[Lung cancer screening : towards the implementation of a pilot project in Switzerland]. / Dépistage du cancer pulmonaire : vers l'implémentation d'un projet pilote en Suisse.

Lung cancer is responsible for one in five cancer-related deaths. Screening for lung cancer using low-dose chest CT (LDCT) is supported by several international studies targeting the at-risk population as part of an organised programme. Given the organisational challenges for the healthcare systems of the countries concerned, this involves setting up pilot screening projects. This requires close collaboration between the players involved, with a multidisciplinary approach structured around the participant, aiming to offer the expertise of the pulmonologist and the radiologist on the LDCT performed, interpreted with the help of artificial intelligence. Here we set out the elements needed to develop a screening programme, starting with the implementation of a pilot project.

Le cancer pulmonaire est responsable d'un décès lié au cancer sur cinq. Le dépistage du cancer pulmonaire par le scanner thoracique à faible dose (LDCT) est soutenu par plusieurs études internationales ciblant la population à risque dans le cadre d'un programme organisé. Vu les enjeux organisationnels pour le système de santé des pays concernés, cela passe par la mise en place de projets pilotes de dépistage. Cela requiert une collaboration étroite entre les différents acteurs, avec une approche multidisciplinaire structurée autour du participant visant à offrir l'expertise du pneumologue et du radiologue sur le LDCT effectué, interprété avec l'aide de l'intelligence artificielle. Nous exposons ici les éléments nécessaires à l'élaboration d'un programme de dépistage, en passant d'abord par la mise en place d'un projet pilote.

Lung CT stabilization with high-frequency non-invasive ventilation (HF-NIV) and breath-hold (BH) in lung nodule assessment by PET/CT.

PURPOSE: To evaluate the effect of lung stabilization using high-frequency non-invasive ventilation (HF-NIV) and breath-hold (BH) techniques on lung nodule detection and texture assessment in PET/CT compared to a free-breathing (FB) standard lung CT acquisition in PET/CT. MATERIALS AND METHODS: Six patients aged 65 ± 7 years, addressed for initial assessment of at least one suspicious lung nodule with 18F-FDG PET/CT, underwent three consecutive lung PET/CT acquisitions with FB, HF-NIV and BH. Lung nodules were assessed on all three CT acquisitions of the PET/CT and characterized for any size, volume and solid/sub-solid nature. RESULTS: BH detected a significantly higher number of nodules (n = 422) compared to HF-NIV (n = 368) and FB (n = 191) (p < 0.001). The mean nodule size (mm) was 2.4 ± 2.1, 2.6 ± 1.9 and 3.2 ± 2.4 in BH, HF-NIV and FB, respectively, for long axis and 1.5 ± 1.3, 1.6 ± 1.2 and 2.1 ± 1.7 in BH, HF-NIV and FB, respectively, for short axis. Long- and short-axis diameters were significantly different between BH and FB (p < 0.001) and between HF-NIV and FB (p < 0.001 and p = 0.008), but not between BH and HF-NIV. A trend for higher volume was shown in FB compared to BH (p = 0.055) and HF-NIV (p = 0.068) without significant difference between BH and HF-NIV (p = 1). We found a significant difference in detectability of sub-solid nodules between the three acquisitions, with BH showing a higher number of sub-solid nodules (n = 128) compared to HF-NIV (n = 72) and FB (n = 44) (p = 0.002). CONCLUSION: We observed a higher detection rate of pulmonary nodules on CT under BH or HF-NIV conditions applied to PET/CT than with FB. BH and HF-NIV demonstrated comparable texture assessment and performed better than FB in assessing size and volume. BH showed a better performance for detecting sub-solid nodules compared to HF-NIV and FB. The addition of BH or HF-NIV to PET/CT can help improve the detection and texture characterization of lung nodules by CT, therefore improving the accuracy of oncological lung disease assessment. The ease of use of BH and its added value should prompt its use in routine practice.

Salvage LATTICE radiotherapy for a growing tumour despite conventional radio chemotherapy treatment of lung cancer.

A 40-year-old patient with cT4cN1M0 squamous cell lung cancer of the upper right lobe received preoperative induction chemotherapy. Systemic induction treatment failed to reverse tumour growth with the addition of conventional radiotherapy (RT). A salvage lattice RT boost of 12 Gy was administered immediately to increase the dose to the tumour. Conventional RT was resumed at the planned dose of 60 Gy. The tumour shrank rapidly, and the patient was surged. The postoperative pathology remained ypT0ypN0 status.

[Radiation-induced pneumonitis : pathophysiology, risk factors and work-up in 2022]. / Pneumopathies radiques - Pathophysiologie, classification, facteurs de risque et prise en charge en 2022.

Despite technical improvements concerning lung irradiation modalities, radiation-induced pneumonitis remains a usual complication, notably in the field of lung cancer treatment. This complication may remain asymptomatic but can also lead to respiratory distress. Thus, a low degree of suspicion and a comprehensive work-up is mandatory to evaluate the indication for specific treatment. In this article, we discuss the hypothesized pathophysiologic pathways, risk factors, clinical/radiological presentation and management.

Malgré les améliorations des techniques d'irradiation à l'étage thoracique, la pneumopathie radique (PpR) reste une complication fréquente, en particulier dans le cadre du traitement du cancer pulmonaire. Cette complication, qu'elle soit précoce ou tardive, peut demeurer silencieuse ou causer une détresse respiratoire potentiellement fatale. C'est pourquoi un faible degré de suspicion est nécessaire, de manière à débuter précocement un bilan d'investigation et décider de l'indication à un traitement spécifique. Dans cet article, nous discutons des hypothèses pathophysiologiques qui sous-tendent la PpR, des facteurs de risque de survenue, de la présentation clinique et radiologique, ainsi que de sa prise en charge.

Altitude-Induced Sleep Apnea Is Highly Dependent on Ethnic Background (Sherpa Vs. Tamang).

Heiniger, Grégory, Simon Walbaum, Claudio Sartori, Alban Lovis, Marco Sazzini, Andrew Wellman, and Raphael Heinzer. Altitude-Induced Sleep Apnea Is Highly Dependent on Ethnic Background (Sherpa Vs. Tamang). High Alt Med Biol. 23:165-172, 2022. Rationale: High altitude-induced hypocapnic alkalosis generates central sleep apnea (CSA). In Nepal, two ethnic groups live at medium-to-high altitude: Tamangs originate from low-altitude Tibeto-Burman populations, whereas Sherpas descend from high-altitude Tibetans. Objective: To compare apnea severity at low and high altitude between Sherpas and Tamangs. Methods: Polygraphy recordings, including airflow and oxygen saturation, were performed in Nepal at "low" (2,030 m) and "high" (4,380 m) altitudes. Resting ventilation (V̇E) and mixed-exhaled CO2 (FECO2) were also measured at the same altitudes. Differences in apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and % of nocturnal periodic breathing (NPB) at the two altitudes were compared between ethnicities. Measurements and Main Results: Twenty Sherpas and 20 Tamangs were included (males, median [interquartile range] age: 24.5 [21.5-27.8] years vs. 26.0 [21.5-39.8] years, body mass index: 23.9 [22.1-26.1] kg/m2 vs. 25.21 [20.6-27.6] kg/m2). Compared with Tamangs, Sherpas showed a lower increase in AHI (+7.5 [2.6-17.2]/h vs. +31.5 [18.2-57.3]/h, p < 0.001), ODI (+13.8 [5.5-28.2]/h vs. +42.0 [22.6-77.6]/h, p < 0.001), and NPB proportion (+0.9 [0-3.5]% vs. +12.8 [3.1-27.4]%, p < 0.001) from low to high altitude. Resting V̇E was higher in Sherpas versus Tamangs at both low (8.45 [6.89-10.70] l/min vs. 6.3 [4.9-8.3] l/min, p = 0.005) and high (9.7 [8.5-11] l/min vs. 8.74 [7.39-9.73] l/min, p = 0.020) altitudes, whereas the mean ± standard deviation FECO2 decrease between low and high altitude was greater in Tamangs versus Sherpas (-0.50% ± 0.44% vs. -0.80% ± 0.33%, p < 0.023). Conclusion: Overall, altitude-adapted Sherpas showed a 3.2-times smaller increase in sleep-disordered breathing between low and high altitude compared with Tamangs, and higher ventilation and a smaller drop in FECO2 at high altitude. These data suggest that genetic differences in breathing control can be protective against CSA.

Comparison Between Magnetic Resonance Imaging and Computed Tomography in the Detection and Volumetric Assessment of Lung Nodules: A Prospective Study.

Rationale and Objectives: Computed tomography (CT) lung nodule assessment is routinely performed and appears very promising for lung cancer screening. However, the radiation exposure through time remains a concern. With the overall goal of an optimal management of indeterminate lung nodules, the objective of this prospective study was therefore to evaluate the potential of optimized ultra-short echo time (UTE) MRI for lung nodule detection and volumetric assessment. Materials and Methods: Eight (54.9 ± 13.2 years) patients with at least 1 non-calcified nodule ≥4 mm were included. UTE under high-frequency non-invasive ventilation (UTE-HF-NIV) and in free-breathing at tidal volume (UTE-FB) were investigated along with volumetric interpolated breath-hold examination at full inspiration (VIBE-BH). Three experienced readers assessed the detection rate of nodules ≥4 mm and ≥6 mm, and reported their location, 2D-measurements and solid/subsolid nature. Volumes were measured by two experienced readers. Subsequently, two readers assessed the detection and volume measurements of lung nodules ≥4mm in gold-standard CT images with soft and lung kernel reconstructions. Volumetry was performed with lesion management software (Carestream, Rochester, New York, USA). Results: UTE-HF-NIV provided the highest detection rate for nodules ≥4 mm (n = 66) and ≥6 mm (n = 32) (35 and 50%, respectively). No dependencies were found between nodule detection and their location in the lung with UTE-HF-NIV (p > 0.4), such a dependency was observed for two readers with VIBE-BH (p = 0.002 and 0.03). Dependencies between the nodule's detection and their size were noticed among readers and techniques (p < 0.02). When comparing nodule volume measurements, an excellent concordance was observed between CT and UTE-HF-NIV, with an overestimation of 13.2% by UTE-HF-NIV, <25%-threshold used for nodule's growth, conversely to VIBE-BH that overestimated the nodule volume by 28.8%. Conclusion: UTE-HF-NIV is not ready to replace low-dose CT for lung nodule detection, but could be used for follow-up studies, alternating with CT, based on its volumetric accuracy.

The Swiss Approach - feasibility of a national low-dose CT lung cancer screening program.

BACKGROUND: Lung cancer is the leading cause of cancer-related deaths in Switzerland. Despite this, there is no lung cancer screening program in the country. In the United States, low-dose computed tomography (LDCT) lung cancer screening is partially established and endorsed by guidelines. Moreover, evidence is growing that screening reduces lung cancer-related mortality and this was recently shown in a large European randomized controlled trial. Implementation of a lung cancer screening program, however, is challenging and depends on many country-specific factors. The goal of this article is to outline a potential Swiss lung cancer screening program. FRAMEWORK: An exhaustive literature review on international screening models as well as interviews and site visits with international experts were initiated. Furthermore, workshops and interviews with national experts and stakeholders were conducted to share experiences and to establish the basis for a national Swiss lung cancer screening program. SCREENING APPROACH: General practitioners, pulmonologists and the media should be part of the recruitment process. Decentralisation of the screening might lead to a higher adherence rate. To reduce stigmatisation, the screening should be integrated in a "lung health check". Standardisation and a common quality level are mandatory. The PLCOm2012 risk calculation model with a threshold of 1.5% risk for developing cancer in the next six years should be used in addition to established inclusion criteria. Biennial screening is preferred. LUNG RADS and NELSON+ are applied as classification models for lung nodules. CONCLUSION: Based on data from recent studies, literature research, a health technology assessment, the information gained from this project and a pilot study the Swiss Interest Group for lung cancer screening (CH-LSIG) recommends the timely introduction of a systematic lung cancer screening program in Switzerland. The final decision is for the Swiss Cancer Screening Committee to make.

Fiducial markers for stereotactic lung radiation therapy: review of the transthoracic, endovascular and endobronchial approaches.

Stereotactic body radiation therapy is an alternative to surgery for early-stage, inoperable peripheral non-small cell lung cancer. As opposed to linear accelerator (linac)-based (e.g. gating) and free-breathing techniques, CyberKnife® with Synchrony® technology allows accurate radiation delivery by means of a real-time respiratory motion tracking system using, in most cases, metal fiducial markers (FMs) placed in the vicinity of the target. The aims of this review are as follows. First, to describe the safety and efficacy of the transthoracic, endovascular and endobronchial FM insertion techniques for peripheral pulmonary lesions (PPLs). Second, to analyse performance in terms of the migration and tracking rates of different FM types. Recent developments in FM tracking for central lesions will also be reviewed. In conclusion, for PPLs, the endobronchial approach provides a low rate of pneumothorax, offers the possibility of concurrent diagnostic sampling for both the PPL and the lymph nodes, and, finally, reduces the intervention time compared to other techniques. In this context, coil-tailed and coil-spring FMs have shown the lowest migration rate with a consequently high tracking rate.

Novel Technique for Fixing Tracheal Stents.

Endoscopic management of benign or malignant airway obstructions sometimes requires stenting after dilatation or debulking of the tumor. Straight stents are highly prone to migration in the trachea and the main bronchus, with potential catastrophic consequences. Multiple fixation strategies have been described to secure subglottic stents, each having certain limitations. This report describes a novel, "inside-to-outside" stent fixation in the upper airway using the Lichtenberger needle carrier in 2 consecutive patients.

Is sleeve lobectomy safe after induction therapy?-a systematic review and meta-analysis.

BACKGROUND: Sleeve lobectomy (SL) is a lung-sparing procedure, which is accepted as a valid operation for centrally-located advanced tumors. These tumors often require induction treatment by chemotherapy and/or radiotherapy to downstage the disease and thus facilitate subsequent surgery. However, induction therapy may potentially increase the risk of bronchial anastomotic complications and related morbidity. This meta-analysis aims to determine the impact of induction therapy on the outcomes of pulmonary SL. METHODS: We compared studies of patients undergoing SL or bilobectomy for non-small cell lung cancer (NSCLC) with and without induction therapy. Outcomes of interest were in-hospital mortality, morbidity, anastomosis complication and 5-year survival. Odds ratio (OR) were computed following the Mantel-Haenszel method. RESULTS: Ten studies were included for a total of 1,204 patients. There was no statistical difference for between patients who underwent induction therapy followed by surgery and patients who underwent surgery alone in term of post-operative mortality (OR: 1.80, 95% confidence interval (CI): 0.76-4.25, P value =0.19) and morbidity (OR: 1.17, 95% CI: 0.90-1.52, P value =0.237). Anastomosis related complications rate were 5.2% and appears increased after induction therapy with a statistical difference close to the significance (OR: 1.65, 95% CI: 0.97-2.83, P value =0.06). Patients undergoing surgery alone showed better survival at 5 years (OR: 1.52, 95% CI: 1.15-2.00, P value =0.003). CONCLUSIONS: SL following induction therapy can be safely performed with no increase of mortality and morbidity. However, the need for induction therapy before surgery is associated with increased anastomotic complications and poorer survival prognosis at 5 years.

[Clinical approach to enlarged mediastinal and hilar lymph nodes other than the oncological causes]. / Adénomégalies médiastinohilaires - Approche clinique chez l'adulte immunocompétent hors contexte oncologique.

Widespread use of CT-scans leads to increased discovery of mediastinal and hilar lymph node enlargement, a frequent motive for consulting a pulmonologist. The persistence or progression of such lymphadenopathies outside of an oncological context is most often associated with an infectious process or inflammatory disorders. The history will also point to possible occupational or environmental exposure. The radiological characteristics specific to lymphadenopathies and any associated parenchymal lung damage will most often orient the diagnosis. Endobronchial ultrasound-guided techniques allow targeted and real-time sampling of the mediastinum and hilar lymph nodes, representing the first-line investigation before more invasive surgical procedures.

La découverte d'adénomégalies médiastinohilaires (AMH) est un motif fréquent de consultation en pneumologie. Utilisés à grande échelle, les CT-scans thoraciques en sont les principaux révélateurs. La persistance ou la progression d'AMH en dehors d'un contexte oncologique est le plus souvent d'origine infectieuse ou associée à un processus inflammatoire. L'anamnèse nous orientera vers une possible exposition à des facteurs environnementaux y compris en milieu professionnel. La plupart du temps, les caractéristiques radiologiques propres aux AMH ainsi qu'une éventuelle atteinte parenchymateuse pulmonaire associée pourront orienter le diagnostic. L'échoendoscopie bronchique permettant un échantillonnage ganglionnaire médiastinohilaire ciblé est l'examen de première intention avant des abords diagnostiques plus invasifs.

Limited Index of Clinical Suspicion and Underdiagnosis of Histopathologically Documented Invasive Mold Infections.

Invasive mold infections (IMIs) are difficult to diagnose. This analysis of histopathologically proven IMIs at our institution (2010-2019) showed that 11/41 (27%) of them were not suspected at the time of biopsy/autopsy (9/17, 53% among autopsies). The rate of missed diagnosis was particularly high (8/16, 50%) among nonhematologic cancer patients.

Invasive Hormographiella aspergillata infection in patients with acute myeloid leukemia: Report of two cases successfully treated and review of the literature.

Hormographiella aspergillata is a rare cause of invasive mold infection, mostly described in patients with hematological malignancies. We describe two cases of invasive H. aspergillata infections in patients with acute myeloid leukemia, successfully managed with complete surgical resection of the lesions and antifungal therapy of voriconazole alone or liposomal amphotericin B, followed by voriconazole, highlighting the key role of a multidisciplinary approach for the treatment of this rare and severe invasive mold infection.

Stereotactic lung reirradiation for local relapse: A case series.

INTRODUCTION: Local recurrence after lung SBRT for early stage NSCLC is rare but its treatment remains a challenge due to limited surgical options. We report a case series of 5 patients treated by stereotactic lung salvage reirradiation for local relapse after a previous lung SBRT. MATERIAL AND METHODS: Included patients presented an isolated primary lung relapse within at least the 50% isodose of the previous SBRT treatment. Typical reirradiation schedule was 60 Gy in 8 fractions at isodose 80% and was delivered by Cyberknife® using Synchrony® fiducial tracking system. Dose summations were performed to evaluate the safety of the reirradiation. RESULTS: We identified 5 patients presenting peripheral lesions. All reirradiated lesions were locally controlled after a median follow-up of 11.1 months (6,7-12,2), while PFS at 6 months was 60% (n = 3). We did not notice any Grade 3 or more acute or late adverse event. CONCLUSION: We observed encouraging short-term outcome of lung SBRT reirradiation in patients presenting isolated local relapse of an early-stage NSCLC. Further studies are necessary to confirm the safety and efficiency of this salvage treatment approach.

Endobronchial coil spring fiducial markers for CyberKnife® stereotactic body radiation therapy.

BACKGROUND AND OBJECTIVE: SBRT is an alternative treatment for early-stage inoperable lung cancer. Metallic FM allow to increase tumour tracking precision by CyberKnife®. Currently used techniques for FM placement have many limitations; transthoracic insertion has a high risk for pneumothorax, endovascular insertion requires expertise and dedicated angiography infrastructure and endobronchial linear-gold FM dislocate frequently. This is the first study to assess the safety and efficacy of cs-FM endobronchial insertion under fluoroscopy with or without R-EBUS assessment. METHODS: We retrospectively evaluated all consecutive patients undergoing endobronchial cs-FM placement for at least one PPL <25 mm between 10.2015 and 12.2019. TBB of the PPL were performed in case of a typical R-EBUS signal. PPL tracking accuracy by CyberKnife, complications, cs-FM migration rate and procedure duration were analysed. RESULTS: A total of 52 patients were treated during 55 procedures and 207 cs-FM were placed in 70 PPL. Tracking was successful for 65 of 70 (93%) PPL. R-EBUS was performed for 33 (47%) PPL and TBB for 9 (13%) PPL. Bronchospasm occurred once and any other complications were observed. Migration of cs-FM occurred in 16 of 207 (8%) cs-FM. Migration was more frequent when the target was in a previously irradiated area (P = 0.022). The median bronchoscopy duration was 31.5 min (n = 48 procedures). CONCLUSION: Bronchoscopic cs-FM placement is a rapid and safe procedure. It is associated with a low migration rate and allows precise SBRT delivery. Previous irradiation of the PPL was associated with a higher migration rate.

[Lung cancer screening in Switzerland†: Who†? How†? When†?] / Dépistage du cancer pulmonaire en Suisse†: Qui†? Comment†? Quand†?

Professional societies encourage the establishment of coordinated national screening programs for lung cancer by «â€…low-dose ¼ chest CT scans. The interdisciplinary Swiss Lung Cancer Screening Implementation Group (CH-LSIG) is exploring the feasibility of such a project. However, several questions still remain unanswered, namely the -financing of such a program, the ideal «â€…number-needed to screen ¼, the definition and follow-up of «â€…positive cases ¼, as well as the role of smoking cessation measures. The key points to discuss in the future with patients requesting screening are based on the «â€…shared -decision-making ¼ approach. Pilot projects guided by the CH-LSIG could help to identify the optimal strategy for establishing a national screening program based on the best available scientific evidence.

Les sociétés savantes encouragent le développement de programmes nationaux de dépistage du cancer pulmonaire par CT-scan thoracique low-dose. En Suisse, le groupe de travail ­interdisciplinaire Swiss Lung Cancer Screening Implementation Group (CH-LSIG) s'emploie à la mise en œuvre d'un tel projet. Néanmoins, de nombreuses questions demeurent encore ouvertes, portant sur le financement d'un tel programme, le Number ­Needed to Screen idéal, la définition des «â€…cas positifs ¼ et l'intégration optimale des mesures de sevrage tabagique. Le concept de décision médicale partagée servira de modèle pour répondre aux futurs patients demandeurs d'un examen de dépistage. Des projets pilotes guidés par le CH-LSIG pourraient permettre d'identifier la stratégie la plus performante afin d'implémenter un programme fondé sur les preuves.

[Lung cancer screening: what can we tell our patients while we await a screening program†?] / Dépistage du cancer du poumon†: que dire à nos patient·e·s en attendant un programme organisé†?

The NLST study in the United States showed, in 2011, that low-dose lung CT scans can reduce lung cancer mortality but was limited in its routine recommendation by 96% of false positive screening results. The European NELSON trial, published in 2020, confirmed a 24% decrease in lung cancer mortality and, by using lung nodule volume and volume doubling time, decreased false positive results to 56% of positive tests. The implementation of screening programs is now expected in Europe, including Switzerland. In anticipation, we have developed a decision aid to present patients with the benefits (decreased lung cancer mortality), risks (false positives and indeterminate results), and uncertainties (incidental findings) of lung cancer screening.

L'étude clinique américaine National Lung Screening Trial a démontré en 2011 que le dépistage du cancer du poumon par CT-scan thoracique à faible dose (low-dose) pouvait en diminuer la mortalité, mais était limité dans son applicabilité par une proportion rédhibitoire de 96 % de faux positifs. L'étude clinique européenne Nederlands-Leuven Screening Onderzoek, publiée en 2020, confirme une diminution de la mortalité du cancer du poumon de 24 % et, en se basant sur le temps de doublement du volume des nodules pulmonaires, a pu réduire la prévalence de faux positifs à 56 %. Des programmes de dépistage se préparent dans plusieurs pays européens, y compris la Suisse. Dans ce contexte, nous avons développé une aide à la décision qui reprend les bénéfices (diminution de la mortalité), les risques (faux positifs et résultats indéterminés) et incertitudes (découvertes fortuites) du dépistage du cancer du poumon.

Lung MRI assessment with high-frequency noninvasive ventilation at 3 T.

PURPOSE: To investigate three MR pulse sequences under high-frequency noninvasive ventilation (HF-NIV) at 3 T and determine which one is better-suited to visualize the lung parenchyma. METHODS: A 3D ultra-short echo time stack-of spirals Volumetric Interpolated Breath-hold Examination (UTE Spiral VIBE), without and with prospective gating, and a 3D double-echo UTE sequence with spiral phyllotaxis trajectory (3D radial UTE) were performed at 3 T in ten healthy volunteers under HF-NIV. Three experienced radiologists evaluated visibility and sharpness of normal anatomical structures, artifacts assessment, and signal and contrast ratio computation. The median of the three readers'scores was used for comparison, p < .05 was considered statistically significant. Incidental findings were recorded and reported. RESULTS: The 3D radial UTE resulted in less artifacts than the non-gated and gated UTE Spiral VIBE in inferior (score 3D radial UTE = 3, slight artifact without blurring vs. score UTE Spiral VIBE non-gated and gated = 2, moderate artifact with blurring of anatomical structure, p = .018 and p = .047, respectively) and superior lung regions (score 3D radial UTE = 3, vs. score UTE Spiral VIBE non-gated = 2.5, p = .48 and score UTE Spiral VIBE gated = 1, severe artifact with no normal structure recognizable, p = .014), and higher signal and contrast ratios (p = .002, p = .093). UTE Spiral VIBE sequences provided higher peripheral vasculature visibility than the 3D radial UTE (94.4% vs 80.6%, respectively, p < .001). The HF-NIV was well tolerated by healthy volunteers who reported on average minor discomfort. In three volunteers, 12 of 18 nodules confirmed with low-dose CT were identified with MRI (average size 2.6 ±â€¯1.2 mm). CONCLUSION: The 3D radial UTE provided higher image quality than the UTE Spiral VIBE. Nevertheless, a better nodule assessment was noticed with the UTE Spiral VIBE that might be due to better peripheral vasculature visibility, and requires confirmation in a larger cohort.

Percussion assisted radiation therapy in Hodgkin lymphoma allows a marked reduction in heart dose.

BACKGROUND AND PURPOSE: Early-stage Hodgkin lymphoma (HL) is a highly curable disease but the treatment can induce late complications many years later. Irradiation of the healthy heart is inevitable during radiation treatment of mediastinal sites. We developed a novel method to induce a prolonged apnea-like state that can help decrease the dose to organs at risk during radiation therapy. We present the results of the first 8 HL patients treated routinely with percussion assisted radiation therapy (PART) in our clinic. MATERIAL AND METHODS: We used a newly developed high-frequency non-invasive ventilation system to suppress respiratory motion for prolonged periods and push the heart away from the treated volume. RESULTS: All 8 patients were able to rapidly learn the technique and had an advantage to be treated by PART. We lowered the mean heart dose by an average of 3 Gy with similar target coverage compared to a classical free breathing treatment plan. They were all treated for 15 radiotherapy sessions by PART without any notable side effects. CONCLUSIONS: Percussion assisted radiation therapy can be used routinely to reduce the dose to the heart in Hodgkin lymphoma.