Radiation Medicine Commons^™

Phase Iib, Randomized, Double-Blind Trial Of Gc4419 Versus Placebo To Reduce Severe Oral Mucositis Due To Concurrent Radiotherapy And Cisplatin For Head And Neck Cancer., Carryn M. Anderson, Christopher M Lee, Deborah P. Saunders, Amarinthia Curtis, Neal Dunlap, Chaitali Nangia, Arielle S. Lee, Sharon M. Gordon, Philip Kovoor, Roberto Arevalo-Araujo, Voichita Bar-Ad, Abhinand Peddada, Kyle Colvett, Douglas Miller, Anshu K. Jain, James Wheeler, Dukagjin Blakaj, Marcelo Bonomi, Sanjiv S. Agarwala, Madhur Garg, Francis Worden, Jon Holmlund, Jeffrey M. Brill, Matt Downs, Stephen T. Sonis, Sanford Katz, John M. Buatti

Department of Radiation Oncology Faculty Papers

PURPOSE: Oral mucositis (OM) remains a common, debilitating toxicity of radiation therapy (RT) for head and neck cancer. The goal of this phase IIb, multi-institutional, randomized, double-blind trial was to compare the efficacy and safety of GC4419, a superoxide dismutase mimetic, with placebo to reduce the duration, incidence, and severity of severe OM (SOM).

PATIENTS AND METHODS: A total of 223 patients (from 44 institutions) with locally advanced oral cavity or oropharynx cancer planned to be treated with definitive or postoperative intensity-modulated RT (IMRT; 60 to 72 Gy [≥ 50 Gy to two or more oral sites]) plus cisplatin (weekly …

Combined Modality Therapies For High-Risk Prostate Cancer: Narrative Review Of Current Understanding And New Directions., Benjamin A. Greenberger, Victor E. Chen, Robert B. Den

Department of Radiation Oncology Faculty Papers

Despite the many prospective randomized trials that have been available in the past decade regarding the optimization of radiation, hormonal, and surgical therapies for high-risk prostate cancer (PCa), many questions remain. There is currently a lack of level I evidence regarding the relative efficacy of radical prostatectomy (RP) followed by adjuvant radiation compared to radiation therapy (RT) combined with androgen deprivation therapy (ADT) for high-risk PCa. Current retrospective series have also described an improvement in biochemical outcomes and PCa-specific mortality through the use of augmented radiation strategies incorporating brachytherapy. The relative efficacy of modern augmented RT compared to RP is …

Recent Updates In The Management Of Merkel Cell Carcinoma, Ahmed Nadeem Abbasi, Syed Mustajab Ahmed, Bilal Mazhar Qureshi

Department of Radiation Oncology

Merkel cell carcinoma is an aggressive non-melanomatous cutaneous tumour of neuroendocrine origin with an increasing incidence in the recent years. It is a tumour of the elderly and immunosuppressed, which most often appears on sun-exposed areas of the body. The clinical features of the cutaneous or subcutaneous lesions hardly contribute to the diagnosis, and, hence, histopathology and immunohistochemistry play a vital role in diagnosis. The latest staging system by the American Joint Committee on Cancer includes non-nodal invasion to adjacent structures i.e. bone, muscle, fascia, or cartilage into the criteria, in additionto size and depth of invasion. The management reliesheavily …

Characterization And Longitudinal Assessment Of Daily Quality Assurance For An Mr-Guided Radiotherapy (Mrgrt) Linac, Kathryn Mittauer

All Publications

No abstract provided.

Value Of Elastography In Differentiating Benign From Malignant Breast Lesions Keeping Histopathology As Gold Standard, Faryal Farooq, Syed Mubarak, Shaista Shaukat, Noman Khan, Kahkashan Jafar, Tariq Mahmood, Muhammad Arif Saeed

Department of Radiology

Background: Breast cancer is the most common cancer in females, both in developed and developing countries. Pakistan has the highest breast cancer incidence rate in Asia. Guidelines recommend screening for detecting breast cancer with mammography and ultrasonography (US). Shear-wave elastography (SWE) is a newer technique that can aid additional characterization of breast lesions.
Objective: The aim of this study was to determine the diagnostic accuracy of breast ultrasound elastography in differentiating benign from malignant breast lesions using histology diagnosis as the gold standard.
Materials and methods: The study was conducted at the Abbasi Shaheed Hospital and Jinnah Post Graduate Medical …

Prediction Of Anal Cancer Recurrence After Chemoradiotherapy Using Quantitative Image Features Extracted From Serial (18)F-Fdg Pet/Ct, Michael Chuong

All Publications

No abstract provided.

Wilms Tumor Survivorship: Does Childhood Cancer Treatment Predict Late-Term Adverse Effects?, Ava Bibergal

Grace Peterson Nursing Research Colloquium

Abstract

Background: Wilms tumor is the leading cancer to affect the kidneys in children most commonly between the age of 3 and 5 years old. Treatment of Wilms tumor typically consists of chemotherapy, radiation, or a combination of the two – which are often successful in eradicating the cancer. However, current treatment options often leave patients with a high risk of late-term adverse effects such as cardiac diseases or secondary cancers later in life. Wilms’ tumor patients currently have a 90% survival rate from their disease, however face a future of indeterminate health problems due to their treatment regimen.

Objectives: …

Mice Exposed To Combined Chronic Low-Dose Irradiation And Modeled Microgravity Develop Long-Term Neurological Sequelae, Amber M. Paul, Eliah G. Overbey, William A. Da Silveira, Candice G.T. Tahimic, Sigrid S. Reinsch, Nathaniel Szewczyk, Seta Stanbouly, Charles Wang, Jonathan M. Galazka, Xiao Wen Mao

Publications

Spaceflight poses many challenges for humans. Ground-based analogs typically focus on single parameters of spaceflight and their associated acute effects. This study assesses the long-term transcriptional effects following single and combination spaceflight analog conditions using the mouse model: simulated microgravity via hindlimb unloading (HLU) and/or low-dose γ-ray irradiation (LDR) for 21 days, followed by 4 months of readaptation. Changes in gene expression and epigenetic modifications in brain samples during readaptation were analyzed by whole transcriptome shotgun sequencing (RNA-seq) and reduced representation bisulfite sequencing (RRBS). The results showed minimal gene expression and cytosine methylation alterations at 4 months readaptation within single …

Response Of Human Small Intestinal Epithelium To Fractionated Irradiation: Dynamical Modeling Approach, Francis A. Cucinotta, Olga A. Smirnova

Health Physics and Diagnostic Sciences Faculty Research

A biologically motivated mathematical model of the dynamics of the small intestinal epithelium in humans treated with fractionated radiotherapy has been developed and is further investigated here. This model, originating from our previous work, is implemented as a system of nonlinear ordinary differential equations, in which the variables and parameters have a clear biological meaning. The model also includes, as input, the key parameters of fractionated irradiation. The modeling results on the dynamical response of the human normal small intestinal epithelium to fractionated radiation therapy regimens were in agreement with the corresponding empirical data, which, in turn, demonstrates the capability …

Meta-Analysis Of Cognitive Performance By Novel Object Recognition After Proton And Heavy Ion Exposures, Eliedonna Cacao, Francis A. Cucinotta

Health Physics and Diagnostic Sciences Faculty Research

Experimental studies of cognitive detriments in mice and rats after proton and heavy ion exposures have been performed by several laboratories to investigate possible risks to astronauts exposed to cosmic rays in space travel and patients treated for brain cancers with proton and carbon beams in Hadron therapy. However, distinct radiation types and doses, cognitive tests and rodent models have been used by different laboratories, while few studies have considered detailed dose-response characterizations, including estimates of relative biological effectiveness (RBE). Here we report on the first quantitative meta-analysis of the dose response for proton and heavy ion rodent studies of …

Following The Growth Of Sarah's Baby: An Ipe Activity For Medical Nutrition & Diagnostic Sonography Students, Tanya M. Custer, Megan Timmerman, Cynthia M. Schmidt, Teresa L. Hartman, Harlan Sayles, Kathryn Wampler, Lea Lambing, Kim Michael

Posters and Presentations: Medical Imaging & Therapeutic Sciences

Objectives: Interprofessional education (IPE) involves collaborative learning among students from different professions. While acceptance of these types of activities is increasing, there are opportunities to expand the number of health care professions involved in IPE. The purpose of this study was to explore student perceptions and outcomes after participation in a Diagnostic Medical Sonography (DMS) and Medical Nutrition Education (MNE) interprofessional education activity centered around a clinical case study on fetal growth. Subjects & Methods: The IPE activity was administered to four student cohorts from academic years to 2015-2016 to 2018-2019. Participants included 66 students (n=39 DMS and n=27 MNE). …

Impact Of Peer Review In The Radiation Treatment Planning Process: Experience Of A Tertiary Care University Hospital In Pakistan, Bilal Mazhar Qureshi, Muhammad Atif Mansha, Muneeb Uddin Karim, Asim Hafiz, Nasir Ali, Benazir Mir, Fatima Shaukat, Maria Tariq, Ahmed Nadeem Abbasi

Department of Radiation Oncology

Purpose: To evaluate and report the frequency of changes in radiation therapy treatment plans after peer review in a simulation review meeting once a week.
Materials and Methods: Between July 1 and August 31, 2016, the radiation plans of 116 patients were discussed in departmental simulation review meetings. All plans were finalized by the primary radiation oncologist before presenting them in the meeting. A team of radiation oncologists reviewed each plan, and their suggestions were documented as no change, major change, minor change, or missing contour. Changes were further classified as changes in clinical target volume, treatment field, or dose. …

Modeling Proton Relative Biological Effectiveness Using Monte Carlo Simulations Of Microdosimetry, Mark A. Newpower

Dissertations and Theses (Open Access)

Proton therapy is a radiotherapy modality that can offer a better physical dose distribution when compared to photon radiotherapy by taking advantage of the Bragg peak, a narrow region of rapid energy loss. Proton therapy is also known to offer an enhanced relative biological effectiveness (RBE) compared to photons. In the current clinical standard, RBE is fixed at 1.1 at all points along the proton beam, meaning protons are assumed to require 10% less dose than photons to achieve target coverage and organ at risk (OAR) sparing. However, there is mounting clinical evidence, and a significant number of in vitro …

Fasting Reduces Intestinal Radiotoxicity Enabling Dose-Escalated Radiotherapy For Pancreatic Cancer, Marimar De La Cruz Bonilla

Dissertations and Theses (Open Access)

Surgical resection is the only potentially curative treatment for pancreatic cancer, but only 15-20% of patients have resectable tumors. In unresectable cases, stereotactic body radiotherapy (SBRT) may be used to give tumor-directed radiotherapy (RT). Unfortunately, this can cause severe gastrointestinal (GI) toxicity due to proximity of the pancreatic head to the duodenum. Protecting the intestine from the toxic side-effects of radiation may enable dose-escalation that could achieve more effective local control of disease. We and others have previously shown that a fast of 24 hours protects mice from lethal doses of the DNA-damaging agent etoposide. In this study, we demonstrate …

Report Of The First Patient Treated For Pelvic Sarcoma With A Directional 103pd Brachytherapy Device., Serguei A. Castaneda, Marian Khalili, Jacqueline Emrich, Veronica M Zoghbi, Michael S Weingarten, Mark J Rivard, Wilbur B Bowne, Jaganmohan Poli

Department of Radiation Oncology Faculty Papers

No abstract provided.

Retrospective Evaluation Of Weight Loss In Maine Medical Center Cancer Institute (Mmcci) Patients Receiving Radiation Treatment For Head And Neck Cancer, Julian Johnson, David Debartolo-Stone, Jessica Moore, Ruth Hanselman, Stephen Tyzik, Suneela Nayak, Amy Sparks

Operations Transformation

Treatment for head and neck cancer often results in weight loss as a side effect. One option to mitigate this weight loss is placement of a percutaneous endoscopic gastrostomy (PEG) tube placement. Radiation oncologists at a academic tertiary medical center discuss the option of PEG placement during patient consultation.

A retrospective evaluation of weight loss in patients receiving radiation was conducted over a two-year period. The goal of this data collection was to create a standard for oncology consultations regarding PEG tube placement.

Baseline metrics and a root cause analysis drove subsequent data collection steps. After analyzing the raw data, …

Multi-Institutional Dosimetric Evaluation Of Modern Day Stereotactic Radiosurgery (Srs) Treatment Options For Multiple Brain Metastases., Irina Vergalasova, Haisong Lui, Michelle Alonso-Basanta, Lei Dong, Jun Li, Ke Nie, Wenyin Shi, Boon-Keng Kevin Teo, Yan Yu, Ning Jeff Yue, Wei Zou, Taoran Li

Department of Radiation Oncology Faculty Papers

Purpose/Objectives: There are several popular treatment options currently available for stereotactic radiosurgery (SRS) of multiple brain metastases: 60Co sources and cone collimators around a spherical geometry (GammaKnife), multi-aperture dynamic conformal arcs on a linac (BrainLab Elements™ v1.5), and volumetric arc therapy on a linac (VMAT) calculated with either the conventional optimizer or with the Varian HyperArc™ solution. This study aimed to dosimetrically compare and evaluate the differences among these treatment options in terms of dose conformity to the tumor as well as dose sparing to the surrounding normal tissues.

Methods and Materials: Sixteen patients and a total of 112 metastases …

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 Conference (2016-2019)

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 …

Solitary Brain Metastasis: A Rare Initial Presentation Of Prostate Carcinoma, Asim Hafiz, Muneeb Uddin Karim, Bilal Mazhar Qureshi, Adnan Jabbar, Zubair Ahmad

Department of Radiation Oncology

Cerebral metastasis as an initial clinical presentation of prostate carcinoma is extremely rare. Usually, patients have widespread metastasis in the body before presenting with brain metastasis. In the absence of extensive metastasis, especially without bony metastasis, only brain metastasis is an unusual presentation of the disease. We report a case of a 59-years-old patient who presented with a lack of concentration and decreased vision. Magnetic resonance imaging (MRI) of the brain revealed a large right parietal-occipital space-occupying lesion. He underwent surgery and the pathological diagnosis of the tumor turned out to be metastatic prostate carcinoma. Further evaluation by a whole-body …

Single Institution Implementation Of Permanent 131cs Interstitial Brachytherapy For Previously Irradiated Patients With Resectable Recurrent Head And Neck Carcinoma, Voichita Bar-Ad, Emily Hubley, Adam Luginbuhl, David Cognetti, Joseph Curry, Amy Harrison, Jennifer Johnson, James Keller, Cheng Peng, David To, Laura Doyle

Department of Radiation Oncology Faculty Papers

Purpose: Permanent interstitial brachytherapy is an appealing treatment modality for patients with locoregional recurrent, resectable head and neck carcinoma (HNC), having previously received radiation. Cesium-131 (131Cs) is a permanent implant brachytherapy isotope, with a low average photon energy of 30 keV and a short half-life of 9.7 days. Exposure to medical staff and family members is low; patient isolation and patient room shielding are not required. This work presents a single institution’s implementation process of utilizing an intraoperative, permanent 131Cs implant for patients with completely resected recurrent HNC.

Materials & Methods: Fifteen patients receiving 131Cs permanent seed brachytherapy were included …

Carotid Dosimetry After Re-Irradiation With 131cs Permanent Implant Brachytherapy In Recurrent, Resected Head And Neck Cancer, Amanda Walsh, Emily Hubley, Laura Doyle M, David Cognetti, Joseph Curry, Voichita Bar-Ad, Adam Luginbuhl

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Purpose: Permanent seed implant cesium-131 (¹³¹Cs) brachytherapy provides highly localized radiation for patients with recurrent head and neck cancer (HNC), who may be ineligible for external beam radiation therapy due to a high-risk of toxicity. As carotid blowout is a concern in the setting of re-irradiation, a dose to the carotid artery was examined for ¹³¹Cs brachytherapy implants.

Material and methods: Eleven patients were implanted with¹³¹Cs adjacent to carotid at the time of resection for recurrent HNC. Vascularized tissue flaps were used in some patients. The carotid artery was contoured on the post-implant brachytherapy treatment …

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 at …

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 and Diagnostic Sciences Faculty Research

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 …

An Evaluation Of The Supply And Demand Of Radiation Oncology Medical Physicists In The United States., Christine Marie Swanson

Electronic Theses and Dissertations

Background: This dissertation is a mixed methods evaluation of the radiation oncology medical physics workforce in the United States. Radiation oncology medical physicists serve a vital role in the safe treatment of patients with radiation therapy. While cancer incidence continues to rise, the pathways to board certification in radiation oncology medical physics continue to narrow causing a potential shortage of radiation oncology physicists in the United States. While there is no lack of data about the medical physics community it has scarcely been used to evaluate the current state of the workforce. In order to ensure patient safety, appropriate physics …

Development Of Automated Radiotherapy Treatment Planning For Cervical And Breast Cancer For Resource-Constrained Clinics, Kelly Kisling

Dissertations and Theses (Open Access)

Globally, cancer rates are on the rise, especially in low- and middle-income countries (LMICs). However, many of these countries lack access to radiotherapy, which is due in part to a substantial shortage of the staff necessary to deliver safe and effective radiotherapy. This staff shortage could be mitigated by the automation of the radiation treatment planning process. To this end, we developed automated planning for cervical and postmastectomy breast cancer radiotherapy, the two most common types of cancer in women in many LMICs.

For radiotherapy of cervical cancer in resource-constrained clinics, the recommended treatment technique is a four-field box. We …

Mindful Meditation Practice For Imaging Professionals, Tanya M. Custer, Kim Michael

Posters and Presentations: Medical Imaging & Therapeutic Sciences

Although a career in medical imaging is very fulfilling and rewarding, research shows that health care professionals are becoming more prone to burnout. The healthcare environment can be face-paced, stressful and demanding. Burnout syndrome results from emotional exhaustion that causes depersonalization and decreased professional accomplishment.1-3 Burnout can have a negative impact not only on the individual, but the environment as well. Decreased patient satisfaction and increased errors are both associated with burnout in the healthcare setting.2

Mindfulness can be defined as the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of …

Ms211: Texas Natural Resource Conservation Commission (Tnrcc) [Readme Tnrcc], Armin Weinberg

Works on Radiation Effects: 1990-2020

Describes the files in this folder that summarize my disappointment in the TX agencies failure to include radiation/nuclear threats to the environmental assessment they were conducting. See more at Armin Weinberg, PhD Papers and its finding aid.

Survival And Treatment Outcomes Of Metaplastic Breast Carcinoma: Single Tertiary Care Center Experience In Pakistan, Zarka Samoon, Madiha Beg, Romana Idress, Adnan Jabbar

Department of Radiation Oncology

Background: Metaplastic breast carcinoma (MBC) is a rare disease with incidence of less than 1%. MBC present with a larger tumor size, less number of nodes involved, mostly undifferentiated triple negative tumors. We aimed to determine progression-free and overall survival and reported hospital-based incidence of MBC.
Material and Methods: A retrospective closed Cohort study elicited data of 42 patients with MBC from January 2008 to December 2013; followed till August 2016. Kaplan-Meier method was applied to compute overall and progression-free survival analysis. Cox Proportional hazard ratios were computed to assess associations between survival and independent variables.
Results: Hospital-based incidence of …

Rethinking Pulmonary Toxicity In Advanced Non-Small Cell Lung Cancer In The Era Of Combining Anti-Pd-1/Pd-L1 Therapy With Thoracic Radiotherapy., Mengqian Li, Lu Gan, Andrew Song, Jianxin Xue, You Lu

Department of Radiation Oncology Faculty Papers

The combination of programmed cell death 1/programmed cell death ligand 1 blockade and thoracic radiotherapy has become the new standard of care in the treatment of locally advanced non-small-cell lung cancer. The information regarding the pulmonary safety of such therapy remains limited to mostly retrospective studies and case reports with a small portion of data from prospective clinical trials. By analyzing the underlying mechanisms of interactions between radiation and immunotherapy from preclinical data and summarizing safety data from relevant clinical studies with pulmonary toxicity, we believe that longer and rigorous follow-up is warranted, to determine if the combination of such …

Development And Long-Term Stability Of A Comprehensive Daily Qa Program For A Modern Pencil Beam Scanning (Pbs) Proton Therapy Delivery System, Suresh Rana, Jaafar Bennouna, Alonso Gutierrez

All Publications

No abstract provided.