Mammographic breast density and breast cancer risk in the Saudi population: a case-control study using visual and automated methods.

OBJECTIVE: This study aims to establish risk of breast cancer based on breast density among Saudi women and to compare cancer prediction using different breast density methods. METHODS: 1140 pseudonymised screening mammograms from Saudi females were retrospectively collected. Breast density was assessed using Breast Imaging Reporting and Data System (BI-RADS) density categories and visual analogue scale (VAS) of 285 cases and 855 controls matched on age and body mass index. In a subset of 160 cases and 480 controls density was estimated by two automated methods, Volpara Density™ and predicted VAS (pVAS). Odds ratios (ORs) between the highest and second categories in BI-RADS and Volpara density grades, and highest vs lowest quartiles in VAS, pVAS and Volpara Density™, were estimated using conditional logistic regression. RESULTS: For BI-RADS, the OR was 6.69 (95% CI 2.79-16.06) in the highest vs second category and OR = 4.78 (95% CI 3.01-7.58) in the highest vs lowest quartile for VAS. In the subset, VAS was the strongest predictor OR = 7.54 (95% CI 3.86-14.74), followed by pVAS using raw images OR = 5.38 (95% CI 2.68-10.77) and Volpara Density ™ OR = 3.55, (95% CI 1.86-6.75) for highest vs lowest quartiles. The matched concordance index for VAS was 0.70 (95% CI 0.65-0.75) demonstrating better discrimination between cases and controls than all other methods. CONCLUSION: Increased mammographic density was strongly associated with risk of breast cancer among Saudi women. Radiologists' visual assessment of breast density is superior to automated methods. However, pVAS and Volpara Density ™ also significantly predicted breast cancer risk based on breast density. ADVANCES IN KNOWLEDGE: Our study established an association between breast density and breast cancer in a Saudi population and compared the performance of automated methods. This provides a stepping-stone towards personalised screening using automated breast density methods.

Study of Primordial 226Ra, 228Ra, and 40K Concentrations in Dietary Palm Dates and Concomitant Radiological Risk.

The presence of natural radionuclides in the food chain point to a need to assess concentration levels and concomitant radiological risk. Highly popular and forming a staple part of the diet in North Africa, the Arabian Peninsula, and West Asia, palm dates growing naturally there have even greater marketability than simple satisfaction of domestic demand, the palm dates representing a valuable export item. Accurate knowledge of the levels of natural radioactivity in the fruit is thus of importance. In this study, using high-purity germanium gamma-ray spectrometry, quantification has been made of natural radionuclide concentrations in imported dates originating from Iran, Saudi Arabia, and Tunisia. Sample analyses reveal respective mean activity concentrations of 1.4 ± 0.3, 0.8 ± 0.4, and 186 ± 9 Bq kg dry weight for Ra, Ra, and K. For each nuclide, the mean concentration varies little between the dates of the three represented regions. The estimated committed effective dose resulting from the consumption of date fruits for a typical adult was found to be 29.9 µSv y, well below the global internal dose of 290 µSv y assessed by the United Nations Scientific Committee on the Effects of Atomic Radiation to be due to food and water intake. Similarly, the excess lifetime cancer risk due to naturally occurring radioactive material exposure via date fruit consumption is seen to be below the International Commission on Radiological Protection cancer risk factor of 2.5 × 10 based on the additional annual dose limit of 1 mSv for a member of the general public. The results show no significant uptake in the analyzed date fruits.

Radioluminescence sensing of radiology exposures using P-doped silica optical fibres.

In previous work we investigated the real-time radioluminescence (RL) yield of Ge-doped silica fibres and Al2O3 nanodot media, sensing electron- and x-ray energies and intensities at values familiarly obtained in external beam radiotherapy. The observation of an appreciable low-dose sensitivity has given rise to the realisation that there is strong potential for use of RL dosimetry in diagnostic radiology. Herein use has been made of P-doped silica optical fibre, 2 mm diameter, also including a 271 µm cylindrical doped core. With developing needs for versatile x-ray imaging dosimetry, preliminary investigations have been made covering the range of diagnostic x-ray tube potentials 30 kVp to 120 kVp, demonstrating linearity of RL with kVp as well as in terms of the current-time (mAs) product. RL yields also accord with the inverse-square law. Given typical radiographic-examination exposure durations from tens- to a few hundred milliseconds, particular value is found in the ability to record the influence of x-ray generator performance on the growth and decay of beam intensity, from initiation to termination.

Quantitative imaging characteristics of zirconium-89 on Gemini Time-Of-Flight PET/CT.

PURPOSE: Interest in PET imaging using zirconium-89 (Zr) (t1/2=78.41 h)-labeled tracers for the tracking and quantification of monoclonal antibodies (mAbs) is growing, mainly because of its well-matched physical half-life with the biological half-life of intact mAbs. This study aims to evaluate the imaging characteristics of Zr-PET in comparison with those obtained using fluorine-18 fluorodeoxyglucose (F-FDG) PET (gold standard tracer in PET imaging) using a Time-Of-Flight (TOF) PET/computed tomography (CT) scanner. MATERIALS AND METHODS: The system's spatial resolution, sensitivity, scatter fraction (SF), image uniformity, and image quality were measured on a Gemini TOF PET/CT scanner according to the NEMA NU2-2001 protocols. The NEMA 2001 kit was used to carry out these measurements. Timing and energy resolutions were measured using Na and F-FDG point sources only. RESULTS: Spatial resolution in transverse and axial planes measured at 10 mm off access were 4.7 and 4.6 mm for Zr and F-FDG, respectively. At 100 mm, radial, tangential, and axial spatial resolution values were 5.2, 5.1, and 5.2 mm for Zr and 5.1, 4.9, and 5.2 mm for F-FDG, respectively. Sensitivity measured at the center of the field of view was 14.6 and 4.16 cps/kBq for Zr and F-FDG, respectively. SF was 32.6% for Zr in comparison with 31.8% for F-FDG. Image contrast for Zr-PET images was 36.9 and 29.7% for F-FDG for the smallest (10 mm)-sized sphere, and it was 70.6 and 72.8% for Zr and F-FDG, respectively, for the largest (37 mm)-sized sphere. Background variation was 10.3% for Zr and 6.8% for F-FDG for the smallest-sized sphere and 3.4 and 3.8% for Zr and F-FDG, respectively, for the largest-sized sphere. CONCLUSION: In this study, we measured imaging characteristics of Zr on a Gemini TOF PET/CT scanner. Our results show that Zr has lower spatial resolution and noise-equivalent count rate with increased SF and background variation; however, it offered superior sensitivity and improved image contrast in comparison with F-FDG. Zr is an ideal radiotracer for immuno-PET imaging because of its physical half-life, which is well matched with mAbs, in addition to its affinity to be trapped inside the target cell after internalization of the mAbs.

"To-and-fro" waveform in the diagnosis of arterial pseudoaneurysms.

Medical ultrasound imaging with Doppler plays an essential role in the diagnosis of vascular disease. This study intended to review the clinical use of "to-and-fro" waveform at duplex Doppler ultrasonography (DDU) in the diagnosis of pseudoaneurysms in the arterial vessels of upper and lower extremities, abdominal aorta, carotid and vertebral arteries as well as to review our personal experiences of "to-and-fro" waveform at DDU also. After receiving institutional review board approval, an inclusive literature review was carried out in order to review the scientific foundation of "to-and-fro" waveform at DDU and its clinical use in the diagnosis of pseudoaneurysms in various arterial vessels. Articles published in the English language between 2000 and 2013 were evaluated in this review study. Pseudoaneurysms in arterial vessels of the upper and lower extremities, abdominal aorta, carotid and vertebral arteries characterized by an extraluminal pattern of blood flow, which shows variable echogenicity, interval complexity, and "to-and-fro" flow pattern on color Doppler ultrasonography. In these arterial vessels, Duplex ultrasonography can demonstrate the degree of clotting, pseudoaneurysm communication, the blood flow patterns and velocities. Spectral Doppler applied to pseudoaneurysms lumen revealed systolic and diastolic turbulent blood flow with traditional "to-and-fro" waveform in the communicating channel. Accurate diagnosis of pseudoaneurysm by spectral Doppler is based on the documentation of the "to-and-fro" waveform. The size of pseudoaneurysm determines the appropriate treatment approach as surgical or conservative.

High-Intensity Focused Ultrasound (HIFU) in Localized Prostate Cancer Treatment.

BACKGROUND: High-intensity focused ultrasound (HIFU) applies high-intensity focused ultrasound energy to locally heat and destroy diseased or damaged tissue through ablation. This study intended to review HIFU to explain the fundamentals of HIFU, evaluate the evidence concerning the role of HIFU in the treatment of prostate cancer (PC), review the technologies used to perform HIFU and the published clinical literature regarding the procedure as a primary treatment for PC. MATERIAL/METHODS: Studies addressing HIFU in localized PC were identified in a search of internet scientific databases. The analysis of outcomes was limited to journal articles written in English and published between 2000 and 2013. RESULTS: HIFU is a non-invasive approach that uses a precisely delivered ultrasound energy to achieve tumor cell necrosis without radiation or surgical excision. In current urological oncology, HIFU is used clinically in the treatment of PC. Clinical research on HIFU therapy for localized PC began in the 1990s, and the majority of PC patients were treated with the Ablatherm device. CONCLUSIONS: HIFU treatment for localized PC can be considered as an alternative minimally invasive therapeutic modality for patients who are not candidates for radical prostatectomy. Patients with lower pre-HIFU PSA level and favourable pathologic Gleason score seem to present better oncologic outcomes. Future advances in technology and safety will undoubtedly expand the HIFU role in this indication as more of patient series are published, with a longer follow-up period.

High-Intensity Focused Ultrasound (HIFU) in Uterine Fibroid Treatment: Review Study.

BACKGROUND: High-intensity focused ultrasound (HIFU) is a highly precise medical procedure used locally to heat and destroy diseased tissue through ablation. This study intended to review HIFU in uterine fibroid therapy, to evaluate the role of HIFU in the therapy of leiomyomas as well as to review the actual clinical activities in this field including efficacy and safety measures beside the published clinical literature. MATERIAL/METHODS: An inclusive literature review was carried out in order to review the scientific foundation, and how it resulted in the development of extracorporeal distinct devices. Studies addressing HIFU in leiomyomas were identified from a search of the Internet scientific databases. The analysis of literature was limited to journal articles written in English and published between 2000 and 2013. RESULTS: In current gynecologic oncology, HIFU is used clinically in the treatment of leiomyomas. Clinical research on HIFU therapy for leiomyomas began in the 1990s, and the majority of patients with leiomyomas were treated predominantly with HIFUNIT 9000 and prototype single focus ultrasound devices. HIFU is a non-invasive and highly effective standard treatment with a large indication range for all sizes of leiomyomas, associated with high efficacy, low operative morbidity and no systemic side effects. CONCLUSIONS: Uterine fibroid treatment using HIFU was effective and safe in treating symptomatic uterine fibroids. Few studies are available in the literature regarding uterine artery embolization (UAE). HIFU provides an excellent option to treat uterine fibroids.

Evaluation of common carotid artery changes in Saudi current smokers using medical ultrasound (B-mode and Doppler).

PURPOSE: This study evaluates using ultrasound the changes that occur in wall thickness, blood flow velocity, and Doppler indices of the common carotid arteries (CCAs) in healthy Saudi adult males who are current smokers. METHODS: A prospective study was performed between May 2011 and May 2013 with a group consisting of nonsmokers (n = 180; 36 %) and current smokers (n = 320; 64 %) with a mean age of 25 ± 2.6 years. In all cases, the CCA ultrasound scanning protocol met the standards established by the American Institute of Ultrasound in Medicine (AIUM) to measure intima media thickness (IMT), peak systolic velocity (PSV), and end diastolic velocity (EDV). The Statistical Package for the Social Sciences (SPSS) was used to analyze the results. RESULTS: Significant linear and positive correlations were noted between the level of daily consumption of cigarettes smoked and carotid mean IMT, PSV, and Doppler indices, while a linear and negative correlation was present between cigarette smoking and mean EDV. These findings were significant when compared with the results for nonsmokers. CONCLUSIONS: Cigarette smoking is associated with CCA morphological changes caused by significant impairment of arterial endothelial function, and an increase in daily cigarette consumption significantly leads to a decrease in the blood flow velocity of CCAs.

Preliminary Monte Carlo study of (18)F-FDG SPECT imaging with LaBr(3):Ce Crystal-based Gamma Cameras.

The utility of (18)F-deoxyglucose ((18)F-FDG) in oncology, cardiology, and neurology has generated great interest in a more economical ways of imaging (18)F-FDG than conventional PET scanners. The main thrust of this work is to investigate the potential use of LaBr(3):Ce materials in a low-cost FDG-SPECT system compared to NaI(Tl) using GATE Monte Carlo simulation. System performance at 140 keV and 511 keV was assessed using energy spectra, system sensitivity and count rate performance. Comparison of the LaBr(3):Ce and NaI(Tl) crystal-based systems showed 4.5% and 8.9% higher system sensitivity for the LaBr(3):Ce at 140 keV and 511 keV, respectively. The LaBr(3):Ce scintillator significantly improves intrinsic count rate performance due to its fast decay time with respect to NaI(Tl). In conclusion, because LaBr(3):Ce crystal combines excellent intrinsic count rate performance with slightly increased system sensitivity, it has the potential to be used for (18)F-FDG -SPECT systems.