AP Oblique Projection (Hand) Norgaard (Ball-catcher’s) Method

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Evaluation Criteria

The following should be clearly shown:

▪Both hands from the carpal area to the tips of the digits

▪Metacarpal heads and proximal phalangeal bases free of superimposition

▪Useful level of density over the heads of the metacarpals

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    Single Dose Radiation During Surgery Helps Early Stage Breast Cancer Patients Forgo Longer Radiation Course

    A hospital in New York City (NY, USA) is offering early stage breast cancer patients a new breakthrough in radiotherapy technology, a novel radiation treatment delivered in one dose at the time of surgery.

    Women with early stage breast cancer frequently undergo breast-conserving surgery (lumpectomy), to take out a cancerous tumor. Lumpectomy is followed by daily doses of radiation therapy to the entire breast, typically lasting six to seven consecutive weeks.

    “Intrabeam radiotherapy may be an effective alternative to a six to seven week regimen following surgery for select patients because it allows us to precisely target any remaining cancer cells right inside the tumor bed, where the tumor is most likely to recur,” said Dr. Mary Katherine Hayes, clinical director of radiation oncology at New York-Presbyterian Hospital/Weill Cornell Medical Center and associate professor of clinical radiology and radiation oncology at Weill Cornell Medical College (New York, NY, USA). The Intrabeam technology was developed by Carl Zeiss (Jena, Germany).

    Right after removal of the tumor, while the patient is still on the operating table, the Intrabeam’s applicator’s small, cylindrical tip is positioned inside the tumor cavity to deliver a superficial dose of radiation for 20-30 minutes, while limiting exposure to healthy neighboring tissue and organs. After the applicator is removed, the surgical incision is closed.

    “Our ability to use this radiation technique in such a timely manner may add to its effectiveness since the area in need of treatment can be directly visualized at the moment the tumor is removed,” noted Dr. Alexander J. Swistel, attending breast surgeon at the Iris Cantor Women’s Health Center at New York-Presbyterian/Weill Cornell Medical Center and associate professor of clinical surgery at Weill Cornell Medical College.

    This alternative to traditional full-breast radiation therapy is in step with the hospital’s longstanding practice of customizing partial breast cancer treatments to a growing number of patients with a small, early stage tumor. Eliminating an additional six to seven weeks of radiation therapy is particularly convenient for patients who do not live in close proximity to a hospital or an established radiation therapy facility.

    A 10-year randomized phase III clinical trial of intraoperative therapy for breast cancer found that for selected patients, single dose radiotherapy delivered at the time of surgery yielded the same results as conventional full breast radiation delivered over several weeks. The TARGIT-A Trial, published in the Lancet in July 2010, examined only the Intrabeam system and was the largest randomized clinical trial conducted in this field, more than 2,000 women in multiple countries were enrolled.

    While Intrabeam is restricted to a select group of patients with a very small tumor, if tissue samples removed during surgery are ascertained to be more aggressive than early tests revealed, the patient will still be able to undergo traditional full-breast radiation. However, the patient would not need to undergo the final five-day phase of conventional treatment, called boost therapy, which targets the tumor bed with external radiation.

    “We are very excited to provide this cutting edge treatment to patients with early staged breast cancer. This is a part of our effort toward personalized cancer care,” remarked Dr. K.S. Clifford Chao, a radiation-oncologist-in-chief of New York-Presbyterian Hospital and professor of Weill Cornell Medical Center.

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