The aim of this thesis is to provide more insight into the relationship between pulmonary embolic burden, right and left ventricular function and dysfunction, using ECG-synchronized multidetector... Show moreThe aim of this thesis is to provide more insight into the relationship between pulmonary embolic burden, right and left ventricular function and dysfunction, using ECG-synchronized multidetector-row computed tomography (MDCT). We demonstrated that RV and LV function can be accurately measured by using ECG-synchronized MDCT. Contrary to non-ECG synchronized MDCT-measured RV function, ECG-synchronized technique is a more accurate reflection of the hemodynamic consequences of different embolic locations on RV function. ECG-synchronized MDCT is able to distinguish patients with central PE from those with peripheral PE, while non-ECG-synchronized MDCT is not. RV dysfunction (RV-EF below 35%) is independently predicted by an obstruction index above 50% or a LV-EF below 45%. Show less
Preclinical and clinical studies reveal that left-sided breast cancer radiotherapy is associated with an increased rate of major coronary events. Consequently, when irradiating women with left... Show morePreclinical and clinical studies reveal that left-sided breast cancer radiotherapy is associated with an increased rate of major coronary events. Consequently, when irradiating women with left-sided breast cancer, specific measures should be taken to decrease the heart dose as much as possible and to avoid radiation-induced coronary artery disease. This thesis focuses on several strategies to optimise the radiation treatment for patients with left-sided breast cancer. With respect to whole breast irradiation we concluded that: __ the routine use of MR images in addition to the CT scan, when delineating either the glandular breast tissue or the lumpectomy cavity, does not have added value. __ tangential IMRT technique combined with a breath-hold technique should be the treatment technique of choice for left-sided breast cancer. __ a breath-hold technique should and can be used in all left-sided breast cancer patients, regardless of age and breast size. __ breath-hold in left-sided whole breast radiotherapy results in a less pronounced increase of coronary calcium score and, hence, could result in less radiation-induced cardio vascular damage. Show less
