Radiation Medicine Commons^™

Clinical Audit To Assess Delays In Chemotherapy Administration At Daycare Oncology Center At A Tertiary Care Hospital In Karachi, Pakistan, Arifa Arifa Aziz, Zarka Samoon, Afsheen Feroz, Nadia Ayoub, Safia Awan, Madhia Beg

Department of Radiation Oncology

Aim: There were delays reported by patients in chemotherapy administration in daycare oncology. Therefore, we decided to audit all processes which are involved in chemotherapy administration. The objective was to improve our service by decreasing the time between admission and initiation of chemotherapy and identify the reasons for delays. Materials and Methods: The audit was conducted in three parts. In Review I, audit tool was developed and information documented of 109 patients receiving chemotherapy at daycare center from April 14 to May 13, 2015. Five processes were assessed out of which delay in initial assessment by the nurse was the …

Development And Validation Of A Prostate Cancer Genomic Signature That Predicts Early Adt Treatment Response Following Radical Prostatectomy., R. Jeffrey Karnes, Vidit Sharma, Voleak Choeurng, Hussam Al-Deen Ashab, Nicholas Erho, Mohammed Alshalalfa, Bruce Trock, Ashley Ross, Kasra Yousefi, Harrison Tsai, Shuang G. Zhao, Jeffrey J. Tosoian, Zaid Haddad, Mandeep Takhar, S. Laura Chang, Daniel E. Spratt, Firas Abdollah, Robert B. Jenkins, Eric A. Klein, Paul L. Nguyen, Adam P. Dicker, Robert B. Den, Elai Davicioni, Felix Y. Feng, Tamara L. Lotan, Edward M. Schaeffer

Department of Radiation Oncology Faculty Papers

Purpose: Currently, no genomic signature exists to distinguish men most likely to progress on adjuvant androgen deprivation therapy (ADT) after radical prostatectomy for high-risk prostate cancer. Here we develop and validate a gene expression signature to predict response to postoperative ADT.

Experimental Design: A training set consisting of 284 radical prostatectomy patients was established after 1:1 propensity score matching metastasis between adjuvant-ADT (a-ADT)-treated and no ADT–treated groups. An ADT Response Signature (ADT-RS) was identified from neuroendocrine and AR signaling–related genes. Two independent cohorts were used to form three separate data sets for validation (set I, n = 232; set II, …

Prognostic Factors For Elderly Patients Treated With Stereotactic Body Radiation Therapy For Pancreatic Adenocarcinoma, Philip A. Sutera, Mark E. Bernard, Hong Wang, Dwight E. Heron

Radiation Medicine Faculty Publications

Introduction: Pancreatic ductal adenocarcinoma (PDAC) commonly presents later in life with a median age at diagnosis of 70 years. Unfortunately, elderly patients are significantly underrepresented in clinical trials. Stereotactic body radiation therapy (SBRT) is a promising treatment modality in this population as it has demonstrated excellent local control with minimal toxicity. We aimed to determine prognostic factors associated with outcomes in elderly patients treated with SBRT.

Materials and Methods: Elderly patients older than 70 treated with SBRT for PDAC at our institution, from 2004 to 2014 were included. Our primary endpoints included overall survival (OS) and local-progression-free survival (LPFS). Secondary …

Impact Of The Spop Mutant Subtype On The Interpretation Of Clinical Parameters In Prostate Cancer., Deli Liu, Mandeep Takhar, Mohammed Alshalalfa, Nicholas Erho, Jonathan Shoag, Robert B. Jenkins, R. Jeffrey Karnes, Ashley E. Ross, Edward M. Schaeffer, Mark A. Rubin, Bruce Trock, Eric A. Klein, Robert B. Den, Scott A. Tomlins, Daniel E. Spratt, Elai Davicioni, Andrea Sboner, Christopher E. Barbieri

Department of Radiation Oncology Faculty Papers

Purpose: Molecular characterization of prostate cancer, including The Cancer Genome Atlas, has revealed distinct subtypes with underlying genomic alterations. One of these core subtypes, SPOP (speckle-type POZ protein) mutant prostate cancer, has previously only been identifiable via DNA sequencing, which has made the impact on prognosis and routinely used risk stratification parameters unclear.

Methods: We have developed a novel gene expression signature, classifier (Subclass Predictor Based on Transcriptional Data), and decision tree to predict the SPOP mutant subclass from RNA gene expression data and classify common prostate cancer molecular subtypes. We then validated and further interrogated the association of prostate …

Open Book Testing In Health Science Education: Student Perceptions And Outcomes In Ultrasound Physics, Kim Michael, Tanya M. Custer

Posters and Presentations: Medical Imaging & Therapeutic Sciences

Objectives: The purpose of this study was to investigate the use of open book exams (OBE) in the education of imaging students and to assess the beliefs and perceptions of the students in regard to the use of open book testing.

Subjects & Methods: Study participants included twenty-seven sonography students enrolled in an academic health sciences center. OBE was implemented in two ultrasound physics courses. Data was collected through focus groups & exam outcomes. Creswell’s procedure for data analysis & representation was followed.

Results: Overall outcomes showed no statistically significant difference between exam grades for the different cohorts with the …

Discriminating Radiation Injury From Recurrent Tumor With [18f]Parpi And Amino Acid Pet In Mouse Models, Patrick L. Donabedian, Susanne Kossatz, John A. Engelbach, Stephen A. Jannetti, Brandon Carney, Robert J. Young, Wolfgang A. Weber, Joel R. Garbow, Thomas Reiner

Publications and Research

Background

Radiation injury can be indistinguishable from recurrent tumor on standard imaging. Current protocols for this differential diagnosis require one or more follow-up imaging studies, long dynamic acquisitions, or complex image post-processing; despite much research, the inability to confidently distinguish between these two entities continues to pose a significant dilemma for the treating clinician. Using mouse models of both glioblastoma and radiation necrosis, we tested the potential of poly(ADP-ribose) polymerase (PARP)-targeted PET imaging with [¹⁸F]PARPi to better discriminate radiation injury from tumor.

Results

In mice with experimental radiation necrosis, lesion uptake on [¹⁸F]PARPi-PET was similar to …

Tmsotf Assisted Synthesis Of 2’-Deoxy-2’-[18f] Fluoro-Β-D-Arabinofuranosylcytosine ([18f] Fac), Kishore K. Gangangari, John L. Humm, Steven M. Larson, Naga Vara Kishore Pillarsetty

Publications and Research

[¹⁸F]FAC (2’-deoxy-2’-[¹⁸F]fluoro-β-D-arabinofuranosylcytosine, 1) is a versatile probe for imaging deoxycytidine kinase (dCK) expression levels in vivo. dCK is responsible for phosphorylation of deoxycytidine (dC, 2) and other nucleoside analogs, plays a key role in immune activation and has demonstrated to be one of the key enzymes in activating nucleoside based drugs including gemcitabine. Reported synthesis of [¹⁸F]FAC is high yielding but is quite challenging requiring bromination using HBr and careful drying of excess HBr which is critical for successful synthesis. Here in we report a simplified trimethylsilyl trifluoromethanesulfonate (TMSOTf) assisted synthesis …

Analysis Of Clinical Data To Determine The Minimum Number Of Sensors Required For Adequate Skin Temperature Monitoring Of Superficial Hyperthermia Treatments., Akke Bakker, Rebecca Holman, Dario B. Rodrigues, Hana Dobšíček Trefná, Paul R. Stauffer, Geertjan Van Tienhoven, Coen R.N. Rasch, Hans Crezee

Department of Radiation Oncology Faculty Papers

PURPOSE: Tumor response and treatment toxicity are related to minimum and maximum tissue temperatures during hyperthermia, respectively. Using a large set of clinical data, we analyzed the number of sensors required to adequately monitor skin temperature during superficial hyperthermia treatment of breast cancer patients.

METHODS: Hyperthermia treatments monitored with >60 stationary temperature sensors were selected from a database of patients with recurrent breast cancer treated with re-irradiation (23 × 2 Gy) and hyperthermia using single 434 MHz applicators (effective field size 351-396 cm²). Reduced temperature monitoring schemes involved randomly selected subsets of stationary skin sensors, and another subset …

Bezoar: Imaging Findings & Case Study Of A Rare Pathology, Tanya M. Custer, Kim Michael

Posters and Presentations: Medical Imaging & Therapeutic Sciences

A bezoar is a hard, indigestible mass of material that forms within the alimentary canal, most commonly the stomach.1 Bezoars are classified according to composition. The most common type of bezoar is a phytobezoar composed of indigestible food fibers that occur in fruits & vegetables, including celery, pumpkin, prunes, raisins, & sunflower-seed shells. Other common types of bezoars include trichobezoars, composed of hair, & pharmacobezoars, made of undissolved medications.

A number of risk factors have been associated with bezoar development. Patients who have undergone gastric surgery, such as partial gastrectomy, are at an increased risk of developing a bezoar due …

Antibody-Drug Conjugates For Cancer Therapy: Chemistry To Clinical Implications, Nirnoy Dan, Saini Setua, Vivek K. Kashyap, Sheema Khan, Meena Jaggi, Murali M. Yallapu, Subhash C. Chauhan

School of Medicine Publications

Chemotherapy is one of themajor therapeutic options for cancer treatment. Chemotherapy is often associated with a low therapeutic window due to its poor specificity towards tumor cells/tissues. Antibody-drug conjugate (ADC) technology may provide a potentially new therapeutic solution for cancer treatment. ADC technology uses an antibody-mediated delivery of cytotoxic drugs to the tumors in a targeted manner, while sparing normal cells. Such a targeted approach can improve the tumor-to-normal tissue selectivity and specificity in chemotherapy. Considering its importance in cancer treatment, we aim to review recent efforts for the design and development of ADCs. ADCs are mainly composed of an …

Therapeutic Challenge With A Cdk 4/6 Inhibitor Induces An Rb-Dependent Smac-Mediated Apoptotic Response In Non-Small Cell Lung Cancer., Thangavel Chellappagounder, Boopathi Ettickan, Yi Liu, Christopher Mcnair, Alex Haber, Maryna Perepelyuk, Anshul Bhardwaj, Sankar Addya, Adam Ertel, Sunday Shoyele, Ruth Birbe, Joseph M. Salvino, Adam P. Dicker, Karen E. Knudsen, Robert B. Den

Department of Radiation Oncology Faculty Papers

Purpose: The retinoblastoma tumor suppressor (RB), a key regulator of cell-cycle progression and proliferation, is functionally suppressed in up to 50% of non-small cell lung cancer (NSCLC). RB function is exquisitely controlled by a series of proteins, including the CyclinD-CDK4/6 complex. In this study, we interrogated the capacity of a CDK4/6 inhibitor, palbociclib, to activate RB function.

Experimental Design and Results: We employed multiple isogenic RB-proficient and -deficient NSCLC lines to interrogate the cytostatic and cytotoxic capacity of CDK 4/6 inhibition in vitro and in vivo We demonstrate that while short-term exposure to palbociclib induces cellular senescence, prolonged exposure results …

Pdz-Rhogef Is A Signaling Effector For Troy-Induced Glioblastoma Cell Invasion And Survival, Z. Ding, H. Dhruv, A. Kwiatkowska-Piwowarczyk, R. Ruggieri, J. Kloss, M. Symons, P. Pirrotte, J. M. Eschbacher, N. L. Tran, J. C. Loftus

Journal Articles

© 2018 The Authors Glioblastoma multiforme (GBM) is the most common type of malignant brain tumors in adults and has a dismal prognosis. The highly aggressive invasion of malignant cells into the normal brain parenchyma renders complete surgical resection of GBM tumors impossible, increases resistance to therapeutic treatment, and leads to near-universal tumor recurrence. We have previously demonstrated that TROY (TNFRSF19) plays an important role in glioblastoma cell invasion and therapeutic resistance. However, the potential downstream effectors of TROY signaling have not been fully characterized. Here, we identified PDZ-RhoGEF as a binding partner for TROY that potentiated TROY-induced nuclear factor …

Restricted Single Isocenter For Multiple Targets Dynamic Conformal Arc (Rsimt Dca) Technique For Brain Stereotactic Radiosurgery (Srs) Planning., J. Chang, A. G. Wernicke, S. C. Pano

Journal Articles

In stereotactic radiosurgery (SRS), the multiple isocenters for multiple targets dynamic conformal arc (MIMT DCA) technique is traditionally used to treat multiple brain metastases, with one isocenter for each target. The single isocenter for multiple targets (SIMT) technique has recently been adopted to reduce the treatment time at the cost of plan quality. The objective of this study was to develop a restricted single isocenter for multiple targets DCA (RSIMT DCA) technique that can significantly reduce the treatment time but still maintain similar plan quality as the MIMT DCA technique.Treating multiple brain metastases with a single isocenter poses a challenge …

Reducing Seed Waste And Increasing Value Of Dynamic Intraoperative Implantation Of Pd-103 Seeds In Prostate Brachytherapy, P. K. Taylor, A, C. Riegel

Journal Articles

© 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine. Several nomograms exist for ordering palladium-103 seeds for permanent prostate seed implants (PSI). Excess seeds from PSIs pose additional radiation safety risks and increase the cost of care. This study compared five nomograms to clinical data from dynamic modified-peripheral intraoperative PSI to determine (a) the cause of excess seeds and (b) the optimal nomogram for our institution. Pre- and intraoperative patient data were collected for monotherapy PSIs and compiled into a clinical database. All patients were …

Intermediate-Risk Meningioma: Initial Outcomes From Nrg Oncology Rtog 0539, L. Rogers, P. Zhang, M. A. Vogelbaum, A. Perry, L. S. Ashby, J. M. Modi, A. M. Alleman, J. Galvin, J. P. S. Knisely, M. P. Mehta, +5 Additional Authors

Journal Articles

No abstract provided.

Implementation And Utilization Of Hypofractionation For Breast Cancer, P. Gilbo, L. Potters, L. Lee

Journal Articles

© 2018 The Authors Purpose: Hypofractionation (HF) of whole breast irradiation has become a standard treatment regimen because randomized trials continue to demonstrate equivalence in survival and local control compared with conventional fractionation. In 2011, the American Society for Radiation Oncology (ASTRO) adopted clinical guidelines on the proper selection of HF. Nevertheless, utilization remains lower than predicted. We evaluate the effects of clinical directives that serve as default treatment decisions and prospective contouring rounds on the implementation of HF in a large, multicenter radiation oncology department. Methods and materials: In 2010, we implemented consensus-driven and evidence-based clinical directives to guide …

Dosimetric Comparison Between Using Daily Cone Beam Ct And Planning Ct In Volumetric Modulated Arc Therapy Technique For Prostate Cancer Therapy, Julaluck Chanayota

Chulalongkorn University Theses and Dissertations (Chula ETD)

The variations of shape and size of organs inside, especially bladder and rectum, in prostate cancer patient are mainly factors of external beam radiation therapy that may impact to disease control and normal tissue toxicity. The purpose of this study was to investigate the dosimetric comparison between using daily CBCT and planning CT in Volumetric modulated arc therapy (VMAT) technique for prostate cancer therapy. The HU and electron density between CBCT and planning CT were verified by using Catphan® 600 phantom. Treatment planning system was verified by dose distribution comparison between plans on CBCT and planning CT images of Anthropomorphic …

The Measurement Of Transverse Relaxation Time (T2) Using Histogram From Roi Setting In Muscle Activity Study At 1.5 Tesla Mri, Kannikar Kanyakham

Chulalongkorn University Theses and Dissertations (Chula ETD)

Muscle functional MRI (mfMRI) is the method to evaluate the muscle activity before and immediately after the muscle exercise by the magnetic resonance images. Exercise of skeletal muscles enhances image contrast in T2-weighted magnetic resonance (MR) images. In previous studies, the exercised physiology used multiple-spin-echo (MSE) sequences for calculating transverse relaxation time (T2) with several small regions of interest (ROI) within the target tissue. Such a method may not represent all properties of the target tissue. The purpose of this study is to measure T2 in rest and exercise muscle at 1.5 Tesla MRI using average mode values in histogram …

Eye Lens Dose Measurement In Patients During Brain Arteriovenous Malformation Interventional Neuro-Radiology Procedure, Rasalin Thana

Chulalongkorn University Theses and Dissertations (Chula ETD)

Brain arteriovenous malformation (AVM) interventional neuroradiology (INR) is a complicated procedure which the patients may receive the high radiation dose exceeding the threshold level for detectable eye lens opacities and cataracts (ICRP, 2012). The objectives of this study are to measure the patient eye lens dose using optically stimulated luminescence dosimeter, OSLD, during AVM INR procedure at Interventional Radiology Unit, Department of Radiology, King Chulalongkorn Memorial Hospital (KCMH) and to study the factors affecting the patient eye lens dose. NanoDot OSLDs were attached on the transparent radiation thin film eyewear and closed to the patient eyelids during the procedure. Philips …

Investigation Of Parameters For Metallic Artifact Reduction Using 3-D Space In Mr Lumbar Spine At 1.5 Tesla: A Phantom Study, Thanatchaya Lowong

Chulalongkorn University Theses and Dissertations (Chula ETD)

Metallic artifact reduction in magnetic resonance imaging (MRI) has increasingly interested especially metal implant postoperative in lumbar spine. Recently, the new pulse sequence based on true isotropic 3D voxel with high resolution namely Sampling Perfection with Application Optimized Contrasts using Different Flip Angle Evolutions (SPACE) was introduced. This study aimed to determine the appropriate 3D T2-SPACE parameters for reducing the metallic artifact in MR lumbar spine 1.5 Tesla. Cylindrical phantom filled with 3.3 g/L, NiCl2-6H2O and 2.4 g/L NaCl solution, and two commonly used metal implants (stainless steel and titanium) for lumbar spine were acquired using turbo spin echo (TSE) …