A Case of a Ruptured Aneurysm at the Supracallosal Portion (A4-A5) of the Bihemispheric Anterior Cerebral Artery Treated with Endovascular Surgery.

Objective: To report our experience on a rare case of a ruptured aneurysm at the supracallosal portion (A4-A5) of the bihemispheric anterior cerebral artery (ACA), an ACA anomaly, and present that endovascular surgery was a good treatment even for peripheral cerebral aneurysm. Case Presentation: A 53-year-old woman experienced a sudden onset of severe headache and vomiting. Plain CT scan revealed subarachnoid hemorrhage and hematoma in the supracallosal area. Cerebral angiography showed that the left pericallosal artery supplied blood to the bilateral parietal lobes through the bihemispheric artery. A saccular aneurysm was found at the supracallosal portion of the left bihemispheric ACA. Coil embolization of the cerebral aneurysm was performed completely. Conclusion: Several reports have demonstrated an aneurysm with bihemispheric ACA, all treated by neck clipping. In this case, endovascular treatment for intracranial peripheral cerebral aneurysms becomes possible, and treatment indications are said to expand.

[Evaluation of the Number of Sampling Angles in Three Dimensional Ordered Subset Expectation Maximization: Comparison of Step and Shoot Acquisition and Continuous Acquisition].

Three dimensional ordered subset expectation maximization (3D-OSEM) improves spatial resolution and contrast. Continuous acquisition, and step and shoot acquisition are used in single photon emission computed tomography (SPECT). The purpose of this study was to evaluate the effect of 3D-OSEM when acquisition method was different. We evaluated spatial resolution using a line source phantom and uniformity using a pool phantom. The phantoms were acquired by step and shoot acquisition and continuous acquisition at changing step angles. These projection data were reconstructed using filtered back projection (FBP) and 3D-OSEM. We evaluated reconstruction images using the full width half maximum (FWHM) of line source and root mean square uncertainty (%RMSU) of pool phantom. 3D-OSEM improved spatial resolution and uniformity compared with FBP. Change of FWHM in radial direction and %RMSU by using 3D-OSEM was approximately equal to continuous acquisition in step and shoot acquisition. However, even if using 3D-OSEM, distance between center of rotation and the location of line source is long, a large sampling step angle produced an increase FWHM in tangential direction using continuous acquisition. Step angles need to be set based on the sampling theorem using continuous acquisition.

[Verification of the protective effect of a testicular shield in postoperative radiotherapy for seminoma].

In postoperative radiotherapy for seminoma, control of the testicular absorbed dose is important, since exposure of the testis can lead to temporary or permanent infertility. In this case, instead of using a dog-leg-shaped field, treatment using a field focused near the aorta was provided in several disease stages of seminoma. However, the precise need for testicular shielding during treatment and dose of testis exposure was not clear. We examined these questions by measuring the testicular absorbed dose with and without a testicular shield using two clinical treatment plans and a phantom. The distance from the testis phantom and the lower end of the irradiation field was varied. Where the total dose for the tumor was 20 Gy, the testicular absorbed dose was below 0.1 Gy, the threshold dose for temporary infertility. At this dosage, the distance between the testis phantom and the edge of the irradiation field was 14.6 cm without the shield and 9.99 cm with the shield. Using a testes shield, it was thus possible to reduce the dose by 58.5%.

[Verification of the dose from an iridium-192 ((192)Ir) sealed source absorbed by an implantable cardioverter defibrillator (ICD) during uterine intracavitary brachytherapy].

The purpose of this study was to verify the dose absorbed by an implantable cardioverter defibrillator (ICD) from an (192)Ir sealed source during uterine intracavitary brachytherapy, and to confirm its immunity to radiation effects. First, prior to treatment, the doses around the ICD position of an anthromorphic phantom were evaluated. Next, we also measured the dose at the ICD position using a fluorescent glass dosimeter and silicon diode dosimeter during the treatment of intracavitary brachytherapy of a patient implanted with an ICD. The results of the phantom study showed the dose percentage at the ICD location, 2 cm deep, to be 0.074% of the prescribed dose. The results of a treatment study similarly showed the dose, measured using a fluorescent glass dosimeter in the ICD position, to be 0.071% of the prescribed dose. During the application of the total prescribed dose, 30 Gy/5 fraction, the dose at the surface of the ICD position was estimated to be 21.2 mGy, well below the 1 Gy maximum recommended in the JASTRO guidelines. We regard dose verification and monitoring during treatment to be both necessary and useful in the treatment of individual cases.

[Influence on dose calculation by difference of dose calculation algorithms in stereotactic lung irradiation: comparison of pencil beam convolution (inhomogeneity correction: batho power law) and analytical anisotropic algorithm].

The monitor unit (MU) was calculated by pencil beam convolution (inhomogeneity correction algorithm: batho power law) [PBC (BPL)] which is the dose calculation algorithm based on measurement in the past in the stereotactic lung irradiation study. The recalculation was done by analytical anisotropic algorithm (AAA), which is the dose calculation algorithm based on theory data. The MU calculated by PBC (BPL) and AAA was compared for each field. In the result of the comparison of 1031 fields in 136 cases, the MU calculated by PBC (BPL) was about 2% smaller than that calculated by AAA. This depends on whether one does the calculation concerning the extension of the second electrons. In particular, the difference in the MU is influenced by the X-ray energy. With the same X-ray energy, when the irradiation field size is small, the lung pass length is long, the lung pass length percentage is large, and the CT value of the lung is low, and the difference of MU is increased.

[Comparison of dose evaluation index by pencil beam convolution and anisotropic analytical algorithm in stereotactic radiotherapy for lung cancer].

We previously studied dose distributions of stereotactic radiotherapy (SRT) for lung cancer. Our aim is to compare in combination pencil beam convolution with the inhomogeneity correction algorithm of Batho power low [PBC (BPL)] to the anisotropic analytical algorithm (AAA) by using the dose evaluation indexes. There were significant differences in D95, PTV mean dose, homogeneity index, and conformity index, V10, and V5. The dose distributions inside the PTV calculated by PBC (BPL) were more uniform than those of AAA. There were no significant differences in V20 and mean dose of total lung. There was no large difference for the whole lung. However, the surrounding high-dose region of PTV became smaller in AAA. The difference in dose evaluation indexes extended between PBC (BPL) and AAA that as many as low CT value of lung. When the dose calculation algorithm is changed, it is necessary to consider difference dose distributions compared with those of established practice.