4 - Department of Radiology & Imaging, Dhulikhel Hospital,
Achieving
Banepa, Bagmati, Nepal
5 - Department of Radiology & Imaging, Chitwan Medical College,
Chitwan, Lumbini, Nepal
6 - Department of Radiology & Imaging, Sharda University, Greater
Noida, New Delhi, India
7 - Department of Radiology & Imaging Sciences, Indiana
University School of Medicine, Indianapolis, Indiana, United States
Introduction: Gender determination is a crucial task in forensic medical sci-
ences. Estimating gender is essential to reveal the identity of an unknown indi-
vidual. In this study, we aim to determine gender by using an anteroposterior
(AP) pelvis radiograph.
Methods: Patients referred for AP pelvis radiograph at the Department of Radi-
ology & Imaging, National Trauma Center, Kathmandu, Nepal from Novem-
ber 2020 to January 2021 were included in this study. Four pelvic factors were
measured: transverse diameter of the pelvic brim, subpubic angle, length of
the pubic symphysis, and ischiopubic index. Data were measured in ImageJ
software, 1.51t version, NIH, Bethesda, Maryland, United States. Data anal-
ysis was performed in SPSS software, version 27. The normality of the data
was checked using the Shapiro-Wilk test. P-value was set at a 5% level of sig-
nificance. Two sample t-test was carried out to determine the statistical value.
Binary logistic regression (BLR) was conducted to estimate gender from the
measured data.
Results: A total of 197 patients, 134 male (68%), and 63 female (32%), with
an age range of 16 to 60 years were included in this study. There was a statisti-
cally significant difference in transverse diameter, subpubic angle, length of the
symphysis pubis, and ischiopubic index at p<0.05. Multi-variate BLR model
of four sets of predictors was statistically significant, χ 2 (4) =200.09, p<0.05.
The model explained 89.3% (Nagelkerke R2 ) of the variance in gender and the
accuracy of the model was 96.4%. The subpubic angle provided the highest
accuracy of 90.9% in single variable BLR prediction.
Conclusion: Gender could be estimated with higher accuracy using a pelvis
AP radiograph. Subpubic angle could be used as a better predictor.
Keywords: gender estimation, Nepalese, binary logistic, pelvis, radiograph
Anti-EpCAM and Anti-EGFR Targeted Theranostic
Functionalized I-131 labeled Poly(lactic-co-glycolic acid)
(PLGA) Radio-Nanotherapeutic for Cancer Treatment
SK Marshall 1, Y Panrak 1, N Makchuchit 1, P Jaroenpakdee 1,
B Saelim 1, M Taweesap 1, V Pachana 1
1 - Department of Radiology, Faculty of Medicine, Prince of
Songkla University, Songkhla 90110, Thailand
Introduction: In nuclear medicine, I-131 radiopharmaceutical has been the
major therapeutic and diagnostic agent. Radiation treatment was developed
over a century ago and used to treat 50% of all cancer patients. External radia-
tion beams continue to be used to eradicate tumors within body, however, can
cause incidental damage to normal tissue. As a result, radio-nanotherapeutic
platforms have been developed, allowing radiation therapy to be delivered di-
rectly and specifically to cancer cells. Herein are two nanoparticle platforms
that successfully targeted radiation therapy at cellular level.
Methods: Firstly, a radiolabeled anti-epithelial cell adhesion molecule (anti-
EpCAM) targeted RBC membrane biomimetic coated nanocarrier (EINP) to
treat breast cancer; secondly, a multiple therapeutic radiolabeled anti-epidermal
growth factor receptor (anti-EGFR) targeted nanocarrier (DIE-NP) to treat os-
teosarcoma. Both radio-nanotherapeutic platforms synthesized poly(lactic-co-
glycolic acid) (PLGA) nanoparticles by double emulsion method. Then, I-131
was entrapped in PLGA core and targeting ligands conjugated to nanoparticles
in both platforms.
Results: EINP size was ∼295 nm, zeta potential -35.9 mV, polydispersity of
0.297, and radiochemical purity >95%. Cytotoxicity against EpCAM-positive
MCF-7 breast cancer was 70%, 78%, and 75% at 24, 48, and 72 hours, re-
spectively. In addition, flow cytometer verified MCF-7 fluorescence intensity
was 8.24-fold higher than free Na131 I. In addition, anti-EpCAM targeting re-
sulted in specific targeting and binding to MCF-7 cells. Additionally, DIE-NP
radiolabeled anti-EGFR targeted nanocarrier size was ∼175 nm, zeta potential
P. Khampukdee, D. Chomchan and N. Pongnapang / Journal of Medical Imaging and Radiation Sciences 53 (2022) S1–S64
of -59 mV, polydispersity of 0.15, and radiochemical purity >96%.
∼79-fold greater targeting efficacy to MG-63 cells than fibroblast cells. The
three-dimensional MG-63 model ascertained the targeted DIE-NPs cytotoxic-
ity of 82% compared to free Na131 I with 67% cytotoxicity.
Conclusion: Radio-nanotherapeutic platforms successfully targeted cancer
cells with greater specificity than free Na131 I to overcome off-target toxicity
and additionally delivered enhanced tumor penetration resulting in greater cy-
totoxicity than free Na131 I. These radio-nanotherapeutic platforms signify a
customizable cancer treatment.
Keywords: cancer, I-131, radiopharmaceutical, targeted delivery, theranostic
nanoparticle
Recent advancement in Total Body Irradiation (TBI) procedure-
Institutional experience
A Selva Kumar 1, GK Jadhav 2, Khosa Robin 3, Oommen Saji 4,
Kariya Gaurav 4
1 - Radiotherapy Technologist
2 - Radiation Oncologist
3 - Medical Physicist
4 - Bone Marrow Transplant Unit, Indraprastha Apollo Hospitals,
New Delhi
Introduction: Total Body Irradiation simply known as TBI, is a form of radia-
tion therapy, in which patient’s whole body is treated with radiation. The main
goal of TBI is to suppress the patient’s immune system, which increases the
success rate of transplant process by preventing rejection of donor bone mar-
row and also kills the abnormal cells present in the patient’s body after, surgery,
chemotherapy process. TBI followed by Bone Marrow Transplantation is an
effective treatment for several types of cancers.
Methods: Patient preparation and treatment execution in Total Body Irradia-
tion is not simple, due to its complexity involved. In traditional way TBI in-
volved multiple angle positioning of patient, focusing radiation beam at spec-
ified angle, with the maximum field of radiation and beam focused through
scatter medium for evenly distribution of dose over patient’s body surface. Due
to various restrictions like field-size, distance, difficult patient positioning the
process become, cumbersome and time consuming. With modern Tomother-
apy equipment, most of the restriction involved with traditional radiotherapy
equipment like, field-size, patient positioning, beam modifiers etc. were over-
come. With Tomotherapy equipment in a single field up to 130 CM’s length
covered in one go, which reduces the field junction dose issues, and patients
discomforts a lot. A vacuum cushion and thermoplastic sheet immobilization
reduces the patient’s movements, discomforts and repositioning errors. We
started TBI process using recently installed Tomotherapy Unit RADIXACT,
to support our in-House Bone Marrow Transplant (BMT) unit.
Results: Depending on the medical conditions single fraction to multiple frac-
tions of treatment delivered to the patients, the results are encouraging. The
process of TBI using Tomotherapy become standard, reduces patient’s treat-
ment time, repositioning errors, discomforts and increases the accuracy of de-
livery. In the past 3 months we have treated around 10 patients, out of this 4
single session treatments and rest multiple sessions up to 6 fractions. Overall
experience is promising and satisfactory to the entire treatment team.
Conclusion: Total Body Irradiation using Tomotherapy is quick, easy to set up,
re-position, verify and execute treatment. Our institutional experience shows
promising results.
Keywords: TBI, BMT, Radiotherapy, Radixact
Patient dose from conventional 2-dimension mammography
and combined tomosynthesis techniques: a comparative study
with the Diagnostic Reference Levels
P Khampukdee 1, D Chomchan 1, N Pongnapang 2
1 - Imaging Center, Vimut Hospital, Bangkok, Thailand
2 - Department of Radiological Technology, Faculty of Medical
Technology, Mahidol University, Siriraj Hospital, Bangkok,
Thailand
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