ORIGINAL_ARTICLE Background: The grid size in radiotherapy can have an impact on dose values. When calculating the dose, slice width is a crucial component to consider. A thinner slice provides for a more precise mean dose estimate than a thicker slice. Materials and Methods: For this study, 35 patients with Head and Neck (H&N) cancer were chosen. Planning Target Volume (PTV) and Organ At Risks (OARs) were optimized using the same criteria. Intensity Modulated Radiation Therapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans, which were designed with slice thicknesses (3,5,7 mm) and grid sizes (2,3,5, 7 and 8 mm). Homogeneity (HI) and Conformity Index (CI), dose points, such as D2%, D50%, and D98% for each OAR, assessed in relation to slice thickness and grid size. Results: There is a substantial difference (p<0.05) between grid sizes 3mm, 5mm, 7mm, and 8mm in IMRT and VMAT, but no significant difference (p>0.05) in target and OAR dose between grid sizes 2mm and 3mm. Conversely, the target dosage and OAR dose are significantly affected by variations in the Computed Tomography (CT) slice thickness, with a significant difference (p<0.05) seen in the target dose between 3mm, 5mm, and 7mm slice thickness and an insignificant difference (p>0.05) between 5mm and 7mm in OAR dose. Conclusions: According to this study, using the grid size of 2 mm is not recommended because it generates memory issues in the treatment planning system (TPS) and takes a lot of time, neither of which have a practical clinical effect. http://ijrr.com/article-1-6222-en.pdf 2025-07-16 263 270 10.61186/ijrr.23.2.1 Radiotherapy intensity modulated radiotherapy planning radiotherapy dosage computer-assisted tomography. N. Ayman 1 Radiotherapy Department, Nasser Institute, Cairo, Egypt AUTHOR A. Abdelaal 2 Radiotherapy Department, Nasser Institute, Cairo, Egypt AUTHOR H.H. Amer 3 Biophysics Department, Faculty of Science, Cairo University, Giza, Egypt AUTHOR H.S. Mohammed haitham@sci.cu.edu.eg 4 Biophysics Department, Faculty of Science, Cairo University, Giza, Egypt AUTHOR

ORIGINAL_ARTICLE Background: In this study, it was aimed to evaluate the radiation doses to the heart and uncommon critical organs such as left anterior descending (LAD) and brachial plexus (BP), in breast cancer patients irradiated with tomotherapy. Methods and Materials: Eighty patients with primary breast cancer received whole breast and supraclavicular region radiotherapy (RT) with helical tomotherapy were evaluated. The patients were divided into 4 groups according to the surgical procedure performed right mastectomy (RM-Group 1), left mastectomy (LM-Group 2), right breast-conserving surgery (R-BCS) (Group 3), and left breast-conserving surgery (L-BCS-Group 4). The homogeneity index (HI) for target volume, total volume (V), maximum doses (Dmax), and mean doses (Dmean) for LAD and ipsilateral BP and V, Dmean, V5 (volume of received 5 Gy) and V25 (volume of received 25 Gy) were determined for the heart to all groups. Results: According to the results, HI’s were almost the same in all groups (~1.08). Although the dosimetric parameters for the heart were higher in the left breast irradiations there was a statistical difference between the groups. Dosimetric parameters of LAD are also similar to cardiac dose. However, the increase in the left breast is more pronounced. The brachial plexus dose parameters of all groups were close to each other. Conclusion: It is recommended that the brachial plexus dose should be included in routine dosimetric evaluation in terms of minimizing the risk of radiation-induced plexopathy. Also, the LAD dose should be evaluated with the heart dose to reduce the cardiotoxic effects that may occur after radiotherapy. http://ijrr.com/article-1-6223-en.pdf 2025-07-16 271 276 10.61186/ijrr.23.2.2 Breast cancer radiotherapy heart left anterior descending brachial plexus tomotherapy. S. Barlaz Us barlaz@gmail.com 1 Department of Radiation Oncology, School of Medicine, Mersin University, Mersin, Turkey AUTHOR E.B. Yilmaz 2 Department of Radiation Oncology, School of Medicine, Mersin University, Mersin, Turkey AUTHOR Y. Balci 3 Department of Radiology, School of Medicine, Mersin University, Mersin, Turkey AUTHOR M.B. Çelik 4 Department of Radiation Oncology, School of Medicine, Mersin University, Mersin, Turkey AUTHOR

ORIGINAL_ARTICLE Background: The study aims to explore the relationship between tumor parameters acquired from Ga-68 PSMA PET/CT and GG system in patients who had prostate cancer. Materials and Methods: One hundred and fourteen patients diagnosed with prostate cancer and who underwent Ga-68 PSMA PET/CT imaging for staging purposes were enrolled. The imaging was performed using a Siemens Biograph Horizon-3R 16 slice PET/CT device, and the tumor parameters (SUVmax, SUVmean, and Tumor volume) were calculated by an experienced nuclear medicine physician. Results: There was a correlation between GG with SUVmax (p:0.010; r:0.241) and SUVmean (p:0.06; r:0.258). In redicting high-risk patients, ROC analysis was conducted for SUVmax and SUVmean, resulting in significant cut-off values for both parameters. A cut-off value of 9.8 for SUVmax resulted in a sensitivity of 69% and a specificity of 58%. 5.8 cut-off value for SUVmean resulted in 68% sensitivity  and 58% specificity. Tumor volume was found to be a significant predictor for distant metastasis. When a cut-off value of 11.53 cm3 was used for tumor volume, sensitivity was found to be 62% and specificity 56%. Conclusion: According to the results, correlation between GG with SUVmax and SUVmax was significant. Additionally, SUVmax and SUVmean were significant predictors of high-risk prostate cancer, while TV was a significant predictor of distant metastases. In summary, Ga-68-PSMA PET CT are deemed a beneficial imaging modality for both prognosis assessment and staging in clinical. http://ijrr.com/article-1-6224-en.pdf 2025-07-16 277 281 10.61186/ijrr.23.2.3 Ga-68 PSMA PET/CT prostate cancer pathological grade grouping. F. Demir drfadimedemir@hotmail.com 1 Department of Nuclear Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey AUTHOR S. Karaçavuş 2 Department of Nuclear Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey AUTHOR H. Gençer 3 Department of Nuclear Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey AUTHOR A. Özdal 4 Department of Nuclear Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey AUTHOR Z. Erdoğan 5 Department of Nuclear Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey AUTHOR İ. Çiftçi 6 Department of Nuclear Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey AUTHOR F. Çevik Kaya 7 Department of Pathology, Kayseri Training and Research Hospital, Kayseri, Turkey AUTHOR N. Özhan 8 Department of Oncology, Kayseri Training and Research Hospital, Kayseri, Turkey AUTHOR H. İşçi 9 Department of Nuclear Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey AUTHOR M. Kaya 10 Department of Nuclear Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey AUTHOR

ORIGINAL_ARTICLE Background: Radon (222Rn) and carcinogenic metals are major contaminants in groundwater wells. This research aimed on evaluating the possible lifetime cancer linked with the presence of radon and carcinogenic metals in groundwater wells situated close to a limestone quarry in Ewekoro, Ogun State, Nigeria. Materials and Methods: Twenty (20) groundwater wells near a limestone quarry were sampled for water sample collection. Radon levels in water were assessed utilizing CR-39 detectors, whereas concentrations of carcinogenic metals were analyzed via atomic absorption spectrometry. The resultant data facilitated the estimation of potential lifetime cancer risks for adults exposed to water from these wells. Results: The measured radon concentrations varied between 2.16±1.7 and 11.88±1.6 Bql-1, with an average of 6.67 ± 2.15 Bql-1 across the 20 samples. A significant portion, 81%, of the samples exhibited radon concentrations below the permissible limit of 11.1 Bql-1 fixed by the United States Environmental Protection Agency (USEPA). The annual effective dose (AED) attributable to inhaled and ingested radon ranged from 5.44±4.3 to 29.94±4.0 μSvy-1 and 15.77±13.9 to 86.72±11.7 μSvy-1, respectively. The collective AED across all water sample sources varied from 21.21±16.7 to 116.67±15.7 μSvy-1, with average values of 65.434±10.4 μSvy-1. The cumulative incremental lifetime cancer risk related to the ingested carcinogenic metals adults ranged from 9.70 ×10-5 to 1.03×10-4 with a mean value of 9.72 ×10-5. Conclusion: Water wells situated closer to the limestone quarry exhibited higher mean radon concentrations, while those farther away from the quarry maintained mean radon concentrations below the acceptable limits provided by the World Health Organization (WHO) and the USEPA. http://ijrr.com/article-1-6225-en.pdf 2025-07-16 283 289 10.61186/ijrr.23.2.4 Radon Heavy Metals Cancer Risks Groundwater Limestone Quarry. D. Oluwaseun dosunmusg@gmail.com 1 Department of Physics, Federal University of Agriculture, Abeokuta 110001, Nigeria AUTHOR O. Inioluwa 2 Science Laboratory Technology Department, The Federal Polytechnic, Ilaro, Nigeria AUTHOR A.K. Ademola 3 Physical Sciences Department, Bells University of Technology, Ota 112212, Nigeria AUTHOR

ORIGINAL_ARTICLE Background: The Cone beam computed tomography (CBCT)-based planning is an effective approach and can act as an indicator for adaptive radiotherapy. This study assesses the dosimetric impact of Acuros in comparison to the anisotropic analytical algorithm (AAA) in kilo voltage-CBCT dose calculation using protocol-specific calibration and Hounsfield unit (HU) override techniques. Materials and Methods: In this study, three anatomical sites—pelvis, head and neck and thorax—were considered for evaluation. The anthropomorphic phantoms used were the BrainLab pelvis phantom, Accuray’s head phantom, and an indigenously developed thorax phantom, respectively. Results: In the prostate case, the maximum difference between AAA and Acuros was 0.3% for protocol-specific calibration and 0.6% for HU override. In the head and neck case, the differences were 1.1% and 0.9% for the respective techniques. In the study on lung tumors, there was an 8% underestimation in the ipsilateral lung mean dose for the protocol-specific CBCT calibration with Acuros, compared to a 0.6% overestimation with AAA. Compared with the EBT3 film dose profile, the mismatch was evident, with Acuros showing greater accuracy over AAA. Conclusion: The dosimetric accuracy of CBCT-based dose calculation is affected by the choice of dose calculation algorithm for a given image quality and technique. The effect of the dose calculation algorithm depends on site-specific inhomogeneity: it is least for the pelvic region and significant for the head and neck and thorax regions. Acuros appears to be much more effective than AAA in accounting for the image quality differences of CBCT. http://ijrr.com/article-1-6226-en.pdf 2025-07-16 291 296 10.61186/ijrr.23.2.5 Cone-beam computed tomography Acuros XB Anisotropic analytical algorithm. C.O. Clinto clintoco@gmail.com 1 Department of Physics, Noorul Islam Centre for Higher Education, Kumaracoil, Tamil Nadu, India AUTHOR B. Bindhu 2 Department of Physics, Noorul Islam Centre for Higher Education, Kumaracoil, Tamil Nadu, India AUTHOR

ORIGINAL_ARTICLE Background: To investigate the effects of laparoscopic ultrasound (LUS)-guided microwave ablation (MWA) combined with surgical resection on liver function and immune function of primary liver cancer (PLC) patients. Materials and Methods: Clinical data of 100 patients with PLC after surgery in our hospital from January 2021 to December 2023 were retrospectively analyzed, and divided into laparoscopic hepatectomy (LH group) and laparoscopic ultrasound-guided microwave ablation combined with laparoscopic hepatectomy (LMWA+LH group). Clinical indicators, clinical efficacy, liver function, tumor markers, immune function, incidence of complications, postoperative overall survival rate along with tumor free survival rate between groups were compared. Results: Compared with the LH group, the intraoperative blood loss and postoperative hospital stay was decreased in the LMWA+LH group (P<0.05). Total effective rate of the LMWA+LH group was 90.00%, higher than the 70.00% in LH group (P<0.05). After therapy, reduction in aspartate alanine aminotransferase (ALT), aminotransferase (AST), total bilirubin (TBIL), and the elevation in albumin (ALB) in the LMWA+LH group were more obvious (P<0.05). The LMWA+LH group showed more obvious elevation in CD4+ and CD4+/CD8+ levels and reduction in CD8+ level relative to the LH group (P<0.05). The complication incidence showed no statistical difference between groups (P>0.05). Postoperative survival and tumor free survival rates in the LMWA+LH group were higher than LH group (P<0.05). Conclusion: Laparoscopic ultrasound-guided microwave ablation combined with surgical resection promotes the postoperative recovery, improves liver function and immune function and improves patient survival rate, which might provide guidance for clinical practice. http://ijrr.com/article-1-6231-en.pdf 2025-07-16 297 305 10.61186/ijrr.23.2.6 IMRT Primary liver cancer ultrasonography microwave ablation hepatectomy liver function immune function. L. Zhu 1 Department of Ultrasonic Medicine, Yichun City People's Hospital, Yichun 336000, Jiangxi, China AUTHOR L. Chen LICHEN7006@163.com 2 Department of Ultrasonic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China AUTHOR C. Du 3 Department of Ultrasonic Medicine, Yichun City People's Hospital, Yichun 336000, Jiangxi, China AUTHOR N. Tao 4 Department of Ultrasonic Medicine, Yichun City People's Hospital, Yichun 336000, Jiangxi, China AUTHOR J. Pan 5 Department of Ultrasonic Medicine, Yichun City People's Hospital, Yichun 336000, Jiangxi, China AUTHOR

ORIGINAL_ARTICLE Background: The design of this work was to explore the feasibility of optimizing computed tomography (CT) portal vein image quality and radiation dose by virtual single-energy imaging technology. Materials and Methods: Nighty-two patients who underwent dual-source CT (DSCT) examination in our hospital from September 2021 and August 2022 were selected as the study objects. They received CT scanning (90/Sn150 kV) and the images of 40 keV to 100 keV and M_0.6 linear fusion were obtained. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), subjective image quality, and radiation dose of different models were calculated. Results: Statistical significance in the subjective score of image quality was tested among all groups, and the 40 keV group had the highest score. The SD values in 40 keV to 60 keV were elevated, while were declined in 80 keV to 100 keV compared with the M_0.6 fusion image. CNR values in 40 keV to 70 keV groups were significantly higher, and in 90 keV to 100 keV were lower than those in M_0.6 group. SNR in the 40 keV group was significantly better than that in M_0.6 group. The average radiation doses were 6.12 ± 1.30 CTDIvol (mGy) and the radiation dose length product (DLP) was 304.3 ± 87.67 (mGy.cm). Conclusion: DSCT virtual single energy reconstruction technology could greatly improve image quality, and 40 keV single energy reconstruction had the best image quality. http://ijrr.com/article-1-6232-en.pdf 2025-07-16 305 309 10.61186/ijrr.23.2.7 Computed tomography radiographic image enhancement portal vein radiation dosage signal-to-noise ratio. X. Li 1 Department Radiology Department, Beijing Shijitan Hospital, Beijing 100038, China AUTHOR Z. Liang 2 Department Radiology Department, Beijing Shijitan Hospital, Beijing 100038, China AUTHOR Y. Duan 3 Department Radiology Department, Beijing Shijitan Hospital, Beijing 100038, China AUTHOR W. Liu 4 Department Radiology Department, Beijing Shijitan Hospital, Beijing 100038, China AUTHOR Z. Han 5 Department Radiology Department, Beijing Shijitan Hospital, Beijing 100038, China AUTHOR R. Wang wangrenguibj@163.com 6 Department Radiology Department, Beijing Shijitan Hospital, Beijing 100038, China AUTHOR

ORIGINAL_ARTICLE Background: The To evaluate the value of imaging techniques based on enhanced magnetic resonance imaging (MRI) in diagnosing and predicting radiotherapy for nasopharyngeal carcinoma (NPC). Materials and Methods: This study analyzed 142 hospitalized patient's clinical data with nasopharyngeal carcinoma from March 2020 to December 2021. The patients were divided into valid and invalid groups. Preoperative T2 weighted image (T2WI) images were used for imaging analysis, feature texture parameters were screened based on R language, and a short-term efficacy prediction model for the training group and the validation group was constructed. Results: A total of 432 different texture parameters were obtained by T2WI image analysis of each patient and 5 characteristic texture parameters were obtained by Least Absolute Shrinkage and Selection Operator (LASSO) dimensionality reduction and 10-fold cross-validation screening. Specific examples were standard deviation, Cluster Prominence Angle 135 Offset 4, Correlation Angle 135 offset 4, Inertia Angle 135 Offset 4. The prediction models were constructed and the area under the receiver operating characteristic (ROC) curve of the training group model was 0.826 (95% Confidence intervals (CI): 0.708-0.944). The sensitivity and specificity were 83.67% and 69.14%, respectively. The area under the ROC curve of the validation group model was 0.810 (95% CI: 0.682-0.938) and the sensitivity and specificity were 89.46% and 63.29%, respectively. Conclusion: The prediction model constructed has high predictive accuracy, sensitivity and specificity for diagnosing nasopharyngeal carcinoma. The use of enhanced magnetic resonance imaging (MRI)-based imaging to predict the short-term outcome after radiotherapy for NPC was feasible and the prediction model was stable and reliable. http://ijrr.com/article-1-6233-en.pdf 2025-07-16 311 316 10.61186/ijrr.23.2.8 Magnetic resonance imaging nasopharyngeal carcinoma diagnosis radiotherapy. X. Liu 1 Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou City, China AUTHOR H. Pang 2 Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou City, China AUTHOR H. Zhou 3 Post-graduation Training Department, West China Hospital, Sichuan University, Luzhou City, China AUTHOR J. Li 4 Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou City, China AUTHOR X. Lu 5 Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou City, China AUTHOR Y.R. Wang 6 Nursing School Of Southwest Medical University, Luzhou City, China AUTHOR P. Zhou zhouping11@swmu.edu.cn 7 Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou City, China AUTHOR Y. Zhang zy258789@aliyun.com 8 Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou City, China AUTHOR

ORIGINAL_ARTICLE Background: SUV values from PET/CT can reflect disease progression; however, there are few detailed and comprehensive studies. In this study, we hope to provide data to complement the analysis of diagnostic indicators for NSCLC, LUAD, and LUSC by analyzing the correlation between SUVmax and various pathological parameters. Patients and Methods: Patients (n=298) with lung lesions were retrospectively studied and clinicopathological index of these patients were collected. Radiomics texture features were extracted by PET/CT scanning and histological features of each patient was collected. The values of SUVmax were obtained and the inner correlation was analyzed. Evaluation and scoring were performed by calculating area under the curve (AUC), sensitivity, specificity and accuracy. Results: PET data were counted and analyzed for positive/negative relationship between SUV value and T stage and histology (P<0.05). Mean SUVmax was 13.32±6.41 mm; the SUVmax was 14.01±5.72 for male and 11.19±7.95 for female. The results showed that LUSC tumors were smaller and more homogeneous, but with more uptake and greater PET variability. In contrast, LUAD have lower and weaker uptake, variability and homogeneity. Conclusion: By meticulously grouping nearly 300 NSCLC samples, AUC values were calculated to indicate the diagnostic value in NSCLC, LUAD and LUSC. It provides ideas and basis for pathological staging analysis of NSCLC. http://ijrr.com/article-1-6312-en.pdf 2025-07-16 317 327 10.61186/ijrr.23.2.9 Non-small cell lung cancer (NSCLC) neoplasm histological type 18F-FDG area under curves (AUC) diagnose. Y. Sheng zjjhsyj@163.com 1 Pulmonary and Critical Care Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, China AUTHOR R. Zhou 2 Pulmonary and Critical Care Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, China AUTHOR

ORIGINAL_ARTICLE Background: Exploring the efficacy of levonorgestrel intrauterine contraceptive system combined with hysteroscopic resection for the treatment of early and highly differentiated endometrial cancer in young patients and its impact on reproductive function. Materials and Methods: According to the grouping method, the patients were divided into a single hysteroscopy group and a combined progesterone group, with 77 patients in each group. Among them, the single hysteroscopy group received hysteroscopic resection surgery, while the combined progesterone group received levonorgestrel intrauterine contraceptive system treatment on hysteroscopic resection surgery beside radiation. Results: After treatment, endometrial thickness, uterine volume and myoma volume were lower in the combined treatment group than in the intrauterine sustained release group (P<0.05); after treatment, estradiol, FSH and progesterone levels were lower in the combined treatment group compared with the intrauterine sustained release group (P<0.05); after treatment, Hb and VEGF levels were lower in the combined treatment group compared with the intrauterine sustained release group (P < 0.05); after treatment, compared with the intrauterine sustained release group, Hb and VEGF levels were lower in the combined treatment group (P<0.05);Compared with the intrauterine sustained release group, the dysmenorrhea score and CA125 expression level in the combined treatment group were lower (P<0.05); compared with the intrauterine sustained release group, the effective rate of the combined treatment group was higher (P<0.05). Conclusion: The application of mifepristone combined with levonorgestrel intrauterine sustained release system in the treatment of patients with uterine fibroids can effectively improve the symptoms of patients, alleviate clinical symptoms, alleviate dysmenorrhea, effectively inhibit the further development of the disease, reduce the expression level of CA125, improve the prognosis of patients, and have a significant therapeutic effect. http://ijrr.com/article-1-6313-en.pdf 2025-07-16 329 334 10.61186/ijrr.23.2.10 Endometrial cancer levonorgestrel intrauterine contraceptive system hysteroscopic electrocision fertility function radiotherapy. P. Lian 1 Department of Nursing College of Changsha Health Vocational College, Changsha, Hunan410600, China AUTHOR H. Xu 2 Department of Oncology, Ezhou Central Hospital, Ezhou, Hubei436000, China AUTHOR S. Liu 3 AUTHOR H. Qian medicalsciences.paper@gmail.com 4 Department of Gynecology, Hubei Geological Hospital, Wuhan, Hubei 430000, China AUTHOR

ORIGINAL_ARTICLE Background: This study assessed the efficacy of HyperArc planning for whole-brain radiation therapy (WBRT) with hippocampal sparing, comparing it to conventional coplanar volumetric modulated arc therapy (VMAT) techniques using high-definition multileaf-collimators (HDMLC) and millennium MLC (MMLC). Materials and Methods: In this retrospective study, 25 patients with brain metastases received hippocampus-sparing WBRT by RTOG-0933 trial guidelines. Three treatment plans (HyperArc, VMAT-HDMLC, VMAT-MMLC) were created using Eclipse v16.1 Treatment Planning System (TPS), with a prescribed dose of 30Gy in 10 fractions. The Dosimetric parameters assessed included D98%, D2%, HI, Dmax for PTVeval, and Dmax, Dmean, and D100% for hippocampus and other critical structures. Additionally, Monitor Units (MUs) and delivery checks using portal dosimetry were considered. Results: All plans met RTOG-0933 criteria for PTV and OARs. HyperArc matched VMAT-HDMLC in D98% (28.41 Gy vs. 28.38 Gy), outperforming VMAT-MMLC (28.04 Gy). HyperArc surpassed both VMAT techniques in D2% (32.83 Gy vs. 33.24 Gy vs. 34.06 Gy), HI (0.14 vs. 0.15 vs. 0.18), and Dmax (34.84 Gy vs. 35.5 Gy vs. 36.36 Gy). In hippocampus sparing, HyperArc achieved lower Dmax (12.99 Gy vs. 13.73 Gy vs. 14.76 Gy), Dmean (9.58 Gy vs. 10.23 Gy vs. 10.64 Gy), and D100% (8.25 Gy vs. 8.70 Gy vs. 8.85 Gy) values. Further, the HyperArc method provided better organ-at-risk sparing and higher gamma results. Conclusion: All three methods met RTOG-0933 dosimetric goals, with HyperArc outperforming VMAT. Optimized VMAT collimator angles at 0° and 90° improved organ-at-risk doses, exceeding conventional planning in PTV coverage and hippocampal sparing. http://ijrr.com/article-1-6314-en.pdf 2025-07-16 335 339 10.61186/ijrr.23.2.11 Whole brain radiotherapy hippocampus avoidance HyperArc VMAT MLC. S. Muthu 1 Department of Physics, School of Advanced Sciences, Vellore Institute of Technology, Chennai, India AUTHOR G. Mudhana 2 Department of Physics, School of Advanced Sciences, Vellore Institute of Technology, Chennai, India AUTHOR

ORIGINAL_ARTICLE Background: The differential diagnosis of lung cancer (LC) and benign lung tumors is challenging in clinic. Spiral computed tomography (CT) and X-ray are commonly utilized imaging techniques. Accordingly, the practical significance of CT and X-ray imaging in the differential identification of benign versus malignant pulmonary neoplasms was explored. Materials and Methods: A retrospective analysis was performed on data from 105 patients who had undergone both CT and X-ray examinations to evaluate variations in peripheral blood tumor markers. The imaging features of benign and malignant lung tumors were compared, and the diagnostic efficacy of CT and X-ray was assessed. Results: CT examination of patients with unilateral lung tumors or lung insufficiency demonstrated a greatly higher detection rate of speculated lesions compared to X-ray. Additionally, tumor markers showed a positive correlation with tumor size. The positive rate for differential diagnosis using CT was notably superior to that of X-ray (P<0.05). The sensitivity (Sen), specificity (Spe), accuracy (Acc), positive predictive value, and negative predictive value of CT and X-ray in differential diagnosis were 86.4%, 68.3%, 94.9%, 74.4%, 89.5%, 70.5%, 96.6%, 81.8%, 80.4%, and 58.0%, respectively. CT was considerably more valuable for differential diagnosis (P<0.05). Conclusion: X-ray and CT scans serve as pivotal diagnostic tools for distinguishing between benign and malignant pulmonary neoplasms. CT has a better effect in the differential diagnosis of lung tumors, and its imaging performance is more comprehensive, which is worthy of clinical application. http://ijrr.com/article-1-6392-en.pdf 2025-07-16 341 347 10.61186/ijrr.23.2.12 lung tumor CT X-ray differential diagnosis. B. He 1 epartment of Radiology, the Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), Shaoxing 312000, Zhejiang Province, China AUTHOR J. Xu 2 Department of Radiology, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China AUTHOR L. Wang 3 epartment of Radiology, the Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), Shaoxing 312000, Zhejiang Province, China AUTHOR B. Li 4 epartment of Radiology, the Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), Shaoxing 312000, Zhejiang Province, China AUTHOR X. Xu 472184496@qq.com 5 epartment of Radiology, the Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), Shaoxing 312000, Zhejiang Province, China AUTHOR

ORIGINAL_ARTICLE Background: The aim of this study was to investigate the effects of ozone and melatonin interventions on anti-oxidant effects and enzymatic parameters in the liver and kidneys of mice experiencing busulfan-induced injury, a common chemotherapy-related condition known to severely affect these organs. Materials and Methods: The research included 24 male mice were randomly assigned in four groups of six mice each: a control group without any intervention, busulfan group, busulfan with melatonin group, and busulfan with ozone group. This experimental setup spanned seven days. After a 35-day period, blood, liver and kidney tissues were extracted for the assessment of various parameters, such as super oxide dismutase (SOD), catalase, total antioxidant capacity (TAC), malondialdehyde, and tissue creatinine. Results: Busulfan administration resulted in a decrease in SOD, catalase, and TAC levels, along with an increase in malondialdehyde levels in both the kidneys and liver. Additionally, Busulfan led to elevated ALT levels and decreased AST in liver tissue, as well as increased BUN and tissue creatinine in the kidneys. However, the introduction of ozone and melatonin ameliorated these effects across all parameters. Notably, ozone exhibited a stronger impact on catalase, TAC, and malondialdehyde in both organs. Moreover, ozone showed pronounced effects on ALT and AST in the liver and on creatinine in the kidneys. Conclusion: Both melatonin and ozone show promise in ameliorating Busulfan-induced injury. Interestingly, ozone appears to exhibit greater efficacy in enhancing kidney and liver function in such cases. http://ijrr.com/article-1-6393-en.pdf 2025-07-16 349 355 10.61186/ijrr.23.2.13 Busulfan melatonin ozone oxidative stress liver kidney. R. Dadfar 1 Department of Anatomical Sciences, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran AUTHOR T. Safari 2 Department of Histology, Faculty of Veterinary Medicine Department of Basic Sciences, Shahid Chamran University of Ahvaz, Iran AUTHOR M. Taheri Moghadam taherimoghadam-m@ajums.ac.ir 3 Department of Anatomical Sciences, Faculty of Medicine, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran AUTHOR

ORIGINAL_ARTICLE Background: Background: While conventional ultrasound (US) remains the first-line diagnostic tool, its limitations in distinguishing benign from malignant nodules necessitate exploring complementary techniques. This study aimed to evaluate the potential of integrating contrast-enhanced ultrasound (CEUS) and ultrasound elastography (UE) alongside conventional US to improve diagnostic accuracy compared to individual modalities. Materials and Methods: This retrospective analysis was conducted at Tangshan people's Hospital. We enrolled 180 consecutive patients diagnosed with thyroid nodules between January 2021 and December 2022. All participants underwent comprehensive ultrasound examinations comprising conventional US, CEUS, and UE. Fine-needle aspiration biopsy (FNAB) or surgical specimens were the gold standard for definitive diagnosis. Patients with inconclusive diagnoses or incomplete examinations were excluded. Results: Conventional US (ACR TI-RADS) achieved an AUC of 0.802, excelling in detecting suspicious features but suffering from inherent subjectivity. CEUS, with an AUC of 0.854 and a remarkable sensitivity of 95.29%, captured specific malignant patterns like centripetal enhancement and uneven distribution, but its reliance on contrast limited its applicability. UE provided an area under the curve (AUC) of 0.845 and valuable information about tissue stiffness, but its efficacy was influenced by nodule size and location. However, the true strength emerged when combining all three modalities. Multimodal ultrasound yielded an impressive AUC of 0.958 and a sensitivity of 91.76%, significantly surpassing individual performances. Conclusion: Our findings demonstrate that multimodal ultrasound, integrating conventional US, CEUS, and UE, significantly outperforms individual modalities in diagnosing thyroid nodules. Further research is warranted to refine and optimize this promising diagnostic strategy to benefit patients with thyroid nodules. http://ijrr.com/article-1-6394-en.pdf 2025-07-16 357 364 10.61186/ijrr.23.2.14 Thyroid nodules multimodal ultrasound differential diagnosis application value. J. Zhai 15832577787@163.com 1 Head and Neck Cancer Surgery, Tangshan people's Hospital, Tangshan City, Hebei Province, China AUTHOR J. Li 2 Head and Neck Cancer Surgery, Tangshan people's Hospital, Tangshan City, Hebei Province, China AUTHOR

ORIGINAL_ARTICLE Background: In the management of breast cancer, radiotherapy plays a crucial role, especially in managing local tumor control. To achieve the best possible outcomes while fully protecting normal tissues, it is important to consider anatomic variations, which can differ between individuals and significantly impact treatment field designs. Materials and Methods: The study involved 40 patients with breast cancer who underwent breast-conserving surgery (BCS) and received both whole breast and lymph node irradiation. The study evaluated the impact of anthropometric characteristics including weight, mid-sternum thickness, Haller index, central lung distance (CLD), and breast volume on the doses of organs at risk (OARs). Results: Breast size was found to be an important factor in determining lung doses. Patients with larger breasts had higher ipsilateral lung doses compared with those with small or medium-sized breasts. On the other hand, patients with mid-sternum thickness above 1.7 cm had higher contralateral breast doses. As expected, patients who received internal mammary nodal irradiation had higher lung doses and contralateral breast doses compared with those who did not. Conclusions: In the radiotherapy of breast cancer, it is important to consider treatment portal designs based on anthropometric variables to reduce the doses of organs at risk. Contralateral breast doses in patients with high mid-sternum thickness and lung doses in patients with large breasts should be carefully and treatment options should be evaluated accordingly. http://ijrr.com/article-1-6395-en.pdf 2025-07-16 365 370 10.61186/ijrr.23.2.15 Breast cancer radiotherapy anthropometry heart dose lung dose. T. Koca timurkoca3@gmail.com 1 Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey AUTHOR Y. Sengun 2 Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey AUTHOR E. Atak 3 Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey AUTHOR M.G. Aksu 4 Department of Radiation Oncology, Antalya Yaşam Hospital, Antalya, Turkey AUTHOR N. Tuncel 5 Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey AUTHOR A.F. Korcum 6 Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey AUTHOR

ORIGINAL_ARTICLE Background: Task-based functional magnetic resonance imaging (fMRI) is an effective method for noninvasively studying brain activity. We aim to find representative brain areas of the swallowing movement and compare the functional connectivity differences in these areas. Materials and Methods: A total of 23 participants were recruited to undergo task-based fMRI scans. Subject-level statistical analysis and group-level activation analysis were conducted using SPM12. Seed-based Functional Connectivity (FC) analyses were conducted to construct FC in brain level. We used two-sample t-test to identify distinctive FC patterns in various seeds. The relationship between FC values and swallowing frequency was also explored. Results: In experiment I, group-level activation patterns were observed in 30-second saliva swallowing trial task, but not in 18s-on task. Two sample t-tests showed that the seed located in right pericentral area (Seed3) had significantly more intensive FC than that located in cingulum (Seed5) with left postcentral gyrus, the seed located in left pericentral area(Seed4) had significantly more intensive FC than those located in cerebellum(Seed1,2) or in Seed5 with right postcentral gyrus, Seed5 had significantly more intensive FC than Seed1,2,4 with right middle frontal gyrus, right superior frontal gyrus and left supplementary motor area separately. No significant positive or negative correlations between swallowing frequency and seed-based FC values were found. Conclusions: Saliva swallowing trail task with self-paced rhythm in sufficient time can activate swallowing-related brain regions effectively. The activation peaks in bilateral pericentral area are representative in swallowing process and could be new therapeutic targets for poststroke dysphagia instead of traditional route. http://ijrr.com/article-1-6396-en.pdf 2025-07-16 371 378 10.61186/ijrr.23.2.16 Functional magnetic resonance imaging (fMRI) Brain activation seed-based functional connectivity therapeutic targets. M. Chen evonne_myi@163.com 1 Affiliated Hospital of Hangzhou Normal University, Hangzhou, China AUTHOR Y. Chen 2 Zhejiang University, School of Medicine, Hangzhou, China AUTHOR X. Wang 3 Affiliated Hospital of Hangzhou Normal University, Hangzhou, China AUTHOR X. Ye 4 Affiliated Hospital of Hangzhou Normal University, Hangzhou, China AUTHOR Z. Huang 5 Affiliated Mental Health Center, Zhejiang University, School of Medicine, Hangzhou, China AUTHOR W. Wu 6 Hangzhou Normal University, Hangzhou, China AUTHOR

ORIGINAL_ARTICLE Background: Computed tomography (CT) is a crucial technique in clinical practice for diagnosing thoracic pathologies. However, the risk associated with ionizing radiation requires measures to reduce patient exposure. Materials and Methods: This study aims to optimize thoracic CT protocols on a multislice CT scanner, using both objective and subjective analyses of image quality to decrease radiation dose without compromising diagnostic accuracy. A 16-channel CT scanner with automatic tube current modulation (ATCM) was utilized, along with an analytical phantom for objective evaluation. Six protocols with different standard deviation values were selected, including three used in clinical routines and three additional ones for testing. Parameters such as spatial resolution, low contrast resolution, noise, and dosimetry were assessed. Subjective Image Quality evaluation was conducted through visual grading analysis (VGA). Results: Optimized protocols were selected based on acceptable image quality and dose results. Data were statistically analyzed, demonstrating that optimized protocols showed a significant reduction in radiation dose while maintaining adequate diagnostic quality. Conclusion: This study contributes to clinical practice by adhering to the ALARA (As Low As Reasonably Achievable) principles of dose reduction, ensuring accurate and safe diagnoses in thoracic CT examinations. http://ijrr.com/article-1-6397-en.pdf 2025-07-16 379 385 10.61186/ijrr.23.2.17 Computed tomography dose optimization image quality thoracic imaging. R.A.C. Guassu 1 Department of Physics and Biophysics, Sao Paulo State University Julio de Mesquita Filho, Institute of Bioscience, R. Prof. Dr. Antônio Celso Wagner Zanin, 250 - Distrito de Rubião Junior, Botucatu, Brazil AUTHOR .A. Santana Souza 2 Department of Physics and Biophysics, Sao Paulo State University Julio de Mesquita Filho, Institute of Bioscience, R. Prof. Dr. Antônio Celso Wagner Zanin, 250 - Distrito de Rubião Junior, Botucatu, Brazil AUTHOR M. Alvarez 3 São Paulo State University Julio de Mesquita Filho, Medical School, Av. Prof. Mário Rubens Guimarães Montenegro - UNESP, Botucatu, Brazil AUTHOR S.M. Ribeiro 4 São Paulo State University Julio de Mesquita Filho, Medical School, Av. Prof. Mário Rubens Guimarães Montenegro - UNESP, Botucatu, Brazil AUTHOR J.C.S. Trindade Filho 5 São Paulo State University Julio de Mesquita Filho, Medical School, Av. Prof. Mário Rubens Guimarães Montenegro - UNESP, Botucatu, Brazil AUTHOR D.R. Pina diana.pina@unesp.br 6 São Paulo State University Julio de Mesquita Filho, Medical School, Av. Prof. Mário Rubens Guimarães Montenegro - UNESP, Botucatu, Brazil AUTHOR

ORIGINAL_ARTICLE Background: To explore the therapeutic effect of helical tomotherapy (HT) and three-dimensional conformal radiotherapy (3DCRT) on locally advanced nasopharyngeal carcinoma (NPC) and the impact on patients' quality of life. Materials and Methods: Retrospectively, we analyzed data from 354 patients with locally advanced NPC who were admitted to our hospital from January 2015 to January 2019. Patients were divided into 3DCRT group and HT group with distinct therapy modality. The clinical efficacy, appetite changes and adverse reactions of the 2 groups were observed, and quality of life scale (SF-36) scores and 1-, 2- and 3-year survival ratios of the 2 groups at pre-therapy and post-therapy were compared. Results: the HT group exhibited a markedly superior objective remission rate (ORR) compared to the 3DCRT group (P<0.05), but the difference between the disease control rate (DCR) of the two groups was not statistically significant (P>0.05). Conclusion: HT radiotherapy for patients with locally advanced NPC shows precise advantages, which can effectively improve the clinical therapeutic effect of the patients. http://ijrr.com/article-1-6398-en.pdf 2025-07-16 387 395 10.61186/ijrr.23.2.18 Tomotherapy radiotherapy nasopharyngeal neoplasms patient outcome quality of life. Y. Wen 1 Department of Radiation Oncology, General Hospital of Southern Theatre Command, Pepole`s Liberation Army, Guangzhou City, 510010, China AUTHOR Y. Huang 2 Department of Radiation Oncology, General Hospital of Southern Theatre Command, Pepole`s Liberation Army, Guangzhou City, 510010, China AUTHOR W. Luo 3 Department of Radiation Oncology, General Hospital of Southern Theatre Command, Pepole`s Liberation Army, Guangzhou City, 510010, China AUTHOR X. Liang 4 Department of Radiation Oncology, General Hospital of Southern Theatre Command, Pepole`s Liberation Army, Guangzhou City, 510010, China AUTHOR Y. Cai 5 Department of Radiation Oncology, General Hospital of Southern Theatre Command, Pepole`s Liberation Army, Guangzhou City, 510010, China AUTHOR L. Sun 6 Department of Radiation Oncology, General Hospital of Southern Theatre Command, Pepole`s Liberation Army, Guangzhou City, 510010, China AUTHOR J. Zheng 18127950351@163.com 7 Department of Radiation Oncology, General Hospital of Southern Theatre Command, Pepole`s Liberation Army, Guangzhou City, 510010, China AUTHOR

ORIGINAL_ARTICLE Background: The positron emission tomography (PET) technology has undergone continuous innovation in recent years. New-technology digital PETs are silicon photomultiplier (SiPM) PET systems with digital readouts, which contribute to improved image resolution. This study aimed to compare the image quality of sub-centimeter lesions of NEMA PET phantom images obtained under identical imaging conditions (identical lesion volumes, identical activity and identical scanning time) using dPET, analog PET-1 and analog PET-2 acquired in the clinic. Materials and Methods: For image analysis, a standard NEMA IEC body phantom was used. In the present study, the lesion detection performance of all PETs was evaluated in two categories, sub- and over-centimeter size. The imaging durations of this study were 1, 2, 3, and 5 minutes, while the injection doses were 2.33 and 5.33 kBq/ml for the 1/4 and 1/8 background-to-lesion ratios, respectively. For a quantitative assessment of image quality, a circular ROI with activity concentrations (ACmean) and the mean recovery coefficient were calculated for each lesion via the ACmean. Results: Our study revealed approximately 15% greater RCmean values for dPET with SiPM technology compared to the analog PET-2 with PMT technology. However, analog PET-1 exhibited a significant lack of performance, especially when compared to analog PET-2 and dPET. Conclusion: Although dPET, the first generation of dPETs analyzed in the present study, yields relatively better RCmean values than analog PETs, it is not able to entirely eliminate the unfavorable impacts of PVE for sub-centimeter lesions. http://ijrr.com/article-1-6399-en.pdf 2025-07-16 397 405 10.61186/ijrr.23.2.19 Digital PET analog PET lesion detection capability image quality. M.C. Karaca mervecinoglu@gmail.com 1 Department of Health Physics, Graduate School of Health Sciences, İstanbul Medipol University, İstanbul, Türkiye AUTHOR M. Doyuran 2 Department of Health Physics, Graduate School of Health Sciences, İstanbul Medipol University, İstanbul, Türkiye AUTHOR T. Çakır 3 Department of Nuclear Medicine, School of Medicine, İstanbul Medipol University, İstanbul, Türkiye AUTHOR S. Karyağar 4 Department of Nuclear Medicine, Health Science University, Medical Faculty, Prof Dr Cemil Taşçıoğlu City Hospital, Istanbul, Türkiye AUTHOR M. Çağlar 5 Department of Health Physics, Graduate School of Health Sciences, İstanbul Medipol University, İstanbul, Türkiye AUTHOR

ORIGINAL_ARTICLE Background: To assess the accuracy, specificity, and sensitivity of dynamic contrast-enhanced magnetic resonance imaging (MRI) in assessing lymph node metastasis (LNM) and prognosis after cervical cancer surgery. Materials and Methods: Fifty cervical cancer patients admitted to our hospital from April 2022 to April 2023 were selected. 27 patients were in stage I-IIA and processed radical hysterectomy combined with pelvic lymph node dissection. Twenty-three patients were in stage IIB and beyond and underwent laparotomy with key site biopsy combined with pelvic lymph node biopsy. Postoperative pathological diagnosis was used as the gold standard for diagnosis. All patients underwent MRI scanning, including conventional MRI scanning such as DWI, T2WI, and T1WI of the pelvic cavity. Gadolinium-diethylene triamine pentaacetate (Gd-DTPA) was injected for dynamic contrast-enhanced scanning. The data of postoperative pathological staging, MRI staging, LNM, deep muscle layer invasion, and postoperative recurrence were analyzed. Results: There was no marked difference between MRI staging and postoperative pathological staging (P>0.05). When comparing preoperative clinical staging and MRI staging with postoperative pathological staging as the control group, there was no significant difference in accuracy. Both postoperative pathological diagnosis and MRI diagnosis had high specificity and sensitivity in assessing LNM and deep muscle layer invasion, but the differences were not significant (P>0.05). Conclusion: Dynamic contrast-enhanced MRI examination has high accuracy in assessing lymph node metastasis for cervical cancer patients. It has high sensitivity and specificity in assessing parametrial invasion, LNM, deep muscle layer invasion, and vaginal involvement, as well as has good prognostic value in assessing postoperative recurrence.  http://ijrr.com/article-1-6400-en.pdf 2025-07-16 407 411 10.61186/ijrr.23.2.20 Cervical neoplasm neoplasm metastasis magnetic resonance imaging prognosis. C.Y. Zheng 1 Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China AUTHOR Y.Y. Peng 2 Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China AUTHOR Z.Y. Zhang zhong71313852@163.com 3 Department of Radiology, Shanghai First Maternity and Infant Hospital, Shanghai, China AUTHOR X.M. Zhang zhangxinm@zju.edu.cn 4 Department of Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China AUTHOR

ORIGINAL_ARTICLE Background: The aim of this study is to investigate the shielding effect of the internal wall linings and laminated shield door on photoneutron and capture gamma doses at the isocenter and at the maze entrance of radiotherapy treatment rooms. Material and Methods: The Monte Carlo N-Particle Transport (MCNP5) code was used to simulate the radiotherapy room within a medical linear accelerator operating at 12, 15, 18, and 25 MV. The energy spectra of neutron and secondary gamma rays, with their corresponding dose equivalents, were calculated inside the bunker and at various points along the maze. To verify the accuracy of our Monte Carlo simulation, we compared our findings with those obtained through analytical methods recommended by (IAEA) safety report No.47. Once validated, the Monte Carlo simulation was used for assessing dose reduction by the room wall linings and the laminated shield door. Results: Our results showed that the use of paraffin wax infused with boron carbide within the lining of radiotherapy room walls reduces doses of both neutron and capture gamma radiation at the isocenter by up to 13% and 35.9%, respectively. However, the laminated shield door reduced significantly both neutron and capture gamma dose equivalents near the bunker door by up to 99.75% and 38.20%, respectively. Conclusion: The obtained results show that the use of neutron shielding material in the lining of the radiotherapy wall rooms reduces neutron and capture gamma radiation doses to the patient. While, the laminated shield door presents enough effectiveness in protecting the workers and general public.  http://ijrr.com/article-1-6401-en.pdf 2025-07-16 413 420 10.61186/ijrr.23.2.21 Radiotherapy radiation shielding neutrons gamma rays Monte Carlo method. F. Azairi 1 EPRA, Department of physics, Faculty of Sciences Semlalia, Marrakech, Morocco AUTHOR J. Ghassoun ghassoun@uca.ac.ma 2 EPRA, Department of physics, Faculty of Sciences Semlalia, Marrakech, Morocco AUTHOR R. Bechchar 3 EPRA, Department of physics, Faculty of Sciences Semlalia, Marrakech, Morocco AUTHOR S. Harif 4 EPRA, Department of physics, Faculty of Sciences Semlalia, Marrakech, Morocco AUTHOR S. Kabrane 5 EPRA, Department of physics, Faculty of Sciences Semlalia, Marrakech, Morocco AUTHOR

ORIGINAL_ARTICLE Background: The prediction of prostate motion is important for matching planned and delivered dose distributions in prostate radiotherapy. This study aimed to assess the relationship between anatomical characteristics and inter- and intra-fraction prostate motion. Materials and Methods: Sixty-six patients who underwent fiducial marker implantation were retrospectively evaluated. The anatomical characteristics (subcutaneous adipose tissue thickness, pelvic cavity volume, and fat volume of the lesser pelvis around the prostate), inter- and intra-fraction prostate motion, and standard deviations (SDs) in the anterior-posterior (AP), superior-inferior (SI), and left-right (LR) directions were determined, and their correlations were analyzed. Additionally, the three-dimensional (3D) distance between the coordinates of the center of gravity of the prostate and inferior margin of the symphysis pubis was calculated. Results: The pelvic cavity volume around the prostate exhibited a moderate correlation with the SD for inter-fraction prostate motion in the LR direction (r=0.47) and that for intra-fraction prostate motion in the AP and LR directions (r = 0.41, 0.52). The 3D distance between the coordinates of the center of gravity of the prostate and inferior margin of the symphysis pubis showed a moderate correlation with the average inter-fraction prostate motion in the AP direction (r=0.46). Conclusion: Prostate motion in the AP and LR directions may be related to the fat and pelvic cavity volumes around the prostate. The evaluation of anatomical characteristics can help predict patient-specific prostate motion during treatment planning. http://ijrr.com/article-1-6402-en.pdf 2025-07-16 421 426 10.61186/ijrr.23.2.22 Inter-fraction prostate motion intra-fraction prostate motion radiotherapy treatment planning volumetric modulated arc therapy anatomical characteristics. A. Nakamoto 1 Department of Radiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Yamaguchi, Japan AUTHOR Y. Tanabe tanabey@okayama-u.ac.jp 2 Faculty of Medicine, Graduate School of Health Sciences, Okayama University, 2-5-1 Shikata, Kita-ku, Okayama, Japan AUTHOR K. Nishioka 3 Department of Radiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Yamaguchi, Japan AUTHOR Y. Kunii 4 Department of Radiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Yamaguchi, Japan AUTHOR A. Higashi 5 Department of Radiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Yamaguchi, Japan AUTHOR H. Nishikawa 6 Graduate School of Health Sciences, Department of Radiological Technology, Okayama University, 2-5-1, Shikata, Kita, Okayama, Japan AUTHOR R. Kawano 7 Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, Japan AUTHOR H. Eto 8 Department of Radiology, Yamaguchi University Hospital, 1-1-1 Minami Kogushi, Ube, Yamaguchi, Japan AUTHOR Y. Fuji 9 Department of Radiology, Chugoku Central Hospital of the Mutual Aid Association of Public School Teachers, 148-13, Miyuki, Fukuyama, Hiroshima, Japan AUTHOR H. Aoyama 10 Division of Radiological Technology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, Japan AUTHOR S. Yamada 11 Department of Radiological Technology, Tsukuba International University, 6-20-1, Manabe, Tsuchiura, Ibaraki, Japan AUTHOR S. Takahashi 12 Department of Radiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Yamaguchi, Japan AUTHOR

ORIGINAL_ARTICLE Background: This study aims to evaluate the clinical efficacy of concurrent chemoradiotherapy for nasopharyngeal carcinoma (NPC) following induction chemotherapy (IC) with albumin-bound paclitaxel (ABP) combined with carboplatin, through the analysis of serum biomarkers and dynamic contrast-enhanced magnetic resonance imaging (MRI) data. Material and Methods: Ninety-six NPC patients were rolled into Group I (concurrent chemoradiotherapy) and Group II (IC with ABP and carboplatin+concurrent chemoradiotherapy). DCE-MRI scans were utilized to evaluate changes in lesion characteristics. Serum samples were collected to analyze tumor markers including cytokeratin 19 fragment antigen 21-1 (CYFRA21-1), SCC-associated antigen (SCC-Ag), and carbohydrate antigen 125 (CA-125), as well as superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) activity, and malondialdehyde (MDA) levels. Toxicities and 2-year overall survival (OS) and progression-free survival (PFS) were also assessed. Results: Group II exhibited a markedly higher objective response rate and disease control rate versus Group I (35.4% vs. 58.3%, 50.0% vs. 81.3%, respectively). MRI scans revealed a drastic reduction in the proportion of patients with obvious enhancement of primary lesions, invasion of the base of the skull/medial pterygoid muscle, etc. Serum levels of CYFRA21-1, SCC-Ag, CA125, and MDA were greatly decreased, while SOD and GSH-Px activities were notably increased (P<0.05). Group II showed a considerable increase in OS and PFS versus Group I (75.0% vs. 89.6%, 68.8% vs. 83.3%, respectively, P<0.05). Conclusion: the combination of ABP and carboplatin has demonstrated enhanced efficacy and improved survival outcomes in patients with NPC, providing new insights and evidence for clinical application. http://ijrr.com/article-1-6403-en.pdf 2025-07-16 427 433 10.61186/ijrr.23.2.23 Albumin-bound paclitaxel carboplatin nasopharyngeal carcinoma dynamic contrast-enhanced MRI serum biomarkers clinical efficacy. M. Huang jiqawrp975@163.com 1 Department of Radiotherapy, Zhuji People's Hospital, Zhuji 311809, Zhejiang Province, China AUTHOR G. Wang 2 Department of Radiotherapy, Zhuji People's Hospital, Zhuji 311809, Zhejiang Province, China AUTHOR F. Xuan 3 Department of Radiotherapy, Zhuji People's Hospital, Zhuji 311809, Zhejiang Province, China AUTHOR

ORIGINAL_ARTICLE Background: The current study aimed to investigate the ability of acetylsalicylic acid (ASA) to prevent ionizing radiation-induced DNA damage in human lymphocytes via the micronucleus (MN) assay and compare it with the efficacy of the agent WR-1065 (2-[(3-Aminopropyl) amino] ethanethiol dihydrochloride), which exhibits radioprotective activity. Materials and Methods: Peripheral blood samples were obtained from four participants, and nine experimental groups were established. Blood samples were treated with 25 µg/mL ASA and 40 µg/mL WR-1065 for 30 min before irradiation. After treatment, the samples were irradiated with 6 MV X-rays in the linear accelerator (LINAC) unit at doses of 2 Gy and 4 Gy. All blood samples were then cultured for the micronucleus assay. Results: In vitro treatments with ASA and WR-1065 at the indicated doses did not result in statistically significant changes in MN frequencies (p˃0.05). Conclusion: Both drugs were did not exhibit radioprotective effects in the experimental model used. http://ijrr.com/article-1-6404-en.pdf 2025-07-16 435 439 10.61186/ijrr.23.2.24 Acetylsalicylic acid WR-1065 micronucleus radioprotection ionizing radiation A. Yalcin aydoganyalcin@gmail.com 1 Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey AUTHOR K. Tabakcioglu 2 Department of Medical Biology, Faculty of Medicine, Trakya University, Edirne, Turkey AUTHOR V.Y. Caloglu 3 Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey AUTHOR C. Uzal 4 Department of Radiation Oncology, Faculty of Medicine, Near East University, Faculty of Medicine, Lefkoşa, Turkish Republic of Northern Cyprus AUTHOR I.K. Omurlu 5 Department of Biostatistics, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey AUTHOR

ORIGINAL_ARTICLE Background: To investigate the independent risk factors of pneumothorax after CT-guided pulmonary puncture, and to construct a nomogram model to predict the occurrence of pneumothorax. Materials and Methods The relevant factors of 257 patients with pulmonary nodule puncture in the lung tumor ward of a tertiary hospital from 2021 to 2023 were collected, and the logistic regression analysis method of backward elimination was used to obtain independent predictors. Finally, the multivariate logistic regression results were used. By drawing forest charts, exploreing independent risk factors for pulmonary puncture complicated by pneumothorax, risk prediction models were established and general nomograms and develop more intuitive multivariate dynamic nomograms were constructed to evaluate the model by calculating the AUC value of the area under the curve through the ROC curve performance; and to use Bootstrap's internal resampling method to perform internal validation of the model. Results Multivariate logistic regression analysis showed that lung nodule size (every 1 mm increase) (OR=0.82), education (OR=2.73) and age (OR=1.08) were independent risk factors for pneumothorax after lung puncture. Conclusion The nomogram constructed in this study can effectively predict the occurrence of postoperative pneumothorax in patients undergoing CT-guided pulmonary puncture. The model has a good degree of discrimination and consistency, and clinical medical staff can accurately and quickly predict the nomogram through pulmonary puncture complicated with pneumothorax, quickly identify patients with high risk of pulmonary puncture complicated with pneumothorax, and provide a reference for the development of targeted intervention measures. http://ijrr.com/article-1-6405-en.pdf 2025-07-16 441 446 10.61186/ijrr.23.2.25 Lung puncture pneumothorax risk prediction model forest plot nomogram. X. Wu medicalpaper203@gmail.com 1 Department of Respiratory Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui230032, China AUTHOR H. Wan 2 Department of Respiratory Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui230032, China AUTHOR M. Cheng 3 Department of Respiratory Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui230032, China AUTHOR J. Bai 4 Department of Respiratory Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui230032, China AUTHOR

ORIGINAL_ARTICLE Background: We aimed to accurately and efficiently evaluate Programmed Death Ligand-1 (PD-L1) expression by relevant radiomic studies of fluoro-18-fluorodeoxyglucose (18F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) images in nasopharyngeal carcinoma (NPC) patients. Materials and Methods: This retrospective study included 60 untreated NPC patients had PET/CT. Cohorts of training and validation were randomly selected among the patients. The CT and PET radiomic features from the training cohort were obtained and screened, to construct CT, PET and combined models. Finally, verification and comparative analysis were performed. Results: According to the analysis, the maximum Standardized Uptake Value (SUVmax) alone was the standalone predictive indicator of PD-L1 presence level, thus incorporated into the combined model. Among our training cohort, the CT, PET, and combined models’ Area under Curve (AUC) values respectively were 0.837, 0.852, and 0.948, demonstrating excellent discrimination and calibration. However, the combined model had higher AUC values in the cohorts of training and validation, reaching AUCs of 0.948 and 0.802, respectively. Clinical decision curve analysis (DCA) further illustrated Combined model surpassed both the CT and PET models, attaining a benefit threshold probability of more than 5% and a net benefit (NB) of 0.450 at the optimal threshold probability. Conclusion: The combined predictive model based on relevant radiomic studies of PET/CT scans performed better than other models in assessing individualized PD-L1 expression in NPC. http://ijrr.com/article-1-6421-en.pdf 2025-07-16 447 454 10.61186/ijrr.23.2.26 Nasopharyngeal Neoplasms Immune Checkpoint Inhibitors Radiomics Positron Emission Tomography Computed Tomography. S. Yang nfyyysx@126.com 1 Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China AUTHOR L. Li 2 Department of Nuclear Medicine, the Third People's Hospital of Mianyang City, Sichuan Mental Health Center, Mianyang, Sichuan 621000, China AUTHOR H. Li 3 Department of Nuclear Medicine, the Third People's Hospital of Mianyang City, Sichuan Mental Health Center, Mianyang, Sichuan 621000, China 3PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China AUTHOR Y. Li 4 Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China AUTHOR

ORIGINAL_ARTICLE Background: To analyze the sensitivity and specificity of magnetic resonance imaging (MRI) in diagnosing cartilage invasion in laryngeal neoplasms. Materials and Methods: A comprehensive search for relevant studies was conducted in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and the Cochrane Trials Registry, with the search period extending until September 1, 2024.Sensitivity, specificity, and diagnostic likelihood ratio (DLR) were combined. Symmetrical Receiver Operating Characteristic (SROC) curves and Fagan nomograms were plotted. Meta-regression and subgroup analyses were performed to identify heterogeneity sources. Results: A total of seven studies involving 418 participants were included. MRI demonstrated a sensitivity of 0.93 [95% CI: 0.89–0.96, I²=0.00] and a specificity of 0.88 [95% CI: 0.81–0.92, I²=70.36] for detecting cartilage invasion. The negative diagnostic likelihood ratio (DLR-) was 0.08 with a 95% confidence interval of 0.05 to 0.13. The Area Under Curve(AUC) of the SROC curve was 0.95 with a 95% confidence interval of 0.85 to 0.99. Leave-one-out sensitivity analysis validated the robustness of the results concerning heterogeneity, as subgroup analysis did not mitigate it. Deek's funnel plot showed a symmetrical distribution of studies around the regression line, indicating no significant publication bias (t=0.92, P=0.40). Conclusion: MRI provides a reliable diagnostic performance for cartilage invasion in Laryngeal Neoplasms. http://ijrr.com/article-1-6422-en.pdf 2025-07-16 455 460 10.61186/ijrr.23.2.27 IMRT Laryngeal neoplasms cartilage invasion magnetic resonance imaging meta-analysis. Z.D. Wang 1 Department of Otolaryngology, The Air Force Hospital of the Northern Theater Command of the Chinese People's Liberation Army, Shenyang, Liaoning, China AUTHOR Y. Zhan 2 Department of Otolaryngology, The Air Force Hospital of the Northern Theater Command of the Chinese People's Liberation Army, Shenyang, Liaoning, China AUTHOR H. Cao 3 Department of Otolaryngology, The Air Force Hospital of the Northern Theater Command of the Chinese People's Liberation Army, Shenyang, Liaoning, China AUTHOR X.D. Shan 4 Department of Otolaryngology, The Air Force Hospital of the Northern Theater Command of the Chinese People's Liberation Army, Shenyang, Liaoning, China AUTHOR X.H. Tai 13324042800@163.com 5 Department of Otolaryngology, The Air Force Hospital of the Northern Theater Command of the Chinese People's Liberation Army, Shenyang, Liaoning, China AUTHOR

ORIGINAL_ARTICLE Background: This study aims to identify biomarkers associated with radiation-induced coronary heart disease (RICHD) in breast cancer patients by integrating bioinformatics approaches with single-cell sequencing data, providing potential therapeutic targets for RICHD treatment. Materials and Methods: Gene expression profiles associated with coronary heart disease were sourced from the Gene Expression Omnibus (GEO) database, and GEO2R was utilized to identify differentially expressed genes.  Whole-genome sequencing and clinical data of breast cancer patients were obtained from The Cancer Genome Atlas (TCGA) database. Gene expression levels were analyzed using the 'Limma' package to compare radiation-exposed and non-exposed groups. Biological functional enrichment analysis was conducted using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG). The intersection of TCGA and GEO identified key genes. Further analyses of these key genes in breast cancer patients were conducted using the GEPIA, Kaplan-Meier Plotter websites, and single-cell sequencing results. Results: The intersection of datasets from breast cancer and coronary heart disease revealed Hemoglobin A2(HBA2) as a key gene associated with RICHD. HBA2 exhibited statistically significant differences in mRNA expression levels between breast cancer and normal tissues (P<0.05). Kaplan-Meier Plotter analysis revealed a significant prognostic difference between breast cancer patients with varying HBA2 expression levels (P=0.005). HBA2 exhibited significant expression levels in CD8+ T cells. Conclusion: HBA2 could be a biomarker and therapeutic target for RICHD, offering new perspectives for clinical management of RICHD patients. http://ijrr.com/article-1-6423-en.pdf 2025-07-16 461 466 10.61186/ijrr.23.2.28 DNA Hemoglobin A2 radiation-induced coronary heart disease radiotherapy single-cell RNA sequencing. X.L. Huang 1 Cardiac Intensive Care Unit (CCU), West China Hospital of Sichuan University, Chengdu, Sichuan, China AUTHOR Z. Cai 2 Cardiac Intensive Care Unit (CCU), West China Hospital of Sichuan University, Chengdu, Sichuan, China AUTHOR Y. Xu 1419850448@qq.com 3 Cardiac Intensive Care Unit (CCU), West China Hospital of Sichuan University, Chengdu, Sichuan, China AUTHOR

ORIGINAL_ARTICLE Background: This research aimed to investigate diagnostic value of preoperative chest computed tomography (CT) in the staging of clinical tumor-node-metastasis (TNM) in non-small cell lung cancer (NSCLC). Materials and Methods: Hundred and ninety eight patients with NSCLC accepted by the Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital) from June 2021 to October 2022 were retrospectively selected as the study subjects. Preoperative multislice spiral computed tomography (MSCT) examination was performed, and the results of pathological examination were the gold standard to evaluate accuracy of CT diagnosis of TNM staging. Results: The staging accuracy of CT diagnosis was 86% for T1, 85.34% for T2, 76.92% for T3, and 66.7% for T4, with an overall accuracy of 83.83%. The Kappa value was 0.744. For nodal staging, the accuracy of CT diagnosis was 85.34% for stage N0, 67.86% for stage N1, and 72.22% for stage N2, yielding an overall accuracy of 79.29%. The Kappa value for nodal staging was 0.702. In terms of specific stages, the accuracy of CT diagnosis was 80.39% for stage IA, 81.40% for IB, 59.38% for IIA, 76.47% for IIB, and 73.21% for IIIA, with an overall accuracy of 75.25%. The Kappa value for these stages was 0.701. Conclusion: The clinical T stage, N stage, and TNM stage diagnosed by CT before surgery were consistent with the pathological T stage after surgery, especially in the early stage of LC. http://ijrr.com/article-1-6424-en.pdf 2025-07-16 467 472 10.61186/ijrr.23.2.29 TNM staging CT examination preoperative diagnosis NSCLC. X. Xu 1 Department of Radiology, The Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China AUTHOR J. Xu 2 AUTHOR L. Wang 3 Department of Radiology, The Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China AUTHOR B. Li 4 Department of Radiology, The Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China AUTHOR B. He 277528573@qq.com 5 Department of Radiology, The Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China AUTHOR

ORIGINAL_ARTICLE Background: To introduce a simple glioblastoma (GBM) target delineation method based on peritumoral edema. Materials and Methods: A postoperative GBM patient was selected, the target volume was delineated using three methods, including the methods recommended by the Radiation Therapy Oncology Group (RTOG method), by the European Organization for Research and Treatment of Cancer (EORTC method) and by this study (New method), and radiotherapy plans were formulated by the same physicist. The dose distributions of each schedule were compared. Then, patients treated with the delineation method recommended in this study were retrospectively analyzed, and progression-free survival and overall survival were determined. Results: The distributions of the high-dose regions of the 3 plans were as follows: RTOG method > EORTC method > New method, as was the low-dose region. Thirty-three patients were included in this retrospective study, and the median progression-free survival (PFS) and overall survival (OS) were 12 and 25 months, respectively. Conclusions: Our study suggested that delineating the target volume for GBM radiotherapy based on peritumoral edema is a good choice. http://ijrr.com/article-1-6432-en.pdf 2025-07-16 473 480 10.61186/ijrr.23.2.30 Glioblastoma Target volume Delineating Peritumoral edema. H. Zhang 1 Department of Radiation Oncology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China AUTHOR S. Hao 2 Department of Nuclear Medicine, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China AUTHOR T. Wu 3 Department of Radiation Oncology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China AUTHOR Y. Xu 4 Department of Radiation Oncology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China AUTHOR D. Yang 5 Department of Radiation Oncology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China AUTHOR Y. Sun 6 Department of Radiation Oncology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China AUTHOR P. Zhang 7 Department of Radiation Oncology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China AUTHOR Y. Yan yanyingdoctor@sina.com 8 Department of Radiation Oncology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China AUTHOR

REVIEW_ARTICLE Background: This paper is conducted to analysis the effects of c-Myc gene expression on surgical intervention and outlook of elderly sufferers with Non-Small Cell Lung Cancer (NSCLC) through meta-analysis. Materials and Methods: Through searching the key words "small cell lung cancer, c-Myc" on China National Knowledge Internet (CNKI) and other platforms, the literature meeting the inclusion criteria was screened. Finally, a total of 14 relevant studies were included. Statistical methods were used to analyze the data, including calculation of standard deviation and 95% confidence interval, and for analysis, the fixed effects model was utilized. Results: Meta-analysis of untreated and healthy groups showed that serum c-Myc mRNA expression in untreated group is remarkably superior to healthy group (standard deviation -1.64, 95% confidence interval -1.85 to -1.45, P<0.001). In addition, serum c-Myc mRNA expression levels in elderly sufferers with NSCLC are remarkably superior to younger group (standard deviation 1.45, 95% confidence interval 1.15 to 1.74, P<0.001). In addition, serum c-Myc mRNA expression in the non-smoking group is remarkably superior to smoking group (OR=-1.78, 95% CI -1.95 to -1.60, P<0.001). Conclusions: Serum c-Myc mRNA expression levels in elderly NSCLC suffers are superior to healthy groups, which were related to age and smoking behavior. This finding is significant for the early screening, diagnosis and prognosis assessment of NSCLC, providing a basis for further research on the role of c-Myc gene in elderly NSCLC. http://ijrr.com/article-1-6433-en.pdf 2025-07-16 481 487 10.61186/ijrr.23.2.31 C-Myc gene expression non-small cell lung cancer chemoradiotherapy meta-analysis. Z.L. Guo guo198210062023@163.com 1 Department of Geriatrics, Zhuji People's Hospital, Zhuji, China AUTHOR

OTHERS_CITABLE Background: Utilizing dental cone beam computed tomography (DCBCT) in wrist bone fracture diagnosis is relatively new. This study investigated the diagnostic value of DCBCT using a low-dose radiation technique for wrist fractures. Materials and Methods: This study compared dental CBCT (DCBCT) with multidetector computed tomography (MDCT) and extremity CBCT in terms of radiation dose, using the dose-length product (DLP) as the primary comparison metric. Twenty-nine adult patients presenting with various wrist injuries underwent imaging with different parameters using DCBCT. Image quality was independently assessed by two radiologists using a 5-point Likert scale. Results: DCBCT demonstrated a significantly lower radiation dose than MDCT, though slightly higher than extremity CBCT. The optimized DCBCT protocol (70 kV, 2 mAs, 15 seconds) provided high diagnostic image quality, with an interrater agreement of 85.4%. Conclusion: DCBCT offers an effective, lower-radiation alternative for diagnosing wrist fractures compared to MDCT. Optimized protocols provide good image quality and could be cost-effective, particularly in regions where extremity CBCT is unavailable. http://ijrr.com/article-1-6434-en.pdf 2025-07-16 489 492 10.61186/ijrr.23.2.32 Cone beam computed tomography wrist fracture multidetector computed tomography dental CBCT radiation dose. M. Aljamal mohammad.aljamal@aaup.edu 1 Department of Medical Imaging, Faculty of Allied Medical Sciences, Arab American University, Jenin, Palestine AUTHOR A. Qutit 2 Tower Dental X-ray Center, Nablus, Palestine AUTHOR M. Abuzaid 3 Medical Diagnostic Imaging Departments, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates AUTHOR N. Omarah 4 Department of Medical Imaging, Ministry of Health, Nablus, Palestine AUTHOR M. Zahri 5 Oncological and Radiological Sciences Cluster, Advanced Medical & Dental Institute, University Sains Malaysia, Pulau Pinang, Malaysia AUTHOR M. Fairus 6 Diagnostic Radiography Department, Faculty of Allied Health Sciences, Singapore Institute of Technology, Singapore AUTHOR

OTHERS_CITABLE Background: The study investigates the relationship between aneurysm morphology and incidence angle measured by Computed Tomography Angiography (CTA) and the risk of intracranial aneurysm (IA) rupture. Materials and Methods: We analyzed data from 150 patients with intracranial aneurysms, comparing those with ruptured and non-ruptured aneurysms. Statistical methods were applied to identify key risk factors for rupture. Results: Significant differences were observed in aneurysm morphology, incidence angle, and risk scores between the ruptured and non-ruptured groups. Factors such as irregular aneurysm shape, larger diameter, aspect ratio (AR), size ratio (SR), and incidence angle were associated with higher rupture risk. Conclusion: CTA-measured aneurysm morphology and incidence angle, along with patient-specific factors, are crucial in assessing the risk of IA rupture. These findings can guide clinical decision-making and improve patient outcomes. http://ijrr.com/article-1-6435-en.pdf 2025-07-16 493 496 10.61186/ijrr.23.2.33 Intracranial aneurysm CT angiography aneurysm rupture aneurysm morphology incidence angle. Y. Xu 1 Department of Neurosurgery, Quzhou Hospital, Wenzhou Medical University (Quzhou People's Hospital), Quzhou, China AUTHOR Y. Li 2 Department of Neurosurgery, Quzhou Hospital, Wenzhou Medical University (Quzhou People's Hospital), Quzhou, China AUTHOR R. Liu 3 Department of Neurosurgery, Quzhou Hospital, Wenzhou Medical University (Quzhou People's Hospital), Quzhou, China AUTHOR A. Wu 4 Department of Neurosurgery, Quzhou Hospital, Wenzhou Medical University (Quzhou People's Hospital), Quzhou, China AUTHOR D. Mao 5 Department of Neurosurgery, Quzhou Hospital, Wenzhou Medical University (Quzhou People's Hospital), Quzhou, China AUTHOR R. Zhou 15605701715@163.com 6 Department of Neurosurgery, Quzhou Hospital, Wenzhou Medical University (Quzhou People's Hospital), Quzhou, China AUTHOR

CASE_STUDY Background: Pulmonary artery intimal sarcoma (PAIS), a rare malignancy arising primarily within the pulmonary artery's intimal layer, exhibits an estimated prevalence ranging from 0.001% to 0.003%. Due to overlapping clinical manifestations and imaging characteristics, PAIS is frequently mistaken for acute or chronic pulmonary thromboembolism. Tissue biopsy remains the authoritative method for establishing diagnosis. Regarding therapy, surgery is the principal approach, and undertaking thorough surgical resection alongside endarterectomy yields improved survival outcomes. Case Presentations: This study presents three cases of PAIS, analyzing their radiological characteristics, pathological findings, and therapeutic approaches. A comprehensive review of the literature on this condition is also provided. Conclusion: Timely detection proves paramount and can significantly enhance patient prognosis. Complete surgical resection is pivotal for improving prognosis, and multidisciplinary collaboration (e.g., radiology, pathology, and thoracic surgery) plays a vital role in formulating precise diagnostic and therapeutic strategies. http://ijrr.com/article-1-6436-en.pdf 2025-07-16 497 502 10.61186/ijrr.23.2.34 PAIS endarterectomy computed tomography angioplasty. X. Fu 13586980761@163.com 1 Zhejiang Chinese Medical University, Hangzhou, Hangzhou, China AUTHOR J. Zhao 2 Department of Pathology, Affiliated Jinhua Hospital, Zhejiang University School of Medcine, Hangzhou, China AUTHOR Q. Liu 3 Department of Pathology, Affiliated Jinhua Hospital, Zhejiang University School of Medcine, Hangzhou, China AUTHOR J. Jia 4 Department of Pathology, Affiliated Jinhua Hospital, Zhejiang University School of Medcine, Hangzhou, China AUTHOR M. Wang 5 Department of Pathology, Affiliated Jinhua Hospital, Zhejiang University School of Medcine, Hangzhou, China AUTHOR

CASE_STUDY Background: Acute cerebral infarction following induced abortion is a rare but serious complication, often associated with alterations in the coagulation system of pregnant women, hypertension, pregnancy-related vascular disorders, or infections. Considering the societal impact of maternal health issues in reproductive-age women and their effects on families and society, studying the etiology, prevention, and treatment of postpartum stroke is of significant importance. Case Summary: The patient, a 31-year-old female, was diagnosed with an arachnoid cyst in the posterior fossa of the fetal occipital fontanelle during a prenatal examination, leading to the decision for induced abortion via rivanol amniotic cavity injection. Post-delivery, at four hours and 50 minutes, she presented with acute symptoms of right-sided limb weakness and speech impairment. Emergency cranial CT was performed, revealing extensive infarction within the left cerebral hemisphere. Further diagnostic workup with head CT angiography (CTA) confirmed the presence of a critical occlusion in the left middle cerebral artery, a key finding that directed the subsequent management. Given the contraindications for intravenous thrombolysis during the puerperal period, the patient was promptly transferred for endovascular thrombectomy. The CT imaging was pivotal in establishing the diagnosis and guiding the decision for urgent intervention. Subsequent telephone follow-up indicated a favorable prognosis, highlighting the importance of timely and accurate CT imaging in the management of postpartum stroke. Conclusion: Postpartum stroke often results from thrombus formation and is associated with significantly high mortality and risk of residual neurological deficits. Therefore, healthcare professionals should be vigilant in observing early symptoms and providing appropriate treatment to prevent symptom progression. http://ijrr.com/article-1-6437-en.pdf 2025-07-16 503 507 10.61186/ijrr.23.2.35 Case report left middle cerebral artery thrombosis acute stroke literature review computerized tomography. X. Tan 1 Department of Intensive Care Medicine, Neijiang Maternal and Child Health Hospital, Neijiang, Sichuan Province, China AUTHOR T. Luo 2 Department of Gynecology and Obstetrics, Neijiang Maternal and Child Health Hospital, , Neijiang, Sichuan Province, China AUTHOR Z. Hu 3 Department of Critical Care Medicine, the Second People's Hospital of Neijiang City, Neijiang, Sichuan Province, China AUTHOR L. Li 15884857856@163.com 4 Department of Gynecology and Obstetrics, Neijiang Maternal and Child Health Hospital, , Neijiang, Sichuan Province, China AUTHOR

CASE_STUDY Background: Malignant melanoma of the primary parotid gland (PGMM) is extremely rare, and most of the previous reports are case reports. This study describes the clinical and histological characteristics of a single case of PGMM. Materials and methods: The patient was diagnosed following the detection of a mass in the parotid region. Examination of the resected tissue specimens demonstrated cells with copious eosinophilic cytoplasm, significant pleomorphic in the nuclei, and distinct nucleoli. Immunohistochemical analysis was performed to measure HMB45, S-100, SOX-10, and Melan-A markers expression in tumor tissue. The clinicopathological features of a series of parotid gland malignant melanomas were analyzed. Results: Despite undergoing surgical intervention, immunotherapy, and targeted therapy, this case occurred distant metastases. The patient survived 2 years and 3 months after surgery due to multiple metastases throughout the body. Conclusion: This article reported the clinical characteristics of the case and provided an overview of primary PGMM cases documented over the last three decades. http://ijrr.com/article-1-6438-en.pdf 2025-07-16 509 512 10.61186/ijrr.23.2.36 Parotid gland malignant melanoma metastasis histopathology immunotherapy targeted therapy. S. Qin 1 Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Jining Medical University, Jining 272000, China AUTHOR R. Li 2 Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China AUTHOR D. Zhou 3 Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China AUTHOR M. Li 4 Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China AUTHOR G. Li 5 Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China AUTHOR M. Sun sunmingleidr@163.com 6 Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China AUTHOR

ORIGINAL_ARTICLE Dear Editor, I am writing in response to the article titled “An investigation of radon and heavy metal detection for cancer patients in Barji village, in the Iraqi Kurdistan region” by Kareem et al., published in International Journal of Radiation Research (Vol. 23, No. 1, 2025). The authors are to be acknowledged for their attention to a sensitive and pressing public health issue in a historically impacted region. While the study offers relevant preliminary environmental data, I would like to respectfully offer several critical observations that may enhance the interpretative value and scientific robustness of the findings: http://ijrr.com/article-1-6451-en.pdf 2025-05-30 511 513 10.61186/ijrr.23.2.37 Volkan Çevik 1 AUTHOR