Contrast enhanced oesophageal avoidance for stereotactic body radiotherapy: Barium vs. Gastrografin (original) (raw)
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Oesophageal IGRT considerations for SBRT of LA-NSCLC: barium-enhanced CBCT and interfraction motion
Radiation Oncology
Background To determine the optimal volume of barium for oesophageal localisation on cone-beam CT (CBCT) for locally-advanced non-small cell lung cancers (NSCLC) and quantify the interfraction oesophageal movement relative to tumour. Methods Twenty NSCLC patients with mediastinal and/or hilar disease receiving radical radiotherapy were recruited. The first five patients received 25 ml of barium prior to their planning CT and alternate CBCTs during treatment. Subsequent five patient cohorts, received 15 ml, 10 ml and 5 ml. Six observers contoured the oesophagus on each of the 107 datasets and consensus contours were created. Overall 642 observer contours were generated and interobserver contouring reproducibility was assessed. The kappa statistic, dice coefficient and Hausdorff Distance (HD) were used to compare barium-enhanced CBCTs and non-enhanced CBCTs. Oesophageal displacement was assessed using the HD between consensus contours of barium-enhanced CBCTs and planning CTs. Results...
Journal of Cancer Research and Therapeutics, 2014
Background: The impact of intravenous (IV) contrast media (CM) on radiation dose calculations must be taken into account in treatment planning. Purpose: The aim of this study is to evaluate the effect of an intravenous contrast media on dose calculations in three-dimensional conformal radiation therapy (3D-CRT) for lower esophageal and rectal cancers. Materials and Methods: Seventeen patients with lower esophageal tumors and 12 patients with rectal cancers were analyzed. At the outset, all patients were planned for 3D-CRT based on the computed tomography (CT) scans with IV contrast media. Subsequently, all the plans were copied and replaced on the scans without intravenous CM. The radiation doses calculated from the two sets of CTs were compared. Results: The dose differences between the planning image set using intravenous contrast and the image set without contrast showed an average increase in Monitor Units (MUs) in the lower esophageal region that was 1.28 and 0.75% for 6 and 15 MV photon beams, respectively. Conclusion: There was no statistical significant difference in the rectal region between the two sets of scans in the 3D-CRT plans. The results showed that the dose differences between the plans for the CT scans with and without CM were small and clinically tolerable. However, the differences in the lower esophageal region were significant in the statistical analysis.
Academic Radiology, 1996
C oml~uted tomography (CT) scanning has undergone a revolution with the :advent of helical (spiral) scanning. With rapid scanning, CT angiography can now be done . Most routine abdominal CT scans are obtained with high-density oral contrast material . Routine CT anglograms are hindered by artifacts from oral contrast material. Low-density oral contrast agents were developed primarily to improve assessment of bowel wall abnormalities . An experimental oral low-density contrast agent, blRX-3143 (TomoRx; ImaR x Pharmaceutical, Tucson, AZ), has been developed to improve bowel visualization on routine CT scans. Low-density contrast material should not create significant artifacts on CT angiograms. For this reason, we designed an experiment to assess the effects of high-and low-density oral contrast agents on the quality of CT angiograms in a rat model. In addition, bowel visibility and artifacts were measured.
Canadian Journal of Medical Radiation Technology, 2003
Barium sulphate is considered a safe and efficacious contrast medium that is routinely used for radiologic examinations of the gastrointestinal tract. Although the examinations rarely result in complications, the technique is moderately invasive and not entirely innocuous. Complications resulting from the procedures, and adverse reactions from the barium itself, have ranged from mild to severe and in rare instances have led to patient death. This paper reviews the clinical application, biological requirements and clinical properties of barium sulphate contrast media used in diagnostic x-ray imaging. It also outlines the risk factors and associated adverse reactions and complications involved with the use of barium sulphate, and presents documented cases where iatrogenic injuries have resulted.
Radiography, 2009
To assess whether palatability of oral contrast in CT has an impact on adherence to oral contrast media drinking protocols; and whether such variation has an impact on bowel opacification. Three different types of contrast media were compared; ionic and nonionic iodinated oral contrast (Gastrografin â , Diatrizoate, Schering AG), Gastromiro â (Iopamidol, Bracco SpA) and the barium based contrast E-Z-Cat â (E-Z-EM). Materials and methods: In the first stage of the study 101 prospective patients were randomly given 1 L of a w2% solution of Gastrografin â or Gastromiro â prior to a body CT scan. Data was recorded concerning the palatability of the oral contrast, drinking protocol compliance and bowel opacification. The second stage involved 66 prospective patients given Gastromiro â or E-Z-Cat â (again 1 L of w2% solution). Results: Gastromiro â had better palatability than Gastrografin â (p Z 0.001) and improved protocol compliance. E-Z-Cat had similar palatability to Gastromiro â. Patients who found the oral contrast more palatable had improved drinking protocol compliance (p Z 0.007) and improved small bowel opacification (p Z 0.03). E-Z-Cat â had similar palatability and protocol compliance to Gastromiro â but better overall small bowel opacification (p Z 0.001). Conclusion: In conclusion we suggest that the palatability of oral contrast is not only important to the patients overall experience of body CT, but that it is also linked to adherence with oral contrast drinking protocols leading to better bowel opacification.
European Radiology Experimental, 2022
A negative oral contrast agent (OCA) has been long sought for, to better delineate the bowel and visualise surrounding structures. Lumentin® 44 (L44) is a new OCA formulated to fill the entire small bowel. The aim of this study was to compare L44 with positive and neutral conventional OCA in abdominal computed tomography (CT). Forty-five oncologic patients were randomised to receive either L44 or one of the two comparators (MoviPrep® or diluted Omnipaque®). Abdominal CT examinations with intravenous contrast agent were acquired according to standard protocols. The studies were read independently by two senior radiologists. The mean intraluminal Hounsfield units (HU)-values of regions-of-interest (ROIs) for each subsegment of small bowel and treatment group were -404.0 HU for L44, 166.1 HU for Omnipaque®, and 16.7 HU for MoviPrep® (L44 versus Omnipaque, p < 0.001: L44 versus MoviPrep p < 0.001; Omnipaque versus MoviPrep, p = 0.003). Adverse events, only mild, using L44 were num...
Aspiration of Barium Contrast by a Geriatric Patient with Gastroparesis
Medical Journal of Zambia
Complications due to aspiration of barium contrast occur rarely during studies of the digestive tract. While lung tissue can tolerate small amounts of Barium large quantities can exceed the lung’s capacity and consequently lead to death especially, in geriatric patients. Barium contrast can affect pulmonary ventilation and perfusion function, causing dyspnoea, hypoxemia and respiratory failure. We herein report a barium swallow case in which an 82-year-old woman aspirated barium on the first swallow and was diagnosed with Gastroparesis. The history, procedure and patient management are discussed. The purpose of the case report is to add to the existing literature on aspiration cases during barium swallow studies and the outcomes after the aspiration. Furthermore, this case report also highlights a need for extra care when attending to senior patients with dysphagia during barium studies.
The efficacy of new oral contrast mixture for computed tomography enterography
Polish Journal of Radiology, 2019
Purpose: To show the reliabilities of the new mixture (composed of water, methylcellulose, lactulose, locust bean gum, and sorbitol) and to compare the luminal distension and radiological confidence scores of this solution with water-lactulose mixture. Material and methods: Computed tomography enterography (CTE) images in a three-year period were included randomly in our institutional review board-approved and retrospective study. Ninety-one patients drank a lactulose and water mixture (Group 1), and 54 patients drank the new mixture (Group 2). Patients who drank the oral contrast agent were taken to a 64-detector row multiple detector computed tomography machine. Coronal and sagittal reformatted images were also formed. The gastrointestinal tract was divided into 11 segments for scoring. Each segment was graded for distensional and radiological confidence. CTE images were evaluated by two radiologists. Results: Inter-and intra-reader reliabilities were good or excellent for all gastrointestinal segments in both groups (p < 0.001). The best κ values were obtained in sigmoid colon assessments. Lower agreement values were detected in duodenum and jejunum scores. The new mixture group (Group 2) showed better results than Group 1 for ileum and colonic segments according to distension and confidence scorings. Conclusions: Inter-and intra-reader reliabilities of the new mixture were good or excellent for CTE. The new mixture seems to be more efficient and reliable for ileum and colon. The new mixture can increase bowel distention, radiological confidence, and quality in CTE evaluations.
American Journal of Roentgenology, 1991
Preliminary data suggest that barium sulfate suspension is a potentially useful negative gastrointestinal contrast agent for MR imaging. To evaluate this hypothesis in a controlled fashion, abdominal and pelvic MR studies of 10 normal volunteers were performed before and after both oral (600-900 ml) and rectal (400 ml) administration of barium. Standard spin-echo coronal Ti-, axial Ti-, proton density-, and T2-weighted images were obtained at i.5 T. Images obtained were randomized and interpreted by three observers, who evaluated bowel visualization and delineation of normal anatomy. Bowel segments evaluated were stomach, duodenum, proximal small bowel, proximal colon, distal colon, and rectum. Anatomic structures examined were pancreatic head, pancreatic body, pancreatic tail, retroperitoneum, spleen, liver, pelvic side walls, uterus, vagina, bladder, prostate, and seminal vesicles. Data concerning barium tolerance and safety were recorded. Descriptive, percent change, and kappa statistics were analyzed. Pairwise agreement techniques and repeated measures analysis of variance were performed. This statistical assessment showed a significant improvement in both bowel visualization (59-i23% improvement, depending on the segment) and delineation of normal anatomy (23-68% improvement, depending on the structure) after barium administration, particularly on Ti-weighted images. In addition, barium was a well-tolerated and safe contrast agent that did not produce artifacts. Our results show that barium sulfate is a useful negative gastrointestinal contrast agent for MR because it improves bowel visualization and delineation of abdominal anatomy, particularly on Ti-weighted sequences.
Magnetic Resonance Imaging, 1997
The purpose of this study was to compare the patient tolerance and efficacy, as magnetic resonance imaging negative oral contrast agents, of a mixture of clay compound bentonite and low density barium sulfate suspension with that of higher density barium sulfate. Twenty patients were randomized into two groups: 10 patients receiving a mixture of low concentration 60% w/v barium sulfate plus 2.5% w/v bentonite, and 10 patients receiving 220% w/v barium sulfate Liuqid-HD (E-Z-EM, Westbury, NY). Post-contrast Spin-echo (SE) Tl-and T2-weighted images (WI) were obtained on a l.OT magnet. Two independent readers scored the overall intraluminal signal intensity and delineation of the gastrointestinal tract and adjacent organs. Patient acceptance was evaluated via a short questionnaire, by recording spontaneous comments and documenting the quantity of contrast agent ingested. There was greater intraluminal bowel signal reduction and organ delineation with 220% w/v barium than with the barium-bentonite mixture on both SE TlWI (p = 0.03) and SE T2WI (JJ = 0.42). With both agents there was greater signal reduction on SE T2WI than SE TlWI. Higher scores for organ delineation for both contrast agents were seen with SE TlWI. With 220% w/v barium, there was significantly better delineation of the pancreatic body @ = 0.02) and pancreatic tail (p = 0.02) on TlWI compared with SE T2WI. With the barium-bentonite mix-, SE TlWI showed improved delineation of jejunum compared with SE T2WI (JJ = 0.03). There were no statistically significant differences between the volume of contrast ingested in the two groups. Abdominal cramps were recorded for one patient in each group. These results suggest that bariumbentonite mixture, although useful as a negative gastro-intestinal contrast agent, is not as effective as 220% w/v barium. Further studies with a larger patient population and concentration optimization studies are needed. 0 1997 Elsevier Science Inc.