Fluid collections (seromas) may accumulate at the site of surgery following excision of musculoskeletal soft tissue tumours. The aim of this retrospective study was to review the magnetic resonance (MR) imaging features of postoperative seromas identifying changes over time on follow-up scans. A total of 170 MR scans from 80 patients were reviewed showing one or more seromas. All patients had undergone previous surgery for a musculoskeletal soft tissue tumour. The typical MR appearances of a seroma were shown to be a well-defined oval or rounded (54%) soft tissue mass, arising at the site of previous surgery, with a thin, dark pseudocapsule, surrounding soft tissue oedema (80%), homogeneous contents that are hypointense (relative to adjacent muscle) on T1-weighted images (74%) and hyperintense on T2-weighted and STIR images (79%). Approximately one-quarter of cases revealed atypical features including hyperintense contents on T1-weighted (26%) and/or heterogeneous contents on T2-weighted images (21%), reflecting the breakdown of blood products and organization of the fluid collection. A distinctive fine feathery pattern arising from the inner surface of the seroma or from septations was identified in 10% of cases. In those patients who underwent one or more follow-up scans, the volume of the seromas decreased in 66% cases, remained unchanged in 15% and increased in 19%. Seromas are not an uncommon finding (<10% of cases) following surgery for a soft tissue tumour. The majority of cases show the typical MR features of a fluid collection. The pitfalls in differentiating an atypical seroma from a recurrent soft tissue sarcoma are discussed.

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a b s t r a c tBackground: Most patients with Hodgkin's lymphoma are young and have a favourable prognosis, therefore it is of high importance to decrease the radiation doses to normal tissues received during radiotherapy. A combination of proton therapy and deep inspiration breath-hold technique (DIBH) can improve the sparing effect and thereby reduce the risk of late effects. Case presentation: The two first patient cases treated with proton therapy in DIBH at the Skandion Clinic, Uppsala, Sweden, are presented here. Proton treatment plans were compared to photon plans based on doses to target and organs at risk. Several CT scans were acquired during the treatment course and inter breath-hold variations were evaluated based on anatomical distances and dosimetric comparisons. Conclusions: The results from our first patients treated with proton therapy in DIBH imply that the treatment strategy is robust and has the potential to reduce dose to normal tissue.

Objectives The purpose of this study was to develop a procedure to investigate the occurrence, character and causes of magnetic resonance (MR) imaging incidents. Methods A semi-structured questionnaire was developed containing details such as safety zones, examination complexity, staff MR knowledge, staff categories, and implementation of EU directive 2013/35. We focused on formally reported incidents that had occurred during 2014–2019, and unreported incidents during one year. Thirteen clinical MR units were visited, and the managing radiographer was interviewed. Open questions were analysed using conventionally adopted content analysis. Results Thirty-seven written reports for 5 years and an additional 12 oral reports for 1 year were analysed. Only 38% of the incidents were reported formally. Some of these incidents were catastrophic. Negative correlations were observed between the number of annual incidents (per scanner) and staff MR knowledge (Spearman’s rho − 0.41, p < 0.05) as well as the number of MR physicists per scanner (− 0.48, p < 0.05). It was notable that only half of the sites had implemented the EU directive. Quotes like ‘Burns are to be expected in MR’ and not even knowing the name of the incident reporting system suggested an inadequate safety culture. Finally, there was a desire among staff for MR safety education. Conclusions MR-related incidents were greatly underreported, and some incidents could have had catastrophic outcomes. There is a great desire among radiographers to enhance the safety culture, but to achieve this, much more accessible education is required, as well as focused involvement of the management of the operations. Key Points • Only one in three magnetic resonance–related incidents were reported. • Several magnetic resonance incidents could have led to catastrophic consequences. • Much increased knowledge about magnetic resonance safety is needed by radiologists and radiographers.