Late and sudden thrombosis after PTCA followed by intracoronary radiotherapy is a new phenomenon in interventional cardiology.

A different pattern of remodeling is observed in coronary segments treated with beta-radiation after successful balloon angioplasty. In the irradiated segments, the adaptive increase of EEM volume appears to be the major contributor to the luminal volume at follow-up. Conversely, both edges showed an increase in plaque volume without a net change in EEM volume.

Longitudinal relaxation times (T1) can be measured rapidly in an imaging context using a "one-shot" method based on the pulse sequence originally proposed by D. C. Look and D. R. Locker (Rev. Sci. Instrum. 41, 250 1970). This sequence is significantly faster than either repeated inversion recovery or repeated saturation recovery methods. The method uses a 180 degrees inversion pulse followed by multiple small-angle alpha pulses that sample the longitudinal magnetization during its recovery. Choices of inversion pulse, tip angle, and time intervals are discussed for optimal clinical use. We can produce 29 images sampling the full T1 recovery curve with a 256 x 256 resolution in about 10 min. From this data, T1 images can be calculated with a precision of 10%.

Receiver operator characteristic (ROC) analysis, the preferred method of evaluating diagnostic imaging tests, requires an independent assessment of the true state of disease, which can be difficult to obtain and is often of questionable accuracy. A new method of analysis is described which does not require independent truth data and which can be used when several accurate tests are being compared. This method uses correlative information to estimate the underlying model of multivariate normal distributions of disease-positive and disease-negative patients. The method is shown to give results equivalent to conventional ROC analysis in a comparison of computed tomography, radionuclide scintigraphy, and magnetic resonance imaging for liver metastasis. When independent truth is available, the method can be extended to incorporate truth data or to evaluate the consistency of the truth data with the imaging data.

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Background-Recent reports demonstrate that intracoronary radiation affects not only neointimal formation but also vascular remodeling. Radioactive stents and catheter-based techniques deliver radiation in different ways, suggesting that different patterns of remodeling after each technique may be expected. Methods and Results-We analyzed remodeling in 18 patients after conventional stent implantation, 16 patients after low-activity radioactive stent implantation, 16 patients after higher activity radioactive stent implantation, and, finally, 17 patients who underwent catheter-based radiation followed by conventional stent implantation. Intravascular ultrasound with 3D reconstruction was used after stent implantation and at the 6-month follow-up to assess remodeling within the stent margins and at its edges. Preprocedural characteristics were similar between groups. In-stent neointimal hyperplasia (NIH) was inhibited by high-activity radioactive stent implantation (NIH 9.0 mm 3 ) and by catheter-based radiation followed by conventional stent implantation (NIH 6.9 mm 3 ) compared with low-activity radioactive stent implantation (NIH 21.2 mm 3 ) and conventional stent implantation (NIH 20.8 mm 3 ) (Pϭ0.008). No difference in plaque or total vessel volume was seen behind the stent in the conventional, low-activity, or high-activity stent implantation groups. However, significant increases in plaque behind the stent (15%) and in total vessel volume (8%) were seen in the group that underwent catheter-based radiation followed by conventional stent implantation. All 4 groups demonstrated significant late lumen loss at the stent edges; however, edge restenosis was seen only in the group subjected to high-activity stent implantation and appeared to be due to an increase in plaque and, to a lesser degree, to negative remodeling. Conclusions-Distinct differences in the patterns of remodeling exist between conventional, radioactive, and catheterbased radiotherapy with stenting.

Neointimal proliferation is delayed rather than prevented by radioactive stent implantation. Clinical outcome 1 year after the implantation of stents with an initial activity of 6 to 12 microCi is not favorable when compared with conventional stenting.

The performance of a convolution/superposition based treatment planning system depends on the ability of the dose calculation algorithm to accurately account for physical interactions taking place in the tissue, key components of the linac head and on the accuracy of the photon beam model. Generally the user has little or no control over the performance of the dose calculation algorithm but is responsible for the accuracy of the beam model within the constraints imposed by the system. This study explores the dosimetric impact of limitations in photon beam modeling accuracy on complex 3D clinical treatment plans. A total of 70 photon beam models was created in the Pinnacle treatment planning system. Two of the models served as references for 6 MV and 15 MV beams, while the rest were created by perturbing the reference models in order to produce specific deviations in specific regions of the calculated dose profiles (central axis and transverse). The beam models were then used to generate 3D plans on seven CT data sets each for four different treatment sites (breast and conformal prostate, lung and brain). The equivalent uniform doses (EUD) of the targets and the principal organs at risk (OARs) of all plans ( approximately 1000) were calculated and compared to the EUDs delivered by the reference beam models. In general, accurate dosimetry of the target is most greatly compromised by poor modeling of the central axis depth dose and the horns, while the EUDs of the OARs exhibited the greatest sensitivity to beam width accuracy. Based on the results of this analysis we suggest a set of tolerances to be met during commissioning of the beam models in a treatment planning system that are consistent in terms of clinical outcomes as predicted by the EUD.