Medical Specialties Commons^™

Institutional Experience With Primary Interventional Radiology Sclerotherapy For Lymphatic Malformation, Obiyo Osuchukwu, Brenton Reading, Charlene Dekonenko, Wendy Jo Svetanoff, Jeff Thekkekara, Douglas C. Rivard, Charles L. Snyder, Tolulope A. Oyetunji

Costas T. Lambrew Research Retreat 2021

Interventional Radiology Sclerotherapy is effective for treatment of primary and recurrent lymphatic malformations

Role Of Preoperative Embolization In Management Of Central Nervous System Tumours, Ummey Hani, Ahmer Nasir Baig, Muhammad Shahzad Shamim, Basit Salam

Section of Neurosurgery

Preoperative embolization plays a significant role as an adjunct to surgical intervention in the cases of certain vascular tumours of the brain. While the procedure has resulted in facilitated resection of the tumour, and has reduced morbidity and mortality, its application remains debatable within the neurosurgical community, owing to rare, but major post-procedural complications. Herein, we have reviewed the literature to assess the safety and efficacy of preoperative angiographic embolization for brain tumours.

Magnetic Resonance Neuroblate Fusion For Treating Glioblastomas, Amanda Goldy

Student Research Poster Presentations 2021

The Neuroblate Fusion system utilizes magnetic resonance guided laser therapy to ablate tumors and lesions. The system requires the use of Laser Interstitial Thermo Therapy (LITT) to activate thermocoagulation and focus of tissue destruction. This is a minimally invasive alternative to traditional brain surgery, giving patients a shorter recovery time and fewer complications. Neuroblate Fusion may also be an additional treatment to chemotherapy or radiation therapy. Neuroblate Fusion is best used for treating glioblastomas in the brain and occasionally for reducing the potential for seizures. Under sterile conditions, a small burr hole is made in the patient’s skull which allows …

Commentary: Use Of Bactrac Proteomic Database-Uromodulin Protein Expression During Ischemic Stroke, Gabriella-Salome K. Armstrong, Jacqueline A. Frank, Christopher J. Mclouth, Ann M. Stowe, Jill M. Roberts, Amanda L. Trout, Justin F. Fraser, Keith R. Pennypacker

Neurology Faculty Publications

Introduction: Uromodulin (UMOD) is a glycoprotein expressed by the epithelial cells of the thick ascending limb of Henle's loop in the kidney. Research has shown that increased uromodulin expression may be associated with lower risk of cardiovascular disease in adults. Utilizing the Blood and Clot Thrombectomy Registry and Collaboration (BACTRAC) (clinicaltrials.gov NCT03153683), a continuously enrolling tissue bank, we aimed to examine the associations between serum uromodulin, age, and high BMI (BMI> 25) and its relationship to stroke in patients.

Methods: Arterial blood distal and proximal to the thrombus was collected during a thrombectomy procedure using the BACTRAC protocol and sent …

Imaging Patterns Of Encephalopathy In Patients With Covid-19, Kumail Khandwala, Fatima Mubarak, Nadeem Ahmad

Department of Radiology

The aim of this retrospective observational study was to describe the neuroimaging manifestations of patients with COVID-19. This study was conducted at Aga Khan University Hospital, Karachi, Pakistan from March to July 2020. COVID-19 patients with neurological symptoms and positive neuroimaging were included after confirmation of COVID-19 by polymerase chain reaction test (PCR). In the 12 included patients, seizures and altered mentation were predominant neurological manifestations. Three cases had acute watershed infarcts (25%), two cases had posterior cerebral artery territorial infarcts (16.7%), two cases had periventricular corona radiata infarcts (16.7%), three cases had hypoxic ischemic encephalopathy (25%), two cases had …

Therapy And Medical Imaging Applications Of Focusing Polycapillary X-Ray Optics, Weiyuan Sun

Legacy Theses & Dissertations (2009 - 2024)

Focusing polycapillary optics yield high gains in intensity and increased spatial resolution for a variety of clinical, lab-based, synchrotron, or in situ analysis applications. In this dissertation we investigate the extension of two applications of focusing polycapillary optics. The first is the application of polycapillary optics in radiation therapy. This discussion includes measurements and calculation of dose for focused beam orthovoltage therapy. A system has been designed to investigate whether the polycapillary optics can produce an X-ray beam which can give more accurate dose painting due to the higher dose concentration at the focal spot. X-ray exposures were measured with …

Cost Outcomes Of Physical Therapist Providers Compared To Primary Care Providers In The Treatment Of Musculoskeletal Patients In A Military Treatment Facility: A Retrospective Chart Review”, Troy E. Mcgill, Debra F. Stern, Morey J. Kolber, John Mcgee

Internet Journal of Allied Health Sciences and Practice

Purpose: The purpose of this study was to compare the cost of physical therapist (PT) management of patients with musculoskeletal (MSK) disorders to management by traditional primary care managers (PCMs); medical doctors (MDs), doctors of osteopathic medicine (DOs), advanced registered nurse practitioners (ARNPs), and physician assistants (PAs). Methods: This is a retrospective study of electronic medical records using an exploratory, non-experimental, cross-sectional, and quantitative design method. The records of patients with MSK disorders were assessed at an Air Force military medical clinic for 18 months from January 2016 through June 2017. Results: PT management of MSK patients resulted in a …

Radiographic Patterns Of Different Aetiologies Of Community Acquired Pneumonia In Patients Presenting To Aga Khan University, Hanika Ajaykumar Patel

Master of Medicine in Imaging and Diagnostic Radiology

Background: Community-acquired pneumonia (CAP) is a major cause of significant morbidity and mortality globally. The spectrum of causative organisms of CAP varies markedly with region as well as with the immune status of the patient. Chest radiography remains an important initial imaging modality in the diagnostic work-up of patients with CAP. Although previous studies have highlighted major trends and radiographic patterns of various causative organisms of CAP, there is a paucity of recent literature within Sub-Saharan Africa on these various radiographic patterns. Objective: The primary objective of this study was to identify the association between the radiographic patterns of different …

Spinal Cord Mri Analysis Techniques In Post-Stroke Patients, Sarvani Uppati, Sravani Mannuru, Kelsey Baker

MEDI 9331 Scholarly Activities Clinical Years

Stroke, also termed cerebral infarction, results in neurodegeneration and neuroinflammation in the brain at area of the infarct and peri-infarct regions. Recent research has shown involvement of alternate motor pathways of the spinal cord in disease progression. Creating optimal techniques to study spinal cord MRI can give way to higher prognostic methods and enhanced treatment modalities in post-stroke patients. Here, we will review current research proposing various spinal cord MRI analysis techniques in different neurological conditions that can be applied to analyzing post-stroke spinal cord.

Intense Monochromatic Photons Above 100 Kev From An Inverse Compton Source, Kirsten Deitrick, Georg H. Hoffstaetter, Carl Franck, Bruno D. Muratori, Peter H. Williams, Geoffrey A, Krafft, Balša Terzić, Joe Crone, Hywel Owen

Physics Faculty Publications

Quasimonochromatic x rays are difficult to produce above 100 keV, but have a number of uses in x-ray and nuclear science, particularly in the analysis of transuranic species. Inverse Compton scattering (ICS) is capable of fulfilling this need, producing photon beams with properties and energies well beyond the limits of typical synchrotron radiation facilities. We present the design and predicted output of such an ICS source at CBETA, a multiturn energy-recovery linac with a top energy of 150 MeV, which we anticipate producing x rays with energies above 400 keV and a collimated flux greater than 108 photons per second …

Tisagenlecleucel Infusion In Patients With Relapsed/Refractory All And Concurrent Serious Infection., Erin Hall, Dwight E. Yin, Rakesh K. Goyal, Atif Ahmed, Grace S. Mitchell, Shawn D. St Peter, Terrie Flatt, Ibrahim A. Ahmed, Weijie Li, Richard J. Hendrickson, Keith August, Douglas Myers

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Tisagenlecleucel, an anti-CD19 chimeric antigen receptor T (CAR-T) cell therapy, has demonstrated durable efficacy and a manageable safety profile in pediatric and young adult patients with relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL) in the ELIANA pivotal trial and real-world experience. Experience from investigator-led studies prior to ELIANA suggests that infections and inflammatory conditions may exacerbate the severity of cytokine release syndrome (CRS) associated with CAR-T cell therapy, leading to extreme caution and strong restrictions for on-study and commercial infusion of tisagenlecleucel in patients with active infection. CRS intervention with interleukin (IL)-6 blockade and/or steroid therapy was introduced late in …

Thinking Outside Malaria: A Rare Case Of Disseminated Cysticercosis With Cardiopulmonary Involvement From Urban Tanzania, Frederick R. Lyimo, Ahmed Jusabani, Hilda Makungu, Maria Mtolera, Salim Surani

Imaging & Diagnostic Radiology, East Africa

Dissemination of the cysticerci throughout the body with cardiopulmonary involvement represents a very rare occurrence and an uncommon form of cysticercosis manifestation. We report a rare case of a 48-yearold African male from urban Tanzania who was, at first, referred to our radiology department for a coronary computed tomography angiography (CCTA), but incidentally on further evaluation of the patient revealed a history of recurrent convulsions, loss of consciousness, a single episode of temporary loss of vision and recent skin nodules. The value of a full clinical and radiological evaluation of the patient presenting with adult-onset seizures cannot be overemphasized for …

Bone In The Breast: A Case Report Of A Metaplastic Breast Cancer With Osseous Differentiation, Kyle Luo, Xiaoqin Wang

Radiology Faculty Publications

Metaplastic breast carcinoma is an uncommon malignant tumor with various pathologic subtypes. Diagnosis is often challenging due to the wide spectrum of clinical and imaging presentations. Here, we present the case of a very rare subtype of metaplastic breast carcinoma-a mixed-type metaplastic breast cancer with osseous differentiation in a 55-year-old female patient. The clinical presentation, imaging-pathology diagnosis, and treatment options are reviewed. Knowing this rarely reported but aggressive breast cancer is very important for clinicians to establish a timely diagnosis for effective management.

Joint Modeling Of Rnaseq And Radiomics Data For Glioma Molecular Characterization And Prediction, Zeina A. Shboul, Norou Diawara, Arastoo Vossough, James Y. Chen, Khan M. Iftekharuddin

Electrical & Computer Engineering Faculty Publications

RNA sequencing (RNAseq) is a recent technology that profiles gene expression by measuring the relative frequency of the RNAseq reads. RNAseq read counts data is increasingly used in oncologic care and while radiology features (radiomics) have also been gaining utility in radiology practice such as disease diagnosis, monitoring, and treatment planning. However, contemporary literature lacks appropriate RNA-radiomics (henceforth, radiogenomics) joint modeling where RNAseq distribution is adaptive and also preserves the nature of RNAseq read counts data for glioma grading and prediction. The Negative Binomial (NB) distribution may be useful to model RNAseq read counts data that addresses potential shortcomings. …

Dosimetric Comparison Of Rapidplan And Manually Optimized Plans For Hippocampus Avoidance Whole Brain Radiation Therapy, Laksamon Phimolasawakun

Chulalongkorn University Theses and Dissertations (Chula ETD)

Nowadays, whole-brain radiation therapy (WBRT) is a good method to cure brain metastases. However, it has been noted that whole-brain radiation therapy could be a cause to neurological toxicity which could damage the hippocampus that is an important part of forming long-term memories. The HA-WBRT is a complicated plan depending on planner skills, the researcher would like to simplify this problem using knowledge-based planning called RapidPlan. The objective of this study was to compare the dosimetric difference of RapidPlan and manually optimized plans for the treatment of HA-WBRT. The RapidPlan model was created for HA-WBRT. The PTV and OARs constraints …

Hepatic Lesion Detectability On Dual Energy Computed Tomography Imaging : Phantom Study, Hataipat Jantawong

Chulalongkorn University Theses and Dissertations (Chula ETD)

The purpose of this study is to determine the hepatic lesion detectability in abdomen from various phantom sizes by dual-energy computed tomography (DECT) imaging and to investigate the factors affecting the detectability of hepatic lesion in abdomen by dual-energy CT in phantom study. The anthropomorphic liver with nodule inserted phantom with extension rings simulating the small, medium, and large patients were scanned under DECT acquisitions by varying three kVp combinations (80/-,90/-, and 100/Sn150-kVp). The series of 40-,50-,60-, and 70-keV VMI were generated from DECT data set. All images were used to assess the task-based image quality; task transfer function (TTF), …

Determination Of Field Output Correction Factors In Elongated Small Field Photon Beams, Mananchaya Vimolnoch

Chulalongkorn University Theses and Dissertations (Chula ETD)

IAEA along with AAPM have published a code of practice TRS 483 for small field dosimetry. The field correction output factors of various detectors were introduced to correct detector response changes in relative dosimetry. However, the publication of TRS 483 has focused on symmetry field sizes, the correction factors for elongated small fields are not included in the protocol. The overall objective of this work is to determine the field output correction factor in elongated small field. The correction factors of IBA CC01, Sun nuclear EDGE, and Exradin W2 PSD for 6 MV photon beam were determined using Monte Carlo …

Evaluation Of Integral Depth-Dose Curves In Proton Pencil Beam Scanning Using Plane-Parallel Ionization Chambers, Phatthraporn Thasasi

Chulalongkorn University Theses and Dissertations (Chula ETD)

Proton therapy is an advanced form of radiation therapy treatment that can potentially decrease side effects and increase tumor control probability. The integral depth-dose curve is an essential parameter that has to be determined and introduced into the proton treatment planning system for the dose calculation. Besides the halo, the integral depth-dose curve measurements should be performed with a large-diameter plane-parallel ionization chamber. The purpose of this research is to determine the integral depth-dose curves and assess the geometrical collection efficiency at intermediate depths of different detector diameters in proton pencil beam scanning. The integral depth-dose curves with a proton …

Baselines Of Daily Quality Assurance For Proton Pencil Beam Scanning Using The Sphinx Compact, Tanapat Tiajaroen

Chulalongkorn University Theses and Dissertations (Chula ETD)

Quality assurance (QA) is a systematic process used to determine whether the product meets specified requirements. The American Association of Physicists in Medicine (AAPM) published a comprehensive proton therapy machine QA in TG-224 to provide confidence in use. King Chulalongkorn Memorial Hospital (KCMH) recently operated the first proton therapy center in Thailand, and the data of daily QA are not available or established. This study aims to apply the control chart for establishing the baselines of daily QA for the proton pencil beam scanning system using the Sphinx Compact detector. The Sphinx Compact was used to perform the proton daily …

Moderated Neutron Detector For Accumulated Ambient Dose Equivalent In Proton Therapy, Tanawat Tawonwong

Chulalongkorn University Theses and Dissertations (Chula ETD)

The Varian ProBeam compact was installed at Her Royal Highness Princess Maha Chakri Sirindhorn Proton Center. Since 2017, the project has started at the King Chulalongkorn Memorial Hospital and after 4 years, during Covid19 pandemic, the 1st patient treatment received proton therapy on August, 2021. The radiation safety of the center was accomplished through firstly, the shielding calculation and secondary, the radiation survey at the milestone points such as cyclotron installation and 1st Beam ON at the treatment room. The only one WENDI-II dosimeter was used in radiation survey. The main purpose of this study is to validate the in-house …

Dosimetric Impact Of Interplay Effects Instereotactic Body Radiation Therapy (Sbrt) Lung Cancer, Vanida Poolnapol

Chulalongkorn University Theses and Dissertations (Chula ETD)

Lung cancer patient breathing induced interplay effects in the volumetric modulated arc therapy (VMAT) together with stereotactic body radiation therapy (SBRT), which lead to non-uniform doses within the target volume and unwanted dose to the surrounding tissues. The purpose of this study was to investigate the dosimetric impact of interplay effects in 6 MV FFF of photon beams for lung cancer and to calculate the novel interplay effects factor (IEF) for VMAT-SBRT lung cancer. This study performed the static and dynamic measurements using two dimensions (2D) robotic platform and diode array for 3D-conformal radiation therapy (3D-CRT) plans, while using three …

A Deep Learning U-Net For Detecting And Segmenting Liver Tumors, Vidhya Cardozo

Theses and Dissertations

Visualization of liver tumors on simulation CT scans is challenging even with contrast-enhancement, due to the sensitivity of the contrast enhancement to the timing of the CT acquisition. Image registration to magnetic resonance imaging (MRI) can be helpful for delineation, but differences in patient position, liver shape and volume, and the lack of anatomical landmarks between the two image sets makes the task difficult. This study develops a U-Net based neural network for automated liver and tumor segmentation for purposes of radiotherapy treatment planning. Non-contrast simulation based abdominal CT axial scans of 52 patients with primary liver tumors were utilized. …

To Determine The Efficacy Of Bilateral Inferior Petrosal Sinus Sampling In Differentiating Cushing Disease From Ectopic Cushing Syndrome, Muhammad Azeemuddin, Tanveer Ul Haq, Shahmeer Khan, Raza Sayani, Ayesha Shoukat Hussain, Rumaisa Khan

Department of Radiology

Management of endogenous Cushing syndrome is based on its aetiology. Increased Adrenocorticotropic Hormone (ACTH) levels are the most common cause of this disorder and, therefore, it is critical to determine the source of ACTH before further management. Dynamic post contrast MRI is currently the most common investigation implied to diagnose pituitary adenoma; however, it comes with the drawback of low specificity and high false positive results. Inferior petrosal sinus sampling (IPSS) is an established invasive procedure performed to differentiate central versus peripheral source of ACTH which, in turn, results in hypercortesolaemia. This is a series of 14 patients who underwent …

Complete Edentulism Of Dental Patients In Northeastern Turkey: Prevalence And Radiographic Findings On Panoramic Radiographs, Elif Sadik, Ceren Gökmenoğlu, Cankat Kara

Journal of Dentistry Indonesia

The prevalence of complete edentulism varies from country to country and from one region to another. Previous studies have reported the high prevalence of significant radiographic findings in edentulous patients. Objectives: This study aimed to determine the prevalence of complete edentulism retrospectively and to evaluate the frequency and location of significant radiographic findings on panoramic radiographs in edentulous jaws of dental patients in northeastern Turkey. Methods: The digital panoramic images of all ≥35 year-old patients admitted to our faculty from January 2014 to August 2015 were evaluated. The prevalence of complete edentulism was determined among 8314 panoramic images retrospectively. Radiographic …

Gunshot-Related Pediatric Left Ventricular Apical Aneurysm, Achala Donuru, David Saul, Maansi Parekh, Maruti Kumaran, Vinay Kandula, Rami Kharouf

Department of Radiology Faculty Papers

Penetrating injuries of the thorax and abdomen, such as gunshot and stabbing, are rare in children. We present the case of a pediatric patient with a history of remote gunshot injury presenting with a late aneurysm in the left ventricle.

Radiology In The Era Of Value-Based Healthcare: A Multi-Society Expert Statement From The Acr, Car, Esr, Is3r, Ranzcr, And Rsna., Adrian P Brady, Jaqueline A Bello, Lorenzo E Derchi, Michael Fuchsjäger, Stacy Goergen, Gabriel P Krestin, Emil J Y Lee, David C Levin, Josephine Pressacco, Vijay M Rao, John Slavotinek, Jacob J Visser, Richard E A Walker, James A Brink

Department of Radiology Faculty Papers

Background: The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology’s central role; this may have future negative consequences for resource allocation.

Methods, fndings and interpretation: This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the healthcare value contributions of radiology. …

Us-Triggered Microbubble Destruction For Augmenting Hepatocellular Carcinoma Response To Transarterial Radioembolization: A Randomized Pilot Clinical Trial., John R Eisenbrey, Flemming Forsberg, Corinne E Wessner, Lauren J Delaney, Kristen Bradigan, Sriharsha Gummadi, Mohamed Tantawi, Andrej Lyshchik, Patrick O'Kane, Ji-Bin Liu, Charles Intenzo, Jesse Civan, Warren Maley, Scott W Keith, Kevin Anton, Allison Tan, Amanda Smolock, Susan Shamimi-Noori, Colette M Shaw

Department of Radiology Faculty Papers

Combined US-triggered microbubble destruction and hepatocellular carcinoma radioembolization showed improved treatment response compared with radioembolization alone and no changes in vital signs or liver function.

Background US contrast agents are gas-filled microbubbles (MBs) that can be locally destroyed by using external US. Among other bioeffects, US-triggered MB destruction, also known as UTMD, has been shown to sensitize solid tumors to radiation in preclinical models through localized insult to the vascular endothelial cells.

Purpose: To evaluate the safety and preliminary efficacy of combining US-triggered MB destruction and transarterial radioembolization (TARE) in participants with hepatocellular carcinoma (HCC).

Materials and Methods: In this …

Fractal And Edge-Based Techniques For Kidney Enhancement And Segmentation On Magnetic Resonance Images (Mri), Alaá Rateb Mahmoud Al-Shamasneh

Student Works (2020-2029)

Recently, many rapid developments in digital medical imaging have made further contributions to healthcare systems. However, the segmentation of regions of interest in medical images plays a vital role in assisting doctors in their medical diagnoses and for the early detection of disease. Since health issues related to the kidneys are increasing exponentially, this thesis focused on developing methods for the segmentation of MRI images of the kidney. Kidney images frequently suffer from low contrast, low resolution and noise, and are blur. Hence, it is necessary to enhance the images in order to improve the segmentation. Therefore, the current thesis …

Contrast-Enhanced Ultrasound In Association With Serum Biomarkers For Differentiating Combined Hepatocellular-Cholangiocarcinoma From Hepatocellular Carcinoma And Intrahepatic Cholangiocarcinoma., Jie Yang, Ya-Han Zhang, Jia-Wu Li, Ying-Yu Shi, Jia-Yan Huang, Yan Luo, Ji-Bin Liu, Qiang Lu

Department of Radiology Faculty Papers

BACKGROUND: Combined hepatocellular-cholangiocarcinoma (CHC) is a rare type of primary liver cancer. Due to its complex histopathological characteristics, the imaging features of CHC can overlap with those of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC).

AIM: To investigate the possibility and efficacy of differentiating CHC from HCC and ICC by using contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) and tumor biomarkers.

METHODS: Between January 2016 and December 2019, patients with histologically confirmed CHC, ICC and HCC with chronic liver disease were enrolled. The diagnostic formula for CHC was as follows: (1) LR-5 or LR-M with elevated alpha-fetoprotein …

Association Between Medicaid Expansion Status And Lung Cancer Screening Exam Growth: Findings From The Acr Lung Cancer Registry., Neal Gupta, Ethan J. Halpern, Vijay M. Rao

Department of Radiology Faculty Papers

PURPOSE: To determine if Medicaid expansion is associated with increased volumes of lung cancer screenings.

METHODS: A quasi-experimental study was performed to compare the annual growth rates in lung cancer screenings between states that expanded Medicaid (n = 31) versus those that did not (n = 17). Using the American College of Radiology Lung Cancer Screening Registry, we calculated the average annual growth rate between 2016 and 2019 for both groups. Secondary analyses between these two groups also included calculations of the percentages of studies considered appropriate by USPSTF criteria.

RESULTS: No significant difference was identified in the average annual …