The purpose of the article was to determine the impact of Dual Registration (DR) image-guided radiotherapy (IGRT) on clinical judgement and treatment delivery for patients with oropharyngeal cancer prior to implementation. METHODS Ninety Cone Beam Computed Tomography images from ten retrospective patients were matched using standard clipbox registration (SCR) and DR. Three image guided radiotherapy specialist radiographers performed all registrations and evaluated by; intra-class correlation to determine interrater agreement, Bland-Altman with 95% Limits of Agreement to determine differences between SCR and DR procedures, changes in clinical judgment, time taken to perform registrations and radiographer satisfaction. RESULTS Interrater agreement between radiographers using both SCR and DR was high (0.867 and 0.917 p=<0.0001). The 95% Limits of Agreement between SCR and DR procedures in the medio-lateral, cranial caudal, and ventro-dorsal translational directions were-6.40 to +4.91,-7.49 to +6.05, and-7.00 to +5.44 mm respectively. The medio-lateral direction demonstrated significant proportional bias (p=<0.001) suggesting non-agreement between SCR and DR. 80% of DR matches resulted in a change in clinical judgement to ensure maximum target coverage. Mean registration times for SCR and DR were 94 and 115 seconds respectively and radiographer's found DR feasible and satisfactory. CONCLUSION The standard method using SCR in patients with oropharyngeal cancer underestimates the deviation in the lower neck. In these patients DR is an effective
We present the first case of 45 year-old male with an incidental non-symptomatic right common iliac artery pseudoaneurysm with concomitant aortic ectasia in the setting of severe alcoholic pancreatitis and a horseshoe kidney diagnosed by CT and MRA. Such findings would have posed significant difficulty during an open approach precluding safe surgical repair. Therefore, an exclusion endovascular repair of the pseudoaneurysm was employed using a unibody bifurcated endovascular aortic stent-graft to good results. Although not without their complications, endovascular stent-grafts may be life saving to patients who are not candidates for conventional surgical repair. We describe the diagnosis alongside our technique of endovascular repair.
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