Radiology Commons^™

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 …

Fractionated Radiosurgery Associated With High Rates Of Local Control For Large Volume Intact Brain Metastases, Ryan Ko, Hong Ye, Peter Chen, Zachary Seymour, Kuei Lee, Inga Grills

Posters

Radiosurgery is a well-established treatment modality for patients with intact brain metastases, and there is a known impact of tumor size and volume on tumor control. Utilizing our single-institution database, we investigated outcomes for patients with intact brain metastases treated with FSR using LINAC or GK modalities.

Near-Surface Dose Correlates With Moist Desquamation And Unplanned Reconstructive Surgery In Patients With Implant-Based Reconstruction Receiving Postmastectomy Radiation Therapy, Patrick Thrasher, Ronald Levitin, Bryan S. Squires, Allison J. Hazy, Michael J. Maywood, Anthony P. Delise, Muayad F. Almahariq, Nayana Dekhne, Lauren Oliver, Peter Y. Chen, Kailee J. Walters, Diane Dudley, Joshua T. Dilworth

Posters

Postmastectomy radiation therapy (PMRT) utilized as part of a breast cancer treatment regimen reduces the risk of disease recurrence in appropriately selected patients.1,2,3,4,5 However, PMRT increases risk of radiationrelated toxicities that can interfere with breast reconstruction post-mastectomy.6 Following mastectomy, implant-based reconstruction can increase patient satisfaction and quality of life7,8; complications induced by PMRT such as infection and tissue contracture, though, increase risk for implant loss and may ultimately require further surgeries for the patient.

PMRT is delivered based on treatment plans that are optimized to provide appropriate radiation dosages to tissues along the chest wall while simultaneously limiting exposure of …

Mechanical Venous Thrombectomy For Deep Venous Thrombosis In Cancer Patients: A Single-Center Retrospective Study, Riya M Patel, Koustav Pal, Syed Hadi Ahmed, Joshua D Kuban, Milan Patel, Ketan Shah, Peiman Habibollahi, Zeyad Metwalli, Varshana Gurusamy, Sanjay Gupta, Cristhiam M Rojas-Hernandez, Vahid Afshar-Kharghan, Michael H Kroll, Rahul A Sheth

Faculty, Staff and Student Publications

PURPOSE: Venous thromboembolism (VTE) is a major contributor to the mortality of cancer patients. Mechanical thrombectomy (MT) is an endovascular technique that physically removes a thrombus without thrombolytics. The purpose of this study was to evaluate safety, efficacy, and clinical outcomes following MT for lower extremity DVT in cancer patients.

METHODS: This single-center, retrospective study evaluated outcomes following MT of lower extremity DVT in cancer patients from November 2019 to May 2023. The primary outcome measure was clinical success, defined as a decrease in Villalta score by at least 2 points following the intervention. Secondary outcomes included repeat intervention-free survival …

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 …

Quantifying The Importance Of Orthopaedic Surgeon Attributes By The Public, Rasheed Abdullah, James E. Feng, Phillip Vartanyan, Hassan Alosh, Drew Moore, Leonardo M. Cavinatto, Betina Hinckel

Posters

Evaluate what surgeon attributes are currently important to our patients, and what modalities may be most effective in finding orthopaedic surgeons, using online crowdsourcing.

Assessing The Diagnostic Accuracy Of Ti-Rads In Pediatric Thyroid Nodules: A Multi-Instutional Review, Shachi Srivatsa, Ameer Al-Hadidi, Joseph R. Stanek, Kyle Horvath, Lauren N. Parsons, Claudia Martinez-Rios, Amanda Hopp, Samuel Engle, Matthew Plunk, Gail Shapira-Zaltsberg, Sapna Nagar, Sean E. Masters, Sayf Al-Katib, Rennard B. Tucker, Lamya Atwah, Summit Shah, Adam Bobbey, Robert Hoffman, Jennifer H. Aldrink

Conference Presentation Abstracts

Abstract: Purpose: Thyroid nodules are uncommon in children and adolescents but carry an increased risk of malignancy when present. The Thyroid Imaging Reporting and Data System (TI-RADS) is an adult-validated ultrasound-based risk assessment providing a prediction of malignant potential for thyroid nodules, thereby guiding recommendations for fine needle aspiration biopsy (FNAB). Minimal data exist regarding the applicability of TI-RADS to predict malignancy in pediatric thyroid nodules. This study aims to analyze the performance of TI-RADS for children and adolescents with thyroid nodules, hypothesizing that applying TI-RADS criteria would improve accuracy and reduce the number of recommended FNAB compared to American …

Patient Population Representation In Medical Education Textbooks: Gender Imbalance Of Diagnostic Images, Yasin Sahin, Abdul-Majid Khan, Nicolas Baker, Joshua Daniel, Jacob Keeley

Posters

Gender inequality: a longstanding issue that has been gaining overdue attention. Even within esteemed institutions such as medical schools, gender biases persist. Society trusts that those who attend medical school are given the knowledge needed to provide care and support during their most vulnerable moments as patients. While the education may be there, the “patients” may not be represented accurately. Future healthcare professionals must provide care for all patients, a diverse group encompassing all genders, ages, ethnicities, and backgrounds.

In 2019, the United States Census Bureau reported that the population was about 49% male and 51% female.¹ Therefore, medical students …

You’Re Testing My Patients: Clinicians’ Preferences For Structured Reporting And Measurement Data, Davit Melik, Adela Pouzar, Allan Brazier, Sayf Al-Katib

Posters

Radiological reports are a crucial part of patient care and management. Radiologists play a major role in patient care by interpreting imaging studies and making recommendations to referring physicians. 1,2,3 Although some physicians may prefer to initially interpret the imaging studies by themselves, radiologists’ reports have been shown to be significantly more accurate and detailed, which ultimately results in better patient care. 1,4,5,3 Thus it is important for radiology reports to be timely and as accurate as possible to improve overall patient care. The clarity of communication between radiologists and referring physicians in these reports remains an important factor in …

Hypofractionated Regional Nodal Irradiation In Breast Cancer, Joseph Salib, Allison Hazy, Joshua T. Dilworth

Posters

• In women with breast cancer requiring whole breast irradiation therapy (WBI), current guidelines endorse moderately hypofractionated whole breast irradiation (HWBI), which includes a shorter, 3-4-week regimen of radiation with a higher dose per daily fraction in comparison to conventional whole breast irradiation (CWBI), which includes a 5-6.5-week regimen.
• Patients with certain risk factors may benefit from treatment to the regional lymph nodes (RNI), which include the ipsilateral axillary, internal mammary and supraclavicular chains.
• Some centers have been slower to adopt short-course treatment when regional lymph nodes also require treatment (H-RNI), despite a reduction in the number of treatments for the …

Breast Irradiation Is Well Tolerated In Carriers Of A Pathogenic Atm Variant, Leah R. Rotenbakh, Andrew H. Zureick, Dana Zakalik, Thomas J. Quinn, Vincent P. Grzywacz, Peter Y. Chen, Joshua T. Dilworth

Posters

• The ataxia telangiectasia mutant (ATM) gene is implicated in DNA damage repair.
• A pathogenic germline variant of the ATM gene is present in approximately 1% of the population.
• ATM gene variant increases radiation sensitivity and elevates the life-time risk of developing breast cancer by two- to four-fold.
• Potential for increased radiosensitivity poses concern for the utilization of radiation therapy (RT) for oncologic treatment in patients with the ATM gene variant.
• Current data regarding RT tolerance are limited and conflicting in this patient population.
• Current guidelines for hereditary breast cancer management issued jointly by the American Society for Radiation Oncology, American …

Clinical Outcomes Of Hypofractionated Whole Breast Irradiation In Early Stage, Biologically High-Risk Breast Cancer, Eva Leung, Benjamin D. Willen, Thomas J. Quinn, Muayad F. Almahari, Peter Y. Chen, Maha Saada Jawad, Gregory S. Gustafson, Michelle Ka Yan Wu, Joshua T. Dilworth

Posters

• Whole breast irradiation (WBI) has been used in the treatment of breast cancer patients after partial mastectomy.
• There has been increasing utilization of hypofractionated whole breast irradiation (HWBI), defined as a larger daily dose and fewer fractions compared to conventionally fractionated whole breast irradiation (CWBI). However, HWBI for patients with early-stage, biologically high-risk breast cancer remains relatively low.
• We define biologically high-risk breast cancer as either triple negative (estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 (Her-2) negative), Her-2 amplified, and/or patients with a high-risk multigene assay.
• The 2018 ASTRO guidelines form the basis for treating breast cancer patients with …

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 …

Sars-Cov-2 Viral Load In The Nasopharynx At Time Of First Infection Among Unvaccinated Individuals, Leigh H Fisher, Jia Jin Kee, Albert Liu, Claudia M Espinosa, April K Randhawa, James Ludwig, Craig A Magaret, Samuel T Robinson, Peter B Gilbert, Ollivier Hyrien, James G Kublin, Nadine Rouphael, Ann R Falsey, Magdalena E Sobieszczyk, Hana M El Sahly, Beatriz Grinsztejn, Glenda E Gray, Karen L Kotloff, Cynthia L Gay, Brett Leav, Ian Hirsch, Frank Struyf, Lisa M Dunkle, Kathleen M Neuzil, Lawrence Corey, Yunda Huang, Paul A Goepfert, Stephen R Walsh, Lindsey R Baden, Holly Janes, Covid-19 Prevention Network (Covpn)

Faculty, Staff and Student Publications

Importance: SARS-CoV-2 viral load (VL) in the nasopharynx is difficult to quantify and standardize across settings, but it may inform transmission potential and disease severity.

Objective: To characterize VL at COVID-19 diagnosis among previously uninfected and unvaccinated individuals by evaluating the association of demographic and clinical characteristics, viral variant, and trial with VL, as well as the ability of VL to predict severe disease.

Design, setting, and participants: This secondary cross-protocol analysis used individual-level data from placebo recipients from 4 harmonized, phase 3 COVID-19 vaccine efficacy trials sponsored by Moderna, AstraZeneca, Janssen, and Novavax. Participants were SARS-CoV-2 negative at baseline …

Silent Arterio-Ureteral Fistula: Diagnosis And Endovascular Management, Ahmed Awad, Bader Abou Shaar, Rodrick C Zvavanjanja

Faculty, Staff and Student Publications

We report a patient with history of recurrent invasive rectal adenocarcinoma complicated by obstructive uropathy requiring nephro-ureteral catheter placement. Two years later during a regular catheter exchange, the patient developed unusually bloody urine raising suspicion for possible vascular injury. CT angiogram and conventional angiogram were negative. However, an antegrade nephrostogram revealed a fistulous communication between the right ureter and the right internal iliac artery. Subsequently, the artery was sacrificed using detachable coils. We discuss the rare encounter of a silent arterio-ureteral fistula, the value of antegrade nephrostogram as a diagnostic tool, and the management options in such scenario.

Surgical Management Of Retroperitoneal Hydatid Cysts - Results On A Group Of Six Patients, Dragos George Popa, Cosmin Vasile Obleaga, Ana Maria Rukie Ahmet, Cristin Constantin Vere, Vlad Ionuț Ducu, Cecil Sorin Mirea, Dan Nicolae Florescu, Mihai Călin Ciorbagiu, Dragoş Marian Popescu, Costin Teodor Streba, Lucian Florescu, Teodor Sas, Lorena Sas

Journal of Mind and Medical Sciences

Objectives. Hydatid disease is a potentially lethal parasitic condition caused by the larvae of Echinococcus Granulosus; it is found in humans and more commonly in domestic and wild animals in endemic areas. This pathology is frequently encountered in the liver, the hydatid cyst with retroperitoneal location representing a rarely encountered form of evolution. Materials and Methods. In the present paper, we present a study carried out on 6 patients hospitalized in the Surgery Department of the Craiova County Emergency Clinical Hospital. These patients were diagnosed between 2002-2022 with retroperitoneal hydatid cyst or with multiple cysts (including retroperitoneal), being operated and …

Vegetation Dieback In The Mississippi River Delta Triggered By Acute Drought And Chronic Relative Sea-Level Rise, Tracy Elsey-Quirk, Austin Lynn, Michael Derek Jacobs, Rodrigo Diaz, James T Cronin, Lixia Wang, Haosheng Huang, Dubravko Justic

Faculty, Staff and Student Publications

Vegetation dieback and recovery may be dependent on the interplay between infrequent acute disturbances and underlying chronic stresses. Coastal wetlands are vulnerable to the chronic stress of sea-level rise, which may affect their susceptibility to acute disturbance events. Here, we show that a large-scale vegetation dieback in the Mississippi River Delta was precipitated by salt-water incursion during an extreme drought in the summer of 2012 and was most severe in areas exposed to greater flooding. Using 16 years of data (2007-2022) from a coastwide network of monitoring stations, we show that the impacts of the dieback lasted five years and …

Emergency Department Imaging Utilization Post-Transcatheter Aortic Valve Replacement: Single Institution 7-Year Experience, Andy Mew, Kaustav Bera, Sirui Jiang, Nikhil Ramaiya, Robert Gilkeson

Faculty Scholarship

Purpose: This study aims to highlight presentations, acute findings and imaging phenotypes of patients presenting to the emergency department (ED) within 30 days of a transcatheter aortic valve replacement (TAVR). Methods: A retrospective review of patients diagnosed with aortic valve disease who underwent a TAVR between Jan 2015 and Nov 2021 at a large academic medical center was completed. From an initial 1271 patients, 146 were included based on their presentation to the ED within 30 days post-TAVR procedure. Patient data, including ED presentation details and imaging results, were recorded and de-identified. Results: Of the 146 post-TAVR patients, there were …

Targeting Genomic Receptors In Voided Urine For Confirmation Of Benign Prostatic Hyperplasia, Mathew Thakur, Vivek S. Tomar, Emma Dale, Leonard G. Gomella, Charalambos Solomides, Oleksandr Kolesnikov, Scott W. Keith, Hector T. Navarro, Olivia Dahlgren, Michael Chaga, Edouard J. Trabulsi

Department of Radiology Faculty Papers

Objectives

The objective of this study is to validate a hypothesis that a non-invasive optical imaging assay targeting genomic VPAC receptors on malignant cells shed in voided urine will represent either benign prostatic hyperplasia (BPH) or prostatic cancer (PCa). Risk for BPH in men 50–70 years old is 50–70% and PCa is 17%. BPH and PCa can coexist in 20% of men with BPH. Most commonly practiced methods to diagnose BPH do not distinguish BPH from PCa.

Patients (or Materials) and Methods

Males with BPH (N = 97, 60.8 ± 6.3 years, prostate-specific antigen 0.7 ± 0.4 ng/mL) and …

When Educational Images Don’T Reflect The Population: Phlegmasia Cerulea Dolens, A Case Report, Kasha Bornstein, Elizabeth Larosa, Kelsey Byrd, Dan Laney, Hector Ferral, Heather Murphy-Lavoie

School of Medicine Faculty Publications

Introduction: Phlegmasia cerulea dolens (PCD) is an uncommon, potentially life-threatening complication of acute deep venous thromboses that requires a timely diagnosis. The name of the condition, the visual diagnostic criteria, and the preponderance of cases in the literature referencing findings exclusively in patients with lighter skin complexions means that PCD may not be on the differential diagnosis for the patient with more melanated skin who is experiencing this time-sensitive vascular emergency. Case Report: We describe one case of PCD in a patient with darker skin complexion and the importance of identifying clinical findings, regardless of skin color, given the paucity …