Radiology Commons^™

Validation Of An Automated Contouring And Treatment Planning Tool For Pediatric Craniospinal Radiation Therapy, Soleil Hernandez, Hester Burger, Callistus Nguyen, Arnold C Paulino, John T Lucas, Austin M Faught, Jack Duryea, Tucker Netherton, Dong Joo Rhee, Carlos Cardenas, Rebecca Howell, David Fuentes, Julianne Pollard-Larkin, Laurence Court, Jeannette Parkes

Faculty, Staff and Student Publications

PURPOSE: Treatment planning for craniospinal irradiation (CSI) is complex and time-consuming, especially for resource-constrained centers. To alleviate demanding workflows, we successfully automated the pediatric CSI planning pipeline in previous work. In this work, we validated our CSI autosegmentation and autoplanning tool on a large dataset from St. Jude Children's Research Hospital.

METHODS: Sixty-three CSI patient CT scans were involved in the study. Pre-planning scripts were used to automatically verify anatomical compatibility with the autoplanning tool. The autoplanning pipeline generated 15 contours and a composite CSI treatment plan for each of the compatible test patients (n=51). Plan quality was evaluated quantitatively …

Comparison Of Modified Formalism Output And Trs-398 Absorbed Dose To Water In Electron Beams Reference Dosimetry In Multiple Radiotherapy Centers, Yasumon Thinka

Chulalongkorn University Theses and Dissertations (Chula ETD)

The study aimed to investigate the feasibility and efficacy of utilizing modified calibration with cylindrical chambers for reference dosimetry in electron beam radiotherapy, challenging the recommendation of using plane-parallel chambers in low-energy electron beams by IAEA's TRS-398 and AAPM's TG-51 standards. Data collection involved six radiotherapy centers in Bangkok using Varian linear accelerators, with chambers including the IBA FC65-G, PTW 30013 cylindrical chambers, and PPC40, Roos plane-parallel chambers. Results of dose comparison between modified and TRS-398 protocols fell within ±2%. For low-energy electron beams, percent dose discrepancies ranged from -1.57% to 0.91%, and from -0.37% to 0.91% for high-energy. The …

Characteristics Of Two-Dimensional Ionization Chamber Array For Patient-Specific Quality Assurance In Pencil Beam Scanning Proton Therapy, Nuttida Rawiwan

Chulalongkorn University Theses and Dissertations (Chula ETD)

Proton therapy is an advanced technique that uses positive particles in external treatment. It can spare normal tissue and increase tumor control probability. In radiotherapy, patient-specific quality assurance is an important part, but according to protons’ characteristics, especially finite range, it is challenging to do verification because when the density has changed the finite range will have drastic changes. Although the two-dimensional ionization chamber array is used for patient-specific quality assurance in pencil beam scanning proton therapy, most studies investigate the IBA MatriXX as the dosimetry device, and few studies explored the PTW OCTAVIUS 1500XDR. This research aims to determine …

Determination Of The Surface Dose Correction Factors For Various Detectors In Proton Scanning Therapy, Pakjira Saruang

Chulalongkorn University Theses and Dissertations (Chula ETD)

Proton therapy delivers tumors doses precisely but concerns about skin toxicity due to energy dispersion beyond the Bragg peak remain. Accurate surface dose measurement is crucial for calculating the radiation dose patients receive. Studying factors that improve measurement accuracy is essential, as current methods are challenging and often inaccurate. This research aims to determine the surface dose correction factors (Scf) for various detectors in spot scanning beam proton therapy and study the effect of surface dose according to various clinical factors. The PTW Advanced Markus, PTW Roos chamber and IBA FC65-G Farmer chamber were utilized to measure the surface dose …

Dosimetric Comparison Of Imrt, Co-Planar Vmat, Non-Coplanar Vmat And Hyperarc For Multiple Brain Metastases Srs, Aksarapak Thawornnittayakul

Chulalongkorn University Theses and Dissertations (Chula ETD)

Multiple brain metastases patients are typically treated by stereotactic radiosurgery (SRS) or whole brain radiation therapy (WBRT). In addition, there are advanced techniques for treating multiple brain metastases such as 3-dimensional Conformal Radiation Therapy (3D-CRT), Intensity Modulated Radiation Therapy (IMRT), and Volumetric Modulated Arc Therapy (VMAT). A new isocentric VMAT technique called HyperArc was developed for non-coplanar, it is an automated setting for couch angle and collimator angle. This study aims to compare the dosimetric effect for a single isocenter among Intensity Modulated Radiation Therapy, Volumetric Modulated Arc Therapy, and HyperArc for multiple brain metastases stereotactic radiosurgery. For 25 patients …

Dose Evaluation Of A Deep Learning-Based Synthetic Ct Generation In Head And Neck Cancer For Photon And Proton Therapy, Ailada Kuibumrung

Chulalongkorn University Theses and Dissertations (Chula ETD)

MRI has been increasingly implemented for the treatment planning process and the MRI-only workflow in both photon and proton therapy. This study aims to investigate and explore the accuracy of dose calculations in head and neck region based on synthetic CT (sCT) images, using the commercial software methods for both volumetric modulated arc therapy (VMAT) and intensity modulated proton therapy (IMPT) plans. The sCT images were generated from MRI images for five head and neck cancer cases that underwent VMAT and IMPT by MRI Planner commercial software. The mean absolute error (MAE) and mean error (ME) within the body, bone …

Breast Cancer Characterization Using Artificial Intelligence In Screening And Diagnostic Mammogram Of Thai Women, Jaroonroj Wongnil

Chulalongkorn University Theses and Dissertations (Chula ETD)

Breast cancer is a significant health issue in Thailand, necessitating accurate detection and characterization for effective treatment. This thesis focuses on leveraging artificial intelligence techniques to develop breast cancer screening and diagnosis using mammography images of Thai women. Furthermore, detecting and classifying mammography calcifications, crucial indicators of malignant or benign conditions had also been focused using RCNN and YOLOv4 in this study. AlexNet CNN was developed to increase the robustness of the RCNN model. AlexNet was tested with three different datasets, each consisting of 4,000 cropped ROI images. These datasets were divided into an 80% training set and a 20% …

Ifabp Levels Predict Visceral Malperfusion In The First Hours After Open Thoracoabdominal Aortic Repair, Panagiotis Doukas, Cathryn Bassett, Hanif Krabbe, Jelle Frankort, Michael J Jacobs, Moustafa Elfeky, Alexander Gombert

Faculty, Staff and Student Publications

INTRODUCTION: Intestinal ischemia after open thoracoabdominal aortic repairs, is a rare but devastating complication, associated with high mortality. Notoriously challenging to diagnose, visceral malperfusion necessitates immediate surgical attention. Intestinal fatty acid-binding protein (IFABP) has been proposed as a biomarker for the diagnosis of intestinal wall damage. In this prospectively conducted, observational study we evaluated the diagnostic capacity of IFABP levels in patients' serum and their correlation with visceral malperfusion.

METHODS: 23 patients undergoing open thoracoabdominal aortic repairs were included in this study and 8 of them were diagnosed postoperatively with visceral malperfusion-defined as a partial or complete thrombotic occlusion of …

Feasibility Of And Experience Using A Portable Mri Scanner In The Neonatal Intensive Care Unit., Maura Sien, Amie L. Robinson, Houchun H. Hu, Christopher R. Nitkin, Ara Hall, Marcie G. Files, Nathan S. Artz, John T. Pitts, Sherwin S. Chan

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: A portable, low-field MRI system is now Food and Drug Administration cleared and has been shown to be safe and useful in adult intensive care unit settings. No neonatal studies have been performed. The objective is to assess our preliminary experience and assess feasibility of using the portable MRI system at the bedside in a neonatal intensive care unit (NICU) at a quaternary children's hospital.

STUDY DESIGN: This was a single-site prospective cohort study in neonates ≥2 kg conducted between October and December 2020. All parents provided informed consent. Neonates underwent portable MRI examination in the NICU with support …

Incidental Detection Of A Rare Pediatric High-Grade Fibrosarcoma In A Post-Traumatic Setting: The Conundrum Of Intra-Abdominal Hematoma Versus Neoplasia, Kamand Khalaj, Nikoo Fattahi, Allen C Omo-Ogboi, Jaiyeola O Thomas-Ogunniyi, Olanrewaju A Ogunleye, Ashish Khanal, Larry A Kramer

Faculty, Staff and Student Publications

Infantile fibrosarcoma (IF) is a rare malignant fibroblastic tumor that affects infants and young children, occurring most commonly in the extremities. Here, we present a 14-year-old patient with an abdominal mass incidentally detected after a blunt injury to the abdomen. The initial trauma protocol CT revealed a high attenuation mesenteric lesion in the left central abdomen suggestive of mesenteric hematoma. However, the possibility of a solid neoplastic mass lesion could not be excluded. Further evaluation with dynamic contrast-enhanced serial MRI showed a progressive enhancing mass and excluded a hyperacute hematoma with active bleeding. The mass was resected, and histopathological examination …

Population-Based Linked Longitudinal Surveillance Of Pregnant People And Their Infants: A Critical Resource For Emerging, Re-Emerging, And Persistent Threats, Van T Tong, Kate R Woodworth, Erin Blau, Neha Shinde, Amanda Akosa, Suzanne M Gilboa, Dana Meaney-Delman

Faculty, Staff and Student Publications

Public health emergencies, from Zika to COVID-19, have underscored the importance of addressing the needs of pregnant people and their infants. Recent events have underlined the critical role of mother-infant-linked longitudinal surveillance to characterize and assess the impacts of emerging, re-emerging, and persistent threats, including infectious diseases, on these populations. In partnership with state, local, and territorial health departments, CDC's National Center on Birth Defects and Developmental Disabilities activated the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET) to capture information about pregnant people with laboratory-confirmed infection with SARS-CoV-2 (the virus that causes COVID-19) and their infants. SET-NET …

Feasibility Of Clinical Evaluation Of Individuals With Increased Risk For Hpv-Associated Oropharynx Cancer, Nicholas Scott-Wittenborn, Gypsyamber D'Souza, Nafi Aygun, Sakshi R Tewari, Javad Azadi, Peter Vosler, Zhen Gooi, Vikas Mehta, Wojciech Mydlarz, Melonie Nance, Stefan Mlot, Mihir R Patel, Marietta Tan, Brett A Miles, Tanya Troy, Carole Fakhry

Faculty, Staff and Student Publications

BACKGROUND: Human papillomavirus-associated oropharynx squamous cell carcinoma (HPV-OPSCC) has no known pre-malignant lesion. While vaccination offers future primary prevention, there is current interest in secondary prevention. The feasibility of clinical evaluation of individuals at increased risk for HPV-OPSCC is unclear.

METHODS: Individuals with risk factors for HPV-OPSCC were enrolled in a prospective study (MOUTH). Participants positive for biomarkers associated with HPV-OPSCC were eligible for a clinical evaluation which comprised a head and neck examination and imaging with ultrasound and/or magnetic resonance imaging (MRI). This study was designed to evaluate feasibility of clinical evaluation in a screening study.

RESULTS: Three hundred …

Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy, Jennifer H Gross, Mihir R Patel, Jeffrey M Switchenko, Tyler G Chan, H M Baddour, Azeem Kaka, Brian J Boyce, Nabil F Saba, Jonathan J Beitler, Mark El-Deiry

Faculty, Staff and Student Publications

IMPORTANCE: Controversy exists regarding management of the clinically node-negative neck in patients with recurrent larynx or hypopharynx cancers who received total laryngectomy after definitive radiation with or without chemotherapy.

OBJECTIVE: To explore clinical and oncologic outcomes after elective neck dissection vs observation in patients who received clinically node-negative salvage total laryngectomy.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was performed from January 2009 to June 2021 at a single, high-volume tertiary care center. Follow-up was conducted through June 2021 for all patients. Survival outcomes were based on at least 2 years of follow-up. Patients aged 18 years or older with …

Effects Of Atrazine Exposure On Human Bone Marrow-Derived Mesenchymal Stromal Cells Assessed By Combinatorial Assay Matrix, Crystal C Uwazie, Bonnie M Pirlot, Tyler U Faircloth, Mihir Patel, Rhett N Parr, Halie M Zastre, Peiman Hematti, Guido Moll, Devi Rajan, Raghavan Chinnadurai

Faculty, Staff and Student Publications

INTRODUCTION: Mesenchymal Stromal/Stem cells (MSCs) are an essential component of the regenerative and immunoregulatory stem cell compartment of the human body and thus of major importance in human physiology. The MSCs elicit their beneficial properties through a multitude of complementary mechanisms, which makes it challenging to assess their phenotype and function in environmental toxicity screening. We here employed the novel combinatorial assays matrix approach/technology to profile the MSC response to the herbicide Atrazine, which is a common environmental xenobiotic, that is in widespread agricultural use in the US and other countries, but banned in the EU. Our here presented approach …

Sustained Increases In Immune Transcripts And Immune Cell Trafficking During The Recovery Of Experimental Brain Ischemia, Munish Saini, Eshan Sengupta, Madanjit Singh, Harnoor Singh, Jaswinder Singh

Faculty, Staff and Student Publications

Sustainable Development Goals (SDG) are at the forefront of government initiatives across the world. The SDGs are primarily concerned with promoting sustainable growth via ensuring wellbeing, economic growth, environmental legislation, and academic advancement. One of the most prominent goals of the SDG is to provide learners with high-quality education (SDG 4). This paper aims to look at the perspectives of the Sustainable Development Goals improvised to provide quality education. We also analyze the existing state of multiple initiatives implemented by the Indian government in the pathway to achieving objectives of quality education (SDG 4). Additionally, a case study is considered …

Association Of The Bb Genotype Of The Abo Gene With The Risk Of Acute Myocardial Infarction In Hospital-Based Study, Farzana Abubakar Yousuf, Iqbal Azam Syed, Asal Khan Tareen, Khawar A. Kazmi, Jibran Sualeh Muhammad, Mohammad Perwaiz Iqbal

Department of Biological & Biomedical Sciences

Objectives: The ABO gene locus has been identified to be associated with myocardial infarction in patients with coronary heart disease. The primary focus of this hospital-based study was to explore the relationship of ABO blood groups and ABO genotypes with acute myocardial infarction (AMI) in Karachi, Pakistan.
Methods: In a comparative cross-sectional study, an equal number of adult AMI patients and healthy controls (n=275 in each group; age range 30-70 years, both males and females) were recruited from the Aga Khan University and NICVD, Karachi, with informed consent. The blood samples were analyzed for ABO blood groups and other biomarkers. …

Safety Of Concurrent Radiation Therapy With Brentuximab Vedotin In The Treatment Of Lymphoma, Susan Y Wu, Penny Q Fang, Ethan B Wang, Sairah Ahmed, Madeleine Duvic, Preetesh Jain, Luis E Malpica Castillo, Ranjit Nair, Raphael E Steiner, Paolo Strati, Auris O Huen, Swaminathan P Iyer, Chelsea C Pinnix, Bouthaina S Dabaja, Jillian R Gunther

Faculty, Staff and Student Publications

PURPOSE: Purpose: Radiation therapy (RT) and the antibody-drug conjugate brentuximab vedotin (BV) are standard-of-care treatment options for patients with certain B and T-cell lymphomas; however, there are limited data exploring the safety of concurrent BV and RT (BVRT).

METHODS AND MATERIALS: We performed a single institutional retrospective review of 44 patients who received BVRT.

RESULTS: Twenty percent of patients (9/44) developed new grade 2 or higher (G2+) hematologic toxicity (HT) after BVRT, which was associated with radiation dose (median dose of 35 Gy in those with new G2+ HT compared with 15 Gy in those without;

CONCLUSIONS: Our analysis demonstrates …

Computed Tomography: State-Of-The-Art Advancements In Musculoskeletal Imaging, Hamza Ahmed Ibad, Cesar De Cesar Netto, Delaram Shakoor, Alejandro Sisniega, Stephen Z Liu, Jeffrey H Siewerdsen, John A Carrino, Wojciech Zbijewski, Shadpour Demehri

Faculty, Staff and Student Publications

Although musculoskeletal magnetic resonance imaging (MRI) plays a dominant role in characterizing abnormalities, novel computed tomography (CT) techniques have found an emerging niche in several scenarios such as trauma, gout, and the characterization of pathologic biomechanical states during motion and weight-bearing. Recent developments and advancements in the field of musculoskeletal CT include 4-dimensional, cone-beam (CB), and dual-energy (DE) CT. Four-dimensional CT has the potential to quantify biomechanical derangements of peripheral joints in different joint positions to diagnose and characterize patellofemoral instability, scapholunate ligamentous injuries, and syndesmotic injuries. Cone-beam CT provides an opportunity to image peripheral joints during weight-bearing, augmenting the …

Deep Learning-Based Dose Prediction For Automated, Individualized Quality Assurance Of Head And Neck Radiation Therapy Plans, Mary P Gronberg, Beth M Beadle, Adam S Garden, Heath Skinner, Skylar Gay, Tucker Netherton, Wenhua Cao, Carlos E Cardenas, Christine Chung, David T Fuentes, Clifton D Fuller, Rebecca M Howell, Anuja Jhingran, Tze Yee Lim, Barbara Marquez, Raymond Mumme, Adenike M Olanrewaju, Christine B Peterson, Ivan Vazquez, Thomas J Whitaker, Zachary Wooten, Ming Yang, Laurence E Court

Faculty, Staff and Student Publications

PURPOSE: This study aimed to use deep learning-based dose prediction to assess head and neck (HN) plan quality and identify suboptimal plans.

METHODS AND MATERIALS: A total of 245 volumetric modulated arc therapy HN plans were created using RapidPlan knowledge-based planning (KBP). A subset of 112 high-quality plans was selected under the supervision of an HN radiation oncologist. We trained a 3D Dense Dilated U-Net architecture to predict 3-dimensional dose distributions using 3-fold cross-validation on 90 plans. Model inputs included computed tomography images, target prescriptions, and contours for targets and organs at risk (OARs). The model's performance was assessed on …

Disruption Of Specific White Matter Tracts Is Associated With Neurogenic Lower Urinary Tract Dysfunction In Women With Multiple Sclerosis, Darshil Choksi, Bradley Schott, Khue Tran, Ryan Jang, Khader M Hasan, John A Lincoln, Ali Jalali, Christof Karmonik, Betsy Salazar, Rose Khavari

Faculty, Staff and Student Publications

OBJECTIVE: To identify specific white matter tracts (WMTs) whose disruption is associated with the severity of neurogenic lower urinary tract dysfunction (NLUTD) in two independent cohorts of women with multiple sclerosis (MS) and NLUTD.

METHODS: Cohort 1 consisted of twenty-eight women with MS and NLUTD. The validation cohort consisted of 10 women with MS and NLUTD. Eleven healthy women served as controls. Participants of both MS cohorts had the same inclusion and exclusion criteria. Both MS cohorts and the healthy controls underwent the same clinical assessment and functional MRI (fMRI) protocol, except that the validation MS cohort underwent 7-Tesla fMRI …

Optimizing Human Performance In Extreme Environments Through Precision Medicine: From Spaceflight To High-Performance Operations On Earth, Michael A Schmidt, Jeffrey A Jones, Christopher E Mason

Faculty, Staff and Students Publications

Humans operating in extreme environments often conduct their operations at the edges of the limits of human performance. Sometimes, they are required to push these limits to previously unattained levels. As a result, their margins for error in execution are much smaller than that found in the general public. These same small margins for error that impact execution may also impact risk, safety, health, and even survival. Thus, humans operating in extreme environments have a need for greater refinement in their preparation, training, fitness, and medical care. Precision medicine (PM) is uniquely suited to address the needs of those engaged …

Color Doppler Ultrasound Imaging In Varicoceles: Is The Difference In Venous Diameter Encountered During Valsalva Predictive Of Palpable Varicocele Grade?, Kelly Lehner, Catherine Ingram, Utsav Bansal, Colleen Baca, Adithya Balasubramanian, Nannan Thirumavalavan, Jason M Scovell, Saneal Rajanahally, Matthew Pollard, Larry I Lipshultz

Faculty, Staff and Students Publications

OBJECTIVE: The clinical grading system for varicoceles is subjective and dependent on clinician experience. Color Doppler ultrasound (US) has not been standardized in the diagnosis of varicoceles. We aimed to determine if US measurement of varicocele could be predictive of World Health Organization (WHO) varicocele grade.

METHODS: Men who presented for either scrotal pain or infertility to a tertiary men's health clinic underwent physical examination, and varicoceles were graded following WHO criteria (0=subclinical, 1, 2, 3). US was used to measure largest venous diameter in the pampiniform plexus bilaterally at rest and during Valsalva maneuver. Receiver operator characteristic curve analysis …