Medical Specialties Commons^™

A Phase Ii Randomized Trial Of Observation Versus Stereotactic Ablative Radiation For Oligometastatic Prostate Cancer (Oriole)., Noura Radwan, Ryan Phillips, Ashley Ross, Steven P. Rowe, Michael A. Gorin, Emmanuel S. Antonarakis, Curtiland Deville, Stephen Greco, Samuel Denmeade, Channing Paller, Daniel Y. Song, Maximilian Diehn, Hao Wang, Michael Carducci, Kenneth J. Pienta, Martin G. Pomper, Theodore L. Deweese, Adam Dicker, Mario Eisenberger, Phuoc T. Tran

Department of Radiation Oncology Faculty Papers

BACKGROUND: We describe a randomized, non-blinded Phase II interventional study to assess the safety and efficacy of stereotactic ablative radiotherapy (SABR) for hormone-sensitive oligometastatic prostate adenocarcinoma, and to describe the biology of the oligometastatic state using immunologic, cellular, molecular, and functional imaging correlates. 54 men with oligometastatic prostate adenocarcinoma will be accrued. The primary clinical endpoint will be progression at 6 months from randomization with the hypothesis that SABR to all metastases will forestall progression by disrupting the metastatic process. Secondary clinical endpoints will include local control at 6 months post-SABR, toxicity and quality of life, and androgen deprivation therapy …

Individual Patient-Level Meta-Analysis Of The Performance Of The Decipher Genomic Classifier In High-Risk Men After Prostatectomy To Predict Development Of Metastatic Disease., Daniel E. Spratt, Kasra Yousefi, Samineh Deheshi, Ashley E. Ross, Robert B. Den, Edward M. Schaeffer, Bruce J. Trock, Jingbin Zhang, Andrew G. Glass, Adam P. Dicker, Firas Abdollah, Shuang G Zhao, Lucia L.C. Lam, Marguerite Du Plessis, Voleak Choeurng, Zaid Haddad, Christine Buerki, Elai Davicioni, Sheila Weinmann, Stephen J. Freedland, Eric A. Klein, R. Jeffrey Karnes, Felix Y. Feng

Department of Radiation Oncology Faculty Papers

Purpose To perform the first meta-analysis of the performance of the genomic classifier test, Decipher, in men with prostate cancer postprostatectomy. Methods MEDLINE, EMBASE, and the Decipher genomic resource information database were searched for published reports between 2011 and 2016 of men treated by prostatectomy that assessed the benefit of the Decipher test. Multivariable Cox proportional hazards models fit to individual patient data were performed; meta-analyses were conducted by pooling the study-specific hazard ratios (HRs) using random-effects modeling. Extent of heterogeneity between studies was determined with the I(2) test. Results Five studies (975 total patients, and 855 patients with individual …

Genomic Classifier Augments The Role Of Pathological Features In Identifying Optimal Candidates For Adjuvant Radiation Therapy In Patients With Prostate Cancer: Development And Internal Validation Of A Multivariable Prognostic Model., Deepansh Dalela, María Santiago-Jiménez, Kasra Yousefi, R. Jeffrey Karnes, Ashley E. Ross, Robert B. Den, Stephen J. Freedland, Edward M. Schaeffer, Adam P. Dicker, Mani Menon, Alberto Briganti, Elai Davicioni, Firas Abdollah

Department of Radiation Oncology Faculty Papers

Purpose Despite documented oncologic benefit, use of postoperative adjuvant radiotherapy (aRT) in patients with prostate cancer is still limited in the United States. We aimed to develop and internally validate a risk-stratification tool incorporating the Decipher score, along with routinely available clinicopathologic features, to identify patients who would benefit the most from aRT. Patient and Methods Our cohort included 512 patients with prostate cancer treated with radical prostatectomy at one of four US academic centers between 1990 and 2010. All patients had ≥ pT3a disease, positive surgical margins, and/or pathologic lymph node invasion. Multivariable Cox regression analysis tested the relationship …

The Added Value Of Spect/Ct In Endocrinology: A Pictorial Essay, Cheryl Rickley, Cnmt, Michele Barasch, Cnmt, Charles Intenzo, Md, Sung Kim, Md

Department of Radiology Posters

Objective:

Dedicated radionuclide imaging of the spleen in useful in conditions such as accessory spleen and splenic trauma. Nuclear Medicine plays a key role in the diagnostic molecular SPECT/CT imaging of splenic disorders.

Poster presented at SNMMI Annual Conference in Denver Colorado, United States.

Optimal Radionuclide Imaging Of Splenic Disorders: The Value Of Spect/Ct, Cheryl Rickley, Cnmt, Michele Barasch, Cnmt, Charles Intenzo, Md, Sung Kim, Md

Department of Radiology Posters

Objective:

Dedicated radionuclide imaging of the spleen in useful in conditions such as accessory spleen and splenic trauma. Nuclear Medicine plays a key role in the diagnostic molecular SPECT/CT imaging of splenic disorders.

Poster presented at Society of Nuclear Medicine Molecular Imagining in Denver Colorado, United States.

“Step & Shoot” Cardiac Gated Ct For Detection Of Pulmonary Embolism: Technique And Advantages, Dinesh K. Sharma, Md

Department of Radiology Posters

Introduction

Pulmonary Embolism (PE) is a common condition with significant morbidity and mortality. Prompt recognition, diagnosis and management is important, as untreated PE complications are high; also treatment with long term anticoagulation has serious complications.

Poster presented at The 11th Congress of Asian Society of Cardiovascular Imaging in Kyoto Japan.

Correlation Between Ovarian Volume And Polycystic Ovarian Syndrome Using Ultrasound., Ndecho Muriuki Guandaru

Master of Medicine in Imaging and Diagnostic Radiology

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine abnormality in women of reproductive age with a prevalence of 5-10% in different populations. The prevalence of PCOM in patients with PCOS has been shown to be ≥ 90% in different populations. Diagnostic evaluation accounts for a relatively minor part of the total costs of providing care and evaluating women with PCOS. Hence more widespread and liberal screening for the disorder appears be a cost-effective strategy in susceptible patients. PCOM on ultrasound is diagnosed if one of the following is present in one or both of the ovaries; Ovarian volume …

Comparison Of Online 6 Degree-Of-Freedom Image Registration Of Varian Truebeam Cone-Beam Ct And Brainlab Exactrac X-Ray For Intracranial Radiosurgery., Jun Li, Wenyin Shi, David W. Andrews, Maria Werner-Wasik, Bo Lu, Yan Yu, Adam Dicker Md, Phd, Haisong Lui

Department of Radiation Oncology Faculty Papers

PURPOSE: The study was aimed to compare online 6 degree-of-freedom image registrations of TrueBeam cone-beam computed tomography and BrainLab ExacTrac X-ray imaging systems for intracranial radiosurgery.

METHODS: Phantom and patient studies were performed on a Varian TrueBeam STx linear accelerator (version 2.5), which is integrated with a BrainLab ExacTrac imaging system (version 6.1.1). The phantom study was based on a Rando head phantom and was designed to evaluate isocenter location dependence of the image registrations. Ten isocenters at various locations representing clinical treatment sites were selected in the phantom. Cone-beam computed tomography and ExacTrac X-ray images were taken when the …

Outcomes Of Spatially Fractionated Radiotherapy (Grid) For Bulky Soft Tissue Sarcomas In A Large Animal Model, Michael W. Nolan, Tracy L. Gieger, Alexander A. Karakashian, Mariana N. Nikolova‑Karakashian, Lysa P. Posner, Donald M. Roback, Judith N. Rivera, Sha Chang

Physiology Faculty Publications

GRID directs alternating regions of high- and low-dose radiation at tumors. A large animal model mimicking the geometries of human treatments is needed to complement existing rodent systems (eg, microbeam) and clarify the physical and biological attributes of GRID. A pilot study was undertaken in pet dogs with spontaneous soft tissue sarcomas to characterize responses to GRID. Subjects were treated with either 20 Gy (3 dogs) or 25 Gy (3 dogs), delivered using 6 MV X-rays and a commercial GRID collimator. Acute toxicity and tumor responses were assessed 2, 4, and 6 weeks later. Acute Radiation Therapy Oncology Group grade …

Primary Lung Carcinoid Metastatic To The Breast, Marianna Zagurovskaya, Karen Tran-Harding, Richard Gibbs

Radiology Faculty Publications

Lung carcinoid tumors account for approximately 2% of lung cancers, with 10% of the tumors represented by the atypical type. While atypical carcinoids are metastatic to intrathoracic lymph nodes in approximately half of the cases on the initial presentation, distant metastases are seen in only 20% of the patients and are found most frequently in bones, liver, adrenal glands, and brain. We present a case of an unusual metastatic disease to the breast in 51-year-old female who developed a new breast mass 2 years after left lower lobectomy due to atypical carcinoid tumor. Atypical pulmonary carcinoid metastases to the breast …

Implementation Of Quality Measures In Site-Specific Multidisciplinary Tumour Boards, Ahmed Nadeem Abbasi, Huriye Senay Kiziltan

Department of Radiation Oncology

No abstract provided.

Association Between Calcaneal Spurs And Plantar Fasciitis: A Study Comparing Heel Plain Radiography And Sonography, Micah Silaba Ominde

Master of Medicine in Imaging and Diagnostic Radiology

Background: Heel pain is a common clinical entity that requires appropriate diagnostic evaluation. Multiple clinical conditions are known to cause heel pain but plantar fasciitis is the most common. Calcaneal spurs are thought to be associated with heel pain and plantar fasciitis but conclusive studies to prove this are sparse. Plain radiography is usually the first line imaging modality for imaging patients with heel pain. Magnetic Resonance Imaging is the gold standard for diagnosing plantar fasciitis but studies have shown ultrasound to be comparable in sensitivity and specificity. The aim is to establish whether a relationship exists between calcaneal spurs …

Diagnostic Value Of Complementary Strain Elastography In The Classification Of Breast Masses, Sarah Muthoni Wambui

Master of Medicine in Imaging and Diagnostic Radiology

Background: Breast cancer is the commonest cancer in women. Ultrasound has a high sensitivity but low specificity in the classification of benign and malignant breast masses. Strain elastography has the potential of increasing the specificity of breast ultrasound in classifying malignant and benign breast masses and reducing the number of benign breast biopsies performed. The diagnostic value of breast elastography in African women is not known. Objective: The aim of this study was to evaluate the additive diagnostic value of strain elastography to conventional ultrasound in the classification of malignant and benign breast masses in an African population. Materials and …

Comparison Of Image Quality In High Pitch Free Breathing Versus Standard Pitch Breath-Holding Computed Tomographic Pulmonary Angiography., Kevin Onyinkwa Ombati

Master of Medicine in Imaging and Diagnostic Radiology

Background: Pulmonary embolism (PE) is the third most common acute cardiovascular disease. Missed diagnosis is responsible for most preventable deaths associated with PE. Artefacts from cardiac and breathing motion are a main pitfall. Advances in Computed Tomographic imaging have enabled rapid imaging in an attempt to overcome these pitfalls. Objective: To compare image quality when using high pitch free breathing versus standard pitch breath holding Computed Tomographic Pulmonary Angiography (CTPA) using a dual source scanner. Methods: This was a randomised control trial whereby patients referred to the radiology department for CTPA examination for suspected pulmonary embolism were randomly selected into …

In Pursuit Of Quality Research: Editors' Perspective, Jamshed Akhtar, Saba Sohail

Department of Radiology

No abstract provided.

Quality Assurance Guidelines For Superficial Hyperthermia Clinical Trials : Ii. Technical Requirements For Heating Devices., Hana Dobšíček Trefná, Johannes Crezee, Manfred Schmidt, Dietmar Marder, Ulf Lamprecht, Michael Ehmann, Jacek Nadobny, Josefin Hartmann, Nicolleta Lomax, Sultan Abdel-Rahman, Sergio Curto, Akke Bakker, Mark D. Hurwitz, Chris J. Diederich, Paul R. Stauffer, Gerard C. Van Rhoon

Department of Radiation Oncology Faculty Papers

Quality assurance (QA) guidelines are essential to provide uniform execution of clinical trials with uniform quality hyperthermia treatments. This document outlines the requirements for appropriate QA of all current superficial heating equipment including electromagnetic (radiative and capacitive), ultrasound, and infrared heating techniques. Detailed instructions are provided how to characterize and document the performance of these hyperthermia applicators in order to apply reproducible hyperthermia treatments of uniform high quality. Earlier documents used specific absorption rate (SAR) to define and characterize applicator performance. In these QA guidelines, temperature rise is the leading parameter for characterization of applicator performance. The intention of this …

Sensitivity Of Diffuse Reflectance Spectroscopy To Dose- And Depth-Dependent Changes In Tumor Oxygenation After Radiation Therapy, Daria Semeniak

Graduate Theses and Dissertations

Along with chemotherapy, immunotherapy, and surgery, radiotherapy is one of the most common treatments used against cancer. Around 50% of all cancer patients undergo radiation therapy. While for some patients radiotherapy works efficiently and lead to a complete cancer disappearance, for others treatment outcome may be less favorable due to radioresistance processes happening within a tumor on the molecular level. Radioresistance remains a big challenge for modern oncology. The ability to identify radioresistance at the early stage of radiotherapy would help physicians to improve therapy efficiency. At the current moment, despite the rapid progress in cancer understanding and diagnostic modalities, …

The Use Of Intraosseous Needles For Injection Of Contrast Media For Computed Tomographic Angiography Of The Thoracic Aorta, Michael A. Winkler, Cynthia Talley, Connor Woodward, Alexander Kingsbury, Frank Appiah, Hossam Elbelasi, Kevin P. Landwehr, Xingzhe Li, Dominik Fleischmann

Radiology Faculty Publications

Background

The objective of this study is to evaluate the safety and quality of computed tomographic angiography of the thoracic aorta (CTA-TA) exams performed using intraosseous needle intravenous access (ION-IVA) for contrast media injection (CMI).

Methods

All CTA-TA exams at the study institution performed between 1/1/2013 and 8/14/2015 were reviewed retrospectively to identify those exams which had been performed using ION-IVA (ION-exams). ION-exams were then analyzed to determine aortic attenuation and contrast-to-noise ratio (CNR). Linear regression was used to determine how injection rate and other variables affected image quality for ION-exams. Patient electronic medical records were reviewed to identify any …

Value Of Superb Microvascular Imaging Ultrasonography In The Diagnosis Of Carpal Tunnel Syndrome: Compared With Color Doppler And Power Doppler., Jie Chen, Li Chen, Lei Wu, Rui Wang, Ji-Bin Liu, Bing Hu, Li-Xin Jiang

Department of Radiology Faculty Papers

The aim of this study was to compare the value of superb microvascular imaging (SMI) in carpal tunnel syndrome (CTS) with that of color Doppler ultrasonography (CDUS) and power Doppler ultrasonography (PDUS).Fifty patients with symptomatic CTS and 25 healthy volunteers were enrolled. The cross-sectional area (CSA), CDUS score, PDUS score, and SMI score of the median nerve (MN) at the carpal tunnel were recorded. The value of different ultrasonography (US) diagnostic strategies was calculated.The blood flow display ratio in the MN of the healthy volunteers had no statistical difference between CDUS, PDUS, and SMI (20%, 32%, and 48%, respectively, P …

Sonoelastography Of The Common Flexor Tendon Of The Elbow With Histologic Agreement: A Cadaveric Study., Andrea S Klauser, Mathias J Pamminger, Ethan J. Halpern, Mohamed M H Abd Ellah, Bernhard Moriggl, Mihra S Taljanovic, Christian Deml, Judith Sztankay, Guenter Klima, Leonhard Gruber, Werner R Jaschke

Department of Radiology Faculty Papers

Purpose To determine the correlation of the results of conventional B-mode ultrasonography (US) and compression sonoelastography with histologic results in common flexor tendons of the elbow in human cadavers. Materials and Methods Twenty-five common flexor tendons were evaluated in 16 fresh, unembalmed cadavers of 11 women with a median age of 85 years (range, 71-101 years) and five men with a median age of 78 years (range, 70-88 years). Informed consent was provided according to the last will of the donors. B-mode US results were classified as grade 1, normal tendon with homogeneous fibrillar pattern; grade 2, tendon thickening or …

Needs Assessment Of Pediatric Radiological Equipment And Cross-Cultural Investigation Into Parental Empowerment In Pediatric Radiology Program Development In The Kingdom Of Bhutan, Danielle Canter

GW Research Days 2016 - 2020

Background:

Bhutan is a magnificent mountainous country hugged by India to the east and west and by China to the North and South. This peaceful nestled country faces challenges in combating non-communicable diseases due to the lack of radiological equipment necessary for early diagnosis. Prior to implementation of these medical devices, it is imperative to investigate the cultural attitudes, beliefs, and infrastructure, to ensure successful integration. Bhutan is beginning to implement a pediatric radiology program for the nation with the assistance of ABAH Foundation and RAD-AID International, both of whom partnered with graduate students at George Washington University School of …

Nuclear Medicine Imaging In Emergency Room And Priority Clinical Decision Making, Nosheen Fatima, Maseeh Uz Zaman

Department of Radiology

No abstract provided.

Thyroid Ultrasound: State Of The Art. Part 2 - Focal Thyroid Lesions., Manjiri Dighe, Richard Barr, Jörg Bojunga, Vito Cantisani, Maria Cristina Chammas, David Cosgrove,, Xin Wu Cui, Yi Dong, Franziska Fenner, Maija Radzina, Sudhir Vinayak, Jun Mei Xu, Christoph F Dietrich

Department of Radiology

Abstract

Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.

Effect Of A Poloxamer 407-Based Thermosensitive Gel On Minimization Of Thermal Injury To Diaphragm During Microwave Ablation Of The Liver., Li-Li Zhang, Gui-Min Xia, Yu-Jiang Liu, Rui Dou, John R. Eisenbrey, Ji-Bin Liu, Xiao-Wei Wang, Lin-Xue Qian

Department of Radiology Faculty Papers

AIM: To assess the insulating effect of a poloxamer 407 (P407)-based gel during microwave ablation of liver adjacent to the diaphragm.

METHODS: We prepared serial dilutions of P407, and 22.5% (w/w) concentration was identified as suitable for ablation procedures. Subsequently, microwave ablations were performed on the livers of 24 rabbits (gel, saline, control groups, n = 8 in each). The P407 solution and 0.9% normal saline were injected into the potential space between the diaphragm and liver in experimental groups. No barriers were applied to the controls. After microwave ablations, the frequency, size and degree of thermal injury were compared …

Mri-Guided Stereotactic Biopsy Of Murine Gbm For Spatiotemporal Molecular Genomic Assessment, Stefanie Galban, Waid Al-Holou, Hanxiao Wang, Amanda Welton, Kevin Heist, Yuan Zhu, +Several Additional Authors

Pediatrics Faculty Publications

Brain tumor biopsies that are routinely performed in clinical settings significantly aid in diagnosis and staging. The aim of this study is to develop and evaluate a methodological image-guided approach that would allow for routine sampling of glioma tissue from orthotopic mouse brain tumor models. A magnetic resonance imaging-guided biopsy method is presented to allow for spatially precise stereotaxic sampling of a murine glioma coupled with genome-scale technology to provide unbiased characterization of intra- and intertumoral clonal heterogeneity. Longitudinal and multiregional sampling of intracranial tumors allows for successful collection of tumor biopsy samples, thus allowing for a pathway-enrichment analysis and …

Labrad : Vol 43, Issue 1 - March 2017, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Chikungunya
• Rapid Molecular Diagnosis of Chlamydia Trachomatis (CT) and Neisseria Gonorrhoeae (NG) Urethritis
• Overview of Rubella Testing
• Most Common Bone and Soft Tissue Infections Seen in our Practice
• Diagnosis of Helicobacter Pylori Infection in Developing Countries- Pros & Cons
• Screening for Neonatal Infections with TORCH Profile
• Blood and Bone Marrow Changes in Viral Infections
• Malaria
• World Rare Disease Day
• Radiology Pathology Correlation

Prostate Brachytherapy Seed Migration To The Heart Seen On Cardiovascular Computed Tomographic Angiography, Shilpa Sachdeva, Nneka S. Udechukwu, Hossam Elbelasi, Kevin P. Landwehr, William H. St. Clair, Michael A. Winkler

Radiation Medicine Faculty Publications

Brachytherapy consists of placing radioactive sources into or adjacent to tumors, to deliver conformal radiation treatment. The technique is used for treatment of primary malignancies and for salvage in recurrent disease. Permanent prostate brachytherapy seeds are small metal implants containing radioactive sources of I-125, Pd-103, or Cs-131 encased in a titanium shell. They can embolize through the venous system to the lungs or heart and subsequently be detected by cardiovascular computed tomography. Cardiovascular imagers should be aware of the appearance of migrated seeds, as their presence in the chest is generally benign, so that unnecessary worry and testing are avoided. …

Hypovolemic Shock And Hemoperitoneum From Spontaneous Avulsion Of A Large Pedunculated Uterine Leiomyoma, Daniel J. Mizrahi, Chhavi Kaushik, Robert Adamo

Department of Radiology Faculty Papers

Hemoperitoneum with hypovolemic shock from avulsion of a pedunculated leiomyoma is a rare but highly fatal condition that can occur spontaneously or as a result of trauma. We report a case of hemoperitoneum and hypovolemic shock secondary to a bleeding leiomyoma detected via computed tomography (CT) scan in a 39 year old premenopausal, gravida 0 female that presented with abdominal pain and became hemodynamically unstable in the emergency department. A preoperative bimanual exam revealed a mass consistent with a 20 week gestational uterus. Following fluid resuscitation, the patient underwent emergent myomectomy and ligation of the right uterine artery and was …

Memri Is A Biomarker Defining Nicotine-Specific Neuronal Responses In Subregions Of The Rodent Brain., Aditya N. Bade, Howard Gendelman, Michael D. Boska, Yutong Liu

Journal Articles: Radiology

Nicotine dependence is defined by dopaminergic neuronal activation within the nucleus accumbens (ACB) and by affected neural projections from nicotine-stimulated neurons. Control of any subsequent neural activities would underpin any smoking cessation strategy. While extensive efforts have been made to study the pathophysiology of nicotine addiction, more limited works were developed to find imaging biomarkers. If such biomarkers are made available, addictive behaviors could be monitored noninvasively. To such ends, we employed manganese (Mn(2+))-enhanced magnetic resonance imaging (MEMRI) to determine whether it could be used to monitor neuronal activities after acute and chronic nicotine exposure in rats. The following were …

Metastatic Biomarkers In Synovial Sarcoma, Rosalia De Necochea-Campion, Lee M. Zuckerman, Hamid R. Mirshahidi, Shahrzad Khosrowpour, Chien-Shing Chen, Saied Mirshahidi

Library Articles and Research

Synovial sarcoma (SS) is an aggressive soft tissue sarcoma (STS) that typically occurs in the extremities near a joint. Metastatic disease is common and usually occurs in the lungs and lymph nodes. Surgical management is the mainstay of treatment with chemotherapy and radiation typically used as adjuvant treatment. Although chemotherapy has a positive impact on survival, the prognosis is poor if metastatic disease occurs. The biology of sarcoma invasion and metastasis remain poorly understood. Chromosomal translocation with fusion of the SYT and SSX genes has been described and is currently used as a diagnostic marker, although the full impact of …