser speckle contrast imaging, and polarized light spectroscopy imaging were used to measure radiation-induced changes in microvascular perfusion and red blood cell concentration (RBC) in the skin of 15 patients undergoing adjuvant radiation therapy for breast cancer. Measurements were made before treatment, once a week during treatment, and directly after the last fraction. RESULTS In the treated breast, perfusion and RBC concentration were increased after 1-5 fractions (2.66-13.3 Gy) compared to baseline. The largest effects were seen in the areola and the medial area. No changes in perfusion and RBC concentration were seen in the untreated breast. In contrast, Radiation Therapy Oncology Group (RTOG) scores were increased only after 2 weeks of treatment, which demonstrates the potential of the proposed methods for early assessment of skin changes. Also, there was a moderate to good correlation between the perfusion (r = 0.52) and RBC concentration (r = 0.59) and the RTOG score given a week later. CONCLUSION We conclude that radiation-induced microvascular changes in the skin can be objectively measured using novel camera-based techniques before visual changes in the skin are apparent. Objective measurement of microvascular changes in the skin may be valuable in the comparison of skin reactions between different radiation treatments and possibly in predicting acute skin effects at an earlier stage.
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Affiliation(s)
- Erik Tesselaar
- Department of Radiation Physics and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna M. Flejmer
- Department of Oncology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Simon Farnebo
- Department of Hand and Plastic Surgery and Burns and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Alexandru Dasu
- Department of Radiation Physics and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- The Skandion Clinic, Uppsala, Sweden
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15
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Mayrovitz HN. Diurnal changes in local skin water assessed via tissue dielectric constant at 300 MHz. Biomed Phys Eng Express 2017. [DOI: 10.1088/2057-1976/aa7d8c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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16
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Seppälä J, Voutilainen A, Heikkilä J, Vauhkonen M. Surface doses of flattening filter free beams with volumetric modulated arc therapy dose delivery for breast cancer. Phys Imaging Radiat Oncol 2017. [DOI: 10.1016/j.phro.2017.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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17
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Evaluation of acute skin toxicity in breast radiotherapy with a new quantitative approach. Radiother Oncol 2017; 122:54-59. [DOI: 10.1016/j.radonc.2016.09.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/20/2022]
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18
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Koyano Y, Nakagami G, Iizaka S, Minematsu T, Noguchi H, Tamai N, Mugita Y, Kitamura A, Tabata K, Abe M, Murayama R, Sugama J, Sanada H. Exploring the prevalence of skin tears and skin properties related to skin tears in elderly patients at a long-term medical facility in Japan. Int Wound J 2016; 13:189-97. [PMID: 24674027 PMCID: PMC7949576 DOI: 10.1111/iwj.12251] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/10/2014] [Accepted: 02/18/2014] [Indexed: 11/28/2022] Open
Abstract
The identification of appropriate skin tear prevention guidelines for the elderly requires clinicians to focus on local risk factors such as structural alterations of the epidermis and dermis related to skin tears. The aim of this cross-sectional study is to explore the prevalence of skin tears and to explore skin properties related to skin tears in elderly Japanese patients at a long-term medical facility. After doing the prevalence study, 18 participants with skin tears and 18 without were recruited and an evaluation of their skin properties using 20-MHz ultrasonography, skin blotting and also Corneometer CM-825, Skin-pH-meterPH905, VapoMeter, Moisture Meter-D and CutometerMPA580 was undertaken. A total of 410 patients were examined, the median age was 87 years and 73·2% were women. The prevalence of skin tears was 3·9%, and 50% of skin tears occurred on the dorsal forearm. The changes in skin properties associated with skin tears included increased low-echogenic pixels (LEP) by 20-MHz ultrasonography, decreased type IV collagen and matrix metalloproteinase-2, and increased tumour necrosis factor-α by skin blotting. In conclusion, this study suggests that increased dermal LEP, including solar elastosis, may represent a risk factor for skin tears; this indicates that skin tear risk factors might not only represent chronological ageing but also photoageing.
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Affiliation(s)
- Yuiko Koyano
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Noguchi
- Department of Life Support Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nao Tamai
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Kitamura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Masatoshi Abe
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Sapporo Skin Clinic, Hokkaido, Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Sugama
- Wellness Promotion Science Center, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Mayrovitz HN, Grammenos A, Corbitt K, Bartos S. Age-related changes in male forearm skin-to-fat tissue dielectric constant at 300 MHz. Clin Physiol Funct Imaging 2015; 37:198-204. [PMID: 26278683 DOI: 10.1111/cpf.12286] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/29/2015] [Indexed: 11/29/2022]
Abstract
Prior research suggests that tissue dielectric constant (TDC) values are useful to assess localized skin water in females for early diagnosing breast cancer treatment-related lymphoedema and TDC values in young adults have shown gender differences. However, no TDC data are available for older males nor have ageing effects been studied despite known shifts in water state and other skin age-related changes. Thus our goals were to (i) characterize TDC values at various skin depths in young and older males, (ii) determine the dependence of these values on body composition parameters and (iii) establish inter-arm TDC ratios for use as normal male reference values. TDC measurements were made to depths of 0·5, 1·5, 2·5 and 5·0 mm bilaterally on volar forearm skin in 60 males in three groups of 20 that had mean ages ± SD of 24·0 ± 0·9, 40·0 ± 12·9 and 71·0 ± 8·0 years. Total body fat and water percentages were determined via bioimpedance at 50 KHz. Results showed that (i) for all age groups TDC values decreased with increasing depth, (ii) TDC values were not statistically different among age groups except at a depth of 0·5 mm, (iii) TDC values were highly negatively correlated with total body fat and (iv) inter-arm ratios varied little among age groups and depths. It is concluded that (i) age-related larger TDC values at only the shallowest depth is consistent with skin water shifting state from bound to more mobile in the oldest group and (ii) inter-arm ratios at any depth provide a basis to test for unilateral oedema.
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Affiliation(s)
- Harvey N Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Alexandra Grammenos
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Kelly Corbitt
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Simona Bartos
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
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20
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Mayrovitz HN, Singh A, Akolkar S. Age-related differences in tissue dielectric constant values of female forearm skin measured noninvasively at 300 MHz. Skin Res Technol 2015; 22:189-95. [DOI: 10.1111/srt.12249] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 11/30/2022]
Affiliation(s)
- H. N. Mayrovitz
- College of Medical Sciences; Nova Southeastern University; Ft. Lauderdale FL USA
| | - A. Singh
- College of Medical Sciences; Nova Southeastern University; Ft. Lauderdale FL USA
| | - S. Akolkar
- College of Medical Sciences; Nova Southeastern University; Ft. Lauderdale FL USA
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21
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Mayrovitz HN, Grammenos A, Corbitt K, Bartos S. Young adult gender differences in forearm skin-to-fat tissue dielectric constant values measured at 300 MHz. Skin Res Technol 2015; 22:81-8. [DOI: 10.1111/srt.12232] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2015] [Indexed: 11/27/2022]
Affiliation(s)
- H. N. Mayrovitz
- Physiology; College of Medical Sciences; Nova Southeastern University; Fr. Lauderdale FL USA
| | - A. Grammenos
- College of Osteopathic Medicine; Nova Southeastern University; Fr. Lauderdale FL USA
| | - K. Corbitt
- College of Osteopathic Medicine; Nova Southeastern University; Fr. Lauderdale FL USA
| | - S. Bartos
- College of Osteopathic Medicine; Nova Southeastern University; Fr. Lauderdale FL USA
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22
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Huang CJ, Hou MF, Luo KH, Wei SY, Huang MY, Su SJ, Kuo HY, Yuan SSF, Chen GS, Chu-Sung Hu S, Chuang HY. RTOG, CTCAE and WHO criteria for acute radiation dermatitis correlate with cutaneous blood flow measurements. Breast 2015; 24:230-6. [DOI: 10.1016/j.breast.2015.01.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 12/09/2014] [Accepted: 01/28/2015] [Indexed: 11/28/2022] Open
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23
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Mayrovitz HN, Weingrad DN, Lopez L. Patterns of Temporal Changes in Tissue Dielectric Constant as Indices of Localized Skin Water Changes in Women Treated for Breast Cancer: A Pilot Study. Lymphat Res Biol 2015; 13:20-32. [DOI: 10.1089/lrb.2014.0024] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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Mayrovitz HN, Weingrad DN, Lopez L. Assessing Localized Skin-to-Fat Water in Arms of Women with Breast Cancer Via Tissue Dielectric Constant Measurements in Pre- and Post-surgery Patients. Ann Surg Oncol 2014; 22:1483-9. [DOI: 10.1245/s10434-014-4185-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Indexed: 11/18/2022]
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25
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Cortázar TM, Guzmán-Alonso M, Novoa H, Riaño M. Comparative study of temporary effect on the water content at different depths of the skin by hot and cold moisturizing formulations. Skin Res Technol 2014; 21:265-71. [DOI: 10.1111/srt.12185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- T. M. Cortázar
- Innovation and Development Centre; Belcorp; Tocancipá Colombia
| | | | - H. Novoa
- University of Quindío; Armenia Colombia
| | - M. Riaño
- Innovation and Development Centre; Belcorp; Tocancipá Colombia
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26
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Zu G, Dou Y, Tian Q, Wang H, Zhao W, Li F. Role and mechanism of radiological protection cream in treating radiation dermatitis in rats. J TRADIT CHIN MED 2014; 34:329-37. [PMID: 24992761 DOI: 10.1016/s0254-6272(14)60098-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the role and mechanism of a radiation protection cream (Rp) in the treatment of radiation dermatitis, and to accumulate necessary technical information for a new drug report on Rp. METHODS High-performance liquid chromatography was used to establish the method of measuring the main effective ingredients of sovereign and adjuvant herbs of Rp drugs, and to formulate the draft quality standards of Rp. A total of 48 Sprague-Dawley male rats were randomly divided into the Model, Trolamine cream (Tc), Rp and Blank groups according to a random number table method. The skin of each rat's buttocks was irradiated using an electron linear accelerator to establish an acute radiation dermatitis model. The histological changes were observed under light microscopy and electron microscopy during wound healing and the effect of Rp on rat fibroblast Ku70/80 gene expression was detected at the transcriptional level. RESULTS Pathological examination revealed that Rp protected the cellular and subcellular structures of skin after irradiation, promoting the proliferation and restoration of collagen fibers. Ku70/80 mRNA expression levels in the Rp and Tc groups were higher than that in the model group (P < 0.05). Moreover, The majority of grade radiation dermatitis relative to the Model, Rp and Tc groups for reducing grade III and IV dermatitis efficiency were 85.7% and 69.2% (P < 0.05), respectively. The efficacy of Rp group in treating radiation dermatitis was better than the Trolamine cream group by 16.5% (P < 0.05). CONCLUSION Compared with Tc, Rp had certain advantages in the efficacy and performance to price ratio. Thus, Rp is considered an effective alternative formulation for the prevention and treatment of radiation dermatitis.
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27
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Moloney EC, Brunner M, Alexander AJ, Clark J. Quantifying fibrosis in head and neck cancer treatment: An overview. Head Neck 2014; 37:1225-31. [PMID: 24797251 DOI: 10.1002/hed.23722] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/01/2013] [Accepted: 04/28/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Fibrosis is a common late complication of radiotherapy and/or surgical treatment for head and neck cancers. Fibrosis is difficult to quantify and formal methods of measure are not well recognized. The purpose of this review was to summarize the methods available to quantify neck fibrosis. METHODS A PubMed search of articles was carried out using key words "neck" and "fibrosis." RESULTS Many methods have been used to assess fibrosis, however, there is no preferred methodology. Specific to neck fibrosis, most studies have relied upon hand palpation rating scales. Indentation and suction techniques have been used to mechanically quantify neck fibrosis. There is scope to develop applications of ultrasound, dielectric, bioimpedance, and MRI techniques for use in the neck region. CONCLUSION Quantitative assessment of neck fibrosis is sought after in order to compare treatment regimens and improve quality of life outcomes in patients with head and neck cancer.
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Affiliation(s)
- Emma C Moloney
- Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Markus Brunner
- Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Ashlin J Alexander
- Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jonathan Clark
- Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Birkballe S, Jensen M, Noerregaard S, Gottrup F, Karlsmark T. Can tissue dielectric constant measurement aid in differentiating lymphoedema from lipoedema in women with swollen legs? Br J Dermatol 2014; 170:96-102. [DOI: 10.1111/bjd.12589] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- S. Birkballe
- Department of Dermatology and Copenhagen Wound Healing Centre; Copenhagen Lymphoedema Centre; Bispebjerg University Hospital; Bispebjerg bakke 23 DK-2400 Copenhagen NV Denmark
| | - M.R. Jensen
- Department of Dermatology and Copenhagen Wound Healing Centre; Copenhagen Lymphoedema Centre; Bispebjerg University Hospital; Bispebjerg bakke 23 DK-2400 Copenhagen NV Denmark
- Department of Clinical Physiology and Nuclear Medicine; Bispebjerg University Hospital; Bispebjerg bakke 23 DK-2400 Copenhagen NV Denmark
| | - S. Noerregaard
- Department of Dermatology and Copenhagen Wound Healing Centre; Copenhagen Lymphoedema Centre; Bispebjerg University Hospital; Bispebjerg bakke 23 DK-2400 Copenhagen NV Denmark
| | - F. Gottrup
- Department of Dermatology and Copenhagen Wound Healing Centre; Copenhagen Lymphoedema Centre; Bispebjerg University Hospital; Bispebjerg bakke 23 DK-2400 Copenhagen NV Denmark
| | - T. Karlsmark
- Department of Dermatology and Copenhagen Wound Healing Centre; Copenhagen Lymphoedema Centre; Bispebjerg University Hospital; Bispebjerg bakke 23 DK-2400 Copenhagen NV Denmark
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Chao PJ, Huang EY, Cheng KS, Huang YJ. Electrical impedance spectroscopy as electrical biopsy for monitoring radiation sequelae of intestine in rats. BIOMED RESEARCH INTERNATIONAL 2013; 2013:974614. [PMID: 24093111 PMCID: PMC3777171 DOI: 10.1155/2013/974614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 08/05/2013] [Indexed: 11/17/2022]
Abstract
Electrical impedance is one of the most frequently used parameters for characterizing material properties. The resistive and capacitive characteristics of tissue may be revealed by electrical impedance spectroscopy (EIS) as electrical biopsy. This technique could be used to monitor the sequelae after irradiation. In this study, rat intestinal tissues after irradiation were assessed by EIS system based on commercially available integrated circuits. The EIS results were fitted to a resistor-capacitor circuit model to determine the electrical properties of the tissue. The variations in the electrical characteristics of the tissue were compared to radiation injury score (RIS) by morphological and histological findings. The electrical properties, based on receiver operation curve (ROC) analysis, strongly reflected the histological changes with excellent diagnosis performance. The results of this study suggest that electrical biopsy reflects histological changes after irradiation. This approach may significantly augment the evaluation of tissue after irradiation. It could provide rapid results for decision making in monitoring radiation sequelae prospectively.
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Affiliation(s)
- Pei-Ju Chao
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan
| | - Eng-Yen Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan
| | - Kuo-Sheng Cheng
- Biomedical Imaging and Instrumentation Laboratory, Department of Biomedical Engineering, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan
- Biomedical Imaging and Instrumentation Laboratory, Department of Biomedical Engineering, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan
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On the feasibility of treating to a 1.5 cm PTV with a commercial single-entry hybrid applicator in APBI breast brachytherapy. J Contemp Brachytherapy 2013; 4:29-33. [PMID: 23346137 PMCID: PMC3551370 DOI: 10.5114/jcb.2012.27949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 01/20/2012] [Accepted: 02/04/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate and determine whether 30 patients previously treated with the SAVI™ device could have been treated to a PTV_EVAL created with a 1.5 cm expansion. This determination was based upon dosimetric parameters derived from current recommendations and dose-response data. Material and methods Thirty patients were retrospectively planned with PTV_EVALs generated with a 1.5 cm expansion (PTV_EVAL_1.5). Plans were evaluated based on PTV_EVAL_1.5 coverage (V90, V95, V100), skin and rib maximum doses (0.1 cc maximum dose as a percentage of prescription dose), as well as V150 and V200 for the PTV_EVAL_1.5. The treatment planning goal was to deliver ≥90% of the prescribed dose to ≥90% of the PTV_EVAL_1.5. Skin and rib maximum doses were to be ≤125% of the prescription dose and preferably ≤100% of the prescription dose. V150 and V200 were not allowed to exceed 52.5 cc and 21 cc, respectively. Plans not meeting the above criteria were recomputed with a 1.25 cm expanded PTV_EVAL and re-evaluated. Results Based on the above dose constraints, 30% (9/30) of the patients evaluated could have been treated with a 1.5 cm PTV_EVAL. The breakdown of cases successfully achieving the above dose constraints by applicator was: 0/4 (0%) 6-1, 6/15 (40%) 8-1, and 3/11 (27%) 10-1. For these PTV_EVAL_1.5 plans, median V90% was 90.3%, whereas the maximum skin and rib doses were all less than 115.2% and 117.6%, respectively. The median V150 and V200 volumes were 39.2 cc and 19.3, respectively. The treated PTV_EVAL_1.5 was greater in volume than the PTV_EVAL by 41.7 cc, and 60 cc for the 8-1, and 10-1 applicators, respectively. All remaining plans (17) successfully met the above dose constraints to be treated with a 1.25 cm PTV_EVAL (PTV_EVAL_1.25). For the PTV_EVAL_1.25 plans, V90% was 93.7%, and the maximum skin and rib doses were all less than 109.2% and 102.5%, respectively. The median V150 and V200 volumes were 41.2 cc and 19.3, respectively. The treated PTV_EVAL_1.25 was greater in volume than the PTV_EVAL by 16 cc, 24.9 cc, and 33.5 cc for the 6-1, 8-1 and 10-1 applicators, respectively. Conclusions It is dosimetrically possible to treat beyond the currently advised 1.0 cm expanded PTV_EVAL. Most patients should be able to be treated with a 1.25 cm PTV_EVAL and a select group with a 1.5 cm PTV_EVAL. Applicator size appears to determine the ability to expand to a 1.5 cm PTV_EVAL, as smaller devices were not as propitious in this regard. Further studies may identify additional patient groups that would benefit from this approach.
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31
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Mayrovitz HN, McClymont A, Pandya N. Skin tissue water assessed via tissue dielectric constant measurements in persons with and without diabetes mellitus. Diabetes Technol Ther 2013; 15:60-5. [PMID: 23145992 DOI: 10.1089/dia.2012.0197] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Skin changes in diabetes mellitus (DM) include possible increases in foot skin water content as interpreted from altered echogenicity in high-frequency ultrasound images. The present goal was to investigate the possibility of undetected increased local skin water in persons with DM using a handheld portable rapid measuring device that measures the tissue dielectric constant (TDC) as an indicator of skin tissue water. SUBJECTS AND METHODS TDC measurements were done bilaterally on 18 persons with DM and 18 persons without DM (NODM) at foot dorsum and anterior forearm to tissue depths of 0.5, 1.5, and 2.5 mm. DM duration was 11.1 ± 10.9 years. Age, body mass index, and blood pressures were not significantly different between groups. RESULTS NODM and DM TDC values decreased with increasing depth at forearm but were depth independent at foot dorsum. All DM foot TDC values were significantly (P<0.05) greater than for NODM, with foot TDC values at 2.5 mm depth being 14.8% greater than in NODM. DM forearm TDC values were not significantly greater than NODM. CONCLUSIONS A technology that characterizes local skin water in a rapid and noninvasive way has been used for the first time in persons with DM. The greater TDC value at the foot dorsum of the DM group is consistent with the presence of previously unrecognized increased fluid content. This suggests that there may be benefit utilizing this measurement method as a way to screen for early changes in foot skin features that may tend to cause DM-related edema.
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Affiliation(s)
- Harvey N Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, Florida 33328, USA.
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Mayrovitz HN, Bernal M, Brlit F, Desfor R. Biophysical measures of skin tissue water: variations within and among anatomical sites and correlations between measures. Skin Res Technol 2012; 19:47-54. [DOI: 10.1111/srt.12000] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Harvey N. Mayrovitz
- College of Medical Sciences; Nova Southeastern University; Ft. Lauderdale; FL; USA
| | - Maria Bernal
- College of Medical Sciences; Nova Southeastern University; Ft. Lauderdale; FL; USA
| | - Frances Brlit
- College of Medical Sciences; Nova Southeastern University; Ft. Lauderdale; FL; USA
| | - Rebecca Desfor
- College of Medical Sciences; Nova Southeastern University; Ft. Lauderdale; FL; USA
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Mayrovitz HN, Guo X, Salmon M, Uhde M. Forearm skin tissue dielectric constant measured at 300 MHz: effect of changes in skin vascular volume and blood flow. Clin Physiol Funct Imaging 2012; 33:55-61. [DOI: 10.1111/j.1475-097x.2012.01163.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/17/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Harvey N. Mayrovitz
- College of Medical Sciences; Nova Southeastern University; Ft. Lauderdale; FL; USA
| | - Xiaoran Guo
- College of Osteopathic Medicine; Nova Southeastern University; Ft. Lauderdale; FL; USA
| | - Mark Salmon
- College of Osteopathic Medicine; Nova Southeastern University; Ft. Lauderdale; FL; USA
| | - Matt Uhde
- College of Osteopathic Medicine; Nova Southeastern University; Ft. Lauderdale; FL; USA
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Prone accelerated partial breast irradiation after breast-conserving surgery: five-year results of 100 patients. Int J Radiat Oncol Biol Phys 2012; 84:606-11. [PMID: 22494589 DOI: 10.1016/j.ijrobp.2012.01.039] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE To report the 5-year results of a prospective trial of three-dimensional conformal external beam radiotherapy (3D-CRT) to deliver accelerated partial breast irradiation in the prone position. METHODS AND MATERIALS Postmenopausal patients with Stage I breast cancer with nonpalpable tumors <2 cm, negative margins and negative nodes, positive hormone receptors, and no extensive intraductal component were eligible. The trial was offered only after eligible patients had refused to undergo standard whole-breast radiotherapy. Patients were simulated and treated on a dedicated table for prone setup. 3D-CRT was delivered at a dose of 30 Gy in five 6-Gy/day fractions over 10 days with port film verification at each treatment. Rates of ipsilateral breast failure, ipsilateral nodal failure, contralateral breast failure, and distant failure were estimated using the cumulative incidence method. Rates of disease-free, overall, and cancer-specific survival were recorded. RESULTS One hundred patients were enrolled in this institutional review board-approved prospective trial, one with bilateral breast cancer. One patient withdrew consent after simulation, and another patient elected to interrupt radiotherapy after receiving two treatments. Ninety-eight patients were evaluable for toxicity, and, in 1 case, both breasts were treated with partial breast irradiation. Median patient age was 68 years (range, 53-88 years); in 55% of patients the tumor size was <1 cm. All patients had hormone receptor-positive cancers: 87% of patients underwent adjuvant antihormone therapy. At a median follow-up of 64 months (range, 2-125 months), there was one local recurrence (1% ipsilateral breast failure) and one contralateral breast cancer (1% contralateral breast failure). There were no deaths due to breast cancer by 5 years. Grade 3 late toxicities occurred in 2 patients (one breast edema, one transient breast pain). Cosmesis was rated good/excellent in 89% of patients with at least 36 months follow-up. CONCLUSIONS Five-year efficacy and toxicity of 3D-CRT delivered in prone partial breast irradiation are comparable to other experiences with similar follow-up.
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Jensen MR, Birkballe S, Nørregaard S, Karlsmark T. Validity and interobserver agreement of lower extremity local tissue water measurements in healthy women using tissue dielectric constant. Clin Physiol Funct Imaging 2012; 32:317-22. [DOI: 10.1111/j.1475-097x.2012.01129.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 02/24/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - Susanne Birkballe
- Department of Dermatology and Venereology; Bispebjerg Hospital; University Hospital of Copenhagen; Copenhagen; Denmark
| | - Susan Nørregaard
- Department of Dermatology and Venereology; Bispebjerg Hospital; University Hospital of Copenhagen; Copenhagen; Denmark
| | - Tonny Karlsmark
- Department of Dermatology and Venereology; Bispebjerg Hospital; University Hospital of Copenhagen; Copenhagen; Denmark
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Mayrovitz HN, Bernal M, Carson S. Gender differences in facial skin dielectric constant measured at 300 MHz. Skin Res Technol 2011; 18:504-10. [DOI: 10.1111/j.1600-0846.2011.00582.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2011] [Indexed: 12/01/2022]
Affiliation(s)
- Harvey N. Mayrovitz
- College of Medical Sciences; Nova Southeastern University; Ft. Lauderdale; Florida; USA
| | - Maria Bernal
- College of Medical Sciences; Nova Southeastern University; Ft. Lauderdale; Florida; USA
| | - Sophia Carson
- College of Medical Sciences; Nova Southeastern University; Ft. Lauderdale; Florida; USA
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Seppälä JKH, Kulmala JAJ. Increased beam attenuation and surface dose by different couch inserts of treatment tables used in megavoltage radiotherapy. J Appl Clin Med Phys 2011; 12:3554. [PMID: 22089010 PMCID: PMC5718753 DOI: 10.1120/jacmp.v12i4.3554] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/14/2011] [Accepted: 04/25/2011] [Indexed: 11/23/2022] Open
Abstract
The use of solid carbon fiber table materials in radiotherapy has become more common with the implementation of image‐guided radiotherapy (IGRT), since the solid materials give less imaging artifacts than the so‐called tennis racket couchtops. The downside of the solid carbon fiber couch inserts is that they increase the beam attenuation, resulting in increased surface doses and inaccuracies in determine the dose in the patient. The purpose of this study was to evaluate the interaction of 6 and 15 MV photons with eight different couch inserts. The presented results enable direct comparison of the attenuation properties of the studied couchtops. With a direct posterior beam the maximum attenuations reach 3.6% and 2.4% with 6 and 15 M V, respectively. The measured maximum attenuation by a couchtop with an oblique gantry angle was 10.8% and 7.4% at 6 and 15 MV energies, respectively. The skin‐sparing effect was decreased substantially with every couchtop. The highest increases in surface doses were recorded to be four‐ and threefold, as compared to the direct posterior open field surface doses of 6 and 15 MV, respectively. In conclusion, the carbon fiber tabletops decrease the skin‐sparing effect of megavoltage photon energies. The increased beam attenuation and skin doses should be taken into account in the process of treatment planning. PACS number: 07.90.+c
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Affiliation(s)
- Jan K H Seppälä
- Department of Oncology and Radiotherapy, Turku University Hospital, Finland.
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Huang YJ, Huang EY, Lu YY, Chen CY, Cheng KS. Electrical biopsy of irradiated intestinal tissue with a simple electrical impedance spectroscopy system for radiation enteropathy in rats-–a pilot study. Physiol Meas 2011; 32:1491-504. [DOI: 10.1088/0967-3334/32/9/010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wong S, Kaur A, Back M, Lee KM, Baggarley S, Lu JJ. An ultrasonographic evaluation of skin thickness in breast cancer patients after postmastectomy radiation therapy. Radiat Oncol 2011; 6:9. [PMID: 21261940 PMCID: PMC3035589 DOI: 10.1186/1748-717x-6-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 01/24/2011] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To determine the usefulness of ultrasonography in the assessment of post radiotherapy skin changes in postmastectomy breast cancer patients. METHODS Patients treated for postmastectomy radiotherapy in National University Hospital (NUH) and Tan Tock Seng Hospital (TTSH), Singapore between January 2004- December 2005 was recruited retrospectively. Ultrasound scan was performed on these Asian patients who had been treated to a total dose of 46-50 Gy with 1 cm bolus placed on the skin. The ultrasound scans were performed blinded to the RTOG scores, and the skin thickness of the individually marked points on the irradiated chest wall was compared to the corresponding points on the non-irradiated breast. RESULTS The mean total skin thickness inclusive of the epidermis and the dermis of the right irradiated chest wall was 0.1712 mm (± 0.03392 mm) compared with the contra-lateral non-irradiated breast which was 0.1845 mm (± 0.04089 mm; p = 0.007). The left irradiated chest wall had a mean skin thickness of 0.1764 mm (± 0.03184 mm) compared with the right non-irradiated breast which was 0.1835 mm (± 0.02584 mm; p = 0.025). These independent t-tests produced a significant difference of reduced skin thickness on the right irradiated chest wall, p = 0.007 (p < 0.05) and left irradiated chest wall p = 0.025 (p < 0.025) in comparison to the non-irradiated skin thickness investigating chronic skin reactions. Patients with grade 2 acute skin toxicity presented with thinner skin as compared to patients with grade 1 (p = 0.006). CONCLUSIONS This study has shown that there is a statistically significant difference between the skin thicknesses of the irradiated chest wall and the contra-lateral non-irradiated breast and a predisposition to chronic reactions was found in patients with acute RTOG scoring of grade1 and grade 2.
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Affiliation(s)
- Sharon Wong
- National University of Singapore, Yong Loo Lin School of Medicine, 21 Lower Kent Ridge Road, 119077, Singapore
- Nanyang Polytechnic, School of Health Sciences, 180 Ang Mo Kio Avenue 8, 569830, Singapore
| | - Amarjit Kaur
- Nanyang Polytechnic, School of Health Sciences, 180 Ang Mo Kio Avenue 8, 569830, Singapore
| | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - Khai Mun Lee
- National University Cancer Institute, Department of Radiation Oncology, National University of Singapore, 1E Kent Ridge Road, Tower Block, Level 7, 119 228, Singapore
| | - Shaun Baggarley
- National University Cancer Institute, Department of Radiation Oncology, National University of Singapore, 1E Kent Ridge Road, Tower Block, Level 7, 119 228, Singapore
| | - Jiade Jay Lu
- National University of Singapore, Yong Loo Lin School of Medicine, 21 Lower Kent Ridge Road, 119077, Singapore
- National University Cancer Institute, Department of Radiation Oncology, National University of Singapore, 1E Kent Ridge Road, Tower Block, Level 7, 119 228, Singapore
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Yoshida K, Yamazaki H, Takenaka T, Tanaka E, Kotsuma T, Fujita Y, Masuda N, Kuriyama K, Yoshida M, Nishimura T. Objective assessment of dermatitis following post-operative radiotherapy in patients with breast cancer treated with breast-conserving treatment. Strahlenther Onkol 2010; 186:621-9. [PMID: 21072624 DOI: 10.1007/s00066-010-2134-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 08/26/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate radiation dermatitis objectively in patients with breast cancer who had undergone post-operative radiotherapy after breast-conserving surgery. PATIENTS AND METHODS Skin color (L*, a*, and b* values) and moisture analyses were performed for both breasts (before, after, 1 month, 6 months, and 1 year after radiotherapy) to examine irradiated and non-irradiated skin divided into four quadrants in 118 patients. These patients underwent breast conservative surgery followed by 50 Gy/25 fractions (median) of radiotherapy with or without boost irradiation (10 Gy/5 fractions). RESULTS L*, a*, and moisture values were changed by irradiation and maximized at completion or 1 month after radiotherapy. One year after radiotherapy, the skin color had returned to the range observed prior to radiotherapy. However, moisture did not return to previous values even 1 year after treatment. The lateral upper side (quadrant C) showed greater changes than other quadrants in the L* value (darker) at the end of radiotherapy. The Common Toxicity Criteria version 3 scores were found to correlate well with a* and L* values at the completion and 1 month after radiotherapy. Boost radiotherapy intensified reddish and darker color changes at the completion of radiotherapy, while chemotherapy did not intensify the skin reaction caused by radiotherapy. CONCLUSION Moisture impairment as a result of irradiation lasts longer than color alterations. Objective assessments are useful for analyzing radiation dermatitis.
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Affiliation(s)
- Ken Yoshida
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan
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Mayrovitz HN, Carson S, Luis M. Male–female differences in forearm skin tissue dielectric constant. Clin Physiol Funct Imaging 2010; 30:328-332. [DOI: 10.1111/j.1475-097x.2010.00946.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Harvey N. Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Sophia Carson
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Michelle Luis
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
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Mayrovitz HN. Local tissue water assessed by measuring forearm skin dielectric constant: dependence on measurement depth, age and body mass index. Skin Res Technol 2010; 16:16-22. [DOI: 10.1111/j.1600-0846.2009.00398.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rönkä RH, Pamilo MS, von Smitten KAJ, Leidenius MHK. Breast lymphedema after breast conserving treatment. Acta Oncol 2009; 43:551-7. [PMID: 15370612 DOI: 10.1080/02841860410014867] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The authors aimed to evaluate breast lymphedema after breast conserving therapy (BCT) and sentinel node biopsy (SNB) or axillary clearance (AC). Fifty-seven breast cancer patients with BCT underwent SNB only and 103 underwent AC (57 with tumor negative and 46 with positive axillary nodes). Clinical examination and breast ultrasonography (US) were performed one year after surgery. Clinical examination revealed breast edema in 48% of patients in the AC node positive group, in 35% in the AC node negative group, and in 23% in the SNB group (p<0.05 between SNB and AC node positive). US revealed subcutaneous edema in the operated breast in 69-70% of the patients in the AC groups and in 28% in the SNB group (p=0.001-0.0001 between the SNB and the AC groups). Breast lymphedema was less common one year after BCT in patients with SNB only than in those with more extensive axillary treatment.
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Affiliation(s)
- Riitta H Rönkä
- Breast Surgery Unit, Department of Mammography Maria Hospital, Helsinki University Hospital, Helsinki, Finland.
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Abstract
Lymphedema is increasingly being seen in patients receiving home health care and throughout the general population. Substantial risks of complications are associated with failure to recognize its presence, worsening of the condition and the use of inadequate or incomplete therapy. Therapeutic truncal clearance as a component of therapy is universally accepted by professional therapists as being essential, but often rejected by third-party payers. This therapeutic component is based on sound physiological principles, but there has not been, nor will there likely be, peer-reviewed testing because it is deemed unethical to subject patients to therapy without its use. We believe that if the physiological basis for this therapy were more widely understood, its absolute need would be better recognized. Thus, our goal is to describe those lymphatic system features that directly impact lymphedema development and complications emphasizing the role of and scientific basis for truncal clearance as an essential treatment component.
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Mayrovitz HN, Davey S, Shapiro E. Local tissue water assessed by tissue dielectric constant: anatomical site and depth dependence in women prior to breast cancer treatment-related surgery. Clin Physiol Funct Imaging 2008; 28:337-42. [DOI: 10.1111/j.1475-097x.2008.00814.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Reliability and validity of a bioimpedance measurement device in the assessment of UVR damage to the skin. Arch Dermatol Res 2008; 300:253-61. [DOI: 10.1007/s00403-008-0844-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 10/05/2007] [Accepted: 03/05/2008] [Indexed: 10/22/2022]
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Huang YP, Zheng YP, Leung SF, Choi APC. High frequency ultrasound assessment of skin fibrosis: clinical results. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:1191-8. [PMID: 17467155 DOI: 10.1016/j.ultrasmedbio.2007.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 01/24/2007] [Accepted: 02/06/2007] [Indexed: 05/04/2023]
Abstract
Fibrosis is a common late effect of radiotherapy treatment for cancer patients. Current clinical assessment of radiation-induced fibrosis is generally limited to clinician-based rating scales, which are usually not sufficient for quantitative and objective evaluations. Ultrasonic propagation properties of tissues are widely reported to be sensitive to the alterations of tissue compositions and structures. Based on our previous feasibility study, we used four parameters including skin thickness and three ultrasonic parameters of dermal tissues (attenuation slope [beta], integrated attenuation [IA] and integrated backscatter [IBS]) in the frequency range of 10 to 25 MHz for the assessment of skin fibrosis. Experiments were conducted on the forearm and neck skin in patients with postirradiation fibrosis in the neck region. The palpation score and stiffness of the neck soft tissue were also measured as an indication of fibrotic severity. Comparisons of the results between 38 patients and 20 control subjects showed a significantly smaller beta (p = 0.005) and a significantly larger skin thickness (p < 0.004) and IA (p = 0.04) in the neck skins of the patients. However, age-matched comparisons showed there were neither significant differences among patient subgroups with different fibrotic levels assessed using manual palpation or significant correlations between the four parameters and the overall stiffness of the neck soft tissues (p > 0.05). In conclusion, ultrasound tissue characterization may provide additional information for the assessment of postirradiation skin fibrosis in the neck region. Further studies are necessary to investigate the feasibility of applying the current measurement for differentiating the severity of skin fibrosis.
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Affiliation(s)
- Y P Huang
- Department of Heath Technology and Informatics, Hong Kong Polytechnic University, Hong Kong, China
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Lofland SE, Mazzatenta JD, Croman J, Tyagi SD. Multimode near-field microwave monitoring of free water content of skin and imaging of tissue. Phys Med Biol 2007; 52:1295-301. [PMID: 17301455 DOI: 10.1088/0031-9155/52/5/006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We have used the near-field scanning microwave microscopy (NSMM) technique in the 1-10 GHz range to monitor the free water content of skin. The water content is interpreted from the measured dielectric properties of the epidermis. The finger skin was first hydrated by soaking in water at 37 degrees C for 30 min followed by monitoring of water content as the free water evaporated under ambient conditions. The same technique has also been employed to image a 1 cm x 1 cm sample of chicken skin. It has been shown that variations exist in the resonant frequencies and quality factors of tissue under varying physical parameters. The samples analysed were as-received and thermally dehydrated or damaged chicken tissue samples. We contrast between the dielectric properties with the optical images. We also discuss possible application of our imaging technique in clinical monitoring of the wound healing process.
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Affiliation(s)
- S E Lofland
- Department of Physics and Astronomy, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028, USA.
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Mayrovitz HN, Brown-Cross D, Washington Z. Skin tissue water and laser Doppler blood flow during a menstrual cycle. Clin Physiol Funct Imaging 2007; 27:54-9. [PMID: 17204039 DOI: 10.1111/j.1475-097x.2007.00716.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Previous work offers conflicting evidence concerning whether basal skin blood flow (SBF) varies with the menstrual cycle. Our goal was to determine the extent of cycle-dependent changes in forearm SBF parameters and if they are linked to local tissue water content and arm volume changes. Both arms of 10 premenopausal women were evaluated three times during their cycle (days 4, 12 and 22) and 10 postmenopausal women were evaluated once. Each evaluation included laser Doppler blood flow parameters (perfusion, volume and velocity), skin temperature, arm volume and local tissue water determined by a new tissue dielectric constant method. Estradiol and progesterone concentrations were determined at each visit by using saliva samples and analysis showed the expected pattern of variation over the cycle. Main results showed no significant cycle-dependent variations in any SBF parameter, temperature, tissue water or arm volume. Postmenopausal women had significantly less estradiol levels, but did not differ with respect to premenopausal women in any measured parameter except for a slightly less blood velocity (P<0.01). We hypothesize that that the absence of changes in tissue water and arm volume in our group may account for the constancy of the measured SBF parameters. However, in other populations, hormonally induced tissue changes may occur and contribute to the cycle-dependent changes in resting blood perfusion that have been reported. This possibility suggests that it may be useful to measure and report a skin tissue water index when serial changes in blood perfusion are being investigated.
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Affiliation(s)
- Harvey N Mayrovitz
- Physiology Department, College of Medical Sciences, Nova Southeastern University, Davie, FL 33328, USA.
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