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Background: Particle mini-beam therapy exhibits promise in sparing healthy tissue through spatial fractionation, particularly notable for heavy ions, further enhancing the already favorable differential biological effectiveness at both target and entrance regions. However, breathing-induced organ motion affects particle mini-beam irradiation schemes since the organ displacements exceed the mini-beam structure dimensions, decreasing the advantages of spatial fractionation., Purpose: In this study, the impact of breathing-induced organ motion on the dose distribution was examined at the target and organs at risk(OARs) during carbon ion mini-beam irradiation for pancreatic cancer., Methods: As a first step, the carbon ion mini-beam pattern was characterized with Monte Carlo simulations. To analyze the impact of breathing-induced organ motion on the dose distribution of a virtual pancreas tumor as target and related OARs, the anthropomorphic Pancreas Phantom for Ion beam Therapy (PPIeT) was irradiated with carbon ions. A mini-beam collimator was used to deliver a spatially fractionated dose distribution. During irradiation, varying breathing motion amplitudes were induced, ranging from 5 to 15 mm. Post-irradiation, the 2D dose pattern was analyzed, focusing on the full width at half maximum (FWHM), center-to-center distance (ctc), and the peak-to-valley dose ratio (PVDR)., Results: The mini-beam pattern was visible within OARs, while in the virtual pancreas tumor a more homogeneous dose distribution was achieved. Applied motion affected the mini-beam pattern within the kidney, one of the OARs, reducing the PVDR from 3.78  ± $\pm$  0.12 to 1.478  ± $\pm$  0.070 for the 15 mm motion amplitude. In the immobile OARs including the spine and the skin at the back, the PVDR did not change within 3.4% comparing reference and motion conditions., Conclusions: This study provides an initial understanding of how breathing-induced organ motion affects spatial fractionation during carbon ion irradiation, using an anthropomorphic phantom. A decrease in the PVDR was observed in the right kidney when breathing-induced motion was applied, potentially increasing the risk of damage to OARs. Therefore, further studies are needed to explore the clinical viability of mini-beam radiotherapy with carbon ions when irradiating abdominal regions., (© 2024 The Authors. Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Objective. To study the secondary neutrons generated by primary oxygen beams for cancer treatment and compare the results to those from primary protons, helium, and carbon ions. This information can provide useful insight into the positioning of neutron detectors in phantom for future experimental dose assessments. Approach. Mono-energetic oxygen beams and spread-out Bragg peaks were simulated using the Monte Carlo particle transport codes FLUktuierende KAskade , tool for particle simulation, and Monte Carlo N-Particle, with energies within the therapeutic range. The energy and angular distribution of the secondary neutrons were quantified. Main results. The secondary neutron spectra generated by primary oxygen beams present the same qualitative trend as for other primary ions. The energy distributions resemble continuous spectra with one peak in the thermal/epithermal region, and one other peak in the fast/relativistic region, with the most probable energy ranging from 94 up to 277 MeV and maximum energies exceeding 500 MeV. The angular distribution of the secondary neutrons is mainly downstream-directed for the fast/relativistic energies, whereas the thermal/epithermal neutrons present a more isotropic propagation. When comparing the four different primary ions, there is a significant increase in the most probable energy as well as the number of secondary neutrons per primary particle when increasing the mass of the primaries. Significance. Most previous studies have only presented results of secondary neutrons generated by primary proton beams. In this work, secondary neutrons generated by primary oxygen beams are presented, and the obtained energy and angular spectra are added as supplementary material. Furthermore, a comparison of the secondary neutron generation by the different primary ions is given, which can be used as the starting point for future studies on treatment plan comparison and secondary neutron dose optimisation. The distal penumbra after the maximum dose deposition appears to be a suitable location for in-phantom dose assessments., (© 2024 Institute of Physics and Engineering in Medicine.)

Objective . Carbon ion radiotherapy is a promising radiation technique for malignancies like pancreatic cancer. However, organs' motion imposes challenges for achieving homogeneous dose delivery. In this study, an anthropomorphic P ancreas P hantom for I on-b e am T herapy (PPIeT) was developed to simulate breathing and gastrointestinal motion during radiotherapy. Approach . The developed phantom contains a pancreas, two kidneys, a duodenum, a spine and a spinal cord. The shell of the organs was 3D printed and filled with agarose-based mixtures. Hounsfield Units (HU) of PPIeTs' organs were measured by CT. The pancreas motion amplitude in cranial-caudal (CC) direction was evaluated from patients' 4D CT data. Motions within the obtained range were simulated and analyzed in PPIeT using MRI. Additionally, GI motion was mimicked by changing the volume of the duodenum and quantified by MRI. A patient-like treatment plan was calculated for carbon ions, and the phantom was irradiated in a static and moving condition. Dose measurements in the organs were performed using an ionization chamber and dosimetric films. Main results . PPIeT presented tissue equivalent HU and reproducible breathing-induced CC displacements of the pancreas between (3.98 ± 0.36) mm and a maximum of (18.19 ± 0.44) mm. The observed maximum change in distance of (14.28 ± 0.12) mm between pancreas and duodenum was consistent with findings in patients. Carbon ion irradiation revealed homogenous coverage of the virtual tumor at the pancreas in static condition with a 1% deviation from the treatment plan. Instead, the dose delivery during motion with the maximum amplitude yielded an underdosage of 21% at the target and an increased uncertainty by two orders of magnitude. Significance . A dedicated phantom was designed and developed for breathing motion assessment of dose deposition during carbon ion radiotherapy. PPIeT is a unique tool for dose verification in the pancreas and its organs at risk during end-to-end tests., (Creative Commons Attribution license.)

Background: Interest in spatial fractionation radiotherapy has exponentially increased over the last decade as a significant reduction of healthy tissue toxicity was observed by mini-beam irradiation. Published studies, however, mostly use rigid mini-beam collimators dedicated to their exact experimental arrangement such that changing the setup or testing new mini-beam collimator configurations becomes challenging and expensive., Purpose: In this work, a versatile, low-cost mini-beam collimator was designed and manufactured for pre-clinical applications with X-ray beams. The mini-beam collimator enables variability of the full width at half maximum (FWHM), the center-to-center distance (ctc), the peak-to-valley dose ratio (PVDR), and the source-to-collimator distance (SCD)., Methods: The mini-beam collimator is an in-house development, which was constructed of 10 ×  40 mm 2 tungsten or brass plates. These metal plates were combined with 3D-printed plastic plates that can be stacked together in the desired order. A standard X-ray source was used for the dosimetric characterization of four different configurations of the collimator, including a combination of plastic plates of 0.5, 1, or 2 mm width, assembled with 1 or 2 mm thick metal plates. Irradiations were done at three different SCDs for characterizing the performance of the collimator. For the SCDs closer to the radiation source, the plastic plates were 3D-printed with a dedicated angle to compensate for the X-ray beam divergence, making it possible to study ultra-high dose rates of around 40 Gy/s. All dosimetric quantifications were performed using EBT-XD films. Additionally, in vitro studies with H460 cells were carried out., Results: Characteristic mini-beam dose distributions were obtained with the developed collimator using a conventional X-ray source. With the exchangeable 3D-printed plates, FWHM and ctc from 0.52 to 2.11 mm, and from 1.77 to 4.61 mm were achieved, with uncertainties ranging from 0.01% to 8.98%, respectively. The FWHM and ctc obtained with the EBT-XD films are in agreement with the design of each mini-beam collimator configuration. For dose rates in the order of several Gy/min, the highest PVDR of 10.09 ± 1.08 was achieved with a collimator configuration of 0.5 mm thick plastic plates and 2 mm thick metal plates. Exchanging the tungsten plates with the lower-density metal brass reduced the PVDR by approximately 50%. Also, increasing the dose rate to ultra-high dose rates was feasible with the mini-beam collimator, where a PVDR of 24.26 ± 2.10 was achieved. Finally, it was possible to deliver and quantify mini-beam dose distribution patterns in vitro., Conclusions: With the developed collimator, we achieved various mini-beam dose distributions that can be adjusted according to the needs of the user in regards to FWHM, ctc, PVDR and SCD, while accounting for beam divergence. Therefore, the designed mini-beam collimator may enable low-cost and versatile pre-clinical research on mini-beam irradiation., (© 2023 The Authors. Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Objective . The purpose of this study is to estimate the energy and angular distribution of secondary neutrons inside a phantom in hadron therapy, which will support decisions on detector choice and experimental setup design for in-phantom secondary neutron measurements. Approach . Dedicated Monte Carlo simulations were implemented, considering clinically relevant energies of protons, helium and carbon ions. Since scored quantities can vary from different radiation transport models, the codes FLUKA, TOPAS and MCNP were used. The geometry of an active scanning beam delivery system for heavy ion treatment was implemented, and simulations of pristine and spread-out Bragg peaks were carried out. Previous studies, focused on specific ion types or single energies, are qualitatively in agreement with the obtained results. Main results . The secondary neutrons energy distributions present a continuous spectrum with two peaks, one centred on the thermal/epithermal region, and one on the high-energy region, with the most probable energy ranging from 19 up to 240 MeV, depending on the ion type and its initial energy. The simulations show that the secondary neutron energies may exceed 400 MeV and, therefore, suitable neutron detectors for this energy range shall be needed. Additionally, the angular distribution of the low energy neutrons is quite isotropic, whereas the fast/relativistic neutrons are mainly scattered in the down-stream direction. Significance . It would be possible to minimize the influence of the heavy ions when measuring the neutron-generated recoil protons by selecting appropriate measurement positions within the phantom. Although there are discrepancies among the three Monte Carlo codes, the results agree qualitatively and in order of magnitude, being sufficient to support further investigations with the ultimate goal of mapping the secondary neutron doses both in- and out-of-field in hadrontherapy. The obtained secondary neutron spectra are available as supplementary material., (© 2022 Institute of Physics and Engineering in Medicine.)

A chemical actuator was developed taking advantage of the internal microstructure of a plant stem. Stem xylems of Cucurbita moschata were chemically modified with a pH-responsive polymer to obtain an intelligent hydraulic valve. The chemical composition of the device was based mainly on biological scaffolds combined with a minimum content of a tailor-made synthetic copolymer. A pH-sensitive hydrogel composed of a copolymer of acrylic acid was grafted on the inner surface of stem microchannels, assessing the physicochemical properties and the response of the developed actuator under different pressure and pH conditions. Variation of average microcapillary diameter in response to pH stimuli was estimated using Poiseuille's model. This microfluidic device demonstrated the pH-responsive properties and efficient control of flux, showing its open/close transition at pH 3.25 and mechanical stability until pressures of 1.75 meters of water column (mH 2 O). This actuator has adequate response to open/close cycling and relevance to be evaluated as a pH-response valve of aqueous systems. This kind of actuator is a research topic of high interest with potential application to technology demands.

Organoboron compounds have been playing an increasingly important role in analytical chemistry, material science, health applications, and particularly as functional polymers like boron carriers for cancer therapy. There are two main applications of boron isotopes in radiation cancer therapy, Boron Neutron Capture Therapy and Proton Boron Fusion Therapy. In this study, a novel and original material consisting of a three-dimensional polymer network crosslinked with [Formula: see text]B enriched boric acid molecules is proposed and synthesized. The effects of the exposition to thermal neutrons were studied analyzing changes in the mechanical properties of the proposed material. Dedicated Monte Carlo simulations, based on MCNP and FLUKA main codes, were performed to characterize interactions of the proposed material with neutrons, photons, and charged particles typically present in mixed fields in nuclear reactor irradiations. Experimental results and Monte Carlo simulations were in agreement, thus justifying further studies of this promising material.

Purpose: Dosimetry of ionizing radiation quantifies the energy deposited by an incident beam to the medium. This study presents the relative response of two types of gel dosimeters describing their differences by estimating radiation chemical yields produced in water radiolysis., Methods: Two types of gel dosimeter were used, namely an acid ferrous ion solution infused with xylenol orange known as Fricke gel and a polymer gel based on acrylamide and N,N'-methylenebis(acrylamide) known as PAGAT. Samples were irradiated using two photon beam energies, one from a conventional X-ray tube operated at 44 kV and the other one from a LINAC operated at 6 MV. The dosimeters were analyzed by optical absorbance and magnetic resonance imaging. Additionally, the linear energy transfer of each beam was calculated using Monte Carlo simulations for further estimation of the radiation chemical yields produced during water radiolysis., Results: Obtained results for both gel dosimeters indicate that their response at 44 kV and 6 MV are different, regardless of the read-out technique. On average, the sensitivity at 44 kV was found to be 65 % of the response at 6 MV. The calculated radiation chemical yields are in agreement with the observed experimental results., Conclusions: The main reason for the difference in the response of the dosimeters may be related to the linear energy transfer of each photon beam, which varies the production of primary chemical species during water radiolysis., (Copyright © 2021 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

This work presents a mathematical model implementation for studying the diffusion process of ferric ions in post-irradiated Fricke gel dosimeters. Fricke gel samples were manufactured in layers for their analysis by optical transmission imaging and benzoic acid was incorporated to improve their radiosensitivity. The developed method consists on designing the dosimeters with a suitable composition for their optical analysis which allows accurate measurements in a wide dose range with noticeable linear responses with an average linear correlation coefficient of r 2 =0.993. The developed algorithm calculates the diffusion coefficient by means of an inverse problem formulation. Moreover, the proposed method is capable of modeling time-dependent physical properties and evolution over time of the irradiated dosimeters accurately and comparable with experimentally measured data. The obtained results evince the complexity of the diffusion phenomena in this type of materials and the capacity of the proposed method to provide a reliable quantification of the diffusion coefficient as a scalar approximation of the diffusion tensor. The obtained diffusion coefficient varies from 1.21 to 1.61 mm 2 /h with uncertainties lower than 2%. The model is also transferable to other diffusion driven systems and the numerical solving method can also be adapted to solve diffusion calculation based on other theoretical approaches., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Imaging post bariatric surgery is becoming more common over the past decade due to increasing incidence of obesity in the population and subsequent treatment. In recent years, the use of topical haemostatic agents and bioabsorbable prostheses has increased leading to higher likelihood of encountering these agents on post-operative imaging. Imaging in the post-operative period is occasionally performed to assess for complications such as obstruction, leak and abscess formation. Familiarity with these agents is crucial in preventing incorrect diagnosis. Laparoscopic Roux-en-Y gastric bypass (RYGB) is favoured over the open approach as it is safer and more effective, with a mortality rate of 0.5% and morbidity around 7-14 %. The main cause of late post-RYGB complications is the development of internal hernias such as a Petersen's hernia. During the procedure, a space between the alimentary loop of the small bowel and the transverse mesocolon is created and is called the Petersen's defect. Subsequently, a part of the small bowel can herniate through this orifice. As this operation is becoming more common, the incidence of internal herniation has been increasing. This case report describes a new bariatric surgical technique and the associated post-operative radiological appearances on CT. The surgical technique has been pioneered in Sydney, Australia and involves a laparoscopic RYGB using bioabsorbable prosthesis with fibrin glue fixation to prevent a Petersen's space hernia.

Internal herniae are rare, those involving the falciform ligament even rarer. To the best of our knowledge, there have been approximately 20 cases of herniae involving the falciform ligament previously reported. Of these cases, only one previously reported case involves herniation of the greater omentum through the falciform ligament. We present a second case of an adult man who presented with a 48-hour history of epigastric pain and was found on contrast multidetector CT to have a strangulated transfalciform greater omental hernia. The hernia was repaired laparoscopically and the patient recovered uneventfully., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Fricke solution has a wide range of applications as radiation detector and dosimetry. It is particularly appreciated in terms of relevant comparative advantages, like tissue-equivalence when prepared in aqueous media like gel matrix, continuous mapping capability, independence of dose rate and incident direction, as well as linear dose response. This work presents the development and characterization of an improved Fricke gel system, based on modified chemical compositions, making possible its application in clinical radiology due to its improved sensitivity. Properties of standard Fricke gel dosimeter for high-dose levels are used as a starting point, and suitable chemical modifications are introduced and carefully investigated in order to attain high resolution for low-dose ranges, like those corresponding to radiology interventions. The developed Fricke gel radiation dosimeter system achieves the expected typical dose-dependency, showing linear response in the dose range from 20 up to 4000 mGy. Systematic investigations including several chemical compositions are carried out in order to obtain an adequate dosimeter response for low-dose levels. A suitable composition from among those studied is selected as a good candidate for low-dose-level radiation dosimetry consisting of a modified Fricke solution fixed to a gel matrix containing benzoic acid along with sulfuric acid, ferrous sulfate, Xylenol orange, and tridistilled water. Dosimeter samples are prepared in standard vials for in-phantom irradiation and further characterization by spectrophotometry measuring visible light transmission and absorbance before and after irradiation. Samples are irradiated using typical X-ray tubes for radiology and calibrated Farmer-type ionization chamber is used as reference to measure dose rates inside phantoms at vial locations. Once sensitive material composition is optimized, dose-response curves show significant improvement regarding overall sensitivity for low dose levels. The aim of this work consists of implementing the optimized gel dosimeter to perform direct measurements of absorbed dose in samples irradiated during microcomputed tomography scanning in order to preliminary assess dose levels for further scanning of small animals for further applications in veterinary and paleontology. As a first attempt, dose distributions were measured in water-equivalent phantoms having dimensions comparable to small animals, 100 to 1000 cm3, approximately. According to the obtained results, it is found that the proposed method shows satisfactory reliability and adequate performance for a promising gel dosimetry system., (© 2016 The Authors.)

A new polymeric dosimeter based on itaconic acid and N, N'-methylenebisacrylamide was studied. The preparation method, compositions of monomer and crosslinking agent and the presence of oxygen in the dosimetric system were analyzed. The resulting materials were irradiated with an X-ray tube at 158cGy/min, 226cGymin and 298cGy/min with doses up to 1000Gy. The dosimeters presented a linear response in the dose range 75-1000Gy, sensitivities of 0.037 1/Gyat 298cGy/min and an increase in the sensitivity with lower dose rates. One of the most relevant outcomes in this study was obtaining different monomer to crosslinker inclusion in the formed gel for the dosimeters where oxygen was purged during the preparation method. This effect has not been reported in other typical dosimeters and could be attributed to the large differences in the reactivity among these species., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Polymer gel dosimeters have specific advantages for recording 3D radiation dose distribution in diagnostic and therapeutic medical applications. But, even in systems where the 3D structure is usually maintained for long periods of time after irradiation, it is still not possible to eliminate the diffusion of the different species in the regions of dose gradients within the gel. As a consequence, information of the dose loses quality over time. In the pursuit of a solution and to improve the understanding of this phenomenon a novel system based on itaconic acid and N-N'-methylene-bisacrylamide (BIS) is hereby proposed. Effects of changes in the chemical structure of the monomers over the dosimetric sensitivity and over the post-irradiation diffusion of species was studied. In this study, one of the carboxylic groups of the itaconic acid molecule was modified with aniline to obtain molecules with similar reactivity but different molecular sizes. Then, dosimeters based on these modified species and on the original ITA molecules were irradiated in an X-ray tomography apparatus at different doses up to 173Gy. Afterwards, the resulting dosimeters were characterized by Raman spectroscopy and optical absorbance in order to study their feasibility and capabilities as dosimetric systems, and by optical-CT to analyze the post irradiation diffusion., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: To examine the safety and re-intervention rates following magnetic resonance-guided focused ultrasound (MRgFUS) for uterine fibroids at 5 years. To assess how the non-perfused volume (NPV), fibroid signal intensity and use of gonadotrophin-releasing hormone analogues (GnRHa) affect the re-intervention rates., Study Design: Cohort study of women undergoing MRgFUS for treatment of their uterine fibroids between 2003 and 2010., Results: Of 280 women undergoing MRgFUS the rate of minor complications was 3.9% and there were 3 serious complications (1.1%) including one skin burn, a fibroid expulsion and one case of persistent neuropathy. The NPVs achieved following MRgFUS have increased as the experience with this treatment has grown. In a 5-year follow-up study of 162 women, the overall re-intervention rate was 58.64%, but in those treatments with greater than 50% NPV the re-intervention rate was 50%., Conclusion: MRgFUS treatment of uterine fibroids is a safe treatment for uterine fibroids. The re-intervention rate at 5 years is high, but the improvements in NPVs achieved may further improve the long term results., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: A range of measurement techniques have been described which may be used to calculate uterine fibroid volume. A commonly-reported method involves application of a formula for the volume of an ellipsoid sphere to three orthogonal axes of a fibroid as measured on cross-sectional images. We aimed to compare this method and a second method, that of software-computed parallel planimetric uterine fibroid computation on MRI images, to a gold standard: the volume of objects measured by water displacement. We also compared these methods in volume estimation of patient fibroids using MRI data., Study Design: Mixed observational study and blinded cross-sectional analysis of imaging data., Results: Large inter-observer variability was noted when using the ellipsoid formula method, which was also inaccurate when compared to the gold standard. Conversely, the parallel planimetric method showed excellent interobserver correlation and a high degree of correlation with gold standard volume measurements., Conclusion: We conclude that the parallel planimetric method, although a more complex and time consuming technique, is the more accurate and therefore preferred method for measuring uterine fibroid volume., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: This research investigates whether modifications to the magnetic resonance-guided focused ultrasound ablation of uterine fibroid (MRgFUS) system used resulted in improved treatment volumes of uterine fibroids, while maintaining safety., Methods: This study is a prospective cohort analysis of 34 women undergoing the ExAblate 2100 MRgFUS treatment for their uterine fibroids., Results: The percentage of non-perfused volume (NPV) achieved with the ExAblate 2100 system was 54.92% compared with 50.49 % with the ExAblate 2000 system over the preceding year (p = 0.543). The ExAblate 2100 system resulted in a greater NPV in hyper-intense fibroids compared with the ExAblate 200 system (43.20% versus 36.33%, p = 0.005). There have been no recorded hospital admissions, no skins burns, and no reported major adverse events since the introduction of this new system., Conclusion: Overall, the new system has thus far shown an encouraging safety record and an improvement in non-perfused volumes achieved, especially in hyper-intense fibroids.

Background: The extent of vascular invasion is a key factor determining the resectability of non-metastatic pancreatic adenocarcinoma. The purpose of this study is to determine the diagnostic accuracy of computed tomography (CT), endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI) in the pre-operative evaluation of vascular invasion in pancreatic adenocarcinoma, with surgery as the reference standard., Methods: A search of the MEDLINE database for relevant articles in the English language published between January 2000 and February 2009 was performed. From each study, 2 × 2 tables were obtained, and pooled sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and diagnostic odds ratios were calculated for each modality, along with a summary receiver operating characteristics (SROC) curve., Results: 16 studies with a total of 797 patients who had surgical assessment of vascular invasion were included in the analysis. Several studies evaluated more than one imaging modality, allowing 24 datasets to be obtained in total. Sensitivity was highest for CT (0.73, 95% CI 0.67 - 0.79), followed by EUS (0.66, 95% CI 0.56 - 0.75) and MRI (0.63, 95% CI 0.48 - 0.77). The specificity for all three imaging modalities was comparable. The diagnostic odds ratios for CT, EUS and MRI were 45.9 (95% CI 18.0 - 117.4), 23.0 (95%CI 9.4 - 56.6), 23.9 (95% CI 5.4 - 105.1) respectively., Conclusion: CT was more accurate than EUS and MRI in the evaluation of vascular invasion in pancreatic adenocarcinoma and should be the first line investigation in pre-operative staging., Competing Interests: The authors have no conflicts of interest.

A persistent sciatic artery is a rare developmental anomaly which may predispose to a range of vascular complications. We report a 60-year-old woman presenting with right lower limb ischemia. Computed tomography angiography revealed an aneurysmal right-sided sciatic artery occluded by thrombus. An aberrant right subclavian artery and anomalous common carotid origins were also incidentally discovered. It is unknown whether an association exists between a persistent sciatic artery and other congenital arterial abnormalities. This is the first case report, so far as we are aware, describing both such arterial anomalies coexisting in a patient., (Crown Copyright © 2011. Published by Mosby, Inc. All rights reserved.)

Idiopathic pulmonary haemosiderosis (IPH) is a rare condition that usually presents as a triad of haemoptysis, iron deficiency anaemia and pulmonary infiltrates. We report a case of IPH diagnosed in a 7 year old boy who had recurrent hospital admissions with severe chest infections and haemoptysis from his first few months of life. He was found to have microcytic hypochromic anaemia, diffuse infiltrate shadowing on his chest X-ray (CXR) and ground-glass opacification on his computed tomogram (CT). Perl's Prussian blue staining of his bronchoalveolar lavage fluid revealed haemosiderin-laden macrophage infiltration. After exclusion of infective, cardiac, immunological and glomerular causes, he was diagnosed with idiopathic pulmonary haemosiderosis. He has since been treated intermittently with steroids, which have failed to control his symptoms fully.

We present a case of stent-assisted coil embolization of a wide-necked renal artery aneurysm performed at our institution. The technique involved a stent being delivered over the neck of the aneurysm. Subsequently a catheter was placed into the aneurysm through the stent mesh and the aneurysm was then filled with detachable coils. Complete aneurysm occlusion was obtained and there was no evidence to suggest renal infarction on a follow-up contrast CT scan 6 months later. Our preliminary experience suggests that stent-assisted coil embolization of wide-necked renal artery aneurysms is a technically challenging but potentially effective renal-sparing endovascular approach.

The 2007 New South Wales/Queensland Royal Australian and New Zealand College of Obstetricians and Gynaecologists Annual Scientific Meeting convened a panel to discuss multidisciplinary perspectives on the management of placenta accreta, percreta or increta. While it was anticipated that this panel would stimulate discussion, the cohesion between the approaches was underestimated. This document represents an integration of the perspectives of the invited speakers at this presentation, with backgrounds in maternal-fetal medicine, gynaecological oncology, radiology and general obstetrics and gynaecology.