Radiation proctitis denotes the radiation damage of rectum caused by radiotherapy to pelvic malignancy. The clinical practices of radiation proctitis should be fully considered from diagnosis, treatment and prevention. In order to determine appropriate treatment strategies, the diagnosis of radiation proctitis should be based on clinical symptoms, endoscopic findings, imaging and histopathology to assess severity of symptoms and stage of disease. In terms of treatment decisions, non-surgical interventions are generally applied to relieve major symptoms and avoid serious complications. Diverting colostomy and restorative resection are the main surgical treatments for patients with recurrent symptoms. In terms of prevention, radiation proctitis should be prevented by improvement of radiotherapy technology, physical protection and prophylactic medication. This guide aims to provide guidance for the clinical practices of radiation proctitis in China.
China ; Consensus ; Humans ; Proctitis ; diagnosis ; therapy ; Radiation Injuries ; diagnosis ; prevention & control ; therapy ; Rectum ; pathology ; radiation effects

The prognosis and medical handling of individuals exposed to external radiation depend upon whether the whole body has been exposed, or the exposure was localized. It is very important for the prognosis and choice of treatment to know how the absorbed dose has been distributed within the body. The dose distribution depends on the condition of exposure and the circumstances of the accident. Local radiation injury (LRI) is much more frequent than whole body exposure (WBE) and hence described in detail in a variety of literature. LRI caused by high doses of radiation (> or = 8~10 Gy) produces signs and symptoms similar to a thermal burn except for the striking delay in the onset of clinical changes, from several days to a week or longer. The severity of LRI depends not only on the dose and type of radiation, but also on the location and size of the area exposed. In general, the higher the dose received, the more rapid the development of pathological symptoms and the more severe the prognosis. Therefore, diagnosis and prognosis should be based upon various parameters, besides the clinical observation, such as dosimetry, reconstruction of the accident, thermography, scintigraphy, etc.
Burns ; Diagnosis* ; Prognosis ; Radiation Injuries* ; Radionuclide Imaging ; Strikes, Employee ; Thermography

The applications of three dimensional conformal radiotherapy(3-DCRT)in the abdomen has been associated with the increased incidence of radiation-induced liver injury(RILI). Timely and appropriate evaluation of RILI is particularly important for the design and modification of clinical management of tumors. This article reviews the pathological and serological features of RILI, focusing on in the application of medical imaging.
Diagnostic Imaging ; Humans ; Liver ; radiation effects ; Liver Diseases ; Radiation Injuries ; diagnosis ; Radiotherapy, Conformal

Skin has long been known to be a very radiosensitive organ. Furthermore, the damaging effects of radiation exposure induced by fluoroscopic procedures have been recognized for some time. However, accurate diagnosis of fluoroscopy-induced chronic radiation dermatitis (FICRD) can be very challenging, since the provided clinical history regarding radiation exposure may not be accurate and the signs of cutaneous radiation injury may develop months to years after radiation exposure. Recognition of FICRD is important to avoid unnecessary treatment and interventions and also guarantees appropriate surveillance for radiation-induced malignancy. We herein report a case of a 65-year-old woman who was diagnosed with radiation dermatitis after endoscopic retrograde cholangiopancreatoscopy (ERCP).
Aged ; Cholangiopancreatography, Endoscopic Retrograde ; Dermatitis* ; Diagnosis ; Female ; Humans ; Radiation Exposure ; Radiation Injuries ; Skin

OBJECTIVETo evaluate the role of perfusion weighted imaging (PWI) in the differentiation between recurrent glioma and radiation-induced brain injuries.

METHODSTwenty-three patients with previously resected and irradiated glioma, presenting newly developed abnormal enhancement, were included in the study. The final diagnosis was determined either histologically or clinicoradiologically. PWI was obtained with a gradient echo echo-planar-imaging (GRE-EPI)technique. The normalized relative cerebral blood volume (rCBV) ratio [rCBV (abnormal enhancement)/rCBV (contralateral tissue)], relative cerebral blood flow (rCBF) ratio [rCBF (abnormal enhancement)/rCBF(contralateral tissue)], mean transit time(MTT) ratio [MTT (abnormal enhancement)/MTT(contralateral tissue)],time to peak(TTP)ratio[TTP(abnormal enhancement)/TTP(contralateral tissue)],and bolus arrive time(BAT)ratio[BAT(abnormal enhancement)/BAT(contralateral tissue)] were calculated. The regions of interest (ROIs) consisting of 20-40mm(2) were placed in the abnormal enhanced areas on postcontrast T1-weighted images.Ten ROIs measurements were performed in each lesion.T test was used to determine whether there was a difference in the rCBV/rCBF/rMTT/rTTP/rBAT ratios between recurrent glioma and irradiated injuries.Significance was set to a P value <0.05.

RESULTSThirteen of the 23 patients were proved recurrent glioma and 10 were proved radiation-induced brain injuries. The rCBV ratio (3.60±3.86 vs. 0.82 ± 0.74, P = 0.000)and rCBF ratio (2.88 ± 2.27 vs. 0.84 ± 0.80, P = 0.000) in glioma recurrence were markedly higher than those in radiation injuries. The areas under rCBV and rCBF ROC curve were both 0.8763. rMTT (P=0.204), rTTP (P=0.260), and rBAT (P=0.071) ratios showed no statistical difference between the two groups.

CONCLUSIONPWI is an effective technique in distinguishing glioma recurrence from radiation injuries,and the ratios of rCBV and rCBF ratio differential diagnosis of critical value to 1.3088 and 1.1235, respectively, can be used as a reliable clinical indicator.

Adult ; Aged ; Brain Injuries ; diagnosis ; Brain Neoplasms ; diagnosis ; Diagnosis, Differential ; Female ; Glioma ; diagnosis ; Humans ; Magnetic Resonance Angiography ; methods ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; diagnosis ; Radiation Injuries ; diagnosis

The purpose of this pictorial essay is to illustrate the multimodality imaging findings of a wide spectrum of radiation-induced complications of breast cancer in the sequence of occurrence. We have classified radiation-induced complications into three groups based on the time sequence of occurrence. Knowledge of these findings will allow for the early detection of complications as well as the ability to differentiate tumor recurrence.
Breast Neoplasms/*radiotherapy ; *Diagnostic Imaging ; Female ; Humans ; Radiation Injuries/*diagnosis ; Radiotherapy/*adverse effects

It is very difficult to differentiate radiation myelopathy from metastatic intramedullary spinal cord tumor. We described a case of chronic progressive radiation myelopathy, in which serial magnetic resonance imaging was of great value for the differential diagnosis.
Diagnosis, Differential ; Magnetic Resonance Imaging* ; Radiation Injuries ; Spinal Cord Diseases* ; Spinal Cord Neoplasms

Humans ; Laryngeal Cartilages ; pathology ; Laryngeal Neoplasms ; diagnosis ; pathology ; Male ; Middle Aged ; Necrosis ; Neoplasm Recurrence, Local ; diagnosis ; Radiation Injuries ; diagnosis ; pathology

OBJECTIVETo summarize the clinical presentation, pathogenesis, neuroimaging, treatment, and outcome of stroke-like migraine attacks after radiation therapy (SMART) syndrome, and to propose diagnostic criteria for this disorder.

DATA SOURCESWe searched the PubMed database for articles in English published from 1995 to 2015 using the terms of "stroke-like AND migraine AND radiation." Reference lists of the identified articles and reviews were used to retrieve additional articles.

STUDY SELECTIONData and articles related to late-onset effects of cerebral radiation were selected and reviewed.

RESULTSSMART is a rare condition that involves complex migraines with focal neurologic deficits following cranial irradiation for central nervous system malignancies. The recovery, which ranges from hours to days to weeks, can be partial or complete. We propose the following diagnostic criteria for SMART: (1) Remote history of therapeutic external beam cranial irradiation for malignancy; (2) prolonged, reversible clinical manifestations mostly years after irradiation, which may include migraine, seizures, hemiparesis, hemisensory deficits, visuospatial defect, aphasia, confusion and so on; (3) reversible, transient, unilateral cortical gadolinium enhancement correlative abnormal T2 and fluid-attenuated inversion recovery signal of the affected cerebral region; (4) eventual complete or partial recovery, the length of duration of recovery ranging from hours to days to weeks; (5) no evidence of residual or recurrent tumor; (6) not attributable to another disease. To date, no specific treatment has been identified for this syndrome.

CONCLUSIONSSMART is an extremely rare delayed complication of brain irradiation. However, improvements in cancer survival rates have resulted in a rise in its frequency. Hence, awareness and recognition of the syndrome is important to make a rapid diagnosis and avoid aggressive interventions such as brain biopsy and cerebral angiography.

Central Nervous System Neoplasms ; therapy ; Female ; Humans ; Male ; Migraine Disorders ; diagnosis ; etiology ; Radiation Injuries ; complications ; diagnosis ; Stroke ; diagnosis

BACKGROUND/AIMS: The increasing use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) calls for greater consideration of radiation exposure risk to endoscopists and assistants, and emphasizes the proper system of radiation protection. This study was designed to assess the effect of a newly developed, self-designed, protective lead shield. METHODS: A curtain-shaped protective shield composed of seven movable lead plates was developed, each with the following dimensions: depth, 0.1 cm; width, 15 cm; length, 70 cm. The curtain-shaped protective shield was designed to be located between the patient and the endoscopist. Twenty-nine patients (11 men and 18 women) undergoing ERCP between January 2010 and March 2010 were selected for this study. The dose of radiation exposure was recorded with or without the protective lead shield at the level of the head, chest, and pelvis. The measurement was made at 50 cm and 150 cm from the radiation source. RESULTS: The mean patient age was 64 years. The mean patient height and weight was 161.7+/-6.9 cm and 58.9+/-9.9 kg, respectively. The mean body mass index (BMI) was 22.5+/-3.0 kg/m2. Endoscopists received 1522.2+/-537.0 mR/hr without the protective lead shield. At the same distance, radiation exposure was significantly reduced to 68.8+/-88.0 mR/hr with the protective lead shield (p-value<0.0001). The radiation exposure to endoscopists and assistants was significantly reduced by the use of a protective lead shield (p value<0.0001). The amount of radiation exposure during ERCP was related to the patient's BMI (r=0.749, p=0.001). CONCLUSIONS: This self-designed, protective lead shield is effective in protecting endoscopists and assistants from radiation exposure.
Adult ; Aged ; Body Mass Index ; Cholangiopancreatography, Endoscopic Retrograde/*adverse effects ; Common Bile Duct Diseases/diagnosis/therapy ; Female ; Humans ; Male ; Middle Aged ; Radiation Dosage ; Radiation Injuries/*prevention & control ; *Radiation Monitoring/methods ; Radiation Protection/*methods