Radiation Medicine Commons^™

Assessing Breast Disease With Deep Learning Model Using Bimodal Bi-View Ultrasound Images And Clinical Information, Fengping Liang, Yihua Song, Xiaoping Huang, Tong Ren, Qiao Ji, Yanan Guo, Xiang Li, Yajuan Sui, Xiaohui Xie, Lanqing Han, Yuanqing Li, Yong Ren, Zuofeng Xu

Faculty, Staff and Students Publications

Breast cancer is the second leading cause of carcinoma-linked death in women. We developed a multi-modal deep-learning model (BreNet) to differentiate breast cancer from benign lesions. BreNet was constructed and trained on 10,108 images from one center and tested on 3,762 images from two centers in three steps. The diagnostic ability of BreNet was first compared with that of six radiologists; a BreNet-aided scheme was constructed to improve the diagnostic ability of the radiologists; and the diagnosis of real-world radiologists' scheme was then compared with the BreNet-aided scheme. The diagnostic performance of BreNet was superior to that of the radiologists …

Data-Driven Gated Positron Emission Tomography/Computed Tomography For Radiotherapy, Tinsu Pan, Dershan Luo

Faculty, Staff and Student Publications

PURPOSE: Software-based data-driven gated (DDG) positron emission tomography/computed tomography (PET/CT) has replaced hardware-based 4D PET/CT. The purpose of this article was to review DDG PET/CT, which could improve the accuracy of treatment response assessment, tumor motion evaluation, and target tumor contouring with whole-body (WB) PET/CT for radiotherapy (RT).

MATERIAL AND METHODS: This review covered the topics of 4D PET/CT with hardware gating, advancements in PET instrumentation, DDG PET, DDG CT, and DDG PET/CT based on a systematic literature review. It included a discussion of the large axial field-of-view (AFOV) PET detector and a review of the clinical results of DDG …

Scanless Two-Photon Voltage Imaging, Ruth R Sims, Imane Bendifallah, Christiane Grimm, Aysha S Mohamed Lafirdeen, Soledad Domínguez, Chung Yuen Chan, Xiaoyu Lu, Benoît C Forget, François St-Pierre, Eirini Papagiakoumou, Valentina Emiliani

Faculty, Staff and Students Publications

Two-photon voltage imaging has long been heralded as a transformative approach capable of answering many long-standing questions in modern neuroscience. However, exploiting its full potential requires the development of novel imaging approaches well suited to the photophysical properties of genetically encoded voltage indicators. We demonstrate that parallel excitation approaches developed for scanless two-photon photostimulation enable high-SNR two-photon voltage imaging. We use whole-cell patch-clamp electrophysiology to perform a thorough characterization of scanless two-photon voltage imaging using three parallel illumination approaches and lasers with different repetition rates and wavelengths. We demonstrate voltage recordings of high-frequency spike trains and sub-threshold depolarizations from neurons …

Adding 6 Months Of Androgen Deprivation Therapy To Postoperative Radiotherapy For Prostate Cancer: A Comparison Of Short-Course Versus No Androgen Deprivation Therapy In The Radicals-Hd Randomised Controlled Trial, Chris C Parker, Noel W Clarke, Adrian D Cook, Howard Kynaston, Charles N Catton, William R Cross, Peter M Petersen, Rajendra A Persad, Fred Saad, Lorna C Bower, John Logue, Heather Payne, Silvia Forcat, Cindy Goldstein, Claire Murphy, Juliette Anderson, Maroie Barkati, David M Bottomley, Jennifer Branagan, Ananya Choudhury, Peter W M Chung, Lyn Cogley, Chee L Goh, Peter Hoskin, Vincent Khoo, Shawn C Malone, Lindsey Masters, Stephen L Morris, Abdenour Nabid, Aldrich D Ong, Rakesh Raman, Kathryn L Tarver, Alison C Tree, Jane Worlding, James P Wylie, Anjali M Zarkar, Wendy R Parulekar, Mahesh K B Parmar, Matthew R Sydes, Radicals Investigators

Faculty, Staff and Student Publications

BACKGROUND: Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear.

METHODS: RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy …

Longitudinal Changes In The Carotid Arteries Of Head And Neck Cancer Patients Following Radiation Therapy: Results From A Prospective Serial Imaging Biomarker Characterization Study, Efstratios Koutroumpakis, Abdallah Sherif Radwan Mohamed, Peter Chaftari, David I Rosenthal, Dorothy Gujral, Christopher Nutting, Serageldin Kamel, Mohamed A Naser, Peter Kim, Roland Bassett, Clifton D Fuller, Elie Mouhayar, Md Anderson Head Neck Radiation Oncology Cardiovascular Working Group

Faculty, Staff and Student Publications

INTRODUCTION: We prospectively evaluated morphologic and functional changes in the carotid arteries of patients treated with unilateral neck radiation therapy (RT) for head and neck cancer.

METHODS: Bilateral carotid artery duplex studies were performed at 0, 3, 6, 12, 18 months and 2, 3, 4, and 5 years following RT. Intima media thickness (IMT); global and regional circumferential, as well as radial strain, arterial elasticity, stiffness, and distensibility were calculated.

RESULTS: Thirty-eight patients were included. A significant difference in the IMT from baseline between irradiated and unirradiated carotid arteries was detected at 18 months (median, 0.073 mm vs -0.003 mm; …

An International Phantom Study Of Inter-Site Variability In Technetium-99m Image Quantification: Analyses From The Target Radioembolization Study, Grace Keane, Rob Van Rooij, Marnix Lam, S Cheenu Kappadath, Bilal Kovan, Stephanie Leon, Matthew Dreher, Kirk Fowers, Hugo De Jong

Faculty, Staff and Student Publications

BACKGROUND: Personalised multi-compartment dosimetry based on [

RESULTS: Regarding the LSF, inter-site variation with planar site-specific protocols was minimal, as determined by comparing computed LSF between sites (interquartile range 9.6-10.1%). A standardised protocol did not improve variation (interquartile range 8.4-9.0%) but did improve mean accuracy compared to the site-specific protocols (5.0% error for standardised protocol vs 8.8% error for site-specific protocols). Regarding the CRC, inter-system variation was notable for site-specific SPECT protocols and could not be improved by the standardised protocol (CRC interquartile range for 37 mm sphere 0.5-0.7 and 0.6-0.8 respectively), however the standardised protocol did improve accuracy of …

A Novel Positive-Contrast Magnetic Resonance Imaging Line Marker For High-Dose-Rate (Hdr) Mri-Assisted Radiosurgery (Mars), Li Wang, Yao Ding, Teresa L Bruno, R Jason Stafford, Eric Lin, Tharakeswara K Bathala, Jeremiah W Sanders, Matthew S Ning, Jingfei Ma, Ann H Klopp, Aradhana Venkatesan, Jihong Wang, Karen S Martirosyan, Steven J Frank

Faculty, Staff and Student Publications

Magnetic resonance imaging (MRI) can facilitate accurate organ delineation and optimal dose distributions in high-dose-rate (HDR) MRI-Assisted Radiosurgery (MARS). Its use for this purpose has been limited by the lack of positive-contrast MRI markers that can clearly delineate the lumen of the HDR applicator and precisely show the path of the HDR source on T1- and T2-weighted MRI sequences. We investigated a novel MRI positive-contrast HDR brachytherapy or interventional radiotherapy line marker, C4:S, consisting of C4 (visible on T1-weighted images) complexed with saline. Longitudinal relaxation time (T1) and transverse relaxation time (T2) for C4:S were measured on a 1.5 T …

Mammographic Density Mediates The Protective Effect Of Early-Life Body Size On Breast Cancer Risk, Marina Vabistsevits, George Davey Smith, Tom G Richardson, Rebecca C Richmond, Weiva Sieh, Joseph H Rothstein, Laurel A Habel, Stacey E Alexeeff, Bethan Lloyd-Lewis, Eleanor Sanderson

Faculty, Staff and Student Publications

The unexplained protective effect of childhood adiposity on breast cancer risk may be mediated via mammographic density (MD). Here, we investigate a complex relationship between adiposity in childhood and adulthood, puberty onset, MD phenotypes (dense area (DA), non-dense area (NDA), percent density (PD)), and their effects on breast cancer. We use Mendelian randomization (MR) and multivariable MR to estimate the total and direct effects of adiposity and age at menarche on MD phenotypes. Childhood adiposity has a decreasing effect on DA, while adulthood adiposity increases NDA. Later menarche increases DA/PD, but when accounting for childhood adiposity, this effect is attenuated. …

Photon Irradation And Cisplatin Enrich Cancer Stem Cells In Ovarian Cancer, Ashley Antonissen

Electronic Theses, Projects, and Dissertations

High Grade Serous Ovarian Cancer (HGSOC) has a 5-year survival rate of less than 50%. Ovarian cancer is one of the deadliest gynecological diseases and the 7th most common female cancer worldwide. Ovarian cancer patients generally have a poor prognosis despite the relatively successful treatments. When conventional cancer treatments, such as cisplatin chemotherapy and photon irradiation, are administered, residual cancer stem-like cells (CSCs) can survive, leading to CSC enrichment. CSCs are a small population of cancer cells that exhibit stem-like characteristics: quiescence (slowing of the cell cycle), differentiation, proliferation, and self-renewal to regenerate new CSCs. We hypothesized that providing cancer …

Special Anatomy Series Imaging Inner Ear Structures With High-Frequency Ultrasound: Application To Physical Rehabilitation Space Medicine, Jeffrey Strakowski, Han Zhang, Millard Reschke, Faye Y Chiou-Tan

Faculty, Staff and Students Publications

OBJECTIVE: The objective of this paper is to document the feasibility of image acquisition, image optimization, and sonographic appearance of the exposed anatomic windows of cadaveric inner ear dissection for purposes of potential future clinical evaluation as part of the developing area of physical and rehabilitation space medicine.

METHODS: Cadaveric dissection of the inner ear was conducted with the goal of exposing areas relevant to vestibular balance. Middle and inner ear structures of 3 human cadavers were imaged with multiple broadband transducers, including emphasis with higher frequency transducers.

RESULTS: The images were best optimized with 17 MHz and 22 MHz …

Mr-Guided Stereotactic Radiation Therapy For Head And Neck Cancers, He Wang, Jinzhong Yang, Anna Lee, Jack Phan, Tze Yee Lim, Clifton D Fuller, Eun Young Han, Dong Joo Rhee, Travis Salzillo, Yao Zhao, Nitish Chopra, Mary Pham, Pam Castillo, Angela Sobremonte, Amy C Moreno, Jay P Reddy, David Rosenthal, Adam S Garden, Xin Wang

Faculty, Staff and Student Publications

PURPOSE: MR-guided radiotherapy (MRgRT) has the advantage of utilizing high soft tissue contrast imaging to track daily changes in target and critical organs throughout the entire radiation treatment course. Head and neck (HN) stereotactic body radiation therapy (SBRT) has been increasingly used to treat localized lesions within a shorter timeframe. The purpose of this study is to examine the dosimetric difference between the step-and-shot intensity modulated radiation therapy (IMRT) plans on Elekta Unity and our clinical volumetric modulated arc therapy (VMAT) plans on Varian TrueBeam for HN SBRT.

METHOD: Fourteen patients treated on TrueBeam sTx with VMAT treatment plans were …

Long-Term Patient-Reported Dyspareunia After Definitive Chemoradiation For Anal Cancer: Using The Anterior Vaginal Wall As An Organ-At-Risk To Define An Actionable Dosimetric Goal, Michael K Rooney, Joshua S Niedzielski, Ramon M Salazar, Angelica Arzola, Prajnan Das, Eugene J Koay, Albert Koong, Ethan B Ludmir, Bruce D Minsky, Sonal Noticewala, Grace L Smith, Cullen Taniguchi, Emma B Holliday

Faculty, Staff and Student Publications

PURPOSE: Chemoradiation therapy (CRT) is the standard treatment for squamous cell carcinoma of the anus (SCCA). This study aimed to investigate the relationship between vaginal dosimetry and long-term patient-reported dyspareunia after treatment. We further aimed to use the anterior vaginal wall (AVW) as an organ at risk to define an actionable dosimetric clinical goal to decrease the risk of patient-reported dyspareunia.

METHODS AND MATERIALS: Women with SCCA treated with intensity modulated radiation therapy-based CRT were surveyed at least 2 years after successfully completing therapy. A Female Sexual Function Index (FSFI) pain subscore ≤4 was used to define dyspareunia. Dosimetric parameters …

Evaluation Of An End-To-End Radiotherapy Treatment Planning Pipeline For Prostate Cancer, Mohammad Daniel El Basha, Court Laurence, Carlos Eduardo Cardenas, Julianne Pollard-Larkin, Steven Frank, David T. Fuentes, Falk Poenisch, Zhiqian H. Yu

Dissertations and Theses (Open Access)

Radiation treatment planning is a crucial and time-intensive process in radiation therapy. This planning involves carefully designing a treatment regimen tailored to a patient’s specific condition, including the type, location, and size of the tumor with reference to surrounding healthy tissues. For prostate cancer, this tumor may be either local, locally advanced with extracapsular involvement, or extend into the pelvic lymph node chain. Automating essential parts of this process would allow for the rapid development of effective treatment plans and better plan optimization to enhance tumor control for better outcomes.

The first objective of this work, to automate the treatment …

Methods For The Prediction Of Osteoradionecrosis Resulting From Head And Neck Cancer Radiation Therapy, Brandon Reber

Dissertations and Theses (Open Access)

Head and neck cancer (HNC) is the sixth most diagnosed cancer worldwide with over 600,000 patients diagnosed every year. One of the primary methods to treat HNC is through radiation therapy (RT). While RT is effective at treating HNC, late toxicities resulting from treatment can occur months to years post-treatment and can cause debilitating quality of life changes for HNC survivors. One of these late toxicities is osteoradionecrosis (ORN), which is the death of bone due to radiation. For HNC, the mandible is commonly affected and can cause challenges chewing, swallowing, and physical appearance changes. Several factors indicate the pressing …

New Horizons In Hyperpolarized13c Mri, Myriam M Chaumeil, James A Bankson, Kevin M Brindle, Shdema Epstein, Ferdia A Gallagher, Martin Grashei, Caroline Guglielmetti, Joshua D Kaggie, Kayvan R Keshari, Stephan Knecht, Christoffer Laustsen, Andreas B Schmidt, Daniel Vigneron, Yi-Fen Yen, Franz Schilling

Faculty, Staff and Student Publications

Hyperpolarization techniques significantly enhance the sensitivity of magnetic resonance (MR) and thus present fascinating new directions for research and applications with in vivo MR imaging and spectroscopy (MRI/S). Hyperpolarized 13C MRI/S, in particular, enables real-time non-invasive assessment of metabolic processes and holds great promise for a diverse range of clinical applications spanning fields like oncology, neurology, and cardiology, with a potential for improving early diagnosis of disease, patient stratification, and therapy response assessment. Despite its potential, technical challenges remain for achieving clinical translation. This paper provides an overview of the discussions that took place at the international workshop "New Horizons …

High-Density Glass Scintillators For Proton Radiography-Relative Luminosity, Proton Response, And Spatial Resolution, Ethan Stolen, Ryan Fullarton, Rain Hein, Robin L Conner, Luiz G Jacobsohn, Charles-Antoine Collins-Fekete, Sam Beddar, Ugur Akgun, Daniel Robertson

Faculty, Staff and Student Publications

Proton radiography is a promising development in proton therapy, and researchers are currently exploring optimal detector materials to construct proton radiography detector arrays. High-density glass scintillators may improve integrating-mode proton radiography detectors by increasing spatial resolution and decreasing detector thickness. We evaluated several new scintillators, activated with europium or terbium, with proton response measurements and Monte Carlo simulations, characterizing relative luminosity, ionization quenching, and proton radiograph spatial resolution. We applied a correction based on Birks's analytical model for ionization quenching. The data demonstrate increased relative luminosity with increased activation element concentration, and higher relative luminosity for samples activated with europium. …

Ensuring Successful Biomarker Studies In Bladder Preservation Clinical Trials For Non-Muscle Invasive Bladder Cancer, David J. Mcconkey, Brian C. Baumann, Stephanie Cooper Greenberg, David J. Degraff, Scott E. Delacroix, Jason A. Efstathiou, Jared Foster, Susan Groshen, Edward E. Kadel, Francesca Khani, William Y. Kim, Seth P. Lerner, Trevor Levin, Joseph C. Liao, Matthew I. Milowsky, Joshua J. Meeks, David T. Miyamoto, Kent W. Mouw, Eugene J. Pietzak, David B. Solit, Debasish Sundi, Abdul Tawab-Amiri, Pamela J. West, Sara E. Wobker, Alexander W. Wyatt, Andrea B. Apolo, Peter C. Black

School of Medicine Faculty Publications

Recent technological advances have created new opportunities for performing biomarker studies within the National Cancer Institute’s (NCI’s) National Clinical Trials Network (NCTN) clinical trials. These new platforms yield more robust measurements when tissue and blood handling is optimized. At the same time, there is a strong interest in banking tissue and derivatives, such as DNA and RNA, for future biomarker studies using novel platforms that may emerge during the intervening time to trial completion. The NCI recently hosted a Clinical Trials Planning Meeting focused on two trial concepts for bladder preservation in patients with high-risk non-muscle invasive bladder cancer (NMIBC) …

Clinical And Dosimetric Results Of Proton Or Photon Radiation Therapy For Large (>5 Cm) Hepatocellular Carcinoma: A Retrospective Analysis, Rodney Cheng-En Hsieh, Ching-Hsin Lee, Hsiao-Chieh Huang, Shu-Wei Wu, Chen-Yu Chou, Sheng-Ping Hung, Chao-Wei Lee, Sunil Krishnan, Bhanu Prasad Venkatesulu, Jin-Chiao Lee, Yung-Chih Chou, Kun-Ming Chan, Po-Ting Lin, Wei-Chen Lee, Chen-Chun Lin, Shen-Yen Lin, Ji-Hong Hong

Faculty, Staff and Student Publications

Purpose: Our purpose was to report the clinical and dosimetric attributes of patients with large unresectable hepatocellular carcinoma (HCC) undergoing proton or photon radiation therapy.

Methods and materials: We retrospectively analyzed the outcomes and dosimetric indices of 159 patients with >5 cm nonmetastatic HCC who underwent definitive radiation therapy using either protons (N = 105) or photons (N = 54) between 2014 and 2018. Additional photon plans were performed in the 105 proton-treated patients using the same dose prescription criteria for intragroup dosimetric comparison.

Results: After a median follow-up of 47 months, patients with biologically effective dose (BED10) ≥ 75 …

Fully Automated Deep Learning Based Auto-Contouring Of Liver Segments And Spleen On Contrast-Enhanced Ct Images, Aashish C Gupta, Guillaume Cazoulat, Mais Al Taie, Sireesha Yedururi, Bastien Rigaud, Austin Castelo, John Wood, Cenji Yu, Caleb O'Connor, Usama Salem, Jessica Albuquerque Marques Silva, Aaron Kyle Jones, Molly Mcculloch, Bruno C Odisio, Eugene J Koay, Kristy K Brock

Faculty, Staff and Student Publications

Manual delineation of liver segments on computed tomography (CT) images for primary/secondary liver cancer (LC) patients is time-intensive and prone to inter/intra-observer variability. Therefore, we developed a deep-learning-based model to auto-contour liver segments and spleen on contrast-enhanced CT (CECT) images. We trained two models using 3d patch-based attention U-Net ([Formula: see text] and 3d full resolution of nnU-Net ([Formula: see text] to determine the best architecture ([Formula: see text]. BA was used with vessels ([Formula: see text] and spleen ([Formula: see text] to assess the impact on segment contouring. Models were trained, validated, and tested on 160 ([Formula: see text]), …

Quality Assurance For Stereotactic Body Radiation Therapy For Gynecologic Malignancies, Samuel N Andersen, Mark D Bonnen, Michelle S Ludwig, Shraddha M Dalwadi

Faculty, Staff and Students Publications

The use of stereotactic body radiation therapy (SBRT) is not well studied or reported in the treatment of gynecologic malignancies, despite its success in the definitive management of other cancer sites. This report describes a rigorous quality assurance process for patients to undergo dose escalation to the pelvis via stereotactic photon beam irradiation. Patients who receive SBRT must be ineligible for conventional brachytherapy boost and undergo comprehensive informed consent. Fiducial placement, bowel prep, Foley catheter placement with standardized bladder filling, computerized tomography (CT) simulation with whole-body immobilization, magnetic resonance imaging (MRI)-assisted target delineation, planning aims based on the established brachytherapy …

Tumor Treating Fields Increases Blood-Brain Barrier Permeability And Relative Cerebral Blood Volume In Patients With Glioblastoma, Michael Iv, Lewis Naya, Sajal Sanan, Samuel L Van Buskirk, Seema Nagpal, Reena P Thomas, Lawrence D Recht, Chirag B Patel

Faculty, Staff and Student Publications

BACKGROUND AND OBJECTIVE: 200 kHz tumor treating fields (TTFields) is clinically approved for newly-diagnosed glioblastoma (nGBM). Because its effects on conventional surveillance MRI brain scans are equivocal, we investigated its effects on perfusion MRI (pMRI) brain scans.

METHODS: Each patient underwent institutional standard pMRI: dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast (DSC) pMRI at three time points: baseline, 2-, and 6-months on-adjuvant therapy. At each timepoint, the difference between T1 pre- versus post-contrast tumor volume (ΔT1) and these pMRI metrics were evaluated: normalized and standardized relative cerebral blood volume (nRCBV, sRCBV); fractional plasma volume (V

RESULTS: Among 13 pMRI datasets …

Predicting Radiotherapy Patient Outcomes With Real-Time Clinical Data Using Mathematical Modelling, Alexander P Browning, Thomas D Lewin, Ruth E Baker, Philip K Maini, Eduardo G Moros, Jimmy Caudell, Helen M Byrne, Heiko Enderling

Faculty, Staff and Student Publications

Longitudinal tumour volume data from head-and-neck cancer patients show that tumours of comparable pre-treatment size and stage may respond very differently to the same radiotherapy fractionation protocol. Mathematical models are often proposed to predict treatment outcome in this context, and have the potential to guide clinical decision-making and inform personalised fractionation protocols. Hindering effective use of models in this context is the sparsity of clinical measurements juxtaposed with the model complexity required to produce the full range of possible patient responses. In this work, we present a compartment model of tumour volume and tumour composition, which, despite relative simplicity, is …

Overcoming Resolution Attenuation During Tilted Cryo-Em Data Collection, Sriram Aiyer, Philip R Baldwin, Shi Min Tan, Zelin Shan, Juntaek Oh, Atousa Mehrani, Marianne E Bowman, Gordon Louie, Dario Oliveira Passos, Selena Đorđević-Marquardt, Mario Mietzsch, Joshua A Hull, Shuichi Hoshika, Benjamin A Barad, Danielle A Grotjahn, Robert Mckenna, Mavis Agbandje-Mckenna, Steven A Benner, Joseph A P Noel, Dong Wang, Yong Zi Tan, Dmitry Lyumkis

Faculty, Staff and Students Publications

Structural biology efforts using cryogenic electron microscopy are frequently stifled by specimens adopting "preferred orientations" on grids, leading to anisotropic map resolution and impeding structure determination. Tilting the specimen stage during data collection is a generalizable solution but has historically led to substantial resolution attenuation. Here, we develop updated data collection and image processing workflows and demonstrate, using multiple specimens, that resolution attenuation is negligible or significantly reduced across tilt angles. Reconstructions with and without the stage tilted as high as 60° are virtually indistinguishable. These strategies allowed the reconstruction to 3 Å resolution of a bacterial RNA polymerase with …

Racial Disparities In Thoracic Aortic Surgery: Myth Or Reality?, Ourania Preventza, Elizabeth Akpan-Smart, Khan Lubna, Katherine Simpson, Lorraine Cornwell, Sydney Schmitt, Hiruni S Amarasekara, Scott A Lemaire, Joseph S Coselli

Faculty, Staff and Students Publications

Objective: We examined the relationship between Black or White race and adverse outcomes in patients who underwent surgery of the ascending aorta, aortic root, or aortic arch at our center.

Methods: We analyzed 2335 consecutive patients who identified as Black (n = 217, 9.3%) or White (n = 2118, 90.7%) and underwent proximal aortic surgery. Patient zip codes were used to determine community socioeconomic (CSE) characteristics. The composite adverse outcome comprised mortality, persistent neurologic injury, and renal failure necessitating dialysis at discharge. We performed multivariable analysis, Kaplan-Meier analysis, and propensity score matching adjusted for CSE factors.

Results: Median follow-up time …

A Look-Up-Table Development To Facilitate Ct Simulation Of Mr-Linac Treatment, Neil Hughes, Travis C Salzillo, Sastry Vedam, Tze Yee Lim, Xin Wang, He Wang, Mustefa Mohammedsaid, Clifton D Fuller, Jihong Wang, Jinzhong Yang

Faculty, Staff and Student Publications

While current MR-Linac (MRL) treatment workflows utilize a large table overlay during CT simulation to convert indexing between the two machines, we developed a look-up-table (LUT) as an alternative approach. After populating the LUT, index conversion factors were verified at three separate table locations. The resultant root-mean-square isocenter shifts on the MRL were 0.04/0.08 cm, 0.08/0.07 cm, and 0.09/0.08 cm with/without using the table overlay during simulation in the lateral, longitudinal, and vertical directions, respectively, which is within registration tolerance. Clinical implementation of the LUT has resulted in a more efficient MRL treatment workflow while maintaining accurate patient setup.

Harnessing Uncertainty In Radiotherapy Auto-Segmentation Quality Assurance, Kareem A Wahid, Jaakko Sahlsten, Joel Jaskari, Michael J Dohopolski, Kimmo Kaski, Renjie He, Enrico Glerean, Benjamin H Kann, Antti Mäkitie, Clifton D Fuller, Mohamed A Naser, David Fuentes

Faculty, Staff and Student Publications

One of the key contributions of this study is the reappropriation of standard DL outputs as a quality indicator to identify cases that clinicians should review further. The authors achieve this by applying an empirically derived threshold to the softmax output of their DL network, computing the mean of the thresholded score map (termed the HiS metric), and correlating it with standard geometric quality indices. When juxtaposed with a mean entropy — a commonly used measure of model output uncertainty — HiS consistently demonstrated a stronger correlation with the geometric indices, suggesting its superior ability to stratify cases needing additional …

Reporting Quality Of Endoscopic Colorectal Cancer Screening Randomized Controlled Trials: Adherence To Recommendations And Interventions, Fouad Jaber, Khalid Ahmed, Osama Hamid, Willie Mohammed Johnson, Saqr Alsakarneh, Abubaker O Abdalla, Yazan Abboud, Mouhand Mohamed, Dushyant Singh Dahiya, Shifa Umar, Mohamed Abdallah, Mohammad Bilal, Aasma Shaukat

Faculty, Staff and Student Publications

BACKGROUND AND AIMS: In 2013, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) steering group published recommendations to standardize reporting quality in randomized controlled trials (RCTs). We aim to assess adherence to SPIRIT reporting guidelines in RCTs on endoscopic colorectal cancer (CRC) screening and participants' adherence to trial protocols.

METHODS: We searched databases for RCTs evaluating flexible sigmoidoscopy or colonoscopy for CRC screening published in English language through September 2023. Each eligible study was evaluated using the 8 core SPIRIT statement areas, totaling 51 points. Each item received 1 point if it met the criteria and 0 points if …

Clinical Acceptability Of Automatically Generated Lymph Node Levels And Structures Of Deglutition And Mastication For Head And Neck Radiation Therapy, Sean Maroongroge, Abdallah Sr Mohamed, Callistus Nguyen, Jean Guma De La Vega, Steven J Frank, Adam S Garden, Brandon G Gunn, Anna Lee, Lauren Mayo, Amy Moreno, William H Morrison, Jack Phan, Michael T Spiotto, Laurence E Court, Clifton D Fuller, David I Rosenthal, Tucker J Netherton

Faculty, Staff and Student Publications

BACKGROUND AND PURPOSE: Auto-contouring of complex anatomy in computed tomography (CT) scans is a highly anticipated solution to many problems in radiotherapy. In this study, artificial intelligence (AI)-based auto-contouring models were clinically validated for lymph node levels and structures of swallowing and chewing in the head and neck.

MATERIALS AND METHODS: CT scans of 145 head and neck radiotherapy patients were retrospectively curated. One cohort (n = 47) was used to analyze seven lymph node levels and the other (n = 98) used to analyze 17 swallowing and chewing structures. Separate nnUnet models were trained and validated using the separate …

Commentary: The Power Of A Patch: Utilizing Exosome Therapy To Treat Heart Disease, Michael Tyler Guinn, Todd K Rosengart

Faculty, Staff and Students Publications

No abstract provided.

Editor's Choice - Trends In Management And Outcomes Of Type B Aortic Dissection: A Report From The International Registry Of Aortic Dissection, Santi Trimarchi, Tom G Gleason, Derek R Brinster, Jean Bismuth, Eduardo Bossone, Thoralf M Sundt, Daniel G Montgomery, Chih-Wen Pai, Daniele Bissacco, Hector W L De Beaufort, Joseph E Bavaria, Firas Mussa, Raffi Bekeredjian, Marc Schermerhorn, Davide Pacini, Truls Myrmel, Maral Ouzounian, Amit Korach, Edward P Chen, Joseph S Coselli, Kim A Eagle, Himanshu J Patel

Faculty, Staff and Students Publications

Objective: To describe the trends in management and outcomes of patients with acute type B aortic dissection in the International Registry of Acute Aortic Dissection.

Methods: From 1996 - 2022, 3 908 patients were divided into similar sized quartiles (T1, T2, T3, and T4). In hospital outcomes were analysed for each quartile. Survival rates following admission were compared using Kaplan-Meier analyses with Mantel-Cox Log rank tests.

Results: Endovascular treatment increased from 19.1% in T1 to 37.2% in T4 (ptrend < .001). Correspondingly, medical therapy decreased from 65.7% in T1 to 54.0% in T4 (ptrend < .001), and open surgery from 14.8% in T1 to 7.0% in T4 (ptrend < .001). In hospital mortality decreased in the overall cohort from 10.7% in T1 to 6.1% in T4 (ptrend < .001), as well as in medically, endovascularly and surgically treated patients (ptrend = .017, .033, and .011, respectively). Overall post-admission survival at three years increased (T1: 74.8% vs. T4: 77.3%; p = .006).

Conclusion: Considerable changes in the management of acute type B aortic dissection were observed over time, with a significant increase in …