[Image-guided radiotherapy: Overview of devices and practice in France in 2015]. / État des lieux des dispositifs et des pratiques de radiothérapie guidée par l'image en France en 2015.

Image-guided radiation therapy consists in acquiring in-room images to improve patient and mainly tumour set up accuracy. Many devices based on ionising or non-ionising radiations were designed in recent years. The use of such devices is of major importance in the management of patient radiotherapy courses. Those imaging sessions require to clearly define procedures in each radiotherapy department (image modality, acquisition frequency, corrective action, staff training and tasks). A quick review of the different existing image-guided radiation therapy devices is presented. In addition, the results of a French national survey about image-guided radiation therapy are presented: the survey is about both equipment and procedures. A total of 57 radiotherapy departments have participated, representing more than 160 treatment devices. About three linear accelerators out of four are equipped with an image-guiding device. The most common equipment is the CBCT system. Most centres have set up training sessions for the technicians to allow them to analyse online daily images. The management of in-room imaging dose is still under investigation, but many centres use an accounting scheme. While the devices are used to adjust the positioning of patients, in more than half of the centres, the practice had an impact on the choice of clinical and planning target volume margins. This survey led to an inventory in 2015, and could be renewed in some years.

Dosimetric comparison of free-breathing and deep inspiration breath-hold radiotherapy for lung cancer.

PURPOSE: The goal of this work was to evaluate the potential benefit of deep inspiration breath-hold (DIBH) compared to free breathing (FB) radiotherapy in a homogeneous population of patients with lung cancer. METHODS AND MATERIALS: A total of 25 patients with non-small cell lung cancer treated by DIBH underwent an additional FB CT scan. The DIBH and FB treatment plans were compared. Target volume was compared using coverage, homogeneity, and conformal indices. Organs at risk were compared using V(5), V(13), V(20), V(25), V(37), mean dose (D(mean)) for lungs, V(40) and D(mean) for the heart, V(50), D(mean) and maximum dose (D(max)) for the esophagus, and using biological indices, i.e., the equivalent uniform dose (EUD) and the normal tissue complication probability (NTCP). RESULTS: Median age was 62 years. Prescribed total dose was 66 Gy. Conformity index was improved with DIBH (0.67 vs. 0.58, p = 0.046) but coverage and homogeneity indices were not significantly different. Lung dosimetric parameters were improved using DIBH: D(mean) (13 vs. 15 Gy, p = 10(-4)), V(5) (43 vs. 51%, p = 6.10(-5)), V(13) (31 vs. 38%, p = 2.10(-3)), V(20) (25 vs. 31%, p = 0.01), V(25) (22% vs. 27%, p = 0.01) and V(37) (12 vs. 16%, p = 0.03), EUD (8.2 vs. 9.9 Gy, p = 3.10(-4)), and NTCP (1.9 vs. 4.8%, p = 10(-3)). For the heart, D(mean) (14 vs. 17 Gy, p = 0.003), V(40) (12 vs. 17%, p = 0.004), and EUD (19 vs. 22 Gy, p = 6.10(-4)) were reduced with DIBH, whereas V(30) and NTCP were similar. DIBH improved the D(mean) (28 vs. 30 Gy, p = 0.007) and V(50) (25 vs. 30%, p = 0.003) for the esophagus, while EUD, NTCP, and D(max) were not altered. CONCLUSION: DIBH improves the target conformity index and heart and lung dosimetry in lung cancer patients treated with radiotherapy. The clinical implications of these findings should be confirmed.

[Percutaneous compression plate for pertrochanteric fixation of hip fractures: surgical technique and first results]. / Ostéosynthèse des fractures du massif trochantérien par plaque de compression percutanée: Technique chirurgicale et premiers résultats.

We have used a minimally invasive technique for fixation of trochanteric fractures since 2003. We use the percuntaneous compression plate described by Gotfried. We describe here the osteosynthsis technique and our special approach which limits operative time. This technique avoids wide opening of the aponeurosis of the tensor fascia lata, major detachment, and section of the vastus lateralis. The plate is inserted via a 2-cm incision over the greater trochanter. Head and shaft screws are inserted via a second incision measuring 3 to 4 cm. Perfect reduction before plate insertion is the key to success. The results of our first twenty cases have demonstrated an uneventful postoperative period and a short operative time of 25 minutes on average. Peri-operative bleeding has been very limited. Radiographic healing was obtained in three months. Weight bearing was possible immediately after fixation in five cases and was delayed in fifteen. There were two early displacements which were analyzed.

[Severe angular deformity of the humerus: unilateral external fixation for correction and bone lengthening]. / Allongement et correction d'une déformation angulaire sévère de l'humérus par fixateur externe mono-latéral.

We report the case of a 10-year-old child who presented a severely deformed upper limb due to post-traumatic partial proximal epiphysiodesis of the humerus. The goal of treatment was to correct the severe angular deformity, prevent recurrence, and lengthen the humerus 6 cm. We used the De Bastiani callotasis method with osteotomy of the humeral shaft and unilateral external fixation (Orthofix LRS). The bony deformations were corrected progressively. Angular correction induced a geometric lengthening sufficient to match the length of the healthy limb. Lengthening index was 22.7 days/cm. The functional and esthetic results were remarkable. Complementary epiphysiodesis of the proximal physis successfully prevented recurrent deformation.

[An original procedure for cement diaphyseal extraction. The segmental cement extraction system or SEG-CES]. / Un procédé original d'extraction des gaines cimentées diaphysaires. Le segmental ciment extraction system ou SEG-CES.

PURPOSE OF THE STUDY: We report our first eleven uses of a new cement mantle extraction system. The basis of this technique relies on a cement bone interface with a lower strength compared to the old cement-new cement interface. MATERIAL AND METHODS: The first stage of the procedure consists in a specific preparation of the inner surface of the old cement, mantle. It should be clean and dry after being abraded with a stainless steel wire brush. Then a thin cement syringe filled with low Viscosity PMMA cement, is injected in the old mantle in a retrograde fashion. A threaded rod with nuts is centered within the cement sheath to the bottom and held until the injected cement has fully polymerised. Then the threaded rod is unscrewed from the femur; nuts are established along the entire length of the cement column. To prevent trochanteric fracture occurring upon cement extraction, its is important to clear away sufficient bone from the lateral aspect of the canal. A series of extraction rods are then used to sequentially remove the cement mantle. The removal rod is screwed back into the threaded channel at a distance of every one to three nuts, and then attached to the slap hammer via a quick release connection. Cement extraction is performed using deliberate slaps of the slap hammer. The last segment is drilled with the use of a distal plug drill centering sleeve. After having inserted the plug removal rod, the last segment is extracted. We used this technique eleven times in 8 hips for 5 loosening of femoral component and 3 revisions hip arthroplasties without loosening and 2 revisions knee arthroplasties without loosening (an extraction system for the femur and the tibia). RESULTS: For the 5 loosening cases extraction was easy. In 2 cases, cement mantle was removed as a single "en bloc" piece. In the 3 other cases, the extraction was segmental only in the distal third of the cement mantle. Without loosening, the extraction was completely segmental. In all cases, cement mantles were successfully removed. There was no fracture and no loss of bone stock. There was only one "fissuration" alpha the great trochanter and we only made one distal window. All hip arthroplasties were replaced and arthrodesis were performed after removal of the knee arthroplasties. DISCUSSION: The cement-assisted mantle removal technique appears to be a simple, quick and effective methods for cement mantle removal. Perforation and diaphyseal window can be avoided by the technique even when loosening does not exist. However, it is necessary to establish a thorough preoperating plan in order to eliminate contraindications such as too narrow or too curved sheath. CONCLUSION: It appears that this new procedure will facilitate future reoperations which are reputed to be difficult and dangerous.

[An unusual variation of luxation of the wrist: external vertical luxation. Apropos of a case. Review of the literature]. / Une variété rare de luxation du carpe: la luxation verticale externe. A propos d'un cas. Revue de la littérature.

A case of lateral dislocation of the carpal scaphoid associated with a fracture of the triquetral and carpo-metacarpal dislocation of the ring and little finger is described. A thorough search of the literature failed to reveal any previous report of this combination of injuries. The dislocation was reduced by manipulation, but the scapholunate ligament required surgical repair. The results after two year was good.

[Thalamic fractures of the calcaneus. Value of computed x-ray tomography in therapeutic decisions]. / Les fractures thalamiques du calcanéum. Intérêt de la tomodensitométrie dans la décision thérapeutique.

The authors have studied 35 fractures of the calcaneal thalamus and compared the information provided by plain radiology and CT scans of the calcaneal tuberosity, especially those connected with the condition of the posterior subtalar joint. In 8 cases out of 35, the study of the CT sections yielded information that allowed changing the indications for treatment. The authors emphasize the quality of the data obtained, which makes it possible to justify a functional treatment or to establish a preoperative schedule.