Kauno klinikų filialas Onkologijos ligoninė (K510000)

Image-guided radiotherapy (IGRT) has enhanced the precision of cancer treatment by integrating imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT) into daily radiotherapy workflows. In head and neck cancer, where anatomical changes are common, accurate image registration between planning and treatment scans is essential to ensure dose accuracy. However, geometric distortions in CBCT (such as translation, rotation, and scaling resulting from patient positioning variations observed in daily CBCT images) can affect tumour targeting and dose delivery. This pilot study assesses a MATLAB-based image correction algorithm that uses rigid bony landmarks and point cloud registration together with spatial transformation to align CBCT with planning CT. Two head and neck cancer patients were retrospectively analysed, selected for their contrasting anatomical responses: one with substantial tumour regression and one with minimal change. Imaging was performed on the Halcyon V3.1 linear accelerator (Varian Medical Systems), with 25 daily CBCT scans per patient (85–96 slices per scan), resulting in 50 datasets for analysis. Spatial deviations were measured along the X, Y, and Z axes, and dose recalculations were performed for each treatment fraction. The correction method significantly improved spatial congruence and reduced geometric discrepancies caused by voxel spacing and acquisition parameters. Uncorrected scans showed dose deviations of up to ± 12% in organs at risk, notably the spinal cord and parotid glands. These findings demonstrate the feasibility and dosimetric relevance of automated CBCT correction in daily head and neck radiotherapy. Although limited in sample size, the study provides a detailed technical and dosimetric analysis of spatial distortions and supports future validation in larger patient cohorts.

Patient positioning, together with physical changes in soft tissues during the course of radiotherapy, significantly affects the irradiation of targeted tissues and adjacent structures. This leads to a high risk of under-dosage of the tumour and/or over-dosage of critical normal structures during the late sessions of treatment. Accurate and timely identification of irradiation-affected tissue regions is highly valuable for adaptive radiotherapy planning. We propose a method for the identification and evaluation of specific computed tomography (CT) attenuation changes that can reveal the affected tissue regions. The search for correlated CT attenuation changes in the tumour and surrounding tissues, based on principal component analysis of series of intensity values in each fixed voxel, can reveal the actual three-dimensional region of irradiation-affected tissues for radiotherapy control and replanning.

Temos aktualumas A lateral ankle sprain (LAS) is one of the most common injury, which occurs in children. Despite large number of studies, diversity of treatment strategies persists. Over 20 years acronym PRICE (protection, rest, ice, compression, elevation) and anti-inflammatory drugs (NSAIDs) is first option, despite its lack of high quality evidence. Lately acronym PEACE and LOVE (protection, elevation, avoid anti-inflammatory drugs and icing, compression, education, load, optimism, vascularisation, exercise) was announced, which involves immediate care and rehabilitation of soft tissue damage. It is thought that phases of inflammation help tissue to heal and NSAIDs combined with icing interferes it, so new strategy excludes this combination. Darbo tikslas (-ai) To compare PRICE vs PEACE and LOVE for LAS treatment, to evaluate injury severity outcomes and to verify the need of plaster cast immobilization in adolescents. Tyrimo metodai A prospective randomised study of 65 (37 male, 28 female) patients from 12 to 17 years old who admitted LUHS Paediatric emergency department (ED) in year 2022- 2024 after LAS was executed. Inclusion criteria were first time LAS, acute period of 1 to 4 days after injury, exclusion of chronic pain and any fracture, except avulsion. Depending on symptoms immobilization by plaster cast was applied for 30 patients (46,2%) in the ED. At first visit to the policlinics cast was removed for all of them, lace-up splint was prescribed to all 65 patients and they were randomly allocated to two age and gender homogenous groups: classic (A) PRICE (n = 32, male 62,5%, female 37,5%) or new (B) PEACE and LOVE (n = 33, male 51,5%, female 48,5%) treatment method. Patient diagnose was confirmed by x rays and ultrasound system MyLab 9 eXP 20071, Esaote S.p.A., CE 0123. Ankle function was tested by Biodex isokinetic dynamometer to compare range of motion (ROM) and peak torque to body weight (PEAK TQ/BW) of inversion (IN) and eversion (EV), Y balance test composite scores (YBT CS) were counted to evaluate proprioception between involved (I) and uninvolved (U) legs 1 to 2, 5 to 7 and 12 to 15 weeks after injury comparing two methods. Depending on radiologic findings patients were divided into two groups: I – diagnosed with sprains (grade I) or partial tears (grade II) of lateral ankle ligaments; II – diagnosed with complete tears (grade III) and/or avulsions of lateral malleolus. Data analysis was performed by IBM SPSS 22 software. Two independent samples were compared by Mann-Whitney U test, three measurements in each group were compared by Friedman test. Rezultatai Mean patient age in group was A 14,31 (SD 1,67), in group B 14,64 (SD 1,64). Depending on injury severity 30 patients (46.2%) formed group I and 35 patients (53.8%) group II. There was a significant difference measuring YBT CS deficiencies between U and I legs in group I and II after third testing: YBT-3 CS group I -0,47% vs group II 1,43% (U=353, p=0,02). Only first Biodex testing showed higher deficit of IN for I leg: 1 PEAK TQ/BW IN group I 27,43% vs group II 37,77% (U=358, p=0,028) but later testings showed no significant difference depending on injury severity. Group II showed significantly higher ROM deficit at second and third testing: 2 ROM group I 27,83 ° vs 37,43 ° (U=370, p=0,04), 3 ROM group I 26,53 ° vs 38,54 ° (U=331, p=0,011). Immobilization by plaster cast in the ED was applied to total of 30 (46,15%) patients: 12 (40,0%) group I and 18 (51,4%) group II patients (p=0,357). Application of plaster cast had no better outcomes over 3 testings in IN, EV or ROM: : 3 PEAK TQ/BW IN cast group 31,62% vs no cast group 34,19% (U=483,5, p=0,585); 3 PEAK TQ/BW EV cast group 29,8% vs no cast group 35,74% (U=429, p=0,206); 3 ROM cast group 33,40 ° vs no cast group 32,66 ° (U=513, p=0,875). Two different treatment strategies were compared by Friedman test, pairwise comparisons were performed and B treatment method showed significant better results in YBT CS, PEAK TQ/BW IN and ROM deficit scores: group A YBT CS-1 2,28% and YBT CS-3 1,7% vs group B YBT CS-1 2,42% and YBT CS-3 1,61% (p=0,003); group A 1 PEAK TQ/BW IN 2,09 and 3 PEAK TQ/BW IN 1,84 vs group B 1 PEAK TQ/BW IN 2,27 and 3 PEAK TQ/BW IN 1,68 (p=0,049); group A 1 ROM 2,59 ° and 3 ROM 1,45 ° vs group B 1 ROM 2,64 ° and 3 ROM 1,47 ° (p<0,001). Išvados, rekomendacijos Higher grade of lateral ankle ligaments tear has no significant impact on ankle proprioception outcomes, but has impairement of ROM and early post injury inversion force. Immobilization by plaster cast is used too often even for minor injuries because it has no better outcomes for LAS treatment, it should be used as short as possible and only for pain control. PEACE and LOVE treatment method showed better results than PRICE in YBT CS, ROM and inversion force.

Temos aktualumas Stipinkaulio galvos ir kaklo lūžiai vaikams sudaro apie 10-15% alkūnės srities lūžių. Dažniausiai įvyksta vaikams nuo 7 iki 12 metų, krintant ant ištiestos rankos. Lūžiai dažnai susiję su didele komplikacijų rizika, neretai įvyksta kartu su dilbio kaulų išnirimu, žastikaulio medialinio antrkumplio ar alkūninės ataugos lūžiu. Dislokuotiems lūžiams reikalingas operacinis gydymas, tačiau optimalaus operacinio gydymo metodo dėl šioje zonoje esančios augimo linijos nėra. Darbo tikslas (-ai) Parinkti tinkamą gydymo metodą pacientams, patyrusiems stipinkaulio galvos lūžį. Tyrimo metodai

1. 7 m. mergaitė nukrito nuo suoliuko ant kairės ištiestos rankos ir patyrė kairės alkūnės traumą, atvyko į vaikų SPS, jai buvo atlikta dviejų krypčių alkūnės rentgenograma, diagnozuotas stipinkaulio galvos lūžis su didele dislokacija, todėl buvo stacionarizuota operaciniam gydymui – atlikta atvira repozicija ir vidinė fiksacija, panaudojant 2,0mm diametro elastinę vinį, žiedinis raištis susiūtas. Pritaikytas šarnyrinis įtvaras 5 sav. laikotarpiui – 3 sav. alkūnė fiksuota, likusias 2 sav. – palaipsniui didinta fleksija/ekstenzija, ribojant dilbio rotaciją. Pacientei paskirta 20-ies dienų stacionarinė reabilitacija, po jos alkūnės funkcija buvo patenkinama, neskaudėjo, judesių amplitudė gera. 2 mėn. po operacijos pacientė grįžo į mokyklą, 3 mėn. po operacijos patyrė nedidelę traumą - krito ant kairės alkūnės, tačiau nebuvo hematomos, patinimo ar stipraus skausmo, todėl į gydymo įstaigą nesikreipė. Po kelių dienų pastebėjo ribotą judesio amplitudę, todėl atvyko SPS, atlikus rentgenogramą, diagnozuota implanto migracija, todėl stacionarizuota į VOTS skubiai implanto eliminacijai. Implantas eliminuotas, lūžio stabilumas įvertintas operacinėje C lanko kontrolėje. Nors pilno sugijimo radiologiškai dar nebuvo, tačiau fragmentas stabilus. Nuspręsta pacientę stebėti kas 6 mėn. 2 metai po pirmos operacijos pacientė pradėjo jausti skausmą alkūnėje, alkūnės srityje pastebėta deformacija, atsirado judesių ribotumas. KT ir rentgenogramose – hiperosifikuota stipinkaulio galva, subchondrinės cistos, sklerozė, aseptinės nekrozės požymiai.
2. 7 m. berniukas, nukrito nuo batuto ant kairės rankos. Dėl kairės alkūnės skausmo, tinimo, deformacijos ir negalimų judesių atvyko į vaikų SPS. Atlikta dviejų krypčių rentgenograma, nustatyta stipinkaulio kaklo lūžis su visiška stipinkaulio galvos dislokacija, stacionarizuotas operaciniam gydymui. Operacijos metu atlikta atvira repozicija, lūžis fiksuotas dviem Kiršnerio vielomis, alkūnė imobilizuota, pooperacinėse rentgeno nuotraukose – fragmentų ir implantų padėtis gera. 5 sav. po operacijos pastebėta Kiršnerio vielos migracija, pacientas stacionarizuotas implantų eliminacijai. Lūžis stabilus, todėl revizinė operacija neatlikta, nuspręsta stebėti pacientą kas 6 mėn. 6 mėn. po operacijos pacientas skundėsi skausminga fleksija ir ekstenzija, visiškai ribota supinacija ir pronacija. Rentgeno nuotraukose ir KT – pilno stipikaulio galvutės sugijimo nematyti, alkūnkaulyje matoma egzostozė nusitęsianti link stipinkaulio proksimalinės dalies; stipinkaulyje matomos subchondrinės cistos, hiperosifikacija ir deformacijos požymiai. MRT – nesugijusios stipinkaulio galvos potrauminiai pakitimai, antrinės avaskulinės nekrozės požymiai, žastikaulio epifizės srityje reaktyvūs kraujotakos sutrikimai. Rezultatai Abiem pacientams dėl alkūnės skausmo, sumažėjusios judesių amplitudės, atsižvelgiant į radiologinius pokyčius, nuspręsta atlikti stipinkaulio galvos rezekciją, siekiant sustabdyti potrauminių pokyčių progresavimą, žastikaulio galvutės pažaidą ir atkurti dilbio rotacinę funkciją. Po operacijos pacientams fleksija ir ekstenzija neskausminga, neribota. Dilbio pronacijos ir supinacijos amplitudė 1-ajai pacientei atsistatė pilnai, 2-ajam pacientui matyti ryškus funkcijos pagerėjimas, tačiau pilna amplitudė išlieka ribojama kontraktūros. Abiems pacientams radiologiškai stebima nežymi alkūnės sąnario valgus deformacija. 12 mėn. po mergaitės operacijos ir 6 mėn. po berniuko operacijos riešo judesiai nesutrikę, neskausmingi, radiologiškai stipinkaulio migracijos proksimalyn ir riešo sąnario kongruentiškumo pažeidimo nematyti. Išvados, rekomendacijos • Stipinkaulio galvos rezekcija gali pagerinti alkūnės sąnario funkciją ir sumažinti skausminį sindromą, esant lūžių komplikacijoms; • Galimos komplikacijos riešo sąnaryje po stipinkaulio galvos rezekcijos; • Prieš atliekant stipinkaulio galvos rezekciją būtina apsvarstyti galimus alternatyvius gydymo metodus. Vengti skuboto sprendimo galvos šalinimui, kadangi procesas yra negrįžtamas.

Objective Main objective of this research is to find out what is the pattern of patient positioning errors when treating with a gamma knife. Methods In this study it was analyzed at the theoretical level the methodology of fractional treatment with a gamma knife. Evaluated and compared with each other the accuracy of several patients positioning without correction in the fractional treatment. Compared the obtained empirical data and estimated the possible errors if no additional positioning correction is applied. Results Study showed errors in the treatment with a gamma knife, when no additional patient positioning corrections are made, and the patterns of the errors. Assessing the positioning accuracy of fractional treatment without correction, it was observed that the errors are variable and different. However, pattern is seen in all investigated cases. The deviation was greatest at the beginning of fractional treatment and the smallest at mid- or late-treatment. Thus, dividing the treatment into more fractions reduces errors. ConclusionsThe Gamma Knife is a very precise treatment in the field of stereotactic radiosurgery. Treatment with a gamma knife uses cobalt-60 isotopes. 192 rays of ionizing radiation concentrated at a single point affect the desired cells and kill them. With the help of computers and many sensors, this is done very accurately. The treatment can be performed once or in fractions - several times. Assessing the positioning accuracy of fractional treatment without correction, it was observed that the errors are variable and different. However, pattern is seen in all five cases. The deviation was greatest at the beginning of fractional treatment and the smallest at mid- or late-treatment. Thus, dividing the treatment into more fractions reduces errors. In the absence of additional correction, treatment would be inaccurate and cause damage to healthy tissues. Although the errors are small, accuracy is the most important indicator when working with ioniz ing radiation.Brief description of the abstractThe Gamma Knife is a very precise treatment in the field of stereotactic radiosurgery. Treatment with a gamma knife uses cobalt-60 isotopes. 192 rays of ionizing radiation concentrated at a single point affect the desired cells and kill them. The treatment can be performed once or in fractions. However there is patient possitioning errors. The research shows those error patterns. Although the errors are small, accuracy is the most important indicator when working with ionizing radiation.

Synopsis: Hydatid disease or echinococcosis is a worldwide parasitic disease, that can occur almost anywhere in the body. The lung parenchyma is the second most affected organ after the liver, but it may develop in the pleural cavity, mediastinum, heart, vascular structures, chest wall, and diaphragm. Diagnosis is mainly based on serological and radiological findings. Radiologic findings can be very different and vary from purely cystic lesions to a completely solid appearance, it depends on type of infection, growth stage, affected tissue and associated complications. So, radiologists must be familiar with the imaging features of this disease and contemplate the diagnosis when facing atypical chest lesions, especially in patients whose work involves farm animals like sheep’s or their breeding or with evidence of echinococcosis in a different anatomical location.

Bolus is used as an additional body to ensure the delivery of appropriate irradiation dose for shallow tumours. The aim of this study was to apply an individualised 3D printed polylactic acid (PLA) boluses for a simulated case of shallow head and neck cancer on the anthropomorphic phantom “Shane”. Obtained results showed that the 3D minimum dose of the planned tumour volume increased more than 30 % in comparison with a plan without individualised 3D printed bolus. Therefore, 3D printed bolus could be successfully used in clinical practice to provide an adequate superficial tumour irradiation. Introduction Radiotherapy aims at accurately targeting tumours with sufficient dose while preserving as much healthy tissue as possible. Radiotherapy are frequently delivered using photons with energies in the megavoltage (MV) range. The benefit of such beam energies is that the majority of the dose is delivered deeper inside the patient, with maximum dose depths reaching several centimetres below the patient's surface. Because of this effect, radiotherapists may target tumours on organs such as the prostate. On the other hand, larger dose often must be deposited to the near-skin area, for example, in cases of head and neck cancer . Thus, the most important aspects to consider when irradiating surface and shallow tumours are achieving conformal dose distribution in tumour area while protecting healthy tissues. In such clinical cases, one way of solving the issue may be the use of an additional body, also known as a bolus. It provides a water equivalent material with sufficient coverage of the tumour and a uniform dosage delivery. However, the problem is that commercially available boluses made of sheet gels are difficult to apply to certain uneven skin surfaces, such as those of the nose, ears, eyes, and scalp. [...].

Ilgus metus didžiausias medicinos dėmesys buvo skiriamas ligų gydymui: mirtinos ligos tapo išgydomos arba perėjo į lėtines formas. Kreipiant dėmesį į visuminius žmogaus poreikius ir integruojant į mediciną dvasingumą, biopsichosocialinis priežiūros modelis buvo išplėstas, įtraukiant dvasinę pagalbos dimensiją. Tikslas – pristatyti Biopsichosocialinį – dvasinį pagalbos modelį ir slaugytojo vaidmenį teikiant dvasinę pagalbą pacientams. Terminas dvasingumas turi labai plačią ir sunkiai apibrėžia,ą reikšmę. Šis terminas gali apimti bet kokį "paprastą arba nepaprastą patyrimą, kuris pasižymi holistine, sudėtine prasme tokių reiškinių, kaip: užuojauta, meilė, gerumas, džiaugsmas, šventumas, tyrumas, intuicija ir kūrybiškumas". [...].

Įvadas. Siekiant užtikrinti, kad būtų įsiklausoma į paciento ir jo artimųjų pa-geidavimus, kad būtų atstovaujami ligonio interesai, teikiama išsami ir savalaikė in-formacija, kad priimti sprendimai neprieštarautų paciento bei jo šeimos narių slaugos tikslams, būtinas holistinis supratimas, kokius vaidmenis atlieka slaugytojai ir kokias strategijas jie naudoja spręsdami paciento gyvenimo pabaigos problemas [1]. Slaugytojo vaidmuo (angl. caregiver role) – būdingas savybes turinti bendra-vimo vaidmenų rūšis. Tai bendravimas, atsižvelgiant į slaugytojo įsipareigojimus; sveikatos apsaugos institucijų ir jų darbuotojų, šeimos narių, visuomenės formuoja-mos pažiūros apie tinkamą ir netinkamą slaugą, šių požiūrių raiška elgesiu ir verty-bėmis; dažniausiai slaugomas nuo aplinkinių priklausomas šeimos narys [2]. Išanalizavus užsienio literatūrą, galima išskirti tris pagrindinius slaugytojų vaidmenis, atliekamus paciento gyvenimo pabaigoje: informacijos teikėjo (angl. in-formation broker), rėmėjo (angl. supporter) ir advokato (angl. advocate) . Tyrimo tikslas - išanalizuoti dominuojantį slaugytojo vaidmenį slaugant pa-cientus gyvenimo pabaigoje onkologijos slaugytojų požiūriu. Metodai. Tyrimas vyko 2014 m. rugsėjo – spalio mėn. Apklausti didžiųjų specializuotą onkologinę pagalbą teikiančių stacionarų LSMUL Kauno klinikų filialo Onkologijos ligoninės, LSMUL Kauno klinikų onkologijos ir hematologijos klinikos ir Vilniaus Nacionalinio vėžio instituto skyrių onkologijos profilio slaugytojai. Tyri-me dalyvavo 239 respondentai. Anketa sudaryta remiantis prof. Renea L. Beckstrand klausimynu. Rezultatai. Analizuojant slaugytojo vaidmens elementus, buvo atlikta su-bskalių vidurkių analizė, paskaičiuotas standartinis nuokrypis, esant 95 proc. pasi-kliautinajam intervalui. Tyrimo metu, apklausus 239 onkologijos profilio slaugytojus, nustatyta, kad dauguma respondentų sau priskiria slaugytojo-r

Cancer is a relevant problem of public health in Lithuania. According to statistics the incidence of cancer and mortality in Lithuania has increased respectively 78.8% and 31.9% since 1990. Chemotherapy is one of the most widely used treatment of cancer. It is essential to ascertain oncology patients’ level of knowledge about side-effects of chemotherapy and their management, the source of information and additional ways and means to relieve unwanted side-effects. Material and Method: The aim of the study was to evaluate oncology patients’ knowledge about side-effects of chemotherapy and their management. Anonymous survey of 100 oncology patients with various oncological diagnosis and different stages of cancer was carried out in chemotherapy departments of two Lithuania’s hospitals. SPSS 17.0 version of statistical analysis program was used to process the data. Results and Discussion: The survey established that more than a half of patients who were treated with chemotherapy reported fatigue (62.5%), alopecia (61.5%), nausea and vomit (51%) whereas constipation (41.7%), taste changes (29.2%), ulceration of oral mucosa (22.9%) and diarrhoea (20.8%) were mentioned more rarely. Only 2.1% of the patients didn’t report any side-effect of chemotherapy. Statistically significantly higher proportion of women (p < 0.05) than men reported alopecia whereas diarrhoea was statistically significantly more often (p < 0.05) reported in a group of patients with age of 31–40 years in comparison with the patients over 71 years of age. The highest proportion of oncology patients stated the first side-effect after 24 hours (34.4%) and after 12 hours (26.7%) while after 36 and 48 hours side-effect of chemotherapy occurred respectively to 13.3% and 16.7% of the patients. The study revealed that 78.6% of the oncology patients received information about side-effects of chemotherapy from a doctor, 29.6% from a nurse and 18.. [...].