Radiation Medicine Commons^™

Can Anemia Be A Prognostic Indicator To Scope For Gastroesophageal Junction Adenocarcinoma?, Ryan Tam, Neha Narayanan, Evan Basha, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

Gastroesophageal junction adenocarcinoma is a rapidly progressive disease that has a poor prognosis with a 5-year survival rate of 20%. It commonly presents with major symptoms of dysphagia and weight loss in addition to a long-standing history of reflux. As of now, screening for esophageal adenocarcinoma (EAC) is dependent on identifying risk factors which include a family history of Barrett’s esophagus and esophageal adenocarcinoma or patients with gastroesophageal reflux disease and at least one other risk factory for EAC such as age greater than 50 years, obesity or central adiposity, history of smoking, or male gender. Here, we present a …

Impact Of Post-Operative Radiation Therapy On Survival In Nsclc Patients With Incomplete Surgical Resection, Farrah R. Khan Md

Posters

Postoperative radiation therapy (PORT) has a limited role in the management of resectable non-small cell lung carcinoma (NSCLC). A relatively strong indication for its use is in the presence of residual tumor after surgical resection, as PORT has been shown to improve survival in such patients. However, it is unclear how much of the survival detriment of incomplete resection PORT is able to offset compared to negative margins. We aim to answer this question in our study

Automated Radiotherapy Treatment Planning For Breast Cancer: A Robust To Ol For Global Deployment, Hana Baroudi

Dissertations and Theses (Open Access)

Breast cancer incidence continues to rise worldwide, particularly in low- and middle-income countries, where limitations in resources already constrain access to timely care. Radiotherapy is a cornerstone of breast cancer management, proven to significantly lower both recurrence and mortality. However, a growing shortage of radiation staff worldwide threatens the prompt delivery of these treatments.This thesis proposes an automated solution to address the limited accessibility of radiotherapy planning in breast cancer management by developing an end-to-end automated treatment planning model and evaluating its performance and limitations across diverse patient populations.

An automated contouring model was trained using data from 104 whole-breast …

Development Of Lineal Energy Spectrum-Based Biological Effects Models For Protons, Joseph M. Decunha, Fada Guan, David Grosshans, Zhongxing Liao, Dragan Mirkovic, Oleg Vassiliev, Radhe Mohan

Dissertations and Theses (Open Access)

In this dissertation, methods are developed and described to allow for the rapid calculation of microdosimetric spectra (specifically, lineal energy) for protons. SuperTrack, a GPU-accelerated tool for calculation of microdosimetric spectra was developed and is capable of computing lineal energy spectra up to 5000x faster than using Geant4 directly. Proton lineal energy spectra generated by SuperTrack are indistinguishable from those generated by Geant4. With SuperTrack, large libraries of lineal energy spectra for monoenergetic protons spanning 0-300 MeV have been developed. The proton lineal energy spectra calculated by SuperTrack have been compared to experimental measurements made by a tissue equivalent proportional …

Advances In Minimally Invasive Hepatobiliary Interventions For Non-Operative Candidates, Tulasi Talluri, Philip Cieplinski, Kristian Loveridge

Posters

Cholangioscopy is a technique used for diagnosing and treating patients with pathologies of the gallbladder, liver, and pancreas. It has been available since 1976 but with limited use in interventional radiology (IR) due to issues with steerability, irrigation capabilities, requirement for more than one operator, and poor percutaneous access options; however, direct intraluminal visualization of the gallbladder, common bile ducts, and even the ampulla and duodenum has become more practical with the advent of single operator percutaneous systems. Access to the biliary system can now be made through smaller 11 French sheath/delivery systems allowing for improved maneuverability into the common …

Toxicity And Clinical Outcomes Following Brachytherapy Using 3-D Dosimetric Planning In Patients With Cervical Cancer: An Institutional Experience, Nikita M. Patel, Jacob F. Oyeniyi, Maha Saada Jawad

Posters

• Cervical cancer is the most common gynecological cancer worldwide.1

• The standard of care for locally advanced cervical cancer (LACC) includes primary chemoradiation, brachytherapy, and external-beam radiotherapy.2

• Brachytherapy (BT) involves the targeted delivery of radiation to the cervix (Fig 1). However, radiation can be toxic to surrounding structures, most commonly affecting the gynecological, genitourinary, and gastrointestinal systems.3

• Historically, brachytherapy was planned using a 2-D approach, which had limitations in accuracy and increased toxicity to the adjacent bowel and bladder. 3-D planning using CT or MRI has been shown to have improved dose precision and reduced toxicity.4

• …

Comparison Of Two Adjuvant High-Dose Rate Vaginal Cuff Brachytherapy Dose Fractionation Regimens For Treatment Of Early-Stage Uterine Cancer, Catherine Raciti, Hong Ye, Allison J. Hazy, Maha Saada Jawad

Posters

• Endometrial cancer is the most common gynecologic malignancy in the United States, with peak incidence at 63 years of age.¹

• PORTEC-2 trial established VBT alone as an effective modality for select high-intermediate risk patients.2

• There was no strict ABS guideline for dose fractionation; our institution adopted a 30Gy in 6 fractions regimen based on radiobiological calculations.3,4

• COVID-19 pandemic led to a shift towards 22Gy in 4 fractions

• Objective: Compare oncologic outcomes and toxicity between the 30Gy/6fx and 22Gy/4fx regimens.

• Hypothesis: Both regimens are well-tolerated and equally effective.

• Impact: Findings will inform clinical practice …

Primary Central Nervous System Lymphoma: Predictors Of Response To Induction Therapy And Patterns Of Progression, Louis Cappelli, Allison Kayne, Jennifer Newman, Ahmed Elguindy, Narendranath Epperla, Joshua D. Palmer, Ubaldo E. Martinez-Outshoorn, Pierluigi Porcu, Wenyin Shi, Iyad Alnahhas

Department of Radiation Oncology Faculty Papers

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is a rare and aggressive variant of non-Hodgkin lymphoma. While PCNSL is often sensitive to induction high-dose methotrexate (HDMTX) based chemotherapy, recurrence rates remain high, approaching 50% within 5 years. The most common molecular alterations in PCNSL include mutations in MYD88 and CD79 and CDKN2A homozygous deletion. There are no predictive or prognostic molecular markers in PCNSL.

METHODS: We conducted a retrospective review of 40 patients with PCNSL treated at Thomas Jefferson University and Ohio State University between 2011 and 2023. We created a clinically annotated database of patient characteristics and outcomes. For …

Desmoplastic Small Round Cell Tumor: An Update Of Current Management Practices, Ahmed Gawash, Alexa Simonetti, Brandon J Goodwin, Alissa Brotman O'Neill

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Desmoplastic small round cell tumor (DSRCT) poses a diagnostic challenge, initiating with imaging techniques like ultrasound, CT, MRI, and PET scans, with CT being the primary choice for abdominal tumor visualization. Despite advances, the absence of a standardized staging system complicates the diagnostic process.

METHODS: A comprehensive literature review and search strategy, encompassing databases like PubMed and Cochrane was performed.

RESULTS: Systemic chemotherapy, notably the P6 regimen, is the cornerstone of DSRCT treatment, while other options, including CDK4/6 inhibitors, antibody-drug conjugates, and anlotinib present varying efficacy. A novel chemotherapeutic agent, ONC-201, exhibits promise, inhibiting tumor growth in preclinical models. …

3d-Printed Organ-Realistic Phantoms To Verify Quantitative Spect/Ct Accuracy For 177lu-Psma-617 Treatment Planning, Lydia J. Wilson, Sara Belko, Eric L. Gingold, Shuying Wan, Rachel Monane, Robert S. Pugliese, Firas Mourtada

Department of Radiation Oncology Faculty Papers

Background/Objectives: Accurate patient-specific dosimetry is essential for optimizing radiopharmaceutical therapy (RPT), but current tools lack validation in clinically realistic conditions. This work aimed to develop a workflow for designing and fabricating patient-derived, organ-realistic RPT phantoms and evaluate their feasibility for commissioning patient-specific RPT radioactivity quantification. Methods: We used computed tomographic (CT) and magnetic resonance (MR) imaging of representative patients, computer-aided design, and in-house 3D printing technology to design and fabricate anthropomorphic kidney and parotid phantoms with realistic organ spacing, anatomically correct orientation, and surrounding tissue heterogeneities. We evaluated the fabrication process via geometric verification (i.e., volume comparisons) and leak testing …

Evaluating Artifact-Free Four-Dimensional Computer Tomography With 16 Cm Detector Array, Inhwan Yeo, Wei Nie, Jiajin Fan, Mindy Joo, Michael Correa, Qianyi Xu

Department of Radiation Oncology Faculty Papers

PURPOSE: To evaluate a 16 cm-array axial four-dimensional computer tomography (4DCT) in comparison with a 4 cm-array 4DCT in the presence of respiration irregularity.

METHOD: Ten traces of lung tumor motion from CyberKnife treatments were imported to move the lung cylinder, containing a spherical target, of a phantom. Images were acquired for the lung that moved to each of the 10-positions/phases (1) step-wisely by nominal helical scan at each movement (ground truth), (2) continuously by 4D scan with the 16 cm array, and (3) the same with the 4 cm array, involving table shift. Irregularities, consisting of baseline shift and/or …

Cost-Effectiveness Of Personalized Policies For Implementing Organ-At-Risk Sparing Adaptive Radiation Therapy In Head And Neck Cancer, Seyedmohammadhossein Hosseinian, Daniel Suarez-Aguirre, Cem Dede, Raul Garcia, Lucas Mccullum, Mehdi Hemmati, Aysenur Karagoz, Abdallah S R Mohamed, Stephen Y Lai, Katherine A Hutcheson, Amy C Moreno, Kristy K Brock, Fatemeh Nosrat, Clifton D Fuller, Andrew J Schaefer

Faculty, Staff and Student Publications

Background and purpose: The principle of adaptive radiation therapy (ART) is to adjust radiation plans in response to anatomical changes during treatment. The purpose of this study was to develop a decision-making model for implementation of personalized ART that balances the costs and clinical benefits of radiation plan adaptations in head and neck cancer (HNC).

Materials and methods: Using retrospective imaging data from 52 HNC patients, a Markov decision process (MDP) model was developed to determine optimal timing for plan adaptations based on the difference in normal tissue complication probability (ΔNTCP) between planned and delivered doses to organs-at-risk. To capture …

Differentiation Stage Predicts Radiosensitivity In Mesenchymal-Like Pancreatic Cancer, Tingshi Su, Xinjian Yu, Mojtaba Hoseini-Ghahfarokhi, David B Flint, Scott J Bright, Joana I D S Antunes, David K J Martinus, Mandira Manandhar, Mariam Ben Kacem, Poliana C Marinello, Eurico J G Pereira, Hua-Sheng Chiu, Uwe Titt, David R Grosshans, Jan Schuemann, Henning Willers, Harald Paganetti, Pavel Sumazin, Gabriel O Sawakuchi

Faculty, Staff and Student Publications

Purpose: To derive a genomic classifier to predict radiosensitivity of pancreatic cancer cell lines and patients with pancreatic cancer to allow genomic-guided radiation therapy.

Methods and materials: We collected a comprehensive data set of full clonogenic cell survival curves of 45 pancreatic cancer cell lines irradiated with clinical photon and proton beams. We derived classifiers based on data from human embryonic and fetal pancreas single-cell RNA-sequencing to distinguish between epithelial and mesenchymal cells and to predict pancreas cell-line differentiation stage. Independent testing was done with an embryonic mouse pancreas single-cell RNA-sequencing data set. We then used bulk RNA-seq profiles from …

Bridging Gaps In Cancer Care: Utilizing Large Language Models For Accessible Dietary Recommendations, Julia A. Logan, Sriya Sadhu, Cameo Hazlewood, Melissa Denton, Sara Burke, Christina A. Simone-Soule, Caroline Black, Corey Ciaverelli, Jacqueline Stulb, Hamidreza Nourzadeh, Yevgeniy Vinogradskiy, Amy Leader, Adam Dicker, Wookjin Choi, Nicole L Simone

Department of Radiation Oncology Faculty Papers

Background/Objectives: Weight management is directly linked to cancer recurrence and survival, but unfortunately, nutritional oncology counseling is not typically covered by insurance, creating a disparity for patients without nutritional education and food access. Novel ways of imparting personalized nutrition advice are needed to address this issue. Large language models (LLMs) offer a promising path toward tailoring dietary advice to individual patients. This study aimed to assess the capacity of LLMs to offer personalized dietary advice to patients with breast cancer. Methods: Thirty-one prompt templates were designed to evaluate dietary recommendations generated by ChatGPT and Gemini with variations within …

Quality Control Of Clinical Protocols Of Ct Using The Accreditation Phantom, Walaiporn Suksancharoen, Apawadee Chakrapong, Sakultala Ruenjit, Anchali Krisanachinda

Chulalongkorn Medical Journal

Background: The daily quality control of the Computed Tomography system consists of the measurement of the accuracy of CT Number and the artifact evaluation. The annual quality control includes the clinical protocol review. The CT radiologist is responsible for ensuring that all Quality Assurance (QA) requirements are met. The clinical team reviews and manages the CT protocol to deliver the appropriate radiation dose to the patient for each examination.

Objectives: To verify CT Number Accuracy, to review clinical protocols and to verify that the low-contrast performance of clinical protocols is adequate for diagnosis.

Methods: American College of Radiology (ACR) CT …

Chemoradiation Treatment With Or Without Concurrent Tumor-Treating Fields (Ttfields) Therapy In Newly Diagnosed Glioblastoma (Gbm) Patients In China, Liping Liang, Lingchao Chen, Chunxia Ni, Wenyin Shi, Zhirui Zhou, Shu Chen, Wenjia Zhu, Jiabing Liu, Xianxin Qiu, Wanzun Lin, Junyan Zhang, Zhiyong Qin, Yang Wang

Department of Radiation Oncology Faculty Papers

BACKGROUND: Tumor-treating fields (TTFields) therapy and radiotherapy may have synergistic anti-glioma effect based on preclinical studies. The combination of chemoradiation therapy (CRT) with TTFields therapy has noticeably attracted clinicians' attention. This study aimed to provide insights into the clinical outcomes of patients with newly diagnosed glioblastoma who received either concurrent CRT and TTFields therapy or adjuvant TTFields therapy following CRT. The findings were based on a cohort of patients who were treated at Huashan Hospital (Shanghai, China).

METHODS: This retrospective study analyzed ndGBM patients' clinical outcomes who were treated at Huashan Hospital and received TTFields therapy. Patients were categorized into …

Robust Automated Method Of Spatial Resolution Measurement In Radiotherapy Ct Simulation Images, Pavel Govyadinov, Rick R Layman, Tucker Netherton, Raymond Mumme, Aaron K Jones, Laurence E Court, Moiz Ahmad

Faculty, Staff and Student Publications

Background: Variation in imaging protocol, patient positioning, and the presence of artifacts can vary image quality in CT images used for radiotherapy planning. Automated methods for spatial resolution (SR) estimation exist but require further investigation and validation for wider adoption.

Purpose: To validated previously existing algorithm for SR estimation and introduce improvements that make it robust to patient positioning, CT protocol, site, and artifacts.

Method: A reference algorithm based on the previous gold standard was recreated and modified to improve robustness. The algorithms were tested on three different datasets: (1) a cylindrical ACR CT QC phantom scanned using a Siemens …

Triswinunetr Lobe Segmentation Model For Computing Dir-Free Ct-Ventilation, Gabriela Roque Oliveira Nomura, Aarom T. Luong, Ananya Prakash, Annabelle Alemand, Tanish Bhowmick, Alisa Ali, Jaimie Ren, Basil Rehani, Girish Nair, Richard Castillo, Yevgeniy Vinogradskiy, Edward Castillo

Department of Radiation Oncology Faculty Papers

Purpose: Functional radiotherapy avoids the delivery of high-radiation dosages to high-ventilated lung areas. Methods to determine CT-ventilation imaging (CTVI) typically rely on deformable image registration (DIR) to calculate volume changes within inhale/exhale CT image pairs. Since DIR is a non-trivial task that can bias CTVI, we hypothesize that lung volume changes needed to calculate CTVI can be computed from AI-driven lobe segmentations in inhale/exhale phases, without DIR. We utilize a novel lobe segmentation pipeline (TriSwinUNETR), and the resulting inhale/exhale lobe volumes are used to calculate CTVI. Methods: Our pipeline involves three SwinUNETR networks, each trained on 6,501 CT image pairs …

Patient-Reported Outcomes: Comparing Functional Avoidance And Standard Thoracic Radiation Therapy In Lung Cancer, Spencer Poiset, Joseph Lombardo, Edward Castillo, Richard Castillo, Bernard Jones, Moyed Miften, Brian Kavanagh, Adam Dicker, Cullen Boyle, Nicole Simone, Benjamin Movsas, Inga Grills, Chad Rusthoven, Yevgeniy Vinogradskiy, Lydia Wilson

Department of Radiation Oncology Faculty Papers

PURPOSE: Novel methods generate functional images using image processing techniques combined with four-dimensional computed tomography (4DCT) data (4DCT-ventilation). 4DCT-ventilation was implemented in a phase II, multicenter functional avoidance clinical trial. The work compares functional avoidance patient-reported outcomes (PROs) against historical standards.

METHODS: Patients with locally advanced lung cancer undergoing curative-intent chemoradiation were accrued. 4DCT-ventilation imaging was generated and functional avoidance treatment plans created reduced dose to functional lung. PRO instruments included Functional Assessment of Cancer Therapy Lung questionnaire and accompanying subscales (including the Trial Outcome Index [TOI]), EuroQol-5 Dimension (EQ-5D), and EQ-Visual Analog Scale (EQ-VAS). The average change from baseline …

Atypical Presentation Of Non-Small Cell Lung Carcinoma With Metastasis To Breast Tissue, Tylar P. Seckman, Diane Krutzler-Berry, Mohamed Ashal, Waqas Mahmud, Krista L. Denning, Logan M. Lawrence

Marshall Journal of Medicine

Malignant neoplasms of the lung commonly metastasize to lymph nodes, bone, brain, and liver via hematogenous and lymphatic routes. Much less commonly, metastasis occurs in the breast. Secondary metastatic disease of the breast is very rare, with a reported incidence ranging from 0.4-1.3%­­—with primary lung cancer being one of the most anomalous sources. This case details non-small cell lung cancer metastasis to the breast with proven primary contralateral lung origination. This atypical finding prompts medical professionals to consider these malignant cells' immunologic, histologic, and pathologic makeup to understand further and treat the neoplasm.