Purpose: To evaluate the dose loads during radiation planning for critical structures of lung cancer patients during the transition from standard RT with SD = 2 Gy to a regimen with a single dose of SD = 3 Gy.

Materials and methods: The study included a group of 53 patients who received radiation therapy using the modern IMRT (intensive modulated radiation therapy) technique. The group receiving a single dose of SD = 2 Gy included 35 patients, and the group with SD = 3 Gy included 18 patients.

Results: The group with a single dose of SD = 2 Gy is characterized by a higher dose in the target volume, as well as improved planning quality parameters HI and CI. The dose loads on critical organs in the group with SD = 2 Gy (spinal cord, heart, lungs, esophagus) are slightly higher than in the group with SD = 3 Gy, however, they remain within acceptable values. The group with SD = 3 Gy demonstrates a more gentle profile of the dose load on the risk organs, which makes this regimen preferable for patients with limited somatic reserve, especially with cardiopulmonary disorders. In addition, the SD = 3 Gy regimen is used as part of an accelerated course of treatment, which reduces the overall duration of therapy.

Background: There are no data on in vivo skin dosimetry of volumetric modulated arc therapy (VMAT) without bolus for tumor bed irradiation after breast-conserving surgery (BCS) and whole breast irradiation (WBI). The purpose of this study was to evaluate the accuracy of the expected dose to the tumor bed in patients undergoing non-bolus VMAT using in vivo skin dosimetry.

Materials and Methods: In vivo skin dosimetry was performed in 78 patients who underwent image-guided helical VMAT to the tumor bed after BCS and WBI. The expected doses at 1279 points were compared with the measured doses. The relative errors and variations of the relative errors were evaluated.

Results: The relative errors for 0.01–0.09 Gy, 0.10–0.49 Gy, 0.50–0.99 Gy, 1.00–1.49 Gy, 1.50–1.74 Gy, and ≥ 1.75 Gy were –0.666 ± 9.442 % (95 % CI –1.958–0.627 %), –0.265 ± 4.010 % (95 % CI –0.809–0.278 %), –0.205 ± 2.506 % (95 % CI –0.511–0.101 %), 0.207 ± 2.024 % (95 % CI –0.045–0.459 %), and –0.182 ± 1.665 % (95 % CI –0.449–0.084 %), respectively. The absolute value of the relative error was smallest for expected doses of 1.75 Gy or greater. The variation in relative errors was significantly greater at 0.01–0.09 Gy (p<0.001), 0.10–0.49 Gy (p<0.001), 0.50–0.99 Gy (p=0.023), and 1.00–1.49 Gy (p=0.003) than at 1.75 Gy or greater. The variation of the relative error at 1.50–1.74 Gy was not significantly different at 1.75 Gy (p=0.465).

Conclusions: In vivo skin dosimetry has confirmed that image-guided non-bolus VMAT is capable of accurately delivering radiation to the tumor bed after BCS and WBI.

Introduction: Peptide-receptor radionuclide therapy (PRRT) is currently a well-studied treatment option for patients with neuroendocrine tumors. Based on the results of the Phase III NETTER-1 and NETTER-2 trials, ¹⁷⁷Lu-DOTA-TATE therapy has become the standard for second- and subsequent-line therapy. However, there are currently no domestic studies investigating PRRT. In our study, we evaluated the efficacy and safety of ¹⁷⁷Lu-DOTA-TATE, a radiopharmaceutical drug synthesized in the cyclotron-radiochemistry laboratory of the Department of Radionuclide Diagnostics and Therapy at the N.N. Blokhin National Medical Research Center of Oncology and having undergone preclinical trials, in patients with neuroendocrine neoplasias (NENs).

Materials and Methods: This phase I/II study enrolled patients with metastatic NENs of various locations with Ki-67 <55 %, progressing despite ≥​​ 2 prior lines of therapy. Patients received 4 cycles of PRRT with the ¹⁷⁷Lu-DOTA-TATE radiopharmaceutical every 8–10 weeks, along with extended-release somatostatin analogs. The primary endpoints were response rate (disease control) of ≥​​ 6 months and safety. Secondary endpoints were objective response rate, progression-free survival (PFS), and overall survival (OS). Patients were enrolled from June 2024 to July 2025. This study analyzes the Įrst 11 patients enrolled in the study.

Results: Eleven patients were included in this analysis. The median age was 54 years. Primary tumor localizations: gastroenteropan‑ creatic (GEP) NEN — 6 patients (54.5 %), pheochromocytomas/paragangliomas — 3 patients (27.3 %), lung NEN and NEN metastases from the esophagus — 1 patient each (9.3 %). Median Ki-67 was 10 % (5–25 %). All patients had previously received everolimus therapy, 9 patients (81.8 %) — chemotherapy. The objective response rate (ORR) was 54.5 %, all responses were partial. Disease stabilization (DS) was recorded in 36.4 %. Disease control (DC) ≥​​ 6 months was noted in 90.9 % of cases. Median PFS and OS with a median follow-up of 11.3 months were not achieved. Grade 3–4 leukopenia was recorded in 2 patients (18.2 %). No decrease in renal function was noted. One serious adverse event associated with disease progression was recorded: pleurisy, requiring thoracentesis for fluid evacuation.

Conclusion: Peptide-receptor radionuclide therapy with ¹⁷⁷Lu-DOTA-TATE, manufactured at the Blokhin National Medical Research Center of Oncology, resulted in high ORR and CFS rates in patients with NEN of various locations. Clinically signiĮcant myelosuppres‑ sion was observed in 18.2 % of cases.

Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common form of aggressive non-Hodgkin͛s lymphoma, accounting for up to 40 % of all cases. Despite significant advances in chemotherapy and immunotherapy, long-term treatment outcomes are not always satisfactory. In recent years, quantitative metrics derived from ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET/CT), such as metabolic tumor volume (MTV), total glycolytic tumor volume (TLG), and others, have received increasing attention as potential biomarkers for risk stratification and assessment of treatment response.

Purpose: To evaluate the prognostic value of ¹⁸F-FDG PET/CT volumetric-metabolic parameters in patients with diffuse large B-cell lymphoma (DLBCL) and to compare the effectiveness of different tumor burden segmentation methods.

Materials and methods: Data from 150 DLBCL patients treated with R-CHOP regimen between 2018 and 2024 were included. All patients underwent ¹⁸F-FDG PET/CT prior to therapy initiation. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were calculated using two segmentation thresholds: a fixed threshold (SUV > 4) and a relative threshold (41 % of SUV_max). Receiver operating characteristic (ROC) analysis, machine learning techniques (yGBoost), and progression-free survival (PFS) assessment were used to evaluate prognostic significance.

Results: All investigated parameters (MTV, TLG, and their normalized counterparts) demonstrated comparable prognostic accuracy (AUC 0.766–0.790). The body weight-normalized MTV using the SUV > 4 threshold (sMTV) showed the highest prognostic significance, enabling patient stratification into low-risk (< 3 mL/kg) and high-risk (≥​​3 mL/kg) groups. The 5-year PFS rates were 83.3 % and 39.4 %, respectively (p < 0.001).

Discussion: Traditional methods such as ROC analysis and the DeLong test do not account for interactions, making it difficult to select the best metric. In this study, the yGBoost algorithm identified the weight-normalized volume, calculated using the SUV > 4 threshold (sMTV SUV > 4), as the most significant predictor.

Conclusion: Body weight-normalized metabolic tumor volume is the most informative prognostic marker in DLBCL patients, highlighting its potential clinical value for personalized treatment approaches.

Nuclear medicine is currently undergoing a tremendous boom. The use of radiopharmaceuticals (RPHs) for the diagnostics & treatment of various diseases in routine medical practice is becoming increasingly widespread, significantly enhancing the overall efficacy of the treatment process. Currently the possibility to manufacture radiopharmaceuticals in-house, at hospital radiopharmacies, provides the domestic hospitals with the opportunity to use new highly effective, yet unregistered, radiopharmaceticals. They are based on radionuclides produced in Russia (such as ¹⁷⁷Lu, ²²⁵Ac etc.)

Purpose: To determine the possibilities of PET/CT with ¹⁸F-FBFA in the diagnostics of oncological diseases.

Material and methods: This prospective study included 32 patients with various verified oncological diseases. All patients underwent two consecutive PET/CT studies with two ¹⁸F-FDG and ¹⁸F-BPA. Two parameters were measured for ¹⁸F-BPA: 1) Accumulation in the primary tumor and/or in metastases / recurrent tumors; 2) The tumor to normal tissue ratio (TNR).

Results: Data on the physiological accumulation of ¹⁸F-BPA were obtained (the lowest values in the brain were SUV_min-max 0.45–2.99 (median 1.42), the highest values were in the oral mucosa SUV_min-max 2.24–8.81 (median 4.76). Foci of pathological accumulation of ¹⁸F-BPA corresponding to tumor tissue were identified (the highest values of accumulation of ¹⁸F-BPA were detected in multiple myeloma — SUV_max 9.59, the lowest — in nasopharyngeal plasmocytoma — SUV_max 4.42). The TNR calculation made it possible to divide patients into 2 groups: TNR ≥ 2,5 (n = 15), TNR < 2,5 (n = 6), determining the potential for BNCT.

Conclusion: ¹⁸F-BPA has potential as an independent diagnostic tool. ¹⁸F-BPA deserves attention for study as an agent that allows for differential diagnosis between tumor and non-tumor changes. The further search for the possibilities of using PET/CT with ¹⁸F-BPA on larger cohorts of patients with various oncological diseases planned.

Introduction: Prostate cancer (PCa) remains one of the leading causes of cancer-related mortality. Traditional diagnostic methods, including PSA testing and transrectal ultrasound (TRUS), have limitations in detecting early-stage PCa. MRI plays a key role in diagnosis, particularly in identifying clinically significant tumors. However, the PI-RADS v2.1 system has limitations in the quantitative assessment of pathological changes.

Purpose: To develop and evaluate quantitative MRI criteria for the differential diagnosis of PI-RADS 3 and PI-RADS 4 lesions, and to identify statistically significant predictors of cancer presence in lesions.

Materials and Methods: A retrospective analysis was conducted on 105 patients (aged 49–78 years, median age 65) with suspected PCa from 2019 to 2024. Patients were grouped based on clinical history: negative biopsy (34 %), elevated PSA and negative MRI dynamics (33 %), and rising PSA without ultrasound changes (32 %). Prostate MRI was performed using 1.5 T and 3 T scanners (bi-or multiparametric), with assessment according to PI-RADS v2.1. PI-RADS 4 lesions were identiĮed in 73.3 % of cases, and PI-RADS 3 lesions in 26.7 %. All patients underwent stereotactic MRI-targeted biopsy with sampling from target lesions and systematic biopsy. Statistical analysis included frequency tables, chi-square and Fisher͛ s tests, t-test, Mann–Whitney test, and ROC analysis.

Results: PCa was conĮrmed in 78 % of cases (predominantly Gleason 7, ISUP grade 2 adenocarcinomas). PI-RADS 3–4 lesions were most often located in the peripheral zones (73.3 %, posterior regions). New quantitative parameters were introduced: the signal intensity ratio on high b-value DWI (b₁/b₂) and on ADC maps (ADC₂/ADC₁). For all lesions, a b1/b2 threshold х1.56 showed sensitivity of 81.7 % and speciĮcity of 91.3 %; ADC₂/ADC₁ >2.65 showed 52.4 % sensitivity and 82.6 % speciĮcity. For PI-RADS 4 lesions, thresholds of b1/b2 >1.57 (87.1 % sensitivity, 85.7 % speciĮcity) and ADC2/ADC1 >2.2 (81.4 % and 85.7 %, respectively) were significant predictors of cancer. For PI-RADS 3 lesions, these ratios were not significant. Dynamic contrast enhancement (performed in 34.2 % of cases) helped to reĮne lesion localization but did not influence the biopsy decision; type 3 curves correlated with cancer in PI-RADS 4 lesions (95 %).

Discussion: The introduction of quantitative criteria (b₁/b₂ and ADC₂/ADC₁) allows for a more objective assessment of PI-RADS 4 lesions, reducing the dependence on radiologist experience. These parameters are signiĮcant predictors of clinically significant PCa, particularly in PI-RADS 4. Further research is needed to identify reliable quantitative markers for PI-RADS 3 lesions. Biparametric MRI (without contrast) was suĸcient for biopsy decision-making in most cases (65.7 %), making the method more accessible and safer. Quantitative analysis may assist in selecting between bi- and multiparametric MRI protocols.

Conclusion: MRI with quantitative assessment of b₁/b₂ and ADC₂/ADC₁ improves the detection of clinically signiĮcant PCa, especially for PI-RADS 4 lesions. The b₁/b₂ and ADC₂/ADC₁ ratios are reliable cancer predictors for PI-RADS 4 and reduce diagnostic subjectivity. Using the proposed quantitative thresholds can support more informed decision-making regarding the need for biopsy in patients with equivocal MRI findings (PI-RADS 3 and 4).

Purpose: To analyze the effectiveness of endoscopic choledochoduodenostomy for malignant distal block.

Materials and methods: Treatment analysis was performed on 5 patients with mechanical jaundice caused by an unresectable malignant tumor of the pancreatic head. All patients underwent EUS-guided choledochoduodenostomy. Transpapillary drainage was impossible in 2 patients (40 %) due to tumor stenosis of the duodenum, in 2 (40 %) due to severe deformation and disrupted anatomy of the duodenal ulcer caused by tumor growth, in 1 patient (20 %) due to the formation of a false passage during transpapillary intervention caused by tumor destruction. The technical and clinical success of the operations performed and the presence of complications were assessed.

Results: EUS-guided choledochoduodenostomy provided 100 % technical and clinical success in the treatment of mechanical jaundice in the study group of patients. The method allowed achieving a significant decrease in bilirubin already on the 3rd day (on average from 182.4 to 102.8 μmol/l). The technique demonstrated a shorter duration of the intervention (20.4±3.3 min for EUS-CDA versus 54.7±9.6 min for transpapillary attempts). With observance of the technical aspects of the operation, no complications were recorded, but the method requires high-tech equipment and the experience of an endosonographist.

Conclusion: EUS-guided choledochoduodenostomy is an effective method of biliary decompression. Prevention of possible complications, taking into account the capabilities of endosonography, design features of the equipment and endoscopic instruments used, allows avoiding undesirable consequences. Positive results of using this technique justify the need for its further implementation in the practice of specialized centers.

Introduction: The relevance of this study stems from the current clear trend toward maximum individualization of differential diagnostic programs for lung pathology. Particular attention is paid to the diagnosis of small peripheral lesions not associated with the bronchus and endoscopic signs of disease. This article examines the potential of bronchoscopy with various bronchial biopsy options for diagnosing peripheral lung lesions under CT guidance in fluoroscopy with preliminary CT navigation.

Purpose: To evaluate the effectiveness of bronchoscopy with various types of bronchobiopsy under CT control in fluoroscopy mode with preliminary CT navigation in the diagnosis of peripheral focal lung lesions up to 3 cm in maximum dimension.

Materials and methods: The study included patients with focal peripheral lung lesions measuring up to 3 cm in size. The study group included 84 patients and the control group consisted of 85 patients. The groups were matched for age, size, structure, relationship to the bronchus, and location of the lesions. Bronchoscopy with various types of bronchobiopsy was performed under CT guidance using fluoroscopy and preliminary CT navigation. CT scan was retrospectively performed in patients from the control group to determine the presence/absence of bronchial visualization.

Results: The combined approach (CT navigation + bronchoscopy + CT fluoroscopy) demonstrated statistically significant (p< 0.001) and clinically relevant superiority over traditional bronchoscopy. The absolute increase in diagnostic yield was +41.0 % (78.6 % versus 37.6 % in the control group). The odds ratio (OR) of successful diagnostic verification reached 6.2 (95 % CI: 3.3‑11.6), which indicates a 6-fold increase in the probability of establishing a morphological diagnosis when using a combined technique.

Conclusion: The combined method of bronchoscopy with CT navigation and intraoperative CT fluoroscopy is a diagnostic tool that significantly expands the possibilities of morphological verification of peripheral lung formations. Its implementation in the practice of specialized pulmonology and thoracic centers is a justified and promising direction that contributes to improving patient treatment outcomes by increasing the accuracy and timeliness of the diagnostic process.

Introduction: Morphological veriĮcation remains the cornerstone of tumor diagnosis, providing an objective basis for treatment planning. Among instrumental diagnostic methods, Įne-needle aspiration biopsy (FNA) occupies a leading position due to its minimal invasiveness and high diagnostic yield. However, traditional aspiration techniques are limited by unstable negative pressure and frequent cellular damage, which may compromise smear quality. The development of vacuum Įne-needle aspiration biopsy (v-FNA) introduces the potential for procedural standardization and improved cytological specimen quality.

Objective: To experimentally evaluate the eĸciency and diagnostic value of v-FNA for obtaining cytological material from porcine liver tissue, to assess the feasibility of using small-diameter needles (including 25G), and to compare the results with conventional FNA.

Materials and Methods: The study was conducted on porcine liver specimens, which closely resemble human liver in structure and density. Biopsies were performed using Chiba needles of 18G, 20G, 22G, and 25G diameters. Each puncture was carried out both with traditional syringe aspiration and with vacuum aspiration under a stable negative pressure of -0.8 bar. All procedures were performed under ultrasound guidance to ensure precise needle positioning and controlled advancement through the parenchyma. Cytological smears were prepared using the standard technique and stained by the May–Grunwald method for microscopic evaluation.

Results: The quality and quantity of aspirated material strongly depended on the needle diameter. Conventional FNA using 18G and 20G needles yielded excessive cell masses, often accompanied by hemorrhagic contamination and cellular destruction. Needles of 22G produced more homogeneous and diagnostically suitable smears. The application of vacuum-assisted aspiration signiĮcantly improved cell preservation and smear uniformity. Notably, even 25G needles, traditionally considered ineffective for cytological sampling, provided limited but diagnostically valuable material when used with v-FNA.

Conclusions: Vacuum-assisted fine-needle aspiration biopsy represents a promising direction in cytological diagnostics, improving the quality and informativeness of aspirated material while maintaining minimal invasiveness. The method expands the range of usable needle diameters, supports procedural standardization, and has strong potential for clinical implementation in liver, pancreatic, and lymph node lesion diagnostics.

Purpose: To study the diagnostic capabilities of the ultrasonic contrast agent sulfur hexafluoride in the detection of sentinel lymph nodes in patients with breast cancer; to assess the cordance of radioisotope and ultrasound techniques in the detection of sentinel lymph nodes.

Materials and methods: In this study included 152 patients with breast cancer (clinical stages T_1‑3N_0‑1M₀), mean age 52.0±12.5 years. For the method of detecting SLN with ultrasound contrast, the drug Sonovue (Bracco Swiss, SA, Switzerland) was used.

Discussion: The frequency of sentinel lymph node detection using ultrasound contrast in the first and second groups was 97.6% and 89.9%, respectively, with the use of radiopharmaceuticals, 90.4% and 87%, respectively. The cordance of the two methods was 91%. Metastases in the sentinel lymph nodes were detected in 44 cases (28.9%). The detection rate of metastatic sentinel lymph nodes with ultrasound contrast was 95.5%, using a radiopharmaceutical — 88.6%.

Conclusion: The technique of sentinel lymph node detection using ultrasound contrast in breast cancer is characterized by simplicity and speed of execution, and high detection rates allow it to be used as an independent technology in axillary staging.

The development and increasingly widespread use of high medical technologies associated with sources of ionizing and non-ionizing radiation requires the organization and implementation of appropriate measures for radiation protection and ensuring the safety of patients, personnel and the environment. Conducting relevant medical interventions requires high competence in the field of radiation safety from both radiologists and physicians of other specialties who do not have an education in medical radiology, but by the nature of their work occasionally work in certain fields of ionizing radiation. In such situations, radiation safety of patients is usually ensured by professional radiologists, while ensuring their own radiation safety of a non-radiologist physician largely depends on him or her. The article provides practical recommendations on assessing the radiation levels in such situations and organizing appropriate radiation protection at a level accessible to non-radiologists.