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Continuity Of Care In The Resected Pancreatic Cancer Patient Population At Thomas Jefferson University Hospital, Christian Fernandez, MD, Nazanin Sarpoulaki, Andrew J. Song, MD, Mark D. Hurwitz, MD 2019 Thomas Jefferson University

Continuity Of Care In The Resected Pancreatic Cancer Patient Population At Thomas Jefferson University Hospital, Christian Fernandez, Md, Nazanin Sarpoulaki, Andrew J. Song, Md, Mark D. Hurwitz, Md

House Staff Quality Improvement and Patient Safety Posters

Introduction

  • Standard of care for resectable pancreatic cancer according to the National Comprehensive Cancer Network guidelines includes surgery, chemotherapy, and consideration of radiotherapy
  • Thomas Jefferson University Hospital is a high volume institution with over 100 surgical pancreatic cancer cases per year
  • Adjuvant treatment at high volume centers is recommended at all stages and inpatients at TJUH routinely receive inpatient radiation and medical oncology consultations prior to discharge to discuss the benefit of adjuvant therapies
  • Despite these efforts and potential benefit to patients, the rate of follow up and delivery of adjuvant therapies at TJUH have not be characterized
  • We retrospectively ...


Scintillation Event Localization In Novel Hemi-Ellipsoid Detector For Spect, Hanif R. Soysal 2019 Louisiana State University and Agricultural and Mechanical College

Scintillation Event Localization In Novel Hemi-Ellipsoid Detector For Spect, Hanif R. Soysal

LSU Master's Theses

A high sensitivity Cardiac SPECT system using hemi-ellipsoid crystals with pinhole collimation was previously proposed by Dey et al. To investigate detector resolution for this design, the scintillation light spread on a monolithic hemi-ellipsoidal CsI crystal was simulated using Geant4 Monte Carlo. The expected distribution of scintillation light on the outer surface of the crystal from photoelectric absorption events was obtained from the simulations for selected points inside the crystal. Two sets of simulations were performed. For the first set, a look-up table (LUT) of 12 points was created and each point mapped to its expected light distribution—four points ...


Sub-Region Based Radiomics Analysis For Survival Prediction In Oesophageal Tumours Treated By Definitive Concurrent Chemoradiotherapy, Congying Xie, Pengfei Yang, Xuebang Zhang, Lei Xu, Xiaoju Wang, Xiadong Li, Luhan Zhang, Ruifei Xie, Ling Yang, Zhao Jing, Hongfang Zhang, Lingyu Ding, Yu Kuang, Tianye Niu, Shixiu Wu 2019 Wenzhou Medical University

Sub-Region Based Radiomics Analysis For Survival Prediction In Oesophageal Tumours Treated By Definitive Concurrent Chemoradiotherapy, Congying Xie, Pengfei Yang, Xuebang Zhang, Lei Xu, Xiaoju Wang, Xiadong Li, Luhan Zhang, Ruifei Xie, Ling Yang, Zhao Jing, Hongfang Zhang, Lingyu Ding, Yu Kuang, Tianye Niu, Shixiu Wu

Health Physics & Diagnostic Sciences Faculty Publications

Background: Evaluating clinical outcome prior to concurrent chemoradiotherapy remains challenging for oesophageal squamous cell carcinoma (OSCC) as traditional prognostic markers are assessed at the completion of treatment. Herein, we investigated the potential of using sub-region radiomics as a novel tumour biomarker in predicting overall survival of OSCC patients treated by concurrent chemoradiotherapy. Methods: Independent patient cohorts from two hospitals were included for training (n = 87) and validation (n = 46). Radiomics features were extracted from sub-regions clustered from patients' tumour regions using K-means method. The LASSO regression for ‘Cox’ method was used for feature selection. The survival prediction model was constructed ...


Ten-Year Outcomes Of Moderately Hypofractionated (70 Gy In 28 Fractions) Intensity Modulated Radiotherapy For Localized Prostate Cancer, Rupesh Kotecha 2019 Baptist Health Medical Group; Miami Cancer Institute

Ten-Year Outcomes Of Moderately Hypofractionated (70 Gy In 28 Fractions) Intensity Modulated Radiotherapy For Localized Prostate Cancer, Rupesh Kotecha

Rupesh Kotecha

No abstract provided.


Stereotactic Radiosurgery With Concurrent Lapatinib Is Associated With Improved Local Control For Her2-Positive Breast Cancer Brain Metastases, Rupesh Kotecha 2019 Baptist Health Medical Group; Miami Cancer Institute

Stereotactic Radiosurgery With Concurrent Lapatinib Is Associated With Improved Local Control For Her2-Positive Breast Cancer Brain Metastases, Rupesh Kotecha

Rupesh Kotecha

No abstract provided.


State Of The Art: The Evolving Role Of Rt In Combined Modality Therapy For Gbm, Minesh Mehta 2019 Baptist Health Medical Group; Miami Cancer Institute

State Of The Art: The Evolving Role Of Rt In Combined Modality Therapy For Gbm, Minesh Mehta

Minesh Mehta

No abstract provided.


Combining Radiation And Immune Checkpoint Blockade In The Treatment Of Head And Neck Squamous Cell Carcinoma., Gregor Manukian, Voichita Bar-Ad, Bo Lu, Athanassios Argiris, Jennifer M. Johnson 2019 Thomas Jefferson University

Combining Radiation And Immune Checkpoint Blockade In The Treatment Of Head And Neck Squamous Cell Carcinoma., Gregor Manukian, Voichita Bar-Ad, Bo Lu, Athanassios Argiris, Jennifer M. Johnson

Department of Radiation Oncology Faculty Papers

Head and neck squamous cell carcinoma (HNSCC) is a significant cause of morbidity and mortality worldwide. Current treatment options, even though potentially curative, have many limitations including a high rate of complications. Over the past few years immune checkpoint inhibitors (ICI) targeting cytotoxic lymphocyte antigen-4 (CTLA-4), programmed cell death protein 1 (PD-1), and programmed cell death ligand 1 (PD-L1) have changed treatment paradigms in many malignancies and are currently under investigation in HNSCC as well. Despite improvements in treatment outcomes and the implementation of combined modality approaches long-term survival rates in patients with locally advanced HNSCC remain suboptimal. Accumulating evidence ...


A Nomogram To Determine Required Seed Air Kerma Strength In Planar 131 Cesium Permanent Seed Implant Brachytherapy, Emily Hubley, Michael Trager, Voichita Bar-Ad, Adam J. Luginbuhl, Laura Doyle 2019 Thomas Jefferson University

A Nomogram To Determine Required Seed Air Kerma Strength In Planar 131 Cesium Permanent Seed Implant Brachytherapy, Emily Hubley, Michael Trager, Voichita Bar-Ad, Adam J. Luginbuhl, Laura Doyle

Department of Radiation Oncology Faculty Papers

Purpose: Intraoperatively implanted Cesium-131 ( 131 Cs) permanent seed brachytherapy is used to deliver highly localized re-irradiation in recurrent head and neck cancers. A single planar implant of uniform air kerma strength (AKS) seeds and 10 mm seed-to-seed spacing is used to deliver the prescribed dose to a point 5 mm or 10 mm perpendicular to the center of the implant plane. Nomogram tables to quickly determine the required AKS for rectangular and irregularly shaped implants were created and dosimetrically verified. By eliminating the need for a full treatment planning system plan, nomogram tables allow for fast dose calculation for intraoperative ...


The Oncology Care Model: Oncology's First Foray Away From Volume And Toward Value-Based Care., Andrew Song, Valerie P. Csik, Amy Leader, Vittorio Maio 2019 Thomas Jefferson University

The Oncology Care Model: Oncology's First Foray Away From Volume And Toward Value-Based Care., Andrew Song, Valerie P. Csik, Amy Leader, Vittorio Maio

Department of Radiation Oncology Faculty Papers

No abstract provided.


Radiation Dose Estimation By Completely Automated Interpretation Of The Dicentric Chromosome Assay, Peter Rogan, Yanxin Li, Ben Shirley, Ruth Wilkins, Farrah Norton, Joan Knoll 2019 The University of Western Ontario

Radiation Dose Estimation By Completely Automated Interpretation Of The Dicentric Chromosome Assay, Peter Rogan, Yanxin Li, Ben Shirley, Ruth Wilkins, Farrah Norton, Joan Knoll

Biochemistry Publications

Accuracy of the automated dicentric chromosome (DC) assay relies on metaphase image selection. This study validates a software framework to find the best image selection models that mitigate inter-sample variability. Evaluation methods to determine model quality include the Poisson goodness-of-fit of DC distributions for each sample, residuals after calibration curve fitting and leave-one-out dose estimation errors. The process iteratively searches a pool of selection model candidates by modifying statistical and filter cut-offs to rank the best candidates according to their respective evaluation scores. Evaluation scores minimize the sum of squared errors relative to the actual radiation dose of the calibration ...


An In-Silico Quality Assurance Study Of Contouring Target Volumes In Thoracic Tumors Within A Cooperative Group Setting, Hesham Elhalawani, Thomas J. Fitzgerald, Fran Laurie, Kenneth Ulin, Roy Decker, Charles R. Thomas Jr., Clifton D. Fuller 2019 University of Texas M.D. Anderson Cancer Center

An In-Silico Quality Assurance Study Of Contouring Target Volumes In Thoracic Tumors Within A Cooperative Group Setting, Hesham Elhalawani, Thomas J. Fitzgerald, Fran Laurie, Kenneth Ulin, Roy Decker, Charles R. Thomas Jr., Clifton D. Fuller

Open Access Articles

Introduction: Target delineation variability is a significant technical impediment in multi-institutional trials which employ intensity modulated radiotherapy (IMRT), as there is a real potential for clinically meaningful variances that can impact the outcomes in clinical trials. The goal of this study is to determine the variability of target delineation among participants from different institutions as part of Southwest Oncology Group (SWOG) Radiotherapy Committee's multi-institutional in-silico quality assurance study in patients with Pancoast tumors as a "dry run" for trial implementation.

Methods: CT simulation scans were acquired from four patients with Pancoast tumor. Two patients had simulation 4D-CT and FDG-FDG ...


Dosimetric Performance And Planning/Delivery Efficiency Of A Dual-Layer Stacked And Staggered Mlc On Treating Multiple Small Targets: A Planning Study Based On Single-Isocenter Multi-Target Stereotactic Radiosurgery (Srs) To Brain Metastases., Taoran Li, Peyton Irmen, Haisong Lui, Wenyin Shi, Michelle Alonso-Basanta, Wei Zou, Boon-Keng Kevin Teo, James M. Metz, Lei Dong 2019 University of Pennsylvania

Dosimetric Performance And Planning/Delivery Efficiency Of A Dual-Layer Stacked And Staggered Mlc On Treating Multiple Small Targets: A Planning Study Based On Single-Isocenter Multi-Target Stereotactic Radiosurgery (Srs) To Brain Metastases., Taoran Li, Peyton Irmen, Haisong Lui, Wenyin Shi, Michelle Alonso-Basanta, Wei Zou, Boon-Keng Kevin Teo, James M. Metz, Lei Dong

Department of Radiation Oncology Faculty Papers

Purpose: To evaluate the dosimetric performance and planning/delivery efficiency of a dual-layer MLC system for treating multiple brain metastases with a single isocenter.

Materials and Methods: 10 patients each with 6-10 targets with volumes from 0.11 to 8.57 cc, and prescription doses from 15 to 24 Gy, were retrospectively studied. Halcyon has only coplanar delivery mode. Halcyon V1 MLC modulates only with the lower layer at 1 cm resolution, whereas V2 MLC modulates with both layers at an effective resolution of 0.5 cm. For each patient five plans were compared varying MLC and beam arrangements: the ...


Spaceoar To Improve Dosimetric Outcomes For Monotherapy High-Dose-Rate Prostate Implantation In A Patient With Ulcerative Colitis., Michael Trager, Benjamin Greenberger, Amy S. Harrison, James Keller, Robert B. Den 2018 Thomas Jefferson University

Spaceoar To Improve Dosimetric Outcomes For Monotherapy High-Dose-Rate Prostate Implantation In A Patient With Ulcerative Colitis., Michael Trager, Benjamin Greenberger, Amy S. Harrison, James Keller, Robert B. Den

Department of Radiation Oncology Faculty Papers

High-dose-rate (HDR) brachytherapy is an attractive option for patients receiving definitive radiation therapy for prostate cancer with decreased overall dose to the pelvis. However, ulcerative colitis increases rectal toxicity risk and may be a contraindication. A synthetic hydrogel, SpaceOAR (Augmentix Inc., Waltham, MA, USA), can facilitate the use of HDR brachytherapy for patients where rectal toxicity is a limiting factor. SpaceOAR gel (13.19 cc) was utilized in a monotherapy HDR prostate treatment with Ir-192 under transrectal ultrasound guidance, with the intention of decreasing rectal dose. SpaceOAR gel was inserted transperineally into the patient 18 days prior to the procedure ...


Prognostic Factors For Elderly Patients Treated With Stereotactic Body Radiation Therapy For Pancreatic Adenocarcinoma, Philip A. Sutera, Mark E. Bernard, Hong Wang, Dwight E. Heron 2018 University of Pittsburgh

Prognostic Factors For Elderly Patients Treated With Stereotactic Body Radiation Therapy For Pancreatic Adenocarcinoma, Philip A. Sutera, Mark E. Bernard, Hong Wang, Dwight E. Heron

Radiation Medicine Faculty Publications

Introduction: Pancreatic ductal adenocarcinoma (PDAC) commonly presents later in life with a median age at diagnosis of 70 years. Unfortunately, elderly patients are significantly underrepresented in clinical trials. Stereotactic body radiation therapy (SBRT) is a promising treatment modality in this population as it has demonstrated excellent local control with minimal toxicity. We aimed to determine prognostic factors associated with outcomes in elderly patients treated with SBRT.

Materials and Methods: Elderly patients older than 70 treated with SBRT for PDAC at our institution, from 2004 to 2014 were included. Our primary endpoints included overall survival (OS) and local-progression-free survival (LPFS). Secondary ...


Implementation And Utilization Of Hypofractionation For Breast Cancer, P. Gilbo, L. Potters, L. Lee 2018 Zucker School of Medicine at Hofstra/Northwell

Implementation And Utilization Of Hypofractionation For Breast Cancer, P. Gilbo, L. Potters, L. Lee

Journal Articles

© 2018 The Authors Purpose: Hypofractionation (HF) of whole breast irradiation has become a standard treatment regimen because randomized trials continue to demonstrate equivalence in survival and local control compared with conventional fractionation. In 2011, the American Society for Radiation Oncology (ASTRO) adopted clinical guidelines on the proper selection of HF. Nevertheless, utilization remains lower than predicted. We evaluate the effects of clinical directives that serve as default treatment decisions and prospective contouring rounds on the implementation of HF in a large, multicenter radiation oncology department. Methods and materials: In 2010, we implemented consensus-driven and evidence-based clinical directives to guide treatment ...


Reducing Seed Waste And Increasing Value Of Dynamic Intraoperative Implantation Of Pd-103 Seeds In Prostate Brachytherapy, P. K. Taylor, A, C. Riegel 2018 Northwell Health

Reducing Seed Waste And Increasing Value Of Dynamic Intraoperative Implantation Of Pd-103 Seeds In Prostate Brachytherapy, P. K. Taylor, A, C. Riegel

Journal Articles

© 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine. Several nomograms exist for ordering palladium-103 seeds for permanent prostate seed implants (PSI). Excess seeds from PSIs pose additional radiation safety risks and increase the cost of care. This study compared five nomograms to clinical data from dynamic modified-peripheral intraoperative PSI to determine (a) the cause of excess seeds and (b) the optimal nomogram for our institution. Pre- and intraoperative patient data were collected for monotherapy PSIs and compiled into a clinical database. All patients were prescribed ...


Restricted Single Isocenter For Multiple Targets Dynamic Conformal Arc (Rsimt Dca) Technique For Brain Stereotactic Radiosurgery (Srs) Planning., J. Chang, A. G. Wernicke, S. C. Pano 2018 Zucker School of Medicine at Hofstra/Northwell

Restricted Single Isocenter For Multiple Targets Dynamic Conformal Arc (Rsimt Dca) Technique For Brain Stereotactic Radiosurgery (Srs) Planning., J. Chang, A. G. Wernicke, S. C. Pano

Journal Articles

In stereotactic radiosurgery (SRS), the multiple isocenters for multiple targets dynamic conformal arc (MIMT DCA) technique is traditionally used to treat multiple brain metastases, with one isocenter for each target. The single isocenter for multiple targets (SIMT) technique has recently been adopted to reduce the treatment time at the cost of plan quality. The objective of this study was to develop a restricted single isocenter for multiple targets DCA (RSIMT DCA) technique that can significantly reduce the treatment time but still maintain similar plan quality as the MIMT DCA technique.Treating multiple brain metastases with a single isocenter poses a ...


Intermediate-Risk Meningioma: Initial Outcomes From Nrg Oncology Rtog 0539, L. Rogers, P. Zhang, M. A. Vogelbaum, A. Perry, L. S. Ashby, J. M. Modi, A. M. Alleman, J. Galvin, J. P. S. Knisely, M. P. Mehta, +5 additional authors 2018 Zucker School of Medicine at Hofstra/Northwell

Intermediate-Risk Meningioma: Initial Outcomes From Nrg Oncology Rtog 0539, L. Rogers, P. Zhang, M. A. Vogelbaum, A. Perry, L. S. Ashby, J. M. Modi, A. M. Alleman, J. Galvin, J. P. S. Knisely, M. P. Mehta, +5 Additional Authors

Journal Articles

No abstract provided.


Pdz-Rhogef Is A Signaling Effector For Troy-Induced Glioblastoma Cell Invasion And Survival, Z. Ding, H. Dhruv, A. Kwiatkowska-Piwowarczyk, R. Ruggieri, J. Kloss, M. Symons, P. Pirrotte, J. M. Eschbacher, N. L. Tran, J. C. Loftus 2018 Zucker School of Medicine at Hofstra/Northwell

Pdz-Rhogef Is A Signaling Effector For Troy-Induced Glioblastoma Cell Invasion And Survival, Z. Ding, H. Dhruv, A. Kwiatkowska-Piwowarczyk, R. Ruggieri, J. Kloss, M. Symons, P. Pirrotte, J. M. Eschbacher, N. L. Tran, J. C. Loftus

Journal Articles

© 2018 The Authors Glioblastoma multiforme (GBM) is the most common type of malignant brain tumors in adults and has a dismal prognosis. The highly aggressive invasion of malignant cells into the normal brain parenchyma renders complete surgical resection of GBM tumors impossible, increases resistance to therapeutic treatment, and leads to near-universal tumor recurrence. We have previously demonstrated that TROY (TNFRSF19) plays an important role in glioblastoma cell invasion and therapeutic resistance. However, the potential downstream effectors of TROY signaling have not been fully characterized. Here, we identified PDZ-RhoGEF as a binding partner for TROY that potentiated TROY-induced nuclear factor kappa ...


Outlier Identification In Radiation Therapy Knowledge-Based Planning: A Study Of Pelvic Cases., Yang Sheng, Yaorong Ge, Lulin Yuan, Taoran Li, Fang-Fang Yin, Qingrong Jackie Wu 2017 Duke University Medical Cente; Duke University

Outlier Identification In Radiation Therapy Knowledge-Based Planning: A Study Of Pelvic Cases., Yang Sheng, Yaorong Ge, Lulin Yuan, Taoran Li, Fang-Fang Yin, Qingrong Jackie Wu

Department of Radiation Oncology Faculty Papers

PURPOSE: The purpose of this study was to apply statistical metrics to identify outliers and to investigate the impact of outliers on knowledge-based planning in radiation therapy of pelvic cases. We also aimed to develop a systematic workflow for identifying and analyzing geometric and dosimetric outliers.

METHODS: Four groups (G1-G4) of pelvic plans were sampled in this study. These include the following three groups of clinical IMRT cases: G1 (37 prostate cases), G2 (37 prostate plus lymph node cases) and G3 (37 prostate bed cases). Cases in G4 were planned in accordance with dynamic-arc radiation therapy procedure and include 10 ...


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