2^nd World Congress on Radiology and Oncology July 16-17, 2018 Dubai, UAE

Partha S Choudhury is an internationally acclaimed leading Nuclear Medicine Physician of India with special interest in Radionuclide Therapy of various types of cancers. He has more than 25 years of experience in Nuclear Oncology. He is heading the department of Nuclear Medicine in Rajiv Gandhi Cancer Institute & Research Centre Delhi India since 1998 and has been instrumental in its sustained growth over the last 20 years. He has introduced and standardized new procedures in the department both in terms of disease specific diagnostic, molecular imaging & molecular therapy. He is an invited speaker in conferences

and symposiums across many countries, the main ones being United Kingdom, Austria, South Africa and South America. He is an avid clinical researcher with publications in peer reviewed journals. He is a technical co-operation consultant & participant of co-ordinated research projects of International Atomic Energy Agency (IAEA) Vienna

The term theranostics is the combination of a diagnostic tool that helps to define the right therapeutic tool for specific disease. It signifies the “we treat what we see & see what we treat” concept. A diagnostic radionuclide labelled with the target and once expression is documented, the same target is labelled with a therapeutic radionuclide and treatment is executed. In addition a molecular biomarker based targeted treatment can be tailored with either biomarker or molecular imaging. The concept is utilized in few malignancies especially NET & prostate cancer currently. Molecular imaging modalities exploit the receptor expression aspects of the pathophysiology for both diagnostic imaging & therapeutic purposes. The receptor expression changes with tumor grades and hormone resistance. We have reported excellent sensitivity and detection capability of both primary and metastatic disease. Besides evaluation of recurrence, 68Ga-labelled radiopharmaceuticals can be utilized for detection of metastasis and selection of patients for therapy. 68Ga- DOTA or PSMA serves the basis of treatment of these conditions with 177Lu . Based on the theranostic concept the aims of treatment with 177Lu are to improve outcome by early interventions in suboptimal responders, sparing low risk patients from over treatment, reduce treatment related side effects, ensure effective palliation & improve quality of life. Tumor targeting with 177Lu DOTA or PSMA saves normal tissue & delivers high dose to tumor. Easy radiopharmaceutical labelling & high expression in all cancer cells makes it an optimal target for radionuclide therapy, with a low toxicity profile. In our experience at RGCI & RC (our institute) we have seen objective regression in lesions and symptomatic relief. It has been found to be a safe & effective method for treating end stage androgen independent, progressive CRPC and metastatic NET. Similarly a personalized treatment model based on molecular biomarkers and imaging in breast cancer is possible based on imaging of estrogen receptors and 18F FES imaging in breast cancer. In this presentation, I am going to discuss our experience in precision oncology based on the above concepts.

Partha S Choudhury is an internationally acclaimed leading Nuclear Medicine Physician of India with special interest in Radionuclide Therapy of various types

of cancers. He has more than 25 years of experience in Nuclear Oncology. He is heading the department of Nuclear Medicine in Rajiv Gandhi Cancer Institute

& Research Centre Delhi India since 1998 and has been instrumental in its sustained growth over the last 20 years. He has introduced and standardized new

procedures in the department both in terms of disease specific diagnostic, molecular imaging & molecular therapy. He is an invited speaker in conferences

and symposiums across many countries, the main ones being United Kingdom, Austria, South Africa and South America. He is an avid clinical researcher with

publications in peer reviewed journals. He is a technical co-operation consultant & participant of co-ordinated research projects of International Atomic Energy

Agency (IAEA) Vienna

The term theranostics is the combination of a diagnostic tool that helps to define the right therapeutic tool for specific disease. It signifies the “we treat what we see & see what we treat” concept. A diagnostic radionuclide labelled with the target and once expression is documented, the same target is labelled with a therapeutic radionuclide and treatment is executed.

In addition a molecular biomarker based targeted treatment can be tailored with either biomarker or molecular imaging. The

concept is utilized in few malignancies especially NET & prostate cancer currently. Molecular imaging modalities exploit

the receptor expression aspects of the pathophysiology for both diagnostic imaging & therapeutic purposes. The receptor

expression changes with tumor grades and hormone resistance. We have reported excellent sensitivity and detection capability

of both primary and metastatic disease. Besides evaluation of recurrence, 68Ga-labelled radiopharmaceuticals can be utilized

for detection of metastasis and selection of patients for therapy. 68Ga- DOTA or PSMA serves the basis of treatment of these

conditions with 177Lu . Based on the theranostic concept the aims of treatment with 177Lu are to improve outcome by early

interventions in suboptimal responders, sparing low risk patients from over treatment, reduce treatment related side effects,

ensure effective palliation & improve quality of life. Tumor targeting with 177Lu DOTA or PSMA saves normal tissue &

delivers high dose to tumor. Easy radiopharmaceutical labelling & high expression in all cancer cells makes it an optimal target

for radionuclide therapy, with a low toxicity profile. In our experience at RGCI & RC (our institute) we have seen objective

regression in lesions and symptomatic relief. It has been found to be a safe & effective method for treating end stage androgen

independent, progressive CRPC and metastatic NET. Similarly a personalized treatment model based on molecular biomarkers

and imaging in breast cancer is possible based on imaging of estrogen receptors and 18F FES imaging in breast cancer. In this

presentation, I am going to discuss our experience in precision oncology based on the above concepts.

Vikas Leelavati BalaSaheb Jadhav has completed postgraduation in Radiology in 1994. He has a 23 years of experience in the field of Gastro-Intestinal Tract Ultrasound & Diagnostic as well Therapeutic Interventional Sonography. He is the pioneer of Gastro-Intestinal Tract Sonography, especially Gastro-Duodenal Sonography. He has delivered many Guest Lectures in Indian as well International Conferences in nearly 27 countries as an Invited Guest Faculty, since March 2000. He is a consultant Radiologist & the specialist in conventional as well unconventional Gastro-Intestinal Tract Ultrasound & Diagnostic as well Therapeutic Interventional Sonologist in Pune, India.

Transabdominal Sonography of the Small & Large Intestines can reveal following diseases. Bacterial & Viral Entero-Colitis. An Ulcer, whether it is superficial, deep with risk of impending perforation, Perforated, Sealed perforation, Chronic Ulcer & Post-Healing fibrosis & stricture. Polyps & Diverticulum. Benign intra-mural tumours. Intra-mural haematoma. Intestinal Ascariasis. Foreign Body. Necrotizing Entero-Colitis. Tuberculosis. Intussusception. Inflammatory Bowel Disease, Ulcerative Colitis, Cronhs Disease. Complications of an Inflammatory Bowel Disease – Perforation, Stricture. Neoplastic lesion is usually a segment involvement, & shows irregularly thickened, hypoechoic & aperistaltic wall with loss of normal layering pattern. It is usually a solitary stricture & has eccentric irregular luminal narrowing. It shows loss of normal Gut Signature. Enlargement of the involved segment seen. Shouldering effect at the ends of stricture is most common feature. Primary arising from wall itself & secondary are invasion from adjacent malignancy or distant metastasis. All these cases are compared & proved with gold standards like surgery & endoscopy. Some extra efforts taken during all routine or emergent ultrasonography examinations can be an effective non-invasive method to diagnose primarily hitherto unsuspected benign & malignant Gastro-Intestinal Tract lesions, so should be the investigation of choice.

Abdalla Abo Taleb, MD is a World Health Organization expert. He is also a consultant on health economics at the Egyptian Ministry of Health, as well as a member of the Egyptian health care reforming committee Ispor (member, judge and reviewer).

Background & Objective: Due to incidence of breast cancer in low middle-income country like Egypt, which is the most prevalent cancer among women in Egypt, representing 18.9% of total cancer cases (35.1% in women and 2.2% in men) with an age-adjusted rate of 49.6 per 100000 population, stages III and IV constitute 68% of all breast cancer cases. The previous feature of disease lead to economic burden on budget for the health care system and raise the question-does the policy maker need to develop treatment policy based on prioritization and sequencing for treatment lines to enhance patient's outcome including (quality of life-economic value-clinical effectiveness). The objective of this study is to determine cost-effectiveness of Vinorelbine oral plus Capecitabine oral against Docetaxel IV plus as first line for metastatic breast cancer over time horizon three years from payer prospective.

 

Method: A cost-effectiveness analysis from the perspective of the Ministry of Health and population was conducted. A Markov model was applied with three health states. Utility data were incorporated in the model to make adjusted results. Costs used were the local ones according to the national fund list. Discounting was applied at 3.5% annually both on costs and benefits. The results obtained were in term of ICER and number of QALYs. Robustness of our findings was checked using sensitivity

analyses. Results are expressed in QALYs.

 

Result: During the three-year time horizon for Vinorelbine oral 2017 exchange rate: 0.13 with a 2.46 QALY gained versus 0.84 QALY gained for Docetaxel IV, which yields a difference of 1.62 in QALY. Vinorelbine oral is economically dominating the Docetaxel strategy, producing more benefit at a lower cost. The one-dimensional sensitivity analysis indicated that the overall survival medians of both drugs had the largest impact on the results. When conducting sensitivity analysis using plausible ranges, Vinorelbine oral remained economically dominant in all.

Conclusion: Developing prioritization and sequencing treatment policy by starting with Vinorelbine oral plus Capecitabine oral as first line of treatment for metastatic breast cancer may have positive impact on patient’s outcome including (quality of life-economic value-clinical effectiveness) and cost saving effect on treatment budget. This saving effect may lead to treat more patients with same budget and enhance outcomes for those patients.

Rashmi Chand is an oncoradiologist and currently working as a consultant radiologist for Apollo Gleangles Hospital, Kolkata, India. She had got the recommended poster nomination in ESGAR 2017 for my work in primary peritoneal tumor imaging.

Objective: The purpose of the presentation is to review the CT imaging patterns of primary peritoneal tumors and to correlate the imaging findings with pathologic features based on the proposed histogenesis. Primary peritoneal tumors are classified into mesothelial, epithelial, smooth muscle and uncertain origin groups.

 

Method: This presentation describes various primary peritoneal tumors and demonstrates the characteristic CT appearances using images from patients referred to with histological confirmation. Multidetector Computed Tomography (MDCT) imaging is approximately 90% sensitive in the detection of peritoneal neoplastic lesions greater than 5 mm. CT scan also plays an important role in guiding biopsy for tissue diagnosis and assist with the management of disease namely in surgical planning.

 

Result: Primary peritoneal tumors are an uncommon group of diverse pathological disorders. They share a common anatomic site of origin and have overlapping imaging features yet are distinctly different clinically. Their imaging appearances overlap with those of diffused peritoneal metastatic disease and infectious disease.

 

Conclusion: Differentiating primary peritoneal tumors from metastatic disease is important clinically so that patient management is appropriate.

Shina Ghafoor has completed her MBChB from the Medical School of Baghdad, Iraq. She is a Postgraduate and had Specialist Training for Radiology at the University Hospital of Basel, Switzerland. She has the Fellowship for Musculoskeletal Radiology and is currently working as Consultant Radiolologist and MRI Lead at Thun Hospital, Bern, Switzerland. She has worked as a Consultant General and Musculoskeletal Radiologist in United Kingdom.

Screening and early diagnosis of tumor has an important role in reducing morbidity and mortality associated with cancer. Magnetic Resonance Imaging (MRI) has the highest sensitivity of current imaging modalities. MRI is an emerging modality

of choice for whole body screening to detect disease in its early stages while effective treatment is still possible. MRI is also used worldwide as a surveillance imaging technique to identify cancer in individuals who are at increased risk of disease. Costs of MR imaging modality is an important consideration and the society bears the burden of costs of the procedure. This is however less of an issue if the individual is paying for it independently.

Background: Diffuse Axonal Injury (DAI) detected on Magnetic Resonance Imaging (MRI) may be useful to predict outcome after Traumatic Brain Injury (TBI).

 

Aim & Method: This study compared the ability of the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) prognostic model with DAI on MRI to predict the 18-month neurologic outcome in 56 patients who had required

decompressive craniectomy after TBI.

 

Results: Of the 56 patients included in the study (19 scans occurred within 14 days, median time for all patients 24 days, interquartile range 14-42), 18 (32%) had evidence of DAI on the MRI scans. The presence of DAI on the MRI Diffusion- Weighted (DW) T2*-weighted gradient echo and Susceptibility-Weighted (SWI) sequences was associated with an increased risk of unfavorable outcome at 18 months compared with patients without DAI (44% vs. 17%, difference = [ 27%, 95% confidence interval 2.4-46.7% ; P = 0.032), particularly when the brainstem was involved. However, neither the grading (1 to 4) nor the number of brain regions with DAI was as good as the IMPACT model in discriminating between patients with unfavorable and favorable outcomes (area under the receiver operating characteristic curve: 0.625 and 0.621 vs. 0.918, respectively; P<0.001 for both comparisons). After adjustment for the IMPACT prognostic risks, DAI in different brain regions and the grading of DAI were also not independently associated with unfavorable outcome.

 

Conclusion: The prognostic significance of DAI on MRI may, in part, be captured by the IMPACT prognostic model. More research is needed before MRI should be routinely used to prognosticate the outcomes in patients with TBI requiring

decompressive craniectomy.

Background: Diffuse Axonal Injury (DAI) detected on Magnetic Resonance Imaging (MRI) may be useful to predict outcome after Traumatic Brain Injury (TBI).

 

Aim & Method: This study compared the ability of the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) prognostic model with DAI on MRI to predict the 18-month neurologic outcome in 56 patients who had required

decompressive craniectomy after TBI.

 

Results: Of the 56 patients included in the study (19 scans occurred within 14 days, median time for all patients 24 days, interquartile range 14-42), 18 (32%) had evidence of DAI on the MRI scans. The presence of DAI on the MRI Diffusion- Weighted (DW) T2*-weighted gradient echo and Susceptibility-Weighted (SWI) sequences was associated with an increased risk of unfavorable outcome at 18 months compared with patients without DAI (44% vs. 17%, difference = [ 27%, 95% confidence interval 2.4-46.7% ; P = 0.032), particularly when the brainstem was involved. However, neither the grading (1 to 4) nor the number of brain regions with DAI was as good as the IMPACT model in discriminating between patients with unfavorable and favorable outcomes (area under the receiver operating characteristic curve: 0.625 and 0.621 vs. 0.918, respectively; P<0.001 for both comparisons). After adjustment for the IMPACT prognostic risks, DAI in different brain regions and the grading of DAI were also not independently associated with unfavorable outcome.

 

Conclusion: The prognostic significance of DAI on MRI may, in part, be captured by the IMPACT prognostic model. More research is needed before MRI should be routinely used to prognosticate the outcomes in patients with TBI requiring

decompressive craniectomy.

Background: Scintimammography (SM) is a promising functional radionuclide imaging technique that is generally undertaken using high resolution parallel-hole collimators with Gamma Cameras. The main clinical limitation of this technique is inaccuracy in detecting small lesions less than 1 cm diameter. This limitation is due to resolution-efficiency trade-off that is inherent in the use of collimation. As an alternative approach this study proposes using a simple Coded Aperture (CA) mask, instead of a collimator, coupled to a standard clinical gamma camera for breast tumor imaging. This imaging technique successfully predicts the overall form of artefacts arising from the near-field imaging geometries.

 

Aim & Methods: To investigate the applications of CA technique a Monte Carlo Simulation (MCS) is used using MCNPX package. To emulate SM, 3D pseudo-anthropomorphic phantoms have been developed and verified and used along with a realistic model of a clinical gamma camera. This study examines a moderately compressed breast phantom in a cranio caudalprojection.

 

The performance of such an imaging system is modeled by the MCS method and images are reconstructed by correlation analysis. This imaging system was quantitatively evaluated using variable parameters: The detected photon from tumor, spatial resolution, photon statistics and lesion visibility of the system at several tumor-background activity ratios. The effectiveness and the performance of the CA-SM system was assessed and compared with low energy high resolution parallelhole collimator and ultra-high resolution parallel-hole collimator image formation systems.

 

Results: The predicted background can be used to correct the near-field effect of 3D sources, as might be found in SM using CA. The simulated planar images from these collimator-based image formation systems suggest tumors of 1 cm diameter may be observable with a tumor-background-ratio of 5:1. However, when the tumor diameter is ≤0.8 cm these become less reliable detecting small (less than 1 cm in diameter) lesion unless a tumor-background-ratio of more than 10:1 is used.

 

Conclusion: The results of the simulations demonstrate that with near-field artefacts corrections the CA-SM approach shows

good performance in lesion detection for all lesions (located 3 cm deep in a 6 cm thick breast phantom) and for a tumorbackground ratio as low as 3:1. This level of performance is highly competitive, in some cases, superior to conventional

collimator based image formation methods.

M A Alnafea is presently working as an Assistant professor in King Saud University, Saudi Arabia. He attended several International and National conferences. He published several article in different journals as well.

Swati Pacharne has completed her MD Radio-diagnosis at the age of 29 years from Mumbai University, India. Currently, she is working in Thumbay Hospital, Dubai, UAE as a Specialist Radiologist, which is one of the leading private healthcare having the only medical university in Ajman, for whole UAE. She has rich experience of 17 years in the field of Radiology, specially, Breast, Women’s, Fetal & MSK Imaging, specially working on MRI & USG modalities. She is a life member of more than 15 national & international organizations and she has given multiple lectures & published multiple papers in many national & international conferences