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Dose Summation Strategies for External Beam Radiation Therapy and Brachytherapy in Gynecologic Malignancy: A Review from the NRG Oncology and NCTN Medical Physics Subcommittees
Definitive, nonsurgical management of gynecologic malignancies involves external beam radiation therapy (EBRT) and/or brachytherapy (BT). Summation of the cumulative dose is critical to assess the total biologic effective dose to targets and organs at risk. Cumulative dose calculation from EBRT and BT can be performed with or without image registration (IR) and biologic dose summation. Among these dose summation strategies, linear addition of dose-volume histogram (DVH) parameters without IR is the global standard for composite dose reporting. This approach stems from an era without image guidance and simple external beam and brachytherapy treatment approaches. With technological advances, EBRT and high-dose-rate BT have evolved to allow for volume-based treatment planning and delivery. Modern conformal therapeutic radiation involves volumetric or intensity modulated EBRT, capable of simultaneously treating multiple targets at different specified dose levels. Therefore, given the complexity of modern radiation treatment, the linear addition of DVH parameters from EBRT and high-dose-rate BT is challenging to represent the combined dose distribution. Deformable image registration (DIR) between EBRT and image guided brachytherapy (IGBT) data sets may provide a more nuanced calculation of multimodal dose accumulation. However, DIR is still nascent in this regard, and needs further development for accuracy and efficiency for clinical use. Biologic dose summation can combine physical dose maps from EBRT and each IGBT fraction, thereby generating a composite DVH from the biologic effective dose. However, accurate radiobiologic parameters are tissue-dependent and not well characterized. A combination of voxel-based DIR and biologic weighted dose maps may be the best approximation of dose accumulation but remains invalidated. The purpose of this report is to review dose summation strategies for EBRT and BT, including conventional equivalent dose in 2-Gy fractions dose summation without image registration, physical dose summation using 3-dimensional rigid IR and DIR, and biologic dose summation. We also provide general clinical workflows for IGBT with a focus on cervical cancer.
Using the Unified Medical Language System to Expand the Operative Stress Score – First Use Case
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Gross tumor volume confidence maps prediction for soft tissue sarcomas from multi-modality medical images using a diffusion model
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A multi-collector ICP-MS method for quantification of plutonium, uranium, and americium in hair and nails of occupationally or medically exposed individuals
The 239 Pu, 238 U, and 241 Am concentrations and 239 Pu/ 240 Pu, 235 U/ 238 U, and 236 U/ 238 U atom ratios were measured in the hair and nail samples from individuals who donated their bodies to the United States Transuranium and Uranium Registries. Further, the concentration of 239 Pu ranged from 0.22–15.8 ng/kg. The 240 Pu/ 239 Pu isotopic ratios ranged from 0.026 to 0.127 which is consistent with weapons-grade plutonium. Concentration of uranium fell between 1.84 µg/kg and 29.5 µg/kg and 235 U/ 238 U ratios ranged from 4.8×10 -3 to 7.6×10 -3 . Elevated 236 U/ 238 U atom ratios were measured in two cases and ranged from 5.0×10 -6 – 2.4×10 -5 indicating exposure to spent or reprocessed uranium material. The concentration of 241 Am was measured in four hair samples and ranged from 0.02–0.21 ng/kg.
Novel applications of ultrasonic atomization in the manufacturing of fine chemicals, pharmaceuticals, and medical devices
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Enhancement of Two Heterogeneous Reactions in the Production of the Medical Isotope 188 W
We report the efficiency of heterogeneous reactions is influenced by kinetic conditions with an emphasis on reactants in different phases to have effective interactions. Optimal interactions of reactants rely on the rational design of the equipment and engineering parameters for the reaction process, especially for the process on a large scale. 188 W production at the Oak Ridge National Laboratory is such an example. In processing the irradiated 186 W metal target for the 188 W product, two of the heterogeneous reactions are essential ones: (1) the gas–solid reaction of O 2 + W to form WO 3 and (2) the gas–liquid reaction of OsO 4 being absorbed by the NaOH sorbent. Better understanding of the two reactions has led to revisions to the design of the quartz reaction vessel (gas–solid reaction) and the scrubbing system (gas–liquid reaction). The optimized quartz vessel resulted in less heating hours, whereas a more efficient OsO 4 scrubbing system ensured that all volatile OsO 4 was qualitatively captured.
Network Analysis of Academic Medical Center Websites in the United States
Healthcare resources are published annually in repositories such as the AHA Annual Survey Database TM . However, these data repositories are created via manual surveying techniques which are cumbersome in collection and not updated as frequently as website information of the respective hospital systems represented. Also, this resource is not widely available to patients in an easy-to-use format. Network analysis techniques have the potential to create topological maps which serve to aid in pathfinding for patients in their search for healthcare services. This study explores the topological structure of forty United States academic health center websites. Network analysis is utilized to analyze and visualize 48,686 webpages. Several elements of network structure are examined including basic network properties, and centrality measures distributions. The Louvain community detection algorithm is used to examine the extent to which these techniques allow identification of healthcare resources within networks. The results indicate that websites with related healthcare services tend to form observable clusters useful in mapping key resources within a hospital system.
Training calibration-based counterfactual explainers for deep learning models in medical image analysis
The rapid adoption of artificial intelligence methods in healthcare is coupled with the critical need for techniques to rigorously introspect models and thereby ensure that they behave reliably. This has led to the design of explainable AI techniques that uncover the relationships between discernible data signatures and model predictions. In this context, counterfactual explanations that synthesize small, interpretable changes to a given query while producing desired changes in model predictions have become popular. This under-constrained, inverse problem is vulnerable to introducing irrelevant feature manipulations, particularly when the model’s predictions are not well-calibrated. Hence, in this paper, we propose the TraCE (training calibration-based explainers) technique, which utilizes a novel uncertainty-based interval calibration strategy for reliably synthesizing counterfactuals. Given the wide-spread adoption of machine-learned solutions in radiology, our study focuses on deep models used for identifying anomalies in chest X-ray images. Using rigorous empirical studies, we demonstrate the superiority of TraCE explanations over several state-of-the-art baseline approaches, in terms of several widely adopted evaluation metrics. Our findings show that TraCE can be used to obtain a holistic understanding of deep models by enabling progressive exploration of decision boundaries, to detect shortcuts, and to infer relationships between patient attributes and disease severity.
Medication abortion via digital health in the United States: a systematic scoping review
Digital health, including telemedicine, has increased access to abortion care. The convenience, flexibility of appointment times, and ensured privacy to abortion users may make abortion services via telemedicine preferable. This scoping review systematically mapped studies conducted on abortion services via telemedicine, including their effectiveness and acceptability for abortion users and providers. All published papers included abortion services via telemedicine in the United States were considered. Articles were searched in PubMed, CINAHL, and Google Scholar databases in September 2022. The findings were synthesized narratively, and the PRISMA-ScR guidelines were used to report this study. Out of 757 retrieved articles, 33 articles were selected based on the inclusion criteria. These studies were published between 2011 and 2022, with 24 published in the last 3 years. The study found that telemedicine increased access to abortion care in the United States, especially for people in remote areas or those worried about stigma from in-person visits. The effectiveness of abortion services via telemedicine was comparable to in-clinic visits, with 6% or fewer abortions requiring surgical intervention. Both care providers and abortion seekers expressed positive perceptions of telemedicine-based abortion services. However, abortion users reported mixed emotions, with some preferring in-person visits. The most common reasons for choosing telemedicine included the distance to the abortion clinic, convenience, privacy, cost, flexibility of appointment times, and state laws imposing waiting periods or restrictive policies. Telemedicine offered a preferable option for abortion seekers and providers. The feasibility of accessing abortion services via telemedicine in low-resource settings needs further investigation.
The enduring legacy of Marie Curie: impacts of radium in 21st century radiological and medical sciences
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Quality Standards in State Programs Permitting Cannabis for Medical Uses
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State-of-the-art γ-ray assay of 86 Y for medical imaging
An emerging direction in nuclear medicine is the coupling of a therapeutic isotope with an imaging isotope to form a so-called theranostic pair, which allows one to quantitatively track and image the delivery of the therapeutic isotope. 90 Y is used in several therapy applications and a convenient candidate imaging partner is the positron emitter 86 Y. A 27.6 MBq source of 86 Y was produced at the University of Wisconsin and assayed with the Gammasphere array at Argonne National Laboratory. Over 200 γ-ray transitions were identified, more than double that which was previously known. In conclusion, the positron emission probability inferred from the present level scheme leads to 27.9(12)%, an important (≈14%) reduction with respect to the previously recommended value.
Acoustic effects of medical, cloth, and transparent face masks on speech signals
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