Cardiac doses of accelerated partial breast irradiation with perioperative multicatheter interstitial brachytherapy.

PURPOSE: To quantify mean heart dose (MHD) and doses to the left anterior descending artery (LAD) and left ventricle (LV) in a retrospective series of patients who underwent perioperative accelerated partial breast irradiation with multicatheter interstitial brachytherapy (MIB-APBI). METHODS: Sixty-eight patients with low-risk left breast cancer were treated with MIB-APBI at our institution between 2012 and 2017. Interstitial tubes were inserted during the tumorectomy and sentinel node biopsy and APBI was started 6 days later. The prescribed dose was 34 Gy in 10 fractions (twice a day) to the clinical target volume (CTV). The heart, LAD, and LV were contoured and the distance between each structure and the CTV was measured. The MHD, mean and maximum LAD doses (LAD mean/max), and mean LV doses (LV mean) were calculated and corrected to biologically equivalent doses in 2­Gy fractionation (EQD2). We also evaluated the impact of the distance between the cardiac structures and the CTV and of the volume receiving the prescribed dose (V100) and high-dose volume (V150) on heart dosimetry. RESULTS: Mean EQD2 for MHD, LAD mean/max, and mean LV were 0.9 ± 0.4 Gy (range 0.3-2.2), 1.6 ± 1.1 Gy (range, 0.4-5.6), 2.6 ± 1.9 Gy (range, 0.7-9.2), and 1.3 ± 0.6 Gy (range, 0.5-3.4), respectively. MHD, LAD mean/max, and LV mean significantly correlated with the distance between the CTV and these structures, but all doses were below the recommended limits (German Society of Radiation Oncology; DEGRO). The MHD and LV mean were significantly dependent on V100. CONCLUSION: Perioperative MIB-APBI resulted in low cardiac doses in our study. This finding provides further support for the value of this technique in well-selected patients with early-stage left breast cancer.

Aspects of Austenitization for the Bearing Steel Induction Quenching Design.

The dissolution of carbides during the heating to the quenching temperature has a significant effect on the martensite oversaturation and the resulting mechanical properties. The kinetics of dissolution can be influenced by various external factors. This work deals with monitoring the carbide dissolution utilizing dilatometer analysis. The austenitization of 100CrMnSi6-4 bearing steel in two initial states was compared-after accelerated spheroidization annealing and conventional soft annealing. The main objective was to determine the amount of undissolved cementite during austenitization in the temperature range where only austenite and cementite are present in the structure. The austenitization temperature determines the degree of cementite dissolution and, consequently, the carbon content in austenite and thus the final properties after quenching. The cementite dissolution was quantified from dilatometric curves and image analysis.

Kinetics of Austenite Decomposition in 54SiCr6 Steel during Continuous Slow Cooling Conditions.

In this study, dilatometry and metallography were used to investigate the effect of silicon and copper alloying on the decomposition kinetics of 54SiCr6 steel during continuous slow cooling. It is different from the published literature for using the approach of the local activation energy of the austenite decomposition Ef and the local Avrami exponent n of the volume fraction of the transformed phase f to study the kinetics of austenite-pearlitic transformation in cooled 54SiCr steel at slow cooling rates. The Johnson-Mehl-Avrami equation was used to determine the dependence of the local activation energy for austenite decomposition Ef and the local Avrami exponent n on the volume fraction of the transformed phase f. The mechanism of the austenite decomposition was analysed based on the calculated values of n. Both the local and average activation energies were used to evaluate the alloying effect, and the results were compared with those obtained from other methods. The type of microstructure formed as a result of cooling at rates of 0.5 K/s, 0.3 K/s, 0.1 K/s and 0.05 K/s was determined. The effects of changes in the cooling rate and the content of silicon (1.5-2.5 wt.%) and copper (0.12-1.47 wt.%) on the dimension of nucleation and growth kinetics of the transformed phase were studied. It was revealed that the pearlite microstructure was formed predominantly in 54SiCr6 steel as a result of continuous cooling at slow cooling rates. It was also found that alloying this steel with copper led to a significant decrease in the value of Ef, as well as to a change in the mechanism of the kinetics of the austenite-pearlite transformation, which was realised in predominantly two- and three-dimensional nucleation and growth at a constant nucleation rate. At the same time, alloying this steel with silicon led only to a slight change in Ef. The results of the study of 54SiCr steel presented the dependence of the activation energy of transformation and the local Avrami exponent on the volume fraction of the transformed phase at a given cooling rate at different copper and silicon contents. In addition, the study provides insight into the mechanism of kinetics in cooled 54SiCr steel as a function of the cooling rate.

A New Alloying Concept for Low-Density Steels.

This paper introduces a new alloying concept for low-density steels. Based on model calculations, samples-or "heats"-with 0.7 wt% C, 1.45 wt% Si, 2 wt% Cr, 0.5 wt% Ni, and an aluminium content varying from 5 to 7 wt% are prepared. The alloys are designed to obtain steel with reduced density and increased corrosion resistance suitable for products subjected to high dynamic stress during operation. Their density is in the range from 7.2 g cm-3 to 6.96 g cm-3. Basic thermophysical measurements are carried out on all the heats to determine the critical points of each phase transformation in the solid state, supported by metallographic analysis on SEM and LM or the EDS analysis of each phase. It is observed that even at very high austenitisation temperatures of 1100 °C, it is not possible to change the two-phase structure of ferrite and austenite. A substantial part of the austenite is transformed into martensite during cooling at 50 °C s-1. The carbide kappa phase is segregated at lower cooling rates (around 2.5 °C s-1).

Enhanced Spring Steel's Strength Using Strain Assisted Tempering.

Spring steels are typical materials where enhancement of mechanical properties can save considerable mass for transport vehicles, in this way the consumption of fuel or electric energy can be decreased. A drastic change in both the resulting microstructure and mechanical properties could be achieved due to the inclusion of strain into the tempering process after quenching. The strain assisted tempering (SAT) technology was applied, i.e., the process of quenching and following a sequence of tempering operations alternating with strain operations. After the first tempering, controlled deformation by rotary swaging was carried out with a strain of 17% (strain rate is about 120 s-1). Considerably higher strength parameters after SAT compared to conventional quenching and tempering (QT) technology were nevertheless accompanied by enhanced notch toughness at the same time by the decrease of elongation and reduction of area. However, by optimizing the process it is was also possible to achieve acceptable values for those parameters. Remarkable differences are visible in resulting microstructures of compared samples, which were revealed by metallographic analysis and X-ray diffraction measurement. While the standard microstructure of tempered martensite with transition carbides was observed after QT processing, carbideless islands with nanotwins occurred in martensitic laths after SAT processing.

Effect of 1.5 wt% Copper Addition and Various Contents of Silicon on Mechanical Properties of 1.7102 Medium Carbon Steel.

Requirements for mechanical properties of steels are constantly increasing, and the combination of quenching and tempering is the method generally chosen for achieving high strength in medium carbon steels. This study examines the influence of various silicon contents from 1.06 to 2.49 wt% and the addition of copper (1.47 wt%) on the behavior of 1.7102 steel starting with the as-quenched state and ending with the tempered condition at the temperature of 500 °C. The microstructure was characterized by SEM and TEM, the phase composition and dislocation density were studied by XRD analysis, and mechanical properties were assessed by tensile and hardness testing, whereas tempered martensite embrittlement was assessed using Charpy impact test and the activation energy of carbide precipitation was determined by dilatometry. The benefit of copper consists in the improvement of reduction of area by tempering between 150 and 300 °C. The increase in strength due to copper precipitation occurs upon tempering at 500 °C, where strength is generally low due to a drop in dislocation density and changes in microstructure. The increasing content of silicon raises strength and dislocation density in steels, but the plastic properties of steel are limited. It was found that the silicon content of 1.5 wt% is optimum for the materials under study.

Effects of Silicon, Chromium, and Copper on Kinetic Parameters of Precipitation during Tempering of Medium Carbon Steels.

Understanding the tempering behavior of medium carbon steels is mandatory if their mechanical properties are to be improved. For an optimal technology to be developed for this purpose, a substantial experimental basis is needed to extract quantitative information on the microstructure of the tempered material. This paper reports on the characterization of microstructural changes induced by tempering in medium-carbon steels alloyed with Si, Cr, Cu, and Mn using state-of-the-art experimental techniques. Complementarities among these techniques are highlighted. The evolution of transition carbides, cementite, and copper precipitates is described using data from X-ray diffraction, small and ultra-small angle neutron diffraction, transmission electron microscopy, and dilatometry observation. The effects of silicon, chromium, and copper on the mechanism of carbide and copper precipitation are discussed. The considerable changes found in the size and volume of copper precipitates correlate well with the difference in the yield stress between tempered steels with and without copper.

Ruptured bronchial artery aneurysm: case report.

Bronchial artery aneurysm is a very rare condition. Its rupture can cause a life threatening hemorrhage. We report a case of a 50-year-old patient with a ruptured bronchial artery aneurysm who presented with epigastric pain. It is the first published case with such signs of a rupture of a bronchial artery aneurysm. CT scan confirmed the diagnosis. The patient was treated with endovascular embolization.

Accelerated partial breast irradiation with perioperative multicatheter interstitial brachytherapy-A feasibility study.

PURPOSE: To assess the feasibility of high-dose-rate perioperative multicatheter interstitial brachytherapy to deliver accelerated partial breast irradiation (APBI) in selected patients with early breast cancer. METHODS AND MATERIALS: Perioperative multicatheter interstitial brachytherapy for APBI has been used at our department since 2012 for patients with low-risk breast cancer. Interstitial catheters were inserted perioperatively via hollow needles immediately following tumorectomy with sentinel node biopsy. APBI started on Day 6 after surgery. The prescribed dose was 34 Gy (10 fractions of 3.4 Gy bid). Hormonal therapy was prescribed in all cases. RESULTS: Between June 2012 and December 2017, 125 patients were scheduled for APBI. Of these, APBI was not performed in 12 patients (9.6%) due to adverse prognostic factors identified on the definitive biopsy. We observed wound dehiscence in 2/113 cases (1.8%), inflammatory complications requiring antibiotics in 7/113 cases (6.2%), transient Grade I radiodermatitis in 6/113 patients (4.4%), and seroma which resolved spontaneously in 3/113 patients (2.7%). With median followup of 39 months (range 3.3-75.3) no relapses were observed. No late complications in Radiation Therapy Oncology Group Grade 3 or higher were documented. Cosmetic outcome in patients with followup > 2 years was excellent or good in 92%. CONCLUSION: Our preliminary results show that the perioperative multicatheter interstitial high-dose-rate brachytherapy for APBI in selected patients with early breast cancer is feasible. This treatment schedule reduces treatment duration, spares the patients of repeated anesthesia, and enables precise application of the afterloading tubes under direct visual control.

Diverting ileostomy set removable without laparotomy--feasibility study.

We constructed an ileostomy set that creates a diverting ileostomy not requiring surgery for closure. The set has two primary components: a double-balloon drainage catheter and a plastic holder. The plastic holder has a rotary component that is used to tighten a percutaneosly placed lasso-loop stitch and purse the enterotomy after the drainage catheter is removed. We tested the ileostomy set in 10 experimental pigs. The drainage catheter was introduced transcecally into the terminal ileum behind Bauhin's valve, and the balloon was inflated. Three to seven days later the drainage catheter was removed, and the cecotomy was closed by percutaneous tightening of the lasso-loop stitch. One week later each animal underwent relaparotomy, and we examined the abdominal cavity for peritonitis. An ileocecal resection was performed, and specimens were collected and evaluated microscopically to ensure that the catheter had not damaged the intestinal wall. The only change noted in the terminal ileum was submucosa lymphatic tissue hyperplasia. No intestinal leaks occurred, and percutaneous enterotomy closure was successful.